Maternal and neonatal outcomes of grand multiparity in Khartoum, Sudan.

Objectives: Grand multiparity is a major health problem that leads to adverse maternal and perinatal outcomes. We aimed to assess the maternal and perinatal outcomes of grand multiparity. Methods: A case-control study was conducted in Saad Abualila Hospital, Khartoum, Sudan from February to December 2019. The cases were grand multiparous (≥ 5 deliveries) women. The controls were women with low parity (multiparous women who delivered two to four times). Maternal and perinatal characteristics were compared between the two groups. Logistic regression analysis was performed. Results: There was a significant association between grand multiparity and higher maternal age (adjusted odds ratio [AOR]=1.19, 95% confidence interval [CI]=1.16-1.23), lower education level (AOR=3.38, 95% CI=2.49-5.58) and lower antenatal care attendance (AOR=1.73, 95% CI=1.02-2.92). Grand multiparous women were at increased risk for Anemia (AOR=1.48, 95% CI=1.08-2.03), diabetes mellitus (AOR=10.61, 95% CI=4.89-23.00), caesarean delivery (AOR=1.87, 95% CI=1.40-2.48), preterm birth (AOR=1.90, 95% CI=1.37-2.62) and admission to the neonatal intensive care unit (AOR=3.8, 95% CI=1.95-7.75). Conclusions: Grand multiparity was associated with poor maternal and neonatal outcomes. Development of a national health program addressing family planning, health education and improvement of antenatal, intrapartum and neonatal care are needed.

Retraction: Transversus Abdominis Plane Block Versus Local Anesthetic Wound Infiltration for Postoperative Analgesia in Adult Patients Undergoing Hernia Repair in Daycare Procedure: A Randomized Control Trial.

[This retracts the article DOI: 10.7759/cureus.21311.].

Transversus Abdominis Plane Block Versus Local Anesthetic Wound Infiltration for Postoperative Analgesia in Adult Patients Undergoing Hernia Repair in Daycare Procedure: A Randomized Control Trial.

INTRODUCTION: Various modalities are now being used to manage postoperative pain, such as regional nerve blocks techniques, continuous epidural analgesia, patient-controlled analgesia, opioids, and systemic non-steroidal anti-inflammatory drugs. This study compared the mean postoperative pain score between ultrasound-guided transversus abdominis plane (TAP) block and a local anesthetic wound infiltration at the surgical incision site. METHODOLOGY: A prospective, comparative, randomized controlled trial (RCT) was carried out from February 2021 to September 2021. The study was conducted in the anesthesia department of Dow University of Health Sciences, Karachi, Pakistan. Patients aged 18-80 years presenting with elective surgery of (both direct and indirect) inguinal hernia repair were enrolled in the study. Participants were randomly assigned into one of the two groups that are local anesthetic wound infiltration (Group A) and TAP block (Group B). The mean pain score was assessed using a visual analog scale and compared between the two groups. RESULTS: The study included 168 patients grouped in two different groups. The mean age in Group A was 43.87 (+17.21), and Group B was 47.01 (±15.37). Mean pain scores in groups A and B were 6.36±1.94 vs 4.51 ± 1.99 (p-value=0.001). The pain rescue medications were given to 57.14% of patients in Group A and 34.52% of patients in Group B, and it was significantly different in the two groups (p-value=0.003). It was found that patients in Group A reported more severe pain (41.67%) than patients in Group B (10.71%). CONCLUSION: When compared to local anesthetic wound infiltration, ultrasound-guided TAP block had better analgesic activity compared to local anesthetic wound infiltration.

Maternal age and miscarriage: A unique association curve in Sudan

This study's aim was to estimate the prevalence and maternal age and other risk factors of miscarriage among Sudanese women. Across-sectional study was conducted at the Saad Abuelela Tertiary Hospital in Khartoum, Sudan, from February to December 2019. Sociodemographic, obstetric and clinical data were collected. A multivariate logistic regression analysis was performed. Four hundred thirteen (20.5%) women reported experiencing a miscarriage. Risk factors included older age, high parity, histories of caesarean delivery, and obesity. Logistic regression showed that the lowest risk for women aged less than 20 years (adjusted odds ratio [AOR], 0.33) or 20 to 24 years (AOR, 0.57), primiparas (AOR, 0.42) and women educated below the secondary level (AOR, 0.78). Unlike the global age-associated risk of miscarriage, the risk of miscarriage among Sudanese women follows a unique curve in relation to maternal age. Interestingly, the curve showed a lower risk for women less than 20 years and at 40 years. (Afr J Reprod Health 2022; 26 [7]: 15-21).

Thyroid function/antibodies in sudanese women with polycystic ovarian disease

OBJECTIVE: To evaluate thyroid function and hormonal profile in women with polycystic ovary syndrome (PCOS). METHODS: A case-control study was conducted at Saad Abualila Center, Khartoum, Sudan. The cases were women with confirmed PCOS based on Rotterdam criteria. The controls were infertile women with no evidence of PCOS. The socio-demographic characteristics and medical history were gathered using a questionnaire. Thyroid hormones (thyroid-stimulating hormone, free tri-iodothyronine, and free thyroxine), anti-thyroid peroxidase, and anti-thyroglobulin antibodies were measured. RESULTS: While there were no significant differences in the age and haemoglobin levels of the two studied groups (55 women in each arm), body mass index was significantly higher in women with PCOS. There were no significant differences in the levels of thyroid-stimulating hormone, luteinizing hormone, follicle stimulating hormone, luteinizing hormone/follicle stimulating hormone, anti-thyroid peroxidase, anti-thyroglobulin antibodies, cholesterol, triglycerides and low-density lipoprotein cholesterol between the cases and the controls. The mean±standard deviation of free tri-iodothyronine (3.50±0.2 vs. 3.38±0.3 pg/mL, P=0.040) and median (interquartile) high-density lipoprotein cholesterol (37.0 [34.0 to 42.0] vs. 35.80 [29.0 to 41.0] mg/dL, P=0.015) were significantly higher in PCOS patients compared with the control group. In linear regression, PCOS (0.151 pg/mL, P=0.023) and anti-thyroid peroxidase levels (-0.078 pg/mL, P=0.031) were significantly associated with free tri-iodothyronine. CONCLUSION: Free tri-iodothyronine was a significantly higher among PCOS patients compared with the control group.

Poor Adherence To Antiretroviral Therapy And Associated Factors Among People Living With Hiv In Omdurman City, Sudan

Adherence to antiretroviral therapy (ART) plays an important role in the treatment outcomes of human immunodeficiency virus (HIV) infection. Poor adherence would result in failure to prevent viral replication as well as an increased risk of developing drug resistance. Adherence to a life long treatment such as antiretroviral therapy is usually a complicated issue that requires careful and continuous collaboration of patient, family and healthcare provider. The objective of this study was to assess adherence to antiretroviral therapy and its associated factors among people living with HIV. This is a health facility-based cross sectional study conducted among adults’ people living with HIV in Omdurman HIV/AIDS centre, Sudan. Data was collected through direct interview using semi-structured questionnaire. There were only 144/846 (17.02%) who adhered to antiretroviral therapy as prescribed by their doctors. The remaining 51.18% were taking the therapy but not regularly, 31.21% were taking it but currently not and 0.59% stated that they have never taken any antiretroviral therapy. Factors associated with poor adherence that have been identified include female gender (Adj. OR = 3.46 (95%CI: 1.46–8.21), P = 0.005), younger age (Adj. OR = 1.14 (95%CI: 1.02–1.28), P = 0.022), being unemployed (Adj. OR = 5.94 (95%CI: 1.51–23.40), P = 0.011), those who were divorced, separated or widowed (Adj. OR = 11.35 (95%CI: 1.74–73.96), P = 0.011) and respondents who perceived that their health status is poor (Adj. OR = 5.21 (95%CI: 1.44–18.81), P = 0.012) or very poor (Adj. OR = 4.04 (95%CI: 1.27–12.81), P = 0.018). Educational level and social support against HIV-related stigma and discrimination were not significantly associated with adherence. Adherence to antiretroviral therapy among the respondents is very poor. Urgent interventions based on modifiable factors and mainly targeting females and younger age group are needed to improve adherence to antiretroviral therapy among people living with HIV.

Cortisol and uncomplicated Plasmodium falciparum malaria in an area of unstable malaria transmission in eastern Sudan.

OBJECTIVE: To investigate the levels of serum cortisol in patients with uncomplicated Plasmodium falciparum (P. falciparum) malaria in an area of unstable malaria transmission in eastern Sudan. METHODS: The concentrations of cortisol were measured in sera of 25 patients with uncomplicated P. falciparum malaria (at presentation, 24 h and 7 d later) and 25 healthy volunteers using radioimmunoassay gamma counter. RESULTS: There was no significant difference in mean (SD) of total cortisol levels in patients with malaria in comparison with the control group; 602.2 (369.6) vs. 449.2(311.7) ng/mL, P=0.12. In patients with uncomplicated P. falciparum malaria, the mean (SD) presenting cortisol levels were significantly higher in comparison to the levels on day 7; 602.2 (369.6) vs. 373.6(139.1) ng/mL, P=0.009. In the patients with uncomplicated P. falciparum malaria (on presentation) cortisol levels were not correlated with initial temperature or the presenting parasitaemia. CONCLUSIONS: Thus, cortisol levels were not significantly different between the patients and the controls.

A perspective of the epidemiology of malaria and anaemia and their impact on maternal and perinatal outcomes in Sudan

Introduction: Both malaria and anaemia have adverse effects on maternal and perinatal outcomes. Thus there is an urgent need to investigate the co-epidemiology of malaria and anaemia and their combined impact on maternal and perinatal outcomes in the different regions of Sudan.Methodology: Various cross-sectional and case control studies conducted during the years 2003-2010 to investigate the epidemiology of malaria and anaemia and their impact on maternal and perinatal outcomes in different regions of Sudan were compared. Results: While 13.7of antenatal attendants in New Halfa had peripheral microscopically detected Plasmodium falciparum malaria; placental malaria (using histological examinations) was prevalent in 32.0-40and 19.5of parturient women in New Halfa and Gadarif Hospitals; respectively. Malaria was a risk factor for anaemia in New Halfa and for stillbirths in Omdurman Maternity Hospital. Anaemia was present in 52.5; 62.6and 80.2of pregnant women in Medani; New Halfa; and Gadarif Hospitals; respectively. In Gadarif; 57.3of pregnant women had a folate deficiency; while 1had a vitamin B12; deficiency. In Medani; zinc and copper deficiencies were detected in 45.0and 4of pregnant women; respectively. Anaemia was a risk factor for low birth weight in Al-Fashir; for fetal anaemia in New Halfa; and for stillbirth in Kassala Hospital. Conclusion: More care should be taken to ensure proper nutrition and malaria prevention such as bed nets and intermittent preventive treatments to avoid these diseases and their effects on maternal and perinatal outcomes

Pattern of medical diseases and determinants of prognosis of hospitalization during 2005 Muslim pilgrimage Hajj in a tertiary care hospital. A prospective cohort study.

OBJECTIVE: To document the pattern of medical diseases necessitating admission in a tertiary care hospital during Muslim pilgrimage (Hajj). To assess the risk factors associated with mortality during hospitalization. METHODS: The study was conducted at Al Noor Specialist Hospital, a 550-bed tertiary care teaching hospital, in Makkah, KSA. The participants included all Hajj patients admitted in the Department of Medicine in a 5-week period (January 3 to February 6, 2005) during the 2005 (1425 AH) Hajj. Information about demographics; past medical history; pre-Hajj functional status; presence of language barrier and translator availability; diagnosis for admission and complications during hospitalization including mortality was obtained prospectively using a standardized form. RESULTS: Six hundred and eighty-nine patients, belonging to 49 countries, with mean age of 62 years and male:female ratio of 1.8:1 were admitted. Two hundred-twenty (31.9%) had diabetes mellitus, 256 (37.2%) had hypertension, 219 (31.8%) had cardiac disease, and 103 (14.9%) patients had chronic lung disease. Of the 449 (65.2%) patients assessed, 284 (63.2%) patients had language barrier, and translator was not available for 152 (53.5%) of them. Pre-Hajj functional status assessment of 240 patients showed that 20 (8.3%) required assistance in performing activities of daily living (ADL), and 40 (16.7%) could not walk for half kilometer without difficulty. Common causes of morbidity were: 235 (34.1%) cardiovascular, 137 (19.9%) infectious and 85 (12.3%) neurological diseases. One hundered and fourteen (16.5%) patients died, with the common causes being pneumonia (28 patients), acute coronary syndrome (21), and stroke (20). The risk factors associated with higher mortality were older age (65 +/- 1 versus 61 +/- 0.6 years, p=0.008), prior history of chronic lung disease (crude odds ratio, 1.81, p=0.034), dependence in any ADLs (4.90, p=0.025), inability to ambulate for half kilometer without difficulty (4.17, p=0.017) and non-availability of translator for patients with language barrier (5.51, p<0.0001). CONCLUSION: Most patients were elderly with high prevalence of chronic medical disorders. Non-infectious diseases accounted for most morbidity and mortality. Pre-Hajj functional assessment should be carried out to identify patients at high risk of mortality. Provision of translator services for patients with language barrier is essential to improve future outcomes.