Wilson's disease and autoimmune hepatitis coexistence: A cause of diagnostic delay

This case report describes a 27-year-old housewife who presented with a progressive and insidious onset of abdominal distension, loss of appetite, and fatigue which started 3 months before her presentation. The physical assessment showed moderate ascites and small liver size, and no other peripheral evidence of chronic liver disease was observed. A diagnosis of liver cirrhosis and was confirmed by investigations and imaging, where ascites responded well to therapy with diuretics. Investigations for the cause of cirrhosis was established through the diagnosis of autoimmune hepatitis, and she was started on steroids and azathioprine with partial improvement in liver biochemistry. She presented 8 months later with neuropsychiatric symptoms in the form of slurred speech and difficulty walking. Accordingly, Wilson's disease was suspected to be the cause and further investigations confirmed this. A chelating agent, D penicillamine, was added to her immunosuppressive treatment. Nine months later she showed slow improvement in her neurological symptoms and was referred for assessment for liver transplantation. Wilson's disease, although rare, should be suspected in patients with decompensated liver disease. The dominance of clinical and epidemiological features of autoimmune hepatitis as a common causative pathology for chronic liver disease in young and middle-aged ladies may hide the presence of other serious different pathologies such as Wilson's disease.

Tobacco use among male inmates and their attitudes toward its prevention in Khartoum State: A cross-sectional study.

INTRODUCTION: Tobacco use remains the most preventable cause of death and disability, with prisoners being a neglected population of tobacco users. The aim was to determine the prevalence of tobacco use and attitudes toward its prevention among adult male prisoners. METHODS: We conducted a descriptive cross-sectional study among 349 adult male inmates from three prisons in Khartoum State. The interview questionnaire included questions related to tobacco use status, type of tobacco used, previous attempts to quit, smoking inside a room, frequency of tobacco use before and after incarceration, and attitude toward its prevention. Chi-squared and paired t-test were used to compare between different variables, with the level of significance set at p≤0.05. RESULTS: The majority (69.1%) were in the age group 30-50 years. All of the studied prisoners were tobacco users of which: 43.8% used oral snuff (toombak); 22.1% were cigarette smokers; 30.9% used both cigarette and toombak; 0.6% used cigarette and waterpipe; and 3.2% used cigarette, toombak and waterpipe. Toombak users (alone or with other types of tobacco) were 272 (78%) with the majority (62.4%) dipping 2-5 times per day. There were 96 (57%) cigarette smokers (alone or with other types), and waterpipe users were 12 (3.8%). The majority (74.6%) of cigarette users shared their cell with other toombak users. For the majority (79.6%), the number of cigarettes and snuff dipping per day was directly proportional to the period of incarceration. Almost all (99.1%) prisoners know the harmful effects of tobacco use, and 64.5% had previously attempted to quit. Also, 98% of tobacco users reported a desire to quit and expressed willingness to participate in a tobacco-cessation program. CONCLUSIONS: Different patterns and methods of tobacco use were explored, and all the studied prisoners were users. Tobacco use increased after incarceration. The willingness to participate in tobacco-cessation counselling should be met with the implementation of a planned and well-designed prevention program.

Five canals on mandibular first molar successfully managed by undergraduate dental student: an educational case report

Undergraduate dental student's eligibility and ability to treat difficult endodontic cases is a new area open for debate. a fifth year undergraduate dental student managed to perform a successful root canal treatment (RCT) on a 42 year old male patient diagnosed as a rare case of mandibular first molar with five root canals. as an educational case report, in a country like Sudan, close supervision and clinical training of undergraduate students in treating difficult endodontic cases is recommended.

Radiographic technical quality of root canal treatment performed by undergraduate dental students at the Academy Dental Teaching Hospital, UMST, Sudan.

AIM: To radiographically evaluate the technical quality of root canal treatment performed by undergraduate dental students and compare the findings with other institution's work. MATERIALS AND METHODS: A retrospective, cross-sectional study was conducted at the Academy Dental Teaching Hospital involving postoperative periapical radiographs of patients who were endodontically treated by batch #14 undergraduate dental students of final year (2013-2014) from UMST, Sudan. The total number of the students was 21, while periapical radiographs fulfilling the required criteria were 173. The radiographs of each case were evaluated in terms of length, density, and taper of the root canal filling. Procedural errors such as presence of a ledge, perforation, and a separated instrument were also recorded. Chi-square test was used to determine statistically significant differences between variables, with the level of significance set at P ≤ 0.05. RESULTS: The overall quality of performed root canal treatment was adequate in almost half (55.5%) of the evaluated teeth. The length and taper of the root canal filling were found to be significantly associated with maxillary and mandibular posterior teeth with P = 0.018 and 0.006, respectively. No associations were found between the density and presence of separated instrument in the maxillary and mandibular posterior teeth, P = 0.314 and 0.480, respectively. CONCLUSION: The radiographic quality of root canal treatment performed by undergraduate students of batch #14 UMST was acceptable in 55.5% of the cases. Special emphasis must be placed on the educational methods and training of students for providing root canal treatment on molar teeth.