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BackgroundFragility fractures caused by osteoporosis are known to increase the risk of further fragility fractures. Also, several factors have been associated with an increasing risk of fracture in postmenopausal women with osteoporosis, as prior fracture, advancing age, low bone mineral density (BMD), greater risk or history of falls certain, pharmacologic therapies such as glucocorticoids, and medical conditions increase the risk of secondary osteoporosis and related fractures through their direct impact on bone density or structure. Menstrual history including age at menarche menopause and a history of amenorrhea is documented as a predicting osteoporotic fracture.ObjectiveThe aim of the current study is to find the proportion of hidden vertebral fractures among Egyptian females with fragility hip fracture.Patients and methodsA cross-sectional study was conducted on patients who presented to the orthopedic emergency room (ER) of Ain Shams University Hospitals in Cairo, Egypt, from September 2020 to September 2021. Our inclusion criteria include females aged 40 years or older, who presented to the ER with fragility hip fractures. A simple random sample of females fulfilling our inclusion criteria for osteoporotic hip fracture was thoroughly investigated. Conventional lateral and anteroposterior radiographs of the dorsolumbar spine were obtained excluding those with high-impact fractures or pathological fractures.ResultsDuring the study period, a total of 43,935 persons presented to the orthopedic ER, of whom 30,901 were females, comprising 70.03% of total orthopedic ER visits. A sample of 150 females met our inclusion criteria. Results showed that 16 of our 150 cases had concomitant vertebral fracture, meaning that 10.7% of cases had hidden vertebral fracture at the time of osteoporotic hip fracture, as diagnosed by the screening lumbosacral plain X-rays. Older age at menarche, younger age at menopause, and amenorrhea are shown to be risk factors for hidden vertebral fracture in Egyptian females.ConclusionOsteoporosis is a complex and costly disease. Osteoporotic fractures may be largely preventable, as environmental factors are open to intervention, and effective pharmacological agents are available. Concomitant hidden vertebral fracture is prevalent among females with osteoporotic hip fractures, and those who had later menarche, earlier menopause, and menstrual irregularities have a higher incidence of developing associated vertebral fracture, which warrants identification and management to evade complications and mortality.

Sudanese students seem to lack proficiency in writing English. In addition, teachers continue to use traditional, teacher-centered methods in teaching English as a second language (ESL). The flipped learning (FL) approach where video lectures are assigned as online homework before class, followed by learning activities during class, might be able to address the issue of the lack of proficiency in writing. A module for teaching English paragraph-writing using FL for Sudanese students in Secondary Year 1 was developed. The purpose of this study is to investigate the effects of this module on students’ writing proficiency and their satisfaction with the module. An exploratory-implementation study was conducted with 28 student volunteers in two groups, in which only one group used the module. The analysis of data collected from tests, focus group interviews and online interactions indicated that there was improvement in the students’ writing proficiency, and satisfaction, based on their engagement and interaction, with the module. In future, further studies can be done to determine if the module which used the FL approach, could be implemented on a larger scale in Sudan, and extended for other topics in ESL in other countries.

Background Surgical site infections (SSIs) are a critical concern in healthcare, particularly in developing countries, where they are among the most prevalent and challenging hospital-acquired infections. Adherence to proper hand hygiene practices is essential to prevent SSIs. However, compliance among surgical teams remains suboptimal due to factors such as time constraints, lack of training, and resource limitations. This study evaluates and enhances adherence to surgical hand scrubbing protocols at Osman Degna Teaching Hospital using World Health Organization (WHO) guidelines. Methods An observational cross-sectional audit was conducted in two cycles between August and October 2024, with 54 observations per cycle. Baseline adherence was assessed in the first cycle. Targeted interventions, including video demonstrations, hands-on training, and feedback, were implemented before the second cycle. Data were collected using a structured checklist and analyzed quantitatively to compare compliance rates and qualitatively to identify barriers to adherence. Results Compliance with hand scrubbing protocols improved significantly from 63.1% in the first cycle to 94.3% in the second. The most notable improvement (51.5%) was observed in rotational rubbing with clasped fingers. Other areas, including scrubbing palms and rinsing hands, showed substantial increases (30.3-42%). These findings highlight the effectiveness of structured training and feedback in enhancing adherence. Conclusion Targeted educational interventions significantly improved compliance with surgical hand scrubbing protocols, contributing to better infection control practices. While these improvements demonstrate the potential of training programs, continued efforts and long-term strategies are necessary to sustain progress and further reduce the risk of SSIs.

Background Clinical audits serve as a critical tool for quality improvement, evaluating current practices to enhance patient care. Radiology request forms (RRFs) are essential for accurate diagnosis and treatment but often face challenges like incomplete or inaccurate information, illegibility, and non-compliance with established guidelines. This audit aimed to assess the adequacy of RRF completion at Othman Digna Teaching Hospital, Sudan, and implement interventions to improve compliance with guidelines. Materials and methods A prospective audit was conducted between November and December 2024. The first cycle involved assessing 50 randomly selected RRFs for adherence to the Royal College of Radiologists (RCR) guidelines. Interventions included introducing standardized forms and providing physician training. A second cycle of 50 RRFs was evaluated post-intervention. Data were analyzed using descriptive statistics and graphical representations. Results Compliance with eight key standards improved significantly post-intervention. Patient name compliance increased from 98% to 100%, while patient age rose from 12% to 98%. The inclusion of clinical background details and the question to be answered both reached 100% from initial rates of 16% and 4%, respectively. Overall mean compliance improved from 26% to 95.5%. Conclusions The study demonstrated significant improvements in the completion of RRFs following targeted interventions. Regular audits, standardized procedures, and continuous training are essential to sustaining compliance and improving communication between clinicians and radiologists, ultimately enhancing patient care.

New excavations at the Jebel Moya cemetery in Sudan reveal extensive evidence for Meroitic-era occupation, providing valuable data on contemporaneous diet, migration, exchange and population composition in sub-Saharan Africa.

Trimetallic nanoparticles (TMNPs) have emerged as a pivotal area of research due to their unique properties and diverse applications across medicine, agriculture, and environmental sciences. This review provides several novel contributions that distinguish it from existing literature on trimetallic nanoparticles (TMNPs). Firstly, it offers a focused exploration of TMNPs, specifically addressing their unique properties and applications, which have been less examined compared to other multimetallic nanoparticles. This targeted analysis fills a significant gap in current research. Secondly, the review emphasizes innovative biosynthesis methods utilizing microorganisms and plant extracts, positioning these green synthesis approaches as environmentally friendly alternatives to traditional chemical methods. This focus aligns with the increasing demand for sustainable practices in nanotechnology. Furthermore, the review integrates discussions on both medical and agricultural applications of TMNPs, highlighting their multifunctional potential across diverse fields. This comprehensive perspective enhances our understanding of how TMNPs can address various challenges. Additionally, the review explores the synergistic effects among the different metals in TMNPs, providing insights into how these interactions can be harnessed to optimize their properties for specific applications. Such discussions are often overlooked in existing studies. Moreover, this review identifies critical research gaps and challenges within the field, outlining future directions that encourage further investigation and innovation in TMNP development. By doing so, it proactively contributes to advancing the field. Finally, the review advocates for interdisciplinary collaboration among material scientists, biologists, and environmental scientists, emphasizing the importance of diverse expertise in enhancing the research and application of TMNPs.

This study addresses the urgent need for culturally sensitive cognitive assessments in Egypt by validating an adapted version of Harmonized Cognitive Assessment Protocol (HCAP) to the Egyptian context. This version is to be used as a part of the Egyptian Aging Survey (AL-SEHA). We enrolled 300 participants aged 55 + from diverse backgrounds and meticulously adapted the HCAP for Egypt's linguistic and cultural context. Demonstrating strong reliability and validity (sensitivity 87.6%, specificity 89.2%, accuracy 89.7%), the Egyptian HCAP effectively identified cognitive impairment. Integrated into the AL-SEHA, this validated HCAP offers valuable insights on cognitive function decline in Egypt's aging population. Our findings not only contribute to global understanding of cognitive health but also set a precedent for future cross-cultural HCAP validations, informing policies and early diagnosis for dementia care.

Soft tissue mechanical properties are strongly linked to physiology and pathology.Shear wave elastography (SWE) is used to reconstruct soft tissue mechanical properties by observing and processing shear wave motion that is commonly induced after application of an acoustic radiation force (ARF). Despite the successful application of SWE in imaging different diseases and organs, there are still several hardware and/or software limitations associated with any SWE method. For example, the mainstream SWE modalities are limited to two dimensional imaging. This is because conventional ultrasound (US) devices detect motions only in a plane. However, 2D imaging does not account for the out-of-plane scattering and does not provide a complete picture of the tissue’s geometrical and mechanical properties.Also, most of the existing SWE techniques assuming local homogeneity for convenient wave speed calculations, thus neglecting the reflections which may cause loss of important information. In addition, many existing SWE algorithms assume directional waves with local plane wave approximation. These assumptions are often violated in most circumstances involving heterogeneities. Moreover, the objective functions of the underlying reconstruction algorithms are often highly nonlinear. Also, acoustic radiation force signature and amplitude are not precisely known, thus any reconstruction algorithm that is dependent of ARF signature and amplitude would result in erroneous reconstruction. Also, it is well established that human soft tissues are viscoelastic in nature. Several existing algorithms are limited to elasticity reconstruction. However, there is increasing evidence that soft tissue viscosity can add valuable information to disease diagnosis. Motivated by the hardware and software limitations of SWE technology, in this work we address most of the challenges with an overarching goal of reconstructing 3D maps from 2D measurements (conventional SWE devices). We have approached this in a step-by-step fashion and provide several methodologies and approaches for mitigating each of them.Specifically, we first present a new reconstruction framework based on PDE constrained optimization for quantitatively evaluating soft tissue stiffness, which has the following features: (a) there is no assumption made about direction of shear wave propagation,(b) incorporates the effects of all reflections and scattering, (c) has better behaving objective function e.g., less nonlinear compared to the traditional objective functions, (d) robust even with few measurements and (e) not dependent on the ARF signature and amplitude. Ther obustness of the framework is tested in reconstruction of 2D images using synthetically generated SW motions.We then extend the new framework for reconstruction of not only the elasticity but also the viscosity map of soft tissue, by inverting the anti-plane shear visco elastic wave equation in two dimensions. We introduced several techniques to improve the reconstructed images, e.g.,multi-resolution and multi-acquisition imaging. We tested these methodologies on several different digital phantoms.We then validate the new framework using two phantom data sets of different mechanical properties. The data is acquired in three measurement planes after application of acoustic pushes, one at a time, with 3 mm between each. Only measurements at the depth of the push focus are considered, resulting in one line of measurements per plane. The three lines of measurements were then used for successfully reconstructing the out-of-plane 2D elasticity map.

BackgroundAchieving recommended calories and protein is important for critical care patients to enhance their recovery from critical illness.1 Hamad Medical Corporation guidelines2 recommend providing a minimum of 80% of the recommended calories and a minimum protein of around 1.2 gm/kg/day 72 hours after initiation of nutrition. As per audit of patients receiving enteral nutrition, conducted in March-April 2022, 43% of them did not achieve 80% of their calorie and protein requirements after 72 hours of starting enteral nutrition. The aim of this project was to achieve 80% of recommended calories (25Kcal/Kg) and recommended proteins (1.2 gm/kg) in 80% of Surgical Intensive Care Unit (SICU) patients within 72 hours after starting enteral nutrition, by December 31, 2023.MethodsAll patients who are eligible for enteral nutrition on admission are initiated on enteral nutrition within 48 hours. A Dietician consultation occurs after initiation of enteral nutrition. A default type and rate of feeding was ordered by the physician and a physician champion was assigned to monitor nutrition practices. Feeding interruptions were reduced as much as possible. A Surgical Intensive Care Unit (SICU) enteral nutrition order set was designed and implemented.ResultsFeeding initiation was achieved in 100% of eligible patients (figure 1). Consultation to dietician was ordered in 80% of patients and 100% of those were reviewed by a dietician. The dietician compared nutritional status with the recommended guidelines. In 100% of patients, feeding goals including calories and proteins were achieved after introduction of SICU enteral feeding order set which commenced in November 2023 (figure 2).ConclusionBy implementing practice changing ideas like reducing feed interruption, use of order sets incorporating consult to dietician and ordering proper feed type and rate, the nutritional goals were achieved.Abstract 57 Figure 1Percentage of eligible patients started on enteral feeding within 48 hours[Figure omitted. See PDF]Abstract 57 Figure 2Percentage of patients who achieved nutritional goals within 72 hours[Figure omitted. See PDF]ReferencesSinger P, Blaser AR, Berger MM, Alhazzani W, Calder PC, Casaer MP, Hiesmayr M, Mayer K, Montejo JC, Pichard C, Preiser JC, van Zanten ARH, Oczkowski S, Szczeklik W, Bischoff SC. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 2019;38(1):48–79. doi: 10.1016/j.clnu.2018.08.037Clinical Practice Guideline-Nutrition in adult Intensive care (CG10161). https://itawasol.hamad.qa/EN/How%20We%20Work/Clinical-Guidelines/Clinical%20Guidelines/Nutrition%20in%20Adult%20Intensive%20Care.pdfEthical Approval/IRB StatementThis is a Quality project approved and sponsored by the Director of SICU and the Assistant Director of Nursing, Hamad General Hospital, Doha, Qatar.Disclosures and AcknowledgmentsThe authors report no disclosures or conflict of interest