Moawia Mohammed Ali Elhassan

The onset of the Sudanese military conflict on April 15, 2023, has had a profound impact on the healthcare infrastructure across the entire nation. While wars impact all individuals with non-communicable diseases, cancer patients are particularly vulnerable. The war has influenced the treatment of Sudanese cancer patients in many ways. It has disrupted and delayed the diagnostic process, suspended surgery, and all forms of cancer management such as radiotherapy, chemotherapy and palliative… عرض المزيد

The onset of the Sudanese military conflict on April 15, 2023, has had a profound impact on the healthcare infrastructure across the entire nation. While wars impact all individuals with non-communicable diseases, cancer patients are particularly vulnerable. The war has influenced the treatment of Sudanese cancer patients in many ways. It has disrupted and delayed the diagnostic process, suspended surgery, and all forms of cancer management such as radiotherapy, chemotherapy and palliative care. This unfortunate situation has likely worsened the outcomes for many Sudanese cancer patients. This editorial reflects the situation of cancer services in Sudan post conflict. عرض أقل

Abstract
Background
In Sudan, there is limited knowledge on the epidemiology, clinical characteristics and pathological patterns of thyroid cancer. To address this shortcoming, we studied the clinical, pathological and treatment patterns of thyroid cancer at the National Cancer Institute ‒ University of Gezira (NCI-UG), Sudan.

Methods
We performed a retrospective health facility–based study of patients with thyroid cancer who were treated at NCI–UG from January 2009 to December… عرض المزيد

Abstract
Background
In Sudan, there is limited knowledge on the epidemiology, clinical characteristics and pathological patterns of thyroid cancer. To address this shortcoming, we studied the clinical, pathological and treatment patterns of thyroid cancer at the National Cancer Institute ‒ University of Gezira (NCI-UG), Sudan.

Methods
We performed a retrospective health facility–based study of patients with thyroid cancer who were treated at NCI–UG from January 2009 to December 2017.

Results
A total of 139 patients with thyroid cancer were identified during the study period. Tumors were more common among women (69%). Goiter was the main presenting symptom (85%). The most common type of thyroid cancer was follicular carcinoma (41%), followed by papillary carcinoma (24%), then anaplastic carcinoma (20%). The mean age of the women was 56.3 years (SD ± 14.7), compared to 52.5 years (SD ± 16.6) for the men. The frequencies of stage I, II, III, and IV were 17%, 22%, 16%, and 45%, respectively. Different types of thyroidectomies were performed in 79% of the cases, lobectomy in 4%, and no surgery in 17%. Only 28% of the cases received radioactive iodine. Palliative chemotherapy and radiotherapy were prescribed to 17% and 37% of the cases, respectively.

Conclusion
Thyroid cancer is more prevalent among women and most patients present at later stages. The dominance of follicular type suggests that the majority of this population is iodine-deficient. عرض أقل

Colorectal cancer is the most common cancer in Saudi males and the second most common cancer in Saudi females with increasing incidence throughout the last four decades. Although the disease incidence is on the rise, still there is no systemic screening for colorectal cancer in the Saudi population. Early onset colorectal cancer is common in the Saudi population and up to 50% in Saudi patients diagnosed at late stages with regional and distal metastasis. Therefore, more efforts are required to… عرض المزيد

Colorectal cancer is the most common cancer in Saudi males and the second most common cancer in Saudi females with increasing incidence throughout the last four decades. Although the disease incidence is on the rise, still there is no systemic screening for colorectal cancer in the Saudi population. Early onset colorectal cancer is common in the Saudi population and up to 50% in Saudi patients diagnosed at late stages with regional and distal metastasis. Therefore, more efforts are required to control the disease in the Kingdom of Saudi Arabia. In this regard,  systematic work at national level is highly required to make  colorectal cancer screening for population at risk part of the routine primary health care activities. This paper highlights the current situation of colorectal cancer in the Kingdom of Saudi Arabia with relation to incidence, mortality and morbidity in addition to the disease control efforts going on. Finally, some recommendations are provided to strengthen the control program of colorectal cancer. عرض أقل

Head and neck cancers (HNCs) are prevalent in Sudan, but the reasons for this and the incidence of different types of HNCs are not well understood. A cross-sectional retrospective study was conducted to provide baseline data on the epidemiology of HNCs among patients treated at the National Cancer Institute (NCI) in central Sudan. All cancer cases from 2016 to 2020 were retrieved from the NCI records. Of the 9475 new cancer patients who were registered at the NCI during the study period, 1033… عرض المزيد

Head and neck cancers (HNCs) are prevalent in Sudan, but the reasons for this and the incidence of different types of HNCs are not well understood. A cross-sectional retrospective study was conducted to provide baseline data on the epidemiology of HNCs among patients treated at the National Cancer Institute (NCI) in central Sudan. All cancer cases from 2016 to 2020 were retrieved from the NCI records. Of the 9475 new cancer patients who were registered at the NCI during the study period, 1033 (11%) had HNCs, of whom 767 (74.2%) were adults. The mean age of the adult patients was 54.5 years (standard deviation 15.8) and 449 (58.5%) patients were male. The annual incidence in adults was 4/105 population. The most common HNC sites were the nasopharynx (25.3%), hypopharynx (22.8%), and oral cavity (22.2%). Carcinoma was the most common diagnosis (87.6%), followed by lymphoma (5.6%). Most patients’ tumors were at a locally advanced (22%) or metastatic stage (47%) of HNCs at the time of presentation. Further studies to identify risk factors for HNCs, particularly for the most prevalent types in central Sudan, are needed. In addition, Sudan requires capacity building for cancer, including a national cancer registry عرض أقل

Aim: This study aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality.

Methods Prospective cohort study in 109 institutions in 41 countries.

Inclusion criteria

children <18 years who were newly diagnosed with or undergoing active treatment for acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumour, glioma, osteosarcoma, Ewing… عرض المزيد

Aim: This study aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality.

Methods Prospective cohort study in 109 institutions in 41 countries.

Inclusion criteria

children <18 years who were newly diagnosed with or undergoing active treatment for acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumour, glioma, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, medulloblastoma and neuroblastoma. Of 2327 cases, 2118 patients were included in the study. The primary outcome measure was all-cause mortality at 30 days, 90 days and 12 months.

Results

All-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3-11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); p<0.001), lower middle income (OR 3.32 (95% CI 1.96 to 5.61); p<0.001) and upper middle income (OR 3.49 (95% CI 2.02 to 6.03); p<0.001) country status and chemotherapy (OR 0.55 (95% CI 0.36 to 0.86); p=0.008) and immunotherapy (OR 0.27 (95% CI 0.08 to 0.91); p=0.035) within 30 days from MDT plan. Multivariable analysis revealed laboratory-confirmed SARS-CoV-2 infection (OR 5.33 (95% CI 1.19 to 23.84); p=0.029) was associated with 30-day mortality.

Conclusions

Children with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer. عرض أقل

Objective
This study was undertaken to estimate the 5-year relapse free survival (RFS) rate and factors related to BC relapse in Sudanese women with non-metastatic BC.

Methods
Data of BC women with BC diagnosed and treated at the National Cancer Institute-University of Gezira during 2012 were retrieved from medical records. The cases were followed-up through hospital records and telephone contact. Survival functions were calculated using Kaplan-Meier method and compared by log-rank… عرض المزيد

Objective
This study was undertaken to estimate the 5-year relapse free survival (RFS) rate and factors related to BC relapse in Sudanese women with non-metastatic BC.

Methods
Data of BC women with BC diagnosed and treated at the National Cancer Institute-University of Gezira during 2012 were retrieved from medical records. The cases were followed-up through hospital records and telephone contact. Survival functions were calculated using Kaplan-Meier method and compared by log-rank test. The prognostic factors were tested using univariate and multivariable Cox regression analyses.

Results
We included 168 women with median age of 45 years (range, 22–83 years). 53.5%of women had stage III at time of diagnosis, whereas 4.2% and 42.3% of women presented with stage I and stage II, respectively. At the end of 5 years follow-up, with median follow-up period of 64 months, 94 (56.0%) women were alive in remission, 11 (6.5%) were alive with BC relapse, 49 (29.2%) were dead, and survival status was unknown in 14 (8.3%) women. Most of the occurred relapses were distant relapses. The 5-year RFS was 59%. The independent predictors of relapse were: larger primary tumor size (HR:1.84, 95% CI: 1.54-5.48, p=0.018); involved axillary lymph nodes with tumour (HR: 2.91, 95% CI: 1.53–7.91, p=0.001); not receiving adjuvant radiotherapy (HR: 2.2, 95% CI: 1.22–3.95, p=0.009); and not receiving hormone therapy (HR: 1.67, 95% CI: 1.01–2.76, p= 0.046).

Conclusion
We found a high risk of BC relapse in our resource-constrained settings. Advanced stages, not receiving adjuvant radiotherapy, and not receiving adjuvant hormone therapy were independent predictors associated with worse 5-year RFS. Therefore, enhancing the early diagnosis of BC and improving timely access to appropriate treatments represent key approaches to achieving better treatment outcomes. عرض أقل

Molecular pathology services for colorectal cancer (CRC) in Sudan represent a significant unmet clinical need. In a retrospective cohort study involving 50 patients diagnosed with CRC at three major medical settings in Sudan, we aimed to outline the introduction of a molecular genetic service for CRC in Sudan, and to explore the CRC molecular features and their relationship to patient survival and clinicopathological characteristics. Mismatch repair (MMR) and BRAF (V600E) mutation status were… عرض المزيد

Molecular pathology services for colorectal cancer (CRC) in Sudan represent a significant unmet clinical need. In a retrospective cohort study involving 50 patients diagnosed with CRC at three major medical settings in Sudan, we aimed to outline the introduction of a molecular genetic service for CRC in Sudan, and to explore the CRC molecular features and their relationship to patient survival and clinicopathological characteristics. Mismatch repair (MMR) and BRAF (V600E) mutation status were determined by immunohistochemistry. A mismatch repair deficient (dMMR) subtype was demonstrated in 16% of cases, and a presumptive Lynch Syndrome (LS) diagnosis was made in up to 14% of patients. dMMR CRC in Sudan is characterized by younger age at diagnosis and a higher incidence of right-sided tumours. We report a high mortality in Sudanese CRC patients, which correlates with advanced disease stage, and MMR status. Routine MMR immunohistochemistry (with sequential BRAF mutation analysis) is a feasible CRC prognostic and predictive molecular biomarker, as well as a screening tool for LS in low-middle-income countries (LMICs). عرض أقل

Abstract

Aim: Data on the adverse events of opioids for cancer-related pain in Sudanese patients are limited. We conducted this study to evaluate the pattern and severity of adverse events of immediate release morphine, and tramadol used in the treatment of cancer-related pain. A secondary aim was to determine the response rate to opioids for pain control in cancer patients treated at the National Cancer Institute-University of Gezira (NCI-UG), Sudan.
Methods: This descriptive… عرض المزيد

Abstract

Aim: Data on the adverse events of opioids for cancer-related pain in Sudanese patients are limited. We conducted this study to evaluate the pattern and severity of adverse events of immediate release morphine, and tramadol used in the treatment of cancer-related pain. A secondary aim was to determine the response rate to opioids for pain control in cancer patients treated at the National Cancer Institute-University of Gezira (NCI-UG), Sudan.
Methods: This descriptive cross-sectional study was conducted at NCI-UG between 12 March 2019 and 12 May 2019.
Results: 113 patients were screened in the study. Of these, three suffered from cognitive dysfunction and ten patients declined to participate in the study. Thus, 100 patients met the criteria for inclusion in this study. Breast cancer was the most frequent diagnosis (17%) followed by colorectal cancer (16%). The majority (91%) of patients had advanced or metastatic disease. The most frequently reported opioids-related adverse events were dry mouth (68%), constipation (61%), sedation (49%), nausea (31%) and vomiting (24%). Most of these symptoms were graded as mild to moderate and no patient had grade IV or V adverse events. Constipation and dry mouth were more frequent among patients received morphine compared to patients received tramadol (p value < 0.005). Pain was controlled in 36% of patients, improved in 53% and not controlled in 11% of them.
Conclusion: This study shows a high prevalence of opioids-related adverse events. The majority of the opioids-related adverse events were grade I or grade II. There seem to be differences in the prevalence of opioids-related adverse events between patients receiving tramadol and those treated with morphine. Moreover, suboptimal pain control adds to the burden on already limited health resources. Therefore, the adequacy of cancer pain management in our setting sh عرض أقل

Cancer is becoming a major health problem in the developing world and the number of cancer cases in Sub-Saharan Africa is rising. Being an African country, Sudan has its share of the cancer burden. Yet, the real data on cancer incidence, prevalence, and mortality in Sudan is unknown and hard to obtain because of the lack of a national population-based cancer registry. According to the Global Cancer Incidence, Mortality, and Prevalence 2020 estimates, breast and prostate are the most common type… عرض المزيد

Cancer is becoming a major health problem in the developing world and the number of cancer cases in Sub-Saharan Africa is rising. Being an African country, Sudan has its share of the cancer burden. Yet, the real data on cancer incidence, prevalence, and mortality in Sudan is unknown and hard to obtain because of the lack of a national population-based cancer registry. According to the Global Cancer Incidence, Mortality, and Prevalence 2020 estimates, breast and prostate are the most common type of cancer in Sudanese men and women, respectively. The incidence rate of lung cancer (the second most prevalent cancer globally) in Africa is low. Information about epidemiology, management, and survival of lung cancer are lacking in Sudan. In this article, we provide an up-to-date situational analysis of lung cancer in Sudan as an example of an African limited-resource setting. عرض أقل

Introduction:Sudan is the third largest country in Africa and has rich reserves of petroleum and other ground resources, but its per capita Gross Domestic Product is only $808 and researchers work in insufficient institutional facilities and with little funding. Previous studies about its scientific productivity have been limited to specific subjects and relatively short periods, with no large analyses until now.
Objective:To analyze the scientific output of Sudan in depth, considering all… عرض المزيد

Introduction:Sudan is the third largest country in Africa and has rich reserves of petroleum and other ground resources, but its per capita Gross Domestic Product is only $808 and researchers work in insufficient institutional facilities and with little funding. Previous studies about its scientific productivity have been limited to specific subjects and relatively short periods, with no large analyses until now.
Objective:To analyze the scientific output of Sudan in depth, considering all research areas and several decades of scientific activity.
Methods:We retrieved the documents with “Sudan” in field country in the Science Citation Index Expanded for the period 1900-2019.
Results:We retrieved over 9 000 publications and found that most were articles; that citation was higher for review articles and book chapters, and that this index mostly covered articles in English. Beginning in 1972, the number of publications in this database has increased rapidly. The citation lifespan indicates slow growth in the Sudanese scientific literature, and collaboration is frequent both nationally and internationally, possibly because the scarce resources make collaboration almost compulsory. Most external collaboration is done with Saudi Arabia but citation is higher for articles resulting from international megaprojects, led by Europe and the USA, in which Sudanese researchers play secondary roles. Research focusses on applied technological subjects with little innovation value. Women play a smaller role in Sudanese science.
Conclusions:Our recommendations for Sudanese science include increasing the number of women in leading research positions; providing funding directly to researchers (i.e., bypassing bureaucratic bodies); increasing basic research to avoid stagnation; training Sudanese researchers for leading positions; and identifying specific research areas where Sudan can lead in its region. عرض أقل

Abstract
Background
Aim: This study was undertaken to assess medical students’ perception towards implementing E-learning during COVID 19 Pandemic and to highlight for E-learning implementation in Sudan as an example of a limited-resource setting.
Methods: A cross-sectional survey was conducted between 10 and 25 of May 2020 among the undergraduate medical students at the Faculty of Medicine, University of Gezira, Sudan. The study used self-administered online-based questionnaire… عرض المزيد

Abstract
Background
Aim: This study was undertaken to assess medical students’ perception towards implementing E-learning during COVID 19 Pandemic and to highlight for E-learning implementation in Sudan as an example of a limited-resource setting.
Methods: A cross-sectional survey was conducted between 10 and 25 of May 2020 among the undergraduate medical students at the Faculty of Medicine, University of Gezira, Sudan. The study used self-administered online-based questionnaire. E-mail and social media platforms such as Facebook and WhatsApp were utilized to disseminate the questionnaire.
Results: The total numbers of 358 undergraduate medical students responded to the online survey questionnaire. The majority (87.7 %) of students agreed that the closure of the university is an essential decision to control the spread of the COVID-19 infection. Approximately two-thirds (64 %) of students perceived that E-learning is the best solution during COVID 19 lockdown. The level of medical students (Pre-clerkship and Clerkship) and place of residence had significant correlation (p-value < 0.05) with medical students opinion regards starting the E-learning. Internet bandwidth and connectivity limitation, unfamiliarity with E-learning system, technical support limitation and time flexibility in case of technical problems during online exams, and lack of face-to-face interaction were the factors considered by medical students to be against the E-learning implementation.
Conclusions: Most medical students had a positive perception of E-learning. However, there are many challenges considered as an inhibitory factor for utilizing electronic technologies for medical education. We recommend that challenges of E-learning in our limited-resource setting should be systematically evaluated and that effective strategies should be developed to overcome their inhibitory effects. عرض أقل

PURPOSE
Breast cancer (BC) is the leading malignancy among Sudanese women. Yet, data on survival are limited. This study aimed to determine 5-year overall survival (OS) of BC in Sudanese women, and identify prognostic demographic and clinicopathologic factors.

PATIENTS AND METHODS
A hospital-based retrospective study was conducted by reviewing data of women with BC diagnosed and treated at the National Cancer Institute—University of Gezira during 2012, and followed up to end of… عرض المزيد

PURPOSE
Breast cancer (BC) is the leading malignancy among Sudanese women. Yet, data on survival are limited. This study aimed to determine 5-year overall survival (OS) of BC in Sudanese women, and identify prognostic demographic and clinicopathologic factors.

PATIENTS AND METHODS
A hospital-based retrospective study was conducted by reviewing data of women with BC diagnosed and treated at the National Cancer Institute—University of Gezira during 2012, and followed up to end of August 2018. Data were retrieved from medical records and analyzed, OS was determined, and the prognostic factors were explored.

RESULTS
A total of 225 cases were recruited. The median age at presentation was 45 years (range, 22-85 years). Clinical stage I, II, III, and IV represented 3.1%, 31.6%, 48%, and 17.3%, respectively. Most women (81.3%) were treated with curative intent. Of those, 25.1% received neoadjuvant chemotherapy. Mastectomy was the commonest (61.7%) type of surgery. The median follow-up period was 59.8 months with mean OS time of 55.7 months. The 5-year cumulative survival rate was 58%. The 5-year OS rates for stages I, II, III, and IV were 71.5%, 82.4%, 56.5%, and 8.4%, respectively. For lymph node (LN)-positive cases, 5-year OS rate was 63% and for LN-negative was 83.5%. Presenting with advanced-stage disease and positive LN status associated with short OS times (P < .005).

CONCLUSION
OS of women with BC in Central Sudan is worse than in the developed world, but similar to African countries. Our findings indicate that advanced stage at diagnosis and lymph nodal involvement are strong predictors of short survival times. Raising awareness and introducing early detection programs are critical for better survival of these patients. عرض أقل

Abstract
Background The travel distance from home to a treatment centre, which may impact the stage at diagnosis, has not been investigated for retinoblastoma, the most common childhood eye cancer. We aimed to investigate the travel burden and its impact on clinical presentation in a large sample of patients with retinoblastoma from Africa and Europe.

Methods A cross-sectional analysis including 518 treatment-naïve patients with retinoblastoma residing in 40 European countries and… عرض المزيد

Abstract
Background The travel distance from home to a treatment centre, which may impact the stage at diagnosis, has not been investigated for retinoblastoma, the most common childhood eye cancer. We aimed to investigate the travel burden and its impact on clinical presentation in a large sample of patients with retinoblastoma from Africa and Europe.

Methods A cross-sectional analysis including 518 treatment-naïve patients with retinoblastoma residing in 40 European countries and 1024 treatment-naïve patients with retinoblastoma residing in 43 African countries.

Results Capture rate was 42.2% of expected patients from Africa and 108.8% from Europe. African patients were older (95% CI −12.4 to −5.4, p<0.001), had fewer cases of familial retinoblastoma (95% CI 2.0 to 5.3, p<0.001) and presented with more advanced disease (95% CI 6.0 to 9.8, p<0.001); 43.4% and 15.4% of Africans had extraocular retinoblastoma and distant metastasis at the time of diagnosis, respectively, compared to 2.9% and 1.0% of the Europeans. To reach a retinoblastoma centre, European patients travelled 421.8 km compared to Africans who travelled 185.7 km (p<0.001). On regression analysis, lower-national income level, African residence and older age (p<0.001), but not travel distance (p=0.19), were risk factors for advanced disease.

Conclusions Fewer than half the expected number of patients with retinoblastoma presented to African referral centres in 2017, suggesting poor awareness or other barriers to access. Despite the relatively shorter distance travelled by African patients, they presented with later-stage disease. Health education about retinoblastoma is needed for carers and health workers in Africa in order to increase capture rate and promote early referral. عرض أقل

The primary aim of the study was to determine the cause of unplanned visits of cancer patients to an outpatient clinic in a limited-resource setting. A secondary aim was to provide an overview of the demographic, clinical characteristics and outcomes of this cohort of patients.
Setting: Outpatient clinic at National Cancer Institute, Sudan.

Pediatric craniopharyngioma is a rare tumor with excellent survival but significant long‐term morbidities due to the loco‐regional tumor growth or secondary to its treatment. Visual impairment, panhypopituitarism, hypothalamic damage, and behavioral changes are among the main challenges. This tumor should be managed under the care of a multidisciplinary team to determine the optimum treatment within the available resources. This is particularly important for low middle‐income countries where… عرض المزيد

Pediatric craniopharyngioma is a rare tumor with excellent survival but significant long‐term morbidities due to the loco‐regional tumor growth or secondary to its treatment. Visual impairment, panhypopituitarism, hypothalamic damage, and behavioral changes are among the main challenges. This tumor should be managed under the care of a multidisciplinary team to determine the optimum treatment within the available resources. This is particularly important for low middle‐income countries where resources are variable. This report provides risk‐stratified management guidelines for children diagnosed with craniopharyngioma in a resource‐limited setting. عرض أقل

The world is experiencing an unprecedented health crisis with the coronavirus disease 2019 (COVID-19) pandemic threatening human existence and livelihood. Patients with cancer are thought to be more susceptible and have higher morbidity and mortality rates from COVID-19 than the general population.1 Africa, with a heterogeneity of economies, cultures, and disease patterns, is thankfully the last continent to be hit by the pandemic. We acknowledge the points made by our colleagues from Morocco.2… عرض المزيد

The world is experiencing an unprecedented health crisis with the coronavirus disease 2019 (COVID-19) pandemic threatening human existence and livelihood. Patients with cancer are thought to be more susceptible and have higher morbidity and mortality rates from COVID-19 than the general population.1 Africa, with a heterogeneity of economies, cultures, and disease patterns, is thankfully the last continent to be hit by the pandemic. We acknowledge the points made by our colleagues from Morocco.2 With many lessons learnt from other countries and the experiences within Africa from the Ebola and cholera epidemics, Africa should be prepared for COVID-19. However, with a record of poor economic discipline, weak health systems, and poor health-seeking behaviours across the continent, outcomes could be dismal. Unfortunately, poverty, low health literacy rates, and cultural practices that negatively affect cancer outcomes will result in poor assimilation of COVID-19 containment strategies in Africa. عرض أقل

Abstract
Importance Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child’s life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale.

Objectives To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical… عرض المزيد

Abstract
Importance Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child’s life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale.

Objectives To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis.

Design, Setting, and Participants A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017.

Main Outcomes and Measures Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis.

Results The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblast عرض أقل

Abstract

Purpose: Studies of epidemiology, treatment modalities, and outcomes of childhood central nervous system (CNS) tumors in Sudan are scarce. To address this shortcoming, we evaluated baseline information about the epidemiology, treatment types, and outcomes of childhood CNS tumors at the National Cancer Institute, University of Gezira (NCI-UG) in Wad Madani, Sudan.

Methods: We performed a retrospective health facility-based study of children with CNS tumors who were treated… عرض المزيد

Abstract

Purpose: Studies of epidemiology, treatment modalities, and outcomes of childhood central nervous system (CNS) tumors in Sudan are scarce. To address this shortcoming, we evaluated baseline information about the epidemiology, treatment types, and outcomes of childhood CNS tumors at the National Cancer Institute, University of Gezira (NCI-UG) in Wad Madani, Sudan.

Methods: We performed a retrospective health facility-based study of children with CNS tumors who were treated at the NCI-UG from January 2000 to December 2015.

Results: A total of 62 (5.4% of all childhood cancers) pediatric patients with CNS tumors were identified over the study period. Tumors were more common among male children and involved the infratentorial compartment in 58% of cases. The median age at diagnosis was 9 years (range, 2–14 years). Approximately 60% (n = 37) of the study population had histology-determined diagnoses. Astrocytomas and medulloblastomas were the most common tumors in these cases. The mean time to diagnosis was 6 months (SD, 9). During the study period, the number of children with CNS tumors who were referred for treatment at the NCI-UG increased every year. Of the 37 patients who received surgical interventions, 8 received gross total resections, 20 received partial resections, and 24 received postoperative radiotherapy. The treatment abandonment rate was 11%. The 2-year and 5-year survival rates were 33% and 13%, respectively.

Conclusion: Our findings reveal a high incidence of poor outcomes for patients with CNS tumors in Sudan, which is most likely due to many distinct factors. عرض أقل

Abstract
Pediatric radiotherapy is a critical part of pediatric oncology protocols and the quality of the radiotherapy may determine the future quality of life for long-term survivors. Multidisciplinary team decision making provides the basis for high-quality care. However, delivery of high-quality radiotherapy is dependent on resources. This article provides guidelines for delivery of good quality radiation therapy in resource-limited countries based on rational procurement and maintenance… عرض المزيد

Abstract
Pediatric radiotherapy is a critical part of pediatric oncology protocols and the quality of the radiotherapy may determine the future quality of life for long-term survivors. Multidisciplinary team decision making provides the basis for high-quality care. However, delivery of high-quality radiotherapy is dependent on resources. This article provides guidelines for delivery of good quality radiation therapy in resource-limited countries based on rational procurement and maintenance planning, protocol development, three-dimensional planning, quality assurance, and adequate staff numbers and training. عرض أقل

Abstract
Background
Posterior cranial fossa tumours (PCF) comprise 54–70% of childhood brain tumours. The clinical profile and outcomes of these tumours differ in area of the world. The aim of this study is to describe clinical characteristics, treatment and outcome of posterior cranial fossa tumours in Sudan.
Material and methods
A retrospective study of children diagnosed with posterior cranial fossa tumours and treated between January 1998 and December 2015 at National Cancer… عرض المزيد

Abstract
Background
Posterior cranial fossa tumours (PCF) comprise 54–70% of childhood brain tumours. The clinical profile and outcomes of these tumours differ in area of the world. The aim of this study is to describe clinical characteristics, treatment and outcome of posterior cranial fossa tumours in Sudan.
Material and methods
A retrospective study of children diagnosed with posterior cranial fossa tumours and treated between January 1998 and December 2015 at National Cancer Institute, Sudan.

Results
A total of 31 paediatric patients with a posterior cranial fossa brain tumour were identified over the study period. The mean age was 7.9 years (standard deviation (SD) = 3.37). Females were slightly more affected (51%) than males (49%), and the majority of patients were from rural areas (71%). Brainstem tumours were the most frequent tumour type (48%) followed by medulloblastoma (36%). The mean pre-diagnostic symptomatic interval was 3.6 months (SD = 3.95). Overall survival rate of our total study population at 1, 2 and 5 years was 23, 19 and 13%, respectively.
Conclusion
Overall, this study draws attention to the situation of paediatric brain tumours in Sudan. Late presentation, misdiagnosis and limited diagnostic and treatment resources are challenges that may contribute to poor outcome in these patients.
Keywords
Posterior cranial fossa tumours Childhood Brain tumour Brainstem Medulloblastoma عرض أقل

Abstract

Objective: To evaluate the adherence to American Society of Clinical Oncology (ASCO) guidelines for antiemetic prophylaxis of chemotherapy-induced nausea and vomiting and assess the outcomes of the prescribed antiemetic drugs.
Methods: This prospective, observational study enrolled chemotherapy-naive cancer patients who were admitted to the National Cancer Institute between May and July 2015 for intravenous chemotherapy. Patient’s demographic data, chemotherapy protocols and… عرض المزيد

Abstract

Objective: To evaluate the adherence to American Society of Clinical Oncology (ASCO) guidelines for antiemetic prophylaxis of chemotherapy-induced nausea and vomiting and assess the outcomes of the prescribed antiemetic drugs.
Methods: This prospective, observational study enrolled chemotherapy-naive cancer patients who were admitted to the National Cancer Institute between May and July 2015 for intravenous chemotherapy. Patient’s demographic data, chemotherapy protocols and types of antiemetic drugs were collected by reviewing patients’ files, chemotherapy prescription forms and interviewing the patients.
Results: The data revealed that 90% of pre-chemotherapy antiemetic prescriptions did not adhere to antiemetic guidelines. The trends of non-adherence included an overuse of ondansetron (14%), under-prescribing of dexamethasone (16%) and corticosteroid duplication (14%). Regarding antiemetic use for the prevention of delayed emesis, the data showed that 90% of antiemetic prescriptions were non-adherent with ASCO guidelines, with overuse of ondansetron (20%) and metoclopramide (37%) and lack of dexamethasone prescriptions (80%) on days 2 and 3 being the most frequently reported trends. The percentage of patients with complete response (no emesis or rescue therapy) over 5 days post chemotherapy was 36%.
Conclusion: The study indicated an extremely low adherence rate to ASCO guidelines for antiemetic prophylaxis of chemotherapy-induced nausea and vomiting. Non-adherence included a trend of both underuse and overuse of indicated antiemetic medications. عرض أقل

Abstract

An epithelioid trophoblalstic tumour (ETT) is an extremely rare form of gestational trophoblastic disease (GTD).1 Usually, patients are of child-bearing age with a prior gestation.2 The uterus is the most common site for an ETT.3 This tumour has the same clinical behaviour as that of a placental site trophblastic tumour, but the treatment options may differ. Histologically, an ETT is a distinct neoplasm whose cytological features and growth patterns mimic those of squamous cell… عرض المزيد

Abstract

An epithelioid trophoblalstic tumour (ETT) is an extremely rare form of gestational trophoblastic disease (GTD).1 Usually, patients are of child-bearing age with a prior gestation.2 The uterus is the most common site for an ETT.3 This tumour has the same clinical behaviour as that of a placental site trophblastic tumour, but the treatment options may differ. Histologically, an ETT is a distinct neoplasm whose cytological features and growth patterns mimic those of squamous cell carcinoma.3 An ETT does not appear to be as chemosensitive as other GTDs, making hysterectomy the treatment of choice in patients with disease confined to the uterus.3 This tumour may present a diagnostic challenge to the pathologist, while clinicians often face problems with treating this tumour because of its rarity. We describe two cases of an ETT occurring in two women, one aged 44 years and the other 42 years. عرض أقل

Abstract
Background: Esophageal cancer (EC) is among the most common malignancies in Eastern Africa, but the occurrence of EC in Sudan has rarely been described in the scientific literature. This paper reports the results of a consecutive case series of all EC patients who visited one of the two public cancer treatment centers in the country in 1999-2012, providing a first description of this disease in a treatment center located in central Sudan. Materials and Methods: Clinical and… عرض المزيد

Abstract
Background: Esophageal cancer (EC) is among the most common malignancies in Eastern Africa, but the occurrence of EC in Sudan has rarely been described in the scientific literature. This paper reports the results of a consecutive case series of all EC patients who visited one of the two public cancer treatment centers in the country in 1999-2012, providing a first description of this disease in a treatment center located in central Sudan. Materials and Methods: Clinical and demographic data for all EC patients who visited the Department of Oncology of the National Cancer Institute at the University of Gezira (NCI-UG) from 1999 to the end of 2012 were abstracted and tabulated by sex, tumor type and other characteristics. Results: A total of 448 EC patients visited NCI-UG in 1999-2012, and the annual number of EC cases increased steadily from 1999. Squamous cell carcinoma (SCC) was the predominant EC tumor type (90%), and adenocarcinoma (ADC) was reported in 9.4% of the EC cases. The overall male-to-female ratio for EC was 1:1.8, but the ratio was tumor type-dependent, being 1:2 for SCC and 2:1 for ADC. Only 20% of EC patients reported having ever used tobacco and/or alcohol, and the vast majority of these patients were male. At the time of EC diagnosis, 47.3% of the patients resided in Gezira State. Some EC patients from Gezira State seek out-of-state treatment in the national capital of Khartoum instead of visiting NCI-UG. Conclusions: The annual number of EC patients visiting NCI-UG has increased in recent years, approximately half of these patients being from Gezira State. Although this consecutive series of EC patients who visited NCI-UG was complete, it did not capture all EC patients from the state. A populationbased cancer registry would provide more complete data required to better understand EC patterns and risk factors. عرض أقل

Cancer is becoming a major health problem in the developing world and the number of cancer cases in Sub-Saharan Africa is rising. Being an African country, Sudan has its share of the cancer burden. Yet, the real data on cancer incidence, prevalence, and mortality in Sudan is unknown and hard to obtain because of the lack of a national population-based cancer registry. According to the Global Cancer Incidence, Mortality, and Prevalence 2020 estimates, breast and prostate are the most common type… عرض المزيد

Cancer is becoming a major health problem in the developing world and the number of cancer cases in Sub-Saharan Africa is rising. Being an African country, Sudan has its share of the cancer burden. Yet, the real data on cancer incidence, prevalence, and mortality in Sudan is unknown and hard to obtain because of the lack of a national population-based cancer registry. According to the Global Cancer Incidence, Mortality, and Prevalence 2020 estimates, breast and prostate are the most common type of cancer in Sudanese men and women, respectively.

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 The incidence rate of lung cancer (the second most prevalent cancer globally) in Africa is low.

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 Information about epidemiology, management, and survival of lung cancer are lacking in Sudan. In this article, we provide an up-to-date situational analysis of lung cancer in Sudan as an example of an African limited-resource setting. عرض أقل