A Cross-Sectional Study of Anesthesia Safety in Wad Medani, Sudan: A Pre-war Status Indicating a Post-war Crisis.

BACKGROUND: As the surgical burden grows, increasing patient safety during anesthesia and surgery becomes a major global public health priority. Anesthesia can be safely administered in higher-income countries, yet it is more challenging in third-world countries. This study focuses on Sudan, a third-world country, and its unmet anesthetic needs before the current war and how these needs might compromise the post-war status. AIM: The aim of this study is to compare Sudan's outstanding anesthesia requirements to the World Health Organization's safe anesthesia practice standards in terms of workforce, medications, equipment, and anesthesia conduct. METHODS: This study was carried out in four hospitals (Wad Medani Teaching Hospital, Wad Medani Maternity Hospital, Gezira Centre for Renal and Urological Surgeries, and the National Centre for Pediatric Surgeries) in Wad Medani, two of which were referral and two were state-run. Each hospital from every category was identified using a convenience sampling technique. The World Health Organization-World Federation of Societies of Anesthesiologists International Standard and earlier regional African publications were used to determine the minimum predicted safe anesthesia needs. RESULTS: The results of our study demonstrate that overall, the hospitals surveyed fulfilled the minimum standards set by the World Health Organization and the World Federation of Societies of Anesthesiologists (WHO-WFSA) for safe anesthesia practice by 73% with no significant difference in the safety of anesthesia practice between state and referral hospitals. CONCLUSIONS: The state of safe anesthesia care in Wad Medani hospitals surveyed fell well short of the expected minimal criteria due to important requirements such as patient monitoring indicators, the inaccessibility of life-saving facilities such as defibrillators, and difficult intubation instruments. More importantly, the conduct of anesthesia was far below the standard.

Prevalence and prognosis of fulminant type 1 diabetes mellitus in The Middle East: a comparative analysis in a 5-year nationwide cohort.

PURPOSE: To analyze the prevalence and progression of fulminant type 1 diabetes (FT1D) in Qatar. METHODS: This retrospective study analyzed consecutive index- diabetic ketoacidosis (DKA) admissions (2015-2020) among patients with new-onset T1D (NT1D) in Qatar. RESULTS: Of the 242 patients, 2.5% fulfilled the FT1D diagnostic criteria. FT1D patients were younger (median-age 4-years vs.15-years in classic-T1D). Gender distribution in FT1D was equal, whereas the classic-T1D group showed a female predominance at 57.6% (n = 136). FT1D patients had a mean C-peptide of 0.11 ± 0.09 ng/ml, compared to 0.53 ± 0.45 ng/ml in classic-T1D. FT1D patients had a median length of stay (LOS) of 1 day (1-2.2) and a DKA duration of 11.25 h (11-15). The median (length of stay) LOS and DKA duration in classic-T1D patients were 2.5 days (1-3.9) and 15.4 h (11-23), respectively. The FT1D subset primarily consisted of moderate (83.3%) and severe 916.7%) DKA, whereas classic T1D had 25.4% mild, 60.6% moderate, and 14% severe DKA cases. FT1D was associated with a higher median white cell count (22.3 × 103/uL) at admission compared to classic T1D (10.6 × 103/uL). ICU admission was needed for 66.6% of FT1D patients, compared to 38.1% of classic-T1D patients. None of the patients in the FT1D group had mortality, while two died in the classic-T1D group. CONCLUSION: This is the first study establishing the existence of FT1D in ME, which presented distinctively from classic-T1D, exhibiting earlier age onset and higher critical care requirements. However, the clinical outcomes in patients with FT1D seem similar to classic T1D.

The role of medical-grade maggots in facilitating healing of diabetic foot ulcers in Kano, northern Nigeria: a case series.

OBJECTIVE: Approximately 13% of people living with diabetes develop one or more ulcers during the course of the disease, and diabetic foot ulcer (DFU) is responsible for >60% of lower limb amputations worldwide. This case series aimed to demonstrate the effectiveness of medical-grade maggots on DFUs in promoting wound healing and reducing related hospital stays in northern Nigeria. METHOD: Maggot debridement therapy (MDT) was applied to the DFUs of patients who consented to this treatment between January-August 2021 at the Orthopaedic Unit of the Aminu Kano Teaching Hospital (AKTH), Kano, Nigeria. Sterile first instar larvae of Lucilia sericata were obtained indigenously and applied using the confinement (free-range) method under aseptic procedure. RESULTS: A total of 15 patients with DFUs of Wagner classification grades III (33.3%) and IV (66.7%), were seen and documented. The patients included 10 (66.7%) females and five (33.3%) males, giving a female:male ratio of 2:1. The mean age (±standard deviation) of the respondents was 51.6±10.8 years. The surface area of the wounds ranged from 24-140cm2, with a median value of 75cm2. Among the patients, 60% had two cycles of MDT, with a median duration of five days. Most of the wounds (53.3%) were debrided within five days; 13.3% (two wounds) took seven days to be fully debrided. A paired sample t-test showed a statistically significant association between wound surface area and therapy duration (t=8.0; p=0.000) and between wound surface area and cycles of therapy (t=8.3; p=0.000). Before maggot application, 14 (93.3%) DFUs were completely (100%) covered with slough and only one (6.7%) was 95% covered with slough. After maggot application, 10 (66.7%) wounds were completely debrided while five (33.3%) wounds required bedside surgical debridement to achieve complete debridement. A paired sample t-test showed statistically significant difference between the pre- and post-MDT slough covering the wounds (t=45.1; p=0.000). CONCLUSION: In this case series, MDT was successfully used in the debridement of DFUs, which facilitated the healing process with an encouraging clinical outcome.

An overview of diabetes mellitus in pregnant women with obesity.

Rates of obesity are increasing world-wide with an estimated 1billion people projected to be obese by 2030 if current trends remain unchanged. Obesity currently considered one of the most significant associated factors of non-communicable diseases poses the greatest threat to health. Diabetes mellitus is an important metabolic disorder closely associated with obesity. It is therefore expected that with the increasing rates of obesity, the rates of diabetes in pregnancy will also be rising. This disorder may pre-date pregnancy (diagnosed or undiagnosed and diagnosed for the first time in pregnancy) or may be of onset in pregnancy. Irrespective of the timing of onset, diabetes in pregnancy is associated with both fetal and maternal complications. Outcomes are much better if control is maximised. Early diagnosis, multidisciplinary care and tailored management with optimum glycaemic control is associated with a significant reduction in not only pregnancy complications but long-term consequences on both the mother and offspring. This review brings together the current understanding of the pathogenesis of the endocrine derangements that are associated with diabetes in pregnancy how screening should be offered and management including pre-pregnancy care and the role of newer agents in management.

DiaNet v2 deep learning based method for diabetes diagnosis using retinal images.

Diabetes mellitus (DM) is a prevalent chronic metabolic disorder linked to increased morbidity and mortality. With a significant portion of cases remaining undiagnosed, particularly in the Middle East North Africa (MENA) region, more accurate and accessible diagnostic methods are essential. Current diagnostic tests like fasting plasma glucose (FPG), oral glucose tolerance tests (OGTT), random plasma glucose (RPG), and hemoglobin A1c (HbA1c) have limitations, leading to misclassifications and discomfort for patients. The aim of this study is to enhance diabetes diagnosis accuracy by developing an improved predictive model using retinal images from the Qatari population, addressing the limitations of current diagnostic methods. This study explores an alternative approach involving retinal images, building upon the DiaNet model, the first deep learning model for diabetes detection based solely on retinal images. The newly proposed DiaNet v2 model is developed using a large dataset from Qatar Biobank (QBB) and Hamad Medical Corporation (HMC) covering wide range of pathologies in the the retinal images. Utilizing the most extensive collection of retinal images from the 5545 participants (2540 diabetic patients and 3005 control), DiaNet v2 is developed for diabetes diagnosis. DiaNet v2 achieves an impressive accuracy of over 92%, 93% sensitivity, and 91% specificity in distinguishing diabetic patients from the control group. Given the high prevalence of diabetes and the limitations of existing diagnostic methods in clinical setup, this study proposes an innovative solution. By leveraging a comprehensive retinal image dataset and applying advanced deep learning techniques, DiaNet v2 demonstrates a remarkable accuracy in diabetes diagnosis. This approach has the potential to revolutionize diabetes detection, providing a more accessible, non-invasive and accurate method for early intervention and treatment planning, particularly in regions with high diabetes rates like MENA.

Pathways to sustainability: how China's Belt and Road Initiative is shaping responsible production and consumption in Africa.

Africa faces significant economic and environmental challenges, including waste generation, food insecurity, and energy inefficiency, jeopardizing future generations. To address this, Africa has adopted the 10-year Sustainable Consumption and Production Framework for Africa (10-YFP), evident through national and local projects focusing on sustainable food and agriculture, technology transfer in water irrigation, and related initiatives. The Belt and Road Initiative (BRI) presents an opportunity for promoting green cooperation and sustainable development in Africa, though its impact on ethical production and consumption remains unexplored. This study evaluates the BRI's role in achieving Africa's Twelve Sustainable Development Goals (SDGs) and catalyzing responsible consumption and production. Through interviews and focus group discussions (FGDs) involving 42 participants from 19 African countries, thematic patterns emerged using the thematic inductive method. Findings indicate that BRI initiatives effectively integrate advanced technologies to enhance sustainable agriculture and industrial production. Notably, BRI investments in countries like Morocco, Algeria, Ethiopia, Kenya, and Zambia are fostering renewable energy projects to provide electricity to underserved communities. A stronger alignment between national sustainable development plans and the green BRI is essential to maximize the benefits without compromising BRI principles of inclusivity, coordination, coherence, and capacity building. This research fosters dialogue among academics, educators, government officials, business leaders, and investors about the transformative potential of China's BRI in African nations. By shedding light on the positive strides made by BRI programs, this study underscores the need for strategic synergy between international cooperation efforts and localized sustainability agendas, ultimately propelling Africa toward its long-term development goals.

Differential evolution of diabetic ketoacidosis in adults with pre-existent versus newly diagnosed type 1 and type 2 diabetes mellitus.

BACKGROUND: Diabetic ketoacidosis (DKA) was once known to be specific to type-1 diabetes-mellitus (T1D); however, many cases are now seen in patients with type-2 diabetes-mellitus (T2D). Little is known about how this etiology shift affects DKA's outcomes. METHODS: We studied consecutive index DKA admissions from January 2015 to March 2021. Descriptive analyses were performed based on pre-existing T1D and T2D (PT1D and PT2D, respectively) and newly diagnosed T1D and T2D (NT1D and NT2D, respectively). RESULTS: Of the 922 patients, 480 (52%) had T1D, of which 69% had PT1D and 31% NT1D, whereas 442 (48%) had T2D, of which 60% had PT2D and 40% NT2D. The mean age was highest in PT2D (47.6 ± 13.1 years) and lowest in PT1D (27.3 ± 0.5 years) (P < 0.001). Patients in all groups were predominantly male except in the PT1D group (55% females) (P < 0.001). Most patients were Arabic (76% in PT1D, 51.4% in NT1D, 46.6% in PT2D) except for NT2D, which mainly comprised Asians (53%) (P < 0.001). Patients with NT2D had the longest hospital length of stay (LOS) (6.8 ± 11.3 days) (P < 0.001), longest DKA duration (26.6 ± 21.1 h) (P < 0.001), and more intensive-care unit (ICU) admissions (31.2%) (P < 0.001). Patients with PT1D had the shortest LOS (2.5 ± 3.5 days) (P < 0.001), DKA duration (18.9 ± 4.2 h) (P < 0.001), and lowest ICU admissions (16.6%) (P < 0.001). CONCLUSIONS/INTERPRETATION: We presented the largest regional data on differences in DKA based on the type and duration of diabetes- mellitus (DM), showing that T2D is becoming an increasing cause of DKA, with worse clinical outcomes (especially newly diagnosed T2D) compared to T1D.

Advancements of microalgal upstream technologies: Bioengineering and application aspects in the paradigm of circular bioeconomy.

Sustainable energy transition has brought the attention towards microalgae utilization as potential feedstock due to its tremendous capabilities over its predecessors for generating more energy with reduced carbon footprint. However, the commercialization of microalgae feedstock remains debatable due to the various factors and considerations taken into scaling-up the conventional microalgal upstream processes. This review provides a state-of-the-art assessment over the recent developments of available and existing microalgal upstream cultivation systems catered for maximum biomass production. The key growth parameters and main cultivation modes necessary for optimized microalgal growth conditions along with the fundamental aspects were also reviewed and evaluated comprehensively. In addition, the advancements and strategies towards potential scale-up of the microalgal cultivation technologies were highlighted to provide insights for further development into the upstream processes aimed at sustainable circular bioeconomy.

Incidence of diabetic ketoacidosis does not differ in Ramadan compared to other months and seasons: results from a 6-year multicenter study.

BACKGROUND: Diabetic ketoacidosis (DKA) is a life-threatening adverse complication of patients with diabetes mellitus (DM). It is postulated that fasting during Ramadan can increase the risk of DKA; however, there are contradicting data in this regard. Furthermore, studies from Western countries have suggested a seasonal variation in the incidence of DKA. This study examines the differences in the number of DKA episodes during Ramadan compared to the rest of the year in patients with type 1 DM (T1D) and type 2 DM (T2D). Besides, we aim to examine the seasonal difference in the incidence of DKA. METHODS: We included consecutive index-DKA admissions from 2015 to 2021 and used descriptive statistics to compare the episodes of DKA in Ramadan vs other months and seasons. RESULTS: Of 922 patients, 480 (52%) had T1D, whereas 442 (48%) had T2D. The median age (IQR) was 35 (25-45) years, with the majority being Arab (N = 502, 54.4%). There were 94 DKA admissions in six collective Ramadan months, whereas the DKA admissions ranged from 61 to 88 episodes in other months (p = .3). The highest DKA admissions were observed in Autumn (N = 236) and the lowest in Spring (N = 226) with no statistically significant difference (p = .4). There were no differences in DKA severity or new-onset diabetes rates when analyzed based on Hiji months, Roman months, or seasons. CONCLUSIONS: DKA occurrence is not increased during Ramadan. We found no evidence of seasonal variations in the rates of DKA in the State of Qatar.

Bariatric surgery and reproduction-implications for gynecology and obstetrics.

As the rates of obesity continue to rise across the world, there has been an increasing resort to bariatric surgery amongst the options for treatment. Through the reproductive lifespan, between menarche and menopause, women might benefit from this surgical intervention, which may have a bearing on other aspects of their health. The consequences of bariatric surgery have been reported and evaluated from various perspectives in obstetrics and gynecology. Fertility and sexuality are enhanced, but not all gynecological diseases are ameliorated. There are also psychological and behavioral sequelae to be cognizant of. With multi-disciplinary and responsive care, most post-bariatric pregnancies have satisfactory outcomes. The effects of bariatric surgery on the babies conceived thereafter remains a subject of interest, whereas the possible effect on the climacteric is speculative.

Clinical and biochemical predictors of intensive care unit admission among patients with diabetic ketoacidosis.

BACKGROUND: Diabetic ketoacidosis (DKA) contributes to 94% of diabetes-related hospital admissions, and its incidence is rising. Due to the complexity of its management and the need for rigorous monitoring, many DKA patients are managed in the intensive care unit (ICU). However, studies comparing DKA patients managed in ICU to non-ICU settings show an increase in healthcare costs without significantly affecting patient outcomes. It is, therefore, essential to identify suitable candidates for ICU care in DKA patients. AIM: To evaluate factors that predict the requirement for ICU care in DKA patients. METHODS: This retrospective study included consecutive patients with index DKA episodes who presented to the emergency department of four general hospitals of Hamad Medical Corporation, Doha, Qatar, between January 2015 and March 2021. All adult patients (> 14 years) fulfilling the American Diabetes Association criteria for DKA diagnosis were included. RESULTS: We included 922 patients with DKA in the final analysis, of which 229 (25%) were managed in the ICU. Compared to non-ICU patients, patients admitted to ICU were older [mean (SD) age of 40.4 ± 13.7 years vs 34.5 ± 14.6 years; P < 0.001], had a higher body mass index [median (IQR) of 24.6 (21.5-28.4) kg/m2 vs 23.7 (20.3-27.9) kg/m2; P < 0.030], had T2DM (61.6%) and were predominantly males (69% vs 31%; P < 0.020). ICU patients had a higher white blood cell count [median (IQR) of 15.1 (10.2-21.2) × 103/uL vs 11.2 (7.9-15.7) × 103/uL, P < 0.001], urea [median (IQR) of 6.5 (4.6-10.3) mmol/L vs 5.6 (4.0-8.0) mmol/L; P < 0.001], creatinine [median (IQR) of 99 (75-144) mmol/L vs 82 (63-144) mmol/L; P < 0.001], C-reactive protein [median (IQR) of 27 (9-83) mg/L vs 14 (5-33) mg/L; P < 0.001] and anion gap [median (IQR) of 24.0 (19.2-29.0) mEq/L vs 22 (17-27) mEq/L; P < 0.001]; while a lower venous pH [mean (SD) of 7.10 ± 0.15 vs 7.20 ± 0.13; P < 0.001] and bicarbonate level [mean (SD) of 9.2 ± 4.1 mmol/L vs 11.6 ± 4.3 mmol/L; P < 0.001] at admission than those not requiring ICU management of DKA (P < 0.001). Patients in the ICU group had a longer LOS [median (IQR) of 4.2 (2.7-7.1) d vs 2.0 (1.0-3.9) d; P < 0.001] and DKA duration [median (IQR) of 24 (13-37) h vs 15 (19-24) h, P < 0.001] than those not requiring ICU admission. In the multivariate logistic regression analysis model, age, Asian ethnicity, concurrent coronavirus disease 2019 (COVID-19) infection, DKA severity, DKA trigger, and NSTEMI were the main predicting factors for ICU admission. CONCLUSION: In the largest tertiary center in Qatar, 25% of all DKA patients required ICU admission. Older age, T2DM, newly onset DM, an infectious trigger of DKA, moderate-severe DKA, concurrent NSTEMI, and COVID-19 infection are some factors that predict ICU requirement in a DKA patient.

The impact of minimum unit pricing on traumatic brain injury in Scotland: a retrospective cohort study of routine national data.

BACKGROUND: Traumatic brain injury (TBI) is a common cause of disability and mortality and is associated with alcohol consumption. On 1st May 2018, the Scottish Government introduced Minimum Unit Pricing (MUP) legislation which set the floor price at which alcohol can be sold to 50 pence per unit. While MUP has led to a 7.6% decrease in off trade alcohol purchases, there are limited studies investigating the clinical impact of this legislation. This study aims to explore the impact of MUP on traumatic brain injury in Scotland. METHODS: Retrospective cohort study using routinely collected national data collated by the Scottish Trauma Audit Group. Data were requested for all TBI incidents from 1st May to 31st December for both 2017 and 2018. Primary outcome was alcohol-related TBI. Secondary outcomes were injury mechanism, injury severity, clinical course, and short-term mortality. Analysis was conducted using multiple regression models adjusted for age, sex, season, and deprivation. RESULTS: A total of 1166 patients (66% male, and 46% in the 60-79-year bracket) were identified. Alcohol-related TBI was evident in 184 of 509 (36%) patients before MUP and in 239 of 657 (36%) patients injured after its implementation (p = 0.638). Further, there was no change in injury mechanism, injury severity, hospital course and short-term mortality of TBI after MUP. CONCLUSIONS: MUP has not resulted in a change in alcohol-related TBI nor in the mechanism and severity of TBI. Limitations in two-point analysis mean that findings should be interpreted with caution and further studies investigating the clinical outcomes of MUP must be conducted.

A Rare Case of Incarcerated Inguinal Hernia Containing Fat and a Penile Reservoir.

The inflatable penile prosthesis (IPP) is a three-piece device indicated to treat erectile dysfunction. Although it is considered a safe procedure, it can result in complications, such as reservoir herniation. Literature is scarce regarding reservoir incarcerated herniation as a complication of IPP and its management. Surgery is required to reduce symptomatic hernias and properly secure the reservoir to avoid recurrence. An untreated incarcerated hernia may lead to strangulation and necrosis of abdominal organs, as well as implant malfunction. We present a rare case of a left-sided incarcerated inguinal hernia containing fat and a penile reservoir of a previous penile prosthesis implant in a 79-year-old man, as well as the technique used to correct it.

Clinical and biochemical determinants of length of stay, readmission and recurrence in patients admitted with diabetic ketoacidosis.

BACKGROUND: The increasing prevalence of diabetic ketoacidosis (DKA) related admissions poses a significant burden on the healthcare systems globally. However, data regarding the predictors of healthcare resource utilization in DKA is limited and inconsistent. This study aimed to identify key predictors of hospital length of stay (LOS), readmission and recurrent DKA episodes. METHODS: We undertook a retrospective cross-sectional analysis of all DKA admissions from 2015 to 2021 across four hospitals in Qatar. The primary outcomes were the length of stay (LOS), 90-day readmission and 6-month and 1-year DKA recurrence. RESULTS: We included 922 patients with a median age of 35 years (25-45). 62% were males with type-1 diabetes-mellitus (T1DM) and type-2 DM (T2DM), present in 52% and 48% of patients. The median LOS was 2.6 days (IQR 1.1-4.8), and the median DKA resolution time was 18 h (10.5-29). Male-gender, new-onset DM, higher Charlson Comorbidity Index (CCI), lower haemoglobin, sodium and potassium, higher urea, longer DKA duration and MICU admission predicted a longer LOS in a multivariate regression analysis. None of the factors were significantly associated with 90-day readmission. Patients with pre-existing T1DM were more likely to have a six-month DKA recurrence than pre-existing T2DM. Patients with a 6-month DKA recurrence, female gender and T1DM had higher odds of 12-month recurrence, whereas a consult with a diabetes educator at the index admission was associated with decreased odds of recurrence. CONCLUSIONS/INTERPRETATION: This is the most extensive study from the Middle-East region reporting on LOS, readmissions and the recurrence of DKA. Results from this study with a diverse population may be valuable for physicians and healthcare systems to decrease the diabetes-related healthcare burden in DKA patients.

Appraising the performance of oil palm fibre biochar for low concentration ammoniacal nitrogen recovery from aquaculture wastewater.

Oil palm fibre is a type of solid waste generated from palm oil processing plant. At present, there is no proper utilization of this abundant waste. Ammoniacal nitrogen (NH3-N) has received a lot of attention as a water pollutant due to its toxicity, which has an impact on both the environment and human health. In aquaculture wastewater (AQW), NH3-N is present in low concentrations (<10 ppm), and removing low concentrations of NH3-N is tedious. Thus, this study focuses on the potential of oil palm fibre biochar (OPFB) for sustainable low concentration NH3-N recovery from AQW and the recovered spent adsorbent to be used as a bio-fertilizer. The Physico-chemical properties of OPFB show a positive correlation with NH3-N recovery. A significant reduction of value-added metals in OPFB has confirmed the recovery of NH3-N through the ion exchange process. The adsorption isotherms and kinetics of NH3-N recovery had good correlation coefficients under the Freundlich and pseudo-second-order kinetic model confirming a multilayer heterogeneous and chemical adsorption respectively. Thermodynamic parameters indicated that the recovery process via adsorption was exothermic and had a Physio-chemical mechanism. At optimum conditions, OPFB could recover up to 66% of NH3-N actual AQW. The properties of spent OPFB showed potential reutilization as a soil amendment agent or biofertilizer which could be easily degraded.

Maggot debridement therapy and complementary wound care: a case series from Nigeria.

OBJECTIVE: Maggot debridement therapy (MDT) is an emerging procedure involving the application of sterile maggots of the Dipteran species (commonly Lucilia sericata) to effect debridement, disinfection and promote healing in wounds not responding to antimicrobial therapy. Data on MDT in sub-Saharan Africa (including Nigeria) are scarce. This study aimed to use medicinal grade maggots as a complementary method to debride hard-to-heal necrotic ulcers and thereby promote wound healing. METHOD: In this descriptive study, we reported on the first group of patients who had MDT at Aminu Kano Teaching Hospital (AKTH), a tertiary hospital in northern Nigeria. The first instar larvae of Lucilia sericata were applied using the confinement (free-range) maggot therapy dressing method under aseptic conditions. RESULTS: Diabetic foot ulcer (DFU) grade III-IV constituted more than half of the wounds (53.3%), followed by necrotising fasciitis (30%), and post-traumatic wound infection (10%). Others (6.7%, included pyomyositis, surgical site infection and post traumatic wound infection). The median surface area of the wounds was 56cm2. Of the 30 patients, half (50%) had two MDT cycles with a median time of four days. Of the wounds, 22 (73%) were completely debrided using maggots alone while eight (27%) achieved complete debridement together with surgical debridement. Wound culture pre-MDT yielded bacterial growth for all the patients and Staphylococcus aureus was the predominant isolate in 17 wounds (56.7%) while Pseudomonas aeruginosa and Streptococcus pyogenes were predominant in five wounds (16.7%) each. Only four (13.3%) wound cultures yielded bacterial growth after MDT, all Staphylococcus aureus. CONCLUSION: A good prognosis was achieved post-MDT for various wounds. MDT effectively debrides and significantly disinfects wounds involving different anatomical sites, thus enhancing wound healing and recovery. MDT is recommended in such wounds.

Potential use of algae for the bioremediation of different types of wastewater and contaminants: Production of bioproducts and biofuel for green circular economy.

Remediation by algae is a very effective strategy for avoiding the use of costly, environmentally harmful chemicals in wastewater treatment. Recently, industries based on biomass, especially the bioenergy sector, are getting increasing attention due to their environmental acceptability. However, their practical application is still limited due to the growing cost of raw materials such as algal biomass, harvesting and processing limitations. Potential use of algal biomass includes nutrients recovery, heavy metals removal, COD, BOD, coliforms, and other disease-causing pathogens reduction and production of bioenergy and valuable products. However, the production of algal biomass using the variable composition of different wastewater streams as a source of growing medium and the application of treated water for subsequent use in agriculture for irrigation has remained a challenging task. The present review highlights and discusses the potential role of algae in removing beneficial nutrients from different wastewater streams with complex chemical compositions as a biorefinery concept and subsequent use of produced algal biomass for bioenergy and bioactive compounds. Moreover, challenges in producing algal biomass using various wastewater streams and ways to alleviate the stress caused by the toxic and high concentrations of nutrients in the wastewater stream have been discussed in detail. The technology will be economically feasible and publicly accepted by reducing the cost of algal biomass production and reducing the loaded or attached concentration of micropollutants and pathogenic microorganisms. Algal strain improvement, consortium development, biofilm formation, building an advanced cultivation reactor system, biorefinery concept development, and life-cycle assessment are all possible options for attaining a sustainable solution for sustainable biofuel production. Furthermore, producing valuable compounds, including pharmaceutical, nutraceutical and pigment contents generated from algal biomass during biofuel production, could also help reduce the cost of wastewater management by microalgae.

Bimodal distribution of thyroid dysfunction triggered by COVID-19 Infection: An experience from a single endocrine center-a case series and literature review.

BACKGROUND: COVID-19 infection has been spreading across the globe since the end of 2019, and it continues to cause chronic multi-system sequelae, of which thyroid dysfunction appears to be the major one. We have discussed here 10 cases of thyroid dysfunction after COVID-19 infection. METHODS: Case series report. From October 2020 to July 2021, a series of 10 cases of thyroid dysfunction after COVID-19 infection were recorded and managed in a single outpatient endocrine center in Doha, Qatar. CASES PRESENTATION: We have reported 5 cases of Graves's hyperthyroidism, 2 of chronic primary hypothyroidism (including one with Grave's disease [GD]) who was treated through radioactive iodine (RAI) therapy, one case of subacute thyroiditis, one case with "Sick euthyroid disease," and one case of central hypothyroidism. Presently, patients with GD are being treated with carbimazole and those with hypothyroidism are being treated with levothyroxine. The remaining patients had recovered with euthyroid. CONCLUSION: This is the largest case series reported from a single center to date. The findings of this series indicate a bimodal distribution of thyroid dysfunction in patients with COVID-19 infection. A review of the literature and discussion of potential pathophysiological mechanisms has been presented. We have emphasized the importance of screening for thyroid dysfunction in "post-COVID-19" cases, considering that the prevalence may be underestimated.

Recent advancements in the treatment of palm oil mill effluent (POME) using anaerobic biofilm reactors: Challenges and future perspectives.

Palm oil is the most utilized vegetable globally which is mostly produced in countries such as Malaysia, Indonesia and Thailand. The great amount of POME generation from palm oil mills is now a threat to the environment and require a suitable treatment of POME to reduce the organic strength in accordance with the standard discharge limit before releasing to the environment. Currently, the technology to combine the anaerobic process and biofilm system in bioreactors have produced a fresh idea in treatments of high strength wastewater like POME. Anaerobic biofilm reactor is a convincing method for POME treatment due to its significant advantages over the conventional biological treatments consisting of anaerobic, aerobic and facultative pond systems. Overall, integrated anaerobic-aerobic bioreactor (IAAB) can remove more than 99% of chemical oxygen demand (COD), biochemical oxygen demand (BOD) and total suspended solids (TSS) with the combination of anaerobic and aerobic digestion for POME treatment. It has better performance as compared to up-flow anaerobic sludge blanket (UASB) and up-flow anaerobic filter (UAF) with 80% and 88-94% COD removal efficiency respectively. Anaerobic pond was found to perform well also by removing 97.8% of COD in POME but require long retention time and larger land. Hence, this study aims to provide intensive review of the performance of the anaerobic biofilm reactor in treating POME and the recent advancements in this technology. The limitations and future perspectives in utilization of anaerobic biofilm reactor during its operation in treating POME are discussed.

Qatar Diabetes Mobile Application Trial (QDMAT): an open-label randomised controlled trial to examine the impact of using a mobile application to improve diabetes care in type 2 diabetes mellitus-a study protocol.

BACKGROUND: Mobile health (mHealth) is increasingly advocated for diabetes management. It is unclear if mobile applications are effective in improving glycaemic control, clinical outcomes, quality of life and overall patient satisfaction in patients with type 2 diabetes (T2DM). A new mobile application was specifically built for people with T2DM with the help of the local expertise. The objective of the study was to evaluate the effectiveness of the mobile app. METHODS: The planned study is an ongoing open-label randomised controlled trial in which adults living with T2DM treated with insulin will be randomised 1:1 to the use of this diabetes application versus current standard care. The primary outcome will be the difference in mean HbA1c from baseline to 6 months. Other outcome measures include anthropometric measures, hypoglycaemic events, medication adjustments, number of clinical interactions and missed appointments and patient perceptions of their disease and diabetes self-management. The study will randomise 180 subjects for assessment of the primary outcome. DISCUSSION: We hypothesise that the diabetes-specific mobile application will improve glycaemic control, increase patient empowerment for self-management of diabetes and improve interaction between patients and healthcare providers. If the Qatar Diabetes Mobile Application Trial (QDMAT) demonstrates this, it will inform clinical services for the future self-management of T2DM. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03998267 . Registered on 26 June 2019.