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Background: Breast cancer (BC) is prevalent in Sudan, yet data on its epidemiology in Eastern Sudan is limited. This study aims to provide insights into the demographic and clinicopathologic features of BC patients treated at the East Oncology Centre (EOC) in Gadarif State, Eastern Sudan. Furthermore, we aim to identify the factors that contribute to a late-stage diagnosis. Methods: This cross-sectional study included patients diagnosed with BC and treated in the EOC between 2016 and 2022. Data obtained from medical records were analysed using R software, with descriptive statistics and multiple logistic regressions applied to determine determinants of advanced-stage presentation. A p-value < 0.05 was considered statistically significant. Results: Among the 394 patients studied, the majority were women (96%), married (66%) and from rural areas (43%). The peak years for BC diagnoses were 2018 and 2022, with a median age at diagnosis of 48 years. A family history of cancer was reported by 20% of patients. Clinical stages were distributed as follows: I (1.6%), II (17%), III (50%) and IV (32%). Twenty-five percent tested positive for human epidermal growth factor receptor 2, while 73% tested negative and 43% had triple-negative BC. Modified radical mastectomy was performed in 47% of patients, with 21% undergoing breast-conserving surgery. Treatment rates were 38% for radiotherapy, 84% for chemotherapy and 46% for hormonal therapy. Higher grade BC and lower education levels were associated with advancedstage presentation, while a family history of cancer reduced the risk of advanced-stage disease (OR: 0.38, 95% CI: 0.18--0.78). Conclusion: The study found that females in East Sudan often present at a young age and advanced stage, with a significant prevalence of triple-negative BC. Notably, family cancer history exhibited a protective effect against advanced-stage presentation, while grade 3 cancer was positively associated with advanced disease. [ABSTRACT FROM AUTHOR]

Background: Lower extremity amputations (LEAs) significantly contribute to mortality and morbidity, often resulting from peripheral artery disease and diabetes mellitus (DM). Traumatic injuries also account for many LEAs. Despite the global burden, the epidemiology of LEAs, particularly in the Middle East and North Africa (MENA) region, remains underexplored. This study utilizes the Global Burden of Disease (GBD) dataset to analyze temporal trends in LEAs in the MENA region from 1990 to 2019. Methods: The study utilized the 2019 GBD dataset, which includes estimates for incidence, prevalence, and disability-adjusted life-years (DALYs) across 369 diseases. Age-standardized incidence rates (ASIRs) for LEAs were extracted for 21 MENA countries. Trends were analyzed using percentage change calculations and Joinpoint regression to identify significant shifts in LEA rates over time. Results: From 1990 to 2019, male LEA rates generally decreased, while female rates increased. Significant increases in LEA rates were observed in Syria, Yemen, and Afghanistan, correlating with periods of conflict and instability. Conversely, countries like Iraq, Palestine, Sudan, Lebanon, Iran, and Kuwait saw marked decreases. The study highlighted a complex interplay of socio-political factors, natural disasters, and chronic diseases like DM in shaping LEA trends across the region. Conclusion: The study reveals variable LEA trends in the MENA region, influenced by conflicts, natural disasters, and chronic diseases. These findings underscore the need for targeted public health interventions, improved healthcare access, and robust data collection systems to reduce the burden of LEAs and improve patient outcomes in the MENA region. [ABSTRACT FROM AUTHOR]

Background: Mental health during armed conflicts is of paramount importance, as such situations often lead to increased risks of anxiety and depression symptoms among civilians. The military conflict between the Sudanese army and Rapid Support Forces, which began on April 15, 2023, is currently ongoing mainly in Khartoum State. Despite the significant impact of the conflict on the region, there is a lack of data regarding the mental health status of the residents. The aim of this study is to assess anxiety and depression symptoms among residents of Khartoum State during the first months of the 2023 military conflict. Method: We conducted a cross-sectional study among residents of Khartoum State between May 27 and June 19 using an online questionnaire. We used standardized screening questionnaires, namely the Generalized Anxiety Disorder (GAD-7) for anxiety and the Patient Health Questionnaire (PHQ-9) for depression. Multiple logistic regression was used to identify sociodemographic factors that are associated with anxiety and depression symptoms. Results: Out of the 393 participants in the study, 70% had symptoms suggestive of depression and 57.3% suffered from anxiety symptoms. Both anxiety and depression were associated with being female (p < 0.001). Being married was a predictor of anxiety (p = 0.028) but not depression (p = 0.3). Other predictors were not significant (p > 0.05). Conclusion: High levels of anxiety and depression symptoms were prevalent among Khartoum residents during the conflict, with females and married individuals at higher risk. Immediate medical assessment is essential for identifying cases and providing support. Mental health services should be integrated into emergency response efforts, particularly focusing on vulnerable groups. Future research should address study limitations and explore coping strategies for anxiety and depression in Sudanese adults. [ABSTRACT FROM AUTHOR]

Background: Leishmaniasis is an endemic disease in Sudan that caused by Leishmania spp. Several studies suggest neurological manifestations in visceral leishmaniasis, such as burning sensation, and weakness. This study was aimed to assess the frequency of the neurological manifestations in Visceral Leishmaniasis. Methods: This is a descriptive, prospective cohort study, was conducted in The Tropical Teaching Hospital - Khartoum for one-year duration. A pretested questionnaire contained the study variables were conducted, nerve conduction Study (NCS) and laboratory tests were done. SPSS v 26.0 was used to analyze the data. Results: Forty four percent of total patients (22/50) were symptomatic. Peripheral neuropathy was elicited in 60% (30/50), Numbness has been the most common feature 56.6% (17/30), and Weakness 26.6% (8/30) all were Axonal damage. Sensorimotor neuropathy was exhibited in 70% (21/30), pure motor neuropathy in 26.7% (8/30). Polyneuropathy was encountered in 46.6% (14/30), poly-radiculopathy in 20% (6/30) along with 23.3% (7/30) as mononeuropathy. Conclusions: peripheral neuropathy was developed in patients with visceral leishmaniasis, frequent occurrence of subclinical neurological manifestations is higher than reported. [ABSTRACT FROM AUTHOR]

Background: Hemoglobin A1C (HbA1c) levels are known to be linked to a higher risk of stroke. However, no research data is available on the impact of HbA1C on the severity of acute ischemic stroke in Sudan. Methods: This study is a descriptive, cross-sectional hospital-based study of 40 cases of acute ischemic stroke. Ischemic stroke was confirmed using computed tomography (CT) scan at admission; all subjects' blood HbA1C levels were also measured. Participants were divided into two subgroups based on HbA1C at admission, good glycemic control (GGC) (<7 HbA1C) and poor glycemic control (PGC) (>7 HbA1C), and neurological impairment was assessed using the National Institutes of Health Stroke Scale (NIHSS). Results: The age distribution of the participants was 45-85 years, with an average age of 63.5±9.2 years with the highest frequency (67.5%) in the age group of 55-75 years. PGC had a statistically significant high HbA1C value of 8.9±1.3 (P=0.000), when compared to GGC subgroups 5.1±0. The association between stroke severity and HbA1C levels on admission in this study was statistically significant (P value=0.005), on admission (78.6%) PGC had moderate to severe stroke (> 18.8 NIHSS) versus (33.3%) that of the GGC (>10.4NIHSS). The frequency of elevated HbA1C levels in patients with acute ischemic stroke was 70% in this study. Conclusion: PGC was shown to be linked to the occurrence of stroke and to its severity. [ABSTRACT FROM AUTHOR]

Introduction: Clinical presentations of leptospirosis are diverse, with meningitis easily confused with other microbial causes. We aimed to investigate the involvement of pathogenic leptospira in the cerebrospinal fluid (CSF) of meningitis-suspected children in Sudan. Methods: A total of 153 CSF specimens were collected over 5 months from patients attending a reference pediatric hospital in Omdurman, Sudan. All patients had provisionally been diagnosed with meningitis on admission. Demographic, clinical, and conventional laboratory findings were obtained. DNA was extracted using a QIAamp mini kit, and the secY gene investigated using real-time PCR. Results: Nine of 153 (6%) CSF specimens were positive for pathogenic leptospiral DNA. All these patients were male (seven infants and two toddlers aged ˂4 years). Typical conventional laboratory findings for aseptic meningitis (ie, CSF turbidity/pleocytosis, normal or reduced CSF glucose, normal or elevated proteins) were seen in five (56%). All patients presented with fever and seizures, 56% vomiting and stiff neck, and 29% bulging fontanel. Most (67%) patients presented in summer (March to May). Polymicrobial infections were identified in three patients (33%). Conclusion: We conclude that pathogenic leptospira are probably a common cause of meningitis in children in Sudan; therefore, we recommend including leptospirosis in the differential diagnosis of CNS infections and other undifferentiated febrile illnesses in this country. [ABSTRACT FROM AUTHOR]

Background: diabetes and smoking were known serious factors for developing cardiovascular and other abnormalities threaten wellbeing. Objective: to estimate the impact of smoking and diabetes on cardiovascular disease (CVD) markers. Methods: 44 type 2 diabetes never smoke compared to 32 type 2 diabetes currently smoking and 30 healthy subjects, lipids, apolipoprotein, lp(a), CK-MB Troponin, MDA, and MPO were measured in participants. Results: FPG, Lp(a) and MDA were higher in patients than controls (p>0.01). In addition, Lp(a) and MDA were higher in SDM than DM (p>0.05). Moreover, CVD markers were higher in smoker's patients with diabetes (SDM) who were overweight or hypercholesterolemia than others (p>0.01). Furthermore, Lp(a) was increased gradually and correlate directly with diabetes in all three-period settings in the study (p>0.05). Conclusion: smoking increased the risk of CVD in Sudanese type diabetes, the risk was increased with overweight, hypercholesterolemia and become serious in a long period of diabetes. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate and correlate the serum activity of α-amylase in Sudanese patients with type 2 long standing diabetes mellitus. Methodology: This is a descriptive, cross- sectional, hospital based, case- control study was done in fifty patients (twenty male &thirty female) above forty yearswith long period diabetes mellitus type 2 referred to Jabber Abu ElizDiabetes Center and Bahri Diabetes Center in Khartoum state in central Sudan within six months. Thirty healthy volunteers with matching age and sex and socioeconomic status were included. Data was collected through, clinical evaluation form, questionnaire, and laboratory investigations. Serum concentrations of α- amylasewere measured by spectrophotometer and t test and correlation were used in statistical analysis for the comparison between test and control group for example: control group. Results: The result showed a significant difference between the mean of serum α- amylase of the control group compared with that of the test group (Mean ±SD): (39.83±9.0) versus (32.22±13.5) U/L respectively, (P<0.05). Also, there wasa significant positive correlation between the levels of α- amylase and the duration of diabetes mellitus. Correlation coefficient (r) = (r = 0.27, P= 0.000) for example: 0.0000. Conclusion: From this study it was concluded that; the diminution of the serum levels of α- amylase could be part of the exocrine pancreatic insufficiency since α- amylase activity decline correlated well with the duration of long-standing type 2 Diabetes Mellitus. [ABSTRACT FROM AUTHOR]

Objective: To examine concentration of Paraoxonase 1 enzymes across both Sudanese patients suffering from Type-I and Type-II diabetes. Methods: This was a cross-sectional study done in Khartoum/Sudan during the period from June 24th 2018 to August 23, 2018. One hundred seven diabetic patients (40 T1DM and 67 T2DM) compared with 45 healthy people from both genders. Biochemical parameters include PON1, FBG, HbA1C, and lipids were done and compared between study groups. Results: PON1 was reduced in patients than controls (P < 0.01), in addition PON1 was lower in T1DM than T2DM (P < 0.01), moreover, FBG, HbA1c and lipids was higher in diabetes than controls (P < 0.05). PON1 inversely correlated with LDL and apo B in T1DM (P < 0.01) and T2DM (P < 0.05), in addition PON1 correlated with HDL and apo A1 in T1DM (P < 0.01), inversely correlated with LDL in T2DM (P < 0.05) and with apo A1 in T2DM (P < 0.01). Moreover, PON1 inversely correlated with diabetes duration in T1DM (P < 0.01) and T2DM (P < 0.05). Conclusion: Sudanese T1DM and T2DM have a lower PON1 concentration than healthy subjects, T1DM have lower level of PON1 than T2DM. PON1 was inversely correlated with bad lipids and duration of diabetes, but it has positive correlation with good lipids. [ABSTRACT FROM AUTHOR]

Objective: To investigate maternal and perinatal outcomes when pregnant women with visceral leishmaniasis (VL, also known as kala-azar) are treated with the antimonial sodium stibogluconate.Method: Forty-two pregnant women with VL were treated with sodium stibogluconate at Gadarif Hospital, Gadarif, Sudan, and mother and child were followed up for 1 year.Results: The treatment began at a mean+/-SD of 24.4+/-9.2 weeks of pregnancy. None of the patients had malaria or HIV. Two (4.7%) who received the treatment in the first trimester had miscarriages; 4 (4.9%) died from hepatic encephalopathy during the second week of treatment; and 2 (4.7%) had preterm deliveries. One of the newborns had a myelomeningocele and died at 2 hours, and the other died from VL at 2 months.Conclusion: Preventive measures against VL should be employed in the region, and more research on VL and its treatment during pregnancy is needed. [ABSTRACT FROM AUTHOR]

Crops reveal considerable capability to regulate their phytochemicals and trace element contents to seasonal changes in temperature and rainfalls. In this study, we have measured the secondary metabolites, volatiles, and trace elements of Cassia senna L leaves collected from the Red Sea State, Sudan during winter 2018, summer 2019, and autumn 2020. Chemical profiles were evaluated by High-performance liquid chromatography with diode-array detection (HPLC-DAD), Ultra-high performance liquid chromatography (UHPLC); Inductively coupled plasma mass spectrometry(ICP-MS), Gas chromatography-mass spectrometry (GC–MS), Fourier-transform near-infrared spectroscopy (FT-NIR). 46 metabolites, 33 volatile compounds, and 13 elements were reported. The findings suggested significant seasonal variations in sennoside (A-B) compounds, which were reported to have positive health effects. In this study, aloesin was identified for the first time in senna leaves. Analysis of seasonal variations was obtained by principal component analysis and orthogonal partial least squares discriminant model. Additionally, chemical markers for each harvest season were reported. Overall, the number of metabolites and volatiles identified as a function of the season was autumn > summer> winter. Our results have enhanced the knowledge of the selection of harvesting time, with the best characteristics for the intended therapeutic application. [Display omitted] • The chemical composition of C. senna l leaves was monitored over three growing seasons. • Volatile compounds, secondary metabolites and elemental in leaves of C. senna were reported. • C. senna l leaf samples are a new potential source of aloesin. • The contents of sennosides (A-B) and aloesin were higher in autumn and summer. • PCA and OPLS-DA were used to classify and identify chemical markers for each season. [ABSTRACT FROM AUTHOR]

Background: Since 1900s, visceral leishmaniasis (VL) has been among the most important health problems in Sudan, particularly in the endemic areas such as eastern and central regions.Methods: This was a cross sectional, hospital-based study conducted from 1st January 2015 to 31st December 2015 to investigate the epidemiological factors of VL in Gadarif hospital, eastern Sudan.Results: During the study period there were 47 identified children with VL among 145 suspected cases. The most common clinical presentations were fever (47, 100%), pallor (47, 100%), weight loss (40, 85.1%), splenomegaly (37, 78.7%), lymphadenopathy (33, 70.2%), vomiting (32, 68%) cough (28, 59%), loss of appetite (22, 46.8%), diarrhoea (17, 36.1%) and jaundice (5, 10.6%). With regard to the outcome after short term follow up 37 patients (78.8%) improved without complications, while 3 (6.4%, 2 (4.3%), 2 (4.3%), 1 (2.1%), 1 (2.1%) and 1 (2.1%) developed pneumonia, otitis media, septicaemia, urinary tract infection, parasitic infestation and PKDL respectively. Lower mean of haemoglobin level was observed among the VL cases in comparison with the suspected cases (in whom VL was excluded) haemoglobin level {8.9 (3.1) Vs 11 (6.3), P = 0.021}. Again more proportion of anaemic (47 (100%) Vs 14 (14.2%), P = 0.000) and severely anaemic (23 (48.9%) Vs 2 (2%), P = 0.006) patients was detected among the infected children. Using logistic regression analyses there was significant association between rural residence (CI = 1.5-24, OR = 19.1, P = 0.023), male gender (CI = 6.6-18.7, OR = 6.4, P = 0.001) and VL among children.Conclusions: While there is an advance in prevention and management of visceral leishmaniasis our results indicate that VL is still a public health problem with its severe complications among children in eastern Sudan. [ABSTRACT FROM AUTHOR]

Background: In this study, we share our experience of different operative techniques undertaken on 584 eumycetoma patients in the Gezira Mycetoma Center. Methods: This is a retrospective, descriptive, hospital-based study, conducted to review the surgical treatment of eumycetoma patients. We included all patients diagnosed with eumycetoma who underwent a surgical operation in the center during January 2013–December 2016. Results: A total number of 1654 patients were seen during the study period, and their records were revised, while 584 (35.3%) of them underwent an operation and included in the study. There was a male predominance 446 (76.4%). Surgical excision of mycetoma was the commonest operation performed among 513 (87.8%) patients in comparison with amputation 71 (12.2%). Below-knee amputation and toe amputation are the commonest types of amputation in 36 (6.1%) and 14 (2.3%) patients, respectively. Clinical features determining the type of operation performed included the size of the lesion, whether or not a bone was involved, and the feasibility of primary closure. A wide surgical excision (WSE) is performed mainly when the bone is not involved and when moderate or primary closure is possible or reconstruction is feasible. Amputations will typically follow identifying bone involvement, secondary infection, and an already disabled patient. Conclusion: The commonest procedure in our series was WSE and primary skin closure undertaken when the lesion was small (< 5 cm); there was no bone involvement, and the skin closure was achievable. Larger lesions (> 10 cm) without bone involvement were treated with excision and flap/graft. Bone involvement and large primary lesions were more likely to be managed by amputation. Recurrent and relapse of mycetoma were observed in patients with bone involvements or presented with recurrent mycetoma for the second time. [ABSTRACT FROM AUTHOR]

Asthma is a chronic inflammatory condition leading to intermittent airway narrowing and obstruction. Although millions suffer from asthma globally, there is limited data from African countries, particularly Sudan. This study addresses the gap in research on asthma knowledge, attitudes, and practices among the adults in Shendi locality, Northern Sudan. This cross-sectional, community-based study was conducted in Kabushiya village, Shendi, Sudan, involving 148 participants selected through multistage random sampling. Data were collected via face-to-face interviews using a validated, structured questionnaire. Statistical analyses included Mann-Whitney, Kruskal-Wallis, Chi-square, Fisher exact tests, and multiple linear regression. Participants demonstrated high levels of knowledge, positive attitudes, and good practices regarding asthma. Knowledge scores were significantly associated with marital status, education, occupation, and income (P values: .040, .003, .000, and .006, respectively), with the highest medians among divorced individuals, those with higher education, professional workers, and people earning <50,000 SDGs (medians: 17, 16, 17, and 16, respectively). Attitude scores varied significantly by marital status, education, occupation, and family asthma history (P values: .001, .000, .003, and .016, respectively), with highest scores among divorced individuals, those with high school or higher education, professionals, and those with a first-degree relative with asthma (medians: 6, 5, 5, and 5, respectively). Patient practice scores differed by marital status and income (P values: .026 and .006, respectively), with higher scores among singles and those earning <50,000 SDGs. Co-patient practice scores were significantly influenced by occupation, personal or familial asthma experience, and family asthma status (P values: .026, .003, and .000, respectively). No significant differences were observed in co-patient practice scores between groups. The study highlights a generally good level of asthma knowledge and positive attitudes among participants, with some variability in practices based on socio-demographic factors. These findings emphasize the need for targeted education and intervention programs to improve asthma management in rural Sudan., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Hereditary spinocerebellar degenerations (SCDs) is an umbrella term that covers a group of monogenic conditions that share common pathogenic mechanisms and include hereditary spastic paraplegia (HSP), cerebellar ataxia, and spinocerebellar ataxia. They are often complicated with axonal neuropathy and/or intellectual impairment and overlap with many neurological conditions, including neurodevelopmental disorders. More than 200 genes and loci inherited through all modes of Mendelian inheritance are known. Autosomal recessive inheritance predominates in consanguineous communities; however, autosomal dominant and X-linked inheritance can also occur. Sudan is inhabited by genetically diverse populations, yet it has high consanguinity rates. We used next-generation sequencing, genotyping, bioinformatics analysis, and candidate gene approaches to study 90 affected patients from 38 unrelated Sudanese families segregating multiple forms of SCDs. The age-at-onset in our cohort ranged from birth to 35 years; however, most patients manifested childhood-onset diseases (the mean and median ages at onset were 7.5 and 3 years, respectively). We reached the genetic diagnosis in 63% and possibly up to 73% of the studied families when considering variants of unknown significance. Combining the present data with our previous analysis of 25 Sudanese HSP families, the success rate reached 52-59% (31-35/59 families). In this article we report candidate variants in genes previously known to be associated with SCDs or other phenotypically related monogenic disorders. We also highlight the genetic and clinical heterogeneity of SCDs in Sudan, as we did not identify a major causative gene in our cohort, and the potential for discovering novel SCD genes in this population., (© 2023. The Author(s).)

Camel brucellosis is a major public health concern in Sudan; however, there is no overall estimation of the prevalence of camel brucellosis in Sudan. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this study aimed to perform a meta-analysis of 30 eligible studies published before December 31, 2022, with a total of 70059 dromedary camels, to estimate the pooled prevalence of camel brucellosis and its risk factors in Sudan. The random effect model was used for the final analysis due to the significantly high heterogeneity among the included studies, and the results showed that the overall pooled prevalence of camel brucellosis was 17%, with a confidence interval (CI) of 12%-21%. The prevalence was higher in males than females (54% vs. 46%) and in adults than youngling (77% vs. 23%). The prevalence also varied by region, with central and northern Sudan having the highest prevalence (24%), compared to other regions of Sudan. Moreover, the prevalence of camel brucellosis appeared to be decreasing over time. The current study concluded that camel brucellosis infection is still endemic in many areas of Sudan, with the disease being especially prevalent in central and northern Sudan. Thus, this study provides valuable information for the prevention and control of camel brucellosis in Sudan. However, the significant heterogeneity among the included studies should be taken into account when interpreting these results. Finally, to provide adequate information, research must be updated, and more research must be conducted in many regions of Sudan.

Background: Ramadan is a holy month for Muslims. The aim of this study was to assess risk associated with Ramadan fasting among Sudanese individuals with diabetes (high, moderate, and low risk) according to International Diabetes Federation in collaboration with Diabetes and Ramadan International alliance (IDF-DAR) Practical Guidelines 2021 risk score., Methods: This was a cross-sectional hospital-based study recruited 300 individuals with diabetes (79% have type 2 diabetes) from diabetes centers in Atbara city, the River Nile state, Sudan., Results: The risk score was distributed as low risk (13.7%), Moderate risk (24%), and High risk (62.3%). T-test showed a significant difference in mean risk score by gender, duration and type of diabetes (p values = 0.004, 0.000, & 0.000, respectively). One-way ANOVA revealed a statistically significant difference in the risk score by age groups (p = 0.000). Logistic regression revealed that the odds of being in the 41-60 years age group had lower probability to be categorized in the moderate risk group of fasting rather than low risk by 4.3 times than being in the age more than 60 years. (p = 0.008), the odds of being in the age group 41-60 years lower probability to be categorized in the high risk of fasting rather than low risk by 8 times than being in the age more than 60 years. (p = 0.000)., Conclusion: The majority of patients in this study have a high risk for Ramadan fasting. IDF-DAR risk score is of great significance in assessing individuals with diabetes for Ramadan fasting., (Copyright © 2023. Published by Elsevier Ltd.)

Background: Diabetic ketoacidosis (DKA) is a potentially life threatening acute complication of Type I diabetes mellitus (T1DM). This study aimed to determine the frequency and clinical characteristics of pediatric DKA at diagnosis of new-onset T1DM in Khartoum during 2000-2017 period., Methods: The study was retrospective and involved review of medical files of children (<15 years) with T1DM in the city hospitals and diabetes centers., Results: The overall frequency of DKA among T1DM children at onset of disease diagnosis was 17.6% (173/982). The episodes of DKA increased from 26% in first 6- year period (2000-2005) to 46.3% in the last 6-year period (2011-2012; p<0.001). No significant difference in the frequency of DKA was observed according to gender (p=0.9) and age (p=0.24). Compared to other age groups, the severity of DKA (pH<7.1) was higher in pre-school children (p<0.01). Approximately, 5% of patients were complicated with cerebral edema with a mortality rate of 1.7%., Conclusion: The DKA frequency at diagnosis of childhood T1DM in Khartoum was lower than previous reports. In addition, the severity of DKA was high among pre-school age children with a relatively high mortality rate when compared to the global rate., (© 2020 Ahmed AM et al.)

Background: Providers are often unaware of adverse drug reactions (ADRs) or may even lack basic knowledge about them. Underreporting has been attributed to time constraints, misconceptions about spontaneous reporting and bureaucratic reporting procedures, lack of information on how to report and a lack of availability of report forms, and physicians' attitudes to ADRs. This study was undertaken to determine baseline data for health care leaders' and policymakers' knowledge, attitudes, and policies related to ADRs at eight hospitals in Wad Madani, Sudan., Methods: A random sample of participants completed the survey, which consisted of 35 closed questions and/or open-ended statements., Results: Five hundred (83.3%) of the initial 600 surveys were returned, of which 475 (95%) were completed. Of the respondents, 175 (36.8%) were physicians, 100 (21.1%) were pharmacists, and 200 (42.1%) were nursing staff. The results indicated lack of polices for ADRs in most of the surveyed facilities. More than two thirds of the participants stated that they were not performing any ADR monitoring. The main reasons for not reporting ADRs were lack of knowledge on how to report (27.0%) and lack of awareness about the existence of national or international reporting systems (26.5%). Almost half (46%) of the participants reported the lack of any educational efforts for ADR prevention., Discussion: Low awareness among health care professionals toward ADRs may reflect lack of basic knowledge and lack of vigilance. The study has helped promote health care professionals' ADR awareness and vigilance at the surveyed health care facilities. Education and training regarding ADRs of health professionals are warranted. Steps have been taken to develop ADR monitoring programs in collaboration with other stakeholders.