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Sudan’s healthcare system has been severely disrupted by the ongoing humanitarian crisis, limiting access to essential services and medications. Understanding health-seeking behaviors during such disruptions is critical to informing culturally appropriate public health responses, particularly regarding traditional medicine use. This study aimed to assessPatterns of Herbal Medicine Utilization for Hypertension During the Sudanese Crisis of 2025. This cross-sectional study was conducted from February to June 2025 among adults with physician-diagnosed hypertension who were prescribed antihypertensive medication at diagnosis. Data were collected using a structured validated questionnaire administered face-to-face using Kobo Toolbox. Convenience sampling yielded 749 valid responses. Data were analyzed using SPSS v27, with statistical significance set at p  < 0.05. The mean age was(56.8 ± 11.9) years; (54.1%) were female, (29.8%) were displaced and (50.5%) reported difficulty accessing antihypertensive medications. Herbal medicine use was reported by (91.2%); 65.2% used herbs before and during the crisis, and (19.8%) initiated use after the crisis began. Concurrent use of herb-drug use was reported by (71.7%), while adverse effects were uncommon(5.7%), and mostly mild. Lower income and rural residence were significantly associated with herbal use ( p  < 0.05). Herbal medicine use was wide spread among hypertensive Sudanese adults during the crisis, largely driven by affordability, accessibility challenges, and cultural familiarity. Given the high rate of concurrent use, public health messaging and clinician training on herb–drug safety should be prioritized.

Introduction Surgical site infections (SSI) represent a significant burden on patients and healthcare systems particularly in low-income countries with limited resources. This study aimed to assess the knowledge and counselling practices of medical personnel regarding the prevention of SSI in Sudan. Methods A cross-sectional hospital-based study was conducted. from June to December 2024. The target population included medical personnel involved in the surgical care in Sudan (surgeons, medical officers, house officers, final year medical students, operating room nurses, and ward nurses). Personnel not directly involved in surgical care were excluded. A structured, self-administered questionnaire was used to assess participants’ knowledge of SSI signs/symptoms, risk factors, and preventive techniques, as well as their counselling practices and perceived challenges to implementing SSI prevention strategies. Results The study included 403 participants. The majority (72%) correctly identified hand hygiene as a crucial preventive practice. However, a significant proportion (62.5%) incorrectly believed that routine preoperative shaving is recommended, indicating a common misconception. While (70.2%) correctly recognized antibiotic prophylaxis as important for reducing bacterial load, knowledge regarding its appropriate duration was variable. Only (37.2%) reported always providing preoperative counselling. Key challenges identified included limited resources, lack of updated guidelines and inadequate training. Conclusion Despite adequate awareness of certain preventive strategies, significant gaps in knowledge and inconsistent counselling practices persist. Education and training, the provision of up-to-date guidelines and ensuring resources availability are crucial interventions to reduce SSIs rates and improve surgical outcomes in Sudan.

IntroductionAccess to medications for chronic diseases is a major component of effective disease management, particularly in conflict-affected areas. The armed conflict ongoing since April 2023 in Sudan has caused destruction to health infrastructures and thus severely disrupted medication supplies. This study aimed to assess effect of war in Sudan on the medication’s accessibility.MethodsA descriptive cross-sectional community-based study was conducted during the period from July to December 2024. Total of 1000 Sudanese patients in conflict-affected areas were surveyed using a pre coded and pretested structured questionnaire. The questionnaire was designed for this study in Arabic for easy understanding by the targeted population. Pilot study was done first, and the questionnaire was modified accordingly. All data was summarized in frequency tables. Chi square and binary logistic regression tests were done to assess the association between demographic characteristics of the participants and medications accessibility. p value less than 0.05 was considered statistically significant.ResultsMore than half of the surveyed participants (59.7%) reported difficulty accessing medications. As a result, many sought alternatives through private healthcare facilities (35.0%) or local pharmacies (51.5%). The most common chronic conditions among respondents were diabetes (48.5%) and hypertension (33.3%). Inaccessibility to medications led to several adverse outcomes, including psychological distress (19.9%), worsening of symptoms (32.0%), increased hospital visits (16.3%), and reduced ability to work (24.8%). Some individuals resorted to traditional or herbal remedies (22.2%) or reduced their medication doses (12.0%) due to the lack of access. A significant association was found between medication inaccessibility and both the duration of displacement and monthly income (p < 0.001). Reported barriers to accessing medications included high costs (34.0%), low income (26.7%), insecurity (42.5%), and displacement-related challenges (29.9%).ConclusionThis study reveals that Sudan’s conflict has severely disrupted access to chronic disease medications due to widespread healthcare collapse, facility closures, and supply chain breakdowns. Both displaced and non-displaced populations face major barriers, worsened by economic hardship and the halt in local drug production. Heavy reliance on herbal remedies reflects medication scarcity. Immediate global intervention is essential to restore care and prevent further health deterioration.

Refractory status epilepticus (RSE) is defined as prolonged or repeated seizures without recovery despite the initiation of at least two anti-seizure medications (ASMs). It is a neurological emergency, with potentially devasting short term consequences and significant risk of longer-term morbidity.Tocilizumab is a humanized monoclonal antibody against the IL-6 receptor, used primarily for rheumatological conditions and cytokine-release syndrome. It is thought to promote an anti-seizure effect for patients with status epilepticus via downregulation of IL-6, a component of the acute phase response. Tocilizumab has been successful in treating new onset refractory status epilepticus (NORSE) that has been refractory to other treatments, including rituximab, though has been associated with significant adverse events.We present five cases of RSE, including two with a pre-existing history of seizures. Toclizumab administered within 18 days of presentation (8mg/kg, second dose after 4 weeks) terminated status in four cases, longer term outcomes varied depending on the underlying aetiology.All patients were received steroids and a minimum of five ASMs in the context of sedation pre-Toclizumab. Plasma exchange had been given in four cases.There is a potential role for Toclizumab in the early treatment of RSE.asha.patel1@nhs.net

Introduction The ongoing armed conflict in Sudan that started April 2023 resulted in over 8 millions internally displaced persons (IDPs), in addition to the already previously displaced 3.8 millions. Post-traumatic stress disorder (PTSD) is one of the most documented mental health problems among IDPs. Additionally, factors such as personal safety concerns and financial losses have been identified as potential stressors contributing to the development of PTSD. Our study aimed to understand the relationship between displacement-related stressors and trauma symptom severity. Methods This was an observational, multi-center cross-sectional study conducted across seven conflict-free states in Sudan. A pre-tested questionnaire assessing the displacement stressors and the Harvard trauma questionnaire (HTQ) were used to collect the data through face-to-face interviews. The data analysis was conducted using R software. A structural equation model was generated to visualize the comprehensive relationship between the study variables. Results Most of the participants ( N  = 1470) were females (81.4%), married (63.9%), employed (42.5%), Muslims (93.0%) and previously displaced (54.1%), with a mean age of (35.25 ± 13.92) years old. The prevalence of PTSD was (34.5%) and it was significantly associated with gender ( P  = 0.003), religion ( P  < 0.001), level of education ( P  = 0.031), and number of displacements ( P  = 0.005). Personal safety concerns, financial loss and hardship, and personal hardships were positively correlated with PTSD symptoms severity. War exposure losses were negatively correlated with the severity of PTSD symptoms. Conclusion The strong association between PTSD symptoms and personal safety concerns, financial loss and hardship, and personal hardships emphasizes the urgent need for targeted mental health interventions that could mitigate the impact of PTSD in Sudanese communities.

Background Hepatitis C virus (HCV) is a global public health problem, with ~ 11 million people in Africa infected. There is incomplete information on HCV in Sudan, particularly in haemodialysis patients, who have a higher prevalence compared to the general population. Thus, our objectives were to genotype and molecularly characterize HCV isolated from end-stage renal disease haemodialysis patients. Methods A total of 541 patients were recruited from eight haemodialysis centres in Khartoum and screened for anti-HCV. Viral loads were determined using in-house real-time PCR in seropositive patients. HCV was genotyped and subtyped using sequencing of amplicons of 5′ untranslated (UTR) and non-structural protein 5B (NS5B) regions, followed by phylogenetic analysis of corresponding sequences. Results The HCV seroprevalence in the study was 17% (93/541), with HCV RNA-positive viremic rate of 7% (40/541). A low HCV load, with a mean of 2.85 × 10 4  IU/ml and a range of 2.95 × 10 3 to 4.78 × 10 6  IU/ml, was detected. Phylogenetic analyses showed the presence of genotypes 1, 3, 4, and 5 with subtypes 1a, 1b, 1 g, 3a, 4a, 4 l, 4 m, 4 s, and 4t. Sequences of HCV from the same haemodialysis units, clustered in similar genotypes and subtypes intimating nosocomial infection. Conclusion HCV infection is highly prevalent in haemodialysis patients from Sudan, with phylogenetic analysis intimating nosocomial infection. HCV genotyping is useful to locate potential transmission chains and to enable individualized treatment using highly effective direct-acting antivirals (DAAs).

Background. Poor access to diagnosis stymies control of visceral leishmaniasis (VL). Antibody-detecting rapid diagnostic tests (RDTs) can be performed in peripheral health settings. However, there are many brands available and published reports of variable accuracy. Methods. Commercial VL RDTs containing bound rK39 or rKE16 antigen were evaluated using archived human sera from confirmed VL cases (n = 750) and endemic non-VL controls (n = 754) in the Indian subcontinent (ISC), Brazil, and East Africa to assess sensitivity and specificity with 95% confidence intervals. A subset of RDTs were also evaluated after 60 days' heat incubation (37°C, 45°C). Interlot and interobserver variability was assessed. Results. All test brands performed well against ISC panels (sensitivity range, 92.8%–100%; specificity range, 96%–100%); however, sensitivity was lower against Brazil and East African panels (61.5%–91% -and 36.8%–87.2%, respectively). Specificity was consistently >95% in Brazil and ranged between 90.8% and 98% in East Africa. Performance of some products was adversely affected by high temperatures. Agreement between lots and readers was good to excellent (κ > 0.73–0.99). Conclusions. Diagnostic accuracy of VL RDTs varies between the major endemic regions. Many tests performed well and showed good heat stability in the ISC; however, reduced sensitivity against Brazilian and East African panels suggests that in these regions, used alone, several RDTs are inadequate for excluding a VL diagnosis. More research is needed to assess ease of use and to compare performance using whole blood instead of serum and in patients coinfected with human immunodeficiency virus.

The aim of this research is to assess sustainable green building awareness in Kano State, in a case study of the Gwale local government area. This research makes use of both primary and secondary data to address these offered solutions. Descriptive and quantitative analysis using the BREAM and LEAD evaluation standards was used to analyze the case study and 251 questionnaires were distributed. To ensure a fair trial of each of the 251 building samples, they were chosen at random from various parts of the Gwale Yan-Alawa ward. A case study of a selected green building was chosen and analyzed. The logical comparison with Saudi Arabia was made. It is concluded that the Nigerian government at the national level should put more effort into encouraging green building construction through public awareness programs and incentives and subsidizing the green system.

Heart failure (HF) remains a global health challenge, necessitating improved risk stratification tools. This systematic review evaluates the combined role of epicardial fat thickness (EFT) and B-type natriuretic peptide (BNP)/N-terminal pro B-type natriuretic peptide (NT-proBNP) in HF risk stratification, examining their pathophysiological interplay and clinical utility across diverse populations, including a wide age range, various comorbidities (e.g., obesity, diabetes, and systemic sclerosis), and geographic regions. EFT, a measurable marker of epicardial adipose tissue (EAT) located between the myocardium and visceral pericardium, was evaluated alongside BNP/NT-proBNP, established biomarkers of cardiac stress. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, 12 case-control studies were included after screening 192 records from PubMed/MEDLINE, Embase, Scopus, Web of Science, and Cochrane Library. Studies assessed EFT and BNP/NT-proBNP in HF or at-risk populations. Methodological quality was appraised using the Newcastle-Ottawa Scale (NOS). EFT consistently correlated with elevated BNP/NT-proBNP, though patterns differed by HF phenotype. In HF with reduced ejection fraction (HFrEF), NT-proBNP associated more strongly with muscle loss than adiposity, while in HF with preserved ejection fraction (HFpEF), EFT was linked to metabolic comorbidities and inflammatory markers. Paradoxically, lower EFT predicted worse outcomes in nonischemic cardiomyopathy (NICMP), potentially reflecting disease-related fat depletion or cachexia; this finding underscores the need for phenotype-specific interpretation of EFT in risk stratification. Mechanistically, EAT contributed to myocardial remodeling via adipokine secretion and inflammatory signaling. Four studies had a low risk of bias (NOS ≥ 8), while one showed a high risk. The combined assessment of EFT and BNP/NT-proBNP offers complementary prognostic insights, EFT capturing subclinical inflammation and adiposity-related remodeling, while BNP/NT-proBNP reflects myocyte stress, potentially guiding personalized treatment decisions, including closer monitoring of HFpEF patients with elevated EFT and early nutritional or anti-inflammatory interventions in those with muscle loss and elevated NT-proBNP. Inclusion criteria encompassed adult populations with HF or related conditions, with exclusion of reviews, case reports, and non-English articles, supporting the methodological rigor of this synthesis. Standardized EFT measurement and targeted EAT-modulating therapies warrant further investigation.

Obesity is a global health crisis, with bariatric surgery considered a highly effective intervention for sustained weight loss and resolution of associated health conditions. Despite its benefits, some patients experience postoperative complications, emphasizing the importance of accurate risk prediction. Traditional models often lack the capacity to manage complex clinical data. Artificial intelligence (AI) offers transformative potential for improving the prediction of surgical complications. This systematic review synthesizes existing research on AI's role in forecasting complications following bariatric surgery. The review followed PRISMA 2020 guidelines, with searches conducted across PubMed, Scopus, Web of Science, and IEEE Xplore for studies examining AI applications in this context. Seven retrospective cohort studies were included, and data were extracted on study design, AI algorithms, and outcomes. Risk of bias was assessed using PROBAST, and a narrative synthesis was conducted due to study heterogeneity. The included studies showed variability in AI model performance, with ensemble methods and neural networks generally performing better than traditional logistic regression. Reported area under the curve (AUC) values varied widely, with higher accuracy noted for predicting specific complications such as diabetes and leaks. Key challenges included overfitting, data imbalance, and limited generalizability, especially in deep learning models. Most studies were conducted in Sweden and the United States, utilizing large datasets that may introduce regional biases. Overall, AI shows promise in enhancing complication prediction in bariatric surgery, though methodological limitations highlight the need for prospective, multicenter validation. Future research should focus on addressing data imbalance, refining feature selection, and facilitating the clinical integration of AI through decision-support systems to improve patient care.