Breaking Bad News for Patients with Gastro-Intestinal Malignancy: Experience at Ibn Sina Teaching Hospital

Background: Integrity, beneficence, non-maleficence and Justice are the pillars of the professional behaviour. Confidentiality is a serious issue governed by the law. However, in developing countries, patients’ relatives urge to know the diagnosis and often request the doctor not to mention the word cancer or malignancy to their patient.Objectives: To evaluate the communication skills for breaking bad news to Sudanese patients suffering of gastrointestinal cancer and to find out the patients’ responses on that matter.Materials and Methods: This is a hospital based non-randomized  prospective study, carried out at Ibn Sina Specialized Hospital in the period August through December 2011. The study involved113 patients of whom there were 56 males.Results: Doctors had talked about the disease to 75% of the patients  whereas the rest were told by either the psychologists and/or their  relatives. Only 25% of the patients were told the truth, the rest were told to have mass or lump without explaining its nature. Patients’ responses were as follows: 41.6% were felt terrified, 23.9% were shocked and became  anxious, while 33.6% were stable, but 0.9% became angry and frustrated. No patient was told about the prognosis and the chances of cure.Conclusion: Sympathy over-ride empathy in communicating bad news to Sudanese patients suffering of cancer. Patient education and training in breaking the bad news is needed.Key words: Communication skills, breaking bad news, truth telling, Sudan

ANALISIS DAMPAK DAN DINAMIKA PERNIKAHAN ONLINE DALAM PERSPEKTIF MAQASID ASY-SYARIAH

Penelitian ini membahas tentang analisis dampak dan dinamika pernikahan online dalam perspektif maqasid asy-Syariah. Hadirnya peristiwa nikah virtual conference menggunakan live streaming yang ada di berbagai wilayah di Indonesia mengakibatkan dinamika dalam kehidupan rumah tangga yang berbeda, mulai dari latarbelakang pekerjaan sehingga pernikahan yang merupakan moment penting sekalipun tidak bisa ditinggalkan dalam bertugas, belum lagi dengan alasan-alasan lainnya sehingga menjadikan problem dan wajah baru terhadap implikasi dalam rumah tangga. Bagi Sebagian orang menilai nikah belum afdhol jika tak bertatap muka secara langsung, karena menurutnya pernikahan hal yang sakral. Maka penelitian ini bertujuan untuk mengetahui tinjauan hukum Islam pada pernikahan online dalam perspektif maqasid asy-Syari’ah. Penelitian ini bersifat penelitian pustaka dan metodologi yang digunakan dalam pendekatan deskriptif. Data-data yang terkait dengan studi ini dikumpulkan melalui penelusuran dan analisis pustaka. Data disajikan dengan teknis analisis deskriptif. Adapun hasil dari dinamika pernikahan dalam rumah tangga secara online adalah menjaga masalahat yang terjadi secara umumnya yaitu menjaga keturunan dan harta. Pernikahan online ini menjadikan dinamika baru dalam rumah tangga yang menjadi unsur diwajibkannya batasan dalam waktu agar jarak yang tercipta oleh pasangan ini tidak lama bertemu, sehingga dapat menikmati keindahan hidup dengan seorang anak

Long-distance migration and venting of methane from the base of the hydrate stability zone

\ua9 2023, The Author(s).Marine methane hydrate is an ice-like substance that is stable in sediment around marine continental margins where water depths are greater than ~450–700 m. The release of methane due to melting of hydrates is considered to be a mechanism for past global carbon-cycle perturbations and could exacerbate ongoing anthropogenic climate change. Increases in bottom-water temperature at the landward limit of marine hydrate around continental margins, where vulnerable hydrate exists at or below the seabed, cause methane to vent into the ocean. However, this setting represents only ~3.5% of the global hydrate reservoir. The potential for methane from hydrate in deeper water to reach the atmosphere was considered negligible. Here we use three-dimensional (3D) seismic imagery to show that, on the Mauritanian margin, methane migrated at least 40 km below the base of the hydrate stability zone and vented through 23 pockmarks at the shelf break, probably during warmer Quaternary interglacials. We demonstrate that, under suitable circumstances, some of the 96.5% of methane bound in deeper water distal hydrates can reach the seafloor and vent into the ocean beyond the landward limit of marine hydrate. This reservoir should therefore be considered for estimating climate change-induced methane release during a warming world

Preliminary report on theNeurology workload ina central hospital in Sudan.

Introduction: Identification of the local pattern of neurological diseases is expected to help setting the priorities for good planning of management and public education.Objectives: To identify the pattern of neurological disorders in a second biggest central hospital in Sudan.Methodology: Review of the diagnosis of 170 patients, seen in the out patients neuro-clinic and the neurology ward from March 2010 to February 2011, was done. Patients who were in follow up by other neuro-clinics were excluded.Results: The male to female ratio was 1:1 Patients who were 20-60 years old comprised 54%.About 50% of patients live in Omdurman city. Motor symptoms were the most common presenting symptoms forming 64.1% followed by cranial nerves symptoms 27.6%. Stroke was the commonestencountered diagnosis seen in 20.7%, followed by epilepsy in 16.6%, headache in 9.6%, movement disorders in 7.7%, peripheral neuropathy in 3.6%, demylination in 1.8%, cerebral venous sinus thrombosis (CVST) 1.8% and tumours in 1.2% patients. Stroke was more common in patients from East Sudan and Epilepsy was more common in patients from West Sudan. Vascular and degenerative changes were the commonest abnormalities seen in imaging studies. Demyelination and neoplasms were more common in females.Conclusion: Stroke, epilepsy and headache were the commonest neurological disorders met in Omdurman Teaching Hospital.Key words: general hospital, neurology department, neurological disorders

THE IMPACT OF TRUS IN DETECTION OF PROSTATE CANCER IN GEZIRA, SUDAN

Introduction:  Prostate cancer (P ca) is the most commonly diagnosed visceral cancer worldwide. It is the second cause of cancer death in men. Objective: To study the impact of introducing transrectal ultrasound (TRUS)-guided biopsy in detection of Prostate cancer in Central Sudan. Methods: This was a retrospective hospital based study. A review was done for data of prostate cancer patients treated in the Institute of Nuclear Medicine and Oncology & Gezira Hospital of Renal Diseases & Surgery (GHRD&S), Wad Medani, Sudan during the years 2002-2007. Comparison was done between the data available before and after introduction of trans rectal ultrasound biopsy, TRUS in 2005. Results: Prostate cancer cases were contributing for only 8% of all cancers during the time period before TRUS introduction. During the year 2007 the figure increased to 14%. The leading cancer in males now is the P ca. previously it was the third registered cancer before TRUS was introduced. The detection of new cases per year increased dramatically after the introduction of TRUS service. Conclusion and recommendation: Prostate cancer was found to be the most common cancer in Sudanese males. TRUS guided biopsy contributed significantly in early detection of prostate cancer in this region. Distribution of this facility with adequate training of the staff optimizes a proper and early detection of prostate cancer

Hermite Coherent States for Quadratic Refractive Index Optical Media

Producción CientíficaLadder and shift operators are determined for the set of Hermite–Gaussian modes associated with an optical medium with quadratic refractive index profile. These operators allow to establish irreducible representations of the su(1, 1) and su(2) algebras. Glauber coherent states, as well as su(1, 1) and su(2) generalized coherent states, were constructed as solutions of differential equations admitting separation of variables. The dynamics of these coherent states along the optical axis is also evaluated.MINECO grant MTM2014-57129-C2-1-P and Junta de Castilla y Leon grant VA057U16

Non HLA genetic markers association with type-1 diabetes mellitus

The currently available data identified IDDM1 and IDDM2 as 2 susceptibility loci for type 1 diabetes (T1D). The major histocompatibility complex (MHC)/HLA region referred to as IDDM1 contains several 100 genes known to have a great influence on T1D risk. Within IDDM2, a minisatellite variable number of tandem repeats (VNTR) locus in the insulin gene (INS) promoter region is likely to represent the etiologic polymorphism. The aim of the present work was to study the association between genotypes and susceptibility to T1D among Egyptian diabetic children and their family members. Twenty-five nuclear Egyptian families with 27 children having T1D, aged 3–14 years, their nondiabetic 44 sibs, aged 3–15 years and their parents were included in our study. All studied children were subjected to: detailed history and family pedigree. Thorough clinical examination and anthropometric measurements. Laboratory work up of diabetes including random blood sugar (RBS) and HbA1C. Molecular genetics of INS was studied in four steps; nucleic acid purification, amplification, sequencing and haplotyping using flanking single nucleotide  polymorphisms (SNPs) as surrogate markers for minisatellite alleles identification. Analysis of variant repeat distribution among Egyptian families combined with flanking haplotypes revealed that all our diabetic children had class I alleles of INS; 9 had class IC+, 9 had classID+ and 9 had class ID, while all non-diabetic family members had class III alleles of INS. Therefore the three class I alleles were considered to be equally predisposing to T1D, while class III alleles are dominantly protective. There was significant positive correlations between body massindex (BMI) and both HbA1C and AST liver enzyme among diabetic children with class IC+ but not other alleles; indicating that they need close monitoring of their diabetic control and liver functions beside following specific dietary regimens. It can be concluded that all class I alleles (IC+, ID+ and ID) are equally important susceptibility factors for T1D among Egyptian children, while class III alleles (IIIA and IIIB) are dominantlyprotective. It is concluded also that our diabetic children with class IC+ are an especially endangered subgroup of diabetics. Genotyping for INS-VNTR alleles is recommended for diabetic children as an important step of diagnostic and follow up regimens and for their non-diabetic familymembers for family counseling and early identification of potential diabetics. Further studies of INS-VNTR alleles and HLA haplotypes all over Egypt are recommended to define the Egyptian susceptibility loci for T1D and their relations to the clinical and laboratory findings as an importantnational programs

'Pilot' spectator events in British horseracing during COVID-19: post-event SMS COVID-19 reporting

This study aimed to assess: i) COVID-19 transmission prior to and following spectator events, and ii) methodological approaches to capturing event-related transmission during the spectator return. Local authority population transmission rates were used to identify higher transmission areas, which were excluded from participant attendance following registration. Using observational online and SMS questionnaires, self-reported COVID-19 diagnoses (positive tests) and racing-related NHS Test and Trace contacts within 14 days of spectating were reported for two British Horseracing events and three Point to Point (PTP) grassroots races. There were 1,477 registrations for the British Horseracing events, and 1,678 registrations for PTP races. Responses were received from 464 attendees of British Horseracing events (31.4% response rate). Two attendees reported a COVID-19 diagnosis, and no attendees reported NHS Test and Trace contact. From PTP races, 862 attendees (51.3%) consented to receive the SMS survey, and responses were received from 495 attendees (57.4% response rate). Five attendees reported positive COVID-19 diagnoses, and two attendees reported being contacted by NHS Test and Trace, of which one was following a non-racing potential COVID-19 exposure. There was limited evidence of COVID-19 transmission at outdoor elite and grassroots level horseracing events during Autumn 2020. A higher response rate was received with SMS surveys, however there was a reluctancy to 'opt in' to SMS methodology. This study describes different methodological approaches to monitoring COVID-19 transmission risk at events, which may have relevance for other sporting and event contexts during the current pandemic, and sustained attendances during periods with circulating transmissible diseases

Chromosome 22 microdeletion in children with syndromic congenital heart disease by fluorescent in situ hybridization (FISH)

Congenital heart diseases (CHDs) are the most common of all birth defects. Congenital heart disease may occur as an isolated malformation or may be part of a syndrome. One of the most common syndromes associated with CHDs is the 22q11.2 microdeletion syndrome, the various conditions associated with del22q11 include DiGeorge syndrome (DGS), velocardiofacial syndrome (VCFS), conotruncal anomaly face syndrome (CTAFS), and others. The abnormalities associated with this syndrome include parathyroid hypoplasia, thymic hypoplasia, immune defect, cleft palate, and abnormal facies. The cardiac defects are usually derived from conotruncus. The aim of the study was to detect the prevalence and the most common or frequent clinical manifestations of chromosome 22q11.2 microdeletion among children with syndromic congenital heart disease. The study was conducted on 20 children with syndromic CHD presenting to the Menoufiya University Hospitals, Egypt. Their ages ranged from 10 days to 12 years. Cytogenetic study and fluorescence in situ hybridization (FISH) were performed in the patients. The study revealed that 2 patients were with chromosomal aberrations [one with 46,XY, add (13)(p13) & the other with 47,XX,+13]. In addition, FISH revealed 4 patients (20%) with 22q11.2 microdeletion syndrome. The congenital heart malformations detected in patients with 22q11.2 microdeletion were somewhat unexpected and included VSD, ASD, PDA, and double outlet right ventricle. The most frequent extracardiac features were hypocalcemia, microcephaly, brain atrophy, epicanthus, low set posteriorly rotated ears, micrognathia, and anemia. The extracardiac features were in some cases subtle. It is concluded that 22q11.2 microdeletion is not uncommon and its manifestations are highly variable. This entails that screening for the microdeletion by FISH should be performed in all patients with syndromic CHD especially those with hypocalcemia, microcephaly, brain atrophy, epicanthus, low set ears, posteriorly rotated ears, micrognathia, and anemia. In addition, patients with minor features and those with non-conotruncal heart disease should not be excluded from the screening for 22 microdeletion.Keywords: Chromosome 22 microdeletion; Syndromic congenital heart disease; DiGeorge syndrome; Hypocalcemia; Velocardiofacial syndrom

The effect on work presenteeism of job retention vocational rehabilitation compared to a written self-help work advice pack for employed people with inflammatory arthritis: protocol for a multi-centre randomised controlled trial (the WORKWELL trial)

Abstract: Background: Work problems are common in people with inflammatory arthritis. Up to 50% stop work within 10 years due to their condition and up to 67% report presenteeism (i.e. reduced work productivity), even amongst those with low disease activity. Job retention vocational rehabilitation (JRVR) may help prevent or postpone job loss and reduce presenteeism through work assessment, work-related rehabilitation and enabling job accommodations. This aims to create a better match between the person’s abilities and their job demands. The objectives of the Workwell trial are to test the overall effectiveness and cost-effectiveness of JRVR (WORKWELL) provided by additionally trained National Health Service (NHS) occupational therapists compared to a control group who receive self-help information both in addition to usual care. Methods: Based on the learning from a feasibility trial (the WORK-IA trial: ISRCTN76777720), the WORKWELL trial is a multi-centre, pragmatic, individually-randomised parallel group superiority trial, including economic evaluation, contextual factors analysis and process evaluation. Two hundred forty employed adults with rheumatoid arthritis, undifferentiated inflammatory arthritis or psoriatic arthritis (in secondary care), aged 18 years or older with work instability will be randomised to one of two groups: a self-help written work advice pack plus usual care (control intervention); or WORKWELL JRVR plus a self-help written work advice pack and usual care. WORKWELL will be delivered by occupational therapists provided with additional JRVR training from the research team. The primary outcome is presenteeism as measured using the Work Limitations Questionnaire-25. A comprehensive range of secondary outcomes of work, health, contextual factors and health resource use are included. Outcomes are measured at 6- and 12- months (with 12-months as the primary end-point). A multi-perspective within-trial cost-effectiveness analyses will also be conducted. Discussion: This trial will contribute to the evidence base for provision of JRVR to people with inflammatory arthritis. If JRVR is found to be effective in enabling people to keep working, the findings will support decision-making about provision of JRVR by rheumatology teams, therapy services and healthcare commissioners, and providing evidence of the effectiveness of JRVR and the economic impact of its implementation. Trial registration: Clinical Trials.Gov: NCT03942783. Registered 08/05/2019 (https://clinicaltrials.gov/ct2/show/NCT03942783); ISRCTN Registry: ISRCTN61762297. Registered:13/05/2019 (http://www.isrctn.com/ISRCTN61762297). Retrospectively registered