South Sudan Medical Journal

No smoke without fire: Recreational cannabis use among South Sudanese youth

2024-05-22T07:11:47+00:00

No abstract.

Reflections on a clinical observership in London: Lessons and impact on medical training

2024-05-22T07:34:11+00:00

No abstract.

Ischaemic strokes and myocardial infarctions in a young male cannabis user

2024-05-22T07:20:48+00:00

Ischaemic cerebral infarctions are seen in young people but, under the age of 30, multiple bilateral infarcts are uncommon; genetic pre-disposition and co-morbidities often underlie them. There is growing awareness of the potential impact of modifiable risk factors, such as cannabis, for those experiencing stroke and other cardiovascular events. A case of a 29-year-old man is described who presented with sudden onset occipital headache and right eye vision loss. Computerised axial tomographic scanning (CT) of the brain demonstrated multifocal bilateral areas of low attenuation. A brain magnetic resonance imaging (MRI), confirmed bilateral acute cerebral infarctions. In view of a significant elevation in troponin levels at a previous admission, cardiac viability magnetic resonance imaging (cvMRI) was carried out and demonstrated acute infarction affecting the left ventricular apex and multiple smaller infarcts elsewhere within the myocardium. On this occasion he did not complain of chest pain. The electrocardiogram (ECG) showed ischaemic changes. The patient denied a family history of ischaemic heart disease, diabetes mellitus, hypertension and hypercholesterolaemia, but admitted to daily use of cannabis and cigarette smoking. We considered the regular use of cannabis as a possible aetiology in the development of multi-territory cerebral and myocardial infarcts, previous myopericarditis and left ventricular dysfunction

A haemopneumothorax revealing thoracic endometriosis

2024-05-22T07:22:56+00:00

Thoracic endometriosis is a rare disease but its actual frequency may be underestimated. Optimal management remains controversial. A multidisciplinary management approach, including surgery and hormone therapy, seems to give the best results and reduces recurrence. We report a case of a patient presenting with recurrent haemopneumothorax caused by thoracic endometriosis and treated surgically by video thoracoscopy and hormonal treatment.

A giant primary ovarian fibrosarcoma in a South Sudanese patient

2024-05-22T07:25:50+00:00

Ovarian fibrosarcomas account for less than 1% of all ovarian malignancies. Clinical diagnosis is extremely difficult. A 20-year-old, illiterate, married nulliparous woman presented to our Outpatient Department Clinic (OPD) with chronic abdominal distension. Ultrasound and CT scan revealed a very large intra-abdominal mass, 23.8x27.8x35.7cm. She underwent a laparotomy and left salpingo-oophorectomy with her uterus and right adenexum conserved. After surgery, the mass weighed 11.1kg and measured 43x38x35cm. Histological findings were in line with a giant primary ovarian fibrosarcoma. To date, as far as we are aware, this is the largest ever recorded primary ovarian fibrosarcoma.

Endoscopically diagnosed hookworm infestation in an adult with chronic iron deficiency anaemia

2024-05-22T07:30:17+00:00

Despite advances in hookworm control and prevention campaigns, the prevalence remains high in sub-Saharan Africa. Iron deficiency anaemia is a major complication in those with prolonged infection, a high hookworm burden, and undernutrition, though most infected people are asymptomatic. While infected patients are commonly diagnosed by the presence of ova or cysts in the stool, gastrointestinal (GI) endoscopy is required for those with negative stool tests and chronic iron deficiency anaemia. A 48-year-old female with symptoms of anaemia for nearly two years presented to Mbarara Regional Referral Hospital with worsening palpitations, easy fatigability, and dizziness over a period of one month. She was given blood transfusions on two occasions. She lives near the lake where she also gets water for drinking and domestic use. We advise GI endoscopy for all patients with chronic iron deficiency anaemia of unexplained aetiology on standard non-invasive testing. Hookworm’s mass empirical treatment policy in endemic areas should be further emphasised.

Inadequacy of a 12.5 cm MUAC as a cutoff for malnutrition for children aged three to five years

2024-05-22T07:13:16+00:00

Introduction: MUAC (mid-upper arm circumference) is a simple and easily taught screening tool for identifying malnutrition in children. South Sudan use a MUAC of 12.5 cm for children aged between six months and five years as a cut-off for moderate acute malnutrition. Currently, in South Sudan, children from six months to five years have the same MUAC cutoff for malnutrition.

Method: This study evaluated the sensitivity of using a MUAC of 12.5 cm as a screening tool for children between 6 and 60 months applied to data obtained from children enrolled in urban and rural primary schools in Maridi County, South Sudan. We used the 12.5 cm cutoff which was 2 standard deviations from the median for boys at nine months and for girls at 20 months. We also used 14.0 cm as the cutoff and compared the number of children identified, and also the false positive rate, assuming -2 SD from the median to be the accepted norm for malnutrition. Finally, we considered two different standards, using 14.0 cm for children aged 3-5 years and 12.5 cm for children under three years.

Results: Comparing the results obtained using the two different MUAC standards (12.5 cm versus 14.0 cm) against a single MUAC standard there is a dramatic difference in outcome. Using the current standard (12.5 cm), only 7.3% of the children were found to be malnourished. Using 14.0 cm, 33.8 % were found to be malnourished (Table 4). If we accept the norm of 2 SD below the median for age as an adequate definition of malnutrition, the false positive rate using 14.0 cm is 9.6 %, an acceptable figure for a screening device, but the false negative rate for 12.5 cm is 17.4 %, a clearly unacceptable rate for a screening device. If, however, instead of using one cut-off for children from six months to five years, a period characterized normally by rapid growth and changes in body composition, we used two different standards—12.5 cm for those under three years and 14 cm for those aged 3-5 years, the number of false positives drops down to 2.7% and false negatives to 0.9 %

Conclusion: We suggest that the use of 12.5 cm for malnourished children is inappropriate above two years, that 14 cm would be a more appropriate screening measurement from 3-5 years of age.

Prevalence and associated factors of family planning among students of health training institutes in Juba: A cross sectional descriptive study

2024-05-22T07:15:16+00:00

Introduction: Family planning (FP) is less prevalent in South Sudan yet information on the subject is scarce and varied from one source to another. This study assessed the prevalence and associated factors in family planning among students at health science training institutes in Juba City.

Method: This was a cross-sectional survey of students’ self-reported utilisation of FP methods. Four hundred randomly selected students from five health training institutes (HTIs) in Juba City participated. Data collection was done using a pretested structured questionnaire. IBM SPSS 23 software was used for data analysis. Chi squared tests and regression analyses were performed to determine the associated factors.

Results: Among the 400 participants, the lifetime prevalence of FP methods was 77.3%, of which modern contraceptive use was 22%. FP was more prevalent among participants aged 45-50 (85.7%) and females (80.7%). Eighty-seven percent of divorced couples and 91.3% of traditional believers reported practicing FP. More nursing/midwifery cadres within the professional category reported practicing FP, as well as 90.4% of rural respondents. Eighty-three percent of respondents working in pharmacies said they practice FP, compared to 68.1% of those working in clinics. FP practice was similar among participants who were aware (78.9%) and those who denied being aware (72.5%). Marital status (p < 0.001), religion (p < 0.001), residence (p < 0.001), and place of work (p = 0.037) were significantly associated with FP.

Conclusion: The prevalence of family planning among students at Health Training Institutes in Juba City is high compared to national estimates, but the contraceptive overall prevalence rate is still low. It is significantly associated with marital status, religion, residence, and place of work. There is a need to continue the effort.