IBS Associated Demographical and Economic Factors in Northern Saudi Arabia

Objective: The aim of the present study was to assess the association of Irritable bowel syndrome (IBS) with demographical and economic factors in Northern Saudi Arabia. Methodology: Data about IBS was obtained from 946 Saudi volunteers. IBS was ascertained using Rome IV criteria. Each questionnaire was filled by a medical student during an active interview. Results: The prevalence rates of IBS with continuous symptoms and intermittent symptoms were 12% and 34%, respectively. IBS was significantly predominant among females (RR (95% CI)=1.1775(1.0182 to 1.3618), p=0.0276). IBS was significantly among relatively younger adults (21-40 years) (RR (95% CI)=1.6203 (1.3425 to 1.9556), p<0.0001). Conclusion: IBS associated symptoms are prevalent in Northern Saudi Arabia. IBS was significantly associated with females’ gender and younger age.

Prevalence and causes of blindness and visual impairment in population aged 50 years and over in North Kordofan State, Sudan

Objectives: To estimate the prevalence and causes of blindness and other degrees of vision impairment in people aged 50 years and older in North Kordofan state, Sudan, using the Rapid Assessment for Avoidable Blindness methodology

Design: Cross-sectional, population-based survey

Participants: Forty-three clusters of 50 people aged 50 years and older were selected by probability proportionate to size sampling of clusters. Households within clusters were selected through compact segment sampling. A total of 2167 eligible persons were selected, of whom 2032 [93.8%] persons were examined

Materials and Methods: Participants underwent a comprehensive ophthalmic examination in their houses by trained ophthalmic teams, including measurement of visual acuity [VA] with a tumbling-E chart and the diagnosis of the principal cause of visual impairment

Results: The prevalence of bilateral blindness [presenting VA < 3/60] was 8.37% [95% confidence interval [CI]: +/- 1.60], the prevalence of severe visual impairment [VA < 6/60-3/60] was 2.71% [95% CI: +/- 0.59] and the prevalence of bilateral visual impairment [VA < 6/18-6/60] was 9.06% [95% CI: +/- 1.76] in the sample. Definite avoidable causes of blindness [i.e., cataract, refractive error, trachoma and corneal scarring] were responsible for 76.5% of bilateral blindness. Cataract was the major cause of blindness [60.6%], followed by Glaucoma [20%]

Conclusions: The prevalence of blindness in people aged 50 years and older in North Kordofan state was higher than that expected for Sudan. The main cause of blindness was Cataract, followed by Glaucoma. More than 75% of blindness was due to avoidable causes

Reporting ureteroscopy complications using the modified Clavien classification system

Perioperative complications are one of the surrogate indicators of surgical outcomes. However, reporting these complications need a precise grading system. Our aim is to report and grade the complications of semirigid ureteroscopy in ureteral stone management according to the modified Clavien classification system. This is a prospective study conducted From January 2012 to June 2013. All patients with ureteral stones who were indicated for semirigid URS were evaluated. All procedures were performed by the same surgeon. The data recorded including patient demographics, clinical indication, stone size and location, operative time and complications were classified according to the modified Clavien classification system. The patients were followed for 8 weeks postoperatively.148 patients included, Stone distribution was: 89 [60.1%] lower ureteral, 26 [17.6%] mid ureteral, and 33 [22.3%] upper ureteral. the mean stone size was 8.6 mm. Urgent URS done in 23% of patient. The overall stone free rate was 88.5%, the individual stone free rate for the upper, middle and lower ureter were 87.9%, 84.6%, and 89.9%, respectively. The mean operative time was 31.9 min [20-50 min.]. Complications occurred in 26.35% of patients. Grade I complications occurred in 32 patients [26.1%], grade II in 9 [6.1%], grade IIIa in 7 [4.7%], grade IIIb in 8 [5.4%], grade IVa in two patient [1.35%], and grade IVb in one patient [0.7%]. No grade V complication was encountered. Ureteroscopy becomes the vanguard interventional therapy for ureteral stones with well-established efficacy and safety. It is of paramount importance to adopt a precise structured classification system for reporting surgical complications, that should be flexible and comprehensive in order to accommodate the various and rapidly expanding surgical fields

Sigmoid Colonic Perforation with Faecal Peritonitis due to Faecaloma.

Colon perforation is an uncommon event usually caused by malignancy, diverticular disease, amoebic colitis, steroid therapy, trauma and ulcerative colitis, but stercoral perforation is very rare. Severe chronic constipation is considered to be the main causative factor in development of stercoral perforation of colon. Sometimes it can also produce catastrophic complications like colonic obstruction, faecal peritonitis and septicaemia. We report a rare case of sigmoid colonic perforation with faecal peritonitis and pneumoperitonium due to faecaloma which was diagnosed after exploratory laparotomy.

Tarsal tunnel syndrome in patients with rheumatoid arthritis, electrophysiological and ultrasound study

Tarsal tunnel syndrome [TTS] is an entrapment neuropathy of the tibial nerve at the ankle. Rheumatoid arthritis is one of the systemic causes that has been responsible for TTS. In this study thirty feet of patients diagnosed as rheumatoid arthritis with complaints of burning pain or paresthesia on the plantar aspect of the foot and toes with 15 feet of age and sex matched control subjects were included. The aim of this study: To detect TTS among patients with rheumatoid arthritis. All patients included in this study were subjected to history taking, clinical examination [general and local], nerve conduction studies and ultrasonography of both tarsal tunnels. In this study, we detected the presence of TTS in rheumatoid arthritis patients group and none was found in the control group. A total of 28 cases were confirmed as having TTS. In the patients group a strong statistically significant correlations were found between ultrasonographic and electrodiagnostic findings. So it is concluded that TTS is detected in patients suffering from rheumatoid arthritis and that the use of both methods could lead to more reliable confirmed diagnosis which could lead to better management

Pelvic floor electrophysiology patterns associated with faecal incontinence

Pelvic floor electrophysiological tests are essential for assessment of patients with faecal incontinence. The present study was conducted to determine the patterns of pelvic floor electrophysiology that are associated with faecal incontinence. The present study included 40 patients with faecal incontinence and 20 apparently healthy subjects as a control group. All patients were subjected to history taking, clinical examination, proctosigmoidoscopy, anal manometry and electrophysiological studies. Electrophysiological studies included pudendal nerve motor conduction study, pudendo-anal reflex, needle electromyography of the external anal sphincter and puborectalis muscles, pudendal somatosensory evoked potential and tibial somatosensory evoked potential. The control group was subjected to electrophysiological studies which include pudendal nerve motor conduction study, pudendo anal reflex, pudendal somatosensory evoked potential and tibial somatosensory evoked potential. The most common pelvic floor electrodiagnostic pattern characteristic of faecal incontinence was pudendal neuropathy, abnormal pudendo-anal reflex, denervation of the external anal sphincter and puborectalis at rest, incomplete interference pattern of the external anal sphincter and puborectalis at squeezing and cough and a localized defect in the external anal sphincter. There were characteristic pelvic floor electrodiagnostic patterns for faecal incontinence

Giant and absent somatosensory evoked potentials in children with cerebral palsy with and without epilepsy

Many studies have reported the relationship between giant somato-sensory evoked potentials [SEP] and myoclonic epilepsy in adults and children. However there are few reports about giant SEP and absent SEP in children with cerebral palsy. To assess the diagnostic significance of giant SEP and absent SEP in children with cerebral palsy with and without epilepsy. The study included 25 children [10 boys and 15 girls] with cerebral palsy, 10 of them with a history of epilepsy. The age of all the CP children was 5.2 +/- 2.3 years. Ten healthy children of matched age, sex and height were included in the study as a control group. SEP to median [N20] and posterior tibial [P40] nerves stimulation was recorded. Giant SEP was defined as that bigger than 3 SD of the mean amplitude in normal children. Inter-ictal EEG recordings were done for all the patient population as well as for the controls. The peak latency of N20 in normal children was: 16.2 ms +/- 1.1 ms while its amplitude was: 7.5 micro.V +/- 2.6 micro V. The peak latency of P40 in normal children was: 31.3 ms +/- 3.2 ms while its amplitude was: 4.8 micro V +/- 1.8 micro V. Giant SEP was considered if the amplitude was more than 15.3 micro V for N20 and 10.2 micro V for P40. SEP was absent in 5 CP children without epilepsy [33.3%] and a patient [10%] with epilepsy. All of them were severely handicapped. On the other hand 4 CP children with epilepsy [myoclonic seizures] [40%] showed giant SEP while none of the CP children without epilepsy showed giant SEP. EEG recordings were unremarkable in 10 patients [40%]. Abnormal EEG findings were: focal paroxysmal discharges in 5 children [20%], polyspike and slow wave complexes In 4 children [16%] and abnormal background activity in 6 children [24%]. Both groups of CP children [with and without epilepsy] showed significant increase of the SEP latency and significant decrease of the SEP amplitude of the median and posterior tibial nerves compared to the control group. Giant SEP being present in CP children only with epilepsy, suggests that it is related to a state of cortical hyper-excitability. Absent SEP is present in CP children with and without epilepsy, but more in severely handicapped children. So absent SEP is attributed to the severity of neurological disorder

Sympathetic and somatic neuropathy in patients with scleroderma

Peripheral neurologic involvement is regarded as uncommon in systemic sclerosis. On the other hands, some studies showed that the peripheral nervous system is often affected in systemic sclerosis though it is not clearly understood whether the involvement represents a primary or a secondary event. Nonetheless, a number of patients develop parasthesia and neuropathic pain in their hands and occasionally precede the onset of clinical edema. To assess the sympathetic and somatic neuropathy in patients with scleroderma. Ten patients with scleroderma diagnosed according to the ACR criteria for systemic sclerosis 1980 as well as 10 healthy volunteers were included in the study. Included clinical neurological examination, semi-quantitative sensory testing, standard nerve conduction study of median, ulnar, common peroneal and sural nerves, needle EMG of the 1[st] dorsal interosseous and tibialis anterior, and electrically evoked sympathetic skin response [SSR] of the hand. Sensory symptoms was found in 5 patients, decrease of pinprick sensation was found in 4 patients, decrease of vibration sense was found in 4 patients, damped deep tendon jerks was found in 4 patients, unilateral facial parasthesia and hyposthesia in 2 patients. Nerve conduction study revealed low amplitude of the SNAP in 3 patients, slow sensory conduction in 2 patients and carpal tunnel syndrome in 4 patients. Slow motor conduction was found in the common peroneal nerve of a patient. Four patients showed poor SSR. The other 6 patients showed significant decrease of the amplitude and delayed latency of the SSR compared to the control subjects. Peripheral neuropathy in patients with scleroderma is not uncommon. It is predominantly sensory and sympathetic and seems to be non length dependent

Natural feeding in acanthopagrus latus[Houttuyn, 1782]see fish in Al Razzaza lake

During the period between June 2003 to May 2004. Three station were chosen at Al - Razzaaza lake for fish sampling. Silver Sheim [Shank] Acantinopagrus latus [Houttuyn, 1782] Length between 102- 380 mm and total weight between 24- 1000 gm. Stomachs of 210 fish were examined to study the natural food during the study period. It was noticed that higher feeding amplitude of silver Sheim fish was in summer season [33.1 point/fish] and the lower feeding amplitude was recorded in spring season [7.4 point/fish] and fish were more active in feeding during summer, autumn, and winter seasons. It reached 89.5 percent, 97.8 percent, and 100 percent respectively; and a lower feeding activity was during spring season [58.4 percent]. The consumd food of silver Sheim fish in Al-Razzaza lake was consisted of small fish, and their parts [77.2 percent], Larval bugs and insects [15 percent], then a digested food of undetermined animal origin [6.5 percent] matured insects [2.9 percent], Zooplankton [2.5 percent], different worms [0.6 percent], Mollusca [0.2 percent] and finally plant tissues [0.1 percent], [according to importance level guideline way], which indicated that shank is a carnivores, it prefers fish as food

Rheumatoid arthritis: early induction of disease remission

To evaluate the efficacy of tumor necrosis factor-alpha [TNF-alpha] blockade as bridge-therapy combined with methotrexate [MTX] in induction of early remission in rheumatoid arthritis patients. Patients and Sixty six patients with rheumatoid arthritis with poor prognostic disease features were enrolled in the current study. All had moderate to severe disease activity with unsatisfactory response to disease modifying antirheumatic drugs [DMARDs] mono-therapy. Patients were randomized into 3 groups: Group 1 were the patients who received TNF-alpha blockade therapy in combination with methotrexate [MTX] for 6 weeks than they were maintained on MTX alone for 18 weeks, group 2 included patients who received MTX mono-therapy and patients in group 3 who received prednisolone according to micro-dose regimen with MTX. All patients underwent initial full clinical examination as well as laboratory investigations [baseline evaluation]. The following disease activity parameters were determined at baseline, 6 weeks and 24 weeks after being enrolled in the study: Global patieny's and global physician's assessment scores, patients's pain score, number of tender as well as swollen joints, Health assessment questionnaire, serum C-reactive protein, erythrocyte sedimentation rate as well as morning stiffness duration. Standard plain X-rays were carried out for both hands, wrists, ankles as well as the forefeet. Joint erosions were assessed according to Larsen's score. Induction of disease remission after the 1st 6 weeks of therapy occurred in 45.45%, 27.27%, 36.36% in group1, 2 and 3 respectively, reflecting the higher efficacy of TNF-alpha blockade therapy in induction of early disease remission. After 18 weeks of stopping TNF-alpha blockad and maintaining the patients of group1 on MTX [24 weeks from start of the study], the 3 study groups showed comparable disease control revealing the absence of superiority of TNF-alpha blockade therapy compared with prednisolone-MTX combination as well as MTX monotherapy. On the other hand radiological evaluation of joint damage showed comparable incidence of joint erosions in the 3 groups reflecting equal efficacy of the 3 treatment regimens in controlling joint destruction. In view of results of the current study it can be concluded that TNF-alpha blockade is an effective therapy in RA that can induce early disease remission, however, this induced remission was not associated with superior efficacy in protection of joint damage compared with MTX mono-therapy and combined MTX-steroid therapy