Diabetes mellitus is a very rampant metabolic disorder, particularly type II. It has many complications such as the septic foot. Diabetic septic foot (DSF) patients are at high risk for coagulation abnormalities as well as surgical hazards. Owing to the potential sequelae of coagulation and vascular abnormalities, this work aimed at studying the hemostatic state and platelet indices in diabetes type II patients with septic foot. A case-control study was conducted during the period from July to September 2017 at Dr. Awaad medical center, Red Sea State, Sudan. 57 diabetic patients with septic foot, aged between 17 and 78 years along with 57 non-diabetic subjects as control were enrolled. Sociodemographic data were collected using a structured questionnaire. Venipuncture blood was taken with necessary safety measures. Diabetes profile, coagulation studies as well as platelet indices were estimated. Data was analyzed using SPSS version 24.0 for windows. Ethical approval was considered and written consent from each participant was obtained. The mean age of diabetic patients with septic foot and healthy controls were 48.49 ± 15.8 and 32.77 ± 14.0, respectively. The duration of the diabetes onset was 10.43 ± 9.5 years. Plasma prothrombin time (PT) value (12.61 ± 2.6 vs 13.67 ± 1.5, P < 0.009) was found to be significantly shorter in DSF compared to control. Plasma activated partial thromboplastin time (APTT) value was significant in diabetic septic foot (32.64 ± 5.2 vs 28.49 ± 4.13, P < 0.000), and thrombin time (TT) did not changed in DSF. Mean platelet volume (MPV), platelet distribution width (PDW), and platelet large cell ratio (P-LCR) values were significantly decreased in DSF compared to control (P < 0.013, 0.034, and 0.020, respectively). PDW values were positively correlated with PT, APTT, and D-Dimer (DD) (r = 0.28/p < 0.003, r = 0.29/p < 0.029, and r = 0.32/p < 0.016, respectively). FVIII activity (121.86 ± 174.4 vs 98.66 ± 31.83, P < 0.951) was insignificant with DSF, as the DD was also insignificant (P < 0.081). Diabetes mellitus is associated with prothrombotic tendency. Hypercoagulable state in DSF is indicated by shortened PT finding. PDW is a manifesting evidence that proves the presence of more reactive and aggregable platelets in DSF patients.

Dengue is a global endemic and most prevalent human arbovirus disease. This study aimed at evaluating thrombocytopenia and to find out platelet activation in dengue across the spectrum of the disease. A prospective study was conducted from February, 2013 to June, 2014 at Port Sudan Teaching Hospital, Red Sea State, Sudan. 334 cases of dengue caused by dengue virus along with 101 cases of control were enrolled. Laboratory-positive dengue cases were confirmed by immune chromatography and World Health Organization (WHO) criteria were used for classifying the dengue severity. Platelet counts (PLT) and platelet distribution width (PDW) were measured. Out of 334, 289 patients had dengue fever (DF) and 45 patients had dengue haemorrhagic fever (DHF). Thrombocytopenia was present in 234 (81%) DF cases and 45 (100%) DHF cases. Bleeding manifestation was seen in 35 (10.5%) patients. Haematuria (5.7%), haematamesis (0.3%), haemoptysis (0.3%), epistaxis (1.5%), and gum bleed (2.7%) are the common forms of bleeding. PLT and PDW were found to be significantly low and high in case of dengue (P < 0.000), respectively. Thrombocytopenia (low PLT) and high PDW shows considerable sensitivity for dengue virus infection. Key words: Dengue, thrombocytopenia, bleeding manifestations, PDW, Port Sudan.

Background and Objectives: HIV disease is recognized to cause inconsistencies in coagulation via various pathways during infection. Some studies have indicated that HIV-infected patients are prone to developing thrombocytopenia, thrombosis, or autoantibodies that may cause difficulties in diagnosis. This study is intended to measure the trend of coagulation parameters in Sudanese patients with HIV. Materials and Methods: A cross-sectional study was carried out in patients with HIV admitted to the Sudan National AIDS Program (SNAP) from January 2018 to December 2019. Prothrombin time (PT), partial thromboplastin time (PTT), thrombin time (TT), D-dimer (DD), hemoglobin (HB), total lymphocyte count (TLC), platelet count (PLT), and a disintegrin and metalloproteinase with thrombospondin type 1 motif, member 13 (ADAMTS13), were evaluated among HIV Sudanese patients. Results: Out of the 44 HIV patients included, 6 (13.6%) were found to have thrombotic thrombocytopenic purpura-like events and 12 (27.2%) had antiphospholipid antibodies, of whom 8 (66.6%) showed anticardiolipin antibody (1gG (75%) and IgM (25%)) and 4 showed lupus anticoagulants. The HB, TLC, and PLT values were found to be significantly lower in HIV patients than in control (p = 0.000, 0.000, and 0.050, respectively). The PT and ADAMTS13 values showed no significant difference between HIV patients and control (p = 0.613 and 0.266, respectively). The PTT, TT, and DD values were found to be augmented in HIV patients versus the control (p = 0.000). Conclusions: Thrombotic thrombocytopenic purpura-like events among HIV Sudanese patients were explored. In addition, antiphospholipid antibodies were strikingly seen in these patients. Additional research is anticipated to confirm these diagnoses.

Background: The plasma serine protease inhibitor alpha 2-antiplasmin (α₂-AP, otherwise known as α₂-plasmin inhibitor) is a rapid-acting plasmin inhibitor recently found in human plasma, which seems to have a significant role in the regulation of in vivo fibrinolysis. Congenital deficiency of α₂-AP is extremely uncommon. Case presentation: We report here a case of absolute deficiency of α₂-AP in an 11-year-old Sudanese boy, who had a lifelong intermittent hemorrhagic tendency (gum bleeding, epistaxis, and exaggerated bleeding after trauma). Coagulation tests including prothrombin time, partial thromboplastin time, thrombin time, bleeding time, platelet count, clot retraction test, antithrombin, and factor VIII levels were within normal limits. Hepatic function tests and complete blood count were also normal. The main interesting finding in this patient was that the whole blood clot lysis was extremely fast, completed within 5–8 hours. The second abnormal finding is that the euglobulin clot lysis time was short. Nevertheless, the concentration of α₂-AP in the patient's plasma was 0.2 IU/ml (reference range is 0.80–1.20 IU/ml). The addition of pooled plasma (with normal α₂-AP) to the patient's whole blood corrected the accelerated fibrinolysis. Conclusion: The study showed that α₂-AP deficiency resulted in uninhibited fibrinolysis that caused the hemorrhagic tendency in this patient. Thus, this report demonstrates the significant role of α₂-AP in coagulation.

Iron indices are pivotal in tuberculosis (TB) owing to their influence on pathogens and immune reactions. Iron indices substantially affect TB progression, resulting in inflammation and anemia. Tuberculosis can induce iron deficiency or excess that may result in compromised immunological function. This study examined the iron index hemoglobin (Hb), serum iron, ferritin, total iron binding capacity (TIBC), unsaturated iron binding capacity (UIBC), and transferrin saturation (TSAT) in PTB patients. Between January 2016 and December 2018, the Port Sudan Tuberculosis Diagnostic Center studied a cohort of 100 adult patients definitively diagnosed with PTB. Additionally, 100 healthy individuals of similar age and sex were chosen as controls for comparative analysis. Among the 100 PTB patients studied, 90% (90/100) had anemia, with an odds ratio of 0.923 (95% CI 0.82–1.04). Anemia of chronic disease (ACD) was the most prevalent type (37%, 31/90). The patients showed diminished levels of HB, serum iron, TIBC, and TSAT compared to the controls, except for ferritin levels. UIBC was higher in patients than in controls, but this difference was not statistically significant. The research concludes that iron metabolism is modified during tuberculosis infection. Consequently, anemia in PTB patients is primarily attributed to ACD rather than iron shortage. The indices of serum iron, TIBC, and UIBC were ineffective in distinguishing between the forms of anemia in PTB patients, as their levels fluctuated in response to the infection. Ferritin served as superior metric for distinguishing between anemia of chronic disease and iron deficiency anemia.