QUALITY ASSESSMENT OF PATIENTS REFERRAL LETTERS

This study is a descriptive undertaking aiming at assessing the quality of referral letters submitted to departments of seven selected Medani Hospitals from different levels of health institutions.   Required data was collected by observation and by a check list with a scoring system. Indirectly relevant data was extracted from historical data sources. METHOD:  The total number of the collected referral letters was 412 of which 206 were randomly and systematically sampled out and studied. The letters were checked for items that should be included in a good referral letter. Results and interpretation were obtained manually and with the aid of SPSS. RESULTS: It was found that 171 (83%) letters were of poor quality. Factors that lead to this were: bad handwriting, writing on slips of paper 69 (33.5%), senders poor perception of the importance of mentioning the negative as well as positive findings, improper utilization of health units pharmacies and laboratory facilities and lastly referring of cases without trying to manage first at the site of origin. Recommendations suggested were: training of GPs and health auxiliaries on writing good referral letters as well as having continuous medical education to improve their knowledge and skills on managing cases before instantly referring them. Design a standardized "fill-in- space" form and provide facilities for typing

Age-related increase of kynurenine enhances miR29b-1-5p to decrease both CXCL12 signaling and the epigenetic enzyme Hdac3 in bone marrow stromal cells

Mechanisms leading to age-related reductions in bone formation and subsequent osteoporosis are still incompletely understood. We recently demonstrated that kynurenine (KYN), a tryptophan metabolite, accumulates in serum of aged mice and induces bone loss. Here, we report on novel mechanisms underlying KYN's detrimental effect on bone aging. We show that KYN is increased with aging in murine bone marrow mesenchymal stem cells (BMSCs). KYN reduces bone formation via modulating levels of CXCL12 and its receptors as well as histone deacetylase 3 (Hdac3). BMSCs responded to KYN by significantly decreasing mRNA expression levels of CXCL12 and its cognate receptors, CXCR4 and ACKR3, as well as downregulating osteogenic gene RUNX2 expression, resulting in a significant inhibition in BMSCs osteogenic differentiation. KYN's effects on these targets occur by increasing regulatory miRNAs that target osteogenesis, specifically miR29b-1-5p. Thus, KYN significantly upregulated the anti-osteogenic miRNA miR29b-1-5p in BMSCs, mimicking the up-regulation of miR-29b-1-5p in human and murine BMSCs with age. Direct inhibition of miR29b-1-5p by antagomirs rescued CXCL12 protein levels downregulated by KYN, while a miR29b-1-5p mimic further decreased CXCL12 levels. KYN also significantly downregulated mRNA levels of Hdac3, a target of miR-29b-1-5p, as well as its cofactor NCoR1. KYN is a ligand for the aryl hydrocarbon receptor (AhR). We hypothesized that AhR mediates KYN's effects in BMSCs. Indeed, AhR inhibitors (CH-223191 and 3',4'-dimethoxyflavone [DMF]) partially rescued secreted CXCL12 protein levels in BMSCs treated with KYN. Importantly, we found that treatment with CXCL12, or transfection with an miR29b-1-5p antagomir, downregulated the AhR mRNA level, while transfection with miR29b-1-5p mimic significantly upregulated its level. Further, CXCL12 treatment downregulated IDO, an enzyme responsible for generating KYN. Our findings reveal novel molecular pathways involved in KYN's age-associated effects in the bone microenvironment that may be useful translational targets for treating osteoporosis

Medical Evidence of Human Rights Violations against Non-Arabic-Speaking Civilians in Darfur: A Cross-Sectional Study

Alexander Tsai and colleagues review medical records from the Amel Centre, Sudan, to assess consistency between recorded medical evidence and patient reports of human rights violations by the Government of Sudan and Janjaweed forces

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Efficacy of tranexamic acid as pleurodesis agent in malignant pleural effusion

Design: A prospective case series. Aim: On a search for an effective, safe, cheap, and available sclerosing agent, the present study aimed to evaluate the effectiveness and the safety of tranexamic acid as a chemical agent for pleurodesis in malignant pleural effusion (MPE). Methods: Tube thoracostomy was done for drainage of pleural fluid. Once the tube in the pleural space drains 150 ml per day or less with fully expanded lung, infusion of pleurodesis solution containing 2000 mg of tranexamic acid [four ampoules of tranexamic acid each is 5 ml (100 mg/ml), mixed with 50 ml of normal saline] was done through the intercostal tube. The tube was then clamped immediately and left in the pleural cavity for 2 h. Follow up chest radiographs were done every 24 h till removal of the tube which was done when daily drainage is 100 ml or less. Chest X ray (CXR) was done after three months to judge success (no fluid re-accumulation). The results were statistically analyzed and tabulated. Results: Sixteen patients with MPE were included in this study, 9 (56%) males and 7 (44%) females with age ranging from 45 to 70 with mean age ± SD = 57.5 ± 8.3 years. The follow up after 3 months showed a complete response rate (no fluid re-accumulation on CXR) of 75% (12⧹16), a partial response rate (asymptomatic fluid re-accumulation on CXR) of 12.5% (2⧹16) and a no response rate (symptomatic fluid re-accumulation on CXR that required pleural drainage) of 12.5% (2⧹16). Conclusion: Tranexamic acid was found to be an effective, safe, cheap, and available sclerosing agent for pleurodesis in recurrent malignant pleural effusion

Beneficiation of Iraqi Akash at Phosphate Ore Using Organic Acids for the Production of Wet Process Phosphoric Acid

In the present work, leaching process studiedusing organic acids (acetic acid and lactic acid) to extract phosphate from the Iraqi Akashat phosphate ore by separation of calcareous materials (mainly calcite). This approach characterized by energy conservation, environmental enhancement by recovery of calcite as calcium sulfate (gypsum), keeping the physical and chemical properties of apatite. Samples were analyzed using X-ray diffraction and FTIR spectrophotometer. From the obtained experimental data it was found that using the two organic acids yields closed purity values of the produced apatite at the optimum conditions, while at different acid concentrations, it was found that the efficiency of acetic acid is higher at the low acid concentration (2 wt%), and that lactic acid gives the higher efficiency at high acid concentration (10 wt%).Concerning the ratio of acid volume to ore weight ratio, it was found that reducing this ratio to 5 ml/gm cause an increase in the purity of apatite at the optimum concentrations of the two acids. In addition, it was found that the reaction ofthe two organic acids with the calcareous material are fast and that the optimum reaction time, in which high purity apatite produced is 10 minutes

New records and addition to the flora of Saudi Arabia, mainly from Faifa Governorate, Jazan Region

Based on vegetation surveys made in the southern region of Saudi Arabia between 2020 and 2021, five new plant taxa including four species and one subspecies, belonging to four families that had not previously been recorded in Saudi Arabia's flora were discovered. Within the Arabian Peninsula, all newly recorded species (i.e., Alysicarpus vaginalis (L.) DC. (Fabaceae), Commiphora schimperi (O.Berg) Engl. (Burseraceae), Maerua angolensis DC. subsp. angolensis (Capparaceae), Peperomia leptostachya Hook. & Arn. (Piperaceae), and Vigna vexillata (L.) A.Rich. (Fabaceae) were recorded in Yemen while A. vaginalis was also recorded in Oman. Brief descriptions and comments on the phytogeography of each taxon are given. The distribution of plants in Faifa Mountains and surrounding areas was mapped using geographic information systems (GIS) and ground surveys

Comprehensive power quality performance assessment for electrical system of a nuclear research reactor

Abstract Studying the power quality (PQ) is an essential issue to ensure the safe and accurate operation of sensitive equipment particularly for nuclear installations. Assessment of PQ involves collecting and analysing data resources and then evaluating it with reference to PQ standards. There are many alternatives for PQ and it is difficult to make an appropriate selection among them in the existence of their multiple criteria which are usually conflicted. So this selection subject can be classified as a Multi Criteria Decision Making (MCDM) problem. To do so, a reliable and scientific method for studying and evaluating the overall system PQ is required. This study aims to assess performance of PQ for the electrical power system at a Nuclear Research Reactor (NRR) during a certain period using multiple measures for the most decisive PQ phenomena. It focuses on a number of the most important PQ phenomena namely frequency fluctuation (deviation), unbalances of current and voltage, current and voltage harmonic distortion, flicker and power factor. After combining all results into six samples (alternatives), the criteria weights are determined based on an objective method for weighting which is called CRITIC method. Then, the alternatives are ranked using compromise MCDM method-VIKOR method. The obtained results are analyzed and discussed to evaluate performance of NRR electrical system from the PQ view. It showed that the compromise solution that obtained by CRITIC-VIKOR can be a guide to facilitate the PQ evaluation of nuclear installation electrical system. Also, it can empower the operators with the benefits of benchmarking and monitoring a single index instead of several indices. Moreover, it is very useful for helping stakeholders to understand how the PQ performance changes under a certain operating condition of the facility. Finally, it is can be considered as a good model to weight each PQ phenomena and identify the time intervals for best and worst total PQ in NRR