National Ribat University

Tonsillectomy is one of the most commonly performed surgical procedures on children. Indications for tonsillectomy include recurrent tonsillitis, obstructive sleep apnea, and peritonsillar abscess, among others. Bipolar diathermy and coblation surgeries are the most common used surgeries. Bipolar Diathermy efficiently manages postoperative hemorrhage but often results in increased postoperative pain due to higher thermal tissue destruction. In contrast, coblation is a procedure that offers a lower output of heat and results in lesser pain and shorter healing times. The present study compares the above two procedures to evaluate the postoperative outcomes regarding pain, healing, and safety of pediatric tonsillectomy patients. This was a prospective, randomized, experimental study on 120 pediatric patients ranging from 5 to 14 years who experienced recurrent or chronic tonsillitis or obstructive symptoms, amongst them sleep apnea. Both groups were operated on with extracapsular tonsillectomy under general anaesthesia, with standardized preoperative management and uniform anaesthetic protocols. The aforementioned parameters of pain, hemorrhage, and healing process were similarly followed up for postoperative evaluations at one, two, three, and 4 weeks. Mean scores of pain were very highly significantly lower in patients of Group A at visits than in patients of Group B. Patients of Group A received scores for visit for the first week at 9.45 ± 0.58 versus 9.82 ± 0.22 (p = 0.001) and scores for visit in the fourth week at 0.35 ± 0.40 versus 1.92 ± 1.78 (p = 0.001). Group A compared with group B had early healing time and fewer cases of bleeding complications. Time to pain resolution was shorter in Group A with a mean of 15.5 ± 2.0 days compared with a mean of 24.8 ± 3.4 days in Group B, (p = 0.001). The study results show that in pediatric patients, coblation-assisted tonsillectomy proved to have advantageous benefits over bipolar diathermy tonsillectomy. Coblation provided less postoperative pain and quick healing, with an overall shorter pain duration and fewer bleeding complications.

Nearly 300 million people globally require humanitarian assistance, primarily due to conflicts and complex emergencies (CE). Modern conflicts are increasingly prolonged, deadly and frequent, severely disrupting health systems and hindering the provision of quality tuberculosis (TB) care. Managing drug-resistant TB (DR-TB) in these settings is particularly challenging. War and post-war conditions could potentially amplify resistance. However, evidence on DR-TB in CE-affected countries remains scarce. A scoping review, including grey literature and consultation with implementing agencies, was conducted to analyse published experiences worldwide in delivering DR-TB care in CE. The review included 16 peer-reviewed articles and 11 reports. Countries affected by war exhibit multiple risk factors for amplifying TB resistance. DR-TB management in CE is ongoing, yet diagnostic access is limited, with notification rates below 20% of estimated cases. Treatment success rates among those diagnosed are comparable to global averages. Innovative approaches, such as molecular tests, shorter regimens and patient-centred approaches, have achieved higher success rates. Information on vulnerable populations, including internally displaced persons, prisoners and children, remains minimal. Only one country had reliable information on DR-TB in prisoners (Iraq), accounting for one-third of the national resistant cohort. Most CE countries rely on external funding for DR-TB programmes. Like in other infectious diseases, war significantly alters DR-TB dynamics in affected countries and bordering or refugee-hosting countries, threatening progress towards TB elimination and exacerbating the global antimicrobial resistance crisis. While innovations have improved the feasibility of DR-TB care in CE, access remains severely constrained. Identified risk factors, challenges and priorities underscore the need for expanded TB support and targeted research, particularly for vulnerable populations in CE scenarios.

BackgroundCellular angiofibroma is a rare, benign mesenchymal tumor most commonly arising in the vulvovaginal region in middle-aged to elderly women. Despite its indolent nature, it is frequently misdiagnosed due to a nonspecific clinical presentation and its resemblance to other vulvar masses.Case reportWe present a case of a 65-year-old postmenopausal woman with a neglected, slowly growing giant pedunculated mass on her left labia majora that developed over 5 years. The patient underwent surgical excision and cosmetic reconstruction, with an uneventful postoperative recovery. Histopathological examination confirmed a benign myxoid spindle cell neoplasm consistent with cellular angiofibroma.Discussion and conclusionThis case highlights the challenges in the diagnosis of cellular angiofibroma owing to the tumor’s often nonspecific presentation and emphasizes the importance of surgical excision as the standard treatment, despite a low reported risk of recurrence even with positive surgical margins.

Pharmacokinetics (PK) is vital for optimizing patient care, yet a gap remains between education and clinical application. This study aimed to evaluate clinical pharmacists’ perspectives on the educational, practical and implementation barriers to PK. This cross-sectional analytical study conveniently surveyed practicing clinical pharmacists in Sudanese hospitals using a self-administered online google form questionnaire. The survey assessed perceptions of PK education, utilization in clinical practice, perceived skill adequacy, difficulty of application, and barriers to PK implementation. A total of 129 clinical pharmacists participated; 118 (91.5%) were female, 58 (45%) were aged 36–40 years, 122 (94.6%) held an MSc in Clinical Pharmacy, and 58 (45%) had under five years of experience. Regarding PK education, 79 (61.2%) reported taking both basic and clinical courses, and 28 (21.7%) received continuing education. The overall median rating of perspectives on PK education was 53% (IQR: 43–60%), with low agreement in terms of importance 13 (10.1%) and relevance 35 (27.1%). Only the nature of the PK course was significantly associated with these perspectives (p = 0.043). Barriers to PK implementation were strongly reflected in participants’ perspectives (median 84%, IQR 76–92%), mainly due to a lack of practical knowledge 110 (85.3%), the absence of role models 99 (76.7%), and poor understanding among clinical pharmacists 112 (86.8%). In practice, 59 (45.7%) used PKs occasionally, 72 (55.8%) reported skill gaps, and the median difficulty rating was 5 (IQR: 2–6). This study reveals a critical gap between PK education and clinical application among Sudanese clinical pharmacists. From the perspective of clinical pharmacists, these findings highlight an urgent need for improved educational approaches and targeted professional development to better integrate PK into patient care.

Hypertensive disorders of pregnancy (HDP) are a major worldwide issue, affecting 5-10% of pregnancies and causing feto-maternal mortality and morbidity. It includes chronic, gestational hypertension, preeclampsia, and chronic hypertension with preeclampsia. The underlying pathophysiology includes aberrant placental perfusion, angiogenic imbalance, endothelial dysfunction, and hereditary susceptibility. Women with HDP face a markedly increased risk of cardiovascular disease, chronic renal disease, and metabolic syndrome, with larger connections than those with gestational diabetes. Measures such as early aspirin prophylaxis, lifestyle modifications, and prompt antihypertensive therapy are beneficial, but adherence remains low. Postpartum monitoring is generally underused, despite its importance in reducing future cardiovascular risk. Addressing these gaps is critical for lowering maternal mortality, avoiding recurring problems, and improving health outcomes.

Acute kidney injury (AKI) is a particularly major complication among patients with acute pancreatitis, which markedly increases the length of hospitalization, morbidity, and mortality. Low serum albumin levels have been associated with disease severity and worse outcomes in various critical illnesses. Accordingly, this meta-analysis was done to assess the association between serum albumin level and AKI in patients with acute pancreatitis.A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was performed in PubMed, Web of Science, and Scopus. Pooled standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated to investigate the difference in albumin values between AKI and non-AKI patient groups.A total of seven studies, including 3,496 patients with acute pancreatitis, were included in the meta-analysis. The results indicate that patients who developed AKI had substantially lower serum albumin concentrations at baseline compared to those who did not develop AKI, with the pooled SMD being -0.55 (95% CI: -0.64 to -0.47; p < 0.001). Assessment of between-study variability demonstrated no significant heterogeneity, and sensitivity analysis confirmed robustness of the results.This meta-analysis demonstrated that hypoalbuminemia could serve as a reliable biomarker for identifying patients at increased risk of kidney injury during the course of acute pancreatitis.

Abstract Background Physiological changes during pregnancy significantly alter drug pharmacokinetics, yet research remains limited due to ethical and methodological challenges. A consolidated overview of the most influential studies is lacking. Objective This study aimed to perform a comprehensive bibliometric and thematic analysis of global research on pharmacokinetic changes during pregnancy from 1971 to 2025, identifying trends, influential contributors, emerging themes, and knowledge gaps. Methods A bibliometric analysis was conducted on October 8th, 2025 using data extracted from the Scopus database for publications between 1971 and 2025. Performance indicators were analyzed using descriptive statistics and correlation analyses. Bibliometrix (R), VOS viewer, and GraphPad Prism were used for bibliometric mapping, co-authorship networks, and thematic clustering. Results A total of 1,391 publications by 8,192 authors across 511 journals were identified, showing an annual growth rate of 6.18% and 18.89% international collaboration. The United States (13%), Italy (5%), and New Zealand (4%) were leading contributors. Clinical Pharmacokinetics was the top journal, while the "University of Washington, Seattle, united states" and "Wolters Kluwer health - Adis, Auckland, New Zealand”, were the most influential institutions. Core keywords included “pregnancy,” “pharmacokinetics,” “HIV,” “epilepsy,” and “therapeutic drug monitoring,” with emerging themes such as “metabolism” and “controlled study.” Thematic evolution revealed a shift from methodological foundations (1971–1988) to clinical applications (1989–2015) and mechanistic approaches (2016–2025). Conclusions Global research on pharmacokinetic changes during pregnancy has grown steadily, transitioning toward model-informed and mechanistic studies. However, the absence of mature motor themes indicates thematic fragmentation. Strengthening international collaboration, advancing physiologically based pharmacokinetic modeling, and expanding studies across diverse populations and drug classes remain priorities to optimize pharmacotherapy in pregnancy.