Hospital General de Almansa

Background: Effective discharge documentation is essential for ensuring continuity of care and patient safety. In many resource-limited hospitals, discharge summaries are often incomplete, leading to communication gaps, preventable errors, and avoidable readmissions. This audit evaluated the impact of introducing a standardized discharge card on the quality of discharge documentation at Hasahesa Teaching Hospital, Sudan.Methods: A two-cycle clinical audit was conducted in the Internal Medicine Department. The baseline review (Cycle 1) assessed 50 discharge cards retrospectively over a two-week period (20 March to 2 April 2025) using a structured checklist adapted from international standards. Following this, a one-month intervention was implemented, introducing a newly designed discharge card supported by staff training and visual aids. The re-audit (Cycle 2) reviewed 50 discharge cards over three months (3 May-2 August 2025). Compliance across multiple documentation domains was compared using the chi-square test.Results: Documentation improved significantly across all domains after the intervention. Recording of demographic details, clinical information, treatments, discharge diagnosis, and follow-up instructions rose from baseline levels of 22-56% to post-intervention levels of 94-100%, representing absolute improvements of 38-72 percentage points (95% CIs provided in the full text). All improvements were statistically significant (p < 0.001). Staff feedback indicated that the standardized card was clear, practical, and enhanced workflow.Conclusion: The standardized discharge card markedly improved the quality and completeness of discharge documentation, providing a simple, low-cost, and effective intervention to strengthen patient safety and continuity of care in a resource-limited setting. Wider implementation and longer-term evaluation are recommended to ensure sustainability and scalability.

Background: Sudan’s last war recorded the highest wave of Internally Displaced Persons (IDPs) in the world. Gezira State had a large share of IDPs in Kassala city, Eastern Sudan. Studying IDP's health condition, especially mental status, is not less important than food and shelters. Therefore, this study aimed to estimate the prevalence of anxiety and depression among IDPs and their association with socio-demographic variables. Methods: A cross-sectional study was conducted between June and July 2024 among Gezira State IDPs residing in Kassala, who were selected from 191 shelters using a cluster-simple random sampling technique. The prevalence of anxiety and depression was measured using the Hopkins Symptom Checklist (HSCL-25), a validated questionnaire (translated to Arabic) at a cut-off of mean ≥1.75 to consider significant elevation. The association between demographic variables (chi-square test of independence) and the questionnaire items was identified. Variables with a P-value less than 0.05 were considered statistically significant at a 95% confidence interval. Results: A total of 386 participants (101% response rate) were interviewed with trained, graduated medical students. The estimated prevalence of anxiety and depression was 239 (61.9%) and 271 (70.2%), respectively. The association between demographic variables and anxiety was found to be significant in gender, level of education, marital status, employment status, and current financial status. While depression was found significantly associated only with gender. Conclusion: This study found a high prevalence rate of anxiety and depression among IDPs in Kassala, Eastern Sudan. The socio-demographic variables found in association with high prevalence of anxiety were gender (higher in females), level of education (higher in universities level), marital status (higher in married), work status (higher in students), financial (higher in low income); while depression was found significantly associated only with female gender. Implementing any health interventions should include mental health services as priorities in IDP shelters.

Ischemic colitis constitutes about half of mesenteric vasculopathies, and it shares a similar pathophysiologic process with acute and chronic mesenteric ischemia. These, in turn, can be divided intoocclusive and nonocclusive mesenteric ischemia (NOMI). We present this case of a patient presenting withabdominal pain secondary to right-sided colitis, initially presumed to be infectious, but later attributed tolocalized NOMI. The correlation between localized NOMI, specifically right-sided colitis, andright ventricular (RV) failure has not been well described in the literature. NOMI, in general, is suspected to be secondary tosplanchnic vasoconstriction, which results from sympathetic stimulation and renin-angiotensin-aldosterone system (RAAS) activation. Additionally,patients with RV failure have been shown to develop intestinal congestion due to elevated right atrial pressure (RAP), leading to bowel wall thickening and impaired mesenteric venous drainage, which may further contribute to ischemia. This mechanismsuggests that botharterial hypoperfusion and venous congestionmay play a role in the pathogenesis of right-sided ischemic colitis in RV failure. The predominance of ischemia in the right colon, rather than in classical watershed areas, may be attributed to preferential vasoconstriction of the superior mesenteric artery (SMA), which supplies the right colon, as well as localized venous congestion impairing mesenteric drainage in this region. Individual variability in vascular anatomy and autoregulatory responses could also contribute to this atypical presentation. This case highlights apotentially underrecognized associationbetweenRV dysfunction and right-sided ischemic colitis, emphasizing the interplay oflow cardiac output, mesenteric hypoperfusion, and venous congestion. Given theabsence of direct studies on this relationship, further research is needed to better understand its clinical significance.

There are several operative modes to address hand fractures to gain better anatomical and functional results including external fixator, percutaneous K-wire fixation, lag screw fixation, tension band wiring, intra-medullary nails or wires, and plate-screw fixation. We evaluated the results of plate osteosynthesis in fractures of metacarpals and phalanges in a prospective manner. A total 50 adults (19-60 years) of either sex having 58 fractures managed by miniature plate osteosynthesis and followed for a minimum six months (6-19), including metacarpal and phalangeal fractures (unstable or serial fractures), intra-articular fractures, fracture-dislocation of proximal interphalangeal and distal interphalangeal joints with joint incongruity or subluxation were enrolled while contaminated compound fractures, pathological fractures and cases of reimplantation were excluded from study. Clinical assessment was done using the American Society for Surgery of the Hand (ASSH), total active flexion (TAF), total active range of motion (TAM) score, and the Disabilities of the Arm, Shoulder, and Hand (quick DASH) score while sequential radiographs were done at each follow-up. All the fractures had perfect union clinically as well as radiologically with a mean duration of six weeks while functional outcomes in reference to clinical scores were observed excellent and fair in all cases. None of the cases had any loss of reduction, loosening of the implant, or other major complications. Miniature plate fixation provides enough stability in metacarpal and phalanges fractures, thereby allowing immediate active movements, which leads to excellent functional outcomes and early return to normal activities.

Stone can be considered as a piece of resistance for jewelry, not just an accessory fixed on a noble metal. This current study reflects the biography and the activity of Harry Winson – one of the most important american diamond collectors and specialists of 20th century. Winston House, during several decades, presents one of the most impressive natural stones, rarely found in sizes, unique properties, such as President Vargas’ diamond, Hope, the sapphire of Queen Maria of Romania and so on, creations of clothing jewelry and watches produced in history for royal houses (Duchess Windsor, Queen Elizabeth's II, Queen Maria of Romania...) and also for cinema stars (Katharine Hepburn, thus, Winston is a remarkable personality. Refurbishing jewelry by reshaping into contemporary clothing ornamental items. His authority and professionalism were so imposing, that it was impossible for him not to be a source of influence and inspiration in contemporary art, such as jewelry making, painting, sculpture from the territory of Bessarabia and the whole world. The goal of this study was to shortly reflect the most representative stones and well-known jewelry from Winston’s House, and their impact in the jewelry making field and fashion, which lasted in time.

Background: Early-onset neonatal bacterial sepsis (EOS) is a serious medical condition where pathogenic bacterial species are isolated from the blood of newborns within the first 72 hours of life. Neonatal healthcare providers face challenges in managing well-appearing newborns born at 35 weeks gestational age or more who are at an increased risk of developing EOS. The American Academy of Pediatrics (AAP) has recommended three approaches for managing EOS. One of these approaches includes enhanced observation to observe the progression of the newborn's clinical condition within the first 48 hours after birth. The AAP recommends that birth centers should adopt institutional approaches that are tailored to their specific local resources and structures. It recommends that the chosen approach is evaluated to identify infrequent negative outcomes and to confirm its effectiveness.Aims: To report our experience in managing EOS in newborns born at 35 weeks gestation or later with an increased risk for EOS.Methods: This was a review of electronic medical records from the past five years. We included a sample of newborns born at or after 35 weeks gestational age who were at increased risk of EOS and appeared to be healthy. We implemented universal antenatal culture-based screening for Group B streptococcus (GBS). We followed the recommendations of the AAP in 2012 to manage these newborns. We performed a complete blood count (CBC) with differential and C-reactive protein (CRP) tests to predict EOS. We also considered the newborns symptomatic if they displayed any clinical signs of EOS.Results: A total of 806 newborns were included in the study, out of which 27 (3.3%) of them had symptoms of EOS, while the remaining 782 newborns appeared healthy. Predictive blood tests were performed on 281 (34.9%) of the newborns, out of which 126 (44.8%) of them had a positive test result. However, blood cultures were obtained from 134 (16.6%) of the total cohort. Intravenous antibiotics were administered to 33 (4.1%) of the newborns. All symptomatic newborns had a positive predictive blood test result, and two of them had culture-proven EOS. Blood cultures obtained from the remaining 107 asymptomatic newborns were negative. In this context, 140 newborns needed to be pricked for positive predictive blood tests to predict one case of EOS. However, if the positive predictive blood tests were only performed on symptomatic newborns, then only 14 newborns would need to be pricked to predict one case of EOS.Conclusion: Based on the present study, it is advised to follow the current AAP recommendation against predicting EOS by solely relying on CBC with differential or CRP. The study suggests that the enhanced observation approach is a more sensible option for managing EOS, but this needs to be confirmed in a larger study.