The differences between the Sudanese and Italian breast cancer series reflect stage at diagnosis rather than intrinsic biological characteristics. This may have relevant implications for breast cancer prevention and treatment in Africa.

Eight patients with cutaneous ulcers were referred to the Institute of Endemic Diseases, Khartoum, Sudan, from June 2000 to March 2002 for the diagnosis of suspected cutaneous leishmaniasis (CL). Diagnosis was confirmed parasitologically by both positive Giemsa-stained smears and successful culture of Leishmania promastigotes in NNN medium. The eight parasite isolates were shown to belong to the Leishmania donovani complex by kDNA PCR. Isoenzyme typing of three isolates revealed that they were identical to the L. donovani MON-82 reference strain, and the gp63 PCR-RFLP profile showed similar patterns to a reference strain of MON-82. CL is endemic in most regions of Sudan and has been reported previously as being caused by L. major MON-74. The results of this study suggest that L. donovani is also a cause of CL in Sudan and that further study of isolates from Sudanese patients with cutaneous ulcers is warranted to ascertain whether L. donovani or L. major is the causative agent.

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A 60-year-old woman with chronic renal failure, hyperphosphatemia, normocalcemia and hyperparathyroidism presented with skin and subcutaneous tissue necrosis over the upper lateral aspects of both thighs which became progressively worse with subsequent ulceration over the period of 1 week. A biopsy of the affected skin and subcutaneous tissues demonstrated discrete foci of calcification compatible with the diagnosis of calcifying panniculitis. While it was possible to control the patient’s hyperphosphatemia using magnesium carbonate, local ulcer care, including daily whirlpool and repeated local surgical excision, failed to stop the progression of the surrounding skin and subcutaneous tissue necrosis with subsequent ulceration. A trial of oral prednisone for a total of 10 days followed by oral cimetidine for 3 months resulted in complete healing at the incision sites without recurrence after 9 months. In this case of calcifying panniculitis the conditions for calciphylaxis were present, and a new management approach was applied.

Background Plasmodium vivax infection is rising in sub-Saharan Africa, where Plasmodium falciparum is responsible for more than 90% of malaria cases. While P. vivax is identified as a major cause of severe and cerebral malaria in South east Asia, the Pacific and South America, most of the severe and cerebral cases in Africa were attributed to P. falciparum. Cases of severe malaria due to P. vivax are emerging in Africa. A few severe P. vivax cases were reported in Eastern Sudan and they were underestimated due to the lack of accurate diagnosis, low parasitaemia and seldom use of rapid diagnostic tests (RDTs). Case presentation A 60-year-old Sudanese male presented to the Al Kuwaiti hospital in the Sudan capital Khartoum. On admission, the patient was complaining of fever (measured temperature was 38 °C), sweating, chills, vomiting and confusion in the past 2 days prior to his admission. He rapidly deteriorated into a coma state within 48 h of the admission, with significant neck stiffness. He was admitted to the intensive care unit and was suspected of meningitis. Lumbar puncture was not performed since the patient was suffering from spinal cord disc. Brain CT scan was unremarkable. Several biochemical, haematological tests, and blood film for malaria were performed. The results of the laboratory tests were within the normal range except of mild elevation of the total white blood cell count and a significant decrease in the platelets count. Malaria parasites were seen in the blood film with high parasitaemia (quantified as 3 +++). The patient was diagnosed as P. vivax cerebral malaria based on the positive blood film and the amplification of P. vivax specific 499 bp amplicon using Plasmodium multi-species multiplex Polymerase Chain Reaction (PCR). The patient was treated with quinine 10 mg/kg body weight for 10 days followed by primaquine 15 mg/days PO for 2 weeks. The symptoms subsided within 48 h and the patients was cured and released from the hospital. Conclusions Plasmodium vivax is an emerging cause of cerebral malaria in adults in Sudan and should be considered in the differential diagnosis of cerebral malaria for proper management of patients.

The main aim of this study is to review the environmental and socioeconomic sustainability of the gum arabic farming system in central Sudan. A further aim is to analyse some of the main factors influencing production in recent decades in order to understand the future trade potential and consequently the smallholder livelihood. The study shows that end-user imports of gum arabic have increased during recent decades. Gum arabic is mainly for uses such as soft drinks, confectionary, and pharmaceuticals. However, even with this increased demand the production in Sudan, the main country of production, is declining. The producers, mainly smallholders, suffer from fluctuating prices. If the gum arabic farming system should be able to provide the environmental benefits of improved soil fertility and the socioeconomic benefits of risk spreading and dry season income opportunities, the prices paid to smallholders must be stabilized at a fair level, otherwise a shift to other crops or practices might take place.

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-value = 0. 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.

Objectives: The aim of this study is to detect Epstein-Barr virus (EBV) in nasopharyngeal carcinoma (NPC) biopsies of Sudanese patients using EBV-encoded RNA (EBER) in Situ hybridization (EBER-ISH). Study Design: This is a descriptive cross-sectional study conducted at the National Center for ENT diseases and Head and Neck Surgery and the Institute of Endemic Diseases, University of Khartoum, Khartoum City, Sudan. Subjects and Methods: Biopsies from 43 patients with nasopharyngeal carcinoma were examined for the presence of Epstein-Barr virus using EBER-ISH. Ten normal samples were used to assess the presence of the virus in non cancer tissues. Results: Fifty three samples were examined for the presence of the virus by EBER-ISH, 43 biopsies were NPC and ten were normal. Histologically the cases were, 20 (46.5%), 20 (46.5%) and 3 (7%) of the biopsies were classified as WHO types II, III and mixed type II and III, respectively; there were no cases of type I NPC. All nasopharyngeal carcinoma biopsies (100%) were positive for EBER1 in almost all carcinoma cells with focal and intense dark-blue staining limited to the nucleus; no hybridization was observed in the cytoplasm. No hybridization was observed in all ten non cancer tissues. Conclusion: All NPC cells are clearly EBV-infected. The virus is located in the nucleus of the tumour cells. The presence of Epstein-Barr virus in normal nasopharyngeal epithelia is not a common event.