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

Gum Arabic a superb anti-diarrheal agent

Back ground: Diarrhoea is the second most common cause of death in young children, after pneumonia.Gum Arabic (GA) is a soluble fibre with moderate emulsifying properties that may result in greater accessibility of electrolytes and associated water to the microvillus membrane. Additional work indicated that GA enhanced absorption of the solutes transported by diffusion and does not act via sodium dependent mechanisms.Objective: The objective of this study was to evaluate the effect of Sweetfibre (gum Arabic preparation) as an additive to WHO-ORS in the management of acute diarrhoea in children.Methods: An interventional randomized controlled hospital based clinical trial was performed in OPEH (March to August 2011). One hundred and eighty children presenting with acute none bloody diarrhoea in the absence of severe systemic illnesses were enrolled in the study. These children were divided randomly into two equal groups (study group1 and control group2), their ages ranged between sixand 60 months. The control group received the conventional treatment of diarrhoea according to WHO recommendations and the other group received in addition gum Arabic solution (sweetfibre), 5-10 mg until recovery and continued with 5 mg thereafter. Data were analysed using the SPSS.Results: In the group of children who received gum Arabic; diarrhoea stopped within 24 hours in 90% and 80% were discharged after one day. All of them were improved and discharged within first five days of admission. None of them went into severe dehydration or shock. Only three children developed electrolyte imbalance. The weight at the end of the study increased in 47.8% and decreased in only 5.5%. Sixty one children were followed after 6 weeks only two of them (3.3%) had recurrence of diarrhoea. In the control group diarrhoea stopped within 24 hours in 38.9% and 30% were discharged after one day.10% did not recover during the first five days of admission. Electrolytes imbalance developed in 23.3%, two children developed severe dehydration and one became shocked. The weight decreased in 35.6% and increased in 15.6%. Sixty seven children were followed, 13 (19.4%) of them developed diarrhoea again.Conclusion: Sweetfibre as an additive to WHO-ORS reduces the duration of diarrhoea and hospital stay. It decreases diarrhoea complications and facilitates regaining weight. It has a prebiotic effect in prevention of diarrhoea. All these indicate its potential as a new antidiarrheal therapy for acute diarrhoea in children.Keywords: prebiotic, antidiarrheal, contamination, isonatraemic, isotonic dehydration

Epilepsy among elderly Sudanese patients

Objective: The aim of this study was to evaluate the clinical presentation and characteristics of elderly Sudanese patients with epilepsy. Methodology: This is a prospective study (from Feb. 2005 to Jun 2008). The study population included 240 elderly epileptic patients (age 60 years or above). Results: Cerebrovascular accident was found to be the most common cause of secondary epilepsy (31%).Generalize epilepsy was seen in 120 (50%) of patients. Abnormal neurological findings were more common (49%) among patients with partial epilepsy. Fifty percent of our patients showed abnormal EEG. Abnormal CT brain findings were common among patients with partial epilepsy. Conclusion: The pattern of clinical presentation of epilepsy among elderly Sudanese epileptic patients is similar to what was mentioned in the literature except that the percentage of epilepsy following infections was more among our studied group (6%Keywords: Cerebrovascular, EEG, seizure

The patterns of clinical presentations of cerebellar syndromes among adult Sudanese patients

Cerebellar syndromes are one of the commonest neurological diseases.Objectives: To study the patterns of clinical presentations of cerebellar syndromes and to identify the possible causes.Methods: This is a prospective hospital based, cross-sectional study. One hundred adult Sudanese patients with cerebellar syndromes were included in the study during the period from January 2006– January 2007.Results: The most common age group affected was 18 – 25 years. Male to female ratio was 1.5: 1 unsteadiness on walking was the most common symptom (83%). Gait-ataxia was the most common sign (83%). Cerebrovascular disease was the most common aetiology (25%).Conclusion: Cerebellar syndromes are not rare in Sudan. However, they were diagnosed more commonly at the central regions of the country probably because of more awareness of patients and better facilitiesfor diagnosis. The age of onset, the male predominance, the presentation and clinical findings were not different from reported literature. This also goes for the common causes apart from alcohol which is a strikingly rare as a cause in this study and could be accounted for the implementation of Elshariya (Islamic laws) Laws in Sudan.Keywords: ataxia, dysmetria, disdiadochokenesis, decomposition, nystagmus, dysarthria

Psychological Disorders and Quality of Life among Sudanese Dialysis Patients and Renal Transplant Recipients

Introduction: Psychiatric illness is common among patients with chronic disorders, particularly in those with end-stage renal disease on renal replacement therapy (RRT). Patients with a functioning renal allograft have an improved quality of life (QOL) compared to patients on dialysis.Objective: to evaluate the psychological disorders and QOL among dialysis patients and renal transplant recipients.Patients and Methods: This is a prospective cross-sectional study that included 168 patients on RRT. Their psychological health status was assessed through clinical examination and relevant designed questionnaires .The data obtained were fed to the SPSS for analysis. Significance was assumed at P< 0.05.Results: Out of 168 ESRD Sudanese patients, 43 (25.6%) received renal allograft. The frequency of depression was 90 (72%) and nine (25.6%) of patients on dialysis; and kidney transplant recipients respectively. Anxiety was reported with significant difference (p < 0.001) in the dialyzed patients compared to kidney transplant recipients. Sleep disorders were experienced by 81 (64.8%) of dialyzed, and nine (20.9%) of kidney transplant recipients (

Upper Gastrointestinal Endoscopy in Sudanese Infants and Children

Background: Upper gastrointestinal endoscopy [UGIE] in children is safe and useful. Pediatric gastrointestinal endoscopy was introduced relatively recently in Sudan. The indications and patterns of endoscopic findings of UGIE in Sudanese children were not reported before. Objectives: Our objective was to identify the indications and findings of UGIE among Sudanese children and to compare that with others findings. Patients and methods: The Demographic data of the first 200 children less than 15 years of age who underwent UGIE during January 2005 to December 2007 were retrieved from their files and analysed. Results: Two hundred children had UGIE. Their ages ranged between 6 months and 15 years. 80 and 20 had UGIE because of hematemesis and abdominal pain respectively. 50 children had esophageal varices while peptic ulcer disease was found in 19. 65 out of 100 children who presented with failure to thrive, short stature, and persistent diarrhoea were found to have macroscopic duodenal lesions. 65 duodenal biopsies showed total villous atrophy. H. pylori infection andgastritis were found in 165out of 180 biopsies [91.7%]. Ultrasound abdomen was performed in the 125 children who presented with hematemesis or abdominal pain. 20 out ofthe 52 who had ultrasonographic abnormalities were found to have cavernous transformation of the portal vein, whereas10 children had features of liver cirrhosis. Conclusions: The patterns of upper GIT diseases in the study population were comparable to literature. However, H. pylori infection and cavernous transformation of the portal vein were higher than reports from other parts of the world. Keywords: cavernous transformation, portal vein, H. pylori, hematemesis, esophageal varices. Sudan Journal of Medical Sciences Vol. 2 (2) 2007: pp. 91-9

Hepatitis C virus infection in Saudi Arabian recipients of renal transplantation

Background: Studies of recipients most of whom had been infected prior to transplantation, had yielded conflicting conclusions in regard to the clinical impact of hepatitis C virus [HCV] infection. We determined the frequency of new HCV infection and assessed its effect on patient and graft survival and occurrence of chronic hepatitis in renal transplant recipients. Methods: We studied 54 Saudi recipients [37 males and 17 females; mean age (SD); 38.2(17.1) years] they were anti- HCV negative at the time of transplantation and followed for 3 to 19 years [mean = 8.1]. The prevalence of anti-HCV at the time of censorship was compared with the rates in 99 hemodialyzed patients, 400 healthy volunteers and 113 hospitalized patients. Results: The period prevalence of anti-HCV in recipients was 37% [20 of 54], compared to hemodialyzed patients [17.1%], hospital patients [1.8%] and healthy volunteers [2.3%]. [P < 0.01]. Seroconversion to anti-HCV positivity occurring from 2 to 11 years [mean =7.8] after transplantation and was not influenced by age, gender or source of donor kidney. Cumulative frequency of HBsAg was 14.8%. Graft loss occurred in 1 HCV positive recipient. Serum aminotransferase was abnormal [>2 - fold elevation] in 2 anti-HCV positive recipients transiently. No deaths occurred among the recipients. Conclusion: The acquisition of new HCV infections had a relatively high frequency among renal transplant recipients in the study. The course of the infection was benign in the medium term, with no discernible progression to clinically recognized chronic liver disease. Further studies are required to determine cost- benefit of antiviral therapy in such patients. Sudan Joural of Medical Studies Vol. 2 (1) 2007: pp. 9-1

Pattern of plasma lipoprotein (a) in Sudanese patients with coronary artery disease

No Abstract. Sudan Journal of Medical Sciences Vol. 2 (3) 2007: pp. 197-20

Disease recurrence following cetuximab completion and declining a gastrectomy: what next to manage Ménétriers disease?

Ménétriers disease is a rare mucosal hyperproliferative disorder of the stomach, however, the evidence for long-term care remains limited, especially if a gastrectomy is declined. We present a case of 25-year-old Caucasian woman with a history of end-stage renal failure (ESRF) who experienced worsening symptoms of abdominal pain, haematemesis and abdominal swelling, with her serum albumin dropping to 20 g/L and haemoglobin to 4.9 g/dL. Endoscopy showed markedly hyperplastic gastric folds consistent with Ménétriers disease, confirmed histologically by gland dilation and gastric pit expansion. Intravenous cetuximab was prescribed for 12 months, with clinical, biochemical and endoscopic improvement. However, 5 weeks post cetuximab completion, there was relapse to 50% gastric coverage with Ménétriers. A discussion around gastrectomy was rejected by the patient. This is the first report of relapsing Ménétriers disease in a female patient with ESRF; we suggest that long-term cetuximab should be considered if a gastrectomy is declined

Gastroesophageal reflux disease in Asia: A condition in evolution

10.1111/j.1440-1746.2008.05380.xJournal of Gastroenterology and Hepatology235716-72