High malignancy rate in the absence of viral prophylaxis after kidney transplantation in Sudan.

BACKGROUND: Kidney transplantation in Sudan is funded by the government. Cytomegalovirus prophylaxis is provided for patients who receive biological induction or have recipient-negative donor-positive cytomegalovirus serology. Doctor Selma Center for Kidney Diseases joined the national kidney transplant program in May 2019. Since then, we observed the frequent occurrence of cancer in patients who received modest immunosuppression without viral prophylaxis. METHODS: We retrospectively divided kidney transplant recipients between 2019 and 2021 into two groups according to cytomegalovirus prophylaxis and compared tumor occurrence rates. RESULTS: The first group included 77 patients who did not receive biological induction or cytomegalovirus prophylaxis. The second group included 92 patients who received valganciclovir for 3-6 months. There was no other antiviral treatment except entecavir for chronic hepatitis B virus infection in eight patients. Five patients in the first group developed malignancy. The first patient presented eight months post-transplant with Kaposi sarcoma of the stomach and responded to treatment with sirolimus. The second patient presented nine months post-transplant with cutaneous Kaposi sarcoma and also responded to sirolimus. Two patients presented two and four months post-transplant with aggressive non-cutaneous Kaposi sarcoma that involved the gastrointestinal tract and lymphatic system and died soon afterwards. The fifth patient presented three years post-transplant with non-Hodgkin lymphoma of the duodenum and is currently receiving chemotherapy. Malignancy rate (6.5% vs 0.0%, P = 0.02) and Kaposi sarcoma rate (5.2% vs 0.0%, P = 0.04) were significantly higher in the first group. CONCLUSION: In Sudan, omitting valganciclovir prophylaxis after kidney transplantation was associated with a high rate of virus-induced malignancy.

Skeletal manifestations of hydatid cystic disease in Sudan.

OBJECTIVES: Hydatid bone disease is a zoonotic disease caused mainly by Echinococcus granulosus. Middle Eastern, African, and Mediterranean populations are endemically affected. Hydatid disease of the bone is a rare clinical condition that affects people with a history of animal contact. This research aims to revisit clinical presentations of hydatid cystic disease in the skeletal system. METHODS: Data of all clinical cases with hydatid cystic disease of the skeletal system, presenting between 2011 and 2016 were collected. Clinical manifestations and radiographic and histopathological reports were reviewed, and the patients were followed for a period of 12-22 months. RESULTS: Two patients had hydatid disease in the spine, one in the pelvis, one in the sternum, and one in the femur. The symptoms were suggestive of pathological fractures and bony deformities. Spinal hydatid disease presented with nerve root compression and paraparesis in one case, and radicular pain in the other case. Sternal involvement of hydatid disease presented with pain and deformity, while femoral involvement presented with deformity and fracture. Surgical resection with a pre- and post-surgical anthelminthic course and application of the puncture, aspiration, injection, and aspiration (PAIR) technique were completed in four cases. One case showed residual disease during follow-up visits. CONCLUSIONS: Hydatid cystic disease of the skeletal system is a rare presentation of a common disease. A multidisciplinary approach is optimal for the management of these cases. Long-term follow-up is mandatory to prevent complications and recurrence, and to monitor residual disabilities.

Comparing the use of virtual and conventional light microscopy in practical sessions: Virtual reality in Tabuk University.

Virtual microscopy has an established role in medical practice and education across all medical disciplines. It provides economical and pedagogical advantages, albeit with some shortcomings. We randomly assigned two groups of second-year medical students from the University of Tabuk in KSA to use either conventional light or virtual microscopy practical sessions. The students' perceptions were assessed by written and practical exams. Students in the virtual microscopy group performed better than those in the light microscopy group in both practical and written exams, as reflected by their more-uniform performance and less-scattered grades. The virtual microscopy group had the advantage of optional online off-campus access to study materials, which they spent an average of 2.5 h reviewing. Virtual microscopy is a valid educational tool that can augment conventional microscopy in pathology practical sessions, and its application is convenient for both students and staff.