Medico-Legal Aspects of Abortion: Updates of the Literature.

Background: Abortion is an increasingly important issue since it is discussed from multiple points of view including medical, social, religious, and legal aspects. Abortion is an old topic that is continuously discussed from various perspectives including medicine, laws, and society. Abortion is an illegal in general terms, but it can be carried out under certain medical conditions for the interest of pregnant woman, if the pregnancy is threatening her life. Objective: The aim of this article is updates of the literature about medico-legal aspects of the abortion. Methods: This is descriptive study about medico-legal aspects of the abortion based on searching this topic in the scientific literature deposited in on-line databases. Results and Discussion: . At global level, more and more women are opting to terminate their pregnancies for societal reasons. It is estimated that 50 million unborn babies are terminated every year across the globe, causing the lives of 200,000 pregnant women and the agony of millions more people. It is a difficult decision to conduct abortion. In this study, a comprehensive review of the literature was made to discuss abortion from medical, legal, and cultural points of view. In general, abortion was legally discussed because legal aspects involve the various perspectives. Conclusion: From religious points of view, abortion implies ending the life of the fetus. The right of life is to be kept. The international laws do not permit abortion and criminalize the parties involved in its existence unless it is recognized it is crucial to save the life of pregnant woman..

Bouveret Syndrome: A Rare Case and Review of the Literature.

Bouveret syndrome is a subtype of gallstone ileus, wherein a calculus becomes entrapped in the duodenum via a cholecystocolic fistula, leading to gastric outlet obstruction. Due to the non-specific symptoms the patients present with, a diagnosis is reliant on computed tomography (CT), magnetic resonance imaging (MRI) or direct endoscopic visualisation. We report a case of Bouveret syndrome and review current literature, outlining the aetiopathogenesis and management strategies of this condition.

Variations of Arterial Supply of the Liver: C.T. Angiographic Study Among Sudanese Adults

Hepatobiliary surgery through laparoscopic approach is becoming a routine. Knowledge of extrahepatic arterial tree is essential for surgical and imaging procedures. Anatomical complexity is expected since the liver is developed by mergingof lobules with its separate blood supply. This makes a wide range of variations in the pattern of vascular arrangement and so reinforces the need for an accurate understanding of full spectrum of variations. This study aimed to investigate the variations in origin and distribution of extrahepatic arterial supply. Fifty volunteers (32 males and 18 females) aged 20­70 years were randomly recruited from the department of CT scan in Al Amal Hospital, Khartoum North, Sudan. The patients were already candidates for CT angiography with contrast for conditions other than hepatobiliary diseases. The reported data is related to those who accepted to participate in the study. Patients with history of hepatobiliary disease were excluded. 3D views of the scans were treated and the extrahepatic arterial tree was traced in a computer-based software. Key findings suggest that Michel's classification was considered the standard template for description ­ 76% of them showed Michel's type I classification. Types III and V constituted about 2%. About 4% of the cases were represented by types VI and IX. Other types of variations constituted about 12%. To conclude, although type I classification which describes the textbook pattern of hepatic artery distribution was significantly detected among the Sudanese population, other variants were to be considered since they are related to major arteries like aorta and superior mesenteric.

Identification and characterisation of mosquitoes from different locations in Qatar in 2017-2019.

Mosquito-borne infections have considerable consequences for public health. The mere presence of a single case of vector-borne disease (VBD) introduces a risk to the local community particularly when associated with the compatible vector, host, and suitable environmental factors. Presently, there is no well-established vector control and surveillance programme in Qatar; therefore, the likelihood of VBDs spreading is undetermined. As a result, there is a pressing need to address this gap and enable successful management of VBDs. This study presents the results of three consecutive field surveys conducted between 2017 and 2019 with the aim of defining the types and distribution of mosquitoes that are of public health importance in Qatar. The results of the adult mosquito trappings show that the southern house mosquito Culex quinquefasciatus is the most widespread and abundant mosquito species, followed by Cx. perexiguus, both species representing a risk of West Nile virus transmission. All sampling methods show that the malaria vector Anopheles stephensi is widespread including in urbanised areas, suggesting a risk of local malaria transmission. The wetland mosquito Aedes caspius is also widespread, representing a risk of Rift Valley fever virus transmission. The dengue vector Ae. aegypti was not detected and can be considered neither widespread nor abundant, suggesting a minimal risk for local transmission of dengue, chikungunya and Zika viruses. Interestingly, the study detected Culiseta longiareolata for the first time in Qatar. Regular field studies are needed to further address the knowledge gaps in terms of distribution, ecology, and biting habits of different mosquito species currently present in Qatar to accurately assess the risk of mosquito-borne diseases.

TITLE: Identification et caractérisation des moustiques de différents sites du Qatar en 2017­2019. ABSTRACT: Les maladies transmises par les moustiques posent de considérables risques en santé publique. La simple présence d'un cas de maladie à transmission vectorielle (MTV) introduit un risque pour la communauté locale lorsque associé à un vecteur, un hôte et des facteurs environnementaux compatibles. À ce jour il n'y a pas de programme de surveillance et de contrôle des vecteurs bien établi au Qatar, et de ce fait la probabilité de diffusion de MTV est indéterminée. C'est pourquoi il existe un besoin pressant de combler ce vide et de permettre une gestion effective des MTV. Ce travail présente les résultats de trois études de terrain successives conduites entre 2017 et 2019, dans l'objectif de caractériser les moustiques d'importance en santé publique et leur distribution au Qatar. Les résultats des piégeages d'adultes révèlent que le moustique domestique méridional Culex quinquefasciatus est l'espèce la plus répandue et abondante, suivie de Cx. perexiguus, les deux espèces présentant un risque pour la transmission du virus West Nile. L'ensemble des échantillonnages montrent que le vecteur du paludisme Anopheles stephensi est largement répandu y compris dans les zones urbanisées, ce qui suggère un risque de transmission locale du paludisme. Le moustique des zones humides Aedes caspius est également largement répandu, présentant un risque pour la transmission du virus de la fièvre de la Vallée du Rift. Le vecteur de la dengue Ae. aegypti n'a pas été détecté et peut être considéré ni répandu ni abondant, ce qui suggère un risque minimal de transmission locale des virus dengue, chikungunya et Zika. Il est intéressant de noter que cette étude a détecté la présence de Culiseta longiareolata pour la première fois au Qatar. Des études de terrain régulières sont nécessaires pour mieux combler les lacunes de connaissances en termes de distribution, écologie et comportement trophique des différentes espèces de moustiques présentes au Qatar, et d'évaluer plus précisément le risque de maladies transmises par les moustiques.

Recurrent thyrotoxic periodic paralysis with normokalemia in a 36-year-old man: A case report.

Among patients with thyrotoxicosis and proximal muscle weakness, some patients with TPP may present with apparent normokalemia in whom a careful administration of potassium may lead to rapid reversal of muscle weakness.

Brain Metastasis from Breast Cancer: risk factors and radiotherapy perspective from a tertiary Middle Eastern facility.

BACKGROUNDS: Breast cancer represents the second most frequent cause of brain metastases after lung cancer. Previous studies have identified the subgroups of patients with triple-negative and HER2-positive as having an increased risk for the development of brain metastases. We are not aware in Kurdistan - Iraq of any national studies that are in parallel with these findings. PATIENTS AND METHODS: A cross-sectional descriptive study conducted on 57 patients who were known cases of breast cancer with brain metastasis, managed with whole brain radiotherapy at a tertiary radiotherapy institute in two years (January 2015 to December 2016), as a convenient sample. Data were collected from patients' archives and phone calls and then analyzed using SPSS version 23. RESULTS: Younger age at diagnosis and cancers with HER2-positive receptor phenotype are risk factors for brain metastasis. Median survival post-brain metastasis is significantly affected by receptor phenotypes (2 months in triple negative versus 7 months in hormone receptor positive) and performance status (18 months if performance score of 70% and above versus 1.5 months if it is 60% and less). CONCLUSION: Primary breast cancer patients have more risk to develop brain metastases if they are at younger age and HER2-positive and the survival post-brain metastases is dramatically affected by both triple negative receptor phenotype and lower performance score.

Immune-mediated drug-induced liver injury secondary to Omeprazole: A case report.

Omeprazole is a rare cause of DILI with autoimmune hepatitis features and should be considered when seeing patients with acute liver injury. The causative drug should be promptly identified and discontinued to avoid any permanent liver damage.

The Challenge of COVID-19: The Biological Characteristics and Outcomes in a Series of 130 Breast Cancer Patients Operated on During the Pandemic.

Background: The worldwide outbreak of the 2019 novel coronavirus disease (COVID-19) emerged in Wuhan, China close to the end of 2019. We analyse the clinical characteristics and management outcomes of a small group of patients who have been treated in the early stage of the COVID-19 disease, and discuss the impact of the pandemic on the service delivered to breast cancer patients. Material Methods: We analysed a cohort of 130 breast cancer patients who underwent elective surgical procedures during the early period of COVID-19. The patients were operated on in the period from March 16th, 2020 to May 18th, 2020. Results: All the patients were female, with an age range of 33-88 years, with a median age of 57.6 years. Most of the cases were admitted as a day case surgery after passing through a preoperative screening pathway, which was developed gradually. Patients were contacted by phone after their surgery to ensure that they have had no symptoms and were reviewed in person two weeks after the procedure with histology results. Only one patient developed COVID-19 symptoms after surgery and recovered. Conclusions: Early and careful implementation of modified practice policies during emerging situation of viral pandemics will reduce the risk of perioperative complications, reduce the risk of patient to staff to patient transmission and minimize the negative impact of COVID-19 on breast cancer management.

Breast Adenoid Cystic Carcinoma in a patient with Previous Contra-lateral Breast Ductal Carcinoma in-situ: A Case Report.

Breast adenoid cystic carcinoma (BACC) is a rarely encountered malignant breast neoplasm with a favourable outcome, despite its triple-negative receptor status. It is comprising less than 0.1% of all breast cancers. The more usual primary site of the adenoid cystic carcinoma is seen in the salivary glands, however BACC prognosis is better than the one for salivary gland and also than that of other breast invasive carcinoma. BACC also known to have fewer lymph node metastases as well as fewer distant metastases, hereby we present 73 years old female with previous history of breast ductal carcinoma in-situ, then developed contralateral breast adenoid cystic carcinoma.

Posterior Mediastinal Paravertebral Müllerian cyst (cyst of Hattori): literature review.

Mediastinal cysts are typically of bronchogenic, thymic or neurenteric origin, but may also represent oesophageal duplication. Posterior paravertebral mediastinal Müllerian cysts of undetermined pathogenesis are very rare occurrences. The first case of a ciliated cyst arising in the mediastinum, of probable Müllerian origin, was reported by Hattori in 2005, which gave rise to the name cyst of Hatorri (COH) The number of reported cases in literature of a similar nature have since then increased significantly. One of the main concerns about this pathology is the possibility of malignant transformation of the Müllerian tissue. Over the course of this paper we will discuss the pathogenesis, immunohistochemistry and its role in differential diagnosis as well as optimal treatment of such cysts.

Gestational Exposure to Synthetic Steroid Hormones Impaired Sperm Quantity and Quality in Wistar Rats.

This study was designed to investigate the effect of prenatal exposure to synthetic sex steroid on sperm quantity and quality, relative testicular and epididymal weights, and reproductive hormones level in adult Wistar rats. Forty male Wistar rats were divided into two groups: a test group (n = 20) that included mature rats that were born to dams exposed to gestational treatment with hydroxyprogesterone and a control group (n = 20) that included mature rats born to untreated dams. Compared to the control group, the test group showed a significant reduction in the sperm count, viability and motility, relative testicular and epididymal weights together with increased abnormal spermatozoa (p < 0.001). The reproductive hormonal assay revealed significantly lower serum testosterone and higher levels of FSH and LH among the test groups compared to the control (p < 0.05 for all). Prenatal exposure to synthetic progesterone negatively affected sperm production and function, relative testicular and epididymal weights, and reproductive hormone levels.

Reference values (RV), MNS and MTS for morphological characteristics of normal and abnormal human spermatozoon describing Teratozoospermic Index (TZI) & Sperm Deformity Index (SDI) in Sudanese infertile couples using CASA System / Valores de referencia (RV), MNS y MTS para las características morfológicas de espermatozoides humanos normales y anormales que describen el Índice Teratozoospérmico (TZI) y el Índice de Deformidad del Esperma (SDI) en parejas infértiles de Sudán que utilizan el sistema CASA

A scientific determination of fertilization ability of the sperm can be made by motility, viability and morphological examinations that are called as potential fertility criteria. Some previous studies documented only the total morphological defect rates without including the morphologic subjects. As it is recorded in many studies, the success of IUI, ICSI and IVF depends mainly on the quality of the collected semen. 1) Determine and classify the common morphological defects and rates of sperms. 2) Analyze the effect of age on the sperm abnormalities and to assess the impact of environment on changing normal sperm characteristics. 3) Determine the common types of semen abnormalities (Asthenoterato-zoospermia, Asthenozoospermia, Azoopyospermia, Azoospermia, Hypospermia, Oligoasthenoteratozoospermia, Oligoasthenozoopyospermia, Oligoasthenozoospermia and Teratozoospermia). 4) Determine the range of teratozoospermic index (TZI) and sperm deformity index (SDI). A prospective case series study for 566 men of infertile couples who were requesting semen analysis was applied to those came to the ULTRALAB laboratory center main campus and ULTRALAB branch of the Sudan Assisted Reproduction Center (SARC), Khartoum, Sudan. Data collection was done for 20 months from April 1st, 2010 to December 31st, 2011. analysis of semen samples was done using Computer Assisted Semen Analysis (CASA). 1) The study demonstrates that there are differences in normality and abnormality of sperm morphology parameters of sperm between Sudanese population and other studies including WHO standards. 2) SDI and TZI were higher in overall semen as well as in abnormal semen samples. 3) Common semen abnormalities were oligoasthenoteratozoospermia, asthenoteratozoospermia and asthenozoospermia. There are differences in sperm morphology of both normal and abnormal parameters between Sudanese population and other studies including WHO standards.

Se realizó una determinación científica de la capacidad de fertilización de los espermatozoides mediante motilidad, viabilidad y exámenes morfológicos denominados criterios de fertilidad potencial. Algunos estudios previos documentan solamente el total de las tasas de defectos morfológicos sin incluir a los sujetos morfológicos. Como se registra en muchos estudios, el éxito de IUI, ICSI y FIV depende principalmente de la calidad del semen recolectado. Los objetivos de este trabajo fueron: 1) Determinar y clasificar los defectos morfológicos comunes y las tasas de espermatozoides; 2) Analizar el efecto de la edad en las anomalías de los espermatozoides y evaluar el impacto del medio ambiente en el cambio de las características normales de los espermatozoides; 3) Determinar los tipos comunes de anomalías en el semen (astenoterato-zoospermia, astenozoospermia, azoopiepermia, azoospermia, hipospermia, oligoastenoteratozoospermia, oligoastenozoopermia, oligoastenozoospermia y teratozoospermia); 4) Determinar el rango del índice teratozoospérmico (TZI) y el índice de deformidad del esperma (IDE). Se realizó un estudio prospectivo de series de casos en 566 hombres, de parejas infértiles, que solicitaban análisis de semen en laboratorios ULTRALAB y la sucursal de ULTRALAB del Centro de Reproducción Asistida de Sudán (SARC), Jartum, Sudán. La recolección de datos se realizó durante 20 meses, desde el 1 de abril de 2010 hasta el 31 de diciembre de 2011. El análisis de las muestras de semen se realizó mediante el análisis de semen asistido por computadora (CASA). Existen diferencias en la normalidad y anormalidad de los parámetros de la morfología de los espermatozoides entre la población sudanesa y otros estudios, incluidas las normas de la Organización Mundial de la Salud. Los parámetros SDI y TZI fueron más altos en el semen general, así como en muestras de semen anormales. Las anomalías comunes del semen fueron oligoastenatoatoospermia, astenoteratozoospermia y astenozoospermia. Existen diferencias en la morfología de los espermatozoides de los parámetros normales y anormales entre la población sudanesa y otros estudios que incluyen las normas de la Organización Mundial de la Salud.

A retrospective epidemiological study on the incidence of salmonellosis in the State of Qatar during 2004-2012.

BACKGROUND: Salmonella is a food- and water-borne pathogen that can be easily spread in a population, leading to the outbreak of salmonellosis that is caused by ingestion of mixed salads contaminated by the pathogen. Most cases occur in the late spring months and can be seen as single cases, clusters, or episodes. OBJECTIVE: The aim of this study was to describe the incidence and epidemiological characteristics of salmonellosis in the State of Qatar. METHODS: This was a retrospective, descriptive study carried out in laboratory-confirmed cases of salmonellosis during 2004-2012 from all Salmonella surveillance centers. Therapeutic records of patients who were clinically suspected of having Salmonella diseases were analyzed. Initially, cases with typhoid fever were investigated in the laboratory by means of Widal agglutination tests, while non-typhoidal Salmonella diseases were determined based on culture technique. RESULTS: The annual incident of salmonellosis cases were 12.3, 23.0, 30.3, 19.4, 15.3, 18.0, 22.7, 18.5, and 18.1 per 100,000 population in 2006-2011 and 2012, respectively. The number of salmonellosis cases was high among less than 2-year-old females and 3-year-old males. In addition, one-fourth of patients (27.7%) were Qatari when compared to other nationalities. A significant difference in age was found between Qatari (6.08 ± 12.28 years) and non-Qatari (15.04 ± 19.56 years) patients. Of the reported cases, 79.8% included the onset date of the first symptoms. Contact phone numbers were available for 94% of the cases but addresses were available for only 50.4% of cases. The time difference between onset of symptoms and diagnosis was 5.4 ± 5.7 days. The most frequent serotype reported were type b (41.9%), type d (26.9%), and type c1 (12.2%). CONCLUSION: The present surveillance data showed a high incidence of salmonellosis in Qatar that poses a serious public health problem. Special intervention and health awareness programs are required for early screening, detection, and treatment as well as for strengthening the surveillance system of salmonellosis, with special emphasis on the laboratory study of cases.

Concentration of free vascular endothelial growth factor and its soluble receptor, sFlt-1 in the maternal and fetal circulations of normal term pregnancies at high and low altitudes.

OBJECTIVE: Vascular endothelial growth factor (VEGF) is regulated by hypoxia that is essential for placental development. It is antagonized by a soluble form of its receptor (sFlt-1). The purpose of this study was to measure these factors in the maternal and the cord bloods, at low and high altitude. METHODS: Samples were collected from full term births normal pregnant women. Free (unbound) VEGF and sFlt-1 levels were measured in plasma samples from cord and maternal blood for each subject by enzyme-linked immunosorbent assay (ELISA) using commercially available kits from R&D systems, UK (Cat # DVE00 and Cat # SVR100B, respectively). RESULTS: At high altitude, the average maternal free VEGF in pg/ml was significantly (p < 0.001) lower than that of the cord level (71.30 ± 282.14 and 431.35 ± 424.31, respectively). On the other hand, the average maternal sFlt-1 was significantly (p < 0.001) higher than that of the cord level (8205.41 ± 6244.72 and 1811.74 + 3469.30, respectively). At low altitude, the average maternal free VEGF was significantly lower than that of the cord level (0.47 ± 0.89 and 483.44 ± 457.31, respectively, p < 0.001). On the other hand, the average maternal sFlt-1 was significantly higher than that of the cord level (9267.82 ± 6345.68 and 958.66 ± 1359.92, respectively, p < 0.001). There were no significant differences by altitude. CONCLUSION: Secretion of sFlt-1 appears to be polarized, in that concentrations are higher in the maternal compartment than on the fetal side at both high and low altitudes. This may be a normal physiological phenomenon to permit angiogenesis in the placenta and fetus while protecting the mother. Chronic exposure to hypobaric hypoxia at high altitude does not affect these distributions.

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

OBJECTIVE: 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 it cause if any, and to determine the symptoms and signs of the disease. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Characteristics associated with severe pneumonia in under-five children admitted to emergency units of two teaching hospitals in Khartoum, Sudan.

Pneumonia, defined as infection of lung parenchyma, is associated with severe complications especially in the very young and old patients. It is the world's leading cause of childhood mortality. The World Health Organization (WHO) classification and guidelines are commonly used in Sudan in the diagnosis and management of pneumonia patients. A group of 224 patients at Gaafar Ibn Oaf Children's Hospital and Omdurman Children's Hospital were assessed and managed for severe presentation of pneumonia. The data collected showed that most of the patients were of low socioeconomic class families. The vast majority (99%) of patients had chronic exposure to tobacco smoke at home. Female patients (52.7%) were more than males, with 42% of the presenting patients in the less than 12 months age group. Pneumonia is a dangerous childhood menace that is associated with severe presentations. Public health community outreach programs should be put in place to raise awareness. The case fatality rate during the study period was 4%.