Faculty of Medicine and Surgery

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Start date: 2020

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    PI3K/AKT/mTOR Pathway in Breast Cancer Pathogenesis and Therapy: Insights into Phytochemical-Based Therapeutics
    (Nutrition and Cancer, 2025) Wali, Adil Farooq; Talath, Siajunisa; El Tanani, Mohamed; Rangraze, Imran Rashid; Babiker, Rasha; Shafi, Sadat; Bansal, Ruby
    Breast cancer (BC) is listed as the most prevalent cancer form in women worldwide, with major subtypes classified by hormone receptor (HR) and HER2 status including, HR+/HER2– (~65–70%), HER2+ (~15–20%), Triple-Negative-HR–/HER2– (~10–15%) and rare sybtypes (<5%). Scientific evidence has revealed that PI3K/AKT/mTOR signaling cascade plays an important role in the development and progression of BC, contributing to key cellular processes including cell growth, proliferation, angiogenesis, and metastasis. Dysregulation of the components of this cascade including functional loss of Phosphatase and TENsin homolog (PTEN), PI3K hyperactivation, and gain-of-function of AKT, are frequently observed in BC subtypes, making it a promising target for therapeutic intervention. A myriad of studies have documented the potential of phytochemicals, including curcumin, chrysin, fisetin, genistein, resveratrol and lycopene as modulators of the PI3K/AKT/mTOR axis. These phytochemicals exhibit multifaceted mechanisms of action, including inhibition of key kinases, induction of apoptosis, suppression of angiogenesis, and reversal of resistance to chemotherapy. This review aims to provide a detailed overview about the role of PI3K/AKT/mTOR alteration in BC development and the current research on phytochemicals that modulate the PI3K/AKT/mTOR pathway in BC. We documented the molecular mechanisms through which these compounds exert their effects, their potential synergistic interactions with conventional therapies, and the challenges and prospects for their clinical application. The evidence presented underscores the promise of phytochemicals as novel, less toxic adjuncts to traditional BC therapies, warranting further exploration and development for clinical use
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    Potential Role of Acacia Senegal (Gum Arabic) as Immunomodulatory Agent among newly diagnosed COVID 19 Patients: A structured summary of a protocol for a randomised, controlled, clinical trial
    (2020) Kaddam,Lamis; Babiker,Rasha; Ali,Sara; Satti,Shahinaz; Ali,Nour; Elamin,Maha; Mukhtar,Mowaia; Elnimeiri,Mustafa; Saeed,Amal
    Objectives: To investigate the potential efficacy of Acacia Senegal extract Gum Arabic (GA) supplementation as immunomodulatory and anti-inflammatory dietary intervention among newly diagnosed COVID 19 Sudanese patients. To study the effect of GA on the level of cytokines, TNFα, IL8, IL6 IL10, CRP and the viral load. Secondary outcomes will be the effect of GA oral intake on mortality rate and days of hospital admission. Trial design: Quadruple blind, randomized placebo-controlled clinical trial Phase II & III. Prospective, two-arm, parallel-group, randomised (1:1 allocation ratio) superiority trial of oral GA among seropositive COVID-19 patients. Participants: Inclusion criteria: COVID-19 infected (newly diagnosed) as proved by real-time PCR within 72 hours of PCR. Age 8-90 years Both genders Exclusion criteria: Intubated patients on parenteral treatment Allergy to Gum Arabic The study will be conducted in COVID Isolation Centres and Soba University Hospital Khartoum State Sudan. Intervention and comparator: Experimental: Intervention Group (Continued on next page) This arm will receive 100% natural Gum Arabic provided in a powder form in 30-grams-dose once daily for four weeks Placebo Comparator: Control group: This group will be provided with pectin powder provided as one-gram-dose once daily for four weeks Both GA and placebo will be in addition to standard care treatment based on local clinical guidelines. Main outcomes: Mean change from baseline score of Immune Response to end of the trial. Changes of the level of Tumor Necrosis Factor (TNFα), interleukin IL8, IL6, and IL10 from the baseline values (Four weeks from the start of randomization). Mortality rate: The percentage of deaths among COVID 19 patients received Gum Arabic compared to placebo (Four weeks from the start of randomization]). Randomisation: Randomization (1:1 allocation ratio) and will be conducted using a sequence of computer-generated random numbers by an independent individual. Each participating centre will be assigned a special code generated by the computer. The randomization will be kept by the PI and a research assistant. Blinding (masking): Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor) Numbers to be randomised (sample size): 110 eligible patients will be randomly assigned to either GA (n=55) or placebo (n=55) groups. Trial Status: Protocol Version no 2, 30th June 2020. Recruitment will start on 15th September 2020. The intended completion date is 15th January 2021. Trial registration: ClinicalTrials.gov Identifier: NCT04381871. Date of trial registration: 11 May 2020. Full protocol: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.
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    Measurements of the cerebral cortical thickness in healthy Sudanese subjects during third and fourth decades of age
    (Khartoum Medical Journal, 2020) Ahmed,Wegdan; Osman,Tahir; Sahin,Bunyamin; Elfaki,Amani
    Introduction The cortex is the outer covering of cerebrum that contains the functional areas including motor, sensory, visual, auditory, and speech. Measuring the cortical thickness of the cerebral hemisphere has greater importance because it supports the neuroscientists in their investigations of normal and abnormal changes in the cortical thickness. The aim of the present study was to measure cortical thickness of the cerebral hemisphere, frontal lobe, and frontal lobe gyri in young adult Sudanese in the third and fourth decade and to determine the effect of sex and age on the cortical thickness of cerebral hemisphere and its gyri. Material and methods The study included 139 healthy Sudanese subjects (80 males and 59 females) ranging between 20-39 years of age; they were assigned into the third and fourth decades. T1-weighted MR brain images with thickness 1mm were obtained. MR images of the subjects were analysed using the automatic segmentation software (BrainSuite). Cerebral cortical thickness (CCT) of the cerebral hemispheres, frontal lobes, and frontal lobe gyri were estimated using the output data of process of the software. Results The CCT of the cerebral hemispheres (3.810.21±mm) (3.840.16±mm) and frontal lobes (4.26±0.22mm) (4.240.22±mm) during third and fourth decade, respectively was not different between genders (P>0.05). Within third decade, there was no gender difference in CCT of frontal lobe gyri, except for the left precentral gyrus. While within fourth decade, the gender difference was reported in the middle frontal, pars opercularis, pars triangularis, precentral and paracentral, and subcallosal gyri (P<0.05). CCT of the cerebral hemisphere and frontal lobe did not change from third to fourth decade (P>0.05). Changes in CCT from third to fourth decade were noticed in the precentral, paracentral gyri, and pars opercularis. Conclusion Cortical thickness of the cerebral hemisphere and frontal lobe were not different between genders and was not changed by age; so they are independent values from sex and age. However, gender differences and change by age were reported in some frontal lobe gyri. This data can serve as normative database and reference data for both researchers and clinicians.
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    Unraveling the tumor microenvironment: Insights into cancer metastasis and therapeutic strategies
    (Cancer Letters, 2024) El-Tanani, Mohamed; Rabbani , Syed Arman; Babiker, Rasha; Rangraze, Imran; Kapre, Sumedha; Palakurthi, Sushesh Srivastsa; Alnuqaydan, Abdullah M.; Aljabali, Alaa A.; Rizzo, Manfredi; El-Tanani, Yahia; Tambuwala, Murtaza M.
    This comprehensive review delves into the pivotal role of the tumor microenvironment (TME) in cancer metastasis and therapeutic response, offering fresh insights into the intricate interplay between cancer cells and their surrounding milieu. The TME, a dynamic ecosystem comprising diverse cellular and acellular elements, not only fosters tumor progression but also profoundly affects the efficacy of conventional and emerging cancer therapies. Through nuanced exploration, this review illuminates the multifaceted nature of the TME, elucidating its capacity to engender drug resistance via mechanisms such as hypoxia, immune evasion, and the establishment of physical barriers to drug delivery. Moreover, it investigates innovative therapeutic approaches aimed at targeting the TME, including stromal reprogramming, immune microenvironment modulation, extracellular matrix (ECM)-targeting agents, and personalized medicine strategies, highlighting their po tential to augment treatment outcomes. Furthermore, this review critically evaluates the challenges posed by the complexity and heterogeneity of the TME, which contribute to variable therapeutic responses and potentially unintended consequences. This underscores the need to identify robust biomarkers and advance predictive models to anticipate treatment outcomes, as well as advocate for combination therapies that address multiple facets of the TME. Finally, the review emphasizes the necessity of an interdisciplinary approach and the integration of cutting-edge technologies to unravel the intricacies of the TME, thereby facilitating the development of more effective, adaptable, and personalized cancer treatments. By providing critical insights into the current state of TME research and its implications for the future of oncology, this review highlights the dynamic and evolving landscape of this field.
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    Neurological Manifestation among Patients with Visceral Leishmaniasis at the Tropical Teaching Hospital – Khartoum
    (Zagazig University Medical Journal, 2023) Ebrahim, Ahmed Alameleman Edris; Saeed, Mohammed Khalfallah; Nail, Abdelsalam; Abdelmalik, Rawan Iz Eldin Mohamed; Mohammed, Eltayeb Abdalla; Ahmed, Sali Elhaj; Ahmed, Ahmed Abdelaziz; Babiker, Rasha; Ali, Ibrahim A
    Background: Leishmaniasis is an endemic disease in Sudan that caused by Leishmania spp. Several studies suggest neurological manifestations in visceral leishmaniasis, such as burning sensation, and weakness. This study was aimed to assess the frequency of the neurological manifestations in Visceral Leishmaniasis. Methods: This is a descriptive, prospective cohort study, was conducted in The Tropical Teaching Hospital – Khartoum for one-year duration. A pretested questionnaire contained the study variables were conducted, nerve conduction Study (NCS) and laboratory tests were done. SPSS v 26.0 was used to analyze the data. Results: Forty four percent of total patients (22/50) were symptomatic.Peripheral neuropathy was elicited in 60% (30/50), Numbness has been the most common feature 56.6% (17/30), and Weakness 26.6% (8/30) all were Axonal damage. Sensorimotor neuropathy was exhibited in 70% (21/30), pure motor neuropathy in 26.7% (8/30). Polyneuropathy was encountered in 46.6% (14/30), poly-radiculopathy in 20% (6/30) along with 23.3% (7/30) as mononeuropathy. Conclusions: peripheral neuropathy was developed in patients with visceral leishmaniasis, frequent occurrence of subclinical neurological manifestations is higher than reported.
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    The Mycetoma Research Center, University of Khartoum, Sudan’s experience in community engagement initiatives spans 3 decades
    (PLOS NEGLECTED TROPICAL DISEASES, 2024) Fahal, Ahmed Hassan; Ahmed, Eiman Siddig; Mahmoud, Ahmed Hussein; Saaed, Ali Awadella
    Mycetoma profoundly affects marginalised communities, especially in impoverished and remote areas with limited access to healthcare. This chronic and debilitating inflammatory disease highlights the typical issues of neglected tropical diseases (NTDs), such as insuffi cient attention, funding, and resources, which perpetuate neglect and suffering. Patients often delay seeking medical help, leading to advanced disease stages, severe complica tions, and lasting disabilities. The lack of medical infrastructure and skilled healthcare pro fessionals worsens the situation, causing delays in diagnosis and inadequate treatment. Engaging affected communities in tailored interventions is essential to tackle these chal lenges, promote collaboration, raise awareness, and mobilise resources to improve health care access and enhance diagnostic and treatment capabilities. Since 1991, the Mycetoma Research Center (MRC) atthe University of Khartoum, Sudan, has led community engage ment initiatives aimed at improving the quality of life for mycetoma-affected individuals through education, advocacy, and local collaboration. In this communication, the MRC shares its extensive experience in community engagement to benefit mycetoma-affected communities.
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    The burden of end-stage renal disease in Khartoum, Sudan: cost of illness study
    (Journal of Medical Economics, 2024) Hajomer, Hiba Ali; Elkhidir, Osama Ahmed; Elawad, Shaima Omer; Elniema, Ola Hatim; Khalid, Mustafa Khalid; Altayib, Lina S.; Abdalla, Ibrahim Ahmed; Mahmoud, Tahani Amin
    Background and purpose: The incidence of end-stage renal disease (ESRD) in Sudan is increasing, affecting the economic status of patients, caregivers and society. This study aimed to measure ESRD’s costs, including direct and morbidity indirect expenditures, and to investigate any associated factors and financial consequences. Materials and methods: This cross-sectional study used a standardized questionnaire to collect data from 150 ESRD patients who had been receiving dialysis for at least one year before the time of data collection at 13 specialized renal centres in Khartoum state. Data about sociodemographic, clinical, and economic factors were gathered, and their relationship to the cost of ESRD was examined using both bivariate (Man Whitney test, Kruskal Wallis test and Spearman correlation) and multivariate ana lytical procedures (multivariate linear regression). Results: This study reported a median direct per capita ESRD cost of 38 600 SDG ($1 723.2 PPP) annu ally with an interquartile range of 69 319.3 SDG ($3 094.6 PPP). The median morbidity indirect cost was estimated to be 0.0±3 352 SDG ($ 0.0±149.6 PPP) per annum. In 28.8% of cases, the patients were their family’s primary income earner and over 85% were covered by medical insurance. Our study found that none of the study variables were significantly associated with the total cost of ESRD. Conclusion and limitations: Our findings point out considerable direct out-of-pocket expenses and productivity losses for patients and their households. However, these results should be carefully applied for comparison between the different countries due to differences in the cost of medical inter ventions and insurance coverage. Further longitudinal studies and studies on health finance and insur ance policies are recommended.
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    Comparative Efficacy of Immune Checkpoint Inhibitors and Therapeutic Vaccines in Solid Tumors: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
    (Vaccines, 2025) Babiker, Rasha; Wali, Adil Farooq; El-Tanani, Mohamed; Rabbani, Syed Arman; Rangraze, Imran; Satyam, Shakta Mani; Patni, Mohamed Anas; El-Tanani, Yahia
    Background: Immune checkpoint inhibitors (ICIs) and therapeutic vaccines have emerged as promising immunotherapeutic strategies for solid tumors. However, their comparative efficacy in improving overall survival (OS) remains unclear. This systematic review and meta-analysis aimed to evaluate the efficacy of ICIs and therapeutic vaccines in improving OS in patients with solid tumors. Methods: A comprehensive search was con ducted across PubMed, Cochrane Library, Embase, and Clinical Trials.gov for randomized controlled trials (RCTs) published between 1 January 2010 and 31 December 2024. Studies comparing ICIs or therapeutic vaccines against control treatments (placebo, standard of care, or active comparators) in adults with solid tumors were included. The primary out come was OS, and data were pooled using RevMan (web). Risk of bias was assessed using the Cochrane Risk of Bias tool. Results: Thirteen RCTs involving 10,991 participants were included. A total of 5722 of them were treated with therapeutic vaccines or checkpoint inhibitors. Therapeutic vaccines demonstrated insignificant improvement in OS, with a pooled mean difference of 1.89 months (95% CI: −0.54–4.31; P = 0.13), although with homo geneity (I2 = 0%). ICIs showed a statistically significant OS benefit, with a pooled mean difference of 1.32 months (95% CI: 0.62–2.02; P = 0.0002) and low heterogeneity (I2 = 12%). Conclusions: Therapeutic vaccines provide a larger but less consistent benefit, whereas ICIs offer modest but more consistent survival advantage. These findings support the need for personalized immunotherapy approaches as well as further research to identify predictive biomarkers and optimize treatment strategies by acquiring deep insights into the TMEdynamic and behaviors.
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    Nerve conduction and its correlations with duration of diabetes mellitus and glycosylated haemoglobin in type 2 diabetes mellitus (T2DM)
    (Journal of Endocrinology, Metabolism and Diabetes of South Africa, 2021) Hamid, W. S.; Ahmed, H. S.; Osman, M. A.; Babiker, R.
    Background: Diabetic neuropathy is one of the most common microvascular complications associated with diabetes mellitus. Diabetic peripheral neuropathy (DPN) has been linked to hyperglycaemia and long duration of uncontrolled type 2 diabetes mellitus (T2DM) as measured by glycosylated haemoglobin (HbA1c). To our knowledge the estimated duration between diagnosis and developing DPN and the level of HbA1c have not yet been investigated in Sudanese patients with type 2 DM. Therefore, this study aims to investigate the relationship between the duration of diabetes and HbA1c with nerve conduction velocity (NCV) in patients with type 2 DM. Methods: This cross-sectional study recruited 63 male and female patients with T2DM who attended the diabetic outpatient clinic of Academy Charity Teaching Hospital (ACTH) and Alzaytouna Private Hospital for Nerve Conduction Velocity (NCV) and electromyography (EMG) tests. Nerve conduction was done by using ADInstruments PowerLab series 26. SPSS was used to analyse the data and p-value < 0.05 was considered significant. Results: The mean duration of DM was 14.7 (± SD 9.24) years and the mean age of participants was 57.71 (± SD 12.2) years. The most common symptom was numbness (50%). Pearson’s correlation test revealed a significant negative correlation between HbA1c and nerve conduction velocity (r=0.4, p < 0.05) and negative significant correlation between the duration and the amplitude (r =0.35, p < 0.05). Conclusion: There is a slowing of nerve conduction velocity in type 2 diabetic patients, which is accelerated by the poor glycaemic control (HbA1c). These findings support the need for tight glycaemic control to avoid drastic neuropathic complications of diabetes.
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    Epigenetic Alterations in Hepatocellular Carcinoma: Mechanisms, Biomarkers, and Therapeutic Implications
    (Pharmaceuticals, 2025) Wali, Adil Farooq; Ansari, Abid Reza; Mir , Prince Ahad; El-Tanani , Mohamed; Babiker , Rasha; Hussain, Md Sadique; Uppal, Jasreen; Zargar, Asma Ishrat; Mir, Reyaz Hassan
    Hepatocellular carcinoma (HCC), the most prevalent primary liver cancer, continues to pose a significant global health burden due to its high mortality rate. In addition to genetic alterations, epigenetic aberrations, including DNA methylation, histone modifications, chromatin remodeling, and noncoding RNA (ncRNA) dysregulation, play critical roles in HCCinitiation and progression. Notably, miR-375 and miR-483-5p are among the most dysregulated miRNAs in HCC, with their altered expression levels closely associated with tumor stage and patient survival. These epigenetic modifications offer promising therapeu tic avenues due to their reversibility and dynamic nature. Furthermore, specific epigenetic signatures such as CDH1 promoter hypermethylation and HOTAIR overexpression are being explored as potential biomarkers for early detection and treatment response. In this chapter, we review recent advances in the epigenetic landscape of HCC and discuss their diagnostic and therapeutic implications, highlighting their potential to improve patient outcomes through personalized medicine approaches

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