Diabetes mellitus is a systemic disease affecting microvascular and macrovascular systems and is considered as the strongest risk factor for peripheral arterial disease. Although the prevalence of the peripheral arterial disease is high among people living with diabetes, its severity is not accurately detected with the prevalent diagnostic methodologies. The ankle-brachial index measurement is a simple, objective, and reliable tool for diagnosis of peripheral arterial disease. However, it is of limited value in the diagnosis of peripheral arterial disease among diabetic patients due to its low sensitivity among diabetic individuals. Diabetes mellitus results in atherosclerosis and calcification of peripheral arterial walls leading to false normal ankle-brachial index values. Therefore, healthcare practitioners should be careful not to misinterpret ankle-brachial index results among diabetic patients. A literature search was conducted using the keywords “ankle-brachial index,” “interpretation,” “limitations,” “diabetic foot,” and “peripheral arterial disease” on different medical search engines. The results were manually scanned and then further reviewed to select the articles related to our topic of discussion. This article will review the use of ankle-brachial index measurement among diabetic patients, its limitations and its prognostic value. In Conclusion, Ankle-brachial index can be used for diagnosis of peripheral arterial disease with some precautions (e.g. raising the threshold of diagnosis or using the lowest systolic pressure value measured at the ankle) and can also be a prognostic indicator for cardiovascular morbidity and mortality.

Over the recent past few years, there is a huge innovation in plastic surgery and orthopedic surgery through implantation of new techniques, which enabled a great level of success in hand salvage. Conditions such as trauma, tumor, sepsis, or vascular disease, may necessitate hand salvage. The most frequent argument among surgeon from different subspecialties (orthopedics, plastics, trauma, and vascular surgery) are characterized by in what way each one can do his own part of the salvage operation, be it bony fixation, revascularization, or soft-tissue coverage, but none of them is sure whether it should be endeavored. What is necessary in such clinical situations is an interdisciplinary team attitude led by individual or groups of clinicians who are conversant not only with their identifiable subspecialized skills but also with those of their coworkers and the consequences accompanying the joined efforts at hand salvage. The perception of orthoplastic surgery is based on such an indication, where the integrated skills and techniques of the orthopedic surgeon and reconstructive microsurgeon are performed in recital to direct efforts concerning hand salvage or choose against it when it is not designated. The current article reviews the roles of orthopedic and plastic surgery and how this team can deal with the existing techniques to improve outcomes in hand salvage surgery.

Background: The incidence of esophageal cancer continues to rise in Sudan. High risk Human papilloma virus (HR-HPV) has been postulated to play a major etiological role in the development of esophageal carcinoma. The aim of the present study was to identify HR-HPV 16 & 18 among Sudanese patients with esophageal cancer.

Objective: The aim of this study was to screen for the existence of Epstein Barr Virus (EBV) in esophageal cancer (EC) tissue samples obtained from Sudanese patients and to review the available literature associated with surgical management. Methodology:In this retrospective study 102 formalin fixed paraffin wax embedded tissue's blocks were retrieved from histopathology laboratories in Khartoum City, Sudan and subsequently tested by Immunohistochemical methods for the presence of EBV. All specimens were previously diagnosed as having esophageal carcinoma. Results:As regards Immuno histochemistry (IHC) staining for EBV, positive findings were revealed in 22 (21.5%) and 79/ (78.5%) of the study subjects were negative. Of the 55 males with esophageal cancer, 15/55 (27%) were identified with EBV infection and the remaining 40/55(73%) found without EBV infection. Of the 46 females with esophageal cancer, 7/46(13%) were found positive for EBV immuno staining and the remaining 39/46(87 %) were found negative for EBV. Conclusion:EBV might have some etiological effects contributing to the occurrence of esophageal cancer in Sudan. Crucial preventive strategies are extremely needed to reduce the burden of esophageal cancer in Sudan.