Clofazimine (Lamprene or B668) is a phenazine congener that is used in leprosy, and the patients treated with the drug may develop red discoloration, dark brown pigmentation and ichthyotic skin. The authors observed 181 leprosy patients who had developecl discoloration, pigmentation and ichthyotic skin during clofazimine therapy, as well as disappearance of the pigmentation after stop of it. The results are summarized as follows: 1) Reddish discoloration was most frequently observed 2 weeks after beginning treatment in 66 patients (50. 4%), which showed earlier in the higher dosage grow up, 2) Dark brown pigmentation was iviost frequently observed 4 weeks after beginning treatment in 64 patients (48. 9%), which showed earlier in the higher dosage group. R) For histopathological evaluation of pigmentation, various ataining rnethods were used. On unstained frozen sections, yellow brown crystals were scattered in the dermis of both discolored and pigmented skin, and in H R E stain pigments, melanin were niarkedly increased in the epidermal basal layer and a, faint yellow brown. ghost was seen in dermis of pigmented skin. With fat stains using oil-red-0 and Sudan III, reddish amorphous materials were scattered in and around the cytoplasm of the macrophages c>f the pigmented skin. 4) Ichthyotic skin was observed in 97 patients, and most frequently 2 and R months after beginning treatment in 26 patients (26. 8%), but it was never observec1 in 34 of all patients in spite of a continuous intake of the drug for more than a. year. -countinue-
Clofazimine* ; Coloring Agents ; Cytoplasm ; Dermis ; Frozen Sections ; Humans ; Leprosy* ; Macrophages ; Melanins ; Pigmentation ; Skin ; Sudan

Membranous lipodystrophy is a peculiar type of fat necrosis, present in patients with various types of skin diseases. It is charaeterized by the presence of microcysts and macrocysts lined by amorphous eosinophilic material with a crenelated arabesque appearance and microgranules in the subcutis with massive fat necrosis. The eosinophilic lining and microgranules stain positively with periodic acid-Schiff, are resistant to diastase, and also stain with Sudan black B. We report three cases of subcutanous membranous lipodystrophy in patients with erythema induratum, posttraumatic panniculitis and morphea with typical clinical and histopathologic findings.
Amylases ; Eosinophils ; Erythema Induratum ; Fat Necrosis ; Humans ; Lipodystrophy* ; Panniculitis ; Scleroderma, Localized ; Skin Diseases ; Sudan

BACKGROUND: Sickle cell disease is an autosomal recessive condition that results from the presence of a mutated form of hemoglobin. Some genetic variants of BCL11A are amenable to therapeutic manipulation. The present study investigated the relationship of a BCL11A variant (rs1427407) and its plasma levels with vaso-occlusive crises and stroke complications among patients in Sudan with sickle cell disease. METHODS: This cross-sectional study was performed between June 2014 and October 2016. The subjects included 166 patients who were diagnosed with sickle cell disease and 35 healthy control subjects, who were grouped according to sex and age ( < 15 years, 15–25 years, and >25 years). All patients and/or their guardians provided informed consent. Blood samples were collected from the patients and controls under aseptic conditions. RESULTS: Plasma BCL11A levels were elevated in cases with vaso-occlusive crises that lasted for >3 years. In addition, plasma BCL11A levels were high in cases with the GG genotype (vs. GT and TT) at rs1427407. Furthermore, the BCL11A rs1427407 GG/GT genotypes increased the risk of vaso-occlusive crisis and stroke in the patients with sickle cell disease. CONCLUSION: The BCL11A variant (rs1427407) and its plasma levels were associated with vaso-occlusive crisis and stroke in patients with sickle cell disease.
Anemia, Sickle Cell* ; Cross-Sectional Studies ; Genotype* ; Humans ; Informed Consent ; Plasma ; Stroke* ; Sudan*

BACKGROUND: Although immunophenotyping of leukemias has improved diagnostic accuracy and reproducibility, it has also caused diagnostic confusion regarding the lineage of leukemic cells. So far, lots of papers about acute leukemias with coexpression of another lineage markers with different technical methodologies and different criteria have been published in Korea and other countries. The authors investigated the frequency and immunophenotypic characteristics of the leukemias with aberrant lineage markers from data obtained at Korea University Hospital by a retrospective study. METHODS: From Jan. 1993 to Feb. 1996, 179 leukemias had been requested for immunophenotypig and 28 cases among them with unusual immunophenotypes were retrieved according to their immunophenotyping results. For the final diagnosis all the slides stained with Wright-Giemsa, peroxidase, Periodic-Acid Schiff, Sudan black B, and nonspecific esterase were re-examined, and all the flow cytometric results were reanalyzed. RESULTS: Among 28 cases, 3 cases(10%) were acute biphenotypic leukemias(BP) one with B lymphoid and myeloid markers and the other two with T lymphoid and myeloid markers. One case of intralineage bilinear acute leukemia(ILBL) with two separate populations of megakaryocytic cells and monocytic cells was noted. 6 cases(21%) were acute myeloblastic leukemias expressing lymphoid associated markers(Ly+AMLs; CD19) and 8 cases(28%) were myeloid antigen-positive acute lymphoblastic leukemias(My+ALLs, four with CD13+ and three with CD33+ and one with blastic transformation of chronic myelogeneous leukemia). Because of the change in diagnostic criteria, lymphocyte contamination, or low setting of negative control, 10 cases (36%) were not included to be of unusual immunophenotypes. CONCLUSIONS: Frequency of acute hybrid leukemia was 2.2 % of all leukemias. Ly+AMLs was 3.4%, and My+ALL was 4.4%. In conclusion, first, quality control of the flow cytometry and careful interpretation especially in terms of positive cut-off value and gating, are needed. Secondly, national guidelines for the criteria of the hybrid leukemia and My+ALLs and Ly+AMLs are necessary for the elucidation of the prognostic implication of those leukemias.
Carboxylesterase ; Diagnosis ; Flow Cytometry ; Immunophenotyping ; Korea ; Leukemia* ; Leukemia, Myeloid, Acute ; Lymphocytes ; Peroxidase ; Quality Control ; Retrospective Studies ; Sudan

OBJECTIVES: The emergence of multidrug-resistant tuberculosis (MDR-TB) is a major challenge for the global control of tuberculosis (TB). The aim of this study was to determine the risk factors associated with MDR-TB in Sudan. METHODS: This case-control study was conducted from May 2017 to February 2019. Patients newly diagnosed with MDR-TB were selected as cases, and controls were selected from TB patients who responded to first-line anti-TB drugs. A questionnaire was designed and used to collect data from study participants. Logistic regression was used to evaluate associations between risk factors and MDR-TB infection. The best multivariate model was selected based on the likelihood ratio test. RESULTS: A total of 430 cases and 860 controls were selected for this study. A history of previous TB treatment (adjusted odds ratio [aOR], 54.85; 95% confidence interval [CI], 30.48 to 98.69) was strongly associated with MDR-TB infection. We identified interruption of TB treatment (aOR, 7.62; 95% CI, 3.16 to 18.34), contact with MDR-TB patients (aOR, 5.40; 95% CI, 2.69 to 10.74), lower body weight (aOR, 0.89; 95% CI, 0.87 to 0.91), and water pipe smoking (aOR, 3.23; 95% CI, 1.73 to 6.04) as factors associated with MDR-TB infection. CONCLUSIONS: Previous TB treatment and interruption of TB treatment were found to be the main predictors of MDR-TB. Additionally, this study found that contact with MDR-TB patients and water pipe smoking were associated with MDR-TB infection in Sudan. More efforts are required to decrease the rate of treatment interruption, to strengthen patients’ adherence to treatment, and to reduce contact with MDR-TB patients.
Body Weight ; Case-Control Studies ; Humans ; Logistic Models ; Odds Ratio ; Risk Factors ; Smoking ; Sudan ; Tuberculosis ; Tuberculosis, Multidrug-Resistant ; Water

OBJECTIVES: The emergence of multidrug-resistant tuberculosis (MDR-TB) is a major challenge for the global control of tuberculosis (TB). The aim of this study was to determine the risk factors associated with MDR-TB in Sudan.METHODS: This case-control study was conducted from May 2017 to February 2019. Patients newly diagnosed with MDR-TB were selected as cases, and controls were selected from TB patients who responded to first-line anti-TB drugs. A questionnaire was designed and used to collect data from study participants. Logistic regression was used to evaluate associations between risk factors and MDR-TB infection. The best multivariate model was selected based on the likelihood ratio test.RESULTS: A total of 430 cases and 860 controls were selected for this study. A history of previous TB treatment (adjusted odds ratio [aOR], 54.85; 95% confidence interval [CI], 30.48 to 98.69) was strongly associated with MDR-TB infection. We identified interruption of TB treatment (aOR, 7.62; 95% CI, 3.16 to 18.34), contact with MDR-TB patients (aOR, 5.40; 95% CI, 2.69 to 10.74), lower body weight (aOR, 0.89; 95% CI, 0.87 to 0.91), and water pipe smoking (aOR, 3.23; 95% CI, 1.73 to 6.04) as factors associated with MDR-TB infection.CONCLUSIONS: Previous TB treatment and interruption of TB treatment were found to be the main predictors of MDR-TB. Additionally, this study found that contact with MDR-TB patients and water pipe smoking were associated with MDR-TB infection in Sudan. More efforts are required to decrease the rate of treatment interruption, to strengthen patients' adherence to treatment, and to reduce contact with MDR-TB patients.
Body Weight ; Case-Control Studies ; Humans ; Logistic Models ; Odds Ratio ; Risk Factors ; Smoking ; Sudan ; Tuberculosis ; Tuberculosis, Multidrug-Resistant ; Water

A 43 year-old Korean male has had multiple, grouped, asymptomatic, yellowish brown flat papules and nodules on the knees, elbows, buttocks, palms and soles for 3 years. Small yeIlowish, discrete papules first appeared on the right palm and left elbow, and gradually increased in size and number and spread to knees, buttocks and soIes. Physical examination revealed normal except for the skin lesions and no familial occurrence was noted. Gross finding of the serum was turbid, more or less creamy and paper electrophoresis revealed marked increase of prebetalipoprotein, increase of betalipoprotein and alphalipoprotein and absence of chylomicron, suggesting type III or type IV hyperlipoproteinemia. Serem choleterol was 200mg% and fasting blood sugar was 115.0mg%. with normal glucose tolerance test. Histopathology showed many aggregates of foam cells on H-E stain and many lipid droplets in the dermis on Sudan red stain. Based on the clinical and histopathological findings and lipoprotein analysis by the paper electrophoresis, the patient was diagnosed as type IV hyperlipoproteinemia with xanthoma tuberosum.
Adult ; Blood Glucose ; Buttocks ; Dermis ; Elbow ; Electrophoresis, Paper ; Fasting ; Foam Cells ; Glucose Tolerance Test ; Humans ; Hyperlipoproteinemia Type IV ; Knee ; Lipoproteins ; Male ; Physical Examination ; Skin ; Sudan ; Xanthomatosis*

Two Cases of Juvenile XanthogranuIoma(JXG) are reported with review of literatures. JXG is a rare disease, and have not yet been reported in this country. Case I: Two months oId healthy female infant has two firm, discrete, brownish yellow waxy nodules on the left postauricular region and the left forearm. The lesion had begun as erythematous pinhead sized papules, and have been enlarged rapidly to pea siez during last three weeks. Case II: Three year old healthy male has firm, discrete, pinhead to pea sized scattered 16 papules and nodules on the trunk and right side of neck. Laboratory findmgs and X-ray studies were normal in both cases and there were no evidence of metabolie disorder or bony abnormality. Histopathologic studies show similar findings in both cases. In hematoxylin-eosin staining, epidermis shows parekeratosis and slight elongation of rete ridges with suprapapillary thinning with focal spongiosis and invasion of inflammatory cells. The entire dermis, from dermal papillae to sbcutis, is replaced by granulomatous lesion composed with histioeytes and a few giant cell reaction, in addition to histiocytic proliferation, considerable amount of eosinophils are infiltrated with some lymphocytes and plasma cells. The dermal collagen fibers are partly degenerated. In the upper most portion, some foamy histiocytes are also seen. In frozen section and Sudan III fat staining, the tissue shows rnild reactivities.
Collagen ; Dermis ; Eosinophils ; Epidermis ; Female ; Forearm ; Frozen Sections ; Giant Cells ; Histiocytes ; Humans ; Infant ; Lymphocytes ; Male ; Neck ; Peas ; Plasma Cells ; Rare Diseases ; Sudan ; Xanthogranuloma, Juvenile*

OBJECTIVETo investigate the epidemiological factors of tuberculosis (TB) in eastern Sudan.

METHODSThe socio-demographic and clinical data was retrieved from the database at Kassala hospital during the year of 2011. The medical file of consequent patients who was discharged from the same ward in the hospital was reviewed to act as control for the TB patients.

RESULTSA total of 670 patients were registered at Kassala hospital with clinical, laboratory and radiological evidence proven TB. Pulmonary TB accounted for 73.4% while extra-pulmonary TB was reported in 26.6% of all TB patients. The mean age (SD) was not significantly different between the cases and controls (670 in each arm). TB patients were those who had less education, and the infection more likely common among male patients.

CONCLUSIONSIntervention from outside the health field in particular awareness of associated risk factors and improvement of the educational level potentially will strengthen TB control.

Analysis of Variance ; Educational Status ; Health Knowledge, Attitudes, Practice ; Health Services Accessibility ; Humans ; Medical Records ; statistics & numerical data ; Public Health ; Sex Distribution ; Sudan ; epidemiology ; Tuberculosis ; epidemiology ; prevention & control

The patient was a 1-day-old female with full term normal vaginal delivery. Petechiae and purpura were noted on body surface at birth. She did not have mongoloid face and hand-foot deformity. The skin nodules were bluish to slate-grey in color, and observed on all body surfaces. Hepatosplenomegaly was also noticed. Peripheral blood smear showed marked leukocytosis (109,400/microliter), thrombocytopenia (16,000/microliter) and leukoerythroblastosis. VDRL and TORCH tests were negative. The bone marrow was replaced by leukemic lymphoblasts. The normal hematopoietic cells were depleted. The leukemic lymphoblasts expressed markers of mature B cell differentiation, negative for Sudan black B, peroxidase, and positive for PAS (en bloc pattern) stain. Skin biopsy specimen showed diffuse infiltration of the leukemic cells. The diagnosis was congenital mature B cell lymphoblastic leukemia. This patient died at 7 days after birth.
Biopsy ; Bone Marrow ; Cell Differentiation ; Congenital Abnormalities ; Diagnosis ; Female ; Humans ; Leukocytosis ; Parturition ; Peroxidase ; Precursor Cell Lymphoblastic Leukemia-Lymphoma* ; Purpura ; Skin ; Sudan ; Thrombocytopenia