Effect of uncontrolled type-II diabetes mellitus and Its duration on nerve conduction parameters in adult Sudanese patients in Khartoum State

Background: Peripheral neuropathy is a serious complication of diabetes, which has socioeconomic consequences as well as a reduced quality of life. Early neuropathic process recognition and management could alter its course and considerably reduce the associated morbidity and mortality. This study determines the effect of long-term glycemic control on diabetic peripheral neuropathy in people with type 2 diabetes (T2DM). Methods: A hospital-based study was carried out at the National Centre of Neurosciences and Ibrahim Malik Hospital in Khartoum. All individuals who were older than 18 years and have had T2DM for less than 10 years were recruited. Using accepted techniques, the BMI, HbA1c level, and nerve conduction studies (NCS) were measured. Data were analyzed using the Statistical Package for Social Sciences (SPSS), version 25.0 software. P-value ≤ 0.05 was considered significant. Results: Of the 95 patients with T2DM, 52 were male patients. Our findings showed that as the duration of diabetes increased, the sensory velocity reduced from 64.07 ± 3.22 to 54.00 ± 5.34 and the motor nerve from 63.39 ± 2.38 to 53.87 ± 2.08 (P = 0.05, P = 0.003, respectively). Additionally, with increased duration of diabetes, a significant decrease was seen in both motor nerve amplitude from 8.79 ± 3.11 to 6.94 ± 1.84 (P = 0.05) and sensory nerve amplitude from 25.71 ± 5.70 to 19.51 ± 6.51 (P = 0.003). Also, all parameters of NCS (velocity and amplitude) decreased when Hb A1c was >6 ­ sensory velocity from 63.96 ± 2.36 to 55.49 ± 2.43 (P = 0.03) and motor velocity from 63.00 ± 2.59 to 51.44 ± 1.66 (P = 0.02). And sensory amplitude decreased from 26.91 ± 1.26 to 20.85 ± 2.1 (P = 0.05), while motor amplitude decreased from 6.88 ± 3.55 to 6.61 ± 3.29 (P = 0.05). Additionally, there is a substantial (P = 0.05) correlation between sensory and motor amplitudes and the BMI. Conclusion: High BMI and poorly controlled (high HbA1c) long-term diabetes had a negative impact on all nerve conduction study parameters

Subarachnoid lavage following inadvertent intrathecal injection of tranexamic acid

Tranexamic acid (TXA) is a commonly used antifibrinolytic drug during surgical procedures to reduce blood loss. An Inadvertent intrathecal injection of TXAmay lead to serious side effects including seizures and ventricular fibrillation with reported fatalities. We report a case of an inadvertentintrathecal injection of TXAwhich occurred as a result of similarities in appearance between TXAand heavy bupivacaine ampoules. The patient had subarachnoid lavage after experiencing back pain, systemic hypertension followed by generalized tonic clonic seizures

Effect of occupational exposure on hematological and biochemical parameters in workers at oil and gas companies

Petroleum refineries are largest chemical industries that are responsible for emission of several pollutants into the atmosphere. Benzene and its metabolites are regarded as the most hazardous compounds that are emitted by petroleum refineries. These contribute to toxic oxidants, which cause many serious health risks to petroleum refineries workers. This study was aimed to analyze the effects of chemical exposure on hematological and biochemical parameters among workers at Zawia oil refinery and Mellituh oil and gas refinery companies. A total of 200 workers participated in this study which consisting of two equal groups (each group: n = 100). The first group consists of petroleum refineries workers and the second group consists of non-oil work civil servants serving were recruited as exposed and control subjects, respectively. The results of blood picture, liver enzymes and kidney functions were compared between the groups. Mean white blood cells counts, platelet counts, and hematocrit count were significantly higher, while the mean red blood cells count was insignificantly changed in petroleum refineries workers. While the mean hemoglobin and corpuscular hemoglobin concentration levels were significantly lower, whereas the mean corpuscular volume and mean corpuscular hemoglobin levels were insignificantly changed in petrol refineries workers. Liver enzymes and renal functions were significantly higher in petrol refineries workers. The present findings indicate that occupational exposure to benzene causes significant alterations in hematological and biochemical parameters and workers are at high risk of developing blood, hepatic or renal related disorders. Protection and frequent medical attention should be given to petroleum refineries workers.

Factors associated with viral non-suppression among patients on antiretroviral therapy (ART) at the Federal Medical Centre, Abeokuta, Ogun State, Nigeria

Objectives: Human Immunodeficiency Virus (HIV) remains a public health issue with more than 25 million deaths since 1990. As of 2019, Nigeria has a national prevalence of 1.4% among 15-49 years and about 1.9 million people living with HIV, according to the Joint United Nations Programme on HIV/AIDS. This study assessed the factors responsible for unsuppressed viral load among patients accessing care at Federal Medical Centre HIV Clinic in Abeokuta, southwest Nigeria.Methods: The study design was descriptive cross-sectional. Data was collected using the qualitative method; an In-depth interview was conducted among 20 virally unsuppressed HIV patients currently on Antiretroviral Therapy (ART) at Federal Medical Centre Abeokuta. The participants were purposively selected. The data were analyzed using thematic analysis.Results: Although almost all the participants were aware of HIV, their knowledge of HIV was inadequate. Non-adherence to drugs, side effects of medications, the psychological effects of the disease, forgetfulness, and combination of anti-retroviral drugs with local herbs and alcohol were the associated factors of viral non-suppression among the patients.Conclusion: Scaling up psychological care services using Short Message Services (SMS) to improve viral suppression is, therefore, strongly recommended.

Utilization and determinants of postnatal care services in Ethiopia: a systematic review and meta-analysis

BACKGROUND: Postnatal care use is vital in saving mother and newborn lives which is a continuum of care for maternal, neonatal and child health. This reviewaimed to determine the utilization and determinants of postnatal care use in Ethiopia. METHODS: PubMed, Scopus, Web of Science, and Embase databases were searched on June 25, 2017. The study screening, data extraction and quality assessment were done independently by two reviewers. Effect sizes were pooled using a random-effects model. RESULTS: Nine articles were included in the review. The pooled estimate for utilization of the service was 32% (95% CI: 21%, 43%). The pooled results of determinants of postnatal care use was statistically significant among those mothers who had ability to make decisions (1.89; 1.25, 2.54), had a history of antenatal care utilization (2.55; 1.42, 3.68), received more than two antenatal care visits (1.84; 1.28, 2.40), and received the service from skilled service provider (3.16; 1.62, 4.70). It was also found that mothers who gave birth in health faciliteis (2.13; 1.14, 3.12), had middle monthly income, richer, were from urban areas, and had knowledge of obstetric danger signs were significantly associated with increased odds of postnatal care use. CONCLUSION: Utilization of the services is low in Ethiopia. Antenatal care utilization, skilled service provider, being from urban area and delivery in health facility had a significant effect on postnatal care utilization. More rigorous studies are needed to identify determinant with the causal association to postnatal care utilization. The reviewwas registered on PROSPERO CRD42017060266

Assessment of musculoskeletal ultrasound guided injection of the new regenerative medicine techniques (neural prolotherapy and platelet rich plasma) impact versus well established techniques (steroid injection) in cases of carpal tunnel syndrome secondary to rheumatoid arthritis

Background: Rheumatoid arthritis is a systemic rheumatic disease characterized by symmetrical, often erosive and deforming poly-arthritis with extra-articular manifestations in 10­20% of patients, especially those with high titers of rheumatoid factor. Extra articular pathology includes bursitis, tendonitis and neuritis, which results from entrapment, nerve ischemia due to vasculitis or drugs used to treat this condition. Carpal tunnel syndrome is the most common compression neuropathy associated with rheumatoid arthritis. Aim of the Work: To evaluate the efficacy of Neural Prolotherapy and Platelet Rich Plasma in treatment of carpal tunnel syndrome secondary to rheumatoid arthritis. Patients and Methods: Ninety patients with Rheumatoid Arthritis (RA) that were all fulfilling the 2016 ACR/EULAR classification criteria for RA. All were over the age of sixteen years at time of diagnosis, complaining of burning pain or paresthesia in the median nerve distribution of the hand. They were recruited from Rheumatology and Rehabilitation Department at Al-Hussein and Sayed Galal University Hospitals during the period from December 2018 to July 2019. Results: Neural Prolotherapy and Platelet Rich Plasma (PRP) have improved all measured parameters like visual analogue scale (VAS), nerve conduction studies and neuromuscular ultrasonography parameters in carpal tunnel syndrome secondary to rheumatoid arthritis. Conclusion: Neural Prolotherapy and Platelet Rich Plasma proved to be effective treatments of carpal tunnel syndrome secondary to rheumatoid arthritis

Relationship between Elevated Liver enzymes and Metabolic syndrome among Egyptian adults

Background and study aim: Liver enzymes are important markers for hepatocyte damage. Metabolic syndrome (MS) is a combination of metabolic abnormalities including high blood glucose, obesity, hypertension and dyslipidemia. The incidence of MS is believed to be increasing in Egypt. The purpose of this study is to examine the relationship between elevated liver enzymes and MS among Egyptian adults. Patients and Methods: A total 138 apparently healthy subjects were randomly included (99 females and 39 males). Demographic, clinical (blood pressure, body mass index and waist circumference) and biochemical (measurements of alanine aminotransferase (ALT), aspartate amino-transferase (AST), alkaline phosphatase (ALP), lipid profile, blood glucose and viral markers) were collected from every subject. Metabolic syndrome was defined according to a well-known criteria and subjects in the final analysis were divided into group I; metabolic syndrome and group II; non-metabolic syndrome subjects. Results: In this study, 92 persons fulfilled three of the five criteria of metabolic syndrome (group I) with prevalence of 66.7% while group II (non-metabolic syndrome) represented 33.3%. Patients with MS were older and less physically active in comparison with group II. There were an association between elevations in liver enzymes (ALT, AST, ALP) and MS. ALT, AST and ALP were elevated in 42.4%, 17.2% and 20.7% of patients with MS respectively. ALT and AST showed positive correlation with elevated blood glucose and triglycerides levels while AST/ALT ratio showed negative correlation with diastolic blood pressure, triglycerides level and waist circumference. The more items of MS the patient have the higher the level of liver enzymes. Conclusion: Among Egyptian adults elevated levels of liver enzymes were associated with MS and a correlation was noticed with its components

Early prediction of acute kidney injury in patients with acute on chronic liver failure by measuring kidney injury Molecule-1 level in Urine at Zagazig University Hospitals

Background and study aim: Some of patients with decompensated cirrhosis will exhibit newly developed acute liver failure. This condition is called acute-on-chronic liver failure (ACLF). Acute kidney injury (AKI) is common with ACLF. Kidney injury Molecule-1 (KIM-1) is an ideal biomarker of AKI. The aim of this study was to evaluate role of KIM-1 in prediction of AKI in ACLF patients. Patients and Methods: Eighty four patients were included in this study. They were selected from hospitalized patients with acute decompensated cirrhosis. They were allocated into two groups; group I: patients with no acute-on-chronic liver failure (ACLF), group II: patients with ACLF. Results: KIM-1 was significantly higher in the ACLF (group II). KLM-1 median was 2.4 in group I vs 7.35 in group II with p value <0.001. We found that at cut off value of ≥0.5 KLM-1 can predict the presence of AKI with sensitivity of 85.7%, specificity 88.1%, positive predictive value 87.8%, negative predictive value 86%, accuracy 86.9% and AUC= 0.867 p <0.001. Conclusion: KLM-1 rises significantly in patients with ACLF. KLM-1 can be reliable in prediction of the presence of acute kidney injury in decompensated cirrhosis

Breast Cancer Screening in a Resource Poor Setting: A Preliminary Report

Background: Breast cancer is a leading cause of death among Nigerian women. Patients typically present late with advanced and aggressive diseases from a younger age. Cure for breast cancer is only possible when the disease is discovered early and breast cancer screening greatly increases the chances of early detection. We present the results of a breast cancer screening program at the Taimako Breast and Cervical Cancer Screening Centre; Lafia; Nigeria. Methodology: This is a prospective study of subjects who presented to our breast cancer screening centre between May 2009 and April 2010. A community mobilization and awareness campaign was mounted 3 months before screening began. A structured questionnaire was administered on each subject to elicit demographic data and risk factors. Each had a clinical breast examination. Those 35 years and above had a mammography while those below 35 years had breast ultrasound scan. Where a lump was discovered; it was subjected to tissue biopsy and histology. Results: Two thousand and ninety five subjects were seen over the one year period. Mean age was 34 + 12 years. Mean age at menarche was at 14.3 + 1.7 years; mean parity was 3.6 +2.6. Two thousand and thirty six subjects (97.2) had some knowledge about breast cancer; 1;269 (60.5) had no formal education; 881(42.1) were petty traders while 501(23.9) were full time housewives. Four hundred and seventy (22.4) had a positive family history of breast disease; 437 (20.9) had history of use of oral contraceptives; and 9 (0.4) had a previous breast biopsy. Four hundred and sixty one (22.0) complained of breast discomfort; 184 (8.8) complained of breast lumps; but only 95 (4.6) of them had lump on clinical breast examination; while a further 8 (0.4) lumps were found on breast imaging. One thousand nine hundred (90.7) had normal breast screening results; 166 (7.9) had benign breast diseases and 29 (1.4) had breast cancer. Conclusion: Knowledge about breast cancer was high because of prior campaigns and should be encouraged. Proportion of subjects with breast cancer is low even though many complained of breast lumps on presentation. Majority of the lumps were found at clinical breast examination while mammogram had a very low yield. A treatment arm needs to be incorporated into the screening program to demonstrate survival benefit

Breast Cancer Screening in a Resource Poor Setting: A Preliminary Report

Background: Breast cancer is a leading cause of death among Nigerian women. Patients typically present late with advanced and aggressive diseases from a younger age. Cure for breast cancer is only possible when the disease is discovered early and breast cancer screening greatly increases the chances of early detection. We present the results of a breast cancer screening program at the Taimako Breast and Cervical Cancer Screening Centre; Lafia; Nigeria. Methodology: This is a prospective study of subjects who presented to our breast cancer screening centre between May 2009 and April 2010. A community mobilization and awareness campaign was mounted 3 months before screening began. A structured questionnaire was administered on each subject to elicit demographic data and risk factors. Each had a clinical breast examination. Those 35 years and above had a mammography while those below 35 years had breast ultrasound scan. Where a lump was discovered; it was subjected to tissue biopsy and histology. Results: Two thousand and ninety five subjects were seen over the one year period. Mean age was 34 + 12 years. Mean age at menarche was at 14.3 + 1.7 years; mean parity was 3.6 +2.6. Two thousand and thirty six subjects (97.2) had some knowledge about breast cancer; 1;269 (60.5) had no formal education; 881(42.1) were petty traders while 501(23.9) were full time housewives. Four hundred and seventy (22.4) had a positive family history of breast disease; 437 (20.9) had history of use of oral contraceptives; and 9 (0.4) had a previous breast biopsy. Four hundred and sixty one (22.0) complained of breast discomfort; 184 (8.8) complained of breast lumps; but only 95 (4.6) of them had lump on clinical breast examination; while a further 8 (0.4) lumps were found on breast imaging. One thousand nine hundred (90.7) had normal breast screening results; 166 (7.9) had benign breast diseases and 29 (1.4) had breast cancer. Conclusion: Knowledge about breast cancer was high because of prior campaigns and should be encouraged. Proportion of subjects with breast cancer is low even though many complained of breast lumps on presentation. Majority of the lumps were found at clinical breast examination while mammogram had a very low yield. A treatment arm needs to be incorporated into the screening program to demonstrate survival benefit

Quality of Antenatal Care Provided For Pregnant Women in Ribat University Hospital; Khartoum

Background:The purpose of antenatal care is to assure that every pregnancy culminates in the birth of a healthy baby without any impairment of the mother's health. The objective of this study was to study thequality of care given to pregnant women attending the referral clinics in Ribat University Hospital; Khartoum;Sudan.Methods:This is a descriptive; cross sectional study. 300 antenatal care cards were checked fordocumentation for the following parameters at the 5th month of pregnancy: date of the first visit; age of the pregnant woman; the address; date or duration of marriage; parity; the first day of the last menstrual period; the expected date of delivery; the gestational age; vaccination; blood pressure; fundal level; foetal heart sound; haemoglobin estimation; urine analysis; blood group; ultrasound check and the date of ultrasound check. Data was analysed by the computer using SSPS soft ware; version 16.Results:The date of the first visit; the age of the pregnant woman and her address were documented in 294(98); 296(98.7) and226(75.3) respectively. The date/duration of marriage; parity; the first day of the last menstrual period; the expected date of delivery; the gestational age and vaccination were documented in 70(23.3); 298(99.3);298(99.3); 295(98.3); 278(92.7) and 45(15) respectively. Blood pressure; fundal level and foetal heart sound were checked in 266(88.7); 280(93.3); 244(81.3) respectively. Haemoglobin; urine analysis; blood group and Rhesus factor; ultrasound were done in 187(62.3); 159(53); 173(57.7); 121(40.3) respectively.Conclusions: The study concluded that documentation of the personal history and obstetrical examination were adequate. On the other hand documentation of obstetrical history was high except for date of marriage and vaccination which were very poor. Documentation of results of investigation were average

Seroprevalence of hepatitis C virus antibodies amongst blood donors in Ahmadu Bello University Teaching Hospital (ABUTH) Kaduna

Background: Hepatitis C virus (HCV) is one of the most common transfusion transmissible infections hence the introduction of routine screening for its antibodies in blood donors in most blood banks. Methods: This was a retrospective study in which the blood donor screening register for all intending donors were reviewed and analyzed. Results: There were 4;731 potential donors with age range 20-41years. Eighty six (1.8) were sero-positive to HCV antibodies with a decreasing incidence over the period under review. The highest incidence was recorded the age group 31-40 years. Aim: To determine the sero-prevalence of HCV among blood donors in ABUTH Kaduna. Conclusion: HCV infection is not uncommon in our environment hence the need to emphasize it's routine screening among all potential donors

Histopathological Pattern of Breast Carcinoma in Different Age Groups

Background: Breast cancers tend to be more aggressive in younger patients and some histopathological types like medullary; mucinous and tubular variants have a better prognosis. This study describes the histopathologic pattern and tumour grade of breast carcinoma in younger patients. Methods: This was a retrospective analysis of all consecutive breast cancer specimens submitted to the histopathology department of Federal Medical Centre Gombe during the study period. The data was analyzed with EPI Info 2002 using simple means and percentages. Results: A total of 167 cases of breast carcinoma in 164 females were reviewed with three patients having bilateral disease. The age range of the study population was 22-75 years with a mean age of 44 +/-11.7 years. One hundred and twenty seven patients (76) were aged less than 50 years while the rest were above 50 years. A total of 133 tumours were invasive ductal carcinomas; 107(80.45) of which were in the premenopausal age group and 26(19.55) in post menopausal age. One hundred and six patients (63.5) had low grade tumours (grades 1 and 2) while 61(36.5) had high grade tumours (Grades III and IV tumours). Forty three (70.5) of these high grade tumours were seen in premenopausal age group. Eleven patients had invasive lobular carcinoma of which 4(36.4) were premenopausal while 7(63.6) were post menopausal. Conclusion: It is concluded that younger patients tended to frequently have aggressive and high grade disease

Nonspecific Colitis a Forgotten Entity in Central Sudan

Background: Nonspecific colitis is an inflammatory Bowel Disease (IBD) that runs a clinically benign course. Histopathologically it is characterized by superficial mucosal erosions with lymphocytic infiltration in the lamina propria with no granuloma. Aim of this study: is to describe the clinical presentation of Non-Specific Colitis (NSC); and to evaluate its response to 5-aminosalicylic acid (5-ASA) in Sudanese patients. Setting and Design: This study is a prospective cohort. A total of 26 patients presenting with bloody; mucoid diarrhoea; lower abdominal pain or colonic mass were included in the study. Methods and Materials: A total of 26 patients presenting with bloody mucoid diarrhoea; lower abdominal pain with or without colonic mass were included in the study. All patients underwent colonoscopy. Statistical analysis: A descriptive statistical analysis was done using SPSS. Results: 19 () of patients were males and 7 were females with male to female ratio of 3:1. The majority of patients 16 (61.6) had bloody diarrhea while 18 (69.2) opened their bowel 4-6 times a day. The majority 10 (38.8) had rectum and sigmoid involvement. All patients showed a good response to 5-ASA. Conclusions: This study showed that NSC has clinical features that are very much similar to mild UC with a rather good clinical response to oral 5-ASA

Audiometric Findings in Waardenburg's Syndrome amongst the Institutionalised Deaf Blind in Kaduna-Nigeria

Introduction:Waardenburg's syndrome is a rare inherited disorder of congenital hearing loss and Pigmentary disturbances of the eyes; hair; skin and neural crest derivatives. Methodology: 620 students in a deaf/blind school were examined and four had Waardenburg's syndrome with a frequency of 0.65. 2 males and 2 females with Waardenburg's syndrome and age ranges between 10-19years (mean 15.75years) All 4 subjects had complete blue irides; white forelock and sensorineural hearing loss; and thus met the diagnostic criteria. They were then subjected to Audiometric assessment. Results: Otoscopy was essentially normal but Audiometry revealed sensorineural hearing loss [SNHL] in all the subjects ranging from severe to profound with one subject being stone deaf. Conclusion: Waardenburg's syndrome is a rare disorder in our environment although it may be under reported.Two of the subjects benefited from amplification and were given hearing Aids. Provision of early amplification cannot be over emphasized

Abdominal Tuberculosis in Surgical Practice in Northern Nigeria

Background: Abdominal tuberculosis is a common complication of pulmonary tuberculosis. With the rising incidence of HIV; tuberculosis has become a major public health problem particularly in developing countries. Methods: This is a retrospective study involving patients whose surgical specimens were processed at the central histopathology laboratory of the Ahmadu Bello University Teaching Hospital (ABUTH) Zaria - Nigeria; between January1975 to December 2006. Results: There were 68 males and 49 females; aged 12-70 years (mean 28.6yrs 11yrs). While paroxysmal dry cough was present in about 20 patients; abdominal pain and distension were very common. Concomitant pulmonary tuberculosis was confirmed in 15 patients (14). The findings at Surgery in 66 patients are presented in fig.2. Multiple deposits on the peritoneum and momentum were the commonest findings (48.7and 26.2) respectively. Conclusion: Abdominal tuberculosis is not uncommon and there is need to establish an early less invasive diagnostic protocol

Cancer management in Sudan: current status and future perspectives

Introduction:Sudan is one of the developing countries that face a great challenge with cancer management.About 5700 cases had been seen during year 2007 in Radiation and Isotope Center- Khartoum (RICK)and Institute of Nuclear medicine; Molecular biology; and Oncology (INMO) Wadmedani which are the only cancer centers in Sudan. Purpose:Aim of this work is to highlight the difficulties of cancer management in Sudan and to propose possible solutions.Methods:This paper evaluates the current situation of cancer management in Sudan through reviewing of data available in cancer centers and reports from the Sudan national bureau of statistic.Suggestions are also made for cancer control plan in Sudan having the currentsituation in mind and guided by the published international data on cancer control.Results:The preliminary analysis of the available data reveals that Sudan has very limited resources available to deal with cancer and the service provided is not evenly distributed.Conclusion:Establishment of new centers is extremely needed with special attention to good distribution of services.To achieve such a goal training of more staff and upgrading of the existing centers is mandatory to manage all types of cancer.Cancer registry is the right way to plan for cancer control in sudan

A Preliminary Inventory of Hazardous Medical Waste Disposal Systems and their Influence on Groundwater Quality in Lusaka

Water forms the basis of life and an essential prerequisite for any socio-economic development and growth. Currently; groundwater has increasingly become a comparatively cheap source of water supply for domestic and other uses in Zambia. However; in Lusaka; the aquifer is vulnerable and fragile because it is shallow and hosted by an open karst system. Since waste management practices have become increasingly inappropriate; such that some of the waste has ended up in karst caverns; there are increased threats of unhindered infiltration of leachate and contaminants to the aquifer. Medical waste constitutes one form of waste; which is inappropriately handled and disposed of in Lusaka. To check on the effects of such practices; the research team undertook mapping of healthcare centres in Lusaka; took an inventory of the types of medical wastes produced at each centre; and their methods of disposal. Seven water points located near these possible sources of pollution were sampled in Chawama; Kanyama; Matero Main; Matero Reference; Kalingalinga; Chipata and George clinics and tested for pH; conductivity; total dissolved solids; total coliforms; faecal coliforms and chemical oxygen demand (COD) as O.Results of these tests revealed that only two water points met the WHO guidelines for drinking water