unusual case of bezoar from Sudan

Pica is an abnormal eating behavior in which patients persistently eat non-food materials, which can lead to health consequences. A man presented complaining of several months of back pain and constipation without vomiting, abdominal pain, or distension. He experienced increasing social isolation and emotional lability over 5 years. Radiological findings confirmed the diagnosis, noting multiple radiopaque foreign bodies. Several types of pica are described based on the substance consumed. Bezoars may develop in the gastrointestinal tract as a result of these ingestions. Lithobezoars are rare types of bezoars, more common in males and psychiatric patients. An important clue to the diagnosis of lithobezoars is severe constipation, recurrent abdominal or back pain, and painful defecation. The diagnosis might not be made for years if such symptoms are not related to careful history, abdominal examination, or radiological findings

Evaluation of a rapid immunochromatographic test for detection of Brucella abortus antibodies in Egyptian cattle sera and milk

Rapid diagnostic tests are needed to facilitate diagnosis and control of brucellosis. Sero-epidemiology of brucellosis is currently done by employing the Rose Bengal test [RBT]. Also the world organization for animal health [OIE] has approved an indirect ELISA for testing serum and milk. The Immuno-Chromatographic brucellosis test [ICT] is a rapid, card-based immunochromatographic test for detection of antibodies directed against B. abortus antigens. To the best of our knowledge, ICT has not been used for the diagnosis of brucellosis in cattle yet. The objective of the study was to evaluate the performance of the ICT brucellosis test for the diagnosis of B. abortus in cattle sera versus RBT and ELISA as a gold standard, Also evaluation of ICT brucellosis test efficacy for detection of antibodies against B. Abortus in milk samples. 94, 90.36 and 84.3% of sera samples were positive by RBT, ICT and ELISA respectively. The ICT had 94.44% sensitivity and 100% specificity versus RBT and ELISA as a gold standard. The kappa value between ICT and ELISA was 0.76. Also ICT detected antibodies against B. abortus in serum and milk samples of 7 cows while a recently calved cow showed antibodies in the milk sample only. In conclusion, ICT provides a handy and accurate tool for the rapid detection of antibodies to B. abortus in cattle sera and milk

role of enchinacea purpurea against immuno - supressive effect of dimethoate on male albino rat

Dimethoate, an organophosphate pesticide, is used in controlling the pests of a variety of crops. Herbal medicine is the most widely used form of medicine in the world today where the medicinal plants contain many curative bioactive ingredients. The present work was planned to evaluate the potential protective effect of Enchinacea purpurea [EP] against the immunotoxic effect induced by dimethoate in adult male albino rats. Rats were classified into four groups [10 in each]. Rats in the 1[st] group received no treatment and served as control. Rats in the 2[nd] group were orally administered dimethoate 40%EC in a dose level of 3mg / kg bw. Equivalent to 1/10 LD50. Rats in the 3[rd] group were orally administered EP [Immulant] in a dose level of 2.5 ml/kg bw. The fourth group was treated with dimethoate 40%EC as in group II in addition to EP in a dose level as in the third group. Administration of tested substances was carried out daily for successive 7 days. Rats from treated as well as from control group were injected IP with [1-2x10[8]] sheep RBCs as non specific antigen. After 7 and 14 days from injection of sheep RBCs [SRBCs] five rats from each group were taken, blood and tissue samples were collected. The present data revealed a significant decrease in WBCs count [leucopenia], neutrophillia and lymphocytpenia with lower haemagglutination inhibition antibody titre [HI] and significant decrease in IgM in serum samples from dimethoate treated rats. Also in the same group there was a significant decrease in serum thymus were recorded in dimethoate treated group. EP supplementation induced appreciable improvement in all previous abnormal alterations observed in dimethoate treated rats. Therefore, this study revealed that EP exhibit marked protective role against the toxic effect of dimethoate on immune system of male albino rats

Detection of some organophosphrous compounds residues in nile fish markets of some villages of Kaliobia governorate

A total sixty samples Nile tilapia [Qreochromis niloticus] and Clarias garpinus [Thirty of each] collected from fish markets of some villages of Kaliobia governorate and subjected to fat extraction and determination of organophosphrous residue by gas chromatography. Organophosphrous residues including diazinon, chlorpyrifos-ethyl, Malathion, Methyl-parathion, ethyl parathyion and Ethion with an incidence from muscles of Tilapia nilotica were [33%, 6.7%, 20%, 12%, 12% and 3% respectively] and from Clarias garpinus were[50%, 6.7%, 16%, 10%, 12% and 3% respectively]. The obtained result revealed that the residues of diazinon came in the first rank followed other organophosphrous residue. Most residues detected within action limit for fish, however, residues of these pesticide were not detected in collected samples may be due to their percent in very trace amount or gave indicter for safety environment from different types of pollution

Detection of some pesticides residues in beef and mutton meat in Menofia governorate

A total one hundred and sixty samples of beef and Mutton meat [eighty of each]. Collected from butcher's shops in four centers of Menofia governorate [Kausina, Menouf, Ashmoun and Shebin Elkom]. Twenty samples of each center were collected from each center and subjected to fat extraction and determination of some organo chlorine pesticide residues by G.C. [Gas chromatography]. Organochlorine residues including total DDT, [HCH] alpha-hexachlorocyclohexan Hexachlorobenzene [HCB], aldrin, dieldrin, endrine, toxaphene and heptachlorepoxide with an incidence from beef meat were [12.5%, 10%, 10%, 10%, 10%12.5%, 0% and 0%] respectively. While the residue levels were detected in Mutton meat with an incidence [25%, and 12.5% respectively]. The Most detectable chlorinated hydrocarbones residues were total DDT in Both Meat samples either beef or mutton, while Toxaphene residue could not be detected in beef Meat. All examined samples were sanitary safe for human consumption according to comparison with FAO/WHO records the chlorinated hydrocarbon residues gave us indicator for safety environment from different types of pollution

S100A1 protein as a potential discriminating marker between chromophobe renal cell carcinoma and renal oncocytoma

The morphological differentiation between chromophobe renal cell carcinoma [RCC] and renal oncocytoma [RO] may be difficult. This study evaluates S100A1 protein as a new marker for the differentiation between these two tumors. We selected twenty cases; fifteen of which were typically diagnosed after routine histopathological staining by hematoxylin and eosin [7 chromophobe RCC and 8 RO] while the remaining five cases showed confusing cytomorphological features and uncertainly diagnosed. Immunoperoxidase technique using atni-S100A1 antibody carried out semiquantitavely in all cases displayed a strong cytoplasmic positive granularity in five typical RO, moderate immunopositivity in two typical RO and weak reactivity in on typical RO while all seven typical chromophobe RCC cases were immunonegative. Regarding uncertainly diagnosed cases, three were immunopositive for S100A1 antibody [one strong, one moderate and one weakly reactive] in the same pattern as typical RO while the remaining two cases were immunonegative like typical chromophobe RCC cases. From our study, we concluded that S100A1 may be a potentially powerful marker to differentiate the chromophobe RCC from RO particularly when these tumors are in doubt about routine histologic diagnosis

Necrotizing fasciitis and its association with Diabetes Mellitus

To analyze the different presentation, types of infection, predisposing factors [particularly diabetes mellitus] of necrotizing fasciitis; a rare potentially fatal rapidly progressing necrotizing infection of subcutaneous tissue and superficial fascia with secondary necrosis of overlying skin, the medical records were reviewed retrospectively of 94 patients [71 male; 23 female,] admitted to the surgical intensive care unit of Hamad General Hospital, Qatar, between January 1995 and February 2005. Fifty-three patients [56.4%] were diabetic with a mean age of 55 years compared with 40.2 years in non-diabetic patients. Type 1 necrotizing fasciitis, especially of the perineal and genital regions, was more common in diabetic patients whereas type 2 necrotizing fasciitis, especially of torso and upper limbs, was more common in non-diabetic patients. Overall 63.4% of cases were type 2 necrotizing fasciitis. E.coli was the most common bacterium isolated from necrotic tissue of diabetic patients and streptococci were the most common cause of necrotizing fasciitis in non-diabetic patients. Fifteen [16%] patients died but there was no significant difference in mortality between the groups, eight [15.1%] diabetic, seven [17.1%] non-diabetic, although diabetic patients were significantly older

Cardio-respiratory pre-participation screening of competitive athletes

Substantially, it was to highlight how valuable is the routine use of ECG, echocardiography and spirometry among the pre-participation routine examinations for the athletes to differentiate between normal physiological and the pathological changes that could face down the performance of the athletes during competitions or even more might endanger their lives. The study was conducted among some junior athletes who were attending at Sports Medicine center in Madinat Nasr for regular assessment of their physical fitness. The study sample included 120 junior athletes from the national team of football [< 17 years and < 19 years]. Another 95 non- athletic healthy individuals from the school for talented students were selected to represent the control group. They were classified into two groups, each one was matching with a corresponding athletic group in age. Age, body weight, height and body mass index were recorded. Ergometric test with Spirometry, ECG and echocardiography were applied for all the participants. Both groups were matching with their corresponding controls concerning age and height, while the weight and body mass index were found to be statistically significantly higher among their corresponding controls. It was proved in our study that athletes do have statistically significantly lower resting heart and maximum heart rates with higher VO2 max comparing with the non athletes. The anaerobic threshold values were statistically significantly lower among the athletes that were found to be achieved after prolonged times of performance if compared with the control groups. All the spirometric parameters were statistically significantly higher among the athletes. EGG and echocardiography, revealed a normal and accepted physiological changes that can be acquired due to prolonged training. Based on the results of the study, it's deemed that spirometry, ECG, and echocardiography must be tabled among the pre-participation routine examinations of the athletes as a sensible approach to differentiate the physiological changes from the pathological ones, which subsequently can mitigate the usual raised concern of sudden death of athletes during prolonged competitions

Micronized progesterone: a beneficial new modality of treatment for Egyptian patients with hyperemesis gravidarum

Hyperemesis gravidarum [HG] is a condition of intractable vomiting during pregnancy, leading to fluid, electrolyte and acid-base imbalance, nutrition deficiency and weight loss often severe enough to require hospital admission. Theories on how pregnancy hormones could cause HG assert that patients who develop HG may be exposed to higher levels of hormones during early pregnancy. Because HG is most prevalent in weeks when both the placenta and the corpus luteum produce hormones, progesterone and HCG in particular are thought to be associated with HG. Pregnancies with iatrogenic-elevated progesterone levels, such as pregnancies with multiple corpora lutea caused by controlled ovarian stimulation [COS], or pregnancies in which progesterone is administered for luteal phase support do not exhibit an increased incidence of HG, suggesting that high progesterone levels [endogenous or exogenous] alone do not cause HG. The aim of the present study was to evaluate the therapeutic role of progesterone therapy [Utrogestan] as a new modality in the management of hyperemesis gravidarum and to compare this new modality of treatment with the conventional methods used before. Forty Egyptian pregnant women below 40 years of age who are pregnant 20 weeks and had no preconception history of any other medical illnesses. They were suffering from pernicious vomiting: > 5 times per day with subjective weight loss, fluid and electrolyte imbalance and ketonuria. They were randomly divided into group I, which included 20 patients suffering from HG. These patients were managed by iv fluids [5-6 litres/day] and micronized progesterone [Utrogestan] 300-400 mg vaginally/day for two weeks. Group II included another 20 pregnant women suffering from HG who received the traditional lines of treatment of HG. A control group composed of 15 pregnant women not suffering from vomiting or weight loss was also included in the study. Routine investigations included midstream urine analysis, complete blood picture [CBC], fasting blood glucose, liver function tests [serum bilirubin, AST and ALT], kidney function tests [blood urea and serum creatinine], serum electrolytes [Na and K], and serum uric acid were also measured. Assessment of fasting serum progesterone and serum estradiol level was done. Transabdominal ultrasound examination was carried out in all patients to exclude vesicular mole and multiple pregnancies. It was also done for assessment of the gestational age using crown-rump length. No statistically significant difference was found in haemoglobin or haematocrit values. Blood urea was significantly higher in the group of HG treated conventionally both before and after treatment. Serum creatinine did not show any statistically significant difference in both groups of HG patients. The same could be said about serum electrolytes. Before treatment no statistically significant difference was found in serum uric acid levels of both groups of HG patients. Serum total bilirubin, ALT and AST were comparable in both groups. Although the mean serum estradiol level of both groups of HG patients was significantly higher than that of control subjects, yet before treatment, the mean value of serum estradiol in HG patients treated with micronized progesterone was found not to be significantly different from that of HG patients treated conventionally. Before treatment, the mean serum progesterone value of HG patients treated with micronized progesterone was found to be not significantly different from that of HG patients treated conventionally or that of control subjects. Before treatment, HG patients treated conventionally had a significantly higher E2/P ratio than normal controls. In HG patients treated with micronized progesterone, the E2/P ratio before treatment did not differ significantly from that of group II patients or normal control subjects. The E2/P ratio after treatment was significantly lower in HG patients treated with micronized progesterone when compared to those HG patients who were treated conventionally, but it was still significantly higher than that of control subjects. Estradiol is implicated in NVP. Serum levels of estradiol are significantly higher in hyperemetic patients compared to normal pregnant women. When balance is restored by increasing natural progesterone levels, these symptoms typically disappear. Therefore, micronized progesterone has a significant beneficial effect to treat Egyptian pregnant women suffering from hyperemesis gravidarum

Molluscicidal saponins from leaves of Hedera canariensis

Activity-guided fractionation of the methanol extract of Hedera canariensis [var. Gloire de Maringo] Wild leaves afforded five saponins 1-5. Chemical and spectral methods [MS, [1]HNMR, [13]CNMR] showed that they are glycosides of hederagenin and oleanolic acid. The results showed that 4,5 exhibited molluscicidal properties, compound 1 was inactive. Mortality rate of exposed snails increased by increasing plant extract concentration. Lymnaea cailliaudi was more sensitive to plant extract than Biomphalaria alexandrina. The histopathological study revealed distinct damage in the structure of the stomach and ovotestis of treated L. cailliaudi snails. Saponin content was determined in term of haemolytic index

Introducing the IMCI community component into the curriculum of the Faculty of Medicine, University of Gezira

In 2001 the Faculty of Medicine of the University of Gezira [FMUG] started to introduce the Integrated Management of Childhood Illness [IMCI] strategy into its medical curriculum. The emphasis was on pre-service training that addresses standard case management and the IMCI community component. This report presents the experience of FMUG in integrating such a training package into the medical curriculum. It explains the rationale for introducing the IMCI community component and the guiding principles for doing so. It describes the community-based courses into which the community component was integrated, the implementation and impact of the programme and the constraints faced

Ankle-midtarsal arthrodesis for paralytic deformed ankle-foot in chronic poliomyelitis

Residual paresis and deformity of the ankle-foot is a common sequel of chronic poliomyelitis. Twenty patients with a mean age of 18.6 years [range 18 - 20 years] suffering paralytic flail deformed ankle-foot, but with adequate gluteus maximus muscle power and stable knee, secondary to chronic poliomyelitis acquired during infancy, had been treated with ankle-midtarsal arthrodesis using Charnley's external fixator-compression for the ankle and staples for the midtarsal joints. They were retrospectively evaluated for the results after arthrodesis at a mean interval of 3.8 years [range, 2 - 6 years] by physical examination and radio-graphs. All patients had a stable painless plantigrade resilient foot after arthrodesis. Neither nonunion [pseudoarthrosis] developed nor did talar avascular necrosis. Complications included wound slough [one], and reflex sympathetic dystrophy [one]. Four cases [20%] were classified as excellent, 10 cases [50%] as good, 5 cases [25%] as fair, and one case [5%] as poor. With the numbers available for study, it could be possible to show that the extent of the arthrodesis and involvement of hindfoot and midfoot joints sparing the subtalar joint affected functional outcome in a significant fashion. The principle, though applied to paralytic cases, can also be used in other non-paralytic ankle-foot deformity

Renovascular protective effects of the angiotensin converting enzyme inhibitor "Ramipril" and the angiotensin receptor blocker "osartan" on experimentally diabetic rats

Diabetes mellitus is one of the most common diseases in the world. It has the potential to cause many complications such as increased blood pressure, disturbance in the kidney functions and elevation of blood lipids.. The aim of the present work was to evaluate the possible renal and vascular protective effects of the angiotensin converting enzyme inhibitor [ACEI], ramipril, as well as the selective angiotensin II receptor blocker [AIIRB], losartan, and the combination of both drugs in diabetic rats. We used 50 rats divided into 5 groups: control, diabetic control and three other diabetic groups each was treated by one of the described drug regimen. Systolic blood pressure, blood glucose, renal function tests, lipid/profile and histopathological examinations were performed to all the groups. Our results revealed that after'6eeks of treatment with rarnipril, losartan, and ramipril plus losartan, there was a significant decrease in the systolic blood pressure [SBP]. When we analyzed the obtained data, we found that the described drug groups had a renoprotective effects in diabetes meilitus. In addition, there were significant decrease in serum triglyceride, and low density lipoprotein [LDL], while serum high density lipoprotein [HDL] was increased as compared with diabetic control group. However, the intensity of changes produced by losartan was of greater extent than that produced by ramipril. The combination of ramipril plus losartan proved to be superior on the two other separate drugs

Chromogenic in-situ hybridization [CISH] as a potential economic tool in diagnostic pathology

Chromogenic in-situ hybridization [CISH] is a molecular cytogenetic technique that utilizes non-fluorescent molecules as reporters for the detection of molecular alterations. The clinical experience with CISH is limited. The present study aimed to evaluate the possibility of utilization of CISH in routine pathology laboratory setting. A total of 177 different tumors and 10 different control tissues collected from three different laboratories were tested. Two tumor cell lines were used for validation studies. Both commercial and in-house CISH probes were utilized for in-situ hybridization. CISH correlated strongly with the more established fluorescent in-situ hybridization technique. Tissue fixation and processing was crucial for the efficiency of CISH hybridization. There was marked variation in the efficiency of hybridization of different tissue types, most prominent in the time required for tissue pre-treatment. Also there was variation in the efficiency of hybridization of the same tissue type from different sources. CISH is a useful alternative for detection of molecular genetic abnormalities in routinely fixed tissue. However, tissue fixation and processing is crucial for success of in-situ hybridization experiments and implementing a uniformly utilized fixation and processing protocols is essential

Immunohistochemical expression of P53 and cyclin D1 proteins in follicular thyroid tumors: evaluation of their significance

The sequential mutational events which may underlie the tumorigenesis of thyroid neoplasia are gradually becoming apparent. To clarify the role of P53 and cyclin D1 in the oncogenesis and tumor progression of thyroid neoplasms, we examined the immunoreactivity of these proteins in one hundred and thirty [130] thyroid tumors originating from the follicular epithelium using immunohistochemistry. The tumors were divided into two groups group I: included thirty five [35] follicular adenomas and group II: included ninety five [95] follicular carcinomas; 65 of which were well differentiated [WDC] while the remaining [30] were poorly differentiated [PDC]. P53 positivity was more frequent in group II [20/95; 21.1%] than in group I [6/35; 17.1%] and in PDC [11/30; 26.6%] than WDC [9/65; 13.8%]. On the other hand, cyclin D1 positivity was frequent in WDC [21/65; 32.3%] and rarely seen in adenoma group [2/35; 5.7%]. Co -positivity for P53 and cyclin D1 proteins was more observed in PDC [5/30; 16.7%] than in WDC [3/65; 4.6%]. The study suggested that cyclin DI may be involved in the thyroid oncogenesis and concluded that both proteins may be incriminated in the progression of follicular thyroid neoplasms. Moreover, we found that age at the time of diagnosis, the histologic differentiation, necrosis in primary tumor, extrathyroidal invasion and the presence of distant metastases are important prognostic and risk factors. In addition, our study revealed that the detection of P53, but not cyclin D1, in primary follicular carcinomas is a significant independent prognostic indicator which, together with the above mentioned important prognostic factors, may be of value in the theraputic planning of these tumors

Effects of aging on pancreatic islet cell function: an experimental immunohistochemical and ultrastructural study

A strong relationship between aging and diabetes mellitus has been clinically suggested, however, none of the previous published data had clearly focused on the age-related cytomorphological changes in the pancreas which are the goal of this study. Three groups of male apparently healthy rabbits have been used, ten animals each; classified as group-1 [3-5months old]; group-2 [9-12 months old] and group-3 [24-36 months old]. After sacrification, sections from the pancreas were stained by Haematoxylin and Eosin [H and E], Gomori trichromic stain and ultrastructurally to detect aging histologic changes as well as immunohistochemically to identify insulin and glucagon secreting cells using their appropriate monoclonal antibodies. A progressive histological distortion with fibrosis and fatty changes were directly proportional to age, being mild in group-2 and severe in group-3. Morphometric studies by computerized image analysis showed that the mean number of islets was significantly higher in group2 [8.98+/-1.51], lowest in group-1 [5.08+/-1.48] and intermediate in group-3 [6.37+/-1.37]. The mean diameter and square area of islets were significantly higher in group-2 compared to other groups [P< 0.05]. The mean number of beta cells per islet and their secretary granules were significantly [P <0.05] higher in group-2, intermediate in group-1 and lowest in group-3.In contrast, the mean number of alpha cells per islet and their secretory granules were insignificantly [P< 0.05] higher in group -2, intermediate in group-3 and lowest in group-1.Also, the beta/alpha ratio [beta cells/alpha cells] was greatest in group-2 [3.059:1], intermediate in group-1 [3.37:1], and lowest in group-3 [2.479:1]. The increased number of beta cells may be due to a compensatory process to correct the hormonal feedback mechanism of insulin .The results of this work suggest that beta cells are generally more vulnerable to aging, an observation which might be correlated clinically with higher incidence of diabetes in older ages

Acute appendicits: still a missed diagnosis in El Obeid, Western Sudan

One hundred and one patients with appendicitis were admitted to the emergency wards of the University Surgical Unit in El Obeid Teaching Hospital, Western Sudan during the period from July 2005 to June 2006. There were 64 males and 37 females. The mean age was 20.8 years +/- S.D. 12.8. 34 patients had appendicular mass, four patients had appendicular abscess and five patients had generalized peritonitis presenting with acute abdomen. Out of the 58 patients admitted as acute appendicitis, 15 patients were found to have perforated appendices at operation and the rest inflamed oedematous appendices, with a negative appendicectomy rate of zero per cent. These findings reflect the poor awareness about acute appendicitis and its seriousness in this area. It is the problem of late diagnosis rather than late presentation as all patients were misdiagnosed and put under treatment for other medical conditions before being admitted to the surgical wards

BDN programmes and the effect of medical students' interventions to promote child health in Sudan

Basic development needs [BDN] is an approach to community development that aims at improving quality of life through the full involvement and self-management of communities, supported by intersectoral collaboration. The objective of this study was to assess the effects of BDN implementation in an area of Sudan on aspects of a programme implemented by students from the Faculty of Medicine, University of Gezira. The study revealed that the joint implementation of BDN programmes and students' interventions brought about marked improvement of family and community practices as well as greater reduction in the incidence of all assessed major childhood illnesses [diarrhoea, cough and fever] than when the students' programme was implemented alone. BDN implementation also facilitated the retrieval of good quality community-based data

Cd 34 glycoprotein as a differentiating marker between basal cell Carcinoma and Trichoepithelioma

Trichoepithelioma [TE] is a benign skin tumor with follicular differentiation, which is sometimes difficult to distinguish clinically and histologically from basal cell carcinoma [BCC]. One of the most helpful differences is the histologic appearance of the stroma. CD34 is an antigen known to stain the spindle shaped cells located around the middle portion of normal hair follicles. We selected twenty clinically confused cases. After routine histopathological staining by haematoxylin and eosin, all cases showed typical diagnosis in seventeen cases [9BCC and 8 TE] while the remaining three cases revealed overlapped features. Immunoperoxidase technique using anti-CD34 antibody carried out in all cases displayed two out of the three overlapped cases had a staining pattern similar to the typical BCC cases; the immediate tumor stroma together with the spindle cells intermixing the tumor nests were CD34 negative. Moreover, the remaining uncertainly diagnosed case had a pattern resembling the typical TE cases; the immediate tumor stroma as well as the spindle cells surrounding the tumor islands were focally CD34 positive. From our study, we concluded that the CD34 staining pattern can be considered as a helpful tool in differentiation between TE and BCC particularly when these lesians are in doubt about the clinical or routine histologic diagnosis