unusual case of bezoar from Sudan

Pica is an abnormal eating behavior in which patients persistently eat non-food materials, which can lead to health consequences. A man presented complaining of several months of back pain and constipation without vomiting, abdominal pain, or distension. He experienced increasing social isolation and emotional lability over 5 years. Radiological findings confirmed the diagnosis, noting multiple radiopaque foreign bodies. Several types of pica are described based on the substance consumed. Bezoars may develop in the gastrointestinal tract as a result of these ingestions. Lithobezoars are rare types of bezoars, more common in males and psychiatric patients. An important clue to the diagnosis of lithobezoars is severe constipation, recurrent abdominal or back pain, and painful defecation. The diagnosis might not be made for years if such symptoms are not related to careful history, abdominal examination, or radiological findings

Bedside teaching at the cinderella status. options for promotion

Recently, there are increasing published reports that there is a decline in bedside skills of medical students and young doctors. The decline is thought to be due to decline in bedside teaching in medical schools. The aim of this paper is to study the reasons of decline in bedside teaching, and to suggest some remedies for this decline. This study discusses reasons of decline in clinical teaching itemized under 4 subheadings: teaching methods and curricular factors, teachers' factors, students' factors, and patients' factors. We suggest some strategies to improve the status of bedside teaching, including curricular change to better introduce students to properly approach patients clinically, use of community health settings, and outpatient departments as teaching sites and use of clinical skill centers, simulated patient and multimedia programs to enhance clinical skills of students. The situation of bedside teaching is somewhat inadequate, but in adopting innovative solutions, there are hopes for betterment

Deficiencies in physical examination of the cardiovascular system among medical students

The aim of this study was to assess the patterns of errors committed by medical students [on the clinical phase of their study] at a medical school on performing examination of the cardiovascular system. The author used a study battery in which performance errors were classified into four patterns: errors of technique, omission, detection and interpretation. The patterns and frequencies of errors reported in this study included: 13 errors of technique, 4 errors of omission, 5 errors of detection and 11 errors of interpretation. The medical students have deficiencies in their bedside skills of cardiovascular examination. The author suggested some solutions to improve and maintain these skills

Response of Sudanese doctors to domestic violence

The aim of this study was to assess the awareness, and response of the Sudanese doctors to domestic violence. The study was carried out among the doctors of the Police University Hospital, Khartoum, Sudan. Self-administered questionnaires were distributed to all doctors who were attendants at the hospital, one morning in July 2002. The information required from the surveyed doctors included their familiarity, and views on domestic violence as a health problem, number of cases of abuse encountered, barriers to diagnose or screen cases, their views on intervention beyond physical treatment and if they had been taught or trained in domestic violence. Out of 142 doctors who received the questionnaires, 102 returned it giving a response rate of 71.8%. The respondent's ages ranged from 25-54 years; 53 were female [51.9%]; and 32 [31.3%] had experience of more than 10 years. Forty-three doctors [42.1%] had a fair knowledge of the concept of domestic violence, 28 [27.4%] viewed it as a worthwhile health problem and 21 [20.5%] reported encountering 1-2 cases in the last year. Barriers to screen cases included a lack of knowledge and training, insufficient time at clinics and fear of problems with perpetrators. The female gender and long professional experience had positive correlations with a better knowledge regarding violence and the desire to intervene beyond physical treatment [P<0.005]. Our study indicated clearly the missing role of the medial profession in recognition and helping the victims of domestic violence. The authors discussed several suggestions to promote the role of doctors in addressing this problem

Diabetic autonomic neuropathy

The diabetic autonomic neuropathy is a poorly studied subject in our medical literature. This study is aimed at investigating the presence of diabetic autonomic neuropathy in a group of Sudanese diabetic patients and its relationship to factors like glycemic control, duration of diabetes and presence of peripheral neuropathy. During one year we examined 120 diabetic patients and an age-matched control group of 42 by applying a battery of 5 cardiovascular autonomic tests, beside a full history and clinical examination. The patients were also tested for glycemic control and presence of peripheral neuropathy. Diabetic autonomic neuropathy was diagnosed in 48 patients [40%] of a mean age of 48.411 + 12.50 years, type 1/2 diabetes was 10/38, mean duration of diabetes 16.2 + 7.3 years, 41 with poor glycemic control [81%] and peripheral neuropathy was present in 32 patients [66%]. We found a significant association between diabetic autonomic neuropathy and prolonged duration of diabetes [P<0.001], poor glycemic control [0.01>P>0.001] and presence of peripheral neuropathy [0.02>P>0.01]. Diabetic autonomic neuropathy [both asymptomatic and symptomatic] is a common problem among our diabetic patients. It is significantly associated with prolonged duration, poor control of diabetes and presence of peripheral neuropathy. We need to augment the awareness of diabetes care providers to the occurrence, and peculiar features and tests of this syndrome

Gastroparesis diabeticorum: a clinical study in sudanese patients

Gastroparesis diabeticorum is a distressing and little mentioned gastrointestinal complication among our diabetic patients. The objective of this study was to confirm the occurrence of this syndrome and to identify its clinical features and impact on glycemic control of diabetes mellitus. The authors set a special clinic in Medani, Sudan, to receive the diabetic patients complaining of chronic [more than two weeks] symptoms related to the upper gastrointestinal tract. The criteria of diagnosis of gastroparesis diabeticorum were: symptoms [nausea, vomiting, epigastric discomfort and feeling of fullness for long periods after meals] in patients with diabetic autonomic neuropathy, and confirmatory findings of gastric stasis in the barium studies. The similar conditions were excluded. Fasting blood glucose was measured to assess the glycemic control of diabetes. Eight patients were identified, of a wide range of age group [27 - 64 years], longstanding diabetes [8 - 26 years] and poor glycemic control [fasting blood glucose > 8 mmol / L in 7 out of 8 patients]. More than one diabetic complication was recorded in each patient. We established the occurrence of gastroparesis diabeticorum as one of the manifestations of diabetic autonomic neuropathy among our patients. It should be thought of as one of the etiological factors of the upper gastroenteropathies, like peptic ulcer and giardiasis, in Sudanese diabetic patients