Indications, outcome and complications of ureteroscopy, at Gezira Hospital for renal diseases and surgery, Sudan: a seven years ‘experience

Background: Ureteroscopy (rigid and flexible) with irrigating and working channels have expanded the capability of the urologist to diagnose and treat most abnormalities of the upper tracts.Objective: This study was conducted as a part of holistic auditing to the services provided by Gezira Hospital for Renal Disease and Surgery (GHRD&S), and specifically to evaluate ureteroscopy done in GHRD&S with emphasis on the indications, outcome and complications.Methods: Across-sectional- hospital-based study was adopted. All patients who underwent ureteroscopy since the inauguration of the hospital from 2005-2011 were included.Results: The total number of patients satisfying the inclusion criteria was 472 with a mean age of 40.6 years. Male to female ratio was 1.46:1. The mean hospital stay was 2.74 days.The commonest indication for ureteroscopy was ureteric stone amounting (74%) to a tangible share of ureteric stenting or removal as indication were found in (56.8%) . and therapeutic ureteroscopy for (92.3%). Ureteric stricture was not uncommon (24%). The success rate of therapeutic ureteroscopy was (93.7%) with definite correlation to the site of pathology been (91.75%), (92.3 %) and (87.5%) for the lower, mid and upper ureter respectively. The complications recorded were bleeding (3.3%), penetration (2.5 %), post-operative colic (13%) and infection (0.4%). Mortality rate was zeroConclusion: Because the experience of ureteroscopy in GHRD&S was auspiced by regular training from the SIU the outcome is really comparable to the literature.Keywords: Ureteroscopy, Gezira Hospital for Renal Disease and Surgery, Wad Medani, Success and safet

Urethral Stricture; Etiology, Presentation, Complications, and Outcome of Management at Gezira State, Central Sudan

Objectives: The objective is to evaluate urethral strictures in term of etiological factors, presentations and management at GHRDS, Gezira State, Central Sudan. Patients and Methods: One hundred sixty patients, who were diagnosed as urethral stricture, were enrolled in this study. All patients were dealt with through a scientific stratum of a thorough work up and managed according to the EAU guidelines. The bio-data, etiological factors of strictures, presenting symptoms and signs, the pathological types and modalities of treatment were recorded and analyzed. Results: The total number of patients was 160, only two females and the rest were males. The mean age was 46.2 ±2 years. The etiological factors were: post-surgical in 67 patients (41.9%), gonococcal urethritis in 48 patients (30%) followed by post traumatic stricture in 28 patients (17.5%). Concerning the sites 41 (25.6%) patients had bulbar urethral stricture and 24 (15%) with membranous urethra strictures. One hundred forty two (88.8%) patients were treated with visual internal urethrotomy (VIU) and the outcome of treatment was comparable to the literature Conclusion: The commonest etiological factors for urethral strictures in GHRDS were post-surgery followed by gonococcal urethritis. The outcome of management was comparable

Idiopathic Macular Hole: Algorithm for Nonsurgical Closure Based on Literature Review

Our purpose is to review the closure time and optical coherence tomography (OCT) biomarkers that result in the non-surgical repair of idiopathic full-thickness macular holes (IFTMH). Our methodology consisted of a comprehensive literature review of the nonsurgical resolution of IFTMH followed by the calculation of the estimated closure time using the structural equation model. Forty-nine studies were found eligible yielding 181 eyes with IFTMH: 81.1% being small holes (<250 μm) with a median diameter of 166 μm. Final vision (mean 20/41) was related to initial vision (mean 20/65) and mean age (67 years). The hole diameter was correlated with initial vision and closure time (mean 3.9 months). Closure time was related to hole diameter and initial vision in the following algorithm: Closure time (month)= −0.057 + 0.008 diameter (μm) + 0.021 age (year) + 2.153 initial vision (logMAR). Biomarkers by OCT for self-closure included in decreasing frequency: pointed edge, de-turgescence of cystic macular edema (CME) with reversal of bascule bridge, and vitreomacular traction (VMT) release. The crucial function of Muller cell bridging in sealing the hole attests to its exceptional capacity for regeneration. After the hole has begun to close; however in less than 5%, a delayed restoration of the ellipsoid layer or a persistent outer foveal defect may prevent visual recovery and reopening of the hole is possible. In conclusion, eyes with small-size IFTMH and good baseline vision can have the additional option of close OCT monitoring for biomarkers of self-sealing biomarkers. When rehabilitative activity seems to be lacking, surgery is therefore mandatory

The Initial Experience of Trans-Rectal Ultrasound and Biopsy in Diagnosis of Carcinoma Prostate In Gezira Hospital For Renal Disease And Surgery (GHRDS)

Background: Prostate cancer prevalent cancer in males above sixty-five worldwide, this lead to the introduction of screening of the PSA and using of the transrectal ultrasound scanning, and sextant biopsy of the prostate.Objectives: To compare the accuracy of the Transrectal Ultrasound guided biopsy (TRUS/BX) in the diagnosis of prostate cancer in Gezira Hospital for Renal Diseases and Surgery (GHRDS), with specific considerations to the digital rectal examination (DRE) findings and prostate specific antigen (PSA) level.                      .Materials and Methods:  This is a prospective, descriptive small-scale hospital based study.  A total of 297 patients with clinically symptomatic enlarged prostate underwent transrectal ultrasound guided true cut needle biopsy of the prostate were studied in (GHRDS) in the period from June2006 to June2009.                    Results: The majority 188 (63.3%) of patients were between 50-70 years of age. Abnormal digital rectal examination (DRE) like obliteration of the median sulcus, and fixed mucosa revealed higher incidence of carcinoma prostate (CaP) with a significant value (p= 0.0000). PSA level showed significant relation (p= 0.0001) with the diagnosis of carcinoma prostate. Transrectal U/S findings well correlated to the histopathological results, where abnormal findings (like hypo-echoic lesions or calcifications and cysts) showed higher incidence of malignancy in 46 patients constitute 52.8% of the abnormal U/S findings.Conclusions and recommendations: PSA level is highly sensitive but less specific in detection of prostate cancer. Normal DRE doesn’t exclude prostate cancer, fixed mucosa and obliterated median sulcus has the highest predictors of cancer prostate in DRE. Presence of calcifications and cyst on trans-rectal ultrasound has the highest liability for cancer prostate in compare to the other ultrasonic findings.                 Key words: Prostate cancer, DRE, PSA level, TRUS/ BX (Transrectal ultra sound biopsy), sextant biopsy

Objective Assessment of the Core Laparoscopic Skills Course

Objective. The demand for laparoscopic surgery has led to the core laparoscopic skills course (CLSC) becoming mandatory for trainees in UK. Virtual reality simulation (VR) has a great potential as a training and assessment tool of laparoscopic skills. The aim of this study was to determine the role of the CLSC in developing laparoscopic skills using the VR. Design. Prospective study. Doctors were given teaching to explain how to perform PEG transfer and clipping skills using the VR. They carried out these skills before and after the course. During the course they were trained using the Box Trainer (BT). Certain parameters assessed. Setting. Between 2008 and 2010, doctors attending the CLSC at St Georges Hospital. Participants. All doctors with minimal laparoscopic experience attending the CLSC. Results. Forty eight doctors were included. The time taken for the PEG skill improved by 52%, total left hand and right hand length by 41% and 48%. The total time in the clipping skill improved by 57%. Improvement in clips applied in the marked area was 38% and 45% in maximum vessel stretch. Conclusions. This study demonstrated that CLSC improved some aspects of the laparoscopic surgical skills. It addresses Practice-based Learning and patient care

The Study of Learning Styles among Medical Students at Majmaah University, Saudi Arabia

The main objectives of this research were to detect types of learning styles (LS), time spending in studying, to know the relation with GPA, and to determine which LS is suitable with teaching style used in the College of Medicine at Majmaah University. The study was cross-sectional self-survey conducted among male and female medical students at College of Medicine at Majmaah city over 6 months. Cluster sampling was used and total participants were 194 students from College of Medicine (males & females). The data was collected using a designed questionnaire and analysis of data was performed by SPSS (V26).This study showed that majority of participants preferred the Visual learning (VL) style (27.79%), the second most used type was Kinesthetic (24.79%), and the least used type was Auditory (24.53%). It also showed that students who prefer VL style score more than students who prefer other learning styles. It was observed that the student who prefers kinesthetic style spent more time in the studying the more use of this type. In Conclusion, The study concluded that the majority of participants were preferred the VL style. It is also showed that student who prefers visual learning style score more than students who prefer other learning styles. It is important to increase awareness of students regarding types of their learning styles and teaching strategies in college during admission

Types of glaucoma in a university health centre in Al‑Ahsa, Saudi Arabia: a pilot study

Objective: The objective was to assess the profile of different types of glaucoma in a University Health Centre in Al‑Ahsa, Saudi Arabia.Materials and Methods: It is a retrospective study in which the files of the patients at King Faisal University Health Centre were reviewed. The data collected included: Age, sex, race, visual acuity, the slit lamp examination findings, the intraocular pressure (IOP) as the average of 3 readings, the cup‑to‑disc ratio (CDR), the visual field changes, and the details of treatment received.Results: Eighty glaucomatous eyes from 50 patients were included in the study. The mean age was 54.8 ± 12.7 years, and the mean IOP was 19 ± 3.9 mmHg that ranged from 11 to 28 mmHg. The mean CDR mean was 0.48 ± 0.16 that ranged between 0.3 and 0.9. Ninety‑one percent of the visual field defects were arcuate scotomata. Primary open‑angle glaucoma (POAG) (60%) was the most predominant type of glaucoma, followed by primary angle closure glaucoma (ACG) (21.3%), secondary OAG (7.5%), and secondary ACG (6.3%). As for the anti‑glaucoma medications, 88% of the studied patients were on more than one medicine.Conclusion: This pilot study has demonstrated that POAG may be the predominant type of glaucoma in Al‑Ahsa, Kingdom of Saudi Arabia (KSA). Apopulation‑based study with a larger sample size is warranted to confirm the outcome and to provide a baseline data on the prevalence of types of glaucoma in this region of KSA.Keywords: Glaucoma, glaucoma types, prevalence, Saudi Arabi

Breast cancer awareness and breast self-examination among future female university graduates: comparison between medical and non-medical students

Background: Breast cancer is a common health problem among females in Saudi Arabia. The disease account for 27% of all female malignancies representing 25.1% of all newly diagnosed female cancers. The objectives of the current study were to assess the level of carcinoma breast awareness of female university students, Majmaah University in Saudi Arabia and to compare the level of awareness, breast self-examination and breast cancer screening between medical and non-medical students.Methods: The current study was a cross-sectional, conducted among female students in Majmaah University in Saudi Arabia. The stratified and the systematic sampling were employed to select the colleges and the students respectively. The sample size was calculated as 325. Data was collected by a pre tested questionnaire and analyzed by SPSS.Results: The university students who acquired good knowledge were 111 (34.2%). Students who acquired average and poor knowledge were 42.2% and 23.6% respectively. Medical students who had good knowledge were 37.6% compared to 26.9% of non-medical students.  The results showed that 94 (28.9%) of the participants practice breast self-examination and 25 (7.6%) performed a screening test.Conclusions: The study concluded that Majmaah University students’ awareness of carcinoma breast is low. There is no significant difference in the level of awareness between students of medical colleges and those of non-medical colleges. The level of practicing breast self-examination and performing screening test for carcinoma breast among female university students is low. There is a significant difference in performing carcinoma breast screening test between medical and non-medical students.

SARS-CoV-2 and Obesity: "CoVesity"-a Pandemic Within a Pandemic

Individuals who are overweight or suffering from obesity are in a chronic state of low-grade inflammation, making them particularly susceptible to developing severe forms of respiratory failure. Studies conducted in past pandemics link obesity with worse health outcomes. This population is thus of particular concern within the context of the COVID-19 pandemic, considering the cessation of obesity management services. This systematic review highlights [1] the reciprocal link between the obesity and COVID-19 pandemics, [2] obesity as a risk factor for more severe disease in past pandemics, [3] potential mechanisms that make individual's suffering from obesity more susceptible to severe disease and higher viral load, and [4] the need to safely resume bariatric services as recommended by expert guidelines, in order to mitigate the health outcomes of an already vulnerable population