Clinical Characteristics And Analysis Of Risk Factors For Disease Progression Of COVID-19 Among Patients Within Wad Medani Isolation Centers, Gezira State: A Retrospective Cohort Study From Sudan (preprint)

Background: (COVID-19) had a great impact on the world’s health systems since December 2019. A little is known about the clinical characteristics and risk factors associated with COVID-19 severity in Sudanese Patients; therefor it is necessary to summarize the clinical characteristics of patients with COVID-19 and to explore the risk factors associated with COVID-19 severity. Methods : A one-year retrospective cohort study (May 2020- May2021) was done at three isolation centers in Wad Medani. Sample contained all COVID-19 patients who are over 18 years old and were confirmed to be COVID-19 by nucleic acid testing or features Suggestive of Covid19 on Chest CT scan. Results : This study included 418 patients confirmed COVID-19 cases with a median age of 66.3±13years. 179 (64.2%) patients were men. Hypertension (n=195; 46.7%) and diabetes (n=187; 44.7%) were the most common comorbidities. The most common symptoms at COVID-19 onset were fever (n=303; 72.5%), cough (n=278; 66.5%) and dyspnea (n= 256; 61.2%). the overall mortality rate was 35.4% (n=148). The morality rate was 42.3% (n=118) among patients with severe disease. The Chi-square test and ANOVA analysis revealed that older age, anemia, neutrophilia and lymphcytopenia, higher glucose levels, HbA1c levels and creatinine levels were variables associated with severe COVID-19. In inflammatory markers, the levels of CRP and d-dimer were elevated in severe infection more than moderate and mild infections. Conclusion : Patients with these factors are more likely to deteriorate into severe infection and have higher mortality rate than those without these factors.

Knowledge, Attitude and Practice of medical students towards COVID19 in Sudan, 2020: A cross sectional study among 19 universities (preprint)

Introduction: Since December 2019, an outbreak of severe respiratory infection (COVID-19) emerged in the city of Wuhan in China. It quickly spread around the world and is now a pandemic of epic proportions. Medical students are the future generation of doctors who will have to face this and any future similar catastrophe. The knowledge, awareness and practice of medical students toward Covid19 pandemic is of most importance as it demonstrates their preparedness to deal with this pandemic.Objective: To assess the knowledge, awareness and practice of medical students in 19 universities in Sudan about COVID 19.Methodology: This is a cross-sectional study done in 19 universities which have medical schools in Sudan. Data from at least 100 medical students from each university was included in the study. Data was collected using an online questionnaire in April 2020.Results: 2603 medical students from 19 universities were included. Overall good knowledge and practice were demonstrated by the medical students (88.9%) and (78.6%), respectively. Respondents answered that the most common clinical symptoms of COVID-19 were fever (51.9%), dry cough (40.5%). The main combination of clinical symptoms was dry cough, fatigue and fever in (27.7%), and the first initial symptom was headache (48.4%.).(60.2%) wear medical masks, (94.9%) said that avoiding crowded places protects against the spread of Covid19. (50.9%) have confidence that Sudan can win the battle against the COVID-19 with (48.6%) amongst males and (52.2%) amongst females. 69.0% agreed that COVID-19 will finally be successfully controlled.Conclusion: This study showed that medical students in Sudan demonstrated excellent Knowledge and good practice toward Covid19.Recommendations: Although the results were very positive, further education and awareness should be carried out to increase the preparedness of medical students towards such pandemics and public health modules should also focus more on the importance of the knowledge of newly emerging diseases and the practices toward them.

COVID-19 and Epilepsy (preprint)

Introduction: COVID-19 caused by SARS-CoV-2 acquired via respiratory droplets. It can present with many systemic disorders, includingA 45-year-old Sudanese male known to have well-controlled generalized tonic-clonic epilepsy, He presented to the Accident and Emergency (A&E) department complaining of refractory status epilepticus. Despite immediate initial stabilization, the seizure attacks were still refractory to intravenous loading doses of antiepileptic drugs AEDs. Hence the patient was intubated and mechanically ventilated. Brain MRI and EEG were normal. The chest X-ray was normal. The screening of COVID-19 was positive.Epilepsy is one of the most common neurological disorders. Since the beginning of the Coronavirus outbreak in December 2019, no available research data is suggesting that the patients with epilepsy are at more risk than others. As no available data relating epilepsy to severe COVID-19 infection (6). Moreover, no data studied COVID-19 and the sudden unexpected death among epileptic patients (SUDEP).Conclusion: This case might report the effect of SARS-CoV-2 on provoking the refractory seizures in a previously well-controlled patient with epilepsy. More researches are needed to explain the relation between COVID and seizure threshold.

COVID-19 and Ischemic Stroke (preprint)

Background: SARS-CoV-2 causes COVID-19 disease. It was identified in December 2019 and rapidly evolved into a pandemic. During the outbreak of COVID-19, researches demonstrated its effect on many systems, including the nervous system. In our clinic, we have reported an impact of SARS-CoV-2, causing the ischaemic stroke.Case Report: A 62-year-old Sudanese male with some comorbidities brought to the A&E with fever, chest symptoms, and acute evolving left-sided hemiplegia power grade 0/5 MRCS with left upper motor neuron facial palsy. Investigations: CT brain: right middle cerebral artery MCA infarction. CT- chest: bilateral ground-glass appearance. COVID-19 Test was positive. elevated D-dimer and C-reactive protein.Discussion: A retrospective study of data from the COVID-19 outbreak in China showed that the incidence of stroke among hospitalized patients was approximately 5%. The fact that COVID-19 is an acute inflammatory condition associated with an increased incidence of fatty plaques formation, injury of the vascular wall, and hypercoagulability, causing brain infarct can be a reasonable hypothesis.ConclusionPatients with COVID-19 are at increased risk of thrombo-embolization, leading to arterial and venous cerebrovascular accident. This case report enhances the importance of further studies to clarify the relationship between stroke and COVID-19.