Congenital heart disease in a cohort of Sudanese patients with cleft defects

Background and objectives:Cleft defects are among the most visible congenital defects worldwide and congenital heart disease (CHD)being one of the most common associated anomalies. This study aimed to assess the prevalence of CHD among a cohort of Sudanese patients with cleft lip and/or palate.Patients and Methods:All patients who presented to Soba University Hospital with cleft lip and/or palate from March 2009 toMarch 2015 were included.Results:Out of 381 patients included; 168 patients (44%) had cleft lip and palate (CLP), 156 (41%) had cleft lip (CL)and isolated cleft palate (CP) was found in 57 patients (15%). Facial dysmorphic features were identified in 57 (15%) and cardiac defects in 42 (11%) patients. Ventricular septal defect (VSD) was diagnosed in 16 patients (38%), and ASD in 12 (30.9%). Other macroscopic anomalies were identified in 57 patients (15%)and were associated with CHD (P<0.001). Significant association was found between the type of cleft andCHD (P<0.002), as cardiac defects were maximally observed among CP cases (21%) followed by CLP cases (13%) then CL cases (5.12%). Significant association was also found between facial dysmorphicoccurrence and CHD (P < 0.001).Conclusion:CHD is a common anomaly in cleft population. The pattern of CHD is consistent with the literature withVSD being the most frequent. The cardiac defects are most prevalent in CP group. Echocardiography isjustified for screening of CHD due to the relatively higher incidence of CHD among clefts patients than ingeneral population

Benign effects of Helicobacter pylori in gastric mucosa among symptomatic Sudanese patients

Infection with Helicobacter pylori is a worldwide problem. It plays an important role in gastric malignancies.The pathogenesis of gastric malignancies involves multistep progression changes in gastric mucosa and the Helicobacter pylori infections is the first step in most of cases.Aim:The aims of this study were to clarify the benign changes in gastric mucosa after Helicobacter pylori infection;to evaluate the endoscopic and histological patterns of infection and to correlate endoscopic findingwith histopathological parameters.Materials and Methods:A descriptive, retrospective study was done in Soba University Hospital between January 2009 - February2013. Paraffin-embedded blocks, Giemsa and Haematoxylin and Eosin-stained slides, were obtained from 50 cases of Helicobacter pylori-associated chronic gastritis and examined under light microscopy. The clinical information and endoscopy findings were obtained from the records. The data was analyzed using Statistical Package for Social Sciences Software.Results:The most common affected age group was between 40-60 years. The prevalence of infection was equal in males and females. The commonest endoscopic finding was inflammation of gastric mucosa. Most patients presented with moderate degree of colonization; 62% of patients presented with a severe degree of chronic inflammation. There was a significant statistical correlation between the degree of Helicobacter pylori colonization and the degree of chronic inflammation (p<0.05). Most patients presented with severe degree of active gastritis. A significant correlation was found between the degree of chronic inflammation and degree of activity. The prevalence of lymphoid follicles in a single biopsy specimen from antral mucosa was 36%.The dysplasia was seen in 12%; eosinophilia 8%; atrophy 8% and intestinal metaplasia in 6% of the cases.No significant correlation was found between the endoscopic findings and histological findings.Conclusion:Helicobacter pylori infection causes chronic active gastritis and it has a role in the development of lymphoid follicles, intestinal metaplasia, atrophy and dysplasia

Ulcères gastriques et duodenaux à Cotonou: aspects épidémiologiques, cliniques, endoscopiques et thérapeutiques

L'ulcère gastrique ou duodénal (UGD) est une affection plurifactorielle. Une prévalence de 16,6% en avait été rapportée en 2005 au Bénin. Le but de notre étude est de décrire les aspects épidémiologiques, cliniques, endoscopiques et thérapeutiques des UGD observés de nos jours à Cotonou. Patients et méthodes : Il s'agissait d'une étude prospective, transversale, descriptive et analytique. Elle a colligé du 1er octobre 2015 au 30 avril 2016, tous les sujets de plus de 15 ans ayant présenté un UGD à l'endoscopie dans les services des maladies digestives de l'hôpital de Zone de Mènontin et de l'hôpital d'Instruction des Armées de Cotonou. Résultats : Sur 411 patients inclus, 30 avaient un UGD soit une prévalence de 7,3 %. Les ulcères duodénaux étaient observés chez des sujets jeunes avec un âge moyen de 38 ± 6,9 ans ; tandis que les ulcères gastriques étaient observés chez des sujets plus âgés avec un âge moyen de 58 ± 7 ans. La sex-ratio était de 2,8. Les épigastralgies étaient la principale manifestation présente dans 70% des cas. La localisation de l'ulcère était gastrique dans 36,7%, duodénale dans 53,3 %, double dans 10% des cas. Les principales causes étaient la consommation de médicaments gastro-toxiques et l'Helicobacter pylori. Les Inhibiteurs de la pompe à protons étaient prescrits dans tous les cas et l'éradication de l'Helicobacter pylori faite dans 94,7% des cas avec une évolution favorable à 2 mois de contrôle. Conclusion : la prévalence des UGD a diminué de plus de 50% en onze ans à Cotonou. L'amélioration du niveau d'hygiène et la sensibilisation contre l'automédication pourraient davantage contribuer à réduire cette prévalence

Role of Nitric Oxide and Endogenous Antioxidants in Thyroxine Facilitated Healing of Ischemia-Reperfusion Induced Gastric Ulcers

Background: Studies have revealed the role of thyroxine during healing of gastric ulcers with information lacking on the mechanism involved hence the focus of this study.Materials and Methods: Adult male Wistar rats (150 ­ 200g) were randomly divided into 4 groups (n=5 per group): Normal control (NC), Sham ulcerated (SU), Thyroidectomised ulcerated untreated (ThU) and Thyroidectomised ulcerated + Levo-thyroxine (100µg/kg/day) (ThU + T4). Animals were stabilised for 35 days following thyroidectomy and treated accordingly to experimental groupings. Weekly body weight changes were recorded, gastric ulcer was induced by ischemia-reperfusion and gastric acid secretion evaluated. They were sacrificed 1 hour, 3 and 7 days post ulcer induction, blood samples collected for haematological indices through cardiac puncture and their stomachs prepared for gross and microscopic examinations to assess gastric healing. Gastric tissue protein, malondialdehyde (MDA), Superoxide Dismutase (SOD), Catalase (CAT), and Nitric oxide (NO) were assessed as biomarkers of healing. Data were analysed using one way ANOVA and Student's t test with p< 0.05 considered statistically significant.Results: Thyroxine treated rats showed significant weight loss compared with NC and ThU groups. Percentage healing rate was significantly increased in thyroxine treated group compared with ThU animals by 1 hour (42.45% and -42.81%), days 3 (35.14% and -59.36%), and 7 (64.29% and -115.7%).Hematological indices significantly increased in thyroxine treated group compared with other groups. Thyroxine treatment significantly reduced Neutrophil/Lymphocyte; Platelet/NO as well as lipid peroxidation index in this study.Superoxide dismutase, CAT and NO increased significantly in thyroxine treated rats compared with other groups.Conclusion: Thyroxine treatment facilitates the healing of ischeamic-reperfused gastric ulcers possibly by increasing NO activity which in turn causes increased vasodilatation and enhanced endogenous antioxidants at the ulcer sites

Anti-ulcer and Anti-inflammatory Effects of Hydro-Alcohol Extract of Aloe buettneri A. Berger (lilliaceae)

Purpose: Aloe buettneri A. Berger is commonly used in Togolese folk medicine to treat inflammation and gastric ulcer. In this study we investigated the anti-oedema; analgesic; antipyretic and ulcer healing properties of the hydro-alcohol extract of their leaves. Methods: Rat oedema paw were induced by the injection of 0.1 ml of formaldehyde 1; tail flick method is used to study analgesic property; hyperthermia was induced by subcutaneous injection of 15of a brewers' yeast suspension at dose of 10 ml/kg and ulcers were induced by ethanol or HCl/ethanol mixture. Results: The extract showed anti-inflammatory properties at doses between 250-500 mg/kg. It inhibited; in a dose- dependent manner; the oedema induced by 0.1 ml of formaldehyde 1. Scores of 73.70and 83.63were obtned when the doses of extract administered were 100 and 500 mg/kg; respectively. The tail flick analgesic index showed an increase of 36.56when the dose was 500 mg/kg. The extract decreased significantly the hyperthermia induced by the injection of yeast. 1000 mg/kg of the extract inhibited 63.77of the gastric lesion induced by acid-water-ethanol mixture while daily administration of the same dose accele- rated the cicatrisation of gastric ulcer induced by 95ethanol. Conclusion: The results obtained show that the hydro-alcohol extract of Aloe buettneri A. Berger (Lillia- ceae) has anti-inflammatory; anti-ulcer and wound healing properties

Perforated gastric ulcer - reappraisal of surgical options

Background: The available operative procedures for perforated gastric ulcer are gastrectomy; ulcer excision and omental patch closure. This study analysed the outcome of these operative options in a single institution.Patients and methods: Seventy-two patients (mean age 43 years; 62 males) with perforated gastric ulcers were managed by laparotomy. There were 34 lesser curve (incisural) and 38 antral ulcers. Results: Partial gastrectomy was performed in 27 patients; ulcer excision in 27 and simple patch closure in 18. Two ulcers were malignant. The mortality rate was 18(26for gastrectomy; 19for ulcer excision and 5for patch closure). Shock on admission (p=0.006) and Candida (p=0.020) in the histological specimen were predictive of poor outcome. Hospital stay was similar in the 3 groups. Conclusion: Omental patch closure and ulcer excision are as effective as gastrectomy in the management of perforated gastric ulcer and merit consideration as first-line therapy in technically applicable cases

Perforated gastric ulcer - reappraisal of surgical options : general surgery

Background. The available operative procedures for perforated gastric ulcer are gastrectomy; ulcer excision and omental patch closure. This study analysed the outcome of these operative options in a single institution. Patients and methods. Seventy-two patients (mean age 43 years; 62 males) with perforated gastric ulcers were managed by laparotomy. There were 34 lesser curve (incisural) and 38 antral ulcers. Results. Partial gastrectomy was performed in 27 patients; ulcer excision in 27 and simple patch closure in 18. Two ulcers were malignant. The mortality rate was 18(26for gastrectomy; 19for ulcer excision and 5for patch closure). Shock on admission (p = 0.006) and Candida (p = 0.020) in the histological specimen were predictive of poor outcome. Hospital stay was similar in the 3 groups. Conclusion. Omental patch closure and ulcer excision are as effective as gastrectomy in the management of perforated gastric ulcer and merit consideration as first-line therapy in technically applicable cases

Tolerance digestive du celecoxib compare au diclofenac : resultats preliminaires a propos de 42 cas

"BUT : Evaluer la tolerance digestive du Celecoxib en le comparant au Diclofenac; en particulier l'incidence des ulceres gastro-duodenaux (critere de jugement principal).des lesions endoscopiques gastro-duodenales non ulcereuses (LGDNU) et des signes fonctionnels digestifs (criteres de jugement secondaire) apres 7 jours d'utilisation de ces 2 anti-inflammatoires dans le cadre d'un essai clinique. PATIENTS ET METHODES : Essai clinique randomise en simple aveugle sur 2 groupe paralleles. Les patients ont ete recrutes simultanement dans les services d'Hematologie clinique et de chirurgie traumatologique du CHU de Yopougon (huit mois). Une fibroscopie oeso-gastro duodenale (FOGD) a ete realisee avant l'inclusion (J0) et au 8eme jour (J8) pour evaluer l'etat initial de la muqueuse et l'incident des lesions gastro-duodenales a J8. Parmi les 73 patients favorables a l'etude. 22 avaient un ulcere gastrique ou duodenal (UGD) a la FOGD de J0 et n'ont pas ete inclus. Les 51 autres ont ete randomises dans l'un des deux protocoles suivants : 50 mgx3/jour de diclofenac pendant 7 jours ou 200 mgx2/jour de celecoxib pendant 7 jours. La recherche d'effets secondaires digestifs (signes fonctionnels et endoscopiques) a ete faite en simple aveugle par l'endoscopiste. Les LGDNU ont ete evaluees par le "" systeme de Sydney "" et le score de Lanza. Neuf patients initialement inclus ont ete perdus de vue (FOGDde J8 non realisee). Seuls 42 patients (22sous Celecoxib et 20 sous Diclofenac) ont ete pris en compte pour cette analyse intermediaire. RESULTATS : Les 2 groupes etaient comparables pour l'age; le sexe; le revenu mensuel moyen et le service d'inclusion. Les signes fonctionnels digestifs etaient moins importants avec le Celecoxib mais la difference n'etait pas significative (27.3pour cent contre 55pour cent pour le diclofenac ; p =0;07). Il en etait de meme pour les LGDNU evaluees par le "" systeme de Sydney "" ;score peu specifique des AINS( 45;5pour cent pour le Celecoxib contre 55pour cent pour le diclofenac ;p = 0;54pour cent ).La difference ;quoique non significative ;etait plus nette avec les lesions plus specifiques des AINS(9;1pour cent pour le Celecoxib contre 25pour cent pour le diclofenac avec le score de Lanza ; p = 0;23 et 4;6pour cent pour le Celecoxib contre 20pour cent pour le diclofenac pour les erosions ;p =0;17 ).L'incidence des UGD etait moins importante chez les patients sous Celecoxib (4;6pour cent ) que sous diclofenac (30pour cent ) avec un risque relatif (RR) =0;15 (p = 0;04).En d'autres termes; compare au Diclofenac ;le Celecoxib reduisait de 85pour cent le risque de survenu d'un UGD. CONCULSION : Ces resultats preliminaires suggerent une meilleure tolerance du Celecoxib par rapport au diclofenac; notamment pour le risque de survenue d'un UGD. L'incidence des signes fonctionnels digestifs et des LGDNU n'etait pas significativement differente dans les 2 groupes; probablement par manque de puissance (faible effectif). Cette etude doit etre poursuivie jusqu'a son terme pour estimer de facon plus precise l'incidence des effets secondaires digestifs de chacun de ces anti-inflammatoires (75 patients prevus par groupe; soit 150 patients en tout)."

Gastrites et infection a helicobacter pylori a Kinshasa (Zaire)

La prevalence de la gastrite chronique associee a l'infection a H. Pylori est inconnue dans notre milieu. Le but de ce travail est de determiner cette prevalence dans un echantillon de la population zairoise. Tous les patients consultant pour epigastralgies diverses entre le 1er janvier et le 30 juin ont subi une endoscopie digestive haute avec prelevement biopsique pour recherche de H. pylori. 46 patients souffraient d'epigastralgies sans ulcere; 3 avaient un ulcere gastrique et 9 un ulcere duodenal. Une gastrite chronique etait presente dans 82;8 pour cent des cas. L'infection a H. Pylori etait associee a la gastrite chronique dans 68;75 pour cent des cas; a l'ulcere gastrique dans 100 pour cent des cas et a l'ulcere duodenal dans 66;6 pour cent des cas. Au total; la presence de l'infection a H. Pylori etait etroitement en correlation avec l'activite de la gastrite