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This article is a medical report about Zubair Pasha's final illness and the cause of his death. It also documents how medical treatment was perceived and practiced in Sudan in the early years of the British rule at the turn of the twentieth century. Zubair Pasha was born in 1831 and died in 1913, almost hundred years ago. Zubair had dictated his life story to Naoum Shugair in Cairo in 1900. In that succinct account Zubair described how he strived to build a successful business kingdom that existed in Bahr Al Ghazal. He traded in ivory, ostrich feather, cattle, metals and all types of seeds; as a result he gained huge wealth and influence. Additionally he helped extend the Turkish rule to Darfour and the neighboring districts. Despite that Zubair was retained in Egypt for more nearly thirty years. He came back after the reconquest of Sudan and stayed at El Geili, his home town. Dr Squire who was the physician at Khartoum Civil Hospital was sent by the Governor General of Sudan to attend to Zubair who was seriously ill in Al Geili, his home town. This article includes the medical report of Dr Squire in 4/1/1913. The final cause of death was described in the report of Dr Andrew Balfour [Head of Welcome Laboratory in Khartoum] as heavy infection with quartan malaria parasite and both ring and crescent forms of malignant tertian parasites were found. Despite treatment with quinine Zubair died two days later
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Diabetic cardiomyopathy [DC] is defined as heart muscle disorder, due to or presumably due to Diabetes mellitus [OM]. The relationship between DC and indices of metabolic control in DM is still a matter of debate. Our aim was to determine the prevalence of DC in young diabetic patients and to find its correlation with age, duration of OM, and indices of glycemic control. The study material consisted of 50 diabetic patients below 50 years of age and 50 age and sex matched control group. Echo was done to assess left ventricular function and to rule out other structural heart disease. Their metabolic indices were taken. Left Ventricular Function: all controls had normal LV function. Studied patients had normal LV systolic function. A total of 29 patients [58%] were found to have LV diastolic dysfunction. Grade I LVDD was most common [40%].LVOD was significantly correlated with duration of DM and age of the patient [P<0.05]. There was a trend towards higher grades of LVDD, as age of the patient and duration of DM increased. There was no significant correlation between fasting blood sugar level, serum lipid profile and LV diastolic dysfunction. LVDD is very common in patients with DM. Its prevalence is related to age and duration of the disease while severity has a tendency towards these two variables but demonstrated no significant statistical value. Early detection of LVDD may have important diagnostic, prognostic and therapeutic implications
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Introduction Patent foramen ovale [PFO] is implicated in several pathologic processes including paradoxical embolism in cryptogenic stroke.1 Patients with PFO have significantly higher rates of recurrent cerebral ischemic events than those without PFO.2 Atrial septal abnormalities are associated with embolic events and cryptogenic ischemic stroke in young patients, but the causal link has not yet been established. Paradoxical embolism is considered the most likely mechanism but is rarely proven.3 The role of atrial septal aneurysm [ASA] as a risk factor for cerebral ischemia of unknown etiology is still controversial. Burger et al. have reported that the morphological characteristics of ASA and associated cardiac abnormalities do not distinguish patients at risk for cerebrovascular events.4 The presence of right-to-left shunt [RLS] is essential to allow clot to cross into the left atrium and hence the arterial circulation. In the absence of an identifiable source of embolism, ASA plays an important role as a substrate for clot formation. Consequently, the presence of ASA and RLS are crucial for ischemic stroke to develop and not the mere presence of PFO. Most sources agree that ASA is best detected by transesophageal echocardiography [TEE] while saline agitated contrast enhances the detection of interatrial shunting. The prevalence of ASA in a general referral population of patients was investigated by use of transthoracic echocardiograpy [TTE] and TEE. Contrast TEE was performed to detect interatrial shunting in patients with ASA. In this population, the prevalence of ASA as determined by TTE was 0.47% [24/5079], and 0.78% [40/5079] by TEE. Of these 40 patients, 16 [40%] were judged to be normal by TTE. Of the 40 patients who were positive for ASA, 50% demonstrated interatrial shunting [atrial septal defects, 10; patent foramen ovale, 10]. The authors concluded that TEE is of significant value in detecting the presence of ASA and associated cardiac abnormalities. Contrast TEE further enhances the detection of interatrial shunting in patients with ASA.5 In this paper, we report our experience with a case of young female who developed cryptogenic ischemic stroke. The offending clot was believed to originate from an ASA. The presence of RLS and PFO provided access to the systemic circulation