Nonspecific colitis a forgotten entity in Central Sudan

Background: Nonspecific colitis is an inflammatory Bowel Disease (IBD) that runs a clinically benign course. Histopathologically it is characterized by superficial mucosal erosions with lymphocytic infiltration in the lamina propria with no granuloma. Aim of this study: is to describe the clinical presentation of Non-Specific Colitis (NSC), and to evaluate its response to 5-aminosalicylic acid (5-ASA) in Sudanese patients.Setting and Design: This study is a prospective cohort. A total of 26 patients presenting with bloody, mucoid diarrhoea, lower abdominal pain or colonic mass were included in the study.Methods and Materials: A total of 26 patients presenting with bloody mucoid diarrhoea, lower abdominal pain with or without colonic mass were included in the study. All patients underwent colonoscopy. Statistical analysis: A descriptive statistical analysis was done using SPSS.Results: 19 (%) of patients were males and 7 were females with male to female ratio of 3:1. The majority of patients 16 (61.6%) had bloody diarrhea while 18 (69.2%) opened their bowel 4-6 times a day. The majority 10 (38.8%) had rectum and sigmoid involvement. All patients showed a good response to 5-ASA.Conclusions: This study showed that NSC has clinical features that are very much similar to mild UC with a rather good clinical response to oral 5-ASA.Keywords: Nonspecific colitis, indeterminate colitis, 5-aminosaclyic acid

Pathological response for neoadjuvant chemotherapy in locally advanced breast cancer at NCI, Sudan: 6 years’ experience

Background: Breast cancer is the leading cancer in Sudanese females.Objectives: This study was done to evaluate the clinical response to neoadjuvant chemotherapy for patients treated at National Cancer Institute (NCI) and to compare it with the published literature.Methods: This is a retrospective study conducted in National Cancer Institute (NCI), Gezira State, Sudan during the period from April 2005 to August 2011. We studied the data for all patients who have locally  advanced breast cancer and treated at NCI during study period. Patients who remained inoperable after treatment were considered as having no response to therapy. Data were introduced and analyzed using SPSS software. Data evaluated includes Patient age, disease stage,  chemotherapy regimens, and number of cycles, tumor histology, grade and histopathology after chemotherapy.Results: A total of 110 patients who received neoadjuvant chemotherapy and fulfilled criteria for inclusion during the period 2005 to 2011 were evaluated. Majority of patients were between 30-50 years of age (63%). Patients who achieved response and had surgery were 65%. Among those who underwent surgery 22% have complete pathological response. Most of patients who achieved complete histopathological response had six cycles of chemotherapy.Conclusion: this study demonstrated that neoadjuvant systemic therapy is an accepted approach for women with locally advanced breast cancer for whom immediate surgery is inappropriate, and we achieved results similar to the international literature.Key words: breast cancer, neoadjuvant, chemotherapy, response, NCI, Sudan

Cancer management in Sudan: Current status and future perspectives

Introduction: Sudan is one of the developing countries that face a great challenge with cancer management. About 5700 cases had been seen during year 2007 in Radiation and Isotope Center- Khartoum (RICK) and Institute of Nuclear medicine, Molecular biology, and Oncology (INMO) Wadmedani which are the only cancer centers in Sudan.Purpose: Aim of this work is to highlight the difficulties of cancer management in Sudan and to propose possible solutions.Methods: This paper evaluates the current situation of cancer management in Sudan through reviewing of data available in cancer centers and reports from the Sudan national bureau of statistic. Suggestions are also made for cancer control plan in Sudan having the current situation in mind and guided by the published international data on cancer control.Results: The preliminary analysis of the available data reveals that Sudan has very limited resources available to deal with cancer and the service provided is not evenly distributed.Conclusion: Establishment of new centers is extremely needed with special attention to good distribution of services. To achieve such a goal training of more staff and upgrading of the existing centers is mandatory to manage all types of cancer. Cancer registry is the right way to plan for cancer control in Sudan.Keywords: Nuclear medicine, radiation, oncologis

Receptor-defined subtypes of breast cancer in indigenous populations in Africa: a systematic review and meta-analysis.

BACKGROUND: Breast cancer is the most common female cancer in Africa. Receptor-defined subtypes are a major determinant of treatment options and disease outcomes but there is considerable uncertainty regarding the frequency of poor prognosis estrogen receptor (ER) negative subtypes in Africa. We systematically reviewed publications reporting on the frequency of breast cancer receptor-defined subtypes in indigenous populations in Africa. METHODS AND FINDINGS: Medline, Embase, and Global Health were searched for studies published between 1st January 1980 and 15th April 2014. Reported proportions of ER positive (ER+), progesterone receptor positive (PR+), and human epidermal growth factor receptor-2 positive (HER2+) disease were extracted and 95% CI calculated. Random effects meta-analyses were used to pool estimates. Fifty-four studies from North Africa (n=12,284 women with breast cancer) and 26 from sub-Saharan Africa (n=4,737) were eligible. There was marked between-study heterogeneity in the ER+ estimates in both regions (I2>90%), with the majority reporting proportions between 0.40 and 0.80 in North Africa and between 0.20 and 0.70 in sub-Saharan Africa. Similarly, large between-study heterogeneity was observed for PR+ and HER2+ estimates (I2>80%, in all instances). Meta-regression analyses showed that the proportion of ER+ disease was 10% (4%-17%) lower for studies based on archived tumor blocks rather than prospectively collected specimens, and 9% (2%-17%) lower for those with ≥ 40% versus those with <40% grade 3 tumors. For prospectively collected samples, the pooled proportions for ER+ and triple negative tumors were 0.59 (0.56-0.62) and 0.21 (0.17-0.25), respectively, regardless of region. Limitations of the study include the lack of standardized procedures across the various studies; the low methodological quality of many studies in terms of the representativeness of their case series and the quality of the procedures for collection, fixation, and receptor testing; and the possibility that women with breast cancer may have contributed to more than one study. CONCLUSIONS: The published data from the more appropriate prospectively measured specimens are consistent with the majority of breast cancers in Africa being ER+. As no single subtype dominates in the continent availability of receptor testing should be a priority, especially for young women with early stage disease where appropriate receptor-specific treatment modalities offer the greatest potential for reducing years of life lost. Please see later in the article for the Editors' Summary