The educational value of ward rounds as a learning and teaching opportunity for house officers, medical officers, and registrars in Sudanese hospitals: a multi-center cross-sectional study.

BACKGROUND: Ward rounds are a cornerstone in the educational experience of junior doctors and an essential part of teaching patient care. Here, we aimed to assess the doctors' perception of ward rounds as an educational opportunity and to identify the obstacles faced in conducting a proper ward round in Sudanese hospitals. METHOD: A cross-sectional study was conducted from the 15th to the 30th of January 2022 among house officers, medical officers, and registrars in about 50 teaching and referral hospitals in Sudan. House officers and medical officers were considered the learners, while specialist registrars were considered the teachers. Doctors' perceptions were assessed using an online questionnaire, with a 5-level Likert scale to answer questions. RESULTS: A total of 2,011 doctors participated in this study (882 house officers, 697 medical officers, and 432 registrars). The participants were aged 26.9 ± 3.2 years, and females constituted about 60% of the sample. An average of 3.1 ± 6.8 ward rounds were conducted per week in our hospitals, with 11.1 ± 20.3 h spent on ward rounds per week. Most doctors agreed that ward rounds are suitable for teaching patient management (91.3%) and diagnostic investigations (89.1%). Almost all the doctors agreed that being interested in teaching (95.1%) and communicating appropriately with the patients (94.7%) make a good teacher in ward rounds. Furthermore, nearly all the doctors agreed that being interested in learning (94.3%) and communicating appropriately with the teacher (94.5%) make a good student on ward rounds. About 92.8% of the doctors stated that the quality of ward rounds could be improved. The most frequently reported obstacles faced during ward rounds were the noise (70%) and lack of privacy (77%) in the ward environment. CONCLUSION: Ward rounds have a special value in teaching patient diagnosis and management. Being interested in teaching/learning and having good communication skills were the two major criteria that make a good teacher/learner. Unfortunately, ward rounds are faced with obstacles related to the ward environment. It is mandatory to ensure the quality of both ward rounds' teaching and environment to optimize the educational value and subsequently improve patient care practice.

Splenic infarction caused by a rare coinfection of Epstein-Barr virus, cytomegalovirus, and Mycoplasma pneumoniae.

Epstein-Barr virus (EBV), cytomegalovirus (CMV), and Mycoplasma pneumoniae are common pathogens of respiratory infection among children and young adults. Although single infection of 1 of these pathogens is common enough, their coinfection has been rarely reported. A 19-year-old woman presented with severe upper abdominal pain for 5 hours as well as flu-like symptoms and jaundice for 2 to 3 weeks. Initial tests found pancytopenia, abnormal liver functions, and presence of atypical lymphocytes in blood smear; the computed tomography of the abdomen revealed para-aortic lymphadenopathy, splenomegaly, and a wedge-shaped focal hypodensity lesion at the periphery of the spleen that was later diagnosed as splenic infarction. Her presentation raised suspicion of infectious mononucleosis. Nevertheless, monospot test, human immunodeficiency virus screening, and hepatitis viral serology were all negative, except that her M pneumoniae immunoglobulin M was found positive. Azithromycin was promptly given, but her fever and abdominal pain persisted. A strong suspicion of mononucleosis led to serological tests for EBV and CMV, which confirmed coinfection of EBV and CMV. By hospital day 7, her fever and abdominal pain had subsided and her liver function became normal. This case exemplifies the challenges in the diagnosis of coinfection of multiple respiratory pathogens and its associated complications. Greater awareness among clinicians would ensure an earlier and more accurate diagnosis of coinfection of EBV/CMV with other respiratory pathogen(s).

Pyrolysis of Canarium schweinfurthii hard-shell: Thermochemical characterisation and pyrolytic kinetics studies.

Canarium schweinfurthii fruit used in food and cosmetics produces waste nuts with a hard shell (hard-shell) and kernel. The hard-shell contained lignin and holocellulose, besides 51.99 wt% carbon, 6.0 wt% hydrogen, 41.68 wt% oxygen, and 70.97 wt% volatile matter. Therefore, this study commenced thermochemical investigations on the hard-shell through extensive intermediate pyrolysis and kinetic studies. During the active stage of thermogravimetric pyrolysis, the hard-shell lost a maximum of 56.45 wt%, and the activation energies obtained by the Kissinger-Akahira-Sunose, Flynn-Wall-Ozawa, and Starink methods were 223, 221 and 217 kJ/mol, respectively. The Flynn-Wall-Ozawa method depicted the degradation process accurately, where the Coat-Redfern method's contraction and diffusion mechanisms governed the pyrolysis reactions at activation energies of 16.62 kJ/mol and 38.83 kJ/mol, respectively. The pyrolysis process produced 25 wt% biochar and 25 wt% bio-oil under optimum conditions. The calorific values of the bio-oils with 6.81-7.11 wt% hydrogen and 68.01-71.12 wt% carbon was 26.32-27.83 MJ/kg, with phenolics and n-hexadecanoic and oleic acids as major compounds. Biochar, by contrast, has a high carbon content of 75.11-79.32 wt% and calorific values of 25.45-28.61 MJ/kg. These properties assert the biochar and bio-oils among viable bioenergy sources.

Physicochemical analysis and intermediate pyrolysis of Bambara Groundnut Shell (BGS), Sweet Sorghum Stalk (SSS), and Shea Nutshell (SNS).

ABSTRACTThe current work focused on the intermediate pyrolysis of Bambara Groundnut Shells (BGS-G1), Sweet Sorghum Stalk (SSS), and Shea Nutshells (SNS). These feedstocks are readily available as wastes or by-products from industrial and agricultural activities. The thermo-gravimetric analysis of the biomass samples exhibited decomposition and devolatilization potentials in the temperature range of 110-650°C. The kinetic modelling resulted in the activation energy of BGS G1 being the lowest as 20.43 kJ/mol and SNS as the highest 24.89 kJ/mol among the three biomass samples. Intermediate pyrolysis was conducted in a vertical tube reactor at a temperature of 600°C, with nitrogen flow at 10 ml/min and heating rate ≥ 33.0℃/min. The yield of pyrolysis bio-oil was 38.0 ± 6.4, 44.2 ± 6, and 39.7 ± 5.2 wt.% for BGS-G1, SSS, and SNS, respectively. The HHV of bio-oil varied as 23.7 ± 1.8, 23.8 ± 1.8, to 26.5 ± 2.0 MJ/kg for BGS-G1 SSS and SNS respectively. The biochar recorded the lowest HHV for BGS-G1 as 18.8 ± 1.2 MJ/kg and the highest for SNS as 26.4 ± 1.8 MJ/kg. The FTIR of bio-oil revealed significant functional groups, and GC-MS (Gas Chromatography and Mass Spectrometry) analysis categorized the compounds in bio-oils as ketones, furans, phenolics, acids, phenols and benzene derivatives. The physicochemical analysis of the feedstocks and the products (bio-oil and biochar) showed their potential for bioenergy and biochemical (green chemicals) production.

Evaluation of potential feedstock for biogas production via anaerobic digestion in Malaysia: kinetic studies and economics analysis.

As the population increases, energy demands continue to rise rapidly. In order to satisfy this increasing energy demand, biogas offers a potential alternative. Biogas is economically viable to be produced through anaerobic digestion (AD) from various biomass feedstocks that are readily available in Malaysia, such as food waste (FW), palm oil mill effluent (POME), garden waste (GW), landfill, sewage sludge (SS) and animal manure. This paper aims to determine the potential feedstocks for biogas production via AD based on their characteristics, methane yield, kinetic studies and economic analysis. POME and FW show the highest methane yield with biogas yields up to 0.50 L/g VS while the lowest is 0.12 L/g VS by landfill leachate. Kinetic study shows that modified Gompertz model fits most of the feedstock with R 2 up to 1 indicating that this model can be used for estimating treatment efficiencies of full-scale reactors and performing scale-up analysis. The economic analysis shows that POME has the shortest payback period (PBP), highest internal rate of return (IRR) and net present value (NPV). However, it has already been well explored, with 93% of biogas plants in Malaysia using POME as feedstock. The FW generation rate in Malaysia is approximately 15,000 tonnes per day, at the same time FW as the second place shows potential to have a PBP of 5.4 years and 13.3% IRR, which is close to the results achieved with POME. This makes FW suitable to be used as the feedstock for biogas production.

Presentation and anatomical distribution of diverticular disease in four hospitals in Sudan.

INTRODUCTION: diverticular disease (DD) was thought to be more prevalent in the western countries, especially the white populations, but the recent increase in incidence among African and Asian population, was reported. Up to our knowledge, there is no previous study of DD in Sudan. METHODS: this is a descriptive cross-sectional study conducted at the department of endoscopy in four Sudanese hospitals in the period from October 2017 to February 2019. We included all patients who underwent colonoscopy during the study period. The main objective is to study the presentation and the anatomical pattern of diverticular disease among the Sudanese population. RESULTS: prevalence of DD in the included population was 7.5% (104/1393). The mean age was 66.4 ± 12.5 years with the percentage of males in our study is 77.1% and females were 22.9%. Presenting complains were: abdominal pain in all patients, constipation in 78.8% and rectal bleeding in 57.7%. Regarding anatomical distribution: 63.5% have left colonic DD, 19.2% in the right colon and 17.3% involving the entire colon. There was a significant correlation between the left side DD and following clinical presentations: mucus per-rectum (p = 0.015) and weight loss (p = 0.048). Other endoscopic findings of significance were internal pile in 21.2% and colo-rectal polyp in 15.4%. CONCLUSION: the prevalence of DD in the included population, is 7.5% which is consistent with recent literature from the Middle East, Africa and Asia but still less than the prevalence in the western countries and left side colon is predominantly affected.

Prostate cancer leading to monoclonal gammopathy of undetermined significance: A case report.

Prostate cancer is one of the most common cancer types, affecting millions of individuals worldwide. The present study reported two cases of metastatic prostate cancer presenting with newly diagnosed monoclonal gammopathy of undetermined significance (MGUS). To the best of our knowledge, prostate cancer leading to MGUS has not been documented previously. MGUS is generally thought to be benign and has been demonstrated to convert into multiple myeloma (MM), as well as other lymphoproliferative disorders. Due to the high mortality rate associated with MM, further studies are required to confirm and clarify the association between prostate cancer and MGUS. Additionally, patients can be counseled on the requirement for follow up studies following a diagnosis of prostate cancer.

Primary Small Intestinal Angiosarcoma: Epidemiology, Diagnosis and Treatment.

Angiosarcoma is an aggressive mesenchymal sarcoma of endothelial cell origin with high mortality. Its occurrence in the small intestine is exceedingly low. In addition to the rarity of small intestine angiosarcoma, the nonspecific early clinical symptoms obscure the suspicion of such tumors and thereby delay the diagnosis. In a hope to improve the knowledge of this rare but fatal neoplasm, we report one case of angiosarcoma of duodenum and jejunum in a 73-year-old man. Furthermore, we summarize and analyze the common clinical features, tumor markers, treatment, and survival of previous reported cases of this malignancy. Small bowel angiosarcoma occurs more often in men than women (1.6:1). The median age at diagnosis is 68.5 years. The overall median survival time is 150 days; the median survival time in female (300 days) is longer than that of male patients (120 days). Von Willebrand factor (vWF), CD31, CD34, vimentin, and Ulex europaeus agglutinin 1 appear to be the most useful markers for the diagnosis. The majority of the patients underwent surgical resection alone or surgery with subsequent chemotherapy. The patients treated with surgery plus chemotherapy survive longer than those underwent surgical resection only (median 420 days, n = 7 vs. 96.5 days, n = 26, respectively; P = 0.0275). Further studies of more cases are needed for a better understanding of this rare entity, as well as the development of effective strategies for prevention, early diagnosis, and treatment.

A case of reversible drug-induced liver failure.

Acute fulminant liver failure and acute renal failure are devastating complications caused by many drugs. The use of N-acetylcysteine has been well established in acetaminophen toxicity, but it remains controversial in other cases. Dialysis is a very effective method of removing certain drugs from the system. With the invention of new street drugs such as "synthetic marijuana," it may be beneficial in patients whom the substances ingested are unknown. We report a case of a 42-year-old male who developed acute fulminant hepatic failure and acute renal failure, who was cured with dialysis, N-acetylcysteine, and other supportive measures.

A rare cause of acute abdomen: spontaneous dissection of the superior mesenteric artery.

Spontaneous superior mesenteric artery (SMA) dissection is a rare, but potentially fatal disease. Prompt diagnosis and treatment of SMA dissections result in a lower prevalence of intestinal infarction and mortality. In the current era, imaging techniques can promptly diagnose SMA dissection; however, no definitive guidelines have been established to treat this condition.

Normal Pressure Hydrocephalus in a Human Immunodeficiency Virus Type 1 Patient.

Normal pressure hydrocephalus (NPH) is a relatively common disease of adulthood characterized by a typical combination of clinical and radiological findings. In this report, we discuss a 54-year-old female presenting with symptoms suggestive of NPH and found to have a history of human immunodeficiency virus (HIV) type 1. She was not treated as she was in denial state and developed NPH as a possible complication. In the literature, there has only been one reported case of HIV type 2 causing NPH; however, no relationship has been properly documented with HIV type 1. These findings bring about a question on whether NPH is associated or a complication of HIV with awareness of this association. Earlier screening of HIV can be done in patients presenting with such symptoms, thus to prevent further progression of its complications.

Defibrillator-Induced Tricuspid Abscess Presenting as Diabetic Ketoacidosis and Wound Ulceration.

Right-sided endocarditis is predominantly seen in patients with a history of intravenous drug abuse. However, it is well shown in the literature to be associated with patients containing foreign bodies such as pacemakers, central venous lines, and in those with congenital heart disease. In patients with pacemaker leads and in those with automatic implantable cardioverter defibrillators (AICDs), it is important to suspect foreign body infection when there are signs and indications of bacteremia. When these leads become infected, they can spread the infection to the tricuspid valve resulting in vegetations. The proper management is removal of the infected lead and foreign body along with a prolonged course of antibiotics. However, it is unusual and a relatively rare entity to see foreign body infection resulting from a wound ulcer resulting in not only endocarditis but also abscess formation on the tricuspid valve. Here we report a case of a 60-year-old male with recent AICD placement presenting as diabetic ketoacidosis due to tricuspid abscess formation as a result of a foot ulcer.

Cocaine-Induced Delayed Myocardial Infarction Complicated by Apical Thrombus.

It is well demonstrated in the literature that cocaine use has been well linked to the formation of various forms of acute and chronic cardiovascular problems including but not limited to acute coronary syndromes. However, cocaine has been commonly associated with coronary vasospasms and less commonly with myocardial infarction and the formation of atrial thrombus. Through this case presentation, we illustrate the findings of a 35-year-old gentleman with history of cocaine use presenting with acute coronary syndrome and complicated by thrombus formation. Furthermore, through this report, we illustrate in a patient with no other risk factors and at a young age, how chronic cocaine use or even a history of usage may result in complications even weeks after its consumption.

Mixed Adenocarcinoid Tumor Presenting as Acute Appendicitis.

Mixed adenocarcinoid tumors are not uncommon neoplasms of appendix. The clinical presentation of these tumors is often similar to that of acute appendicitis or may present as asymptomatic. These tumors are found incidentally during histopathological examination of the resected appendix following appendectomy or other abdominal procedures. Mixed adenocarcinoids usually behave as adenocarcinomas with rapid metastasis, so prognosis depends upon how aggressive the tumor behaves. The present study reports a case of a 53-year-old male who presented with abdominal pain and fever for 1 day and underwent successful appendectomy and recovered later. Subsequently, a mixed adenocarcinoma with carcinoid features of the appendix was diagnosed by histopathological examination. Follow-up examination of the patient in 3 months revealed metastasis of carcinoma to the peritoneum with adenocarcinoma features.

A rare case of orthostatic headache due to spontaneous intracranial hypotension.

Headache is one of the most common clinical entities, and has a long list of differential diagnoses; however, one of the more uncommon causes of postural headache is spontaneous intracranial hypotension. It is important that clinicians be aware of this condition, as it is often overlooked, leading to invasive and unnecessary diagnostic testing. A good history and physical exam, paired with an MRI of the brain is sufficient to make the diagnosis of SIH, relieve the symptomology of the patient in a quick and efficient manner, and avoid costly invasive procedures.

Thoracic Actinomycosis: A Rare Occurrence.

Actinomyces israelii is a branching anaerobic bacilli microorganism that can be identified as normal flora throughout various portions of the human alimentary canal. It is crucial to establish a diagnosis as treatment will vary depending on the clinical form of the disease. We report a case of a 78-year-old man who initially presented with an acute onset of respiratory distress displayed contrast leakage on computed tomography from the site of a previously inserted esophageal stent for an unsuccessful surgical repair of an esophageal rupture. In addition to the contrast leakage, the presence of a bronchopulmonary fistula imaging prompted the need for further investigation. Our patient was empirically treated with antibiotics and obtained blood cultures, which returned positive A. israelii.

Convulsive Syncope Induced by Ventricular Arrhythmia Masquerading as Epileptic Seizures: Case Report and Literature Review.

It is important but difficult to distinguish convulsive syncope from epileptic seizure in many patients. We report a case of a man who presented to emergency department after several witnessed seizure-like episodes. He had a previous medical history of systolic heart failure and automated implantable converter defibrillator (AICD) in situ. The differential diagnoses raised were epileptic seizures and convulsive syncope secondary to cardiac arrhythmia. Subsequent AICD interrogation revealed ventricular tachycardia and fibrillation (v-tach/fib). Since convulsive syncope and epileptic seizure share many similar clinical features, early diagnosis is critical for choosing the appropriate management and preventing sudden cardiac death in patients with presumed epileptic seizure.

Increased erythropoietin levels as a biomarker of pancreatic adenocarcinoma: A case report.

Pancreatic cancer is one of the deadliest cancers commonly diagnosed at an advanced stage. Early diagnosis is crucial for the timely and potentially curative treatment of this highly fatal disease. Although screening tests have improved the survival rate in malignancies such as colon, breast, cervical and prostate cancer, there is currently no effective screening method available for the early detection of pancreatic cancer. As the sensitivity and specificity of existing biomarkers, such as carbohydrate antigen 19-9, for the early detection of pancreatic cancer is low, there is a pressing need for the identification of novel cancer markers. An increase in erythropoietin (EPO) levels has been observed in several cases of pancreatic neoplasms. However, the potential role of EPO as a biomarker of pancreatic cancer or malignant transformation requires further investigation. We herein present a case of increased EPO levels in an adult male patient with stage IV pancreatic cancer.

Muir-Torre Syndrome Presenting as Sebaceous Adenocarcinoma and Invasive MSH6-Positive Colorectal Adenocarcinoma.

Muir-Torre syndrome (MTS) is a rare genodermatosis, diagnosed by the presence of sebaceous neoplasms along with an internal malignancy, most commonly colorectal carcinomas. MTS is most commonly caused by microsatellite instabilities of the hMLH1 and hMSH2 mismatch repair genes, and is rarely caused by mutations of the hMSH6 gene. We describe the case of a 56-year-old male who presented with an enlarging mass on his back as well as hematochezia. The back mass was excised, and pathology confirmed microsatellite instability in MSH2 and MSH6. Abdominal CT and colonoscopy confirmed the presence of synchronous masses in the cecum, ascending colon, and the transverse colon. He refused any further workup or treatment, only to return 8 months later complaining of hematochezia and discomfort due to an enlarging mass protruding from the rectum. After consenting to surgical intervention, he agreed to outpatient chemotherapy treatment. The presence of sebaceous neoplasms should raise suspicion for the possibility of an associated internal malignancy.

Hypertriglyceridemia-Induced Pancreatitis: Choice of Treatment.

Severe hypertriglyceridemia is one of the many yet rare risk factors associated with acute pancreatitis. The level of triglycerides plays a crucial role in determining the method and duration of treatment. As with the treatment of other causes of acute pancreatitis, bowel rest, intravenous fluids, and supportive care play a crucial role. However, depending on the degree of hypertriglyceridemia, the role of other treatment options may need to be implemented. There are no set established guidelines for the management of hypertriglyceridemia-induced pancreatitis, but the role of insulin, heparin, and plasmapheresis has been studied and successfully used in its management. We report the case a 44-year-old female with clinical acute pancreatitis secondary to hypertriglyceridemia who was successfully managed with the addition of intravenous insulin.