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Dome Osteotomy with a Contoured DCP Plate to Correct Coxa Vara after SCFE in an Overweight Adolescent: Case Report from a Resource-limited Setting
No full textBackground: Coxa vara, defined as a femoral neck–shaft angle <120º, alters hip biomechanics and predisposes adolescents to slipped capital femoral epiphysis (SCFE). Severe coxa vara deformity presents surgical challenges, particularly in resource-limited settings where implant availability is restricted. Dome intertrochanteric osteotomy offers multiplanar correction, preserves limb length, and can be stabilized with widely available implants, making it a preferred option in such contexts.
Case Report: A 14-year-old male (BMI 32.8 kg/m²) with a three-month history of left groin pain radiating to the knee after a fall, had a painless limp since age eight. The exam revealed an antalgic gait, a positive Trendelenburg sign, limited hip motion, and a 4 cm leg-length discrepancy. Radiographs revealed SCFE with coxa vara (neck–shaft 110º left, 135º right; Southwick angles: 18º AP, 38º frog-leg). MRI confirmed epiphyseal slip with a viable femoral head. He underwent dome intertrochanteric valgus osteotomy via lateral approach, fixed with a 9-hole DCP and screw due to the unavailability of locking/blade plates. Post-op, neck–shaft angle improved to 132∘, discrepancy reduced to 1.5 cm, with no complications. Recovery was uneventful; partial weight-bearing for six weeks. At three months, signs of healing; at six months, pain-free ambulation with slight limp and heel lift. CHOHES scores improved from 26 pre-op to 64 at three months and 84 at six months.
Conclusion: Dome osteotomy is a reliable surgical option for correcting SCFE-associated coxa vara and leg-length discrepancy, particularly in resource-poor settings where implant choice is constrained. It provides multiplanar correction, restores the mechanical axis, and preserves limb length. Long-term follow-up remains essential to monitor for avascular necrosis, chondrolysis, or degenerative changes
Anatomical Variations of Celiac Artery: A Scoping Review on the Embryological Basis, Radiological Identification, and Clinical Implications
No full textBackground: The celiac artery, as the first main anterior branch of the abdominal aorta, plays a pivotal role in supplying arterial blood to vital upper abdominal organs. Traditionally described as trifurcating into the splenic, left gastric, and common hepatic arteries, this textbook configuration is not consistently observed in clinical or cadaveric studies. Increasing access to high-resolution imaging and careful anatomical dissections has highlighted the diversity in celiac artery branching patterns. These variations, while often asymptomatic, carry significant implications for surgical, radiologic, and interventional procedures.
Methods: This scoping review aims to provide a detailed, structured exploration of variations in celiac artery anatomy, with emphasis on prevalence across populations, recognized classification systems, embryological development, and associated vascular anomalies. The article also aims to connect theoretical knowledge with applied anatomical relevance, especially for clinicians, radiologists, and surgeons. Special attention is given to the radiological identification of these variants and the importance of recognizing them during surgical planning.
Results: Understanding variations in the celiac artery is essential for anatomy researchers and clinicians alike. These deviations from the classic branching pattern are not merely academic curiosities but also have real-world consequences, particularly in hepatobiliary surgery, organ transplantation, and interventional radiology. By integrating embryological insights, validated prevalence data, and current classification frameworks, this review reinforces the anatomical complexity of the upper abdominal vasculature.
Conclusion: Knowledge of these patterns supports safer surgical approaches, enhances diagnostic accuracy, and underscores the necessity of thorough anatomical education in medical training
Traditional Uses, Phytochemicals, and Pharmacological Effects of Cichorium intybus: A Narrative Review
No full textBackground: Medicinal plants remain an important source of therapeutic agents worldwide. The review compiles the traditional uses, phytochemistry, and pharmacological effects of Cichorium intybus to serve as a valuable guide for researchers and healthcare professionals. This review fills important gaps by bringing together scattered information on C. intybus, offering a clearer and more comprehensive reference than previous studies.
Methods: Data were collected from 2000 to 2025 through extensive searches across multiple databases, including Scopus, Web of Science, Google Scholar, PubMed, and Springer Nature, following PRISMA guidelines.
Results: Traditionally, different parts of the C. intybus were used to cure conditions like gallstones, jaundice, fever, and diarrhea. Previous literature studies have revealed that multiple pharmacological activities have been explored in different parts of the plant, including antidiabetic, anti-inflammatory, anti-ulcerative, and antioxidant activities. Fiftyone studies met the inclusion criteria, including seventeen on traditional uses and phytochemistry, twenty-eight preclinical investigations, and six clinical trials. The phytochemical analysis indicates that the majority of sesquiterpene lactones found in C. intybus are lactucin and lactucopicrin. Moreover, C. intybus contains several important caffeic acid derivatives, most notably caftaric acid, along with isochlorogenic acid, cichoric acid, and chlorogenic acid. Cichorium intybus has been shown to contain additional pharmacologically active compounds, such as proteins, sugars, terpenoids, hydroxycoumarins, alkaloids, sugars, flavonoids, inulin, steroids, and volatile chemicals.
Conclusion: C. intybus is a rich source of various phytochemicals, which are responsible for its therapeutic effects. Future research is necessary to confirm the plant’s efficacy, safety, and its potential in therapeutic applications
Profile of Positive Specific IgE to Food Allergens in Adults and Children at a Sudanese Medical Laboratory: A Descriptive Cross-Sectional Study
No full textBackground: This research aimed to examine the profile of IgE sensitization to food allergens among Sudanese adults and children.
Methods: This descriptive cross-sectional study was conducted in a laboratory in Khartoum State from 2018 to 2020. It included all adults and children with a positive food allergy panel (n = 106). No specific exclusion criteria were used. IgE antibodies against 20 food allergens were detected using the EurolineFoodGulf (IgE) immunoblotting approach. Results were categorized by antibody detection and titer, and compared by gender and age. SPSS v26.0 was used for data analysis, with P < 0.05 considered statistically significant.
Results: Of the 106 participants, 52 (49.1%) were females, and 54 (50.9%) were males. Nut mix, tomato, and peanut allergens showed the highest sensitization rates, with 71 (67%), 60 (56%), and 53 (50%) participants testing positive, respectively. Nut mix was the only allergen to show a statistically significant gender difference (57.7% in females vs. 75.9% in males; χ2 = 4.0, P = 0.046).
Conclusion: The most common allergens were nut mix, tomato, and peanut. There was evidence that age plays a substantial role in the distribution of sensitization. Overall, gender was not associated with sensitization, except for nut mix, for which sensitization was significantly higher in males (P = 0.046). As this research reports sensitization rather than confirmed clinical food allergy, clinical correlation is needed in practice. We recommend establishing allergy clinics and prioritizing testing for the most relevant allergens in Sudan
Management of Spherophakia- or Microspherophakia-associated Mild to Moderate Glaucoma with Lensectomy, Anterior Vitrectomy, and Iris-Claw Intraocular Lens Implantation
No full textPurpose: To report the outcomes of lensectomy, anterior vitrectomy, and iris-claw lens implantation in patients with spherophakia- or microspherophakia-related glaucoma.
Methods: In this retrospective case series, we focused on patients with isolated microspherophakia or microspherophakia associated with various syndromes and mild to moderate angle-closure glaucoma who had undergone lensectomy, anterior vitrectomy, and iris-claw lens implantation.
Results: We analyzed a total of 12 eyes of 6 patients with a mean age of 19 ± 6 years and a mean postoperative follow-up of 66 ± 12 months. All patients had lenticular myopia, and the mean refraction improved from −7.26 ± 0.67 diopters (D) to −1.18 ± 1.04 D after surgery. The mean corrected visual acuity improved from 0.92 ± 0.57 logMAR before surgery to 0.17 ± 0.15 logMAR at the last follow-up (P = 0.001). The mean intraocular pressure (IOP) decreased from 21.2 ± 3.9 mmHg on 1.9 ± 0.7 anti-glaucoma medications at baseline to 15.0 ± 1.5 mmHg (P = 0.006) on 0.8 ± 0.7 medications (P = 0.006) at the last follow-up.
Conclusion: Lensectomy and iris-claw lens implantation in our cases not only decreased the IOP and reduced the number of glaucoma medications, but also improved the best-corrected visual acuity. Removal of the abnormally shaped lens likely contributed to these changes
Disposable Diaper Overuse and Nocturnal Enuresis in School-aged Children: A Hospital-based Case–Control Study in Eastern Sudan
No full textBackground: Disposable diaper (DD) overuse is defined as the use of diapers after age two, which can affect toilet training (TT) and may result in nocturnal enuresis.
Methods: This hospital-based case–control study was conducted at Kassala Teaching Hospital in Eastern Sudan. The main adjusted odds ratio (OR) for DD overuse with a 95% confidence interval (CI) was calculated. The sample consisted of 150 children with nocturnal enuresis (case group) and 150 healthy children (control group), all recruited from the same population during the same period.
Results: The study identified several predictors of nocturnal enuresis, including difficulty waking from sleep (OR = 2.4; CI = 1.4–4.1; P = 0.001), family history of enuresis (OR = 2.6; CI = 1.5–4.4; P = 0.000), lack of TT (OR = 2.0; CI = 1.2–3.5; P = 0.006), delayed age of TT initiation (OR = 1.2; CI = 1.04–1.3; P = 0.002), and DD overuse (OR = 12.9; CI = 7.4–22.5; P = 0.000).
Conclusion: This study found that excessive use of DDs and other factors—such as difficulty waking from sleep, family history of nocturnal enuresis, lack of TT, and delayed age of TT—are linked to nocturnal enuresis among Sudanese children
Association Between Glaucoma and Mental Health Disorders Based on a Large National Database
No full textPurpose: To investigate the association between glaucoma and various mental health disorders and to examine whether there were indications of effect measure modification of this association in Black compared to Non-Black populations.
Methods: The study included 65,140 individuals from the Medical Expenditure Panel Survey database, with an in-depth focus on 15,016 patients suffering from glaucoma or specific mental health disorders. We included patients aged 18 and above diagnosed with glaucoma or specific mental health disorders based on International Classification of Diseases codes from 2017 to 2020.
Results: Out of the 65,140 patients, 1492, 6359, 5756, 786, and 209 were diagnosed with glaucoma, anxiety, major depressive disorder (MDD), bipolar disorder, and schizophrenia, respectively. Of the 1492 glaucoma patients, 196 (13.2%) were diagnosed with anxiety, 183 (12.2%) with MDD, 20 (1.3%) with bipolar, and 15 (1%) with schizophrenia. The unadjusted OR (95% CI) was calculated for the association between glaucoma and anxiety (OR = 1.36 [1.17-1.58]) P < 0.001), glaucoma and MDD (OR = 1.4 [1.20-164], P < 0.001), glaucoma and bipolar (OR = 1.08 [0.69-1.6], P = 0.71), and glaucoma and schizophrenia and (OR = 3.08 [1.82-5.21], P < 0.001). After adjustment for confounding factors, the association between glaucoma and anxiety, glaucoma and MDD, and glaucoma and schizophrenia remained statistically significant. Furthermore, for this association after interaction analysis, the interaction term of glaucoma and race with MDD (OR = 1.02 [0.6-1.5], P = 0.9), anxiety (OR = 0.64 [0.39-1], P = 0.069), and schizophrenia (OR = 2.8 [0.9-8.6], P = 0.9) didn’t yield a significant evidence of effect measure modifications in Black compared to Non-Black groups after Bonferroni correction.
Conclusion: There was a statistically significant association between glaucoma and MDD, anxiety, and schizophrenia. However, for this association, there was no significant evidence of effect measure modifications in Black compared to Non-Black populations
Effectiveness of Neurology Consultations: Comparing Emergency and Inpatient Requests
No full textBackground: Neurological symptoms account for a significant portion of emergency department (ED) visits. Neurological evaluation may be needed in 8–15% of ED admissions. In this study, neurology consultation requests from emergency and other inpatient services are analyzed to determine the workload of the neurology consultation service.
Methods: This was a retrospective, 13-week audit of 373 neurology consultations performed between December 1, 2019, and February 29, 2020. Both emergency and inpatient referrals were evaluated, and each case was categorized by urgency level.
Results: The majority of ED consultations were classified as “Urgent” (n = 135 [61.09%]). Almost all consultations classified as “Very urgent” were requested from the ED (n = 19 [95%]). Consultations classified as “Elective” were least likely to be requested from the ED (n = 40 [18.1%]; P < 0.01). While the highest level of concordance between the neurologist and the requesting physician’s preliminary diagnoses was observed in the most Urgent cases (n = 149 [68.3%]), the highest level of inconsistency was observed in the Elective cases (n = 59 [46.8%]). Urgent or Very urgent cases were significantly more frequent in ED consultations (69.7%, 95% CI: 63.3–75.4) compared to non-ED consultations (36.2%, 95% CI: 28.9–44.1). Diagnostic concordance was highest in Urgent cases (68.3%, 95% CI: 61.9–74.1).
Conclusion: A non-neurologist physician can recognize an Urgent and a Very urgent situation, but the workload of the neurologist increases in non-primary neurological or elective situations. The fact that no management changes were made in 29.6% of the patients indicates the extent of unnecessary workload and costs
Association Between Preoperative Negative Emotional States and Eye Movement During Photorefractive Keratectomy
No full textPurpose: To describe the link between negative emotions—depression, anxiety, and stress—and eye movement during photorefractive keratectomy (PRK).
Methods: This comparative case series was conducted on 53 PRK candidates and involved completing the Depression, Anxiety, and Stress Scale (DASS-21) before surgery. Eye movement, measured as the radial distance between the pupil and laser center during each shot, was analyzed. Average distance indicated centralization accuracy, while standard deviation (SD) indicated precision. Stress, depression, anxiety, and their relationship with eye movement during PRK were studied.
Results: The mean and SD of eye movements were not significantly correlated with depression, anxiety, stress, or the total DASS-21 score. A weak negative correlation was observed between the preoperative spherical equivalent (SE) and stress (r = –0.305, P = 0.004), anxiety (r = –0.401, P < 0.001), and total DASS-21 scores (r = –0.324, P = 0.002). Lastly, a weak positive correlation was found between ablation time and the SD of eye movement (r = 0.473, P < 0.001).
Conclusion: The DASS-21 questionnaire showed no link between negative emotions and eye movement. Additionally, longer ablation times correlated with greater SD of eye movement
Potential Links Between Coagulation Disorders and Mycetoma in Sudan: An Expert Commentary
No full textMycetoma is one of the neglected diseases with a high burden in Sudan. Its clinical characteristics, chronic, progressive, tumefaction with discharge from sinuses, have been documented for decades. Nevertheless, despite its widely reported cutaneous and musculoskeletal effects, it has not historically received significant consideration for its systemic effects or potential actions related to the coagulation system until now. Drawing from personal clinical observations and relevant experience with similar chronic infections, the hypothesis of mycetoma association with derangement of hemostasis is discussed for Sudanese patients. Knowledge of this relationship could greatly influence surgical decision-making and associated patient safety in endemic areas where both material and financial resources are scarce. The expert commentary aimed to describe the possible connection between mycetoma and blood clotting problems, look at indirect evidence from similar illnesses, and provide practical clinical and research suggestions for areas where mycetoma is common but resources are limited. It’s based on the authors' clinical findings and a targeted, non-systematic literature review conducted on PubMed and Google Scholar, and has the potential to significantly impact future research. While the Mycetoma Research Center (MRC) has managed more than 12,000 patients, direct hemostatic profiling data from this group are not yet accessible, which is a gap this study aims to emphasize