Comparison Between Endoscopic Sclerotherapy and Band Ligation for Haemostasis of Variceal Bleeding at National Centre for Gastrointestinal and Liver Disease, IbnSina Specialized Hospital – Khartoum

The objective of this hospital-based  and prospective study was to compare the outcome of endoscopic variceal sclerotherapy and band ligation regarding early and late rebleeding. Oesophagealvariceal bleeding is the most common cause of upper gastrointestinal tract haemorrhage. Patients with oesophageal variceal bleeding have higher rates of rebleeding, complications, and death than patients with non-variceal bleeding such as ulcer bleeding(1). Between the year Dec. 2016 –Apr. 2017 a total of 140 patients were reviewed. Variables selected for the study included: intervention type: whether it was sclerotherapy or banding , OGD findings at presentation, presence of shock upon presentation, duration of having the disease before the intervention and outcome of each procedure . Males were (110) females (40). The Majority of patients presented with hematemesis and melena (74.28  %), hematemesis alone  occurred in (28.57%) and melena alone in ( 7.14%) of patients. All patients were diagnosed as portal hypertension due to PPF (Belharziasis) and most of them were from Gezira State.  Most of the patients  had portal hypertension  for more than two years (41.4%). Sixty patients presented with different stages of shock (42.9%).Sengestaken tube was used to control bleeding in (5%) of patients. On the other hand 79.4% of patients received blood during resuscitation. Regarding OGD findings, nearly all patients were found to have OV alone (97.6). Previously only six patients underwent splenectomy, three between 1-2 years, one before five years and one in less than one year. Of the 140 patients (49.3%) were treated with Sclerotherapy and (50.7%) underwent band ligation. With regard to rebleeding, of those who were treated with Sclerotherapy, (14.49%) of patients rebled early, (26.09%) rebled late, (49.28%) did not rebleed and seven patients lost their follow up. Comparing to Sclerotherapy, re bleeding in band ligation were found early in(15.95%), ( 23.19%) presented as late, (57.97%) did not rebled and two patients lost the follow up.. In conclusion: Treatment of oesophageal variceal bleeding with band ligation has lower rates of re-bleeding. Chronicity of portal hypertension appears to be a significant risk factor for re-bleeding after both procedures

Prevalence of Pancreaticobiliary Maljunction (PBM) Among Sudanese Patients with Obstructive Jaundice in Ibnsina Specialized Hospital

Background: pancreaticobiliary maljunction is a congenital malformation in which the pancreatic and bile ducts join outside the duodenal wall. The common channel is long that leads to continuous reciprocal reflux between pancreatic juice and bile, resulting in various pathologic conditions in the biliary tract and pancreas. Methods and patients: This is a hospital based descriptive cross-sectional study, which was conducted in Ibn Sina Specialized Hospital over a period of one year (August 2018 – August 2019). The study included 62 patients. Data was collected using a constructed structure pretest questionnaire. Results: the mean age of the patients was 50.5, with male to female ratio 1:2.1. The majority of patients presented with the symptoms of bile obstruction .MRCP was done for all patients ; showed that CBD stones was the most common diagnosis in 82.3 %(n=51), followed by pancreatic carcinoma 6.5%(n=4). PBM found in 35.5 %( n= 22); the majority were type B 24.2% (n=15). In patients with CBD stones 82.3 %(n=51), PBM type B was the most common anomaly found 23.5% (n=12), the serum direct bilirubin was <5 mg/dl in 78%(n=40),and ALP more than 300 U/L in the majority of them. Conclusion : The prevalence of PBM is 35.5% , commonly found in female. The most common type of PBM is - type B, commonly found in patients with obstructive jaundice due to CBD stones

Mycobacterium avium subsp. paratuberculosis and microbiome profile of patients in a referral gastrointestinal diseases centre in the Sudan

Mycobacterium avium subsp. paratuberculosis (MAP) causes Johne’s disease in animals with zoonotic potential; it has been linked to many chronic diseases in humans, especially gastrointestinal diseases (GID). MAP has been extensively studied in Europe and America, but little reports were published from Africa. Sudan is a unique country with close contact between humans and livestock. Despite such interaction, the one health concept is neglected in dealing with cases of humans with GID. In this study, patients admitted to the reference GID hospital in the Sudan over a period of 8 months were screened for presence of MAP in their faeces or colonic biopsies. A total of 86 patients were recruited for this study, but only 67 were screened for MAP, as 19 did not provide the necessary samples for analysis. Both real-time PCR and culture were used to detect MAP in the collected samples and the microbial diversity in patients´ faecal samples was investigated using 16S rDNA nanopore sequencing. In total, 27 (40.3%) patients were MAP positive: they were 15 males and 12 females, of ages between 21 and 80 years. Logistic regression analysis revealed no statistical significance for all tested variables in MAP positive patients (occupation, gender, contact with animal, milk consumption, chronic disease, etc.). A unique microbiome profile of MAP-positive patients in comparison to MAP-negative was found. These findings suggest that a considerable proportion of the population could be MAP infected or carriers. Therefore, increase awareness at community level is urgently needed to decrease the risk of MAP at human/animal interface. This study represents the first report of MAP in humans in the Sudan; nevertheless, a better view of the situation of MAP in humans in the country requires a larger study including patients with other conditions.Additional co-authors: Ahmad Amanzada, Kamal H. Eltom , ElSagad Eltaye

Outcome of Palliative Surgery in Advanced Pancreatic Cancer in Sudanese Patients in Ibn Sina Specialized Hospital

Introduction: Pancreatic cancer is the 4thleading cause of death and due to late presentation, the curative procedures are more challenging and difficult. Pancreatic cancer is not uncommon in Sudanese patients and usually presents late. The aim of this study was to assess the outcome of palliative surgery in advanced pancreatic cancer and to reflect our local experience. Methodology: It was a prospective cross-sectional hospital-based study.  It included 92 patients with advanced pancreatic cancer in Ibn Sina Specialized Hospital. Data were collected and variables; age, gender, origin and clinical features were measured. Patients were classified based on type of surgery (single, double or triplebypass). Data collected and analyzed by using statistical package for social sciences (SPSS) computer program version 20.Qualitative data were analyzed by using descriptive statistic t test and pearson chi_square. The P value was considered significant if <0.05. Results:The mean age of the study was 65.4, (+/_13SD)male to female ratio was 1.8:1. The majority of the patients (36%) were from northern state; namely Shwaiga, Mahas, Bederia and Gaalian and 22% from Western state namely Baggara, Jamoaia and Foor. Nearly two-third of the patients had double bypass, and the remaining were equally single and triple bypass. The main presenting symptoms were jaundice, dyspepsia and vomiting and it is significantly common among alcohol consumers. Dyspepsia was statistically early symptoms and serum aspartate transaminase (AST) and alkaline phosphatase (ALP) were statistically high. There was less than 30 % of those who survived more than one year. There was no statistically significant difference between type of bypass and the outcome. Conclusion: The outcome of those patients was not affected by modality of bypass. Dyspepsia was the earliest complain and high serum aspartate transaminase (AST) and alkaline phosphatase (ALP) could be important prognostic factors. pancreatic cancer is common in certain populations

Emergence of reduced susceptibility to metronidazole in Clostridium difficile

Antimicrobial treatment for Clostridium difficile infection (CDI) has typically been metronidazole, although reports have questioned the efficacy of this option. We screened recently isolated C. difficile (2005-06) for susceptibility to metronidazole and compared results for historic isolates (1995-2001).Peer reviewe