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Abstract Background Ward rounds are a cornerstone in the educational experience of junior doctors and an essential part of teaching patient care. Here, we aimed to assess the doctors’ perception of ward rounds as an educational opportunity and to identify the obstacles faced in conducting a proper ward round in Sudanese hospitals. Method A cross-sectional study was conducted from the 15th to the 30th of January 2022 among house officers, medical officers, and registrars in about 50 teaching and referral hospitals in Sudan. House officers and medical officers were considered the learners, while specialist registrars were considered the teachers. Doctors’ perceptions were assessed using an online questionnaire, with a 5-level Likert scale to answer questions. Results A total of 2,011 doctors participated in this study (882 house officers, 697 medical officers, and 432 registrars). The participants were aged 26.9 ± 3.2 years, and females constituted about 60% of the sample. An average of 3.1 ± 6.8 ward rounds were conducted per week in our hospitals, with 11.1 ± 20.3 h spent on ward rounds per week. Most doctors agreed that ward rounds are suitable for teaching patient management (91.3%) and diagnostic investigations (89.1%). Almost all the doctors agreed that being interested in teaching (95.1%) and communicating appropriately with the patients (94.7%) make a good teacher in ward rounds. Furthermore, nearly all the doctors agreed that being interested in learning (94.3%) and communicating appropriately with the teacher (94.5%) make a good student on ward rounds. About 92.8% of the doctors stated that the quality of ward rounds could be improved. The most frequently reported obstacles faced during ward rounds were the noise (70%) and lack of privacy (77%) in the ward environment. Conclusion Ward rounds have a special value in teaching patient diagnosis and management. Being interested in teaching/learning and having good communication skills were the two major criteria that make a good teacher/learner. Unfortunately, ward rounds are faced with obstacles related to the ward environment. It is mandatory to ensure the quality of both ward rounds' teaching and environment to optimize the educational value and subsequently improve patient care practice.

Influenza-like illness (ILI) remains a major cause of severe mortality and morbidity in the elderly. Aging is associated with a decreased ability to sense pathogens and mount effective innate and adaptive immune responses, thus mandating the development of protective nutraceuticals. Biobran/MGN-3, an arabinoxylan from rice bran, has potent anti-aging and immunomodulatory effects, suggesting that it may be effective against ILI. The objective of the current study was to investigate the effect of Biobran/MGN-3 on ILI incidence, natural killer (NK) cell activity, and the expressions of RIG-1 (retinoic acid-inducible gene 1), MDA5 (melanoma differentiation-associated protein 5), and their downstream signaling genes ISG-15 (interferon-stimulated genes 15) and MX1 (myxovirus (influenza) resistance 1, interferon-inducible). A double-blind, placebo-controlled clinical trial included eighty healthy older adults over 55 years old, 40 males and 40 females, who received either a placebo or Biobran/MGN-3 (500 mg/day) for 3 months during known ILI seasonality (peak incidence) in Egypt. The incidence of ILI was confirmed clinically according to the WHO case definition criteria. Hematological, hepatic, and renal parameters were assessed in all subjects, while the activity of NK and NKT (natural killer T) cells was assessed in six randomly chosen subjects in each group by the degranulation assay. The effect of Biobran/MGN-3 on RIG-1 and MDA5, as well as downstream ISG15 and MX1, was assessed in BEAS-2B pulmonary epithelial cells using flow cytometry. The incidence rate and incidence density of ILI in the Biobran/MGN-3 group were 5.0% and 0.57 cases per 1000 person-days, respectively, compared to 22.5% and 2.95 cases per 1000 person-days in the placebo group. Furthermore, Biobran/MGN-3 ingestion significantly enhanced NK activity compared to the basal levels and to the placebo group. In addition, Biobran/MGN-3 significantly upregulated the expression levels of RIG-1, MDA5, ISG15, and MX1 in the human pulmonary epithelial BEAS-2B cell lines. No side effects were observed. Taken together, Biobran/MGN-3 supplementation enhanced the innate immune response of elderly subjects by upregulating the NK activity associated with reduction of ILI incidence. It also upregulated the intracellular RIG-1, MDA5, ISG15, and MX1 expression in pulmonary epithelial tissue cultures. Biobran/MGN-3 could be a novel agent with prophylactic effects against a wide spectrum of respiratory viral infections that warrants further investigation.

Background: To investigate the incidence and potential predictors of immune tolerance among adult living donor liver transplant (LDLT) recipients. Methods: This case-control study included adult recipients who underwent LDLT between May 2004 and January 2018, with at least a 5-year follow-up after LDLT. We divided the study recipients into two groups: Group 1 (Tolerance Group) included recipients who achieved operational or prope tolerance for at least one year; Group 2 (Control Group) included recipients who did not achieve tolerance. We used logistic regression analysis to study the potential predictors of tolerance after LDLT. Results: We included 368 recipients, 275 (74.7%) in Group 1 and 93 (25.3%) in Group 2. Operational tolerance occurred in 13/275 (4.7%) recipients and prope tolerance in 262/275 (95.3%) recipients. Age was significantly higher in Group 1. The median time for tolerance among the study recipients was 60 months (36–168). During follow-up, Group 1 showed lower serum levels of bilirubin, liver enzymes, alkaline phosphatase, and gamma-glutamyl transferase. Group 1 had a lower incidence of acute cellular rejection (ACR), recurrent viral hepatitis, and biliary complications. Logistic regression identified preoperative MELD, indication for LDLT, ACR, recurrent viral hepatitis, and biliary complications as significant predictors for allograft tolerance after LDLT. Conclusion: Allograft tolerance occurred in 74.7% of this cohort. We suggest that the MELD score, indication for LT, ACR, recurrent viral hepatitis, and biliary complications are predictors of allograft tolerance after LDLT. [ABSTRACT FROM AUTHOR]

Acute respiratory distress syndrome (ARDS) is one of the major problems in COVID-19 that is not well understood. ARDS is usually complicated by co-infections in hospitals. Although ARDS is inherited by Europeans and Africans, this is not clear for those from the Middle East. There are severe limitations in correlations made between COVID-19, ARDS, co-infectome, and patient demographics. We investigated 298 patients for associations of ARDS, coinfections, and patient demographics on COVID-19 patients’ outcomes. Of the 149 patients examined for ARDS during COVID-19, 16 had an incidence with a higher case fatality rate (CFR) of 75.0% compared to those without ARDS (27.0%) (p value = 0.0001). The co-infectome association showed a CFR of 31.3% in co-infected patients; meanwhile, only 4.8% of those without co-infections (p value = 0.01) died. The major bacteria were Acinetobacter baumannii and Escherichia coli, either alone or in a mixed infection with Klebsiella pneumoniae. Kaplan–Meier survival analysis of COVID-19 patients with and without ARDS revealed a significant difference in the survival time of patients with ARDS (58.8 +/− 2.7 days) and without ARDS (41.9 +/− 1.8 days) (p value = 0.0002). These findings prove that increased hospital time was risky for co-infectome-induced SDRS later on. This also explained that while empiric therapy and lethal ventilations delayed the mortality in 75% of patients, they potentially did not help those without co-infection or ARDS who stayed for shorter times. In addition, the age of patients (n = 298) was significantly associated with ARDS (72.9 +/− 8.9) compared to those without it (56.2 +/− 15.1) and was irrespective of gender. However, there were no significant differences neither in the age of admitted patients before COVID-19 (58.5 +/− 15.3) and during COVID-19 (57.2 +/− 15.5) nor in the gender and COVID-19 fatality (p value 0.546). Thus, Gram-negative co-infectome potentially induced fatal ARDS, aggravating the COVID-19 outcome. These findings are important for the specific differential diagnosis of patients with and without ARDS and co-infections. Future vertical investigations on mechanisms of Gram-negative-induced ARDS are imperative since hypervirulent strains are rapidly circulating. This study was limited as it was a single-center study confined to Ha’il hospitals; a large-scale investigation in major national hospitals would gain more insights.

Ionospheric scintillation is a pressing issue in space weather studies due to its diverse effects on positioning, navigation, and timing (PNT) systems. Developing an accurate and timely prediction model for this event is crucial. In this work, we developed two machine learning models for the prediction of ionospheric scintillation events at the equatorial anomaly during the maximum and minimum phases of solar cycle 24. The models developed in this study are the Random Forest (RF) algorithm and the eXtreme Gradient Boosting (XGBoost) algorithm. The models take inputs based on the solar wind parameters obtained from the OMNI Web database from the years 2010–2017 and Pc5 wave power obtained from the Bear Island (BJN) magnetometer station. We retrieved data from the Scintillation Network and Decision Aid (SCINDA) receiver in Egypt from which the S4 index was computed to quantify amplitude scintillations that were utilized as the target in the model development. Out-of-sample model testing was performed to evaluate the prediction accuracy of the models on unseen data after training. The similarity between the observed and predicted scintillation events, quantified by the R2 score, was 0.66 and 0.74 for the RF and XGBoost models, respectively. The corresponding Root Mean Square Errors (RMSEs) associated with the models were 0.01 and 0.01 for the RF and XGBoost models, respectively. The similarity in error shows that the XGBoost model is a good and preferred choice for the prediction of ionospheric scintillation events at the equatorial anomaly. With these results, we recommend the use of ensemble learning techniques for the study of the ionospheric scintillation phenomenon. [ABSTRACT FROM AUTHOR]

Maize is one of the most important cereal crops in Egypt where used in animal nutrition. The research problem: with studying the economic impacts for using varieties technology of maize in Gharbia Governorate, the most of farmers cultivate many of available varieties without looking efficiency of productivity, her, we asked what is the impact application of technological methods of modern varieties of maize in Gharbia Governorate. The aim of the research: the impact of shifting the supply function, and appreciate efficiency of productivity and economic, and access to the best map of the study crop. By studying the economic impact of the cultivation of modern varieties of white maize on shifting the supply function in Gharbia governorate: with replace single hybrid (haitek 2030) instead of single hybrid: 10, 130, 128, 323, it has led to shift the supply function to the right, which leads to increase the production by about 30 thousand ardebs assuming cultivation half of the area under maize in Gharbia governorate for the season 2017, its value reached about 13.5 million pounds. As for the triple varieties, it showed that by replacing the variety triple hybrid (321) instead of the triple hybrid varieties 310, 324, 311, its productivity reached about 24.6 ardebs / feddan of 2017, the production from 50% of the total area of maize in governorate increase with about 40 thousand ardebs, its value about 18 million pounds, and thus the cultivation of the total area of the maize crop in Gharbia governorate with single (haitc 2030) and triple 321 increase the production by about 70 thousand ardebs, its value about 31.5 million pounds, thus recommends with cultivate the two varieties in Gharbia governorate . With studying the economic efficiency of hybrid single white maize of seed component of the varieties mentioned that the value of the marginal product reached about 576.0, 369.9, 841.5, 399.15 pounds, while the price of each element of about 58.06, 38.58, 54.97, 30.0 pounds respectively, that means there is an economic efficiency seed element Where the value of the marginal product of the element is greater than its price in the market. But it is possible increase this efficiency until the value marginal product equals the price of element in the market. The economic efficiency of the triple hybrid of white maize of seed component of the items indicate that the value of the marginal product reached about 445.95, 147.6, 312.3, 606.15 L. E, while the price of each component reached about 20.9, 20.55, 20.45, 19.24 pounds respectively, indicate that the seed component has achieved the Efficiency Where the value of marginal product of seed component greater than its price, but it is still possible to increase the efficiency until the value of the marginal product of element equal price in the market. By studying some of the economic measures of single white maize: the percentage of the profit margin of the producer reached about 43.66%, 44.51%, 43.97%, 43.97%, 35.26% respectively, as the rate of economic efficiency of the single varieties reached about 177.51%, 180.20%, 178.47%, 154.47% respectively, It is possible arrange single maize varieties, according to the percentage the proportion of the profit margin and the rate of Economic efficiency as follows: single Hybrid (10), single hybrid (130), single hybrid (2030), single hybrid (128) respectively. As for the triple hybrid of white maize: the percentage of the profit margin of the producer estimated about 42.20%, 22.32%, 38.55%, 38.61%respectively, and the rate of economic efficiency in triple varieties reached about 173.02%, 128.73%, 162.72%, 162.90% respectively. So it can arrange the triple maize varieties, where the percentage of the profit margin and the rate of economic efficiency as follows: triple hybrid (321), triple hybrid (311), triple hybrid (324), triple hybrid (310) respectively. [ABSTRACT FROM AUTHOR]