Gum Arabic in treatment of functional constipation in children in Sudan

Constipation represents a common problem in children. The worldwide prevalence of functional constipation in children varies from 0.7% to 29.6%.The aim of this study is to assess the response to Gum Arabic in addition to laxative in management of functional constipation. All children less than 16 years old who suffered from constipation and attended Gaafar Ibnaouf Specialized Children Hospital and gastroenterology private clinic of one pediatric gastroenterologist between June 2011 and May 2012 were included in this study. Patients were considered having functional constipation according to Rome III criteria. They were divided randomly into two similar groups. Children in the first group were treated with laxative [lactulose], and those in the second group were treated with Gum Arabic in addition to laxative [lactulose], children in both groups were educated about the process of developing constipation, defecation process and approach to toilet training. All children were seen after 1 month and 3 months after treatment, they were rated as successfully treated when they had >3 bowel movements per week, soft stool, no soiling or abdominal pain in the last 3 weeks of treatment. A total of 150 children suffered from constipation were seen. [81 males], the age was divided into three groups, the majority 96 [64%] aged between l-5years, and the least were 12 [8%] aged less than lyear. 133 children [88.7%] had functional constipation, while the remaining 17 children [11.3%] had an associated organic disorders, among them 12 children [8%] had Hirschsprung's disease, 2 children [1.3%] had hypothyroidism, 2 children [1.3%] had celiac disease, and 1 child [0.7%]Tiad cerebral palsy. The main clinical characteristic of functional constipation were faecal impaction presented in 59.4% of patients, straining in 43%, withholding behavior in 32.3%, soiling in 16.5%, abdominal pain in!2% of patients. In those who were treated with Gum Arabic, 41/63 [65%] showed improvement at 1st month of treatment and 59/63 [93.6%] at 3rd month of treatment, while those who were treated with laxative alone showed that 34/60 [56.66%] improved at Imonth of treatment and 48/60 [80%] at 3rd month, with p value O.025 Functional constipation is the most cause of constipation in Sudanese children. Gum Arabic achieved better results than laxative alone in treatment of functional constipation

Pattern and clinical presentation of constipation in children in Sudan

Constipation represents a common problem in children. The worldwide prevalence of functional constipation in children varies from 0.7% to 29.6%. The aim of this study is to identify common causes of childhood constipation, clinical profiles of functional constipation. All children less than 16years old who suffered from constipation and attended Gaafar Ibnaouf specialized children hospital and gastroenterology private clinic of one pediatric gastroenterologist between June 2011 and May 2012 were included in this study. Patients were considered having functional constipation if there were no objective evidences of pathological condition, and the rest were termed as organic constipation. A total of 150 children suffered from constipation were seen. [81males], the age was divided into three groups, the majority 96 [64%] aged between 1-5years, and the least were 12 [8%] aged less than 1year.133 children [88.7%] had functional constipation, while the remaining 17 children [11.3%] had an associated organic disorders, among them 12 children [8%] had Hirschsprung's disease, 2children [1.3%] had hypothyroidism, 2 children [1.3%] had celiac disease, and 1child [0.7%] had cerebral palsy. The main clinical characteristic of functional constipation were faecal impaction presented in 59.4% of patients, straining in 43%, withholding behavior in 32.3%, soiling in 16.5%, abdominal pain in12% of patients. Functional constipation is the most common cause of constipation in Sudanese children

use of height versus weight in determining praziquantel dose for treatment of schistosomiasis in children

Praziquantel [PZQ] is currently the drug of choice in treatment of Schistosomiasis because of its high efficacy, few and transient side effects, simple administration and competitive cost. In community-based management and during mass chemotherapy of Schistosomiasis, WHO recommended a dose pole where height is taken as a single parameter to select the required dose. To compare PZQ dose according to WHO dose pole with the calculated weight-dependent dose and test their consistency. We used a growth percentile ruler [MOSWAR] that includes weight, height, head circumference and body surface area according to age and sex. Data were then compiled into a table-form that included PZQ dose according to the dose pole and the calculated mean weight-dependent dose. The results showed that PZQ dose according to the dose pole is not consistent with the weight-dependent dose. During mass chemotherapy and community-based management of Schistosomiasis in children, we recommend the use of a similar table or a device similar to [MOSWAR] to determine PZQ dose according to whichever of the growth parameters is available

Neurological manifestaions among Sudanese patients with multiple myeloma

Multiple myeloma may involve the nervous system at every level, including the neuromuscular junction, peripheral nerve, plexus, spinal nerve root, spinal cord, meninges, and brain. Such involvement may be primary or secondary, as well as non-invasive paraneoplastic effects. To find out the perevalence and pattern of CNS manifestations in Sudanese patients with multiple myeloma seen in Al-Shaab Teaching Hospital and Khartoum Nuclear Hospital. Methodology: This is a prospective descriptive cross sectional, hospital based study. It was conducted in Al-Shaab Teaching Hospital and Khartoum Nuclear Hospital in the period from June2009 to June 2010. 50 patients with multiple myeloma were included in the study. Males were more than females with ratio of 2.8:1. The common [36%] age of presentation was between 55-64 years. There was increased incidence of multiple myeloma in patients from the west of Sudan. Farmers and free workers had high incidence of multiple myeloma [34% and 27% respectively]. The study demonstrated that the most common non-neurological symptoms was locomotor symptoms [24%], while the most common neurological symptoms were backache and neck pain. The most common neurological findings were cord compression [8%] followed by peripheral neuropathy [2%] and CVA [2%]. 22% of patients completed treatment with good response, 12% with partial response, 18% with no response and 48% are still on treatment. CNS involvement among our studied group was not uncommon

HBV, HCV and HIV among patients with Hemophilia in Khartoum- Sudan

Hepatitis B, C and HIV infections and their impact forms one of the major health problems worldwide and in Sudan. Studies of hepatitis B, C and HIV virus among hemophiliacs in Sudan are lacking. The main objective is to determine the screening, vaccination, seroconversion of hepatitis B, C and HIV among Sudanese hemophilic patients registered in Hemophilia Center Khartoum Teaching Hospital. During the period from July to November 2008, sixty two hemophilic male patients were randomly selected from hemophilic patients attending Hemophilic Center and were studied using simple direct standardized interview questionnaire and a blood sample from each patient was taken after consent for screening for hepatitis B, C and HIV. Out of the 62 patients, 39 [62.9%] were found to be screened before this study. Out of these 23[58.97%] were fully vaccinated for HB V, 23.08% were partially vaccinated and seven had no vaccination at all. Only one patient had seroconverted to HBsAg positive. HCV was detected in eight patient one of them was also found to have HIV infection. The low figures of HBs Ag positivity we got in this study is probably an under estimation of the actual prevalence of HBV as we did not use other serological marker and modern technology for detection of exposure to HBV. To determine the real magnitude of the problem we have to applying other markers like HBc Antibody in the screening procedures which are simple and cost effective. The coverage of our hemophilic patients with HBV vaccine was 52% so a significant number of our patients are at risk of contracting HBV. Unlike HIV, HCV was detected in an alarming percentage. Health education is a cornerstone in prevention of these serious viral infections

Recurrent exudative pleural effusion with flare up of chronic hepatitis B virus infection

We describe herein a young male patient who presented with exudative pleural effusion that appeared with flare up of chronic HBV infection and spontaneously recovered with the clinical and biochemical improvement of the hepatitis on two occasions five months apart. Other causes of hepatitis and exudative pleural effusion were excluded with appropriate investigations

prevalence of sickle cell anaemia in northern areas of algadaref state, Sudan

Sickle cell anaemia is one of the major types of anaemia found in Sudan, especially in western Sudan in which the sickle cell gene is frequent. This study estimates the prevalence of sickle cell anaemia in other areas rather than western Sudan where it is more prevalent [Algadaref state]. 100 blood samples of blood were taken from different tribes [eleven tribes] living in the northern area of Algadaref state. 24 samples were collected from urban area, 76 from rural area, all tribes originated from Afro-Asiatic speaking regions. All samples were tested for complete blood count [CBC], and haemoglobin electrophoresis. The study revealed that the majority of sickle cell anaemia cases was found among the Masaleet tribe. 20 samples were [Hb-SS], SSsamples were [Hb- AS] and 25 samples were [Hb -AA]

Vitamin D status in health care professionals in Qatar

To investigate the prevalence of vitamin D deficiency among health care professionals working at Hamad Medical Corporation in Doha, Qatar. Between 15th January 2007 and 15th January 2008,340 healthy volunteers were included in this study. Each subject completed a diary to determine the duration of sunlight exposure, and vitamin D supplements. Serum levels of 25-hydroxyvitamin D [25OHD], parathyroid hormone [PTH], calcium, phosphorus, alkaline phosphatase, total protein, and albumin were obtained. Those with abnormal results were called for counselling. The mean overall vitamin D level was 11.7 ng/ml. It was lower in females [10.3 ng/ml] than in males [13.7 ng/ml]. Ninety-seven percent of all participants had a mean level <30 ng/ml. Eighty-seven percent had a mean level of <20 ng/ml. We concluded that the prevalence of vitamin D deficiency among health care professionals in Qatar is very high

The Pattern and Presentation of Myathenia Gravis in Al-Shaab and Omdurman Teaching Hospitals

Introduction:Myasthenia gravis (MG) is the most common acquired autoimmune disorder of neuromuscular transmission. It has different patterns of presentation. Objective: to study the pattern and mode of presentation of Myasthenia Gravis in Al-Shaab and Omdurman Teaching Hospitals; Khartoum Sudan. Methods: The demographic and clinical characteristics of 50 patients of myasthenia gravis (MG) were reviewed in Alshab and Omumdrman Teaching Hospitals for five months period from May to October 2008.Results: Out of 2400 patients attending neurology clinics 50 were found to have Myathenia Gravis [MG] with female; male ratio of 2.5:1. The age at presentation was the second decade of life in 34. Most of the patients [42] were from Khartoum State followed by North Kordofan State [14]. High occurrence of late onset fatigability and weakness was seen in 92of our patients. Ocular muscles involvement was detected in 78. MG was aggravated by hot weather and fever in 12of the patients. Quinine represented the most common drug which aggravated the myasthenia symptoms in 4. Diabetes mellitus and thyroid diseases were the most associated auto immune diseases seen in 12and 4respectively. The diagnosis was made by classic history and neurological examinations in 88and positive neostigmin test in64. The majority of patients were treated with steroids. Thymectomy was done in 10patients. The outcome was excellent as 82improved and only one [2] patient died.Discussion: Going with literature diagnosis of MG was made depending on classical history; full neurological examination and confirmed by tensilon test. Because of different reasons more sophisticated tests were not done in our patients. Only patients with malaria who were treated with quinine showed deterioration of their symptoms in our study. Strikingly; myasthenia crisis which were reported in 27of patients were not seen in our population. Because of lack of usage of steroid sparing agents the vast majority [96] of our patients were treated with steroids. Conclusion:Generalized myasthenia gravis with ocular involvement is common in our patients. However; pure OMG was not seen. Thymectomy was done in a small number of our patients with reference to other studies

Amputations of the upper limb at El Obeid hospital, western Sudan: role of traditional bone setters

Extremity amputation is common, but repugnant events to the patient and surgeon alike. Upper limb amputation results in incapacitating functional impairment especially in economically poor settings at developing countries. The aim is to study the pattern, indications and outcomes of upper limb amputations and their predictive factors in patients seen at El Obeid Hospital, Western Sudan. The medical records of patients who underwent upper limb amputations during five years at El Obeid Hospital were reviewed. The data were analyzed for gender, age, causes, level of amputations, outcomes and the possible predictive factors. There were 27 children and 19 adults. Trauma was the sole cause of upper limb amputations in children and was responsible together with burns and animal bites for 68.4% of upper limb amputations in adults. Diabetic sepsis resulted in 5 amputations in adults and all were finger amputations. The main level for amputation was above elbow [65.2%] while below elbow was 13.1% and finger amputations were 21 .7% of cases. There was no mortality among the study group. In adults road traffic accidents [RTA]. diabetic sepsis and machinery injuries were the main causes of upper limb amputations. In children, the main injury was factures due to domestic falls treated by traditional hone setters [TBS], the majority of them were potentially avoidable

pattern and presentation of myasthenia gravis in Al-Shaab and Omdurman Teaching Hospitals

Myasthenia gravis [MG] is the most common acquired autoimmune disorder of neuromuscular transmission. It has different patterns of presentation.to study the pattern and mode of presentation of Myasthenia Gravis in Al-Shaab and Omdurman Teaching Hospitals, Khartoum Sudan. The demographic and clinical characteristics of 50 patients of myasthenia gravis [MG] were reviewed in Alshab and Oumdrman Teaching Hospitals for five months period from May to October 2008. Out of 2400 patients attending neurology clinics 50 were found to have Myasthenia Gravis [MG] with female; male ratio of 2.5:1. The age at presentation was the second decade of life in 34%. Most of the patients [42%] were from Khartoum State followed by North Kordofan State [14%]. High occurrence of late onset fatigability and weakness was seen in 92% of our patients. Ocular muscles involvement was detected in 78%. MG was aggravated by hot weather and fever in 12% of the patients. Quinine represented the most common drug which aggravated the myasthenia symptoms in 4%. Diabetes mellitus and thyroid diseases were the most associated auto immune diseases seen in 12% and 4% respectively. The diagnosis was made by classic history and neurological examinations in 88% and positive neostigmin test in64%. The majority of patients were treated with steroids. Thymectomy was done in 10% patients. The outcome was excellent as 82% improved and only one [2%] patient died. Going with literature diagnosis of MG was made depending on classical history, full neurological examination and confirmed by tensilon test. Because of different reasons more sophisticated tests were not done in our patients. Only patients with malaria who were treated with quinine showed deterioration of their symptoms in our study. Strikingly, myasthenia crisis which were reported in 27% of patients were not seen in our population. Because of lack of usage of steroid sparing agents the vast majority [96%] of our patients were treated with steroids. Generalized myasthenia gravis with ocular involvement is common in our patients. However, pure OMG was not seen. Thymectomy was done in a small number of our patients with reference to other studies

Esophageal stricture causes and pattern of presentation at Ibn Sina Specialized Hospital

The aim of this study is to evaluate the causes and pattern of presentation of esophageal stricture in Ibn Sina Specialized Hospital. This is a retrospective study done at Ibn Sina Specialized Hospital during the period from April 2008 to December 2008. All patients had upper gastrointestinal endoscopy [UGIE], and those who were found to have esophageal stricture were enrolled in the study. The data collected were then processed and analyzed using appropriate statistical tests. Out of 780 patients who had UGIE, 60 were found to have esophageal stricture; 37 [61.6%] were males. The age group ranged between 20 years and 89 years, with a mean [ +/- SD] age of 50.483 [ +/- 17.437] years. Esophageal cancer of the squamous cell carcinoma type [SCC] was the most important cause of stricture in the study. In both genders, the cancer was common in the elder age groups. Dysphagia was the commonest presenting symptom. Malignant and benign strictures were located at different site of the esophagus. In males postsclerotherapy was more common especially in the young, while peptic stricture was common in elderly. In females peptic stricture and esophageal webs were common in young adults [20 - 50 years]. Endoscopic dilatation was performed successfully to 59 patients. Only one male in the age group 60 - 69 years was managed with percutaneous endoscopic gastrostomy [PEG] tube due to failure of dilatation. Esophageal stricture is an alarming sign of malignancy. Post-SCC stricture was detected in a considerable number of patients in our study group, therefore it require careful early diagnosis and distinction from other varieties because of their good outcome. Adenocarcinoma and other malignant tumors which cause esophageal stricture were not detected in our study group. Alcohol consumption was not a significant risk factor contributing to the development of post-SCC stricture in this study. Post-sclerotherapy stricture represented the peak in male farmers residing in the center of Sudan compared to females, other occupations and regions, and to other causes of benign stricture

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

Menetrier's disease: an excellent response to octreotide. A case report from the Middle East.

Menetrier's disease is a rare acquired cause of protein losing enteropathy, with premalignant potential. Since its first description in 1888, around 300 cases have been reported. This disease occurs more frequently in males aged 30-50 years. We report here the case of a 31 year- old Sudanese female who presented with generalized edema. Laboratory investigations showed hypoproteinemia and hypoalbuminemia without evidence of renal or liver disease. Upper gastrointestinal endoscopy showed giant gastric folds. The histopathological features of biopsies taken from these folds were consistent with Menetrier's disease. Our patient showed excellent response to treatment with subcutaneous octreotide and this may ameliorate the need for surgery as the definitive treatment of this disease.

frequency of upper gastrointestinal malignancy in Gizan

Upper gastrointestinal malignancy occurs in variable frequencies among different populations and there is an increasing epidemiological data in The Kingdom of Saudi Arabia. Aim of the Study: To determine the frequency of upper gastrointestinal malignancy in an endoscopic population in Gizan. Patients and A retrospective analysis of 63 patients who had esophageal or gastric malignancy among 2572 patients evaluated in a 6-year period [July 1992 to June 1998] at King Fahad Central Hospital in Gizan. Esophageal cancer was found in 39 patients [20 males and 19 females], whereas gastric malignancy in 24 [22 males and two females]. The majority of the patients were in their seventh and eighth decade of life with male predominance. Seven patients had primary gastric lymphoma and one patient had primary malignant melanoma of the esophagus. Upper gastrointestinal malignancy represented 2.4% of 2572 endoscoped patients, occurring more commonly among elderly male

Influence of short chain fatty acids on the absorptive clearance of ranitidine HCL from rabbit intestine

Ranitidine HCl is a histamine H2-receptor antagonist reducing gastric acid secretion under daytime and nocturnal basal conditions. Ranitidine HCl is 50% absorbed after oral administration. This research was undertaken in order to examine the effect of short-chain fatty acids [SCFAs], acetate, propionate, and butyrate on the absorptive clearance of ranitidine HCl as a function of intestinal site [jejunoileum vs ascending-colon]. A "through-and-through" in situ intestinal perfusion technique was adopted using the rabbit as an animal model. Coperfusion of either sodium acetate, sodium propionate, or sodium butyrate, 25 mM each, along with ranitidine HCl, 0.2 mM, allowed for an examination of increased solvent drag on intestinal permeability of this compound in both anatomical sites. The results show that ranitidine HCl is absorbed from rabbit jejunoileum as well as the ascending-colon, however the value of the absorptive clearance of this compound normalized to the intestinal length PeA/L in the ascending-colon was almost double that in the jejunoileum. A strong correlation was found between the absorptive clearance and the net water flux in both segments suggesting that the mechanism of ranitidine HCl absorption apparently consists of passive diffusion via the paracellular pathway. The negative value of anatomical reserve length ARL in both segments reflects the incomplete absorption of this compound. SCFAs had a significant effect on increasing the absorptive clearance of ranitidine HCl in both segments studied. This effect was in the order butyrate > propionate > acetate. However there was no statistical difference between the effect of butyrate and propionate. The permeability enhancing effect of SCFAs was much higher in the ascending-colon, this could be attributed to the higher Na+, Cl-, and water influx in this segment. In conclusion, marked segmental differences in the absorption of ranitidine HCl are apparent in the rabbit small and large intestine which could be significantly enhanced by the use of SCFAs

Investigation of polar surface area as a novel parameter affecting oral bioavailability of drugs

Fast and reliable prediction of intestinal absorption is a key factor in drug design. New parameters for this prediction have been introduced recently. These included the hydrogen bonding capacity and the polar surface area [PSA]. High PSA accounted for poor oral absorption and vice versa. Here we are investigating the significance of PSA in intestinal absorption of a series of lipophilic steroidal model drugs. These included; Betamethason valerate [BMV], Betamethasone [BM], prednisone [PD] and methyltestosterone [MT], with PSA values of 100.9, 94.83, 91.67 and 37.3 [A with ring above], respectively. An in situ intestinal perfusion technique was employed using the rabbit as model animal. The study investigated drug absorption from the jejunoileum and ascending colon. The results revealed good absorption from both segments for all tested drugs except PD which was absorbed from the jejunoileum only. Poor correlation was evident between the absorptive clearance and the net water flux in both segments suggesting mainly a trans-cellular absorption of these compounds. The percentage fraction absorbed [%Fa] was in the order of BMV > MT > BM > PD with the later showing negligible absorption from the ascending colon. These results did not correlate with the calculated PSA values. Accordingly, the octanol/water partition coefficient [log P] was considered. The log P values were, 3.6, 3.36, 1.94 and 1.46 for BMV, MT, BM and PD, respectively. These values correlated with the %Fa values. However, it should be noted that the recorded colonic absorption is against expectation for such lipophilic drugs. In conclusion PSA failed to correlate with the oral absorption of the lipophilic steroids. Although log P correlated well with the absorption of these compounds especially with jejunoileum segment it is advisable not to rely on single factor for predicting oral bioavailability

Clinico- pathologlcal evaluation of cellac disease in Iraq

A study of the clinical and histopathological aspect of celiac disease was done. The work consisted of 196 subjects who were suspected on clinical basis to have celiac disease. The upper gastro-intestinal tract was examined carefully by esophago-gastro- duodenoscopy [OGD] and three biopsies from distal duodemum were taken for histopathological examination. It had been found that there was significant association between gluten free diet regimen, OGD finding and histopathological changes. In conclusion, histopathology could be considered the golden standard test for diagnosis of celiac disease patients

Prevalence of resistance to antituberculosis drugs in Riyadh and a review of previous reports

Resistance to antituberculosis drugs is an important cause of treatment failure. We evaluated the prevalence and pattern of antituberculosis drug resistance in the central region of Saudi Arabia, and reviewed previous reports from Saudi Arabia. Materials and We retrospectively examined the records of sputum smear and culturepositive pulmonary tuberculosis patients admitted consecutively from 1998 through 1999 in a main referral hospital in Riyadh, and analyzed drug sensitivity reports. We also reviewed previous reports on antituberculosis drug resistance in Saudi Arabia. Of 515 patients with pulmonary tuberculosis, 80 [15.5%] had resistance to at least one antituberculosis drug. Resistance to streptomycin was most frequent [9.7%], followed by rifampicin [9.5%], isoniazid [4.3%], and ethambutol [0.2%]. Resistance to one antituberculosis drug was found in 8.9%, resistance to two drugs in 5.2%, resistance to three drugs in 1.2%, and resistance to four drugs in 0.2%. Multidrug resistance [defined as resistance to at least isoniazid and rifampicin] was found in 1.9% of patients. A literature review including 6114 patients in Saudi Arabia showed that resistance against streptomycin was most common [8.8%], followed by rifampicin [8%], and isoniazid [7.2%]. Of the 6114 patients, 6.8% patients were resistant to only one drug, 3.6% were resistant to two drugs, and 3.7% to three drugs. The high prevalence of rifampicin resistance and resistance to multiple drugs in the Riyadh region and in other parts of Saudi Arabia is a major challenge to the control of tuberculosis in this country. Efforts should be made to prevent the emergence of further antituberculosis drug resistance