The First Coronary Care Unit in Sudan

Until the end of the eighties El Shaab Hospital was the only hospital in the country capable of receiving cardiac; pulmonary medicine and neurosurgery. It consisted of nine wards accommodating the above specialties. A well-equipped operating theatre and recovery room were stationed at the south east corner. By 1981 a cardiac catheter laboratory was installed. Patients who were referred from all provinces for cardiac care were seen at the referred outpatient where they would either be admitted to hospital for treatment or followed up at the outpatient clinics. There were basic equipment like ECG; chest X-ray facility and small laboratory for basic haematology and biochemistry investigations. 2D and M-mode echo equipment was supplied. Dr. Khalid Gharieb was the first to perform studies on that machine. By the mid-eighties it became clear to all cardiologist and physicians in the country that the toll from coronary artery disease was increasing. Very ill patients with acute myocardial infarction were coming to hospital looking for help. Some of them were admitted at the recovery room of the operating theater where monitoring and oxygen supply were available

Reliability of Agglutination Test to Detect Alloantibodies in Patients with Repeated Blood Transfusion

Background: Blood transfusion is an integral part in the management of sickle cell disease patients. Allogeneic blood transfusion is a form of temporary transplantation. A recipient often mounts an immune response to the donor antigens resulting in various clinical consequences including delayed hemolytic transfusion reactions. Delayed reaction is often seen in individuals who have received repeated transfusion of ABO compatible blood that incompatible for other blood group antigens because of minor allelic difference stimulate the production of IgG antibodies. In the Patients who have sickle cell disease the majority of tests may have low sensitivity and in turn may fail to show the autoantibodies. Objectives: This study has been conducted for detection of allo-antibodies in patient with sickle cell anaemia and hemophilia who received repeated blood transfusions using newly introduced test system; the DiaMed-Immuno-Diffusion microtyping system. Methods: Samples were collected randomly from 60 patients with repeated blood transfusions. Micro column gel test as well as agglutination method were performed for all samples. All the results were analyzed using Statistical Packages of Social Sciences (SPSS). Results and Discussion: This test provides clear and stable reactions that improve result interpretation. It proved to be more sensitive than the conventional tube agglutination technique as it captures agglutinate in a semi solid medium and on the other hand it has the capacity to detect unexpected antibodies. This in turn enhances visibility of agglutination compared to the traditional Tube techniques

Does tubularized incised plate urethroplasty fit primary and repeat shat hypospadias repair ?

Objective To evaluate prospectively our experience using tubularized incised plate (TIP) urethroplasty in primary and repeat penile shaft hypospadias. Patients and Methods Thirty-two boys with penile shaft hypospadias were selected to undergo TIP procedure. Their age ranged from 22 months to 9 years. Twenty-two cases were primary and 10 cases were repeat hypospadias repairs. To correct penile chordee; complete degloving of the penis and lateral dissection of tethering tissues was done in every case. This was followed by tunica albuginea plication in 7 cases; while ellipse excision was needed in 3 cases. Using the preserved urethral plate; single-layer urethroplasty was done in all cases. A vascularized subcutaneous flap (36 cases) or tunica vaginalis (4 cases) was always used to cover the neourethra. A postoperative stent was used for 8 - 12 days in all cases. Results The patients were followed up for a mean of 14.2 months. Postoperative clinical evaluation revealed success rates of 95.5and 90for primary and repeat cases; respectively. Among the primary cases; only one patient had urethro-cutaneous fistula concomitant with meatal stenosis; while among the repeat cases urethro-cutaneous fistula occurred in one patient. No case of urethral stricture or wound dehiscence was encountered. Our criteria for success were a single unimpeded forward-directed urine stream; a straight penis; good cosmesis and no need for further surgery. Conclusion We feel that TIP urethroplasty in primary and repeat cases of penile hypospadias is a reasonable option in cases with chordee not severe enough to necessitate excision of the urethral plate and when midline incision of the plate yields an adequate width amenable to tubularization