Analysis of syphilis and associated risk factors in pregnant women belongs to remote areas of sukkur

To determine and analysis of Syphilis and Associated Risk Factors in Pregnant Women Belongs to Remote Areas of Sukkur. Cross sectional study. This study was conducted on women belongs to peripheral areas of sukkur over a period of fifteen months, which beginning in May, 2012. Patient's 5ml whole blood was collected through venepuncture technique. Data were collected by all women answered a questionnaire and by investigating Blood Sample VDRL test and FTA-ABS test. The study was conducted in a confidential manner and numbers were used to identify the participant. Total 200 Pregnant women were included in the present study. Mean age of women was 25.4 years while range was 18 to 39 years. Out of the 200 samples, 6 [3.0%] were positive for active syphilis. Majority was belonging to low socioeconomic group of population. Active syphilis infection in pregnant women belongs to remote areas with low socioeconomic level were significantly disquieting. Alarming results of this study suggestive that seropositive status is often discovered in routine serological studies during pregnancy at health centers and efficient prolonged treatment of mother were available

Case report and systematic review of blunt abdominal trauma as a cause of acute appendicitis

Acute appendicitis commonly presents as an acute abdomen. Cases of acute appendicitis caused by blunt abdominal trauma are rare. The aetiology and pathphysiology of appendicitis have been well investigated. However, the occasional cases of co-existent appendicitis and blunt abdominal trauma raise questions regarding a possible cause/effect relationship. We present a case and review of appendicitis following blunt abdominal trauma. The aim of this study is to collate and report the clinical presentations and experience of such case by internet search using PubMed and the keywords 'appendicitis', 'abdominal' and 'trauma' a literature review was carried out. The initial search returned 382 papers, of which 18 articles were included. We found 29 cases of acute appendicitis secondary to blunt abdominal trauma reported in the literature between 1991 and 2010. Mechanisms of injury included road traffic accidents, falls, assaults and accidents. Presenting symptoms invariably included abdominal pain, also nausea, vomiting and anorexia. Only 13 patients had computed tomography scans and 10 patients had ultrasonography. All reported treatment was surgical and positive for appendicitis. Although rare, the diagnosis of acute appendicitis must be considered following direct abdominal trama especially if the patient complains of abdominal right lower quadrant pain, nausea and anorexia. Haemodynamically stable patients who present shortly after blunt abdominal trauma with right lower quadrant pain and tenderness should undergo urgent imaging with a plan to proceed to appendicectomy if the imaging suggested an inflammatory process within the right iliac fossa

Chronic pain after inguinal hernia repair

Hernia repair is one of the most common surgical procedures, and some patients suffer from chronic pain after hernia surgery. Chronic pain was believed to be a recognized but infrequent complication after inguinal hernia repair. Although it is usually mild, its exact cause and lack of evidence-based treatment path present problems in the effective management of this surgical complication. It has significant variable degrees of effects on work and social activities. The aim of the present study was to evaluate chronic post-herniorrhaphy pain in patients who underwent Darn or modified Bassinis' repair. We evaluated the patients over the subsequent 3 months, using a telephone filled questionnaire. The questionnaire included the chronic pain grading scale [CPG] questionnaire to focus on chronic pain and its limitations to their quality of life. The results show that the majority of patients were successfully treated by therapeutic injection into the point of maximal tenderness. It was concluded that chronic pain following open inguinal hernia repair can be disabling, sometimes seriously affecting quality of life. It is, therefore, very important to discuss the possibility of resulting chronic severe pain when obtaining preoperative informed consent. This paper highlights the importance of education of junior trainees about the appropriate issues and skills needed to get informed consent. We believe that each patient must be informed about the possibility of chronic, severe pain and its impact on their quality of life should it occur. The present findings indicate that identification and preservation of nerves during open inguinal hernia repair reduce chronic incapacitating groin pain and that, in the majority of patients with chronic pain at 6 months, the pain at 1 year is resolved only with conservative or medical treatment

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 was 10;000/mm3 in 133 (15.4) patients.Conclusions: Clinical assessment is the best criterion to reach a confident diagnosis. Investigations may supplement the diagnosis but are never a substitute for it

Importance of Fine Needle Aspirationin 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 andaccuracy 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 thyroid surgery '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; 99.5and 99.4respectively.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 7 1cm in diameter might be evaluated by FNA

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

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. This study is designed to evaluate the sensitivity and specificity of clinical examination in the diagnosis of acute appendicitis. 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. Clinical diagnosis was made correctly in 807 [93.2%] of the patients. White blood cells count ranged from 3.70 to 45.30 /mm[3] [mean 17.5353 /mm[3]]. It was <10.000/mm[3] in 133 [15.4%] patients. Clinical assessment is the best criterion to reach a confident diagnosis. Investigations may supplement the diagnosis but are never a substitute for it

reliability of modified Alvarado score as a tool for diagnosis of acute appendicitis in Sudanese adults

Decision making in cases of acute appendicitis may be difficult especially for junior surgeons as diagnosis of that condition is sometimes difficult. In conditions like acute appendicitis, it is not possible to have definitive diagnosis by gold standard test [histopathology] before surgery, so various diagnostic modalities are introduced to establish accurate diagnosis. Modified Alvarado score [MAS] system is one of the examples. This work was carried out to evaluate the reliability and sensitivity of modified Alvarado scoring system in Sudanese adult patients with suspected diagnosis of acute appendicitis This prospective study included 866 [452 males and 414 females] who underwent appendicectomy in different centers in Khartoum, Sudan in the period from January 2006 to August 2007. It included all adult patients above 16 years with clinical diagnosis of acute appendicitis. Modified Alvarado score system was calculated for all patients; however decision to operate was clinical.The results showed that the overall sensitivity, specificity and accuracy were 87.78%, 24.78% and 79e.56% respectively. Our data suggested that the modified Alvarado scoring system had little applicability to the local adult population. Its sensitivity was high but the specificity was too low. So, we conclude that the modified Alvarado scoring system is not accurate in the diagnosis of suspected cases of acute appendicitis in Sudanese adult patients

Importance of fine needle aspiration in evaluation of single nodular goiter

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. 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. A thousand and three hundred thirty one patients who underwent thyroid surgery between January 2004 to June 2007 were enrolled. 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. 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

study of the hospital stay in laparoscopic cholecystectomy versus open cholecystectomy

Each year, large numbers of Sudanese have gallbladder surgery. Surgery options include the standard procedure, called laparoscopic cholecystectomy, and an older more invasive procedure, called open cholecystectomy. While elective cholecystectomy now carries extremely low morbidity and mortality rates, the operation does incur sizable expense in terms of hospitalization and time lost from work. The advantages of hospital stay in laparoscopic cholecystectomy versus open cholecystectomy were questioned because the recovery from open cholecystectomy is brief

Comparison between usages of a single preoperative metronidazole dose with other antibiotic regimens in nonperforated acute appendicitis

In this study, the safety and efficacy of a single dose of metronidazole in preoperative prophylaxis in nonperforated appendicitis were evaluated. Records of 866 patients underwent appendectomy were evaluated and 11.43% [99] of these patients received 500 mg of metronidazole only before undergoing operation on induction for anaesthesia. Factors known to affect the incidence of wound infection, such as abdominal or wound drains, and the inclusion of patients with perforated or ruptured appendicitis, were eliminated. The patients were divided into three groups: patients with a normal appendix, patients with an acutely inflamed appendix, and patients with a gangrenous appendix. The study showed for each group a significant reduction of the incidence of wound infection in patients receiving prophylaxis. Routine preoperative prophylaxis is recommended before appendectomy. The findings demonstrated that more than ninety-four percent of the wound infections were detected after discharge from the hospital strongly indicate the need for follow-up

Outcomes and complications of thyroid surgery among the Sudanese patients

To reveal the outcomes and complications of post-thyroidectomy, a study was carried out on 1351 patients aged between 18 and and 76 years [mean, 43.9 years] of whom 945 were female [69.95%] and 406 [30.05%] were male patients [female to male ratio was 2.3:1]. The most common Indications for total thyroidectomy were diffuse goiter and multlnodular goiter [45.7% and 36.04%of cases respectively]. Incidence of malignancy was 41 cases [2.7%]. Of those patients with malignancy, thirty cases [73.2%] underwent an associated nodal dissection along with total thyroidectomy. The Incidence of postoperative wound haematoma was 0.6% [8 cases], wound infection was 0.4% [5 cases], and mortality rate was 0.0%. The Incidence of postoperative hypocalcaemia was 8.4% [113 cases]. Younger age was statistically associated with an Increased Incidence of hypocalcaemia [P<0.002], whereas sex [P=0.31], Indication for surgery [P=0.16], and associated neck dissection [P=0.13] were not. The Incidence of hyperthyroidism was 0.148% [2 cases]. The mean duration of hospital stay was 4.2 days and was unaffected by occurrence of postoperative hypocalcaemia. The Incidence of unilateral and bilateral vocal cord paralyses was 1.1% [23 cases] and 0.22% [3 cases], respectively. The study showed that there is an Increase of the Incidence of complications when the operation performed for carcinoma. This Increase may be due to the extent of disease found at operation or the less experienced surgeons. Postoperative hypocalcaemia is the most common immediate surgical complication of total thyroidectomy. Other complications, including recurrent laryngeal nerve paralysis, hypothyroidism, hyperthyroidism, and haematoma formation

Symptomatic empty sella syndrome - a case report and review of the literature

The pituitary gland is a hormone-responsive gland and is known to vary in size depending on the hormonal status of the patient and the multifaceted positive and negative hypothalamic-pituitary-gonadal axis. We are reporting on a case of symptomatic empty sella syndrome occurring in 68 years old Sudanese woman with a long history of hypothyroidism. Concepts and definitions of the empty-sella [ESS] syndrome, origins of primary and secondary empty-sella syndrome [ESS] including defect of the Turkish saddle diaphragm, pituitary abnormality, and disease states [development frequency, symptom, and test result] are reviewed. In addition, preventive strategies of late diagnosis are suggested

Acute adrenocortical insufficiency [Addison's disease]: a case report and review of the literature

Acute adrenocortical insufficiency [Addisonian crisis] is an emergency caused by insufficient cortisol and can manifest as a defect anywhere in the hypothalamic-pituitary-adrenal axis. It may be misdiagnosed as acute renal dysfunction due to similar clinical manifestations and laboratory findings. The causes, clinical features and management of Addison's disease are discussed in this review