Investigation of Diffuse Hair Fall Case Due to Vitamin D Deficiency: A Case Report and Literature Review

A 45-year-old female from northern Sudan presented a complaint of diffuse hair loss from her scalp for 4 years. The condition started when she was in Saudi Arabia, where she resided for five years with her husband and children. The condition is associated with fatigability and easily falling asleep. The condition is static with no known relieving or aggravating factors. She looks well, not pale, jaundiced or cyanosed, regular pulse, no lymph node enlargement; thyroid is central with normal size and no lower limb edema. Scalp: looks normal, no scales or erosions. Hair: hair is dry with normal texture; loss is diffuse, no apparent patch of alopecia. Axillary and pubic hair is normal. All investigations were within normal values except serum vitamin D that was found to be very low: 9 (average value 30–300). Management plans to correct the deficiency for three months, and then a daily maintenance dose is to be prescribed. The monitoring of vitamin D serum level is to be assessed to avoid hyper vitaminosis. Vitamin D supplement was prescribed as oral tabs of 50,000 IU weekly for three months. Daily maintenance dose of 1000 IU was prescribed. Improvement was noticed starting from the first month, and excellent result was achieved after three months of daily supplementation; daily maintenance dose was then prescribed with an advice of being outdoors to enhance endogenous synthesis. Conclusion: Serum vitamin D level should be assessed in patients with hair loss, especially those at a risk because of being indoors

Assessment of Serum Copper Level among Sudanese Patients with vitiligo

Background: Vitiligo is a common skin disease of unknown etiology characterized clinically by depigmented patches, which can be localized or generalized; it usually runs a chronic course with an un predictable outcome and failure of complete cure in many affected individuals. Many communities consider it a contagious disease which leads to a great psychological and social stigma for patients; previous studies showed that copper might be associated with the pathogenesis of vitiligo. The aim of this study was to assess copper level in Sudanese vitiligo patients. Methods: This is a case-control study conducted in dermatology clinics in Khartoum state during the period from November 2018 to February 2019. Blood samples were obtained from 100 participants, 50 from vitiligo patients and 50 from non-vitiligo subjects representing a control  group. Serum copper was measured by mind-ray (automation). Results: A highly significant increase (P-value = 0.000) in the copper level was seen in vitiligo patients compared with the control group. Of the total number of patients, 17 (34%) were females and 33 (66%) were males. According to the duration of the disease, the copper level was significantly increased in patient group with a disease duration of > one year compared to the patient group six months–one year and patient group < 6 months; we found no significance of the family history, 18% of the case group had a family history while 42 (82%) had no family history. Discussion: The relationship between the serum level of copper and vitiligo has been assessed by many studies. Copper is one of the trace elements that was found to be important for tyrosinase enzyme that catalyzes the first steps in melanin synthesis in the skin. Some studies showed that the disease was associated with low serum levels of copper and since vitiligo is a disease that is characterized clinically by white areas of skin with no melanin, these studies seem to be logical. However, in this study, the serum level of copper was found to be high in vitiligo patients which might be justified by the release of copper from the destroyed melanocytes. Another justification might be a defect in the carrier protein for copper. Conclusion: The study found that the serum copper was significantly increased in vitiligo patients compared to the control and it is recommended that serum copper level and copper profile should be assessed routinely in vitiligo patients. Keywords: vitiligo, depigmentation, copper, Sudanes

Assessment of Plasma von Willebrand factor antigen in non-metastatic Prostate Cancerpatients: across-sectional study of the Sudanese Population

Backgrounds: VonWillebrand disease (VWD) is reportedly the most common inherited bleeding disorder and can also arise as an acquired syndrome (AVWS). These disorders arise due to defects and/or deficiency of the plasma protein von Willebrand factor (VWF)..High plasma vWF concentrations have been reported in patients with various types of cancer, such as prostatic cancer.Metastasization may be associated with activation of haemostatic processes resulting in increased levels of circulating factor VIII-related antigen (FVIIIRAg) (von Willebrand factor antigen). Objective: To evaluate the status of VWF AginSudanese patients with Prostate Cancer attending RICK Methodology: This is a cross-sectional study carried out in Khartoum state at Khartoum oncology (RICK) hospital, during the period from April to June 2018, 45 samples were collected from patients with non-metastatic CA prostate, their ages ranged between 51 to 82 years. The vWF level was measured using Enzyme-linked immunosorbent assay (ELISA). Data were analyzed by the statistical package for social science (SPSS).   Results: Serology for vWF antigen was done for 45 cases of prostate cancer. According to the age, 2(8%) of patients with age 51-66 had a high concentration of VWF while 24(92%) had normal vWF antigen concentration; of those with age 67-82 years, 4(21%) had high vWF antigen and 15(79%) had normal antigen. Conclusion: The study revealedthat more than 80% of Sudanese patients withnon-metastatic prostate cancer have anormal concentration of VWF. Keywords: vWF, Prostate cancer, Age, ELIS

Treatment of Extensive Plaque Psoriasis and Psoriatic Arthropathy using Methotrexate in a Patient with High Serum Alkaline Phosphatase

Background: Psoriasis is an autoimmune inflammatory, chronic, and relapsing disease of the skin, which can also present with severe joint inflammation and deformity. There are many treatment options, but the severe forms of psoriasis are treated successfully with cytotoxic and biologic therapies. Methotrexate being cheap and available in Sudan is considered a good option for patients with severe and extensive forms of psoriasis.One of the main drawbacks is hepatotoxicity. The aim of this report is to share an experience of treating the patient with oral methotrexate in the presence of a relative contraindication to this therapy. Method: We present a 60-year-old female with extensive skin psoriasis and psoriatic arthropathy. Investigations showed high serum alkaline phosphatase and low serum albumen. Other liver enzymes, CBC, ultrasound abdomen were all unremarkable. Patient was admitted and a weekly dose of methotrexate was given in addition to topical preparation and supportive treatment; three months later, patient improved andwas moved to topical therapy. A check of serum alkaline phosphatase and albumen every week was done. Results: The patient was successfully and safely treated with methotrexate. Serum alkaline phosphatase was normal within the second month treatment, and serum albumen was normal after only one month of treatment. Conclusion: High serum alkaline phosphatase is considered a relative contraindication to the use of methotrexate, high level can be found in bone diseases. Serum albumen can be low in dermatologic diseases with excessive shedding of scales and can be corrected with protein formulas and high protein diets. Recommendations: Methotrexate is recommended for the treatment of severe morbid forms of psoriasis. The biologic therapy for severe forms of psoriasis is now available and can be a good alternative for the treatment of severe forms of psoriasis in good centers and for patients who can afford and in patients with absolute contraindications to methotrexate therapy

Hematological Changes in Sudanese Patients with Falciparum Malaria Attending Elnihoud Teaching Hospital

Backgrounds: Malaria is a major public health problem in the tropical and subtropical areas of the world, including Africa. Most cases of malaria in Africa are caused by Plasmodium falciparum. Objectives: This study was aimed to assess the hematological changes in patient with falciparum malaria and to estimate the incidence of leucopenia, thrombocytopenia, and its response to anti-malaria therapy, and to correlate the association of the hematological changes with P. falciparum-positive (study group) and P. falciparumnegative (control group). Methodology: A total of 453 participants (353 cases and 100 as control group) were enrolled in this study, all of them were randomly selected from Elnihoud Teaching Hospital, Elnihoud Locality, West Kordufan State, Sudan. Questionnaire was filled by every participant and thick and thin blood films for malaria were prepared and stained by giemsa stain and the CBC was done by sysmex automated hematological analyzer. Results: Thrombocytopenia, leucopenia, microcytic hypochromic red blood cells and relative lymphocytosis have significant association with falciparum malaria with Pvalues 0.008, 0.001, 0.008, and 0.004, respectively. Conclusion: Patients with thrombocytopenia and/or leucopenia with malaria should receive anti-malaria therapy and follow-up by CBC, and shouldn’t be hurried for a bone marrow examination

Letterer Siwe Disease (LSD): A Case Report

Background: Letterer–Siwe Disease (LSD) is one of the variants of Langerhans cell histiocytosis (LCH), which is considered as a rare disease that affects many systems in the body; it is characterized by monoclonal migration and proliferation of specific dendritic cells. The disease affects the bones and skin primarily, but can involveother organs as well, or appear as a multi-system disease leading to different clinical manifestations and eventually death. Summary: The authors present a case report of LSD in a two-year-old child from western Sudan, Messeria tribe, who is presented with one and a half-month history of fever, cutaneous ulcers, purprae,scaly crusted scalp, and pallor. His full blood count showed very low Hb with marked reduction of platelets. TWBC was normal. US showed hepatosplenomegaly with lymphadenopathy. A suspicion of sickle cell anemia and leukemia was suggested. He received treatment in his area in the form of antibiotics, skin care, blood transfusion and platelets aggregate without improvement. Patient was referred to Khartoum for further investigations and management. On presentation, a diagnosis of histiocytosis x was suggested depending on the clinical presentation of a general ill health in a child with purpurae, skin ulcers, and a scaly crusted scalp. A skin biopsy, bone marrow aspirate, and a skull x-ray were requested. Bone marrow aspiration showed hyper cellular BM with marked hemophagocytosis. Patient was admitted in a pediatric ward for further general investigations and blood transfusion, but he passed few days later before starting chemotherapy. Usually this is the prognosis of this rare and fatal aggressive form of histiocytosis x. Conclusion: A sick child with fever, anemia, hepatosplenomegaly, scaly scalp, and skin lesions should be investigated for LSD

Assessment of serum copper level among Sudanese patients with vitiligo

Background: Vitiligo is a common skin disease of unknown etiology characterized clinically by depigmented patches, which can be localized or generalized; it usually runs a chronic course with an un predictable outcome and failure of complete cure in many affected individuals. Many communities consider it a contagious disease which leads to a great psychological and social stigma for patients; previous studies showed that copper might be associated with the pathogenesis of vitiligo. The aim of this study was to assess copper level in Sudanese vitiligo patients. Methods: This is a case-control study conducted in dermatology clinics in Khartoum state during the period from November 2018 to February 2019.  Blood samples were obtained from 100 participants, 50 from vitiligo patients and 50 from non-vitiligo subjects representing a control group. Serum copper was measured by mind-ray (automation). Results: A highly significant increase (p = 0.000) in the copper level was seen in vitiligo patients compared with the control group. Of the total  number of patients, 17 (34%) were females and 33 (66%) were males. According to the duration of the disease, the copper level was significantly increased in patient group with a disease duration of > one year compared to the patient group six months – one year and patient group < 6 months; we found no significance of the family history, 18% of the case group had a family history while 42 (82%) had no family history. Discussion: The relationship between the serum level of copper and vitiligo has been assessed by many studies. Copper is one of the trace elements that was found to be important for tyrosinase enzyme that catalyzes the first steps in melanin synthesis in the skin. Some studies showed that the disease was associated with low serum levels of copper and since vitiligo is a disease that is characterized clinically by white areas of skin with no melanin, these studies seem to be logical. However, in this study, the serum level of copper was found to be high in vitiligo patients which  might be justified by the release of copper from the destroyed melanocytes. Another justification might be a defect in the carrier protein for copper. Conclusion: The study found that the serum copper was significantly increased in  vitiligo patients compared to the control and it is recommended that serum copper level and copper profile should be assessed routinely in vitiligo patients

Biochemical Reactions and Their Biological Contributions in Honey

Honey is known for its content of biomolecules, such as enzymes. The enzymes of honey originate from bees, plant nectars, secretions or excretions of plant-sucking insects, or from microorganisms such as yeasts. Honey can be characterized by enzyme-catalyzed and non-enzymatic reactions. Notable examples of enzyme-catalyzed reactions are the production of hydrogen peroxide through glucose oxidase activity and the conversion of hydrogen peroxide to water and oxygen by catalase enzymes. Production of hydroxymethylfurfural (HMF) from glucose or fructose is an example of non-enzymatic reactions in honey