The diaphysial axis-metacarpal head angle in the management of fractures of the base of the proximal phalanx in children.

The diaphysial axis-metacarpal head angle (DHA) is the angle formed between the longitudinal axis of the diaphysis of the proximal phalanx and central point of the metacarpal head. The normal DHA ranges from 177.1° and 180.0°. There were no significant differences between DHA measurements when taken by the same observer at two separate occasions (P = 0.986) or when taken by two different observers (P = 0.948). We have put an algorithm of management of paediatric phalangeal base fractures incorporating the DHA in the decision making. A prospective study of 92 children (5-14 years) with phalangeal base fractures was conducted. Closed reduction was possible in all but one case in which open reduction and K-wire fixation was required. Closed reduction of the remaining 91 fractures yielded a 'good' reduction in 80 cases (no finger deformity on clinical examination with a post-reduction DHA greater than 177°). After a mean follow-up of 4.2 months, all these 80 cases qualified for an excellent outcome as per Al-Qattan's criteria. The remaining 11 children were considered to have an 'acceptable' reduction (no scissoring, but there was a mild residual lateral deviation of the finger with a DHA angle of 169.4° to 176.2°). At a mean follow-up of 28 months, all these 11 mal-united fractures remodelled with normalization of the DHA; and all 11 children qualified for an excellent outcome as per Al-Qattan's criteria. The current series stresses on the advantages of using DHA in the objective assessment of paediatric phalangeal base fractures and demonstrates the remodelling of fractures with about 10° of lateral deviation.

Vaginal and cervical abnormalities associated with trichomonal infection.

Cytological changes were studied among 393 women, reporting to Samir Health Centre, Khartoum (Sudan), using Papanicolaou staining. Vaginal trichomoniasis was confirmed by wet-mounts and cultural methods. Non-specific inflammatory changes were prominent (17.4%). In 33.5% of parasitised patients, the cervix was found healthy. Cancer of the cervix was not detected in patients investigated.

Evaluation of the laboratory diagnosis of vaginal trichomoniasis in Khartoum.

A total of 403 vaginal discharge specimens were investigated for Trichomonas vaginalis using fresh wet-mounts, culture and Papanicolaou staining. By fresh wet-mounts, 58 specimens (14.4%) were found harbouring the parasite. On culture 67 isolates (16.7%) were identified. Both wet-mount and cultural procedures detected 18.3% positive isolates. Papanicolaou staining detected 40 positive cases (9.9%) from the patients investigated. Two culture media were tried in this study to isolate T. vaginalis, namely Lumsden's medium and Diamond's medium. Their efficacy was found to be 16.9% and 14.8%, respectively.

Vaginal trichomoniasis at a sexually transmitted disease clinic at Khartoum.

At a sexually transmitted disease clinic at Khartoum 613 Sudanese women presenting with vaginal discharge were investigated. Specimens were examined by microscopy and culture. Trichomonas vaginalis infestation was found in 123 patients (20.1%), predominantly in the age groups 16-19 years (27.1%) and 46-65 years (27%). Frequency of trichomonal vaginitis was highest (35.9%) among divorced women. Of the pregnant women investigated, 16.3% were found to harbour the parasite. There was no significant difference in the parity of parasitized and non-parasitized patients.

PIP: This investigation was carried out to evaluate the prevalence of vaginal trichomoniasis in relation to subjects' age, marital status, parity, pregnancy and the intensity of the discharge. The subjects were 613 Sudanese women presenting with vaginal discharge, investigated at a sexually transmitted disease clinic in Khartoum. On the day of examination, a full history was taken, and particular attention was paid to the duration and amount of any vaginal discharge, as well as to past antitrichomonal therapy. 123 (20.1%) of the patients examined were found infested with T. vaginalis. The duration of the vaginal discharge ranged from a few days to 10 years. The discharge in parasitized women was copious in 30 cases (24.2%), moderate in 42.3%, scanty in 26.9% and absent in 6.6% of the cases. In non-parasitized patients, the discharge was copious in 8.1% of cases. The frequency of vaginal trichomoniasis was 20.1% in all patients examined. Trichomonal infestation was predominant in the age groups 16-19 years (27.1%) and 46 years and above (27%), thus confirming reports that trichomonal infestation may occur during the period of greatest sexual activitiy, as well as at older ages. The highest frequency was among divorced women (35.9%), followed by widowed women (29.4%) and may be related to promiscuity and to variety of sexual contacts. 16.3% of the pregnant women investigated were found harboring the parasite; there was no significant difference in the parity of parasitized (81.6%) and non-parasitized patients (82.3%). Association of T. vaginalis with gonorrhea and candidiasis was significant, though this did not modify the symptoms and signs of trichomoniasis. The results suggest that there is no significant difference between whites and dark-skinned peoples.

Seroepidemiological survey of chlamydial genital infections in Khartoum, Sudan.

A total of 494 patients (90 men and 404 women) attending a sexually transmitted diseases (STDs) clinic in Khartoum, Sudan, were studied to assess the prevalence of chlamydial genital infections. Antibodies to Chlamydia trachomatis serotypes D to K were found in four (4.4%) men and 42 (10.4%) women, and 10 (2.5%) women had antibodies to serotypes A to C.

Torulopsis glabrata and Candida albicans in female genital infections in the Sudan.

Four hundred and seventy Sudanese women with vaginal discharge were investigated for yeast-like fungi. High vaginal specimens were cultured and isolates fully identified according to standard mycological techniques. All patients were married and some were pregnant. Of 138 yeast-like fungi identified, Torulopsis glabrata (34.1%) was the commonest followed by Candida albicans (25.4%) and Candid krusei (14.5%). Differing social and economic factors may be responsible for the higher prevalence of T glabrata in the Sudan. Although its pathogenicity is not well established, its association with vulvovaginitis should not be overlooked.