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Volume No. 24 2019-06-01 0

Possible association of CAT gene-21A/T on diabetic retinopathy in Sudan

Hamdan Z Hamdan1,2*, Mahgoub Saleem1, 3, Awatif Salah2, Sana E Abdalla2, Maha I Elamin1

Catalase (CAT) is one of the active anti-oxidative enzymes that its deficiency has been related to diabetic retinopathy. The aim of the current study was to determine whether CAT-21 A/T polymorphism is associated with the development of diabetic retinopathy or not among Sudanese patients with type 2 diabetes mellitus.

A case-control study was conducted at Makkah Eye Complex, Khartoum, Sudan. Fifty patients with diabetic retinopathy (cases) and 50 diabetic control were included in this study. The single nucleotide polymorphism (SNP) in the promoter region of CAT gene -21A/T was genotyped using polymerase chain reaction and restriction fragment length polymorphism endonuclease Hinf1 enzyme (PCR-RFLP) in cases and control. 

The TT genotype frequency of the CAT-21A/T was significantly higher in cases compared with control (P=0.043), and showed that a risk effect in diabetic retinopathy patients (OR=2.56, 95% CI=1.01-6.45). While the AA genotype showed a protective consequence (P= 0.011, OR=0.33, 95% CI= 0.13-0.79) in control. The allele frequency of the variant T allele was significantly different in the cases group (P=0.003, OR=2.35, 95% CI=1.33– 4.16).

The TT genotype and T allele frequency of CAT-21A/T polymorphism may be associated with an increased risk of diabetic retinopathy in this setting.

Keywords: Catalase, CAT – 21A/T, Polymorphism, Diabetes, Diabetic Retinopathy, Suda

Pattern and Outcome of Small Bowel Atresia in Khartoum Teaching Hospital

Dr. Amir Abdalla Mohamadain, Dr. ElmutazEltag Sirelkhatim, Dr.  AamirAbdullahi Hamza

Introduction: Small bowelatresia is a common cause of neonatal intestinal obstruction. Duodenal atresia occurs most properly due to failure of recanalization of the foregut during the 8-10 weeks of gestation, while jejuno-ilealatresia is due to intra uterine ischemic insult.Jejuno-ilealatresia is the commonest type of bowel aresia.

Objectives: To describe the site ,clinical presentation, surgical treatment and outcome of bowel atresia.
Patients & Method: This study wasprospective , descriptive , analytic, hospital based study.

Result: Study of 40 patients with small bowel atresia showed that; more than 80% of patients were neonates, males: females’ ratio was 1.4:1. Duodenal atresia was found in 27.5 % while jejunoilealatresia was found in 82.5% (57.5% was jejunal and 15% was ileal). All patients presented with vomiting most of them were bilious. Features of Down syndrome reported in four patients, all of them were duodenal (36%), cardiac anomalies occurred in 18% of duodenal atresia.No reported genitor-urinary anomalies because all the neonates presented late and not investigated for this anomalies . No associated ano-rectal malformations in our series .Malrotation was found in three patients one was duodenal and two were jejunoileal.Prematurity occurred in 20% of patients, low birth weight was found in 45%.

Duodenal atresia was treated by duodenoduodenostomy, duodeno- jejunostomy or duodenotomy for stenosis. While jejunoilealatresia was treated resection and anastomosis in most of the cases, enteroplasty was done in patients with short bowel, one patient treated by stoma because of perforation and peritonitis.

Mortality rate was 32.5% due to multiple causes; cardiac anomalies, jaundice, prematurity and type of atresia were the commonest causes.

Conclusion: In our country lack of neonatal intensive care unit and total parenteral nutrition increases the mortality rate, availability of these things plus pre natal diagnosis will improve the outcome.
Keywords: duodenal atresia, jejunalatresia, ilealatresia.


Imad R Musa,  Gasim I Gasim


 29 years female presented with sudden onset severe abdominal pain, mainly epigastric associated with bouts of bloody stained vomitus. The patient denied history of taking neither non-steroidal anti-inflammatory drugs nor any other substance. The patient was stable at the emergency department with normal physical examination and basic investigations. Hence she was admitted for elective upper gastrointestinal endoscopy. The condition of the patient deteriorated due to marked unexplained massive blood loss. Hence an urgent blood transfusion was commenced and the patient shifted to the intensive care unit for stabilization and close monitoring. Then urgent endoscopy conducted at the intensive care unit showed findings consistent with a severe caustic mucosal injury of the lower oesophagus and the stomach. These findings paved the road for the correct diagnosis and initiation of the proper management. It could be concluded that an urgent endoscopy should be done as earlier as possible in patients who present with unexplained severe upper gastrointestinal bleeding to confirm the diagnosis and initiate a proper management to reduce the severity of acute complications, improve the prognosis and achieve a better outcome. 

Fenugreek Usein Wound Management

Omer Mohammed Ibrahim


Wounds are disabling disorders, affecting people's quality of life.Many studies were done to investigate a novel way of wound management but still are lacking.

Patients and methods:

We are reporting four cases with different types of wounds using Fenugreek dressing. Their ages range from (30-70) years,two of them have concomitant chronic diseases. Verbal and written informed consent taken. Swabs from infected wounds taken to isolate causative microorganisms before and after Fenugreek dressing.


Fenugreek is used locally in Sudan in treating many different diseases.Many studies reported the efficacy of using fenugreek in wound healing acceleration in experimental animals.

In this study there is good response to fenugreek dressing in terms of pain relief, subsidence of edema, clearance of infection, wound contraction and wound healing promotion.

Conclusions and recommendation:

It is clear that fenugreek dressing in our patients has a beneficial effect on wound healing but further study as a clinical trial is needed to investigate fenugreek dressing as a novel treatment in wound healing acceleration.

Variables: wound healing, acceleration, Fenugreek, concomitant chronic diseases, edema subsidence, clearance of infection, wound contraction

The relationship between the smoker age,the age of initiationof smoking and Fagerström Test for nicotine dependence among male Sudanese smokers

Waeel A Aldosh,Omer Elgaili, Abdelrahman M Abukanna, Ahmed H Sulaiman, Hafiz O IbnIdris

Objective:The aim of this study was to determine the relationship between smoker’s age,the age of initiation of smoking and Fagerström Test for nicotine dependence (FTND) among male Sudanese smokers.

Methodology:This is a prospective cross-sectional survey. We enrolled fifty-five adult participants in the study at smoking cessation centerof Alshaab institute of cardio-pulmonary diseases in Khartoum, Sudan in the period from August to December 2015 after taking their informed written consent.Fagerström Test for Nicotine Dependence (FTND) was recorded.

A score of (0-2) was defined as very low, (3-4) as low, (5) as moderate, (6-7) as high and score of (8-10) as very high.

The relationship between the smoker age, the age of initiation of smoking and FTND we analyzed using the International Business Machines statistical package for social science (IBM-SPSS version 22).

Results:All participantswere males (n=55). The mean age at initiation of regular smoking was 20 years. Around 31% of the participants started smoking before 11years, 36.4% between (11-20 years) and21.8 % between (21-30 years) whileonly 11% started smoking after 30 years. According to FTND,we found very high nicotine dependence in 30.9%, high in 23.6%, moderate in 7.3%, low in 14.5% and very lowin 23.6% of the participants.All elderly participants had high and very high nicotine dependence.

Conclusion:Initiating smoking at an early agewas associated with low nicotine dependence and the older participant had significantly high nicotine dependence (P values= 0.001 &0.002 respectively).

Keywords;Age, smoking, nicotine dependence and Fagerström Test.

Elevated levels of Plasma Procoagulant  Microvesicles in Saudi Children in Steady-state Sickle cell Disease

Orwa G. Elhussein, E Ahmed, A.Hamali

Introduction: Sickle cell disease (SCD) is a genetic disorder resulting from the presence of a mutated form of hemoglobin;known as hemoglobin S (HbS).It is characterized by various complications, including thrombosis. Increased levels of circulating procoagulantmicrovesilces (MVs) had been reported in this disease and many other diseases, which are causing the plasma to have prothrombotic tendency.

Objectives: This study compares the levels of circulating MVs in Saudi children with SCD intheir steady state with their healthy matched controls (HMCs).

Method: Citrated whole blood was collected from 102 children homozygous for sickle hemoglobin (HbSS) (aged from 2 to 18 years-old) and 51 HMCs.MVswere measured using an indirect ELISA method.

Results:The mean level of MVsin the Saudi children with SCD is significantly higher than in HMCs (30.49 ± 2.84 vs 14.41 ± 1.68 nM)(P = 0.0002). Males with SCD children showed higher mean levels of MPs in their plasma than females but that was not statistically significant(36.97 ± 5.42 nM) vs (27.66 ± 3.29 nM) (P = 0.13).


This study demonstrateda significantly high plasma level of MVsin Saudi children with SCD than the HMCs. Male children with SCD showed higher level of MVsthan females and younger children had lower levels than older children.

ABO Blood Group and Susceptibility to Urinary Tract Infection in Children

Mohammed Ahmed Ibrahim, Ahmed Kamal Bolad, Nada Boshra Nasr

Background: ABO blood group antigens with carbohydrate molecules are found on thesurface of erythrocytes, phagocytes, lymphocytes and certain epithelial tissues including urothelium, which may influence to human susceptibility for infectious diseases. Many bacteria cross-react with ABO blood groups antibodies, the Isohaemagglutinins may have an important protective role against cross-reacting bacteria.

Objective: The aims of present study were to determine the ABO blood groups andsusceptibility to Urinary tract infection (UTI), and to determine the relationship between ABO blood group antigens and the type of bacteria that cause urinary tract infections.

Materials and Methods : ABO blood grouping was performed by poly clonal ABO Antisera,and the distribution of ABO Blood groups for 50 children with urinary tract infection (UTI) with positive urine culture (Patients group) were compared with the ABO blood group distribution for 50 uninfected UTI children (control group). Patients were matched one-to-one with control of the same age, sex and origin. Questionnaires were filled out from two groups regarding to their ages, sexes, blood group types, Geographical origin and the type of Uropathogen was filled out for each patient. The blood groups of patients were compared with bacteria types isolated from cultures, ages, sexes and Geographical origin. Data were analyzed by IBM SPSS v20, Fisher exact test. The level of statistical significance was set at 5% (p< 0.05).

Results: The distribution of blood groups was as follows: blood group O was 41%.28%, 23%and 8% for Blood group A, B, and AB respectively. Escherichia coli (E.coli) was the major cause of UTI in the studied group (60% of the patient), followed by Klebsiella (18%). The other types of bacteria were less frequent. There was a significant difference found in the distribution of the types of bacteria among the four blood groups (p=0.049). However, urinary tract pathogens had no significant correlation with sex and age, origin. No significant found in the distribution of blood group between two (patients and control) groups. Blood group A was much less infected with E.coli (25%) than those with the other three blood groups (AB was 80%. 69.2%, 70% for B and O respectively).

Conclusion: This study extends and confirmed previous studies in Sudan regardingcorrelation between UTI and ABO blood groups. However, the current study in contrast with other studies and this could be due to differences in genetic makeup and epidemiological settings. In conclusion the current study finds that E.coli is the most common known cause of UTI in children. Blood group A showed less chance to get UTI by E.coli infection in children. This could be due to protectively with anti B Isohaemagglutinins, or antigen A)it self which present in urotheilum, or both protective factor.

Key words: ABO blood group ,carbohydrate , susceptibility , Isohaemagglutinins cross-reactingbacteria , urinary tract infections, children , Klebsiella , Escherichia coli (E.coli)

Determinants of Erythropoietin Level in Steady-state Homozygous Sickle cell Anemia

Dr. Lamis Kaddam, Professor Imad Fdle Almula, Dr Nada Hassan Eltayeb, Professor Amal M.Saeed

Background: Previous studies have suggested that erythropoietin (EPO) levels may be inappropriately low in patients with sickle cell disease compared to the extent of the related anemia they demonstrate. Here, we evaluate EPO level vs. renal function, Hb F, and markers of hemolysis for patients with sickle cell disease.

Materials and Method: Blood was drawn from 33 patients with hemoglobin SS aged 5-42 years, during routine visits to the outpatient hematology unit in Military Hospital. Hb F, complete blood count, Erythropoietin level and renal function were measured. The data were analyzed using SPSS 19 and Pearson correlation test was used to find correlation. P value < 0.05 was considered significant.

Results: Neither age nor gender have an effect on EPO level. In addition, a correlation between Hb level and EPO was not consistently observed. Higher EPO levels were seen in patients with high HbS percentage, but no correlation with hemolysis, renal function, or inflammation was observed.

Conclusion: Erythropoietin levels in patients with sickle cell disease do not correlate with known inducers of erythropoietin in healthy individuals.