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Volume No. 1 2011-10-08 18
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Volume No. 8 2013-01-01 12
Volume No. 9 2013-03-01 8
Volume No. 10 2013-06-01 10
Volume No. 11 2013-08-01 9
Volume No. 12 2013-11-01 10
Volume No. 13 2014-03-01 9
Volume No. 14 2014-06-01 6
Volume No. 15 2014-09-01 7
Volume No. 16 2016-04-01 8
Volume No. 17 2016-05-01 5
Volume No. 18 2016-06-01 5
Volume No. 19 2017-02-01 7
Volume No. 20 2017-03-01 8

Gastric Outlet obstruction due to retained surgical swab(gossypiboma) after open cholecystectomy: a case report

Prof.Tarig Abbas, MD Surgery, department of surgery, Alneelain faculty of medicine,Dr Alsagad Eltaieb, MD Surgery, department of surgery, Alneelain faculty of medicine,  Dr Ahmed Abdurrahman, MD Surgery, algezera faculty of medicine

A surgical compress retained in the abdominal cavity following surgery is a serious problem. Here, we describe a 48-year-old woman that had epigastric fullness, pain, nausea, and vomiting after eating. She had an open cholecystectomy at another medical center 2 months previously. The physical examination revealed nothing. OGD showed a foreign body material that completely obstructing the pylorus. Therefore, a laparotomy was performed. A surgical compress was removed at enterotomy and the final diagnosis was gossypiboma. Here, we present a case of transgastric gossypiboma after a splenectomy 4 years previously

Introduction:

Surgical mop retained in the abdominal cavity following surgery is a serious but avoidable complication. Synonyms are textiloma and cottonoid [1]. Fortunately, cases where instruments or sponges are left behind following a surgical procedure are uncommon, although they are potentially dangerous medical errors [2, 3]. The literature estimates that a foreign body is retained after intra-abdominal surgery in 1:1,000 to 1:1,500 cases [2,3]. Here, we present a case of transgastric gossypiboma after a splenectomy 4 years previously. The condition may manifest either as an exudative inflammatory reaction with formation of abscess, or aseptically with a fibrotic reaction developing into a mass. Intraluminal migration is relatively rare[4]. Here, we present a case of transgastric gossypiboma causing gastric outlet after an open cholecystectomy 2 months previously

Case report:

A 48-year-old woman had epigastric fullness, pain, nausea, and vomiting after eating. She had open cholecystectomy for symptomatic gallstones 2 months prior to presentation. She realized a short smooth postoperative course after which she began having intermittent symptoms of gastrointestinal reflux and regurgitation, especially when supine. She had to stop eating solid food because it exacerbated her symptoms and also caused abdominal pain, epigastric fullness, and vomiting. Vomiting was worse 1 hour after meal and the vomitus contained undigested food. For the past week she has been unable to tolerate any intake except sports drinks. Her bowel movements are normal. She has no fever, chills, or night sweats.Her medical history is positive for migraine headache. There is no alcohol, tobacco, or substance abuse, and no significant family history of disease.Results of physical examination were unremarkable; vital signs were normal. There was no lymph node enlargement. There was no mass or succussion splash in her abdomen. Routine laboratory studies revealed normal values of CBC, RFT, electrolytes and LFT.OGD showed a foreign body material that

completely obstructing the pylorus.And the diagnosis of gastric outlet Obstruction made

Expression of E-Cadherin and H.pylori in Sudanese patients with gastric adenocarcinoma and gastrointestinal stromal tumors.

Haitham Awad, Nada Salih, Elsadig A. Adam, Amanda Gamal and Mona Ellaithi

Introduction: E-cadherin (epithelial-cadherin), is a trans-membrane glycoprotein and is down regulated in gastric cancer. H. pylori (Helicobacter pylori) infection is associated with down-regulation of E-cadherin at the early stage of gastric cancer development. Testing E-cadherin and H.pylori expression can provide potential clinical applications for diagnosis, prognosis, and therapeutic targets in gastric cancer. The role of E-cadherins and H.pylori in the progression of gastric cancer and gastrointestinal stromal carcinoma has never been studied in Sudanese samples before.  This study aimed to assess the effect of H. pylori infection and E-cadherin expression and their co-expression in gastric mucosa.

Materials and Methods: Fifty consecutive paraffin tissue blocks from patients diagnosed with gastric cancer (GCs) and gastrointestinal stromal carcinomas GISTs were enrolled to assess E-cadherin and H.pylori expression using immunohistochemistry biomarkers. The patients median age was 60 and mean age was 55.08. P-value was calculated using Chi- squire test (P value <0.05 is significant).

Results: There was 33 (66%) samples from males and 17 (34%) from females. Thirty five (71%) were diagnosed with adenocarcinoma of gastrointestinal tract (GCs) and 15 (29%) were Gastro Intestinal Stromal Tumor (GISTs). Out of the 50 samples; 4 (8%) were diagnosed with well differential adenocarcinoma, 18 (36%) diagnosed with moderately differential adenocarcinoma, 13 (27%) diagnosed with poorly differentiated adenocarcinoma and 15 (29%) were diagnosed with gastrointestinal stromal tumor (GISTs). Expression of H.pylori were detected in 8 (16%) of GCs while in 42 (84%) of the samples H.pylori protein were not expressed. E-cadherin, was expressed in 18 (36%) while in 32 (64%) E-cadherin was unexpressed. Histological differentiation of GCs and GISTs showed significant statistical association (P=0.02) with E-cadherin under-expression. H.pylori has significant statistical association with histological differentiation of GCs (P=0.01) especially moderately differentiated and poorly differentiated adenocarcinoma, however, H.pylori expression was not detected in GISTs and well differentiated adenocarcinoma cases. Moreover H.pylori and E-cadherin co-expression showed insignificant association (P= 0.391) with neither GCs, nor with GISTs.

Discussion: Progression of gastric adenocarcinomas and GISTs is mainly dependant on under-expression of E-cadherin. H.pylori might play a role in GCs development, but it does not have a role in GISTs development. Our findings showed that E-cadherin can be used as biomarker for detection of GCs and GISTs in Sudanese patients.
Keywords: Gastointestinal adenocarcinoma, gastrointestinal stromal carcinoma, Gastric cancer in Sudan, E-cadherin expression, H. pylori.

Evaluation of data accuracy of Health Information System at the Locality level - Khartoum State ,2011-2012

Dr. Wiam Bushra Mohamed Mustafa, Dr. Mustafa Khidir Mustafa Elnimeiri

Background:

Introduction Health Information System is the system that integrates data collection, processing, reporting and use of the information necessary for improving health services. It’s actually a crucial determinant for health planners to implement and distribute health services in balance equitable way in the society
The overall aim of this study is to investigate the quality of health information system in Khartoum State at different administrative levels during 2011-2012.

METHODOLOGY:

The study was a descriptive cross sectional health facility based study, characterized by two stage cluster sample. It was limited to three randomly selected localities namely, Khartoum, Omdurman and Sharg Elneel. The sample size of health centers was 93 health centers. The health centers represented three categories namely: governmental health centers (42), non-governmental organizations centers (46) and only five private centers. Direct Interviews were conducted with (93) medical directors and (93) statistical technicians at the health centers through pre-tested standardized administered questionnaire.
In-depth interviews were carried out with the mangers and statistical technicians at the health team, locality and State Ministry of Health levels. A standard checklist was used to review the statistical monthly reports and the infrastructures of the statistical units at the health centers. The data was analyzed by using SPSS version 11, and chi-square test was used to find correlation. P value < 0.05 is considered significant.

RESULTS:

The study revealed that the statistical monthly reports of the year 2010 were not up to the required standard of accuracy. The percentage of statisticians using tally tables at the governmental centers was (21.4%) while in NGOs centers, it was (37%) and (40%) at the private centers. This study showed that there was an evident accuracy of the information of the statistical monthly report of the year 2010, regarding the diseases reported in outpatient clinic of the health centers.

CONCLUSION:

The study concluded that the health information system was inadequately functioning at the locality level in Khartoum State. There were many loopholes and negative aspects that need to be managed, mainly the inaccuracy of the statistical monthly report.

Sudan National Health Information System: Assessment of Resources at Federal Level-2014

Amel El Amin Mohammed El-Nour, M. K. Alnemiry, M. Rabie M. Hassan, Amal M.O. Abbas, M.Slah

Background: Health information system (HIS) is an integral part of the national health system and an important  tool  of  management  and  a  key  input  for  evidence based decision making. Improvement in health information system cannot be achieved unless there are sound policies, legislations and regulations to govern its function.  Attention to capacity building and emerging technologies is also essential. This paper aims to investigate the health information resources at the national level; it focus on the information policies, human resources and communication infrastructures.

Methods: This was a descriptive cross sectional study covering the Federal Ministry of Health (FMOH) directorates. Desk review of relevant government documents was carried out using a standard checklist for existence, endorsement and implementation. A pre-tested questionnaire was used and in-depth interviews were conducted. Collected data was analyzed using Statistical Package for Social Sciences (SPSS) version 20 and the evaluation matrix.

Results: The HIS strategic plan of 2012-2016 was found to be endorsed and implementation moving according to plan. HIS units were available in 89.5% of the directorates .Assessment of infrastructure for HIS showed the availability of furnished offices to be just 63.2% with 15.8% having a good working environment. Federal information units suffer from lack of statisticians and information technicians and a serious shortage of demographers and only 57% of the workforce received the basic statistical training.

Conclusion: The system has no written regulations to ensure the perfect functioning of HIS and the integrity of national statistical services. Federal unit have shortage in demographer and statisticians. Continuous and refreshing training program are not adequate at all, little attention is given to systematic training on ICD-10 usage. The level of using computers for information analysis is good.

Status of serum magnesium in Sudanese patients with cardiac syndrome X

Nasir Abdelrafie Hamad, Hamdan Zaki Hamdan, ImadFadlElmula

Background: Cardiac syndrome X (angina chest pain, positive stress - ECG, and normal coronary angiogram) has serious medical complications. Magnesium may be an important factor associated with the disease. The present study aimed to examine the association between serum magnesium and cardiac syndrome X (CSX) in Sudanese patients.

Materials and Methods: A total of 50 patients with CSX and their matching control were enrolled in this study, 4 ml of venous blood were collected and placed in plain containers, centrifuged and used for determination of serum magnesium. Magnesium quantified by using a calmagite method. Data were entered to the computer and analysed by using SPSS.

Results: Median (75th -25th quartile) of the serum magnesium showed no significant difference between the patients with CSX and their well-matched control [2.4(1.9-2.8) vs. 2.5 (1.9-3.2) mg/dl;P= 0.150]. Direct correlation was observed between serum magnesium and urea [r= 0.214;P=0.032].

Conclusion: serum magnesium was not associated with cardiac syndrome X in this setting.