Knowledge, attitude, and practice of Sudanese clinicians regarding leukopenia and arthritis as early indicators for differentiating systemic lupus erythematosus Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder that shows variable early symptoms. Leukopenia and non-erosive arthritis are two important early features that can guide timely diagnosis, but there are often under-recognized, particularly in resource-limited countries such as Sudan. Evaluating clinicians’ knowledge and practices is vital for improving early detection. To assess the knowledge, attitudes, and clinical practices of Sudanese clinicians regarding leukopenia and non-erosive arthritis as early signs of systemic lupus erythematosus (SLE), aiming to support timely diagnosis and improved patient management.

Methods: A descriptive cross-sectional study was conducted among 348 Sudanese clinicians. Participants completed a structured self-administered questionnaire assessing knowledge, attitudes, and practices related to early SLE recognition, alongside the demographic and professional characteristics. Data were analyzed using Chi-square, t-tests, ANOVA, and Pearson’s correlation.

Results: Among 348 clinicians (53% female; mean age 30.2 years), only 7% were rheumatologists and 33% had formal rheumatology and autoimmune training. Overall knowledge of early SLE features was moderate (mean 4.1/7), with higher scores in rheumatologists (p < 0.021) and trained clinicians (p < 0.036). Attitudes were positive (mean 21.5/25), especially with training (p < 0.038). In practice, 70% ordered Complete blood count (CBC) and 60% ordered Antinuclear antibody/double-stranded DNA (ANA/dsDNA) or referred appropriately; rates were higher among specialists (p < 0.017) and trained clinicians (p < 0.028). Main barriers were overlapping symptoms (33%) and limited test access (30%). Knowledge correlated with attitude (p < 0.020) and practice (p < 0.024) attitude correlated with practice (p < 0.011).

Conclusion: Sudanese clinicians are aware of early SLE features, but confirmatory diagnostic steps remain inconsistent. Expanding training and improving access to specialized tests could enhance early diagnosis and patient outcomes.

]]> systemic lupus erythematosus, leukopenia, non-erosive arthritis, early diagnosis, clinical knowledge Research Article Wed, 31 Dec 2025 00:00:00 IST Assessment of viral load and liver enzymes levels among infected individuals with hepatitis B virus in Kassala State, Sudan Background: Hepatitis B Virus (HBV) is a major global health issue, affecting over 296 million people worldwide. This study aimed to assess the relationship between viral load and liver enzyme levels among HBV-infected individuals in Kassala State, Sudan.

Methods: A cross-sectional study was conducted from August to November 2024 in Kassala State. Data were collected from 50 HBV-positive individuals using a structured questionnaire. Viral load was measured via quantitative PCR, and liver enzyme levels (ALT, AST, and ALP) were analyzed using standard biochemical assays. Data analysis was performed using SPSS version 22.

Results: The study population consisted of 50% males and 50% females. Significant correlations were found between viral load and liver enzymes: ALT (r=0.833, p=0.000), AST (r=0.733, p=0.000), and ALP (r=0.586, p=0.000). Gender analysis revealed higher viral loads in females (p=0.044). No significant associations were observed between viral load and marital status (p=0.905), age (p=0.985), or duration of infection (p=0.960).

Conclusion: Elevated viral load was associated with increased liver enzyme levels, particularly in females. Routine viral load and liver enzyme monitoring are recommended to improve HBV management.

]]> Hepatitis B Virus (HBV), Viral Load, Liver Enzymes, Sudan Research Article Wed, 31 Dec 2025 00:00:00 IST Diagnostic value of MLR, MHR and Alvarado score in patients with acute appendicitis at Hasahiesa Emergency hospital, Gezira State, Sudan Background: Acute appendicitis continues to be a primary reason for emergency abdominal surgery worldwide. Its diagnosis is often challenging due to variable clinical presentations and limited access to advanced imaging, especially in resource-constrained settings. Recent research has focused on identifying accessible laboratory markers such as monocyte-to-lymphocyte ratio (MLR) and monocyte-to-high-density lipoprotein ratio (MHR) to improve the overall diagnostic precision for acute appendicitis, extending beyond merely differentiating between uncomplicated and complicated instances.This research focused on assessing the diagnostic significance of the monocyte-to-lymphocyte ratio (MLR), the monocyte-to-high-density lipoprotein cholesterol ratio (MHR), and the Alvarado score for diagnosing acute appendicitis, as well as their effectiveness in distinguishing disease severity among patients at Hasahiesa Emergency Hospital, Gezira State, Sudan.

Methods: A cross-sectional hospital-based study was carried out, enrolling 100 patients diagnosed with acute appendicitis from October 2022 to March 2023. MLR, MHR, and Alvarado scores were assessed for each patient. Their diagnostic performance for acute appendicitis was assessed, and values were compared between uncomplicated and complicated cases. Statistical analysis was performed using SPSS v22.0.

Results: MLR, MHR, and Alvarado scores were significantly elevated in patients with acute appendicitis and showed strong associations with disease severity and ultrasound findings (P value <0.05). These markers demonstrated robust diagnostic value for detecting acute appendicitis in general, as well as for distinguishing between uncomplicated and complicated cases.

Conclusion: MLR, MHR, and Alvarado score are valuable, available aids for diagnosing acute appendicitis and assessing its severity. Their integration into clinical protocols can improve early detection, risk stratification, and clinical decision-making, particularly in settings where advanced imaging is limited.

]]> MLR, MHR, Alvarado scores, Acute appendicitis, Sudan Research Article Mon, 30 Jun 2025 00:00:00 IST Acute appendicitis as the initial presentation of primary appendiceal diffuse large b-cell lymphoma: a diagnostic challenge Background: Primary appendiceal lymphoma is exceedingly rare, representing less than 1% of appendiceal neoplasms. Its clinical presentation is usually indistinguishable from acute appendicitis, often leading to a diagnosis only after histopathological evaluation.

Case presentation: We report the case of a 14-year-old male who presented with acute right iliac fossa pain and underwent appendectomy for suspected appendicitis. The patient was operated on, and the tissue was sent for histopathology, where a diagnosis of primary appendiceal lymphoma was made. Histopathological analysis and immunohistochemistry revealed a diffuse large B-cell lymphoma that was immunopositive for CD20. The patient succumbed to death on the seventh post-operative day.

Conclusion: This case highlights the importance of routine histopathological examination of appendectomy specimens and the need for multidisciplinary management. A high suspicion of non-Hodgkin lymphoma is important for early diagnosis, so that patients will receive treatment in the early stage, which can lead to a better prognosis.

]]> Appendicitis, Gastrointestinal, Non-Hodgkin Lymphoma, Rare, Diffuse large B-cell lymphoma Case Report Mon, 30 Jun 2025 00:00:00 IST Comparative efficacy of advanced and conventional vision therapy for amblyopia, convergence insufficiency, and accommodative dysfunction Background: To compare the effectiveness of Advanced Vision Therapy (AVT) versus Conventional Vision Therapy (CVT) in amblyopia, convergence insufficiency (CI), and accommodative dysfunction (AD).

Methods: In this prospective, randomized clinical trial, 90 patients aged 6–30 years with amblyopia (n = 30), CI (n = 30), or AD (n = 30) were randomized equally to AVT or CVT. Primary outcomes included best-corrected visual acuity (BCVA, LogMAR), near point of convergence (NPC, cm), positive fusional vergence (PFV, Δ), amplitude of accommodation (AA, D), accommodative facility (AF, cycles/min), and near point of accommodation (NPA, cm). Secondary outcome was symptom burden (CISS score). Outcomes were assessed at baseline, 2, 4, and 6 months.

Results: AVT improved amblyopia (BCVA) more than CVT, with a mean difference of -0.19 LogMAR at 6 months (95% CI -0.22 to -0.17; p < 0.001; Cohen's d = 2.84). AVT increased PFV by +2.6Δ (95% CI 1.90 to 3.30; p < 0.001; d = 1.77) and decreased NPC by -3.7 cm (95% CI -4.18 to -3.22; p < 0.001; d = 4.03), indicating convergence insufficiency. Accommodative dysfunction (NPA, AA, AF): AF increased by +2.6 cycles/min (95% CI 1.83 to 3.37; p < 0.001; d = 1.78), whereas AA changes were negligible and did not statistically differ across groups. NPA improved by –3.2 cm (95% CI –3.63 to –2.77; p < 0.001; d = 3.81). Symptoms (CISS): 82% of AVT patients achieved asymptomatic state, compared to 48% in CVT, and AVT decreased ratings by -5.2 points as compared to CVT (95% CI –6.58 to –3.82; p < 0.001; d = 2.00).

Conclusions: When compared to the traditional method, advanced vision therapy showed more rapid and noticeable enhancements in visual acuity, convergence, accommodation, and symptom reduction. According to these findings, AVT is a useful and successful treatment for common binocular vision problems.

]]> Amblyopia, convergence insufficiency, accommodative dysfunction, binocular vision, advanced vision therapy, vision rehabilitation Research Article Mon, 30 Jun 2025 00:00:00 IST Hypertension in chronic kidney disease: pathophysiology and innovative treatment approaches Hypertension is both a cause and a consequence of chronic kidney disease (CKD), creating a bidirectional relationship that exacerbates cardiovascular and renal complications. The pathophysiology of hypertension in CKD is multifaceted, involving deregulation of the renin-angiotensin-aldosterone system (RAAS), endothelial dysfunction, volume overload, and increased arterial stiffness. Additionally, uremic toxins and oxidative stress further amplify vascular injury and inflammation, contributing to the progression of both hypertension and renal impairment. Traditional antihypertensive therapies, including RAAS inhibitors, calcium channel blockers, and diuretics, remain central to management; however, therapeutic challenges persist due to CKD-associated pharmacokinetic alterations and patient heterogeneity. Recent advancements in treatment approaches have introduced novel pharmacological and non-pharmacological interventions. These include using sodium-glucose cotransporter-2 (SGLT2) inhibitors, which have demonstrated Renoprotective and blood-pressure-lowering effects, and non-steroidal mineralocorticoid receptor antagonists, offering improved safety profiles. Emerging technologies such as renal denervation and baroreceptor activation therapy provide innovative, non-invasive options for resistant hypertension. Additionally, personalized medicine approaches, including genomics and biomarker-based risk stratification, hold promise for tailoring interventions to individual patient profiles. This review highlights the intricate interplay between hypertension and CKD pathophysiology, discusses recent advancements in therapeutic strategies, and underscores the need for a multidisciplinary approach to optimize patient outcomes. By integrating cutting-edge research with clinical practice, future strategy can mitigate the dual burden of hypertension and CKD, reducing morbidity and mortality in affected populations.

]]> hypertension, Chronic Kidney Disease (CKD), pathophysiology, innovative therapies, Renin-Angiotensin-Aldosterone System (RAAS) Review Article Mon, 30 Jun 2025 00:00:00 IST Multiple loop connectors - an aesthetic alternative solution for missing anteriors Background: Spacing in the midline of the natural dentition has long been a focus for Prosthodontists. The challenge often proves difficult, with the common approach being to incorporate the gap into the treatment plan, rather than attempting to eliminate it entirely. This is due to the fact that closing a midline diastema with a fixed prosthesis frequently leads to aesthetic compromises.

Case Presentation: In this article, 2 cases with excessive space in the anterior region are discussed. The prosthetic rehabilitation was done by using a modified FPD with loop connectors instead of a conventional FPD design. Using this method to restore patients’ natural smiles helped boost confidence and patient satisfaction.

Conclusion: Replacing a single anterior tooth is a complex and demanding procedure that can be successfully achieved using implant-supported restorations, conventional porcelain-fused-to-metal crowns, or resin-bonded fixed partial dentures. A range of aesthetic treatment options should be carefully considered when planning the best approach for such patients.

]]> loop connectors, midline diastema, modified fixed partial denture, spacing Case Report Mon, 30 Jun 2025 00:00:00 IST Barriers and considerations in preoperative dental care for bariatric and metabolic surgery patients The treatment and quality of life of individuals living with obesity represent a significant challenge to global public health. This is due to the multifactorial etiology of the condition, its high prevalence, the exponential increase in incidence, the associated costs of therapy, and, most importantly, its broad impact on the general health of affected individuals (Caballero, 2019; Sharma et al., 2024). Oral health in this population may be adversely affected, directly compromising orofacial functions such as mastication and swallowing. The lifestyles and typical dietary patterns of individuals with obesity must be taken into account (Wang et al., 2021). When present, eating and anxiety disorders may promote compulsive, periodic consumption of ultra-processed, high-calorie foods rich in sugars, sodium, and saturated fats. Under these conditions, several oral manifestations are frequently observed, including dental erosion, caries, bruxism with incisal wear, xerostomia, gingival recession, periodontal disease, dentin hypersensitivity, aphthous ulcers, and oral lichen planus (Voß et al, 2024; Arbildo-Vega et al., 2024). Drawing on clinical experience from dental evaluations of individuals with severe (Class III) obesity who are candidates for bariatric surgery at a public referral center in Northeastern Brazil, we reflect on the challenges involved in addressing oral health needs during the preoperative period for bariatric and/or metabolic surgery. The anticipation of surgical intervention and the expected changes in appearance (aesthetics), self-esteem (related to stigma), mobility, pain levels, and general health indicators often correlates with emotional distress among these patients, influenced by individual and cultural values. The waiting period prior to surgery can range from several months to years and involves a multidisciplinary approach, preoperative weight loss, and behavioral modifications, all of which are critical to achieving a successful treatment outcome. Although most literature on oral health in this context focuses on the postoperative period, optimizing masticatory function preoperatively particularly to improve chewing cycles and enhance satiety remains a major clinical challenge. Faster eating rates and insufficient mastication significantly reduce satiety, increase caloric intake, and alter enteroendocrine responses.

Oral processing including bite size and the number of chews per gram of food is influenced by food texture and complexity (Slyper, 2021). Even when patients are informed about the relevance of dental care in this context, additional barriers often arise. These include emotional responses to the proposed therapeutic approach, conflicts with other scheduled appointments, limited access to services, the need for consistent dental management and monitoring of individuals with severe obesity, the cost and time required for care, and the pursuit of satisfactory outcomes. These factors must be addressed without compromising the broader treatment goals or becoming obstacles within the multidisciplinary process. This sense of lack of control and professional ineffectiveness is frequently reported by oral health practitioners, particularly in the public healthcare system in Northeastern Brazil. The current scenario calls for the adoption of innovative approaches and strategic planning, enabling the full and effective integration of dentistry within the multidisciplinary care team.

]]> Barriers, preoperative, dental care, bariatric, metabolic surgery patients Opinion Tue, 31 Dec 2024 00:00:00 IST NRBCs associated leukopenia: alternative formula for correction of leukocytes count: a case study Background: White blood count is considered one of the important inflammatory markers, and its age and gender dependent, under unusual pathological conditions, which can lead to false elevation in TWBCs and should be corrected. Rare cases associated with severe hemolytic anemia and severe leukopenia have potential limitation when corrected using conventional formula.

Case presentation: A case report of 4 years old Sudanese boy patient who was hospitalized with sickle cell disease (SCD). Complete blood count (CBC) parameters were analyzed using 3PD Automated Hematology Analyzer. Peripheral blood picture (PBP) was prepared and stained using leishmen's stain. The data calculate using alternative formula as following. Corrected TWBCs = {mean white blood cells (HPF)/ mean NRBCs (HPF)} × TWBCs. The laboratory findings revealed TWBCs: 124×103/μL, PBP show one WBCs among each 30 NRBCs in ratio of 0.033, the corrected TWBCs: 4.09×103/μL. NRBCs: 119.9×103/μL.

Conclusion: The presence of NRBCs on ratio more than 1:1 NRBCs to WBCs must be calculated using an alternative formula for calculation of NRBCs and corrected TWBCs specially in cases of severe hemolytic anemia and megaloblastic anemia.

]]> corrected TWBCs, NRBCs, alternative formula Case Report Tue, 31 Dec 2024 00:00:00 IST Renal artery stenting reversing ischemic nephropathy Background: Atherosclerotic renal artery stenosis (RAS) is a significant cause of renal failure, especially in patients with a solitary functioning kidney. Timely revascularization can potentially reverse ischemic nephropathy and prevent further complications like pulmonary edema and uncontrolled hypertension.

Case Presentation: A 71-year-old male with a solitary functioning kidney presented with worsening renal function, chronic hyponatremia, and recurrent flash pulmonary edema. The patient presented with a 95% ostial stenosis of the right renal artery. Percutaneous renal artery stenting was performed successfully, resulting in improved clinical status and renal function. Serum creatinine decreased from 3.07 mg/dL to 2.1 mg/dL post-procedure. The patient remained stable at a two-month follow-up.

Conclusion: Renal artery stenting in patients with ischemic nephropathy secondary to RAS can significantly improve renal function and overall clinical outcomes. Early intervention should be considered in similar cases to prevent irreversible renal damage.

]]> renal artery stenosis, renal artery stenting, atherosclerosis, renal failure, ischemic nephropathy Case Report Tue, 31 Dec 2024 00:00:00 IST Correlation between anthropometry measurements, adipokines, lipid profile and blood pressure parameters in hypertensive patients treated with enalapril Background: Hypertension and obesity are major risk factors for health problems and cardiovascular diseases in developing and developed countries. There is limited evidence available on the correlation between high blood pressure and obesity despite their close association.

Methods: The current study aimed to find the correlation between anthropometric measurements, lipid profile, visfatin, apelin, and blood pressure parameters in 31 newly diagnosed hypertensive patients and 32 enalapril-treated hypertensive patients.

Results: In enalapril treated patients, a significant negative relationship between visfatin and triglyceride (TG). Conversely, there is a positive correlation between visfatin and HDL. Moreover, visfatin expressed a negative correlation with VLDL. Concerning the newly diagnosed hypertensive group, a non-significant correlation was found between serum visfatin and lipid profile parameters. Additionally, a significant negative correlation between apelin and DBP in enalapril treated patients. Moreover, significant negative correlation between apelin and SBP in enalapril treated patients. On the other hand, a non-significant correlation between apelin and blood pressure parameters in the newly diagnosed hypertensive group was found. Moreover, there was a significant positive relationship between BMI and visfatin by comparing these two variables in all studied group participants.

Conclusion: We concluded that anthropometric measurements, adipokines, and lipid profiles most closely relate to high blood pressure in hypertensive patients.

]]> enalapril, adipokine, lipid, hypertension Research Article Tue, 31 Dec 2024 00:00:00 IST Correlation of waist-height index with total fat mass in obese and overweight patients Background: Excess total body fat causes low-grade systemic inflammation that precedes cardiometabolic damage. Plycometry is a widely accepted method for measuring total body fat, but not all physicians are trained to do it. The waist-to-height ratio is simpler to assess and has been recognized as a predictor of cardiovascular risk, but not as an indicator of total body fat. This study evaluated whether plycometry can be substituted by this ratio, and thus make an early intervention on systemic inflammation without having to be trained in plycometry.

Methods: Cross-sectional study based on a clinical trial of 40 patients who underwent a 14-week weight loss intervention. As part of the evaluations, weight, height, waist circumference and total body fat were obtained, which are the variables analyzed in this study. Pearson's correlation test was performed in duplicate: before and after the intervention. In all cases a p<0.05 was considered significant.

Results: The waist-to-height ratio correlated moderately with total body fat (R=0.7) before the intervention. At the end of the intervention the correlation increased to strong (R=0.8). When stratifying by body mass index grades, a trend of higher correlation was observed in the body mass index group between 25 and 26.9 kg/m2 (0.7 before and 0.85 after the intervention, respectively).

Conclusions: The waist-to-height ratio is not a substitute for plycometry, but it can be useful in predicting a low-grade systemic inflammatory state, especially in patients with a body mass index under 27 kg/m2. Further research is needed to assess the cutoff point at which low-grade systemic inflammation begins, so that more accurate information can be provided for intervention based on waist-to-height ratio.

]]> weight-height ratio, total fat mass, BMI, cardiometabolic risk, obesity Research Article Tue, 31 Dec 2024 00:00:00 IST Emergency room and neurosurgery cases Dear Editor,

In this study, demographic data of neurosurgery patients brought to the emergency room were examined and their results were evaluated. Patients who were brought to the Emergency Department of the Faculty of Medicine Hospital and hospitalized for neurosurgery over a three-year period were retrospectively analyzed from computer records. Of the 82250 patients who came to the emergency department within three years, 354 (0.43%) were followed up in the neurosurgery clinic. The mean age of the patients was 39.42 ± 22.50 (0-90), of which 213 (60.4%) were male and 141 (39.6%) were female. The most frequent applications were in October, December and January. The patients were brought to the emergency department with the most common complaints of headache, low back pain, traffic accident, falling from a height and dizziness. Glasgow coma scale was below 8 in 70 of the patients, and it was between 9-12,160 in 124 and 13-15 in 124 patients.

The most common diagnoses were lumbar pathologies (disc hernia, vertebral fracture), brain mass (diagnosed control patients), subarachnoid hemorrhage, hydrocephalus, epidural and subdural hemorrhage. Medical treatment was applied to 187 patients and surgical treatment was applied to 167 patients. While the number of patients hospitalized in the intensive care unit was 136, the mean day was 1.75 ± 5.91 (0-82) days, while the mean length of stay in the service was 8.06 ± 5.62 (1-37) days. Of the patients followed, 66 died and the most common diagnosis was intracranial hemorrhage. 288 patients were discharged with good recovery and were followed up in the outpatient clinic.

As a result, when neurosurgery patients are evaluated in emergency service admissions, it is seen that the number is low.

However, patients who are really urgent should be evaluated by making a differential diagnosis with a good physical examination and necessary tests (Şenol et al., 2014; Cook et al., 2020; Yang et al., 2021;  Madhok et al., 2022).

]]> emergency room, neurosurgery, lumbar pathologies, brain mass, subarachnoid hemorrhage Letter to Editor Sun, 30 Jun 2024 00:00:00 IST Tube thoracostomy cases and emergency department Background: Tube thoracostomy is a surgical method frequently used by thoracic surgeons and emergency physicians to drain air, fluid, pus, blood and bile from the pleural cavity. In our study, we aimed to evaluate the demographic and clinical characteristics, complications, morbidity/mortality of patients who underwent tube thoracostomy in the emergency department of our hospital.

Methods: We retrospectively analysed 111 patients who presented to the emergency department and underwent tube thoracostomy. Pearson chi-square test, Fisher's Exact test and Mann Whitney U test were used to analyse the data in our study.

Results: In our study, 22.5% (25) of the patients died and 54.1% (60) were discharged. The mean duration of hospitalisation was 8.9±6.3 days. Among the patients who underwent tube thoracostomy, 79.3% (88) had traumatic and 20.7% (23) had spontaneous pneumothorax. The incidence of pneumothorax was significantly higher in patients under 40 years of age than in patients over 40 years of age (p=0.003). Complications developed in 17.1% (19) of the patients. The most common complication was malposition.

Conclusion: Tube thoracostomy is frequently performed in our emergency department. Although it is a life-saving procedure, complications are common and may result in death. Morbidity and mortality can be reduced with experience and compliance with surgical sterility.

]]> tube thoracostomy, complication, pneumothorax, emergency department Research Article Sun, 30 Jun 2024 00:00:00 IST Effects of storage of blood sample at room temperature on measurement of red blood cell parameters Background: Accurate measurement of hematologic analytes is essential for physicians to establish correct diagnoses, plan of patient’s treatment, evaluate treatment response and monitor the progression of disease over time. For the most accurate hematological results, blood specimens should be analyzed as soon as possible after collection. This study aimed to determine the effect of storage durations of blood samples stored at room temperature on the measurement of red blood cell (RBC) count, hemoglobin (Hb) concentration, packed cell volume (PCV), red cell indices (MCV, MCH, MCHC) and red cell distribution width-Coefficient of variation (RDW-CV).

Methods: A cross sectional study was conducted between 2019 to 2020. Fifty healthy students (male and female) were randomly selected according to predefined inclusion and exclusion criteria. Blood samples were collected into EDTA tubes. RBCs parameters were measured immediately after collection to obtain baseline values, then stored at room temperature (24°C) and further measurements were obtained at  6, 12 and 24 hours after collection. Analysis was performed using fully automated hematology analyzer (sysmex XP-300).

Results: Data were analyzed using Statistical Package for Social Sciences (SPSS) computer program (version 20).  P-value >0.05 was considered statistically significant. The study proved that RBC's count, Hb and MCH were least affected by storage at 24°C, showed stability after 24 hours (P= 0.943, 0.999, 0.75 respectively). In contrast, MCV showed a significant increase after 6 hours (P= 0.002), and PCV increased significantly after 12 hours (P> 0.001). A highly significant decrease was observed in MCHC after 12 hours (P> 0.001). While RDW-CV, revealed a highly significant increase after 12 hours (P < 0.001).

Conclusion: The study concluded that some RBCs parameters are changed with storage at room temperature. Therefore, it is recommended that RBCs parameters should be measured immediately after blood sample collection.

]]> RBCs count, Hb, PCV, MCV, MCH, MCHC, RDW-CV and Room temperature Research Article Sun, 30 Jun 2024 00:00:00 IST Discordantly low hemoglobin A1c in the context of marked hyperglycemia Background: Hemoglobin A1c (HbA1c) acts as the primary biomarker for evaluating long-term glucose regulation. Nevertheless, high concentrations of fetal hemoglobin (HbF) can affect the accuracy of HbA1c assays in a manner dependent on the method used, possibly leading to falsely low HbA1c readings even when there is considerable hyperglycemia.

Case Presentation: The outpatients showed significant hyperglycemia (random blood glucose: 433 mg/dL) and highly positive urine ketones (+++), aligning with a diagnosis of diabetic ketoacidosis. Ironically, HbA1c obtained through standard immunoassay was 6.5%, which is categorized within the non-diabetic range. Follow-up hemoglobin fractionation showed an increased fetal hemoglobin (HbF) concentration of 4.1%, causing worry about assay interference and leading to a reassessment of the HbA1c outcome.

Conclusion: Elevated fetal hemoglobin (>4%) can falsely lower HbA1c, especially with immunoassay or boronate-affinity methods. Ion-exchange HPLC or electrophoresis is recommended, and clinicians should integrate alternative glycemic markers or continuous glucose monitoring to guide management accurately.

]]> hemoglobin A1c, fetal hemoglobin, HbF interference, Ion-exchange HPLC, capillary electrophoresis, glycemic markers Case Report Sun, 30 Jun 2024 00:00:00 IST Strengthening antibiotic sensitivity patterns of Klebsiella pneumoniae isolated from urine samples: impact of an antimicrobial stewardship program in a tertiary care hospital in central India Background: Gram-negative pathogens, notably Klebsiella pneumoniae, pose a global challenge due to their propensity for multidrug resistance, particularly in nosocomial infections like urinary tract infections (UTIs). Antimicrobial stewardship programs (ASPs) have been instituted to address the rampant misuse of antibiotics, aiming to foster judicious prescribing practices. This study evaluates the impact of an ASP on antibiotic sensitivity patterns of K. pneumoniae in a tertiary care hospital in Central India.

Methods: Urine samples positive for K. pneumoniae collected during 2023 and 2024 were subjected to antimicrobial susceptibility testing.

Results: Results demonstrate significant improvements in sensitivity patterns, notably in carbapenems and chloramphenicol. These findings underscore the effectiveness of ASPs in guiding antibiotic prescribing practices, attributed to enhanced acceptance among healthcare professionals.

Conclusion: Sustained initiatives to encourage responsible antibiotic utilization and garner support from healthcare professionals remain crucial in effectively tackling antibiotic resistance. Additionally, further research is needed to assess the long-term viability and scalability of such interventions.

]]> antibiotics, gram negative bacilli, urine Research Article Sun, 30 Jun 2024 00:00:00 IST Assessment of two-point discriminatory ability in patients with type-II diabetes mellitus Background: Diabetes is a complex, chronic condition that is a severe public health concern of the modern world. A wide range of co-morbidities and microvascular complications are associated with diabetes and one such major microvascular condition of diabetes that, if left untreated, leads to long-term disability among patients is Diabetic neuropathy. The primary goal of this study is to assess the tactile discriminatory function in patients with Type-2 Diabetes Mellitus and compare it with patients who do not have type-2 diabetes mellitus.

Methods: This case-control study, conducted at a tertiary rural healthcare centre, used a cross-sectional design. 53 individuals with a verified diagnosis of type-2 diabetes were included in the case group based on non-randomized sampling. These were contrasted with patients in the control group who did not have diabetes who were age and sex matched. The participants' tactile discrimination ability was measured using a millimetre-marked compass aesthesiometer. The tips of the index fingers on both the right and left hands, the palmar surfaces of the palms on the hands, the ventral surface of the forearms on the right and left, the plantar surfaces of the big toes on both the right and left foot, and the plantar surfaces of the soles on both the right and left foot were used as the testing sites. Data showing the two-point discrimination thresholds of the case and control groups were compared and tabulated.

Results: The unpaired t-test was done using all the values of two-point discriminatory thresholds in the diabetic and non-diabetic groups at 10 different sites at the upper and lower limbs as mentioned previously. The t values for all the test sites were significant with p values < 0.05. This indicates that the tactile discriminatory thresholds at all the testing sites, differ significantly in diabetic and non-diabetic groups. The current study also aimed to demonstrate a statistically significant association between the duration of diabetes and the reduced sensory abilities of diabetic patients. The Pearson's correlation Test was used to achieve this, but the results were unsatisfactory and somewhat at odds with the findings of several earlier investigations, which had discovered a strong positive link with the duration of diabetes with that of increased values of tactile discriminatory thresholds of the diabetic group. Since the correlation coefficients were not significant, it was not possible to determine a meaningful relationship between the duration of diabetes and the diabetic case group's reduced sensory abilities.

Conclusion: Our study highlights how the two-point discrimination test can aid in the early detection of tactile sensation loss in diabetic patients. The two-point discriminatory thresholds between the diabetic and non-diabetic groups differ significantly, according to the results of the study. Additionally, the data indicates higher threshold values, which point to a marked decline in tactile function in the diabetic group.

]]> diabetes, tactile discrimination, sensory, assessment, control Research Article Sun, 31 Dec 2023 00:00:00 IST Assessing perception of medical teachers on the implementation of elective module in an Indian medical college Background: As per recent recommendations of the National Medical Commission (NMC) of India, our medical college introduced an elective module for the MBBS admission batch of 2019. Being the inaugural implementation of its kind within our institution and across the nation, our study was designed to gauge the faculty's perception of the elective module. A survey with a cross-sectional design was carried out among the faculty members supervising the implementation.

Methods: A pre-validated questionnaire, formulated by members of the Medical Education Unit (MEU) at our college, was utilized for data collection. The questionnaire was distributed to faculty members through online platforms such as WhatsApp groups and email, using a Google Form. The data analysis considered responses from a cohort of faculty members actively engaged in the elective module implementation.

Results: The faculty consensus indicated that the elective module’s objectives were effectively achieved. The faculty were praised for their supportive and accommodating demeanor, with active involvement in facilitating the electives. The majority of faculty members acknowledged the elective module as a valuable academic activity, citing an appropriate time duration that allowed for the demonstration of creativity and encouraged teamwork. Faculty members expressed apprehension regarding the process of students obtaining signatures in the logbooks.

Conclusion: The study's findings indicate a positive reception of the elective module among faculty. This positive perception underscores the value of electives as learning experiences, offering learners the opportunity to immerse themselves in a chosen career stream, discipline, or research project.

]]> elective module, medical faculty, perception, India Research Article Sun, 31 Dec 2023 00:00:00 IST A comprehensive review on haptic feedback for minimally invasive surgery The objective of this article is to provide a thorough examination of the current state of haptic information feedback in minimally invasive surgery (MIS), including research conducted between 1985 and the present. Despite the fact that haptic information input in MIS is currently scarce, the comprehensive analysis emphasises that it represents a potential option. Surgeons might potentially get substantial benefits from receiving more input about force information, which would therefore enhance their surgical accuracy and control. The extant literature highlights a significant knowledge deficit regarding the intricate ramifications of haptic feedback, specifically with regard to the sense of slip and gripping forces. It is crucial to investigate the possible advantages of incorporating supplementary haptic information in order to protect against tissue damage when performing manipulation treatments. It is of the utmost importance to fill this void, since doing so might revolutionise the field of MIS via the mitigation of unintended tissue injury and the improvement of surgical results. By capitalising on technology progress to provide more extensive haptic feedback, surgeons have the ability to enhance their tactile perception, optimise the application of force, and reduce the likelihood of tissue injuries when performing complex surgical procedures.

]]> laparoscopy, tactile perception, force feedback Review Article Sun, 31 Dec 2023 00:00:00 IST Mixed infection of Plasmodium falciparum and dengue virus: a case report from Garg Nursing Home, Neemuch, Madhya Pradesh Background: Malaria and Dengue, transmitted by the Female Anopheles and Aedes aegypti mosquitoes respectively, are significant global health concerns. Recent improvements in sanitation and mosquito control have reduced malaria cases in several parts of India. However, areas where both vectors coexist pose a risk of concurrent infections, complicating diagnosis and treatment. Falciparum malaria and Dengue are known for their severe complications, including cerebral malaria and bleeding tendencies due to reduced platelet count.

Case presentation: A 60-year-old patient presented with high-grade fever, severe headache, body aches, and dehydration. Despite prior treatment at a village clinic, the symptoms persisted and worsened. Upon admission, the patient exhibited high fever, rapid pulse, and mild dehydration. Further examination revealed no respiratory or cardiac issues, but severe headache persisted despite fever reduction. Symptomatic management commenced while awaiting test results. Lab reports indicated a positive result for P. falciparum antigen via immunochromatography.

Conclusion: This case underscores the necessity of testing for both malaria and Dengue in cases of acute high-grade fever to avoid missed diagnoses and untreated severe complications. Coinfection of P. falciparum and Dengue can intensify the severity and duration of both diseases, challenging accurate diagnosis and management. Vigilance in testing and reporting such cases is crucial for effective public health responses. The first documented case of malaria and Dengue coinfection dates back to 2005, highlighting the emerging nature of this phenomenon.

]]> Aedes aegypti, dengue, elisa, fever, malaria, Plasmodium falciparum Case Report Sun, 31 Dec 2023 00:00:00 IST Aeromonas hydrophila bacteremia in a patient on dialysis: a case report Background: Aeromonas hydrophila, typically found in aquatic environments, is recognized as an infrequent yet significant etiological agent of bloodstream infections.

Case presentation: This case report documents a 61-year-old male undergoing hemodialysis for end-stage renal disease who presented with fever, edema, and laboratory abnormalities indicative of renal dysfunction and inflammation. Blood cultures revealed Aeromonas hydrophila growth, emphasizing the importance of considering this pathogen in dialysis patients with bloodstream infections. The patient's immunocompromised state due to renal disease and diabetes, coupled with frequent medical interventions like dialysis, created a conducive environment for opportunistic infections. Laboratory findings of proteinuria, glucosuria, and electrolyte imbalances further underscored the patient's susceptibility to infection. This case highlights the intricate interplay between underlying comorbidities and immune compromise in predisposing individuals to Aeromonas hydrophila bloodstream infection. Prompt recognition and appropriate antibiotic therapy are crucial for managing such cases.

Conclusion: Healthcare practitioners should maintain vigilance for unusual pathogens in immunocompromised patients, particularly those undergoing dialysis, to ensure timely diagnosis and treatment, thus optimizing patient outcomes.

]]> Aeromonas hydrophila, bacteremia, dialysis, end-stage renal disease, diabetes mellitus Case Report Sun, 31 Dec 2023 00:00:00 IST