Sudanese Patients Research Articles

Rouviere’s Sulcus: Frequency and Types among Patients presented to Wad Madani Teaching Hospital for Laparoscopic Cholecystectomy; Gezira State; Sudan

Scientific background: Laparoscopic cholecystectomy is the gold standard for surgical treatment of gallstones disease. Method: The study aimed to determine presence and types of Rouviere’s sulcus along with its association with gender, and postoperative morbidity among Sudanese patients presented for laparoscopic cholecystectomy, and operated on at Wad Madani Teaching Hospital, Gezira State, Sudan; during the period from November 2022 to November 2023. It was a comparative cross-sectional study. Study population were patients of more than 18 years old; where total coverage of them (150) was done. Data was collected from files and records of patients presented there during study period. Master sheet was used for data collection. SPSS version 25.0 was used for analysis. P-value ≤ 0.05 was considered significant. Results: Age of participants ranged from 17 to 85 years, with a mean age of 47.57 (SD ± 15.14). Majority of them were female (93.3%). Gallstones were present in 99.3%. Rouviere’s sulcus was identified intraoperatively among 92.7%. Identified sulcus type was: Open sulcus (54.0%), Close sulcus (27.3%), and Scar sulcus (11.3%). Postoperative operative outcomes: 95.3% experienced uneventful outcomes; and 4.7% experienced complications. Both postoperative complications and gender, had no statistical associations with the presence of Rouviere’s sulcus; P-value = 0.470, and 0.112 respectively. Also, there was no significant statistical association between gender and sulcus type (P-value 0.301). Conclusion and recommendations: No significant statistical association between both postoperative complications and gender with the presence of Rouviere’s sulcus, or between gender and sulcus type; was identified. Further study was highly recommended.

Hematological picture of pediatric Sudanese patients with visceral leishmaniasis and prediction of leishmania donovani parasite load.

Visceral leishmaniasis (VL) is a systemic protozoan infection caused by Leishmania donovani (L. donovani) and transmitted by sand flies, causing macrophage invasion in the liver, spleen, and bone marrow. Diagnosis of VL is currently based on clinical signs, symptoms, and specific in-vitro markers and bone marrow investigations. However, VL's specific hematological and bone marrow manifestation in Sudanese pediatric patients is not well studied. To examine the blood and bone marrow characteristics in pediatric patients from Sudan who have VL. This is a retrospective hospital-based study with a sample of 107 consecutive Sudanese pediatric patients. The data focused on hematological and bone marrow results. We included only the completed records of the pediatric patients with VL in the Tropical Disease Teaching Hospital in Khartoum, Sudan from the period of 2016 to 2020. The majority of pediatric patients included in this study are below 5-years-old (n = 59, 55.2%). Moreover, anemia, thrombocytopenia, and leukopenia were among the prevalent characteristics in the population under study. To further analyze the data, we developed a machine learning model using boosted forest algorithms to predict L. donovani parasites load, with a mean accuracy of 0.88 for the training dataset and an accuracy of 0.46, 0.50, and 0.74 for mild, moderate, and severe L. donovani parasite load in the validation dataset. This study shows that the most common bone marrow change among Sudanese VL children was increased chronic inflammatory cells (n = 88, 82.2%) with present macrophage hemophagocytes (n = 103, 96.3%). While anemia and thrombocytopenia were the most common hematological changes. These results will hopefully lead to an early diagnosis and hence better management for Sudanese pediatric patients with suspected VL.

Plasma glucose, HbA1c, insulin and lipid profile in Sudanese type 2 diabetic patients with cardiovascular disease: a case control study

Background: Type 2 diabetes mellitus (T2DM) and its consequences are a serious global public health issue. By 2030, the number of people with type 2 diabetes is predicted to reach 439 million. The purpose of this study is to evaluate the plasma levels of glucose, HbA1c, insulin, and lipid profile in Sudanese T2DM patients. Methods: This case control study included 165 Sudanese patients with diabetic type 2 and a cardiovascular condition as cases and 165 diabetic type 2 volunteers without a cardiovascular disorder as controls. The concentrations of plasma glucose, HbA1c, and lipid profile were assessed using a Mindray BS-480 auto-chemistry analyzer, and insulin was analyzed using a Cobase 411 auto analyzer. The collected data were analyzed using statistical tools for social science computer programs (SPSS version 21). Results: According to the findings, (59.4%) of patients between the ages of (50-69). Females made up 50.9%. (38.2%) of patients had an illness duration of between (8-15 years). (41.8%) of individuals did not have hypertension. There was a substantial rise in BMI, FBG, HbA1c, HDL-C, and insulin among diabetics with cardiovascular disease compared to diabetics without cardiovascular disease (p-value = 0.001, 0.000, 0.018, and 0.000). Females had significantly higher blood TC, LDL-C, HDL-C, and BMI than males (p-values = 0.000, 0,001, and 0.000, respectively). There were significant positive correlation between FBS, HBA1c, insulin and duration of disease (r=0.155, p, value=0.005) (r=0.160, p, value=0.004)(r=0.103, p. value=0.061)respectively, while there were significant negative correlation between TC, TG,LDL-C, HDL-C and duration of disease (r=-0.152, p, value= 0.006)(r=-0.023, p, value=0.678)(r=-0.113, p, value= 0.040)(r=-0.145, p, value=0.008)respectively. Conclusion: When comparing diabetics with cardiovascular disease to diabetics without cardiovascular disease, there was a substantial rise in BMI, FBG, HbA1c, HDL-C, and insulin. FBS, HBA1c, insulin, and illness duration all had a strong positive connection.

Herbal Self-medication Practice for Coronavirus Disease 2019 in Sudan: A Public Survey, 2021

Background: the COVID19 emerged in China in late 2019 with high rate of spread and transmission. As there was no recognized therapy many people worldwide used herbs in attempt to help their body overcome the disease. This study aimed to document Sudanese patients experience in using herbs to treat the disease and decrease its severity. Methods: A cross-sectional population-based online survey was done targeting those who experienced COVID-19 among Sudanese through an online internet-based questionnaire distributed on social media platforms (mainly Facebook and WhatsApp). Descriptive statistics used to summarize data and present it as frequency tables and graphs. Multivariate logistic regression was used to quantify the association between independent variables (comorbidities and use of herbs) and the outcome variable reflecting the severity of the disease (hospitalization). Results: a total of 204 responses received from COVID-19 former and active cases. Typical symptoms of the disease were identified; fever (68.1%), cough (52.7%), shortness of breathing (59.3%), sore throat (76.5%), and loss of smelling and/or taste (67.2%). All the respondents reported using traditional herbs or plants for cure with strong statement of their usefulness. Citrus plants like lemon, orange and grape fruits, were the commonest, used by 94%, followed by the local herbs, Acacia (65%), Ginger (56%), Baobab (46%), Hibiscus (45%), Black Seed (45%) and Cinnamon (17%). Other used plants included onion (29%) and garlic (24%). An adjusted analysis found that obesity was associated with higher hospital admission, while using herbs had no effect on hospital admission. Conclusions: all participants reported the use of herbs for cure beside other treatment. The most commonly used herbs were citrus fruits followed by Acacia and Ginger and other herbs. All participants stated that herbs were useful for their recovery, however our analysis revealed no significant effect on rate of hospitalization. We recommend further deeper, well-designed study to better assess the effect of herbs.

Prevalence of Erectile Dysfunction among Sudanese Patients at Gezira Hospital for Renal Disease and Surgery

Background: Erectile dysfunction (ED) is a disorder that makes it hard or impossible to keep or get an erection that is good enough for sexual activity. ED can be caused by physical, mental, or combined factors, and it is usually associated with a long-term health issue. Methods: The study is a prospective and cross-sectional research conducted in a hospital setting. It took place from December 2019 to December 2022 at Gezira Hospital for Renal Disease and Surgery. The study sample consisted of 246 patients. Results: The most frequently affected age groups were 30–40 years and 50–60 years, accounting for 26% and 25.2% of the sample, respectively, while the least affected age groups were >20 years and >70 years, representing 1.2% and 3.7% of the sample, respectively. The most common symptoms reported by the patients were ED alone (74%) and ED with penile curvature (22%). The most prevalent causes were psychogenic, Peyronie’s disease, and venogenic, affecting 54.1%, 24.4%, and 16.3% of patients, respectively. The most frequent comorbidities associated with ED were diabetes mellitus (DM) and hypertension, occurring in 12.2% and 4.1% of the patients, respectively. There was a statistically significant correlation between age and etiology (P-value = 0.00), age and symptom (P-value = 0.012), and symptom and cause (P-value = 0.000). Conclusion: The age group of 30–40 years was the most affected by ED, and ED alone was the most frequent symptom. Psychological factors were the main cause of ED, and DM was the most common comorbidity associated with ED.

Diagnosis and management of bacterial meningitis in adult Sudanese patients: a six years hospital based, retrospective, cross-sectional study

PurposeTo evaluate the diagnosis and management of bacterial meningitis in adult Sudanese patients in accordance with the Infectious Diseases Society of America (IDSA) guidelines for bacterial meningitis management.Patients and methodsA cross-sectional, retrospective study design was used to recruit all patients aged > 18 years who were diagnosed with or suspected of having bacterial meningitis and admitted to Wad Medani Teaching Hospital, Gezira State, Sudan, between January 2017 and October 2022.ResultsIn total, 201 patients were included in the analysis. The mean age of the participants was 44.1 ± 21.4 years, and 107 (53.2%) were male. Community-acquired bacterial meningitis accounted for 193 (96%) of the studied patients, and only 8 (4%) of the patients had healthcare-associated meningitis. Neuroimaging was utilized appropriately in 148 (73.6%) patients, blood cultures were not performed entirely, and lumbar puncture was seldom performed in 1 (0.5%) patient. Corticosteroids were appropriately administered to 65 (32.3%) patients, and antibiotics were administered appropriately to only 5 (2.5%) patients. Ceftriaxone 185 (76.1%) was the most frequently utilized antibiotic, followed by vancomycin 23 (9.5%). In terms of overall adherence, this study demonstrated that the IDSA guidelines were not followed at all in the treatment of patients with suspected bacterial meningitis.ConclusionThe results of this study contradict the IDSA guidelines for the standard of care for bacterial meningitis. Antibiotic regimens are often incorrect, corticosteroids are administered appropriately in approximately one-third of patients, and neuroimaging is reasonably utilized. This study raises attention to several important issues regarding the diagnosis of bacterial meningitis, including the lack of confirming microbiological tests and the reliance of the diagnosis primarily on CT and clinical examination.

Prevalence and clinical characterization of hepatitis D virus (HDV) infection among Sudanese patients with hepatitis B virus (HBV): a cross-sectional study.

Sudan has a high prevalence of hepatitis B surface antigen, exceeding 8%. The prevalence of hepatitis B varies across different regions of Sudan, ranging from 6.8% in central Sudan to as high as 26% in southern Sudan. Hepatitis D virus (HDV) relies on HBV for replication and can accelerate the progression of HBV-related liver diseases, leading to more severe outcomes. This study aims to determine the prevalence of HDV infection among Sudanese patients with HBV-related liver diseases and to investigate the clinical characteristics of patients with HDV co-infection. This descriptive cross-sectional hospital-based study was conducted in Sudan between June and September 2022. Ninety HBV patients aged 16 years and above were included. Patients were interviewed using a structured questionnaire, and medical histories and examinations were recorded. Investigations included liver function tests, abdominal ultrasounds, and ELISA for Anti-HDV IgG. In this study of 90 HBV patients, most were male (68.9%) and under 40 years old (58.9%). HDV-IgG antibodies were found in 8 patients (8.9%), all male. Among the HDV-positive patients, one (12.5%) had jaundice and one (12.5%) had ascites. Elevated ALT levels were seen in 50% of HDV-positive patients. One (12.5%) HDV-positive patient had low albumin. Cirrhosis was present in 25% of HDV-positive patients, and HCC was present in 12.5% of HDV-positive patient. The prevalence of HDV infection among Sudanese patients with HBV-related liver diseases is 8.9%. This highlights the need for enhanced screening and diagnostic measures in Sudanese populations. Further research is needed to develop targeted interventions.

The Outcome of Management of Multiple Myeloma in Sudanese Patients

The Outcome of Management of Multiple Myeloma in Sudanese Patients

P149 HYPERTENSION AS A SILENT KILLER: DOES OUR MANAGEMENT REACH THE RECOMMENDED TARGETS: SUDAN MMM 2022?

Introduction: Several explanations might address the failure of antihypertensive medications: poor compliance, excessive salt ingestion, drug interactions, or an unsuspected secondary cause for hypertension. Resistant hypertension, as an additional failure cause, is relatively rare, but all patients should be considered medically treatable until proven otherwise. Therefore, we aim to explore the blood pressure readings and the current control status in hypertensive Sudanese patients. Methods: Utilizing the MMM 2022 Sudan screening data, participants’ BP >18 years was measured using a standard device by trained physicians for three consecutive measures, and a single mean value was calculated excluding the first reading. Participants with a history of hypertension were included in the analysis. Continuous data was presented in mean and standard deviation, and categorical data was presented in frequencies and percentages. According to current guidelines, several antihypertensive medications used were counted for each patient. All participants completed a structured questionnaire after obtaining their approval. Results: The study included 2,292 participants with an established diagnosis of hypertension. The mean age at diagnosis was 46±13 years, around 60% were females, and the median duration of hypertension was 5 (2, 10) years. Of these, 936 (40.9%), 790 (34.5%), and 543 (23.7%) had blood pressure exceeding SBP≥140 mmHg, DBP≥90 mmHg, and BP≥140/90 mmHg, respectively. Table 1 shows the baseline characteristics for each group. Despite the guideline recommendations to control hypertension, 78 (14.4%) were not adherent to medications, and 56 (10.3%) were taking three or more antihypertensive drugs. Conclusions: BP screening enables future decisions to control hypertension-related burden. Adherence to the internationally recommended guidelines will lead to achieving BP targets and prevent undesired outcomes. The subgroup of resistant hypertensive patients needs close monitoring and appropriate medical evaluation.

MM-599 The Outcome of Management of Multiple Myeloma in Sudanese Patients

MM-599 The Outcome of Management of Multiple Myeloma in Sudanese Patients

Surgical management and histopathological patterns of periampullary cancers in Sudanese patients: A single‐center prospective study

AbstractBackgroundHistopathological patterns of periampullary cancers (PAC) provide valuable information for clinicians in the selection of effective postoperative therapies and serve as a prognostic marker for patients. Therefore, this study was conducted to determine the surgical management and histopathological patterns of PAC necessary to achieve excellent surgical outcomes.MethodsThis prospective study was conducted from October 2021 to September 2023 at Ibn Sina Specialized Hospital, Khartoum, Sudan. Eighty patients diagnosed with resectable PAC were enrolled.ResultsPAC was more prevalent in male patients (52.5%), with a male: female ratio of 1.1:1.0. The peak incidence occurred between 46 and 60 years, representing 38.75% of patients. The most significant reported comorbidity was cigarette smoking (36.25% of patients). Scleral icterus was found in 47.5% of patients. Pancreatic head cancer was found in 55% of patients. Histopathological analysis revealed adenocarcinoma in 82.5% of patients. R0 resection (tumor‐free margins) was the most common resection category (87.5% of patients). Lymphovascular invasion was detected in 37.5% of patients. Malignant lymph node involvement (1–3 nodes) was found 47.5% of patients. Perineural invasion was found in 55%. Finally, the most common histopathological differentiation of PAC was well‐differentiated (Grade I) in 67.5% of patients. The mortality rate was 0%.ConclusionsUpdated knowledge regarding the management modalities of PAC is a prerequisite for accurate histopathological assessment and good surgical outcomes. Furthermore, histopathological analysis helps clinicians to select effective postoperative therapies for greater improvement in survival outcomes.

Normal range of white blood cells among Sudanese in Wad-Medani, Gezira state, Sudan “2015 to 2022”

Introduction: The white blood cells (WBCs) count is a crucial parameter used to assess the immune system’s function and diagnose various diseases, including infections, autoimmune disorders and certain types of cancers. Appropriate local reference values for hematological parameters are important for diagnosis, treatment, follow up and screening. It is well noticed by practicing medical personnel for many years that, WBCs count in Sudanese patients is much lower than standard references for the rest of the world. SO knowing the baseline values of WBCs in the Sudanese population is essential. Therefore, this study aimed to determine the normal range of WBCs among Sudanese people in Wad-Medani, Gezira state, Sudan. Method and material: Retrospective descriptive cross-sectional study was conducted to patients attending Dr. Ahmed A. Adam private clinic in Wad-Medani city. Sample was selected from medical records from 2015 to 2022 and 1st of August to 2nd of November 2023, by trained medical students in the period from the 1st of August to the 2nd of November 2023. Semi-structured questionnaire containing personal data and other information related to health status was obtained from medical records. Result: A total of 673 healthy participants were included, 357 males (53%) and 316 females (47), with age range between 14 to 100 years. The mean ± SD of WBCs count for the Sudanese population in the study in Wad-Madani state was 6.04 ± 1.31 × 103/ µl Conclusion: The results of this study showed that normal WBCs Count of Sudanese people was similar to WBCs count in African countries but was less than the international count.

A randomized, double-blind phase 2b trial to evaluate efficacy of ChAd63-KH for treatment of post kala-azar dermal leishmaniasis

In a recent Phase IIa clinical trial, the candidate leishmaniasis vaccine ChAd63-KH was shown to be safe and immunogenic in Sudanese patients with post kala- azar dermal leishmaniasis. However, its value as a stand-alone therapeutic was unknown. To assess the therapeutic efficacy of ChAd63-KH, we conducted a randomized, double-blind, placebo-controlled Phase IIb trial (Clinicaltrials.gov registration: NCT03969134). Primary outcomes were safety and efficacy (≥90% improvement in clinical disease). Secondary outcomes were change in severity grade and vaccine-induced immune response. 86 participants with uncomplicated post kala azar dermal leishmaniasis of ≥ six months duration were randomised to receive ChAd63-KH (7.5x1010 viral particles once i.m.) or placebo. 75 participants (87%) completed the trial as per protocol. No severe or serious adverse events were observed. At day 90 post vaccination, 6/40 (15%) and 4/35 (11%) participants in the vaccine and placebo groups respectively showed ≥ 90% clinical improvement (RR 1.31 [95% CI, 0.40 to 4.28], p=0.742). There were also no significant differences in PKDL severity grade between study arms. Whole blood transcriptomic analysis identified transcriptional modules associated with interferon responses and monocyte and dendritic cell activation. Thus, a single vaccination with ChAd63-KH showed no therapeutic efficacy in this subset of Sudanese PKDL patients.

Differences in the Cellular Immune Response during and after Treatment of Sudanese Patients with Post-kala-azar Dermal Leishmaniasis, and Possible Implications for Outcome

BackgroundThe host cellular immune response associated with two treatments for post-kala-azar dermal leishmaniasis (PKDL) - paromomycin plus miltefosine (Arm 1), and liposomal amphotericin B plus miltefosine (Arm 2) - was examined in Sudanese patients before treatment (D0), at the end of treatment (D42), and during the post-treatment period (D180).MethodsWhole blood samples were stimulated with soluble Leishmania antigen for 24 h (whole blood assay [WBA]) and the concentrations of Th1/Th2/Th17-associated cytokines, IP-10, PDL-1 and granzyme B were determined.ResultsThe Arm 1 treatment (98.2% cure rate) induced a Th1/Th2/Th17 response, while the Arm 2 treatment (80% cure rate) induced a Th1/Th2 response. Five Arm 2 patients relapsed and showed lower IFN-γ, TNF and IL-1β concentrations at D0 than non-relapsers in this Arm. In patients with low-IFN-γ-production at D0, Arm 1 treatment led to a better host immune response and clinical outcome than Arm 2 treatment.ConclusionsA Th1/Th2/Th17 response was associated with a higher cure rate. Patients with low IFN-γ, TNF and IL-1β before treatment are more likely to relapse if they undergo Arm 2-type treatment. Determining IFN-γ, TNF and IL-10 levels prior to treatment could help predict patients at higher risk of relapse/recovery from PKDL.Trial RegistrationClinicalTrials.gov NCT03399955, Registered 17 January 2018, https://clinicaltrials.gov/study/ NCT03399955.Graphical

Pattern of Presentation of Newly Diagnosed Diabetes Mellitus Among Sudanese Patients

Pattern of Presentation of Newly Diagnosed Diabetes Mellitus Among Sudanese Patients

Clinical Presentation of Sudanese Patients with Breast Cancer

Background: Breast cancer with advanced stages at a young age is a significant new challenge in Sudan. The purpose of this study was to determine the most common presentations of breast cancer patients in western Sudan. Methodology: For this retrospective descriptive investigation, materials for 183 breast cancer patients were obtained from two histopathology centers (Kordofan histopathology center and El-Obeid International Hospital). A full coverage sample was collected, spanning from January 2019 to May 2024. All data pertaining to the patient's essential identifying, clinical, and histological data were gathered. Results: This study looked at 183 breast cancer patients (177 (96.7%) women and 6 (3.3%) men). Their ages ranged from 20 to 90, with a mean ± standard deviation of 50.78 ± 13.6 years. The majority of participants were aged 41-50 years, followed by ≥61 and 51-60 years, with 50/183 (27%), 43 (23%), and 35 (19%), respectively. For clinical appearance, the most common skin change was unremarkable, followed by ulcerated skin change, which accounted for 127/183 (69%) and 48 (26%) respectively. Conclusion: Breast cancer with advanced stages upon presentation is common in Sudan. The majority of patients presented at a younger age and had distinct initial manifestations.

Effect of Blue Light Filter Intraocular Lens (IOL) on Colour Vision.

Purpose The objective of this study is to knowthe effect of blue light filter (BF) intraocular lenses (IOL) on colour vision of Sudanese patiens as BF IOLs are relatively new in Sudan and its effect on Sudanese patients is not yet studied. Methods This was a descriptive cross-sectional observational study. Data collection was done through interview andpretested structured questionnaire containing three sections: (i) personal data, (ii) past medical and ocular surgical history, and (iii) visual acuity (VA), the anterior and posterior segment exam result, and the D15photopic color vision test result. Results In this study, 206 eyes of 103 patients were enrolled. Of them, 57 (55.3%) were females and 46 (44.7 %) were males. The mean age of the participants was 58.38 years±11.488 (SD). Furthermore, 81 patients (78.64%) achieved normal D15 color vision test results, while 22 patients (21.4%) had abnormal results. There was a significant effect (P=.00) on photopic color vision perception. Finally, the gender-wise performance showed an insignificant difference (P=.933)with 78.3% of the males having normal D15 color vision test and the females having slightly better results with 78.9 %. Conclusions The results suggested that implantation of BF IOLs has a significanteffect on photopic color vision perception.

Disease-modifying therapies as positive predictors of quality of life for Sudanese patients with multiple sclerosis: a cross-sectional study

BackgroundMultiple sclerosis (MS) is an immune-mediated, neurodegenerative disease with devastating, disabling, and negative impacts on the patients’ quality of life (QoL). Although MS was not known in Sudan, it seems to be rising in recent years. This is a cross-sectional, hospital-based study aimed at assessing the impact of MS medications on patients’ QoL in neurology clinics in Khartoum City. Sixty-four patients diagnosed with MS were recruited. SF-36 questionnaire was used to assess the patients’ QoL. Data were collected from patients’ records in addition to the hand-delivered questionnaire. Data were analyzed using ANOVA test and logistic regression; p ≤ 0.05 was considered statistically significant.ResultsThe majority of patients were females from north Sudan (92.2%). The mean age was 28.2 ± 6.5. Relapsing–remitting was the most diagnosed MS type (65.6%). Fatigue and urinary incontinence were the most observed symptoms. All patients had vitamin D deficiency (5–20 ng/ml). Disease-modifying therapies (DMTs) were prescribed to 37.5% of patients.The overall mean QoL was 53.9 ± 14.7 with fair physical and mental health (51.8 ± 19.2 and 57.0 ± 10.9, respectively). Patients on DMTs showed a significantly good QoL compared to azathioprine (p ≤ 0.01), corticosteroids (p ≤ 0.01.), and no medications (p ≤ 001). Azathioprine (OR = 0.12; p ≤ 0.05), corticosteroids (OR = 0.14; p ≤ 0.05) and no treatment (OR = 0.01; p ≤ 0.001) negatively affected MS patients’ QoL when compared to DMTs. Vitamin D supplementation was significantly (p ≤ 0.01) associated with good QoL.ConclusionsMS was prominent in young females’ descendants of Sudanese northern tribes. DMTs improve the devastating effect of MS on patients’ QoL, and vitamin D supplementation was significantly associated with good QoL of MS patients.

Short-Term Outcome of Ultrasound Therapy in Sudanese Patients with Knee Osteoarthritis

Objectives: the aim of this study is to evaluate the short term effectiveness of therapeutic ultrasound therapy modalities in patient with knee OA. Methodology: This is a prospective, double blinded clinical trial, conducted among 45 participants. Participants were divided into three groups each of 15 patients. In Group A – continuous ultrasound was used, in Group B – pulsed ultrasound was used and in Group C – traditional physiotherapy without ultrasound therapy was used. Groups A and B also received traditional physiotherapy in addition to ultrasound. Visual analog scale, WOMAC questionnaire, range of motion assessment, manual muscle test, and circumference were used for evaluation before and after rehabilitation program. Data were analyzed using Statistical Package for the Social Sciences (SPSS) and multiple regression analysis of variables was done. The ethical approval was obtained from the institutional review board at Alneelain University and a verbal and written consent was obtained from the participants before the interview. Result: When comparing the three groups, we Found that no difference in WOMAC score, and there was no differences in the edema and stiffness between the three groups. The only difference was in reduced pain (VAS) in the pulsed group (P-value 0.004*), when compared to the other two groups. Conclusion: Among 45 patients in this study we found that pulsed ultrasound therapy was very effective in reduction of pain, and there was no difference in the WOMAC index score, edema between the three groups at the end of treatment. When comparing the range of motion, Group B showed the greatest improvement in the motion. The traditional physiotherapy group(c) and the two ultrasound therapy groups (A & B) had the same outcomes at the end of treatment programs. Keywords: Knee osteoarthritis, Ultrasound therapy, Pulsed ultrasound, Continuous ultrasound, Traditional physiotherapy, Effect of ultrasound therapy, Outcome of ultrasound therapy.

Clinical characteristics and associated factors of diabetic retinopathy in Sudanese patients

Background: Diabetic retinopathy (DR) is a leading cause of vision loss and preventable blindness, particularly in middle- and high-income countries.Aim: This study aimed to assess the characteristics and associated factors of DR in Sudanese patients with type 2 diabetes mellitus (DM).Setting: A cross-sectional hospital-based study included 119 patients with type 2 DM was conducted at EL-Walidain Eye Hospital, Khartoum, Sudan, from February 2021 to May 2021.Methods: A non-mydriatic digital fundus camera was used for fundus photography, and Scottish Diabetic Retinopathy Grading Scheme was used for the final classification of DR.Results: Females comprised 53.8% of patients, mean age of 58.8 ± 8.5 years. Uncontrolled DM was found in 37.8% with a mean duration of 10.5 ± 4.8 years. Myopia was the most common refractive error found in 57.8% of the uncontrolled group, followed by emmetropia (17.8%). Whereas in the controlled group, 47.3% were hyperopic and 39.2% were myopic. Maculopathy grade M1 was found to be 37.8% in the uncontrolled group and 18.9% in the controlled group, with no significant difference (p = 0.361). Conversely, the difference in retinopathy between the two groups was statistically significant (p = 0.043).Conclusion: Decreased vision and increased retinopathy were associated with an increase in patients’ age. More widespread diabetes awareness and screening programmes to improve diabetes management and control in Sudan and other developing countries.Contribution: This study observed maculopathy grade M1 and myopia were more common in uncontrolled DM, and vision function was inversely correlated with age (p 0.05).