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Biomedical subjects

A H Fahal

Publications and source records attributed to A H Fahal.

At least 19 recordsLinked to original sources
PubMed2004

Mycetoma: a thorn in the flesh.

Mycetoma is a chronic, granulomatous, subcutaneous, inflammatory disease caused by true fungi (eumycetoma) or filamentous bacteria (actinomycetoma). It occurs in the mycetoma belt stretching between the latitudes of 15 degrees South and 30 degrees North and is endemic in relatively arid areas. The organisms are present in the soil and may enter the subcutaneous tissue by traumatic inoculation. Mycetoma commonly affects adults aged 20 to 40 years, predominantly males. The foot is most commonly affected. Both forms of mycetoma present as a progressive, subcutaneous swelling, although actinomycetoma has a more rapid course. Multiple nodules develop which may suppurate and drain through sinuses, discharging grains during the active phase of the disease. Diagnosis may involve radiology, ultrasonic imaging, cytology, culture, histology or immunodiagnosis. Actinomycetoma is amenable to treatment by antibiotics, preferably by combined drug therapy for long periods. Eumycetoma is usually treated by aggressive surgical excision combined with medical treatment.

Antifungal Agents↗
PubMed2002

Minor role for BRCA2 (exon11) and p53 (exon 5-9) among Sudanese breast cancer patients.

A cohort of 20 breast cancer patients from the Sudan was tested for germ line and somatic mutation in their BRCA2 exon 11 as well as the main conserved area of the p53 tumor suppressor gene. The results indicate that both regions may play a limited role in the pathogenesis of breast cancer in those patients. The fact that there are no somatic mutations detected in p53 was particularly surprising as the expected rate for mutations in breast cancer is 30-50%.

Adult↗
PubMed1999

Development of a species-specific PCR-restriction fragment length polymorphism analysis procedure for identification of Madurella mycetomatis.

Madurella mycetomatis is the commonest cause of eumycetoma in Sudan and other countries in tropical Africa. Currently, the early diagnosis of mycetoma is difficult. In attempting to improve the identification of M. mycetomatis and, consequently, the diagnosis of mycetoma, we have developed specific oligonucleotide primers based on the sequence of the internal transcribed spacer (ITS) regions spacing the genes encoding the fungal ribosomal RNAs. The ITS regions were amplified with universal primers and sequenced, and then two sets of species-specific primers were designed which specifically amplify parts of the ITS and the 5.8S ribosomal DNA gene. The new primers were tested for specificity with DNA isolated from human mycetoma lesions and DNA extracted from cultures of M. mycetomatis reference strains and related fungi as well as human DNA. To study the genetic variability of the ITS regions of M. mycetomatis, ITS amplicons were obtained from 25 different clinical isolates and subjected to restriction fragment length polymorphism (RFLP) analysis with CfoI, HaeIII, MspI, Sau3AI, RsaI, and SpeI restriction enzymes. RFLP analysis of the ITS region did not reveal even a single difference, indicating the homogeneity of the isolates analyzed during the current study.

Humans↗
PubMed1998

Nasal carriage of staphylococcus aureus and epidemiology of surgical-site infections in a Sudanese university hospital.

Surgical site infections (SSI) due to Staphylococcus aureus among 256 male and 158 female patients (mean age, 28 years) undergoing elective surgery at the Soba University Hospital (Khartoum, Sudan) were studied. During an 11-month study period all patients were analyzed for nasal carriage of S. aureus at the time of admission. Follow-up of the development of SSI proceeded until 4 weeks after the operations. In addition, nasal swabs were obtained periodically during the same period from 82 members of the staff. In order to discriminate autoinfection from cross infection, bacterial isolates were typed by random amplification of polymorphic DNA (RAPD), pulsed-field gel electrophoresis (PFGE) of DNA macrorestriction fragments, and restriction fragment length polymorphism analysis of the protein A and coagulase genes. Preoperative cultures revealed the presence of S. aureus in the noses of 98 patients (24%). The overall number of postsurgical wound infections in the entire group was 57 (14%), 24 of which were due to S. aureus. Only 6 of the 98 nasal S. aureus carriers suffered from wound infections by the same species. In these six cases the infecting strain could not be genetically discriminated from the nasal inhabitant, substantiating autoinfection. However, nasal carriage of S. aureus is not a significant risk factor for the development of SSI in this setting (6 of 98 patients with autoinfection versus 18 of 316 patients [414 - 98 patients] with cross infection; P = 0.81), most probably due to the fact that noncarriers are at a significant and relatively large risk for acquiring an independent S. aureus SSI. The other S. aureus strains causing SSI showed a high degree of genetic heterogeneity, demonstrating that it is not an epidemic strain that is causing the SSI. Among the staff personnel screened, 47.4% did not carry S. aureus in the nose at any time during the study period, whereas 13. 2% persistently carried a single strain in the nose. Another 39.5% could be classified as intermittent carriers. When strains derived from staff personnel were genetically typed, it was demonstrated that most of the strains represented genetic variants clearly differing from the isolates causing SSI. On the other hand, possible cross colonization among staff personnel and even cross infection from staff personnel to patients or from patient to patient were demonstrated in some cases, but epidemic spread of a single strain or a few clonally related strains of S. aureus could be excluded.

Adult↗
PubMed1997

Ultrasonographic imaging of mycetoma.

INTRODUCTION: The ultrasonographic appearance of mycetoma is described in this prospective study. METHODS: One hundred patients with foot swellings had sonographic evaluation of the swelling and surgical excision within 2 weeks of ultrasonography. The histopathological findings were compared with the preoperative images. Some of the excised swellings and grains were also imaged and compared with the in vivo findings. RESULTS: The mycetoma grains, their capsules and the accompanying inflammatory granulomas have characteristic ultrasonographic appearances. In eumycetoma lesions, the grains produce numerous, sharp hyper-reflective echoes and there are single or multiple thick-walled cavities with no acoustic enhancement. In actinomycetoma, the findings are similar but the hyper-reflective echoes are fine, closely aggregated and commonly settle at the bottom of the cavities. None of the non-mycetoma foot swellings (which included lipoma, ganglion, foreign body granuloma and others) studied had these features. CONCLUSION: Ultrasonography is simple, non-invasive, quick, reproducible and acceptable to patients. Mycetoma has characteristic ultrasonographic features. Furthermore, ultrasonography delineates the extent of mycetoma more accurately than clinical examination alone.

Adult↗
PubMed1996

Pattern of postoperative pyrexia in Khartoum.

The pattern of postoperative pyrexia in Khartoum was prospectively studied in 260 patients who underwent a variety of surgical operations. Ninety four patients (36.1%) developed postoperative pyrexia. The commonest causes of pyrexia encountered were wound sepsis (10%), malaria (9.6%) and respiratory tract infection (7.3%). Less frequent causes were urinary tract infection, thrombophlebitis, intra-abdominal sepsis and deep vein thrombosis. In 14.6% of the patients, the cause of pyrexia was undetermined. The risk factors for postoperative pyrexia were the patient's age, diabetes mellitus, obesity, preoperative chest infection, smoking, duration of surgery, operator's surgical experience and urethral catheterisation. The postoperative pyrexia was associated with 7.4% mortality rate which was due to intra-abdominal sepsis and pulmonary embolism. The incidence of postoperative pyrexia can be minimised by adequate preoperative preparation, meticulous surgical technique and good postoperative care.

Adolescent↗
PubMed1996

Ossification of the penis: report of two cases.

Two patients with histologically proven penile ossification are reported from Africa, for the first time, in this communication. The aetiological causes in these patients are unclear and the pathogenesis of the condition is discussed.

Diagnosis, Differential↗
PubMed1996

Intestinal obstruction in Khartoum.

The pattern of intestinal obstruction at Khartoum Teaching Hospital was reviewed in this study which included 239 patients. 170 of them were males and 68 were females. Their ages ranged from two days to 95 years (mean 31.4 +/- 5.3 years). The commonest causes of intestinal obstruction were strangulated external hernias (27.7%), intestinal adhesions (21%), intussusception (12%) and sigmoid volvulus (11%). Less frequent causes were paralytic ileus, large bowel tumours, peritoneal bands and Hirschsprung's disease. Of the strangulated hernias, inguinal hernia (70%) was the most frequent type of hernia seen, followed by paraumbilical hernia (20%). Previous appendicectomy (40%) and laparotomy for abdominal trauma (20%) were the commonest causes of adhesive intestinal obstruction. The mortality rate of intestinal obstruction was 19.7%. This high mortality is attributed to delayed presentation, fluid and electrolyte imbalance, intestinal ischaemia and gangrene. This could be minimised by health education, adequate preoperative preparation, meticulous surgical technique and good postoperative care.

Adolescent↗
PubMed1995

Aspiration sclerotherapy for hydroceles in the tropics.

OBJECTIVE: To assess the usefulness of aspiration sclerotherapy in the treatment of hydroceles in the tropics. PATIENTS AND METHODS: This prospective study included 82 patients with 94 primary vaginal hydroceles of which 62 hydroceles were treated by aspiration and tetracycline hydrochloride sclerotherapy as an outpatient procedure (mean age of patients 56.5 years, range 40-82) and 28 were treated surgically and included as controls (mean age 52.4 years, range 40-70). All patients were followed for a year. RESULTS: In the sclerotherapy group, the overall cure rate after a year was 95%. Few complications were encountered in this group: six patients (10%) experienced pain during the procedure, seven patients (12%) had local infection and three patients (5%) developed haematoma. No recurrence was encountered in the surgical group, seven patients (25%) had infection and two patients (7%) developed haematoma. The mean hospital stay for the surgical group was 3.4 +/- 1.3 days (range 1-7). Four patients with thick-walled hydroceles had persistent swelling after sclerotherapy, the recurrence of which dissatisfied the patients. CONCLUSIONS: Aspiration sclerotherapy for thin-walled hydroceles proved to be a curative, simple, safe and cost-effective out-patient procedure. It can be an alternative to surgery in developing countries where resources are limited.

Adult↗
PubMed1995

Gastrointestinal tract cancer in association with hepatitis and HIV infection.

One hundred and fifty patients with histologically proven gastrointestinal tract (GIT) cancer, 150 patients with a variety of other malignancies and 150 normal subjects were screened for human immunodeficiency virus (HIV) and hepatitis B sero-markers. Only one patient with nasopharyngeal carcinoma proved to be HIV seropositive. Hepatitis B surface antigen (HBsAg) was detected in 18% (n = 26) of the GIT cancer patients, in 16% (n = 24) of the other cancers group and in 12% (n = 20) of the control. There was no significant difference between the three groups (P > 0.1). The HBsAg was detected mainly in patients with primary hepatocellular (25%), gastric (12%), rectal (10%) and colonic carcinoma (8%). Hepatitis B core antibody (HBc AB) was detected in 12% of the GIT cancer patients, in 11% of the other cancers patients and in 13% of the control. In this study, there was no association between HIV, hepatitis B infections and GIT cancer.

Adolescent↗
PubMed1995

Thyroid function in patients with mycetoma.

Thyroid function was assessed in seventy two patients with various types of mycetoma. There was no evidence of clinical or biochemical thyroid dysfunction in these patients. The symptoms encountered in some of the mycetoma patients mimic those of hypothyroidism should be attributed to other factors possibly mental depression and apathy.

Adolescent↗
PubMed1995

Dual infection with mycetoma and tuberculosis: report of two cases.

Dual infection with tuberculosis and mycetoma has not been reported in literature to date. This communication is a report on two patients with such infection. It indicates the serious impact of the dual infection as each of them augments the pathological effects of the other.

Adult↗
PubMed1994

Pneumatosis cystoid intestinalis: a case report.

A case of pneumatosis cystoid intestinalis associated with duodenal ulcer and pyloric stenosis is reported. Review of literature revealed that, this is the first reported case in the Sudan and in Africa at large. The clinical presentation of this patient was confusing and it seems reasonable to consider pneumatosis in the differential diagnosis of pneumoperitonium associated with duodenal ulcer to avoid unnecessary laparotomy.

Adult↗
PubMed1994

A preliminary study on the ultrastructure of Actinomadura pelletieri and its host tissue reaction.

This is the first report on the fine structure of Actinomadura pelletieri. The in vitro ultrastructure of the organism and that of the grain in vivo were similar. The grain consisted of packed filaments with a faintly electron-dense matrix in between. The individual filament was septate, the cytoplasm was either vacuolated or contained intracellular organelles and the cytoplasmic membrane was adherent to the filamentous wall, which has three electron-dense and two electron-lucent layers. The absence of cement substance around the grain may partially explain the aggressive and destructive behaviour of this organism and may probably also explain its good response to medical treatment. The inflammatory host reaction was similar to that seen with all mycetoma organisms except that there was a massive neutrophil reaction. This was confirmed by electron microscopy.

Actinomycetales↗
PubMed1992

Mycetoma.

Mycetoma is a chronic infective condition of tropical and subtropical regions. It is commoner in males, especially those in their third or fourth decade who work on the land. The clinical triad of subcutaneous nodule, sinuses and discharge usually leads to diagnosis; the disease is commonly painless. Treatment is by extensive surgical excision of affected areas and may include limb amputation. Recurrence is common, rates ranging from 20 to 90 per cent. Medical treatment may be used on its own or as an adjunct to surgery. Although such therapy may cure over half of those with actinomycetoma (caused by bacteria, mainly aerobic actinomycetes), those affected by eumycetoma (caused by fungi) have a poorer prognosis and may require many years of drug therapy.

Humans↗