The current novel coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).COVID-19 is presenting a significant challenges to the surgical specialties specifically otolaryngologists and head and neck specialties those are dealing with upper airway such as larynx, trachea, and bronchus. The traditional airway procedure like microlaryngeal surgery, tracheostomy, and bronchoscopy are highly aerosol generating surgery often managed by otolaryngologists. The laryngotracheobronchial airway has a high viral density and so it is expected to expel more transmission of the infections in COVID-19 pandemic. This is why the otolaryngologists or laryngologists are more vulnerable medical professional in this dreaded pandemic. Surgeons have high risk for getting the infections during examinations or surgical procedure on the laryngotracheobronchial airway. The surgical interventions should adopt adequate precautions to limit the viral dissemination. Effective management of the suspicious or positive cases of COVID-19 required careful consideration for the safety of the surgeons and associated team members for ensuring the best possible care of the patients. This review article will provide an overview of common methods to limit the viral transmission to the otolaryngologists/surgeons and assisting health care staffs from COVID-19 infections during management of the laryngotracheobronchial airway.

Background: Deep venous thrombosis (DVT) considered a common emergent condition with life-threatening complications that require rapid intervention with an effective antithrombotic drug regimen; for that, this study was conducted. The current study aimed to evaluate the use and outcomes of heparins in treating acute DVT at selected hospitals in Khartoum state. Methods: A descriptive retrospective, hospital-based study was conducted in different hospitals at Khartoum state from July 2016 to July 2017. The sample size was 147 participants. Data were collected using a well-designed data collection form and analyzed with the Statistical Package for the Social Sciences. Results: A total of 147 DVT patients were included, most of them (77.6%) were females, and 49.8% of them were old and aged more than 60 years. The patients with a past medical history of major surgery were represented 27.9%. Low-molecular-weight heparins (LMWHs) were the most prescribed drugs (74.1%), of which enoxaparin at a dose of 6000 IU twice per day is the most frequently prescribed in 32% of the patients. LMWHs were shown to achieve their therapeutic goal of activated partial thromboplastin time earlier compared with unfractionated heparin (UFH). Enoxaparin 6000 IU twice daily was the most suitable regimen, since it achieved its therapeutic goal within 3 days and maintained it for up to 5 days. 86.1% of the patients were discharged to their homes, whereas 12.9% were dead, and the percentage of death increased with advanced age. Conclusions: Past medical history of major surgery and advanced age were the major risk factors of DVT. LMWHs are the most frequently used drugs and were more effective than UFH, and enoxaparin 6000 IU twice per day was the most suitable regimen as a fixed dose for adults.

Background: Fibroid is the most frequently recorded benign, monoclonal smooth muscle tumor of the uterus, affecting 20%–60% women of reproductive age. Being remarkably common, fibroids are an important health concern. Fibroids are the most frequent indication for the performance of hysterectomy. The health-care consequences of these tumors are substantial both for the mother as well as the fetus. Objective: The objective is to study the obstetric outcome in pregnancies complicated with uterine fibroids. Materials and Methods: This is an observational study conducted in the Department of Obstetrics and Gynaecology, SKIMS, Soura, Srinagar, from May 2019 to February 2020. A prospective evaluation of a series of 28 antenatal patients presenting with fibroids (>1 cm), who delivered in our hospital was done. Maternal age, parity, size of fibroid, type of fibroid, complications during pregnancy, and mode of delivery were noted. Ultrasonogram was done at booking visit and during subsequent visits to assess the size of the fibroid and degeneration. Obstetric outcome was assessed in terms of abortion, premature delivery, malpresentation, abruption, postpartum hemorrhage (PPH), subinvolution, and puerperal pyrexia. Fetal outcome was assessed in terms of intrauterine growth retardation (IUGR), low-birth weight, and neonatal intensive care unit (NICU) admissions. Results: Majority of the patients belonged to the age group of 25–29 years (35.7%), majority 19 (67.9%) were multigravida, most 17 (60.7%) of the fibroids were >3 cm in size. There were 2 (7.1%) cases of miscarriage, 6 (21.4%) cases of malpresentation, abruption in 2 (7.1%) cases, 3 (10.7%) had PPH and only 1 (3.6%) needed blood transfusion. A total of 18 (69.2%) patients delivered by lower segment caesarean section and 8 (30.7%) had vaginal delivery. Of 26 babies, 6 (23.1%) had low-birthweight, 2 (7.7%) were IUGR and there were 2 (7.7%) NICU admissions. Conclusion: Even though most of the fibroids in pregnancy are asymptomatic but such pregnancies should be considered as high risk pregnancies. Hence, pregnancy has to be cautiously screened in the antenatal period, through regular follow-up, to detect any adverse obstetric complications thereby improving fetomaternal outcome. Our study also suggests that reduction in fibroid size pre-pregnancy may play a vital role in preventing maternal and fetal complications which became inevitable once pregnancy reaches advanced gestation.

Objective: The objective of this study was to assess the accuracy of radiographic Singh index (SI) with respect to dual-energy X-ray absorptiometry (DEXA) scan in diagnosing osteoporosis. Materials and Methods: We conducted a cross-sectional study on 100 postmenopausal women in the Department of Radiodiagnosis, SKIMS, Soura, Srinagar, from June 2019 to December 2019. We obtained right or left standard anteroposterior hip radiograph in each patient and compared its SI grade to the densitometry results obtained from the DEXA study of the corresponding hip. Results: Out of the selected patients, 7% had DEXA bone mineral density (BMD) values in normal range (T-score ≤1), 81% in osteopenic range (T-score >1.00–<2.5), and 12% in osteoporotic range (T-score ≥2.5). There was no statistically significant correlation (r = −0.108, P = 0.286) between SI grade and WHO BMD category (normal, osteopenia, or osteoporosis). There was no statistically significant correlation (r = 0.191, P = 0.057) between the SI grade and the mean absolute DEXA BMD value. There was also no statistically significant correlation (r = −0.195, P = 0.052) between SI grade and mean DEXA T-score. Conclusion: Our study found a poor correlation between radiographic SI and DEXA densitometry results. We concluded that the SI cannot be used as a substitute for DEXA study in diagnosing osteoporosis.

Background: Renal anemia is a cause of significant morbidity, and to lesser extent mortality in patients with chronic kidney disease (CKD), the leading causes of anemia in CKD primarily are the lack of erythropoietin (EPO) and iron. Thus, effective management is possible using oral and intravenous (IV) iron preparation and genetically engineered erythropoiesis-stimulating agents such as EPO. This study aimed to assess the effect of EPO in the treatment of anemia among hemodialysis (HD) patients. Methods: A descriptive, retrospective hospital-based study was conducted in Elshaheeda Salma Hospital, Khartoum, Sudan. All patients who were anemic or had a history of anemia and undergoing HD during the period (January to June 2018) were recruited. Data were collected using a checklist and analyzed with the Statistical Package for the Social Sciences software. Results: A total of 191 anemic patients were included: 60% of them were males, and more than half of the participants were aged between 41 and 65 years. Clinically, the average duration of the dialysis among participants was 7.7 ± 5 years, and 97% of them had two dialysis sessions per week. Patients were used either IV or subcutaneous injection of EPO. 8000 IU/week were the most prescribed (52.2%) EPO dose. Whereas, only 6% and 18% were taking 100 mg IV and 150 mg oral ferrous sulfate, respectively. Furthermore, 70% of them were taking 5 mg folic acid. Moreover, the mean hemoglobin level among the participants at the end of the study was 10 ± 2.1 g/dl. Conclusion: EPO was effective in treating renal anemia in HD patients. Among the studied patients, 8000 IU/week was the most frequently used dose. The present study highlights significant low adherence to international guidelines in the management of anemia in patients on HD.

The ongoing Corona Virus Disease-2019 (COVID-19) outbreak has already been given a Pandemic status and also continues to be a public health emergency of international concern. The epidemiological analysis and the trends of mortality clearly suggests that even though, the disease is quite common in all age-groups, the disease has manifested in severe forms among elderly and those people who are having pre-existing medical illnesses. It is the need of the hour to ensure that both these high-risk groups are offered additional attention, without subjecting them to isolation or stigmatization, which decreases their overall probability of access to health care services. Further, it is extremely important to strengthen the risk communication mechanism and take appropriate steps for the relay of timely and trustworthy measures to the entire community, with special attention to the two high-risk groups. In conclusion, as the COVID-19 continues to increase in magnitude and geographical distribution, it is our responsibility to take appropriate steps to improve the wellbeing of community, with an additional support to the high-risk population groups.