Elwaleed M. Elamin

Malignant gastric tumors in Sudan

Hematol Oncol Stem Cell Ther 1(2) April 2008 hemoncstem.edmgr.com 130 Gastric cancer is the second leading cause of death due to cancer worldwide.1 Its incidence varies widely in the world with Costa Rica and Japan having the first and the second highest incidence rates in the world.1,2 The risk for developing gastric cant cer in North Africa and the Middle East is less than in the developed countries.3 There is little information on the frequency of gastric malignancies in the rest of Africa. Previous reports from Sudan showed that these tumors were uncommon.4 Most of the cases were ret ported before endoscopy was introduced in the country in the last twenty years. The purpose of this paper is to report on the frequency of gastric malignancies seen in one pathology center over a period of 5 years in Sudan.

Isolation and identification of Leishmania donovani from Phlebotomus orientalis, in an area of eastern Sudan with endemic visceral leishmaniasis.

In Sudan, human visceral leishmaniasis (VL) or kala-azar is endemic in many areas (Zijlstra and El Hassan, 2001). Although epidemics of VL have claimed the lives of thousands of Sudanese people in the last few decades, the local epidemiology of the disease is not well understood (Zijlstra and El Hassan, 2001). Sudanese cases have been found infected with Leishmania donovani (of the MON-18, MON-274 and MON-276 zymodemes), L. infantum (MON-30) and L. archibaldi (MON-257 and MON-258) and, since the same zymodemes have been isolated from patients with post-kala-azar dermal leishmaniasis and from dogs, both anthroponotic and zoonotic transmission cycles may occur (Pratlong et al., 2001; Dereure et al., 2003). In southern Sudan, the sandfly Phlebotomus orientalis has been found infected with L. donovani MON-18 and L. archibaldi MON82 (Ashford et al., 1992), although Minter et al. (1962) incriminated P. martini as a vector of the parasites causing the VL in Kapoeta. The molecular detection of Leishmania DNA in wild-caught sandflies has indicated that P. orientalis is the main vector for the parasites causing the VL in the east of the country (Elnaiem et al., 1998; Hassan et al., 2004). Prior to the present study, however, no Leishmania parasites appear to have been cultured from naturally infected sandflies from this region. The successful culture of L. donovani from P. orientalis caught in a national park in Gadaref state, an area of eastern Sudan where VL is known to be endemic, is described below. In March–June 2005, adult sandflies were collected, using CDC light traps (John Hock Co., Gainsville, FL) set to run between 18.00 and 06.00 hours, from dense areas of Acacia seyal/Balanites aegyptiaca forest in the Dinder National Park (35u29E, 12u369N). The female sandflies were dissected in saline and examined for the presence of Leishmania promastigotes (Elnaiem et al., 2001; Hassan et al., 2004). Each fly was identified to species level from the morphology of its head and terminalia, which were removed and mounted in Berlese’s medium. When promastigotes were observed, more saline was added before the sandfly gut was homogenized with sterile needles, to liberate the parasites (Elnaiem et al., 2001). The saline containing the parasites was then inoculated into NNN medium supplemented with antibiotics (5 mg penicillin and 5 mg streptomycin/ml). The cultures were kept in a cool box, at 20–24uC, while being transported to the research laboratory in Khartoum, where they were incubated at 25uC. In the laboratory, each inoculated tube of medium was checked every 3 days for parasite multiplication and/or contamination. Each parasite-positive culture was subinoculated into 200 ml RPMI 1640 medium supplemented with 10% foetal calf serum, and then incubated at 25uC, so that large numbers of promastigotes of each isolate could be produced. While in the log phase of their growth, the parasites in these monophasic cultures were harvested so that their DNA could be extracted using the phenol/chloroform method (Maniatis et al., 1986). Each DNA sample was then used as the template in a PCR in which the size of the amplicon produced, which represents a Annals of Tropical Medicine & Parasitology, Vol. 102, No. 6, 553–555 (2008)

Association of Epstein - Barr virus and breast cancer in Eritrea

BackgroundThe oncogenic potential of Epstein-Barr virus (EBV) in breast cancer is being increasingly recognized. Despite some controversies regarding such role, new evidence is suggesting a culpability of EBV in breast cancer, particularly in Africa where the virus has been originally associated with causation of several solid and hematological malignancies. One example is a report from Sudan implicating EBV as a prime etiologic agent for an aggressive type of breast cancer, where nearly 100% of tumor tissues were shown to carry viral signatures. To get a broader view on such association, other nearby countries should be investigated. The present study aims to determine the prevalence and possible associations of the virus in Eritrean breast cancer patients.MethodsDetection of EBV genome using primers that target Epstein Barr Encoded RNA (EBER) gene and Latent Membrane Protein-1 (LMP-1) gene sequences was performed by polymerase chain reaction (PCR) on DNA samples extracted from 144 formalin fixed paraffin embedded breast cancer tissues and 63 non-cancerous breast tissue as control group. A subset of PCR positive samples was evaluated for EBER gene expression by in situ hybridization (ISH). Expression of Latent Membrane Protein-2a (LMP2a) was also assessed by immunohistochemistry in a subset of 45 samples.ResultsBased on PCR results, EBV genome signals were detected in a total of 40 samples (27.77%) as compared to controls (p-valueu2009=u20090. 0031) with a higher sensitivity when using the EBER primers. Five out of the 14 samples stained by EBER-ISH 35.71% were positive for the virus indicating the presence of the viral genome within the tumor cells. Of those stained for IHC 7 (15.55%) were positive for LMP2a showing low viral protein frequency.ConclusionsBased on these findings it can be concluded that EBV in Eritrea is associated with a smaller subset of tumors, unlike neighboring Sudan, thus pointing to possible differences in population predisposition and diseases epidemiology.

pathology of nasopharyngeal carcinoma in sudanese patients and its Association with epstein-Barr Virus: A Report from a single center in Khartoum

Objectives: The aim of this study is to describe the pathology of nasopharyngeal carcinoma in Sudanese patients and to investigate its association with the Epstein-Barr virus (EBV). nStudy design: This is a prospective descriptive cross-sectional study conducted at the ENT Khartoum Teaching Hospital, Khartoum City, Sudan. nSubjects and methods: Patients with suspected nasopharyngeal carcinoma reporting to our centre between 2006 and 2008 were studied. Biopsy samples from the nasopharynx were obtained from 68 patients suspected to have NPC. Part of the biopsy was fixed in neutral 10% formalin and processed for light microscopy. The other part was not fixed and was used to extract DNA for the detection of EBV genome. The tumours in the formalin-fixed paraffin-embedded biopsies were classified according to the WHO system of classifying NPC. Genomic DNA was extracted from the fresh unfixed biopsies of patients with histologically confirmed NPC and individuals who had other non-NPC lesions or a normal mucosa. The majority of the lesions in the non-NPC cases were adenoids. The EBV genome was detected by PCR using EBNA-1, and LMP-1 primers. nResults: Of the 68 patients studied, 58 had histologically proven nasopharyngeal carcinoma. The tumours were classified as type 2 in 23 patients, type 3 in 32 and mixed types 2 and 3 in 3 patients. EBV genome was detected in 77.6% and 84.5% of the tumours by EBNA-1 and LMP-1 primers, respectively. Of the non-NPC cases, the highest infection with EBV was in patients with adenoids. The virus was detected in 8 of the 44 adenoids (18.2.%) with EBNA-1 primer and in 11 (25%) samples with LMP-1 primer. The significance of these findings is discussed. nConclusion: In Sudan, EBV is strongly associated with nasopharyngeal cancinoma at a frequency comparable to that in countries with intermediate degree of endemicity for the tumour.

First report on Leishmania major/HIV coinfection in a Sudanese patient

This case report emerged from a large study on biotechnological typing of leishmania parasites in Sudan. Thetyp -ing study was approved by the National Ethical Committeeof the Federal Min-istry of Health, Sudan. The approved protocol included obtaining consent of the participants for sample collection and HIV testing for unusual and severe clinical presentations to assist effective treatment and control. Thepatient in this case report gave writtenconsent for HIV testing and enrolment in the typing study. Based on the severity of the presenting lesions he was suspected of HIV coinfection and was referred to the national HIV control programme for pre-counselling and HIV testing. Following the diagnosis of

Coexistence of sickle cell nephropathy and lupus nephritis in a Sudanese child.

In spite of the wide distribution of sickle cell disease (SCD) in Africa, an association with systemic lupus erythromatosis (SLE) is seldom reported. This may be due to the poor association between the two diseases or the high prevalence of missed cases. Progressive renal injury is prominent in both SCD and SLE. In this communication, we are presenting a case of an 11-year-old male who presented with sickle cell nephropathy that manifested as nephrotic syndrome with no response to conservative therapy, alongside unexplained massive hemolysis. His renal biopsy proved SLE superimposed on sickle cell nephropathy. We are stressing the importance of considering alternate disease processes in patients with SCD when symptoms change or when there is an atypical clinical course.

Bartonella Infection: An Emerging Neglected Zoonotic Disease in Sudan

Bartonella infection occurs in three forms: Cat scratch disease (CSD) due to Bartonella henselae, Trench fever due to Bartonella quintana and Carrion′s disease caused by Bartonella bacilliformis. CSD occurs worldwide and may be present wherever cats are found. The bacteria infect the red cells of cats which are usually symptomless. Transmission of the bacteria between cats is usually by fleas. Transmission to humans is by cat bites and scratches. In this paper we describe CSD for the first time in Sudan. Human cases were diagnosed pathologically at a single histopathology service center in Khartoum, Sudan. Following written informed consent, twenty four cases were enrolled in 2013, 2014 and the first quarter of 2015. The sites affected included the skin, subcutaneous tissue, lymph nodes, the lung, the spleen, brain, bone, breast, gallbladder and retro-peritoneum. In half of the cases (12/24; 50%), lymph nodes were infected. The majority (9/12; 75%) of the infected nodes were cervical. In the Hematoxylin and Eosin stained sections the bacteria were seen as clumps of black small filamentous structures. They stained positive for melanin by Masson Fontana and Melan-A. The bacteria were identified as Bartonella henselae by a specific monoclonal antibody. The disease may be more common than is realized. A high clinical index of suspicion has to be maintained to diagnose cases of Bartonella in Sudan.

Myasthenic Crisis Manifesting as Postoperative Respiratory Failure following Resection of Unsuspected Intrathoracic Thymic T-Cell Lymphoma during Thyroidectomy for an Adjacent Large Retrosternal Goiter

A middle-aged female with a goiter of 10 years duration presented with progressive pressure symptoms, nocturnal choking and dyspnea on exertion for 5 months. Physical examination demonstrated a large simple multinodular goiter. Imaging revealed a deep retrosternal goiter extending below the tracheal bifurcation with marked tracheal deviation. Total thyroidectomy was carried out via a cervical approach and a median sternotomy. Extubation was not possible, and the patient had to be kept intubated. She then went into a myasthenic crisis. Initial ventilatory support was followed by intravenous immunoglobulin, steroids and pyridostigmine. The patient had complete remission and was asymptomatic 18 months later. Histopathology showed a T-cell-rich thymoma in addition to a nodular colloid goiter.

Lipoblastoma in a four-year-old African child.

A four-year old Sudanese child presented with a growing mass in the medial aspect of the right thigh. The mass appeared during the neonatal period. On clinical examination a diagnosis of lipoblastoma was entertained on the basis of the patients age and the clinical features of the mass. The tumor was completely excised surgically. The clinical diagnosis of lipoblastoma was confirmed pathologically. Follow-up of the patient for 6 months postoperatively showed no evidence of recurrence.