Harm reduction of drug use and dependance

Harm reduction is an approach to addiction which supports people who engage in addictive behaviors and their communities by minimizing the negative impact of alcohol, drug and other addictive behaviors. As harm reduction stategies are controversial, information about harm reduction programs is not always easily available, but you can find it here. In Morocco, adoption of a national strategy and implementation of a comprehensive system of risk reduction among injecting drug users are part of the national fight against drug abuse adopted by the Ministry of Health, including the establishment of a comprehensive system to reduce HIV risk among injecting drug users with the creation of fixed units [low threshold] and mobile units and the establishment of a program pilot treatment to opioid substitution methadone. The objective of this paper is to present a history of risk reduction in the field of drugs and then give an overview of key programs and strategies to reduce risk and / or drug-related harm

Opioid substitution therapy

Opiate addiction is a complex phenomenon in which biological, psychological and social interact. Heroin is one of those substances that are highly addictive that some users do very difficult to unravel. Opiate addicts express requirements that require strategies for comprehensive care including medication opioid substitution, methadone and buprenorphine, have a prominent place. These therapies allow patients to reduce or stop their illicit opioid use and thus promote change their consumption patterns and lifestyles. Thereby reducing the various consequential damages, these strategies diversify modes of care and provide access to a significant proportion of people dependent on heroin or opiates to support associated with the substitution, to promote their medical care their social inclusion and reduce the use therapeutic injection. This article provides an overview of the history of these therapies, discuss the goals and outcomes of these treatments, their indications and cons-indications and finally addresses the modalities of care necessary for their implementation and monitoring

Portal vein thrombosis in Sudanese children

Portal Vein Thrombosis [PVT] is one of the most common causes of portal hypertension among children in Sudan. To determine the incidence, aetiology and mode of presentation of PVT among children and find its relation to gastrointestinal bleeding in a Sudanese hospital. This is a prospective hospital based study conducted at a tertiary care paediatric hospital in Khartoum, Sudan [Gaffer Ibn Oaf Specialized Children Hospital [GIO]]. 350 children were diagnosed on clinical grounds [heamatemiss, splenomegaly] to have portal hypertension. After laboratory investigations [CBC, LFTs, coagulations profile and RFTs], abdominal sonography with Doppler, 275 patients turned to have portal vein thrombosis. Upper GI endoscopy was done for all patients and liver biopsy when indicated. Data were analysed, discussed and conclusion were reached. Out of 800 children presented with upper GI bleeding 350 were diagnosed as having esophageal varices bleeding due to portal hypertension [44%], out of these 250 [70%] children were found to have PVT as a cause of their portal hypertension, and another 25 children were diagnosed to have PVT without GI bleeding. Their ages ranged between 4 month and 16 years. Two hundred were males. Seventy five were below one year of age. History of risk factor for PVT was found only in 68 children. All the bleeders had sclerotherapy, band ligation or both beside propranolol and H2 blockers or PPI. Time for follow up was between 6 month to 4.5 years. 150 children cleared their varices with 4-6 cession of either sclerotherapy, banding or both, the rest of the children are still receiving sclerotherapy. Ten children received liver support for portal biliopathy, five children had splenectomy because of hypersplenism. Four children died. Propranolol was stopped in 50 children out of 150 children who cleared their varices after two years Conclusions: PVT in children is common in Sudanese children, and represents the second common cause of upper GI bleeding. Its aetiology is obscure in the majority of cases and more studies and facilities are needed to uncover the underlying cause. Simple clinical data, ultrasonography and upper GI endoscopy are quite adequate measures to reach accurate diagnosis. Combinations of endoscopic sclerotherapy and band ligations with propranolol are very effective in controlling the bleeding of the esophageal varices, though it has a remarkable effect on the quality of life of affected children. Thus appropriate medical alternative or surgical treatments are needed in order to reduce morbidity and mortality and improve the quality of life of these patients

Gum Arabic a superb anti-diarrheal agent

Diarrhoea is the second most common cause of death in young children, after pneumonia.Gum Arabic [GA] is a soluble fibre with moderate emulsifying properties that may result in greater accessibility of electrolytes and associated water to the microvillus membrane. Additional work indicated that GA enhanced absorption of the solutes transported by diffusion and does not act via sodium dependent mechanisms. The objective of this study was to evaluate the effect of Sweet fibre [gum Arabic preparation] as an additive to WHO-ORS in the management of acute diarrhoea in children. An interventional randomized controlled hospital based clinical trial was performed in OPEH [March to August 2011]. One hundred and eighty children presenting with acute none bloody diarrhoea in the absence of severe systemic illnesses were enrolled in the study. These children were divided randomly into two equal groups [study group1 and control group2], their ages ranged between six and 60 months. The control group received the conventional treatment of diarrhoea according to WHO recommendations and the other group received in addition gum Arabic solution [sweet fibre], 5-10 mg until recovery and continued with 5 mg thereafter. Data were analysed using the SPSS. In the group of children who received gum Arabic; diarrhoea stopped within 24 hours in 90% and 80% were discharged after one day. All of them were improved and discharged within first five days of admission. None of them went into severe dehydration or shock. Only three children developed electrolyte imbalance. The weight at the end of the study increased in 47.8% and decreased in only 5.5%. Sixty one children were followed after 6 weeks only two of them [3.3%] had recurrence of diarrhoea. In the control group diarrhoea stopped within 24 hours in 38.9% and 30% were discharged after one day.10% did not recover during the first five days of admission. Electrolytes imbalance developed in 23.3%, two children developed severe dehydration and one became shocked. The weight decreased in 35.6% and increased in 15.6%. Sixty seven children were followed, 13 [19.4%] of them developed diarrhoea again. Sweet fibre as an additive to WHO-ORS reduces the duration of diarrhoea and hospital stay. It decreases diarrhoea complications and facilitates regaining weight. It has a prebiotic effect in prevention of diarrhoea. All these indicate its potential as a new antidiarrheal therapy for acute diarrhoea in children

Liver biopsy: is it safe in children?

The blind liver biopsy technique has been widely used in Sudan as the availability of the ultra sound machines and the committed Pediatrics Radiologist were not always at hands. Liver biopsy is an essential tool in the diagnosis of liver diseases and subsequently, initiating the appropriate treatment. The aim of the study was to observe the safety of blind liver biopsy in our children. One hundred fifty consecutive liver biopsies in hospitalized children were evaluated retrospectively. Using a standard percussion technique biopsy sites were chosen and through intercostals space blind liver biopsies were performed by TruCut biopsy needle. The study was conducted at Gafaar Ibn Oaf Specialized Children Hospital ,Khartoum Sudan, over the last five years, between January 2005-January 2010. The first biopsy sample was considered macroscopically adequate in 94.8% of cases. A definitive histological diagnosis was possible in 99.1% of cases. seventy children were more than 5 years of age and of these 8 [11.4%] complained of pain at the biopsy site, external hemorrhage from the biopsy site was seen in 1 [0.6%] case but no sign of internal hemorrhage was detected during the 24 hours follow up period. No child died following the procedure. Blind liver biopsy in the studied hospitalized children was found to be a safe procedure

Pattern of liver diseases in Sudanese children

We aimed at determining the pattern and the incidence of liver disease in the Sudanese children referred to the Gastroenterology unit as Gaafar Ibn Oaf Specialized Children Hospital, which has not been studied before. In a cross-sectional study conducted over 5 years, 450 liver needle biopsies were sent to the pathology laboratory of our center. Slides were prepared from paraffin-embedded blocks, stained by routine H and E and special stains and were then reviewed. The frequency of each disorder, separately and in combination with the age group or gender of the patient were compared with other similar studies. The male to female ration was 1.5:1. The age range between 1 month and 15 years old and 42% were less than 1 year old. The most common histological diagnosis was liver cirrhosis where no specific cause could be found [26%] followed by neonatal hepatitis [20%], fatty liver [12%], billary Atresia [10%], chornic hepatitis [8%], metabolic liver disease [6%], Progressive Intrahepatic Cholestasis [5.5], non specific pathological changes [4.4%] and Hepato Cellular Carcinoma in [4%]. A liver biopsy is a useful and practical tool for the appropriate diagnosis of pediatric liver diseases. We found that Idiopathic Liver Cirrhosis, Neonatal Hepatitis, Fatty Liver, Billary Atresia and Chronic Hepatitis in the stated order are the most prevalent histological diagnosis in Sudanese children. Hepatocellular Carcinoma is significantly high in our pediatrics population

Result of eradication of esophageal varices in children with extra hepatic portal venous obstruction in Sudan

Extra hepatic Portal Vein Thrombosis is the main cause of Portal hypertension in children in Sudan, which is responsible for almost 30% of heamatemsis in children in Sudan. Treatment is targeted at the complications and includes primary and secondary prophylaxis against upper gastrointestinal bleeding [which results from the rupture of esophageal varices] which is usually a combination of endoscopic sclerotherapy and/or band ligation to eradicate the varices, Porto systemic shunting in selected cases, medical prophylaxis, and to support the child growth and development. In this study we looked beyond the eradications of the varices in these children to help us providing a better long term care plan for such an important problem. The Objectives are to find out the recurrence of esophageal varices, evolution of gastric varices, portal hypertensive gastropathy [PHG] and risk of rebleeding following esophageal variceal eradication in children with Extra hepatic Portal Vein Obstruction [EHPVO]. Between March 2005 and March 2010, children with extra hepatic portal venous obstruction [EHPVO] and bleeding from esophageal varices who referred to the Gastroentrology unit at Gafaar In Oaf Specialized Children Hospital, Khartoum, Sudan, and the Endoscopic unit of the Military hospital, Omderman, Sudan received endoscopic injection sclerotherapy [EIS] and /or Esophageal Varices Band Ligation [EVBL] until eradication. Surveillance endoscopy was performed initially at 3 months and subsequently at intervals of 6 months to one year to detect esophageal and gastric varices, and PHG. Gastric varices were classified as gastroesophageal [GOV] or isolated gastric varices [IGV]. Gastroesophageal varices included types GOV1 and GOV2 that extend along lesser and greater curvatures respectively. Patients who had recurrence of bleeding were evaluated by emergency upper gastrointestinal endoscopy. The therapeutic endoscopy procedures were done by the two authors. 113 of 133 children who achieved esophageal varices eradication were evaluated. Esophageal varices recurred in 40% cases. Primary gastric varices [before EIS/EVBL] were seen in 61% cases [GOV98% [83% GOV1, 15%GOV2] and IGV2%] and secondary gastric varices [after EIS/EVBL] in 28% [GOV 71% [47% GOV1, 24% GOV2] and IGV 29%]. Secondary gastric varices were distributes as 20% GOV1, 42% GOV2 and 87% IGV. Frequency of gastric varices before sclerotherapy or/and banding, at the last follow up showed decrease in GOV1 from 57to 39 [P=0.01], increase in GOV2 from 10 to 16 and increase in IGV from 1 to 10 [P<0.001]. PHG increased in frequency from 12% to 41% [P<0.001] and severity from one patient to 12 [P<0.001]. Eight cases had rebleeding from gastric varices [4 GOV1, 3 GOV2 and 1 IGV]. It was conclude that following esophageal variceal eradication in children with EHPVO a significant decrease in Gastroesophageal Varices, increase in Isolated Gastric Varices and increased frequency and severity of Portal hypertensive Gastropathy takes place. Small rebleeding risk persists from gastric varices irrespective of the type

Pattern of liver diseases in Sudanese children

We aimed at determining the pattern and the incidence of liver disease in the Sudanese children referred to the Gastroenterology unit as Gaafar Ibn Oaf Specialized Children Hospital, which has not been studied before. In a cross-sectional study conducted over 5 years, 450 liver needle biopsies were sent to the pathology laboratory of our center. Slides were prepared from paraffin-embedded blocks, stained by routine H and E and special stains and were then reviewed. The frequency of each disorder, separately and in combination with the age group or gender of the patient were compared with other similar studies. The male to female ratio was 1.5:1. The age range between 1 month and 15 years old and 42% were less than 1 year old. The most common histological diagnosis was liver cirrhosis where no specific cause could be found [26%] followed by neonatal hepatitis [20%], fatty liver [12%], Billary Atresia [10%], chronic hepatitis [8%], metabolic liver disease [6%], Progressive Intrahepatic Cholestasis [5.5%], non specific pathological changes [4.4%] and Hepato Cellular Carcinoma in[4%]. A liver biopsy is a useful and practical tool for the appropriate diagnosis of pediatric liver diseases. We found that Idiopathic Liver Cirrhosis, Neonatal Hepatitis, Fatty Liver, Billary Atresia and Chronic Hepatitis in the stated order are the most prevalent histological diagnosis in Sudanese children. Hepatocellular Carcinam is significantly high in our pediatrics population

Causes of portal hypertension in Sudanese children

The etiological profile of Pediatric Portal hypertension in our hospital, Gafaar Ibn Oaf Specialized Children Hospital a tertiary referral children hospital for the whole of Sudan, showed that the commonest causes were extra hepatic portal venous obstruction [EHPVO] and liver cirrhosis. Cryptogenic liver cirrhosis was the most common cause of cirrhosis

Diagnostic value of Ki-67 antigen in human thyroid tumors

To determine frequency of Ki-67-antigen over-expression in thyroid tumours. A retrospective study of 50 patients suffering form thyroid tumours. Was carried out in BMSI, Jinnah Postgraduate Medical Center, Karachi frornl993-2001. Maximum numbers of tumour among total cases were is age group ranging from 20-39 years. This age group 18 [72%] papillary Carcinoma, 04 [80%] medullary carcinoma, 03 [30%] follicular carcinoma, 04 [57%] follicular adenoma. The mean+ SD of follicular adenoma, follicular carcinoma, papillary carcinoma, medullary carcinoma and anaplastic carcinoma are 12.96 + 54.44, 49 + 8.90, 45.5 + 7.3, 44.62 + 4.7 and 5 1.7 + 2.2 respectively. The p value between benign and malignancy condition is 0.001 which is highly significant. The result and observation of study show that immunohistochemical study using Ki-67 antibody suggest that positive reaction for Ki-67 antigen could be used as a tool for distinguishing malignant tumour from benign tumors. Ki-67 proliferative activity has been shown to have a diagnostic value, further evaluation as prognostic indicator in the study of tumour pathology is warranted in hope that this parameter will allow clinicians to provide more appropriate treatment

Transient glutenopathy and abdominal tuberculosis; a cause or effect? preliminary report

Tuberculosis remains an important disease worldwide. It is difficult to estimate its incidence In children. The association between intestinal tuberculosis and glutenopathy was not reported before. Three hundred patients who presented with chronic diarrhea to Oaafar Ibn Auf Specialized Children Hospital, Khartoum Sudan were investigated for intestinal tuberculosis and gutenopathy. The children were divided into two groups both were put on treatment for tuberculosis. However, one group was put on gluten free diet as well. The serological markers and intestinal biopsies were taken initially, six months after commencement of treatment and six months later. Also their clinical response to treatment was encountered. Out of the 300 children who presented with chronic diarrhea, 30 were diagnosed to have intestinal tuberculosis. Their ages ranged between 2-10 years. At commencement of the study all the patients [30] had positive IgA and IgG antigliadin antibodies and anti tTG [table I]. The group which was put on gluten free diet showed rapid clinical, biochemical and histological response. Despite the limitation of this preliminary study; we can conclude that ITS can cause transient glutenopathy and gluten free diet may facilitate clinical recovery in patients with ITB

Study of the testicular changes in lead poisoning

Lead is the oldest environmental contaminant, which is a known abortifacient and spermicidal agent in case of high exposure. The present experimental animal study is designed to observe the changes in the testes due to excessive use of lead. Distilled water and lead acetate were administered intraperitonially to control and experimental groups respectively. Animals were sacrificed; their testes were weighed and cut into small pieces. After observing plucking and stringing phenomena of the seminiferous tubules testicular pieces were embedded in paraffin and then 5 micro m thick sections were made, stained with PAS-sulfurous acid haematoxylin and examined microscopically for qualitative assessment of germinal epithelium. In the rats of group B mean weight and average tissue ratio of the paired testes was 1.145 gm and 0.0036 respectively, which are significantly less than control. There was decrease in diameter of seminiferous tubules, thickening of basement membrane and an early arrest of spermatogenesis, scanty Leydig cells, prominent sertoli cells and collapsed blood vessels, showing generalized atrophy of the testes. In lead toxicity, testes are atrophied due to degeneration of spermatogenic and Leydig cells