Arrhythmogenic right ventricular dysplasia: a sudanese experience

Arrhythmogenic right ventricular dysplasia cardiomyopathy [ARVDC] is a genetic cardiomyopathy characterized by ventricular arrhythmias and structural abnormalities of the right ventricle [RV].There were no reported studies on the presentation of Sudanese patients with ARVDC. This study aimed to describe patient characteristics and various manifestations of ARVDC among 4 patients seen at Shaab Teaching Hospital [STH] during the period from 2006-2010. This study was carried out in STH. STH is the central reference cardiology hospital in Sudan with the final diagnosis of ARVDC. Initially, none of those patients was diagnosed as having ARVDC. The first patient was treated as myocardial infarction and epilepsy. The second patient was diagnosed as Epilepsy. Both the third and fourth patients were treated for palpitations and the fourth patient was diagnosed as having heart failure as well. The first Patient died suddenly while the others stayed alive and have come for follow-up. They were prescribed anti-arrhythmic drugs, and showed remarkable improvement. The diagnosis of these cases based primarily on findings obtained from clinical assessment and simple laboratory tests, as neither MRI nor endomyocardial biopsy were available. Awareness of the protean presentations of ARVDC shouldn't be overlooked. Palpitation isn't always benign. Big heart shadows in X-rays may have many causes. T-wave changes not necessarily ischemia and Loss of consciousness isn't synonymous with epilepsy only. A national registry is a necessity

Calciphylaxis: a diagnosis to be considered

Calciphylaxis, Calcific uremic artteriolopathy [CUA] is a rare but serious complication of end-stage renal disease [ESRD], though it can occur in non uremic. Its main presentation is skin changes and digital gangrene. We present a case of a 70 years old male who had a previous big toe amputation. He presented with acute heart failure syndrome, with fingers and toes gangrene which was mistakenly diagnosed as cyanosis. Following comprehensive assessment patient was diagnosed as having Calciphylaxis. Histological findings have shown intimal hypertrophy and diffuse calcification of the small arteries which further supported the diagnosis of CUA, calciphylaxis, complicating CRF

Antimalarial prescribing and dispensing practices in health centres of Khartoum state, 2003-04

This indicator-based study assessed the antimalarial drug prescribing and dispensing practices of health care providers in health centres of Khartoum state, and compared these with national guidelines for malaria treatment. A total of 720 patients and their prescriptions in 24 health centres were included. Prescribers adhered to national treatment guidelines for only 278 [38.6%] of patients. Although all were treated for malaria, only 77.6% patients had fever or history of fever and only 64.6% had fever and positive blood films. More than 90% of prescriptions prescribed antimalarial drugs by generic names but dosage forms were correctly written in only 23.5%. There was a high rate of prescribing antimalarial injections. Only half the patients had adequate knowledge of their treatment

Meatal stenosis in circumcised males - Is it preventable?

Meatal stenosis is most commonly seen among the circumcised males. The true incidence of this post circumcision complication is not known. The most favored hypothesis regarding the etiology is ammoniacal fumes produced in the wet diapers, which cause meatitis of unprotected glans. It is treated by meatoplasty. 26 pediatric patients suffering from meatal stenosis were treated between Jan. 2003 and Dec. 2005 both inclusive [Mean age was 4.36 years and ranging 2 - 10] and mean follow up was 4 months. Patients were studied for presenting symptoms, size of meatus, perimeatal balanitis, pyuria and postoperative complications such as bleeding, infection and recurrence. They were advised postoperative dilatation with ophthalmic ointment nozzle for one month. Patients with prior history of circumcision were included in the study. The most common symptom in our study was thinning of urinary stream 17 [65.4%] cases. Other common symptoms were painful micturition in eight and bloody spotting in seven cases. Eight patients were having pin hole meatus and three cases were having pyuria. Compliance for post operative dilatation was 76.9% [20 cases]. No case of recurrence was seen. It can be concluded that meatal stenosis is related to infant circumcision. It is treated by meatoplasty with satisfactory outcome. Whether we would be able to prevent this post circumcision complication ? There is no obvious solution to this problem for the time being

Outcome of Priapism after early and late management

To assess the outcome of patients presenting with priapism during the last six years. Record of the patients presenting with priapism was evaluated retrospectively. Following parameters were assessed; etiology, duration, management, complications and final outcome. Fifteen patients with mean age of twenty seven years presented from Jan 2000 to Dec. 2006. Etiological factors were intracavernosal injection of papavarine 6 [40%]. hakeem medication 4 [26.7%], thalasemia 2 [13.3%] and idiopathic in 3[20%] patients. Mean duration of priapism was 80.8 hours. Initial conservative management was successful in 7 [46.7%] patients. Non responders were treated with distal cavernosospongiousus shunt. Out of eight, three [37.5%] patients responded and remaining four ended up with corporeal fibrosis and erectile dysfunction[ED]. One patient develop urethrocutaneous fistula. Intracavernosal injection of papaverine and hakeem medicines are common etiological factors. Patient usually present late because of embarrassment. Outcome of management depends upon duration of priapism

Acute epididymo-orchitis - is empirical therapy for Chlamydia trachomatis justified?

In sexually active males, the commonest organisms causing acute epididymo-orchitis are Chlamydia trachomatis and Neisseria gonnorhoae. The peak incidence is seen during 20's. The aim of our study was to prove that in majority of cases of acute epididymo-orchitis, the bacterial pathogens cannot be isolated. The reason being that the pathogen responsible in majority of cases is Chlamydia trachomitis which cannot be isolated by routine bacteriological techniques. We reviewed the cases of acute epididymo-orchitis and studied the percentage of patients in which bacterial pathogens were isolated. The clinical and microbiological data of patients from Aug. 2003 to Sep. 2005 was reviewed. The clinical diagnosis of acute epididymo-orchitis was confirmed by scrotal ultrasonography. Midstream urine sample were processed by using standard culture techniques. Patients were followed for a period of three months. There were total 97 patients, with median and interquartile range of 20 and 17-25 years respectively. At the time of presentation the median duration of symptoms was 4.5 days, while median hospital stay was 5 days. Scrotal pain was the main presenting symptom. Pyuria was noticed in 41 [43%] patients and in only 12 [14%] of these the bacterial pathogens were isolated. Main organisms being Escherichia coli and Klebsiella pneumoniae. We have concluded that Chlamydia trachomatis can not be isolated by routine bacteriological techniques. Currently available diagnostic methods are cumbersome and expensive. Therefore there is a need to develop simpler techniques, which can be made available in moderately equipped laboratories; in order to facilitate the detection of Chlamydia trachomatis. Presently the patients in whom the causative organisms can not be isolated can safely be treated for Chlamydia trachomatis

Hyponatraemia during TVRP

Sixty patients undergoing transurethral resection of prostate for benign prostatic hyperplasia were selected for this study. Post-operative changes in serum sodium and incidence of TURP syndrome were studied. Results revealed that most of the patients experienced insignificant hyponatraemia after resection. Six [10%] patients had> 15mEq/L fall in serum sodium. Only two [3.3%] of them developed clinical features of TURP syndrome. Hyponatraemia had positive correlation with weight of the resectate

Extra-corporeal shock-wave lithotripsy for renal calculi in children

Fifty four children underwent lithotripsy for renal calculi. Out of these sixteen were lost to follow-up. Results of thirty-eight were analysed. They were 2.3% of all the patients undergoing lithotripsy. Male to female ratio was 1.8 : 1. Treatment in 29 cases [76.3%] was declared successful, whereas in 9 cases [23.7%] it was declared failed. About half of the children undergoing lithotripsy had transient haematuria, but no other serious complication was observed. There is however, concern about the long term consequences of lithotripsy in children and its use in growing kidney. Although results to date have shown it to be a safe and effective treatment modality in children

Estimation of blood loss during TVRP

Operative blood loss was measured in thirty patients undergoing TURP for benign prostatic hyperplasia. The used irrigating solution was collected and its haemoglobin was determined on Coulter Counter. Blood loss was calculated by calibrating the results against patients own pre- operative haemoglobin. Mean blood loss was 332 ml with a standard deviation of 205 ml. Mean weight of the resected tissue was 18.44 gm. and mean blood loss per gram of the resectate was 18.56 ml. Positive correlation was found between blood loss and weight of the resected tissue. Results are comparable with other studies

Two years study of surgical treatment of carcinoma rectum

A prospective study of 30 patients of carcinoma rectum was carried out at Liaquat Medical College Hospital, Jamshoro / Hyderabad from July 1992 to June 1994. The median age for the series was 60 years. Sex incidence male to female ratio 14:1.23 patients [76.7%] had bleeding per rectum. Twenty [66.6%/ had altered bowel habits. Ten cases [33.3%] had pain in the abdomen. Location of the tumour in the lower one third 18 cases [60%], middle one third 26.7%, upper one third 4 cases [13.3%]. Dukes staging were stage A 0, stage B 7 [23.3%], stage C 13 [43.3%], stage D 10 [33.3%]. Operations done were colostomy 23 [76.7%], abdomino perineal resection 6 [20%]. Anterior resection 1 [3.3%]. Resectability rate 26.7%, operative mortality 3.3%, no recurrence complications, retention of urine 16.7%, urinary tract infection 33.3%, perineal obscess 13.3%, haemorrhage 6.7%, stomal complications 16.7%, abdominal wound infection 13.3%

Factors influencing blood transfusion in patients undergoing transurethral resection of prostate [TURP]

To determine the quantitive requirement of blood transfusion in patients undergoing TURP, and to identify factors which influence it. Design: Prospective study of one hundred patients undergoing TURP, and analysis of pre-determined factors pre operatively and post operatively. Setting: Department of Urology, Mayo Hospital Lahore. Subjects: One hundred consecutive patients with a diagnosis of Bladder Out Flow Obstruction who underwent TURP. Main outcome measures: To asses actual amount of blood transfused and to establish its correlation to various factors identified at the start of the study. Out of one hundred consecutive patients who underwent TURP, thirty seven were transfused and sixty three did not require transfusion. In the first group twenty seven patients required one unit of blood, and ten patients required two units of blood. Forty seven units of blood was used against two hundred units procured, showing a utility of 23.5%. There was statistically significant difference in two groups when mean values of resected weight, resection time, volume of irrigating fluid and episodes of dot retention were compared. Conclusions: Factors identified were similar as in other studies, but the rate of transfusion was on the higher side, especially in the background of hazards like HIV, Hepatitis B,C

role of urinary cytology in the early diagnosis of bladder cancer

A prospective study was conducted on 50 patients with urinary bladder carcinoma to evaluate the role of urinary cytology in the early diagnosis of bladder cancer. Urinary cytology was clearly positive in 87.5% and negative in 12.5% of cases when bladder tumour was visible on cystoscopic examination. Whereas it was clearly positive in 40% and negative in 60% of cases when no tumour was seen on cystoscopy but detected on biopsy. It was observed that urinary cytology is almost as accurate as cystoscopy in appraising the presence or absence of bladder tumour. It may provide information about the neoplastic state of the epithelium not provided by cystoscopic examination. It is recommended that being practical and simple procedure, urinary cytology may be done as a routine procedure in the high risk patients and also suspected cases of bladder carcinoma presenting with unexplained frequency, urgency or haematuria