Research Article
Bone Marrow Examination Findings Among Sudanese Patients During the Sudanese Armed Conflict (April 2023 to February 2025)
Motwakil Imam Awadelkareim Imam*
,
Baker Mohammed Saleh Hadi Gahaf,
Muayid Abdullah Ahmed Mohammed
Issue:
Volume 14, Issue 2, June 2026
Pages:
53-65
Received:
12 April 2026
Accepted:
25 April 2026
Published:
13 May 2026
Abstract: Background: Armed conflict in Sudan has severely disrupted healthcare delivery, and access to diagnostic services. Despite the increasing burden of hematological disorders, data on bone marrow examination (BME) findings in such settings remain limited. This study aimed to characterize the spectrum of BME diagnoses in Sudanese patients during a period of ongoing conflict. Methods: A retrospective cross-sectional study was conducted at Al-Mek Nimer University Hospital, including 291 patients who underwent bone marrow examination (aspiration and trephine biopsy) between April 2023 and February 2025. Data were analyzed using SPSS. Results: Hematological malignancies accounting for 64.6% of cases. Leukemia was the most common diagnosis (38.8%), particularly chronic lymphocytic leukemia (17.2%), acute lymphoblastic leukemia (11.7%), and chronic myeloid leukemia (10.3%). Non-malignant conditions represented 35.4% of cases, mainly reactive marrow changes (17.5%) and megaloblastic anemia (7.2%) being the most frequent. Most patients were aged 41–60 years (29.9%), with a slight male predominance (52.9%). Geographically, most cases originated from River Nile State (52.9%) and Khartoum State (33%). A notable proportion of patients were unemployed (58.8%), suggesting socioeconomic vulnerability. Conclusion: There is high burden of advanced hematological malignancies and reactive marrow patterns likely due to delayed access to care during conflict. Bone marrow examination remains essential diagnostic tool in resource-limited settings. Strengthening mobile diagnostic services, promoting early screening among high-risk groups—particularly the elderly and unemployed—and implementing micronutrient supplementation programs may help reduce morbidity and improve outcomes in conflict-affected populations.
Abstract: Background: Armed conflict in Sudan has severely disrupted healthcare delivery, and access to diagnostic services. Despite the increasing burden of hematological disorders, data on bone marrow examination (BME) findings in such settings remain limited. This study aimed to characterize the spectrum of BME diagnoses in Sudanese patients during a peri...
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Research Article
Safe Radiotherapy Delivery in a Pacemaker-dependent Breast Cancer Patient: Insights from an Initial Institutional Experience
Rajiv Kumar Singh,
Subrata Roy*
Issue:
Volume 14, Issue 2, June 2026
Pages:
66-74
Received:
2 May 2026
Accepted:
16 May 2026
Published:
27 May 2026
DOI:
10.11648/j.jctr.20261402.12
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Abstract: Introduction: Radiation therapy (RT) is a standard component of breast cancer management; however, treatment planning becomes more complex in patients with cardiac implantable electronic devices (CIEDs), including pacemakers (PMs) and implantable cardioverter-defibrillators (ICDs). Exposure of these devices to therapeutic radiation may lead to malfunction, particularly in pacemaker-dependent individuals, where device failure can have serious clinical consequences. Careful treatment planning is therefore essential when irradiating breast cancer patients with implanted cardiac devices. This report presents our institutional experience in the safe administration of adjuvant RT in a pacemaker-dependent patient undergoing treatment for breast cancer. Materials and Methods: A retrospective review was conducted of breast carcinoma patients treated with adjuvant external beam radiation therapy between January 2023 and December 2024, including one pacemaker-dependent patient with a dual-chamber pacemaker implanted in the left anterior chest wall. Simulation imaging was performed using both free-breathing and deep inspiration breath-hold (DIBH) computed tomography (CT) protocols. Target volumes and organs at risk were delineated according to ESTRO/RTOG contouring guidelines, with the pacemaker generator and leads contoured separately as organs at risk. Treatment planning was performed using 6 MV photon beams with field-in-field and hybrid intensity-modulated radiation therapy (IMRT) techniques. Volumetric modulated arc therapy (VMAT) plans were additionally generated for dosimetric comparison. Pacemaker dose constraints were established in accordance with the recommendations of the American Association of Physicists in Medicine Task Group 203 (AAPM TG-203). Prior to treatment initiation, multidisciplinary evaluation was undertaken, including cardiology consultation, device interrogation before and after treatment, and preparation of emergency pacing support protocols. Results: Adjuvant RT was completed successfully without interruption. Target coverage was clinically acceptable, with 96.8% of the planning target volume (PTV) receiving at least 95% of the prescribed dose (PTV V95% = 96.8%). Use of DIBH contributed to cardiac sparing, resulting in a mean heart dose of 1.9 Gy and a mean dose to the left anterior descending artery (LAD) of 4.1 Gy. The maximum recorded dose to the pacemaker was 0.86 Gy, remaining well below established safety thresholds. No pacemaker malfunction, sensing abnormalities, or cardiac complications were observed during treatment. Acute toxicity was limited to grade 1 radiation dermatitis. Conclusion: Adjuvant breast radiotherapy in pacemaker-dependent patients can be delivered safely with appropriate precautions. The use of low-energy photon beams, DIBH techniques, meticulous dosimetric planning, and multidisciplinary coordination enables effective target coverage while maintaining pacemaker dose within acceptable limits, without compromising oncologic outcomes or device functionality.
Abstract: Introduction: Radiation therapy (RT) is a standard component of breast cancer management; however, treatment planning becomes more complex in patients with cardiac implantable electronic devices (CIEDs), including pacemakers (PMs) and implantable cardioverter-defibrillators (ICDs). Exposure of these devices to therapeutic radiation may lead to malf...
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