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Abstract Purpose Juvenile systemic lupus erythematosus (J-SLE) is a complex, heterogeneous disease affecting multiple organs. However, the classification of its subgroups is still debated. Therefore, we investigated the aggregated clinical features in patients with J-SLE using cluster analysis. Methods: Patients (≤ 16 years) diagnosed using the Systemic Lupus International Collaborating Clinics (SLICC) classification criteria were identified from the clinical database of the Egyptian College of Rheumatology (ECR) SLE study group. Demographic data, clinical characteristics, laboratory features, and current therapies were selected. A cluster analysis was performed to identify different clinical phenotypes. Results: Overall, 404 patients, of whom 355 (87.9%) were female, had a mean age at diagnosis of 11.2 years and a mean disease duration of 2.3 years. We identified four distinct subsets of patients. Patients in cluster 1 (n = 103, 25.5%) were characterized predominantly by mucocutaneous and neurologic manifestations. Patients in cluster 2 (n = 101, 25%) were more likely to have arthritis and pulmonary manifestations. Cluster 3 (n = 71, 17.6%) had the lowest prevalence of arthritis and lupus nephritis (LN), indicative of mild disease intensity. Patients in cluster 4 (n = 129, 31.9%) have the highest frequency of arthritis, vasculitis, and LN. Cluster 1 and 4 patients had the highest disease activity index score and were less likely to use low-dose aspirin (LDA). The SLE damage index was comparable across clusters. Conclusions: Four identified J-SLE clusters express distinct clinical phenotypes. Attention should be paid to including LDA in the therapeutic regimen for J-SLE. Further work is needed to replicate and clarify the phenotype patterns in J-SLE.

Abstract Cystinosis is a rare lysosomal storage disorder caused by a variant in the CTNS gene that leads to the accumulation of cystine in the body’s tissues. It has been classified into three subtypes based on its clinical presentation: severe infantile nephropathic cystinosis, intermediate mild form, and ocular non-nephropathic adult form. We report a teenage girl who presented with end stage kidney disease as her first presentation and was found to have corneal cystine crystals upon ophthalmic evaluation. Genetic testing confirmed that she has a CTNS variant, a CTNS variant c.520A > C p.(Ser174Arg) never described in the literature previously. Full family genetic screening supported the diagnosis. She was started on oral and ocular cysteamine and maintained on peritoneal dialysis for a few months and eventually underwent a successful deceased donor kidney transplantation. These findings expand the spectrum of CTNS gene variants and highlight the potential of atypical and severe presentations of this variant during adolescence.

Background: Cleft lip and palate are the most common congenital craniofacial anomalies. They account for approximately 13% of all congenital anomalies. Objectives: To study the presentation of cleft lip and the early results of surgical repair among patients who presented to our centers. Methods: This was a hospital-based prospective cohort study of 72 patients who underwent cleft lip repair in Sudan. Results: The commonest age group was between 10–18 months. The male-to-female ratio was 2:1, and a family history of cleft lip was found in 2.8% of patients. The cleft lip was complete in 81.9%, incomplete in 12.5%, and hybrid in 5.6% of patients. Associated cleft palate was observed in 54 patients. Associated syndromes were found in 10 patients. The surgery was carried out in most patients at 9 months or less; in 4 patients, it was more than 18 months. Achievement of reasonable lip repair was moderate (50% collectively). High achievement was observed for criteria, such as accurate union (90.3%), and sub-moderate achievement in even vermillion border and cupid's bow (44%), low nose symmetry (30.6%), and quality of scar (18.1%). Early complications were reported at the rate of 13.9%. Patient satisfaction was 59.7%; however, the professionals showed higher satisfaction levels (66.7%). The anthropometric measurements of normal infants were moderately similar to those of the infants who underwent surgery. Conclusion: The patients with cleft lip showed early presentation, with a predominance of the male gender and left side pattern. The preliminary outcome of cleft lip repair was moderate, with variations in different criteria. Patient and professional satisfaction were above average.

Ayla M Tourkmani,1 Mohamed Azmi Hassali,2 Turki J Alharbi,1 Hesham I Alkhashan,1 Aljoharah H Alobikan,1 Ahmed H Bakhiet,1 Hala B Alqahtani,1 Alian A Alrasheedy,3 Ahmed D Alawwad,1 Adel M Mishriky,1 Hisham Aljadhey4 1Family and Community Medicine Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia; 2Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia; 3Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Qassim Saudi Arabia; 4Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia Background: Fasting during the month of Ramadan could lead to acute complications and increased hypoglycemic risk of patients with type 2 diabetes. Therefore, diabetes is one of the diseases that need careful observation and special considerations during Ramadan including patients’ education and counseling. Objectives: To evaluate the impact of Ramadan focused education program on acute complications and biomedical parameters. Methods: A prospective nonrandomized interventional controlled design was run on three phases: before, during, and after Ramadan on 262 type 2 diabetes patients. The intervention group (n=140) received focused individualized diabetic education sessions and antidiabetic medications adjustment before and after Ramadan, while the control group (n=122) received standard diabetic care. A validated hypoglycemia questionnaire was used in both groups to assess the change of the risk. Patients were advised to adjust the dosage and timing of antidiabetic agents according to the recommendations for management of diabetes during Ramadan. Primary outcomes were postintervention change of hypoglycemia score and HbA1c over 6-month follow-up. Data were presented as mean ± standard deviation. HbA1c was expressed in percentage. Results: The hypoglycemic scores before, during, and after Ramadan were 14.21±8.50, 6.36±6.17, and 5.44±5.55 in the intervention group, respectively (P

The great importance of the Nile River emerges from the fact that it represents the main water source for Egypt and its being an important water path for sailing or for Nile tourism cruises. Because of climate change and the construction of the Ethiopian Renaissance Dam, Egypt may have to reduce the discharges from the High Aswan Dam (HAD), which may cause a reduction in water depth below a safe level for navigation. Consequently, this study aims to present a quasi-real-time approach to detect the locations of bottlenecks that threat navigation path via mobile Google Maps. Accordingly, the topographic, hydraulic data, the alignment and geometry of the navigational channel, were collected from the Ministry of Water Resources and Irrigation of Egypt. AutoCAD Civil 3d is adopted in this study to determine navigational bottleneck locations of the Nile River's first reach. Two surface models were created: The Riverbed surface and the navigational path surface using a Triangular Irregular Network (TIN). As a result of the created TIN-Surface modelling ; the amount of sediment, that should be dredged, was estimated (at about 2.1 million.m3). In addition, the navigation path bottlenecks map for the studied reach was created based on minimum water levels at Aswan High Dam's winter closure and the navigational path's geometry. In conclusion, this study provides a simple solution for avoiding bottlenecks by presenting a user-friendly web Google Maps of these locations to represent the Nile River's current navigation condition in quasi-real-time and support the decision-maker on river navigation conditions.

Background: Surgical treatments of mycetoma are a cornerstone in management. However, while doing a wide surgical excision of mycetoma lesion, surgeons think about how to close the skin defect, which can be closed primarily, left to heal by secondary intension, by skin grafts or local flaps. In this review, we demonstrate the various applications and changes of mycetoma reconstruction after surgical excision. Methods: This is a systematic literature search and review conducted to determine articles presenting mycetoma reconstruction options. Articles were identified, and the time of publication, type of study, time of study, and country of study were checked. Additionally, all patients in those articles were included. Patients' names, sex, clinical presentation, and management were identified. Results: A total number of 9 articles fulfilled our inclusion criteria; 8 of them are case reports, and 1 is a case series. The first mycetoma reconstruction case was published in 1959. The country of publication varies from tropical and non-tropical countries. The total number of patients found in those articles is 34 patients, most of whom are male. The causative organism is mainly eumycetoma. The site of mycetoma lesions is varied with variable sizes. The reconstruction options used were skin graft and local or regional flaps, where only 1 case underwent a free flap for reconstruction. Conclusion: Reconstruction of mycetoma should be considered following mycetoma surgery in small or large size defects if skin closure is not feasible and there is no indication for amputation.

The increasing usage of smartphones globally necessitates the creation of reliable and valid scales to evaluate their psychological effects, particularly within academic settings such as universities. The current study aimed to identify the factorial structure of the Smartphone Addiction Inventory (SPAI) in the Republic of Yemen. The sample consisted of 1920 university students (1136 males and 784 females). The data was analyzed with the AMOS V25 statistical program. The results of the factor analysis supported the goodness of fit of the five-factor model to the data with excellent indices: RMSEA = 0.052, CFI = 0.910, GFI = 0.931, AGFI = 0.915, TLI = 0.907, NFI = 0.915, RFI = 0.916, and RMR = 0.032, all of which are within the ideal range to support the goodness of fit of the model to the factorial structure of the inventory, as the values of the explained variances ranged between 0.740 and 0.834., with indices of reliability in measurement. The results of the confirmatory factor analysis revealed that four items loaded on the Time Spent factor, four items on the Compulsivity factor, eight items on the Daily Life Interference factor, five items on the Craving factor, and three items on the Sleep Interference factor, with all loadings being statistically significant (>0.001). Based on these findings, research direction and recommendations were provided.

Purpose: Burns are considered as serious health problem in low-income country. They lead to patients’ morbidity and mortality beside their burden on the health care system. This study was conducted to review the clinical presentation and management outcome in a secondary referral hospital in Sudan (sub-Saharan country). Methods: This is a retrospective hospital-based cohort study. It was conducted during 2019–2021. Data was collected to determine socio-demographic characteristics of patients, site of burns, cause of burn and management outcome. Any patient presented with burns during the study periods was enrolled in the study area. Results: Total number of surgical emergency admitted during the study periods were 8126. Total number of patients who are included in this study were 133 with male predominant (53 %). Seventy-two of them are below age of 10 years. Half of the patients (53 %) presented with scalding burn. Only, 36 % of them presented to the emergency department during the first 12 h. Seventy eight percentage of them were treated and discharged while 6 % of them died. Open wound dressing was done for 84 % of patients while skin graft was done in 12 % of patients. Conclusion: This study demonstrates the situation in a low-income setting with higher prevalence among children. There are challenges and difficulty in managing burn patients.

Fatima S Naim,1 Yassir M Bakhiet,2 Mohmmed A Mohmmedahmed,3 Bashir A Yousef4 1Department of Clinical Pharmacy, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan; 2Department of Pediatric Nephrology, Soba University Hospital, Khartoum, Sudan; 3Department of Pediatric Cardiology, Sudan Heart Centre, Khartoum, Sudan; 4Department of Pharmacology, Faculty of Pharmacy, University of Khartoum, Khartoum, SudanCorrespondence: Bashir A Yousef, Department of Pharmacology, Faculty of Pharmacy, University of Khartoum, Al-Qasr Ave, Khartoum, 11111, Sudan, Tel +249155662037, Fax +249183780696, Email bashiralsiddiq@gmail.comBackground: Nephrotic syndrome (NS) is an essential chronic disease in children that has a major impact on a child’s health-related quality of life (HRQoL). This study aimed to evaluate the HRQoL of Sudanese children with NS and clinical parameters that can influence their HRQoL.Methods: This study was a descriptive cross-sectional of children with NS conducted in Khartoum state hospitals. A standardized PedsQLTM 4.0 Scale Score evaluated the HRQoL of the participants. Patients’ socio-demographics, clinical data, and disease complications were collected using a data collection sheet. This study assessed the HRQoL of children with NS and compared it with apparent age and sex-matched to three groups (healthy children, children with chronic diseases, and kidney-transplanted children).Results: 80 children with NS were recruited from April to August 2021. Children over eight years old represented (63.8%) of the study subjects. The total mean HRQoL scores of nephrotic children were significantly lower than those of healthy children (78.46 ± 24.01) (p = 0.001) and those with other chronic diseases (78.45 ± 24.01) (p= 0.006); however, it was not significantly different from those with kidney transplantation. Socio-demographics did not significantly affect the total mean HRQoL scores of children with NS. Clinical parameters such as the duration of illness, “less than one year” (p= 0.006), and the minimum change nephropathy histopathology (p= 0.035) significantly lowered the total mean HRQoL scores of NS children. Regression analysis further confirmed that edema, proteinuria, and hospital admission had a high impact on the total mean HRQoL.Conclusion: The total mean HRQoL scores of children with NS were low and significantly lower than healthy children. Parameters such as the patient’s socio-demographics and phenotype of NS had no significant effect on the total mean HRQoL scores of children with NS. However, other clinical parameters significantly lowered their total mean HRQoL scores.Keywords: health-related quality of life, nephrotic syndrome, clinical parameters, Sudanese children

The importance of programs that develop the thinking skills of students has been emphasized by many educational researchers. However, the majority of these studies have focused on developing these skills of gifted students and of students in public schools. Few have focused on developing and strengthening such skills in students with learning disabilities. Thus, we aimed to a test a program that elevates thinking skills using a sample who have learning disabilities. A quasi-experimental design was employed with 20 female sixth-grade students with learning disabilities who were divided into an experimental group (n = 10) and a control group (n = 10). The instruments utilized were the Torrance Tests of Creative Thinking (TTCT)-Figural Test B and a training program based on active learning strategies (e.g. discussion, dialogue, brain-storming, mind-mapping) comprising 18 training sessions over 6 weeks. Differences (

The neglected tropical disease (NTD) mycetoma is a chronic and progressively destructive infectious disease endemic in Sudan. There is a growing body of scientific research on mycetoma -causes, transmission, treatment, and impact from a clinical and biomedical perspective. However, there is further need for in-depth medical anthropology research on the disease to successfully translate biomedical advances into elimination and control programmes. Given this background the NIHR Global Health Research Unit on NTDs at Brighton and Sussex Medical School is leading multidisciplinary research on skin NTDs, including mycetoma, with a medical anthropology research component exploring how community engagement can lead to earlier presentation of mycetoma in Sudan. This protocol paper sets out the research aims and methods to generate new knowledge on mycetoma in Sudan once the political situation becomes stable and it is safe to carry out global health research once again. We continue to develop appropriate community engagement intervention strategies, while activities like training and capacity strengthening get underway remotely. In what follows we situate this study in the NIHR Research Unit on NTDs and alongside social science research on mycetoma. This study is part of the programme of research conducted by the NIHR Research Unit on NTDs at Brighton and Sussex Medical School (BSMS). Phase I of the Unit was conducted from 2018–2021. Below we detail key findings from Phase I that have informed our more recent work in Phase II (2021)(2022)(2023)(2024)(2025)(2026). It also sits alongside the Social Sciences for Severe Stigmatising Skin Conditions (5-S) Foundation also at BSMS (‘NIHR 5S Foundation -BSMS’ n.d., 5). The 5-S foundation examines the cultural, social, economic, and policy contexts of podoconiosis, mycetoma, and scabies in relation to the dynamics and dimensions of stigma. This study differs from the aims of the 5S Foundation in that it specifically focuses on the role community engagement can have in the early presentation and diagnosis of mycetoma in Sudan.

There is a lack of universal scales for tracking ADHD symptoms in the home for children/adolescents in the Sudanese context. For this reason, this study aimed to validate the ADHD Rating Scale—5 for Children and Adolescents, Home Version for use by parents in Sudan to assess their children for ADHD. This scale is widely used by parents to assess their children aged 5–17 years for ADHD in the home environment. The current study involved 3,742 Sudanese parents of school-aged children and adolescents, each asked to complete the instrument for one child in their family; only one parent per family participated in the study. The authors then examined the psychometric properties of the scale from the completed assessments. The results indicated acceptable to high reliability for the total scale and both the symptom and impairment items. Exploratory and confirmatory factor analyses demonstrated high external and construct validity when applying the scale to the Sudanese sample. the factor structure resembled that of the normative U.S. sample in terms of the number of extractable factors and the strength of factor loadings. Based on the results, this adaptation of the home version of the ADHD Scale—5 for Children and Adolescents is both valid and reliable for use by Sudanese parents in the home environment.

Early intervention programs play an important role in supporting young children with disabilities and developmental disorders in acquiring various life skills before they reach school-going age. The present study aims to examine the current practices of the Individualized Family Service Plan (IFSP) for young children with disabilities in Saudi Arabia using a quantitative design. A sample of 212 early intervention providers--males (n = 35; 16.5%) and females (n = 177; 83.5%)--were surveyed. The IFSP questionnaire was based on Maryland State's IFSP form. The order of the dimensions employed in the study from the highest to the lowest was as follows: initial data, the present level of the child's development, permissions, early intervention services, information about the child and the family, and transition services. The findings of the study revealed that the current practices of the IFSP for young children with disabilities in Saudi Arabia were at the 'often' level.

Background:. Plastic and reconstructive surgery services need to be improved in developing African countries. Research and article publications from those countries are limited. This review was conducted to identify published articles from Sudan in the area of plastic and reconstructive surgery. Methods:. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. The Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines were used for the preparation of this systematic review. A comprehensive systematic search was performed using PubMed, ScienceDirect, and Web of Science databases. Articles published in Sudan, specifically in the area of plastic and reconstructive surgery, and written in English were included in this review. Results:. The total number of articles that fulfilled the inclusion criteria was 23. The articles were written from 1969 to 2023. Only two articles were published in the 20th century. The most common study type was a retrospective study of eight articles, and the most common study area was Khartoum Teaching Hospital. Regarding the publishing journals, the number of subscription journals was six (30%), whereas open access was 17 (70%). Conclusion:. This review demonstrates the lack of articles published on plastic surgery in Sudan. Further investigation is needed to determine the challenges and problems associated with possible clarifications.

Abstract Background Determining the potential barriers responsible for delaying access to care, and elucidating pathways to early intervention should be a priority, especially in Arab countries where mental health resources are limited. To the best of our knowledge, no previous studies have examined the relationship between religiosity, stigma and help-seeking in an Arab Muslim cultural background. Hence, we propose in the present study to test the moderating role of stigma toward mental illness in the relationship between religiosity and help-seeking attitudes among Muslim community people living in different Arab countries. Method The current survey is part of a large-scale multinational collaborative project (StIgma of Mental Problems in Arab CounTries [The IMPACT Project]). We carried-out a web-based cross-sectional, and multi-country study between June and November 2021. The final sample comprised 9782 Arab Muslim participants (mean age 29.67 ± 10.80 years, 77.1% females). Results Bivariate analyses showed that less stigmatizing attitudes toward mental illness and higher religiosity levels were significantly associated with more favorable help-seeking attitudes. Moderation analyses revealed that the interaction religiosity by mental illness stigma was significantly associated with help-seeking attitudes (Beta = .005; p

Hematopoietic stem cells (HSCs) and hematopoietic progenitor cells (HPCs) play a crucial role in the context of viral infections and their associated diseases. The link between HSCs and HPCs and disease status in COVID-19 patients is largely unknown. This study aimed to monitor the kinetics and contributions of HSCs and HPCs in severe and non-severe COVID-19 patients and to evaluate their diagnostic performance in differentiating between healthy and COVID-19 patients as well as severe and non-severe cases. Peripheral blood (PB) samples were collected from 48 COVID-19 patients, 16 recovered, and 27 healthy controls and subjected to deep flow cytometric analysis to determine HSCs and progenitor cells. Their diagnostic value and correlation with C-reactive protein (CRP), D-dimer, and ferritin levels were determined. The percentages of HSCs and common myeloid progenitors (CMPs) declined significantly, while the percentage of multipotent progenitors (MPPs) increased significantly in COVID-19 patients. There were no significant differences in the percentages of megakaryocyte-erythroid progenitors (MEPs) and granulocyte-macrophage progenitors (GMPs) between all groups. Severe COVID-19 patients had a significantly low percentage of HSCs, CMPs, and GMPs compared to non-severe cases. Contrarily, the levels of CRP, D-dimer, and ferritin increased significantly in severe COVID-19 patients. MPPs and CMPs showed excellent diagnostic performance in distinguishing COVID-19 patients from healthy controls and severe from non-severe COVID-19 patients, respectively. Collectively, our study indicated that hematopoietic stem and progenitor cells are significantly altered by COVID-19 and could be used as therapeutic targets and diagnostic biomarkers for severe COVID-19.

Abstract Background: Plastic and reconstructive surgery in developing countries and underserved areas are significantly limited and face changes to start a proper service. This study presents a review of plastic surgery services and experiences in a district hospital located in an underserved area. Methods: This descriptive, retrospective, hospital-based study was conducted to review patients who presented to the plastic and reconstruction departments from January 2014 to January 2015. All patients seen in the outpatient clinic or emergency departments for plastic surgical consultation or management were included in the study. Results: The total of 403 cases fulfilled the inclusion criteria. The emergency surgical operation performed in our unit were distributed in the following descending order; fingertip injury (32%), cut wrist (12.7%), cut extensor tendon (9.9%), gunshot injuries (9.4%), fracture of a small bone of the hand (8.3%), and lower limb trauma. Surgery for congenital deformities constituted the most elective operation done in our unit (31.6 %), followed by tumor surgery (18.7%), burn surgery (17.3%), aesthetic surgery procedure (12.2%), and other miscellaneous cases (12.2%). Conclusion: This report demonstrates the efficacy of secondary hospital setting to accommodate a large volume of patients during the first year of establishment, and further predicting development needs, staff training, and governmental support.

Abstract Background: Gunshot injuries are considered a health burden as well as one of the intricate emergencies in civilian medical practice. In this study, we aim to determine the pattern of presentation and management outcome in a general hospital setting in a sub-Saharan African country. Methods: This is a retrospective, hospital-based study conducted between January 2015 and December 2019 in a general teaching hospital to review the clinical presentation and management outcome of gunshot injuries. All patients' records were reviewed during the study period. Results: The total number of patients involved in the study was 157 with 83% male predominant. About 50% were from the age group 20–29 years that were most affected. The commonest anatomical site affected in the study was the lower limb (41.4%) and upper limb (22.9%), and most of the patients had been diagnosed with limb fractures (49.7%) and soft tissue injuries (28.7%). Wound debridement is the commonest procedure performed for 91 (58.0%) patients. The site of the pullet has a significant relation to the management outcome with a P-value of 0.002. Additionally, about 45% (72 patients) have stayed more than 20 days and it was affected significantly by the types of treatment provided, which has a significant relation to a hospital stay with a P-value of 0.00. Conclusion: Most of the patients in this study were young males. Upper and lower limb fractures were the most common presentations. Wound debridement, bone fixation, and laparotomy were the most common treatments with significant success rates, despite prolonged hospital stays.