Charity Clinic Research Articles

Level of satisfaction of health care among the patients attending at Daoud Charity Clinic between September and December 2021

Level of satisfaction of health care among the patients attending at Daoud Charity Clinic between September and December 2021

Prevalence of depression among epileptic patients attending Daoud Charity Clinic, Khartoum State, Sudan between November to December 2022

Prevalence of depression among epileptic patients attending Daoud Charity Clinic, Khartoum State, Sudan between November to December 2022

Prevalence and risk factors of functional seizures among adult Sudanese patients with epilepsy, a cross-sectional clinic-based study.

BackgroundEpilepsy can be associated with functional seizures. Our main aim is to assess functional seizures' prevalence and risk factors among adult Sudanese patients with epilepsy.MethodsThis cross-sectional clinic-based study was conducted from January to February 2021 at Daoud Charity Clinic in Omdurman city, Sudan. Ninety-nine adult Sudanese patients with epilepsy were included. Data were collected using a validated interview-based semi-structured questionnaire. A senior consultant neurologist and a consultant psychiatrist diagnosed the functional seizures based on full clinical history and investigations. The diagnosis was performed according to International League against epilepsy (ILAE) classification.ResultsThis study included 99 patients with epilepsy, 57% were females, 79% reside in Khartoum state, and 32% reached secondary school. The main types of epilepsy were generalized tonic-clonic (68%), followed by focal seizures with impaired awareness (11%). The majority of the patients have been diagnosed with epilepsy for over three years (65%). Comorbid epilepsy and functional seizures were found in 29% of the patients, with a significantly higher prevalence in patients with social problems and depression (p = 0.005 and p < 0.01, respectively). Patients with depression had a 14 times higher risk of functional seizures than those without depression, 95% CI [3.8, 52.3].ConclusionA remarkably high prevalence of functional seizures was found among adult patients with epilepsy. Patients suffering from social problems and/or depression and poor economic status had a higher tendency to develop functional seizures, especially after two to three years of treatment and above.

Prevalence of depression among Sudanese patients with Parkinson's disease attending Daoud charity clinic in 2020–2021

Parkinson's disease is the second most common neurodegenerative disorder, after Alzheimer's disease. The most common psychological problem that affects those with Parkinson's disease is depression. Depression is a period of two weeks or longer during which there is either depressed mood or loss of interest or pleasure. Objectives: To determine the prevalence rate of depression and associated symptoms among Sudanese Parkinson's patients.

Seizures severity assessment among Sudanese patients with epilepsy, Khartoum, Sudan, 2019–2020

Epilepsy is a well-known neurological disorder. Seizure severity emerges as an important aspect of epilepsy. The severity of seizures depends on many factors which can affect the patient's disease control and management. Aims: To assess seizure severity among patients with epilepsy attending Daoud charity clinic.

Clinical characteristics of Parkinson's disease in Sudanese patients attending Daoud Charity Clinic in 2020–2021

Introduction: Parkinson's disease (PD) is the second most common neurodegenerative disorder, after Alzheimer's disease. Parkinson's disease main four clinical features include muscle rigidity, tremors, and bradykinesia and gait. Also there is secondary features like depression, emotional change, dementia, constipation, postural hypotension, changes in speech, skin problem, and dysphagia. Objectives: To identify the clinical features of Parkinson's disease in Sudanese Parkinson's patients.

Prevalence and risk factors of psychogenic non-epileptic seizures among adult Sudanese epileptic patients who attend Daoud Charity Clinic, Khartoum, Sudan 2021

Seizures can present in many diseases such as epilepsy which is one of the common neurological disorders. Some seizures can present as psychogenic seizures. Epilepsy can be associated with psychogenic non-epileptic seizures. To assess prevalence and risk factors of psychogenic non-epileptic seizures among adult Sudanese epileptic patients attending Daoud charity clinic.

Treatment satisfaction and medication adherence among patients with epilepsy at Daoud Charity Clinic, 2021

Poor adherence to medication is commone specially in the case of chronic diseases like Epilepsy. Treatment satisfaction may impact adherence. The aim of this study was to measure medication adherence and its relationship to treatment satisfaction, duration of illness and Epilepsy control and to determine the causes of nonadherence in Sudanese patients with epilepsy.

Slow tapering of anti-epileptic drugs versus rapid tapering among Sudanese epileptic patients attending Daoud Charity Clinic, Khartoum, Sudan 2019–2020

Treatment of epilepsy should be for at least two years. After successful treatment, the drug withdrawal should be gradual. This study aimed to study the rapid versus slow withdrawal of antiepileptic drugs in Daoud charity clinic in the period between January 2019 to January 2020.

Correlation between functionality and satisfaction index after total hip or knee replacement

Objectives: The evaluation of a successful replacement surgery varies between physicians and patients. Approximately 1 in 5 patients undergoing this type of joint surgery are not satisfied with the result obtained 12 months after their surgery. The aim of this work is to find out the correlation between satisfaction and functionality in patients with either osteoarthritis (OA) or inflammatory joint disease (IJD) who had undergone knee or hip replacement surgery in our institution charity clinic, the satisfaction with program's surgery rate and to the patients' clinical improvement. Methods: This is a prospective cross-sectional study with patients who underwent surgery between 2015 and 2018. The Self-Administered Patient Satisfaction Scale (SAPS) questionnaire was applied at least 12 months after the procedure and correlated to the functional scales Harris hip score (HHS) or Knee Society Score (KSS). Results: The HHS and KSS functional scales had a good and statistically significant correlation with the SAPS of 0.44 (P

Assessment of the common psychiatric disorders among sudanese epileptic patients

Epilepsy is one of the commonest neurological disorders there is strong relation between epilepsy and psychiatric disorders. To study the pattern of relationship between epilepsy and psychiatric disorders. The study was conducted in Daoud charity clinic which is located in Omdurman, 33 patients were included with full detailed history and clinical examination conducted by neurologist and psychiatrist. Out of 33 patients 57.6% were male and 42.4% were female, age distribution found to be; from 1–20 year represents 48.5%, from 21–40 year represents 42.2%, while age group 41–60 year represents 6.1% and >60 year represents 3%. Regarding the type of epilepsy 75.8% have generalized motor epilepsy while 3% have generalized non motor, 9.1% have focal with impairment, and 12.1% have focal to bilateral. Brain magnetic resonance finding 93.9% were normal while 6.1% abnormal. Electroencephalogram finding 87.9% were normal and 12.1% abnormal. Out of 33 patients 31 patients have psychiatric disorders, the commonest is pseudo seizure which is 57.6% followed by depression 9.1% and anxiety 6.1%, while schizophrenia, pseudo+ panic attack, pseudo+ hypochondria sis, schizophrenia + depression, learning disability, nocturnal enuresis and anxiety +depression represent 3%. There is strong relationship between epilepsy and psychiatric disorder, and there is abnormal brain magnetic resonance imaging and electroencephalogram.

Women and epilepsy

Introduction Epilepsy is one of the most common neurological diseases. Both males and females can be affected, however in females there is a significant relationship to menstrual cycle and pregnancy due to hormones effect. Objectives To study the clinical pattern of epilepsy among females, and the cosmetic side effects of epilepsy, the stigma and the relation to menstrual cycle, and pregnancy, effect on delivery, congenital, and fetal abnormalities. Method This is a prospectivecross sectional non-intervention clinical based study that was carried out in DAOUD charity clinic, from Febrewary-2019 to April 2019. 31 women above 18 years old were included and, full detailed history and examination were conducted by a neurologist. Result The study included 31 women whom their ages range between (18) years old to (65) years old. It reviled that 83.8% patients had generalized epilepsy, 12.9% had focal epilepsy15 women out of 31 were well controlled, and 13 were not well controlled (n = 28). Cosmetic effects were recognized to be 64.6% due to the drugs and 32.2% were due to post-epileptic trauma. 26.6% showed a catamenial seizure, 13.3% and 6.4% of the patients had primary and secondary infertility respectively. As a obstetrical complications 6.5% had miscarriage, 3.22% preterm delivery, and 3.22% neonatal death. Also 64.6% of patients were stigmatized. Conclusion Cosmetic effects of antiepileptic drugs are more frequent in women. Also the drugs have effect on the reproductive health of the female, like obstetrical complications, fatal abnormalities, and infertility.

The effect of Ramadan related activities (Mid_day nap), early night prayers, and late night prayers on seizure frequency during Ramadan among fasting epileptic patients

Epilepsy is one of the common neurological disorders; many factors can precipitate on attack of convulsion like sleep deprivation, infection, dehydration, sudden cessation of treatment. To study the effect of Ramadan related activities (Midday nap “qaylola”, Early night prayers “Tarawih”, and late night prayers “tahajud”)and seizure frequency during Ramadan among fasting epileptic patients. This non interventional descriptive study. It was conducted in daoud charity clinic during the period from May to July 2018.Almost 75Sudanese epileptic patients who were fasting Ramadan were included in this study. 53% of them male and 46% female.75% of our patients have generalized tonic clonic, 13% have focal with impairment, 8% have focal to bilateral 2.7% have myclonus, 1.3% have more than one type.The study show the number of attack decrease with the midday nap and early night prayers. Late night prayers don't affect the frequency of attack. There was no relationship between type of epilepsy and developing convulsion during Ramadan. Sleep deprivation in Eltahajud doesn't affect developing convulsion while midday nap and early night prayers decrease the chance of developing the attack.

Patterns of cardiac ischemic changes among adult Sudanese epileptic patients attending Daoud Charity Clinic - Sudan January – May 2019

Introduction Epilepsy is one of the commonest neurologic disorder, with >85% of patients with epilepsy living in low and middle-income countries. Studies have shown that patients with epilepsy have a higher prevalence of structural cardiac disease than those without epilepsy. Seizure activity may not only induce arrhythmias but may also lead to structural cardiac changes. Objectives This study conducted to determine the patterns of cardiac ischemic changes among epileptic patients. Methodology A Community base study was conducted at Daoud Charity Clinic, and case series study design was used. A questionnaire, interviewer–administered, which included 13 items, was employed on a convenient sample consisting of 20 patients. Electrocardiography and echocardiography were used. Results Twenty patients were included with age between eighteen and fifty years, thirteen of them were female and seven were male. Twelve patients presented with tonic clonic, Four patients presented with focal to bilateral and cases of myoclonic, tonic, and focal without impair was observed. Twelve patients are taking sodium valproate, five patients are taking carbamazepine and three patients are taking combination of sodium valproate and carbamazepine. Two patients have ST- segment Abnormalities (St-segment depression and elevation). All patients have normal echocardiography. Conclusion There is a strong relationship between cardiac ischemia and epilepsy, St-segment abnormalities are the commonest finding.

The effect of epilepsy control on psychogenic non epileptic seizures

Epilepsy is one of the most common neurological disorders. The coexistence of epilepsy and PNES places a great challenge for both neurologists and psychiatrists to manage and follow up their patients. To assess the effect of epilepsy control onpsychogenic non epileptic seizure in Sudanese patients with epilepsy attending Daoud charity clinic May to July 2018. Thirty three Sudanese patients with epilepsy and concomitant psychogenic non epileptic seizure where included in this study and full detailed history of both epilepsy and PNES was obtained. The study was conducted in Daoud charity clinic during the period from May to July 2018. Out of 33 patients 19 were males and 14 were females. Seven patients had focal epilepsy, 23 had generalized tonic clonic epilepsy (GTC), 2 had GTC with atypical absent seizure, and one had GTC with myoclonus. Six patients experienced an attack of PNES after more than 1 year of being free of epilepsy, while 9 patients had PNES attack between 3 months to 1 year of the last attack of epilepsy, and 18 patients developed both PNES and epilepsy within less than 3 months. The pattern of presentation of PNES was bizarre movements in 13 patients, abnormal behavior in 9 patients, while 11 patients experienced both bizarre movement and abnormal behavior note that all those 11 patients had GTC epilepsy. Experiencing psychogenic non epileptic seizure (PNES) in patients with coexisting PNES and epilepsy is not affected by the epilepsy free period.

Evaluation of pharmacy-based telephone interventions on medication pick-up rates: a retrospective, quality improvement study at charity outpatient clinics.

To evaluate a live telephonic outreach intervention made by clinical pharmacists and clinical pharmacy technicians on medication pick-up rates. A retrospective, quality improvement study conducted at six outpatient charity clinics in Dallas-Fort Worth area between 1 January 2017 and 31 July 2017. A live telephonic call was made by a pharmacy team member if the patient did not pick-up at least one prescription item. Patients may receive more than one call if they did not pick-up medication(s) more than once during the study period. A live telephonic call resulted in three categories: contacted, left a voice message and unable to contact. Medication pick-up rates were obtained from a pharmacy claims database. The study population included 1726 individual patients who failed to pick-up at least one medication from Baylor Scott & White Health pharmacy. A total of 2551 live telephonic calls were made for the study population. A total of 1175 live telephonic calls (46.1%, n=2551) resulted in a patient picking up medication(s). Results from the generalized estimating equation logistic regression models showed that patients who received a voice message (OR: 1.37; 95% CI: 1.05 to 1.80; P<0.021) or was contacted (OR: 1.99; 95% CI: 1.54 to 2.60; P<0.001) were more likely to pick-up their medications as compared to the 'unable to contact' group. Telephonic interventions from the pharmacy team can serve as a successful means to increase medication pick-up rates among charity clinic patients.

Special care dentistry in a charity clinic: Demographic analysis and barriers to care in Singapore.

Objective:Geriatric and special care dentistry (GSD) aims to improve oral health of seniors or adults disabilities facing barriers to care. This is coherent with the philosophy of “compassion relief.” Tzu Chi Singapore's Free Clinic exemplifies this through promoting health via various avenues to reach out. This article aims to provide a demographic analysis of patients with special care needs (PSCN), including age, gender, race, medical diagnoses, and treatment rendered. The patients were appraised on their complexity with the British Dental Association case mix model.Materials and Methods:PSCN seen by a dentist in Tzu Chi Singapore from November 2016 to December 2017 were recorded. The profiling of patients was done retrospectively.Results:Fifty-five dental PSCN were treated over 82 visits. 58.2% were seen in the free clinic, 27.3% in nursing homes, and 14.5% in oral health day programs for adults with intellectual disability. Their average age was 61.2 years, and the clinic was attended by patients of different races. Their medical profiles were grouped into seven categories, and the average case mix total banded score was 21.6, indicating that the average patient had “severe complexity”. A few themes relevant to Singapore were discussed, such as specialist GSD clinics, accessing dental services, socioeconomic status, state versus charity healthcare, and provision of future GSD services.Conclusions:Charity dental services such as free clinic can capture a niche of complex patients who may become marginalized in an established public healthcare.

Factors Causing Delays and Barriers to Early Diagnosis and Treatment Among Women With Breast Cancer in Shwe Yaung Hnin Si Cancer Foundation Charity Clinic, Yangon

Background: Breast cancer is the most common cancer among females in Myanmar but patients often receive treatment rather late. Delays in seeking treatment of breast cancer for a period longer than 3 months, is associated with lower survival. Hence it is important to find out the causes of the delays so that necessary measures may be implemented with a view to improving treatment outcome. Aim: To explore the delays and barriers to early diagnosis and treatment among the breast cancer patients in Yangon. Methods: A mixed method design. All breast cancer patients (total 104) participated in the structured interview and (16) in the Focus Group Discussion (FGD) sessions. Site at Shwe Yaung Hnin Si Cancer Foundation's Charity clinic from September 2017 to February 2018. Results: Some 32.4% had (patient delay - consulted a medical personnel more than 3 months after noticing signs and symptoms), 19.4% had (general practitioner (GP) delay- to refer to cancer specialist) and 44.4% had (hospital or system delay –i.e., treatment delay after first consultation with specialists). Reasons for patient delay were not knowing that painless small breast lump could be serious (37.5%), socioeconomic constraints (18.8%), too busy working (9.4%) too scared (7.8%) and too shy (4.7%). People living in Yangon had 3.8 times less delay than those living outside (OR 3.8, χ2 = 7.4, P &lt; 0.004); those unemployed were 2.4 times less delay than used (OR 2.4, χ2 = 3.77, P &lt; 0.02); negative attitude toward breast lump and being worried had 8 times less chance of patient delay (OR= 8, χ2=19.9, P ≤ 0.0001). Those who perceived that a painless breast lump was serious are 8.8 times less likely to have patient delay (OR 8.8, χ2 = 3.08, P &lt; 0.001). The odds of having GP delay are 3.2 times higher among those having patient delay (OR=3.2, χ2=5.6, P &lt; 0.02). By FGD most of the survivors revealed reasons for delay which were limited information, economic, use of traditional medicine and sociocultural issues. Conclusion: Lack of knowledge was the highest cause of the patient delay, followed by perception, socioeconomic factors and accessibility to health care and so these need to be overcome. The GP delay and system delay need to be further explored to ascertain the exact causes.

Comments on the dilemma in the May issue: Slipped disk and dyspnoea in a French bulldog

In the dilemma discussed in the May issue of In Practice, Laura McLellan described a scenario where ‘Bella’, a four-year-old female French bulldog, is presented to you as an emergency...

Clinical comparison of alfaxalone, ketamine and propofol following medetomidine and methadone in dogs

ObjectiveTo compare the clinical effects of alfaxalone, ketamine and propofol in dogs following premedication with medetomidine and methadone. Study designProspective, ‘blinded’ and randomized clinical study. AnimalsA total of 75 male dogs presented for neutering at a charity clinic. MethodsDogs were allocated to be administered alfaxalone, ketamine or propofol following premedication with medetomidine (20 μg kg−1) and methadone (0.2 mg kg−1). Dogs were temperament scored prior to premedication. Quality of sedation, induction of anaesthesia, recovery and recovery environment were scored by simple descriptive scales. Physiological variables during anaesthesia were recorded. Continuous numerical data were analysed using analysis of variance with repeated measures as necessary. Nonparametric data were analysed using Kruskal–Wallis tests and multiple comparisons using Dunn's test. Statistical significance was set at p < 0.05. ResultsThe mean (± standard deviation) dose of alfaxalone was 0.6 ± 0.2 mg kg−1, that for ketamine was 1.5 ± 0.7 mg kg−1 and that for propofol was 0.8 ± 0.3 mg kg−1. Alfaxalone inductions were significantly smoother compared to ketamine but not to propofol. Only one of 75 of the inductions was deemed poor. There were no differences in cardiopulmonary variables between groups except immediately after induction of anaesthesia. There were no differences in quality of recovery between groups. Conclusions and clinical relevanceAll three induction agents provided reliable, predictable anaesthesia conditions that were clinically indistinguishable and ideal for teaching anaesthesia skills. The medetomidine and methadone premedication resulted in profound, heavy sedation and the quality of induction of anaesthesia was better with alfaxalone compared to ketamine. No significant difference in induction quality was detected between alfaxalone and proprofol or propofol and ketamine, and these findings are likely to be of limited clinical significance when choosing an induction agent.