Treatment of Ulcerative Colitis; Update

Ulcerative Colitis [UC] is a chronic debilitating inflammatory process that is usually confined to the mucosa and on occasions submucosa of the large bowel. It affects all age groups but is more common at 15-30 years and spares no sex. Typically the disease has relapsing-remitting course. Bloody diarrhea forms the cardinal clinical hallmark symptom of the disease, whereas the histopathological hallmark of the disease is diffuse infiltration of lamina propria with inflammatory cells, crypt abscesses and distortion of the mucosal architecture. Sudan Journal of Medical Sciences Vol. 3 (2) 2008: pp. 153-16

Neurological Manifestations of Dural Sinus Thrombosis

Background:Dural sinus thrombosis is a clinical syndrome that has a diversity of signs and symptoms that can be easily misinterpreted with other common neurological diseases such as brain infections.Objective: to study the clinical presentation of dural sinus thrombosis among Sudanese patients seen at Elshaab Teaching Hospital.Methodology: This is a prospective, descriptive, cross sectional, hospital based study conducted in Elshaab Teaching Hospital- Khartoum Sudan, in the period from November 2008 to July 2010. All adult Sudanese patients with dural sinus thrombosis who were admitted to the hospital and accepted to participate in the study during the period from November 2008-July2010 (50 patients) were enrolled. History, clinical examination and relevant investigations including MRI were done for all patients. Data were collected, analyzed, conclusions drawn and recommendations stated.Results: Females (98%) in child bearing age were mostly affected. Delivery and pregnancy were the common risk factors; head ache, neck pain and stiffness were the frequent neurological symptoms. Papilledema was the commonest neurological finding. Saggital sinus thrombosis wasfound to be the major radiological finding and great majority of patients showed remarkable improvement with treatment.Conclusion: Dural sinus thrombosis is uncommon neurological problem, however the diagnosis should always be considered in the right clinical setting, as it is a treatable conditionKey Word:dura mater,subarachnoid, cerebrospinal fluid

Hepatorenal syndrome: a review

The hepatorenal syndrome [HRS]is a reversible functional acute renal failure secondary to intense renal cortical vasoconstriction in a patient with liver disease. It affects around 40% of patients with cirrhosis and ascites1. The exact cause of the syndrome is not well understood. The state of liver dysfunction [Child-Pugh score] does not predict the occurrence of the disease. Genetic factors play no important role except as risk for liver disease and there is no sex difference. Patients with HRS characteristically have increased cardiac output, low arterial pressure, and reduced systemic vascular resistance. Diagnosis of HRS is one of exclusion. The definitive treatment is liver transplant. Nevertheless, a lot of work was done on medical therapy with promising results. Sudan Journal of Medical Sciences Vol. 1(1) 2006: 59-6

HBV, HCV and HIV among patients with Hemophilia in Khartoum- Sudan

Background: Hepatitis B, C and HIV infections and their impact forms one of the major health problems worldwide and in Sudan. Studies of hepatitis B, C and HIV virus among hemophiliacs in Sudan are lacking.Objectives: The main objective is to determine the screening, vaccination, seroconversion of hepatitis B, C and HIV among Sudanese hemophilic patients registered in Hemophilia Center Khartoum Teaching Hospital.Methods: During the period from July to November 2008, sixty two hemophilic male patients were randomly selected from hemophilic patients attending Hemophilic Center and were studied using simple direct standardized interview questionnaire and a blood sample from each patient was taken after consent for screening for hepatitis B, C and HIV.Results: Out of the 62 patients, 39 (62.9%) were found to be screened before this study. Out of these 23(58.97%) were fully vaccinated for HB V, 23.08 % were partially vaccinated and seven had no vaccination at all.Only one patient had seroconverted to HBsAg positive. HCV was detected in eight patient one of them was also found to have HIV infection.Conclusion: The low figures of HBs Ag positivity we got in this study is probably an under estimation of the actual prevalence of HBV as we did not use other serological marker and modern technology for detection of exposure to HBV. To determine the real magnitude of the problem wehave to applying other markers like HBc Antibody in the screening procedures which are simple and cost effective. The coverage of our hemophilic patients with HBV vaccine was 52% so a significant number of our patients are at risk of contracting HBV. Unlike HIV, HCV was detectedin an alarming percentage. Health education is a cornerstone in prevention of these serious viral infections

Recurrent Exudative Pleural Effusion with Flare up of Chronic Hepatitis B Virus Infection

We describe herein a young male patient who presented with exudative pleural effusion that appeared with flare up of chronic HBV infection and spontaneously recovered with the clinical and biochemical improvement of the hepatitis on two occasions five months apart. Other causes of hepatitis and exudative pleural effusion were excluded with appropriate investigations. Keywords: Extrahepatic, ascites, bilirubin, hepatosplenomegaly, mantou

The pattern and presentation of myathenia gravis in Al-Shaab and Omdurman Teaching Hospitals

Introduction: Myasthenia gravis (MG) is the most common acquired autoimmune disorder of neuromuscular transmission. It has different patterns of presentation.Objective: to study the pattern and mode of presentation of Myasthenia Gravis in Al-Shaab and Omdurman Teaching Hospitals, Khartoum Sudan.Methods: The demographic and clinical characteristics of 50 patients of myasthenia gravis (MG) were reviewed in Alshab and Oumdrman Teaching Hospitals for five months period from May to October 2008.Results: Out of 2400 patients attending neurology clinics 50 were found to have Myathenia Gravis [MG] with female; male ratio of 2.5:1. The age at presentation was the second decade of life in 34%. Most of the patients [42%] were from Khartoum State followed by North Kordofan State [14%]. High occurrence of late onset fatigability and weakness was seen in 92 % of our patients. Ocular muscles involvement was detected in 78%. MG was aggravated by hot weather and fever in 12% of the patients. Quinine represented the most common drug which aggravated the myasthenia symptoms in 4%. Diabetes mellitus and thyroid diseases were the most associated auto immune diseases seen in 12% and 4 % respectively. The diagnosis was made by classic history and neurological examinations in 88% and positive neostigmin test in64%. The majority of patients were treated with steroids. Thymectomy was done in 10% patients. The outcome was excellent as 82% improved and only one [2%] patient died.Discussion: Going with literature diagnosis of MG was made depending on classical history, full neurological examination and confirmed by tensilon test. Because of different reasons more sophisticated tests were not done in our patients. Only patients with malaria who were treated withquinine showed deterioration of their symptoms in our study. Strikingly, myasthenia crisis which were reported in 27% of patients were not seen in our population. Because of lack of usage of steroid sparing agents the vast majority [96%] of our patients were treated with steroids.Conclusion: Generalized myasthenia gravis with ocular involvement is common in our patients. However, pure OMG was not seen. Thymectomy was done in a small number of our patients with reference toother studies.Keywords: autoimmune, tensilon, neostigmin, thymectomy, diplopia, ptosis

Esophageal Stricture Post Endoscopic Injection Sclerotherapy

Background: Post endoscopic sclerotherapy esophageal stricture is usually not fatal but may requires several sessions of esophageal dilation as an effective palliative treatment yet has its own complications.Aim: The purpose of this study is to find out the predictors of sclerotherapy esophageal stricture.Methods: This is a cross sectional descriptive study of the esophageal stricture post sclerotherapy for the patients who were managed in the period from January 2000 through the June 2007 in endoscopic department at Ibn Sina Hospital. Post endoscopic sclerotherapy symptoms, signs, diagnostic and therapeutic methods were analysed to find out possible predictors of developing benign esophageal stricture.Result: A 33 out of 10133 patients who had sclerotherapyl were found to have esophageal stricture and were included in this study. 91% of them were males, 88% wer

Ormond's disease – case report

Retroperitonel fibrosis is a rare disease that occasionally faces the general surgeon as a case of retroperitoneal tumour. Ureteric stenting may succeed in relieving urinary obstruction, however, these stents are only for temporal use. For this reason and to exclude presence of retroperitoneal tumours, surgical ureterolysis remains the corner stone for saving the kidneys from the ultimate fate of renal failure. Steroids are of help when added to the surgical therapy. Recently tamoxifen was reported to be the treatment of choice in primary retroperitoneal fibrosis. Here, we describe the management of 2 cases of idiopathic retroperitoneal fibrosis one in a police officer with diabetes mellitus and the other in a housewife. Keywords: bilateral hydronephrosis, retroperitoneal fibrosis, surgical ureterolysis, bilateral hydronephrosis, tamoxifen Sudan Journal of Medical Sciences Vol. 1(1) 2006: 67-7

Knowledge of HBV Risks and Hepatitis B Vaccination Status Among Health Care Workers at Khartoum and Omdurman Teaching Hospitals of Khartoum State in Sudan

HBV infection is notorious and is endemic in Sudan. Health care workers are at particular increased risk for the infection. Their knowledge and acceptance of vaccination against the virus is of at most importance for the control of the disease.Objective: To study the knowledge and vaccination status among health care workers in some central hospitals in Sudan.Methodology: Data from different categories of health workers were collected using structure questionnaire after taking informed consent. Data were analyzed using Chi-Square and T-Test.Results: Around 96.22% of surgeons knew their increased risk for infection, and 71.69% of them knew vaccine prevention. The overall screening for the virus was 32.2%. Only 26.19% of those who received the vaccination had completed the doses. None vaccination due to a none specified cause was the main reason among doctors and nurses. Knowledge about risk and vaccination was very low among cleaning staff and none of them had vaccination.Conclusion: Although knowledge about HBV risk in our health care workers was reasonable –apart from cleaning staff-, the vaccination among them was not satisfactory. Efforts have to be augmented and special care for cleaning staff is mandatory

Esophageal stricture causes and pattern of presentation at Ibn Sina Specialized Hospital

Introduction: The aim of this study is to evaluate the causes and pattern of presentation of esophageal stricture in Ibn Sina Specialized Hospital. Methods:This is a retrospective study done at Ibn Sina Specialized Hospital during the period from April 2008 to December 2008. All patients had upper gastrointestinal endoscopy (UGIE), and those who were found to have esophageal stricture were enrolled in the study. The data collected were then processed and analyzed using appropriate statistical tests. Results and discussion: Out of 780 patients who had UGIE, 60 were found to have esophageal stricture; 37(61.6%) were males. The age group ranged between 20 years and 89 years, with a mean (± SD) age of 50.483 (±17.437) years. Esophageal cancer of the squamous cell carcinoma type (SCC) was the most important cause of stricture in the study. In both genders, the cancer was common in the elder age groups. Dysphagia was the commonest presenting symptom. Malignant and benign strictures were located at different site of the esophagus. In males postsclerotherapy was more common especially in the young, while peptic stricture was common in elderly. In females peptic stricture and esophageal webs were common in young adults (20 – 50 years). Endoscopic dilatation was performed successfully to 59 patients. Only one male in the age group 60 – 69 years was managed with percutaneous endoscopic gastrostomy (PEG) tube due to failure of dilatation. Conclusion: Esophageal stricture is an alarming sign of malignancy. Post-SCC stricture was detected in a considerable number of patients in our study group, therefore it require careful early diagnosis and distinction from other varieties because of their good outcome. Adenocarcinoma and other malignant tumors which cause esophageal stricture were not detected in our study group.Alcohol consumption was not a significant risk factor contributing to the development of post-SCC stricture in this study. Post-sclerotherapy stricture represented the peak in male farmers residing in the center of Sudan compared to females, other occupations and regions, and to other causes of benign stricture.Keywords: dysphagia, schistosmaisis, achalasia, adenocarcinoma, squamous