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We report a case of a 49-year-old female with a history of HIV infection for 12 years. The patient had excellent compliance with antiretroviral medications, raltegravir 400 mg twice daily and truvada once daily for HIV. Over the years, she maintained an undetectable viral load with a CD4+ count >200 cells/μL. She has a history of type II diabetes, hypertension, bipolar manic depression, endometriosis, recurrent herpes simplex attacks, arthritis in both shoulders, irritable bowel syndrome (IBS), and nonalcoholic fatty liver disease (NAFLD). She weighed 148 kg with a body mass index (BMI) of 52.08 kg/m2. Her medication included diltiazem 60 mg once a day, glyceryl trinitrate (GTN) spray, metformin 1 g twice daily, and linagliptin 500 mg once daily for her type II diabetes with glycated hemoglobin (HbA1c) of 8.4%. She has full capacity and elected to have bariatric surgery; 4 months postprocedure, she lost 28 kg with a reduced BMI of 38.62 kg/m2 with no postoperative complications. Her diabetes control improved, and she no longer required linagliptin and metformin. Following the procedure, she was given supplements including ferrous sulfate, vitamin B12, vitamin D, and calcium. She was also prescribed lansoprazole. The case illustrates that bariatric surgery is an effective and safe operation for people living with HIV. Due to complex needs and the need for regular follow-up; primary care, family, and HIV physicians can all collaborate in the care of individuals living with HIV and who underwent bariatric surgery.

Abstract During the last third of pregnancy period, rabbits are exposed to many challenges, such as health complications and oxidative stress. The present study aims to use garden cress seeds (GAC) as a natural antioxidant to mitigate these challenges and evaluate its effects on reproductive performance, immunity, hormones, protein profile and milk quality. A total of 24 pregnant V-Line rabbits (pregnant at 20 days proved by palpation), with an initial body weight of 2395.83 g and about 6–7 months of age, were randomly distributed to 4 groups, the control group was fed the basal diet without GAC, the other treated groups GAC 3, GAC 4.5 and GAC 6 were fed the basal diet supplemented with 3, 4.5, and 6% GAC, respectively. The experiment lasted six weeks. The results revealed that treated female rabbits with different levels of GAC did not have a noticeable effect on milk yield, average daily milk yield, or most of the milk analysis parameters (milk density, total solids, solids not fat, lactose, ash, and protein). On the other hand, GAC showed a significant increase in milk fat, and GAC 3% rabbits displayed a higher percentage of milk fat (p

It is well known that over the last few decades, there has been significant growth of the aging population worldwide and especially in Europe, with an increase of more than two years per decade since the 1960’s. Currently, in Europe, people aged over 65 years old represent 20% of the population, creating many new and complex challenges for national healthcare systems. In many countries, geriatric medicine is an established medical specialty, integrated into the primary and secondary care of the older population. In some countries, such as Portugal, specialist training in geriatric medicine is not available, even though the life-expectancy in Portugal is currently 81 years due to a decrease in fertility and mortality, and people aged over 60 currently represent nearly a third of the population. There is strong evidence in the medical literature that a fracture following a fall, and especially a neck of femur fracture, is one of the most serious events that can happen in an older person’s lifetime. These fractures have been associated with increased morbidity, loss of independence, a high rate of institutionalization, and mortality. Rates of mortality after a year from femoral fractures have been proven to be three to four times higher than the expected in the general population, ranging between 15% to 36%. This emphasizes the importance of developing well-organized care pathways for these patients, which combine specialized geriatric care (also known as orthogeriatric care). This narrative review will focus on the core principles of orthogeriatric care and how medical professionals, including those who are not specialized in geriatric care, can effectively use them.

Entropy generation(EG) has attracted the attention of scientists and researchers worldwide due to its applications in the industrial and engineering sectors. Applications of entropy generation can be seen in chillers, air conditioners, air separates, air coolers, nuclear reactors, and vehicle engines. In the current investigation, we have analyzed entropy generation in Maxwell hybrid nanofluid(HNF) flow over a porous stretching sheet. Darcy Forchheimer(DF) relation is considered. Due to stretching of sheet flow generates. The thermal expression is reported taking influences of dissipation, radiation, and heat source. The second law of thermodynamics is utilized to obtain EG for considered flow. Boundary layer assumptions are considered in the modeling. Partial differential equations(PDEs) governing the flow are changed into dimensionless ordinary differential equations(ODEs) through transformations. The solution of reduced ODEs is constructed via NDSolve code in Mathematica software. Different influential flow variables impact on velocity, temperature, irreversibility, and Bejan number are discussed graphically. Physical quantities are examined numerically. The results show that velocity diminished for rising porosity and Forchheimer variables. Temperature field upsurges for an upturn in radiation and Eckert numbers, an opposite impact is noticed for higher Prandtl number. EG escalates for greater radiation, temperature, and Brinkman variables.

Background: Patients’ satisfaction with their treatment directly impacts the control of their diabetes. Quality of life is crucial for patients with diabetes mellitus to maintain long-term health and minimize complications. The current study aimed to evaluate the impact of diabetes education on quality of life (QoL) and treatment satisfaction of patients with type 2 diabetes mellitus. Methods: The current study was a randomized controlled trial. Patients with type 2 diabetes who were attending the diabetes clinic for 1 year were recruited. The overall sample in this study was 364 participants; 182 controls 182 cases. The interventional and control group participants were assigned randomly by simple random sampling technique. Controls were managed per usual care while cases were managed per usual care plus education done by the researcher. Pre-structured standardized questionnaires were used to collect the data. Data were processed and analyzed by using SPSS; version 28. Results: More than three-fourth of the participants; 76.4% were females. The average (±SD) age of the cases was 54.5 (±10) years, while was 56 (±9.8) years for controls. The overall median (IQR) years of DM diagnosis for all participants was 8 (4-14) years. The results showed a statistically significant difference between the mean satisfaction score from baseline to 12 months in the cases compared the controls ( P

Diabetic ketoacidosis (DKA) is a life-threatening condition affecting individuals with diabetes characterised by hyperglycaemia, metabolic acidosis and ketonemia. The incidence and financial burden of DKA is still high. Thiamine deficiency is well documented in patients with DKA and could be associated with cardiac dysfunction in those patients. Thiamine deficiency leads to cardiac dysfunction, neuronal death and worsens the prognosis of DKA. There is an existing metabolic relationship between thiamine deficiency in diabetes, obesity and bariatric surgery. Careful monitoring of thiamine, along with other vitamins, is essential for diabetic patients, obese individuals and postbariatric surgery. Further research and clinical studies are urgently needed to assess the following: (1) Whether diabetes, obesity and bariatric surgery make individuals more prone to have DKA related to thiamine deficiency and (2) Whether supplementation of thiamine can protect diabetic patients, obese subjects and individuals undergoing bariatric surgery from DKA. This review summarises the biochemistry of thiamine and the existing metabolic relationships between thiamine deficiency in DKA, diabetes, obesity and bariatric surgery. Primary and family physicians have an important role in ensuring adequate replacement of thiamine in individuals with diabetes, obesity and bariatric surgery.

BACKGROUND: Equity, inclusion, and diversity in medical education are increasingly recognized as crucial for enhancing student engagement and improving health outcomes. This paper aims to analyze trends and assess student attitudes toward ethnic equity, inclusion, and diversity within campus-based modules at the University of Buckingham Medical School, UK. MATERIALS AND METHODS: A mixed-methods approach was employed, involving 97 medical students aged 18–24 years (86.6%) between 2021 and 2023. Quantitative data were gathered through a pretested questionnaire using a five-point Likert scale and analyzed using SPSS software (version 26). Qualitative insights were obtained from five focus group sessions with randomly selected medical students and analyzed thematically. RESULTS: The findings of this study indicated a significant proportion of Asian descent students (56.7%). First-year and White ethnicity students perceived the curriculum as more representative compared to second-year counterparts and peers from other ethnic backgrounds. Notably, first-year students showed a heightened understanding of social science terms, especially “ethnicity,” and 67% of female students demonstrated a deeper comprehension of sociocultural factors influencing health behaviors. Across demographics, there was consistent recognition of these factors impacting patient care. Qualitative findings underscored the importance of representation in medical education, biases in recruitment, and advocated for greater faculty diversity. Additionally, there is a need for a curriculum reflecting diverse dietary habits and including role models from various ethnic backgrounds. CONCLUSION: This study emphasizes the critical need for curricular reform in medical education to prepare students for a multicultural society. Addressing disparities in curriculum representation and promoting diversity within faculties are essential for equipping future healthcare professionals with the skills to provide culturally competent care and navigate diverse patient populations effectively.

We report the case of a 72-year-old woman who was admitted following a fall and sustained a right neck of femur fracture. Prior to this admission, she was undergoing chemotherapy for lung cancer. Upon this admission, it was noted that she had developed neutropenic sepsis. She was initially treated with teicoplanin and ciprofloxacin. However, her neutrophil count dropped further, and she continued to have a high temperature, hence her treatment was switched to meropenem. Administration of meropenem was associated with persistent and difficult-to-correct hypokalemia. The hypokalemia resolved, and potassium levels returned to normal a few days after completing the course of meropenem therapy. To our knowledge, there is a very rare association between hypokalemia and the administration of meropenem. Therefore, clinicians need to be aware of this, especially in cases of refractory hypokalemia.

Introduction: As life expectancy increases, the prevalence of frailty and eye diseases (cataracts, glaucoma, age-related macular degeneration (AMD), and diabetic retinopathy) in the elderly global population is rising. Eye diseases and visual impairment not only contribute to a high incidence of falls, fractures, depression, and social isolation but they also herald cognitive decline and frailty (vision–cognitive impairment). Methods: This narrative review explores the relationship between eye diseases, visual impairment, and frailty, their association with cognitive decline, the current approaches in identifying and managing these conditions and the potential role of interdisciplinary care models. Relevant articles were identified by searching the major databases. Result: Eye diseases are common in elderly individuals and can lead to visual impairment and subsequently contribute to falls, fractures, depression, and social isolation. Visual impairment is strongly linked to cognitive decline, which is a key component of frailty. Reduced sensory input from vision loss leads to decreased cognitive stimulation, reduced engagement in activities such as reading, problem-solving, executive function, attention, and social interactions, which are crucial for maintaining cognitive health. This can lead to a form of “sensory deprivation”, which accelerates neurodegenerative processes. As cognitive decline progresses, it creates a feedback loop where individuals may struggle to manage their health, adhere to treatment regimens, or seek timely medical care, exacerbating both cognitive impairment and frailty. Additionally, subjective cognitive decline (SCD) is common in older adults with vision loss and may precede clinical dementia. This sense of declining cognitive ability can worsen anxiety and depression, further contributing to frailty. Early intervention has the potential to mitigate the cognitive effects of vision loss (vision–cognitive impairment). Conclusions: Ophthalmologists should play an important role in detecting frailty associated with vision loss. Incorporating frailty assessments into ophthalmic practice can facilitate referrals to geriatric care and early interventions, improving patient outcomes. Geriatricians should be vigilant in identifying visual impairment and referring patients for appropriate ophthalmic investigation and management. Regular vision assessments should be part of comprehensive geriatric evaluations. Future research will assess the beneficial role of community geriatricians in detecting frailty and vision–cognitive impairment. An interdisciplinary and collaborative approach between ophthalmologists and geriatricians can lead to earlier detection, comprehensive management, and improved outcomes in frailty, eye diseases, and cognitive function.

Introduction: Post-menopausal women living with Human Immunodeficiency Virus (WLHIV) face an increased risk of bone fractures due to the relationship between HIV-related factors and menopause. This narrative review aims to summarise the current knowledge about fracture risk among post-menopausal WLHIV in particular looking at hormonal changes, combined antiretroviral therapy (cART), lifestyle factors, and psychosocial implications. We also profiled a summary of the significant, recent studies of post-menopausal WLHIV residing in low-income countries (LIC). Methods: A thorough search of the literature was performed across PubMed, Medline, Scopus, and Google Scholar, focussing on studies published between 2000 and 2024. Inclusion criteria entailed original research, reviews, and meta-analyses addressing bone mineral density (BMD), fracture incidence, and related risk factors in post-menopausal WLHIV. Results: The review identified 223 relevant studies. Post-menopausal WLHIV exhibit significantly lower BMD and higher fracture rates compared to both HIV-negative post-menopausal women and pre-menopausal WLHIV. cART, particularly tenofovir disoproxil fumarate (TDF), contributes to reduced BMD. Menopausal status exacerbates this risk through decreased oestrogen levels, leading to increased bone resorption. Moreover, lifestyle choices such as smoking, alcohol consumption, and low physical activity are more prevalent in PWHIV, which further elevates fracture risk. Different psychosocial factors may make WLWHIV more vulnerable at this stage of their life, such as depression, isolation, stigma, and housing and nutritional issues. Women living in LICs face a variety of challenges in accessing HIV care. There are gaps in research related to the prevalence of osteoporosis and bone loss in post-menopausal WLHIV in LICs. Conclusion: Post-menopausal women living with HIV face a significantly higher risk of bone loss and fractures due to the combined effects of HIV and menopause. Antiretroviral therapy (particularly TDF), lifestyle factors, and psychosocial challenges exacerbate this risk. There is a need for careful selection of cART, hormone replacement therapy (HRT), and emerging treatments such as Abaloparatide. A holistic approach including lifestyle changes and psychosocial support is crucial to reduce fracture risk in WLHIV, especially in low-income countries.

Background: Diabetes mellitus is a complex condition to manage. Patients with a greater understanding and knowledge of their condition might achieve better glycemic control than others. This study aimed to evaluate the impact of clinical pharmacist-led diabetes education on the knowledge and attitude of individuals with type II diabetes mellitus (T2DM). Methods: This study was a quasi-experimental study which was conducted at a diabetes clinic in Khartoum, Sudan. The study population was adult individuals with T2DM who attended the diabetes clinic. The estimated sample size was 182 participants. The participants were selected randomly by a simple random sampling method. The knowledge and attitudes of the participants were assessed at baseline and at the end of the study after 12 months. The intervention was carried out through educational materials about diabetes and medications for its treatment. Results: The majority of the participants were females. The mean age was 54.5 (±10) years. Most participants had a family history of diabetes (69.2%). The mean knowledge score after the intervention was increased by 1.4 (±0.1) from baseline, p value (p value (p values < 0.001, 0.032, respectively). Conclusions: The knowledge of and attitudes towards diabetes differed significantly as a result of the educational program provided by the clinical pharmacist.

ABSTRACT: One of the most intriguing areas of research and innovation in the animal production and food sector recently has been designed-enriched products. These items are regarded as functional foods because they feature components that have advantageous physiological impacts on human health. In the production of poultry, designed eggs constitute a significant category of functional foods. The present study hypothesized that adding different kinds of oils to quail diets will help produce designer eggs rich in omega-3 and 6 fatty acids in addition to enhancing productive performance. So, this study examined how linseed (flaxseed) and canola oils with various levels can affect lipid metabolism, immune function, and the amount of n-3 polyunsaturated fatty acids (n-3 PUFA) in Japanese quail eggs. This work was conducted using 3 different vegetable oils (sunflower, linseed, and canola oils) and 3 different antioxidant supplements (0, 250 mg vitamin E/kg feed, and 1,000 mg ginger/kg feed) in a 3 × 3 factorial experiment. When linseed or canola oil was added to the diet, the number of fatty acids in the egg yolks of Japanese quail layers fell by (12.7 and 18.9%) and (41.4 and 24.6%), respectively. The amounts of saturated and monounsaturated fatty acids in total eggs fell by 21.9 and 14.6% and 24.5 and 15.8%, respectively, at 20 wk of age. However, when linseed and canola oil were added to the diet, the sum n-3 PUFA content in the egg yolk of Japanese quail-laying hens was noticeably raised at 15 and 20 wk of age. At 15 and 20 wk of age, the same groups' total n-6 PUFA content considerably increased compared to the group that did not receive flaxseed. In conclusion, during the laying period of Japanese quail, linseed oil, canola oil, vitamin E, or ginger positively affected productivity, blood hematology, constituents, resistance, lipid digestion system, and antioxidative properties in serum and egg yolk.

Background: Vaccines are an essential part of public health interventions to mitigate the devastating health and non-health impacts of COVID-19 pandemic. Despite the fact that Sudan launched the COVID-19 vaccination program in March 2021, only 10% of the population received their two primary doses of vaccines by the end of May 2022. This delayed uptake of vaccines obviously warrants investigation. Therefore, we have conducted this study to evaluate the knowledge, attitude and acceptance of the general population in Sudan toward COVID-19 vaccines. Methodology: A descriptive cross-sectional community-based study. The data were collected using an electronic questionnaire from 403 individuals living in Khartoum, Sudan. The data were processed using the Statistical Package for Social Sciences (SPSS), and data analysis was performed using appropriate tests. Results: 51% of the participants were found to have sufficient knowledge about the COVID-19 vaccine, and the knowledge level is higher among those educated beyond the secondary school and those who were employed. Among those unvaccinated, only 47% of the participants expressed their intention to take the vaccine when offered to them. The major reason for not trusting the vaccine is safety concerns expressed by 65.5% of the unvaccinated. Conclusion: Higher education levels and employment were associated with an increase in sufficient knowledge about the vaccine in around half of the participants. However, most of participants had not taken the vaccine at the time of the study, and the trust in vaccines is not high. Effective interventions by the health authorities are needed to address these issues in order to accelerate the COVID-19 vaccination program in Sudan.

Introduction: Hip fractures globally are associated with high levels of morbidity, mortality, and significant financial burden. This audit aimed to assess the impact of orthogeriatric liaison care on post-operative outcomes following surgical management of neck or femur fractures. Methods: Here, 258 patients who underwent hip fracture surgery over 1-year were included. Data were collected as an audit following the transition to an orthogeriatric liaison care model, involving regular orthogeriatric review (thrice weekly ward rounds, daily board rounds), superseding orthogeriatric review as requested. The audit is meant to assess the development of post-operative non-surgical site infection (NSSI) and mortality and duration of inpatient stay. Outcomes were compared to previous data from our hospital site in 2015/2016. Results: Patients with severe cognitive impairment and systemic disease (Abbreviated Mental Test Score (AMTS) < 7 and American Society of Anesthesiologists (ASA) grade ≥ 3) showed significantly elevated NSSI risk, consistent across the study periods. Both periods demonstrated an increased risk of NSSI associated with admission from nursing homes. Despite the 2021/2022 cohort being notably older, NSSI risk decreased from 40.6% to 37.2% after implementing the orthogeriatric care model. NSSI risk was notably reduced for severe cognitive impairment (51.6% vs. 71%), and the p-value was 0.025. Average hospital stay decreased post-intervention (2.4 days shorter), with a notable reduction for NSSI patients (3.4 days shorter). Overall mortality rates were similar, although mortality due to infection was significantly reduced in 2021/2022 (44.4% vs. 93.3%), and the p-value was 0.003. Conclusion: The orthogeriatric liaison care model significantly decreased NSSI only in individuals with severe cognitive impairment and infection-associated mortality. This highlights the integral role of orthogeriatricians in the care of elderly hip fracture patients.

Abstract Recently, phytochemicals in plants have evoked interest as sources of naturally beneficial substances and as alternatives to antimicrobials. Based on these benefits, it was hypothesized that garden cress (GC; Lepidium sativum) supplementation could overcome the negative impacts of severe heat stress on the reproductive and lactation performance, physiological parameters, and antioxidant status of rabbits. Twenty-four mature V-line does (6 months old) with an average body weight of 3.65 ± 0.54 kg were randomly assigned into four homogenously equal groups (n = 6) according to the level of supplemented GC seeds. Rabbits in the control group were fed a basal diet without GC seeds (GC 0), the other three treatment groups (GC 3, GC 4.5, and GC 6) were fed a basal diet supplemented with GC seeds at levels 3, 4.5 and 6%, respectively. Investigations revealed that the inclusion of 3% GC enhanced the litter weight of heat-stressed rabbits on the 7th, 14th, and 21st days. Furthermore, treatment with 3% and 6% GC seeds increased the milk yield on the 28th day. the most of lipid profile parameters, such as cholesterol, triglyceride, high-density lipoprotein (HDL), low-density lipoprotein (LDL), serum urea levels, and antioxidant status improved in rabbits supplemented with 6% GC. In conclusion, the dietary supplemention of GC seed at 6% increased milk yield at 28th day “weaning age”, consequently, improved the blood lipid profile and antioxidant status. Further studies should be conducted to commercialize theusage of garden cress seeds as a supplement in rabbits.

Abstract Background: Hepatitis E virus (HEV) is a hepatotropic pathogen that causes significant morbidity and mortality in humans. It is an important causative agent of viral hepatitis outbreaks. This study investigates the serological and molecular prevalence of HEV in blood donors attending the Central Blood Bank in Wad Medani City in Gezira State, Sudan. Methods: The study adopted a cross-sectional descriptive design. A structured questionnaire was used to collect data concerning demographic information and risk factors associated with HEV transmission. All enrolled participants (N = 300) were screened for HEV IgG antibodies using commercial ELISA kits, then strong positive samples (N = 84) were selected and rescreened for HEV IgM and HEV RNA by RT PCR. SPSS version 24.0 was used for analysis. Results: Out of 300 male participants, 36.3% (109/300) were positive for HEV IgG. However, only one participant was IgM positive, while the HEV RNA was negative. The highest prevalence rates of the virus were 42 (44.6%) among the age group of 31–40 years, 20 (48.8%) in those who consumed food from outside, 13 (50%) in three to four multiple blood donations, and 5 (62.5%) in those who consumed water from the river source. A significant association of HEV IgG prevalence concerning the occupation of the participants being students or farmers was detected using univariate and multivariate analysis (P-value = 0.007). Conclusion: High prevalence of HEV IgG was demonstrated among the healthy blood donors in this study. Given the possibility of HEV transmission by transfusion from donors to recipients, we recommend that routine screening for HEV should be adopted by blood banks in Sudan.

Background: Tricuspid valve disease is most commonly functional, however, organic affection still accounts for one fourth of cases. Rheumatic fever which is endemic in Egypt is a main cause of organic affection. Current practice largely relies on tricuspid valve repair; however, it has been difficult to determine optimal procedure. Objectives: Herein, we study the outcome of replacement versus repair in such patients. Patients and methods: A prospective study was conducted on 300 consecutive patients with rheumatic heart disease showing severe tricuspid valve affection underwent tricuspid valve surgery, between 2014 and 2018. The patients were divided into two groups; TVR group (n=150) which included patients who underwent tricuspid valve replacement and TVr group (n=150) which included patients who underwent tricuspid valve repair. Diagnosis and follow up were done by echocardiography. Peri-operative variables, clinical outcome, morbidity, mortality, and follow up data were recorded. Results: Mean follow-up was 4±1.32 years. In-hospital mortality was 6 patients (4%) in TVR group and 3 patients (2%) in TVr group (P value ≥ 0.05). Postoperative low cardiac output syndrome and stroke were significantly higher in the repair group. Postoperative RV dysfunction, renal impairment, renal failure and chest re-exploration were significantly higher in the replacement group. Severe tricuspid regurgitation was reported in 19 patients (12.6%) of the repair group on follow up. Conclusion: Tricuspid valve repair is preferable to replacement to avoid the drawbacks of prosthesis. However, tricuspid valve replacement is feasible with comparable survival outcome and the progressive nature of the rheumatic disease may recommend replacement.

Abstract Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder and cause of infertility in women of reproductive age. Knowledge of females about health problems is considered an important factor that promotes females' health-seeking behavior. This study aimed to evaluate females' knowledge and attitude toward PCOS as well as to assess PCOS prevalence among the participants. Methods: A total of 240 females were included in the study between January and April 2019. A convenience sampling technique was used to select the participants. Data were collected using a self-administered questionnaire and analyzed using the Statistical Package for Social Sciences (SPSS) version 24. The analysis included frequencies of discrete variables and descriptors and cross-tabulation of the variables using the Chi-square test and logistic regression analysis. P < 0.05 was considered statistically significant. Results: The results showed a low level of knowledge (scoring < 9) in 41.3%, a good level (scoring between 9 and 15) in 21.3%, and also an excellent level of knowledge (scoring > 15) in 37.5%. The Chi-square statistical test showed significant associations between the level of knowledge and education level, urban residence, health profession, marital status, and the prevalence of PCOS (p < 0.001, < 0.001, < 0.001, 0.045, and < 0.001), respectively. Logistic regression showed that the females' knowledge about PCOS was significantly associated with urban residence and being a health professional (p = 0.004 and p < 0.001, respectively). Conclusion: The study highlighted that there was inadequate knowledge about the disease among participants and showed an urgent need to improve the knowledge about PCOS among Sudanese women.

Abstract Background: Periampullary tumors (PATs) are rare and Whipple pancreaticoduodenectomy is the commonest surgical approach for its management. The aim of this study was to analyze the histopathological features of Whipple-resected periampullary tumors in Sudanese patients. Methods: This retrospective descriptive study included 62 cases of Whipple resection seen in a center in Khartoum, Sudan from January 2016 to June 2021. The specimens were assessed for nine features of the tumor: site of the tumor (whether within the periampullary region), size of the tumor, histological type of the tumor, grade, perineural invasion, lymph vascular invasion, surgical margin status, lymph node metastasis status, and the pathological stage (pTNM). Results: Intotal, 62 cases, 40 (64.5%) males and 22 (35.5%) females, were included. Age ranged from 20 to 90 years with a mean age of 56.08 years ( ± 12.98 SD). Of the 62 cases, 58 were malignant (93.5%), while 4 cases were benign (6.5%). The pancreas was the commonest site for malignanttumors (53.4%), followed by the ampulla (24.1%), duodenum (15.5%), and distal common bile duct tumors (DCBD) (7%). The maximum tumor size was 8 cm, and the number of lymph nodes resected ranged from 3 to 33. Pancreatic ductal adenocarcinomas (PDACs) showed the highest percentage of perineural (62.1%) and lymphovascular (55.2%) invasions, and a positive margin was seen in four cases. The most common tumor stage was pT3pN1pMx. Conclusion: PATs in the Sudanese population showed histological diversity regarding subtyping, grading, and staging. Further studies involving molecular prognostic features will support improving patient management.

Abstract Background Familial Mediterranean Fever (FMF) is a periodic auto-inflammatory disease with multiple systemic manifestations. This study aims to describe the various musculoskeletal and neurological manifestations in a cohort of Egyptian FMF patients and to evaluate their relation to the different Mediterranean fever gene (MEFV) mutations. Results This study involved 145 FMF patients, of them 62.1% were females and 31.7% were of the pediatric age. All involved patients had homozygous MEFV gene mutation. The presenting manifestation in 71.9% of these patients was abdominal pain followed by musculoskeletal manifestations in 35.2% of them. 38.6 % of the involved patients had arthritis during the period of follow-up. Monoarthritis was the most frequent pattern of arthritis. Arthralgia was present in 96.6% of the studied patients. Myalgia was present in 19.3% of the studied patients especially involving the lower limb muscles with one case of protracted febrile myalgia. Neurological manifestations were present in about 86.9 % of patients with vertigo, paresthesia, and seizures as the most common. Five major MEFV gene mutations were found in most of the studied patients (135 patients): M694V, M680I, E148Q, V726A, and M694I. When a comparative study was done between these five major mutations according to the age of onset of the symptoms, different musculoskeletal and neurological manifestations, ESR, serum amyloid level and dose of colchicine, no statistical difference was found. Conclusion Musculoskeletal manifestation is the second most common presenting symptom in a cohort of Egyptian FMF patients after abdominal pain. Arthralgia is the most frequent musculoskeletal manifestation while monoarthritis of the knee or ankle joint is the most common pattern of arthritis in FMF patients. Vertigo, paresthesia, and seizures are the most frequent neurological manifestations. Musculoskeletal manifestations, neurological manifestations, serum amyloid level, and dose of colchicine are not related to the type of the genetic mutation in this cohort.

This paper investigates the physical layer security of inband underlay Device-to-Device (D2D) communication, where the direct link between D2D users is not available. In this respect, optimal relay and suboptimal relay selections are utilized to secure the D2D transmission. The eavesdropper uses either maximal-ratio combining or selection combining to increase the wiretapped signals. The D2D secrecy performance analysis is performed regarding the secrecy outage probability (SOP) and the probability of non-zero secrecy capacity, and closed-form expressions are provided for both relay selection approaches and verified using Monte-Carlo simulation. From the numerical results, it is shown that increasing the number of D2D relays enhances the secrecy performance of D2D communications. Moreover, the exact asymptotic analysis of the SOP is provided. It turns out that the diversity order of both relay selection approaches is the same.

Background: Hepatitis B virus (HBV) is considered one of the most paternally transmissible viruses. Therefore, education about its risk factors and transmission is vital in decreasing the prevalence of the disease burden in Sudan. The aim of the present study was to investigate the relative risk factors of HBV and its impact on the society. Materials And Methods: A facility-based, descriptive, cross-sectional study was conducted among those who were incidentally detected with HBV surface antigen (HbsAg) and their contact family members by ICT and enzyme-linked immunosorbent assay (ELISA) in Tropical Diseases Teaching Hospital, Omdurman locality, Khartoum state, Sudan. Results: The study recruited 112 participants, among whom 63 individuals incidentally attended for screening for HBV and this led to contact tracing of 49 individuals (contact relative group). Among 63 patients of the incidental group, there were 83.9% males and 16.1% females. In the contact tracing group consisting of 49 individuals, there were 83.3% males and 16.7% females (odds ratio [OR] = 1.375, 95% confidence interval [CI] = 0.14–13.6; P = 0.000). All the participants were screened for HBsAg. HBV was found to have a significant association with male gender (OR = 1.375, 95% CI = 0.14–13.6; P = 0.000), marital status (OR = 627.084, 95% CI = 48–8195; P = 0.000), working as police officers (OR = 524.2, 95% CI = 43.5–6314; P = 0.000), residing in Khartoum (OR = 520.173, 95% CI = 43–6290; P = 0.000), being illiterate (OR = 558.4, 95% CI = 47.7–6544.7; P = 0.000), vaccination status (OR = 625.4, 95% CI = 48.9–7996.3; P = 0.000), and with some concomitant diseases (OR = 559.193, 95% CI = 47.7–6561.5; P = 0.000). Conclusion: The HBV is still considered a very critical, highly infectious disease; therefore, primary care physicians have an important role in the investigation, prevention, and health education, in order to prevent the viral spread.

We report a case of a 46-year-old female with HIV for the last 15 years admitted to our hospital with a history of fever. She was diagnosed with pneumonia and was treated with antibiotics and recovered well; however, she was found to be hyponatremic. She mentioned that she tested positive for coronavirus disease 2019 (COVID-19) 4 months prior to the admission, and she gradually lost weight since. Further investigation for hyponatremia showed that she had Addison's disease with isolated adrenocorticotropic hormone (ACTH) deficiency. Magnetic resonance imaging of the pituitary was normal, and all auto-immune, hormonal, and biochemical investigations were normal. COVID-19 is also associated with adrenal insufficiency, and we suggest that further research is needed to establish the link between adrenal insufficiency and COVID-19. Our case report is unique as it demonstrates isolated ACTH deficiency leading to adrenal insufficiency following COVID-19 infections.

Background: Coronavirus disease 2019 (COVID-19) has caused a global public health crisis. The disease is known to be caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, but the detailed characteristics of the immune response to this novel virus have not been fully elucidated yet. In this study, we aimed to determine the level of immunoglobulin G (IgG) antibodies and their correlation with clinical features at three time points postinfection in a group of patients in Saudi Arabia. Method: In this prospective observational study, we collected the demographic and clinical data from 43 polymerase chain reaction (PCR)-confirmed patients and measured the COVID-19 antispike IgG levels at three different visits. Result: The seroconversion rate after COVID-19 infection was 88.4% in the study participants, with no significant changes in the IgG levels through the three visits. The duration of shortness of breath had a significant positive correlation with the IgG level of the patients. Using the logistic regression model, participants having coughs were found to be 12.48 times more likely to develop positive IgG. The IgG levels were less in smokers than nonsmokers [Odds ratio = 6.42 (95% CI 2.11–19.48); P = 0.001]. Conclusion: Positive IgG levels have been developed in most COVID-19 patients and did not significantly change over 3 months following the diagnosis. The level of IgG antibodies was found to be significantly associated with the presence of cough, duration of shortness of breath, and the smoking habit of the patients. These findings have clinical and public health significance and need to be validated in larger studies in different populations.

Abstract Background Medical students encounter various stressors during their studies. The study aimed to assess stress levels, sources, and associated determinants among Sudanese medical students. An online questionnaire-based study was conducted among 617 undergraduate medical students of 6 different universities in Sudan. A 19-item questionnaire was utilized to assess stress sources, in addition to demographics, stress manifestations, and coping strategies. Results The overall prevalence of stress was 31.7% (p

The continuing increase in patient numbers and improvement in healthcare provisions of HIV services in the UK, alongside the effectiveness of combined antiretroviral therapy (cART), has resulted in increasing numbers of the ageing population among people living with HIV (PLWH). It is expected that geriatricians will need to deal with many older people living with HIV (OPLWH) as life expectancy increases. Therefore, geriatric syndromes in OPLWH will be similar to the normal population, such as falls, cognitive decline, frailty, dementia, hypertension, diabetes and polypharmacy. The increase in the long-term use of cART, diabetes, dyslipidaemia and hypertension may lead to high prevalence of cardiovascular disease (CVD). The treatment of such conditions may lead to polypharmacy and may increase the risk of cART drug–drug interactions. In addition, the risk of developing infection and cancer is high. OPLWH may develop an early onset of low bone mineral density (BMD), osteoporosis and fractures. In this review, we have also provided potential psychosocial aspects of an ageing population with HIV, addressing issues such as depression, stigma, isolation and the need for comprehensive medical and psychosocial care through an interdisciplinary team in a hospital or community setting. OPLWH have a relatively high burden of physical, psychological, and spiritual needs and social difficulties, which require palliative care. The holistic type of palliative care that will improve physical, emotional and psychological wellbeing is discussed in this review.

Due to the elevated operating temperatures (800–1000 °C) of tubular solid oxide fuel cells (SOFC), severe thermal stresses are produced during their operation. Functionally graded materials (FGMs) are used in anodes and cathodes to reduce the specific thermal stresses. The use of FGMs compensates for the effect of any sudden shift in the coefficient of thermal expansion of these electrodes with respect to the electrolyte. In this study, the tubular SOFC efficiency, performance, and produced thermal stresses were numerically investigated. A 3D numerical model that includes the equations of mass conservation, momentum, charging transport, and electricity was developed. These coupled equations of the electrochemical phenomena were solved using ANSYS 19.1-Fluent Solver. The temperature values that were obtained were sequentially introduced into the structural finite element model as body loads, and the model was solved with ANSYS 19.1-MAPDL Solver. The numerical model was validated against previously published experimental results. For both electrodes, the FGM was identified by a grading index “m.” The use of the FGM for the anode and cathode instead of conventional electrodes increased the tubular SOFC efficiency and reduced the thermal stress. Optimum results were obtained at grading index m = 2.0, with the cell output increased by 8 % and induced thermal stresses well below the yielding levels.

Abstract Background: Wilson disease is an inherited disorder in which excessive amount of copper accumulates in various tissues of the body. Clinical features related to copper deposition in the liver may appear in the first and second decades followed by neurologic and psychiatric thereafter; however, many patients have a combination of these symptoms. Case: We report a case of 11 year-old girl, admitted to Wad Medani Pediatric Teaching Hospital with generalized body swellings for four days. Initial investigations showed proteinuria and hypoalbuminemia, thought to be due to nephrotic syndrome. Days later, patient developed jaundice and neuropsychiatric manifestations. A slit lamb examination confirmed the presence of Kayser–Fleischer ring (KF ring) and she scored high in the scoring system for the diagnosis of Wilson disease. D-penicillamine treatment therapy was started and unfortunately the patient's clinical condition deteriorated gradually, and eventually went into deep coma and died. Wilson disease mainly affects the liver, but the initial presentation was completely compatible with nephrotic syndrome. Conclusion: Diagnosis of Wilson disease should be suspected in a child presenting with generalized body swellings even in the absence of clinical evidence of hepatic and/or neuropsychiatric involvements.

Background: Lower extremity amputation (LEA) in individuals with diabetes is a serious health issue with a considerable physical and social burden. The aim of this study was to assess the prevalence and risk factors associated with LEA in diabetic foot ulcer (DFU) patients. Materials and Methods: This was a cross-sectional health facility-based study that recruited 315 diabetes individuals with foot ulcers from the diabetes center in Khartoum, Sudan. Direct interviewing of subjects was used to obtain data, using a standardized validated questionnaire. Chi-square and logistic regression analysis were used in data analysis. Results: 69.5% of the diabetic participants were aged 50 years old or more, and 71.1% were males. Most of the subjects (48.2%) were diabetics for a duration of >10 years, while more than one third (37.5%) of them were diabetic for 5–10 years. The majority (89.5%) had type 2 DM, while only 10.5% were type 1 DM. Two hundred forty-five patients had a left lower foot ulcer; 55.1% of the patients' ulcers were present in the toes, while 21.6% were in the foot sole. The overall prevalence of lower limb amputation was 17.1%. Individuals with diabetes patients with LEA had a higher incidence of hypertension (P = 0.000), retinopathy (P = 0.000), nephropathy (P = 0.002), ulcer size >2.5 cm (P = 0.000), and neuropathy (P = 0.000) through Chi-square analysis. Furthermore, logistic regression analysis showed that amputation was significantly associated with retinopathy (P = 0.000), size of ulcer (P = 0.000), and neuropathy (P = 0.016). Conclusion: The overall prevalence of LEA was 17.1%. The primary risks factors associated with amputation were presence of neuropathy and ulcer size >2.5 cm. Presence of retinopathy predispose diabetic individuals to amputation. Amputation is associated with disability and psychological problems; therefore, there is an urgent need for more improvement in preventative measures and primary health care system in low resource setting country like Sudan in order to decrease diabetes complications, especially patient's education about diabetes management by primary care physicians.

Background: Hepatitis E virus is a zoonotic virus with a worldwide epidemic outbreak. The aim of the study was to identify relative risk factors and co-infections concerning the seropositive HEV IgG among blood donors and haemodialysis (HD) patients in the central blood bank and renal dialysis centre in Wad Medani city, Gezira State, Sudan. Materials and Methods: This was a cross-sectional study that included 600 participants, among them 180 showed strong seropositive HEV IgG. The structured questionnaire was used to collect data of the participants' demographics, disease risk factors and HEV IgG co-infections with HBV, HCV, HIV and syphilis. Results: Among the 180 strong seropositive HEV IgG respondents, 84 were blood donors and 96 were haemodialysis patients. The gender and age (18–30 years) had a significant association with the virus exposure (P = 0.000, P = 0.000). Importantly, a significant association of HEV prevalence due to the localities effect exhibited with the highest rate among South Gezira (OR = 38, CI = 14.1–107; P = 0.000). This also observed in Wad Medani, Umm Algura, East Gezira and Managil localities (P = 0.000). The effect of the animal contact on HEV distribution exerted the significant association among the respondents for blood donors and haemodialysis patients in univariate (OR = 4.09, 95% CI 1.5–10.9; P = 0.005) and multivariate (OR = 3.2, CI = 1.1–9.4; P = 0.027) analysis. Conclusion: The relative risk factors of the HEV seroprevalence were gender, age, locality and animal contact. Besides the need of a regular survey for the virus seroprevalence, primary health care physicians can play pivotal role in health education, especially in rural areas of Sudan. In addition, primary health care physicians in Sudan are expected to establish strategies and plans to eradicate and minimise the health impact of HEV.

Background Breaking bad news is an important task for doctors in different specialties. The aim of the study was to assess adherence of Sudanese doctors to the SPIKES protocol in breaking bad news. Methods A descriptive cross-sectional study recruited 192 doctors, at Wad Medani teaching hospital, Sudan. A questionnaire-based on SPIKES protocol was distributed among 10 departments in our hospital. Data were analyzed using SPSS and Microsoft excel. Results There were (n = 101, 52.6%) females and (n = 91, 47.4%) males among the participants. 95.3% have been involved in breaking bad news, but only 56.3 received education and training about this issue. 43% admitted bad experience in breaking bad news, while 65.6% mentioned that bad news should be delivered directly to patients. The majority (>90%) agreed training is needed in the area of breaking bad news. Usual adherence to the SPIKES protocol was reported in a range of 35–79%, sometimes adherence was reported in a range of 20–44% while never adherence was reported in a range of zero–13.5%. Consultants, registrars, obstetrician and gynecologists and surgeons achieved high scores in breaking bad news. Training is an important factor in achieving high score in SPIKES protocol. The unadjusted effect of background factors on SPIKES score, showed that only training has significant impact on protocol adherence (P = 0.034, unadjusted; and P = 0.038 adjusted). Conclusion Large number of Sudanese doctors will try to adhere to SPIKES protocol. Training is an important factor in the success of breaking bad news.

The developments in Human Immunodeficiency Virus (HIV) treatment and in the care of people living with HIV (PLWHIV) and Acquired Immunodeficiency Syndrome (AIDS) over the last three decades has led to a significant increase in life expectancy, on par with HIV-negative individuals. Aside from the fact that bone fractures tend to occur 10 years earlier than in HIV-negative individuals, HIV is, per se, an independent risk factor for bone fractures. A few available antiretroviral therapies (ARVs) are also linked with osteoporosis, particularly those involving tenofovir disoproxil fumarate (TDF). HIV and hepatitis C (HCV) coinfection is associated with a greater risk of osteoporosis and fracture than HIV monoinfection. Both the Fracture Risk Assessment Tool (FRAX) and measurement of bone mineral density (BMD) via a DEXA scan are routinely used in the assessment of fracture risk in individuals living with HIV, as bone loss is thought to start between the ages of 40 and 50 years old. The main treatment for established osteoporosis involves bisphosphonates. Supplementation with calcium and vitamin D is part of clinical practice of most HIV centers globally. Further research is needed to assess (i) the cut-off age for assessment of osteoporosis, (ii) the utility of anti-osteoporotic agents in PLWHIV and (iii) how concomitant viral infections and COVID-19 in PLWHIV can increase risk of osteoporosis.

ABSTRACT: This study aimed to investigate the effects of dietary dried onion and dried cinnamon supplementation on laying performance, egg quality, serum lipid profile, and immune responses of Japanese quails. A total of 120 laying quails aged 12 weeks were randomly allocated into five groups (24 birds each). Each treatment was replicated 4 times with 6 quails in a completely randomized design. Dietary treatments were as follows: control (basal diet only, without any supplementation); tylosin (basal diet + 100 mg tylosin/kg diet); onion (basal diet + 800 mg dried onion/kg diet); cinnamon (basal diet + 800 mg dried cinnamon/kg diet); and onion + cinnamon (basal diet + mixture of 400 mg each of dried onion and dried cinnamon/kg diet). Cinnamon supplementation improved laying rate, egg numbers, egg mass, and feed conversion ratio of quails compared to the control treatment, followed by tylosin supplementation. Egg shell percentage was higher (P < 0.05) in quails that consumed the onion + cinnamon mixture than those fed only the cinnamon supplemented diet. Serum total lipid content, egg yolk lipids and egg yolk cholesterol were lower (P < 0.05) in birds fed with the supplemented diets than that of the control group. On the other hand, dietary supplements did not affect levels of triglycerides and high-density lipoprotein levels. The dietary supplementation with onion and/or cinnamon reduced serum malondialdehyde levels compared to control treatment. The foot web index was higher (P < 0.05) in the onion treatment than in the other experimental groups. The dried cinnamon and the mixture of dried onion + dried cinnamon treatments showed higher (P < 0.05) immunoglobulin M (IgM) levels than the control treatment. In conclusion, dietary supplementation with natural plant materials such as dried onion and cinnamon can be used to improve the laying Japanese quail performance, egg quality, and immunity.

Buruli ulcer and cutaneous leishmaniasis both have the similar cutaneous clinical presentation. Therefore, relying on clinical diagnosis can be challenging. We present a case of 45 years old woman diagnosed with cutaneous leishmaniasis, confirmed by skin biopsy. She received different modalities of anti-leishmanial treatment (fluconazole 450 mg daily for 4 weeks, sodium stibogluconate (SSG) followed by thermal therapy, SSG/IV 20 mg/kg for 30 days combined with paromomycin 15 mg/kg IM for 17 days). These treatments were associated with partial improvement of the ulcer and failure of healing. A second biopsy demonstrated the presence of Mycobacterium ulcerans and hence the diagnosis of Buruli ulcer as a cause of the delayed healing of the ulcer. M. ulcerans releases a toxin known as mycolactone, which decreases immune system function and results in tissue death. M. ulcerans, is regarded as the third most prevalent Mycobacterium after M. tuberculosis and M. leprae. Treatment with streptomycin intramuscular injections 1 g daily and rifampicin 600 mg daily for 8 weeks was associated with complete healing of the ulcer. To our knowledge, this is the first report that describes the co-infection of Buruli ulcer and cutaneous leishmaniasis in Sudan.

INTRODUCTION: Diabetes complications in Sudan were increasing at an alarming rate. The aim of this study was to assess the prevalence of stroke among Sudanese individuals with diabetes. METHODOLOGY: This cross-sectional study recruited 283 individuals with diabetes from three diabetes centers in Sudan. Data were collected using a standardized pretested questionnaire, and data were analyzed using Chi-square and logistic regression analysis. RESULTS: The average age of participants was 51 (±12 standard deviation) and 35% were aged between 51 and 60 years. Females were 66.8%, and most of the participants (73.9%) were from urban areas and 66.1% received formal education between primary school and university. Body mass index (BMI) classification showed that 34.3% were obese, 31.8% overweight, and 30.4% normal BMI. Diabetes for 1-5 years were observed in 71.7% and for more than 10 years (12%). The majority, i.e., 94.3% had type 2 diabetes mellitus while only 5.7% had type 1. Only one-third of the participants were able to achieve glycosylated hemoglobin (HbA1c) target for diabetes control. The prevalence of cerebrovascular accident (CVA) was 2.5%, hypertension (HTN) was 20%, ischemic heart disease 3.2%, and neuropathy was 45.6%. Chi-square test showed significant association between HbA1c, serum creatinine, total cholesterol, triglyceride, low density lipoprotein, high density lipoprotein level, and the presence of CVA. Logistic regression analysis showed HbA1c, and the duration of diabetes are significantly associated with the presence of CVA (P = 0.010, 0.014). CONCLUSION: The prevalence of stroke among Sudanese individuals with diabetes was around 2.5%. The main risk factors were HbA1c, HTN, and duration of diabetes.

Background: Depression is the most common prevalent psychiatric condition among patients with chronic kidney disease (CKD), and especially during dialysis. This study aimed to evaluate depression symptoms in Sudanese patients with end-stage renal diseases (ESRD) who undergo hemodialysis. Methods: This is a case finding, hospital-based study recruited 75 patients on dialysis in Khartoum, Sudan. Data were analyzed by statistical package for social science (SPSS, version 23). Results: The percentage of depression symptoms that satisfies the criteria for the diagnosis of major depression disorders in patients with ESRD undergoes dialysis was 68%. The new patients who undergo dialysis for less than 1 year had more depression symptoms (66.7%) than those on dialysis for 2–3 years (21.6%) or more than 3 years with a percentage of11.8%. Chi-square test showed significant associations between depression and age, the duration of dialysis, signs of significant weight loss when no dieting, and when the clinical symptoms related to distress or social or functional impairment (P = 0.016, 0.000, 0.004, and 0.000, respectively). Logistic regression test showed that age and duration of dialysis were significantly associated with depression with (odds ratios [OR]: 0.724, 0.211) Conclusion: More than two-thirds of patients on dialysis have depressive symptoms. Risk factors associated with depression in Sudanese patients on dialysis were age, duration of dialysis, weight loss, and social and functional impairment. Future research is needed in order to assess the benefit of antidepressants in patients on dialysis. Family physicians should be aware of the association between depression and dialysis, in order to provide early treatment and prevent suicide.

Background: Visceral leishmaniasis (VL) is one of the common infections in Sudan and can be associated with an increase in morbidity and mortality. The aim of this study was to assess the risk factors associated with mortality and morbidity with VL. Materials and Methods: This is a cross-sectional hospital-based study that recruited 150 patients with VL from two centers in Khartoum. Secondary data were extracted from the patient records, and data were analyzed using SPSS version 24.0. Results: The study included 2.5% of infants, 39.4% children, and 58% of adults. Male represents 77.3% of the cohort, and total mortality was 16%. Among the death reported 12.5% in infants, 16.7% were children, and 70.8% were in adults. Laboratory parameters significantly associated with mortality in univariate analysis were low white cell count, low platelets, high creatinine, and high liver enzymes. While risk factors such as infant, male, acquired infection from Eastern Sudan or White Nile, weight loss, morbid diseases, and concomitant bacterial infections were also associated with significant mortality in univariate analysis. Importantly, logistic regression analysis revealed significant association with infant (P = 0.02), concomitant bacterial infections (P = 0.003), comorbid disease (P = 0.001), low total blood cell count (P = 0.018), low platelets (P = 0.013), and high aspartate transaminase/alanine aminotransferase (P = 0.013). Conclusion: Health education and awareness are needed in terms of prevention and control, especially with high mortality seen in the infant. Treatment of underlying co-morbid diseases and bacterial infections are important to enhance survival. Patients with Leishmania are vulnerable; therefore, regular routine blood tests are an essential part of management to manage complications such as renal, hepatic failure, or severe anemia.

Introduction: Medical education in Sudan continues to evolve and progress with proliferation in the number of medical schools after 1990. Social factors and the geographical location of Sudan will increase the opportunity of success of medical schools to be socially accountable. In this analysis, we explained why social accountability is needed in Sudan and how this can enhance both excellence in medical education and primary health care, especially in rural areas. Methodology: PubMed, scopus Medline, and Google Scholar were searched for published-English literature concerning social accountability of medical schools in Sudan and worldwide were reviewed regardless of the time limit. We have also included examples of medical schools from Sudan and the Middle East to reflect on their experience in social accountability. Results: In this critical review, we have shown that social accountability will come with benefits for medical schools and the community. Implementation of social accountability in medical schools in Sudan will increase the effectiveness of medical schools' productivity, research output, and health service in urban and rural areas. There is an urgent need for social accountability alliance in Sudan to increase collaboration between medical schools. This will increase the benefits of social accountability for all stakeholders and also increases the competency in social medicine within the medical school curriculum. Conclusion: Social accountability is regarded as a sign of excellence in medical education. Primary care physicians in Sudan are expected to be the leaders in the implementation of social accountability. This analysis answered two important questions about why medical schools in Sudan should be socially accountable? And do we need a special structure of social accountability in Sudan?

Introduction: Professionalism and ethics are essential components of all dental schools. Therefore, this study aimed to assess the level of professionalism among Sudanese undergraduate dental students. Materials and Methods: This descriptive cross-sectional study was conducted among 307 students in the final year undergraduate Dental Surgery Bachelor program with 155 public and 152 private university students. We collected data through a self-administrated, semistructured questionnaire. Results: Although most of the students enrolled in dental schools due to their performance at higher school (P value 0.00), this has no significant effect on their attendance and academic performance afterward (P value 0.25). The perception of the students toward ethics teaching was generally positive in both public (77.34%) and private schools (78.77%). Ethics was represented in the curriculum of both private (51.7%) and public (48.3%) dental schools as perceived by their students. 95.43% and 94.00% of public and private students, respectively, would always or sometimes work in teams, and 98.02% and 94.04% of public and private students, respectively, would always or sometimes respect patients' preference (P value 0.01). A total of 95.33% of the dental students would consult or refer patients with unexpected situations. Only 26% of all students would treat infectious diseases themselves. Conclusion: About three-quarters of Sudanese dental students showed a satisfactory level of perception toward the importance of teaching dental ethics and professionalism. It was reflected in an excellent attitude for teamwork and respecting patients' choices. The demand for teaching professionalism course in every dental school will increase gradually, and family physicians with interest in medical education may play a pivotal role in teaching professionalism to dental students.

This paper investigates the physical layer security and data transmission in cellular networks with inband underlay Device-to-Device (D2D) communications, where there is no direct link between D2D users. We propose to apply full-duplex (FD) transmission and dual antenna selection at the D2D relay node. The relay node can simultaneously act as a friendly jammer to improve the secrecy performance of the cellular network while enhancing the D2D communication data transmission. This is an appealing and practical scheme where spectrum sharing is beneficial for the D2D and cellular networks in terms of reliability enhancement and security provisioning, respectively. The practical scenario, where the eavesdropper is passive, is considered. The eavesdropper uses either selection combining or maximal ratio combining to combine the wiretapped signals of the cellular network. The secrecy performance of the cellular network is analyzed, and closed-form expressions for the secrecy outage probability and the probability of non-zero secrecy capacity are derived. We show that increasing the number of FD jamming antennas enhances the secrecy performance of the cellular network. A closed-form expression of the D2D outage probability is also provided. Simulation and numerical results are provided to verify the efficiency of the proposed scheme and to validate the accuracy of the derived expressions.

Water wall tube temperature is a major parameter in the steam generator design which has a significant role in keeping the steam generator available. Thus, knowing the tube average temperature in different operating conditions is very important to avoid the causes of tube failures. High temperatures are a major cause of various types of failures, such as overheating, hydrogen damage, thermal stress, etc. Furthermore, deposits on the inner tube wall contribute to such failure by changing the thermal resistance of the tube wall, which causes a significant increase in the tube wall’s average temperature, consequently lowering the allowable stress. Therefore, the model was created by using ANSYS FLUENT (Canonsburg, PA, USA) to determine the wall average water tube wall temperature considering the deposit layer thickness (magnetite). Furthermore, this model was verified. It was found that increasing tube thickness can increase the average tube temperature but combining it with increasing deposit thickness leads to higher temperatures. In other words, the effect of the deposit on the tube with higher thickness is higher than on the tube with lower thickness. By discussing the minimum thickness of the water wall tube, the suitable selection of the tube thickness and courses of action concerning the operating conditions that minimize the potential overheating of water tubes in the furnace section of the boiler can be determined.

Heat transfer through tube walls can be promoted using a ribbed tube configuration. Most of the ribs used in previous reports have equal height along the tube length. In this numerical study, we investigate the heat transfer and pressure drop in a transverse ribbed tube where ribs of unequal heights are mounted such that the tops of the ribs form a zigzag shape. Four configurations were studied. Each configuration had a set of two neighboring ribs of different heights. The set was repeated along the tube length to form a zigzag shape. The rib height ratios, e2/e1, of the four sets were 0.25, 0.5, 0.75, and 1.0. The ratios of the height of the taller rib, pitch, and width to the tube diameter were kept constant at values of e1/d = 0.1, p/d = 1.0, and w/d = 0.05, respectively. The Reynolds number ranged from 10,000 to 60,000, while the Prandtl number ranged from 0.71 to 7.0. The results from the k-ε and k-ω models were first validated and compared with the experimental results of smooth and ribbed tubes. The two models showed comparable results, with the k-ε showing slightly better performance and was thus selected to perform the current study. It was found that the average Nusselt number increases along with increases in the rib height ratio, Prandtl number, and Reynolds number. The friction factor changed exponentially with the rib height ratio, while the Reynolds number showed a minor effect. At the same pumping power, a maximum thermal performance enhancement of approximately 8% was achieved at rib height ratios of 0.25 and 0.5. The rib height ratio of 0.5 has an advantage over that of 0.25 as it has a higher average Nusselt number. Two correlations were introduced to estimate the Nusselt number and friction factor for the current ribbed tube of zigzag configurations.

This study presents a novel current collector design for a tubular SOFC and numerically investigates its performance. The new current collector design has a flow channel with a trapezoidal shape. Several channels, such as four, eight, and twelve, are investigated, and their effects on cell performance are reported and compared. Additionally, a traditional tubular SOFC and the newly developed design are presented. The equations of mass conservation, momentum, charge transport, and energy were considered in the numerical model, and the ANSYS Fluent SOFC module was used to solve the numerical model. The results show that the developed design performed better than the traditional design. The new design with twelve channels collected 0.384 A, higher than the other designs. Although the design with twelve channels gave a high concentration of hydrogen at the outlet compared to the designs with four and eight channels, it gave higher performance than the designs with four and eight channels. Increasing the number of channels in the developed design enhanced the cell performance significantly due to the increased contact area, leading to the efficient collection of the generated current.