Ebara Hospital

Background and objective Enteric fever remains a major public health problem in Sudan, particularly in areas with poor sanitation and limited health care resources. Accurate diagnosis is essential for appropriate management; however, diagnostic practices often rely on unreliable methods. This clinical audit aimed to evaluate current diagnostic practices for enteric fever at Kosti Teaching Hospital, assess adherence to WHO standards, identify gaps in diagnostic methods, and propose recommendations to improve diagnostic accuracy. Methods This study was a retrospective clinical audit conducted at Kosti Teaching Hospital, Sudan, reviewing the medical records of patients diagnosed with enteric (typhoid) fever during the study period. Data were extracted using a structured audit checklist to evaluate diagnostic practices, including documentation of clinical features, laboratory investigations requested (e.g., Widal/Felix-Widal test, serology, antibody testing, blood culture, and stool or rectal swab culture), and adherence to recommended diagnostic guidelines. Descriptive analysis was performed, and results were summarized using frequencies and percentages. Results Fifty-six patient records were reviewed. Headache and body pain (87.5%) and fever (85.7%) were the most common presenting symptoms. The Widal test was the most frequently used diagnostic tool (67.9%), followed by antibody detection (22.6%) and serology (Widal test) (17%). Blood culture, the diagnostic gold standard, was performed in only 1.9% of cases. No patients underwent stool culture or typhoid testing. The heavy reliance on the Widal test and clinical features, with minimal use of confirmatory tests, indicates substantial deviation from international guidelines. Conclusions The audit revealed significant gaps in enteric fever diagnosis at Kosti Teaching Hospital, characterized by heavy reliance on clinical assessment and Widal testing, with minimal use of blood culture due to limited resources. These practices compromise diagnostic accuracy and reflect broader health system challenges, including inadequate laboratory capacity and underfunding. Strengthening diagnostic infrastructure, improving access to reliable tests, and providing ongoing health care worker training are essential to align practices with WHO standards and improve patient outcomes in Sudan.

Introduction: Effective discharge documentation is essential for safe transitions from hospital to community care. The Health Information and Quality Authority (HIQA) outlines seven core data categories for patient discharge summaries. In low-resource settings, structured formats have been shown to improve completeness, clarity, and patient safety. This quality improvement project (QIP) aimed to develop and implement a standardized discharge card in the Internal Medicine Department of Atbara Teaching Hospital, Sudan, adapted from HIQA standards.Methodology: The project followed a two-cycle audit (April-August 2025). In the first cycle, 50 discharge records were reviewed to identify gaps. Records were randomly selected from the pool of available patient files, and auditing was conducted by three physicians not directly involved in patient care during the study period. A standardized discharge card was co-developed with staff, including essential demographic, clinical, and follow-up details. Training was provided, and the tool was implemented. In the second cycle, 40 discharge records were audited. Data was analyzed using chi-square tests to compare pre- and post-intervention documentation rates.Results: Significant improvements were observed in gender documentation (46.8%→100%, P < 0.001), allergy recording (12.9%→88.3%, P < 0.001), telephone number (0%→36.6%, P < 0.001), address (1.6%→43.0%, P < 0.001), referral to specialist (0%→35.0%, P < 0.001), and referrer details (32.3%→55.0%, P = 0.028). High compliance was maintained for the patient’s name, age, primary diagnosis, and clinical summary. These gains are clinically meaningful, as improved allergy and contact documentation directly support patient safety and follow-up. Persistent deficiencies remained for date of birth (0%→5.0%, P = 0.110) and professional role documentation (40.3%→50.0%, P = 0.343), likely reflecting reliance on age notation and limited emphasis on role identification.Conclusion: The standardized discharge card significantly improved documentation in key patient safety domains. Sustained gains require ongoing staff training and regular audits. This model may also be generalizable to other departments and hospitals in low-resource settings.

Background and aim: High-quality surgical operation notes are essential for patient safety, clinical communication, and medicolegal accountability. In low-resource settings like Sudan, inconsistent and incomplete documentation remains a challenge. This study aimed to evaluate and improve the quality of surgical operation notes at the Atbara Teaching Hospital using a closed-loop clinical audit.Methods: A two-cycle audit was conducted using a standardized checklist based on the guidelines of the Royal College of Surgeons of England. Fifty surgical notes were reviewed in each cycle. Following the baseline assessment, interventions including the implementation of a structured proforma and staff education sessions were introduced. A re-audit was then performed to assess the impact of these measures.Results: Significant improvements were observed across most documentation parameters. Patient identification improved from 2% to 100% (p<0.0001), preoperative diagnosis from 8% to 93.5% (p<0.0001), and postoperative care instructions from 0% to 76.1% (p<0.0001). Documentation of anticipated blood loss, antibiotic prophylaxis, and closure techniques also showed statistically significant enhancements. However, gaps remained in areas, such as complication reporting and anesthetist details.Conclusion: Structured interventions, including standardized templates and targeted training, substantially improved the completeness and quality of surgical operation notes. Ongoing audits, reinforced education, and potential integration of electronic records are recommended to sustain and build upon these improvements, particularly in resource-limited settings.

Abstract Background Traditional uvulectomy (TU) is the removal of the uvula, either partially or totally by the traditional healer. It is prevalent in sub-Saharan Africa, driven by cultural beliefs and perceived therapeutic benefits, despite the risks of complications -bleeding, infections, and death, and limited data exist. Our study aimed to assess the prevalence and practice of traditional uvulectomy among Sudanese children and adolescents, along with maternal perceptions, and identify associated risk factors. Method A descriptive cross-sectional community-based study (from January to April 2025) involved 1,135 mothers of children ≤18 years, across more than ten states. Data were collected via face-to-face interviews using a validated structured questionnaire to assess the socio-demographics, TU perception, practice, and complications. A convenience sampling technique was used. We analyzed with R software, and p &lt; 0.05 was considered statistically significant. Results The prevalence was 15%, peaking in infants (&lt;6 years: 16%) and adolescents (12–18 years: 17%). Maternal belief was significantly associated with younger child age (37% for 12–18 years vs 16% for 6–12 years; p&lt;0.001). The reasons included breastfeeding difficulties (18%), cultural tradition (16%), and failure to thrive (13%). Mothers (45%) and grandmothers (41%) primarily decided to perform TU, with traditional healers conducting 55% of procedures using unsterilized tools. Complications included fever (35%), feeding difficulties (21%), and bleeding (13%). TU was associated with younger maternal age (median 22 years), lower education (21% illiterate), and tribal tradition (92% adherence), all p&lt;0.001. Conclusion TU persists in Sudan due to cultural entrenchment, intergenerational influence, and healthcare barriers. Interventions must engage tribal leaders and healers, promote safer alternatives, and improve education and healthcare.

Satralizumab is approved in Japan for relapse prevention of neuromyelitis optica spectrum disorder (NMOSD) in aquaporin-4 immunoglobulin G-seropositive (AQP4[+]) patients. However, clinical trial data for Japanese patients are limited. SAkuraBeyond, an ongoing real-world observational study (UMIN000050027), evaluates NMOSD relapse over 2.5 years among satralizumab-treated patients with AQP4[+] NMOSD in Japan (25 sites). Herein, we present a 26-week interim effectiveness analysis. Patient data were derived from medical chart review and electronic case report forms. Of the 125 enrolled patients who initiated satralizumab, 124 were included in the study (mean age, 51.1 years; female, 93.5 %; mean disease duration, 7.0 years). At week 26, 120 patients were relapse-free (12 withdrew from satralizumab). The annualized relapse rate [95 % confidence interval (CI)] was 0.069 [0.026-0.183] at week 26 after satralizumab initiation and 0.445 [0.342-0.580] within 52 weeks before satralizumab initiation. The relapse-free rate [95 % CI] at week 26 was 96.6 % [91.2-98.7]. Four patients had relapses, of whom 1 discontinued satralizumab. Three recorded a modified Rankin Scale of ≤3 (1 with unknown status). The mean oral glucocorticoid (GC) dose reduced from baseline to 26 weeks of satralizumab treatment; the GC dose was reduced in 71.3 % of patients treated with oral GC >0 mg at baseline. Azathioprine and tacrolimus doses could be reduced to 0 mg/day in 35.3 % and 26.2 % of relapse-free patients, respectively, at week 26. The 6-month relapse-free rate after satralizumab treatment was 96.6 %. Satralizumab use permitted dose reduction of concomitant oral GC and immunosuppressants over 26-weeks.

Several Ephedra Herb-containing Kampo medicines are common initial treatments for various infections; however, the ephedrine alkaloids in Ephedra Herb can cause side effects by stimulating adrenergic receptors. Accordingly, an ephedrine alkaloids-free Ephedra Herb Extract (EFE) has been developed. This study aimed to evaluate whether EFE can be used effectively and safely in patients with mild coronavirus disease 2019 (COVID-19). We randomized patients with mild COVID-19 to receive EFE equivalent to 6 g of Ephedra Herb per day or a placebo for 14 days. The primary efficacy endpoint was the non-aggravation rate up to Day 15. We allocated 41 and 40 patients to the EFE and placebo groups, respectively. All participants were included in the mITT and safety analysis populations [male ratio, mean age: 31.7%, 42.0 years (EFE); 17.5%, 43.2 years (placebo)]. The non-aggravation rate up to Day 15 for the primary endpoint was 100.0% and 94.6% in the EFE and placebo group, respectively, with no between-group difference. The number of days to the improvement in nausea symptoms was significantly shorter in the EFE group. One patient in the placebo group discontinued the trial due to a side effect. Although EFE demonstrated safety in patients with mild COVID-19, it did not show superior efficacy compared to placebo for symptoms other than nausea.

The May Measurement Month (MMM) campaign was carried out in Sudan in 2022 with the aim of raising awareness of raised blood pressure (BP). Here, we report on the findings of the campaign. Adults aged ≥18 years were recruited opportunistically at the community spaces and educational institutes. Three seated BP readings were taken for each participant, along with completing a questionnaire on demographics, lifestyle factors, and comorbidities. Hypertension was defined as a systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg or being on antihypertensive medication. Controlled BP was described as being on antihypertensive medication with a BP < 140/90 mmHg. Multiple imputation was used to estimate any missing BP readings. In total, 16 051 were screened with a mean age of 37.5 ± 15.9 years and 57.7% of them were females. Of all screened participants, 4604 (28.7%) had hypertension, of whom 2038 (44.27%) were aware of being hypertensive, and 1864 (40.5%) were on antihypertensive medication. Of those on antihypertensive medication, 808 (43.3%) had controlled BP, and of all participants with hypertension, 17.5% had controlled BP. Only 6960 (43.4%) of the total participants had their BP measured within the last 12 months. The MMM campaign in Sudan identified a high percentage of significant numbers of participants with either untreated or inadequately treated hypertension. The previously diagnosed cases were a small proportion of the disease load, a situation that deserves extensive efforts of awareness-raising campaigns and community screening.

During the COVID-19 pandemic, the number of patients requiring ventilatory management increased owing to severe pneumonia, and the number of cases of laryngotracheal stenosis increased accordingly. We herein report three cases of laryngotracheal stenosis after percutaneous tracheostomy, cricoid cartilage necrosis and subglottic granuloma, and posterior vocal fold adhesion and cricoarytenoid joint fixation. The affinity of SARS-CoV-2 for the upper respiratory tract and the anatomy of cricoid cartilage were thought to contribute to the development of these complications. We discuss the mechanism by which the combined effects of long-term intubation, tracheostomy management, direct effects of the virus, and inflammatory response cause laryngotracheal stenosis. The importance of early detection and appropriate therapeutic intervention are emphasized, while the establishment of future countermeasures are also discussed.

BackgroundSepsis is one of the most common causes of morbidity and mortality in newborns. Diagnosis of neonatal sepsis may be difficult because the clinical presentations are often nonspecific. Neonatal sepsis may have an early onset (zero to three days) or a late onset (four days or later). Onset is most rapid in premature neonates. In this study, we aimed to assess the correlation between positive cultures, high C-reactive protein (CRP) levels, and the diagnosis of neonatal sepsis.MethodologyThis descriptive, prospective, cross-sectional study was undertaken over four months starting from December 15, 2019, to April 15, 2020, in Atbara Teaching Hospital, Sudan. Data were collected from 71 patients. CRP levels were measured, and blood cultures were performed.ResultsHigh CRP level >10 mg/L was seen in patients having positive blood culture (55.3%), mainly in preterm babies (CRP >10 mg/dL (61.1%), positive culture (55.6%)) and very low birth weight babies (CRP >10 mg/dL (83.3%) and positive culture (67%)).ConclusionsOur findings suggest that Klebsiella is an important cause of neonatal sepsis. CRP was positive in babies mainly with proven sepsis. There is a high correlation between CRP and blood culture in patients with neonatal sepsis which may give access to remodeling the prioritization of the management options in the clinical setting.