Lactic acid – the innocent culprit of muscle fatigue

What causes muscle fatigue? Is lactic acid considered to be a major culprit in the underlying mechanisms of muscle fatigue? These are very important questions and the answers are difficult and sophisticated. For decades, lactic acid was the major culprit of muscle fatigue. This review reveals that muscle fatigue would occur more badly if lactic acid was not produced in anaerobic cellular conditions to regenerate NAD+ required for continuation of glycolysis, the major pathway for generation of energy needed for muscle performance.Key words: Lactic acid, Fatigue, Lactic acidosis, Troponin

Adiponectin

Adiposetissue is not considered anymore as a passive depot for storing excess energy in the form of triglycerides but as an active organ secreting several hormones or adipokines. This review gives some knowledge about history of discovery, ways of measurements, and biochemical and pathophysiological effects of adiponectin.Keywords: Insulin resistance, Obesity, adipokines, Adipose tissue

Spontaneous Achilles tendon rupture in alkaptonuria

Spontaneous Achilles tendon ruptures are uncommon. We present a 46-year-old man with spontaneous Achilles tendon rupture due to ochronosis. To our knowledge, this has not been previously reported in Sudan literature. The tendon of the reported patient healed well after debridement and primary repairs

Importance of Fine Needle Aspiration in Evaluation of Single Nodular Goiter

Background: Improvements in the sensitivity and specificity of biochemical thyroid tests, as well as the development of fine needle aspiration biopsy (FNA) and improved cytological techniques, have dramatically impacted clinical strategies for detecting and treating thyroid disorders. Fine needle aspiration is a safe and relatively painless procedure where a hypodermic needle passed into the lump and samples of tissue taken out. This procedure will provide us with more information about the nature of the lump, and especially differentiate between a benign and malignant mass.Objectives: The current prospective study designed to evaluate the sensitivity, specificity and accuracy of FNA. The study was performed in the regional major hospital, Khartoum, Sudan. Patients and methods: A thousand and three hundred thirty one patients who underwent thyroidsurgery 'between' January 2004 to June 2007 were enrolled.Results: 247 (18.3%) had single nodular goiter. The incidence of benign and malignant lesions in single nodular goiter were 204 (87.6%) and 29 (12.4%) respectively. The overall sensitivity, specificity and accuracy of FNA were 95.5%, 99.5% and 99.4% respectively.Conclusion: Also there is correlation between the nodule size and the result of FNA, as the nodular size increase there is increase of the probability of malignant changes. So, solitary or dominant nodules ≥ 1cm in diameter might be evaluated by FNA.Keywords: Thyroid, Single nodule, Malignancy.

Frequency of Gestational diabetes mellitus and impaired glucose tolerance in urban Sudanese pregnant women in the third trimester

Background: Impaired glucose tolerance may be defined as intermediate group of individuals whose carbohydrate metabolism does not constitute diabetes but is not entirely normal. It carries a higher risk of developing microvascular disease and a significant percentage of these patientseventually become diabetics.Objective: of the study was to estimate the frequency of gestational diabetes mellitus (GDM) and impaired glucose tolerance (IGT) in urban Sudanese pregnant women in the third trimester. The study also showed the effect of age and parity on IGT.Methodology: The study was carried out on hundred pregnant women in the third trimester.Results: The frequency of gestational diabetes was 2% and it was 6% for the IGT incidence whereas, 92% of the pregnant women revealed normal fasting plasma levels. The IGT pregnant women were older than the control pregnant women but, the age difference was not significant [28.7± 5.5 years (mean ± S.D) vs. 27.3 ± 4.8 respectively, p>0.05] . Also, the IGT pregnant women were found to have mean parity significantly greater than that of the control group [ 6.7 ± 2 (mean ± S.D.) vs. 3.9 ± 2.1 respectively , p<0.001].Conclusion: The frequency of GDM and IGT in Sudanese pregnant women is within the universal estimates and parity is an important risk factor that affects impaired glucose tolerance incidence in pregnancy.Keywords: microvascular, chemical diabetes, carbohydrate intolerance

Type 1 diabetes mellitus (T1DM) in toddlers and schoolchildren in Najran region, Southwestern Saudi Arabia

BackgroundThere is an ongoing interest in the relationship between vitamin D status and diabetes control and complications. However, data from Saudi Arabia are limited. Human studies demonstrated the positive association between insulin secretion, insulin sensitivity and serum levels of osteocalcin and vitamin D.AimsThis study aimed to explore the possible role of circulating osteocalcin in the pathogenesis of T1DM and its correlation with fasting plasma glucose (FPG) and vitamin D levels in Saudi Arabia children with T1DM.Methods This cross-sectional observational hospital based- case control study that included 132 Saudi children clinically diagnosed as type 1 diabetes mellitus and 72 apparently healthy children.Results There were statistically weak negative correlations for FPG with UCOC and TOC in diabetic children (r=-0.294, p < 0.01 and -0.358, p < 0.0001 respectively). A moderately significant positive correlation between FPG and BMI and a significantly negative correlation between 25(OH)D3 and FPG (r=-0.62, p < 0.0001) were found. Moreover, there was a moderately significant positive correlation between levels of vitamin D and UCOC in healthy control group (r=0.457, p < 0.0001). Such significance was not present in diabetic group (r=-0.077, p < 0.38).ConclusionLevels of 25(OH)D3, TOC, and UCOC were significantly diminished in children with T1DM suggesting the bidirectional influence of &beta; cells on vitamin D and osteocalcin and vice versa. The reverse correlation between UCOC and HbA1c may indicate the probable prognostic value of UCOC as the lower UCOC, the worse glycaemic control in diabetic children

Article Neurotransmitters – A biochemical view

The neurotransmission at most if not all synapses is chemical and is of great biochemical, physiological and pharmacological importance. Neurons communicate with each other at synapses by a process called synaptic transmission in which the release of small quantities of chemicalmessengers, called neurotransmitters that alter the electrical activity of neurons after they interact with receptors on post-synaptic cell surfaces. This review gives a biochemical view on the nature of neurotransmitters and presents the biochemical chart and the medical relevance of the mostimportant neurotransmitters. Keywords: Neurotransmitter, Synaptic vesicles, Acetylcholine (ACh), g-Aminobutyrate (GABA), Myasthenia Gravis (MG), Parkinson's disease, Opioid peptides

The sensitivity and specificity of the conventional symptoms and signs in making a diagnosis of acute appendicitis

Introduction: Simple appendicitis can progress to perforation, which is associated with a much higher morbidity and mortality. So, surgeons have therefore been inclined to operate when the diagnosis is probable rather than wait until it is certain. Objective: This study is designed to evaluate the sensitivity and specificity of clinical examination in the diagnosis of acute appendicitis.Methods: The study included 866 patients of acute appendicitis who had undergone appendicectomy with preoperative diagnosis of acute appendicitis. They were analyzed retrospectively. The parameters evaluated were age/gender, clinical presentation (signs and symptoms) and total white blood cell counts. The operative findings were recorded and the inflammation of the appendix was graded into normal, acutely inflamed and gangrenous.Results: Clinical diagnosis was made correctly in 807 (93.2%) of the patients. White blood cells count ranged from 3.70 to 45.30 /mm3 (mean 17.5353 /mm3). It wa