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

BACKGROUND: Circular RNA-HIPK3 (CircHIPK3) has been shown to be aberrantly expressed in a variety of diseases, contributing to disease initiation and progression. The aim of the present study is to investigate the role of the circHIPK3 RNA/microRNA-124a interaction in the pathogenesis of rheumatoid arthritis (RA). METHODS: This study included 79 RA patients and 30 control individuals. The patients involved were classified according to the disease activity score (DAS28) into mild (24 patients), moderate (24 patients), and severe (31 patients). Serum samples were collected to estimate the relative gene expression of circHIPK3 RNA and its target gene microRNA-124a by quantitative real time-PCR. Moreover, ELISA was used to detect the serum levels of monocyte chemoattractant protein-1 (MCP-1). Routine laboratory estimation of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and rheumatoid factor (RF) was also done. RESULTS: In all grades of RA groups, there was a significantly substantial elevation of circHIPK3 RNA gene expression, with subsequent downregulation of miRNA-124a when compared to the control group. CircHIPK3 and microRNA-124a expression have been established to be inversely linked. Also, estimation of serum levels of MCP-1, ESR, CRP, and RF exhibited a significant increase in all grades of RA as compared to the control group. CONCLUSION: CircHIPK3 and microRNA-124a might be regarded as key players in the pathogenesis of RA. The cross-talk between them appears to be responsible for inducing joint inflammation by increasing MCP-1 production. Targeting circHIPK3 and microRNA-124a, and their downstream adaptor molecules, poses a new challenge for RA therapy.

Introduction Conservative breast therapy consists of wide local excision followed by local control of the breast cancer by boost radiotherapy. For radiologists, identification of breast tumor bed (TB) is an essential first step for them to start their radiotherapy. There is number of ways to identify the tumor bed, one of them is inserting the metallic clips in the tumor bed cavity intraoperative. They mark the tumor cavity against the whole breast normal tissue as they appear radioopaque during radiotherapy. Purpose The primary aim of this study is to investigate the need & validity of surgical clips insertion in breast tumor bed and its effect on further breast radiotherapy through a systematic review that includes all published studies which used clips for marking the breast tumor bed. The secondary aim is to define the needed number of surgical clips to define the breast tumor bed clearly and obviously and what are the best types of surgical clips to be used for this purpose. Methods The literature review was done by searching on different databases using the keywords for only English studies reporting using surgical clips for localization in breast surgeries. There was no restriction to specific period or study design. Assessment of included studies was done by 2 independent researchers. Results 54 articles (n = 3427 patients) were the total number of studies that met our inclusion criteria. These studies were of different study designs. Cohort studies were the most representing type about 40 articles. The most common used clips type (21 study, n = 1444 patient) was metallic hemostatic clips according to the sum of operated patients and count of studies. Although all studies confirmed the importance and effectiveness of using clips for tumor bed localization, there was no standard optimum number of clips that can be used for localization. However, most studies used definite number of clips as 4 or 5 clips or used number ranging from 1-5 clips. The same for inserted clips margins at tumor bed, only few studies mentioned definite cavity margins. The 4 main margins (anterior, posterior, superior, inferior) were the commonest reported sites. Conclusion Using surgical clips whatever their type is very helpful for radiologists to define breast tumor bed especially with the obvious increase in using oncoplastic techniques. It’s recommended to use more than 5 clips at tumor bed cavity with special concern to insert them at least 4 margins of tumor bed.

Background: Depression is a devastating disease that adversely affects all aspects of one's existence. There is some evidence that low circulating concentration of serum 25- hydroxyvitamin D [25(OH)D], the marker for Vitamin D status, is associated with mood disorders, including major depresssive disorder.Aim of Study: The aim of this work is to investigate the association between serum Vitamin D concentrations and depression and to evaluate the correlation between the con-centrations of Vitamin D and severity of depression.Subjects and Methods: This study was conducted on 66 patients suffering from depression, and 22 apparently healthy individuals as controls. Complete psychiatric interview; with application of Beck Depression Inventory II (BDI-II) Scale for diagnosis and assessment of the severity of depression was done. Laboratory investigations including kidney function tests, liver function tests,serum total calcium,phosphorus and serum Vitamin D (25-OH Vitamin D3/D2) was done for all subjects.Results: 21, 23 and 22 patients had mild, moderate and severe depression respectively. There was statistically very high significant decrease in Vitamin D level in patients group compared to control group. In patients group, 40.9% of patients had Vitamin D deficiency (serum 25(OH]D 20ng/mL). There was statistically sig-nificant decrease of Vitamin D levels in female patients group compared to male patients group. There was statistically significant negative correlation between BDI-II score and Vitamin D level in patients group.Conclusion: The finding of this study revealed evidence of an association between low 25(OH)D, a marker of Vitamin D status, and depression, suggesting a direct effect of Vitamin D on development of depression.There was an association between low Vitamin D status and the severity of depres-sion.Vitamin D deficiency was more pronounced in female patients than male patients.

This study was done to investigate the effects of a supplementation of β-glucan and dried Chicory roots extract into broiler rations on immune system and other parameters like growth performance, intestinal length and serum cholesterol and triglycerides levels. A total of 320 male Ross broiler chicks of one day old were divided into 3groups one of them control and other three are treatment groups, each contain 80 birds. Each group then was further divided into 4 replicate groups of 20 birds in each. The treatment groups were supplemented with 0.7% dried Chicory roots, 0.015% β-glucan and 0.7% dried chicory roots plus 0.015% β-glucan, respectively, and the experiment lasted for 6 weeks. Determining the effects on specific antibody titer for ND virus to investigate some immune-modulatory roles, and for that purpose, administration of ND vaccine on day 10 and then on day 26. In addition, the serum cholesterol and triglyceride levels were investigated. At the end of the experiment, dried Chicory roots supplementation to the diets significantly increased the intestine length. The supplementation of 0.7% dried Chicory roots with 0.015% β-glucan to the diets had negative effects on some performance parameters and also increased serum cholesterol and triglycerides levels (P < 0.001, P < 0.01, respectively). The amount of abdominal fat of the broilers in the post mortem examinations also increased during that treatment in the birds in the Chicory roots with β-glucan group by the end of the trial period.

Background/aims The safety of the human body is maintained by effective monitoring of the mucosal surface integrity and protection against potentially harmful compounds. This function of the gut called intestinal barrier function can be affected by cholestasis and the absence of bile in the intestinal lumen. We aimed to determine whether the gut barrier integrity is impaired in infants with cholestasis by evaluation of the intestinal fatty acid binding proteins (I-FABP) and ileal bile acid binding protein (I-BABP) as markers of intestinal epithelial cell damage and plasma D-lactate level as a marker of gut wall permeability. Methods This case-control study included 53 infants with cholestasis and 29 controls. Serum levels of I-FABP, I-BABP, and D-lactate were measured in all subjects. Results Both groups of patients with neonatal hepatitis and biliary atresia showed significantly higher levels of I-FABP and I-BABP than the controls. There were no differences in the serum D-lactate level between the cases and controls. There was no difference between the two groups of patients (I and II) regarding any of the parameters studied. No significant correlations between serum levels of I-FABP, I-BABP, or D-lactate and total or direct bilirubin levels were found in the cholestatic infants. Conclusions The intestinal epithelial barrier integrity is breached nearly in all parts of the intestine in infants with cholestasis. Further research is recommended to determine the impact of this finding on the management of these infants. The relationship between physical intestinal barrier damage and its functional failure remains subject for further research.

Aim: The purpose of the study is to measure serum and synovial fluid levels of activin A and inhibin A in patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and osteoarthritis (OA) and correlate them with disease activity parameters. Subjects and methods: This study included 60 patients with various rheumatic diseases (20 with RA, 20 with SLE and 20 with OA), as well as 10 healthy controls. All of them were subjected to complete history-taking, examination and estimation of disease activity index. The following investigations were done for all subjects: serum and synovial activin A, inhibin A, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), anti-dsDNA and complements 3 and 4. Results: Serum levels of activin A were significantly higher in RA, SLE and OA than controls and in RA and SLE versus OA The mean values of serum inhibin A were significantly higher in all studied groups than controls. Synovial activin A and inhibin A were significantly higher in RA than OA. Positive correlations were found between serum activin A and disease activity parameters of RA. In SLE, positive correlations were found between serum activin A and inhibin A with ESR and SLE Disease Activity Index. Conclusions: Serum activin A and inhibin A were significantly higher in RA and SLE. Serum levels correlated positively with disease activity parameters of RA and SLE. However, synovial levels were significantly higher in RA than OA but showed no correlation or negative correlation with disease activity. We recommend further studies to detect the exact role of activin A and inhibin A in these conditions.

Due to the presence of two alternating bond angles in the backbone of the polymeric chains, polyisobutylene (PIB) possesses four different rotational isomeric states. Accordingly, conformations of PIB could be represented by a four-state rotational isomeric scheme with only one adjustable statistical weight parameter. Rotational isomeric states (RIS) were determined at +25°, −25°, +120°, −120°. Conformations were divided into a “+class” and “−class,” with bond conformations tended to be followed by those from the same class and with changes from one class to the other rare. Since the configurational and thermodynamic properties of PIB depend to a great deal on the conformational characteristics of the polymer, a modified rotational isomeric state approximation was used to generate the initial configurations of the polymeric chains without allowing for any segment-segment overlap. Attempts were made to test the configurational properties of these systems against those determined experimentally to ensure th...

The purpose of the study is to measure serum and synovial fluid levels of activin A and inhibin A in patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and osteoarthritis (OA) and correlate them with disease activity parameters.This study included 60 patients with various rheumatic diseases (20 with RA, 20 with SLE and 20 with OA), as well as 10 healthy controls. All of them were subjected to complete history-taking, examination and estimation of disease activity index. The following investigations were done for all subjects: serum and synovial activin A, inhibin A, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), anti-dsDNA and complements 3 and 4.Serum levels of activin A were significantly higher in RA, SLE and OA than controls and in RA and SLE versus OA The mean values of serum inhibin A were significantly higher in all studied groups than controls. Synovial activin A and inhibin A were significantly higher in RA than OA. Positive correlations were found between serum activin A and disease activity parameters of RA. In SLE, positive correlations were found between serum activin A and inhibin A with ESR and SLE Disease Activity Index.Serum activin A and inhibin A were significantly higher in RA and SLE. Serum levels correlated positively with disease activity parameters of RA and SLE. However, synovial levels were significantly higher in RA than OA but showed no correlation or negative correlation with disease activity. We recommend further studies to detect the exact role of activin A and inhibin A in these conditions.