Getting our journal to developing countries.
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Developing Countries↗
Biomedical subjects
S S Fedail
Publications and source records attributed to S S Fedail.
Role of genetic polymorphism of glutathione-S-transferase T1 and microsomal epoxide hydrolase in aflatoxin-associated hepatocellular carcinoma.
Exposure to aflatoxins is a risk factor for hepatocellular carcinoma (HCC). Aflatoxins occur in peanut butter and are metabolized by genetically polymorphic enzymes such as glutathione-S-transferases encoded by glutathione-S-transferase mu 1 gene (GSTM1) and glutathione-S-transferase theta 1 gene (GSTT1) and microsomal epoxide hydrolase encoded by epoxide hydrolase gene (EPHX). The rate at which aflatoxins become activated or detoxified may depend on polymorphisms in the encoding genes. GSTM1 homozygous deletion was indeed found to modify the association between peanut butter consumption and HCC. In this study, we investigate possible roles of GSTT1 and EPHX polymorphisms in this relationship. From a Sudanese case-control study on HCC, we analyzed data of 112 incident cases and 194 controls. All participants were interviewed using a standardized questionnaire inquiring about social and demographic factors, peanut butter consumption, and other known HCC risk factors. Univariate analysis showed that GSTT1 polymorphism was not associated with HCC, whereas EPHX 113HH and 139HH genotypes increased the risk of HCC (Odds ratio, 3.10; 95% Confidence interval, 1.18-8.12). Adjustment for age and region of origin slightly attenuated this association (Odds ratio, 2.56; 95% Confidence interval, 0.83-7.95). Interestingly, unlike GSTM1, both GSTT1 and EPHX polymorphism did not modify the association between peanut butter consumption and HCC. In conclusion, these epidemiological findings do not suggest significant roles of GSTT1 and EPHX in aflatoxin metabolism, although EPHX polymorphism is possibly related to the increased risk of HCC. Further studies are needed to investigate mechanisms by which the EPHX polymorphism potentially modifies cancer risk.
Adult↗
Does CagA contribute to ulcer pathogenesis in a developing country, such as Sudan?
BACKGROUND AND OBJECTIVE: In Western populations, peptic ulcer disease is closely associated with Helicobacter pylori (H. pylori) strains expressing the CagA antigen. In Africa the prevalence of H. pylori infection and peptic ulcer disease is high, although information regarding potential virulence factors is lacking. This study examines the prevalence of antibodies to CagA both in African patients with dyspepsia who are undergoing gastroscopy, and in asymptomatic healthy African volunteers. METHODS: Eighty two consecutive patients (median age 34 years, range 15-73 years), attending for gastroscopy were studied, of whom 78 (95.1%) were subsequently found to be Helicobacter positive. Three antral biopsies were obtained from each patient and 5 ml of blood was taken for determination of CagA seropositivity using western blot analysis. CagA seropositivity was also determined in 65 H. pylori positive healthy volunteers (median age 30 years, range 18-70 years), with no symptoms or previous history of gastroduodenal disease. RESULTS: Of the 78 H. pylori positive patients, CagA seropositivity was present in all 22 patients with active peptic ulcer disease (100%), in eight of nine patients with duodenitis (89%), in 15 of 19 patients with macroscopic gastritis (78.9%), and in 24 of 28 patients with a normal endoscopy (85.7%). On histological assessment, 46 patients had chronic active gastritis, 29 patients had gastritis with atrophy and three patients had intestinal metaplasia. CagA seropositivity rates were 84.7%, 93% and 100%, respectively, for these groups. In the 89 healthy volunteers studied, 57 of the 65 H. pylori positive subjects (87.7%) were seropositive for the CagA protein. CONCLUSIONS: As in Western countries, CagA seropositivity in this African population was closely related to endoscopic gastroduodenal disease, and to the presence of more advanced histological lesions in the antrum. However, there was also a high prevalence of CagA seropositivity in asymptomatic healthy individuals, suggesting that factors other than CagA predominate in ulcer pathogenesis in this population.
Adolescent↗
Acarboxy prothrombin (PIVKA II) as a tumour marker for hepatocellular carcinoma and other liver diseases.
The clinical usefulness of plasma abnormal prothrombin, defined as protein induced by vitamin K absence or antagonist II: (PIVKA II) as a tumour marker for hepatocellular carcinoma (HCC) and other liver diseases has been evaluated. PIVKA II concentrations were determined using an enzyme-linked immunosorbent assay (ELISA) with monoclonal antibody that reacts with PIVKA II but does not cross-react with normal prothrombin. Seventy four patients (74%) out of 100 with HCC had abnormal PIVKA II levels above 0.5 AU/ml (median = 3.4 AU/ml). The level was above 1.0 AU/ml in 66 (66%) of the patients. In contrast the level of PIVKA II was low in patients with bilharzial periportal fibrosis (median = 0.09 AU/ml), patients with liver cirrhosis (median = 0.13 AU/ml), patients with hepatitis (median = 0.025 AU/ml), and essentially undetectable in all the 34 controls. The diagnostic ability of serum alphafoetoprotein (AFP) was also evaluated in these patients. AFP alone can diagnose 51% of the HCC cases. Of the remaining patients with low or negative AFP levels (65%) can be diagnosed using PIVKA II. Abnormal prothrombin is a potential marker for the laboratory diagnosis of hepatocellular carcinoma.
Adult↗
Detection of Helicobacter pylori in endoscopic biopsies in Sudan.
We studied the prevalence of Helicobacter pylori in Sudanese subjects with gastroduodenal inflammation. H. pylori was looked for in biopsy specimens taken from the antrum by two methods: rapid urease test [Campylobacter-like organism (CLO) test] and culture using Skirrow's selective supplement. One hundred subjects were studied. H. pylori was found in 80% of patients with gastritis, 56% of patients with duodenal ulcer, 60% of patients with duodenitis and 16% of normal control subjects. It was neither detected in patients with gastric ulcer, nor in patients with oesophagitis or in those with oesophageal varices due to schistosomiasis, when using culture. However, it was found in 50% of patients with oesophagitis, when using CLO test.
Adult↗
Endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy: experience in the Sudan.
Over a 5 year period 626 endoscopic retrograde cholangiopancreatography (ERCP) examinations were attempted in Khartoum, Sudan. The relevant duct was successfully cannulated and visualized in 94% of cases of biliary tract disease and in 73% of cases of pancreatic disease. This was due to the large number of cases with advanced pancreatic cancer. The commonest abnormal finding was stones in the biliary tree in 214 cases (35% of all cases). Cholangiocarcinoma was seen in 18 cases, pancreatic cancer in 64 cases, chronic pancreatitis in 48 cases and periampullary carcinoma in 20 cases. ERCP was considered normal in 100 cases. Endoscopic sphincterotomy (EST) was performed in 48 cases; 44 had common duct stones. ERCP and EST are feasible and useful procedures in a developing country. However they are expensive and should be carried out in referral centres.
Adult↗
Serum trypsin in hepatosplenic schistosomiasis in the Sudan.
Serum trypsin was measured by radioimmunoassay in 30 patients with hepatosplenic schistosomiasis and 30 healthy controls. Patients with hepatosplenic schistosomiasis had a significantly lower serum trypsin 164.3 +/- 43.3 ng/ml than controls 241.3 +/- 74.0 ng/ml (P less than 0.001). It is concluded that the exocrine pancreatic function is impaired with regard to serum trypsin in hepatosplenic schistosomiasis.
Adolescent↗
Hepatitis B virus markers in patients with schistosomiasis, liver cirrhosis and hepatocellular carcinoma in Khartoum, Sudan.
Markers of hepatitis A and B virus were tested in 88 adult Sudanese subjects in Khartoum, Sudan. The subjects consisted of 25 control hospitalized patients, 21 volunteer blood donors, 23 patients with hepatosplenic schistosomiasis, 13 patients with liver cirrhosis and 6 patients with hepatocellular carcinoma (HCC). Antibody to hepatitis A virus was detected in 96% of the total. Hepatitis B surface antigen (HBsAg) was positive in 4, 24, 22, 31, and 67% of the subject groups, respectively. Antibody against hepatitis B core antigen (HBcAb) of undiluted serum was positive in 60, 57, 65, 77 and 83%, and there was no difference in incidence among the groups. It was positive in 200X diluted serum in 4, 24, 17, 23 and 60%. HBsAg and HBcAb (200X) were detected more often in HCC patients than in the control subjects (p less than 0.01). Hepatitis B virus is an important factor in the etiology of HCC in the Sudan.
Adult↗
Primary hypothyroidism with enlargement of the sella tursica in a Sudanese patient: case report.
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Adenoma↗
Endoscopic retrograde cholangiopancreatography in Sudanese diabetics.
Endoscopic retrograde cholangiopancreatography (ERCP) was performed in 40 Sudanese patients with diabetes mellitus. 25 were insulin-dependent and 15 were noninsulin-dependent. ERCP was normal in all the patients with insulin-dependent diabetes. Two patients with noninsulin-dependent diabetes had pancreatographic changes compatible with minimal-change pancreatitis. Diabetes mellitus in Sudan unlike in other tropical countries is not associated with structural changes in the exocrine pancreas.
Adolescent↗
Acute gastric dilatation following upper gastrointestinal endoscopy.
A patient who developed symptoms and signs of acute gastric dilatation following upper gastrointestinal endoscopy is described. Relations of endoscopy to the development of the condition are discussed.
Acute Disease↗
Exocrine pancreatic function in hepatosplenic schistosomiasis in the Sudan.
Exocrine pancreatic function was studied in 36 patients with hepatosplenic schistosomiasis and 31 control subjects. The secretin test and the Lundh test meal were used to assess exocrine pancreas function. Patients with hepatosplenic schistosomiasis had a significantly lower bicarbonate concentration, less than 90 mmol/l in duodenal aspirate, than the control group (p less than 0.001). There were statistically insignificant differences in the volume of the duodenal aspirate after the secretin test and in the mean tryptic activity after the Lundh test meal between patients and controls. We conclude that exocrine pancreatic function is impaired with regard to bicarbonate secretion in hepatosplenic schistosomiasis.
Adult↗
The pathology of the small intestine in human schistosomiasis mansoni in the Sudan.
Peroral small intestinal biopsies were obtained from 17 patients with Schistosoma mansoni infection and 13 control subjects. There was no difference between the dissecting microscopic appearances of patients and controls. The histological sections of patients showed significant shortening and broadening of villi compared to controls. There was no significant difference in the cellularity of the Lamina propria between patients and controls except that patients had significantly more eosinophils. The biopsies from the control subjects showed appearances of tropical enteropathy.
Adolescent↗
The xylose absorption test in normal Sudanese subjects.
The xylose absorption test was carried out in 50 healthy Sudanese men. The 5 g d-xylose oral loading dose was used. Nine subjects (18%) had a d-xylose absorption below the normal range. Thirty of the subjects were of low socioeconomic status and 20 of the subjects were of middle socioeconomic status; there was no difference in the xylose absorption between the two groups.
Absorption↗
The effects of sorghum and wheat bran on the colonic functions of healthy Sudanese subjects.
The effects of sorghum and wheat bran were compared and contrasted in a group of healthy Sudanese subjects. Ten medical students were studied while taking their normal diet, a diet of 20 g/day of sorghum bran and a diet of 20 g/day of wheat bran, each for 3 wk. Toward the end of each dietary period the wet stool weight, gut transit time, and frequency of bowel evacuation were estimated. The mean stool weight on normal diet was 136.6 +/- 43.1 g/day, on sorghum bran 173.3 +/- 48.4 g/day, and on wheat bran 219.1 +/- 98.3 g/day. The increase produced by wheat bran was significant, p less than 0.001. Both brans produced a similar number of bowel evacuations. The results suggest that sorghum bran, which is both cheap and readily available in the Sudan, produces a similar number of bowel evacuations to those of wheat bran without significantly affecting stool weight or transit time.
Adult↗
Upper gastrointestinal fibreoptic endoscopy experience in the Sudan. Analysis of 2500 endoscopies.
The results of 2500 upper gastrointestinal fibreoptic endoscopies carried out at Soba University Hospital, Khartoum, between January, 1980, and June, 1982, were reviewed. 42% of the patients had no disorder visible on endoscopy, 9% had oesophageal varices, 0.7% gastric ulcer, 17% duodenal ulcer, and 2% pyloric obstruction. Duodenal ulcer was seen more commonly in men (male/female ratio 4.5/1) and in young people. Endoscopy is a feasible procedure in developing countries. It is more informative and cheaper than barium meal radiology.
Costs and Cost Analysis↗
Chronic pancreatitis in Bristol.
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Adult↗
Changes in certain blood constituents during Ramadan.
Fasting serum cholesterol, triglycerides, thyroxine, triiodothyronine, uric acid, gastrin, and insulin were measured in a group of 24 Muslims at the beginning and end of Ramadan--the Muslim month of fasting. There was a significant increase in the levels of total serum cholesterol, thyroxine, and uric acid and a significant fall in body weight. There was no significant change in the levels of total serum triglycerides, triiodothyronine, gastrin, insulin (fasting), or in the rise in gastrin or insulin 1/2 h after food. These changes, although unlikely to affect normal people, may be significant in patients. Physicians working in Muslim countries should be aware that Ramadan may affect some laboratory findings.
Adult↗