publications

Research published in scientific journals-2018

Research published in scientific journals-2018

  1. 1. Ahmed ME, Arabi YE. Sepsis following appendectomy. Sudan Med J 1983;19:64 - 71.
  2. 2. Ahmed ME. A trial of skin preparation technique for routine blood sampling in Khartoum. Sudan Med J 1984;20:(1-4):93 - 96.
  3. 3. Omer EE, Arabi YE, Abdin SZ, Ahmed ME. The role of bacterial pathogens in per-operative sepsis of acute mural appendicitis. East Afr Med J 1985;6:379 -85.
  4. 4. Ahmed MEK, Ahmed ME, Fedail SS. Acute gastric dilatation following upper gastrointestinal endoscopy. Endoscopy 1985;17:117 - 18.
  5. 5. Ahmed ME. Diabetic septic foot in Khartoum. East Afr Med J 1986;63:187 - 90.
  6. 6. Ahmed ME. Acute abdomen in Khartoum. East Afr Med J 1986;63:14 - 17. 7. J Neurol Neurosurg Psychiatry. 1986 Sep;49(9):1002-6.

The role of autonomic neuropathy in diabetic foot ulceration. Ahmed ME, Delbridge L, Le Quesne LP.

Abstract

Five standard, non-invasive tests of cardiovascular, autonomic function were performed in each of four groups of 30 subjects: controls, group 1, diabetics without clinical evidence of neuropathy; group 2, diabetics with neuropathy, but without foot ulceration; group 3, diabetics with neuropathic ulceration of the foot. The results showed a significant impairment of autonomic function in diabetics without clinically demonstrable somatic neuropathy compared with controls diabetics with somatic neuropathy compared with those without diabetics with neuropathic ulceration compared with those with neuropathy without ulceration. Parasympathetic function was more seriously affected than sympathetic. In patients who had only mild sensory neuropathy on clinical assessment, those with ulcers had significantly greater impairment of autonomic neuropathy compared with those with uncomplicated neuropathy. 8. J Neurol Neurosurg Psychiatry. 1986 Sep;49(9):1059-62.

Quantitative sweat test in diabetics with neuropathic foot lesions. Ahmed ME, Le Quesne PM.

Abstract

The volume of sweat produced by axon reflex stimulation using acetylcholine was measured in one foot each of 35 control subjects and 52 feet of 37 diabetic patients (28 with neuropathic ulceration, 11 with Charcot arthropathy, nine with somatic neuropathy but no foot lesion and four with no evidence of somatic neuropathy). In controls, the volume of sweat was greater in males than females. A flare response was seen in 94% of control feet. In diabetics, the volume of sweat was within the control range in 17 feet, increased in one, reduced in seven, and absent in 27. Sweating was absent in 75% of feet with a neuropathic ulcer; a flare response was absent in 86% of them. Sweating was only absent in 36% of feet with Charcot arthropathy and was increased in one, whereas the flare response was absent in all. Autonomic cardiovascular reflexes were more frequently abnormal than the sweat test; sweating was absent in only one patient with normal cardiovascular reflexes.

  1. 9. Ahmed ME. Acute appendicitis in Khartoum: pattern and clinical presentation. East Afr Med J 1987;64:17 - 20.
  2. 10. Ahmed ME. Agenesis of the gall bladder. Saudi Med J 1987;8:(7):533 - 4.
  3. 11. Ahmed ME. A discharge clinic with a simple unit record storage system. Sudan Med J 1987;25:(1-4):73 - 80.
  4. 12. Ahmed ME, Ibrahim SZ, Arabi YE, Hassan MA. Metronidazole prophylaxis in acute mural appendicitis: failure of a single intraoperative infusion to reduce wound infection. Br J Hospital Medicine 1987;10:260 - 4.
  5. 13. Kheir AM, Ahmed ME, Yagi K, Kabalo AM, ElMahadi EMA, Hassan MA, Mukhtar E. The clinical pattern of thyroid disease in Khartoum Teaching Hospital. Sud Med J 1986;24:79 - 86.
  6. 14. ElFeil MS, Ahmed ME. The solitary thyroid nodule in Sinnar. Sud Med J 1989;27:62 - 5.
  7. 15. Ahmed ME, Homeida T. Anorectal disease in Khartoum. East Afr Med J 1988;65:28 - 32.
  8. 16. Ahmed ME, Homeida T. Haemorrhoids in Khartoum. East Afr Med J 1990;67:48 - 50.
  9. 17. Ahmed ME. Spontaneous rupture of the spleen. Emirate Med J 1988;6:73 - 74.
  10. 18. Ahmed ME, Fahal AH. Gluteal abscesses: Injectable chloroquine as a cause. J Tropical Med & Hygiene 1989;92:317 -
  11. 19. Ahmed ME, Fahal. Preoperative fasting state in patients undergoing elective surgery. Emirate Med J 1988;6:135 - 37.
  12. 20. Igail IA, Ahmed ME, Yousif MA, Karim WMA, ElAmin A. Effect of local and intravenous cephardine on wound infectionin upper abdominal operations. Emirate Med J 1988;6:241 - 3.
  13. 21. Salih MEM, Ahmed ME, Hassan MA. The treatment of acute superficial abscesses by incision, curettage and primary suture without antibiotics: a controlled clinical trial. Sud Med J 1988;26:17 - 23.
  14. 22. Ahmed ME, Gustavassan S. Current palliative therapeutic modalities for oesophageal carcinoma. Acta Chir Scand 1990,156:95 - 98.

23.Zaki K, Ahmed ME, Hassan MA, Yousif MA, Fahal A. Acute gluteal abscess following chloroquine injection: a clinical and experimental study. J Tropical Medicine & Hygiene 1991;94:206 - 9.

  1. 24. Keiry J, Ahmed ME. Cervical lymphadenopathy in Khartoum. J Topical Medicine & Hygien 1992;95:316 - 19.
  2. 25. ElAmin I, Ahmed ME. Abdominal trauma in Khartoum. Sudan Med J 1991;29(1-3):75 - 84.
  3. 26. IzEldin K, Fahal A, Ahmed ME. Septic Hand in Khartoum. East Afr Med J 1992;69(11):616 - 20.
  4. 27. Higazi I,, Ahmed ME. Nasopharyngeal carcinoma in Khartoum. Sudan Med J 1992;30:55 - 65.

28.Ahmed ME, Sanhouri M. Surgery of the biliary tract in Khartoum. Sudan Med J 1990;28:48 - 50.

  1. 29. Sharif AM, Ahmed ME. Hodgkin`s disease in Khartoum. Tropical & Geographical Medicine 1992;44(3):
  2. 30. Ahmed ME. Carcinoma oesophagus in Khartoum. J Roy Coll Surg of Edinburgh 1993;38:16 - 18.
  3. 31. Omran M, Ahmed ME. Carcinoma of the thyroid in Khartoum.Esat Afr Med J 1993;70(3):29 - 32.

32.Ahmed EA, Ahmed ME, yousif M, Arabi YE. The relationship between bacterial beta-lactamase production and antibiotic resistance in Khartoum. Afr J of Medicine & Medical Sciences

  1. 33. Isam AB, Ahmed ME. Postoperative pain and analgesic prescription in Khartoum: evaluation of current practice. East Afr Med J 1991;70 (8):498 - 501.

34.Ahmed ME, Michail M. Evaluation of different MCQ-scoring-system in a medical school. Esat afr Med j 1993;70(12):787 - 88.

  1. 35. Ahmed ME, ElWasila AA, Sanhouri M, Yagi K. Surgical management of toxic goitre in Khartoum. Tropical & Geographical Medicine 1993;45(3):124 - 5.
  2. 36. Doumi BA, Ahmed ME, Hassan R, ElNour SH, Kashan A. Fractures in children in Khartoum. East Afr Med J 1994;71(6):347 - 50.
  3. 37. Bashier AH, Abdin I, ElHassan M, Sanhouri M, Ahmed ME. Solitary thyroid nodule in Khartoum. East Afr Med J 1996;73(10):66 - 68.
  4. 38. J R Coll Surg Edinb. 1997 Aug;42(4):248-51.

Amputation and prostheses in Khartoum. Mohamed IA1, Ahmed AR, Ahmed ME. Author information

Abstract

One hundred and seventy patients with major lower limb amputation (MLLA) presenting to The National Prosthetic-Orthotic Centre (NPOC) in Khartoum over a 1-year period were studied. There were 141 males and 29 females giving a M:F ratio of 4.9: 1.0, with mean age of 37 years (range 5-72 years). Forty-one patients (24%) underwent amputation of diabetic septic foot, 30 patients (17.6%) underwent amputation as a result of trauma from road traffic accidents and Madura foot, and war injuries accounted for 29 amputations (17%). One hundred and eleven patients had below knee amputation (BKA), 52 had above knee amputation (AKA) and seven patients had Syme's amputation. Diabetic amputees had higher rate of revisional surgery compared with others because of sepsis and/or flap necrosis. Stump pain was reported by amputees with excessive scarring of the stump and those with undue prominence of bony ends. There are two types of prostheses provided by the NPOC for both BKA and AKA: the peg leg and the conventional prostheses. The Syme's amputees were fitted with either simple hoof or articulated prostheses with solid ankle cushion heel (SACH). The peg leg consists of a leather lined side bearing metal socket connected to a rocker base by side steels. It is used by the country natives as it suits different weather and job conditions, particularly farming, and it can be repaired locally. The urban population use the conventional prostheses which is lighter in weight, can be put on and taken off easily and is cosmetically acceptable. However, these prostheses are more expensive and require frequent repair or replacement. The functional outcome of patient's rehabilitation with the prostheses was significantly affected by the level and indication of amputation. Those with BKA and those amputated because of trauma or Madura foot experienced better functional outcome compared with the diabetics, independent of age. 50% of patients with the AKA and 19% of those with BKA reported poor functional outcome. Surgeons should be more involved with the long-term evaluation of functional outcome in such patients, to offer help if feasible and to modify their technique for future procedures.

  1. 39. Adil Fahal AH, Ahmed ME. Postoperative Pyrexia. East Afr Med J
  2. 40. Fred J Hendler, Ahmed . Reverse transcription PCR in situ on cryopressed tissue sections. Chapter in a book to be published.

41.Ahmed ME, Elgizouli S, Suliman SH. Hashim FA, Abdin I, Ahmed HM, Elebeid E. The solitary thyroid nodule in Khartoum. Sudan Med J 1996;34: 13 - 16.

  1. 42. ElHadi EI AA, Ahmed ME. Treatment of diffuse non-toxic goitre with L-thyroxine. Sudan Med J 1996;34:9 - 12.
  2. 43. Abdel Rahim AA, Ahmed ME, Hassan MA. Respiratory complications after thyroidectomy. Brit J Surg 1999; 86:88 - 90.
  3. 44. Hamad K, Khidir Aida, Ahmed ME. Anaesthesia of a patient who underwent resection of small bowel leiomyosarcoma. Saudi Med J 1999;20 (4):322 - 3.
  4. 45. Ahmed ME, Shumo AE. A calculus with an anal fistula tract in a diabetic patient. Saudi Medical Journal 2001;22(2):17- -1.
  5. 46. Ahmed O ElNazeer, Ahmed ME. Presacral fibroma in a young laborer presenting with chronic lumbago. Case Report. Saudi Medical J 2002;23(6):746 – 47.
  6. 47. Ahmed EMO, Ahmed ME. Incidental mucinous cystadenocarcinoma of the appendix with pseudomyxoma peritoni in a diabetic hypoglycaemia. East Afr Med J 2001;78(9):483.
  7. 48. Alla`AH, Mahadi SI, ElHassan AM, Ahmed ME. A large giant cell tumour of the sacrum. Saudi Medical journal 2005;26(1):133 – 5.
  8. 49. Ballal MS, Hadi YS, Ahmed ME. Gastrograffin meal and follow through treating a male with adhesive small bowel obstruction. Saudi Medical J 2004;25(4):527.
  9. 50. E Abdin M, Ahmed ME. The Diabetic Foot, Significant decrease in rate of major lower limb amputation. Juba Medical Journal 2002;1(2): 96 – 100.
  10. 51. Ibrahim M,. Ahmed ME. Acute gangrene of the hand following accidental intra-arterial injection of phenergan. Arab Medical .J of The Arab Board of Medical Specialization 2001;3(3):66 – 68.
  11. 52. Zaki R, Ahmed EN, Ahmed ME. Frequently recurring myxoid liposarcoma. East Afr Med J 2002;79(3):133.
  12. 53. Mahadi SI, ElHassan AM, Ahmed. Crohn’s disease masquerading carcinoma of the oesophagus. Saudi Medical J 2007;28(8):1287 – 8.
  13. 54. Ahmed ME, Ahmed EO, Mahadi SI. Retrosternal goiter : the need for median sternotomy. World Journal of Surgery 2007;30(11): 1945 – 8.
  14. 55. Baleela RM, Huessain MY, Ahmed ME. Anastomotic oesophageal leak due to Taenia saginata following oesophagectomy for oesophageal cancer. Saudi Med J 2006;27(2):241..
  15. 56. Ahmed MA, Baashar TM, Ahmed. Evaluation of palliative management of advanced breast cancer in Khartoum. Saud Med J 2006;26(7):1142 – 4.
  16. 57. ElRashied M, Widatalla AH, Ahmed ME. External strangulated hernia in Khartoum. East Afr Med J 2007,84(5): 103 – 07.
  17. 58. Mahadi SI, Derweesh AMA, Ahmed ME. Esophagobronchial fistula following injection sclerotherapy for esophageal varices. Endoscopy 2007, 39:E1.
  18. 59. Ahmed ElHassan, Lamyaa El Hassan, Hatim Mudawi, Bahaa Gasim, Ali Own, ElWWaleed ElAmin, Mohamed Ibn Ouf, Mohamed ElMakki Abdullah, Suleiman Fedail. Malignant gastric tumors in Sudan. A report from a single pathology center. Haematol Oncol Stem Cell Ther 2008;1(2):130 -2

60.Osama M Izeldin, Mohamed E Ahmed . Presentation of agenesis of hemidiaphragm in an adult. Saudi Medical J 2008;29 (3):1296 – 98.

  1. 61. ElHadi Mohamed ElBashier, Abu Bakr Hassan Widatalla , Mohamed ElMakki Ahmed . Tracheostomy with thyroidectomy:Indications, management and outcome. International Journal of Surgery 2008;6(2)147 –
  2. 62. Mahmoud SM, Mohamed AA, Mahdi SE, Ahmed ME. Split skin graft in the management of diabetic foot ulcers. Journal of Wound Care 2008;17(7):1-4.
  3. 63. Fikri M, Ahmed ME. Giant mesenteric cysts: A case report and review of the literature. Arab j Gastroenterology 2008;9(1):18 - 20.
  4. 64. Khairy GA. Guraya SY. Ahmed ME. Ahmed MA. Bilateral breast cancer. Incidence, diagnosis and histological patterns.[erratum appears in Saudi J. 2005 Aug;26(8):1316]. [Journal Article] Saudi Medical Journal. 26(4 Med):612-5, 2005 Apr.
  5. 65. ElFatih ElNagib, Seif ElDin I Mahadi, Ahmed ME. Perforated peptic ulcer in Khartoum. Khartoum Medical Journal 2008;1(2):62 – 64.
  6. 66. Sami ElYas, M E Ahmed. Surgical removal of perfume stopper impacted in the pharynx. Khartoum Medical Journal 2008;1(2):93 – 94. 67. Al-Laham R Yahya, ElMahadi M Ali, M E Ahmed. The risk factors for development of a diabetic foot in asymptomatic diabetics. Sudan Med J published 2008; 44(1,2,3):19 – 23.
  7. 68. M.E. AHAMED, M.E. AHMED1, A.M. ELTOUM2, G.O. ALTAHIR3, K.M. AHMED3, S.O. HARBI4, J. STANSALAS5 and A.O. MOHAMED2. ABNORMAL PROTEINS IN PRIMARY BREAST CANCER TISSUES FROM 25 SUDANESE PATIENTS. EUROPEAN JOURNAL OF INFLAMMATION Vol. 6, no. 3, 0-0 (2008)

1721-727

  1. 69. Moez SG Ballal, ElNazeer O Ahmed, ElMahadi S Ibrahim, Mohamed E Ahmed. The significance of microscopic urinary pus cells and blood corpuscles in patients with acute appendicitis. Khartoum Medical Journal 2008;1(1): 20 -22.
  2. 70. Mohayad A Bakheit, Seif I Mahadi, Mohamed E Ahmed. Indications and outcome of thyroid gland surgery in Khartoum Teaching Hospital. Khartoum Medical Journal 2008;1(1):34 – 37.
  3. 71. ElFatih MA ElNageeb, A/Aziz C A /Aziz, M E Ahmed. A giant primary lipogranuloma of the scrotum. Khartoum Medical Journal 2008;1(1):38 – 39. 72. Int J Diabetes Dev Ctries. 2009 Jan;29(1):1-5. doi: 10.4103/0973-3930.50707.

Implementation of diabetic foot ulcer classification system for research purposes to predict lower extremity amputation. Widatalla AH1, Mahadi SE, Shawer MA, Elsayem HA, Ahmed ME. Author information

Abstract

BACKGROUND:

Patients with diabetic foot ulcers are at a high risk of having both minor or major lower extremity amputations.

AIM:

To identify the extent of risk factors for major and minor amputations in patients with diabetic foot ulcers.

MATERIALS AND METHODS:

This prospective study was conducted from 2003 to 2005. Using the guidelines for wound classification developed by the International Consensus of the Diabetic Foot, patients were assessed for ischemia, neuropathy, linear measurement of wound diameters, depth of wound, and infection. In addition, end stage renal failure was added as a criterion to assess the association of all these criteria with both toe and lower extremity amputation.

RESULTS:

2,321 patients were studied and their mean age was 55 +/- 12 years. Most (83.5%) of the patients presented with foot ulcers (n = 1394). Plantar ulcers were the most common (42.6%) followed by ulcers of the big toe (39%). Some (28.5%) of the patients had different types of amputations: 10% had major lower extreme amputation (MLEA) with 8.7% amputations being below the knee and minor (toe) amputations accounting for 18.5%. The most commonly amputated (9.9%) toe was the first toe.

CONCLUSION:

The guidelines for wound classification proposed by the International Consensus of the Diabetic Foot are reliable predictive factors and can determine the outcome of diabetic foot management. Significant factors associated with MLEA were ischemia, neuropathy, and end-stage renal disease and those associated with toe amputation were neuropathy, depth of wound, and grade of infection.

  1. 73. Saudi Med J. 2009 Nov;30(11):1454-8.

Hand sepsis in patients with diabetes mellitus. Ahmed ME1, Mahmoud SM, Mahadi SI, Widatalla AH, Shawir MA, Ahmed ME. Author information

Abstract

OBJECTIVE:

To report on the clinical presentation and possible risk factors leading to hand sepsis, amputation, management, and outcome in diabetic patients presenting to a multidisciplinary diabetic center in Khartoum, Sudan.

METHODS:

This is a retrospective descriptive study of all diabetic patients presenting with hand sepsis between September 2002 and March 2008 to Jabir Abueliz Diabetic Centre (JADC) in Khartoum, Sudan.

RESULTS:

A hundred and nineteen diabetic patients with hand sepsis were managed in JADC. The causative agent was unknown in 48.7%, and due to trauma in 42.9%. The most common presentation was cellulitis in 36.1% of patients and deep seated abscess in 29.5%. In 22.7% there was significant sensory neuropathy with loss of perception to 10 gm monofilament nylon. An associated foot ulcer was present in 13.4% of patients. One or more digits amputation was carried out in 17 (14.3%) of patients and hand amputation was unavoidable in 2 (1.7%). Complete healing with good function was achieved in 79%. There was no mortality in this series.

CONCLUSION:

Hand sepsis in diabetics is a serious complication, but with early presentation to a specialized diabetic care facility, satisfactory outcome could be achieved.

  1. 74. ElSadik S Adam, Shadad M Mahmoud, Mohamed E Ahmed. Tobacco and alcohol use as risk factors for major lower limb amputation. Kkartoum Med J 2009;2(1):172 – 74.
  2. 75. Sami Galal, Sef ElDin Ibrahim Mahadi, Mohamed ElMakki Ahmed, Suliman Salih Fedail.

Management of oesophageal leak and perforation by temporary metallic stents: a local experience. . Sudan Med J 2009;45(2):

  1. 76. Aymen EA Doumi, Khalid Yahya Hassan, Batoul A Eltayeb, Asma AbdelAll, Mohamed ElMakki Ahmed. Patients complaints against their treating doctors at the Sudan Medical Council. Sudan Med J 2009;45(2):82-83.
  2. 77. Khalid Yahya Hassan , Aymen EA Doumi, Batoul A Eltayeb Sayed Halaly, M E Ahmed. Patient's satisfaction by information given to them by doctors concerning their illness and their views about the consent form signed before surgical procedures in Khartoum Teaching Hospital. Sudan Med J 2009;45(2):84 – 85.
  3. 78. Seif I Mahadi, Mohd ElTayeb ElSamani, Mohd E Ahmed. Gastric cancer in Khartoum: Presentation and management. J of the Arab Board of Medical Specialization 2009;10(1):54 – 59.
  4. 79. Elshaffie Emad addin Abdelrahman Elhusain 1,, Seif Eldin Ibrahim Mahadi, Kamal eldin Hamed Mohamed, Mohamed ElMakki Ahmed . Clinical presentation and management of thyroid cancer in Khartoum Teaching Hospital & Radiation and Isotope Center Khartoum Sudan.
  5. 80. Moneer A. Abdelgadir, Seif ElDin I. Mahadi, Ayman O. Nasr, Mohamed ElMakki Ahmed. Role of jejunostomy feeding catheter as a model for nutritional support. International Journal of Surgery 8 (2010) 439e443.
  6. 81. Mohamed ElMakki Ahmed, Abdulhakim O. Tamimi, Seif I. Mahadi, AbuBakr H. Widatalla, Mohamed A. Shawer. Hallux Ulceration in Diabetic Patients. The Journal of Foot & Ankle Surgery 49 (2010) 2–7.
  7. 82. Muaz Saifeldin Idris, Mohamed Isam Atiatalla, Seifeldin Ibrahim Mahdi, Ahmed liposarcoma of the pelvis: Mohamed ElHassan, Mohamed ElMakki Ahmed. A large myxoid diagnostic and therapeutic challenge. Khartoum Medical Journal 2011;5(3):.. 83. J Wound Care. 2011 Sep;20(9):440-4.

Extended leg infection of diabetic foot ulcers: risk factors and outcome. Adam KM1, Mahmoud SM, Mahadi SI, Widatalla AH, Shawer MA, Ahmed ME. Author information

Abstract

OBJECTIVE:

To identify the risk factors for extension of infection to the leg in diabetic foot ulcers (DFU) and to evaluate its role as a prognostic measure regarding limb salvage and healing time.

METHOD:

This retrospective case-control study took place in Jabir Abu Eliz Diabetic (JADC) during 2006-2008. Forty-eight patients diagnosed with a diabetic foot ulcer (DFU) with the infection extending to the leg (case group) were compared with an equal number of patients with a DFU without extension (control group). Risk factors for extension were identified by univariate analysis and both groups were compared with regard to limb salvage and healing time.

RESULTS:

Previous history of toe amputation was more frequent in the case group (p=0.004). The case group patients were significantly more likely to present with fever (p=0.01), pallor (p=0.02), confusion (p=0.04), and necrosis (p=0.004). Ulcers located in the heel were more frequent in the case group when compared with controls (p=0.0001) while more toes ulcers were found in the control group (p=0.001). A significant number of patients in the case group had an ulcer of more than 5cm diameter compared with those in the control group (p=0.001). The total number of patients presented with severe disease (Wagner grade 3-5) was significantly more in the case group compared with controls (p=0.004). Patients with severe infection (grade 4) were more in the case group compared with the controls (p=0.04). There were no significant differences between the two groups with

regard to major and minor amputation rate. The case group had a longer duration of healing when compared with the controls. Seventy-five per cent of the controls healed by 6 months (n=31) compared with 22% in the case group (n=8 ; p=0.001).

CONCLUSION:

Toe amputation, wound located in the heel, wound size more than 5cm and advanced Wagner grade (3-5) and severe sepsis, grade 4, may be considered as risk factors for extension of infection to the leg in DFU. However, this extension did not carry a poor prognostic value to the final outcome if adequate therapeutic measures were followed.

  1. 84. Diabet Foot Ankle. 2012;3. doi: 10.3402/dfa.v3i0.18809. Epub 2012 Oct 1.

Diabetic foot infections with osteomyelitis: efficacy of combined surgical and medical treatment. Widatalla AH1, Mahadi SE, Shawer MA, Mahmoud SM, Abdelmageed AE, Ahmed ME. Author information

Abstract

Diabetic foot infections are a high risk for lower extremity amputation in patients with dense peripheral neuropathy and/or peripheral vascular disease. When they present with concomitant osteomyelitis, it poses a great challenge to the surgical and medical teams with continuing debates regarding the treatment strategy. A cohort prospective study conducted between October 2005 and October 2010 included 330 diabetic patients with osteomyelitis mainly involving the forefoot (study group) and 1,808 patients without foot osteomyelitis (control group). Diagnosis of osteomyelitis was based on probing to bone test with bone cultures for microbiological studies and/or repeated plain radiographic findings. Surgical treatment included debridement, sequestrectomy, resections of metatarsal and digital bones, or toe amputation. Antibiotics were started as empirical and modified according to the final culture and sensitivities for all patients. Patients were followed for at least 1 year after wound healing. The mean age of the study group was 56.7 years (SD = 11.4) compared to the control group of 56.3 years (SD = 12.1), while the male to female ratio was 3:1. At initial presentation, 82.1% (n=271) of the study group had an ulcer penetrating the bone or joint level. The most common pathogens were Staphylococcus aureus (33.3%), Pseudomonas aeruginosa (32.2%), and Escherichia coli (22.2%) with an almost similar pattern in the control group. In the study group, wound healing occurred in less than 6 months in 73% of patients compared to 89.9% in the control group. In the study group, 52 patients (15.8%) had a major lower extremity amputation versus 61 in the control group (3.4%) (P=0.001). During the postoperative follow-up visits, 12.1% of patients in each group developed wound recurrence. In conclusion, combined surgical and medical treatment for diabetic foot osteomyelitis can achieve acceptable limb salvage rate and also reduce the duration of time to healing along with the duration of antibiotic treatment and wound recurrence rate.

KEYWORDS:

amputation; diabetic foot; neuropathy; osteomyelitis; ulcer

  1. 85. Diabet Foot Ankle. 2012;3. doi: 10.3402/dfa.v3i0.18980. Epub 2012 Oct 30.

Associated risk factors and management of chronic diabetic foot ulcers exceeding 6 months' duration. Musa HG1, Ahmed ME. Author information

Abstract

BACKGROUND:

The management of chronic diabetic foot ulcers (DFU) poses a great challenge to the treating physician and surgeon. The aim of this study was to identify the risk factors, clinical presentation, and outcomes associated with chronic DFU>6 months' duration.

METHODS:

This prospective study was performed in Jabir Abu Eliz Diabetic Centre (JADC), Khartoum, Sudan. A total of 108 patients who had DFU for >6 months were included. Recorded data included patient's demographics, DFU presentation, associated comorbidities, and outcomes. DFU description included size, depth, protective sensation, perfusion, and presence of infection. Comorbidities assessed included eye impairment, renal and heart disease. All patients received necessary local wound care with sharp debridement of any concomitant necrotic and infected tissues and off-loading with appropriate shoe gear and therapeutic devices.

RESULTS:

The mean age of the studied patients was 56+SD 9 years with a male to female ratio of 3:3.3. The mean duration of DFU was 18±SD 17 months (ranging from 6 to 84 months). Ulcer healing was significantly associated with off-loading, mainly the use of total contact cast (TCC) (p=0.013). Non-healing ulcerations were significantly associated with longer duration of the chronic DFU>12 months (p=0.002), smoking (p=0.000), poor glycemic control as evidenced by an elevated HbA1c (>7%), large size (mean SD 8+4 cm), increased depth (p<0.001), presence of skin callus (p<0.000), impaired limb perfusion (p=0.001), impaired protective sensation as measured by 10 g monofilament (p=0.002), neuroischemia (p=0.002), and Charcot neuroarthropathy (p=0.017).

DISCUSSION:

Risk factors associated with chronic DFU of>6 months' duration included the presentation of an ulcer with increased size and depth, with associated skin callus and neuroischemia, in a diabetic patient with a history of smoking and increased HbA1c >7%. Off-loading mainly with the use of TCC is an effective method of managing long-standing DFU.

KEYWORDS:

amputation; diabetic foot; ischemia; neuropathy; ulcer

  1. 86. Bakheit HE, Mohamed MF, Mahadi SE, Widatalla AB, Shawer MA, Khamis AH, Ahmed ME. J Foot Ankle Surg. 2012 Mar-Apr;51(2):152-5. doi: 10.1053/j.jfas.2011.10.032. Epub 2011 Nov
  2. 88. J Foot Ankle Surg. 2012 Mar-Apr;51(2):152-5. doi: 10.1053/j.jfas.2011.10.032. Epub 2011 Nov 10.

Diabetic heel ulcer in the Sudan: determinants of outcome. Bakheit HE1, Mohamed MF, Mahadi SE, Widatalla AB, Shawer MA, Khamis AH, Ahmed ME. Author information

Abstract

Heel ulceration, on average, costs 1.5 times more than metatarsal ulceration. The aim of this study was to analyze the determinant factors of healing in diabetic patients with heel ulcers and the late outcomes at Jabir Abu Eliz Diabetic Centre Khartoum, Khartoum, Sudan. Data were collected prospectively for 96 of 100 diabetic patients presenting with heel ulcers at the Jabir Abu Eliz Diabetic Centre Khartoum from May 2003 to January 2005. Late outcome was assessed 3 years later (February 2008). Heeling was achieved in one half of the patients (n = 48). In the remaining 48 patients, 22 ended with major lower extremity amputation and 22 were still receiving wound care. A total of 8 patients died, 4 in each group, the healed and unhealed. The most significant determinants of healing using a logistic multivariate regression model, 95% confidence intervals, and odds ratios included a shorter duration of diabetes (p < .009), adequate lower limb perfusion (p < .043), and a superficial foot ulcer (p < .012). Three years later, of the 88 patients who could be traced, 78 were alive and 59 had healed ulcers (7 had died of unrelated causes and 3 of diabetic-related complications), and no additional lower extremity amputation was recorded. Mortality in the series was 18 patients, of whom 14 had undergone a previous lower extremity amputation. Superficial heel ulcers in diabetic patients with a short history of diabetes and with good limb circulation are more likely to heal within an average duration of 25 weeks. At 3 years of follow-up, 75% showed a favorable outcome for ulcer healing, and 22 patients underwent lower extremity amputation (25%), of whom 14 were dead within 3 years.

Copyright © 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

PMID:

22078157

DOI: 10.1053/j.jfas.2011.10.032

  1. 87. Rania Abdalmoneim, Hassan Gubara Musa, Lamyaa A M ElHassan, Elwaleed M Elamin, Mohamed ElMakki Ahmed. Case Reports: A giant gastric pedunculated gastrointestinal stromal.tumour. Khartoum Medical Journal 2012;
  2. 88. Mohamed Osman Suliman, Omer ElFaroug H Salim, Mohamed ElMakki Ahmed. Major lower limb amputation in diabetics. Khartoum Medical Journal 2012;5(1):
  3. 89. Waiel Faisal Abdel Wahab, Mohayad A Bakhiet, Seif ElDin I Mahadi, Shadad M Mahmoud, AbuBakr Hassan Widataal and Mohamed ElMakki Ahmed. Diabetic Foot Infections with Pseudomonas: Jabir Abueliz Diabetic Center Khartoum Experience. Clinical Research on Foot & Ankle 2013, S3 http://dx.doi.org/10.4172/2329-910X.S3-001
  4. 90. Obituary Professor Ahmed Abdel Aziz Ycoub. Sudan mEdical Journal 2013 August;49(2):123
  5. 91. Isameldin O. Ibrahim1, Aamir A. Hamza2*, M. E. Ahmed .. Traumatic Splenic Injuries in Khartoum, Sudan. December 2013 (http://www.scirp.org/journal/ss) http://dx.doi.org/10.4236/ss.2013.412102 Open Access SS
  6. 92. Wafa NE Elhadi, Shadad M Mahmoud, MohAMED elmakki Ahmed. Surgical management of breast cancer among Sudanese patients. Sud Med J 2014;April 50(1): 41 – 47.

93-Mohamed E. Ahmed Mohamed A. Mahgoub,Mohamed G. Alnedar , Seif I. Mahadi ,Maha Alzubeir, Lamyaa A M EL Hassan, ElWaleed M Elamin Ahmed Mohamed El Hassan. Myasthenic crisis manifests as postoperative respiratory failure following resection of unsuspected intrathoracicThymic T-Cell lymphoma during thyroidectomy for an adjacent large retrosternal goiter. Eur Thyroid J 2014;3:206-210 . 94 -Shadad M. Mahmoud, Ahmed I. Abdelrahim, AbuBakr H. Widatalla, Seif ElDin I. Mahadi, Mohamed E. Ahmed Diabetic foot in patients below 40 years of age. International Journal of Diabetes in Developing Countries May 2015 Date: 14 May 2015 95. Antibiotic prophylaxis in clean and clean-contaminated surgery and surgical site infection in Khartoum Teaching Hospital. Sami O. Ahmed, Mohamed ElMakki Ahmed. Sudan Med J 2014 in press 96. Eltahir HB, Dandara C, Parker MI, Ahmed ME, Fedail SS, Mohamed AO. Sulfotransferase 1A1 (G638A) Gene Polymorphism in Sudanese Patients with Oesophageal Cancer. QScience Proceedings 2012, Environmental Mutagens in Human Populations, 104. DOI: 10.5339/qproc.2012.mutagens.3.104 http://www.qscience.com/doi/abs/10.5339/qproc.2012.mutagens.3.104 97. Int J Surg. 2016 Mar 15. pii: S1743-9191(16)00230-2. doi: 10.1016/j.ijsu.2016.03.023. [Epub ahead of print] The surgical treatment of esophageal cancer in Sudan. Ahmed ME1, Mahdi SI2, Ali BM3. 98. J Wound Care. 2015 Sep;24(9):420-5. doi: 10.12968/jowc.2015.24.9.420. Diabetic neuropathic forefoot and heel ulcers: management, clinical presentation and outcomes. Yosuf MK1, Mahadi SI1,2, Mahmoud SM1,2, Widatalla AH1, Ahmed ME1,2. Author information Abstract OBJECTIVE: The two most common sites for diabetic neuropathic foot ulcers are the forefoot and the heel. Each site has

special characteristics that determines its c