Rayan Khalid | Alneelain University (original) (raw)
Papers by Rayan Khalid
Sudanese Journal of Paediatrics, 2024
Trisomy 22 is a rare autosomal constitutional chromosomal disorder with high survival incompatibi... more Trisomy 22 is a rare autosomal constitutional chromosomal disorder with high survival incompatibility being the third most frequent trisomy in spontaneous abortions and accounting for 10%–15% of all cases. Mosaic trisomy 22 is a less severe variant of the disorder associated with mild phenotype and longer lifespan compared to cases with complete trisomy 22. To date, there have only been 25 reported cases of trisomy 22 worldwide. We report a recent case of a 7-year-old
boy brought in by his mother seeking a diagnosis for the condition of her child. The father deceased 6 years earlier, and the obstetrical history of the mother revealed 3 first trimester recurrent
abortions. Upon examination, the child was found to have short stature, dysmorphic features, atrial septal defect, cognitive disability and
other neurological abnormalities. The mother’s karyotype analysis showed a normal female karyotype 46,XX, while the child’s analysis
revealed mosaic trisomy of chromosome 22 syndrome 47,XY,+22/46,XY. This case marks the first documented case of this syndrome in Sudan.
Sudan Journal of Medical Sciences, 2021
Complete Androgen Insensitivity Syndrome (CAIS) is an X-link recessive genetic mutation of androg... more Complete Androgen Insensitivity Syndrome (CAIS) is an X-link recessive genetic mutation of androgen receptor (AR) gene leading to complete inability of cell to respond to the androgens. CAIS occurs in 1 out of 20,400 XY live-birth babies, and affects about 1–2% of prepubertal girls that present with an inguinal hernia. Although individuals with CAIS have XY, those with grades 6 and 7 on the Quigley scale are born
phenotypically female, without any signs of genital masculinization. Thus, individuals affected by CAIS develop a normal external female phenotype with normal female external genitalia, well-developed breast, absent uterus, and bilateral undescended testicles. The question of CAIS diagnosis does not come forward until the absent menses at the puberty is noted or accidentally during an inguinal hernia repair in a
premenarchal girl. The present study reports a case of inguinal hernia repair on 11- year-old girl, which led to unexpected intraoperative notion of CAIS. The diagnostic work-up, genetic counseling, sex assignment, and the need for preoperative CAIS screening in girls with bilateral inguinal hernia are described and discussed.
Sudan Journal of Medical Sciences, 2024
Background: Thiopurine drugs have limited use due to their toxicity, related to the enzyme thiopu... more Background: Thiopurine drugs have limited use due to their toxicity, related to the enzyme thiopurine S-methyl transferase (TPMT) activity, which varies between individuals. This is the first study in Sudan, which aimed to assess the TPMT phenotypic status of healthy Sudanese volunteers.
Methods: A total of 177 healthy volunteers from Sudan were included in the study. TPMT enzymatic activities were measured using the ELISA serum protocol. We used SPSS to analyze the data and determined enzyme level categories and normal range with Z scores and quartile tests. The Sudan Medical Specialization Board (SMSB) Ethical
Committee approved the study.
Results: There were 117 males and 60 females among the volunteers, with ages ranging from 16 to 70 years and a mean age ± SD of 28.0 ±1 0.2, median = 24. Most candidates were from the Afro-Asiatic linguistic group (64.5%), followed by Nilo-Saharan (18.6%) and Niger-Kordofanian (16.9%). The TPMT enzyme level ranged between 0.17 and 9.5 ng/ml, with a mean of 2.26 ± 0.75 ng/ml. The quartile classification included very low enzyme (<0.76 ng/ml) seen in 4 candidates (2.3%), intermediate low (0.76-1.4 ng/ml) seen in 34 (19.2%), the normal range (1.5 – 3.75 ng/ml) seen in 119 (67.2%), and high enzyme activity (>3.76 ng/ml) seen in 20 (11.3%). No significant correlations between age, sex, and ethnic groups were recorded.
Conclusion: The normal TPMT enzyme activity is between 1.5 and 3.76 ng/ml. A higher prevalence of TPMT deficiency was recorded and compared with international studies.
Pretreatment screening using serum ELISA test for TPMT enzyme activity should be used to predict the risk of toxicity.
Sudan Journal of Medical Sciences, 2024
Ethiopian Journal of Reproductive Health, 2024
ABSTRACT BACKGROUND: Primary amenorrhea is defined as the absence of menstruation by age 14 witho... more ABSTRACT
BACKGROUND: Primary amenorrhea is defined as the absence of menstruation by age 14 without secondary
sexual characteristics or by age 16, regardless of normal development. Chromosomal aberrations account for 14-60%
of cases. This study aimed to evaluate chromosomal abnormalities in patients with primary amenorrhea referred to
Elite Genetics Center, Khartoum-Sudan, for genetic analysis.
METHODS: Between 2017 and 2023, 248 patients with PA were investigated. Clinical data, hormonal profiles,
and sonographic findings were recorded. Karyotyping was done initially, and PCR analysis for the SRY gene was
used as a complementary test for patients with normal karyotypes. The clinical diagnosis was based on the history,
clinical presentation, hormonal investigation, sonographic findings, and cytogenetic and molecular results.
RESULTS: The results showed that 68 (27.4%) had female karyotypes (46,XX), and 36 (14.5%) had male
karyotypes. Numerical chromosomal abnormalities were seen in 97 (39.1%) cases, structural changes in 14 (5.6%),
and mosaic abnormalities in 33 (13.3%). Turner syndrome was present in 137 (55.2%), Trisomy X (47, XXX) in
3 (1.2%) cases, and sex reversal (46, XY) in 7 (2.8%) cases. Clinical diagnosis included XY DSD in 21 (8.5%),
Complete Androgen Insensitivity Syndrome in 8 (3.2%), Swyer’s syndrome in 7 (2.8%), Ovotesticular DSD in 4
(1.6%), Mayer-Rokitansky-Küster-Hauser syndrome in 5 (2%), and Triple X in 3 (1.2%) cases.
CONCLUSION: The results highlight the need for cytogenetic analysis as an integral part of the PA diagnostic
protocol. Complementary PCR for the SRY gene is essential in differentiating XY DSD cases.
Pan African Medical Journal, 2020
Introduction: the outbreak of coronavirus disease 2019 (COVID-19) started in China in December ... more Introduction: the outbreak of coronavirus disease
2019 (COVID-19) started in China in December
2019 and spread causing more than 14 million
cases all over the world on July 19th, 2020.
Although, real-time reverse transcription
polymerase chain reaction (rRT-PCR) test is the
gold standard test, it needs a long time and
requires specialized laboratories and highly trained
personnel. All these difficulties forced many
countries with reduced health resources to limit
rRT-PCR tests to individuals with severe symptoms.
Thus, routine blood marker that may help
physicians to suspect COVID-19 and hence,
prioritize patients for molecular diagnosis is badly
needed. Methods: fifty-six Sudanese COVID-19
patients admitted to Jabra hospital were included
in this study. For all the patients we analyzed
complete blood count (CBC), CBC, plasma levels of
C-reactive protein (CRP), erythrocyte
sedimentation rate (ESR), liver function tests (LFT)
and renal function tests (RFT). Statistical analysis
was done using SPSS program with a significance
level of p≤0.05 and confidence limits (CLs) 95%.
The difference between groups was tested using
Mann-Whitney test was for quantitative variables
while qualitative variables was tested using chisquare (Fisher exact) test. Results: the result shows
that, 35 out of the 56 patients (62.5%) were male
and 21 (37.5%) were females with a median age of
60-year-old for both sexes. Lymphocytes % showed decrease to 9.2 (P-value=0.000) and significant
increase in neutrophils to 83.05 (P-value=0.005),
ESR to 65.54 (P-value=0.000) and CRP to 91.07 (Pvalue=0.000). The receiver operating characteristic
curve (ROC)/area under the curve (AUC) ensured
the expellant result of lymphocytes % as a
predictor with 92% area under the curve,
neutrophils were 90% and ESR 95.8%. The percent
of detecting COVID-19 positive RT-PCR (98%) for
suspected individuals using ROC showed best
cutoff of ≤21.8 for lymphocytes %, ≥67.7 for
neutrophils, ≥37.5 for ESR, ≥6.2 for CRP and ≥7.15
for WBCs. Conclusion: the results also showed
that, lymphocyte percentages, neutrophils, CRP and ESR may be used as markers for COVID-19
helping prioritizing individuals for rRT-PCR test.
Sudan Journal of Medical Sciences
African Journal of Reproductive Health, 2024
Given the scarce data on DSD in Sudan, we aimed to characterize DSD's clinical and genetic profil... more Given the scarce data on DSD in Sudan, we aimed to characterize DSD's clinical and genetic profile in Sudanese patients. We studied
60 patients with DSD using clinical data, cytogenetics, and PCR for the SRY gene. The results showed that 65% grew up as females
and 35% as males. There was a high percentage of consanguineous parents (85%). Female genital mutilation (FGM) was performed
in 75% of females. Patients who presented after pubertal age were 63%, with ambiguous genitalia in 61.7%, followed by primary
amenorrhea (PA) in 30%. The SRY gene was positive in 3.3% of patients with 46,XX karyotype and negative in 6.7% of patients with
46,XY karyotype. 5αR2D-DSD was seen in 43.3%, gonadal dysgenesis in 21.7%, Ovotesticular syndrome in 6.7%, Swyer and Turner
syndrome in 5% each, and Androgen Insensitivity Syndrome (AIS) in 3.3%. In conclusion, DSD in Sudan has a distinct profile with
late presentation, dominated by 5αR2D-DSD due to the increased consanguineous marriage, and FGM represents a significant risk
for DSD patients.
Gulf Journal of Oncology, 2022
Abstract Introduction: Bladder cancer (BC) is highly heterogeneous with regard to clinical cour... more Abstract
Introduction: Bladder cancer (BC) is highly heterogeneous with regard to clinical course, etiology, histology, and geographic distribution. Recent clinical observations
suggest changes in the pattern of BC in the Sudan perhaps due to lifestyle change following the massive displacement from rural to urban areas. The present study aimed to characterize the clinical profile of the BC among Sudanese patients and compare it with what has been previous reported. Material and Methods: Demographic, habitual, clinical, and histopathology information of 1610 patients with
BC were obtained from the hospital record of Ibn Sina specialized hospital, Soba University hospital, Khartoum North hospital and Khartoum teaching hospital during the period 2007-2019. The data was analyzed using SPSS program version 23.
Results: Of the 1610 cases of BC, 1480 cases (91.9%) were males and 130 cases (8.1%) were females. The most affected patients (39.3%) were those with age group ranging between 61-75 year-old. The vast majority of the patients (73%) were from urban and/or metropolitan areas of the capital Khartoum, whereas the remaining (27%) were farmers coming from rural areas. Although, smoking habits information were missed in 410 patients, 44% of the patients were smokers. History of hematuria
was present in almost all cases (99.4%), whereas history of urinary bilharziasis was mentioned in 40.9% of the patients’ records.The TCC histology type was seen in 77.4% of the cases, SCC in 21.1%, and adenocarcinoma in only 1.5% of all cases. The vast majority of the tumors were poorly differentiated tumors (700/52.6%), followed by
moderately differentiated tumors (430/32.3%) and well differentiated ones (200/15.1%). Of the total tumors, 346/26% were Ta-T1, 456/34% were T2, and 528/40% were T3-T4a,b. Most of tumors were solid ones, accounting for 74% compared with the papillary ones (26%) with most (54.9%) of the tumor located in the
lateral wall of the bladder. Although in 620 (38.5%) patients, the follow up information
were missing from the records, still the recurrence of the tumors were recorded in 890 (55.3%) of the patients 6 month after the initial therapy.
Discussion: The results showed that poorly differentiated, muscle invasive, and high recurrent TCCs tumors dominate BC profile of Sudanese patients. It revealed also that the most affected population are those between 61-75 yearold. These findings are in clear contrast with BC profile, previously, reported in which solitary muscle invasive
Bilharzia-associated SCCs tumors affecting younger population was the dominated patterns as reported by Daoud el al (1968), Malik et al., (1975) and later by Sharfi
et al., (1992). Thus clear change in BC profile in Sudan is evident, perhaps due to increased urbanization and style of life that led to change in the causative etiology, and
eventually the histology type.
Ethiopian Journal of Reproductive Health, 2024
ABSTRACT BACKGROUND Disorder of Sex Development (DSD) is a condition where there is a misalignme... more ABSTRACT
BACKGROUND
Disorder of Sex Development (DSD) is a condition where there is a misalignment of gonads or chromosomes
with the genitalia. One of the rarest forms of DSD is Ovotesticular DSD (OT-DSD), which is characterized by the
presence of both ovarian and testicular tissues in the same individual and a diverse range of phenotypes with various
penetrations.
CASE SUMMARY
A 16-year-old patient who was raised as a female presented with ambiguous genitalia and regular menstrual cycles.
Ultrasound examination revealed a normal-sized uterus and three gonads. Cy-togenetic analysis showed a mosaic
karyotype, and PCR testing for the SRY gene was positive. Postoperative histology indicated the presence of two
ovaries and one ovotestis gonad.
CONCLUSION
In low-resource healthcare settings, caregivers should remain vigilant for ambiguous genitalia and ensure timely
referral for accurate diagnosis and counseling before sex assignment. This case highlights the importance of
maintaining a high level of suspicion for DSD in adolescents dis-playing abnormal pubertal development or atypical
genital findings.
Sudan Journal of Medical Sciences, 2022
Background: Although warfarin is known as effective oral anticoagulant to prevent thromboembolic... more Background: Although warfarin is known as effective oral anticoagulant to prevent
thromboembolic events, its’ narrow therapeutic index requires ambient and good
follow-up to reduce its therapeutic complications. There is a continuous debate
whether the best practice to accomplish this goal is in a specialized international
normalized ratio clinic (INR-C) or in a general medical clinic (General-C). Few, if any,
studies have been done in Sudan to compare the safety and efficacy of anticoagulant
therapy in those clinics. Thus, the objective of this study was to compare the efficacy
and safety of anticoagulant therapy in INR-C and in General-C.
Methods: This is a prospective hospital-based study where 200 patients were divided
into two groups (group A and B) of 100 patients. Group A were in the INR-C at Ahmed
Gasim specialized hospital and group B in the General-Cat AL-Shaab teaching hospital.
The study was conducted from September 2019 to April 2020. All patients were on
warfarin treatment and regular follow-ups were conducted. Demographic and clinical
data were collected and analyzed statistically using SPSS version 20. Ethical approval
was obtained from the ethical committee of the Sudanese Medical Specialization Board
(SMSB).
Results: Of the 200 patients, 118/59% were females and 82/41% were males. Target
international normalized ratio (INR) for group (A) was achieved in 56% of the patients
in the first visit, increased to 63% in the second visit, and 75% in the third follow-up,
compared with 24% of the patients from group (B) in the initial and second follow-up
visit, to 43% in the third visit (P value=0.05). Knowledge about drug and food interaction
of coagulation agents was higher (91%) among patients in group (A) compared with
group (B) (56%). Drug interaction awareness was found in 89% of the patients in group
(A) compared with only 40% in group (B) (P value=0.05).
Major bleeding was reported in 2% and 14% of the patients of group (A) and (B)
respectively, whereas minor bleeding was seen in 4% of group (A) and 11% of group
(B).
Conclusion: The study showed that INR-C is more efficient and safer for patients on
regular warfarin therapy compared with the General-C.
Sudanese Journal of Paediatrics, 2024
Trisomy 22 is a rare autosomal constitutional chromosomal disorder with high survival incompatibi... more Trisomy 22 is a rare autosomal constitutional chromosomal disorder with high survival incompatibility being the third most frequent trisomy in spontaneous abortions and accounting for 10%–15% of all cases. Mosaic trisomy 22 is a less severe variant of the disorder associated with mild phenotype and longer lifespan compared to cases with complete trisomy 22. To date, there have only been 25 reported cases of trisomy 22 worldwide. We report a recent case of a 7-year-old
boy brought in by his mother seeking a diagnosis for the condition of her child. The father deceased 6 years earlier, and the obstetrical history of the mother revealed 3 first trimester recurrent
abortions. Upon examination, the child was found to have short stature, dysmorphic features, atrial septal defect, cognitive disability and
other neurological abnormalities. The mother’s karyotype analysis showed a normal female karyotype 46,XX, while the child’s analysis
revealed mosaic trisomy of chromosome 22 syndrome 47,XY,+22/46,XY. This case marks the first documented case of this syndrome in Sudan.
Sudan Journal of Medical Sciences, 2021
Complete Androgen Insensitivity Syndrome (CAIS) is an X-link recessive genetic mutation of androg... more Complete Androgen Insensitivity Syndrome (CAIS) is an X-link recessive genetic mutation of androgen receptor (AR) gene leading to complete inability of cell to respond to the androgens. CAIS occurs in 1 out of 20,400 XY live-birth babies, and affects about 1–2% of prepubertal girls that present with an inguinal hernia. Although individuals with CAIS have XY, those with grades 6 and 7 on the Quigley scale are born
phenotypically female, without any signs of genital masculinization. Thus, individuals affected by CAIS develop a normal external female phenotype with normal female external genitalia, well-developed breast, absent uterus, and bilateral undescended testicles. The question of CAIS diagnosis does not come forward until the absent menses at the puberty is noted or accidentally during an inguinal hernia repair in a
premenarchal girl. The present study reports a case of inguinal hernia repair on 11- year-old girl, which led to unexpected intraoperative notion of CAIS. The diagnostic work-up, genetic counseling, sex assignment, and the need for preoperative CAIS screening in girls with bilateral inguinal hernia are described and discussed.
Sudan Journal of Medical Sciences, 2024
Background: Thiopurine drugs have limited use due to their toxicity, related to the enzyme thiopu... more Background: Thiopurine drugs have limited use due to their toxicity, related to the enzyme thiopurine S-methyl transferase (TPMT) activity, which varies between individuals. This is the first study in Sudan, which aimed to assess the TPMT phenotypic status of healthy Sudanese volunteers.
Methods: A total of 177 healthy volunteers from Sudan were included in the study. TPMT enzymatic activities were measured using the ELISA serum protocol. We used SPSS to analyze the data and determined enzyme level categories and normal range with Z scores and quartile tests. The Sudan Medical Specialization Board (SMSB) Ethical
Committee approved the study.
Results: There were 117 males and 60 females among the volunteers, with ages ranging from 16 to 70 years and a mean age ± SD of 28.0 ±1 0.2, median = 24. Most candidates were from the Afro-Asiatic linguistic group (64.5%), followed by Nilo-Saharan (18.6%) and Niger-Kordofanian (16.9%). The TPMT enzyme level ranged between 0.17 and 9.5 ng/ml, with a mean of 2.26 ± 0.75 ng/ml. The quartile classification included very low enzyme (<0.76 ng/ml) seen in 4 candidates (2.3%), intermediate low (0.76-1.4 ng/ml) seen in 34 (19.2%), the normal range (1.5 – 3.75 ng/ml) seen in 119 (67.2%), and high enzyme activity (>3.76 ng/ml) seen in 20 (11.3%). No significant correlations between age, sex, and ethnic groups were recorded.
Conclusion: The normal TPMT enzyme activity is between 1.5 and 3.76 ng/ml. A higher prevalence of TPMT deficiency was recorded and compared with international studies.
Pretreatment screening using serum ELISA test for TPMT enzyme activity should be used to predict the risk of toxicity.
Sudan Journal of Medical Sciences, 2024
Ethiopian Journal of Reproductive Health, 2024
ABSTRACT BACKGROUND: Primary amenorrhea is defined as the absence of menstruation by age 14 witho... more ABSTRACT
BACKGROUND: Primary amenorrhea is defined as the absence of menstruation by age 14 without secondary
sexual characteristics or by age 16, regardless of normal development. Chromosomal aberrations account for 14-60%
of cases. This study aimed to evaluate chromosomal abnormalities in patients with primary amenorrhea referred to
Elite Genetics Center, Khartoum-Sudan, for genetic analysis.
METHODS: Between 2017 and 2023, 248 patients with PA were investigated. Clinical data, hormonal profiles,
and sonographic findings were recorded. Karyotyping was done initially, and PCR analysis for the SRY gene was
used as a complementary test for patients with normal karyotypes. The clinical diagnosis was based on the history,
clinical presentation, hormonal investigation, sonographic findings, and cytogenetic and molecular results.
RESULTS: The results showed that 68 (27.4%) had female karyotypes (46,XX), and 36 (14.5%) had male
karyotypes. Numerical chromosomal abnormalities were seen in 97 (39.1%) cases, structural changes in 14 (5.6%),
and mosaic abnormalities in 33 (13.3%). Turner syndrome was present in 137 (55.2%), Trisomy X (47, XXX) in
3 (1.2%) cases, and sex reversal (46, XY) in 7 (2.8%) cases. Clinical diagnosis included XY DSD in 21 (8.5%),
Complete Androgen Insensitivity Syndrome in 8 (3.2%), Swyer’s syndrome in 7 (2.8%), Ovotesticular DSD in 4
(1.6%), Mayer-Rokitansky-Küster-Hauser syndrome in 5 (2%), and Triple X in 3 (1.2%) cases.
CONCLUSION: The results highlight the need for cytogenetic analysis as an integral part of the PA diagnostic
protocol. Complementary PCR for the SRY gene is essential in differentiating XY DSD cases.
Pan African Medical Journal, 2020
Introduction: the outbreak of coronavirus disease 2019 (COVID-19) started in China in December ... more Introduction: the outbreak of coronavirus disease
2019 (COVID-19) started in China in December
2019 and spread causing more than 14 million
cases all over the world on July 19th, 2020.
Although, real-time reverse transcription
polymerase chain reaction (rRT-PCR) test is the
gold standard test, it needs a long time and
requires specialized laboratories and highly trained
personnel. All these difficulties forced many
countries with reduced health resources to limit
rRT-PCR tests to individuals with severe symptoms.
Thus, routine blood marker that may help
physicians to suspect COVID-19 and hence,
prioritize patients for molecular diagnosis is badly
needed. Methods: fifty-six Sudanese COVID-19
patients admitted to Jabra hospital were included
in this study. For all the patients we analyzed
complete blood count (CBC), CBC, plasma levels of
C-reactive protein (CRP), erythrocyte
sedimentation rate (ESR), liver function tests (LFT)
and renal function tests (RFT). Statistical analysis
was done using SPSS program with a significance
level of p≤0.05 and confidence limits (CLs) 95%.
The difference between groups was tested using
Mann-Whitney test was for quantitative variables
while qualitative variables was tested using chisquare (Fisher exact) test. Results: the result shows
that, 35 out of the 56 patients (62.5%) were male
and 21 (37.5%) were females with a median age of
60-year-old for both sexes. Lymphocytes % showed decrease to 9.2 (P-value=0.000) and significant
increase in neutrophils to 83.05 (P-value=0.005),
ESR to 65.54 (P-value=0.000) and CRP to 91.07 (Pvalue=0.000). The receiver operating characteristic
curve (ROC)/area under the curve (AUC) ensured
the expellant result of lymphocytes % as a
predictor with 92% area under the curve,
neutrophils were 90% and ESR 95.8%. The percent
of detecting COVID-19 positive RT-PCR (98%) for
suspected individuals using ROC showed best
cutoff of ≤21.8 for lymphocytes %, ≥67.7 for
neutrophils, ≥37.5 for ESR, ≥6.2 for CRP and ≥7.15
for WBCs. Conclusion: the results also showed
that, lymphocyte percentages, neutrophils, CRP and ESR may be used as markers for COVID-19
helping prioritizing individuals for rRT-PCR test.
Sudan Journal of Medical Sciences
African Journal of Reproductive Health, 2024
Given the scarce data on DSD in Sudan, we aimed to characterize DSD's clinical and genetic profil... more Given the scarce data on DSD in Sudan, we aimed to characterize DSD's clinical and genetic profile in Sudanese patients. We studied
60 patients with DSD using clinical data, cytogenetics, and PCR for the SRY gene. The results showed that 65% grew up as females
and 35% as males. There was a high percentage of consanguineous parents (85%). Female genital mutilation (FGM) was performed
in 75% of females. Patients who presented after pubertal age were 63%, with ambiguous genitalia in 61.7%, followed by primary
amenorrhea (PA) in 30%. The SRY gene was positive in 3.3% of patients with 46,XX karyotype and negative in 6.7% of patients with
46,XY karyotype. 5αR2D-DSD was seen in 43.3%, gonadal dysgenesis in 21.7%, Ovotesticular syndrome in 6.7%, Swyer and Turner
syndrome in 5% each, and Androgen Insensitivity Syndrome (AIS) in 3.3%. In conclusion, DSD in Sudan has a distinct profile with
late presentation, dominated by 5αR2D-DSD due to the increased consanguineous marriage, and FGM represents a significant risk
for DSD patients.
Gulf Journal of Oncology, 2022
Abstract Introduction: Bladder cancer (BC) is highly heterogeneous with regard to clinical cour... more Abstract
Introduction: Bladder cancer (BC) is highly heterogeneous with regard to clinical course, etiology, histology, and geographic distribution. Recent clinical observations
suggest changes in the pattern of BC in the Sudan perhaps due to lifestyle change following the massive displacement from rural to urban areas. The present study aimed to characterize the clinical profile of the BC among Sudanese patients and compare it with what has been previous reported. Material and Methods: Demographic, habitual, clinical, and histopathology information of 1610 patients with
BC were obtained from the hospital record of Ibn Sina specialized hospital, Soba University hospital, Khartoum North hospital and Khartoum teaching hospital during the period 2007-2019. The data was analyzed using SPSS program version 23.
Results: Of the 1610 cases of BC, 1480 cases (91.9%) were males and 130 cases (8.1%) were females. The most affected patients (39.3%) were those with age group ranging between 61-75 year-old. The vast majority of the patients (73%) were from urban and/or metropolitan areas of the capital Khartoum, whereas the remaining (27%) were farmers coming from rural areas. Although, smoking habits information were missed in 410 patients, 44% of the patients were smokers. History of hematuria
was present in almost all cases (99.4%), whereas history of urinary bilharziasis was mentioned in 40.9% of the patients’ records.The TCC histology type was seen in 77.4% of the cases, SCC in 21.1%, and adenocarcinoma in only 1.5% of all cases. The vast majority of the tumors were poorly differentiated tumors (700/52.6%), followed by
moderately differentiated tumors (430/32.3%) and well differentiated ones (200/15.1%). Of the total tumors, 346/26% were Ta-T1, 456/34% were T2, and 528/40% were T3-T4a,b. Most of tumors were solid ones, accounting for 74% compared with the papillary ones (26%) with most (54.9%) of the tumor located in the
lateral wall of the bladder. Although in 620 (38.5%) patients, the follow up information
were missing from the records, still the recurrence of the tumors were recorded in 890 (55.3%) of the patients 6 month after the initial therapy.
Discussion: The results showed that poorly differentiated, muscle invasive, and high recurrent TCCs tumors dominate BC profile of Sudanese patients. It revealed also that the most affected population are those between 61-75 yearold. These findings are in clear contrast with BC profile, previously, reported in which solitary muscle invasive
Bilharzia-associated SCCs tumors affecting younger population was the dominated patterns as reported by Daoud el al (1968), Malik et al., (1975) and later by Sharfi
et al., (1992). Thus clear change in BC profile in Sudan is evident, perhaps due to increased urbanization and style of life that led to change in the causative etiology, and
eventually the histology type.
Ethiopian Journal of Reproductive Health, 2024
ABSTRACT BACKGROUND Disorder of Sex Development (DSD) is a condition where there is a misalignme... more ABSTRACT
BACKGROUND
Disorder of Sex Development (DSD) is a condition where there is a misalignment of gonads or chromosomes
with the genitalia. One of the rarest forms of DSD is Ovotesticular DSD (OT-DSD), which is characterized by the
presence of both ovarian and testicular tissues in the same individual and a diverse range of phenotypes with various
penetrations.
CASE SUMMARY
A 16-year-old patient who was raised as a female presented with ambiguous genitalia and regular menstrual cycles.
Ultrasound examination revealed a normal-sized uterus and three gonads. Cy-togenetic analysis showed a mosaic
karyotype, and PCR testing for the SRY gene was positive. Postoperative histology indicated the presence of two
ovaries and one ovotestis gonad.
CONCLUSION
In low-resource healthcare settings, caregivers should remain vigilant for ambiguous genitalia and ensure timely
referral for accurate diagnosis and counseling before sex assignment. This case highlights the importance of
maintaining a high level of suspicion for DSD in adolescents dis-playing abnormal pubertal development or atypical
genital findings.
Sudan Journal of Medical Sciences, 2022
Background: Although warfarin is known as effective oral anticoagulant to prevent thromboembolic... more Background: Although warfarin is known as effective oral anticoagulant to prevent
thromboembolic events, its’ narrow therapeutic index requires ambient and good
follow-up to reduce its therapeutic complications. There is a continuous debate
whether the best practice to accomplish this goal is in a specialized international
normalized ratio clinic (INR-C) or in a general medical clinic (General-C). Few, if any,
studies have been done in Sudan to compare the safety and efficacy of anticoagulant
therapy in those clinics. Thus, the objective of this study was to compare the efficacy
and safety of anticoagulant therapy in INR-C and in General-C.
Methods: This is a prospective hospital-based study where 200 patients were divided
into two groups (group A and B) of 100 patients. Group A were in the INR-C at Ahmed
Gasim specialized hospital and group B in the General-Cat AL-Shaab teaching hospital.
The study was conducted from September 2019 to April 2020. All patients were on
warfarin treatment and regular follow-ups were conducted. Demographic and clinical
data were collected and analyzed statistically using SPSS version 20. Ethical approval
was obtained from the ethical committee of the Sudanese Medical Specialization Board
(SMSB).
Results: Of the 200 patients, 118/59% were females and 82/41% were males. Target
international normalized ratio (INR) for group (A) was achieved in 56% of the patients
in the first visit, increased to 63% in the second visit, and 75% in the third follow-up,
compared with 24% of the patients from group (B) in the initial and second follow-up
visit, to 43% in the third visit (P value=0.05). Knowledge about drug and food interaction
of coagulation agents was higher (91%) among patients in group (A) compared with
group (B) (56%). Drug interaction awareness was found in 89% of the patients in group
(A) compared with only 40% in group (B) (P value=0.05).
Major bleeding was reported in 2% and 14% of the patients of group (A) and (B)
respectively, whereas minor bleeding was seen in 4% of group (A) and 11% of group
(B).
Conclusion: The study showed that INR-C is more efficient and safer for patients on
regular warfarin therapy compared with the General-C.