Management Challenges Research Articles

A blockchain‐based secure framework for data management

AbstractData management is a crucial requirement due to the autonomous and constrained nature of Unmanned Aerial Vehicles (UAVs), Internet of Things (IoTs), and the aviation domain. The autonomous and restricted nature of these sectors increases the need for a shared, distributed database, strong access control management, consensus in autonomous decision‐making, and effective communication across diverse protocols and devices. This research presents a comprehensive approach and offers a new viewpoint to the field of blockchain while establishing a fundamental baseline for future improvements in data management systems and addressing the shortcomings of previously proposed existing frameworks in order to fulfill the complex needs of secure data management. This study contributes to the advancement of secure and efficient data management systems by implementing robust data monitoring for error detection, ensuring data integrity, and enabling encrypted or anonymous data sharing based on sensitivity levels. Additionally, the integration of diverse devices, enforcement of immutable regulations compliance, and development of permissioned blockchain systems for identity management further enhance the system's capabilities, offering comprehensive solutions for modern data management challenges. In the tests, the proposed framework showed increased successful transactions in all rate controllers. Besides, effect of the validator number on throughput and latency is tested and analyzed thoroughly.

A distributed algorithm with network‐independent step‐size and event‐triggered mechanism for economic dispatch problem

AbstractThe economic dispatch problem (EDP) poses a significant challenge in energy management for modern power systems, particularly as these systems undergo expansion. This growth escalates the demand for communication resources and increases the risk of communication failures. To address this challenge, we propose a distributed algorithm with network‐independent step sizes and an event‐triggered mechanism, which reduces communication requirements and enhances adaptability. Unlike traditional methods, our algorithm uses network‐independent step sizes derived from each agent's local cost functions, thus eliminating the need for detailed network topology knowledge. The theoretical derivation identifies a range of step size values that depend solely on the objective function's strong convexity and the gradient's Lipschitz continuity. Furthermore, the proposed algorithm is shown to achieve a linear convergence rate, assuming the event triggering threshold criteria are met for linear convergence. Numerical experiments further validate the effectiveness and advantages of our proposed distributed algorithm by demonstrating its ability to maintain good convergence characteristics while reducing communication frequency.

Discovery of novel small molecules targeting the USP21/JAK2/STAT3 axis for the treatment of triple-negative breast cancer

The deficiency in available targeted agents and frequency of chemoresistance are primary challenges in clinical management of triple-negative breast cancer (TNBC). The aberrant expression of USP21 and JAK2 represents a characterized mechanism of TNBC progression and resistance to paclitaxel (PTX). Despite its clear that high expression of USP21-mediated de-ubiquitination leads to increased levels of JAK2 protein, we lack regulator molecules to dissect the mechanisms that the interaction between USP21 and JAK2 contributes to the phenotype and resistance of TNBC. Here, we report a USP21/JAK2/STAT3 axis-targeting regulator 13c featuring a N-anthraniloyl tryptamine scaffold that showed excellent anti-TNBC potency and promising safety profile. Importantly, the therapeutic potential of using 13c in combination with PTX in PTX-resistant TNBC was demonstrated. This study showcases N-anthraniloyl tryptamine derivatives as a novel anti-TNBC chemotype with a pharmacological mode of action targeting the USP21/JAK2/STAT3 axis and provides a potential therapeutic target for the treatment of TNBC.

Probabilistic modeling of renewable energy sources in smart grids: A stochastic optimization perspective

Machine learning (ML) techniques have emerged as powerful tools for optimizing renewable energy management in smart grids. This paper focuses on the application of ML algorithms to enhance the efficiency and reliability of renewable energy integration within smart grid systems. By leveraging predictive analytics, ML models can forecast energy production and consumption patterns, facilitating proactive decision-making for grid operators and energy stakeholders. The abstract explores various ML methodologies such as supervised learning, unsupervised learning, and reinforcement learning, tailored to address specific challenges in renewable energy management. Supervised learning algorithms enable accurate prediction of renewable energy generation, aiding in resource allocation and demand-response strategies. Unsupervised learning techniques facilitate anomaly detection and clustering of energy consumption patterns, contributing to grid stability and optimization. Reinforcement learning algorithms optimize control strategies, enabling autonomous decision-making in dynamic grid environments. The abstract highlights case studies and real-world implementations where ML techniques have demonstrated significant improvements in renewable energy integration, grid reliability, and cost-effectiveness. Through a synthesis of research findings and practical insights, this abstract elucidates the transformative potential of machine learning in shaping the future of smart grids and renewable energy management.

Considerations and challenges in support of science and communication of fish consumption advisories for per- and polyfluoroalkyl substances.

Federal, state, tribal, or local entities in the United States issue fish consumption advisories (FCAs) as guidance for safer consumption of locally caught fish containing contaminants. Fish consumption advisories have been developed for commonly detected compounds such as mercury and polychlorinated biphenyls. The existing national guidance does not specifically address the unique challenges associated with bioaccumulation and consumption risk related to per- and polyfluoroalkyl substances (PFAS). As a result, several states have derived their own PFAS-related consumption guidelines, many of which focus on one frequently detected PFAS, known as perfluorooctane sulfonic acid (PFOS). However, there can be significant variation between tissue concentrations or trigger concentrations (TCs) of PFOS that support the individual state-issued FCAs. This variation in TCs can create challenges for risk assessors and risk communicators in their efforts to protect public health. The objective of this article is to review existing challenges, knowledge gaps, and needs related to issuing PFAS-related FCAs and to provide key considerations for the development of protective fish consumption guidance. The current state of the science and variability in FCA derivation, considerations for sampling and analytical methodologies, risk management, risk communication, and policy challenges are discussed. How to best address PFAS mixtures in the development of FCAs, in risk assessment, and establishment of effect thresholds remains a major challenge, as well as a source of uncertainty and scrutiny. This includes developments better elucidating toxicity factors, exposures to PFAS mixtures, community fish consumption behaviors, and evolving technology and analytical instrumentation, methods, and the associated detection limits. Given the evolving science and public interests informing PFAS-related FCAs, continued review and revision of FCA approaches and best practices are vital. Nonetheless, consistent, widely applicable, PFAS-specific approaches informing methods, critical concentration thresholds, and priority compounds may assist practitioners in PFAS-related FCA development and possibly reduce variability between states and jurisdictions. Integr Environ Assess Manag 2024;00:1-20. © 2024 SETAC.

Intelligent optimal layout of drainage pipe network monitoring points based on information entropy theory

The rapid expansion of urban drainage pipe networks, driven by economic development, poses significant challenges for efficient monitoring and management. The complexity and scale of these networks make it difficult to effectively monitor and manage the discharge of urban domestic sewage, rainwater, and industrial effluents, leading to illegal discharges, leakage, environmental pollution, and economic losses. Efficient management relies on a rational layout of drainage pipe network monitoring points. However, existing research on optimal monitoring point layout is limited, primarily relying on manual analysis and fuzzy clustering methods, which are prone to human bias and ineffective monitoring data. To address these limitations, this study proposes a coupled model approach for the automatic optimization of monitoring point placement in drainage pipe networks. The proposed model integrates the information entropy index, Bayesian reasoning, the Monte Carlo method, and the stormwater management model (SWMM) to optimize monitoring point placement objectively and measurably. The information entropy algorithm is utilized to quantify the uncertainty and complexity of the drainage pipe network, facilitating the identification of optimal monitoring point locations. Bayesian reasoning is employed to update probabilities based on observed data, while the Monte Carlo method generates probabilistic distributions for uncertain parameters. The SWMM is utilized to simulate stormwater runoff and pollutant transport within the drainage pipe network. Results indicate that (1) the relative mean error of the parameter inversion simulation results of the pollution source tracking model is linearly fitted with the information entropy. The calculation shows that there is a good positive linear correlation between them, which verifies the feasibility of the information entropy algorithm in the field of monitoring node optimization; (2) the information entropy algorithm can be well applied to the optimal layout of a single monitoring node and multiple monitoring nodes, and it can correspond well to the inversion results of the tracking model parameters; (3) the constructed monitoring point optimization model can well realize the optimal layout of monitoring points of a drainage pipe network. Finally, the pollution source tracking model is used to verify the effectiveness of the optimal layout of monitoring points, and the whole process has less human participation and a high degree of automation. The automated monitoring point optimization layout model proposed in this study has been successfully applied in practical cases, significantly improving the efficiency of urban drainage network monitoring and reducing the degree of manual participation, which has important practical significance for improving the level of urban water environment management.

Phytoremediation of Grey Water

Greywater, generated from domestic activities excluding toilet waste, presents a significant challenge for water management due to its diverse contaminants and potential environmental impact. Conventional treatment methods often fall short in addressing the complex composition of greywater while maintaining sustainability. Phytoremediation, a green technology that utilizes plants and their associated microorganisms, offers a promising and ecofriendly alternative for greywater treatment. This paper reviews the principles, mechanisms, and applications of phytoremediation in the context of greywater treatment. Various phytoremediation techniques such as rhizofiltration, phytoextraction, and phytodegradation are discussed, highlighting their efficacy in removing pollutants such as organic matter, nutrients, pathogens, and heavy metals from greywater. The role of specific plant species with remediation potential and their physiological mechanisms in contaminant uptake and transformation are examined. Case studies and experimental findings from greywater phytoremediation projects around the world are presented to demonstrate the practicality and effectiveness of this approach. Factors influencing phytoremediation performance, including plant selection, hydraulic conditions, nutrient availability, and system design, are analysed to optimize greywater treatment efficiency.

Plastic and Micro/Nanoplastic Pollution in Sub-Saharan Africa: Challenges, Impacts, and Solutions

Sub-Saharan Africa faces increasing levels of plastic production and importation, unregulated usage, and inadequate waste management systems. This region’s harsh conditions often lead to plastic breaking down into microplastics and nanoplastics. This review explores the abundance of micro/nanoplastics across different environmental mediums, such as surface waters, sediments, and aquatic organisms, in sub-Saharan African countries. It also highlights knowledge gaps concerning the region’s abundance of micro/nanoplastics. The effects of plastics and micro/nanoplastics on food production, water quality, health, and the environment are discussed. Strategies to address the challenges of plastic pollution are proposed. Finally, the review concludes with future perspectives for addressing the ongoing challenges of plastic waste management in sub-Saharan Africa. The materials for this study were sourced from published articles on Scopus, Google Scholar, ResearchGate, and additional platforms, including reports and various press releases, using keywords such as plastic waste, micro/nano-plastic, sub-Saharan Africa, toxicity, and circular economy. Articles were initially screened by reviewing abstracts, followed by a thorough reading of full papers to identify relevant studies. Key information was extracted from these selected articles and incorporated into this review.

Environmental, Energy, and Techno-Economic Assessment of Waste-to-Energy Incineration

Waste-to-energy (WtE) incineration is a feasible way to respond to both the municipal solid waste management and renewable energy challenges, but few studies have been carried out on its environmental and economic impact in fast-developing southeastern Asian countries. To fill such a research gap, this study innovatively conducted a holistic assessment of WtE incineration application potential in Java Island, Indonesia. Here, we have established a life cycle assessment model for WtE incineration in Java, and have estimated the environmental impact, electricity generation potential, and techno-economic feasibility of implementing incineration by 2025. We have revealed that global warming potential, terrestrial ecotoxicity potential, eutrophication potential, and acidification potential are the major environmental impacts stemming from incineration activities. Moreover, we have estimated that promoting incineration in Java could reduce CO2 emissions by 41% on average. The electricity generated from incineration could contribute to 3.72% of Indonesia’s renewable energy target for the electricity grid mix by 2025. The cumulative energy production potential from incineration is estimated to reach 2,316,523 MWh/year in 2025 and will increase by 14.3% in 2050. The techno-economic assessment of incineration implementation in Java cities has been enumerated as feasible. The levelized cost of electricity from incineration (0.044 USD/kWh) is competitive with the current Indonesian electricity price (0.069 USD/kWh). Policies of minimizing incineration pollution, providing financial support guarantees, and overcoming social barriers have been proposed to facilitate the application of WtE incineration.

NEED FOR HUMAN RESOURCE SOFTWARE IN ORGANIZATIONS

Considering how quickly technology is changing in today's world, businesses must modify their HR procedures to satisfy the needs of the digital era. This paper examines how technology breakthroughs have affected the role that HR professionals play, highlighting new developments and the difficulties they provide. The report evaluates the competency levels of HR specialists in technology-based businesses using empirical research, highlighting the need for reliable HR software solutions for effectively tackling the challenges of contemporary labor management. . Keywords— Human Resource Management System, HR Software, Workforce Management, HR Challenges, Recruitment Software, Human Resource Technology.

Opportunities and challenges in accurate early diagnosis and treatment of lung cancer/pulmonary nodules

Lung cancer remains the most prevalent and lethal malignancy in our country. Early diagnosis and treatment are crucial for improving patient prognosis in lung cancer/pulmonary nodules. Recent advancements in non-invasive/minimally invasive liquid biopsy, multi-omics, and artificial intelligence technologies have significantly enhanced the accuracy of early lung cancer/pulmonary nodule diagnosis. However, an early diagnostic method with both high sensitivity and specificity is yet to be established. Furthermore, addressing the methods and extent of early precision surgery, local precision therapy, perioperative combined treatment, and postoperative recurrence and metastasis monitoring are urgent challenges in the early management of lung cancer/pulmonary nodules. Integrating the advantages of various treatment strategies and formulating personalized and precise treatment plans is key to further improving patient survival. In the future, while exploring new therapeutic strategies, it is necessary to continuously search for biomarkers to identify the population that will benefit from the treatment effectively. Additionally, large-sample randomized controlled clinical studies should be conducted to investigate the benefits of long-term patient survival under a diverse range of treatment strategies.

Carbon-based materials impregnated with silver nanoparticle synthesized by gamma irradiation for ethylene gas scavenger application

This study explores the potential of carbon-based materials impregnated with silver nanoparticles, synthesized via gamma irradiation, as ethylene scavengers to address the challenges in post-harvest management of climacteric fruits. Ethylene, an essential plant hormone, significantly impacts fruit ripening and shelf life, necessitating effective management strategies. The research focuses on synthesizing silver nanoparticles at various concentrations (0, 4, 8, and 12 %) and their impregnation onto activated carbon (AC), designated as AC0AG, AC4AG, AC8AG, and AC12AG. These materials underwent comprehensive characterization through scanning electron microscopy (SEM) coupled with energy-dispersive X-ray Spectrometry (EDS) and transmission electron microscopy (TEM). In addition, silver nanoparticles at various concentrations (0, 4, 8, and 12%) in colloidal form designated as 0AG, 4AG, 8AG, and 12AG were characterized through UV-VIS spectroscopy and dynamic light scattering (DLS). The study's findings reveal that AC12AG (AC powder form) demonstrates the most effective ethylene scavenging capability, with a clear inverse correlation between the efficacy and the concentration of AgNO3. Further, the application of these materials in delaying the ripening process and reducing the incidence of pathogens and fungi in tomatoes was evaluated, showing significant efficacy. This research not only elucidates the critical role of silver nanoparticles in enhancing the ethylene scavenging capacity of carbon-based materials but also offers a scientifically grounded approach for improving the shelf life and quality of climacteric fruits, thus contributing a valuable solution to the post-harvest management of agricultural produce.

Semesters Simplified: A Comprehensive Approach to Academic Management

The "Semesters Simplified" project addresses challenges in academic management at Dr. A.P.J. Abdul Kalam Technical University (AKTU) by introducing a dedicated website and mobile application. This technological initiative aims to streamline information dissemination, enhance communication, and foster an engaging learning environment for both students and educators within semester-based academic structures. Grounded in educational technology principles, the project prioritizes user engagement, personalized learning, and inclusivity. The chosen technology stack employs modern tools for front-end and back-end development, ensuring a seamless and responsive user experience. The methodology encompasses needs analysis, user-centric design, development, testing, deployment, and continuous improvement. The proposed facilities, spanning software and hardware requirements, are crucial for the project's success. The literature review provides a solid foundation, aligning the project with established principles and best practices in educational technology. Ultimately, "Semesters Simplified" aspires to contribute significantly to the advancement of academic management, fostering accessibility, engagement, and inclusivity at AKTU.

Potential Stem Cell Treatment for Common Hip Conditions: Osteoarthritis, Osteonecrosis and Gluteal Tendinopathy

Hip pathology, encompassing common conditions such as Osteoarthritis (OA), Osteonecrosis (ONFH) and gluteal tendinopathy, presents significant challenges in clinical management which often necessitate innovative treatment modalities. Stem cell therapy has emerged as a promising approach for addressing these complex hip conditions by promoting tissue regeneration and modifying disease progression. This paper aims to review the current literature on stem cell therapy for hip pathology, focusing on its application in OA, ONFH and gluteal tendinopathy. A comprehensive review of relevant studies and clinical trials was conducted by examining the safety, efficacy and potential mechanisms of action of stem cell therapy in hip conditions. Studies investigating the use of Bone Marrow-Derived Mesenchymal Stem Cells (BMMSCs), Adipose-Derived Mesenchymal Stem Cells (ADMSCs) and Tendon-Derived Stem Cells (TDSCs) were included in the analysis. The reviewed studies demonstrate promising outcomes of stem cell therapy in improving pain, functionality and halting disease progression in patients with hip OA. Intra-articular injections of MSCs have shown sustained benefits and arrested the progression of osteoarthritis. Stem cell therapy has also shown effectiveness in delaying the progression of ONFH, reducing femoral head collapse and decreasing the need for total hip replacement. Furthermore, in cases of gluteal tendinopathy, stem cell therapy has exhibited significant improvements in pain and functionality in a limited number of studies on the topic and also offers sustained relief in patients unresponsive to conventional treatments. Stem cell therapy holds immense potential as a safe and effective intervention for hip pathology and offers disease-modifying effects and sustained clinical benefits in these prevalent conditions. Further research is warranted to optimize treatment protocols, clarify mechanisms of action and validate long-term efficacy in larger cohorts.

Diagnosis and treatment of the Ehlers-Danlos syndromes in China: synopsis of the first guidelines

BackgroundThe Ehlers-Danlos syndromes (EDS) are a group of rare hereditary connective tissue disorders. EDS is clinically and genetically heterogeneous and usually involves multiple systems. There are 14 subtypes of EDS with hallmark features including joint hypermobility, skin hyperextensibility, and tissue fragility. The clinical manifestations and their severity differ among the subtypes, encompassing recurrent joint dislocations, scoliosis, arterial aneurysm and dissection, and organ rupture. Challenges in diagnosis and management arise from the complexity of the disease, which is further complicated by its rarity. The development of clinical guidelines and implementation of coordinated multi-disciplinary team (MDT) approaches have emerged as global priorities.Main bodyChinese Multi-Disciplinary Working Group on the Ehlers-Danlos Syndromes was therefore established. Healthcare professionals were recruited from 25 top hospitals across China. The experts are specialized in 24 fields, including genetics, vascular surgery, dermatology, and orthopedics, as well as nursing care, rehabilitation, psychology, and nutrition. Based on GRADE methodology, the Guidelines were written by the Group supervised by methodologists, following a systemic review of all 4453 articles in PubMed published before August 9, 2023, using the search term “Ehlers Danlos”. A coordinated MDT approach for the diagnosis and management of EDS is highly recommended by the Group, along with 29 specific recommendations addressing key clinical questions. In addition to the treatment plan, the Guidelines also emphasize integrating support from nursing care, rehabilitation, psychology, and nutrition. This integration not only facilitates recovery in hospital settings, but most importantly, the transition from an illness-defined life to a more “normalized” life.ConclusionThe first guidelines on EDS will shorten the diagnostic odyssey and solve the unmet medical needs of the patients. This article is a synopsis of the full guidelines.

Assessing the Impacts of Landuse-Landcover (LULC) Dynamics on Groundwater Depletion in Kabul, Afghanistan’s Capital (2000–2022): A Geospatial Technology-Driven Investigation

Land use/land cover (LULC) changes significantly impact spatiotemporal groundwater levels, posing a challenge for sustainable water resource management. This study investigates the long-term (2000–2022) influence of LULC dynamics, particularly urbanization, on groundwater depletion in Kabul, Afghanistan, using geospatial techniques. A time series of Landsat imagery (Landsat 5, 7 ETM+, and 8 OLI/TIRS) was employed to generate LULC maps for five key years (2000, 2005, 2010, 2015, and 2022) using a supervised classification algorithm based on Support Vector Machines (SVMs). Our analysis revealed a significant expansion of urban areas (70%) across Kabul City between 2000 and 2022, particularly concentrated in Districts 5, 6, 7, 11, 12, 13, 15, 17, and 22. Urbanization likely contributes to groundwater depletion through increased population growth, reduced infiltration of precipitation, and potential overexploitation of groundwater resources. The CA-Markov model further predicts continued expansion in built-up areas over the next two decades (2030s and 2040s), potentially leading to water scarcity, land subsidence, and environmental degradation in Kabul City. The periodic assessment of urbanization dynamics and prediction of future trends are considered the novelty of this study. The accuracy of the generated LULC maps was assessed for each year (2000, 2005, 2010, 2015, and 2022), achieving overall accuracy values of 95%, 93.8%, 85%, 95.6%, and 93%, respectively. These findings provide a valuable foundation for the development of sustainable management strategies for Kabul’s surface water and groundwater resources, while also guiding future research efforts.

Interviewing in the metaverse: The renewed importance of location and embodiment

In this paper, we explore the methodological implications of conducting online qualitative interviews in the metaverse through virtual reality (VR). Technology companies have invested heavily in creating metaverse platforms for bringing people together in digital worlds, yet there is a significant absence of geographical research examining the implications of these spaces. Twenty-six undergraduate students participated in a remote interviewing exercise using the platform AltSpaceVR. Face-to-face interviews were subsequently conducted to gather their reflections about the experience of research interviews in a metaverse. The study highlights the significance of immersion and presence in virtual environments. Participants noted that, in contrast to video interviewing, the immersive nature of the virtual space resembled conventional face-to-face interviews. A sense of immersion and presence enhances the authenticity of the interview experience. There were, however, challenges in interface management and the role of avatars altering the embodied connection with the research subjects. The avatars provided personal representation but introduce complexities in establishing genuine connections and rapport. In our discussion of the implications for VR qualitative research, we emphasise the interplay of immersion, presence and embodiment which can add real value to remote interviewing experience, while reflecting on the technical and physiological limitations.

Evaluating tidal impact on ground source heat exchanger performance under fluctuating groundwater levels

Coastal regions undergo dynamic changes due to tidal forces, posing distinct challenges for groundwater management and utilization of ground source heat pump (GSHP) systems. This study examines the impact of tidal fluctuations on groundwater levels and the performance of ground heat exchangers (GHEs), specifically focusing on the suitability of horizontal directional drilling (HDD) technology in high-tidal zones. Itoman City in Okinawa Prefecture, Southern Japan, serves as an ideal location for this study due to its complex coastal hydrogeological conditions and increasing interest in renewable energy solutions. Employing a comprehensive approach involving field experiments, FEFLOW software simulations, and model validation, we aim to elucidate the intricate relationship between tidal dynamics, groundwater behavior, and GHE performance. Furthermore, our investigation assesses the effectiveness of HDD-GHEs installed in highly tidal-affected zones to determine the optimal installation depth for this type of GHE in coastal regions. According to our research, the layer at a depth of 30 m is most affected by tidal influence and fluctuations in groundwater levels in coastal regions. This layer is the most suitable for installing horizontal HDD-GHEs, with an average heat exchange rate of about 89 W/m. This rate is approximately four and two times higher than the depths above and below this layer, respectively, due to groundwater saturation and flow in the formation. Furthermore, we noticed that the heat exchange rate increases from the top to the bottom of this layer, but the extent of this increase diminishes as the depth increases. This is because deeper depths are less affected by tidal fluctuations in groundwater levels.

Mapping the Global Spread of T. indotineae: An Update on Antifungal Resistance, Mutations, and Strategies for Effective Management.

The global spread of Trichophyton indotineae presents a pressing challenge in dermatophytosis management. This systematic review explores the current landscape of T. indotineae infections, emphasizing resistance patterns, susceptibility testing, mutational analysis, and management strategies. A literature search was conducted in November 2023 using Embase, PubMed, Scopus, and Web of Science databases. Inclusion criteria covered clinical trials, observational studies, case series, or case reports with T. indotineae diagnosis through molecular methods. Reports on resistance mechanisms, antifungal susceptibility testing, and management were used for data extraction. A total of 1148 articles were identified through the systematic search process, with 45 meeting the inclusion criteria. The global spread of T. indotineae is evident, with cases reported in numerous new countries in 2023. Tentative epidemiological cut-off values (ECOFFs) suggested by several groups provide insights into the likelihood of clinical resistance. The presence of specific mutations, particularly Phe397Leu, correlate with higher minimum inhibitory concentrations (MICs), indicating potential clinical resistance. Azole resistance has also been reported and investigated in T. indotineae, and is a growing concern. Nevertheless, itraconazole continues to be an alternative therapy. Recommendations for management include oral or combination therapies and individualized approaches based on mutational analysis and susceptibility testing. Trichophyton indotineae poses a complex clinical scenario, necessitating enhanced surveillance, improved diagnostics, and cautious antifungal use. The absence of established clinical breakpoints for dermatophytes underscores the need for further research in this challenging field.

Epidemiological observations and management challenges in extrapedal mycetoma: A three-decade review of 420 cases.

Mycetoma is a serious, destructive, disfiguring chronic granulomatous inflammatory disease affecting the subcutaneous tissues that spread to involve the skin, deep tissues and bone. The disease predominately affects the limbs, and extrapedal mycetoma is rarely reported. The reported extrapedal ones are characterised by high morbidity and mortality. This communication reports on 420 patients with extrapedal mycetoma seen and managed at the Mycetoma Research Centre (MRC), University of Khartoum, between January 1991 and December 2021. In this descriptive, cross-sectional, hospital-based study, the electronic records of all mycetoma-confirmed patients seen during the study period were carefully and meticulously reviewed. The confirmed patients with extrapedal mycetoma were included in this study. The study included 420 patients with extrapedal mycetoma, 298 (70.7%) had eumycetoma, and 122 (29.3%) had actinomycetoma. There were 343 male patients (81.7%) and 77 (18.3%) females, with a male-to-female ratio of 4:1. Their ages ranged between 1.5 and 95 years, with a median of 28 years. Most of the patients were students and farmers. The majority of patients were from El Gezira, North Kordofan, and the White Nile States. Mycetoma was painful in 21%, and a family history of mycetoma was recorded in 11.5% of patients. The buttocks (37.9%) and head and neck (16.9%) were affected most. Less frequently affected sites were the trunk and back (12%) each, abdominal and chest walls (4.5%) each and loin (1%). The prominent clinical presentation findings were multiple sinuses discharging grains (55%), massive swellings (46%), and lymphadenopathy (11.5%). Less commonly observed clinical findings were local hyperhidrosis (5.3%) and dilated tortuous veins close to mycetoma lesions (0.5%). The study showed that 204 patients (48.6%) had clinical improvement in terms of decreased lesion size and healing of sinuses following medical therapy. Sixty-six patients (15.7%) had no noticeable improvement. The lesion continued progressing despite treatment in 44 patients (10.5%). In the study, 118 patients were on regular follow-up, and in this group, a cure was documented in 25 patients (21.1%) with eumycetoma and 23 (19.4%) with actinomycetoma. Post-operative recurrence among eumycetoma patients was 40%, with a 1% mortality rate. The treatment outcome was unsatisfactory, characterised by a low cure rate, high recurrence (40%) and follow-up dropout (57%) rates. This emphasises the importance of early case detection and management, objective health education programmes and thorough patient counselling to urge people to seek treatment early and reduce dropouts.