Background Medical students encounter various stressors during their studies. The study aimed to assess stress levels, sources, and associated determinants among Sudanese medical students. An online questionnaire-based study was conducted among 617 undergraduate medical students of 6 different universities in Sudan. A 19-item questionnaire was utilized to assess stress sources, in addition to demographics, stress manifestations, and coping strategies. Results The overall prevalence of stress was 31.7% (p < 0.01). The main sources of stress were time pressure, heavy workload, fear of failure, and examination frequency. One-third of students indicated that they experienced at least one source of psychosocial- and teaching-related stress. Female medical students were more significantly stressed due to academics than males. Also, fourth- and fifth-year students were academically more stressed in comparison to the first-year students. Poisson regression analysis model showed that first-year students were less stressed than the final-year students in relation to academics (odds = 0.888, P = 0.003). Male medical students, across all study years, were far less stressed than females (odds = 0.901, P = 0.000153). Expectedly, ‘studying medicine by choice’ was associated with decreased odds for psychosocial stressors (odds = 0.885, P = 0.00781), and improved model-fit (chi-squared = 6.8952, P = 0.008643). Also, the year of study was a predictor of teaching-related stress development. Conclusions Female medical students were more stressed due to academics than males. On the other hand, final-year students were more academically stressed than first-year students. Female medical students were likely having stress related to academic stress development, while being first-year medical student was a predictor of not developing academic stress. Studying medicine by choice’ was associated with ability to cope against stress.

Loeffler's endocarditis and hypereosinophilic syndromes are a unique group of infiltrative disorders characterized by hypereosinophilia, inflammatory thrombotic, and ultimately, fibrotic involvement of the heart leading to multiple complications including valve involvement, thromboembolic phenomena, heart failure. Clinical recognition, comprehensive laboratory and multimodality imaging diagnostic workup, and early initiation of treatment have been shown to slow down the progression and promote remission. This review addresses a detailed analysis of Loeffler's endocarditis and hypereosinophilic syndromes.

Background Breaking bad news is an important task for doctors in different specialties. The aim of the study was to assess adherence of Sudanese doctors to the SPIKES protocol in breaking bad news. Methods A descriptive cross-sectional study recruited 192 doctors, at Wad Medani teaching hospital, Sudan. A questionnaire-based on SPIKES protocol was distributed among 10 departments in our hospital. Data were analyzed using SPSS and Microsoft excel. Results There were (n = 101, 52.6%) females and (n = 91, 47.4%) males among the participants. 95.3% have been involved in breaking bad news, but only 56.3 received education and training about this issue. 43% admitted bad experience in breaking bad news, while 65.6% mentioned that bad news should be delivered directly to patients. The majority (>90%) agreed training is needed in the area of breaking bad news. Usual adherence to the SPIKES protocol was reported in a range of 35–79%, sometimes adherence was reported in a range of 20–44% while never adherence was reported in a range of zero–13.5%. Consultants, registrars, obstetrician and gynecologists and surgeons achieved high scores in breaking bad news. Training is an important factor in achieving high score in SPIKES protocol. The unadjusted effect of background factors on SPIKES score, showed that only training has significant impact on protocol adherence (P = 0.034, unadjusted; and P = 0.038 adjusted). Conclusion Large number of Sudanese doctors will try to adhere to SPIKES protocol. Training is an important factor in the success of breaking bad news.

Background Cardiac arrest carries high mortality and morbidity burden. Different studies showed conflicting data regarding outcomes of targeted temperature management (TTM) for cardiac arrest. The purpose of this meta-analysis is to systematically determine the effect of TTM on all-cause mortality and neurological outcomes after cardiac arrest. Methods We conducted a systematic search for randomized controlled trials in Pubmed, Cochrane & ScienceDirect. Primary outcomes were neurological outcome and all-cause mortality. Results Nine randomized controlled trials utilizing data for in-hospital and out-of-hospital cardiac arrest were selected for meta-analysis. Total number of patients included was 1592. Mortality was lower in targeted temperature management group (OR 0.637, 95% CI 0.436–0.93, p-value 0.019, I 2 = 44.78%, n = 1592). Therapeutic hypothermia group also demonstrated reduction in poor neurological outcomes (OR 0.582, 95% CI 0.363–931, p-value 0.024, I 2 = 56.79%, n = 1567). Subgroup analysis was conducted, after excluding in-hospital cardiac arrest patients, and demonstrated reduction in poor neurological outcome (OR 0.562, 95% CI 0.331–0.955, p-value 0.033, I 2 = 61.78%, n = 1480) and mortality in out-of-hospital cardiac arrest patients (OR 0.674, 95% CI 0.454–999, p-value 0.049, I 2 = 43.8%, n = 1505). Conclusion Targeted temperature management after cardiac arrest may be associated with improvement in all-cause mortality and reduction in poor neurological outcome.

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