Comparison between the academic performance of the national and regional intake medical students at the university of Kordofan, Western Sudan

Admission of students to medical schools in Sudan depends mainly upon the student academic achievement in the Sudan School Certificate Examination [SSCE]. The Faculty of Medicine and Health Sciences at the University of Kordofan [FMHS-UK] adopts a six-year curriculum. It accepts students with two different academic standards; the national intake students from the free competition pool and regional intake students solely from the states of Kordofan with [lower grades] in the same class. The study objective was to determine the academic performance and achievement of the regional intake medical students at the FMHS-UK and compare it to the performance of the national intake students. This prospective study was conducted at the FMHS-UK. It included close follow up of all national intake and regional intake medical students admitted to the faculty in the period between 1991 and 2001. Their academic performances and achievements from admission to graduation were analysed and studied. The placement of the graduates from the regional intake was followed in the local health delivery system. The study included 854 national intake and 220 regional intake students from ten student batches. 769 [90.04%] national intake students had completed the course and graduated compared to 199 [90.45%] regional intake students; during the study period. The study showed that 62.3% of the regional students had graduated in six years compared to 65.0% of the national students. 29.7%of the regional students graduated within 7- 8 years, compared to 28.8% of the national students. 5.0% of the regional students graduated within 9-10 years, compared to 4.8% of the national students and 2.0% of the regional students graduated within 11-12 years compared to 1.3% of the national students. The dropout rate was 5.9% among the regional students compared to 8.9% among the national students. The academic performance of the national intake medical students was better than the regional intake students, but the difference was not statistically significant, [P value > 0.5]. This policy of admitting regional students with lower grades to serve their local community is reasonable as 92% of them had completed the medical school in a reasonable time [6-8 years] compared to 93.8% of the national intake students. However, for various reasons only 60% of the graduates stayed within the regional health delivery system as initially proposed

Perspectives on paediatric surgical admissions at El Obeid Hospital, Western Sudan

Data on the burden of paediatric surgical diseases at Western Sudan are unknown. To determine the burden and pattern of childhood surgical problems presenting to a General Surgical Unit at Western Sudan. The records of all children aged 15 years and below admitted to the University General Surgical Unit at El Obeid Hospital, Western Sudan over two years were studied. The mean age, gender, the clinical diagnosis and the outcomes of the management were determined. There were 574 patients. 410 [71.4%] were males. The mean age was 6.2 years +/- SD 4.7. Congenital anomalies, trauma, and surgical infections accounted for 40.2%, 32.3% and 24.9% respectively. Cancer was found in 1.9% of patients. Many of the childhood surgical problems admitted to hospital are preventable if appropriate community measures are actively considered. There is a need for specialized paediatric surgery unit in the context of a children hospital, attached to or nearby the women hospital

Intestinal obstruction in children at El Obeid Hospital, Western Sudan

Intestinal obstruction is a common cause of childhood surgical emergency in the developing countries with considerable morbidity and mortality. To assess the magnitude, pattern and management outcomes of intestinal obstruction in children presenting to a General Surgical Unit at a rural setup, in Western Sudan. The clinical records of all children below 15 years of age admitted to the University General Surgical Unit at El Obeid Teaching Hospital, in Western Sudan with the diagnosis of intestinal obstruction during the period from 2006 to 2007 were retrospectively reviewed. The mean age, gender, causes of obstruction and management outcomes were studied and analyzed. There were 72 patients, 48 were males [66.7%]. Neonates and infants were 70% of patients. Hirschsprung's disease, intussusception, obstructed hernias and ano-rectal anomalies accounted for 21.8%, 19.4%, 16.7% and 13.9% respectively. Less common causes were pyloric stenosis 8.3% and gut atresia 6.9%. Lymphoma, adhesions, peritonitis and faecal impaction were 2% each. The overall mortality rate was 13.9%. The main causes of childhood intestinal obstruction at Western Sudan were congenital anomalies in neonates, intussusception in infants and obstructed hernias in elder children. The management was associated with high mortality due to poor hospital facilities and late presentations resulting in bowel ischaemia

Pattern and incidence of cancer at El Obeid Hospital, Western Sudan

The growing population of elderly people, the changes in life style, the new dietary habits and the HIV pandemic resulted in more exposure to cancer promoting factors in developing countries, including Sudan. Sudan is a large country with different climatic regions and the population has wide diversity of ethnic groups with varying cultures. Nevertheless, the burden of cancer in the different regions of the country is unknown. To study the incidence rate and the pattern of cancer at El Obeid Teaching Hospital, Western Sudan. The records of all patients admitted with cancer to the wards of El Obeid Teaching Hospital, Western Sudan during 2006 and 2007 were studied. The cancers were classified according to the organs affected and then ranked in their order of relative frequency. The mean age, age range, gender, the incidence rates and the relative frequency rates were calculated. There were 111 new cancer patients in 2006 and 169 patients in 2007. Females were 52.9% of cases. The mean ages were 61.8 and 56.8 years for males and females respectively. Cancer of the gastrointestinal tract is the most common malignancy in both sexes, followed by breast and then cervical cancer in females; while it was followed by leukaemia in males. Hepatocellular, oesophageal, gastric and recto-sigmoid were the main gut cancers. Cancer of the gastrointestinal tract was the commonest malignancy at El Obeid Hospital, Western Sudan. Establishment of a local radiation and isotopes centre is needed in this part of the country to provide oncology services and integrate preventive programs. A regional cancer registry centre supplements the national efforts to evaluate the magnitude of the problem in order to plan further future strategies

Acute abdomen at El Obeid Hospital, Western Sudan

Acute abdominal pain is the presenting complaint in emergency departments of all hospitals worldwide, resulting in a huge drain of human and non-human resources. To study the pattern, causes and management outcomes of patients presenting with acute abdomen to El Obeid Hospital, Western Sudan. This was a prospective study. All patients who presented with acute abdomen to the University Surgical Unit at El Obeid Hospital between January 1999 and December 2000 were included. The patient characteristics, clinical features, investigations, management and postoperative care were recorded in a pre-designed sheet. There were 421 patients. 242 were males [57.5%]. Acute appendicitis was the commonest cause accounting for 63% of the patients, followed by acute intestinal obstruction 20.4% and abdominal trauma 11.6%. One third of the patients with acute appendicitis reported with complications. The majority of acute intestinal obstruction cases were due to obstructed and/or strangulated hernia. Acute cholecystitis and perforated duodenal ulcers were not common. Perforated typhoid ulcers and tuberculous peritonitis were less frequent but had high mortality. The overall mortality was 8.5% and those deaths occurred mostly in patients presenting late with generalized peritonitis. Acute abdomen was a common surgical emergency at El Obeid Hospital, Western Sudan. The leading causes were acute appendicitis, acute intestinal obstruction and abdominal trauma. Awareness of the seriousness of the condition and better hospital facilities and care may reduce an unacceptable high mortality

Cancer in children at El Obeid Hospital, Western Sudan

Cancers form one of the major causes of death in children. They differ markedly from adult cancers in their nature, distribution and prognosis. To determine the pattern of childhood cancer at El Obeid Hospital, Western Sudan. The records of all patients admitted with cancer aged 15 years and below to the wards of El Obeid Hospital, Western Sudan over two years were studied. The cancers were classified according to the organs affected and then ranked in their order of relative frequency. The mean age, age range, gender and the relative frequency rates were calculated. There were 40 newly diagnosed childhood cancer patients during the study period. Males were 29 patients [72.5%]. The age ranged three months to 14 years. Leukaemias were the most common malignancy in both sexes, followed by bone tumours and then nephroblastoma. Cancers in children were seen at Western Sudan, and cases admitted to hospital only reflect the tip of the iceberg as many cases were directly referred to Oncology Hospitals. Establishment of a local radiation and isotopes centre is needed in this part of the country to provide oncology services and to integrate preventive programs

Cancelled elective surgical operations at El Obeid Hospital, Western Sudan [revised article from Volume 44]

Cancellation of scheduled surgical operations on the day of surgery at hospitals upsets the patients and causes great concern to the relatives. It is also a major drain on health resources as the theatre costs increase and its efficiency decreases. The objective of this study is to estimate the frequency of cancellation of scheduled elective surgical operations on the day of surgery and to study the reasons for cancellation at El Obeid Teaching Hospital, Western Sudan. This is a prospective observational study. All the patients who had their major general surgical operations cancelled on the day of surgery during the year 2007 were included. The information were collected in a pre-formed questionnaire containing the patient characteristics, clinical diagnosis, intended operation, proposed anaesthesia and the exact reasons for cancellation. There were 1633 elective major general surgical operations performed during the study period. 162 cases [9.9%] were cancelled, eighty nine patients [55%] were females. The mean age was 46.5 years. The causes of cancellations were 34.6% patient related, 32.1% staff related and 33.3% procedural reasons. Cancellation of scheduled surgical operations on the day of surgery is a significant problem which annoys patients, increases the costs and decreases the efficiency of utilization of the theatre facilities. The reasons for cancellation were discussed. With better arrangements, the majority of the reasons can be avoided

Amputations of the upper limb at El Obeid hospital, western Sudan: role of traditional bone setters

Extremity amputation is common, but repugnant events to the patient and surgeon alike. Upper limb amputation results in incapacitating functional impairment especially in economically poor settings at developing countries. The aim is to study the pattern, indications and outcomes of upper limb amputations and their predictive factors in patients seen at El Obeid Hospital, Western Sudan. The medical records of patients who underwent upper limb amputations during five years at El Obeid Hospital were reviewed. The data were analyzed for gender, age, causes, level of amputations, outcomes and the possible predictive factors. There were 27 children and 19 adults. Trauma was the sole cause of upper limb amputations in children and was responsible together with burns and animal bites for 68.4% of upper limb amputations in adults. Diabetic sepsis resulted in 5 amputations in adults and all were finger amputations. The main level for amputation was above elbow [65.2%] while below elbow was 13.1% and finger amputations were 21 .7% of cases. There was no mortality among the study group. In adults road traffic accidents [RTA]. diabetic sepsis and machinery injuries were the main causes of upper limb amputations. In children, the main injury was factures due to domestic falls treated by traditional hone setters [TBS], the majority of them were potentially avoidable

Acute intussusception in children seen at El Obeid Hospital, Western Sudan

To study the pattern, clinical presentations and management outcomes of childhood intussusception seen at El Obeid Hospital, Western Sudan. This is a retrospective descriptive study. The medical records of children who presented with intussusception during 2004 to 2007 at the University Surgical Unit, in El Obeid Teaching Hospital were reviewed. The data were analyzed for gender, age, clinical presentations and treatment outcomes. There were 24 children, males were 14. Infants constituted 71% of the study group. Patients came from rural areas, mainly during the dry season. They had their symptoms for more than 36 hours, were seen and initially treated elsewhere and only 41% presented with classical clinical features. All patients were operated and found to have ileocolic intussusceptions, with no pathologic lead point. 54.2% of cases had resection and anastomosis for bowel ischaemia, while in 45.8% manual reduction was done. The post-operative mortality was 16.7%. Conclusions: Childhood intussusception was common in male infants from rural areas in the dry season. Late presentation to the surgeon necessitated major operative procedures for bowel ischaemia with considerable morbidity and mortality

Cancelled elective surgical operations at El Obeid Hospital, Western Sudan

Cancellation of scheduled surgical operations on the day of surgery at hospitals upsets the patients and causes great concern to the relatives. It is also a major drain on health resources as the theatre costs increase and its efficiency decreases. The objective of this study is to estimate the frequency of cancellation of scheduled elective surgical operations on the day of surgery and to study the reasons for cancellation at El Obeid Teaching Hospital, Western Sudan. This is a prospective observational study. All the patients who had their major general surgical operations cancelled on the day of surgery during the year 2007 were included. The information were collected in a preformed questionnaire containing the patient characteristics, clinical diagnosis, intended operation, proposed anaesthesia and the exact reasons for cancellation. There were 1633 elective major general surgical operations performed during the study period. 162 cases [9.9%] were cancelled, eighty nine patients [55%] were females. The mean age was 46.5 years. The causes of cancellations were 34.6% patient related, 32.1% staff related and 33.3% procedural reasons. Cancellation of scheduled surgical operations on the day of surgery is a significant problem which annoys patients, increases die costs and decreases the efficiency of utilization of the theatre facilities. The reasons for cancellation were discussed. With better arrangements, the majority of the reasons can be avoided

Major limb amputations in El Obeid hospital, western Sudan

To study the causes and pattern of major limb amputations in El Obeid Hospital, Western Sudan. The records of 50 major limb amputations performed in patients admitted to the University Surgical Unit at El Obeid Teaching Hospital, Western Sudan in two years were retrospectively studied. 72% of the victims were males. The mean age was 51 years +/- SD 34.5. 36% of the amputations were emergency procedures. Sepsis, trauma and vascular causes accounted for 40%, 32% and 16% respectively. The upper limb amputations were due to crushed missile injuries, lacerated wounds of animal bites and gangrenous limbs after post-fracture tight splintage by traditional bone setters. The study showed that 96% of the causes were potentially preventable, and that establishment of a Prothetic-Orthotic Centre is needed in this part of the country

Diabetic septic foot lesions in El Obeid, Western Sudan

To study the magnitude, presentations and outcomes of diabetic septic foot lesions in EI Obeid, Western Sudan. The records of 86 diabetic patients with septic foot lesions admitted to the wards of the University Surgical Unit at EI Obeid Teaching Hospital, Western Sudan during the years 2005 and 2006 were studied. The data of 5 patients who were referred to other hospitals were excluded. There were 55 males and 26 females. The mean age was 56.81 years +/- SD 12. On presentation patients [74.1%] were Wagner's Grade 3, 4 and 5. 20 patients ended with major lower limb amputations [24.7%] and 23 others had minor toe amputations [28.4%]. The mortality was 6 patients [7.4%]. The late presentation and the poor outcomes necessitate the need to raise the awareness among the society and health providers, about the magnitude of the problem. A multi-disciplinary foot care team approach with the establishment of a local diabetic centre is highly recommended

Emergency laparotomy for acute sigmoid volvulus in El Obeid hospital, western Sudan

To evaluate the role of emergency laparotomy in patients presenting with acute sigmoid volvulus at EI Obeid Teaching Hospital, Western Sudan. The records of 22 patients with acute sigmoid volvulus who were offered emergency laparotomy and admitted to the wards of the University Surgical Unit at EI Obeid Teaching Hospital, Western Sudan over 4 years, were studied. They were 18 males and four females. The mean age [[ +/- SD] was 59.7 [ +/- 14. 16] years. Patients had viable bowel for which detortion, deflation and colopexy were done. Eight patients had sigmoid colectomy later. Six patients had gangrenous bowel and underwent immediate resection and anastomosis, following which one patient died [4.5%]. Eight patients were lost in follow up. Emergency laparotomy for sigmoid volvulus may be overdone. A conservative decompression sigmoidoscopy with de rotation and tube deflation should be tried in such patients, with plans for colectomy later