Department of Clinical Medicine

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    Celiac Disease among Sudanese Patients: A Clinico Pathological Study
    (University of Khartoum, ) Noha Mokhtar Mohamed Ahmed ; Salwa Osman Mekki ; Clinical Patholog
    Background: Celiac disease is an Immune-mediated enteropathy triggered by the ingestion of gluten-containing cereals in genetically Predisposed individuals. The disease was first reported in Sudan in 1978 where 7 children’s were diagnosed since that time, many adult and pediatric cases have also been reported .The disease may be under-diagnosed in Sudan because malnutrition, diarrheal diseases and intestinal parasitic infections are more prevalent conditions. Celiac disease can occur at any age but is more common in children. Accurate diagnosis of celiac disease needs correlation between the clinical presentations, serological test, upper endoscopy with histological analysis of the duodenal biopsies. The study aimed to shed a light on the histopathological features of patients with celiac disease using modified Marsh classification system and to correlate the demographic data and the clinical presentations with the histological classification of the disease. Material and Methods: This is a descriptive case series hospital based study included 60 patients with proven celiac disease, carried out at Soba University Hospital and Fedail Hospital during the period January 2010- December 2013. The patients’ data were collected from V records of the laboratory reports and patient’s request form using data collecting sheet. Paraffin embedded blocks of the duodenal biopsies were re cut and slides were prepared and stained using conventional haematoxyline and eosin stain (H & E) and immunohistochemical stain (CD3) to count the intraepithelial lymphocytes . All slides were reviewed. The histopathological classifications were done using modified Marsh classification system. The data were analyzed using Statistical Package for Social Sciences Software (SPSS). Results: The study included 60 patients. Their age ranged between 2- 70 years. The commonest affected age group was below 10years (41.6%). Males and females were equally affected. The most common clinical presentation was chronic diarrhea (50.0%), followed by iron deficiency anemia (40.0%). Less frequent presentation (10%) includes weight loss, abdominal pain and delayed growth and puberty. The histological findings of duodenal biopsies revealed complete villous atrophy in (45.0%), marked atrophy in (38.3%) and mild atrophy in (16.7%) of cases. The degree of villous atrophy was not statistically correlated with intraepithelial lymphocytosis (P: 0.1). Marsh type IIIc was the commonest type, seen in (45.0%) of cases followed by Marsh type III b in (38.3%) of cases and Marsh type III a VI in (16.7%) of cases. There was significant correlation between Marsh classification and age of cases and the clinical presentation with chronic diarrhea and iron deficiency anemia, (P: 0.008, 0.06 &0.04 ) respectively. Conclusion: Celiac disease was common in children below 10 years of age affecting both males and females equally. The commonest clinical Presentation was chronic diarrhea followed by iron deficiency anemia. The use of both H&E and CD3 to count intraepithelial lymphocytes were helpful which was crucial in diagnosis. Marsh type IIIC was the most common type, seen in children below 10 years. Histological classification correlated well with age group, chronic diarrhea and iron deficiency anemia in the study.
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    Blood Profile in Experimentally Induced Lactic Acidosis in Desert Goats
    (University of Khartoum, 2016-03-27) Abdalnoor, Kawther Mohmmed Othman ; Abdel Rahim El Sayed Karrar ; Clinical Medicine
    This study was conducted on Sudanese desert goats. The aim was to detect the effect of experimentally induced rumen lactic acidosis on blood profile. For induction of ruminal acidosis, 12 clinically healthy two years old non pregnant female goats were chosen and were divided into three groups (A, B and C). Goats in group A received sucrose at a dose rate of 18g/kg bwt. Group B was dosed with 15g/kg bwt and group C was dosed with 10g/kg bwt through rumen fistula. Prior to the infusion of sucrose (0 hour), rumen samples were obtained in order to determine baseline rumen pH, and blood samples were collected to determine blood pH, hemoglobin concentration, packed cell volume, red blood cells count and white blood cells count. And sera were separated and stored for biochemical analysis. The clinical parameters temperature, pulse and respiration rates and rumen motility were also obtained. Blood and rumen samples and clinical parameter were collected at 3, 6, 9, 12, 15, 18, 21, 24, 30, 36, and 48 hours after the infusion of sucrose. In group (A) results indicated that the respiratory and pulse rates, blood pH, RBCs, Hb,Total protein, albumin, sodium and phosphorus remained without detectable significant changes through the experiment. Rumen motility, rumen pH, temperature and potassium level decreased significantly. The PCV% and WBCs increased significantly. In group (B) the result indicated thatpulse rate, temperature, blood pH, PCV, RBCs, WBCs, Total protein, albumin, sodium and phosphorus remained without detectable significant changes through the experiment. The respiratory rate increased significantly. Rumen pH, rumen motility, Hb and potassium level were decreased significantly. In group C the results indicated that respiration and pulse rates, rumen motility, rumen pH, blood pH, PCV, RBCs, albumin, total protein, sodium and phosphorus remained without detectable significant changes through the experiment. temperature, WBCs, Hb and potassium level were decreased significantly.
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    Reproduction and Milk Yield of Kenana and Butana Cattle Herds in the Sudan.
    (UOFK, 2015-06-23) Osman Ahmed Ibrahim Fangaly, Fangaly ; Faroug Mohammed Al Amin
    Reproductive and milk yield traits of 471 and 331 Kenana cows at Umbenein and Nesheshiba station covering the years 1960-1977 and 316 Butana cows at Atbara station covering the years 1950-1975 were studied. The study included 1927 and 1877 Kenana records at Umbenein and Nesheshiba, respectively, and 1455 Butana records in Atbara. Reproductive traits studied were: age at first calving (45 and 51 months for Kenana at Umbenein and Nesheshiba, respectively and 43 months for Butana in Atbara). Calving interval (433 and 412 days for Kenana at Umbenein and Nesheshiba, respectively and 373 days for Butana in Atbara); service period (138 and 124 days for Kenana at Umbenein and Nesheshiba, respectively and 88 days for Butana in Atbara); and number of services per conception (1.05 and 1.06 services for Kenana cows at Umbenein and Nesheshiba, respectively and 1.27 services for Butana cows in Atbara). Heritability of reproductive traits were 0.18 and 0.02 for age at first calving in Kenana cows at Umbenein and Nesheshiba, respectively, while it was 0.13 for Butana cows in Atbara. For calving interval, the heritability was 0.05 and 0.09 for Kenana cows at Umbenein and Nesheshiba and 0.14 for Butana cows in Atbara. Average total milk yield per lactation was 1358 and 763 kg at Umbenein and Nesheshiba, respectively and 1527 kg for Butan cows in Atbara. The average lactation length was 222 and 198 days for both Umbenein and Nesheshiba cows, while it was 240 days for Butana cows in Atbara. The average 305–day milk yield was 1872, 1367 and 2254 kg at Umbenein, Nesheshiba and Atbara stations, respectively. Month of calving had a significant effect on 305-day milk yield. The dry period length was 208, 183 and 119 days at Umbenein, Nesheshiba and Atbara stations, respectively. Heritability of total milk yield was 0.75 – 0.81 and at Umbenein, Nesheshiba and Atbara, respectively. Various inter relationships of different traits were studied.
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    Causes of Upper Gastrointestinal Bleeding in Sudanese Patients
    (University of Khartoum, 2003) Tarig Ibrahim Hassan ; Mohamed Ali Al Tahir ; Mosa Mohammed Khair ; Clinical Medicine
    Upper gastrointestinal bleeding in Sudan is a common problem with significant mortality and morbidity and consumption of already scarce medical resources in our country. This study was conducted in Khartoum province, in the main three Tertiary hospitals; Khartoum teaching hospital; Ibn Sina specialized hospital and Soba university hospital. One hundred cases were studied in each hospital in the period from October 2002 to August 2003. The aim of the study was to know the potential causes of upper gastrointestinal tract bleeding in Sudanese patients. Important investigations were done to the patients. These include: oesophagogastroduod-endoscopy, abdominal ultrasonography, liver function tests prothrombin time, complete blood count with peripheral blood picture. The study showed the dominance of the variceal causes, mainly due to bleeding oesophageal varices, resulting from schistosomal periportal fibrosis which contributed to 76% of the causes. Most of the patients were from Gezira area which is indemic for schistosomiasis. Peptic ulcer disease accounted for 9.7% of the cases. Other causes found were gastric erosion (2%), carcinoma of the stomach (2.7%), and Mallory-Weiss (0.7%). Other rare causes found in this study include: Dieulafoy lesions (0.7%), watermelon stomach (1%), duodenal tumors, and A-V malformations (0.3%). There is a rise in the percentage of patients with bleeding oesphageal varices compared to a previous study done almost twenty years ago. Also, this study shows a decrease in the percentage of patients with bleeding peptic ulcers.
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    Causes of hypersplenism in adult Sudanese patients presenting to Khartoum State
    (University of Khartoum, 2004) Erwa Eltayib Haj Elmakki ; Musa Mohamed Khair ; Clinical Medicine
    A total of 100 patients with hypersplenism were studied for a period of 12 months from January 2003 up to January 2004. most of these patients were admitted to Khartoum, Soba and Ibn Sinna Teaching Hospitals. Any patient above 15 years of age was included in the study regardless of the gender. The data was collected through a questionnaire containing a detailed medical history, thorough physical examination and detailed laboratory investigations. The aims of the study is to identify the causes of hypersplenism in Sudan and to know the pattern and presentation of different diseases. 100 patients were included in the study, 72 of them were males (72%) and 28 were females (28%). 50 patients (50%) were due to schistosomal portal hypertension, 6 of them had liver cirrhosis beside periportal fibrosis (PPF) (6%), visceral leishmaniasis detected in (30%) of patients, tropical splenomegaly syndrome (TSS) in (9%), liver cirrhosis in (6%), and in (5%) no cause could be found.