Gastrointestinal Basidiobolomycosis Mimicking Colon Cancer in a Sudanese Patient

Basidiobolomycosisis a rare disease caused by the fungus Basidiobolus ranarum. The incidence Rate of Gastrointestinal Basidiobolomycosis is approximately 1 in 45,333,334 or 0.00% in every 5 people in USA), member of the class Zygomycetes found worldwide (1).Basidiobolomycosis is usually a subcutaneous infection but rarely gastrointestinal1. This fungus is found mainly in the soil and on decaying vegetations2. It has been isolated from the banks of tropical rivers in West Africa, and has also been found in association with some insects2. The fungus is known to be present in the gastrointestinal tracts of reptiles, amphibians, and some bat species3. Definitive diagnosis requires culture and serological testing may be helpful. The fungal morphology and the Splendore-Hoeppli phenomenon are characteristic histological features. Basidiobolomycosis is treated with surgical resection and itracanzole 200mg BD for three months or Amphotericin B 5mg /kg iv/24 hrs4.Keywords: Zygomycetes, vegetations, subcutaneous infection.

Impact of family structure and sociodemographic characteristics on parents headed families in Ramadi City, Iraq

Background: Several factors in the family profile contribute significantly to determining the effective policy when heading the family. This study aims to evaluate the sociodemographic and economic burdens on parents-headed families in Ramadi City, west of Iraq. Methods: A prospective cross-sectional household-based survey was conducted from 1st to 28th February 2019 among Iraqi people residents in Ramadi city, Anbar province. A multistage sampling technique was recruited to identify the eligible sample. A semi-structured questionnaire was used to interview (face-to-face) the respondents. Data from 267 households have undergone univariate and bivariate analyses. Multiple logistic regression, odds ratio (OR), and confidence intervals (CIs) were estimated to explore the predicting variables. The statistically significant is considered at less than 0.05. Results: The mean age of respondents was 43.88 (± 12.1) years (range: 25 to 69 years). Out of the total surveyed people, 52.8% were young (less than 44 years), male-headed families (59.6%), low educated level (65.5%), unemployed (52.4%), married (67.4%) and headed big families of seven members and above (43.1%). History of chronic diseases and smoking habits was positive among 46.4% and 45.7% of respondents, respectively. Findings of the binary logistic regressions showed that history of smoking (OR = 7.201, 95% CI: 3.254 to15.936), families of 7 members and above (OR = 6.239, 95% CI: 2.938 to 13.250), unhappy (OR = 5.237, 95% CI: 2.140 to 12.818), aged 44 years and above (OR = 3.518, 95% CI: 1.581 to 7.829), being single (unmarried, divorced, widow) (OR = 2.697, 95% CI: 1.230 to 5.914), and had a monthly income of less than USD400 (OR = 2.333, 95% CI: 1.112 to 4.859) are significantly associated with female-headed family. Conclusion: Priority must be given to some elements such as genetic, physical differences, biopsychosocial factors, and the economic situation when discussing parents' behavior in heading the family

Quality of life of Sudanese Patients with Benigan Prostatic Hyperplasia. The Oblivious Problem

Background: Although the IPSS and QOL index are universally used, they can only quantify the severity of lower urinary tract symptoms suggestive of benign prostate hyperplasia (BPH) and evaluate treatment efficacy, but cannot fully reflect the overall quality of life. Moreover, because QOL scale depends on the culture background, it is necessary to develop a Sudanese version of the scale. Objective: To evaluate the impact of BPH on the quality of life by assessing the physical, mental and stress states among patients of BPH. Methodology: This study was conducted on 424 patients with BPH in Gezira Hospital for Renal Disease and Surgery (GHRDS), Sudan. The study was cross-sectional, prospective small-scale hospital based study using simple random sampling technique. The subjects were limited to the Sudanese patients, who could hear and answer the questions of the questionnaire independently and that was done for accuracy and privacy. Taking the patient's educational level into account, all items were expressed in spoken language. The data collection tool was a questionnaire which was modified to twelve items from the BPH Quality of Life Index. Results: The majority 386 patients, 91% were physically fit. The pattern of urination was bothering to their daily life of around 320 patients/75.5%, 225 patients/53.1% of patients were worried about the outcome of the disease, 259 patients/61.1% were not concerned of having prostate cancer and 332 patients/78.2% were satisfied with their sleep. The sexual life had been affected in 201 patients/47.4%. The physical state was assessed by the ability of the patient to pray Friday Jomaa at the mosque which was 85.8% and also by attending important Sudanese obliging social activities like condolence which was (91.9%) of the patients. Conclusion: The impact of BPH on quality of life was obviously significant in the three domains; physical, mental and stress state among patients of BPH in GHRD&S.There should be a validated scale for the BPH Quality of Life Index addressing the traditional strata for Sudanese patients.           &nbsp

The Accuracy of FNAC for Diagnosis of Breast Carcinoma in Gezira State, Central Sudan

Background: Breast cancer is a leading cause of death in many countries worldwide and breast lesions remain a common diagnostic dilemma. Fine-needle aspiration cytology (FNAC) has been suggested as the most important, first line, minimally invasive procedure in the management of patients with breast lesions. Objective: The aim of this study is to assess the diagnostic efficacy of breast FNAC in patients with breast lesions compared with that of the definitive histological diagnasis. Materials and Methods: This is a hospital-based retrospective study of 112 breast FNAC samples were carried out at Cancer Institute in Medani Gezira state.  FNAC findings were correlated with data from histopathology records to determine the sensitivity and specificity of FNAC. Results: Age group of the patients ranged from 26 to 80 years with mean of 42 years. Among the study subjects (112 case), ductal carcinoma is the common hitological finding 83/88 (94%). According to the cytology, 79% were malignant, 4% were benign and 2% were suspicious. Histological correlation was done in 68 cases. The overall diagnostic accuracy of FNAC was 92.3%, with sensitivity and specificity of 89.2% and 66.5% respectively.  Conclusion: FNAC of breast is asimple, cost effective and less traumatic method for diagnosing breast cancer. It is highly sensitive and accurate, and can reduce the needs for open biopsies. It is recommended that FNAC should be used as a first line method for determining the nature of breast lumps. &nbsp

The impact of displacement on the social, economic and health situation on a sample of internally displaced families in Anbar Province, Iraq

Background: Internally displaced people in Iraq are still suffering because the solutions were not radical. This study aims to assess the impact of displacement on the socio-economic, wellbeing and mental health status of internally displaced families in Anbar province, Iraq. Methods: A descriptive cross-sectional study was conducted from 3rd to 17th April 2017. Data was collected using a universal sampling technique. A total of 355 households interviewed with a modified questionnaire consisting of 26 close-ended questions related to the socio-economic, demographic, wellbeing and the mental health characteristics. Results: At the time of the study, about 55.5% of the surveyed displaced families have not returned home yet. Big families of more than seven members (59.4%) and residency in renting houses (82.8%) are two variables that may contribute to an economic burden. Mental health disorders such as depression and anxiety spread among 62.3% of surveyed families. Significant rise in chronic diseases from 64 (18.0%) cases before displacement to 102 cases (28.7%) after displacement. Few of them (21.6%) were able to access public health services. People who experienced violence are verbally abused at 52.1%. Lack of the services (50.3%), the inability to repair the destroyed houses (26.4%) and the loss of house due to complete destruction (23.3%) were the significant factors inhibited families to return home back. Conclusion: Our findings indicate the need for urgent and strategic plans to improve the quality of logistics, health and infrastructure services to motivate the displaced families to return back to their homes

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)