Cutaneous Larva Migrans (CLM) may not be easy to diagnose: a case report and narrative review.

BACKGROUND: Cutaneous Larva Migrans (CLM) is one of the most common zoonotic dermatoses in subtropical and tropical regions and some European countries. It is caused by different types of hookworm, such as Ancylostoma braziliense, Ancylostoma caninum, and Uncinaria stenocephala. It is usually easy to diagnose, but the atypical presentation may occasionally mimic other dermatoses. CASE REPORT: A 32-year-old man presented with an extensive eczematous rash that developed during a recent vacation in Thailand. He didn't respond to antihistamines and systemic steroids. Finally, he was diagnosed with an atypical presentation of CLM and treated successfully with anthelminthic therapy. CONCLUSION: The report of an atypical presentation of CLM is crucial to increase awareness among healthcare workers, helping in early diagnosis and reducing potential psychological distress that patients may face.

The critical pharmaceutical situation in Sudan 2023: A humanitarian catastrophe of civil war.

The situation in Sudan have deteriorated since the ongoing war outbreak in April 2023. This article sheds light on the pharmacological status in Sudan in terms of shortage of supply, rising demands, and regulatory issues. The ongoing civil war has acutely impacted the dilapidated pharmaceutical status of Sudan, patients have suffered from the paucity of medical services forcing an out-of-control rise in underreported morbidity and mortality. To mitigate this uprising issue, an increase in stakeholder communication is crucial to deal with this national threat and establish a system for reporting the shortage.

Physician experiences with teleconsultations amidst conflict in Sudan.

The current conflict in Sudan severely hinders the accessibility of health services across the country. To address this, several initiatives were proposed including offering services using teleconsultations. This study aimed to assess Sudanese doctors' teleconsultation experience, perception, and concerns during the recent conflict. This cross-sectional survey focused on Sudanese medical officers, residents, specialists, and consultants living inside or outside the country having a practice license from the Sudan Medical Council and conducting teleconsultations with Sudanese patients during the conflict period. The questionnaire was distributed to personal and professional contacts and via social media platforms in the English language among doctors who provided teleconsultation during the conflict. Data analysis was performed using the Statistical Package for Social Sciences software version 26. The study enrolled 2463 clinicians from 17 different specialties, and females represented more than half the sample (56.8%). Internal medicine was the most frequent specialty (36.1%) and the majority (68.7%) of clinicians had less than 5 years of work experience. Voice call was the most frequent platform (50.1%) used for teleconsultation during the conflict and had the highest convenience score (p < 0.01), whereas messaging platforms had the lowest score. Most clinicians (73.3%) agreed that teleconsultations created a trusted patient-physician relationship and provided good-quality care (61.8%). However, 85.1% highlighted the importance of physical touch in medical practice. Clinicians were concerned that incomplete information (81.4%), missed diagnosis (76.8%), medicolegal problems (71.0%), and prescription errors (68.4%) could arise with teleconsultations. Most respondents (70.7%) emphasized the importance of continuing to offer teleconsultation even after the war abated. In conclusion, physicians who participated in the current study agreed that teleconsultation provided quality care even in this dire crisis in Sudan. Based on our study findings, we recommend upscaling telemedicine interventions including teleconsultations at the national level. This would require unified coordination efforts of a wide mix of stakeholders to address concerns identified in the current study.

Etiological associations of cerebral venous sinus thrombosis among adult sudanese patients: a multicenter cross-sectional study.

Cerebral venous sinus thrombosis (CVST) is a common condition that, if not detected and treated promptly, carries a high risk of morbidity and mortality. CVST's most common aetiological associations are post-partum, pregnancy, and oral contraceptive pills. The purpose of this study was to look into the aetiology of CVST in Sudanese patients in neurological centres in Khartoum state. Methodology: This was a cross-sectional hospital bases study conducted on CVST patients at four neurological centres in Khartoum state in the period from March to October 2020. Patients were studied for the aetiological association of CVST using a standardized questionnaire including medical history, clinical examination, investigation, and treatment. Results: The study included about 60 patients, 50 of whom were female (83.3%) and 10 of whom were male (16.7%). In terms of clinical presentation, almost all patients had headache, followed by visual disturbances in 49 (81.7%), seizures in 46 (76%), disturbed consciousness in 12 (20%), and weakness in 12 (20%). The most common sign was abnormal speech, which was found in eight patients (13.3%), memory disturbances in eight patients (13.3%), evidence of CN VI lesion in three (5%), papilledema in 49 (81.7%), and hemiparesis in 46 (76.7%), while abnormal sensory signs were found in only one patient. The most common aetiological association were pregnancy in 15 (25%), oral contraceptive pills in 11(18.3%), and being in the post-partum period in 23(38.3%). All of the patients' magnetic resonant imaging/magnetic resonant venography results were abnormal. Six patients had extensive sinus involvement, 35 had superior sagittal sinus involvement, and 19 had transverse sinus involvement. After treatment, 45 patients (75%) fully recovered, 11 (18.3%) partially recovered, and 4 (6.7%) died. Conclusion: Post-partum, pregnancy, and oral contraceptive pills were the most common aetiological associations of CVST compared with other populations.

The educational value of ward rounds as a learning and teaching opportunity for house officers, medical officers, and registrars in Sudanese hospitals: a multi-center cross-sectional study.

BACKGROUND: Ward rounds are a cornerstone in the educational experience of junior doctors and an essential part of teaching patient care. Here, we aimed to assess the doctors' perception of ward rounds as an educational opportunity and to identify the obstacles faced in conducting a proper ward round in Sudanese hospitals. METHOD: A cross-sectional study was conducted from the 15th to the 30th of January 2022 among house officers, medical officers, and registrars in about 50 teaching and referral hospitals in Sudan. House officers and medical officers were considered the learners, while specialist registrars were considered the teachers. Doctors' perceptions were assessed using an online questionnaire, with a 5-level Likert scale to answer questions. RESULTS: A total of 2,011 doctors participated in this study (882 house officers, 697 medical officers, and 432 registrars). The participants were aged 26.9 ± 3.2 years, and females constituted about 60% of the sample. An average of 3.1 ± 6.8 ward rounds were conducted per week in our hospitals, with 11.1 ± 20.3 h spent on ward rounds per week. Most doctors agreed that ward rounds are suitable for teaching patient management (91.3%) and diagnostic investigations (89.1%). Almost all the doctors agreed that being interested in teaching (95.1%) and communicating appropriately with the patients (94.7%) make a good teacher in ward rounds. Furthermore, nearly all the doctors agreed that being interested in learning (94.3%) and communicating appropriately with the teacher (94.5%) make a good student on ward rounds. About 92.8% of the doctors stated that the quality of ward rounds could be improved. The most frequently reported obstacles faced during ward rounds were the noise (70%) and lack of privacy (77%) in the ward environment. CONCLUSION: Ward rounds have a special value in teaching patient diagnosis and management. Being interested in teaching/learning and having good communication skills were the two major criteria that make a good teacher/learner. Unfortunately, ward rounds are faced with obstacles related to the ward environment. It is mandatory to ensure the quality of both ward rounds' teaching and environment to optimize the educational value and subsequently improve patient care practice.

Association of d-dimer levels with in-hospital outcomes among COVID-19 positive patients: a developing country multicenter retrospective cohort.

D-dimer levels, which originate from the lysis of cross-linked fibrin, are serially measured during coronavirus disease 2019 illness to rule out hypercoagulability as well as a septic marker. Methods: This multicenter retrospective study was carried out in two tertiary care hospitals in Karachi, Pakistan. The study included adult patients admitted with a laboratory-confirmed coronavirus disease 2019 infection, with at least one measured d-dimer within 24 h following admission. Discharged patients were compared with the mortality group for survival analysis. Results: The study population of 813 patients had 68.5% males, with a median age of 57.0 years and 14.0 days of illness. The largest d-dimer elevation was between 0.51-2.00 mcg/ml (tertile 2) observed in 332 patients (40.8%), followed by 236 patients (29.2%) having values greater than 5.00 mcg/ml (tertile 4). Within 45 days of hospital stay, 230 patients (28.3%) died, with the majority in the ICU (53.9%). On multivariable logistic regression between d-dimer and mortality, the unadjusted (Model 1) had a higher d-dimer category (tertile 3 and tertile 4) associated with a higher risk of death (OR: 2.15; 95% CI: 1.02-4.54, P=0.044) and (OR: 4.74; 95% CI: 2.38-9.46, P<0.001). Adjustment for age, sex, and BMI (Model 2) yields only tertile 4 being significant (OR: 4.27; 95% CI: 2.06-8.86, P<0.001). Conclusion: Higher d-dimer levels were independently associated with a high risk of mortality. The added value of d-dimer in risk stratifying patients for mortality was not affected by invasive ventilation, ICU stays, length of hospital stays, or comorbidities.

Electrocardiographic Changes and Serum Troponin Levels in Patients with Acute Stroke: A Prospective Cross-Sectional Study.

Background: Electrocardiographic changes and elevated serum troponin are frequent findings in acute stroke. They may reflect what is known as the neurogenic myocardial injury. The aim of this study is to determine the electrocardiographic changes and serum troponin level in acute stroke patients and to correlate these changes to the anatomical location and pathological type of the stroke. Methods: A prospective cross-sectional study was conducted at the National Center of Neurological Science, from January to December 2019. Non-probability sampling with total coverage was considered. 50 patients with acute stroke were included in the study. Data were analyzed by using (SPSS) version 25. Standardized ECG was performed in the first hours of admission. 2 samples from each patient were obtained for serum troponin with at least 8 hours apart. Results: All patients had wide variants of ECG changes. But tachycardia was the most frequent one identified in 54% of patients (n=50). Half of them were found to have an anterior circulation stroke. 14% of patients (n=50) have positive troponin; ECG changes are identified in all patients who represent positive troponin 100% (7 patients). Moreover, anterior circulation stroke was recognized in all patients with a positive troponin I marker. Conclusion: This study suggests that ECG abnormalities in patients with acute stroke are very common, especially tachycardia. The site of the lesion appears to play a major factor as a cause of the genesis of arrhythmia. Serum troponin elevation may play a role in diagnosing neurocardiogenic injury; nevertheless, ECG appears to be more sensitive and familial.

Unusual neurological presentation of second stage African trypanosomiasis in a young boy: a case report.

BACKGROUND: In South Sudan, sleeping sickness is a frequent condition caused by human African trypanosomiasis. There are two stages that are well-known. When the CNS is affected, especially with Trypanosoma gambiense infection, the early hemolymphatic stage and the late encephalitic stage have been observed, including mental, motor, and sensory symptoms. In this case, second-stage African trypanosomiasis manifested itself in an atypical neurological manner. CASE PRESENTATION: A 16-year-old boy from South Sudan referred to Sudan National Centre for Neurological Sciences, Khartoum, Sudan suffering from non-convulsive status epilepticus, mental deterioration and behavioral changes for the last nine months. He was conscious but disorientated. Low hemoglobin concentration, elevated ESR, enlarged spleen and positive card agglutination test for trypanosomiasis was found in this patient. Electro-encephalogram (EEG) found an on-going generalized seizure activity. The patient showed improvement after management with carbamazepine and tonic. CONCLUSION: Our case highlights that late second stage African trypanosomiasis with neurological complications such as non-convulsive status epilepticus should be suspected in any patient who developed progressive cognitive decline and behavioral changes following long standing history of African Trypanosomiasis and routine Electro-encephalogram EEG is the best tool to diagnose non convulsive status epilepticus.

Migraine headache in Sudan.

BACKGROUND: Migraine is a main form of headache, it is also a chronic and complex neuroinflammatory disease; it is characterized by recurrent severe headaches, usually affecting one side of the head, and often accompanied by nausea and blurred vision. In susceptible individuals, irritants can trigger migraine attacks, which can be considered as triggers or accelerators. OBJECTIVE: To describe the precipitating factors, clinical presentation, and treatment of migraine headache in Sudanese patients. METHODS: This is a descriptive hospital-based prospective study covering 130 patients during the study period from January 2016 to December 2018. At the National Centre for Neurological Science, Khartoum, participants were Sudanese patients with migraine headache after exclusion of other causes of headache. Data was collected using structured questionnaire entered and analyzed using SPSS version 22.0, p value < .05 is considered significant. RESULTS: The study covered 130 study participants most of them were females (80%), within 26-35 years of age (56.9%) and a considerable proportion of them were housewives (40%). The majority of the study participants had headache without aura in 81.5% and headache with aura in 18.5% (mainly visual type 87.5%). Photophobia and nausea were the main associated symptoms in 51.5% and 50%, respectively. Acetaminophen was the main prescribed treatment in 46.1%, beta blockers was the main prophylaxis in 29.2%. Environmental triggers were the prevalent predisposing factors (43.8%) followed by fasting, lack of sleep, and exertion (24.6% for each). CONCLUSION: Environmental conditions were the commonest triggering factors of migraine headache, while Acetaminophen was the most common drug used for relieving migraine in this population.