Types and Outcomes of Diagnostic Measures provided for women Presented with Postmenopausal Bleeding
Published on: 21st April, 2025
Background: Postmenopausal bleeding (PMB) is bleeding from the genital tract after 12 months of amenorrhea in a woman over the age of 50, or 24 months if below the age of 50 years, in 10% of women presented with PMB, the cause is endometrial cancer.Purpose: To assess the clinical presentation types and outcomes of diagnostic measures provided for women presenting with PMB at Saad Abu-Alela Hospital, Khartoum, Sudan.Methodology: It was a descriptive, cross-sectional study conducted at Saad Abu-Alela Teaching Hospital in the period from January to December 2022.An interview questionnaire was used for data collection. Fifty-nine (59) postmenopausal women were included in this study, age, parity, risk factors, duration of bleeding, duration of menopause, ultrasound findings, and hysteroscopy findings were recorded.Results: The majority of study participants were aged between 50-54 years, menopause duration was most 1-4 years, most of the participants were educated and medically free, DM and HTN, and most of the participants were multiparous. Duration of PMB ranged between weeks in a third of cases and up to more than a year in some cases, amount of bleeding was mild in more than half. Ultrasound is used to assess the endometrial thickness and other findings, also hysteroscopy and biopsy or Dilation and curettage and hysterectomy.Conclusion: The ultrasound and endometrial biopsy via inpatient hysteroscopy and dilatation and curettage were the best tools for evaluation of (PMB), benign conditions were the most frequent outcome and endometrial cancer.
Success Rate and Complications of Endoscopic Deacryocystorhinostomy without Stenting: A Retrospective Study
Published on: 16th April, 2025
Endoscopic dacryocystorhinostomy (EDCR) is a well accepted surgical treatment for patients with nasolacrimal duct obstruction (NLDO). Previously, external dacryocystorhino-stomy was considered as the gold standard treatment for NLDO, however, EDCR has gained momentum due to its several advantages. The EDCR has been sounding more aesthetic and as functional compared to the traditional external dacryocystorhinostomy in the surgical treatment of nasolacrimal duct obstruction with comparable outcomes. Purpose: to determine the success rate and complications of endoscopic dacryocystorhinostomy without stenting.Materials and methods: it was a retrospective study performed in the department of Otorhinolaryngology and Head and Neck Surgery (ORL-HNS), Universal College of Medical Sciences-Teaching Hospital (UCMS-TH) from June 2019 to September 2024. A total of 19 patients charts were reviewed. All the cases were performed under general anesthesia. All the cases had undergone without silicon stenting and were regularly followed up for a period of 3 months. Post operative stomal patency and complications were noted based on subjective and endoscopic evaluation.Results: Out of 19 patients, 12 were female and 7 were male with the age range of 12 to 70 years. Transnasal synechiae was seen in 2 female and 1 male patients. Stomal patency was 100% with no recurrence of epiphora in 17 patients (89.4%) during 3 months of follow up. 2 female patients with released synechiae didn’t come for 3 months follow up.Conclusion: It is a safe and minimally invasive procedure and has a comparable success rate to external DCR with an additional advantage of more aesthetic value.
Unusual Complications of a Dental Prosthesis Esophageal Foreign Body: About a Case
Published on: 16th April, 2025
Foreign bodies of the esophagus are part of the traumatic emergencies in ENT. They are most often encountered in children, whereas in adults they occur in a particular context and are rarely overlooked.This was a 48-year-old patient from a neighboring country referred by a colleague for a history of neglected laryngeal contusion with infectious cervical fistula evolving for 2 years. Further questioning revealed a notion of accidental ingestion of dentures. The first endoscopy was of capital interest in especially in the diagnosis and management of this long-retained foreign body. The extraction under general anesthesia was done by a combined endoscopic and external approach. The postoperative course was marked by superinfection and swallowing disorders.Cervical suppurations secondary to esophageal foreign bodies are rare, especially in adults. Clinicians should consider this possibility in the face of any chronic cervical suppuration that resists treatment.
Metastatic Brain Melanoma: A Rare Case with Review of Literature
Published on: 12th April, 2025
Melanoma is a highly malignant neoplasm arising from melanocytes, which are melanin-producing neural crest cells primarily located in the basal layer of the epidermis, making cutaneous melanoma the most common subtype. However, melanocytes are also found in other anatomical locations, and primary non-cutaneous melanomas, though rare, have been documented. Due to the aggressive nature of this malignancy, it carries a poor prognosis, particularly because it tends to metastasize to various, often atypical, sites. Recognizing these variable presentations is essential for timely diagnosis. Here, we report a rare case of metastatic brain melanoma in a young female and review the relevant literature, highlighting the importance of imaging in identification.
Comparison of Effect of Intrathecal Fentanyl 25µg with 0.5% Hyperbaric Bupivacaine and Only 0.5% Hyperbaric Bupivacaine
Published on: 12th April, 2025
Background: To enhance the duration of sensory anaesthesia and to prolong the duration of post-operative pain relief during spinal anaesthesia, various adjuvants have been tried along with local anaesthetic agent. The present study was undertaken to evaluate and compare the onset and duration of sensory block, motor block and duration of post-operative pain relief by using intrathecal 0.5% Hyperbaric bupivacaine with fentanyl 25µg versus only 0.5% Hyperbaric bupivacaine selected groups.Methods: We enrolled 70 ASA Ι & ΙΙ patients undergoing surgeries below umbilicus level for our Prospective Randomized trial. Those who met our inclusion criteria were randomized using simple random sampling technique, after obtaining informed consent. Patients in Group A received fentanyl 25µg with 0.5% Hyperbaric Bupivacaine and patients in Group B received only 0.5% Hyperbaric Bupivacaine intrathecally. Parameters like onset and duration of sensory and motor block and postoperative pain relief were observed. In postoperative period, VAS score was monitored & time for rescue analgesia was noted, when VAS exceeded 5 or above.Results: It was found that Patients in Group A had significantly prolonged duration of postoperative analgesia as compared to Group B (Z value 17.35). Results of Onset & Duration of sensory and motor block were suggesting insignificant result. Post-operative complication was insignificant in our study.Conclusion: Addition of Fentanyl 25µg with 0.5% Hyperbaric Bupivacaine in Spinal anaesthesia have insignificant effect on duration of sensory and motor blockade and prolongs postoperative pain relief.
Validation of Prognostic Scores for Attempted Vaginal Delivery in Scar Uterus
Published on: 11th April, 2025
Introduction: The rise in cesarean section rates globally has led to a growing population of women with uterine scars, necessitating more targeted obstetric care in subsequent pregnancies. These women are faced with the decision of attempting vaginal delivery after cesarean section (VBAC) or opting for an elective repeat cesarean section. The likelihood of a VBAC depends on various factors both maternal and fetal, gathered in two known scores Grobman and Zhang, utilizing them could make VBAC successful and more widely attempted. This study aims to validate the prognostic of these scores in a Moroccan population.Objectives:• Validate the international predictive scores (Grobman and Zhang) for the probability of a successful VBAC in the Moroccan population.• Explore additional criteria specific to the Moroccan population and develop a simplified VBAC score. Results:• Out of 2,973 women with a cesarean history, 313 attempted TOLAC, 79% of these attempts were successful VBAC.• The characteristics of successful VBAC included lower BMI, previous vaginal birth, lower estimated fetal weight, younger maternal age, and more favorable cervical conditions at admission.• The Grobman and Zhang scores showed good predictive accuracy, with both models achieving 82.2% accuracy.• When dividing women into groups based on predicted success (using both Grobman and Zhang scores), significant differences were found in success rates across different probability categories.Conclusion: Both Grobman and Zhang’s models were effective in predicting VBAC success in the Moroccan population, with a slight preference for the Zhang model. However, further research is needed to validate these models in clinical practice. It could involve developing a more population-specific model.
Microcystic Meningioma: Atypical Meningioma Revisited. Rare Case Report with Review of Literature
Published on: 10th April, 2025
Meningiomas, classical extra-axial dural-based tumors of the meninges, have well-documented classical imaging features and signs on CT and MRI. Most meningiomas are classical lesions with prompt diagnosis on imaging and generally exhibit benign outcomes with slow growth patterns. The latest WHO classification of tumors in 2021 has classified 15 subtypes of meningiomas, and while classical meningiomas are WHO Grade 1 tumors, grading between varying subtypes varies between WHO Grades 1 and 3. The microcystic meningioma is a rare and atypical subtype of meningioma that has been sparsely documented in literature. In this case report, we revisit this rare subtype of meningioma with a brief review of literature.
Toxic Components in Baby Care Products – A Comprehensive Review
Published on: 8th April, 2025
Background: In addition to being used to keep babies clean and comfortable, baby care products may also include hazardous substances that are harmful to the baby’s health. To safeguard the health of new-borns, it is crucial to understand the potential toxins included in baby care products.Objective: This paper focuses on the very bothering aspect of baby care products. The objective of this study is to identify and summarise the effect of toxicants present in baby care products including their source, exposure, toxicity, and adverse effects on infants.Methods: Utilizing several internet databases including various open source, including PubMed, Scopus, and research gate, a thorough literature search was carried out. The review covered articles that were written in English and published in last fifteen years. Studies reporting on the sources, effects, and potential exposure pathways of toxicants found in infant care products have been included.Result: The study deals with a list of harmful toxicants like phthalates, asbestos, parabens, heavy metals, sodium laurel sulphates, etc., and their sources and modes of exposure. Exposure to toxicants such as phthalates, asbestos, parabens, heavy metals, and sodium laurel sulphates can lead to cancer, developmental disorders, and endocrine disruption.Conclusion: It can be concluded that baby care products are having adverse effects on infants, on their skin or health, or in other ways. To avoid the same, the root cause of it should be avoided, which is the inclusion of toxicant chemicals in such baby care products. Parents and caretakers should be aware of the dangers of toxicant chemicals in baby care products and use non-toxic products to protect their babies' health, while manufacturers should use safer components. Government and authorized agencies should enforce restrictions.
Huge Mucinous Cyst Adenoma, Case Report Series
Published on: 8th April, 2025
Mucinous cystadenoma constitutes 15% of epithelial ovarian tumors. In resource limited setting they may reach huge size as there is no regular medical checkup. This case series highlights these aspects along with diagnostic and surgical considerations.
Cystoid Macular Oedema Secondary to Bimatoprost in a Patient with Primary Open Angle Glaucoma
Published on: 7th April, 2025
Cystoid Macular Oedema (CMO) is a condition characterized by fluid accumulation in the macular region of the retina, leading to the formation of cyst-like spaces. This edema often results in visual impairment and is associated with various ocular and systemic conditions, including surgery, inflammation, or medication use. The authors present a case where Cystoid Macular Oedema (CMO) occurred after commencing topical bimatoprost in a pseudophakic patient with primary open angle glaucoma. The macular oedema was treated effectively with a combination of non-steroidal and steroidal topical drops. This case report shows a possible correlation between bimatoprost and CMO, in a patient with no recent confounding risk factors known to contribute to CMO . The recommendation from this report is that all patients treated with topical bimatoprost drops should have a baseline macula OCT examination and a repeated OCT examination 8 weeks after initiation of treatment, to facilitate early detection of CMO.
Clinical and Histopathological Mismatch: A Case Report of Acral Fibromyxoma
Published on: 7th April, 2025
Background: Acral Fibromyxoma (AFM) is a rare benign soft tissue tumour which is described as a fibromatous and myxoid tumour of skin and soft tissue. Case details: A 40-year-old male presented to the Dermatology outpatient department with swelling over the wrist of one year duration. The swelling was associated with mild pain, and it gradually increased in size to reach its present size. Cutaneous examination revealed a 2x2 cm mobile, cystic to firm, non-tender swelling over the dorsum of the right wrist. Based on its location and clinical features, it was provisionally diagnosed as a ganglion cyst and excision biopsy was done. Histology showed stellate-shaped cells in a myxoid background with round to oval nuclei having a small, inconspicuous nucleolus. Acral fibromyxoma presents a distinct histopathology including a myxoid stroma and spindle-shaped cells, which are essential for accurate diagnosis and management.
Forensic Insights into Multiple Stab Wounds: Autopsy Findings from a Case of Sixty Stab Wounds
Published on: 4th April, 2025
Multiple stab wounds are a critical forensic indicator, frequently linked to violent assaults, homicides, or self-inflicted injuries. These penetrating injuries result from sharp-edged weapons such as knives, daggers, or other pointed instruments. The depth, size, and severity of the wounds depend on factors including the type of weapon used, the force applied, and the anatomical location of impact. Forensic examination of stab wounds is essential in determining the manner of death—homicidal, suicidal, or accidental. Detailed analysis of wound characteristics, such as depth, trajectory, and associated injuries, aids in crime scene reconstruction. Additionally, identifying defensive wounds can indicate victim resistance, further supporting forensic interpretations. A meticulous forensic autopsy, including weapon analysis and internal organ assessment, is crucial in establishing the cause of death. These findings play a vital role in medico-legal investigations, providing key forensic evidence that supports legal proceedings and ensures justice.
Advancing Forensic Approaches to Human Trafficking: The Role of Dental Identification
Published on: 4th April, 2025
Background: Human trafficking is a significant global issue that affects millions of individuals, where victim identification remains a major challenge. Traditional methods such as DNA or fingerprint analysis are not always viable, necessitating alternative forensic approaches.Methods: This article reviews the role of dental identification in human trafficking cases through an extensive analysis of existing literature. The study incorporates forensic odontology techniques, including dental charting, radiographic analysis, bite mark analysis, age estimation, and emerging technologies like Artificial Intelligence (AI).Results: Findings indicate that dental identification methods are essential for victim identification, especially when conventional methods prove ineffective. AI integration enhances the accuracy and efficiency of dental forensic investigations, addressing challenges such as record access and cross-border complexities.Conclusion: Dental identification, augmented by AI advancements, is an indispensable tool in forensic investigations related to human trafficking. The study underscores the necessity of international collaboration and technological innovation to enhance forensic practices.
A Comparative Study of Metoprolol and Amlodipine on Mortality, Disability and Complication in Acute Stroke
Published on: 4th April, 2025
Stress in acute stroke may increase mortality and complications, but there is a paucity of information on the efficacy of beta blockers over other anti-hypertensive. To report efficacy of metoprolol over amlodipine in reducing mortality, disability and infections in acute stroke. CT/MRI confirmed stroke patients within 3 days of onset were included whose age was 18 to 75 years. Patients with secondary intracerebral hemorrhage, organ failure, pregnancy, malignancy, and immunosuppressant or on beta-blocker/amlodipine were excluded. Stroke risk factors, Glasgow Coma Scale (GCS) score, National Institute of Health Stroke Scale (NIHSS) score and CT/MRI findings were noted. Patients with a blood pressure of > 160/90 mm of Hg were randomized using 1:1 randomization to metoprolol (25 mg on day 1, 50 mg if BP is not controlled) or amlodipine (2.5 mg on day 1, then 5 mg then 10 mg on, subsequent days if BP is not controlled). Other standard treatment was continued. The primary outcome was mortality at 1 month; secondary outcomes included were in-hospital gastrointestinal hemorrhage, pneumonia, sepsis and 3 months functional outcome based on modified Rankin Scale (mRS). Side effects were noted. 18 (14.4%) patients died; 6 (9.7%) in metoprolol and 12 (19%) in amlodipine (p = 0.20) group. At 3-months, 66 patients had good outcome; 45 (80.4%) in metoprolol and 21 (43.3%) in amlodipine group (p < 0.001). The other secondary outcomes were comparable between the two groups. Metoprolol was withdrawn in 6 patients due to bradycardia, and amlodipine in 5 due to hypotension and in 1 due to allergic reaction. Metoprolol is associated with improved functional outcomes in acute stroke compared to amlodipine.
Comparison of Body Fat Percentage and BMI in Pre-hypertensive and Hypertensive Female College Students of West Tripura
Published on: 3rd April, 2025
Background: Obesity is a significant health risk linked to hypertension and heart-related disorders in adolescents, impacting their future well-being . Since, the present work is to determine the body constitute including percentage of body fat correlates with cholesterol level which associate with Body Mass Index. Methods: This cross-sectional work was held in 120 college girls aged 19-23 years of Bhavan’s Tripura College of Science and Technology, Anandanagar at West Tripura. Anthropometric measurements such as standing height, body weight, sub scapular and triceps skinfolds, waist &hip circumference were collected. These records were used to calculate Body Fat Percentage (%BF) and Fat Mass (FM). Waist and Hip ratio (WHR) and Body Mass Index (BMI). FM, %BF and biochemical studies such as serum cholesterol level were also used to measures the body fat composition. Results: According to the present study, 53.33% of girls have a normal BMI, 8.83% are underweight, 31.67% are overweight, and 6.67% are obese. WHR results indicate that 54.17% of participants are classified as obese and 45.83% as non-obese. Out of 114 (95%) girls with normal cholesterol levels of 16 (13.33%) students are pre-hypertensive and 10 (8.33%) students are hypertensive. Out of 38 overweight and 8 obese students 13.34% are in pre or hypertensive. Based on WHR, 65 (54.17%) female students are obese; out of 65 obese students, 12 (10%) and 7 (5.83%) female students are pre-hypertensive and hypertensive, respectively and this value is statistically significant (p value < 0.05). Out of 55 (45.83%) no-obese students 8 (6.67%) girls are pre-hypertensive and 5 (6.67%) girls are hypertensive. According to BMI female students who are overweight or obese (5%) also have excessive blood cholesterol.Conclusion: This study expressed clear evidence of correlation in BMI, serum cholesterol level and Hypertension. These results are important for epidemiological studies to identify the cardiovascular risk in obese adults and help to solve a health problem of present Youngers in their future life. This study serves as an early health warning for female college students.
Caregivers’ Nutritional Awareness and its Impact on Pediatric Health Outcomes: A Study at Wad-Albasheir Health Center, Sudan
Published on: 3rd April, 2025
Background: Nutritional awareness among caregivers plays a crucial role in ensuring optimal pediatric health and development. This study assesses the level of nutritional awareness among caregivers and examines its association with demographic factors.Objectives: This study aimed to assess the knowledge and awareness of caregivers regarding dietary advice and complementary feeding for children under five years at Wad-Albasheir Family Health Center, Um-Bada locality.Methods: A cross-sectional study was conducted among caregivers in selected healthcare facilities. Data were collected using a structured questionnaire and analyzed using SPSS version 23. Descriptive statistics and chi-square tests were used to evaluate associations between variables.Results: The majority of caregivers demonstrated moderate awareness (60%), while 22.5% had low awareness and 17.5% had high awareness. A significant association was observed between education level and awareness (p < 0.05). Employment status also influenced awareness levels, with employed caregivers showing higher knowledge scores.Conclusion: Nutritional awareness is a key determinant of pediatric health. Strengthening educational programs targeting caregivers can improve child nutrition outcomes.
Anesthetic Management of a Patient with Left Ventricular Thrombus Posted for Emergency Laparotomy
Published on: 2nd April, 2025
Left ventricular thrombus (LVT) is a life threatening complication following acute coronary syndromes but in modern era its incidence has reduced since the introduction of primary percutaneous intervention. LVT is associated with higher morbidity and mortality due to its thromboembolic events and major adverse cardiac events (MACE). This is a case report of 30-year-old male who presented with acute abdomen and left ventricular thrombus. CECT abdomen revealed superior mesenteric artery (SMA) thrombosis and echocardiography revealed severe ventricular dysfunction (ejection fraction, EF<30%) with global hypokinesia and LVT. SMA thrombosis is fatal and if left unattended can lead to intestinal ischemia and gangrene, hence immediate intervention is warranted. This patient had undergone emergency laparotomy under general anesthesia for the resection of gangrenous jejunal segment with mucous fistula . This case report discusses perioperative management considerations in such cases.
Reduced Pain Scores during Indocyanine Green Lymphography by using a Different Preparation Formula
Published on: 1st April, 2025
Purpose: The purpose of this study was to investigate whether a different indocyanine green lymphography formula can reduce the severe pain encountered during this investigation.Methods: Indocyanine green ICG lymphography frequently induces severe and intolerable pain in patients. It is very important to develop a relatively painless lymphography method. This helps reduce patients’ apprehension during examination. Our center conducted randomized control groups of 60 patients with limb lymphedema. Cases were divided into experimental and control groups. Patients in the experimental group were injected with indocyanine green solution containing 5% glucose, while patients in the control group were injected with indocyanine green solution with sterile water.VAS scores were recorded pre-injection, during, and at 10, 20, and 30 minutes post-injection. We recorded possible side effects, e.g. skin redness, itching, subcutaneous bleeding, bruising, severe allergic reactions, and other complications within 24 and 48 hours after imaging, and analyzed the pain score data. Results: The average pain score of the experimental group was 0-3 points, while the control group was 6-8 points. Disease staging was accurately assessed based on imaging results . No other serious complications occurred.Conclusion: Pain can be significantly reduced by the new modality. This method does not affect lymphography results and imaging quality, and there are no obvious serious complications.
Dengue Epidemic during COVID-19 Pandemic: Clinical and Molecular Characterization – A Study from Western Rajasthan
Published on: 1st April, 2025
The concurrent emergence of dengue fever and the COVID-19 pandemic posed significant challenges to India’s healthcare system, particularly in Western Rajasthan, a region characterized by its arid climate and unique socio-demographic conditions. This study aimed to investigate the clinical and molecular characteristics of dengue during the COVID-19 pandemic, focusing on trends, diagnostic challenges, and serotype distribution. Conducted at Dr. S.N. Medical College, Jodhpur, in 2021, the study included 550 dengue-positive patients confirmed via rapid diagnostic tests and further analyzed using Dengue NS1 antigen and IgM antibody ELISA. Molecular characterization was performed using RT-PCR for serotyping.The results revealed a male predominance (72.36%) and a higher incidence in the 21–30-year age group (39.09%). Urban areas accounted for 67.73% of cases, with significant NS1 and IgM positivity (p = 0.042 and p = 0.004, respectively). Most cases (86.91%) were managed outpatient, though IgM positivity was significantly higher among hospitalized patients (19.19%, p < 0.001), indicating severe or prolonged infections. Platelet counts were above 100,000/mm³ in 86.91% of cases, with only 0.37% showing critically low counts (< 20,000/mm³). Seasonal analysis showed a peak in October (n = 325), correlating with post-monsoon vector breeding. Serotyping identified DENV2 as the dominant strain (97.42%), associated with severe dengue manifestations, including Dengue Haemorrhagic Fever (DHF).The study highlights the dual burden of dengue and COVID-19, emphasizing the need for enhanced vector control, improved diagnostic strategies and public health interventions during overlapping outbreaks. The predominance of DENV2 underscores the importance of serotype-specific surveillance and preparedness to mitigate future dengue epidemics in the region.
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