Incidence and Clinical Pattern of Mixed Connective Tissue Disease in Sudanese Patients at Omdurman Military Hospital: Hospital-Based Study.

BACKGROUND: Mixed connective tissue disease (MCTD) is a rare autoimmune disease, characterized by the production of specific autoantibody anti-RNP, which presents with varied overlapping symptoms of different connective tissue disorders. The aim of this study is to identify the frequency and patterns of MCTD. METHODS: This is a descriptive cross-sectional hospital-based study conducted at the rheumatology clinic at Omdurman Military Hospital between February 2019 and July 2019. The study included 30 patients and data were collected using a designated questionnaire. RESULTS: The study showed that the majority of patients (96.7%) were females and only 3.3% was male. About 30% of the patients aged between 30 and 39 years were the most affected. As a first diagnosis, 10% of the patients had a MCTD fulfilling the Alarcon-Segovia criteria. The remaining 90% of the patients were diagnosed with other diseases before evolving into MCTD. The most common clinical presentation was arthralgia in 100% of the patients, 90% were symmetrically followed by myositis in 70% of the patients, arthritis in 63.3% of the patients, puffy fingers in 63.3% of the patients, and hand swelling in 60% as major musculoskeletal symptoms. Regarding the initial results in immunological profile, the most common positive autoantibodies among the patients were anti-RNP titer in 96.7% of the patients, ANA in 90%, anti-Sm in 50%, RF in 50%, anti-Ds DNA in 46.7%, and anti-Ro in 43.3%. CONCLUSION: This study showed that MCTD is more common in females, only 10% of patients presented with a fulfilling criteria of the disease at diagnosis, and the rest of the patients presented with other rheumatologic diseases before evolving into MCTD.

Awareness and perception of COVID-19 among final-year dental students, Sudan.

BACKGROUND: Infection with COVID-19 has serious consequences, which may lead to severe pneumonia and even death. There is a high risk of infection between dental personnel and patients due to working in proximity while performing dental treatments. OBJECTIVE: This study aims to assess the awareness about COVID-19 and its preventive measures among final-year dental students. METHODS: Institutional-based cross-sectional study, among the final-year Bachelor of Dental Surgery students, the sample size was 288 participants during the period from August 8, 2020, to August 15, 2020. The data were collected using a self-administered questionnaire formed of a series of close-ended questions about sociodemographic characteristics, knowledge about COVID-19, prevention in dental clinic, and perception toward COVID-19. Data were analyzed using the Statistical Package for Social Science, version 25 (SPSS 20.0, Chicago, IL). The Chi-square test was used for the significance level, which was set at a value of P = 0.05 or less for all analyses. RESULTS: Form 288 students, the average age (measured in years) was 23.31 ± 1.8. (means ± SD). A total of 224 (77.8%) respondents were females. For COVID-19-related knowledge, 282 (97.9%) students possessed a high knowledge level, 4 (1.4%) had moderate knowledge, and only 2 (0.7%) showed poor knowledge. Also, 95% of participants responded correctly with a total agreement to questions regarding infection control measurements, the least agreement response (85%) was for: avoid aerosol-generating procedures whenever possible. There are statistically significant relations between knowledge score and gender (P = 0.024), knowledge score and source of knowledge (P = 0.017), and perceived severity and knowledge score (P = 0.001). CONCLUSION: This study illustrated that the knowledge score among participants is good. There are associations between gender and level of knowledge, knowledge score and source of knowledge, and perceived severity and knowledge score.

A Rare Association of Thrombotic Thrombocytopenic Purpura with Systemic Lupus Erythematosus in a Sudanese Woman: Case Report.

Thrombotic thrombocytopenic purpura (TTP) is an uncommon life-threatening condition characterized by hemolytic disorders. The coexistence of systemic lupus erythematosus (SLE) with TTP is extremely rare, although Africans are at increased risk due to inherited risk factors. This report describes a rare clinical manifestation of TTP associated with SLE in a Sudanese patient. A 41-year-old Sudanese woman presented to the emergency department with symptoms and features that were suggestive of malaria, for which she had been treated accordingly. However, a few days later she complained of fever, and was found to have a body temperature of 39.5°C, jaundice, anemia, and thrombocytopenia. Soon after admission, she developed confusion and unrecordable blood pressure. After the patient had stabilized, clinical assessment, immune-system investigation (antinuclear antibody profile, complements, blood panel), and imaging revealed a diagnosis of TTP associated with SLE. The patient received imipenem 500 mg, five sessions of plasmapheresis (60 mL/kg), methylprednisolone 1 g pulse for 3 days, and rituximab 375 mg/week. Three weeks later, the patient was discharged after her condition had improved, and she is now on regular follow-up.

Pathological and clinical profile of hearing loss among Sudanese children attending the Khartoum Teaching Hospital.

BACKGROUND: Hearing loss is a common disability affecting nearly 360 million people in the world and 75% of cases live in developing countries. Many children are vulnerable to diseases causing hearing loss that often go untreated. The aim of this study is to identify the possible etiological factors and clinical presentations of children who presented with hearing loss at the Khartoum Teaching Hospital. MATERIALS AND METHODS: a descriptive, cross-sectional hospital-based study. A total of 100 (response rate of 94%) children aged 5-15 who presented with hearing loss at Khartoum Teaching Hospital were included in this study. A detailed structured, pretested, and pre-coded questionnaire was used. After data collection, hearing examination was performed by an E.N.T specialist, then audiometry performed to diagnose hearing loss and for classification of the hearing loss type. Discriptive Statisistics frequencies and cross-tabulation were done. A Chi-square test was used for proportions. A P value of less than 0.05 considered significant. RESULTS: Out of 100 patients, 68 patients (68%) belonged to the 5-10 years age group. The mean age was 8.5 years. The male to female ratio was 1.00-1.13. Conductive hearing loss was found in 66% of the studied group, sensory-neural hearing loss in 23% and the mixed type in 11%. Regarding the etiology, otitis media was found in 41 of patients (41%), congenital hearing loss in 22% (22 patients), traumatic hearing loss in 4%, sickle cell anemia in 2%, mumps in 14%, diabetes mellitus in 3%, and measles in 8% of the patients. In conclusion, a number of preventable causes were shown to contribute significantly to the etiology of hearing loss. CONCLUSION: The commonest factors associated with hearing loss among participants were otitis media and hereditary causes, respectively. Further community-based studies of hearing-impaired children are necessary for planning effective preventive and curative programs.

Sleep pattern and dozing chance among university students.

BACKGROUND: Sleep is defined as a naturally occurring state of the body within a relatively inhibited sensory activity, reduced metabolic rate and decreased interaction with the surrounding. Impaired sleep affects students' productivity, this area is not fully covered in the literature. OBJECTIVES: To assess sleep patterns and dozing chance among university students. METHODS: Institutional based cross-sectional study, a sample of 145 male university students from Almaarefa University aged between 19 and 27 years old, chosen randomly. A self-administered questionnaire developed specifically for this study after consulting literature and epidemiologist. It includes data about the Epworth Sleepiness scale and GPA. Data were analyzed using (SPSS, version 22.0) and (P values of ≤0.05) considered significant. The consent was obtained before data collection. RESULTS: The majority of respondents (62, 1%) reported sleeping time of 5-8 hours per night. To fall asleep at night 13, 1% of participants indicated needing soporific. Overall, only 36, 6% of students showed good sleep behaviors. Among respondents (44, 1%) had moderate chances of dozing and 2, 8% had high chances of dozing, There was no significant statistical relationship between academic performance and bedtime (P-value = 0,231). CONCLUSION: The majority of respondents had poor sleep quality and moderate to high dosing chance, also, most of the participants go to bed after midnight. In addition, one fifth of participants reported sleeping less than 8 hour per day.

Genetic Characterization of Apulian Olive Germplasm as Potential Source in New Breeding Programs.

The olive is a fruit tree species with a century-old history of cultivation in theMediterranean basin. In Apulia (Southern Italy), the olive is of main social, cultural and economicimportance, and represents a hallmark of the rural landscape. However, olive cultivation in thisregion is threatened by the recent spread of the olive quick decline syndrome (OQDS) disease, thusthere is an urgent need to explore biodiversity and search for genetic sources of resistance. Herein,a genetic variation in Apulian olive germplasm was explored, as a first step to identify genotypeswith enhanced bio-agronomic traits, including resistance to OQDS. A preselected set of nuclearmicrosatellite markers allowed the acquisition of genotypic profiles, and to define geneticrelationships between Apulian germplasm and widespread cultivars. The analysis highlighted thebroad genetic variation in Apulian accessions and the presence of different unique genetic profiles.The results of this study lay a foundation for the organization of new breeding programs for olivegenetic improvement.

The Aphasia Rapid Test: an NIHSS-like aphasia test.

The Aphasia Rapid Test (ART) is a 26-point scale developed as a bedside assessment to rate aphasia severity in acute stroke patients in <3 min. We tested its inter-rater reproducibility, its sensitivity to detect changes from Day 1 to Day 8, and the predictive value of D8 ART scores on the 3-month aphasia outcome assessed with the Aphasia Handicap Score (AHS), a 0-5 "Rankin-like" score for aphasic disability. The reproducibility was tested in 91 aphasic patients within one week of stroke onset. The inter-rater concordance coefficient was 0.99 and the weighted Kappa value (κw) was 0.93. The sensitivity was tested in 70 aphasic patients by measuring changes in ART values between D1 and D8. Improvement occurred in 46 patients (66 %) and aggravation in three patients (4 %). In these patients, a logistic regression analysis showed that D8 ART was the only significant predictor of good (AHS 0-2) or poor (AHS 4-5) outcome. The ROC curves analyzes showed areas under the curve above 0.9 for good and poor outcome and revealed D8 ART best cut-off values of <12 for good and >21 for poor outcome, with more than 90 % sensitivity and 80 % specificity. The ART is a simple, rapid and reproducible language task, useful in monitoring early aphasic changes in acute stroke patients and highly predictive of the 3-month verbal communication outcome. It should be easy to adapt to other languages.

Humerus pathological fracture revealing biliary carcinoma.

Tumors of the biliary tract are rare, and their survival prognosis is short since diagnosis is often made at advanced stages of the disease. Diagnosis remains difficult because symptoms are often unspecific. Bone metastasis from biliary carcinoma are rare. We report a case of a humeral metastasis revealing a biliary carcinoma.

Dislocation of the carpometacarpal joint of the thumb associated with trapezium and Bennett's fractures.

We report a case of a 30-year-old man with a carpometacarpal joint dislocation of the thumb associated with trapezium and Bennett's fractures. This combined injury pattern appears to be very rare. Since, to our knowledge a similar case was not found in the literature. The lesion was managed with closed reduction and percutaneous pinning, resulting in good functional outcome.