Computer-based clinical examination (CCE) in surgery: would It complement or replace the OSCE in the post-COVID-19 era?

Objectives: Surgical clinical assessment of medical students is confronted by many challenges particularly the increasing numbers of students with limited resources, and pandemics. The search for new tools of assessment continues. Our objectives were: (1) To develop a computer-based clinical exam (CCE) and identify its characteristics (2) To assess its acceptability of the students. Method: The study was conducted at the Surgical Department, Alzaiem Alazhari University (AAU) between February and August, 2017. We used the modular object oriented dynamic learning environment (MOODLE) program as a platform to upload and deliver the exam. The exam consisted of 45 questions (stations). Each consisted of a clinical scenario accompanied by a photograph (of a patient or investigation) or short video followed by multiple choice questions (MCQs). A questionnaire was designed to get the students' feedback. We analyzed the questionnaire and scores obtained by the students and compared them to their performance in other tools of the surgical exam, using SPSS statistical program. Results: The study included 188 final year medical students. There was a highly significant correlation of the CCE scores of each student with their final result (r= 0.67), and with other tools of the surgery exam particularly the objective structured clinical examination (OSCE). Students' acceptability was high. Conclusion: The CCE is valid and practicable. It saves time and is popular with the students and tutors. It complements the OSCE in the assessment of clinical competency and allows wide coverage of the curriculum. It is expected to gain importance and popularity in the post-COVID-19 era.

Wilson's disease and autoimmune hepatitis coexistence: A cause of diagnostic delay

This case report describes a 27-year-old housewife who presented with a progressive and insidious onset of abdominal distension, loss of appetite, and fatigue which started 3 months before her presentation. The physical assessment showed moderate ascites and small liver size, and no other peripheral evidence of chronic liver disease was observed. A diagnosis of liver cirrhosis and was confirmed by investigations and imaging, where ascites responded well to therapy with diuretics. Investigations for the cause of cirrhosis was established through the diagnosis of autoimmune hepatitis, and she was started on steroids and azathioprine with partial improvement in liver biochemistry. She presented 8 months later with neuropsychiatric symptoms in the form of slurred speech and difficulty walking. Accordingly, Wilson's disease was suspected to be the cause and further investigations confirmed this. A chelating agent, D penicillamine, was added to her immunosuppressive treatment. Nine months later she showed slow improvement in her neurological symptoms and was referred for assessment for liver transplantation. Wilson's disease, although rare, should be suspected in patients with decompensated liver disease. The dominance of clinical and epidemiological features of autoimmune hepatitis as a common causative pathology for chronic liver disease in young and middle-aged ladies may hide the presence of other serious different pathologies such as Wilson's disease.

Out-of-wedlock pregnancy among single mothers in Khartoum, Sudan: sociodemographic characteristics, causes, and consequences

Background: Out-of-wedlock childbearing is a global phenomenon that has lifelong consequences on the lives of both mothers and their children. The aim of this study is to identify the sociodemographic characteristics, causes, and consequences of outof-wedlock pregnancy among single mothers in Khartoum, Sudan. Methods: This descriptive, cross-sectional study was conducted at the Mygoma Orphanage Center (MOC) and Shamaa Rehabilitation Center (SRC) using convenience sampling among 200 participants. A validated questionnaire with 25 items was used to collect data. The data were entered into Epi-Data Manager and analyzed using the SPSS. Results: The study found that most of the single mothers in Khartoum who gave birth out of wedlock were young and had just completed their university education. Most of them discovered their pregnancy during the second or third trimester, and nearly half of them did not receive any antenatal care. The majority of the children born to these mothers were preterm and had a low birth weight. Additionally, many mothers reported experiencing social stigma and rejection from their families due to their out-of-wedlock pregnancy. The study also highlighted loneliness, stress, and romantic relations as the main causes of out-of-wedlock pregnancy among single mothers in Khartoum, Sudan Conclusion: The study provides useful insights into the sociodemographic characteristics, causes, and consequences of out-of-wedlock pregnancy among single mothers in Khartoum, Sudan. Social stigma and lack of support were identified as significant barriers to the reintegration of single mothers and their children into society. Future research should focus on investigating the long-term effects of out of-wedlock pregnancy on mothers and their children

Consolidating medical education in Sudan during war

Providing quality medical education in Sudan faces challenges due to armed conflicts. This short communication explores practical solutions for ensuring the continuity of medical education during the conflict in the Sudanese context. Methods: A comprehensive literature review covered relevant articles published from 1915 to 2023. Four major databases (PubMed, Scopus, Web of Science, and Google Scholar) were searched using keywords related to medical education, war, armed conflict, and affected countries. Data synthesis identified common themes, challenges, and trends and suggested solutions for medical education in conflict zones. Case studies from Ukraine, Liberia, and Iraq were included for a comprehensive understanding. Results: Collaborative alliances among medical schools facilitate resource sharing and support. Engaging the Sudanese diaspora through virtual collaborations, mentorship programs, and faculty exchanges enhance educational experiences. Stable regions as educational hubs ensure uninterrupted academic progress for students from conflict-affected areas. Online and remote education, including asynchronous learning and social media platforms, overcome access barriers and fosters knowledge sharing. Ambulatory teaching provides practical experience and adaptability. Prioritizing faculty well-being and professional development through training and support is crucial. Emphasizing resilience and adaptability in student education prepare them for healthcare delivery in resource-limited settings. Research and innovation contribute to evidence-based strategies. International collaboration and support offer opportunities for knowledge exchange and infrastructure improvement. Conclusion: Implementing collaborative strategies and innovative approaches helps Sudanese medical schools overcome challenges during armed conflicts and maintain quality medical education. These solutions empower students and faculty, enhance resilience, and contribute to improving healthcare systems in post-war Sudan.

Measuring nurses' satisfaction in primary health care centers at Khartoum, Sudan

Background: The primary healthcare sector has experienced significant growth globally, and the nursing workforce has also expanded in recent decades in response to health system reforms. This study aims to assess job satisfaction among primary healthcare nurses in Khartoum, Sudan. Methods: This descriptive cross-sectional study was conducted in 10 primary healthcare centers on 50 nurses who were selected using simple random sampling. Data were collected using an online questionnaire and it was analyzed using SPSS. Results: The findings of this study indicate that the job satisfaction level among nurses working at primary healthcare centers in Khartoum was high (4.4/5). Most nurses reported high satisfaction with all items including protocols, salary, environment, and relationships. The study also found a significant correlation between nurses' sex and experience with their level of job satisfaction. Female nurses reported significantly higher job satisfaction (4.4/5) compared to male nurses (3.6/5), (p-value = 0.04). Additionally, nurses with fewer years of experience reported significantly higher job satisfaction compared to those with more years of experience (p-value = 0.03). Conclusion: The study concludes that nurses working at primary healthcare centers in Khartoum have high job satisfaction, particularly regarding the working environment, salary, relationships, and availability of guidelines. Female nurses and those with less experience have significantly higher job satisfaction.

Adherence to ART drugs among HIV-positive pregnant women at selected hospitals of East Ethiopia

Background: Substance abuse among Human Immune Deficiency Virus-positive patients causes depression, carelessness, and anxiety, which in common results in a decrease in adherence to antiretroviral treatment. The purpose of the study is to assess the prevalence of substance abuse and its association with adherence to ART drugs. Methods: The current study was conducted at three hospitals (Hiwot Fana Comprehensive University Hospital, Dillchora Hospital, and Jugal Hospital) located in East Ethiopia. Bivariate and multivariate logistic regression analysis was used to identify the association of independent variables with the dependent variables. Results: In this study, 119 HIV-positive pregnant patients were included. While 74.8% of the patients were adherent to their medication, the remaining 25.2% were nonadherent. The major reasons for nonadherence to ART medications prescribed were getting better (73.3%) and finishing medication (16.7%). Moreover, 96 (80.7%) respondents abused alcohol while 36 (30.3%) and 75 (35.6%) abused opioids and cigarette smoking, respectively. Mothers who abused alcohol were 38.1 times more likely to be nonadherent to ART medications for PMTCT [AOR = 38.1% CI: 21.47­56.54] compared to their counterparts. Additionally, mothers who abuse opioids were 19 times more likely to be nonadherent to ART treatment medication [AOR = 19, 95% CI: 2.46­ 19.46] than their counterparts. Furthermore, mothers who smoked cigarettes were 43.1 more likely to be nonadherent [AOR = 43.19, 95% CI: 8.42­187.84] than nonsmokers. Unemployment was also found to be associated with nonadherence to ART medication to PMTCT of HIV [AOR = 5.4, 95% CI: 2.8­5.7]. Smoking of marijuana/cannabis/hashish was not significantly associated with nonadherence to ART [AOR = 0.22, 95% CI: 0.084­0.355]. Conclusion: Abuse of alcohol, cigarette smoking, abuse of opioids, and joblessness were found to be significantly associated with nonadherence to ART medications prescribed to PMCT of HIV. Wheareas, smoking of marijuana/cannabis/hashish was not significantly associated with nonadherence to ART medications.

Epilepsy classification (ILAE Classification 2017) in resource-limited countries: A cross-sectional study on epilepsy in pediatric patients from Sudan

Background: The objective of this study is to utilize the ILAE 2017 to classify epilepsy patients and determine its applicability in Sudan. Methods: This study is a prospective, descriptive, cross-sectional research conducted in two pediatric epilepsy clinics in Khartoum State, Sudan. Results: In this cross-sectional study, 350 pediatric patients with epilepsy were included, with a mean age of 8.4 ± 4.7 years and a mean illness duration of 4.71 ± 3.91 years. The ILAE classification was applied, showing that 71.11% of patients had generalized onset seizures, 27.7% had focal onset seizures, and only 1.1% had unknown onset seizures. Among patients with focal onset seizures, 56.4% had intact awareness, while 43.6% had impaired levels of awareness. The majority of patients who had generalized onset seizures experienced motor onset seizures, with tonicclonic seizures being the most common (44.2%). Nearly all patients with unknown onset seizures experienced tonic-clonic convulsions. These findings provide insights into the prevalence and types of seizures among pediatric epilepsy patients in Sudan and can guide clinicians in developing appropriate treatment plans. Conclusion: This study highlights the importance of utilizing the latest ILAE classification 2017 in epilepsy classification and its potential utilization in resource limited areas like Sudan.

Adherence to Immunosuppressive Medications in Kidney Transplant Patients at Three Centers in Khartoum State, Sudan: A Cross-sectional Hospital Study

Background: Graft survival post-kidney transplantation is of paramount importance to patients and nephrologists. Nonadherence to immunosuppressive therapy can be associated with deterioration of renal function and graft rejection. This study aimed to evaluate the adherence to immunosuppressive medications in kidney transplant patients at three centers in Khartoum, Sudan. Methods: In this descriptive cross-sectional hospital-based survey, 277 post-kidneytransplant patients were recruited. Data were collected using a questionnaire and analyzed using the SPSS v.23. Our scoring method was calculated based on Morisky Medication Adherence Scale (MMAS-8) related to immunosuppressive medications and was expressed as questions in the questionnaire; every correct answer was given one mark, then the marks were gathered and their summation was expressed. Results: Overall, 33% ,45%, and 22% of the studied participants reported high, medium, and low adherence, respectively. The major factor for nonadherence was forgetfulness affecting 36.1% of those who did not adhere. The cost of the immunosuppressive medications did not negatively affect any of the participants' adherence (100%). However, a significant association was seen between adherence and occupational status, duration of transplantation, shortage of immunosuppressants, recognizing the name of immunosuppressant, side effect, and forgetfulness (P-values = 0.002, 0.01, 0.006 , 0.000, 0.022, and 0.000, respectively). Logistic regression analysis showed a significant association with occupational status, side effects, and forgetfulness.

Assessment of Variation in Clinical Presentation of Visceral Leishmaniasis Among Patients Attending the Tropical Diseases Teaching Hospital in Sudan

Background: Visceral leishmaniasis (also known as Kala-azar) is a systemic parasitic infection with many clinical presentations. The present study assesses the variation in presentations among patients who attended the Tropical Diseases Teaching Hospital (TDTH) in Khartoum, Sudan. Methods: This analytical cross-sectional, hospital-based study was conducted at the TDTH between November 2019 and September 2020. Medical records of patients who presented at the TDTH were reviewed using a structured data extraction checklist. The Chi-square test was used to determine the associations between sociodemographic and clinical presentations of patients. P-value < 0.05 was considered as statistically significant. Results: Out of 195 patients, 79.5% were male and 48.2% were <31 years old. Fever was the main clinical presentation (90.2%) while 53.3% presented with weight loss and 72.3% and 39% presented, respectively, with splenomegaly and hepatomegaly. HIV was detected in 4.6% of the patients. RK39 was the main diagnostic test. We found a significant association between the abdominal distention and the age of the patients (P < 0.05) ­ age groups 11­20 and 41­50 years were more likely to present with abdominal distention than other age groups. Conclusion: There is no exact clinical presentation or routine laboratory findings that are pathognomonic for visceral leishmaniasis; therefore, it should be considered in the differential diagnosis of any patient with fever, weight loss, and abdominal distention, and among patients with HIV.

Variations of Arterial Supply of the Liver: C.T. Angiographic Study Among Sudanese Adults

Hepatobiliary surgery through laparoscopic approach is becoming a routine. Knowledge of extrahepatic arterial tree is essential for surgical and imaging procedures. Anatomical complexity is expected since the liver is developed by mergingof lobules with its separate blood supply. This makes a wide range of variations in the pattern of vascular arrangement and so reinforces the need for an accurate understanding of full spectrum of variations. This study aimed to investigate the variations in origin and distribution of extrahepatic arterial supply. Fifty volunteers (32 males and 18 females) aged 20­70 years were randomly recruited from the department of CT scan in Al Amal Hospital, Khartoum North, Sudan. The patients were already candidates for CT angiography with contrast for conditions other than hepatobiliary diseases. The reported data is related to those who accepted to participate in the study. Patients with history of hepatobiliary disease were excluded. 3D views of the scans were treated and the extrahepatic arterial tree was traced in a computer-based software. Key findings suggest that Michel's classification was considered the standard template for description ­ 76% of them showed Michel's type I classification. Types III and V constituted about 2%. About 4% of the cases were represented by types VI and IX. Other types of variations constituted about 12%. To conclude, although type I classification which describes the textbook pattern of hepatic artery distribution was significantly detected among the Sudanese population, other variants were to be considered since they are related to major arteries like aorta and superior mesenteric.

Sero-molecular Epidemiology of Hepatitis E Virus in Blood Donors, Gezira State, Sudan: A Cross-sectional Study

Background: Hepatitis E virus (HEV) is a hepatotropic pathogen that causes significant morbidity and mortality in humans. It is an important causative agent of viral hepatitis outbreaks. This study investigates the serological and molecular prevalence of HEV in blood donors attending the Central Blood Bank in Wad Medani City in Gezira State, Sudan. Methods: The study adopted a cross-sectional descriptive design. A structured questionnaire was used to collect data concerning demographic information and risk factors associated with HEV transmission. All enrolled participants (N = 300) were screened for HEV IgG antibodies using commercial ELISA kits, then strong positive samples (N = 84) were selected and rescreened for HEV IgM and HEV RNA by RT PCR. SPSS version 24.0 was used for analysis. Results: Out of 300 male participants, 36.3% (109/300) were positive for HEV IgG. However, only one participant was IgM positive, while the HEV RNA was negative. The highest prevalence rates of the virus were 42 (44.6%) among the age group of 31­40 years, 20 (48.8%) in those who consumed food from outside, 13 (50%) in three to four multiple blood donations, and 5 (62.5%) in those who consumed water from the river source. A significant association of HEV IgG prevalence concerning the occupation of the participants being students or farmers was detected using univariate and multivariate analysis (P-value = 0.007).

COVID-19 in Sudan: Will the mitigation efforts win against the virus?

Background: The COVID-19 pandemic has hit hard both the affluent and poor countries. The objective of this article is to highlight the efforts of the Ministry of Health in Sudan in mitigating the pandemic and reflecting on counteracting factors. Methods: We traced the reports and plans of the Federal Ministry of Health and looked at the models projecting the pandemic in Sudan. Results: The fundamental plan of the government of Sudan to cope up with the pandemic included the control of the source of infection, blocking transmission, and preventing the spread. The response mechanism had a multi-sector approach with involvement of government, civil society organizations, and non-governmental organizations (NGOs). The action plans involved protocols for COVID-19 diagnosis and treatment, surveillance, epidemiological investigation, and management of case contacts. However, several factors continued to jeopardize the mitigation efforts of these plans. At the time of writing this article (at the end of the May 2020), there were about 4,000 confirmed cases, 300 recoveries, and 170 deaths. Although these numbers are below the projected numbers in many proposed models, in the light of the limited testing capacity, case identification and contact tracing, the exact situation might not be ascertained. Conclusion: Sudan has prepared a national plan to prevent and contain COVID19 pandemic. However, tremendous challenges are opposing these efforts. The poor health infrastructure, fragility of the health system, and the economic crisis are the major obstructions

The Association of lymphocyte count, CRP, D-Dimer, and LDH with severe coronavirus disease 2019 (COVID-19): A meta-analysis

Background: The rapid progression of Coronavirus disease 2019 (COVID-19) and its increasing burden on health systems necessitate the identification of parameters of severe infection to help in monitoring, prognoses and development of treatment algorithms.Objectives: This review aims to investigate the association of lymphocyte count, CRP, LDH, and D-Dimer with the severity of COVID-19.Methods: This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The databases of MEDLINE/PubMed, WHO-Virtual Health Library (VHL), and ScienceDirect were used for the systematic search. Random effects model was used to estimate the pooled standardized mean differences (SMD) with the corresponding 95% confidence interval (CI), using OpenMeta Analyst software.Results: A total of 11 studies, with 2437 COVID-19 patients, which fulfilled the eligibility criteria were included in the meta-analysis. The analysis revealed that lymphocyte count was significantly lower in patients with the severe form of COVID-19 (SMD = - 1.025, P value <.001). Also, the analysis of SMD showed that patients with severe COVID-19 have a significantly higher serum levels of CRP (SMD = 3.363, P value <.001), D-Dimer (SMD = 1.073, P value <.001), and LDH (SMD = 3.345, P value <.001). Conclusion: Low lymphocyte count and high levels of CRP, LDH, and D-Dimer are associated with severe COVID-19. These laboratory markers could be used as clinical indicators of worsening illness and poor prognosis of COVID-19

Psychosocial Impacts of Mentally Retarded Children on Parents in Sudan

This study was conducted on a community sample from Khartoum state; Sudan to explore the psychological and social impacts of the mentally retarded child on his/her parents. The study hypothesized that these effects are directly related to the age; number of handicapped children in the family as well as the degree of mental retardation Methods and population: Seven centers for teaching and training of handicapped children were recruited in Khartoum State. Ninety-one children aged 5-16 years were randomly selected and their intelligence quotient (I.Q) was etermined. Interviews for 82 mothers and 64 fathers of these children were held using a standardized anonymous questionnaire including socio-demographic data and information about the psychological and social impacts of the disability of children on their parents. The parents also completed the Hospital Anxiety and Depression Scale (HADS) to assess the presence of anxiety and depression. Results and discussion: The parents reported different psychological effects when they realized the children's disability. However; they tend to overcome their problem and become adapted to the situation. Sometimes; problems arise in the marital life and in social participation. The research showed that most parents suffered from degrees of anxiety and depression ranging mainly from severe to moderate. The number; age or degree of retardation of the children did not affect the social and psychological impacts on the parents significantly. The study recommends preventative measures to reduce the factors that lead to mental retardation. It also recommends the provision of rehabilitation services and training of children in schools and special institutes; besides supporting their families psychologically and socially to reduce their burden

Diarrhea Due to Cryptosporidium Parvum in Immunocompromised and Immunocompetent Patients in Khartoum State

Objective: The objective of this study is to search for Cryptosporidium parvum in Sudanese immunocompromised and immunocompetent patients presenting with diarrhea. Methods: Two hundred and thirteen stool specimens were collected from different groups of patients presenting with diarrhea and healthy control (immunocompromised: 78; immunocompetent: 90; Control: 45). The immunocompromised group included 25 HIV positive patients; 27 tuberculosis patients; 11 patients with renal failure and 15 patients receiving immunosuppressive chemotherapy. Antigen ELISA was performed to detect the presence of the parasite in stool. Positive specimens were examined by the modified ZN stain to look for the oocyst of C.parvum. Result: Seventy one of the immunocompromised patients (91.0); twenty nine of immunocompetent patients (32.2) and ten of the control group (22.2) were found to be positive for C.parvum. A significant difference was noticed between the immunocompromised patients and the other groups (P0.05). Among the immunocompromised patients; the highest percentage of positive results (96.1) was in the HIV patients. The percentage of positive results within the tuberculosis; renal failure and immunosuppressive patients were 92.6; 83.3and 86.6respectively. Conclusion: The significant detection of C. parvum among the different groups of immunocompromised should raise the awareness of the clinicians towards this parasite as an important cause of diarrhea in such groups of patients

Reliability of Anti-Cyclic Citrullinated Peptide Antibodies (Anti-CCP) for the Diagnosis of Rheumatoid Arthritis as Compared to that of Rheumatoid Factor Test

Background: Rheumatoid factor (RF) is commonly used for diagnosis of rheumatoid arthritis (RA). RF positivity is nonspecific for diagnosis of RA because it can be detected in 3-5of normal individuals. Recent studies indicated that anti-Cyclic-Citrullinated protein (Anti-CCP) antibodies are more specific to diagnose rheumatoid arthritis and have the capacity to diagnose RA in early stages of the disease; or even before the onset of the disease when the arthritis is undifferentiated. Objectives: This study has been conducted to assess the reliability and specificity of anti- CCP in the Sudanese as an indicator of RA. Patients and methods: In this study; patients were diagnosed as RA patients according to the American College of Rheumatology (ACR) criteria. To get further insight on the sensitivity and specificity of Anti-CCP test as compared to that of RF test in the diagnosis of RA; analysis of samples obtained was perform negative rate reached 21.2. Although anti-CCP test is more accurate compared with RF; it may sometimes fail to diagnose some patients with rheumatoid antibodies were scarce

Correlation between Retinopathy; Nephropathy and Peripheral Neuropathy among Adult Sudanese Diabetic Patients

Diabetes Mellitus is a worldwide common metabolic disorder. Increasing prevalence of diabetes; lack of proper education about the nature and course of the disease and necessary control are the main factors for an early onset of micro vascular complications. Objective: To correlate between retinopathy; nephropathy and neuropathy; among adult Sudanese diabetic patients at Elshaab Teaching hospital; Ahmed Gasim Teaching hospital and Gabber Abu Eleaz centre; from December 2006 to September 2008. were included. Result: Male to female ratio was1.4:1.Common age group affected was 60-69 (32.4).Common duration of diabetes mellitus was 20-24 years (23.9).All patients who had diabetes for 25 years or more had developed complications (19.7).The commonest long term microvascular complication was found to be retinopathy (71.2); followed by neuropathy (69) and nephropathy (50.7).It was found that (47.6) of our patients had the three complications. Conclusion: Long-term micro vascular complications affect male more than female; with average age of onset 60-69 years. All patients who had diabetes for 25 years or more had developed complications. Retinopathy is the most common micro vascular complication; followed by neuropathy. There is a significant correlation between retinopathy; nephropathy and neuropathy in association with the duration and control of blood glucose level

Retained Placenta: Still a Cause of Maternal Morbidity and Mortality in a Nigerian Semi- Urban Population

Background: Retained placenta is associated with morbidity and mortality when left untreated. This study was done to determine the occurrence of retained placenta in our setting as well as to ascertain the possible risk factors; morbidities and mortality. Method of study: This was a retrospective review of all cases of retained placenta over a three year period (March 2005 to March 2007). There were 3542 deliveries; and of which 64 cases were of retained placenta. Results: The incidence of retained placenta was 1.8of all deliveries with a higher incidence in unbooked patients and a case fatality of 3.12.The commonest complication was postpartum haemorrhage in 51(79.68) of cases with blood transfusion rate of 47. onclusion: Complications associated with retained placenta could be reduced by adequate utilisation of health care facilities manned by skilled attendants; availability of blood transfusion services as well as effective and safe anaesthesia

Heart Rate Variability

Over the last few decades; considerable evolutions were made in the diagnosis of cardiovascular diseases. Interpretive electrocardiography is one of the areas where the progress has been significant. This involves digital recording of cardiac signals at the body surface and subsequent computerized analysis. An important outcome of such analysis is heart rate variability (HRV); which is widely accepted to have prognostic significance in patients with cardiovascular diseases especially after acute myocardial infarction. This is because HRV represents one of the most helpful markers of autonomic balance and hence can predict the tendency to develop fatal arrhythmias. Recently; interest has grown in relating some diseases to abnormal autonomic nervous system (ANS) activity based on HRV studies; for example: hypertension; bronchial asthma; diabetes mellitus; irritable bowel syndrome; anxiety and so many other diseases. This actually reflects the vital role of the autonomic nervous system in maintaining health. Unfortunately; HRV is of little practice; if ever; by Sudanese doctors. Therefore; this review is intended to update the hysiological basis; determinants; common ways of measurements and some important clinical uses of HRV

Thyroglossal Duct Cyst Imaging: Thyroid Scintigraphy Versus Ultrasound

The two imaging modalities most frequently used in thyroglossal duct cyst (TDC) are thyroid scintigraphy and ultrasound. The imaging is mainly used to exclude the cyst from being the only functioning ectopic thyroid tissue. The main objective of this study is to compare the results of scintigraphy and ultrasound. Methods: A total of 56 patients referred to the National Cancer Institute (NCI); University of Gezira in the period from Jan 2007 to Dec 2009 were included in this study; 30 females and 26 males patients; with median of 12.5 years. Data were analyzed by SPSS software. Results: Both thyroid scintigraphy and ultrasound reached the same imaging findings i.e. 53 patients with TDC and 3 patients with ectopic thyroid tissues. The Fisher exact test revealed no significant difference between the two modalities final results (P- value = 1). In addition; Pearson correlation showed complete correlation between the final ultrasound and scintigraphy results (R2 = 1; P-value 0.0001). Furthermore; ultrasound has provided detailed cyst characterization. Conclusion: Both modalities revealed almost identical results. Ultrasound has the additional advantages of being non-ionizing radiation and accurately localizes and characterizes the TDC