Sudden natural death in Khartoum Mortuary

Background: The sudden natural death is defined as: Death occurs within 24 hours from the onset of symptoms. The disclosing of the causes of sudden natural death is important for prevention and improving outcome. The objectives of this study were to determine the causes of sudden natural death in Khartoum Mortuary Methods: Descriptive, cross- sectional study of natural sudden death in Khartoum Mortuary, which was located in Khartoum Teaching Hospital and offers services to the state. The autopsy records of 2007, which were 150, were considered. Data were collected by a structured check list, and analysis was done by the SPSS soft ware. Results:The most important systems involved in sudden natural deaths were respiratory (49.3%), cardiovascular (24%), gastro intestinal (15.3%) and cerebral (4%), while the leading causes of sudden natural death were pneumonia (20%), myocardial infarction (17.3%) and tuberculosis (14%). Sudden natural death occurred in slightly higher ratio in the age group 40 years and below (50.1%), males were dominating (83%). Conclusion: The commonest causes of sudden natural death, which were pneumonia, myocardial infarction and tuberculosis, were different from the literature in which the commonest causes were myocardial infarction followed by pulmonary embolism. The study highlighted the importance of respiratory diseases besides myocardial infarction as leading causes of sudden natural death, and the need for further researches in this issue. Keywords: pneumonia, myocardial infarction and tuberculosis, postmortem Sudan Journal of Medical Science Vol. 3 (4) 2008: pp. 319-32

HER2 Over Expression in Malignant Palpable Breast Lumps of Pre and Postmenopausal Women Attending RICK.

Back ground: Human Epidermal growth factor Receptor 2 (HER-2/neu) over expression in breast cancer is associated with poor outcome and decrease disease free survival (DFS). The aim of this study was to evaluate the over expression of HER2/neu among premenopausal and postmenopausalfemales presented with malignant palpable breast lumps to Radio Isotope Center Khartoum (RICK).Methods: The study was a case-control conducted among patients attending Radiation Isotopes Centre Khartoum (RICK). A total of 328 women were randomly selected. Data were collected by a pre coded, pre tested questionnaire. Tissue biopsies of breast lumps had been analyzed using immunohistochemical techniques for HERR-2/neu over expression and its relation to other prognostic factors was evaluated.Results: HER-2/neu + vein first pregnancy at . 23 years, were 32 (41%) in the cases, 6 (35%) in the controls of premenopausal women, and 21(44%) in the cases, 5 (38%) in the controls of postmenopausal women. HER-2/neu + veexpression in relation to age at menarche . 12 years was39 (51%) in the cases, 7(39%) in the controls of premenopausal women, and 36 (56%) in the cases, 7 (45%) in the controls of postmenopausal women. HER-2/neu+ vein relation to Body Mass Index > 29 kg/m2 showed 7 (37%) in the cases, 2 (33%) in the controls of premenopausal women(x2=0.024), and 8(38%) in the cases, 2(40%) in the controls of postmenopausal women (x2=0.006). HER-2/neu+ veexpression in relation to history of abortion or miscarriage (ever) was found to be 21 (39%) in the cases, 4 (33%) in the controls of premenopausal women, and 18 (44%) in the cases, 3 (33%) in the controls among postmenopausal women. HER-2/neu+ veexpression in relation to the history of breast cancer in a first degree relatives was 3 (25%) in the cases, 1(50%) in thecontrols of premenopausal women, and 4 (22%) in the cases, 2 (28%) in the controls of postmenopausal women. HER-2/neu+ veexpression in relation to the use of oral contraceptives was 3 (37%) in the cases, 1(50%) in the controls among premenopausal women, and 3 (27%) in thecases, 1 (50%) in the controls of postmenopausal women.Conclusion: The study confirmed an etiological association between HER2/neu+ve and HER2/neu . ve and age at first pregnancy . 23 years, age of menarche at . 12 years, abortion or miscarriage in premenopausal and postmenopausal Sudanese women, while an etiological association was confirmed between HER2/neu+ve and HER2/neu .ve, and BMI in premenopausal women, and the family history of cancer in pos menopausal women.Keywords: Human Epidermal, Growth factor, Recepto

First Case Report of Primary Testicular Diffuse Large B-Cell Lymphoma from the Western Region of Saudi Arabia

Primary testicular lymphoma (PTL) represents 1-2% of all types of non-Hodgkin lymphomas (NHLs) and 1-10% of testicular neoplasms. Up to the best of my knowledge, this is the first case of PTL of the diffuse large B-cell lymphoma (DLBCL) in a 60-year-old man presented with a painless mass in the left testis as revealed by physical examination in a tertiary care hospital in Al-Madinah Al-Munwarah in the western region of the Kingdom of Saudi Arabia (KSA). Radiological examination revealed a large well-defined heterogeneous predominantly hypo-echoic mass with increased vascularity in the upper portion of the testis. On the other hand, histopathological examination revealed a tumor involving the whole left testis, which was large (measuring 6 3.5  3.3 cm), solid and dark red with focal areas of hemorrhage and epididymal infiltration. Immunohistochemistry showed positivity of leucocyte common antigen (LCA), pan B-cell marker (CD20) and negativity of pan T-cell marker (CD3). Other immunohistochemical markers such as CD10, placental alkaline phosphatase (PLAP), cytokeratin, vimentin, desmin and S100 protein were also negative. However, there was a marked expression of Ki67 and Bcl2 markers. Accordingly, the diagnosis of DLBCL was established. The tumor was classified as stage I according to the Ann Arbor system. The case was treated by orchiectomy followed by prophylactic anthracycline-based chemotherapy and irradiation of the contralateral testis and central nervous system

Predictive value of S100B and brain derived neurotrophic factor for radiofrequency treatment of lumbar disc prolapse

Abstract Background This work aimed to analyze serum S100B levels and brain-derived neurotrophic factor (BDNF) in patients with lumbar disc prolapse to test their predictive values concerning the therapeutic efficacy of pulsed radiofrequency. Methods This prospective interventional study was carried out on 50 patients candidates for radiofrequency for treating symptomatic lumbar disc prolapse. Pain severity and functional disability were assessed using the Numeric Rating Scale (NRS) and Functional rating index (FRI) before as well as two weeks, 1, 3, and 6 months after the radiofrequency. Quantitative assessment of serum S100B level and BDNF was done for all the included patients one day before radiofrequency. Results The scores of NRS and FRI were significantly improved at two weeks, 1, 3, and 6 months following radiofrequency (P-value < 0.001 in all comparisons). Statistically significant positive correlations were found between duration of pain, NRS, and S100B serum level before radiofrequency, and both NRS (P-value = 0.001, 0.035, < 0.001 respectively) and FRI (P-value = < 0.001, 0.009, 0.001 respectively) 6 months following radiofrequency. Whereas there were statistically significant negative correlations between BDNF serum level before radiofrequency and both NRS and FRI 6 months following radiofrequency (P-value = 0.022, 0.041 respectively). NRS and S100B serum levels before radiofrequency were found to be independent predictors of NRS 6 months following radiofrequency (P-value = 0.040. <0.001, respectively). Conclusion Serum level of S100B is a promising biomarker that can predict functional outcomes after pulsed radiofrequency in patients with lumbar disc prolapse

Assessment of the ability of the radiological incudo-stapedial angle to predict the stapedotomy technique type; a prospective case-series study

Background: Reversal-steps stapedotomy (RSS) has become a standard technique that entails perforation of the footplate when the ossicular chain is still intact, followed by immediate placement and stabilization of the prosthesis and, lastly, removal of the stapes superstructure. It can prevent incus dislocation and footplate luxation, helping to improve surgical outcomes. Objectives: This study aimed to propose a radiological classification of the incudo-stapedial angle on preoperative high-resolution computed tomography (HRCT) images. We also assessed the proposed radiological classification's ability to predict feasibility of RSS. Methods: This prospective case-series observational study was conducted at a tertiary referral institute between January 2021 and August 2022, and included 83 candidates for stapedotomy operation because of otosclerosis. Two physicians reviewed the preoperative HRCT images, focusing on the coronal cut on the incudo-stapedial (IS) joint, and measured its radiological angle. According to this measurement, the radiological incudo-stapedial joint could be divided into three types; obtuse, right, and acute angle. This radiological classification was correlated with the intraoperative use of RSS technique. Results: The RSS technique was used in forty-two (97.7%) patients with an obtuse IS angle and twenty-six (89.7%) patients with a right angle. At the same time, the classical, non-reversal technique was used in all patients with an acute angle. The three groups differed significantly regarding the method used for stapedotomy (P-value&lt;0.001). Moreover, Spearman′s correlation coefficient revealed a significant correlation between the used technique and the radiological type of the IS angle (P-value &lt;0.001). Conclusions: Our prospective study proposes a preoperative radiological classification of the IS angle at the HRCT. This classification was significantly correlated with stapedotomy technique used. The reversal stapedotomy technique was feasible in most cases with obtuse or right radiological IS angles. Conversely, the non-reversal method was used in all patients with an acute radiological IS angle. This radiological classification could help for predict the feasibility of the RSS technique with an accuracy of 95.18%, a sensitivity of 73.33%, and a specificity of 100%

Endometrial Cancer Individualized Scoring System (ECISS): A machine learning-based prediction model of endometrial cancer prognosis

Objective: To establish a prognostic model for endometrial cancer (EC) that individualizes a risk and management plan per patient and disease characteristics. Methods: A multicenter retrospective study conducted in nine European gynecologic cancer centers. Women with confirmed EC between January 2008 to December 2015 were included. Demographics, disease characteristics, management, and follow-up information were collected. Cancer-specific survival (CSS) and disease-free survival (DFS) at 3 and 5 years comprise the primary outcomes of the study. Machine learning algorithms were applied to patient and disease characteristics. Model I: pretreatment model. Calculated probability was added to management variables (model II: treatment model), and the second calculated probability was added to perioperative and postoperative variables (model III). Results: Of 1150 women, 1144 were eligible for 3-year survival analysis and 860 for 5-year survival analysis. Model I, II, and III accuracies of prediction of 5-year CSS were 84.88%/85.47% (in train and test sets), 85.47%/84.88%, and 87.35%/86.05%, respectively. Model I predicted 3-year CSS at an accuracy of 91.34%/87.02%. Accuracies of models I, II, and III in predicting 5-year DFS were 74.63%/76.72%, 77.03%/76.72%, and 80.61%/77.78%, respectively. Conclusion: The Endometrial Cancer Individualized Scoring System (ECISS) is a novel machine learning tool assessing patient-specific survival probability with high accuracy

Endometrial Cancer Individualised Scoring System (ECISS): A machine learning-based prediction model of endometrial cancer prognosis

Objective: Establishing a prognostic model for endometrial cancer (EC), that individualizes risk and management plan per patient and disease characteristics. Methods: this is multicentre retrospective study conducted in 9 European gynaecologic cancer centres. Women with confirmed EC between January 2008 to December 2015 were included. Demographics, disease characteristics, management, and follow-up information were collected. Cancer-specific survival (CSS) and disease-free survival (DFS) at 3 and 5 years comprise the primary outcomes of the study. Machine learning algorithms were applied to patient and disease characteristics. Model I: pre-treatment model. Calculated probability was added to management variables (model II: treatment model), and the second calculated probability was added to perioperative and postoperative variables (model III). Results: Out of 1,150 women, 1,144 were eligible for 3-year survival analysis and 860 for 5-year survival analysis. Model I, II, and III accuracies of prediction of 5-year CSS were 84.88%/85.47% (in train and test sets), 85.47%/84.88% and 87.35%/86.05%, respectively. Model I predicted 3-year CSS at an accuracy of 91.34%/87.02%. Accuracy of model I, II and III in predicting 5-year DFS were 74.63%/76.72%, 77.03%/76.72%, and 80.61%/77.78%, respectively. Conclusion: Endometrial Cancer Individualised Scoring System (ECISS) is a novel machine learning tool assessing patient-specific survival probability with high accuracy