Patterns of Esophageal Cancer in the National Cancer Institute at the University of Gezira, in Gezira State, Sudan, in 1999-2012.

BACKGROUND: Esophageal cancer (EC) is among the most common malignancies in Eastern Africa, but the occurrence of EC in Sudan has rarely been described in the scientific literature. This paper reports the results of a consecutive case series of all EC patients who visited one of the two public cancer treatment centers in the country in 1999-2012, providing a first description of this disease in a treatment center located in central Sudan. MATERIALS AND METHODS: Clinical and demographic data for all EC patients who visited the Department of Oncology of the National Cancer Institute at the University of Gezira (NCI-UG) from 1999 to the end of 2012 were abstracted and tabulated by sex, tumor type and other characteristics. RESULTS: A total of 448 EC patients visited NCI-UG in 1999-2012, and the annual number of EC cases increased steadily from 1999. Squamous cell carcinoma (SCC) was the predominant EC tumor type (90%), and adenocarcinoma (ADC) was reported in 9.4% of the EC cases. The overall male-to-female ratio for EC was 1:1.8, but the ratio was tumor type-dependent, being 1:2 for SCC and 2:1 for ADC. Only 20% of EC patients reported having ever used tobacco and/or alcohol, and the vast majority of these patients were male. At the time of EC diagnosis, 47.3% of the patients resided in Gezira State. Some EC patients from Gezira State seek out-of-state treatment in the national capital of Khartoum instead of visiting NCI-UG. CONCLUSIONS: The annual number of EC patients visiting NCI-UG has increased in recent years, approximately half of these patients being from Gezira State. Although this consecutive series of EC patients who visited NCI-UG was complete, it did not capture all EC patients from the state. A population- based cancer registry would provide more complete data required to better understand EC patterns and risk factors.

Genetic diversity of Schistosoma haematobium parasite IS NOT associated with severity of disease in an endemic area in Sudan.

BACKGROUND: Over 650 million people globally are at risk of schistosomiasis infection, while more than 200 million people are infected of which the higher disease rates occur in children. Eighty three students between 6-20 years (mean 12.45 ± 3.2) from Quran School for boys in Radwan village, Gezira state were recruited to investigate for the relationship between the genetic diversity of Schistosoma haematobium strains and the severity of the disease. METHOD: Schistosoma haematobium infection was detected by filtration of urine. Ultrasonography was done on each study subject, while PCR technique was used for genotyping via random amplified polymorphic DNA (RAPD) with A01, A02, A12, Y20 and A13 primers. A01 primer gave three different genotypes (A01-1, A01-2 and A01-3). RESULTS: About 54.2% (45/83) were S. haematobium egg positive by urine filtration. On assessment of the upper and lower urinary tract by ultrasound technique, 61.4% (51/83) were positiveand73.3% (60/83) samples were PCR positive. No significant difference was found when comparing the three different genotypes with severity of the disease. CONCLUSION: This study concludes that no association was found between the different genotypes of S.haemtobium and the severity of the disease. Examination of more samples from different areas to identify any possible differences between the parasites genes and disease severity was recommended.

Comparison of slope-intercept with single plasma sample methods in estimating glomerular filtration rate using radionuclides.

To evaluate the accuracy of different single plasma sample methods (SPSM) 99m Tc-DTPA clearances and to test whether the SPSM can replace the dual plasma samples method (DPSM) in the measurement of glomerular filtration rate (GFR), we studied 430 subjects counting renal patients and donors (240 male, 190 female; mean age 43.40 ± 16.30 years). All the subjects underwent dynamic renal scintigraphy after injection of 99m Tc-DTPA; the GFR was calculated by seven SPSMs in addition to DPSM as a reference. Each of the SPSM clearance was compared with the DPSM measurement. There was a high correlation of all the SPSMs and the DPSM. The limits of agreement (95%) were found between the DPSM and all the SPSMs. Overall, the best method among the SPSMs, which is closest to the DPSM, is Fleming's single method as it has a statistically significant low mean difference (bias), low standard error, close mean ± SD to the reference method, good limits of agreement and high correlation co-efficient. This study concludes that, among the SPSMs, Fleming can reflect GFR more accurately than other methods, particularly when the expected serum creatinine is normal.

Ultrasound findings in urinary shistosomaisis infection in school children in the Gezira State Central Sudan.

To evaluate the ultrasound findings of urinary schistosomiasis in Quran school (Khalwas) children in Gezira State Sudan, we studied all the students from two schools. A total of 103 boys were tested for urinary schistosomiasis using the urine filtration method. Schistosoma haematobium (S. haematobium) eggs were counted. Ultrasound was performed for all the positive subjects. Seventy-three (71%) subjects were positive for S. haematobium. The mean age was 11.3 ± 2.9 years. Sixty-six (90.4%) subjects showed urinary tract abnormalities. The findings revealed the following degrees of wall thickening: 53.0% mild, 18.2% moderate and 21.2% severe. Urinary bladder polyp(s) were noted in 43.3% (single) and 40.9% (multiple) of the subjects, and calcification of the bladder wall was observed in 7.6% subjects. Ureteric dilatation was noted in 38/73 (52.0%), while hydronephrosis was detected in 19/73 (26.3%). The vast majority of urinary tract schistomiasis lesions were in the urinary bladder. Ultrasound is a useful tool for identifying the morbidity of S. haematobium in endemic areas.

Thyroglossal Duct Cyst Imaging: Thyroid Scintigraphy Versus Ultrasound

The two imaging modalities most frequently used in thyroglossal duct cyst (TDC) are thyroid scintigraphy and ultrasound. The imaging is mainly used to exclude the cyst from being the only functioning ectopic thyroid tissue. The main objective of this study is to compare the results of scintigraphy and ultrasound. Methods: A total of 56 patients referred to the National Cancer Institute (NCI); University of Gezira in the period from Jan 2007 to Dec 2009 were included in this study; 30 females and 26 males patients; with median of 12.5 years. Data were analyzed by SPSS software. Results: Both thyroid scintigraphy and ultrasound reached the same imaging findings i.e. 53 patients with TDC and 3 patients with ectopic thyroid tissues. The Fisher exact test revealed no significant difference between the two modalities final results (P- value = 1). In addition; Pearson correlation showed complete correlation between the final ultrasound and scintigraphy results (R2 = 1; P-value 0.0001). Furthermore; ultrasound has provided detailed cyst characterization. Conclusion: Both modalities revealed almost identical results. Ultrasound has the additional advantages of being non-ionizing radiation and accurately localizes and characterizes the TDC

The contribution of bone SPECT to the diagnosis of bone metastases in an African population.

BACKGROUND: A number of studies have demonstrated the value of performing spinal SPECT in addition to planar scintigraphy for the diagnosis of bone metastases. This has not been demonstrated in an African population, however, where patients typically present with more advanced disease. AIM: To investigate the contribution of bone SPECT to the diagnosis of bone metastases in an African population. METHODS: In a retrospective survey the studies of all patients with known primary tumours who underwent skeletal scintigraphy for the diagnosis of bone metastases during one calendar year were reviewed. The studies of patients who underwent both planar imaging and SPECT were reinterpreted. Blinded to the SPECT study, the planar studies were graded for probability of metastatic disease using a four-point scale, and the number of spinal lesions was noted. This was repeated with the planar and SPECT studies reviewed together. The interpretation using the planar images alone was compared with that obtained after the addition of SPECT using non-parametric tests. Of a total of 576 patients, 119 (45 men and 74 women) underwent planar and SPECT imaging. RESULTS: The addition of SPECT resulted in a significant change in the interpretation of these studies (P<0.05), and a significantly lower proportion of patients had equivocal gradings (P<0.01). However, the actual numbers of patients affected was relatively small, varying from six to 21, representing about 5-18% of the 119 patients who underwent an additional SPECT. Furthermore, of the total population of 576 patients with known malignancies undergoing bone scintigraphy for bone metastases, the availability of SPECT only resulted in an altered classification in 1-4%. Equivocal planar gradings were far more likely to be altered following the addition of SPECT. The addition of SPECT also resulted in the detection of significantly more spinal lesions (P<0.01). CONCLUSION: In a setting where SPECT is not easily available, planar imaging alone is still adequate in the vast majority of cases.