Al-Neelain University

A 29-year-old previously healthy man with a month-long dry cough presented with hematemesis after mild chest trauma. Endoscopy showed a blood-filled stomach, but bleeding originated from the trachea. Bronchoscopy revealed an aspergilloma in the left upper lung lobe, confirmed histologically and by fungal culture. Imaging showed an apical cavity with pleural thickening. The patient had no history of tuberculosis, diabetes, or immunosuppression, and tested negative for human immunodeficiency virus. Hemorrhage resolved with conservative measures, and a 3-month course of voriconazole led to successful recovery without recurrence at 6 months. This case highlights hematemesis as a rare presentation of pulmonary aspergillosis, emphasizing the need to consider it in differential diagnoses of unexplained hematemesis, especially after trauma. Early bronchoscopy, histology, and imaging are key to diagnosis, enabling timely antifungal treatment and favorable outcomes.

Background Autonomic nervous system (ANS) dysfunction is a common complication in patients with diabetes mellitus, potentially affecting the various organ systems leading to significant morbidity. This study aimed to evaluate ANS dysfunction in diabetic patients attending Wad Madani Teaching Hospital, Sudan. Materials and Methods A cross-sectional and hospital-based study was conducted on a sample of 100 patients in Wad Madani Teaching Hospital in Sudan. For each participant, a data collection form was utilized to record the sociodemographic details, previous medical history, and patient assessment results including heart rate (HR), blood pressure (BP), weight, and height. Patients were assessed for the signs of autonomic dysfunction using the clinical examinations and standardized autonomic function tests. HR variability (HRV), BP response to standing, and deep breathing tests were the primary methods used to assess ANS function. The results were analyzed using the Statistical Package for the Social Sciences (SPSS) software version 26. 0. Results The mean age of the participants was 63.4 ± 9.9 years, with males comprising 75% of the sample. Of the participants, 48% were overweight and 22% were obese, with 77% demonstrating poor glycemic control (hemoglobin A1c ≥ 7.0%). Only 11% of participants had normal HRV during deep breathing, while 56% showed abnormal values. For the HR response to standing, 27% of participants had abnormal results. Regarding BP response to standing, 19% had abnormal readings. Autonomic dysfunction was prevalent, with 89% of participants exhibiting some degree of dysfunction, including early parasympathetic (16%) and combined parasympathetic and sympathetic dysfunction (19%). Conclusion Autonomic dysfunction is highly prevalent among diabetic patients in Wad Madani, with most exhibiting parasympathetic and sympathetic dysfunctions. This underscores the need for the early diagnosis and management of autonomic complications in diabetic patients to improve the outcomes and quality of life.

Utilizing remote sensing data is a common protocol in mineral exploration, particularly during the initial stages of identifying alteration zones and understanding the interrelationships between tectonic structures and mineral deposits. The primary objective of this research is to identify and optimize lineaments for the purpose of locating areas of hydrothermal alterations with regard to orogenic gold deposits in the Arkawit area of NE Sudan’s Haya terrain. Landsat-8 OLI, ASTER, and SRTM DEM data were employed. A suite of digital image processing techniques, including false color composites, band ratio, decorrelation stretching, and principal component analysis, was employed to extract useful information and derive insights from the datasets. Landsat-8 OLI effectively delineates the hydrothermal alteration zones, which are predominantly located in the central part of the study area. In addition, the ASTER data has revealed distinctive argillic, phyllic, and propylitic alteration characteristics. The integration of lineaments extracted from Landsat-8 OLI and SRTM DEM analyses culminated in the identification of three primary directions, namely, NE-SW, N-S, and E-W. Subsequently, the resulting alteration zones were classified into four categories based on their intensity: high, moderate, low, and very low. This study demonstrates that the density of lineaments within the study area is positively correlated with the intensity of the alteration zones.

One of the active researchs in metric fixed point theory involves the development of more unifying Lipstchitz-type inequalities so as to fine-tune their applications in various areas of nonlinear functional equations and related domains. In this direction, the goal of this paper is to offer a new hybrid contraction that is a combination of Meir-Keeler and Zamfirescu contractions in the structure of a complete metric space. The existence and uniqueness conditions of a fixed point of such contractions are examined. Mathematical economics is an abstract and applicable science in which economic objects, processes, and phenomena are modeled using mathematically formulated functional equations, either as a differential or an integral equation. In this direction, we study a class of integral equations that can be considered as a form of economic model and apply one of our obtained results to develop new solvability conditions for a unique solution of the integral equation. Additionally, nontrivial examples are formulated to support our proposed results.

Background Wars profoundly impact mental health with growing long lasting consequences. This study assessed the prevalence of post-traumatic stress disorder (PTSD) and well-being among Sudanese affected by the ongoing conflict, with a specific focus on healthcare workers (HCWs). Methods A cross-sectional study was conducted between April 1 and June 30, 2024, using the validated Arabic versions of PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (PCL-5) and the World Health Organization (WHO)-5 Well-Being Index. Results A total of 1022 participants were included, and 44% were recruitted through online questionnaire and face-to-face interviews. Their mean age was 31.4 ± 12.5 years, 63.4% were females, 16.3% were HCWs and 83.3% were displaced due to conflict. The mean score of PTSD was 35 ± 21.3 with 56.9% having PTSD. The mean well-being score was 55.0 ± 23.9 with 40% reporting poor well-being. Among HCWs, 60.5% suffered from PTSD and 27.5% experienced poor well-being. A significant negative correlation was observed between PTSD and well-being scores (r=-0.273, p < 0.001). Predictors of PTSD were being male [β = -10.91, 95% confidence interval (CI) (-13.44, -8.38); p < 0.001], urban area resident [β = -10.38, 95%CI (-18.78, -1.98); p = 0.016], non-medical profession [β = 5.07, 95%CI (1.46, 8.67); p = 0.006], living with 2 to 10 households [β = 6.69, 95%CI (0.46, 12.91); p = 0.035], living with more than 20 households [β = 13.20, 95%CI (4.17, 22.23); p = 0.004], insufficient income [β = 4.32, 95% CI (1.84,6.81); p = 0.001], living in conflict zones [β = 13.38 95%CI (8.83,17.92); p < 0.001], refugee resettlement [β = 13.18, 95%CI (9.98,16.38); p < 0.001], and well-being score [β = -0.20, 95%CI (-0.25, -0.15); p < 0.001]. Predictors of well-being scores were living with more than 20 households [β = -17.44, 95%CI (-28.83, -6.04); p = 0.003], being a HCW [β =-6.22, 95%CI (-11.87, -0.57); p = 0.031], being a student [β = -7.55, 95%CI (-12.94, -2.16), p = 0.006, insufficient income [β = -5.04, 95%CI (-8.17, -1.90); p = 0.002], and living in conflict zones [β = -8.22, 95%CI (-13.96, -2.48); p = 0.005]. Conclusions The study highlights an alarmingly high prevalence of PTSD among Sudanese including HCWs, with significant mental health consequences. These findings emphasize the urgent need for mental health interventions and humanitarian support to mitigate the psychological challenges faced by the conflict affected population.

Introduction Choledocholithiasis is the presence of gallstones within the common bile duct (CBD), affecting 10–20% of gallbladder stone patients. Endoscopic retrograde cholangiopancreatography (ERCP) with stent insertion is a common treatment of CBD obstruction and stenosis to maintain duct patency, with stents typically replaced within 3–6 months. However, prolonged stent presence can lead to complications such as pancreatitis and cholangitis. We report a rare case of a neglected CBD stent left in situ for 14 years without complications. Case presentation A 77-year-old female with controlled hypertension and diabetes presented to the hospital for a routine check-up. Physical examination was unremarkable except for mild scleral jaundice. She had a history of obstructive jaundice treated with ERCP and stent placement in 2010 but missed follow-ups for stent replacement. Laboratory tests revealed mildly elevated total bilirubin and low serum albumin. An abdominal ultrasound showed gallbladder sludge and a mildly dilated CBD. ERCP confirmed a dilated CBD and common hepatic duct stricture. A new plastic stent was placed, with follow-up ERCP scheduled every 6 months. Clinical discussion Forgotten biliary stents (FBS) are plastic stents left in place for more than a year. They can cause complications such as cholangitis, jaundice, stent migration, and pancreatitis. Elderly patients are more susceptible due to physical limitations and potentially inadequate follow-up. Our case highlights the unusual presentation of an asymptomatic FBS for 14 years. Conclusion This case emphasizes the importance of regular monitoring and timely stent replacement to prevent complications. Effective patient education and adherence to follow-up protocols are crucial in managing biliary stents.

An innovative approach is proposed to improve capacity performance by including dynamic reconfigurable intelligent surfaces (DRIS) in the downlink (DL) non-orthogonal multiple access (NOMA) power domain (PD) systems with massive multiple-input, multiple-output) (mMIMO) in the setting of 6G wireless networks. To guarantee the system’s best performance in different scenarios, we used a unique optimization approach to distribute power among users efficiently using the water-filling algorithm. Analysis of the influence of different deployment densities of static, and DRIS on the performance of the system is presented in this paper. The effect on the effective area spectral efficiency (EASE), and the ability of RIS to reduce latency and handle higher user loads are also discussed. The paper also demonstrates practical 6G configurations, including 256 quadrature amplitude modulation (256-QAM), channel state information (CSI), and successive interference cancellation (SIC). The results indicate that including DRIS in the mMIMO DL NOMA PD system significantly boosts capacity, and EASE while decreasing latency. Implementing logarithmic water filling has proven to be a highly effective method for distributing power location to maximize the capabilities of suggested systems. These results establish crucial information for enhancing future wireless communication systems, and in agreement with the estimated equation, the Monte Carlo results show that our work is accurate and reliable. Integrating the DRIS with four distinct user groups (4, 8, 16, and 32) improves the system’s capacity performance by 25%, 25.01%, 25.02%, and 25.03% respectively, compared to the performance conventional static RIS that applied in other related works.

Acacia gums (AGs), derived from Acacia senegal, Acacia seyal, and Acacia polyacantha trees, are widely used in various industries, including food, pharmaceuticals, and cosmetics. They serve as emulsifiers, stabilizers, thickeners, and soluble dietary fibers. This study aimed to optimize the extraction process of secondary metabolites extracted (SME) from AGS to enhance their efficiency and quality for industrial applications. Gum arabic, primarily composed of D-galactose, L-arabinose, L-rhamnose, D-glucuronic acid, and 4-O-methyl-D-glucuronic acid with a small fraction of proteins, is a multifunctional ingredient known for its emulsifying activity, attributed to its amphiphilic nature. Its effectiveness as an emulsifier stems from its high water solubility, low-viscosity, good surface activity, and ability to form a protective film around emulsion droplets. AGS in Sudan play crucial ecological roles by providing fodder, firewood, gums, and soil erosion control, which are essential for gum arabic production. Sudan’s diverse biodiversity hosts many plant species traditionally used for medicinal purposes, with extensive knowledge of medicinal plant species stemming from their widespread use among different ethnic groups. This study highlights the importance of optimizing the extraction of secondary metabolites from AGS for industrial applications, and the significance of AGS in Sudan’s ecological balance and economic stability.

Introduction and importance Managing pregnant patients with mechanical heart valves who require non-cardiac surgery presents unique challenges, particularly in balancing anticoagulation to prevent thromboembolic complications while minimizing bleeding risks. This case report discusses the perioperative management of a pregnant patient with a mechanical mitral valve undergoing emergency appendectomy. Case presentation A 28-year-old pregnant woman at 22 weeks gestation with a history of rheumatic heart disease and a mechanical mitral valve presented with acute appendicitis. Anticoagulation therapy was shifted from warfarin to low-molecular-weight heparin (LMWH) to mitigate the risks of bleeding and teratogenicity. Intravenous unfractionated heparin (UFH) was used perioperatively to maintain adequate anticoagulation. A multidisciplinary team guided the patient’s care, and she underwent a successful laparoscopic appendectomy with stable maternal and fetal outcomes. Clinical discussion Perioperative anticoagulation in pregnant women with mechanical heart valves is critical to avoiding valve thrombosis while minimizing the risk of bleeding. In this case, using LMWH as a bridging therapy and UFH during surgery proved effective in balancing these risks. The case underscores the importance of a coordinated multidisciplinary approach to optimize maternal and fetal outcomes during emergency surgery. Conclusion This case highlights the complexities of managing anticoagulation in pregnant patients with mechanical valves requiring non-cardiac surgery. With appropriate anticoagulation adjustment, multidisciplinary planning, and vigilant perioperative monitoring, both maternal and fetal outcomes can be favorable in such high-risk situations.

Background Inguinal hernias are a common surgical condition that, if untreated, can lead to severe complications. Bilateral inguinal hernias add challenges due to increased recurrence and postoperative risks. Although Lichtenstein repair, a mesh-based approach, is the gold standard for its low recurrence, Darn repair – a mesh-free technique – offers a cost-effective alternative in low-resource settings. This study assesses the applicability and effectiveness of both techniques for bilateral inguinal hernias in a resource-limited environment. Materials and methods With Institutional Review Board (IRB) approval from Al-Waleedeen Specialized Hospital (IRB number WAD.12.01.2021), a retrospective cohort analysis was conducted on 75 adult males who underwent bilateral inguinal hernia repair from January 2021 to October 2023 in Sudan. Patients were divided into Group A (Lichtenstein, n = 30) and Group B (Darn, n = 45). Data on operative time, complications, hospital stay, return to normal activities, patient satisfaction, and economic impact were collected, with a three-month follow-up. Results Darn repair showed fewer postoperative complications, particularly lower surgical site infections (SSI) (8% vs. 20%, P = 0.014). It also had shorter operative times (mean 30 minutes less), reduced hospital stays (1.5 vs. 2.8 days, P < 0.0001), and lower costs. Recurrence rates were comparable across both groups. Conclusion While both methods yielded similar recurrence rates, Darn repair showed advantages in resource-limited settings, with fewer complications, shorter hospital stays, and lower costs, making it a practical option when mesh is not readily available. Limitations include retrospective design, convenience sampling, and possible recall bias from phone follow-ups. The three-month follow-up may not capture long-term outcomes like chronic pain or late recurrences. Future studies should extend follow-ups and conduct prospective trials to optimize Darn repair across diverse settings

Background Dengue fever is a common viral illness in tropical and subtropical regions, typically presenting with fever, myalgia, and hemorrhagic symptoms. While neurological complications are rare, Guillain-Barré Syndrome (GBS) is a known but uncommon sequelae of viral infections, including dengue. Case presentation We report the case of a previously healthy 32-year-old male who developed acute flaccid paralysis secondary to GBS following a dengue fever infection. The patient initially presented with classic dengue symptoms—fever, severe headache, retro-orbital pain, and myalgia. Following resolution of the acute dengue phase, he developed ascending muscle weakness, areflexia, and numbness in both legs. Electromyography confirmed a diagnosis of GBS, and cerebrospinal fluid analysis revealed albuminocytologic dissociation. The patient was treated with intravenous immunoglobulin (IVIG), leading to significant clinical improvement, with gradual recovery of motor function. Discussion This case highlights the rare but significant neurological complication of GBS following dengue fever. Clinicians should maintain a high index of suspicion for GBS in patients recovering from dengue, especially in endemic regions. Early diagnosis and treatment with IVIG or plasmapheresis are critical for improving outcomes in these patients. Conclusion Dengue fever can lead to severe neurological sequelae such as GBS, and early recognition and intervention can prevent long-term disability. This case underscores the need for vigilance in identifying such complications in patients recovering from viral infections.

Introduction Inborn errors of immunity (IEI) are disorders that present a health issue, especially in developing countries where there is a high rate of consanguineous marriages and an increasing rate of diagnosis. One of these disorders is Bare Lymphocyte Syndrome II (BLS II) which is a rare and genetically complex disease that has high morbidity and mortality. The exact genotypic and phenotypic characteristics are still poorly characterized especially in developing countries. Case Presentation Here, we report the first case of BLS II in a seven-month-old Sudanese female with recurrent chest infections, dermatitis, persistent diarrhea, and failure to thrive. The patient’s all four sisters and three paternal uncles died in early infancy. Laboratory investigations revealed low CD3+, CD4+, and CD8+ lymphocytes, along with normal CD19+ and CD16+ lymphocytes, and low serum IgM and IgA levels. Genetic analysis revealed two CIITA variants; c.2296C >G p. (Pro766Ala) and c.439+1G >A. Conclusion Further bioinformatics, immunological and clinical workups supported a pathogenic effect of both mutations affecting the function of CIITA protein, and suggesting a compound heterozygote mutation. The patient was started on prophylactic antibiotics and regular intravenous immunoglobulin replacement therapy. The prognosis of this disease is poor in most of the cases, with only a few reported cases surviving until adulthood.

Agitated depression, also known as melancholia agitata, is a variant of depression characterized by severe symptoms of psychomotor agitation, inner unrest, anxiety, restlessness, prominent vegetative symptoms, and a high risk of suicide. This form of depression is reported to worsen with antidepressants and potentially improve with the use of ECT, lithium, antiepileptics, antipsychotics, and benzodiazepines. We describe a case of a 73-year-old female with a prior history of depression and generalized anxiety disorder who was maintained on flurazepam for 44 years and was admitted for severe depression with psychomotor agitation, prominent vegetative symptoms, thought perseveration, indecisiveness, and psychotic features that emerged following the discontinuation of flurazepam. Symptoms did not resolve with the use of alternative benzodiazepines such as nitrazepam and temazepam and further worsened with the use of several antidepressants. She finally had a complete resolution of these symptoms with a combination of alprazolam, zopiclone, and olanzapine. This case provides insight into this unique variant of depression and the role of GABA agonists in its pathology and management.

Introduction A class of disorders known as inborn errors of immunity (IEI) is defined by a compromised or missing immune response, which increases the vulnerability to infections, immunological dysregulation, and cancer. Severe combined immunodeficiencies (SCIDs), affecting both T and B-cell function are rare but often severe diseases. In this report, we describe a 10-month-old SCID patient from Sudan with disseminated BCG infection. Case Presentation A 10-month-old boy whose parents were first degree relatives, presented with a six-month history of repeated chest infections and fever. Physical examination revealed a very ill-looking boy with respiratory distress dependent on oxygen, had slight abdominal distention and hepatomegaly. Investigations revealed positive polymerase chain reaction (PCR) for M. tuberculosis complex infection and low CD4+ and CD8+ cells. Genetic testing showed compound heterozygosity in trans for two variants in the Zeta-chain Associated Protein Kinase 70 (ZAP70) gene associated with autosomal recessive SCID. The patient was started on BCG-related infection treatment, intravenous immunoglobulin (IVIG) replacement and trimethoprim/sulfamethoxazole prophylaxis with an excellent response and the patient responded well to the treatment. Conclusion SCIDs are rare, and early management is crucial. In this case, a diagnosis of ZAP70 deficiency was based on next-generation sequencing and inhouse bioinformatic computational analysis of the ZAP70 gene, highlighting the importance of genetic testing in the workup of immunodeficiencies in low resource settings.

Background The perception of teledentistry use among dental practitioners in various contexts was assessed using the Teledentistry Survey (the TDS-24). However, this survey’s psychometric analyses have not yet been analysed. This present study aims to examine the validity and reliability of the TDS-24 in a sample of dental practitioners in Saudi Arabia. Methods A self-administered questionnaire, including sociodemographic characteristics and the TDS, was distributed as a cross-sectional survey to 800 current dental practitioners in Saudi Arabia recruited via convenience and snowball sampling. The construct validity and reliability of the TDS were assessed using exploratory factor analysis (EFA) and Cronbach’s alpha. Results The EFA of the survey yielded 20 items supporting a four-factor structure as follows: factor I (10 items), factor II (four items), factor III (three items) and factor IV (three items). The overall Cronbach’s alpha was 0.85, while it was 0.86 for the first factor, 0.70 for the second factor, 0.52 for the third factor and 0.57 for the fourth factor. Conclusions The TDS-20, after excluding four items, revealed four factors with adequate psychometric properties, making it a valid and reliable tool in assessing teledentistry perceptions among dental practitioners in this study sample.

This case report describes the presentation, diagnosis, and surgical management of a rare vesical ectopic pregnancy in a 36‐year‐old woman with a history of multiple cesarean sections. The patient presented with symptoms of suprapubic pain, fever, and amenorrhea. An initial ultrasound indicated retained products of conception, leading to a preliminary diagnosis of septic miscarriage. However, subsequent rescanning revealed an empty uterus and a non‐viable fetus within the bladder, connected to the uterine cavity. Cystoscopy confirmed the presence of fetal parts inside the bladder. Finally, a laparotomy was performed and the fetus was removed from the bladder with repair of the underlying uterovesical fistula. An uneventful postoperative period ensued. The literature review revealed only four previously reported cases with similar overall presentations. This case highlights the importance of considering vesical ectopic pregnancies in patients with a history of cesarean sections and unusual symptoms, as prompt surgical intervention is crucial for ensuring successful management of the condition.

Online case‐based learning (CBL) is a method used by King Abdulaziz University to teach medical students in their preclinical years. The use of CBL in basic sciences is important for enabling medical students to correlate basic sciences with future clinical practice. This study implemented online CBL for biochemistry teaching as part of the medical genetic module for 3rd‐year preclinical students. Teaching during the study was completely online because of restricted precautions caused by the COVID‐19 pandemic, except for practical sessions that were held on campus. The case was presented to the students involved in prenatal screening and diagnosis. Students were guided to learn and discuss the biochemical tests used for prenatal screening and diagnosis and their clinical importance. They were divided into two groups: the control group was given an online lecture and the intervention group was given an online CBL session before the lecture. The online lecture was given to both groups simultaneously by the same instructor, and then 10 MCQs tests were distributed to both groups after the lecture, and their test scores were compared. A 10‐question survey was administered to the intervention group to assess their perception of the online CBL session after the test. A significant difference was found between the intervention and control groups regarding test scores ( p < 0.001), and most students found the online CBL session enjoyable and motivating.