Current Practices and Challenges in the Management of Complex Renal Stones in Africa: A Scoping Review.

This study reviews the challenges and management strategies for complex renal stones in Africa. Historically viewed as infection or struvite stones, recent studies highlight diverse compositions of staghorn stones. These complex stones pose significant risks, including recurrent urinary tract infections and renal impairment. In the past, conservative management of staghorn stones was associated with high morbidity; thus, surgical intervention was necessary for complete eradication. While percutaneous nephrolithotomy (PCNL) remains the standard, it carries notable risks, leading to a shift towards minimally invasive techniques. This study reviews challenges and management practices for complex renal stones and staghorn calculi in African countries, evaluating stone-free rates and associated complications. A scoping review of the literature, following the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, was performed. A systematic search was conducted in PubMed, African Journal Online (AJOL) and Google Scholar, yielding 1,101 articles, but only 11 articles satisfied the inclusion criteria. The study included 1,513 patients with 1,582 renal units, predominantly male (67.2%) with an average age of 40.7 years. Percutaneous nephrolithotomy (PCNL) was the primary treatment for the majority (71.3%), followed by open surgery (21.9%), laparoscopic surgery (4.1%), and retrograde intrarenal surgery (RIRS) (2.7%). The stone clearance rates for PCNL, open surgery, laparoscopic pyelolithotomy, and RIRS were 82.8%, 83.7%, 100%, and 92.8%, respectively. Stone sizes ranged between 22 and 80 mm, with 66% being staghorn stones. Complication rates were highest for open surgery (30.8%) and lowest for RIRS (4.7%). Despite PCNL being the global standard, African studies still indicate a high reliance on open surgery, likely due to healthcare infrastructure, resource availability and socioeconomic factors. Enhancing access to urological care and addressing healthcare disparities are imperative for improving staghorn stone management in Africa.

Investigation of flow behaviour in the nozzle of a Pelton wheel: Effects and analysis of influencing parameters.

The performance of a Pelton wheel is influenced by the jet created by the nozzle. Therefore, a Computational Fluid Dynamics (CFD) simulation was proposed. In this study, the significant output parameters (outlet velocity, outlet pressure, and tangential force component) and input parameters (different pressure and spear locations) were examined. In addition, the influencing parameters and their contributing percentages to the performance of the Pelton wheel were calculated using different optimisation techniques such as Taguchi Design of Experiments (DoE), Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS), Grey Relational Analysis (GRA) and Criteria Importance Through Intercriteria Correlation (CRITIC). The effect of input factors on the output response was examined with DoE, and the results show that the inlet pressure had the most significant impact (97.38%, 99.18%, and 97.38%, respectively, for all different spear sites with a 99% confidence level). In terms of preference values, the TOPSIS and GRA results are comparable (best ranks for simulation runs #24 and #25 and least ranks for simulations #2 and #3, respectively). The CRITIC results for the pressure parameter are in good agreement with the Taguchi ANOVA analysis. The last spear location (5 mm after the nozzle outlet), with an inlet pressure of 413685 Pa generated the best result when employing the TOPSIS and GRA techniques. The outlet pressure of the nozzle was found to have a significant impact on the flow pattern of the Pelton Wheel based on the analysis of the CRITIC, Taguchi, and CFD results.

Telehealth in treating tinnitus: a systematic review and meta-analysis.

OBJECTIVE: Treatment for tinnitus focuses on supportive therapies. Long waiting times in the National Health Service encourage telemedicine options as an alternative. This study aimed to review the literature on telemedicine in the management of tinnitus and analyse its impact on the burden of tinnitus, long-term, anxiety, depression, insomnia and quality of life. METHOD: PubMed, Embase, Cochrane Library, Google Scholar, Scopus and Web of Science were searched. English randomised, controlled trials with adult participants suffering from tinnitus were included. A random effects model looking at standardised mean differences between intervention and control groups was utilised. RESULTS: Eleven randomised, controlled trials were included. Nine studies looked at internet-based cognitive behavioural therapy. A z-value of 9.87 (p < 0.00001; I2 = 21 per cent) showed telemedicine approaches may be better at reducing tinnitus burden compared with passive controls. CONCLUSION: Telemedicine options have multiple benefits, but more research will be needed to conclusively say they are better than alternatives.

Vitamin D Serum Levels in Type 2 Diabetic Patients: A Cross-Sectional Study.

Background and objective Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder characterized by hyperglycemia. It is linked with an increase in morbidity (e.g., blindness, kidney failure, stroke, cardiovascular diseases, limb amputations), premature mortality, high healthcare costs, and is quickly becoming a global epidemic disorder. Several studies have shown that vitamin D supplements reduce insulin resistance in T2DM and improve insulin secretion and sensitivity. In this study, we aimed to determine the prevalence of vitamin D deficiency in T2DM patients in Saudi Arabia. Methods This was a retrospective cross-sectional study conducted at the King Faisal University Health Centre in Saudi Arabia. The study used patient data during the period from October 2014 to January 2021. After obtaining approval from the King Faisal University Polyclinic Administration, we collected patient data from the King Faisal University Health Centre. The Ethics and Research Committee at the College of Medicine of King Faisal University granted ethical approval with the approval number (2020-11-82). The relevant patient data were collected, including age, gender, nationality, and blood test findings (vitamin D and HbA1c levels). Results A total of 191 T2DM patients participated in this study. The mean age of the patients was 56.1 ± 11.4 years (range: 21-85 years); 107 (56%) patients were females, and 137 (71.7%) were Saudis. There were 134 (70.2%) patients with vitamin D deficiency, 53 (27.7%) with vitamin D insufficiency, and only four (2.1%) with normal vitamin D levels. Conclusion Based on our findings, the prevalence of vitamin D deficiency among T2DM patients is highly associated with poor diabetic control.

Reservoir quality and its controlling diagenetic factors in the Bentiu Formation, Northeastern Muglad Basin, Sudan.

The Abu Gabra and Bentiu formations are widely distributed within the interior Muglad Basin. Recently, much attention has been paid to study, evaluate and characterize the Abu Gabra Formation as a proven reservoir in Muglad Basin. However, few studies have been documented on the Bentiu Formation which is the main oil/gas reservoir within the basin. Therefore, 33 core samples of the Great Moga and Keyi oilfields (NE Muglad Basin) were selected to characterize the Bentiu Formation reservoir using sedimentological and petrophysical analyses. The aim of the study is to de-risk exploration activities and improve success rate. Compositional and textural analyses revealed two main facies groups: coarse to-medium grained sandstone (braided channel deposits) and fine grained sandstone (floodplain and crevasse splay channel deposits). The coarse to-medium grained sandstone has porosity and permeability values within the range of 19.6% to 32.0% and 1825.6 mD to 8358.0 mD respectively. On the other hand, the fine grained clay-rich facies displays poor reservoir quality as indicated by porosity and permeability ranging from 1.0 to 6.0% and 2.5 to 10.0 mD respectively. A number of varied processes were identified controlling the reservoir quality of the studies samples. Porosity and permeability were enhanced by the dissolution of feldspars and micas, while presence of detrital clays, kaolinite precipitation, iron oxides precipitation, siderite, quartz overgrowths and pyrite cement played negative role on the reservoir quality. Intensity of the observed quartz overgrowth increases with burial depth. At great depths, a variability in grain contact types are recorded suggesting conditions of moderate to-high compactions. Furthermore, scanning electron microscopy revealed presence of micropores which have the tendency of affecting the fluid flow properties in the Bentiu Formation sandstone. These evidences indicate that the Bentiu Formation petroleum reservoir quality is primarily inhibited by grain size, total clay content, compaction and cementation. Thus, special attention should be paid to these inhibiting factors to reduce risk in petroleum exploration within the area.

How readable and reliable is online patient information on chronic rhinosinusitis?

OBJECTIVE: This study aimed to assess the quality and readability of websites on chronic rhinosinusitis. METHODS: A total of 180 results from 3 different search engines regarding 'chronic rhinosinusitis', 'sinusitis' and 'sinus infections' were analysed for readability using the Flesch-Kincaid Grade Level, Flesch Reading Ease Score and Gunning Fog Index. The Discern tool was used to approximate information quality. RESULTS: From 180 total searches, 69 unique websites were identified. These had an average Flesch-Kincaid Grade Level of 9.75 (95 per cent confidence interval = 9.12-10.4), a Flesch Reading Ease Score of 45.0 (41.0-49.0) and a Gunning Fog Index of 13.7 (12.9-14.4), which equates to the average reading level of a college or university student. Discern scores were variable but consistently showed good-quality information. CONCLUSION: Chronic rhinosinusitis information is of a high quality but is for a reading level higher than that of the average adult. Standardising patient information should ensure adequate comprehension and improve patient compliance.

Effect of acute heat stress on cognitive performance of chickens in a feed-related discriminant task.

Little is known about immediate and long-lasting effect of acute heat stress on chicken cognition. Thirty-five, 9-week-old birds were trained to differentiate two cone colours; white (rewarded, R; with feed underneath) and black (unrewarded, UR; empty). The sixteen birds that learnt the task were randomly assigned to three temperature regimens (TR: 22-24 °C (control), 30-32 and 36-38 °C for 3h/day) for three consecutive days during which rectal (RT), wing (WT) and eye (ET) temperatures were monitored. After the 3 h of exposure, birds were allowed to rest for 1 h before the commencement of the discriminant task. The latencies to open the cones (R and UR) and proportion of cones opened were recorded. A long-lasting effect was tested a week after exposure to TR. TR had a significant effect on RT, WT and ET. The motivation to turn over R cones was weaker in birds exposed to 36-38 °C than birds exposed to 22-24 °C. Also, the proportion of R cones opened were fewer in birds that experienced TR of 36-38 °C compared to birds exposed to 22-24 °C and 30-32 °C specifically on two out of the three cognitive test days (Days 1 and 3). Latency and proportion of UR cones opened was not affected by TR. RT, WT and ET were all negatively and significantly correlated with latency to open the UR cones. Previous exposure of birds to three TR had no effect on the latency to open both cones but the proportion of R cones opened was greater in birds exposed to 30-32 °C compared to the 22-24 °C birds. In conclusion, an immediate (36-38 °C) and long-lasting effect (30-32 °C) of acute heat stress was associated with a weak motivation to perform feed related discrimination task.

Sedimentology, petrography, and reservoir quality of the Zarga and Ghazal formations in the Keyi oilfield, Muglad Basin, Sudan.

The Zarga and Ghazal formations constitute important reservoirs across the Muglad Basin, Sudan. Nevertheless, the sedimentology and diagenesis of these reservoir intervals have hitherto received insignificant research attention. Detailed understanding of sedimentary facies and diagenesis could enhance geological and geophysical data for better exploration and production and minimize risks. In this study, subsurface reservoir cores representing the Zarga formation (1114.70-1118.50 m and 1118.50-1125.30 m), and the Ghazal formation (91,403.30-1406.83 m) were subjected to sedimentological (lithofacies and grain size), petrographic/mineralogic (thin section, XRD, SEM), and petrophysical (porosity and permeability) analyses to describe their reservoir quality, provenance, and depositional environments. Eight (8) different lithofacies, texturally characterized as moderately to well-sorted, and medium to coarse-grained, sub-feldspathic to feldspathic arenite were distinguished in the cored intervals. Mono-crystalline quartz (19.3-26.2%) predominated over polycrystalline quartz (2.6-13.8%), feldspar (6.6-10.3%), and mica (1.4-7.6%) being the most prominent constituent of the reservoir rocks. Provenance plot indicated the sediments were from a transitional continental provenance setting. The overall vertical sequence, composition, and internal sedimentary structures of the lithofacies suggest a fluvial-to-deltaic depositional environment for the Ghazal formation, while the Zarga formation indicated a dominant deltaic setting. Kaolinite occurs mainly as authigenic mineral, while carbonates quantitatively fluctuate with an insignificant amount of quartz overgrowths in most of the analyzed cores. Integration of XRD, SEM, and thin section analysis highlights that kaolinite, chlorite, illite, and smectite are present as authigenic minerals. Pore-destroying diagenetic processes (e.g. precipitation, cementation, and compaction etc.) generally prevailed over pore-enhancing processes (e.g. dissolution). Point-counted datasets indicate a better reservoir quality for the Ghazal formation (ɸ = 27.7% to 30.7%; K = 9.65 mD to 1196.71 mD) than the Zarga formation (17.9% to 24.5%; K = 1051.09 mD to 1090.45 mD).

Communities of Practice: Transforming Medical Education and Clinical Practice for Vulnerable Populations.

The report defines the theory behind communities of practice as a model to transform medical education and clinical practice for vulnerable populations (LGBTQ, persons experiencing homelessness, and migrant farm workers). It also offers lessons learned from this model to demonstrate value creation by communities of practice in medical education.

Evaluation of rumen-protected choline additive to diet on productive performance of male Zaraibi growing goats during hot summer season in Egypt.

Twenty Zaraibi goat bucks were used in this experiment which lasted 3 months during summer season of Egypt. The animals were divided randomly into two equal groups. The first group was kept without treatment as control while in the second group, rumen-protected choline (RPC) at the level of 20 g/buck/day was added to the concentrate feed mixture at the morning feeding. RPC additives to diet of Zaraibi goat bucks during the period of hot summer season increased (P < 0.01) total gain and average daily gain compared to the control group. RPC increased (P < 0.05) dry matter intake and feed conversion while water intake was not affected by RPC additives. RPC increased (P < 0.05) red and white blood cell (RBC × 106, WBC × 103) counts and hemoglobin concentration and hematocrit percentage. RPC increased total protein (P < 0.05), globulin, and γ-globulin (P < 0.01). On the other hand, total lipids, total cholesterol, and triglyceride concentrations decreased (P < 0.05 and P < 0.05) while phospholipids, glucose, and choline concentrations increased (P < 0.01) due to RPC supplementation. RPC increased (P < 0.01) thyroxin and triiodothyronine, increased (P < 0.05) testosterone levels, and decreased (P < 0.01) cortisol level compared with control bucks. It is concluded that dietary RPC at the rate of 20 g daily is required for growing male goats, especially, under heat stress conditions of summer season in Egypt and showed the best results concerning the growth, feed conversion, blood metabolites, and economic efficiency.

Comparing electronic recording with a diagrammatic template versus traditional handwritten recording of tympanomastoid procedures: third audit cycle of 95 cases.

BACKGROUND: The middle ear and mastoid are complex three-dimensional structures and therefore tympanomastoid procedures require detailed documentation. Traditional written accounts can be inaccurate and difficult to interpret. METHODS: This audit of 95 patients compares the completion of essential operative details using: an all-electronic version of a standardised proforma with a diagrammatic template, a non-electronic version with a diagrammatic template, and a traditional handwritten template. RESULTS: The electronic template resulted in 81 per cent of essential operative items being recorded, compared to 78 per cent (p = 0.3) with a previous non-electronic template and 50 per cent (p = 0.0004) when using simple handwritten recording. CONCLUSION: An electronic proforma with a diagrammatic template improves the documentation and interpretation of tympanomastoid procedures compared to traditional handwritten records.

A randomized controlled trial comparing Oxinium and cobalt-chrome on standard and cross-linked polyethylene.

The purpose of the investigation was to assess the clinical and radiographic outcomes in four bearing surfaces. Eighty patients (91 hips) undergoing total hip arthroplasty between 2004 and 2007 were randomized to one of four bearing surfaces: (1) cobalt-chrome (CoCr) and ultra-high molecular weight polyethylene (UHMWPE); (2) CoCr and XLPE; (3) Oxinium and UHMWPE; and (4) Oxinium and XLPE. The mean follow-up for this study was 6.8 years. There were no significant differences in clinical outcomes. The linear wear rates for the four groups were 0.241 mm/year, 0.076 mm/year, 0.238 mm/year and 0.061 mm/year respectively. HXLPE results in significantly less wear than UHMWPE. However, we found no significant reduction in wear rate by using Oxinium in place of CoCr femoral heads at early follow-up.

Assessment of suicidal and self-injurious behaviours among patients with depression.

The aim of this cross-sectional 1-year study was to estimate the prevalence and to identify the risk factors for suicidal and self-injurious behaviours among patients with depression. A convenience sample of 557 out- and inpatients diagnosed with mood disorders was selected from 3 treatment settings in Riyadh, Saudi Arabia. Eligible patients completed data on sociodemographic variables and the Columbia suicide severity rating scale risk assessment version. The reported prevalence of attempted suicide in the previous week was 36.6%, interrupted suicide attempt 29.8%, aborted suicide attempt 34.6% and self-injurious behaviour without suicide intent 7.7%. Concerning suicide ideation, 47.2% reported suicidal thoughts, 36.6% suicidal thoughts with methods but without a specific plan and 35.4% suicidal intent without a specific plan. Male sex, joint family type, literate education, being in employment, smoking and physical co-morbidities were significantly associated with all types of suicide behaviour.

What determines the selection of undergraduate medical students to the specialty of their future careers?

BACKGROUND: It is important to understand the factors that influence the undergraduate medical students' specialties choice for the post-graduation. OBJECTIVES: To identify the number of undergraduate medical students who decided their post-graduate specialty career, factors that may influence their decision to select a particular specialty, and their career specialties preference. METHODS: A self-administered questionnaire was used to achieve the objectives. RESULTS: Less than half of the students (40.2%) showed a future specialty preference. Senior students and having background about specialties were the significant factors for career choices. General Surgery (27.4%), ENT-Ophthalmology (24.6%) and Internal Medicine (22%) were preferred specialties. Male students preferred General Surgery (15.7%), Internal Medicine (15%), ENT-Ophthalmology (12%) and Orthopedics (9.1%). Female students showed interest in ENT-Ophthalmology (12.1%), Surgery (11.7%), Pediatrics (10.8%) and Dermatology (8.2%). The least popular specialties were Community Medicine, (6.6%), Anesthesia, (6%) and Forensic Medicine (4.6%). Obstetrics and Gynecology (Ob/Gyne) was a less popular branch even in female students. CONCLUSIONS: General Surgery, ENT-Ophthalmology and Internal Medicine were the most preferred specialties, while Community Medicine, Forensic and Ob/Gyne, even for female students were least selected specialties. Proper information and counseling should be offered to students about the challenges and opportunities to select their future careers.

Assessment of suicidal and self-injurious behaviours among patients with depression

The aim of this cross-sectional 1-year study was to estimate the prevalence and to identify the risk factors for suicidal and self-injurious behaviours among patients with depression. A convenience sample of 557 out- and inpatients diagnosed with mood disorders was selected from 3 treatment settings in Riyadh, Saudi Arabia. Eligible patients completed data on sociodemographic variables and the Columbia suicide severity rating scale risk assessment version. The reported prevalence of attempted suicide in the previous week was 36.6%, interrupted suicide attempt 29.8%, aborted suicide attempt 34.6% and self-injurious behaviour without suicide intent 7.7%. Concerning suicide ideation, 47.2% reported suicidal thoughts, 36.6% suicidal thoughts with methods but without a specific plan and 35.4% suicidal intent without a specific plan. Male sex, joint family type, literate education, being in employment, smoking and physical co-morbidities were significantly associated with all types of suicide behavior

Pattern of child and adolescent psychiatric disorders among patients consulting publicly-funded child psychiatric clinics in Saudi Arabia.

Data about psychiatric problems among young people are scarce in the Gulf countries. This retrospective review of records describes the pattern of child and adolescent psychiatric disorders among patients consulting 3 child psychiatric clinics in Saudi Arabia during the year 2008. Most patients were referred from the public health sector (92.8%). Psychotropic drugs were prescribed for 86.2% of patients and psychotherapy for 55.2%. Maternal perinatal complications and other psychosocial stressors were noted in almost 45.8% of cases. Family history of psychiatric disorder was reported in 31.5% of patients. Psychiatric comorbidity was noted in 40.5% of cases while physical diseases were noted in 29.9%. The outcome was classified as unstable at the last consultation in 17.9% of cases. In a linear regression analysis the only factors significantly associated with unstable outcome were a higher load of symptoms (OR 2.64) and perinatal complications (OR 2.84).

Pattern of child and adolescent psychiatric disorders among patients consulting publicly-funded child psychiatric clinics in Saudi Arabia

Data about psychiatric problems among young people are scarce in the Gulf countries. This retrospective review of records describes the pattern of child and adolescent psychiatric disorders among patients consulting 3 child psychiatric clinics in Saudi Arabia during the year 2008. Most patients were referred from the public health sector [92.8%]. Psychotropic drugs were prescribed for 86.2% of patients and psychotherapy for 55.2%. Maternal perinatal complications and other psychosocial stressors were noted in almost 45.8% of cases. Family history of psychiatric disorder was reported in 31.5% of patients. Psychiatric comorbidity was noted in 40.5% of cases while physical diseases were noted in 29.9%. The outcome was classified as unstable at the last consultation in 17.9% of cases. In a linear regression analysis the only factors significantly associated with unstable outcome were a higher load of symptoms [OR 2.64] and perinatal complications [OR 2.84]

Syringoid eccrine carcinoma: a clinicopathological and immunohistochemical study of four cases.

BACKGROUND: Syringoid eccrine carcinoma (SEC) is a rare malignant adnexal tumour with variable presentations. AIM: To examine the clinicopathological and immunohistochemical features of SEC. METHODS: Four cases were reviewed by three dermatopathologists and the immunohistochemical profile was examined using antibodies against CK5/6, CK7, CK14, CK20, LMWK, HMWK, EMA, mCEA, p63, ER, PR, AR, S-100 and Ber-EP4. RESULTS: The cases occurred in two men and two women, ranging in age from 61 to 87 years (mean 68.5). Two of the lesions were from the face and two from the trunk. All four lesions were composed of an atypical infiltrative mass with syringoma-like tadpole morphology with ductular differentiation and prominent desmoplasia. Three cases demonstrated perineural invasion and two had positive lymph node metastases. Immunostaining was variable. Immunohistochemistry positivity was as follows: three out of four cases were positive for CK5/6, CK7 (2/4), CK14 (1/3), CK20 (0/2), HMWK (0/2), LMWK (1/2), EMA (3/4), mCEA (4/4), p63 (2/3), ER (2/3), PR (1/2), AR (0/3), S-100 (0/3) and Ber-EP4 (2/2). CONCLUSION: SEC can present on the trunk and are not limited to the head and neck region. In addition to syringoma-like tadpole structures and glandular differentiation, these tumours can also exhibit squamoid and cribriform growth patterns. Immunostaining in SEC is variable and this variability is believed to stem from this tumour's ability to differentiate along multiple routes, including sweat secretory and/or ductal differentiation.

Mental and Social Health Atlas I in Saudi Arabia: 2007-08.

Based on the World Health Organization's Mental Health Atlas, the first Mental and Social Health Atlas in Saudi Arabia describes the historical background of mental health and social services in the country and identifies several deficiencies in the system including infrastructure and logistics and lack of epidemiological data. There is now great progress in strategic planning for developing and improving mental health care services across the nation, with suggestions to develop psychiatric services for identified special populations, to establish community mental health care services, to improve research and training in mental health, and to update mental health annual information systems using advanced information technology.