Histoacryl injection in the management of fourth branchial fistula

Purpose The aim of this study is to evaluate a minimal invasive approach in the management of fourth branchial fistula using N-butyl cyanocrylate (histoacryl) and to study its feasibility.Patients and methods Between 2006 and 2011, a retrospective study of five children with fourth branchial fistula treated at Assiut University hospital was carried out. Their age ranged from 2 to 5.5 years. Three were females. Histoacryl (adhesive material) was injected through the tract under general anesthesia.Results All the children presented with a discharging fourth branchial fistula. Three of them had a left-sided fistula. Fistulogram was carried out in all patients; two of them had a complete fistula. The duration of the procedure ranged between 10 and 15 min. No complications were noted. The duration of follow-up ranged from 2 months to 1 year. No recurrence was encountered during the period of follow-up.Conclusion Histoacryl injection of the fourth branchial fistula is an effective, easy, and minimally invasive procedure that can be carried out by junior staff. Surgery may be performed as a backup if there is failure or recurrence after injection.Keywords: branchial fistula, children, fourth branchial fistula, histoacry

Laparoscopic-assisted percutaneous internal ring ligation in children

Aim To evaluate the feasibility and safety of laparoscopic ligation of internal ring in congenital inguinal hernia in children.Patients and methods Laparoscopic percutaneous ligation of internal inguinal ring has been performed on 97 children with 133 hernias. The age ranged between 6 months and 11.5 years. The procedure was carried out under general anesthesia, through skin puncture opposite to the lateral edge of the internal ring. The needle was passed under direct vision to encircle the internal ring without touching the vas or testicular vessels. The heel of the needle is backed through the subcutaneous tissue and out of the original stab puncture. The contralateral side was examined and the internal ring was closed if it was patent.Results All children were subjected to a follow-up schedule for 1 year to evaluate both efficacy and reliability of the technique. The mean operative time in our series was 15 (± 3) and 20 (± 5) min for bilateral cases, without anesthesia time. Of 133 hernias repaired, two hernias recurred at 1 and 2 months postoperatively. Conversion rate was 0% in our hands. Five (3.8%) cases developed minimal extraperitoneal hemorrhage during surgery. Six (4.5%) cases developed mild hydrocele, which was successfully treated conservatively.Conclusion Laparoscopic percutaneous ligation of internal inguinal ring repair of congenital hernia is proved to be a safe, simple, and easy procedure and can be performed routinely. The procedure has better cosmetic effect because we use a single umbilical port only. The high safety of the procedure we devised is because the cord contents remained untouched during the procedure.Keywords: extracorporeal, inguinal hernia, laparoscopy, subcutaneous ligatio

Sacrococcygeal teratoma: 10-year experience in upper Egypt

Purpose To evaluate our experience with 45 patients with sacrococcygeal teratoma (SCT) in our community (upper Egypt) over a period of 10 years between 2001 and 2011 and determine the outcome of the management and recommendations for treatment strategies.Patients and methods A retrospective study was conducted at our Pediatric Surgical Unit, Assiut University Hospital. The medical records were reviewed for age at presentation, clinical manifestations and investigations, time of surgical approach, histopathology, recurrences, bladder and anorectal function, and cosmetic outcome.Results Forty-five patients with SCT were referred to the Pediatric Surgical Unit. The time of referral was as follows: immediately after birth in the case of five patients; during the first week for 17 patients (four of them died before surgery because of hemodynamic instability and other associated congenital anomalies and were excluded from the study); later in infancy for 22 patients; and at one and half years of age for one child. The lesion was excised in the case of 41 patients. Teratomas were of type I (n =9), type II (n = 20), type III (n= 11), and type IV (n =1) (Altman’s classification). The age of patients at surgery ranged from 2 days to 1.5 years. Histological analysis of results revealed mature teratoma (n =27), immature teratoma (n =9), and malignant teratoma (n= 5). The coccyx was not removed in two cases during the early period of the study. The follow-up period ranged from 3 months to 10 years. Recurrence occurred in five (12%) cases, wound infection in four (9.7%), and diarrhea in two (4.8%) cases. The a-fetoprotein level was high in 35 cases and was normal in two patients; it decreased after excision. Fetal diagnosis was made in five cases by means of a prenatal sonographic scan.Conclusion Prenatal diagnosis of SCT is very important and it is recommended to save the baby from obstructed labor. Early diagnosis allows early surgical intervention and avoids malignant transformation. The coccyx should be excised to decrease the risk of recurrence. Skin flap modification is feasible for large teratomas with healthy skin. Keywords: infants, neonates, sacrococcygeal teratom

Alleviation of oxidative stress induced by spider mite invasion through application of elicitors in bean plants

Spider mite invasion induces oxidative stress on bean plants and increased soluble sugars, phenole, proline and peroxidase activity, but decreased catalase activity and ascorbic acid and carotenoid concentration. Application of elicitors significantly enhanced spider mite tolerance by decreasing hydrogen peroxide, malondialdehyde, electrolyte leakage, and increasing peroxidase activity and antioxidant compounds reported previously, leading to increasing ion percentage in plant shoot. This finding suggests that elicitors might be activating antioxygenic enzymes and elevating antioxidants there by controlling free radical generation, hence preventing membrane peroxidation and denaturation of biomolecules resulting into improving plant growth.Keywords: Tetranychus urticae, Phaseolus vulgaris, salicylate, methyl jasmonate, antioxidants

Transcolostomy-site endorectal pullthrough for Hirschsprung’s disease

Purpose To present our results for an endorectal pullthrough operation as the second stage for the treatment of Hirschsprung’s disease through the colostomy site.Materials and methods This study included 13 patients, four girls and nine boys. Their ages ranged from 9 months to 7 years. They presented with a leveling colostomy with a diagnosis of Hirschsprung’s disease. The colostomy was carried out in the neonatal period because of neonatal intestinal obstruction in three patients (one female and two males), in two patients because of recurrent attacks of enterocolitis, and three patients because of the inability of the patient to withstand major surgery. Four patients presented without a clear history of the cause for the colostomy. One patient aged 7 years presented with sigmoid volvulus. All the patients were subjected to a transcolostomy endorectal pullthrough.Results The operation was completed as described in all patients. The time from colostomy to pullthrough ranged from 3 to 7 months (median 4.7 months). The operation time ranged from 95 to 140 min (median 113 min). All the patients passed stool within 24–48 h. Stool output ranged from two to six stools per day. Optimal wound healing occurred in all patients without wound complications. Postoperative perineal excoriation occurred in four patients. A urinary tract infection developed in one patient. A patient with a history of recurrent attacks of preoperative enterocolitis developed mild enterocolitis 2 weeks after the operation. Adhesive intestinal obstruction occurred in one patient. Recurrence of symptoms occurred in two patients because of stricture at the anastomotic site, one responded to repeated dilatation and the other required internal sphincterotomy.Conclusion Transcolostomy endorectal pullthrough has the following advantages: it is associated with less pain and a shorter hospitalization than the classic endorectal pullthrough. Wound complications are rare. The cosmetic result is better than the classic Soave operation. It has no specific technique-related complications. Long-term outcome and functional results are good. To our knowledge, this approach has not been described before. Keywords: Hirschsprung’s disease, leveling colostomy, pullthroug

The Socio-demography and Clinical Profile of Vitiligo in Sudan.

Introduction: Vitiligo is a chronic skin disease that causes loss of pigment, resulting in irregular pale patches of skin. The precise cause of vitiligo is complex and not fully understood. There is some evidence suggesting it is caused by a combination of auto-immune, genetic, and environmental factors. The population incidence worldwide is considered to be between 0.1% and 2%. The disease has different clinical types but generally, it consists of areas of macular depigmentation, commonly on extensor aspects of extremities, on the face or neck, and in skin folds. Age of onset is often in young adulthood and the condition tends to progress gradually with lesions enlarging and extending until a quiescent state is reached. Objective: To define the socio-demography and clinical profile of vitiligo in Sudan. Study design: This study is a cross-sectional, clinico-epidemiological and hospital-based study, done in Khartoum Dermatologic Hospital (KDH). The data were collected between June 2007 and November 2007. Results: The total number of patients with vitiligo in the study was 113. Male patients were 47 (42%). Children were 13 (11%), adults were 90 (80%) and elderlies were 10 (9%). The mean age of onset of the disease was found to be 11.5 yrs in 22.5% of the patients. Patients with acute (< 1 yr) disease were 6 (5.4 %), while those with chronic (b 1 yr) disease were 107 (94.6 %). The most commonly affected tribe was Algaa\'liyeen tribe (27 %). The commonest precipitating factor for vitiligo has been found to be emotional disturbances (in 27 % of patients). Commonest symptom of the disease was depigmented patch/es (64.8 %). Severe (b10 %) involvement of skin surface area was found in 59 % of patients, while mild

The psychological impact of vitiligo in adult Sudanese patients

Objective: Vitiligo is a chronic skin disease that causes loss of pigment, resulting in irregular pale patches of skin. The disease has profound psychological consequences. These effects range from mild embarrassment to a severe loss of self-confidence and social anxiety, especially for those who have lesions on exposed skin. The study sought to determine the psychological impact of vitiligo in Sudanese patients. Method: This study is a cross-sectional, clinical-epidemiological and hospital-based study, underatken in Khartoum Dermatologic Hospital (KDH). The data was collected between June 2007 and November 2007. 111 adult patients were enrolled sequentially during the study period and they were tested using the 12-item General Health Questionnaire (GHQ-12). Results: Psychological disturbances as a consequence of vitiligo were found in 36 (31 %) adult patients. Patients with mild psychological disturbances were found in 20 of these patients and severe disturbances in 16. Conclusion: Psychological consequences are common in patients with vitiligo.Key words: Vitiligo; Stress; Psychological; Suda

Rotavirus infection among Sudanese children younger than 5 years of age: A cross sectional hospital-based study

Introduction: In Sudan, rotavirus has been one of the important causative agents of diarrhea among children. Rotavirus A is well known as the leading cause of diarrhea in young children worldwide. It was estimated to  account for 41% of hospitalized cases of acute gastroenteritis among children in Sub-Saharan Africa. This study aimed to determine the  prevalence and the common clinical presentations of rotavirus A infection among Sudanese children with gastroenteritis seeking management in hospitals.Methods: 755 Sudanese children less than 5 years of age suffering from acute gastroenteritis in hospital settings were included. The positive stool specimens for rotavirus A was used for extract Ribonucleic acid (RNA) and the RNA product was loaded on formaldehyde agarose gel and visualized under UV illumination.Results: Of the 755 children, 430(57%) were males while 325(43%) were female. The age of children ranged from 1 to 60  months. There were 631 (84%) children who were less than 24 months of age. Out of the 755 stool samples, 121(16%) were positive for rotavirus. Of the 121 infected children with rotavirus, 79(65.3%) were male and  42(34.7%) were female and the highest infection rate was seen among 91(75.2%) of children up to 12 months of age. Children of illiterate parents were more infected with rotavirus than children of educated  parents. Severe dehydration present among 70% of infected children with rotavirus. Conclusion: Since this study is hospital-bas Conclusion:ed, the 16%  prevalence rate may not reflect the true prevalence among Sudanese children, thus a community-based surveillance is needed

COMPARATIVE STUDY OF LEVELS OF SELECTIVE OXIDATIVE STRESS MARKERS (MALONDIALDEHYDE, ZINC, AND ANTIOXIDANT VITAMINS A, E, AND C) IN ISCHEMIC AND NON-ISCHEMIC HEART DISEASE PATIENTS SUFFERING FROM TYPE- 2 DIABETES

Objective: The objective of the current study is to compare the levels of oxidative stress markers malondialdehyde (MDA), zinc, and antioxidant Vitamins (A, E, and C) in ischemic heart disease (IHD) and non-IHD patients with diabetes mellitus.Method: This is cross-sectional study group, conducted in the advanced diagnostic center (Khartoum- Sudan) from the period May 2013 to August 2015. Comprised 100 healthy subjects were, control group with mean (fasting blood sugar) 5.61=m mol/L, the age ranged from 22 to 78 years old, the average of the age was 50.1 years. 300 patients (78 IHD and 222 without) as cases groups, the ages ranged from 30 to 80 years. The age average was 51.2 years, all samples were in a state of fasting for 12 h, and the data were collected using a structured questionnaire and direct interview to collect information. Blood specimens were collected from both groups, and plasma levels of MDA, zinc, and antioxidant Vitamins (A, E, and C) were determined.Results: There was a significant difference between the level of serum Vitamin A, E, and MDA in diabetic patients with IHD and those diabetic without IHD (p&lt;0.05). No significant differences in serum Vitamin C level between both groups (p&gt;0.05).Conclusion: Due to the significant differences in serum Vitamin A, E, Zinc, and MDA between diabetics with IHD and diabetics without IHD, these parameters can be used as prognostic markers for prediction of oxidative stress and antioxidant stress of diabetic patients with IHD complications

Establishment of Hematological Reference intervals for healthy Children in Elobied City, Sudan

Hemogram Reference intervals are established since a healthy population is critical to accurately interpret laboratory tests, which include Hemoglobin estimation, Red blood cells count and indices, White blood cells count and differential in addition to Platelets count. This study aims to establish the reference interval of the complete hemogram amongst healthy Sudanese children in Elobied city, Sudan. A descriptive cross-sectional study&nbsp; included 354 healthy children, aged between 3 to 17 years, who were categorized into three groups according to age. A questionnaire was fulfilled, EDTA anti-coagulated venous blood sample was collected from each child then the complete hemogram was performed automated hematological analyzer (Sysmex Xp 300), Finally, Data was analyzed by a software program (SPSS version 21). The hematological reference intervals for healthy children [Hb g/dl, HCT%, RBCs count x106μL, MCV/fL ,MCH /pg., MCHC g/dl ,WBCs count x10³/μL, Neutrophil count%, Eosinophil count %, Basophile count %, lymphocyte count ,Monocytes count%, RDW CV and PLTs count×10³/μL] are [(12.4±1.2),(37±4),(5.0 ±0.4), (82±5.0), (26±3.0), (32±3.0) ,(7.0±2.0) (47±10), (1±0.1) ,(0±0),(45± 10),(7 ± 4), (13±1.8) &amp;(227±91)] respectively. The hematological RI for healthy children in Elobied was established in this study to be representative of this population, there was a significant gender-based difference in all the evaluated hematological parameters, they were found to be higher in males than in females except for basophil (%). Finally, the results of this study would shed a light on the importance of establishing RI for the children population in Elobied