SSMJ August 2024
Editorials
According to the Africa CDC, the Monkeypox virus has two distinct genetic types or clades: Clade I and Clade II. The symptoms of Mpox include a skin rash/mucosal lesions, fever, headache, muscle and back pains, lethargy, and swollen lymph nodes. The virus can be transmitted to humans through physical contact with an infectious person, contaminated materials, or infected animals.
News, Reports and Policy
The Republic of South Sudan’s Ministry of Health has officially started the Health Sector Transformation Project (HSTP), effective July 1, 2024. This initiative aims to improve the availability, quality, and accessibility of health services across the nation, ensuring they remain free at the point of use.
Mr Richard Hassan Kalamsakit, who died on 3rd July 2024, at Chennai Hospital in India after a short illness, was a well-respected senior orthopaedic surgeon who accomplished a lot in Sudan and South Sudan.
Clinical Guidance
Onchocerciasis-associated epilepsy (OAE) is a neglected public health problem in remote African regions endemic to onchocerciasis with sub-optimal elimination programmes. OAE manifests in previously healthy children aged 3-18 years in the absence of any obvious cause for epilepsy and is marked by a diverse range of seizure types, including head nodding seizures (nodding syndrome). This paper reviews recent studies investigating the association between onchocerciasis and epilepsy in South Sudan. Surveys in Maridi, Mundri West, and Mvolo Counties demonstrated a very high prevalence (3-6%) and incidence of epilepsy, as well as substantial onchocerciasis serological prevalence (12-34%) in young children.
Research
The model street method was developed in 2015 to provide a framework for delivering high-impact, low-cost, scalable community health interventions for communities affected by poverty in Africa. Since then, the method has been adapted to other contexts, including sustainable redevelopment of urban areas in Europe and North America. Therefore, the suitability of the model as a template from which other contexts could benefit should be considered. Post-conflict settings have several features in common with poverty settings, where this model has been well demonstrated as effective.
The Most healthcare professionals (HCPs) face numerous ethical challenges while performing their tasks, regardless of clinical ethics support structures (CESS) in many health facilities. There has been little research on CESS in Africa. This study sought to determine how often Cameroonian HCPs in the Southwest Region (SWR) faced ethical issues, how many health institutions have CESS and whether those with no CESS are willing to have one created.
Case Reports
Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune disease that is often underdiagnosed due to the variability and complexity of its clinical presentation and is frequently misdiagnosed as viral encephalitis. It is sometimes characterized as a form of limbic encephalitis, which predominantly affects children and younger adults, with a female-to-male ratio of 4:1. The neurological disease is commonly associated with an underlying tumour. Its pathophysiology is attributed to the formation and binding of IgG1 and G3 antibodies to the NR1 subunit of the NMDA receptor in the central nervous system. We present the case of a 23-year-old woman with a one-year history of episodic mood lability and psychosis who sought medical attention at the emergency department due to the sudden onset of agitation, hallucinations, and altered mental status.
Patients with single ventricles undergoing non-cardiac surgery have a higher incidence of perioperative complications. Factors associated with the most significant risk are the complexity of cardiac disease and the patient’s physiological status. We here describe the anaesthetic management and pathophysiological considerations of an 18-year-old male with a single ventricle undergoing elective mastoidectomy.
The Intra Uterine Device (IUD) is a safe and common form of contraception. Locating a lost IUD following silent perforation of the uterus either during or after IUD insertion is challenging. Locating the IUD using radiological investigation is straightforward. However, the use of a series of radiological investigations which brings the same management outcome is controversial in terms of cost. This is a report of a rare case in which several radiological investigations were conducted following IUD migration from the uterine cavity.
Neurocysticercosis is prevalent in most developing countries where pork is consumed. It is estimated that approximately 30% of cases of epilepsy may be due to neurocysticercosis. We present a case of a middle-aged man who presented to a health facility in the city of Juba in South Sudan with tonic-clonic seizures and left-sided weakness. He was originally diagnosed as having epilepsy and Transient Ischaemic Attacks (TIA).
Phalangeal Microgeodic Syndrome (PMS) is rare, characterised by cold related discolouration, pain and swelling of the digits. A handful of case reports exist mainly in a paediatric population in Japan. We describe five cases of PMS. The underlying aetiology remains uncertain, however, a possible correlation with infection or autoimmune dysregulation may suggest a common pathway which is yet to be identified. However, many cases seem to resolve spontaneously.
Summaries
Stroke is a serious global health concern, ranking as the second-leading cause of death and the third-leading cause of death and disability combined worldwide. Despite improvements in stroke management, the incidence of stroke among individuals under the age of 55 years is rising, leading to increased economic costs. While age-standardized stroke mortality rates have declined over the past three decades due to advancements in stroke treatments, particularly reperfusion strategies and acute rehabilitation, the global cost of stroke exceeds US$721 billion, accounting for 0.66% of the global GDP.
The Nile Initiative Development Organization (NIDO) in consortium with Relief International (RI) are currently implementing South Sudan Covid-19 Emergency Response Health System Strengthening Programme (CERHSP) funded by the World Bank through UNICEF.
Thank you and your entire team for establishing and maintaining the SSMJ despite limited resources.