Delayed splenic rupture following abdominal trauma: a case report

We present the case of a 20-year-old male who presents multiple traumas of the abdomen 26 days prior to his return to the emergency room. Going again to evaluation with frank data of peritoneal irritation, since there is no hemodynamic commitment, a contrasted abdomen computed tomography (CT) scan is requested, finding a grade III splenic lesion, which is why he is admitted for emergency splenectomy. This case reports a splenic injury with the need for delayed splenectomy.

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

Neurological manifestations of dural sinus thrombosis

Dural sinus thrombosis is a clinical syndrome that has a diversity of signs and symptoms that can be easily misinterpreted with other common neurological diseases such as brain infections. To study the clinical presentation of dural sinus thrombosis among Sudanese patients seen at Elshaab Teaching Hospital. This is a prospective, descriptive, cross sectional, hospital based study conducted in Elshaab Teaching Hospital- Khartoum Sudan, in the period from November 2008 to July 2010. All adult Sudanese patients with dural sinus thrombosis who were admitted to the hospital and accepted to participate in the study during the period from November 2008-July2010 [50 patients] were enrolled. History, clinical examination and relevant investigations including MRI were done for all patients. Data were collected, analyzed, conclusions drawn and recommendations stated. Females [98%] in child bearing age were mostly affected. Delivery and pregnancy were the common risk factors; head ache, neck pain and stiffness were the frequent neurological symptoms. Papilledema was the commonest neurological finding. Saggital sinus thrombosis was found to be the major radiological finding and great majority of patients showed remarkable improvement with treatment. Dural sinus thrombosis is uncommon neurological problem, however the diagnosis should always be considered in the right clinical setting, as it is a treatable condition

Clinical presentation of Parkinson's disease among sudanese patients

Parkinson Disease [PD] is a neurodegenerative disorder affecting motor system. It is a chronic progressive disorder leading to long standing disability. To study the clinical presentation of PD among Sudanese patients seen at Elshaab Teaching Hospital during the period from May 2004 - April 2008. In this descriptive prospective, cross sectional hospital based study, 94 patients were studied using standardized questionnaire including history and clinical examination. The total number diagnosed to have PD was 94 patients. Male to female ratio was found to bel .5:1. Common age group affected was 70-80 years [24.47%]. The common presenting symptom was found to be poverty of movement [93.6%] followed by tremor [82.9 8%]. On neurological examination; rigidity, dyskinesia and festinate gait were the common signs. Primitive reflexes were found in significant number of patients. Idiopathic PD was found to be the common type [75.53%]. Of the side effects of benzhexol, 66.67% of our patients developed dry mouth. Postural hypotension was seen in 10.42% of the patients who were taking levodopa. The clinical presentations of our patients does not differ from what was mentioned in the literature

Hepatitis C virus infection in Saudi Arabian recipients of renal transplantation

Studies of recipients most of whom had been infected prior to transplantation, had yielded conflicting conclusions in regard to the clinical impact of hepatitis C virus [HCV] infection. We determined the frequency of new HCV infection and assessed its effect on patient - and graft - survival and occurrence of chronic hepatitis in renal transplant recipients. We studied 54 Saudi recipients [37 males and 17 females; mean age [SD]; 38.2 [17.1] years] they were anti-HCV negative at the time of transplantation and followed for 3 to 19 years [mean = 8.1]. The prevalence of anti-HCV at the time of censorship was compared with the rates in 99 hemodialyzed patients, 400 healthy volunteers and 113 hospitalized patients. The period prevalence of anti-HCV in recipients was 37% [20 of 54], compared to hemodialyzed patients 1%], hospital patients [1.8%] and healthy volunteers [2.3%]. [P < 0.01]. Seroconversion to anti-HCV positivity occurring from 2 to 11 years [mean =7.8] after transplantation and was not influenced by age, gender or source of donor kidney. Cumulative frequency of HBsAg was 14.8%. Graft loss occurred in 1 HCV positive recipient. Serum aminotransferase was abnormal [>2 - fold elevation] in 2 anti-HCV positive recipients transiently. No deaths occurred among the recipients. The acquisition of new HCV infections had a relatively high frequency among renal transplant recipients in the study. The course of the infection was benign in the medium term, with no discernible progression to clinically recognized chronic liver disease. Further studies are required to determine cost- benefit of antiviral therapy in such patients

Neonatal multiple hepatic haemangiomas:- a rare presentation

Hepatic haemangiomas are vascular malformations that rarely affect infants. They have no characteristic presentation. Clinical diagnosis is difficult and various imaging techniques may be required. Different modalities of treatment were tried but in vain. When ruptured, the out come is grave. They remain a challenge to pediatric surgeons. We are presenting our experience with one infant who presented with a ruptured hepatic haemangioma

Pattern of plasma lipoprotein [a] in Sudanese patients with coronary artery disease

Coronary artery disease is one of the leading causes of death world wide. lipoprotein[a] [Lp [a]] is a cholesterol rich plasma lipoprotein. Its structure and composition closely resembles low density lipoproteins [LDL]. Elevated Lp [a] is the most common familial lipoprotein disorder in patients with premature Coronary Artery Disease [CAD]. To study the pattern of plasma LP[a] levels in Sudanese patients who presented with coronary artery disease [CAD]. This is a case control study. 30 patients randomly selected from a pool of 624 patients admitted to the coronary care unit [C.C.U] in Elshaab Teaching Hospital with acute coronary syndrome in the period from April 2004 to July 2005 while 30 patients with non ischaemic cardiac problems admitted to the same hospital were randomly selected as a matched control group. Serum LP[a], cholesterol and low-density lipoprotein cholesterol [LDLC] concentrations were determined using the conventional enzymatic colorimetric methods. LP[a], cholesterol and LDL levels were all significantly high in patients with CAD [P <0.005, 0.003 and 0.001 respectively]. Lp[a] is also high in patients blew 60years of age. High LP[a] correlates with high cholesterol, LDL and other risk factors. The role of Lp[a] as an independent risk factor is less well established as 3 [20%] patients only of the 15 patients with no other risk factors had high LP[a] level. This study demonstrated significant Lp[a] level in patients with other risk factors of CAD [including cholesterol and LDL]