Anomalous left anterior descending coronary artery arising from pulmonary artery in a 63 year?old male patient: case report and literature review

To present a case of a rare congenital coronary anomaly in an adult patient, which was not reported before in Palestine, review the literature, and compare with previously reported cases

Vancomycin resistance among methicillin-resistant Staphylococcus aureus isolated from clinical samples in Erbil city-Iraq

Bacterial isolates obtained from different sources of 348 human specimens including burn, wound, urine, and stool from the database of Internal Lab of Teaching Hospital, Irbil-Iraqi Kurdistan region, were collected from May 20, 2012, through January 19, 2013, of which 228 isolates were positive for Staphylococcus aureus. Cultural studies were performed using different cultures and biochemical tests to ensure the identity of species under study. The susceptibility of the isolates for the antibiotics test were done using 22 different antibiotic disks including carbenicillin [CAR], vancomycin [VA], clindamycin [DA], methicillin [MY], cephalothin [KF], pipercillin [PRL], nitrofurantoin [F], cephalexin [CL], rifampicin [RA], gentamycin [G], chloramphenicol [C], trimethoprim - sulfamethoxazole [SXT], ceftazidime [CAZ], polymyxin B [PB], amoxicillin-cluvalinic acid [AMC], doxycycline [DO], amikacin [AK], oxacillin [OX], ciprofloxacin [CIP], cefixime [CFM], cefoperazone [CEP], and neomycin [NEO]. The results showed that resistance for the antibiotics ranged from 26.31% to 98.61% for DA and MY, respectively. A total of 78.94% of the isolates that demonstrated resistance to MY were also found to resist VA. Thus, we conclude that some strains of S. aureus isolates acquired genes that are able to resist those antibiotics

Naso-Maxillary extramedullary plasmacytoma: a case report

We report an early case of extramedullary, right maxillary sinus and nasal, plasmacytoma. The patient was a 27 years old female who presented with nasal bleeding and a nasal mass. Imaging studies showed opacities in the nasal cavity and the maxillary sinus but there was no bone involvement. A biopsy from the nasal mass showed a plasmacytoma. She was investigated to rule out systemic disease. The investigations included; serum electrophoresis, urine analysis for Bence Jones proteins, bone marrow aspirates study and radiological skeletal survey. The results of all investigations were negative. After complete excision of the tumour endoscopically the patient was treated with adjuvant radiotherapy. She remained well, without recurrence or spread of the tumour at 4 years follow up. CT scans pre and postoperatively as well as H and E and Immunohistochemistry slides are presented. To our knowledge, this is the first case to be reported in Sudan

Relationship between non-alcoholic fatty liver disease and kidney function: a communication between two organs that needs further exploration

Non-alcoholic fatty liver disease [NAFLD] is now regarded as hepatic component of the metabolic syn-drome. In addition, NAFLD has emerged as a growing public health problem worldwide and an important challenge for health authorities. NAFLD is associated with insulin resistance and hyperlipidaemia and this appears as the potential pathogenic role of NAFLD in the development and progression of chronic kidney disease [CKD]. Interestingly, NAFLD and CKD may share common pathogenic mechanisms like obesity, abdominal obesity, insulin resistance, hyperlipidaemia, hypertension and inflammation. Importantly, the association between NAFLD and CKD is also being shown to be independent of obesity, hypertension, and other potentially confounding features of the metabolic syndrome, and it occurs both in patients without diabetes and in those with diabetes. How the liver communicates with kidney in individuals with NAFLD is not well known and indeed an urgent research is needed to further elucidate the complex and intertwined mechanisms that link NAFLD and CKD. One potential pathway for future exploration may be inflammatory mediators in NAFLD that may lead to deterioration in renal function. In addition, large clinical studies are needed to study the impact of NAFLD on the progression of CKD and in particular during dialysis and transplant and importantly how treatment of NAFLD and weight loss will have reversible potential benefit in improving renal function

Genetic association between common beta-2 adrenoreceptor polymorphism and asthma severity in school-age children

Recent studies have suggested that polymorphism of the beta-2 adrenergic receptor [beta2AR] gene at codon 16 affect an individual's airway responsiveness. This study aimed to evaluate the association between beta-2 adrenoreceptor genotypes at position 16 and asthma severity among 59 school-aged children. They were divided into two groups: control group including 19 healthy children and 40 asthmatic children as the study group. The study group was also divided into 20 mild asthmatic children and the remaining 20 patients suffered from severe asthma. Blood samples were collected from Chest Department, Pediatrics Hospital, Ain Shams University, from February 2008 to March 2009. Molecular analysis was performed at Science Faculty, Ain Shams University, Cairo, Egypt. Venous blood sample were collected and genotyping of beta2AR gene polymorphism at position 16 was identified by polymerase chain reaction-restriction fragment length polymorphism analysis, using the NcoI restriction enzyme. We found a highly statistically significant difference of polymorphisms' distribution of beta2AR gene at codon 16 among asthmatic patients and control subjects [chi[2] = 11.904; P = 0.0026], also among severe asthmatics and mild/moderate asthmatics [chi[2] = 10.108; P = 0.0064]. There was a strong association of heterozygous Arg16Gly of beta2AR with severe asthmatics rather than that in control subjects [70% vs. 5.3%, P < 0.001], with odd ratio [OR] 42 [95% confidence interval [CI]: 4.520-390.297], the highest OR in heterozygous Arg16Gly [42] suggests a dominant mode of action of the heterozygous Arg16Gly in development of asthma severity. So, we concluded that heterozygous Arg16Gly of beta2AR gene appeared to be an important genetic factor in the expression of asthma severity

Inguinal hernioplasty by laparoscopic total extraperitoneal versus open lichtenstein techniques: a randomized prospective study

Different techniques of laparoscopic inguinal hernioplasty are performed. The total extraperitoneal approach [TEP] represents an important such techniquc. In a randomized prospective study, we compared the TEP with the standard open repair. namely Lichtenstein hernioplasty. Thirty two adult males with inguinal hernia were included in the study. They were randomly and equally divided into two groups: open Lichtenstein [OL] group and laparoscopic [TEP] group. Data were collected regarding operative time, complications. positoperative pain, hospital stay, and resumption of normal activities. The mean follow up period was 15 months ranging from 10 to 23 months. The OL group included two direct hernias, while the TEP group included three direct hernias while the rest were indirect. The operative time for the OL group was significantly shorter the TEP group with a mean and range of 44 [30-80] versus 95 [60-160] respectively. TEP group had significantly less postoperative pain and analgesic needs compared to OL group. TEP patients resumed their normal activities significantly sooner than OL patients. Hospital stay did not differ between the two groups. Intraoperative bleeding from the inferior epigastric artery occurred once in the TEP group and was well controlled. Minor postoperative complications in the form or seroma, wound infection, and urinary retention were reported in both groups with no statistically significant differences and resolved spontaneously. Although requires longer operative time than open Lichtenstein inguinal hernioplasty, laparoscopic TEP hernioplasty results in less postoperative pain. analgestic, requirements. and earlier return to normal activities with comparable hospital stay and postoperative complications. Consequently, laparoscopic TEP inguinal hernioplasty could be considered as a strong competitor to the standard Lichtenstein technique. Still larger comparative studies with longer follow up are needed to objectively prefer one technique over the other

Incidence of anaemia in female breast cancer patients attending the national cancer institute, Wad Medani

Anaeia is a public health problem that affects populations in both rich and poor countries. Although the primary cause is iron deficiency, it is seldom present in isolation. More frequently it coexists with a number of other causes, such as malaria, parasitic infection, nutritional deficiencies and haemoglobin apathies. That was the people and female in Sudan suffered from it. Anaemia has a high prevalence in patients with cancer. The aim of this study was to find the incidence of anaemia in new cases of Sudanese female breast cancer patients attending the National Cancer Institute [NCI], Gazira State, Sudan. The study was performed on 250 female breast cancer patients mean age 45.99 +/- 0.82 [age range between 15-70 years]. The study period was from May 2005 to June 2007. The haemoglobin level for anaemia was measured by SYSMEX-KX21M. It was found that 144 [58.8%] of the female breast cancer patients presented with anaemia, 65[26.4%] of them were in the child-bearing age group 15-40. The degree of anaemia varied between moderate to severe [grade II to grade IV]. In this study, it was also found that a considerable number of cases 200[80.0%] were from the rural area. 44[17.6%] of the patients were found to be underweight, 31 of them were anaemic. While 105[42%] of patients were overweight and obese, 52 of them were anaemic. It is concluded that the incidence of anaemia in newly diagnosed Sudanese female breast cancer patients presented at NCI is association presentation with advanced disease stage. It is also related to the age, state of nutrition and social economical factors. Early cancer detection which leads to effective treatment and reduced complication of diseases included anaemia is recommended

normal range of mouth opening in kurdish population and its correlation to age, sex, height, and weight

To many dental disciplines, especially oral and maxillofacial surgeons to perform dental treatments and oral surgical procedures comfortably. This study was conducted to estimate the degree of mouth opening and its correlation to sex, age, height and weight. The maximum mean mouth opening of 1262 Kurdish adult was measured using a calibrated ruler, in addition to body height and weight. Student-t test was used to assess the statistical difference between males and females and Pearson correlation coefficient to assess the correlation between mouth opening and both body height and weight. The mean value of mouth opening was 50.56 mm for males and 48.46 mm for females. The greatest mean mouth opening was noted in the age group of 16-24 and decreased gradually with advanced age. A significant positive correlation was noted between mouth opening and both body height and weight. Mouth opening was higher in males than females in all age groups and decreased gradually with advancing age. It was positively correlated with body height and weight

Assessment of oxidized low density lipoprotein, as atherosclerosis risk marker in type 1 diabetic children with short history of diabetes mellitus

To evaluate the type-1 diabetic children for early atherosclerosis risk by measuring serum oxidized lipoprotein in relation with glycaemic control. Recent studies indicate that systemic markers of inflammation can identify subjects at high risk of cardiovascular disease [CVD]. Oxidized low density lipoprotein [OxLDL] levels have been regarded as one of the independent determinants of atherosclerosis. This cross sectional study involved a total 79 subjects including 39 type 1 diabetics and 40 non-diabetic controls between the ages of 9 to 16 years. A detailed medical history was taken from each subject and the individual with history of type-1 diabetes underwent clinical examination. Individuals with obesity, hypertension, smoking, and chronic infections, autoimmune and renal diseases were excluded. Serum concentrations of glucose and lipid profile were measured in duplicate by kits based on enzymatic methods. OxLDL was measured in duplicate by using standard enzyme linked immunosorbent assay [ELISA] method. Haemoglobin A[1c] and Body mass index [BMI] were also measured. Diabetic patients had significantly elevated levels of blood glucose [320.1 vs 97] and HbA1c [10.3% vs 5.21%] as compared to controls [p<0.001] but the serum levels of OXLDL were found to be significantly elevated in diabetic children [222.4 vs 140.2] as compared to controls [p>0.05]. OxLDL is a strong independent risk marker for atherosclerosis observed in diagnosed old age patients of CVD but in present study we could not find statistically significant elevated levels of OxLDL in young diabetic subjects with short duration of diabetes

Role of inhibin B as a marker of spermatogenesis in infertile patients with varicocele

Varicocele is a state of varicosity and tortousity of the pampiniform plexus around the retrograde blood flow. There is strong association between varicocele and subfertility so treating varicocele may be helping improvement of fertility. Inhibin B levels reflect the functional state of seminiferous epithelium and have been considered as sensitive index of spermatogenesis. This study was to detect the role of serum inhibin B concentration in infertile men with varicocele before and after varicocelectomy. Twenty patients with varicocele were included in this study. Serum inhibin B, serum FSH and semen analysis were performed before and after 6 months after varicocelectomy. There was a significant increase of inhibin B levels [P < 0.01] after varicocelectomy and a significant decrease of serum FSH levels was observed after surgery P < 0.01]. A significant improvement of semen analysis, sperm concentration [P < 0.01] and progressive motility [P < 0.05] was showed after treatment. Serum Inhibin B level in infertile men may provide a useful information about spermatogenesis and could be used as a more direct marker of spermatogenesis than FSH. Moreover, varicocelectomy improves the level of inhibin B and semen parameters in those patients

Efficacy of pre-operative chemotherapy and sequential radiation therapy in irresectable rectal carcinoma

To evaluate the toxicity and relative response rates of addition of cisplatin to 5-fluorouracil and leucovorin preoperative induction chemotherapy followed by local radiotherapy in irresectable rectal cancer and their impact on radical resectability and sphincter preservation. Between January 2002 and April 2006, 29 patients with locally advanced unresectable rectal cancer received two cycles of 5-fluorouracil 600mg/m[2], I.V 6h infusion D[1]-D[5] and D[22]-D[26], Leucovorin 20mg/m[2], I.V 1h infusion D[1]-D[5] and D[22]-D[26] and cisplatin [CDDP] 60mg/m[2], I.V 6h infusion D[1] and D[22] after good hydration. Radiation treatment was administered after two weeks of the second cycle of chemotherapy. The dose was 45 Gray in 25 fractions over 5 weeks prescribed at isocenter of the plan to include the rectum and the draining lymph node chains. Tumor dimensions were assessed by CT scan before the start and 4 weeks after chemoradiotherapy. Tumor response classification was based on the standard World Health Organization criteria. Complete response [CR] is complete disappearance of the disease. Partial response [PR] is a decrease of 50% of the sum of the products of the greatest perpendicular diameters [SPD]. Progressive disease [PD] is appearance of a new lesion or an increase of 25% in SPD. Stable disease [SD] is no change in SPD or a change not reaching PR or PD. Overall response rate [ORR] is CR plus PR. Our regimen was well tolerated. The main toxicity to it was grade II hematological and grade II and III GIT toxicities in 31% and 65.5% respectively. PR occurred in 58.6% [17/29], SD in 20.7% [6/29] and PD in 20.7% [6/26]. Anterior resection of the rectum with total mesorectal excision and sphincter preservation was done in 37.9% [11/29], abdomino-perineal resection in 31.05% [9/29] and palliative colostomy in 31.05% [9/29]. Radical resectability was achieved in 62.1% [18/29] and cytoreductive surgery in 6.9% [2/29]. After 2 years follow up of resected cases, the 2 years disease free survival was 60% [12/20] with 25% [5/20] local recurrence rate and 15% [3/20] distant metastases to the liver. Our pre-operative combined modality therapy seems to have potential advantage in tumor response, local control and sphincter preservation with tolerable acute and chronic toxicity. Sequential use of chemo-radiotherapy needs more studies to estimate the maximum tolerable dose of chemotherapy and radiotherapy with least side effects

Prevalence of oral candida infections in diabetic patients

The purpose of this study was to determine the prevalence, species distribution and antifungal susceptibility profile among oral cavity isolates of Candida species from diabetic and non-diabetic subjects. The contribution of smoking and dental status to the prevalence and distribution of Candida species was also evaluated. Retrospective study of oral cadidiasis in diabetic patients between January and October 2003 was undertaken. Three private clinics in Amman, Jordan and Department of Biological Sciences at Hashemite University. A total of 262 individuals were enrolled in the study, 132 were diabetics and 130 healthy controls. None of the non-diabetic controls had any clinical evidence of oral candidiasis, 8.3% of diabetics had clinical evidence of oral candidiasis, of which, 36% were overnight denture wearers and tobacco smokers. An imprint culture method was used to determine the frequency of isolation and density of Candida species at up to nine intra-oral sites. Yeast-like colonies were identified by classical methods and CHROMagar Candida medium. Broth macrodilution technique was used to determine the antifungal susceptibility pattern of Candida isolates. Positive yeast was detected in 58.3% of diabetics compared with 30% in healthy controls [P<0.001]. C. albicans was the most prevalent species in both diabetics [81.8%] and controls [76.9%] followed by C. tropicalis, C. parapsilosis and C. glabrata. C. kefyr and C. krusei were isolated only from diabetics at a combined rate of 1.3%. Candida was detected more frequently in diabetic denture wearers than in control counterparts in all anatomic sampled sites [P<0.05]. The frequency of Candida isolation was significantly higher in smokers than in the non-smokers in both diabetics and controls [P<0.001]. All C. albicans recovered from diabetics and controls were susceptible to amphotericin B, ketoconazole, itraconazole and fluconazole. Non-albicans Candida isolates were shown to have higher azole MIC values than C. albicans isolates. Our findings show that smoking and continuously worn dentures, promote oral candidal colonization in diabetics

Calcium status in Sudanese cancer patients attending the institute of nuclear medicine, molecular biology and oncology

The aim of this study was to study the incidence of hypercalcaemia together with the related biochemical parameters and anthropometric measurements in Sudanese cancer patients attending the Institute of Nuclear Medicine, Molecular Biology and Oncology [INMO], Gezira State, Sudan. The study was a prospective study performed on 100 cancer patients [age ranging between 4- 70 years]. The study period was from 15/4/2003 to 1/9/2003. Another 100 persons [age and sex matched] were used as control group. The biochemical parameters measured in this study were serum calcium, serum inorganic phosphorus and serum albumin. Calcium, inorganic phosphorus and albumin were measured by Spectrophotometery. Anthropometrics measurements determined were weight and height. A questionnaire was filled in order to obtain information regarding: age, sex, residence, tribe and information about education, occupation, marital status and past medical history. Type of cancer, date of diagnosis, stage of cancer, treatment, and present complaints were recorded. Hypercalcaemia was detected in ten of the patients [10%]. This is similar to the internationally published rates. The types of cancers associated with hypercalcaemia were cancer of the breast [20%], skin [20%], prostate [10%], bladder [10%], rectum [10%], unknown primary [10%] and hematological malignancies [20%].Mean serum calcium [9.48 +/- 1.07 mg/dL] and inorganic phosphorus [4.45 +/- 1.01 mg/dL] were higher in the cancer patients than the control group [9.03 +/- 0.56, 4.13 +/- 0.72 mg/dL respectively]. However, the difference is statistically not significant. Serum albumin concentration was similar in the patients and control groups [4.97 +/- 0.63 and 4.93 +/- 0.41 g/dL respectively]. The differences of weight and height were not significantly different in the two groups. It is concluded that the calcium, phosphorus and albumin levels among Sudanese individuals were similar to the internationally published levels. Hypercalcaemia is not a rare condition among cancer patients and should be checked whenever there is a symptom because it can lead to many serious complications

Nursing role toward patients undergoing abdominal laparoscopic surgery; A suggested training program

Teaching programs for nursing staff constitutes an important part. These programs are urgently designed to assist staff nurses in developing and enhancing their skills needed to provide high standards of care to their patients. In the present study, the researcher tried to investigate and identify needs for developing and implementing a training program designed towards improving the knowledge and performance of nurses working in the surgical departments of Assiut University Hospital. The study aimed to assess the role of nurses in caring for patient's undergoing Abdominal Laparoscopic Surgery and to suggest a training program for nurses caring for patients undergoing Abdominal Laparoscopic Surgery in the surgical department. The assessment needs for developing program was determined by test questionnaire sheet and observation checklist. The study included all male and female nurses [N=63] working in the general surgical departments. They were most of them holders of the diploma of nursing and very small number holders bachelor of nursing. The program was evaluated applying the same tools used in the assessment phase, then immediately after the program implementation. The main results obtained were as follows. The nurses' knowledge and performance related to caring of patients undergoing Abdominal Laparoscopic Surgery in surgical department was quite poor. The educational program showed improvement in nurses knowledge and performance regarding the nursing care of patients undergoing Abdominal Laparoscopic Surgery The results of comparison between the pre-test and post-test showed statistically significant differences. The present study concluded that nurses in general surgical department have unsatisfactory level of knowledge and performance. Attending training or orientation programs about caring for patients undergoing Abdominal Laparoscopic Surgery is absolutely lacking for nurses serving in the general surgical department. During their nursing practice, they usually lose their knowledge and skills related to caring patients after coming form PACU as they are not well trained and are not assigned for such activity. Moreover, they lack background knowledge and any experience as regards pre and post operative caring of patient undergoing Abdominal Laparoscopic Surgery in spite of its crucial importance for managing patients in the general surgical department. However, they can gain the necessary knowledge and technical skills that will enable them to perform better after the exposure to a well planned and organized training program. The present study recommended that educational department should be established within Assiut University Hospital to prepare and improve the nursing staff level of knowledge and performance

Homocysteine in type II diabetes mellitus, its relation to ischemic heart disease and smoking

To study the homocysteine level in type II diabetes mellitus and its relation to ischemic heart disease [IHD] and smoking habits. Thirty one type diabetic patients and 10 healthy normal controls were evaluated by measurement of FBS, HbA1c and fasting homocysteine level. All patients and controls had full clinical examination and investigated for the presence of IHD. Homocysteine level in type II diabetic patients was higher [p<0.0001] than in controls with positive correlation to FBS and HbA1c level. There is significantly high level of homocysteine [P<0.000 1] in type II diabetic patients with IHD compared to the patients without, there was also a significant difference in homocysteine level in diabetic pateints between smokers and non smokers [P<0.0001]

Conclusion: Diabetics had high homocysteine level with positive correlation to FBS and HbA1c The high level of homocysteine in diabetic patients is also correlated to the IHD and smoking habits

Nitrous oxide in isufflation does not increase the incidence of gas embolism during laparoscopic cholecystectomy: detection by transoesaphageal echocardiograply

In a prospective randomized clinical trial, 24 patients with ASA score I or II were scheduled for laparoscopic cholecystectomy. They were divided into two equal groups, where either carbon dioxide [CO2] or nitrous oxide [N2O] was used for pneumoperitoneum. Standard general anesthesia was used in all cases. Transesophageal echocardiography [TEE] probe was introduced to monitor gas embolism [GE] events. The procedure was divided into four operative stages [T1 = insufflation, T2 = dissection of cystic duct and artery, T3 = gallbladder bed dissection and T4 = extraction and desufflation]. For each stage, the number and score [from 1-3] of gas embolism episodes were recorded. In addition, heart rate [HR], mean arterial blood pressure [MAP], saturation of oxygen [SaO2] and end-tidal CO2 [ET CO2] were recorded immediately after induction [baseline], during insufflation and every ten minutes of the procedure. The study concluded that during laparoscopic cholecystectomy, insufflating gas does not increase the incidence of GE events compared with CO2. On the contrary, N2O exhibits slightly less GE events in some of the operative stages. The stage of insufflation predisposes to more GE events than the rest of the operation. Most of the GE events are associated with some rate of gas flow into the peritoneal cavity, whatever the type of gas is. Therefore, more cautions must be taken into consideration whenever there is active gas flow into the peritoneal cavity for the risk of GE

Common bile duct clearance of stones by surgery, endoscopy and laparoscopy [comparative study]

In this study, 70 cases of choledocholithiasis were managed randomly by either conventional surgical techniques, endoscopic techniques or laparoscopic techniques. Most of these patients were presented with calcular obstructive jaundice [54.3%]; however other presentations were also encountered as colic, cholangitis or accidental discovery in 14.3%, 10% and 21.5%, respectively. Group I [surgery] included 30 patients who were treated by open choledocholithotomy and T tube insertion, the mean operative time was 90 [60-180] min. Group II [endoscopy] included 30 cases treated by endoscopic sphincterotomy and basket extraction in 46%, balloon in 26.6%, combined maneuver in 16.6% and mechanical lithotripsy in 13.3%. Group III [laparoscopy] included ten cases treated by laparoscopic approaches in the form of trans- cystic approaches in two cases, trans-choledochotomy approaches in three cases, choledochoscopic techniques in two cases and converted to open techniques with failure of the attempt in three cases. The study showed that open surgery permits direct manual palpation and instrumentation of bile ducts using a variety of instruments. However, it has its drawbacks in long maneuver time, invasiveness, increased mortality and morbidity, long hospital stay and delayed return to work. On the contrary, endoscopic management of choledocholithiasis has the advantage of minimally invasive maneuver, could be done as outpatient clinic, less procedure time, less hospital stay, very low or no mortality and morbidity, rapid return of the patients to work

Plasmodium falciparum infection during pregnancy in an unstable transmission area in eastern Sudan

A 1-year prospective community-based study of malaria during pregnancy was conducted in an area of seasonal and unstable malaria transmission in eastern Sudan. At a village antenatal clinic, 89 non-pregnant controls and 86 pregnant women were enrolled and followed every 2 weeks until 6 weeks after delivery. The incidence of Plasmodium falciparum infection was significantly higher among pregnant than control women [17.4% versus 5.6%] with no difference between primigravidae and multigravidae [22.2% versus 15.2%].There was no significant difference in the mean haemoglobin concentration between infected and uninfected mothers [9.1 +/- 1.3 versus 9.5 +/- 0.6 g/dL] but the mean birth weight of their babies was significantly lower [2.72 +/- 0.26 versus 2.95 +/- 0.05 kg] despite prompt case management of infected women