Assessment of Variation in Clinical Presentation of Visceral Leishmaniasis Among Patients Attending the Tropical Diseases Teaching Hospital in Sudan

Background: Visceral leishmaniasis (also known as Kala-azar) is a systemic parasitic infection with many clinical presentations. The present study assesses the variation in presentations among patients who attended the Tropical Diseases Teaching Hospital (TDTH) in Khartoum, Sudan. Methods: This analytical cross-sectional, hospital-based study was conducted at the TDTH between November 2019 and September 2020. Medical records of patients who presented at the TDTH were reviewed using a structured data extraction checklist. The Chi-square test was used to determine the associations between sociodemographic and clinical presentations of patients. P-value < 0.05 was considered as statistically significant. Results: Out of 195 patients, 79.5% were male and 48.2% were <31 years old. Fever was the main clinical presentation (90.2%) while 53.3% presented with weight loss and 72.3% and 39% presented, respectively, with splenomegaly and hepatomegaly. HIV was detected in 4.6% of the patients. RK39 was the main diagnostic test. We found a significant association between the abdominal distention and the age of the patients (P < 0.05) ­ age groups 11­20 and 41­50 years were more likely to present with abdominal distention than other age groups. Conclusion: There is no exact clinical presentation or routine laboratory findings that are pathognomonic for visceral leishmaniasis; therefore, it should be considered in the differential diagnosis of any patient with fever, weight loss, and abdominal distention, and among patients with HIV.

Serum Levels of Zinc and Copper in Cases of Juvenile Idiopathic Arthritis

Background:Juvenile idiopathic arthritis (JIA) represents a heterogeneous group of autoimmune diseases that arises before the age of 16 years and lasts more than 6 months. During acute inflammation of the disease, serum copper concentration increases and zinc decreases, that could point to the possible pharmacological properties of these trace elements. Aim:To measure the serum level of zinc and copper in patients with juvenile idiopathic arthritis (JIA) with different subtypes and correlate the levels of zinc and copper with the disease activity. Methods:This cross-sectional study was done on 40 patients already diagnosed clinically with JIA; patients were followed-up at the Rheumatology Outpatient Clinic, Children's Hospital, Cairo University. Results:Out of forty patients, 16were males (40%) and 24 were females (60%) with a male to female ratio (M: F) of 1:1.5. Out of the forty patients 17 were in activity and 23 were without activity. Thirty age and sex matched controls were included for comparison. Serum copper level was significantly higher in patients with JIA than those of the controls (P= 0.017) while there were no significant difference in serum level of zinc between JIA patients and that of the controls. Conclusion:Alteration of serum copper and zinc probably is a defense response against JIA; increased copper may be due to inflammation associated, these elements could serve as biomarkers for the disease activity.

Trastorno delirante y conducta suicida: estudio descriptivo de 26 casos / Delusional disorder and suicidal behavior: descriptive study of 26 cases

INTRODUCCÖN/ANTECEDENTES: La conducta suicida en el trastorno delirante (TD) ha sido escasamente estudiada. OBJETIVO: Profundizar en el conocimiento de las características demográficas, ambientales, psicosociales y clínicas del suicido en un grupo de pacientes con TD con la finalidad de contribuir a generar y sugerir estrategias que contribuyan a realizar nuevos estudios de mayor nivel explicativo. MÉTODO: Estudio epidemiológico descriptivo retrospectivo de Registro de Casos en el Dispensario de Psiquiatría e Higiene Mental de Córdoba sobre pacientes con TD según criterios DSM-IV-TR. Aquellos pacientes que cumplieron con los criterios de inclusión definidos constituyeron nuestra muestra final de 261 casos, de ellos 26 casos presentaron evidencias de intento de suicidio. Las variables sobre las que se recogió información en base a protocolos, fueron agrupadas con el orden siguiente: I. Sociodemográficos y generales. II. Factores de riesgo del TD (familiares y personales). III. Cuadro Clínico y el Diagnóstico del TD (Presentación, Sintomatología, Funcionalidad y Discapacidad, utilización de los recursos sanitarios, tratamiento, problemas psicosociales, evolución y curso) y medios letales utilizados. RESULTADOS: La edad media de los pacientes fue de 47 años y el 60% fueron hombres. Los datos sociodemográficos muestran que los pacientes con intento de suicidio residían en núcleos rurales (46,2%), no tenían estudios en un 15,4%, un 57,7% no trabajaba y un 26,9% recibía una pensión por enfermedad o jubilación laboral. El subtipo persecutorio con 8 casos, fue el más frecuente, seguido de los subtipos de grandiosidad (6 casos) y celotípico (6 casos), mixto (3 casos), erotomaníaco (2 casos) y somático (1 caso).DISCUSIÓN Y CONCLUSIÓN: Son necesarios futuros estudios prospectivos para investigar los factores de protección, de riesgo y/o asociados al suicidio en el TD.

Introduction / background: Suicidal behavior in delusional disorder (DD) patients has been poorly studied. Objective: Investigate the demographic, environmental, psychosocial and clinical characteristics of the suicidal behavior in a group of patients with DD. Method: Retrospective descriptive study of DD cases registered at Psychiatry and Mental Hygiene Clinic of Cordoba according to DSM-IV criteria was conducted. We obtained a sample of 261 DD patients who met the inclusion criteria, of them 26 cases presented evidence of suicidal behavior. Data and variables collected were divided into 4 groups: I. Socio-demographic and general data. II. DD risk factors (personal and family). III. DD clinical picture and diagnosis (presentation, symptoms, disability, use of health care resources, treatment, and evolution) and lethal methods used. Results: The mean age of the patients was 47 years old and 60% were males. Socio-demographic data show that 46.2% of patients with suicidal behavior lived in rural areas, only 15,4% were analphabet, 57,7% were unemployed, and 26.9% were receiving a pension because of illness or retirement. The persecutory subtype with 8 cases was the most frequent presentation, followed by grandiose (6 cases) and jealous (6 cases), mixed (3 cases), erotomanic (2 cases) and somatic (1 case) subtypes. Discussion and conclusion: It is necessary to conduct future prospective studies to investigate the protective and risks factors associated with the suicidal behavior in DD patients.

Association of dopamine D4 receptor gene variants with autism.

Background: Autism spectrum disorder (ASD) is a heritable neurodevelopmental disorder with poorly understood and complex etiology. The central dopaminergic system is strongly implicated in ASD pathogenesis. Genes encoding various elements of this system have been linked to ASD. This study aimed to estimate the distribution frequency of dopamine D4 receptor-exon III repeat region polymorphic genotypes among Egyptian children with autism. Methods: This case-control study included 178 children with autism (mean age 4.46±1.72 years) (118 males and 60 females) and a normal control group (n=128) of matching age and gender. Assessments by DSMIV- TR criteria, Stanford-Binet intelligence scale and childhood autism rating scale (CARS) were done. Assay for DRD4 48 bp VNTR genotypes was performed on amplified DNA by RFLP-PCR. Results: The 4/4 allele had the highest frequency among both autistic (39.32%) and control children (62.5%), with no significant difference between them. The 7/7 allele had also a high frequency (33.7%) among autistic patients, which was significantly different (p˂0.05) from the control group (12.5%) Furthermore, 70% of the patients carrying the 7/7 allele had the lowest IQ scores (58.5±6.5). Conclusions: There is a strong evidence that the DRD4 7/7 allele might be a risk factor for autism.

Cytogenetic study in juvenile myoclonic epileptic patients

The association of chromosomal imbalance and neurological abnormalities is well known. These chromosomal abnormalities may indicate that chromosomal sites where atypical neurological characteristics could be mapped. The purpose of our study was to search for cytogenetic abnormalities in patients with juvenile myoclonic epilepsy. This work was carried out on fifteen patients presenting to Epilepsy Centerof Neurology Department of Alexandria Main University Hospital. The age of juvenile myoclonic patients ranged from 16 to 38 years. Ten patients have myoclonic and generalized Tonic-Clonic seizures, 3 patients have myoclonic, absences, and generalized tonic-clonic seizures, and 2 patients have myoclonic seizures only. All patients were cytogenetically normal as all of them had normal karyotypes