Pattern and Management of Obstructive Jaundice in Wad Medani Teaching Hospital, March 2014 -2015

Abstract:                                                     Obstructive jaundice is not uncommon in this area certainly with what is reported in the literature, malignant jaundice is more common than choledocholithiasis. The pre-operative management followed the international guidelines; most of the surgery done to the malignant jaundice was palliative because of the late presentation. Endoscopic service in management of obstructive jaundice is important and shall be utelized after completion of the new GIT Centre-Wad Medani Hospital. This study was a prospective cross sectional descriptive study, conducted in Wad Medani hospital - Gezira state – Sudan from March 2014 to March 2015. Wad Medani Teaching Hospital is a tertiary hospital with 600 beds serving all Gezira state and nearby states  Material and Method: 124 patients admitted to hospital with symptoms and signs of obstructive jaundice including; yellow coloration of the sclera, dark urine,pale stools, itching, with or without the association of vomiting, abdominal pain, abdominal mass and weight loss. Diagnosis was confirmed by history, examination and biochemical and radiological investigations.The data was analyzed by computer using SSPS. Results: 52(41.9%) were males and72 (51.8%) were females, with male to female ratio of 1:1.3. The cases of obstructive jaundice were found to be distributed among their age groups from 18-40yr (15.3%),41-60yr(31.5%) , 60yr and above (53.2%). Definitive diagnosis after completion of investigations results showed that cases due to common bile duct (CBD) stone and carcinoma of the head of pancrease were 55 (44.4%) and 52 (41.9%) respectively. The relation between the diagnosis and sex results showed CBD stone in females was 37(51.4%) where as in males  carcinoma of the head of pancrease was 25(48.11%), ERCP was used in 67(54%) patients both for diagnostic and therapeutic indications. The operative intervention was also studied for all patients with obstructive jaundice and the results showed that 48(38.7%) patients underwent surgical intervention with 7(5.6%) CBD exploration and 41(33.1%) by pass surgical operation. Conclusion: ERCP has a promising role in the study area in managing patients with obstructive jaundice. The family physicians   have an important role to play in early detection and referral of patients with obstructive jaundice to hospitals to avoid delayed presentation and minimize the harmful effects of hyper bilirubinemia on the   liver so the step should start with how to detect the case and after that what to do for the case before referral to nearby hospital

Preoperative evaluation of patients with ovarian masses using the risk of malignancy index 4 model

Objective: To evaluate the performance of the RMI 4 in discriminating benign from malignant ovarian masses. Study Design: Cross-sectional study. Setting: Assiut Women Health Hospital- Egypt. Materials and methods: This was an observational cross-sectional study involving 91 patients at Women\u27s Health Hospital, Assiut University, Egypt during the period between January, 2016 and January, 2017. Women with ovarian masses planned for surgical management were recruited from the outpatient gynecology clinic of the hospital. Risk of malignancy index (RMI 4) was calculated for all study participants. Biopsies obtained from the ovarian masses after surgical intervention were sent to the pathology lab for histopathological examination. The histopathologic diagnosis of the ovarian masses is considered the gold standard for diagnosis. Results: The mean age of patients in the benign group was 34.83±16.28 years versus 43.43±15.91 in the malignant group. There were 12 postmenopausal patients (15.6%) in the benign group versus 4 postmenopausal patients (28.6%) in the malignant group (p=0.0001). An ultrasound score of 4 was recorded in 85.7% of patients in the malignant group versus only 6.5% in the benign group (p=0.0001). Additionally, tumor size ≥ 7 cm was observed in 85.7% of patients in the malignant group versus 55.8% in the benign group (p=0.0001). The mean value of CA-125 was significantly higher in malignant group than the benign group (142.09±41.50 versus 54.51±32.86 ml, respectively) with p=0.01. RMI 4 had a sensitivity of 75%, specificity of 97.3%, PPV of 85.7%, NPV of 94.8 % and an overall accuracy of 93.4%. Conclusions: RMI 4 is a simple and reliable tool in the primary evaluation of patients with ovarian masses. It can further be used to discriminate benign from malignant ovarian masses with high sensitivity and accuracy

Coagulation profile of Sudanese children with homozygous sickle cell disease and the effect of treatment with omega-3 fatty acid on the coagulation parameters

Background: It has been reported that patients with SCD do have an abnormal coagulation profile. Coagulopathy is thought to be one of the key factors that contribute to the vaso-occlusive crisis that characterises sickle cell disease (SCD). In this study, we investigated whether Sudanese sickle cell patients have an abnormal coagulation profile. In addition, the effect of treatment with either omega-3 fatty acids or hydroxyurea on coagulation profile was assessed. Methods: Homozygous SCD patients untreated (n = 52), omega-3 treated (n = 44), hydroxyurea (HU) treated (n = 8) and healthy (HbAA) controls (n = 52) matched for age (4–20 years), gender and socioeconomic status were enrolled. Patients on omega-3 fatty acids, according to age, received one to four capsules containing 277.8 mg DHA and 39.0 mg eicosapentnoic. Patients on Hydroxyurea were in on dosage more than 20 mg/kg/day. The steady state levels of the coagulation parameters and the effect of the treatments with either HU or omega-3 fatty acids on markers of coagulation were investigated. Results: Compared to the healthy controls, treated and untreated HbSS patients had lower hemoglobin, plasma Protein C, proteins S and higher white blood cell count (WBC), platelets count (PLTs) and plasma D-dimer levels,(p 0.05). HU treated group had a lower PLTs count compared to HbSS untreated group (p < 0.5). The prothrombin and activated partial thromboplastin times and international normalized ratio (INR) of untreated patients are significantly higher than n-3 treated, HU-treated patients and health controls, (p < 0.05). Patients treated with omega-3 had lowered D-dimer levels in comparison to HU-treated and untreated HbSS patients, (p < 0.001). Conclusion: This study provides evidence that Sudanese patients have abnormal coagulation profile and treatment with either HU or omega-3 fatty acids might partially ameliorate SCD-associated chronic coagulopathic state. Keywords: Sickle cell disease, Coagulation, Omega-3 fatty acids, D-dimer, Protein C, Protein

Malaria and pre-eclampsia in an area with unstable malaria transmission in Central Sudan

<p>Abstract</p> <p>Background</p> <p>Placental malaria and pre-eclampsia occur frequently in women in tropics and are leading causes of maternal and perinatal morbidities and mortality. Few data exist concerning the interaction between placental malaria and pre-eclampsia.</p> <p>Methods</p> <p>A case control study was conducted in Medani Hospital, which locates in an area of unstable malaria transmission in Central Sudan. Case (N = 143) were women with pre-eclampsia, which was defined as systolic blood presure≥140 mm Hg or diastolic blood pressure ≥ 90 mm Hg and proteinuria. Controls were parturient women (N = 143) without any blood pressure values > 139/89 mm Hg or proteinuria. Obstetrical and medical characteristics were gathered from both groups through structured questionnaires. Placental histopathology examinations for malaria were performed.</p> <p>Results</p> <p>Twenty-eight (19.6%) vs. 16 (11.2%); <it>P </it>= 0.04 of the cases vs. controls, had placental malaria infections. Five (2%), 1 (2%) and 22 (28.0%) vs. 1, 2 and 13 of the placentae showed acute, chronic and past infection on histopathology examination in the two groups respectively, while 115 (80.4%) vs.127 (88.8%) of them showed no infection, <it>P </it>= 0.04. In multivariate analysis, while there were no associations between age, parity, educational level, lack of antenatal care, blood groups and body mass index and pre-eclampsia; family history of hypertension and placental malaria (OR = 2.3, 95% CI = 1.0-5.2; <it>P </it>= 0.04) were significantly associated with pre-eclampsia.</p> <p>Conclusion</p> <p>Placental malaria was associated with pre-eclampsia. Further research is needed.</p

A STUDY ON THE CONTAMINATION OF KHABUR RIVER WITH HEAVY METALS DUE TO SPATIAL AND SEASONAL DISCHARGED WASTEWATER IN THE IRAQI KURDISTAN REGION

The main objective of the present study is to spatially evaluate the water contamination of Khabur River, before it arrives in Zakho City, inside the city, and after  it leaves the city of Zakho by heavy metals. Also, the seasonal effects of Zakho municipal wastewater discharged in the Khabur River were detected in this study. The results showed that some heavy metals, such as Ni, were not detected in all studied samples in this study due to their low concentration levels. It is indicated that heavy metals are statistically affected by spatial location and high amounts were detected after leaving, compared to before entering the city which indicates that municipal wastewater is the main source of metal pollution. However, all water tests met the WHO's authorized limits. The average detected concentrations of copper, iron, manganese, and lead ranges from 0.003 to 0.025 mg/L, 0.000 to 0.054 mg/L, and 0.057 to 0.112 mg/L, and 0.014 to 0.135 mg/L respectively, while the highest concentrations of copper and iron were recorded significantly in Bedare (0.025 mg/L, 0.054 mg/L) respectively. The highest concentration of Lead (Pb) was detected in Chamtre and Tawke 0.117 mg/L and 0.135 mg/L respectively and this increase may be due to the presence of oil in the discharged industrial wastewater, in this village. Regarding season’s effects, higher mean concentrations for Mn 0.13423 mg/L, Fe, and 0.04208 mg/L were recorded in the autumn season. However, copper and lead had higher mean concertation 0.02389 mg/L, and 0.097 mg/L respectively, during the winter season, while the lowest mean concentration of copper was recorded in autumn, and lead in the summer season had a minimum concentration. There was a significant difference (P <0.01) in the seasonal variation of Cu, Fe, Mn, and Pb (P=0.001)

MTA1 Expression Correlates Significantly with Histologic Grade in Salivary Mucoepidermoid Carcinoma

Background: Metastasis associated protein-1 (MTA1) has been a recently identified as a unique gene playing important role in tumorigenesis and progression of cancer cells. Objective:To evaluate MTA1 expression and its predictive value in determining histologic grade of salivary mucoepidermoid carcinoma (MEC).   Patients and Methods: MTA1 expression was evaluated by immunohistochemistry in paraffin-embedded tumor specimens blocks from 22 patients. Assessment of MTA1 immunostaining was achieved by counting the proportion of positively-stained tumor cells in 5 high power microscopic fields; and staining was analyzed in relation to clinicopathological variables.  Results: MTA1 show nuclear and cytoplasmic expression in varying intensity in 95% of cases. No significant correlation was found between MTA1expression and age, gender, site of the tumor (p>0.05). However, statistically significant correlation was found between MTA1expression and clinical stage, nodal involvement (p=0.009 and 0.007; respectively). Regarding histologic grade, high MTA1 level was significantly associated with grade of tumors categorized by Auclair and Brandwein systems (<0.001 and 0.009; respectively). Conclusion:MTA1 expression significantly correlates with tumor grade and progression, and has a potential role in diagnosis and prediction of behavior in salivary MEC

Omega 3 (n−3) fatty acids down-regulate nuclear factor-kappa B (NF-κB) gene and blood cell adhesion molecule expression in patients with homozygous sickle cell disease

Chronic inflammation and reduced blood levels of omega-3 fatty acids (n − 3) are known characteristics of sickle cell disease (SCD).The anti-inflammatory properties of n − 3 fatty acids are well recognized. Omega-3 treated (n = 24), hydroxyurea (HU) treated (n = 18), and n − 3 untreated (n = 21) homozygous SCD patients (HbSS) and healthy (HbAA) controls (n = 25) matched for age (5–16 years), gender and socioeconomic status were studied. According to age (5–10) or (11–16) years, two or three capsules containing 277.8 mg docosahexaenoic (DHA) and 39.0 mg eicosapentaenoic (EPA) or high oleic acid placebo (41%) were assigned to n − 3 treated and n − 3 untreated groups, respectively. Hydroxyurea treated group was on dosage more than 20 mg/kg/day. The effect of supplementation on systemic and blood cell markers of inflammation was investigated. The n − 3 treated group had higher levels of DHA and EPA (p < 0.001) and lower white blood cell count and monocyte integrin (p < 0.05) compared with the n − 3 untreated. No difference was detected between the two groups regarding C-reactive protein, granulocytes integrin and selectin, plasma tumour necrosis factor-α and interleukin-10. The n − 3 treated group had lowered nuclear factor-kappa B (NF-κB) gene expression compared to n − 3 untreated and HU treated groups (p < 0.05). This study provides evidence that supplementation with n − 3 fatty acids may ameliorate inflammation and blood cell adhesion in patients with SCD