CASE PRESENTATION: A 30-year-old man was retrieved from the jungle with severe weight loss and abdominal symptoms. He succumbed to death despite 22 days of intensive medical treatment. An autopsy revealed a ruptured gangrenous ileal volvulus with peritonitis and subdiaphragmatic abscess. Further laboratory analysis detected systemic Candida tropicalis and intestinal gramnegative bacterial sepsis, systemic Zika virus viremia, leptospirosis complicating rhabdomyolysis and disseminated intravascular coagulopathy, Type I Herpes Simplex virus infection of the tongue and upper gastrointestinal tract. The cause of death was the ruptured ileal volvulus, complicated with upper gastrointestinal bleeding due to Herpes simplex virus esophagitis in a malnourished patient with resolving leptospirosis and underlying Zika virus co-infection.
CONCLUSION: Rare clinical scenarios of adult-onset intestinal volvulus with concomitant multiple infections precludes clinical diagnosis and early treatment, leading to devastating consequences of clinical outcome. The positive clinical and postmortem correlation is a good learning lesson in many disciplines of medicine and science.
METHODS: A school-based cross-sectional study was conducted in Khartoum state in Sudan. The study targeted male and female adolescents in secondary schools. A total of 3387 students from public and private schools participated in the study. Multistage random sampling was used to select the participants. The Arabic version questionnaire from the Global Youth Tobacco Survey (GYTS) was utilised to collect the data from the participants.
RESULTS: Among the participants, 57.3% were females and 42.7% were males. Students from private and public schools were 48.4 and 51.6%, respectively. The overall prevalence of those who had ever used smokeless tobacco was 7.6%, in which the prevalence among male students was 11.0% while among females was 5.0%. The determinant factors were male gender (OR 1.53 CI 95% 1.03-2.28), family structure (OR 1.52 CI 95% 1.03-2.23), exposure to second-hand smoke at home (OR 1.60 CI 95% 1.11-2.31), friends smoking cigarettes (OR 1.78 CI 95% 1.22-2.60), lack of restriction of selling tobacco to minors (OR 1.73 CI 95% 1.25-2.39), promotion of smokeless tobacco (OR 2.12 CI 95% 1.20-3.72) and low self-efficacy (OR 7.47 CI 95% 4.45-12.52).
CONCLUSION: A comprehensive prevention programme that enforces the prohibition of the promotion of smokeless tobacco and the selling of smokeless tobacco to minors is crucial. Moreover, the prevention programme should enhance adolescents' self-efficacy.