An International Review of Workplace Violence Against Healthcare Providers: Sudan as a Case Study.

Workplace violence experienced by healthcare providers (HCPs) in Sudan has gone viral, driving many HCPs outside the country. Globally, HCPs have accepted workplace violence as a phenomenon integral to their clinical work, causing an underreporting of incidents. This study reviews the causes and explores solutions for the phenomenon. Search strategies were conducted using internet sources including PubMed, Embase, Google Scholar, and Cochrane. References to Sudan were limited to HCPs in public healthcare facilities. A descriptive analysis was conducted on the global status of workplace violence toward HCPs. Future interventions were examined and discussed considering Sudan's circumstances. Results showed the "pandemic" nature of the phenomenon. Workplace violence contributes to the deterioration of the quality and efficiency of the healthcare system with consequences for effective healthcare delivery. It is concluded that a multiapproach intervention needs to be integrated to circumvent the standing multifactorial situation. Statutory actions are needed towards the widespread violence and impunity. Workplace organizational procedures are needed to address the patient's needs that overwhelm scarce resources. Robust educational efforts are recommended by HCP training bodies, the media, and other stakeholders to improve the doctor/patient relationship.

Medical Students' Perception of Virtual Simulation-Based Learning in Pharmacology.

Virtual simulation-based learning has opened a vista for surmounting ethical issues with the use of animals in compliance with one of the '3Rs' in ethical principles for animal use, which is 'replacement.' It's effective in terms of time, place, and cost. For instance, the time for drug application in cancer models would be less with virtual simulations, and the cost of maintenance and update of the software is less than that of breeding and feeding experimental animals. This paper examines the effects of utilizing a virtual computer tool simulating real pharmacology laboratory equipment in the second semester of a large-scale basic medical course. We looked at the theories of education and instructional designs and used them to develop a virtual computer lab that could help our students meet the intended learning outcomes. We analyzed, developed, implemented, and finally evaluated the students' reactions (at the Kirkpatrick level) using a self-administered questionnaire with responses on a three-point Likert scale. Feedback was obtained from 60 out of 82 (73.2 %) level 4 medical undergraduate students of both sexes, 39/60 (65%) were from the male section of the college. Sixty percent of the students admitted that the software is simple. Sixty percent agreed that it was good. Fifty-seven percent denied previous exposure to the simulation lab. Fifty-two percent reported that the practical lab's content was good, 53.3% rated the achievement of the practical objectives as good, 48.3% rated the practical enforcement of theoretical knowledge as good, 61.7% estimated getting realistic results, 48.3% agreed that the simulation lab encourages formulating a live experiment to test the hypothesis, and 51.7 % decided that the time framework was long. Thirty-eight percent appreciated the learning experience, and 45% felt that it should be repeated elsewhere. Students from the female section opted to record different determinations. The experience of using the virtual computer lab as part of the teaching program in pharmacology confirms the educational value of simulation. By adding a flexible reliable teaching method, we believe it served as a valuable tool for assisting teaching and learning in our context. Moreover, it is perceived as favorable by a good number of our students.

Management of Acute Ferrous Sulfate Poisoning Using Activated Charcoal Monotherapy: A Case Report.

A 13-year-old schoolgirl presented to a public hospital having ingested over 70 tablets of 65 mg of prescription ferrous sulphate within the last hour. She complained of a 7/10 sharp abdominal pain. Signs included lethargy, agony, diaphoresis, and frequent eructation. Gastrointestinal movements were audible and frequent. Heart rate was at 50 beats per minute with intact but weak pulsations. Blood pressure was at 95/65 mmHg. During the clerking, she started vomiting in pouts separated by few-minute intervals. The vomitus was watery, yellowish, and had a rusty-ironic smell. Serum iron was at 200 mcg/dL and 230 mcg/dL at the time of admission to the hospital and the time of discharge, respectively. The patient received intravenous Ringer's lactate solution. She was detoxified by the chewing of a single dose of 100 g activated charcoal. She stayed in remission throughout the follow-up. It was concluded that monotherapy with oral activated charcoal arrests the progress of the toxicodrome.

Diminished penile expression of vascular endothelial growth factor and its receptors at the insulin-resistant stage of a type II diabetic rat model: a possible cause for erectile dysfunction in diabetes.

Erectile dysfunction (ED) is commonly experienced in men with diabetes mellitus. Vascular endothelial growth factor (VEGF) has been extensively documented for its pathogenic significance in different complications of diabetes. We hypothesized that expressions of VEGF, its receptors and its signaling pathway Akt may be drastically altered in diabetic penile tIssues and their alterations may modulate penile expression of the molecules that are believed to play a role in diabetic ED. Otsuka Long-Evans Fatty (OLETF) rats, a type II (non-insulin-dependent) diabetes mellitus, were used at the insulin-resistant stage of type II diabetes (20 weeks of age). We determined protein and mRNA expressions of VEGF, its receptors, Akt, nitric oxide synthase isoforms, and apoptosis-related molecules in the penis using immunohistochemistry, Western blotting, in situ hybridization, and real-time quantitative PCR analyses. The penile sections were also submitted to the Tdt-mediated dUTP nick end labeling assay for apoptosis. OLETF rats showed marked reductions in penile expression of VEGF, its two receptors and Akt. In OLETF rat penises, endothelial and neuronal nitric oxide synthase isoforms were expressed less abundantly. Furthermore, while anti-apoptotic markers, Bcl-2 and phosphorylated Bad, were down-regulated, pro-apoptotic markers, active caspase-3 and Bax, were up-regulated, resulting in the appearance of apoptotic cells in the penile tIssues of OLETF rats. The VEGF signaling system would work less well in diabetic penile tIssues as a result of the reduced expression, leading to diminished endothelial production of nitric oxide and apoptosis-related erectile tIssue damage. We propose that the abnormalities of the VEGF signaling system in the penis may play a role in the pathophysiology of diabetic ED.

Apoptosis and anticancer drug resistance.

Anticancer agents induce cancer cell death through apoptosis or necrosis. As anticancer agents at low and high concentrations cause apoptosis and necrosis, respectively, cancer cells may be merely injured by an anticancer agent in apoptosis, and cell death may result from an activation of the internal constituents to induce apoptosis. Therefore, an alternation of apoptotic pathway must change the efficacy of anticancer agents. As an escape of cancer cells from apoptosis seems to be closely associated with the development of anticancer resistance, this report focuses on mechanisms of apoptosis and its association with anticancer resistance. A Bax induces apoptosis mitochondria-dependently, whereas Fas can induce apoptosis mitochondria-independently. An interaction of Bax and Bcl-2 is very important to decide cell life or death, and Bcl-2 phosphorylation may control this interaction: Paclitaxel treatment induced Bcl-2 phosphorylation and typical apoptosis, whereas hyperthermia induced not Bcl-2 phosphorylation but nuclear translocation and failed to induce apoptosis. Moreover, Fas was localized in the cytoplasm of exponentially growing cells and on the cell membrane of confluent cells. We would like to emphasize that it is very important to check the localization of constituents of apoptosis in order to evaluate the susceptibility of cancer cells to apoptosis.

Abnormal intracellular localization of Bax with a normal membrane anchor domain in human lung cancer cell lines.

Proapoptotic Bax is a member of the Bcl-2 family proteins, which have a key role in regulating programmed cell death. The intracellular localization and redistribution of Bax are important in promoting apoptosis. Bax contains a BH3 domain heterodimerizing with Bcl-2 and a hydrophobic transmembrane segment to be inserted in specified organelle membranes. In this study, Bcl-2 showed cytoplasmic localization in all of ten human lung cancer cell lines tested. Interestingly, Bax was localized in the nucleus in 7 cell lines, although Bax lacks nuclear import signals. This may allow cancer cells to escape from apoptosis. Why Bax is able to exist in the nucleus is still unclear. We hypothesized that mutation in the BH3 domain and / or transmembrane segment of Bax possibly causes intracellular Bax distribution. We analyzed the sequence of the bax gene in these cell lines and found only a silent point mutation at codon 184 (TCG-->TCA) in the transmembrane segment in all cell lines. This finding indicates that changes in cellular localization of Bax in lung cancer cell lines do not depend on bax mutation and that Bax is possibly translocated into the nucleus without any mutation. This is the first report showing that Bax with the normal amino acid sequence can be localized in the nucleus in established lung cancer cell lines without any treatment of the cells.

The Bouveret syndrome: an unusual cause of hematemesis.

Gallstones are usually silent. Less commonly, patients with cholelithiasis develop symptoms and/or complications; biliary fistula occurs in 3% to 5% of the cases. When a large stone is passed and occludes the duodenum, gastric outlet obstruction (the Bouveret syndrome) may result. In reported cases, the stones are usually larger than 2.5 cm. The usual presenting symptoms are those of bowel obstruction: abdominal pain, nausea, and vomiting. Less commonly, the patients experience melena and, rarely, hematemesis. We describe a patient who had the largest stone reported to cause hematemesis rather than bowel obstruction and to be diagnosed endoscopically. The 5 X 4 X 3 cm stone was extracted surgically. Endoscopic diagnosis and extraction of stones up to 3 cm in size has been reported, avoiding the need for surgery.

Papillary cystadenocarcinoma of the bile ducts resulting in hemobilia.

Cystadenocarcinoma is a rare tumor of the intrahepatic and a very rare tumor of the extrahepatic biliary system. In the reported cases, abdominal swelling is the most common presenting symptom, followed by right upper quadrant mass. Melena was the initial presenting symptom in the present case. Bleeding into the second part of the duodenum was observed only during the third diagnostic esophagogastroduodenoscopy. Hemobilia was suspected because of abnormal liver enzymes and a mass in the left lobe of the liver on computerized tomography. At laparotomy, we suspected that the mass was a hemangioma. Cystadenocarcinoma diagnosis was made only by histopathological examination.