Anatomical Variations Of The Cystic Duct And Their Surgical Implications In Sudanese Population: A Cadaveric Study

Background: Anatomic variations of cystic ducts are common and continuously encountered during Surgical andradiological interventions. Failure to identify these clinically important variations may result in complicationsduring surgical or endoscopic procedures.Patients and methods: This is an observational descriptive cross-sectional study. 65 cadavers in the dissectingrooms of the medical colleges, in which the length and mode of insertion of cystic duct (CD) into common bileduct (CBD) were observed.Results: The mean length of the CD in the cadavers examined was (2.06 ± 1.03) with a minimum length of d” 0.5 cmand a maximum of 5 cm. Regarding the mode of insertion of CD into the CBD; 53.8% were found to have a lowjunction between the CD and common hepatic duct (CHD) which is considered the normal insertion. 46.2% foundto be abnormal variations of insertion; short CD (d”0.5 cm) observed in 10.8%; whereas in 13.8% of cadavers wefound that the CD is adherent to the CHD and runs in parallel to it. In 7.8% there was a high junction between theCD and CBD and in 9.2% we found that CD courses anterior or posterior to CBD and joins it medially.Conclusion: CD variations are not uncommon and it is important to identify these anatomical variations. Adetailed knowledge of the extra hepatic biliary tract, as well as of its variations, is important for the diagnosticand therapeutic success in many clinical situations since they allow the surgeon prompt identification ofcertain pathologies, making surgical procedures more accurate and affective.

Adherence to the standards of prescription chart among medical practitioners in Kurdistan region

Background and objective: Controlling medications safely, effectively and efficiently is essential to the delivery of high-quality care. This study aimed to point up prescription errors such as scientific or brand names, the strength of medications, the age of patients, date of prescriptions, specifying dose, dose interval, dosing frequency and dosage form, through systematic studying a certain number of prescriptions

Methods: This study screened the prescriptions from both of public and private sectors in the governorates of Erbil, Sulaimaniyah and Duhok. Adherence was assessed on the basis of these prescriptions charts. Excel program was utilized to evaluate the data in this study

Results: The study covered a total 283 prescriptions involving 976 medications in Kurdistan region. Only 19% of medications were mentioned as a scientific name and just 2% of prescriptions were written via computer. Direction for use of the medicines was only mentioned for 3% and the duration of treatment was scripted in 11%

Conclusion: Majority of medical practitioners in Kurdistan region are not adhering to the international standards of prescriptions

Effects of metabolic syndrome on prostate specific antigen level, prostate volume and international prostate symptom scores in patients with benign prostatic hyperplasia

Background and objective: Benign prostatic hyperplasia involves the enlargement of prostatic glandular tissue and narrowing of the urethra. It affects bladder storage or emptying. Most of the men with benign prostatic hyperplasia have no symptoms. This study aimed to compare international prostate symptom scores, prostate specific antigen level and prostate volume in patients having benign prostatic hyperplasia with and without metabolic syndrome

Methods: This study involved 85 patients with benign prostatic hyperplasia who were divided into two groups. The first group included 40 participants who were only suffering from benign prostatic hyperplasia and the second group involved 45 participants who were suffering from both metabolic syndrome and benign prostatic hyperplasia. The division of subjects was performed depending on three abnormal parameters out of five parameters, such as body mass index [BMI >25kg/m2], dyslipidemia [Triglyceride >/=150 mg/dl, High density lipoprotein-C <40 mg/dl], blood pressure [BP >/=130/85 mmHg], fasting plasma glucose [PG >/=110 mg/dl]

Results: Patients with metabolic syndrome at diagnosis appears to have significantly higher levels of prostate specific antigen comparing with patients without metabolic syndrome, 3.9+/-0.26 and 2.7+/-0.21, respectively. Similarly, patients with metabolic syndrome at diagnosis had significantly higher prostate volume levels [72.69 +/- 2.69 ml] comparing to patients without metabolic syndrome [46 +/- 2.44 ml]. Patients with metabolic syndrome at diagnosis showed considerable higher international prostate symptom scores level [23.62 +/- 0.62] compared to patients without metabolic syndrome [18.87 +/- 0.327]

Conclusions: benign prostatic hyperplasia patients having metabolic syndrome have significantly higher values of prostate specific antigen levels, prostate volume and international prostate symptom scores compared to benign prostate hyperplasia patients without metabolic syndrome

Classification, clinical features, and genetics of neural tube defects

Neural tube defects [NTDs] constitute a major health burden [0.5-2/1000 pregnancies worldwide], and remain a preventable cause of still birth, neonatal, and infant death, or significant lifelong handicaps. The malformations result from failure of the neural folds to fuse in the midline, and form the neural tube between the third and the fourth week of embryonic development. This review article discusses their classification, clinical features, and genetics. Most NTDs are sporadic and both genetic, and non- genetic environmental factors are involved in its etiology. Consanguinity was suggested to contribute to the high incidence of NTDs in several countries, including Saudi Arabia. Syndromes, often associated with chromosomal anomalies, account for >10% of all NTDs; but a higher proportion [20%] has been documented in Saudi Arabia. Genetic predisposition constitutes the major underlying risk factor, with a strong implication of genes that regulate folate one- carbon metabolism and planar cell polarity.

Epidemiology, prenatal management, and prevention of neural tube defects

This review article discusses the epidemiology, risk factors, prenatal screening, diagnosis, prevention potentials, and epidemiologic impact of neural tube defects [NTDs]. The average incidence of NTDs is 1/1000 births, with a marked geographic variation. In the developed countries, the incidence of NTDs has fallen over recent decades. However, it still remains high in the less-developed countries in Latin America, Africa, the Middle East, Asia, and the Far East [>1 to 11/1000 births]. Recognized NTDs risks include maternal diabetes, obesity, lower socioeconomic status, hyperthermia, and exposure to certain teratogens during the periconceptional period. Periconceptional folic acid supplementation decreased the prevalence of NTDs by 50-70%, and an obligatory folic acid fortification of food was adopted in several countries to reach women with unplanned pregnancies and those facing social deprivation. Prevention of NTDs can be accelerated if more, especially low income countries, adopted fortification of the staple food in their communities.

Epidemiology of neural tube defects

To find the prevalence of neural tube defects [NTDs], and compare the findings with local and international data, and highlight the important role of folic acid supplementation and flour fortification with folic acid in preventing NTDs. This is a retrospective study of data retrieved from the medical records of live newborn infants admitted to the Neonatal Intensive Care Unit [NICU], Security Forces Hospital [SFH], Riyadh, Saudi Arabia with NTDs spanning 14 years [1996-2009]. All pregnant women on their first antenatal visit to the primary care clinic were prescribed folic acid 0.5 mg daily, or 5 mg if there is a family history of NTD. The pre-fortification prevalence is compared to post-fortification, before and after excluding syndromic, genetic, and chromosomal causes. The results were compared with reports from other parts of Saudi Arabia and internationally, through a literature search using MEDLINE. The prevalence of NTDs during the period was 1.2 per 1000 live births. The pre-fortification of flour with folic acid prevalence was 1.46 per 1000 live births. The post-fortification prevalence was 1.05 [p=0.103]. After excluding syndromic, genetic, and chromosomal causes from calculation of the prevalence, there was a significant reduction in the prevalence, from 1.46 to 0.81 per 1000 live births [p=0.0088]. Syndromic, genetic, and chromosomal causes were identified in 20 cases [19.4%]. Only 2% of mothers received preconception folic acid, and only 10% of them received it during the first 4 weeks of gestation. Conclusion: Despite the implementation of fortification of flour with folic acid since 2001, the prevalence of NTDs in the Kingdom of Saudi Arabia is still high. This is due to the impact of genetic, syndromic, and chromosomal causes of NTD not preventable by folic acid. Other factors like unplanned pregnancy and lack of awareness of the role of folic acid in preventing nonsyndromic causes, play a significant role.

Sirenomelia and severe caudal regression syndrome

To describe cases of sirenomelia and severe caudal regression syndrome [CRS], to report the prevalence of sirenomelia, and compare our findings with the literature. Retrospective data was retrieved from the medical records of infants with the diagnosis of sirenomelia and CRS and their mothers from 1989 to 2010 [22 years] at the Security Forces Hospital, Riyadh, Saudi Arabia. A perinatologist, neonatologist, pediatric neurologist, and radiologist ascertained the diagnoses. The cases were identified as part of a study of neural tube defects during that period. A literature search was conducted using MEDLINE. During the 22-year study period, the total number of deliveries was 124,933 out of whom, 4 patients with sirenomelia, and 2 patients with severe forms of CRS were identified. All the patients with sirenomelia had single umbilical artery, and none were the infant of a diabetic mother. One patient was a twin, and another was one of triplets. The 2 patients with CRS were sisters, their mother suffered from type II diabetes mellitus and morbid obesity on insulin, and neither of them had a single umbilical artery. Other associated anomalies with sirenomelia included an absent radius, thumb, and index finger in one patient, Potter's syndrome, abnormal ribs, microphthalmia, congenital heart disease, hypoplastic lungs, and diaphragmatic hernia. The prevalence of sirenomelia [3.2 per 100,000] is high compared with the international prevalence of one per 100,000. Both cases of CRS were infants of type II diabetic mother with poor control, supporting the strong correlation of CRS and maternal diabetes.

Split cord malformation associated with spinal open neural tube defect

To illustrate the clinical and radiological findings of split cord malformation [SCM] in patients with spinal open neural tube defect [SONTD], and report the outcome of their treatment. A retrospective study of the clinical and radiological findings of 11 patients diagnosed with SCM, identified among 83 patients with SONTD at King Khalid University Hospital, in Riyadh, Saudi Arabia between 1995 and 2010. There were 6 girls and 5 boys; their age ranged from less than a year to 9 years [mean 4.2 years]. Six patients had type I SCM, and 5 patients type II SCM. The CT and MRI imaging showed characteristic bony, cartilaginous, or fibrous septum, and other SONTD-associated anomalies. Seven patients were graded A and B according to the Frankel grading score, and none of them required surgery, while worsening neurology led to surgical intervention in 3 patients, with clinical improvement after surgery, and one patient that underwent cord untethering remained stable. Split cord malformation is not uncommon among patients with SONTD. It tends to involve mainly the lumbar spine, and female predominance is more remarkable in type I. Neurological manifestations of SCM may be superimposed with SONTD. Surgery is effective for symptomatic patients, and not indicated in the severely disabled.

Genetic, chromosomal, and syndromic causes of neural tube defects

To ascertain the incidence, and describe the various forms of neural tube defects [NTDs] due to genetic, chromosomal, and syndromic causes. We carried out a retrospective analysis of data retrieved from the medical records of newborn infants admitted to the Neonatal Intensive Care Unit with NTDs and their mothers spanning 14 years [1996-2009] at the Security Forces Hospital, Riyadh, Saudi Arabia. The cases were ascertained by a perinatologist, neonatologist, geneticist, radiologist, and neurologist. The literature was reviewed via a MEDLINE search. Only liveborn babies were included. Permission from the Educational Committee at the Security Forces Hospital was obtained prior to the collection of data. Out of 103 infants with NTDs admitted during this period, 20 [19.4%] were found to have an underlying genetic syndromic, chromosomal and/or other anomalies. There were 5 cases of Meckel-Gruber syndrome, 2 Joubert syndrome, one Waardenburg syndrome, one Walker-Warburg syndrome, 2 chromosomal disorders, 2 caudal regression, one amniotic band disruption sequence, one associated with omphalocele, one with diaphragmatic hernia, and 4 with multiple congenital anomalies. There is a high rate of underlying genetic syndromic and/or chromosomal causes of NTDs in the Saudi Arabian population due to the high consanguinity rate. Identification of such association can lead to more accurate provisions of genetic counseling to the family including preimplantation genetic diagnosis or early termination of pregnancies associated with lethal conditions.

Agenesis of the corpus callosum associated with spinal open neural tube defect

To ascertain the incidence and clinical implications of agenesis of the corpus callosum [ACC] in spinal open neural tube defects [SONTD]. All cases of SONTD registered at the Spina Bifida Clinic in King Khalid University Hospital, Riyadh, Saudi Arabia between 1995 and 2010 were retrospectively reviewed, and mid-sagittal MRI of the corpus callosum [CC] area was analyzed in each case. Neurodevelopmental outcome was classified as poor in children with seizures, severe neurodevelopmental impairment, or death. Thirty-eight patients [45.8%] with ACC were identified among 83 cases with SONTD. Patients' age ranged between one and 16 years. Total ACC was found in 10 patients, partial ACC in 25, and in 3 patients, the CC was hypoplastic. Active hydrocephalus was an associated finding in 9 out of 10 patients with total ACC, 22 out of 25 with partial ACC, and in all patients with hypoplasia of the CC. Thirteen patients [34.2%] had normal intellectual function, whereas 24 patients presented with learning disability, epilepsy, or poor intellectual function; and one patient died of respiratory failure. Agenesis of the corpus callosum is found in a significant portion of patients with SONTD. When associated with hydrocephalus, its presence affects neuro-developmental outcome.

Vitamin C administration reduces side effect of Penicillin and Streptomycin on liver cells in Guinea pigs

This study aims at investigating the ability of Vitamin C as antioxidant to reduce the side effect of Penicillin and Streptomycin on function and tissue of liver in guinea pig. A total of fiftyfive adult male guinea pigs weighing 800-900g were divided into six groups, and the period of experiment was 30 days. Group I served as control, group 2 was administrated orally with Vitamin C 100 mg/kg, group 3 was intraperitoneally [i.p.] injected with penicillin 50000 IU/kg, group 4, in addition to Penicillin [50000IU/kg], was orally administrated with Vitamin C 100 mg/kg, group 5 was [i.p.] injected with streptomycin 50 mg/kg, and group 6, in addition to streptomycin [50 mg/kg], was orally administrated with Vitamin C 100 mg/kg. The results showed a significant increase in the levels of AST, ALT and ALP, and a significant decrease in the levels of total protein and albumin, with histopathological changes in Penicillin and Streptomycin treated guinea pigs when compared to the control. Administration of vitamin C to penicillin and streptomycin treated groups produced significant [P<0.01] reduction in AST, ALT and ALP and an increase in total protein and albumin levels. Administration of vitamin C also decreased these histopathological changes in hepatocytes appearance which was more or less similar to control group, as well as its function. The present results indicate that Vitamin C may play an important role as Cytoprotective and pave the way for further studies on the possible use of Vitamin C.

Shear bond strength of resin composite to rotary and Er:YAG laser-prepared enamel

The aim of this study was to compare enamel shear bond strength to resin composite following preparation with a carbide bur, fine diamond bur, or erbium doped, yttrium-aluminium-garnet [Er:YAG] laser. Forty-eight human anterior teeth, randomly assigned to each preparation group, were studied. Each tooth was mounted in self-curing acrylic resin with the desirable flat facial surface exposed and was randomly assigned to 3 groups according to surface preparation: Er:YAG laser irradiation, carbide bur, or fine-grit diamond bur. A polypropylene cylinder was fixed to the prepared surface, which was demarcated for the area to be bonded with the single bonding system. Restorative composite was then incrementallyinserted into the tubing lumens. The teeth were shear tested to failure at a crosshead speed of 1.0mm/minute. One-way ANOVA and the Tukey test were used for analysis. The mean bond strength values were as follows: fine diamond bur, 23.88MPa; carbide bur, 13.28 MPa; and Er:YAG laser, 12.61 MPa. Different enamel preparation methods affect the shear bond strength between enamel and resin composite

Gum Arabic a superb anti-diarrheal agent

Diarrhoea is the second most common cause of death in young children, after pneumonia.Gum Arabic [GA] is a soluble fibre with moderate emulsifying properties that may result in greater accessibility of electrolytes and associated water to the microvillus membrane. Additional work indicated that GA enhanced absorption of the solutes transported by diffusion and does not act via sodium dependent mechanisms. The objective of this study was to evaluate the effect of Sweet fibre [gum Arabic preparation] as an additive to WHO-ORS in the management of acute diarrhoea in children. An interventional randomized controlled hospital based clinical trial was performed in OPEH [March to August 2011]. One hundred and eighty children presenting with acute none bloody diarrhoea in the absence of severe systemic illnesses were enrolled in the study. These children were divided randomly into two equal groups [study group1 and control group2], their ages ranged between six and 60 months. The control group received the conventional treatment of diarrhoea according to WHO recommendations and the other group received in addition gum Arabic solution [sweet fibre], 5-10 mg until recovery and continued with 5 mg thereafter. Data were analysed using the SPSS. In the group of children who received gum Arabic; diarrhoea stopped within 24 hours in 90% and 80% were discharged after one day. All of them were improved and discharged within first five days of admission. None of them went into severe dehydration or shock. Only three children developed electrolyte imbalance. The weight at the end of the study increased in 47.8% and decreased in only 5.5%. Sixty one children were followed after 6 weeks only two of them [3.3%] had recurrence of diarrhoea. In the control group diarrhoea stopped within 24 hours in 38.9% and 30% were discharged after one day.10% did not recover during the first five days of admission. Electrolytes imbalance developed in 23.3%, two children developed severe dehydration and one became shocked. The weight decreased in 35.6% and increased in 15.6%. Sixty seven children were followed, 13 [19.4%] of them developed diarrhoea again. Sweet fibre as an additive to WHO-ORS reduces the duration of diarrhoea and hospital stay. It decreases diarrhoea complications and facilitates regaining weight. It has a prebiotic effect in prevention of diarrhoea. All these indicate its potential as a new antidiarrheal therapy for acute diarrhoea in children

frequency of some deramatoses related to increase solar radiation exposure in Sulaimania city

Various skin disorders are related to increase solar radiation exposure. These diseases mainly increase in spring and summer months among general population due to an increase to sun light exposure and an increase intensity of uhravaiolet radiation [UVR]. This study was done to evaluate different skin diseases related to study the frequency of the skin diseases related to increase exposure to UV light in Sulaimania city. This is a selective prospective study; the data collected during the period of the January 2006 to September 2007 in Dermatology Department in Consulting Clinic in Sulaimania city, 391 cases were collected in both sexes whose ages ranged between 5 and 73 years with a mean age of 39 years. Full history and thorough physical examination was done for all patients. Three hundred ninety one patients were included in this study; they were 190 [4 8.6%] males and 201 [51.4%] females, there ages ranged between 5-73 years with a mean age of 39 years. Sunburn 116 [29.7%] patients was the commonest condition seen, acne like eruption 84 [21 .4%] patients, drug photosensitivity: 74 [18.9%] patients, Polymorphous light eruption: 32 [8.1%] patients, Chronic actinic dermatitis: 24 [6.1%] patients, Lichenoid dermatitis: 21 [5.3%] patients, Actinic prurigo like polymorphic light eruption 18 [4.6%] patients, Lichen planus actinicus: 15 [3.9%] patients, Solar urticaria: 5 [1.2%] patients, Porokeratoses: 2 [0.6%] patients, The number of the eases variable during the months from no cases in January and February to the highest numbers during the summer months with a top [149] patients, in August. To best of our knowledge this is first study done about UVR exposure in Sulaimania city. There are various dermatoses related to increase UVR exposure, as the UV index increases, the number of eases increases. The highest number of eases occurs in summer [especially in July and August], because in summer the UV index reaches its higher levels and the outdoor activities increase with inadequate protective measures in Sulaimania without regular used of sunscreen. We recommend strict use of sunscreen for males and females especially summer times and avoid going out in specific times of the day especially in summer. We recommend future studies about tumors, photo aging, DNA repair-defective disorders and dermatoses aggravated by solar exposure like porphyria, SLE, pellagra, rosacea

Role of selected simple non-invasive laboratory investigations in assessing functional abdominal pain in children aged 5-15 years in Khartoum, Sudan

To determine simple laboratory test in children with functional abdominal pain, to compare this test in those with functional abdominal pain in normal children and to try to search for its cause if any, and to determine the symptoms and signs of the disease. This study was carried out over a period of 3 years, from March 2007 to February 2010 at Gaffar Ibn Auf Specialized Hospital for Children, Khartoum, Sudan. The study was conducted to determine role of simple investigations for functional abdominal pain [FAP] in a group of 35 children with abdominal pain and compared it to the control group [42 children] with an age range of 4-15 years. The results showed no parasitic, no urinary track infection, no Helicobacter pylori infection association with functional abdominal pain. However, gender, socioeconomic status, weight >50th centile had a significant association with functional abdominal pain. Functional abdominal pain is very confusing and puzzling condition to doctors, parents, and patients. Establishment of centers for medical education regarding this cause of abdominal pain is needed

Metastatic signet ring cell adenocarcinoma of proximal femur with uncertain primary site

Although bone metastases can be found commonly in some malignant tumours, diagnosing a primary malignancy site is not a usual event. Secondary signet ring cell carcinoma of the bone is a very rare tumour. We present a case with pure metastatlc signet ring cell carcinoma of the bone, with an uncertain primary site. A 48-year old man was admitted with Rt thigh swelling and inability to walk. One of first diagnostic effort performed was histopathological examination that revealed a metastatic signet ring cell carcinoma, compressing the regional lymphatics. To our knowledge, in Sudan literature, we believe that this case is the first report of metastatic signet ring cell carcinoma of the proximal femur. Because of the very short survival of many patients, all investigational procedures should be judged in view of their rationality, and should be focused on treatable primary tumours

Helicobacter pylori infection in developing countries: the burden for how long?

Approximately 50% [over 3 billion] of the world populations are known to be infected with Helicobacter pylori, mainly in the developing countries. Among those, hundreds of millions of people develop peptic ulceration during their lifetime and still tens of millions might progress to gastric cancer. Possible modes of H. pylori transmission generally described are through direct contact between family members and also through contaminated water and food. Because the high prevalence of infection occurs mainly in developing countries and because the test-and-treat strategy puts a huge economic burden on many of these countries, it is time to take an immediate action toward this bacterial infection and adopt a strategy to prevent it. To address this issue, an updated prevalence of infection, modes of transmission, economics of infection and preventative measures to block the infection process have been discussed

Esophageal candidiasis: An endoscopic and histopathologic study

To determine the frequency of endoscopic esophageal candidiasis and to compare the results with histopathological findings while assessing the relationship between positive oral swabs and stool examinations for Candida and esophageal candidiasis, a study was conducted on 778 patients in Iraq-Baghdad /Alyarmuk Teaching Hospital, Department of Medicine, from January 1999 to December 2000. The major presenting symptom was hematamesis. During upper GI endoscopy 22 [2.8%] had lesions suggestive of esophageal candidiasis but this could be confirmed histopathologically in only fourteen. Oral candidiasis was found in 10 of the 22 patients [45.4%]; stool examinations for Monilia were positive in only two [9%] who also gave positive oral swabs. Twenty control patients gave negative oral swabs and only three [15%] positive stools

[Allergic reaction of goats and cows milk proteins]

Systemic anaphylaxis test in mouse showed that the visual effect of injection of cow casein, whey, casein fraction and bovine beta-lactoglobulin was strong. Similar results were found when goat casein, Kappa-casein and beta-casein were injected. The visual effect of injection of beta-lactoglobulin and alpha[s],-casein was low. No response was found when bovine and goat alpha-Lactalbumin was injected in animals. Passive cutaneous anaphylaxis test in mouse showed that the reaction area of cow casein injection was 0.63 cm[2] in comparison with 0.19 cm[2] for goat casein. The reaction of cow beta-lactoglobulin injection was 0.12 cm[2], while no reaction was occurred when goat beta-lactoglobulin, goat and cow alpha-lactalbumin were injected. The percentage of degranulation of mast cells when treated with cow raw milk, casein, whey, beta-lactoglobulin and alpha-lactalbumin were 32.11, 100, 41.80, 90.01 and 12.73% respectively, In comparison with 14.33, 80.19, 34.73, 39.57 and 10.86% respectively for the same proteins in goat milk