Hussain Gadelkarim Ahmed

Impact of Toombak dipping in the etiology of oral cancer: Gender-exclusive hazard in the Sudan.

BACKGROUND Oral cancer (OC) mortality is very high in Sudan, particularly among men due to the habit of Toombak use (tobacco specific nitrose amine (TSN)) rich tobacco. AIMS Our aim was to determine whether OC is gender-specific due to increased Toombak use among males as suggested a risk for subsequent development of oral cancer. SETTINGS AND DESIGN We conducted a descriptive study of OC in Khartoum and obtained information on Toombak use, confounding variables for 39 incident patients with oral cancerous lesions and 43 hospital-based cases without apparent oral lesions. MATERIALS AND METHODS OC was affirmed by histopathology for all patients with oral lesions, hence oral epithelial atypia and leukoplakias were detected using cytology. STATISTICAL ANALYSIS Data analyzed using a computer SPSS program. RESULTS AND CONCLUSIONS Of the 82 subjects, there were 57 (70%) Toombak users and 25 (30%) non-tobacco users. Among the 39 patients with OC, 24 (61.5%) were Toombak users and 15 (38.5%) were non-tobacco users. Among 43 with atypical changes, 10 (23.3%) were non-tobacco users and 33 (76.7%) were Toombak users. Regarding gender, only 11 (13.4%) were females, of whom 8 (72.7%) were non-tobacco users. We conclude that oral cancer, atypia and leukoplakia were high among males who were Toombak users. In view of the high incidence (29%) of OC due to Toombak use, we propose the implementation of oral screening programme restricted to Toombak users.

Frequency of breast cancer among sudanese patients with breast palpable lumps

BACKGROUND Breast cancer mortality is high in Sudan and most patients are detected at later stages of the disease due to the lack of awareness and absence of screening programs. This study aimed to determine the pattern and frequency of breast cancer among patients presenting with palpable breast lumps within one year duration. SETTINGS AND DESIGN As a part of the continuous development in cancer management, this descriptive longitudinal study was conducted in Khartoum, Sudan. METHODS AND MATERIALS We obtained information (patients personal data) and Fine-Needle Aspiration (FNA) materials, for occurrence of 200 breast lesions in patients. STATISTICAL ANALYSIS USED Data were analyzed by using a computer SPSS program. RESULTS The diagnoses of the 200 breast lesions were as follows: 68 (34%) were malignant, 56 cases (28%) were fibroadenoma, 23 cases (11.5%) were fibrocystic change, 22 cases (11%) were inflammatory lesions (including mastitis and abscess formation), 12 cases (6%) were benign cysts and the remaining 19 patients (9.5%) were with lactation changes (8 cases), lipoma (6 cases), gynecomastia (3 cases) and phyllodes tumor (2 cases). Regarding gender, only 6 patients (0.03%) were males of whom 3 (50%) were diagnosed with gynecomastia. CONCLUSIONS The frequency of advanced breast cancer among patients with breast lesions is high, in this subset of patients, which signals the urgency for implementation of breast screening programs.

Screening for tuberculosis and its histological pattern in patients with enlarged lymph node.

Settings. Tuberculosis is a major health problem in the Republic of Yemen. Tuberculous lymphadenitis is one of the most common forms of extrapulmonary tuberculosis. Therefore, this retrospective descriptive study was conducted in Yemen to investigate the morphological pattern of tuberculous lymphadenitis, as well as to assess the reliability measures of (ZN) Ziehl-Neelsen and fluorescent methods in identification of Mycobacterium tuberculosis. Methodology. One hundred lymph nodes tissue biopsies that were previously diagnosed by conventional histopathology as having tuberculous lymphadenitis were reinvestigated. Five micron in thickness sections were obtained from formalin-fixed paraffin wax processed tissues. The sections were stained using Haematoxylin and eosin (H & E), ZN, and fluorescent methods. Results. All of the 100 specimens were proved as having histopathological pattern of tuberculosis lymphadenitis. The most major histological features were giant cell (88%), caseation (84%), epithelioid cells (80%), granuloma and caseation (68%), lymphocytes (31%), and histiocytes (4%). After staining the specimens with ZN and fluorescent, of the 100 specimens only 3 (3%) and 9 (9%) specimens were found positive, by ZN and fluorescent methods, respectively. Conclusion. Conventional ZN and fluorescent methods have limitations in diagnosis of tuberculous lymphadenitis due to their lower sensitivity. Histopathology remains the most suitable method for the diagnosis of tuberculous lymphadenitis. In cases of suspected tuberculous lymphadenitis, it is advisable to confirm with more sensitive and specific method, such as polymerase chain reaction PCR or immunohistochemistry before reporting the negative results.

Assessment of cytological atypia, AgNOR and nuclear area in epithelial cells of normal oral mucosa exposed to toombak and smoking

The purpose of this study was to assess cellular proliferative activity of clinically healthy oral mucosal epithelial cells of toombak dippers and smokers by means of AgNOR counts and nuclear areas via nuclear morphometry. Smears were collected from normal-appearing mouth floor mucosa and tongue of 75 toombak dippers, 75 smokers and 50 non-tobacco users between the ages of 20 and 70 with a mean age of 36 years. AgNORs were counted in the first 50 well-fixed, nucleated squamous cells and nuclear areas were calculated via microscopic stage micrometer. Cytological atypia was ascertained in 6 tobacco users and could not be ascertained in non-tobacco users. Statistically mean AgNOR numbers per nucleus in the non-tobacco users (2.45±0.30) was lower than the toombak dippers (3.081±0.39, p<0.004), and the smokers (2.715±0.39, p<0.02), and mean nuclear areas of epithelial cells of toombak dippers (6.081±0.39, p<0.009) and smokers (5.68±10.08, p<0.01) was also significantly higher than non-smokers (5.39±9.4). The mean number of nuclei having more than 3 AgNORs was 28%, 19% and 7% in toombak dippers, smokers and non-tobacco users, respectively. These findings support the view that toombak dipping and smoking are severe risk factors for oral mucosal proliferative lesions and exfoliative cytology is valid for screening of oral mucosal lesions.

Oral epithelial atypical changes in apparently healthy oral mucosa exposed to smoking, alcohol, peppers and hot meals, using the AgNOR and Papanicolaou staining techniques.

To evaluate cytological atypical changes in apparently healthy oral mucosa exposed to smoking, alcohol, hot meals, and peppers using the AgNOR and Papanicolaou methods. A total of 180 individuals were evaluated, of which 60 were smokers, 34 were alcohol users, 52 were habitual peppers and hot meal (exposed) consumers, 24 were non‐exposed, and 10 were patients with Oral Squamous Cell Carcinoma (OSCC), as an internal control. Cytological materials were obtained by brushing of buccal mucosa, on the border of the tongue and on the floor of the mouth, and participants underwent the Papanicolaou test for cytological changes and AgNOR staining for evaluation of the mean number of AgNOR dots per nucleus. SPSS program was used to perform the Pearson chi‐square test. The 95% confidence level, Odds Ratio (OR), and the 95% Confidence Intervals (CI) were used.

Immunohistochemical expression of COX2 and iNOS in bladder cancer and its association with urinary schistosomiasis among Sudanese patients.

AimsThe purpose of this study was to determine if any relationship exists between expression of COX2 and iNOS markers and urinary schistosomiasis in bladder cancers.MethodologyImmunohistochemical expression of COX2 and iNOS was assessed in formalin fixed paraffin wax processed tissues obtained from 155 patients with bladder cancers (87 SCC and 68 TCC) and 39 patients with benign bladder cystitis.ResultsThe overall immune-expressions of COX2 and iNOS were 71.6% and 57.2% respectively, of the 194 bladder lesions. A significant Positive association between COX2 or iNOS expression with bladder lesions (SCC, TCC and cystitis) was found (p.value = 0.000). COX2 and iNOS were co-expressed among 73(83.9%) of SCC, 15(22.1%) of TCC and 11(28.2%) of the cystitis group. The relationship between COX2 and iNOS immunostaining and Schistosomal ova positivity was statistically determined by P values 0.0565 and 0.1223 for Cox2 and iNOS, respectively.ConclusionThere are high rates of positive expression of COX2 and iNOS among Sudanese patients with Schistosomal-related bladder lesions. There might be strong association between high rates of bladder cancers and urinary Schistosomiasis in the Sudan since, the great majority of lesions were positive for COX2.

Incidence of Epstein-Barr Virus in Pediatric Leukemia in the Sudan

BACKGROUND Results of several studies have suggested a probable etiologic association between Epstein-Barr virus (EBV) and leukemias; therefore, the aim of this study was to investigate the association of EBV in childhood leukemia. METHODS A direct isothermal amplification method was developed for detection of the latent membrane protein 1 (LMP1) of EBV in the peripheral blood of 80 patients with leukemia (54 had lymphoid leukemia and 26 had myeloid leukemia) and of 20 hematologically healthy control subjects. RESULTS EBV LMP1 gene transcripts were found in 29 (36.3%) of the 80 patients with leukemia but in none of the healthy controls (P < .0001). Of the 29 EBV(+) cases, 23 (79.3%), 5 (17.3%), and 1 (3.4%) were acute lymphoblastic leukemia, acute myeloid leukemia, and chronic myeloid leukemia, respectively. CONCLUSION EBV LMP1 gene transcriptional activity was observed in a significant proportion of patients with acute lymphoblastic leukemia. EBV infection in patients with lymphoid leukemia may be a factor involved in the high incidence of pediatric leukemia in the Sudan.

The effect of fixatives and temperature on the quality of glycogen demonstration

Abstract Glycogen is demonstrated in a number of lesions and is diagnosrically significant, particularly in certain tumors. To stain glycogen accurately, it is essential to choose a suitable fixative, temperature and staining method. We used rabbit liver to assess these variables. Specimens were fixed in three fixatives at two temperatures: 10% formalin, neutral buffered formalin (NBF) and Bouins solution at 37 and 4°C. Seventy-two paraffin sections were prepared and stained with periodic acid-Schiff (PAS), hexamine (methenamine) silver and Bests carmine methods. Negative control sections using diastase digestion were used for all methods to confirm the presence of glycogen. For the PAS reaction, Bouins fixative gave better results at both temperatures compared to the other fixatives. For hexamine (methenamine) silver, the quality of staining was improved for tissues fixed in both 10% formalin and NBF at 37°C compared to Bouins solution. Both 10% formalin and NBF at 4°C gave better results than Bouins solution. For Bests carmine, Bouins solution gave the best results for tissues fixed at 4°C. Fixation of tissues with NBF at 37°C gave the best quality staining. We concluded that the quality of glycogen staining in paraffin sections is greatly affected by both the fixative and the temperature of fixation.

Utility of fine-needle aspiration as a diagnostic technique in breast lumps

Fine‐needle aspiration cytology (FNAC) is a simple, accurate, and safe procedure for the diagnosis of palpable breast lumps. The purpose of this study is to emphasis the utilization of FNAC in the Sudan and to evaluate our experience to identify the types of various breast lesions. A one year descriptive longitudinal study was conducted in Khartoum, Sudan. We obtained information (patients personal data) and Fine‐Needle Aspiration (FNA) samples, for 200 patients with palpable breast lesions. Subsequent tissue biopsies were taken from 131 patients of the 200 studied patients. Data were analyzed using a computers SPSS program. Pearson chi‐square test was used for statistical analyses. The diagnoses of the 200 breast FNAs were as follows: 61 (30.5%) were malignant, 5 (2.5%) were suspicious, and 134 (67%) were benign lesions. Subsequent histopathological examination was performed on 61 (100%) patients with malignant lesions, 5 (100%) of suspicious, and 65 (48.5%) patients of 134 patients with benign lesions. FNAC revealed a 92.6% sensitivity, a 95.2% specificity, a 95.5% positive predictive value, and a 92.2% negative predictive value. Of the 65 benign cases on cytology, five cases were found malignant on histopathology. FNAC of breast lesions is sensitive, specific, and highly accurate as the initial investigation of palpable breast lesions in a population of low resources and without screening program to diagnose breast cancer. We consequently encourage clinicians to embrace this procedure in the management of patients. Diagn. Cytopathol. 2009.

Survey on Knowledge and Attitudes Related to the Relation between Tobacco, Alcohol Abuse and Cancer in the Northern State of Sudan

BACKGROUND The aim of this study was to determine the epidemiology of tobacco smoking, toombak dipping and alcohol consumption as risk factors for cancer in the adult population of the northern state of Sudan. MATERIALS AND METHODS A cross-sectional survey from March to April 2010, covering 963 adults, was performed. RESULT Only 207 had responded, and the male female prevalence was 20.8% and 0.73%. Out of 207 respondents, 29.5% had smoked tobacco in their lifetime, 38% were toombak dippers, while 14% were consumers of alcoholic beverages. CONCLUSIONS The prevalence of toombak dipping was higher than tobacco smoking among the adult population in the northern state of Sudan. Female participation in tobacco and alcohol related studies was found to suffer from major obstacles since these habits are considered as social stigma. Appreciation of the full impact of smoking on population health will definitely make a major contribution to improvement of the poor public health situation in Sudan.