Frequency of Neurological Deficits in Sudanese Lepromatic Patients

"Leprosy has been a major burden on humanity over thousands of years. Perhaps no other disease in the history of mankind has been associated with such a strong social stigma as leprosy. Failure in early detection often leads to severe disability in spite of eradication of mycobacteria at a later date. Untreated the disease is progressive and results in permanent damage to the skin; nerves; limbs and eyes. Objectives: To study the pattern of neurological manifestations among adult Sudanese leprosy patients seen in Khartoum Dermatology Hospital in the period from March 2006 to August 2006.Methodology:This is a prospective cross-sectional hospital-based study. Seventy adult Sudanese leprosy patients were studied using simple; direct; standardized questionnaire including history and neurological examination; during the period from March to August 2006. Results: The most common age group affected was 18- 27 years. Male to female ratio was 3:1. Numbness was the most common neurological symptom seen in 77.14. Each of visual disturbance; headache and bilateral ulnar sensory impairment was detected in 7.14. Half of the patients had upper limbs sensory nerve dysfunction while 42.86exhibited sensory nerve dysfunction in the lower limbs. ""Gloves and stoking"" sensory impairment was the most common finding (30) while bilateral lateral popliteal sensory impairment was seen with the same percentage. Bilateral median and unilateral posterior tibial sensory impairment were found in 1.43each. Unilateral radial cutaneous sensory impairment was seen in 2.86. Approximately half (48.57) of the patients had upper limbs motor dysfunction. Bilateral ulnar distribution motor affection was seen in 40. A significant number (41.43) had upper limbs muscle wasting. Impaired olfaction was the most common cranial nerve sign seen in 12.86. Leprosy reactions were detected in 21.43; type 2 reaction in 14.29while type 1 reaction in 7.14. Conclusion:Numbness and limbs weakness were the most common neurological symptoms in leprosy patients. Peripheral nerve sensory impairment was found in half of the patients with ""Gloves and stokes"" peripheral sensory neuropathy being the most common sensory disturbance. Motor dysfunction was found in 48.57. Ulnar and median nerves motor affection was the most common motor dysfunctions. Signs related to cranial nerves involvement were less common. Leprosy reactions were present in one-fifth of the patients."

Prevalence of neurological manifestations of lung cancer among adult sudanese patients

The objective: is to study the prevalence of neurological manifestations among adults Sudanese patients with lung cancer seen in the Radiation and Isotope Centre in Khartoum. Methods: This is a prospective cross sectional hospital based study; conducted at Radiation and Isotope Centre in Khartoum. Sample of 52 adults Sudanese patients with lung cancer were included in the study. The period of the study was from February 2006 to July 2006. Data were collected by self administered questionnaire; this was constructed in sections to address the different aspects of the study as follows: personal data; presentation; physical examination; and investigations. The results: showed that 41 patients were males. Most of the patients were above 50 years of age. Fifty percent of our patients' were from Khartoum state. All of our patients had chest findings except one. The most common symptoms observed were of cranial nerves involvement; headache; limb weakness; numbness; and sphincteric disturbance. More than half of the patients were smokers. Other extrapulmonary manifestations noticed include: clubbing; lymph node enlargement; bone metastasis or fracture; gynaecomastia; superior vena cava obstruction; hepatomegaly; and ascites. Chest X-ray abnormalities showed pleural effusion; consolidation; hilar lymphadenopthy; collapsed lung; and fibrosis in the majority of patients. Most of our patients had adenocarcinoma; followed by squamous cell carcinoma; poorly differentiated carcinoma; and small cell carcinoma. Conclusion: The common neurological manifestations of lung cancer were found to be cranial nerves palsies; followed by lower limbs weakness; numbness; and sphincteric disturbances

Esophageal Stricture Post Endoscopic Injection Sclerotherapy

Background: Post endoscopic sclerotherapy esophageal stricture is usually not fatal but may requires several sessions of esophageal dilation as an effective palliative treatment yet has its own complications. Aim: The purpose of this study is to find out the predictors of sclerotherapy esophageal stricture. Methods: This is a cross sectional descriptive study of the esophageal stricture post sclerotherapy for the patients who were managed in the period from January 2000 through the June 2007 in endoscopic department at Ibn Sina Hospital. Post endoscopic sclerotherapy symptoms; signs; diagnostic and therapeutic methods were analysed to find out possible predictors of developing benign esophageal stricture. Result: A 33 out of 10133 patients who had sclerotherapyl were found to have esophageal stricture and were included in this study. 91of them were males; 88were 60years old and most of them were cases of hepatic periportal fibrosis. Only two patients had esophageal varices secondary to viral hepatitis B liver cirrhosis. Their presentation was commonly with difficulty in swallowing and few cases presented with food impaction. The majority of patients were treated with wire guided endoscopic Savary Gilliard dilation. Conclusion: Esophageal stricture following endoscopic injection sclerotherapy is a known morbidity; however the rate of these strictures is fairly acceptable. High dose of sclerotherapy in fewer sessions over a short period are potential predictors of esophageal stricture

The Patterns of Clinical Presentations of Cerebellar Syndromes among Adult Sudanese Patients

Cerebellar syndromes are one of the commonest neurological diseases.Objectives:To study the patterns of clinical presentations of cerebellar syndromes and to identify the possible causes.Methods:This is a prospective hospital based; cross-sectional study. One hundred adult Sudanese patients with cerebellar syndromes were included in the study during the period from January 2006 January 2007.Results:The most common age group affected was 18 - 25 years.Male to female ratio was 1.5:1unsteadiness on walking was the most common symptom (83).Gait-ataxia was the most common sign (83). Cerebrovascular disease was the most common etiology (25).Conclusion:Cerebellar syndromes are not rare in Sudan.However; they were diagnosed more commonly at the central regions of the country probably because of more awareness of patients and better facilities for diagnosis.The age of onset; the male predominance; the presentation and clinical findings were not different from reported literature.This also goes for the common causes apart from alcohol which is a strikingly rare as a cause in this study and could be accounted for the implementation of Elshariya (Islamic laws) Laws in Sudan

Primary malignant melanoma of the oesophagus: case report and review.

Primary malignant melanoma of the oesophagus [PMME] is a rare tumour. Worldwide, less than 200 cases have been reported to date. We report here a 72 year-old Saudi male who presented with abdominal pain and anorexia. On endoscopy a dark lesion was found in the oesophagus. Its histopathological features were consistent with malignant melanoma. There were no other melanotic lesions elsewhere. PMME occurs most frequently in the 7th and 8th decades of life with a male predominance. It is an aggressive tumour with the majority of patients dying in less than 2 years due to metastases to vital organs. Surgery is the treatment of choice. However, radiation may be useful as adjuvant therapy.

Upper gastrointestinal diseases in Saudi Arabian children.

In contrast to the experience in the adults, there are limited data concerning the efficacy and safety of upper gastrointestinal endoscopy (UGIE) in paediatric patients. The information on this procedure is very scanty from non-western countries. We analysed 72 children evaluated in Gizan, Saudi Arabia, an area of high endemic hepatitis B and chronic liver disease. The indications comprised abdominal pain (49%), UGI bleeding (24%) and evaluation of suspected portal hypertension. No abnormality was detected in 33 (46%). Mucosal inflammatory lesions (oesophagitis, gastritis and duodenitis) are the commonest abnormal lesions, occurring in 24 (33%). Duodenal ulcer (4 cases) and gastric ulcer (1 case) were relatively few. No case of malignancy was found. Sclerotherapy for variceal bleeding was effective in 4 patients. Helicobacter pylori was detected in 12 of 23 patients and associated with histologically identified gastritis in the majority of these cases. It is concluded that paediatric UGIE is safe and useful in the diagnosis and therapeutic intervention for UGI diseases in children. Our findings provide additional information on the pattern of diseases among Saudi Arabian children.

Barrett's oesophagus and oesophageal cancer in Saudi Arabia.

BACKGROUND/AIMS: Gastrooesophageal reflux disease (GERD) and Barrett's oesophagus (BE) are presumed to be rare among non-western populations. This retrospective survery determined the prevalence of BE and its associated complications of dysplastic lesions (DL) and oesophageal adenocarcinoma (AD) among an Arabian population. METHODOLOGY: From 2572 patients who had endoscopy in King Fahd Central Hospital (KFCH) Gizan, Saudi Arabia, patients (n = 776) were selected for analysis if they had biopsies of the upper gastrointestinal (UGI) tract. The patients (159 of 776) with biopsy-proven oesophageal lesions were categorized and compared. RESULTS: The relative frequencies of BE, DL and AD in 159 patients were 8(5%), 5(3%) and 16 (10%) respectively. These interpreted to prevalence rates of 0.31%, 1.9%, and 0.62% for the respective lesions. The comparison of the mean age +/- SD (in years) of the patients with BE (59.6 +/- 19.8), DL (66 +/- 16.7) and AD (70.6 +/- 12.2) showed to statistically significant difference. Major symptoms in the patients with BE were dyspepsia (4 cases), hematemesis (2 cases) and dysphagia (2 cases). This profile was not different from that observed in 79 patients with GERD. CONCLUSION: The prevalence of 0.31% in our endoscopy population is at the lower range of the 0.3% to 10% reported in the western world. It is likely that the rate was underestimated by this retrospective survey, in which patients were selectively biopsied. Also, it is probable that the majority of individuals in our population with no or minimal symptoms of GERD do not present themselves or are not referred for evaluation. Despite this limitation, our study confirms the occurrence of BE and its complications among a Saudi population. The incidence of BE may increase with the current changes in the life-style and increase in the life-span of the Saudi Arabian population.