Rotator cuff (RC) tears, both partial and full-thickness lesions, are a common source of pain and disability in the adult’s shoulder. Methods: In this study a retrospective cross-sectional study was conducted in 129 patients with shoulder pain, stiffness, restricted motion and trauma. Their age were between 20–65 years those attended into the clinical centers in Sudan (2021–2024). High-resolution ultrasonography (HR-US) was used in a uniform tendon-specific protocol in order to increase the diagnostic precision, reproducibility, then to study the Specificity and Sensitivity of HR-US clinical orientation on a partial and full- thickness tear on Rotator Cuff muscles. The examinations were performed with a 7.5-/12-MHzlinear-array transducer following ESSR guidelines. SPSS v23 was used for statistical analysis and level of significant at p < 0.05. Results: HR-US was over 90% sensitive and over 94% specific in identifying full-thickness tears and had excellent agreement with MRI. Supraspinatus and infraspinatus tendons had optimal diagnostic accuracy, with HR-US superior to MRI in the identification of some partial subscapularis tears. Standardized protocols improved inter-operator variability elimination and diagnostic consistency. Conclusion: HR-US is a highly precise, cost-effective, and interactive first-line imaging modality for evaluating rotator cuff disease. Its real-time imaging can provide functional information beyond MRI, leading to early and precise diagnosis. If performed under formalized protocol, HR-US reduces operator reliance and enables wide acceptance, particularly in resource-poor health care settings.

Background: Alpha-feto-protein producing gastric adenocarcinoma is a rare and aggressive subtype of gastric cancer, associated with poor prognosis. Case Presentation: We report the case of a 66-year-old female with a history of hypertension and hypothyroidism who presented with severe anemia and abdominal pain. Initial imaging revealed a gastric lesion. Serum Alfa-Fetoprotein (AFP) was requested due to a suspicious lesion seen on initial liver imaging, and it was markedly elevated (>9000 ng/mL), raising suspicion for AFP-producing gastric cancer versus liver infarction due to venous thrombosis. Endoscopic biopsy of the gastric lesion confirmed Enteroblastic gastric adenocarcinoma. Subsequent MRI abdomen demonstrated hypermetabolic activity in the gastric lesion and in the abdominal lymph nodes without distant metastasis. Given her frailty and reluctance to undergo intravenous chemotherapy, she was offered oral chemotherapy (Capecitabine). Conclusion: Here, we present a case of AFP- producing gastric adenocarcinoma, a rare tumor that has not previously been reported from the Middle Eastern region, to the best of our current knowledge.

Background: RC pathology includes tendinopathy, partial- and full-thickness tears, and subacromial-subdeltoid bursitis, are a leading cause of shoulder pain and functional loss in active adults. HR-US is an easily accessible and dynamic imaging modality with the capability of conducting tendon-specific assessment with a high degree of accuracy. Nevertheless, variability in operator performance combined with patient positioning is a clinical limitation. Objectives: The aim of this study was to establish the diagnostic performance of HR-US as a first-line imaging modality in the diagnosis of RC pathologies and compare the accuracy with MRI using a standardized scanning protocol based on ESSR guidelines. Methods: In this retrospective cross-sectional study, a total of 283 patients aged between 20 and 65 years with complaints of shoulder pain, stiffness, or trauma were examined in several diagnostic centers in Sudan from 2021 to 2024. Examinations were performed using high-frequency linear transducers (7.5-12 MHz) on a unified HR-US protocol. MRI was used as a reference standard. Statistical analysis was made using SPSS, version 23, and diagnostic indices of sensitivity, specificity, accuracy, PPV, and NPV were calculated; p < 0.05 was considered significant. Results: HR-US obtained a sensitivity of 90.6%, specificity of 94.6%, for full-thickness tears, with an overall diagnostic accuracy of 92.6% and excellent correlation with MRI (r = 0.718, p < 0.001). The modality showed strong diagnostic performance for supraspinatus and infraspinatus lesions and proved superior to MRI in the detection of partial subscapularis tears in many cases. Standardized examination protocols greatly decreased inter-operator variability and improved reproducibility. Demographic analysis yielded strong associations of RC pathology with age and gender. Conclusion: HR-US is a reliable, accurate, and inexpensive first-line modality for diagnosing rotator cuff disorders. If performed in a standardized and tendon-specific protocol, HR-US diagnostic precision is comparable to MRI, while the former offers real-time dynamic assessment and is more accessible. It is worth integrating into routine diagnostic pathways, in particular in resource-constrained settings, for early diagnosis and evidence-based clinical decisions.

Alopecia, defined as thinning or loss of hair, is a condition affecting the hair follicle. Traction alopecia, which is traumatic in nature, mainly results from common hairstyling practices among black women. Conventional treatments, such as minoxidil, have many limitations. This study aimed to formulate hair gels based on pectin extracted from mango and coconut oil, in order to offer a natural alternative for the treatment of traction alopecia. The extracted raw materials were characterized. The pectin gel was prepared at 95°C under agitation at 800 rpm, then dispersed in the lipophilic phase under constant agitation at 1500 rpm for 10 minutes to obtain two formulations, B and B'. These homogeneous gels showed instability under centrifugation. Microscopic examination revealed coarse emulsions. Over 28 days, control showed a slight variation in pH, indicating satisfactory microbiological stability. In stability tests at different temperatures, gel B proved stable at 6 ± 2°C, 25 ± 2°C, and 40 ± 2°C, while gel B' remained stable only at cold and room temperatures. In terms of rheology, gel B exhibited shear thinning behavior, thixotropic behavior and viscoelastic properties, unlike gel B', which showed predominantly elastic behavior. These results are part of the development of innovative phytocosmetics for the management of traction alopecia in black women.

Background: Sacubitril/Valsartan, an angiotensin receptor-neprilysin inhibitor (ARNI), represents a paradigm shift in the management of heart failure with reduced ejection fraction (HFrEF). Its robust efficacy in reducing mortality and hospitalization is well-established. However, as its use becomes ubiquitous, the recognition of rare and serious adverse events is paramount for optimizing patient safety. Case Presentation: A 57-year-old male with a complex medical history including type 2 diabetes, dyslipidemia, hypertension, chronic kidney disease (CKD stage 3a), and NYHA Class III HFrEF was initiated on Sacubitril/Valsartan 24/26 mg twice daily. Two weeks post-initiation, he presented with severe bilateral proximal myalgia, profound weakness, and classic tea-colored urine. Physical examination revealed significant muscle tenderness. Laboratory investigations were diagnostic for severe rhabdomyolysis, with a peak creatine kinase (CK) level of 18,540 U/L and concomitant acute kidney injury (AKI), evidenced by a rise in serum creatinine from a baseline of 1.4 mg/dL to 2.1 mg/dL. A meticulous workup excluded other common etiologies of rhabdomyolysis, including recent trauma, strenuous exertion, hypothyroidism, and illicit substance use. The patient had been on a stable, long-term dose of atorvastatin without prior incident. The Naranjo Adverse Drug Reaction Probability Scale score was 7, indicating a "probable" adverse drug reaction. Management involved immediate and permanent discontinuation of Sacubitril/Valsartan, aggressive intravenous fluid resuscitation, and close monitoring. A positive dechallenge was observed, with rapid symptomatic improvement and normalization of CK and renal function over the following week. Conclusion: This case provides compelling evidence for Sacubitril/Valsartan as a rare but potent precipitant of rhabdomyolysis, particularly in patients with predisposing factors such as CKD and concomitant statin use. It underscores the critical importance of clinician vigilance, pre-emptive patient education, and the prompt institution of management upon symptom recognition to prevent life-threatening complications like acute renal failure.

The pursuit of excellence in healthcare quality is perpetually challenged by systemic fragmentation, where siloed operations among critical departments like Nursing, Radiology, and Health Administration lead to communication breakdowns, clinical errors, and operational inefficiencies. This comprehensive research paper argues that the strategic and deliberate integration of these three pillars is not merely beneficial but essential for achieving superior, patient-centered care. The analysis begins by deconstructing the inherent weaknesses of the traditional "siloed system," demonstrating how it acts as a fundamental barrier to quality. It then elucidates the unique and complementary roles of each discipline: Nursing as the continuous, holistic clinical bedrock; Radiology as the pivotal diagnostic lens guiding decision-making; and Health Administration as the essential architectural framework that enables synergy through resource allocation, policy, and culture. The paper further explores practical models for "forging the link," including multidisciplinary teams, structured communication protocols, integrated clinical pathways, and interprofessional education. By synthesizing evidence from a wide range of literature, this research concludes that a conscious, system-wide commitment to dissolving interdisciplinary boundaries is the definitive pathway to enhancing patient safety, improving clinical outcomes, boosting patient satisfaction, and achieving operational excellence in the modern healthcare landscape.

Background: Small-cell neuroendocrine carcinoma of the prostate (SCPC) is a rare and aggressive malignancy, accounting for less than 2% of prostate cancers. It is typically characterized by low prostate-specific antigen (PSA) levels, rapid progression, and poor response to hormonal therapy. Case Presentation: We report the case of a 71-year-old male with multiple comorbidities, who presented with lower urinary tract symptoms. Imaging revealed a large pelvic mass, extensive lymphadenopathy, and innumerable pulmonary nodules, while PSA was 1.4 ng/ml. Pathology review confirmed small-cell neuroendocrine carcinoma of the prostate (SCPC). The patient underwent systemic chemotherapy with six cycles of carboplatin and etoposide, achieving an eight-month disease-free interval. Surveillance imaging revealed significant locoregional progression with recurrent hydronephrosis, retroperitoneal lymphadenopathy and new liver metastases. Immediate rechallenge with carboplatin and etoposide. Conclusion: This case highlights the aggressive course of small-cell carcinoma of the prostate, characterized by atypical PSA kinetics, early visceral metastasis, and rapid progression despite systemic therapy.

Background: The integration of healthcare technologies in nursing has revolutionized patient care delivery and educational practices. Understanding nursing students’ perceptions toward these innovations is crucial for ensuring workforce readiness in technology-driven healthcare systems. Objectives: This study assessed nursing students’ awareness, readiness, and attitudes toward healthcare technologies, examined demographic variations, and identified perceived educational and training needs. Methods: A descriptive cross-sectional study was conducted among 149 students at Prince Sultan Military College of Health Sciences using a 24-item Likert-scale questionnaire covering awareness, readiness, attitudes, training needs, and perceived effectiveness. Reliability was confirmed (Cronbach’s α = 0.963). Descriptive statistics and one-way ANOVA tests were performed using SPSS v25, with significance set at p < 0.05. Results: Students demonstrated high awareness (76%), confidence (86%), and willingness to use technology (84%). Year of study, GPA, and prior exposure significantly affected perceptions, while age did not. Participants emphasized the need for simulation-based learning, electronic health records training, and telehealth exposure. Conclusion: Although nursing students recognize the benefits of technology, structured training remains insufficient. Educational institutions must integrate comprehensive digital health competencies into nursing curricula to enhance readiness and promote patient-centered innovation.

We present the case of a ruptured splenic artery aneurysm occurring in a 39year-old patient treated by embolization.

Hodgkin's disease or Hodgkin's lymphoma is a rare malignant hemopathy characterized by the presence of Reed-Sternberg cells. It is a lymphoid disease that the cause remains unknown. Subdiaphragmatic localized forms are rare and represent 6 to 13% [4-6]. The revelation of these forms by acute intestinal intussusception is exceptional, and attested by very few data published in the literature. We report the case of a 70-year-old patient with a rare case of subdiaphragmatic Hodgkin's lymphoma revealed by acute intestinal intussusception.

Cystic tumors of the pancreas are a rare entity, accounting for approximately 15-20% of pancreatic cystic lesions, largely due to advances in imaging techniques. The most common types of pancreatic cystic tumors are intraductal papillary mucinous tumors (TIPMP) and mucinous cystadenomas (CM), while serous cystadenomas (CS) and solid pseudopapillary tumors (TPPS) are less frequent. This study aims to report the experience of the General Surgery Department at the Avicenne Military Hospital in Marrakech regarding the diagnostic and therapeutic management of cystic tumors of the pancreas.

Cervical cancer is the second most common gynecological malignancy in developing countries and remains a major cause of cancer-related mortality among women worldwide. This retrospective descriptive study, conducted on 38 cases at the General Surgery Department of the Avicenne Military Hospital in Marrakech from 2018 to 2022, revealed a predominance of squamous cell carcinoma in women aged 50 to 60 years. Vaginal bleeding was the main presenting symptom. Concomitant chemoradiotherapy based on weekly cisplatin followed by uterovaginal brachytherapy was the most frequently used treatment. Strengthening and expanding cervical cancer screening programs remain crucial to improve early detection and patient outcomes.

Cephalic duodenopancreatectomy (CDP), also known as the Whipple procedure, is a major surgery performed on the pancreatobiliary junction. It is mainly indicated for cancers of this region, as well as for certain benign tumors or chronic pancreatitis. Despite technical advances, this procedure remains associated with high morbidity, with postoperative complications such as pancreatic or digestive fistulas, gastroparesis, hemorrhage, infections, and, in the long term, pancreatic insufficiency. A retrospective study conducted in the Department of Visceral Surgery at the Avicenne Military Hospital of Marrakech between 2017 and 2021 analyzed 35 cases of CDP. The average age of patients was 62 years, with a male predominance. The main indications were: Vaterian ampulloma (45.7%), Adenocarcinoma of the pancreatic head (34.3%), Adenocarcinomas of the distal bile ducts (11.4%), And a few rare cases of duodenal or cystic tumors. Most tumors were well-differentiated (74%). The Child reconstruction technique was used in 65.7% of cases, while pancreaticogastric anastomosis was performed in 34.3%. The postoperative mortality rate was 11.4%, mainly due to hemorrhagic shock. Early complications occurred in 42.8% of patients, predominantly gastroparesis (17.1%) and hemorrhage (8.6%). The results are consistent with those reported in the literature. The study emphasizes the importance of thorough preoperative assessment, close postoperative monitoring, and an experienced surgical team to reduce complications and improve prognosis.

Tuberculosis remains a major public health challenge in Pakistan despite available diagnostics and curative therapy. We conducted a community-based cross-sectional survey of 462 adults in Lahore, Pakistan (January to May 2023) using bilingual, venue-based and online questionnaires to assess knowledge, attitudes, and care-seeking for tuberculosis. Most respondents had heard of tuberculosis (439 of 462, 95.0 percent) and recognized at least one cardinal symptom; the most frequently identified was cough lasting more than three weeks (218, 47.2 percent). Airborne transmission via coughing or sneezing was the best-recognized route (262, 56.7 percent), although misconceptions persisted, including transmission through sharing plates (128, 27.7 percent). Knowledge of curability was high (444, 96.1 percent), and most selected specific drugs provided by health facilities as appropriate treatment (339, 73.4 percent). Intended care seeking was favorable: 351 respondents (76.0 percent) would attend a health facility for tuberculosis-like symptoms and 228 (49.4 percent) would do so as soon as they recognized symptoms. However, cost (148, 32.0 percent), uncertainty about where to go (88, 19.0 percent), and transport or distance (58, 12.6 percent) were prominent barriers; most still desired more information about tuberculosis (419, 90.7 percent). These findings indicate a high baseline of awareness in an urban setting, coupled with specific misconceptions and practical obstacles that may delay care. Targeted myth-correction, clear navigation to free or subsidized services, and measures to reduce out-of-pocket and transport barriers are likely to accelerate earlier diagnosis and treatment.

Background: Vesicovaginal fistula remains a debilitating condition in developing countries, largely due to obstructed labor, delayed access to emergency obstetric care, and poor socioeconomic conditions. Understanding the clinical profile of affected women is crucial for improving preventive and treatment strategies. Methods: A total of 55 women with VVF were selected using convenience sampling. Clinical status was assessed through sociodemographic characteristics, parity, socioeconomic background, antenatal care status, causes of delay in reaching hospital, previous fistula repair attempts, and preoperative fistula characteristics including size, location, scarring, urethral involvement, and bony attachment. Results: Most women were multiparous (69.1%) and from low-income households (75.6%). Prior unsuccessful fistula repair was reported in several cases. Of the 55 fistulas, small fistulas were the most common (19 cases), and extensive fistulas were least frequent but had the poorest prognosis. Vaginal scarring varied from none (31 cases) to mild (14), moderate (4), and gross (6). Urethral involvement, circumferential fistulas, and bony attachment were significant adverse clinical findings. Two patients had bladder calculi, both of whom improved postoperatively. Conclusion: Women with VVF commonly present with multiple adverse clinical factors, including low socioeconomic status, delayed access to care, and complex fistula characteristics. Severe scarring, large fistula size, and urethral involvement indicate more complicated clinical status and challenge surgical management. Early obstetric intervention and improved maternal care services are essential for preventing such severe presentations.

This cross-sectional comparative study was done at radiotherapy department of Rajshahi Medical College Hospital, Rajshahi from July, 2009-June, 2010. A total number of 60 diagnosed cases of carcinoma larynx (Histologically squamous cell carcinoma) were enlisted and were divided into study group e.g. Chemo-Radiotherapy group (Group A) consisting 30 patients were treated by sequential chemo-radiotherapy with two cycles of cisplatin (20mg/m2) & 5-FU (500mg) per day for 4 days 3 weeks apart followed by radiotherapy after 1½ weeks at 60-66 Gray in 30-33 fractions in 6-6½ weeks and control group e.g. radiotherapy group (Group B) consisting 30 patients were treated with conventional radiotherapy of 60-66 Gray in 30-33 fractions in 6-6½ weeks. The objective of the study was to observe and compare the results of treatment & side effects of treatment on both arms during & after treatment. In chemo-radiotherapy group (Group-A) complete response (CR) was found in 20 cases (66.67%) and partial response (PR) was found in 10 cases (33.33%). In radiotherapy group (Group-B) complete response (CR) was found in 12 cases (40%) and partial response was found in 18 cases (60%). It was found that complete & partial response was 100%. There was no death or no major complications throughout the study period. Calculated 2 value was 4.28 was greater than the table value 2 i.e. 3.84. It corresponds to probability of 0.05 in 2 table (P < 0.05). Hence treatment of laryngeal cancer with sequential chemo-radiotherapy was statistically significant.

Background: The reverse dorsal metacarpal artery flap is a versatile solution for resurfacing soft-tissue defects of fingers. This is a widely used flap to cover finger defects. Materials and Methods: This prospective observational study was carried out at Dhaka Medical College Hospital, Dhaka from 1st July, 2018 to 30th June 2019. 30 patients were included in the study. Patient age, gender, defect type, defect location, donor site coverage, flap dimensions, range of motion of the meta-carpophalangeal joint and proximal interphalangeal joint, postoperative complications were evaluated. Follow up period was 3 months. Results: 30 patients underwent coverage of skin defects of the finger proximal to DIP joint with reverse dorsal metacarpal artery flap. All flaps survived completely. Flap size ranged from 2.5 cm 1.5 cm to 5.5cm 3.5 cm. 17 flaps were based on the second dorsal metacarpal artery. Skin paddle was taken from the dorsal aspect of the second, third, and fourth intermetacarpal area. All patients had full range of movement of the reconstructed and donor digits when followed at 3 months after surgery. Conclusions: The reverse dorsal metacarpal artery flap is a flap which is safe, easy to apply in the context of soft tissue coverage procedures and does not result in the loss of finger functions. It also confers excellent aesthetic skin suitability and does not require debulking procedures.

The adrenal gland is, despite her small size, among the most important and vital organs in the human body. The purpose of this study was to evaluate the normal adrenal gland's location, shape, texture and size and correlate that with gender and age in Sudanese population by using computed tomography. The study was performed during the period from June 2025 to September 2025 in CT departments of Military hospital Omdurman. The data were collected from randomly selected sample of 50 patients (21 males and 29 females) who underwent CT abdomen for other indications without evidence of adrenal diseases. The main findings of correlations included that most common shape of the adrenal gland was linear, and when correlating the normal texture and size of the adrenal gland with the age and gender, it was found that texture and size of the adrenal gland decreased with age, and the size of the adrenal gland in females was smaller as compared to males.

Lutein as a carotenoid, provides a wide range of nutritional and health benefits due to their multifarious biological impacts on humans, which include antioxidative, immunomodulatory, and anti-inflammatory properties. This study was carried out to evaluate the Cognito motor modulatory function of lutein on Hippocampal cellular Architecture in Diazepam induced memory impairment in Wistar rats. Thirty (30) male rats were used for this study and the rats were acclimatized for a period of 14 days, and was then divided into six groups; 1 (Control), 2 (Diazepam 5mg/kg), 3 (Diazepam + Lutein 20mg/kg), 4 (Diazepam + Lutein 40mg/kg), 5 (Diazepam + Lutein 60mg/kg), and 6 (Diazepam + Donepezil - Standard drug) for a period of 21 days. The catalase level was seen to be statistically significant (p<0.05) when the group 2 (diazepam only treated) and group 3 were separately compared to that of the control group (group 1). In neurobehavioural test conducted, Group 2 in handgrip stability time test conducted showed a significant (p<0.05) decrease signifying a lack of peak force for handgripping when compared with group 1(control group), this was made significant by the increase in the number of incorrect hole entry by group 2 wistar rats in Barnes maze test in week 1 and 2 of the study period, Lutein showed a motor modulatory function in the brain through its antioxidizing and anti-proteolytic properties, with its dose dependence effect on group 3 Wistar rats, of which catalase concentration level seems to be lesser when compared to group 2.

This study aimed to evaluate the diagnostic tests and management approaches for dry eye disease (DED) among eye care practitioners in Saudi Arabia. A cross-sectional, questionnaire-based survey was sent to 200 practitioners, with 88 responses, resulting in a 44% response rate. Of the respondents, 68.2% were optometrists and 31.8% were ophthalmologists. The fluorescein tear break-up time (TBUT) and Schirmer test were the most commonly used diagnostic methods due to their simplicity and accessibility, while assessing the meibomian glands was less frequent. The main causes of DED identified were environmental factors and meibomian gland dysfunction. The most commonly reported symptoms included dry eyes, tearing, and itching. The preferred management options were aqueous-based artificial tears (46.3%) and lipid-based artificial tears (40.1%), with minimal use of advanced therapies. These findings underscore the reliance on conventional diagnostic and treatment methods and highlight the need for standardized protocols and broader adoption of modern diagnostic technologies to improve DED care in Saudi Arabia.

Background: Medical device-associated healthcare infections [MDHAIs] represent a critical threat to patient safety worldwide, constituting approximately 30% of nosocomial infections and imposing substantial morbidity, mortality, and financial burdens on healthcare systems. Objectives: This comprehensive review synthesizes current evidence on the epidemiology, microbiology, pathogenesis, prevention, and quality-of-life implications of MDHAIs, with emphasis on sterilization protocols, reprocessing standards, and emerging antimicrobial technologies. Methods: A systematic literature review was conducted examining device-associated infections in intensive care settings, including central line-associated bloodstream infections [CLABSI], catheter-associated urinary tract infections [CAUTI], and ventilator-associated pneumonia [VAP]. Key Findings: The epidemiology of MDHAIs continues to evolve, with multidrug-resistant [MDR] and extensively drug-resistant [XDR] pathogens demonstrating enhanced biofilm formation capacity [up to 1000-fold increased resistance to antimicrobial agents compared to planktonic cells]. Current surveillance data reveals CAUTI incidence of 1.67 per 1000 catheter-days, CLABSI at 0.59 per 1000 central line-days, and VAP at 4.63 per 1000 ventilator-days. Evidence-based prevention bundles have achieved CLABSI reductions of 60–90% and VAP reductions exceeding 40% in institutional settings. Device-associated infections profoundly impact quality of life through extended hospitalization, prolonged recovery, and significant psychological morbidity including anxiety, depression, and post-intensive care syndrome. Conclusions: Effective prevention of MDHAIs requires multifaceted approaches encompassing appropriate device classification, adherence to ISO 17664:2021 reprocessing standards, rigorous quality assurance monitoring, comprehensive staff training, implementation of bundle prevention strategies, and integration of clinical engineering expertise. Novel antimicrobial technologies [bacteriophages, endolysins, antimicrobial peptides] and anti-adhesion surface coatings offer promise for future device sterilization. Sustainability imperatives and evidence supporting reusable device efficacy warrant reconsideration of single-use device reliance, coupled with investment in institutional reprocessing infrastructure and patient-centered education.