Prolactin and insulin estimates in pregnancy with glucose intolerance

To show the relation of prolactin with the incidence of glucose intolerance in pregnancy. This study was carried out on thirty Sudanese pregnant ladies suffering from gestational diabetes mellitus, 30 ones with impaired glucose tolerance and 30 control ones with normal glucose tolerance. All subjects overnight fasted before the test. A fasting blood sample was drawn at 6.00 a.m. Thereafter, 75g oral glucose dissolved in 200 cc water was given for each, waiting for two hours and then another blood sample was drawn. Fasting and 2-h, after 75g glucose load, plasma glucose concentrations [FBS and 2h-BS] were estimated by glucose oxidase method. The concentrations of serum insulin in the fasting sample [0 min.] and in the 2 hour after 75g glucose load sample [120 min.] were measured with a specific immunoradiometric assay. The concentrations of serum prolactin [120 min.] were measured with a specific radioimmunoassay. There were no significant differences among levels of fasting serum insulin of the three studied groups [p>0.05] while, the mean level of 2h- serum insulin of the GDM group was significantly lower than that of the IGT and control groups [p <0.005]. Results of serum prolactin of the control group in the first, second and third trimester showed that prolactin increases progressively as pregnancy advances [p <0.0001]. Results of serum prolactin of the GDM, IGT and control groups in the third trimester showed that no two groups were significantly different [p>0.05] although the control group recorded the highest mean level of serum prolactin. Prolactin increases progressively as pregnancy advances, reaching a peak in the third trimester when many pregnant ladies may develop gestational diabetes due to the state of insulin resistance which may occur although there is no evidence that prolactin may be directly incorporated with the pathogenesis of glucose intolerance in pregnancy. A decline in insulin secretion may lead to a decline in prolactin since insulin stimulates both acute secretion and de novo synthesis of decidual prolactin

sensitivity and specificity of the conventional symptoms and signs in making a diagnosis of acute appendicitis

Simple appendicitis can progress to perforation, which is associated with a much higher morbidity and mortality. So, surgeons have therefore been inclined to operate when the diagnosis is probable rather than wait until it is certain. This study is designed to evaluate the sensitivity and specificity of clinical examination in the diagnosis of acute appendicitis. The study included 866 patients of acute appendicitis who had undergone appendicectomy with preoperative diagnosis of acute appendicitis. They were analyzed retrospectively. The parameters evaluated were age/gender, clinical presentation [signs and symptoms] and total white blood cell counts. The operative findings were recorded and the inflammation of the appendix was graded into normal, acutely inflamed and gangrenous. Clinical diagnosis was made correctly in 807 [93.2%] of the patients. White blood cells count ranged from 3.70 to 45.30 /mm[3] [mean 17.5353 /mm[3]]. It was <10.000/mm[3] in 133 [15.4%] patients. Clinical assessment is the best criterion to reach a confident diagnosis. Investigations may supplement the diagnosis but are never a substitute for it

reliability of modified Alvarado score as a tool for diagnosis of acute appendicitis in Sudanese adults

Decision making in cases of acute appendicitis may be difficult especially for junior surgeons as diagnosis of that condition is sometimes difficult. In conditions like acute appendicitis, it is not possible to have definitive diagnosis by gold standard test [histopathology] before surgery, so various diagnostic modalities are introduced to establish accurate diagnosis. Modified Alvarado score [MAS] system is one of the examples. This work was carried out to evaluate the reliability and sensitivity of modified Alvarado scoring system in Sudanese adult patients with suspected diagnosis of acute appendicitis This prospective study included 866 [452 males and 414 females] who underwent appendicectomy in different centers in Khartoum, Sudan in the period from January 2006 to August 2007. It included all adult patients above 16 years with clinical diagnosis of acute appendicitis. Modified Alvarado score system was calculated for all patients; however decision to operate was clinical.The results showed that the overall sensitivity, specificity and accuracy were 87.78%, 24.78% and 79e.56% respectively. Our data suggested that the modified Alvarado scoring system had little applicability to the local adult population. Its sensitivity was high but the specificity was too low. So, we conclude that the modified Alvarado scoring system is not accurate in the diagnosis of suspected cases of acute appendicitis in Sudanese adult patients

Comparison between usages of a single preoperative metronidazole dose with other antibiotic regimens in nonperforated acute appendicitis

In this study, the safety and efficacy of a single dose of metronidazole in preoperative prophylaxis in nonperforated appendicitis were evaluated. Records of 866 patients underwent appendectomy were evaluated and 11.43% [99] of these patients received 500 mg of metronidazole only before undergoing operation on induction for anaesthesia. Factors known to affect the incidence of wound infection, such as abdominal or wound drains, and the inclusion of patients with perforated or ruptured appendicitis, were eliminated. The patients were divided into three groups: patients with a normal appendix, patients with an acutely inflamed appendix, and patients with a gangrenous appendix. The study showed for each group a significant reduction of the incidence of wound infection in patients receiving prophylaxis. Routine preoperative prophylaxis is recommended before appendectomy. The findings demonstrated that more than ninety-four percent of the wound infections were detected after discharge from the hospital strongly indicate the need for follow-up

Outcomes and complications of thyroid surgery among the Sudanese patients

To reveal the outcomes and complications of post-thyroidectomy, a study was carried out on 1351 patients aged between 18 and and 76 years [mean, 43.9 years] of whom 945 were female [69.95%] and 406 [30.05%] were male patients [female to male ratio was 2.3:1]. The most common Indications for total thyroidectomy were diffuse goiter and multlnodular goiter [45.7% and 36.04%of cases respectively]. Incidence of malignancy was 41 cases [2.7%]. Of those patients with malignancy, thirty cases [73.2%] underwent an associated nodal dissection along with total thyroidectomy. The Incidence of postoperative wound haematoma was 0.6% [8 cases], wound infection was 0.4% [5 cases], and mortality rate was 0.0%. The Incidence of postoperative hypocalcaemia was 8.4% [113 cases]. Younger age was statistically associated with an Increased Incidence of hypocalcaemia [P<0.002], whereas sex [P=0.31], Indication for surgery [P=0.16], and associated neck dissection [P=0.13] were not. The Incidence of hyperthyroidism was 0.148% [2 cases]. The mean duration of hospital stay was 4.2 days and was unaffected by occurrence of postoperative hypocalcaemia. The Incidence of unilateral and bilateral vocal cord paralyses was 1.1% [23 cases] and 0.22% [3 cases], respectively. The study showed that there is an Increase of the Incidence of complications when the operation performed for carcinoma. This Increase may be due to the extent of disease found at operation or the less experienced surgeons. Postoperative hypocalcaemia is the most common immediate surgical complication of total thyroidectomy. Other complications, including recurrent laryngeal nerve paralysis, hypothyroidism, hyperthyroidism, and haematoma formation

Symptomatic empty sella syndrome - a case report and review of the literature

The pituitary gland is a hormone-responsive gland and is known to vary in size depending on the hormonal status of the patient and the multifaceted positive and negative hypothalamic-pituitary-gonadal axis. We are reporting on a case of symptomatic empty sella syndrome occurring in 68 years old Sudanese woman with a long history of hypothyroidism. Concepts and definitions of the empty-sella [ESS] syndrome, origins of primary and secondary empty-sella syndrome [ESS] including defect of the Turkish saddle diaphragm, pituitary abnormality, and disease states [development frequency, symptom, and test result] are reviewed. In addition, preventive strategies of late diagnosis are suggested

Seminal plasma fructose and zinc levels as indicators of androgenic activity in male infertility

In this study, we aimed to investigate the possibility of using seminal plasma fructose and zinc levels as indicators of androgenic activity. A cross sectional study was conducted on three groups of infertile patients [n = 68] of clearly different sperm densities [20 azoospermic, 24 oligozoospermic and 24 normozoospermic patients]. The patients were randomly selected for this study. The study also included 20 normal subjects as a control group that is a totally different group of men of proven fertility who have recently fathered one or more children and who do not suffer any endocrine or systemic disease. Blood and semen samples were collected from each. Semen analysis was done; serum testosterone, Follicle stimulating hormone [FSH] and luteinizing hormone [LH] were measured using radioimmunoassay technique. Zinc level in seminal plasma was determined using atomic absorption spectroscopy and seminal plasma fructose was measured using colorimetry. Results of analysis showed that seminal plasma zinc levels whether per ml or per total ejaculate were found to increase gradually from azoospermic [6.56 mg/ml, 17mg/ejaculate], through oligozoospermic [11.49 mg/ml, 30.3 mg/ ejaculate] to normozoospermic [12.42 mg/ml, 33.3 mg/ejaculate] infertile patients, indicating increased androgenic activity with increased sperm density. The difference between the azo- and oligozoospermic groups is statistically significant [p < 0.05] and between azo- and normozoospermic is even higher [p < 0.005]. The azoospermic group is not really one homogeneous group but a mixture of two distinct subgroups. A subgroup with severe Leydig cell damage, and consequently low testosterone level and elevated FSH level [Normal range of serum FSH is 1.0 - 8.0 mIU/ml] having a seminal plasma fructose mean level [205.3 mg/ml, 295.7 mg/ejaculate] which is higher than that of the oligozoospermic group [188.3 mg/ml, 537 mg/ejaculate] and much higher than that of normozoospermic group [151.3 mg/ml, 457 mg/ejaculate] whereas, the other subgroup with no interstitial cells involvement [obstructive azoospermic] have normal FSH and testosterone levels and a fructose mean level significantly [p < 0.5] higher than all other groups [217.2 mg/ml, 547 mg/ejaculate] due to normal hormonal stimuli and non-utilization. It seems in case of fructose that the situation is reversed compared to zinc as fructose level is the highest in the subgroup of azoospermic patients and decreases as sperm density increases due to utilization by spermatozoa. Zinc level may act as a good indicator of androgenic activity whereas, fructose level can not be used reliably, except in the azoospermic group. This is mainly due to consumption of fructose by spermatozoa and many other interfering factors which the present study tends to clarify

Prevalence of Gestational diabetes mellitus and impaired glucose tolerance in pregnant Sudanese women in the third trimester

The aim of the study was to estimate the prevalence of gestational diabetes mellitus [GDM] and impaired glucose tolerance [IGT] in pregnant Sudanese women in the third trimester. The study was carried out on hundred pregnant women in the third trimester. The prevalence of GDM was 2% and it was 6% for the IGT whereas, 92% of the pregnant women [considered as a control group], revealed normal fasting plasma levels. The IGT pregnant women were older than those control pregnant women but, the age difference was not significant [28.7 +/- 5.5 years mean [S.D] vs. 27.3 +/- 4.8 respectively, p>0.05]. Also, the IGT pregnant women were found to have mean parity significantly greater than that of the control group [6.7 +/- 2, mean [S.D.] vs. 3.9 +/- 2.1 respectively, p<0.001]. Then, it was concluded that prevalence of GDM and IGT in Sudanese pregnant women is within the universal estimates and parity is a very important risk factor that affects impaired glucose tolerance prevalence in pregnancy

Carbon monoxide poisoning

Many people are poisoned by carbon monoxide [CO] with potentially devastating outcomes. CO is the leading cause of fatal poisoning in the industrialized world as well as being endemic in many parts of the developing world. CO poisoning is a serious threat that people need to get informed about. Diagnosis can be difficult because, the early symptoms are quite nonspecific, resemble those of influenza, motion sickness or heat exhaustion, and are often misinterpreted. Those suffering from CO poisoning may initially complain of vague symptoms but the symptoms can rapidly progress to coma and even death, so called silent death. It is therefore critical that CO be eliminated from the body as soon and quickly as possible. Unless patient dies, recovery occurs as CO is removed from the circulation, accelerated by breathing O[2]

Acute adrenocortical insufficiency [Addison's disease]: a case report and review of the literature

Acute adrenocortical insufficiency [Addisonian crisis] is an emergency caused by insufficient cortisol and can manifest as a defect anywhere in the hypothalamic-pituitary-adrenal axis. It may be misdiagnosed as acute renal dysfunction due to similar clinical manifestations and laboratory findings. The causes, clinical features and management of Addison's disease are discussed in this review

Clear cell carcinoma of the gallbladder: a case report and review of the literature

Fifty-nine years old Sudanese woman from Aldamazeen-Southern Blue Nile region of the Sudan, died 2 months after she had been diagnosed histopathologically as a case of a primary clear cell carcinoma of the gallbladder. Gallbladder cancer is a relatively rare form of malignancy. As yet, the progress in its management is very slow, which leads to high mortality and very low survival. At present, the best chances for this disease are early radical surgery but, in patients with invasion of adjacent organs, extended surgery, excising the invaded tissue, may be justified. In patients with distant lymph-node metastasis, even without adjacent organ invasion, radical surgery may not achieve a good outcome