Background: Tube thoracostomy is a commonly performed procedure to drain fluid or air from the pleural cavity. Despite its common application, there is a notable lack of data concerning the outcomes and complications associated with this procedure in low-resource environments such as Sudan. Aims and Objectives: This study aimed to evaluate tube thoracotomy in Sudan, including the demographic characteristics, indications, complications, and outcomes of tube thoracostomy procedures performed at the Respiratory Care Unit of Shaab Teaching Hospital in Khartoum, Sudan. Materials and Methods: This was a retrospective, descriptive analysis of patients who underwent tube thoracotomy over a six-month period at Respiratory Care Unit of Shaab Teaching Hospital in Khartoum, Sudan. Demographic data, indications, complications, and outcomes were collected from medical records. The Statistical Package for Social Sciences software version 23.0 (SPSS, Chicago, IL, USA) was used to enter and analyze the data. Descriptive and inferential statistics were calculated. Results: The study included revising 77 medical records of patients admitted to the Respiratory Care Unit of Shaab Teaching Hospital, with a mean age of 38.9 years, with a male predominance (61%). The primary indications for the procedures performed were predominantly due to infective causes (71.4% of cases). Followed by the trauma-related causes (19.5%), while other reasons made up 9.1%. Notably, 57.1% of the patients did not encounter any complications. Tube-related issues emerged as the most frequent among those who did, affecting 32.5% of patients. The overall success rate for the procedure was commendably high at 87.0%, with a failure rate recorded at 11.7% and a mortality rate of 1.3%. Moreover, successful drainage was notably more prevalent among patients who underwent procedures lasting less than 14 days, particularly those with infective indications. Conclusions: This study provides valuable insights into the tube thoracostomy experience in the form of demographics, indications, complications, and outcomes of tube thoracostomy in a low-resource setting such as Sudan. The findings highlight the need for early intervention and effective infection control measures to optimize the success of this critical procedure.
Abstract Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening hyperinflammatory syndrome that may mimic severe sepsis, resulting in delayed diagnosis. Bacterial infection-associated HLH is uncommon, particularly with Klebsiella pneumoniae . We report a case of a 38-year-old male presenting with community-acquired pneumonia, persistent fever, pancytopenia, hepatosplenomegaly, and marked hyperferritinemia. Bronchoalveolar lavage culture isolated K. pneumoniae , whereas bone marrow aspiration demonstrated hemophagocytosis. The patient fulfilled five HLH-2004 diagnostic criteria, and the calculated HScore was 209, indicating a high probability of secondary HLH. Initial empirical therapy with intravenous cefoperazone-sulbactam and doxycycline failed to achieve clinical improvement. Following bronchoalveolar lavage culture results, antibiotics were escalated to meropenem and tigecycline, resulting in rapid clinical and hematological recovery without immunosuppressive therapy. This case is unique as recovery was achieved solely with appropriate antimicrobial therapy despite fulfilling diagnostic criteria for HLH. It highlights the importance of early recognition of infection-triggered HLH and emphasizes that prompt treatment of the underlying trigger may prevent unnecessary immunosuppression in selected patients.
Abstract The discipline of anesthesiology has undergone profound transformation over time and is still progressing. However, anesthesiologists still lack ample space in the clinical decision-making process of patient management. Surgeons, hospital owners, and at times primary care physicians dominate their role in preoperative clinics and during recovery. At some places they continue to serve as service providers. This limits their professional autonomy and risks marginalizing their active role within multidisciplinary teams. This perspective argues that anesthesiologists must proactively embrace their identity as clinical decision-makers and central coordinators of the entire surgical continuum. This extends from preoperative risk stratification and physiological optimization through intraoperative homeostasis and postoperative recovery. This transformation is not merely a professional satisfaction but a prerequisite for advancing patient safety, improving perioperative outcomes, and ensuring the specialty’s leadership role in modern healthcare systems.
Abstract Background: Stress and distress are common among undergraduate medical students. It adversely affects the self-efficacy and other personal characteristics. There are many studies from India and abroad related to self-efficacy and perceived stress among undergraduate medical students. However, they either study one factor. Either they studied perceived stress, self-efficacy, or distress. Objective: To study the perceived stress and psychological distress among undergraduate medical students and their association with general self-efficacy (GSE). Materials and Methods: An institution-based cross-sectional study was carried out over a period of 3 months among 430 medical undergraduate students. The Perceived Stress Scale-10 was used to assess the perceived stress. For measuring the coping abilities and self-beliefs, we used the GSE scale. For measurement of psychological distress, we used the General Health Questionnaire-12. Results: Mean age was 20.3 years. There was a strong positive correlation between perceived stress and distress and a weak negative correlation between perceived stress and self-efficacy. Prevalence of high perceived stress, high distress, and low self-efficacy was 29.7%, 17.7%, 7.9%, respectively. Perceived high stress and high distress were significantly associated with 4 th year of medical studies, inadequate sleep, and no exercise. GSE was significantly associated with high perceived stress, high distress, and not doing exercise. Conclusion: Prevalence of high perceived stress, high distress, and low self-efficacy was quite high in these students. First-year students reported high perceived stress. Adequate sleep and regular exercise can reduce the stress and distress and promote self-efficacy.
Abstract Background: Bloodstream infections are deadly, causing multi-organ failure, shock, and death. Treatment depends on the most prevalent microorganisms and antibiotic susceptibility patterns in the area. This knowledge is crucial for starting treatment before culture reports are available. Once the report is available, empirical antibiotic therapy can be initiated. Objective: The objective was to study antibiotic sensitivity patterns in patients with clinically suspected septicemia. Materials and Methods: A 1-year prospective study was conducted among 200 patients with sepsis. Positive blood culture bottles were collected from patients suspected of septicemia. BACTEC 9050 analyzed blood culture samples, following standard guidelines and protocols. BACTEC 9050 analyzed blood culture samples, following standard guidelines and protocols. Results: The most affected age group was 2–10 years (42.5%). Males were more affected (58%) than females. Gram-negative bacilli dominated (87%) over Gram-positive cocci infections. In one-third of cases, blood cultures took 24–72 h to turn positive. The most common microorganism isolated was Salmonella typhi (41%), followed by Klebsiella spp. (27%). Staphylococcus aureus and coagulase-negative Staphylococcus were 100% sensitive to linezolid and vancomycin. Streptococci were 100% sensitive to all antibiotics used. Enterococcus spp. were 100% sensitive to linezolid and teicoplanin. Salmonella spp. (including paratyphi A and B) were 100% sensitive to all except tetracycline and azithromycin. Conclusion: Both Gram-positive and Gram-negative bacteria caused bloodstream infections, many of which were multidrug-resistant, leaving limited treatment options.
