413 NIDDM Sudanese patients were studied. The patients' ages at the onset of diabetes ranged from 20-72 years, with the majority of patients (44%) developing diabetes at the age between 40-50 years. ...Female to male ratio was 1.9:1. 46.2% of patients were obese and a family history of first degree relatives was obtained in 63% of patients. Complications of diabetes in this study were as follows: Neuropathy (31.5%), retinopathy (17.4%), cataract (16%), nephropathy (9.2%), coronary heart disease (5.1%), cerebrovascular disease (4.4%) and peripheral vascular disease (3.4%). Microangiopathic complications of diabetes were significantly related to the duration of diabetes and the degree of hyperglycaemia (P less than 0.001 using chi 2 test). Macroangiopathic complications were significantly related to aging and hyperglycaemia. Patients with good metabolic control (blood glucose less than 160 mg%) had less prevalence of complications than uncontrolled patients. We conclude that NIDDM is a common type of diabetes in our diabetic clinic. It is a disease with severe complications and morbidity and needs more attention regarding metabolic control, since good control reduces the prevalence of diabetic complications.
A single injection of iodized oil was administered intramuscularly in a dose of 0.2-2 ml (475 mg iodine per ml) to 383 children from the villages of Kas and Dibbis of the Darfur region in Western ...Sudan, where goitre is prevalent. After one year the prevalence of goitre had declined from 76% to 49.6%. Of the goitrous children, 81.1% showed either complete resolution of goitre or definite regression of its size. None of the nongoitrous children developed goitre and none of the existing goitres became larger. No cases of hyper- or hypothyroidism were observed. The full 270 children were followed up for four-and-a-half years after treatment and compared with untreated controls from the same area. The prevalence of goitre was significantly lower in the treated than in the untreated group. In treated children the mean urinary iodine excretion three-and-a-half years after treatment was 188.7 micrograms/g creatinine. This was significantly higher than in the untreated group (P less than 0.001). One year later the mean urinary excretion of iodine in the treated children had decreased to 87.1 micrograms/g creatinine. There was no difference in the mean serum values of T3 and T4 in the treated and untreated groups. The level of thyroid stimulating hormone was significantly lower in the treated mean (S.D.) = 3.5 (0.9) than in the untreated children 6.0 (3.5). It is concluded that a single injection of iodized oil is safe and effective in prevention of goitre development, reduces goitre size and maintains a sufficient iodine supply to prevent goitre for at least four-and-a-half years in children from goitre-endemic areas in Western Sudan.
ABSTRACT
Background
Kidney transplant survival benefits are not observed for around 8 months after transplantation because of a higher complications rate in early post-transplant periods. This study ...compares survival of patients awaiting transplantation with survival of transplant recipients and non-listed dialysis patients in Ireland.
Methods
In this retrospective analysis, the relative-risk (RR) of death was assessed with time-dependent, non-proportional hazards analysis, with adjustment for age, cause of end-stage kidney disease (ESKD), time from first treatment for ESKD to placement on the waiting list and year of initial placement on the list.
Results
A total of 3597 patients were included. Annual death rates per 100 patient-years at risk for all patients on dialysis, waiting-list patients and transplant recipients were 16.5, 2.4 and 1.2, respectively. Death rate was highest among diabetics. The relative risk of death for all patients on dialysis was five times higher than the waiting-list patients RR, 4.90; 95% confidence interval (CI), 3.70-6.52; P < 0.001. Time to survival equilibration was 1 year. Thereafter, the 5-year mortality risk was estimated to be 47% lower than that of the patients on the waiting list (RR, 0.53; 95% CI, 0.37-0.77; P = 0.001).
Conclusions
Transplant recipients had a higher risk of death initially, but a better long-term survival. Time to death risk equilibration was longer compared with other studies. This could be explained by better survival rates in our waiting-list cohort.
Stress-induced (Takotsubo) cardiomyopathy is a rare form of cardiomyopathy which presents in a manner similar to that of acute coronary syndrome. This sometimes leads to unnecessary thrombolysis ...therapy. The pathogenesis of this disease is still poorly understood. We believe that reporting all cases of Takotsubo cardiomyopathy will contribute to a better understanding of this disease. Here, we report a patient who, in the absence of any recent stressful events in her life, developed the disease after a session of dancing.
A 69-year-old Caucasian woman presented with features suggestive of acute coronary syndrome shortly after a session of dancing. Echocardiography and a coronary angiogram showed typical features of Takotsubo cardiomyopathy and our patient was treated accordingly. Eight weeks later, her condition resolved completely and the results of echocardiography were totally normal.
Takotsubo cardiomyopathy, though transient, is a rare and serious condition. Although it is commonly precipitated by stressful life events, these are not necessarily present. Our patient was enjoying one of her hobbies (that is, dancing) when she developed the disease. This case has particular interest in medicine, especially for the specialties of cardiology and emergency medicine. We hope that it will add more information to the literature about this rare condition.
Acute renal failure (ARF) is a common health problem worldwide. There is limited data on the pattern of ARF in Sudan. Moreover, glomerular diseases, which are a well-known cause of ARF, have not been ...accurately and adequately diagnosed previously. A retrospective study on the patterns of ARF was carried out in a general nephrology referral center in Sudan during the period from February 2003-February 2004. Patients from intensive care units with ARF and those who developed ARF after massive surgery were excluded from the study. Renal biopsy was performed when indicated and studied with light and immunofluorescent microscopy. Eighty-nine patients (57 (64%) cases were males and mean age was 39+/-19.4 years) fulfilled the criteria for the diagnosis of advanced renal failure requiring renal function replacement therapy. Acute tubular necrosis (ATN) was diagnosed in 50 (56%) patients; 33 (66%) ATN patients had renal failure as a complication of volume depletion, fulminant infections (particularly malaria and typhoid fever) or snakebites and 12 (13.4%) patients ingested paraphenylene-diamine (PPD) (hair/Henna dye) in suicidal attempts. Eight (9%) patients of the total study group had glomerular diseases and 11 (12.3%) had obstructive uropathy associated with ARF; the cause of ARF could not be determined in 17 (19%) patients. Fifty-three (60%) patients recovered their renal function, six (6.7%) patients progressed to chronic kidney disease (CKD), 16 (18%) died and 14 (16%) were lost to follow-up. In conclusion, patients with ARF associated with ATN had a favorable prognosis except when ATN was associated with PPD poisoning.
The technique of Continuous Ambulatory Peritoneal Dialysis (CAPD) is known to be associated with various infectious and non-infectious complications. The latter term includes anatomical/mechanical ...complications as well as hemoperitoneum, inflow pain, electrolyte disturbances, metabolic derangements and delayed gastric emptying.
We retrospectively evaluated all patients who were maintained on CAPD for a minimum of 90 days in Sudan, in the period between May 2005 and Apr 2010. We examined the incidence of various non-infectious complications and their possible associations.
The analysis included 296 patients including 71 children (24%). Males constituted 62.2% of the study population and 13.9% were diabetic. The incidence per 100 patient-years of various non-infectious complications was as follows: hypokalemia (30.4), catheter dysfunction (10.8), dialysate leak (5.3), hernia (4.7), hemorrhagic effluent (4.7), inflow pain (2.3), upper gastrointestinal symptoms (2) and cuff extrusion (0.9). Catheter block and hernia were diagnosed with a median duration after catheter insertion of 6 and 7.5 months, respectively. Catheter block was significantly more prevalent among children (22.5% versus 9.3%; P = 0.006). A high body mass index (BMI) was the only identified independent predictor for leak (OR 1.4, P = 0.005). More than half of the 16 hernias were umbilical, and four of the five inguinal hernias were bilateral. Non-infectious complications were responsible for 32% of technique failures.
Non-infectious complications were fairly common among our CAPD patients and led to catheter removal in a considerable number of patients.
National Ribat University Hospital 1 ; Military
Hospital 2 ; Khartoum Renal
Center 3 ; Soba University
Hospital 4 ; Jaafar Ibn Auf Pediatric
Hospital 5 ; Ibn Sina Specialized
Hospital 6 ; Khartoum ...North Renal
Center 7 ; Central Medical Supplies
Corp. 8 ; and National Center for Kidney
Diseases, 9 Khartoum, Sudan
Correspondence to: E.A.M. Elhassan, Ribat Center for Regular Peritoneal
Dialysis, P.O. Box 363, Khartoum, Sudan.
waleedali{at}yahoo.com
Background: End-stage renal disease is a significant
social and economic burden on the Sudan. Continuous ambulatory peritoneal
dialysis (CAPD) was recently introduced as a national service and is provided
free of charge by the Federal State. We present here an overview of our
experience and outcomes after the first 20 months of operation of the National
Program, displaying its organization and patient and technique survival,
peritonitis rates, and adequacy parameters of the first patients to undergo
CAPD.
Methods: As a national experiment, the program was
sequentially launched in 5 adult and 2 pediatric centers in Khartoum, the
capital city of the country. The data include the entire 111 patients who
underwent CAPD from June 2005 to January 2007. All data were reported to, and
analyzed at, the head office of the Sudan National Peritoneal Dialysis
Program.
Results: CAPD is the modality exclusively utilized thus
far. Automated PD will be added to the program this year. By 30 January 2007,
the total number of patients enrolled was 111. Their age range was 1 –
75 (median 56) years. 20 patients (18%) were shifted to hemodialysis and 5
patients received living related kidney transplants. Two died of severe
septicemia due to peritonitis; 16 (14%) others died of non-PD-related causes.
There were 60 cases of peritonitis in 839 patient-months, which equates to an
overall peritonitis rate of 1 episode every 14 months (0.87 episodes per year
at risk). The individual center rates varied. A critical review of cases at
the end of the first year showed a statistically significant age difference,
with peritonitis being more common in the younger patients. Mean age of
patients that developed peritonitis was 30.53 years, whereas that for
peritonitis-free patients was 44.09 years (p = 0.025). All patients that had
peritonitis presented with abdominal pain and had a cloudy effluent; none had
exit-site or tunnel infection. The culture-negative peritonitis rate was 53%.
Pseudomonas species were responsible for 13.3% and Staphylococcus
aureus for 6.7%. Touch contamination was the likely mechanism behind
46.7% of the episodes. There were 3 cases of refractory peritonitis and a
single case of relapsing peritonitis. Concerning PD adequacy, average Kt/V
urea was 1.74; weekly creatinine clearance was 62.5 L/1.73 m 2 .
Average normalized protein catabolic rate, as a measure of dietary protein
intake in patients in a steady state, was 1.17 g/kg. These measures indicate
that the overall program adequacy was satisfactory and the values fall within
the recommended ranges.
Conclusion: The first 20 months of operation of the
Sudan's National Peritoneal Dialysis Program have proven that it is a
promising project with multifaceted success. The adequacy indicators are
acceptable but the cumulative peritonitis incidence is above that recommended,
indicating several areas for potential improvement. Although CAPD is highly
cost-effective, ongoing difficulties, including the cost of medications and
laboratory tests, are being sorted out with official support and public
involvement.
KEY WORDS: Sudan; Africa; peritonitis; adequacy.
Received 11 April 2007;
accepted 10 July 2007.
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