Causes and Clinical features of patients with Hypersplenism: a case study conducted in Ibn Sina and Soba Teaching Hospitals, Khartoum, Sudan.

Objective: The main objectives of this paper are to identify the main causes of hypersplenism in Sudan and also to see how far the splenic size correlates with degree of thrombocytopenia. Methods: it is "a descriptive hospital- based study" in which a total of 100 patients meeting the diagnosis of hypersplenism were studied for a period of 12 months (from January 2003 up to January 2004).Most of these patients were admitted to Khartoum, Soba and Ibn Sina Teaching Hospitals. Patients above 15 years of age were included in the study. The data was collected through a questionnaire containing a detailed medical history, thorough physical examination and detailed laboratory investigations. The Data was analyzed using SPSS program, simple tabulations and frequency distributions were conducted. Results: 100 patients were included in the study, 72% of them were males and 28%were females. 50% patients were due to schistosomal portal hypertension, 6% of them had liver cirrhosis beside periportal fibrosis (PPF), visceral leishmaniasis detected in 30% of patients, tropical splenomegaly syndrome (TSS) in 9%, liver cirrhosis in 6%, and in 5% no cause could be found. The majority of patients had gross splenomegaly. The main presenting symptoms were fever, symptoms of anemia, bleeding tendency and loss of weight. Conclusion: The common causes of hypersplenism in our study are potentially preventable conditions. There was no correlation between splenic size and severity of thrombocytopenia. Keywords: Hypersplenism, Schistosomal portal hypertension, Visceral Lesishmaniasi

Hypersplenism: Review article

Hypersplenism is a condition in which the spleen becomes increasingly active and then rapidly removes the blood cells. It can result from any splenomegaly. It is most common with splenomegaly secondary to portal hypertension and haematological disorders. Portal hypertension is an important cause of splenomegaly in most tropical countries. Although studies on hypersplenism are few, two studies have shown that schistosomal portal hypertension is the commonest cause of hypersplenism, other common causes include hematological disorders, and visceral lesihmaniasis, Tropical splenomegaly syndrome and liver cirrhosis, however there are wide geographical variations in the etiology of hypersplenism. Also the same above papers reported that there was no direct correlation between size of spleen and severity of cytopenia. This article reviews causes, diagnosis and management of hypersplenism but detailed discussion about management of conditions that causes hypersplenism is out of its scope. Keywords: Hypersplenism, splenomegaly, pancytopenia, portal hypertension

Hyper-Reactive Malarial Splenomegaly Syndrome (HMSS)

Abstract Hyper-reactive malarial splenomegaly syndrome (HMSS) is a massive enlargement of the spleen due to an exaggerated immune response to repeated attacks of malaria. Tropical splenomegaly syndrome (TSS) is the most frequent cause of massive tropical splenomegaly in malarious area

Celiac Disease Initially Mis-Diagnosed as Irritable Bowel Syndrome: Case Report.

Background: The increasing availability of serological testing & upper endoscopy has led to more frequent diagnosis of celiac disease & recognition that it may mimic Irritable bowel syndrome. Objective: The objective of the present case report is to describe the importance of screening those with vague abdominal symptoms (like patients with irritable bowel syndrome) and iron deficiency anemia for celiac disease. Methods: We report the clinical course of a 30-year-old patient with vague abdominal symptoms initially misdiagnosed as having Irritable bowel syndrome; later on when he reviewed our clinic he was noted to have iron-deficiency anemia. On workup for the cause of iron deficiency anemia he was found to have celiac disease on basis of positive serological tests and small-bowel biopsy result. After being placed on gluten free diet plus iron supplement his abdominal symptoms and iron deficiency anemia was totally improved. Conclusion:  Our case demonstrates that routine screening for celiac disease should highly be considered for patients with iron deficiency anemia and Irritable bowel syndrome. Keywords: Celiac disease • Iron deficiency anemia. Irritable bowel syndrome (IBS)

Helicobacter pylori vacA, cagA and iceA genotypes in dyspeptic patients from southwestern region, Saudi Arabia: distribution and association with clinical outcomes and histopathological changes

Abstract Background The aim of this study was to identify the common H. pylori virulence genes among dyspeptic Southwestern Saudi patients and their association with clinical outcomes and histopathological findings to help practitioners and researchers in the region for better management of infections caused by such bacteria. Methods Four hundred two gastric biopsy specimens were analyzed using histopathological examination and real time-PCR. The positive 187 specimens by RT-PCR were genotyped using PCR targeting cagA, vacA and iceA genes. Results One hundred twenty-eight gastric biopsy specimens were positive in genotyping PCRs. The cagA, vacA, iceA1 and iceA2 genes were detected in rates of 49.2% (63/128), 100%(128/128), 42.2% (54/128), 32.8% (42/128), respectively. The vacA s1as1bm2 subtype was the highest 23.4% (30/128), followed by m2 and s1a1b subtypes which were equally detected [16.4% (21/128) for each]. The iceA genes were significantly associated with gastritis and gastric ulcer. Overall, vacA genotypes were significantly associated with gastritis, gastric and duodenal ulcers. The vacA subtypes: s1as1bm2, s1a1b and s2 m2 showed chronic active gastritis in percentages of 90.0, 81, and 84.2%, respectively. All vacA mixed genotypes showed chronic active gastritis. Conclusions H. pylori virulence genes are highly prevalent and diverse among patients with dyspepsia in Southwestern region of Saudi Arabia. The iceA genes and the different vacA subtypes are significantly associated with the clinical outcomes and histopathological changes especially chronic active gastritis

Irritable Bowel Syndrome: Assessment of Prevalence and Risk Factors in Saudi University Students Using Rome IV Criteria

The main objective of this study was to determine the prevalence of Irritable Bowel Syndrome (IBS) and its associated factors among University students in Saudi Arabia, as little is known about this issue in our country. This cross-sectional study was conducted between 13 March and 21 May of the Academic Year 2017-2018 at Jazan University, Saudi Arabia, involving a random sample of 890 students, selected using the stratified multistage method. IBS prevalence was determined using the Rome IV diagnostic Criteria. The overall prevalence of IBS was 8.8%. According to the results of the multivariate logistic regression, the most important independent predictors of IBS were being a student in a medical college (OR = 10.42; 95%CI: 3.45-31.51) and a scientific college (OR = 5.16; 95%CI: 1.64-16.22), cigarettes smoking (OR = 2.74; 95%CI: 1.24-6.07), emotional stress (OR = 2.53; 95%CI: 1.28-5.00), and food intolerance (OR = 2.15; 95%CI: 1.11-4.16). The present study revealed a prevalence rate of 8.8%. The main predictors of IBS were being a medical student, a scientific college student, cigarette smoker, and having emotional stress and food intolerance. No significant association was found between IBS and anxiety and depression

Overweight, Obesity, and Associated Risk Factors among Students at the Faculty of Medicine, Jazan University

Background and Objectives: This study aimed to determine the prevalence of overweight, obesity, and the associated risk factors among medical students at Jazan University in Saudi Arabia. Materials and Methods: A cross-sectional study was conducted among 228 medical students from their second to sixth academic years at the Faculty of Medicine, Jazan University. A self-administered questionnaire was used to collect data regarding sociodemographic characteristics, physical activity, dietary habits, comorbidities, medication use, family history, and lifestyle factors. Anthropometric measurements including height, weight, and waist circumference were recorded. Chi-square test and binary logistic regression were used to identify the risk factors associated with obesity. Results: The prevalence of overweight and obesity among the participants was 13.3% and 15%, respectively. Hence, the combined prevalence of overweight and obesity is 28.3%. The mean weight was 63.39 ± 18.93 kg, and the mean height was 163.48 ± 9.78 cm. On the other hand, 17.3% of participants were underweight, whereas 54.4% had normal BMI. Most of the participants (61%) did not engage in regular exercise. A high proportion consumed fruits (82.9%) and vegetables (58.8%) 3 or fewer days per week, and 84.2% consumed 3 or fewer meals per day. Fast-food consumption more than 3 days per week was reported by 42.1% of participants. Obesity was not significantly associated with sociodemographic factors, physical activity, dietary habits, comorbidities, medication use, or family histories. However, those with a monthly family income of SAR 15,000–24,999 had significantly lower odds of obesity than those in the lowest income group (OR 0.230, p = 0.045). Conclusions: The prevalence of overweight and obesity among medical students at Jazan University is high. Although no significant associations were found between obesity and most risk factors, this study highlights the need for interventions that promote healthy lifestyles among medical students. Further research is needed to identify effective strategies for preventing and managing obesity in this population