Measuring nurses' satisfaction in primary health care centers at Khartoum, Sudan

Background: The primary healthcare sector has experienced significant growth globally, and the nursing workforce has also expanded in recent decades in response to health system reforms. This study aims to assess job satisfaction among primary healthcare nurses in Khartoum, Sudan. Methods: This descriptive cross-sectional study was conducted in 10 primary healthcare centers on 50 nurses who were selected using simple random sampling. Data were collected using an online questionnaire and it was analyzed using SPSS. Results: The findings of this study indicate that the job satisfaction level among nurses working at primary healthcare centers in Khartoum was high (4.4/5). Most nurses reported high satisfaction with all items including protocols, salary, environment, and relationships. The study also found a significant correlation between nurses' sex and experience with their level of job satisfaction. Female nurses reported significantly higher job satisfaction (4.4/5) compared to male nurses (3.6/5), (p-value = 0.04). Additionally, nurses with fewer years of experience reported significantly higher job satisfaction compared to those with more years of experience (p-value = 0.03). Conclusion: The study concludes that nurses working at primary healthcare centers in Khartoum have high job satisfaction, particularly regarding the working environment, salary, relationships, and availability of guidelines. Female nurses and those with less experience have significantly higher job satisfaction.

Our tubularized incised plate urethroplasty Repair. Results for Hypospadias Surgery

Background: The Tubularized Incised Urethral Plate (TIP) urethroplasty is a widely accepted technique among urologists and heavily used in their centers. This technique was developed by Snodgrass in 1994 for repairing varied degrees of hypospadias. Aim: This paper aims at analyzing and evaluating our early experience and the outcomes of using TIP urethroplasty technique. Therefore, the results have to be assessed in a large series. Methods: In this prospective study, 95 patients with varying hypospadiac meatus levels who experienced the procedure of TIP. During the entire sampling period, patients had varying degrees of hypospadias ranging from glanular to penoscrotal (glanular 2, coronal/subcoronal 37, distal shaft 30, mid-shaft 10, proximal shaft 5 and penoscrotal 11). Results: The overall success rate of TIP procedure repair of hypospadias was 87.4%; whereas the overall reoperation rate was 12.6%. The highest percentage was for those with failed previous repair (secondary). The average duration of the procedure was 58.6±18.4 minutes. Nearly a third of the patients developed one or more postoperative major complication. The total rate of fistula was 12.6%, with "10.6% in primary distal, 15.9% in primary proximal and 20% in secondary repair". Sixteen cases had a mild degree of "meatal stenosis" (16.8%), but all were managed by simple dilatation at the office or at home using 8 F feedingtube. Conclusion: The outcomes demonstrated that the TIP procedure is a quick, safe and reliable technique. Additionally, it can provide excellent cosmoses and function with few complications and acceptable reoperation rate.

Effect of Chlorhexidine and/or Ethanol Pre-bonding Treatment on the Shear Bond Strength of Resin Composite to Dentin

Aim of the study: The aim of the study is to evaluate the effect of chlorhexidine and/or ethanol pre-bonding treatment on the shear bond strength of resin composite to dentin using etch and rinse adhesive system after 24 hours, 3 months and 6 months of aging. Materials and methods: Dentin surface of premolars were etched and randomly assigned into 4 groups (n=24). In Group A, dentin surfaces were bonded according to the manufacturer’s instruction. In Group B and C, dentin surfaces were treated with 2% CHX or 100% ethanol for 60 sec respectively. In Group D, dentin surfaces were treated with 2% CHX for 60 sec followed by 100% ethanol for another 60 sec. The adhesive resin was then applied and light cured according to the manufacturer’s instruction. Resin composite build ups were made above the dentin surface for shear bond strength test after 24 hours, 3 months and 6 months’ storage period in normal saline. Bond strength data were analyzed using one-way ANOVA and Tukey’s test. Mode of failure was also analyzed whether adhesive, cohesive or mixed between composite and dentin. Results: Significant differences were found for the 2 factors: ‘storage period’ (p<0.05) and ‘adhesive protocol’ (p<0.05) on bond strength. Numbers of mixed failure were higher when dentin surfaces were treated with 2% CHX and/or 100% ethanol. Conclusion: Dentin surface treatment with 2% CHX and/or 100% ethanol was effective in reducing the deterioration in shear bond strength of composite to dentin up to 6 months of storage.

Positive and Negative Rates in Children with Acute Appendicitis

Background: Acute appendicitis remains the most misdiagnosed condition worldwide. Children tend to present with a variety of clinical symptoms, may have difficult communication and could be difficult to examine

Design: A Retrospective Study

Setting: King Hamad University Hospital, Bahrain

Method: One hundred thirty-six patients who had appendectomy were reviewed between 1 May 2012 and 31 March 2016. The final diagnosis of acute appendicitis was the histological analysis of the excised specimen

Result; One hundred thirty-six underwent appendectomy and were included in this study between 1 May 2012 nd 31 March 2016. One hundred sixteen [85%] patients had uncomplicated appendicitis and 16 [12%] patients had complicated appendicitis. Four patients were histologically negative; Negative Appendectomy Rate [NAR] was 2.9%. Twelve patients had perforation; therefore, the Perforation Rate [PR] was 8.8%. Sixty-six [49%] laparoscopk appendectomies and 70 [51%] open appendectomies were performed. There was no significant difference between hospital stay and surgical technique; the average stay was 4.3 days

Conclusion: Our study has demonstrated NAR of 2.9% for a histologically normal appendix; a perforation rate of 8.8%. This study revealed the need for a prospective study for the pediatric acute abdomen and a dedicated radiological resource focused on pediatric radiology. The diagnosis of appendicitis in children remains largely clinical with appropriate use of US

Antifouling evaluation of extracts from Red Sea soft corals against primary biofilm and biofouling

Objectives:To evaluate antifouling property of extracts from Red Sea soft corals against primary biofilm and biofouling.Methods:Seven species of soft corals Sarcophyton glaucum (a),Sinularia compressa,Sinularia cruciata (a),Heteroxenia fuscescens (a),Sarcophyton glaucum (b),Heteroxenia fuscescens (b) and Sinularia cruciata (b) were chosen to test their extracts as antibacterial and antifouling agents in Eastern Harbour of Alexandria,Mediterranean Sea.Bioactive compounds of soft corals were extracted by using methanol and concentrated under vacuum.The residues of extracts were mixed in formulation of inert paint which consisted of rosin,chlorinated robber and ferrous oxide against micro and macro fouling organisms.The formulated paints were then applied on PVC panels twice by brush,hanged in a steel frame and immersed in Eastern Harbour of Alexandria Mediterranean Sea followed by visual inspection and photographic recordings.Results:After 185 days of immersion in seawater,the antifouling results agreed with the antibactedal results where extracts of Sinularia compressa and Heteroxenia fuscescens (b) gave the best activity against marine fouling tubeworms and barnacles.The inhibition activity was correlated with the major functional groups (hydroxyl,amino,carbonyl,aliphatic (fatty acids),C=C of alkene or aromatic rings and C—Cl of aryl halites) of the extracts.Conclusions:The strong antifouling activity makes them promising candidates for new antifouling additives.After the screening and application of natural organic compounds from soft corals,marine organisms show activity against micro and macro fouling organisms.

Rare cause of dysphagia in children

Dysphagia in children is generally caused by strictures secondary to gastroesophageal reflux disease or post-repair of trachea-esophageal atresia/fistula

A four-year-old female presented with a history of dysphagia for solid food and vomiting of undigested food. Barium swallow showed esophageal duplication cyst, which was confirmed by esophagoscopy

Surgical resection was curative

Causes other than stricture or dysmotility should be considered in children with unrelenting dysphagia.

Evaluation of insertion torque of different orthodontic miniscrews: an in vitro study

Background and objective: The purpose of this study was to evaluate the torque insertion for drill and non drill techniques of two commercially available miniscrews

Methods: Eighty mini screws [forty Dentos miniscrews/Korea and forty 3M miniscrews/USA], having the same length and diameter, were divided into two groups for each type. Two techniques, non-drill and drill, were used. In drill techniques, manufacturer recommended drill was used. Two bovine tibias were obtained. The first technique used pre drill hole, which was made in the bone using the recommended bur [1.0 diameter]. The mini-screw was placed at 9 mm manually, then the remaining 1 mm was inserted through digital torque meter. The same procedure was repeated but without a pilot hole

Results: 3M miniscerws gave high torque insertion in two techniques

Conclusion: The shape, thread design and tip geometry of miniscerw play an important role in the torque insertion

Percutaneous aspiration of large pericardial cysts prior to VATS excision

We report two cases of large congenital pericardial cysts measuring [65 x 80 x 115] mm and [60 x 65 x 100] mm respectively, diagnosed by chest x-ray, computed tomography [CT] of the chest, and clarified more by echocardiography. Both 2 cases were treated by video assisted thoracoscopic surgery [VATS] where percutaneous aspiration of the cyst was performed to make subsequent cyst excision easier by clarifying the surgical anatomy of the field and giving room for manipulation .This technique avoids thoracotomy as an alternative option for treating large pericardial cyst. The postoperative courses were uneventful for both patient

Cystic biliary atresia: why is it important to distinguish this from congenital choledochal cyst?

We present a 2-month-old jaundiced infant with a rare type of biliary atresia who appeared to have a choledochal cyst on magnetic resonance cholangiopancreatography [MRCP] and ultrasound. Intra-operative findings were the only proof of biliary atresia. Following portoenterostomy, the liver function tests [LFTs] and bilirubin levels were returned within normal range and his jaundice was resolved. Any neonate presenting to a pediatric clinic with prolonged jaundice lasting more than two weeks, especially in cases of direct hyperbilirubinemia, must be thoroughly assessed and referred as early as possible for a pediatric surgical opinion to rule out the possibility of biliary atresia

Liver hydatid cyst: pattern and methods of surgical treatment

Hydatidosis of liver is very old surgical problem worldwide and one of the commonest parasitic diseases that affect the man's health. In humans, 50% to 75% of hydatid cysts occur in the liver. The radical surgical removal of the cystic lesion remains the mainstay of treatment with a high success rate. The aim of this paper to report the surgical management of liver hydatid diseases in Iraq. 34 patients [59% males, 41% females] were observed during the period from April 2008 to May 2010, the mean age is 42 years. All patients were examined clinically and diagnosis obtained radiologically [ultrasonography, CT scan and in selected cases MRI], operative and postoperative details were recorded for every patient. The mean age of the patients was 42 years [range, 16-62 years]. 20 patients [59%] were males and 14 patients [41%] were females. The peak age group affected was between 3[rd] - 6[th] decades in 70.5%. The disease was primary in 23 patients [68%] and recurrent in patients [32%]. The cyst was single in 14 patients [41%] and multiple in 20 patients [59%]. Fifty percent multiple hydatid disease was recurrent, while the other 50% was primary. The Rt. Lobe of the liver was affected in 19 cases [56%], the Lt. lobe was affected in 4 patients [12%], and both lobes were involved in 11 patients [32%]. The clinical presentation include: upper abdominal pain/ discomfort in 18 patients [53%], palpable mass in 5 patients [14.7%], jaundice in 3 patients [8%], acute abdomen in 2 patients [6%], incidental findings in 6 patients [17.5%]. Mode of surgical treatment was as follow: excision and external tube drainage in 14 patients [41%], excision and partial pericystectomy [resection of redundant cyst wall and the residual cavity left open] in 7 patients [20.5%], excision and omentoplasty in 6 patients [17.5%], excision and primary suturing of the cyst wall and filling the cavity with normal saline in 5 patients [15%], and excision and marsupialization in 2 patients [6%]. No significant statistical difference in terms of morbidity and mortality between different surgical procedures, however cystectomy with external drainage was considered the standard surgical procedures especially in large sized cysts and bile communicate done

Peritoneal complications of ventriculo-peritoneal shunt: retrospective review of 23 cases

The management of hydrocephalus most commonly involves placement of ventriculoperitoneal shunts. However, high rates of complications have been reported, ranging from 24-47%, among which abdominal complications account for approximately 25%. The aims were evaluation of symptoms, diagnosis and surgical treatment in abdominal complications following ventriculoperitoneal shunt. Between June 2007 and August 2010 a retrospective review of 23 patients suffering from late complications of ventriculoperitoneal shunt were done at Al-Kadhimyia teaching hospital, Baghdad, Iraq. Patient presenting symptoms, time between the insetion of ventriculoperitoneal shunt, onset of abdominal complications and the operative time were recorded. Methods of diagnosis were also recorded. There were 4 male and 19 females, F:M ratio 4-75:1 and mean age of 11.5 years. Methods of diagnosis were as follows: abdominal CT in 10 patients, abdominal Ultrasound in 8 patients and x-ray in remaining 5 patients. Clinical presentations: fever in 26.1%, abdominal distension in 26.1%, abdominal pain in 21.7%, nusea and vomiting in 13% and headache in 13%. Abdominal complications include: infections [abscesses and peritonitis] in 26.1%, shunt disconnection with intraperitoneal distal catheter migration 21.7%, coiled catheters in the subcutaneous tissue in 21.7%, pseudocysts 17.4%, CSF ascites 8.7%, and excessive length of intraperitoenal tube 4.3%. Surgical treatment was: extraction of the foreign body in shunt disconnection with intraperitoneal distal catheter migration, evacuation, debridement, lavage and drainage for pseudocysts, abscess and peritonitis, shortening of the intraperitoneal tube in excessive length. The operative time ranged from 45-150 minutes. Shunts replacement or revision was ultimately successful in all patients. Infection is the most common abdominal complication after ventriculoperitoneal shunt. Infected shunt should be removed and replaced when all signs of infection subside. Reimplantation is successful in patients with CSF pseudocyst and ascitis

Laparoscopic cholecystectomy for acute cholecystitis an experience of 64 cases

To evaluate the feasibility and safety of laparoscopic cholecystectomy in severe acute cholecystitis, and to assess the incidence of complications. A prospective study included Sixty four patients with a confirmed diagnosis of acute cholecystitis at Al-Kadhimyia Teaching Hospital, over a period of 18 months from march 2009 to August 2010. Sixty four patients with diagnosis of acute cholecystitis were enrolled in our study. All of cases underwent laparoscopic cholecystectomy during the first 72 hours of their admission. Of the 64 patients there were 48 female and 16 male with a female to male ratio of 3:1. The age of our patients ranged from 19 years to 63 years with mean age of 35.6 years in female and 49.8 years in male. Cholecystectomy was completed successfully in 52 patients [81%], conversion to open conventional surgery was necessary in 12 patients [19%]. The main reasons were obscured anatomy [calot's triangle], excessive bleeding and dense adhesions. Data on presenting symptom, ultrasound findings, operative findings, hospital stay and complications were recorded. In the presence of severe acute cholecystitis laparoscopic cholecystectomy is feasible in most patients, with minimal risk of injury to surrounding structures, shorter hospital stay and considerable benefits. It is recommended that laparoscopic cholecystectomy should be attempted in these patients when appropriate surgical skill is available

Effects of a pushing intervention on pain andbirthing experiences among women duringthe second stage of labor

Midwifery care for women during second-stage of labor is complex. It involves frequent and assessments of mother and fetus, promoting fetal descent, and supporting each woman's ability to cope with labor pain. Several studies have compared specific categories of pushing methods and pushing positions with regard to the length of the second stage of labor, pain, perineal outcomes and the Apgar scores of newborn infants. To evaluate maternal labor pain, duration of the second stage of labor, the women's bearing-down experiences and the newborn infant Apgar scores when spontaneous pushing is used in an upright position. This study was conducted using a quasi-experimental design. Two groups were included, study and control groups. Each group consisted of 40 women. The study group received comfort measures from the investigator, while the control group received routine nursing care. The women in study group had significantly shorter second stage of labor than the women in the control group [p=0.000], the women in the study group had more positive pushing experiences than the women in the control group [p<0.002]. The spontaneous pushing method and upright position are worthy of further promulgation in hospital. Additionally, in order to allow women to understand the benefits of different pushing techniques and postures, midwives and nurses should provide information during prenatal preparations for childbirth. Suggestions here women should be discouraged from lying supine or semi-supine in the second stage of labor and should be encouraged to adopt any other position such as sitting or squatting position that find most comfortable. In addition to women should be informed that in second stage they should be guided by their own urge to push. If pushing is ineffective or if requested by the women, strategies to assist birth can be used, such as support, change of position, emptying of the bladder and encouragement

Survey study on the sensitivity and resistance of urine specimen pathogens to the therapeutically used antibiotics in Aden city

Resistance to antibiotics refers to unresponsiveness of microorganism to antimicrobial agent related to tolerance observed in higher organism. In Aden, there is still a lack of studies related to the identification of antibiotics-resistance in spite of the opening market for the spread of mostly all types of antibiotics. To perform this study, fifteen medical laboratories were selected. Most of them implicated the diffusion sensitivity method. Computer data base, using Excel-program, was [instructed for the information collected in the period from December 2007 to the end of April 2008. The total number of antibiotics standards used in these laboratories were 60. The highest number if antibiotics standard is available in Aden-diagnostic centre. Most of the collected specimens are of urine [31%].92% of them were adult and most of them were female [67%]. The most frequent pathogens of urinary infection were of gram [-] microorganisms [69%], and the most pathogen was E-coli [48%]. The most sensitive antibiotic against E-coli was Cefotaxim, while the most resistant was Ampicillin

Retained foreign bodies after abdominal surgery

To look into clinical presentations of intra-abdominal foreign bodies, identify risk factors for incorrect sponge and towel counts. Describe complications that can occur from retained sponges and towels, to see measures for prevention. The records of twelve patients with a confirmed diagnosis of gossypiboma after abdominal surgery at AL - Kadhimyia teaching hospital and private hospital, in Baghdad, between January 2007 and January 2010, were retrospectively reviewed. Nine of the twelve patients were female and three male. Previously, of the patients, three underwent elective operations and nine were operated on for emergency. Among retained surgical foreign bodies, sponges accounted for 66.6% of patients, gauze were found in 33.3% of patients. Operated in emergency 75% and elective 25%. Clinical presentations were intestinal obstruction 25%., abdomen Mass 25%, Discharging Sinus 16.6%, Intra abdominal abscess 16.6%, Persistent abdominal pain 16.6%. Retained foreign bodies commonly occur during an emergent procedure when the surgical team's efforts are completely focused on saving the patient's life. In that scenario, speed is essential and taking the time to perform a surgical count may not be an option. Other situations or factors that may lead to a retained foreign body include unplanned changes in the surgical procedure, patients with increased body mass, and procedures involving increased blood loss

Treatment of slipped capital femoral epiphysis by fixation with a single cannulated screw

In this study, 14 children, who had a slipped capital femoral epiphyses, were managed by in situ pinning with a single cannulated screw. The cases were followed for an average of 18.8 months [range 13-40 months]. There were three acute slips and twelve chronic slips. The degree of slip was calculated according to the method described by Southwick and the results graded according to the criteria of Heyman and Herndon. Thirteen hips were graded as either excellent or good. Avascular necrosis was developed in two hips, but chondrolysis did not occur in any patient. There was no increase in the degree of slippage of the capital femoral epiphysis

Retrograde intramedullary stabilization of humeral fractures by flexible nails

Twenty patients with humeral fractures were treated by internal fixation by flexible intramedullary nails. Retrograde nailing was done for all cases using two or three flexible nails [Gliding or Nancy type of nails] through posterior approach in distal humerus, using triceps splitting approach. This technique was adopted in poly-trauma cases, moderately comminuted humeral fractures, segmental fractures and in cases in which maintenance of reduction by non-operative means is difficult. The results obtained were excellent as regards the rate of union [95%] and convenience to the patients with minimal accepted complications. The study recommended flexible nailing in treatment of selected humeral fractures because it is safe, easy, time saving and less costly

Management of tibial non - unions using autologous marrow injection as a substitute for operative grafiting

Autologous marrow injection was used to stimulate healing in fourteen ununited tibial fractures in the period from January 1999 to March 2001. 15-20 ml. Of bone marrow aspirated from the posterior iliac crest was injected at the fracture site twice with an interval of three weeks. The technique was employed in conjunction with cast immobilization in nine cases and intramedullary nail fixation in five cases. Marrow stimulated callus formation sufficient to unite eight of the nine non-unions immobilized with cast and all the five fractures immobilized by intramedullary nails. Bone marrow injection was as effective as open autogenous grafting but with considerably less complications. Thus, the technique provides a reliable source of osteogenic stem cells with numerous advantages compared with standard open grafting techniques

etiologic role of the osteo-meatal complex in the pathogenesis of sinusitis: a retrospective study of clinical, CT and endoscopic findings in 143 patients

The etiological role of the osteo-meatal complex [OMC] in the pathogenesis of sinus disease is a debatable issue. The charts of 143 patients who underwent endoscopic sinus surgery at the American University of Beirut Medical Center between 1992 and 1995 were reviewed. Clinical symptoms included facial pain, nasal obstruction, headache, and postnasal drip. CT scan and endoscopic findings were reviewed. The presence of OMC disease radiologically was correlated with all the clinical, nasal endoscopic and other radiologic findings [disease in the rest of paranasal sinuses, or presence of concha bullosa]. Its etiological role in patients with sinusitis is discussed.No endoscopic findings could be statistically correlated with the OMC disease. Facial pain and postnasal drip were the only clinical symptoms that statistically correlated with the OMC disease lip-value = 0.009 and 0.008, respectively]. The OMC disease correlated with the radiological evidence of sinusitis in any of the sinuses

Frontal sinus oblitration with bioglass

Many alloplastic materials have been used in clinical frontal sinus obliteration. It has been difficult to find reliable obliteration material without short- or long term complications. Most common problem in frontal sinus obliteration is the resorption of occlusion material. This study was made to evaluate the efficacy of Bioglass as an alternative to autologous fat in the obliteration of the frontal sinus. Standard surgical techniques were used to obliterate the frontal sinus. Eight patients underwent Bioglass frontal sinus obliteration. There were 2 women and 6 men in the series with age ranges from 30 to 55 [mean, 38 years]. Two patients underwent obliteration for chronic infections with mucopyocele. Follow-up radiographs were obtained at 3, 6 and 12 months after obliteration of the sinus with Bioglass. No patient has developed clinical or radiographic evidence of recurrent frontal sinusitis. No implant has been rejected. Seven patients reported complete resolution of all symptoms. Bioglass had demonstrated efficacy in obliteration of frontal sinus. The material has the advantage that it takes well, no reaction or rejection and it is also of reasonable expense. The obstruction of the frontonasal duct by this material was ensured. Bioglass offers the advantages of no donor site morbidity and the potential for complete osseointegration