This article reported a case of intestinal tuberculosis (ITB)in a young patient. ITB could mimic many other diseases such as inflammatory bowel diseases (Crohn’s disease), abdominal lymphoma, and others which make it difficult to differentiate; hence, many ITB patients could get mis‐diagnosed and suffer wrong treatment consequences.

Background: As of December 2021, the World Health Organization (WHO) reports that Coronavirus disease 2019 (COVID-19) led to about 5,403,662 deaths. While COVID-19 has resulted in millions of deaths worldwide to date, vaccination remains the mainstay of infection control. AZD1222 (AstraZeneca vaccine) was distributed in Sudan by the COVID-19 Vaccines Global Access facility in March 2021. It was added to the emergency use list by WHO in the middle of February 2021. However, vaccine safety among patients with autoimmune diseases, such as myasthenia gravis (MG), is yet to be established. MG is a relatively rare illness that could result in life-threatening complications. Myasthenic crisis is considered the most serious complication of MG that can lead to death due to aspiration and respiratory failure. Plasma exchange (PLEX), Immunoadsorption (IA), and intravenous Immunoglobulin (IVIG) are the first-line treatment for myasthenic crisis. It is proven that cortisone has a positive effect when used as add-on therapy with PLEX/IA and IVIG.   The case: We report the case of a 37-year-old Sudanese female who presented to the emergency room with an exacerbation of her previously well-controlled MG following her second dose of AZD1222 vaccination. The exacerbation symptoms at time of presentation were severe generalized body weakness that increasing overtime and shortness of breath. Computerized tomography of the chest was performed, and it revealed no evidence of COVID-19. Management at the ER started with rehydration and IV methylprednisolone 1g, followed by IV hydrocortisone 200mg. She continued to deteriorate and was admitted to the intensive care unit where she was intubated and placed on a mechanical ventilator. IVIG was requested but couldn't be obtained due to the low-income setting, and fourteen days after admission patient died due to circulatory collapse. Our study aims to present an MG case with features of MG exacerbation following the administration of the second dose of AZD1222.   Conclusion: Little is known about the effect of different COVID-19 vaccines on subgroups of patients with autoimmune diseases like MG. Although the safety profile of AZD1222 is generally reassuring, people with severe underlying diseases were excluded from trials. Therefore, more efforts and experimental studies may be needed, with closer vigilance in MG patients. It has not been elucidated how the COVID-19 vaccine might provoke autoimmunity, but several theories have been proposed. Molecular mimicry theory can explain how the genetic material of a virus could provoke autoimmunity, it describes the cross-reactivity of antibodies produced against proteins that are encoded by viral genetic material with the proteins located at the post-synaptic membrane. There is a debate about whether vaccine benefit outweighs the risk in MG patients or not. However, we believed that MG patients should be informed about the benefit and risks of COVID-19 vaccination.

Background The impact of cancer extends beyond patients and consumes their families. Family members are widely recognized as informal caregivers. The economic burden on family caregivers is increased with new treatments, prolonged survival, and reduced stay in the acute care setting. This is especially true in African countries where family bonds are sacred and health system is fragile that they need to pay out of pocket for care. The aim of this study is to estimate the perceived caregivers’ economic burden in the subsequent aspects: financial strain, inability to make ends meet, not enough money for necessities, and economic adjustments/cutbacks. Method This study was a quantitative, descriptive cross-sectional study conducted at Khartoum oncology hospital. Included 143 caregivers of cancer patients. Data were collected through face-to-face interviews using the socio-demographic Questionnaire and Economic Hardship Questionnaire (EHQ). Results One hundred forty-three cancer patients and their caregivers were included. 56.6% of patients were females, and about 32.2% were aged 51–65 years. The most common cancer types were breast cancer and leukemia. Roughly 33% of patients had stage IV cancer on presentation, and about 53.9% received chemotherapy. Unlike cancer patients, (47.6%) of family caregivers were aged 18–34 years, yet they were mainly females (54.4%). Most of them (34.3%) were unemployed, with a mean monthly gross income of 53.3 dollars, while the mean household monthly gross income was 113.0 dollars. The mean score of the economic hardship scale was 35.8 out of 64. Most of the caregivers experience no difficulties affording necessities. However, they experience difficulties with medical and leisure activities. There was no significant association between caregiver economic hardship and cancer patient characteristics (patients' age, cancer stage, and treatment type). However, there was a significant association between caregivers' economic hardships and their gender, marital status, educational level, occupation, caregiver monthly gross income, and household monthly gross income. Conclusion The study findings suggest a moderate financial burden among cancer caregivers. The predicting factors include being single, a student, male, of higher educational level, and lower income. Financial difficulties are associated with maladaptive behavior and should come to light.

Background: Vaccination remains the mainstay of strategy for prevention of Coronavirus Disease-2019 (COVID-19). AZD1222 (AstraZeneca vaccine) was distributed in Sudan by the COVID-19 Vaccines Global Access facility in March 2021. It was added to the emergency use list by the WHO in mid-February 2021. However, vaccine safety among patients with autoimmune diseases, such as myasthenia gravis (MG), is yet to be established. MG is a relatively rare illness that could result in life-threatening complications. Myasthenic crisis is considered the most serious complication of MG that can lead to death due to aspiration and respiratory failure. The case: We report the case of a 37-year-old Sudanese female who presented to the emergency room with an exacerbation of her normally well-controlled MG following her second dose of AZD1222 vaccination. She continued to deteriorate and was admitted to the intensive care unit, where she was intubated and placed on a mechanical ventilator. The low-income setting was a major barrier in obtaining intravenous immunoglobulin until the patient died. Our study aims to present an MG case with features of MG exacerbation following administration of a second dose of AZD1222. Conclusion: Little is known about the effect of different COVID-19 vaccines on subgroups of patients with autoimmune diseases like MG. In our case, an exacerbation of MG may have been precipitated by the COVID-19 AstraZeneca vaccine. Therefore, more efforts and experimental studies may be needed, with closer vigilance in MG patients

Background Rheumatic heart disease (RHD) is a major and preventable cause of cardiac mortality in Sudan, particularly in Kordofan. It can be detected early with a handheld echocardiography machine. Methods A cross-sectional study was conducted in South Kordofan State, Sudan (as part of a medical convoy organized by Khartoum Medical Students Association). A team of shortly trained medical students and newly graduated doctors conducted a handheld echocardiographic screening using a simplified protocol. All suspected cases were recorded and reviewed later by a senior pediatric cardiologist. Demographic and clinical features of screened subjects were studied. Data analysis was performed using the Statistical Package for Services and Solutions (SPSS 25). Descriptive statistics were presented as “number (%)” or “mean ± SD”. RHD prevalence was expressed as cases per 1000, and Chi-Square test/Fisher’s Exact test was used to compare RHD findings between different groups. Results The disease frequency was found to be 50 per 1000. Out of 452 screened subjects (age 10-25 years), 23 were found to have RHD with a male to female ratio of 1:1.5. Echocardiographic quality was acceptable in 93% of studies. The disease was mild in 70% and moderate or involving 2 valves in 30% of patients. Patients were contacted, advised to start penicillin prophylaxis and referred to cardiologists. Risk factors for the disease included father's occupation and village of residence. Conclusion Shortly trained junior medicals can assist in RHD echocardiographic surveillance in remote areas. South Kordofan state is highly endemic for RHD and a control program needs to be implemented. Handheld echocardiography is of value for early detection and management.