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.

Sex differences in 30-day readmission rates, etiology, and predictors after transcatheter aortic valve replacement

Background The aim of this study is to analyze sex-specific readmission rates, etiology, and predictors of readmission after transcatheter aortic valve replacement (TAVR). Readmissions after TAVR are common, contributing to increased health care utilization and costs. Many factors have been discovered as predictors of readmission; however, sex-specific disparities in readmission rates are limited. Methods Between January 2012 and September 2015, adult patients after TAVR were identified using appropriate international classifications of diseases, ninth revision, clinical modification from the National Readmission Database. Incidence of unplanned 30-days readmission rate was the primary outcome of this study. In addition, this study includes sex-specific etiology and predictors of readmissions. Multivariate logistic regression was performed to analyze adjusted readmission rates. Hierarchical 2-level logistic models were used to evaluate predictors of readmission. Results Readmission rate at 30 days was 17.3%, with slightly higher readmission rates in women (OR 1.09; CI: 1.01–1.19, p < 0.001) after multivariate adjusted analysis. Noncardiac causes were responsible for most readmissions in both genders. Etiologies for readmissions such as arrhythmias, pulmonary complications, and infections were slightly higher in women, whereas heart failure and bleeding complications were higher in men. History of heart failure, atrial fibrillation, prior pacemaker, and renal failure significantly strongly predicted readmissions in both genders. Conclusion Women undergoing TAVR have slightly higher 30-day all-cause readmission rates. These results indicate that women require more attention compared to men to prevent 30-day readmission. In addition, risk stratification for men and women based on predictors will help identify high-risk men and women for readmissions.

Evaluation of the learning environment and the perceived weakness of the curriculum: student perspective

Background: Educational environment has been shown to have influence on learning outcome and affects student achievement, satisfaction, and success. The study was conducted to assess medical students’ perception of their learning environment and to explore areas of weakness within the educational environment.Methods: A mixed method of study, was performed using non-probability sampling at the Faculty of Medicine, Gezira University (FMUG), Sudan. An updated Arabic Dundee Ready Education Environment Measure (DREEM) was developed and administered to 854 students during the academic year 2016-2017.Results: Seventy five percent of students completed the inventory (638/854) and Sixty four percent (546/854) responded to the open-ended question providing comments and suggestions. The overall reliability coefficient alpha in this study was 0.914. The global score for this study was found positive (122/200). Students were most satisfied with the learning aspects, academic environment, and academic self-perception. However, they were unsatisfied with their teaching and social atmosphere (inadequate social support for stressed students, substandard teaching, overemphasised factual learning, unpleasant accommodation). The qualitative content analysis was performed and emerged with four themes: the physical environment, a number of students, pedagogical approaches and faculty-student communication.Conclusions: The study suggested the overall students’ perceptions of the educational environment in the FMUG were on the positive side. However, certain specific elements of the learning environment and educational programme need to be critically investigated and remedied. The updated Arabic DREAM can be used reliably in the context of medical education in Arabic speaking countries.

Evaluation of the technical specifications of computerized tomography scanners in Jazan

Good quality management for computerized Tomography [CT] scanners is essential to safe and efficient CT units, providing quality clinical images, maintaining patient and staff radiation doses as low as reasonably achievable. to evaluate the technical specifications of [CT] scanners in Jazan region in the period from 2011-2013. 13 CT scanners have been evaluated; 2 of them are in private sectors and the rest in public hospitals. The Technical specifications of CT scanners were assessed using template issued by ImPACT [Imaging Performance Assessment of CT scanners]. When comparing the 11 public scanners age with guidelines rules of European Coordination Committee of the Radiological and Electro medical Industries [ECCREI]; it showed that scanners of Jazan region are within lifecycle guidelines, the total cumulative number of scanners since 1984 to 2013 are 15 scanners, 4 of them were replaced and the rest under use, multi detector CT scanners replaced most of the single detector scanners. for public CT scanners ; results show that all of the scanners are 3rd generation, gantry bores are arranged between70-80cm, the x-ray tube inventory showed that there is no dual source CT scanner in the region and the anode storage heat capacity ranged from [3-8MHU] except Siemens 64slices and 20slices reached up to [30MHU]. All of scanners in the region are built in solid state, image reconstruction time display per second is ranged from 1-40slice/seconds, advance clinical application software are available among the scanners. Jazan region CT scanners have a high capability and their technical specifications are in a rapid pace in developments that impacting on performance which depends on trade-off between image quality and patient dose

Arthrogryposis, renal tubular dysfunction and cholestasis [ARC] syndrome: a case report

Arthrogryposis, renal tubular dysfunctions and chloestasis [ARC] syndrome is a rare multisystem, usually fatal, autosomal recessive disorder. Awareness of this syndrome is growing with more reported cases over the last three decades. Many previously reported cases with similar association are now labeled as ARC syndrome. Although the genetic mutation is recently recognized, the diagnosis still depends on the clinical findings. Our patient is the first case of ARC syndrome to be reported from Kuwait. To the best of our knowledge this is also the first report of an Egyptian family with two siblings of ARC syndrome

disposition of the undergraduate university nursing students toward critical thinking

Thinking is essential to a safe, competent, skillful nursing practice. It helps nurses to identify options from which to choose solutions in client care situations. The disposition toward critical thinking was considered to be crucial to a good critical thinker. Accordingly, the seven critical thinking dispositional characteristics, which are constituents of an overall disposition toward critical thinking were identified, namely: Truth seeking, Open-mindedness, Analyticity, Systematicity, Self-confidence, Inquisitiveness and Maturity. The aim of this study was to determine critical thinking disposition among Alexandria University undergraduate nursing students. The study was carried out in all the four academic year at the Faculty of Nursing, Alexandria University. The sample comprised all undergraduate nursing students of the four academic years [N= 752]. The California Critical Thinking Disposition Inventory [CCTDI] developed by Facione P. and Facione N. [1990] was used to collect data concerning the disposition of the undergraduate nursing students towards critical thinking. It consists of two parts: the first part, included the demographic data of the students. The second part, consisted of 75 items grouped into the previously mentioned seven dispositional characteristics. All items of the seven dispositional characteristics were scrambled. Students responded using a 6-point Likert scale ranging from "strongly agree" to "strongly disagree". Undergraduate nursing students of the four academic years got the highest mean scores in the dispositional characteristic of Inquisitiveness and Analyticity. Meanwhile, they got the lowest mean scores in the dispositional characteristics of Truth seeking and Open-mindedness. The mean scores of the first year students were the highest in all of the dispositional characteristics except in Truth seeking. A statistical significant difference was found in relation to mean scores of the undergraduate nursing students of the four academic years in relation to all of the dispositional characteristics except for the dispositional characteristic of Self-confidence. The study showed that the majority of the undergraduate nursing students at the Faculty of Nursing, University of Alexandria regardless of their academic year showed ambivalent disposition towards most of the dispositional characteristics and the overall CCTDI. They got the highest mean scores in Inquisitiveness and Analyticity. Meanwhile, they got the lowest mean scores in Truth seeking and Open-mindedness

Fulminating shigella encephalopathy [Ekiri syndrome]: a case report

Neurological manifestation, particularly seizures and encephalopathy, are common in childhood shigellosis. Fulminating shigella encephalopathy [Ekiri syndrome] is a rare form of shigella associated encephalopathy characterized by a rapid, severe and fatal course with few dysenteric symptoms. Brain edema is a common finding in patients presenting with severe shigella encephalopathy. Shiga toxin production is not essential for development of shigella-associated neurological symptoms. Early recognition and proper management of cases of severe shigella encephalopathy may help to improve the outcome. We are reporting the case of a six and half year old male child with severe fulminating shigella-encephalopathy [Ekiri syndrome] who made a partial recovery. Brain magnetic resonance image [MRI] findings of this patient are reported. To the best of our knowledge, brain MRI studies were not reported before in the pediatric population with Ekiri syndrome; moreover, this is probably the first case of Ekiri syndrome to be reported in the Arab population

Fatores preditivos de colelitíase em obesos mórbidos após astroplastia em Y de Roux / Predictive factors for cholelithiasis in morbidly obese submitted to Y de Roux gastroplasty

OBJETIVO: Avaliar fatores preditivos de colelitíase em obesos mórbidos submetidos a gastroplastia com reconstrução em Y de Roux. MÉTODOS: Estudou-se um grupo de pacientes obesos inscritos no programa para tratamento cirúrgico da obesidade mórbida do Departamento de Cirurgia da Faculdade de Ciências Médicas da Santa Casa de São Paulo. Os critérios de exclusão foram: pacientes colecistectomizados previamente, pacientes com diagnóstico de colelitíase no pré-operatório e casos em que a ultra-sonografia era duvidosa em relação à presença de cálculos biliares. Foram operados 160 pacientes, sendo 29 com colecistectomia prévia, 23 com litíase biliar pré-peratória, 5 com ultrassonografia duvidosa e 103 com vesícula biliar normal ao ultra-som de abdome. RESULTADOS: Os resultados mostraram que 48 (46,6 por cento) pacientes desenvolveram colelitíase, sendo 22 sintomáticos. Quando comparamos os pacientes com e sem colelitíase, não observamos diferenças significativas em relação à idade, sexo e peso pré-operatório. O índice de massa corpórea, os níveis séricos de triglicérides, o colesterol total e suas frações VLDL-colesterol e LDL-colesterol foram superiores no grupo que desenvolveu colelitíase em relação aos pacientes sem cálculos, sendo esta diferença estatisticamente significativa. A porcentagem de perda de peso no 6° e 12° mês pós-operatório foi significativamente superior nos pacientes que desenvolveram cálculos biliares. CONCLUSÃO: O estudo permite concluir que índice de massa corpórea, os níveis de triglicérides, colesterol total e suas frações LDL e VLDL são fatores preditivos de colelitíase após gastroplastia com reconstrução em Y de Roux.

OBJECTIVE: This study intended to evaluate predictive factors for cholelithiasis in morbidly obese submitted to gastroplasty with "Y" de Roux reconstruction. METHODS: The population under study was a group of obese patients enrolled in a program of surgical procedure for morbid obesity at the Department of Surgery, College of Medical Sciences, Santa Casa de São Paulo. The exclusion criteria were: patients previously cholecystectomized, patients with diagnosis of pre-operative cholelithiasis and patients with a questionable ultrasonography about existence of billiary stones. A total of 160 patients were operated, 29 with prior cholecystectomy, 23 with pre-operative biliar lithiasis , 5 with questionable ultrasonography about billiary stones and 103 with normal gallbladders at abdominal ultrasonography. RESULTS: Results showed that (46.6 percent) of patients developed cholelithiasis, 22 of them symptomatic. When patients with or without cholelithiasis were compared, no significant difference related to age, gender and preoperative weight was observed. The body mass index, the triglycerides serum levels, total cholesterol and the fractions HDL-cholesterol and LDL-cholesterol were higher in the group who developed cholelithiasis compared to patients without gallstones and this difference was statistically significant. The percentage of weight loss in the 6th and 12th postoperative month was significantly higher in patients who developed billiary stones. CONCLUSION: The study leads to conclude that body mass index, levels of triglycerides, total cholesterol and the fractions LDL and VLDL are predictive factors for cholelithiasis post-gastroplasty with the "Y" de Roux reconstruction.

Fine needle aspiration cytology [FNAC] in diagnosis of tumoral calcinosis, a report of three cases

Tumoral calcinosis [T.C.] is very rare and generally of unknown aetiology characterized by calcific deposits in the soft tissues. Commonly seen in the second decade of life [reported age range 15 months to 83 years]. We are reporting 3 cases of T. C. who were initially diagnosed by FNAC. Two of the 3 cases were female siblings who were referred to us as possible cases of recurrent fibrosarcomas following surgical excision. [1] Two female siblings aged 17 and 14 years - complaining of large swelling in the upper outer right thigh and the left outer upper thigh around the hip joints respectively. There was no limitation of movement. The masses recurred within a short period after total excision. Neither specimen was subjected to histopathology. Clinical examination showed two masses each approximately 30cm maximum diameter and 10 cm width. In addition the younger sister showed an additional mass 4.5 cm in the outer aspect of her right elbow. [2] 18 months old female child, unrelated to the above two cases, presented with an egg-sized mass in the mid-lateral aspect of her right thigh - cystic and mobile. There is a history of quinine injection in the same area. No positive family history of a similar condition. All three cases showed normocalcaemia and hyperphosphataemia with specks of calcification on x - ray and cysts in ultrasound. FNAC showed structureless gung, calcium granules and inflammatory cells including foreign body type multinucleated giant cells. Histopathology confirmed the diagnosis of T. C. Described the three types of T. C. [familial, idiopathic, and that in patients of chronic renal failure on dialysis]. The differential diagnoses were also discussed as well as lines of management such as Ca[++] supplementation, phosphate restriction, acetazolamide, parathyroidectomy and the treatment of choice is total surgical excision. To our best knowledge this is the first time to report the use of fine needle aspiration cytology in the diagnosis of T. C. in Sudan

Uso do adesivo butilcianoacrilato no controle da hemorragia após punções hepáticas em ratos / Use of tissue adhesive butylcyanocrylate for hemorrhage control after hepatic puncture in rats

OBJETIVO: Avaliar o uso do adesivo butilcianoacrilato no controle da hemorragia em punções hepáticas de ratos. MÉTODO: Foram utilizados 40 ratos distribuídos em dois grupos, um deles heparinizado e o outro não, submetidos à punção hepática com jelco 14. Metade dos animais de cada grupo foi tratado com o adesivo butilcianoacrilato e a outra metade não recebeu nenhum tipo de tratamento. RESULTADOS: Os animais heparinizados e tratados com adesivo mantiveram os níveis de hematócrito e hemoglobina e uma mínima quantidade de sangue livre na cavidade. Já os animais heparinizados e sem tratamento apresentaram queda significativa dos níveis hematimétricos com moderada quantidade de sangue livre na cavidade (p < 0.005). CONCLUSÃO: O adesivo tecidual butilcianoacrilato mostrou ser eficiente como agente hemostático no controle de sangramento de punções hepáticas em ratos heparinizados.

BACKGROUND: The objective of this study was to assess the effectiveness of tissue adhesive butylcyanocrylate in liver biopsy. METHOD: Forty rats were divided in two groups: one group included heparin-injected rats; the second group was not injected with heparin. Liver punction was performed with a 14-gauge needle. Half of the animals in each group was treated with tissue adhesive butylcyanocrylate and the other half had no treatment. RESULTS: The heparin-injected rats treated with adhesive kept their initial hemoglobin and hematocrit levels and had minimal amount of blood in the abdominal cavity. On the other hand, non treated heparin-injected rats presented a significant drop in hemoglobin and hematocrit levels and had a moderate volume of blood in the cavity. CONCLUSIONS: The tissue adhesive butylcyanocrylate showed be efficient as a hemostatic agent.

Effects of prior [lidocaine - morphine] adminstration on cardiov ascular response to tracheal intubation

This study was carried out on 30 adult patients classified into three groups, ten patients each. Ten minutes preinduction, they were transtracheally injected with either normal saline, lidocaine 40 mg or a mixture of lidocaine [40 mg] with morphine 1 mg in a volume of 2.5 ml. Heart rate, systolic, diastolic and mean arterial blood pressure were monitored ten minutes before induction and every two minutes for 20 minutes after intubation. There was a significant reduction in heart rate, systolic, diastolic and mean blood pressure in lidocaine group and lidocaine-morphine group compared with the saline group. Also, it was found that heart rate and systolic blood pressure were significantly decreased in both lidocaine and lidocaine- morphine groups compared with the preinduction values

Analise do efeito protetor do N2-mercaptopropionilglicina durante a isquemia-reperfusao de lobo hepatico: estudo experimental em caes e ratos / Protective effect analysis of N-mercaptopropionylglycine during of reperfusion ischemia of hepatic lobe: experimental study in dogs and rats

Um potente inibidor da sintese de radicais superoxidos, a N2-Mercaptopropionilglicina (N2-MPG), principalmente radicais hidroxila (OH), foi testado como agente preventivo na degradacao metabolica e estrutural do parenquima hepatico no processo de isquemia/reperfusao testando a hipotese de participacao significativa da superoxidacao na necrose do figado. Para tanto foram utilizados 22 ratos e 22 caes, distribuidos em dois grupos. Grupo I com administracao de solucao salina 0,9 por cento e Grupo II (GII) com administracao de N2-MPG. As amostras foram submetidas a estudo laboratorial, radiologico, anatomopatologico e estatistico. Os resultados revelaram uma elevacao das transaminases significativamente menor nos animais tratados com N2-MPG...

Adenocarcinoma de uretra feminina: relato de caso / Adenocarcinoma of the female urethra

Um caso de adenocarcinoma de uretra em paciente do sexo feminino, onde os autores descrevem a neoplasia baseando-se em estudos histopatológicos, endoscópicos e radiológicos. A neoplasia se apresenta em regiäo proximal da uretra como adenocarcinoma do tipo muco-secretor. É feita uma revisäo literária sendo este o 16§ o caso relatado