Most Viewed Articles

Background: Postmenopausal bleeding (PMB) is bleeding from the genital tract after 12 months of amenorrhea in a woman over the age of 50, or 24 months if below the age of 50 years, in 10% of women presented with PMB, the cause is endometrial cancer.Purpose: To assess the clinical presentation types and outcomes of diagnostic measures provided for women presenting with PMB at Saad Abu-Alela Hospital, Khartoum, Sudan.Methodology: It was a descriptive, cross-sectional study conducted at Saad Abu-Alela Teaching Hospital in the period from January to December 2022.An interview questionnaire was used for data collection. Fifty-nine (59) postmenopausal women were included in this study, age, parity, risk factors, duration of bleeding, duration of menopause, ultrasound findings, and hysteroscopy findings were recorded.Results: The majority of study participants were aged between 50-54 years, menopause duration was most 1-4 years, most of the participants were educated and medically free, DM and HTN, and most of the participants were multiparous. Duration of PMB ranged between weeks in a third of cases and up to more than a year in some cases, amount of bleeding was mild in more than half. Ultrasound is used to assess the endometrial thickness and other findings, also hysteroscopy and biopsy or Dilation and curettage and hysterectomy.Conclusion: The ultrasound and endometrial biopsy via inpatient hysteroscopy and dilatation and curettage were the best tools for evaluation of (PMB), benign conditions were the most frequent outcome and endometrial cancer.

Background: Neonatal Near-miss is defined as complications of neonates so severe as to be imminently life-threatening but survived due to chance or treatment. The number of neonates who survived morbidities were approximately 3 to 6 times greater than those who died. There was little evidence about neonatal near miss in Ethiopia. This study attempted to identify the determinants of neonatal near miss among neonates admitted to the Ambo University Referral Hospital and Ambo General Hospital. Methods: Hospital-based quantitative unmatched case-control study was conducted at the Ambo University Referral Hospital and Ambo General Hospital from March 1 to 28, 2019. The respondents, 134 cases and 268 controls were recruited by simple random technique. Data were coded, entered and cleaned in EpiInfo version 7 and exported to SPSS. Both Bivariable and multivariable logistic regression was computed at 95% CI and the final model was checked by Hosmer and Lemeshow goodness -of-fit test. Multi collinearity and cofounders were not detected. Result: Multivariate analysis showed that distance more than 15km away from health facilities [AOR=2.11, 95% CI: (1.09, 4.095)], Unwanted, and unplanned current pregnancy [AOR=3.71, 95% CI: (1.28, 10.79)], less than four Antenatal care visit [AOR=6.55, 95% CI: (3.07, 13.98)], Instrumental delivery [AOR=4.62, 95% CI: (1.78, 11.98)] were positively associated with Neonatal Near Miss. Whereas Term Neonates [AOR= 87%, 95% CI: (0.05, 0.32)], and Normal birth weight [AOR=91%, 95% CI: (0.03, 0.28)] were negatively associated with Neonatal Near Miss. Conclusion: Distance from health facilities, Antenatal care visit, current pregnancy type, birth weight, gestational age and mode of delivery were determinants of Neonatal Near Miss. Therefore, providing adequate Antenatal services, health education and training is needed to improve neonatal health.

Background: There is enough evidence to suggest that vancomycin increases the risk of acute kidney injury (AKI) but the exact mechanism is not well understood. This study aims to understand the incidence of vancomycin-associated acute kidney injury (VA-AKI) among hospitalized patients and to identify the risk factors for VA-AKI. Methods: Patients aged 18 and above who received a minimum of 24 hours of intravenous vancomycin and who had serial creatinine measurements over a 13-month period were identified through electronic records. Patients with pre-existing AKI, or eGFR of less than 30ml/min, and patients with end stage kidney disease were excluded. Results were analyzed using t-test and Fisher’s test. A logistic regression model was used to identify the predictors for VA-AKI. Results: From the 598 patients who met the inclusion criteria, 70 developed AKI. Compared to those without AKI, patients with VA-AKI had higher mean serum vancomycin trough levels (22.6 mg/L vs. 14.6 mg/L), and a statistically significant longer duration of vancomycin use (6.7 vs. 5.2 days). Multivariate analysis revealed that serum vancomycin level of > 20 mg/L was associated with a six-fold increase in odds of VA-AKI when compared to those with vancomycin levels < 15 mg/L. The presence of hypotension, iodinated contrast use, and concomitant use of piperacillin-tazobactam were all associated with increased odds of VA-AKI. Conclusion: The incidence of VA-AKI in hospitalized patients with eGFR > 30 ml/min was 11.7%. Serum vancomycin levels of > 20 mg/L, hypotension and administration of iodinated contrast significantly increased the risk of VA-AKI. Piperacillin-tazobactam, when used with vancomycin, was noted to be an independent predictor of AKI, regardless of serum vancomycin trough levels, prompting a reevaluation of the safety of this widespread practice as empiric therapy. Close monitoring of kidney function, avoiding high serum vancomycin levels, maintaining hemodynamic stability, and avoiding unnecessary use of iodinated contrast seem to be essential for the prevention of VA-AKI.

Introduction: Implementation of prevention strategies for patients with coronary artery disease (CAD) is essential, but many fall short of reaching their goals. Patients often perceive themselves as healthy and are less motivated to change lifestyle. To obtain better results patients need repeated information, preferably with motivational and person-centered approaches. Aims: To investigate whether health care providers inform CAD patients about risk factors and lifestyle changes at a percutaneous coronary intervention unit. Also to investigate whether the information given at discharge included secondary prevention management and if motivational and person-centered approaches were used. Methods: This is a descriptive, observational study that includes both a qualitative and quantitative design. Physicians and nurses working at a percutaneous coronary intervention (PCI) unit and physicians at a coronary care unit (CCU) participated. A staff nurse observed and noted what information the patients received at the PCI unit. At the CCU, observations regarding secondary prevention strategies during the discharge counselling were performed. Results: There were 50 observations made at the PCI unit. The information mainly consisted of tobacco consumption, physical activity and diet. During the 31 discharge counselling sessions the diagnosis, interventional procedure and medical treatment were frequently included. Most patients received little or no person-centered or motivational counselling. Conclusion: Nearly all patients at the PCI unit received information about the consequence of tobacco consumption, and more than half about the beneficial effects of physical activity. In contrast, the counselling at discharge need to focus more on behavioral changes and a motivational and person-centered approach.

For 51 days, Gaza was pummeled down by the Israeli military in a war known as Operation Protective Edge. During the 50 days (7-7-204 to 28-8-2014) of the Israeli campaign, 2104 Palestinians were killed, including 253 women (12%) and 495 children (24%). According to the UN, at least 69% of Palestinians killed were civilians. It is estimated that 10,224 Palestinians, including 3,106 children (30%) and 1,970 women (19%) were injured. Preliminary estimates indicate that up to 1,000 of the children injured will have a permanent disability and up to 1,500 orphaned children will need sustained support from the child protection and welfare sectors, 17,200 homes destroyed or severely damaged, 58 hospitals and clinics damaged [1]. Major stressful events are well documented to increase the incidence of acute cardiac events [2]. Cardiovascular complications more than doubled during the FIFA World Cup games of 2006 [3]. After the September 11 terrorist attacks, significantly more patients presented with acute myocardial infarction to the hospitals in Brooklyn [4] and New Jersey [5]. We were able to examine the effects of the Isreli attacks on acute STEMI presentations in Gaza city.

Urine typically has an amber-yellow color due to the amorphous pigment urochrome, a distinct scent, and an average pH of 6.0, which is somewhat acidic. Green urine can result from drug intake, dyes, infections, adverse drug reactions, and other causes. Less than 1% of propofol users experience green urine, a rare and benign side effect. The green tint in urine is caused by the phenolic metabolites of propofol. In this case, a 33-year-old man diagnosed with organophosphorus poisoning and aspiration pneumonia had been given a modest dose of propofol sedation for six hours and began to exhibit green urine. After five hours of halting the propofol infusion, the urine returned to its usual color. Healthcare practitioners should be aware of this unusual but safe side effect of propofol.

Introduction: Solitary fibrous tumor is a neoplasm of mesenchymal origin with benign and malignant forms. We aimed to present a case of solitary fibrous tumor which developed in a patient operated for laryngeal cancer and originated from diaphragm in the light of the literature. Case report: A 61-year-old male patient with tracheostomy with an undiagnosed lesion that appears to be almost 10 cm was referred to our clinic. Since it was a large volume mass, we chose to perform a thoracotomy over thorachoscopic approach. Discussion: Although solitary fibrous tumors most commonly occur in the pleura but may also originated from diaphragm, and our case is valuable that originates from diaphragmatic since there are less than 5 reported cases in literature for past two decades. Conclusion: Even in the case of recurrence, the main treatment remains as total surgical excision. Solitary fibrous tumors are usually detected because of compression symptoms. That is the main reason why we chose thoracotomy.

Background: Growing evidence has revealed that fear and anxiety related situations could affect cardiac parameters. P wave dispersion (Pd) is an important index. In the present study, we aimed to evaluate Pd values in patients with premenstrual dysphoric disorder. Methods: The study was composed of twenty-five female patients with premenstrual dysphoric disorder and same number of healthy controls. Pd, Pmin and Pmax values were determined by electrocardiogram (ECG) in the subjects. Results: It was found that patients with premenstrual dysphoric disorder had considerably higher Pmax and Pmin values compared to those of healthy subjects. Pd was also significantly higher in patients with premenstrual dysphoric disorders than that of healthy subjects. Conclusion: Study suggests that patients with premenstrual dysphoric disorder seems to have increased Pd, as can be seen in anxiety and fear related clinical conditions, considering that this group of patients have an increased trend to cardiac abnormalities, particularly cardiac arrythmias. To access strong conclusion, it is required novel studies with larger samples.

Background: Early diagnosis and improved facilities are necessary for determining the optimal timing of surgery and other interventions in children with congenital heart diseases in Nigeria. This is because late presentation, late diagnosis and delayed surgery can lead to mortality and affect the quality of life among these children. Objectives: This review article is aimed at enumerating the timing of cardiac surgeries and other interventions and to seek if there is any factor associated with the timing of cardiac surgery. Methods: A search on PubMed database, World Health Organization libraries, Google scholar, TRIP database, and reference lists of selected articles on timing of cardiac surgery in children was done. The Cochrane Database of Systematic Reviews was also searched. We noted few data from African setting. Key words such as timing of cardiac surgery; children, congenital heart defect were used. Conclusion: Appropriate timing for cardiac surgery in children with congenital heart disease is very important as late surgical intervention could result in several morbidities and mortality.

Objective: To investigate the value of machine learning and traditional Cox regression models in predicting postoperative survivorship in patients with adenocarcinoma of the esophagogastric junction (AEG).Methods: This study analyzed clinicopathological data from 203 patients. The Cox proportional risk model and four machine learning models were constructed and internally validated. ROC curves, calibration curves, and clinical decision curves (DCA) were generated. Model performance was assessed using the area under the curve (AUC), while calibration curves determined the fit and clinical significance of the model.Results: The AUC values of the 3-year survival in the validation set for the Cox regression model, extreme gradient boosting, random forest, support vector machine, and multilayer perceptron were 0.870, 0.901, 0.791, 0.832, and 0.725, respectively. The AUC values of 5-year survival in the validation set for each model were 0.915, 0.916, 0.758, 0.905, and 0.737, respectively. The internal validation AUC values for the four machine learning models, extreme gradient boosting, random forest, support vector machine, and multilayer perceptron, were 0.818, 0.772, 0.804, and 0.745, respectively.Conclusion: Compared with Cox regression models, machine learning models do not need to satisfy the assumption of equal proportionality or linear regression models, can include more influencing variables, and have good prediction performance for 3-year and 5-year survival rates of AEG patients, among which, XGBoost models are the most stable and have significantly better prediction performance than other machine learning methods and are practical and reliable.