Intra-abdominal lymphangioma with ascriasis as diagnostic predicament

Lymphangiomas are rare tumours. About 90% of lymphangiomas manifest in children at the age of three years1. The sex ratio is roughly equal in childhood2. In young patients lymphangiomas are preferentially located in head, neck and axilla, but they also occur sporadically in variousparenchymal organs e.g. spleen, liver and bones. When it is diffuse as multifocal disease [lymphangiomatosis] during adulthood, it develops as superficial cutaneous lymphangioma or as intra-abdominal lymphangiomas. The male to female ratio for intra-abdominal lymphangiomas3 is 3:1. Here we present a case of intra-abdominal lymphangioma in a 14- year old boy who presented as a diagnostic dilemma

The Mysterious, Threat We Will Confront Mycobacterium Chelonae

Background: Surgical wound infection is an internationally recognized complication which is expected to get cured in few days time. Lack of antibiotic policies added to the existing chaos in free market policies is expected to end up with mysterious resistant organisms soon in future. Objectives: To report our experience with 52 key hole protracted surgical wound infections in 23 patients. Patients and methods: Demographic data of patients who suffered post operative subcutaneous wound nodules following minimal access surgery, duration of the disease and its clinical manifestations as well as results of investigations were collected and analysed. Results: Two males and 21 females, age range 27-65 (median 42) years had 32 key-hole wound nodules and 20 persistent discharging wounds that had appeared in an average but latent period of nine weeks (range three weeks to sixmonths after surgery). Only two cultures were positive for Mycobacterium chelonae. Conclusion: Mycobacterium chelonae should be suspected in protracted surgical wounds and treated promptly with meticulous frequent dressings, wound excision and clarithromycin plus ceftazidime. Keywords: surgical wounds, subcutaneous, mycobacterium, catalase, resistant organisms.Sudan Journal of Medical Sciences Vol. 3 (2) 2008: pp. 133-13

Adherence of Sudanese Coronary Artery Disease Patients to Secondary Prevention Medications at Elshaab Teaching Hospital, Sudan

Background: Coronary artery disease (CAD), worldwide, is the most common type of heart disease. Adherence to the evidence-based medications for secondary prevention is associated with further improvement in the outcomes.Objectives: To identify level of adherence towards secondary prevention medications among Sudanese ischemic heart disease patients.Materials and Methods: This is a cross sectional hospital-based study, performed in the period from August 2012 through January 2013.Audit of Adherence of Sudanese Cardiac Patients to Secondary Prevention of Ischemic Heart Disease at Elshaab Teaching Hospital Khartoum, Sudan was done using a questionnaire for assessment.Results: A total of 210 patients were included in this study. Their mean (±SD) age was 60.8(±12.3) years. Of them, 190 patients have high risk factors and 167 were on regular follow up. 195(92.9%)patients were on ACEI/ARBs and Aspirin. 116(55.2%) were on clopidogrel and 203 (96.7%) on statin.Conclusion: 140(66.7%) patients were strictly adherent to medications, 21(10%) partially adherent and 49(23.3%) were totally not adherent. Lack of adherence was mainly due to poverty and high cost of medications.Key words: Adherence, coronary artery disease, secondary prevention, evidence-based medications, Sudan

Lymphangioma CircumscriptumA Rare Form Of Lymphangiomas

Superficial lymphangiomas are either cavernous type, diffuse or circumscribed (circumscriptum). Lymphangima circumscriptum (LC) is a rare benign condition characterized by the appearance of persistent clusters in the skin and subcutaneous tissue which may contain fluctuant cysts1. The firstreported description ofLC was done by Fox and Fox2 in1878. They named it as lymphangiectodes2. The term LC is first used by Morris3 in1889. Complete surgical excision is the main treatment. Here we are reporting a case of lymphangioma circumscritum of the thigh in a six-year old girl

Breaking Bad News for Patients with Gastro-Intestinal Malignancy: Experience at Ibn Sina Teaching Hospital

Background: Integrity, beneficence, non-maleficence and Justice are the pillars of the professional behaviour. Confidentiality is a serious issue governed by the law. However, in developing countries, patients’ relatives urge to know the diagnosis and often request the doctor not to mention the word cancer or malignancy to their patient.Objectives: To evaluate the communication skills for breaking bad news to Sudanese patients suffering of gastrointestinal cancer and to find out the patients’ responses on that matter.Materials and Methods: This is a hospital based non-randomized  prospective study, carried out at Ibn Sina Specialized Hospital in the period August through December 2011. The study involved113 patients of whom there were 56 males.Results: Doctors had talked about the disease to 75% of the patients  whereas the rest were told by either the psychologists and/or their  relatives. Only 25% of the patients were told the truth, the rest were told to have mass or lump without explaining its nature. Patients’ responses were as follows: 41.6% were felt terrified, 23.9% were shocked and became  anxious, while 33.6% were stable, but 0.9% became angry and frustrated. No patient was told about the prognosis and the chances of cure.Conclusion: Sympathy over-ride empathy in communicating bad news to Sudanese patients suffering of cancer. Patient education and training in breaking the bad news is needed.Key words: Communication skills, breaking bad news, truth telling, Sudan

Prospective Randomised Controlled Trial of Teaching Medical Students Behavioural Sciences

Background: In the last few decades, medical professionalismcame upas a challenging issue to teach and assess.Objective: To compare the level of understanding of the medical professionalism, medical ethics and human rights among the first year and fifth year medical students at Omdurman Islamic University in Sudan.Methods: Prospective randomised controlled trial. Students were randomized in to four groups during teaching of behavioural sciences which was given at different spectra in the different groups. Responders were 365(91.25%), they were 143(39.2%) first year males, 141(38.6%) first year females split in two groups and 81(22.2%) fifth year mixed male and female.Conceptual understanding of medical ethics, professionalism, human rights and the religion values as part of the university requirement were assessed with a pretested questionnaire.Results: Of the fifth year students 69(86.3%) were able to describe triggering organisational help for patients as an advocacy and 119(83.2%) first year male students were able to identify that availing medical facilities to the disabled and the vulnerable groupsas basic human right. Themajority (>90%) of all students were described well professional integrity and 132(93%) of first year medical students were able mention correctly the differences between the Healer and the professional and 83(58.5%) of fifth year students specified the confidentiality issue in taking informed consent, respectively. However, the students' categorised the regulation of organ transplantation and tissue engineering has human rights followed by Religion Teachings bases.Conclusion: Teaching medical ethics, human rights, professionalism and University requirements to the first year medical students and gains during the practical experience of the clinical clerkship have a considerable impact on the student perception of these subjects. Gains are expected to improve if these issues are integrated in all areas of the curriculum.Key words: Professionalism, Human rights, Medical ethics, medical student

Trends of gastric malignancies: Case study of Ibn Sina Hospital 2010-2011

Back ground: Gastric malignancies carry poor prognosis, because they commonly present at an advanced stage.Objective: to find out mode of presentation and its impact on the outcome and management of gastric cancer and to find if there are changes in trends of gastric malignancies over the last decade.Patients and methods: A review of 53 patients with gastric malignancies, treated at Ibn Sina Hospital from August 2010 through August 2011. Their demographic data, pattern of clinical presentation, histopathology grading and staging, type of management and hospital mortality were studied.Statistical analysis: Data was fed to Statistical Package for Social Sciences. Means and correlations were computed where appropriate. One sample t-test was performed. Statistical significance was taken at P = 0.05.Results: Out of 53 patients males comprise 30(56.6%) males. The peak frequency was at the age group 55-70 years. Patients from the Northern Region of Sudan constituted 34%. Adenocarcinoma comprised 43(81.3%), GIST 8(15%), lymphoma 1(1.9%) and carcinoid 1(1.9%). Epigastric painwas the commonest symptom in 47(88.7%) patients. Smoking and snuff (Tombak) and high salt diet were found in 7.5% and 5.7% and 3.8% patients respectively. Blood group A and O was found in 22.6% and 60.4% respectively. Family cancer syndrome was found in 11.3% patients.Malignancies of the antrum constitute 27(65.85%), cardia 4(9.8%), body 7(17.1%), and whole stomach 3(7.3%) patients. There were only 6.25% clinically early cases. Potentially curative resection was attempted in 31.7%. The mean hospital stay was 12 days.Conclusion: Patients presented at stage III and IV comprise 30 (93.75%) out of 32 carcinoma patients. The hospital morbidity was 13(24.6%) patients and mortality 4(7.5%) patients. When compared with results from same hospital there is improvement in outcome over a decade.Keywords: Adenocarcinoma, lymphoma, carcinoid, dysphagia

Preliminary report on theNeurology workload ina central hospital in Sudan.

Introduction: Identification of the local pattern of neurological diseases is expected to help setting the priorities for good planning of management and public education.Objectives: To identify the pattern of neurological disorders in a second biggest central hospital in Sudan.Methodology: Review of the diagnosis of 170 patients, seen in the out patients neuro-clinic and the neurology ward from March 2010 to February 2011, was done. Patients who were in follow up by other neuro-clinics were excluded.Results: The male to female ratio was 1:1 Patients who were 20-60 years old comprised 54%.About 50% of patients live in Omdurman city. Motor symptoms were the most common presenting symptoms forming 64.1% followed by cranial nerves symptoms 27.6%. Stroke was the commonestencountered diagnosis seen in 20.7%, followed by epilepsy in 16.6%, headache in 9.6%, movement disorders in 7.7%, peripheral neuropathy in 3.6%, demylination in 1.8%, cerebral venous sinus thrombosis (CVST) 1.8% and tumours in 1.2% patients. Stroke was more common in patients from East Sudan and Epilepsy was more common in patients from West Sudan. Vascular and degenerative changes were the commonest abnormalities seen in imaging studies. Demyelination and neoplasms were more common in females.Conclusion: Stroke, epilepsy and headache were the commonest neurological disorders met in Omdurman Teaching Hospital.Key words: general hospital, neurology department, neurological disorders

Sudanese Medical Students and Scientific Research

Background: Most of developing countries face problems in assessment of their public health practices. Gain of this knowledge is orchestrated by  research. Medical students can play an essential role in improving public database.Objective: to explore knowledge, attitude and skills of medical students in the Faculty of Medicine and Health Sciences (FMHS), Omdurman Islamic University (OIU) towards research.Materials and Methods: This is a descriptive, analytical, cross-sectional, institution-based study. A total of 442 students, equally from each batch participated in the study. Equal numbers of male andfemale were considered to eliminate gender and seniority bias. Structured pretested questionnaire was used for data collection. Data collected were fed to Statistical Package for Social Sciences(SPSS) version 15. Means, standard deviation and correlations were done where appropriate. Statistical  significance was taken at P =0.05.Results: The mean knowledge score was 37% and attitude was positive in 77.1% of the students. Only 18.3% had attended research methodology workshop. The rate of internet navigation is directly proportional to the social class. Only 14.7% knew the engines used for finding medical literature.Conclusion: The low knowledge score is due to lack of application of research in the academic curriculum; however, the students have a fairly positive attitude. The knowledge is expected to improve with the intended policy to include practical research in the curriculum.Key Words: Public health, academic curriculum, Suda

The impact of gender on difficulty of classical open cholecystectomy

Background: Cholecystectomy demands attention, and expectation of abnormal anatomy in the veins, arteries or ducts. Prediction of difficult cholecystectomy does not only helpin patient counseling but also helps the surgeon to prepare better for the technical difficulties that may be encountered1-3.The aim: To find out whether there is impact of gender on the difficulty of surgery during open cholecystectomy.Patients and methods: This is a prospective hospital based study. Patients who presented to Ibn Sina Hospital for open cholecystectomy during the period from April 2011 to April 2012 were included in this study. Special emphasis was put on gender, the operative time, difficulty of surgeryand complications of open cholecystectomy. A pre-tested questionnaire was filled during interview of patients and operating surgeons.Results: A total 327 operations were included in the study. Of them there were 34(64.2%) males and 99(36.1%) females presented early i.e. after the first diagnosis was made. The mean operative time was 44.6 min for males and 43.57 min for females. Difficult surgery was described in 6(11.3%) of male and 23(8.4%) females.Conclusion: There was no significant statistical difference in the operative time, difficulty of operation and complication rate between males and females.Key words: Open cholecystectomy, difficulty, gender