Omdurman Ahlia University

For infection control in the high-risk dental environment, the use of Personal Protective Equipment (PPE) is not only crucial, but its correct and consistent use is a matter of urgency. A study in public teaching hospitals in Khartoum State, Sudan, and involved 117 General Dental Practitioners (GDPs) has revealed systemic problems in the use of PPE that could have serious consequences in the dental setting. According to the results, 74.4% of clinics lacked written infection prevention and control policies, and shockingly, only a 10.6% percentage of GDPs received adequate supplies of PPE. A whopping 88% staff hadn’t any formal training in the use of PPE, and therefore, practitioner compliance to this is quite unpredictable. In one area, glove use was up to 91.5% but the instant removal of damaged gloves was just 54.7%. The mask compliance was somewhat satisfactory, but, the procedure wasn’t consistently executed; only 18.8% of the GDPs changed their wet masks between patients. Coming in last were protective eyewear with a deplorable 26.5% and gowns with a despicable 22.2% adherence. The general picture here is of PPE usage that is not up to par and is fundamentally undermined by the absence of clear policies, inconsistent access to equipment, and lack of training.

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.

Background: Efflux-mediated macrolide resistance represents an emerging threat in Streptococcus infections globally. However, molecular epidemiological data from the Gulf region, particularly the United Arab Emirates (UAE), remain limited. This study addresses this knowledge gap by investigating efflux pump resistance mechanisms in clinical Streptococcus isolates. Methods: A cross-sectional study analyzed 100 clinical isolates (99 Streptococcus and 1 Enterococcus) from Thumbay Hospital, Ajman, UAE (October–December 2024). Antimicrobial susceptibility testing for minimum inhibitory concentration (MIC) determination was performed using the DxM 1096 MicroScan WalkAway system (Beckman Coulter Inc., Brea, CA, USA; LabProv4.42). PCR detected mef(A/E), msr(D), and tet(K) resistance genes with sequencing confirmation. Comparative genomic analysis was performed using a total of 30 publicly available Streptococcus genomes: 15 from India and 15 from Saudi Arabia. Statistical analysis employed chi-square tests, Fisher’s exact tests, and multivariate logistic regression with Bonferroni correction (α = 0.05). Results: Among the isolates, erythromycin resistance occurred in 39 isolates (39%, 95% CI: 29.4–49.2%) and clindamycin resistance in 31 isolates (31%, 95% CI: 22.1–40.9%). The mef(A/E) gene was detected in 31 isolates (31%, 95% CI: 22.1–40.9%), and msr(D) in 3 isolates (3%, 95% CI: 0.6–8.5%), with co-occurrence in 3 isolates (3%). No isolates harbored tet(K). Multivariate analysis identified mef(A/E) as the strongest predictor of macrolide resistance (OR = 18.7, 95% CI: 7.9–44.2, p < 0.001). Regional comparison revealed significant differences: mef(A/E) prevalence was 31% (UAE), 87% (India), and 0% (Saudi Arabia) (p < 0.001). Conclusions: This study provides the first molecular characterization of efflux-mediated macrolide resistance in UAE Streptococcus isolates. The predominance of mef(A/E)-mediated resistance with confirmed efflux activity highlights the clinical significance of active surveillance and targeted antimicrobial stewardship in the region.

Background:Epilepsy is a chronic non-communicable disease defined as recurrent and unprovoked seizures. Epilepsy causes a wide range of challenges that affect the patient’s quality of life (QoL). This study aimed to assess the quality of life and associated factors among patients with epilepsy in Khartoum State, Sudan.Methods:This hospital-based cross-sectional study involved epileptic patients recruited from three neurological clinics located in Khartoum State, Sudan. The questionnaire consisted of the Short-Form Health Survey (SF-36) to assess quality of life, along with items covering the patients’ sociodemographic and clinical characteristics. The data were analyzed using SPSS v.23. The Kruskal–Wallis test, Mann-Whitney U test, and multiple logistic regression were used to analyze associations between clinical and demographic factors and QoL scores. The level of significance was set at 0.05.Results:A total of 106 epileptic patients were interviewed. The total mean score of QoL SF-36 in these patients was 59.8 ± 13.9. A total of 44.3% of the epileptic patients demonstrated a good quality of life. For different SF-36 subscales, the highest mean score was for the physical functioning domain (78.7 ± 21.3). All demographic and clinical characteristics were not significantly associated with the QoL score. Age, gender, and the presence or absence of workdays were found to be significantly associated with the physical functioning subscale (P = 0.003, 0.036, and 0.003, respectively), while marital status and number of outpatient visits were significantly associated with the mental health subscale (P = 0.041 and 0.038, respectively). Additionally, the presence or absence of workdays was significantly associated with the role limitation due to the physical health subscale (P = 0.023).Conclusion:The study findings suggested that most patients with epilepsy have a moderate-to-good quality of life. The highest score was for the physical functioning domain. A significant relationship was identified between specific socio-demographic and clinical factors and various SF-36 QoL subscales. These findings highlight the need for targeted, culturally sensitive interventions, as well as longitudinal research to address the broader determinants of quality of life in this population.

Schistosomiasis poses a significant global health threat, particularly in tropical and subtropical regions like Sudan. Although numerous epidemiological studies have examined schistosomiasis in Sudan, the genetic diversity of Schistosoma haematobium populations, specifically through analysis of the mtcox1 gene, remains unexplored. This study aimed to investigate the risk factors associated with urogenital schistosomiasis among school pupils in El-Fasher, Western Sudan, as well as the mtcox1 genetic diversity of human S. haematobium in this region. A cross-sectional study was conducted among school pupils aged 4 to 19 years. In total, 196 urine samples and 196 fecal samples were collected from participants across schools, health centers, and refugee camps in El-Fasher. Samples were examined using simple centrifugation/sedimentation technique and formol-ether concentration method to detect S. haematobium and S. mansoni eggs, respectively. S. haematobium mtcox1 partial gene was amplified and sequenced by the Sanger technique. A neighbor-joining phylogenetic tree was generated by MEGA software, and a haplotype network was constructed using PopART v.1.7 with the median-joining network method. In this study, S. haematobium was detected in 6.1% (12/196) of the participants while no S. mansoni ova were observed in fecal samples. The infection was more common among those who relied on indirect water supply like tankers (6, 50%). No infection was observed among residents of refugee camps. Only eight samples were PCR-positive, which were successfully sequenced, and included in the genetic diversity analysis. A unique haplotype (Hap_1) with no sequence diversity was found among cox1 sequences from El-Fasher strains. Both El-Fasher S. haematobium haplotype (Hap_1) and Gezira haplotype (Hap_31) fall within the mainland Africa group (group 1). In conclusion, this study identified a novel S. haematobium strain and provides insights into the evolutionary history and phylogeography of S. haematobium in Sudan, particularly in the western region. This genetic data could help in the control and monitoring of urogenital schistosomiasis in this region. For the first time, we utilized the DNA mtcox1 barcoding to investigate S. haematobium haplotypes in Western Sudan.

In this work, we present an innovative approach to enhance multiband communication systems by enabling the antenna subsystems to simultaneously transmit and receive across multiple independent in-band full-duplex (IBFD) channels, i.e. multiband-IBFD (MIBFD). This capability is powered by fractal antenna arrays, specifically using hexagonal star array (HSA) geometry. The approach provides a unique self-interference cancellation (SIC) capability across multiple bands (MB-SIC), achieved through translation or rotational transformations of self-similar or self-affine array structures. Simulation results demonstrate significantly enhanced SIC bandwidth for three signals at sub-frequencies near 5 GHz, with the integration of subbands’ SIC bandwidths achieving 1.4 GHz across these subbands. Further enhancements include combining this method with a technique involving the elevation of the central receiving element, significantly broadening the SIC bandwidth compared to traditional methods. Additionally, the multiband functionality is validated with pilot signals at 2.68 and 5.2 GHz, showing effective SIC in these narrow bands. This research presents a promising path for optimising radio resources in multiband communication systems.

Background: Maternal deaths and disabilities remain a major public health problem in developing countries, in spite of the efforts of many international and developmental health agencies. Despite the worldwide commitment to improving maternal health, measuring, monitoring and comparing mortality estimates remain a challenge. Maternal death review (MDR) is a tool used to measure the maternal mortality ratio (MMR) and to improve the quality of obstetric care. Objectives: This study was done to assess maternal mortality and to identify underlying causes during 2010-2012. Materials and Methods: Facility and community-based maternal death review was conducted during three years in Sudan to study maternal mortality. All women who died in the hospital or community from pregnancy-related conditions were included. Data was collected by trained registrars and healthcare providers. National and state’ maternal death review committees were established. A focal person for each state, health facility and locality was nominated. Notification of maternal deaths was done by telephone, followed by a review of all notified maternal deaths using a structured format. Data was analyzed using a microcomputer, with SSPS, version 18.0. Results: Maternal mortality ratios remained unacceptably high across much of the developing world. This study showed that, over three years, 2933 maternal deaths were notified, out of 1509354 Live births (LB). MMR was 194/ 100000 LB, with different variation between states. Facility maternal deaths were 2503 (85.3%) and community deaths were 430 (14.7%), reviewed formats were 2859 (97.5%). Direct obstetric deaths were 1845 (64.5%), mainly due to haemorrhage 884 (30.9%), eclampsia 383 (13.4%) and sepsis 321 (11.2%). Indirect causes were 1014 (35.5%), 363 (12.7%) due to hepatitis and 197 (6.9%) to anemia. Most of the hospital deaths 1947 (77.9%); admitted late from home, 2462 (73.4%) were critically ill and 1484 (60.3%) died within 24 hours. Conclusion: Home delivery, late presentation, unavailability of blood and poor referral system, are the main factors behind maternal deaths. Maternal death review has to be integrated within the health management information system (HMIS) with a strong commitment of various stakeholders. Slow implementation of suitable interventions at the country level to utilize MDR recommendations for reducing MMR and lack of operational plans and suitable framework for monitoring and evaluation of MDR progress.

BackgroundSocioeconomic status (SES) is a social classification factor that takes into account income, parental education and occupation. SES has been shown to play an important role in shaping students’ academic performance, including in medical schools, but there still remains significant variation in findings around SES and academic achievement worldwide. We aim to assess and explore socioeconomic disparities and their effects on medical school performance at Sudanese public and private universities.ObjectivesThe objective of our study was to assess the effects of age, sex, living conditions, parental education and income level on the academic achievement of medical students from universities in Sudan.MethodsThis cross-sectional study was conducted among undergraduate medical students at ten public universities in Sudan between September and December 2023. Participants were included if they were older than 18 years and were studying in their 2nd year or older. The data were collected using an online questionnaire with open- and closed-ended questions measuring age, living conditions, parental income level and education. A convenience sampling method was used to recruit participants from universities. The data were analyzed using SPSS v28.0.0, and a p value less than 0.05 was used to indicate statistical significance.ResultsWe received 832 responses, 516 (62%) from females and 307 (36.9%) from males. The median age was 23 years. Most students lived with their families (61.1%), followed by student housing (28.2%). This study revealed age (p = .024) (95% Cl: 0.025- 0.023) andhigh family income (p = .019) (95% Cl: 0.018- 0.02) are associated with academic achievement in the long term, as demonstrated through cumulative grade point average (cGPA).ConclusionThe findings underscore the importance of targeted support systems to bridge the socioeconomic gaps that exist among medical students, allowing all students to thrive academically regardless of their background.Clinical trial numberNone.

Introduction: Environmental data play a crucial role in social change, especially in ancient Yemen, where the natural environment is closely linked to ancient civilizations. The development of tribal areas in Yemen, such as Saba and Hamir, has been affected by the growth of trade, handicrafts and traditional industries. The integration of the natural environment has led to the growth of maritime navigation and the establishment of modern industrial and administrative units. Urbanization in these areas has diversified the components of tribal populations, requiring new social, political, economic and legal regulation. The population also had to adapt to modern standards and regulations, such as monetary handling in the labour market and production. The geographical and environmental dimension plays a significant role in the emergence and expansion of cities, which are often found in fertile and resource-abundant locations. Urban development in the Arabian Peninsula has a long history dating back to ancient times. The region has witnessed the first civilization in history and has witnessed significant urbanization. The middle Ages experienced significant urban development, with cities reaching unprecedented sizes. The nineteenth century saw a new phase of urban development, with urban land subject to economic processes, including competition. The discovery and extraction of oil in the twentieth century led to the emergence of new cities, highlighting the current urban landscape. The Arab population has grown rapidly, rising from 13% in 1900 to 49% in 2005(according to the Central Bureau of Statistics). Today, the Arab city community is a mix of cultures and nationalities, with institutions replacing the family, the warmer and the tribe in different societies. Aspects of life and social systems. It is estimated that half of the Arab population inhabits urban areas because of urban growth and urbanization, a health phenomenon that is indicative of civilized development and economic and social growth. Methodology: The physical changes in the Republic of Yemen and the identification of the city of Aden were studied by reviewing the studies that monitored these changes and their social, economic and population effects. The study relied on secondary data in the first place. Results: this research was conducted to study The Influence of Urbanization on Social Dynamics in Yemen: Insights from Environmental and Climate Data, we find that urban society's relationship with the natural environment influences its social and cultural environment, influenced by collective and individual traditions and economic habits. Rural societies are more connected to the natural environment, while urban communities live in relative isolation, resulting in a dominant social and human environment. Discussion: Urban growth refers to the physical framework for society's stability and existence, indicating social well-being and basic needs such as housing, water security, energy, and transportation. In the Arab world, urbanization dates back to ancient times, with cities growing up in the Arabian Peninsula. The Middle Ages saw major urban development, while the 19th century saw rapid urban population growth. Today, half of the Arab population is urban, reflecting civilization's development and economic and social growth. Yemen is experiencing significant urbanization, transforming from an urban environment to a diverse, modern society, influenced by social construction and cultural values. The natural environment influences social and cultural environments, with rural societies being more connected to it. Urbanization requires preserving rural social characteristics, strengthening inhabitants' sense of belonging, and promoting participation in community development plans. Spatial justice and regional balance are crucial in developing world urban environments, as they help overcome alienation and promote collective affiliation.