No abstract

Background The neonatal morbidity and mortality is very high in the Sudan, the umbilical cord association and contribution to this is planned to be answered. Therefore the present study was designed to provide some information on the morphological variations of human umbilical cord via gross anatomical assessment and their correlation with foetal factors such as foetal weight and length. Methods A prospective hospital - based study conducted in Wad Madani Maternity Teaching Hospital Department of Obstetrics and Gynecology between July 2014 and March 2018 Results The mean diameter of the 371 umbilical cords was 2.1±0.24cm. Length was 53.8±3.8 cm length ranging from 48 – 62 cm and 10 (2.7%) of 371 umbilical cords were uncoiled. of which, 1 (0.3%) cords were with absent Wharton’s Jelly. The mean neonatal indices were 2.95 kg, 33.19 cm and 44.42 cm for weight, head circumference and length respectively. There was just significant strong positive correlation between umbilical cord length and length of neonates. Also Umbilical cord diameter had a positive correlation with length of neonates and negative correlation with weight of neonates and APGAR Score. Conclusion The present study suggests that ‘normal’ cord length should be between 40 cm and 70 cm in length. Umbilical cord diameter had a positive correlation with fetal length and negative correlation with fetal weight and APGAR score. The diameter range of 1-2 cm suggests that a normal cord must not exceed 2 cm in diameter. However the umbilical cord index had negative correlation with length of neonates.

Background: Tarsal tunnel is situated medial to the ankle lying deep to the flexor retinaculum. Within which lies the neurovascular bundle in separate compartments. This study examines the level of bifurcation points of tibial nerve and posterior tibial artery, and the location of medial and lateral plantar nerves in the tarsal tunnel. As well as the origin of the medial calcaneal nerves. Methods: This study was a descriptive observational cross sectional study. Step by step dissections of the tarsal tunnel were performed on 30 Sudanese cadavers, the contents of the tarsal tunnel were explored. Results: The tibial nerve was found to bifurcate before the the medial malleolus calcaneal axis (MMCA) in (n=4/30, 13.3%) specimens , and inside the tunnel (n=26/30, 86.7%). The branching point of the posterior tibialartery was found before the MMCA in (n=10/28, 35.7%) of specimens, at the MMCA in (n=16/28, 57.1%), and after the MMCA in (n= 2/28, 7.1%). Medial calcaneal nerves were found to be derived from the LPN plus the TN in (n=13/30, 43.3%), while in (n=6/30, 20%) were derived from LPN plus MPN plus TN. only (n=5/30, 16.7 %) were derived from LPN alone. Conclusion: anatomical knowledge of the bifurcation points of tibial nerve and posterior tibial artery is of great importance in many medical procedures like external fixation of medial malleolus fractures, medial displacement osteotomy and nerve blocks in podiatric medicine.

Background: Anterior clinoid process is usually drilled in order to approach cavernous sinus and related structures in neurosurgical operations. The presence of carotico-clinoid foramen and interclinoid osseous bridge create difficulties while approaching anterior clinoid process and increases the risks of injury to the internal carotid artery and nearby structures. Aim: To observe incidence, anatomy of carotico-clinoid foramen and interclinoid osseous bridge in the Sudanese dry skulls. Methods: This was a cross sectional study, conducted in the departments of anatomy in different medical schools in Sudan between the period from June 2019 to January 2020. Total 30 dry adult human skulls were examined to observe incidence of carotico-clinoid foramen and of interclinoid osseous bridge. Result: The incidence of carotico-clinoid foramen was 13.3% (4 skulls out of 30). The foramen was bilaterally present in one skull (n=1/30, 3.3%) and unilateral in 3 skulls (n=3/30, 10%). Type I bridge is the carotico-clinoid foramen itself, the Type II interclinoid osseous bridge was found in one skull (n=1/30, 3.3%) , no Type III and Type IV bridges were observed in the present study. Conclusion: the presence of this foramen and interclinoid osseous bridge can complicate neurosurgical operations in cavernous sinus, sellar and para-sellar regions. Therefore, the detailed anatomical knowledge is very important to decrease complications and to increase success rates of neurosurgical operations in this area.

Patients with chiari malformation type one ( CM -1 ) headache may be mistaken by chronic migraines or other causes of headache, so analysis of headache related to CM-1 is corner stone in early diagnosis of the disease. The purpose of this study was to assess the frequency and clinical characteristics of headache in the patients with CM-1 to help primary care clinicians better understand the relationship between an individual's presenting symptoms of CM 1, so aiding for early diagnosis and early management and for better outcome. This was prospective observational analytical study carried out in Khartoum state hospitals that provide neurosurgical services, (NCNS, Neurospine Center-Ribat Teaching Hospital, Military Hospital, and Omdurman Teaching Hospital) from February 2018- September 2019. Study was included 18 adult males and females of different ages diagnosed with Chiari MF -1 who undergoing decompressive surgery. Symptomatic patients diagnosed with Chiari MF -1Patients with no history of neurological illnesses or history of cranial surgery were included. Patients with history of any neurological diseases such as multiple sclerosis and with other causes of headache were excluded from the study. Evaluation and full analysis of headache were registered including type of headache, site, duration headache, time lasting, radiation of pain, severity using headache scale, associated ocular and visual symptoms. This study included 18 patients diagnosed with chiari 1 malformation and suffering from headache related to chiari 1 malformation. Full analysis of the headache was obtained. The headache was mostly in the back of the head (n=17/18 , 94.4%) and only in (n=1/18, 5.6%), the headache was in the sides or front of the head. In 12 patients (n=12/18 , 66.7%) headache worsen by bending forward. And in 6 patients (n=6/18 , 33.3%) worsen by cough. Regarding the type of headache, mostly pressure in nature (n=17/18 , 94.4%) and it was rarely throbbing in nature(n=1/18, 5.6%),. All patients were asked to evaluate their headache in headache scale from 1 to 10 (10 more severe). The scale ranged between 5 and 9 with mean 6.88. headache could be long or short lasting (from hours to days).Eye symptoms included blurring of vision complained by 9 patients(n=9/18, 50%), light sensitivity in 5 patients ((n=5/18, 27.8%), and 6 patients (n=6/18 , 33.3%) there were no eye symptoms. Neck pain was a dominant symptom seen in 17 patients (n=17/18, 94.4%) , and back pain in 18 patients (n=18/18 , 100%) . headache subsided after decompression surgery in all patients included in this study. Knowledge and understanding the CM-1 headache characters are important for early diagnosis and early treatment of the disease.