Active tuberculous infection among adult Sudanese patients on long term peritoneal dialysis

The prevalence of tuberculosis in Sudan is 209 cases per 100,000 populations. There are no reports available regarding the prevalence of tuberculosis among the end-stage kidney disease and dialysis populations. We reviewed the medical records of all adults who were on peritoneal dialysis [PD] in the Sudan Peritoneal Dialysis Program, during the period from June 2005 to December 2011. Those diagnosed as having active tuberculous infections were retrospectively studied regarding their demography, clinical presentation and outcomes. Out of 350 patients in our program, 19 were diagnosed as having active tuberculosis [5.4%]. All patients were diagnosed during their first year on peritoneal dialysis, 74% were males; the mean age was 37 +/- 11 years, extrapulmonary tuberculosis was seen in 16/19 [84%] patients and it was abdominal in nine of the 16 [47%] patients. In addition to high clinical suspicion, the diagnosis of active tuberculosis was supported by tissue biopsy findings in 16%, positive polymerase chain reaction in 26%, exudative ascites with suggestive radiological features in 21%, strongly positive tuberculin test in 21% and a favourable response to empirical antituberculous therapy in 26% of patients. HIV test was negative in all 19 patients and only one patient tested positive for hepatitis B viral infection. Antituberculous drugs side effects were seen in 68% of patients. Forty seven percent of patients showed complete recovery and continued on peritoneal dialysis. Our case fatality was 32%. Abdominal tuberculosis is common among PD patients and its diagnosis should always be considered in suspected patients

Ethnic distribution and clinical features of systemic lupus erythematosus in the Sudan

Systemic lupus erythematosus [SLE] is a multisystem chronic inflammatory autoimmune disease characterized by periods of remissions and relapses. It is thought to develop when genetically predisposed individuals are exposed to one or more environmental triggers. The ethnically mixed population of the Sudan offers an opportunity to look into the effect of ethnicity on the distribution and systemic expression of the disease. Eighty seven consecutive patients fulfilling the clinical and laboratory criteria for the diagnosis of SLE were prospectively interviewed and examined using a unified protocol in three medical clinics in different parts of Khartoum. Appropriate investigations, including renal biopsies were carried out when indicated. Eighty three of the 87 patients [95.4%] were females [female to male ratio 20.6:1]. Mean age at diagnosis was 31.89 years [range 21-30]. The disease was most frequently seen in tribes of mixed ethnicity [Afro-Arabs] and least common in pure African tribes. Thus, subjects with Afro-Arab ancestry constituted 94.3% of the sample seen whereas, subjects from Nubian ancestry [descendents from ancient tribes living in central and northern Sudan] were 5.7% of the group and no subjects from the black tribes of Southern and Western Sudan were represented. The disease affected multiple systems as seen elsewhere. Most of the patients [96.6%] were antinuclear antibodies [ANA] positive while [51.1%] were antidouble stranded dioxyribonucleic acid [Anti-dsDNA] positive. The clinical features of SLE in our patients are comparable to what has been studied in the region. However, there was an overwhelming tendency of the disease to affect subjects of mixed ethnicity and less affection of subjects of pure African ancestry. The study is in support of the observation that SLE is rare in Black Africans living in Africa, however, it is not uncommon in subjects with Afro-Arab genetic admixture

Hypertension and obesity in police forces households in Khartoum, Sudan: a pilot report - part of the "police hypertension, diabetes, renal insufficiiency, and thyroid derengements [HyDRIT] study", Sudan

Premature mortality from cardiovascular diseases could be prevented by the effective control of hypertension [HTN]. Excess weight is associated with increased rate of death from all-causes. Nationwide data for the status of hypertension and excess weight in the Sudanese population are not available. All the consenting 426 inhabitants of two police housing-complexes were included. Blood pressure [BP], anthropometric measurements as well as blood samples were taken. Standard interviewing procedures were used to record medical history, socio-demographic and lifestyle characteristics. The data was analysed through univariate and multivariate regressions. The overall prevalence of hypertension [based on two BP measurements] was 27%. Less than a third [29.8%] of the hypertensive subjects were aware of their disease. Pharmacotherapy among those aware of their disease was prescribed in 94.1%. However, 59.4% of them were compliant with their prescribed medicines and 28.1% attained effective BP control. Prevalence of hypertension was significantly higher in older individuals [> 50 years of age], overweight [body mass index, [BMI] > 25] and those who had better education [> 10 years of schooling]. The cumulative prevalence of overweight [BMI 25-29.9 kg/m[2]] was 30% while that for obesity [BMI >/= 30 kg/m[2]] was 19.2%. Abdominal obesity was observed in 19.5% of males and 46.2% of females. Overweight subjects were more than twice likely to be hypertensive than their non-overweight counterparts [odds ratio 2.33 [1.49-3.64]]. In the sample examined, the prevalence of hypertension and excess weight seemed to be comparable to other countries; this makes them a public health priority

Diabetes mellitus and overweight in adult police forces households in Khartoum, Sudan: a pilot report

Diabetes mellitus [DM] and obesity are significant global health problems that are on the rise. DM is particularly escalating in the developing world where its major hit is on the middle-aged productive individuals. Epidemiological information about their prevalence, awareness, risk factors, and control is scarce in Africa. The present study was primarily designed to assess such information among Police Forces households, as an identified Sudanese urban population residing in Khartoum. In a pilot survey for the Police Forces Study; all the 436 inhabitants of two police housing complexes were targeted. Of these, 426 [98%] individuals consented to participate in the study. Standard interviewing procedures were used to record medical history and socio-demographic and lifestyle characteristics. Blood pressure [BP], anthropometric measurements as well as blood and urine samples to measure glucose, creatinine and thyroid stimulating hormone [TSH] were taken by trained medical students and technicians. The data was analyzed through univariate and multivariate regressions. Out of 436 individuals approached, 426 responded to our questionnaire and 275 underwent blood draws. Of the 426 respondents to the questionnaire 22 [5%] were told to have DM. Of those, 15 [68%] were prescribed blood sugar lowering medicines. Among the latter, 14 were compliant. Of the 275 subjects tested for blood sugar, 9 [3.3%] were labeled [diabetic] by blood sugar of 200 mg/dl or more. Also, there were 11 individuals taking drugs but not tested. Thus, the total number of diabetics in the sample actively examined for DM was 20 of 286 subjects, making a prevalence rate of 6.99%. Six out of the 20 [30%] diabetics where unaware of their diagnosis. Seventeen of the 20 diabetics had a body mass index [BMI] measurements. Thirteen [76.5%] had a BMI > 25 and 4 [23%] had BMI < 25. Six out of 12 diabetic males [50%] and 4 out of 8 [50%] females had abdominal obesity [waist>102 cm for males, >88 cm for females]. Ten out of 20 diabetics [50%] were also hypertensive. Eight out of 17 [47.1%] hypertensive diabetics were prescribed and compliant with blood pressure lowering medicines, however, none of those had their blood pressure controlled to <130/80. Thyroid studies among all study participants revealed hypothyroidism in four females and hyperthyroidism in a single male. The prevalence of diabetes, overweight and abdominal obesity seem to be comparable to other African countries. In this population, DM prevalence is above that is projected by the WHO for Sudan. These results render diabetes and obesity a public health priority