Metabolic syndrome; Definition, Pathogenesis, Elements, and the Effects of medicinal plants on it's elements.

Introduction: Metabolic syndrome (MetS) is a cluster of metabolic risk factors that include central obesity, hypertension, insulin resistance, and atherogenic dyslipidemia and is strongly associated with a greater risk for developing cardiovascular disease and type 2 diabetes mellitus. Methods: A literature search was conducted using the words metabolic syndrome, definition and pathogenesis in Scopus, and PubMed. The search also extended to cover medicinal plants and their role as a potential treatment of the metabolic syndrome. The search based on studies published in the English language from 1st of January 2000 to 30th of May 2021. The abstracts and the articles were then screened. Articles were scanned and read; further relevant references in the reference lists are also included. Results: Both lifestyle factors and genetic factors are involved in the pathogenesis of the metabolic syndrome. Recently, MetS have gained significant attention due to the high prevalence of obesity worldwide. Diagnosis of patients with MetS is important to improve the outcomes of the disease by employing lifestyle and risk factors modifications. Currently, there is a rising interest in medicinal plants and their extracts because the medicinal plants have minimal side effects. Here we review the history, definitions, pathogenesis, management of metabolic syndrome and summarize the beneficial effects of some medicinal plants and their extracts on MetS. Conclusion: Further research and clinical studies are needed to establish whether medicinal plants can be safely given as potential therapy for metabolic syndrome and whether this can be beneficial in low resources setting countries.

Correction to: Metabolic syndrome; Definition, Pathogenesis, Elements, and the Effects of medicinal plants on it's elements.

[This corrects the article DOI: 10.1007/s40200-021-00965-2.].

Knowledge, Attitudes and Practice Among Primary Care Physicians in Sudan Regarding Prediabetes: A Cross-Sectional Survey.

BACKGROUND: Prediabetes is an important stage before diabetes that can be treated with intensive lifestyle changes. The aim of this study was to assess knowledge, attitudes, and practice of primary care physician in Sudan about prediabetes. METHODS: A cross-sectional questionnaire-based study was conducted among primary care physicians working at two family and primary health care centers in Khartoum. Data were analyzed using descriptive statistics and expressed as percentages. RESULTS: Out of 200 primary care physicians, 189 completed the questionnaire. 60.8% of the participants had satisfactory knowledge about prediabetes and positive attitude towards prediabetes and their practice was relatively good. Knowledge score was significantly correlated with age (P = 0.000), duration of experience (P value = 0.000), the number of working hours per day (P value = 0.001), and the number patients seen per day (P value = 0.001). Logistic regression analysis showed that attending courses relevant to prediabetes revealed statistically significant result in knowledge, and attending such courses were likely to be associated with gaining sufficient knowledge than those who didn't by 2 times (P value 0.033, OR 2, CI. 1.063-4.079). CONCLUSIONS: Primary care physicians in Sudan have satisfactory knowledge, attitude, and practice about prediabetes. As they are in the front line in dealing with community, primary care physicians' efforts can help in slowing down the epidemic of diabetes in Sudan.

The prevalence and risk factors for systemic hypertension among Sudanese patients with diabetes mellitus: A survey in diabetes healthcare facility.

BACKGROUND AND AIMS: Diabetes and hypertension are common chronic diseases that affect about one fifth of Sudanese adults. The aim of this study was to assess the prevalence of hypertension among Sudanese individuals with diabetes. MATERIALS AND METHODS: This a survey in diabetes healthcare facility-based study that recruited 266 individuals with diabetes mellitus (DM). Data was collected using a standardized pretested questionnaire, and was analyzed by performing descriptive and inferential statistics through SPSS program. RESULT: The study showed that average age of participants was 58.7 (±10.5 SD) years, males were 59% and most of the participants (72.6%) from urban areas. Diabetes for 1-5 years was observed in 10.9% and for more than 11 years in 71.4%. The majority (91.7%) had type 2 diabetes mellitus while only (8.3%) had type 1 diabetes. The prevalence of hypertension was 47.7% among the study group, this was significantly associated with age (p value 0.016), and retinopathy (p value 0.001). Logistic regression analysis showed that age, body mass index (BMI), serum creatinine and retinopathy had statistically significant associations with the presence of hypertension (p values 0.002,0,016, 0.008,0.001) respectively. CONCLUSION: Prevalence of hypertension in Sudanese patients with diabetes presenting to diabetes clinic was 47.7%, and it increased with age and presence of retinopathy. Risk factors of hypertension were age, body mass index (BMI), serum creatinine and retinopathy.

The prevalence of diabetes and metabolic syndrome and associated risk factors in Sudanese individuals with gallstones: a cross sectional survey.

BACKGROUND: The gallstones are common health problem across the world with huge financial burden on health authorities. Obesity and insulin resistance are associated with risk of gallstones disease (GSD). The aim of this study was to assess the prevalence of metabolic syndrome (MetS) and diabetes and associated risk factors in Sudanese patients with gallstones. METHODS: A prospective cross-sectional study, enrolled patients with gallstones attending Ibn Sina Specialized Teaching Hospital for gastrointestinal and hepatobiliary diseases. A structured questionnaire was applied, anthropometric measures were taken, and blood tested for HbA1c, fasting glucose and lipid profile. Data was analysed using SPSS version 23. RESULTS: A total number of 151 participants were recruited in the study, 71 of them were ultrasound confirmed GSD patients, and the other 80 were controls without GSD over a period of six months. The prevalence of the MetS and diabetes was 30% and 23.9% respectively. Borderline diabetes was 16.9% and overweight and obesity constituted more than half of the sample 59.6%. Using Chi-Square test, a statistically significant association was found between MetS and HDL, TG, LDL level, waist circumference and blood pressure (BP). Absolute predictors and the risk factors for gallstone disease were waist circumference, age, HbA1c and LDL. CONCLUSIONS: The prevalence of MetS and diabetes among gallstone patients was 30% and 23.9% respectively. Absolute predictors and the risk factors for gallstone disease were waist circumference, age, HbA1c and LDL.

The prevalence and risk factors of stroke among Sudanese individuals with diabetes: Cross-sectional survey.

INTRODUCTION: Diabetes complications in Sudan were increasing at an alarming rate. The aim of this study was to assess the prevalence of stroke among Sudanese individuals with diabetes. METHODOLOGY: This cross-sectional study recruited 283 individuals with diabetes from three diabetes centers in Sudan. Data were collected using a standardized pretested questionnaire, and data were analyzed using Chi-square and logistic regression analysis. RESULTS: The average age of participants was 51 (±12 standard deviation) and 35% were aged between 51 and 60 years. Females were 66.8%, and most of the participants (73.9%) were from urban areas and 66.1% received formal education between primary school and university. Body mass index (BMI) classification showed that 34.3% were obese, 31.8% overweight, and 30.4% normal BMI. Diabetes for 1-5 years were observed in 71.7% and for more than 10 years (12%). The majority, i.e., 94.3% had type 2 diabetes mellitus while only 5.7% had type 1. Only one-third of the participants were able to achieve glycosylated hemoglobin (HbA1c) target for diabetes control. The prevalence of cerebrovascular accident (CVA) was 2.5%, hypertension (HTN) was 20%, ischemic heart disease 3.2%, and neuropathy was 45.6%. Chi-square test showed significant association between HbA1c, serum creatinine, total cholesterol, triglyceride, low density lipoprotein, high density lipoprotein level, and the presence of CVA. Logistic regression analysis showed HbA1c, and the duration of diabetes are significantly associated with the presence of CVA (P = 0.010, 0.014). CONCLUSION: The prevalence of stroke among Sudanese individuals with diabetes was around 2.5%. The main risk factors were HbA1c, HTN, and duration of diabetes.

Knowledge and practice of diabetic foot care in Sudan: A cross sectional survey.

BACKGROUND: Diabetes in Sudan is real health challenge for health authorities especially optimum glycemic control and complications in particular diabetic septic foot. This is study aimed to assess knowledge of individuals with diabetes about self-foot care. METHODS: This is descriptive cross sectional, health facility-based study conducted in diabetes center in Khartoum, Sudan. The study recruited 150 individuals with diabetes. Data was collected using a standardized pretested questionnaire. RESULTS: Among the participants 64.7% were females and 35.3% were males, 36% of the participants were between the age of 51-60 years old. Good glycemic control (HbA1c) were achieved by 41.3% only. The participants who had good knowledge about diabetic foot self-care were 46.7%, poor knowledge 29.3% and moderate knowledge 24%. Good self-practice toward diabetic foot self-care was reported by 42.6%, moderate by 36.7% and poor practice by 20.7%. The awareness and practices significantly correlated with an increase in ages (≥51 years), higher level of education, medium income, unemployment, longer duration of diabetes > 10years, family history, controlled diabetes mellitus and education about diabetes complications and diabetic foot care (P value < 0.05). CONCLUSIONS: Only (46.7%) of participants address good awareness and practices about self-foot care. Accordingly, there is a great need to provide continuous health education to the patients about diabetic foot self-care and this knowledge-application gap must be narrowed down.

Cytomorphologic patterns of breast lesions in Sudanese patients: lessons learned from fine needle aspiration cytology.

BACKGROUND: Cytology for breast lesions is a safe, rapid and cost-effective with a high specificity and sensitivity. OBJECTIVE: To determine the cytomorphologic patterns of breast lesions identified among a group of Sudanese patients. MATERIALS AND METHODS: This study included 759 patients undergoing either a fine needle aspiration FNA, nipple discharge (ND) smears or breast skin scraping (SS) at a cytology clinic in Khartoum. Clinical and demographic data were reviewed. Stained smears were categorized into: inadequate sample, normal breast, benign lesion, suspicious, or malignant neoplasm. RESULTS: of the 759 cases, 734 (96.71%) were FNA, 18 (2.37%) ND and 7 cases (0.92%) SS. For 28 cases, FNA was done under ultrasound guidance. Females were 720 (94.86%). Benign lesions were 423(55.75%) and 248 (32.67%) were malignant and 77 (10.14%) of smears were normal without any detected abnormality. Ten (1.31%) cases were suspicious for malignancy, and only one case (0.13%) was reported as inadequate. Most lesions were observed among the age group 30 years and above. CONCLUSION: Most patients investigated have benign lesions, one third of cytological smears were malignant. FNAC is a useful tool for investigating breast lesions in limited-resource settings.

Utility of fine-needle aspiration as a diagnostic technique in breast lumps.

Fine-needle aspiration cytology (FNAC) is a simple, accurate, and safe procedure for the diagnosis of palpable breast lumps. The purpose of this study is to emphasis the utilization of FNAC in the Sudan and to evaluate our experience to identify the types of various breast lesions. A one year descriptive longitudinal study was conducted in Khartoum, Sudan. We obtained information (patient's personal data) and Fine-Needle Aspiration (FNA) samples, for 200 patients with palpable breast lesions. Subsequent tissue biopsies were taken from 131 patients of the 200 studied patients. Data were analyzed using a computer's SPSS program. Pearson chi-square test was used for statistical analyses. The diagnoses of the 200 breast FNAs were as follows: 61 (30.5%) were malignant, 5 (2.5%) were suspicious, and 134 (67%) were benign lesions. Subsequent histopathological examination was performed on 61 (100%) patients with malignant lesions, 5 (100%) of suspicious, and 65 (48.5%) patients of 134 patients with benign lesions. FNAC revealed a 92.6% sensitivity, a 95.2% specificity, a 95.5% positive predictive value, and a 92.2% negative predictive value. Of the 65 benign cases on cytology, five cases were found malignant on histopathology. FNAC of breast lesions is sensitive, specific, and highly accurate as the initial investigation of palpable breast lesions in a population of low resources and without screening program to diagnose breast cancer. We consequently encourage clinicians to embrace this procedure in the management of patients.