Sudden natural death in Khartoum Mortuary

The sudden natural death is defined as: Death occurs within 24 hours from the onset of symptoms. The disclosing of the causes of sudden natural death is important for prevention and improving outcome. The objectives of this study were to determine the causes of sudden natural death in Khartoum Mortuary Descriptive, cross- sectional study of natural sudden death in Khartoum Mortuary, which was located in Khartoum Teaching Hospital and offers services to the state. The autopsy records of 2007, which were 150, were considered. Data were collected by a structured check list, and analysis was done by the SPSS soft ware. The most important systems involved in sudden natural deaths were respiratory [49.3%], cardiovascular [24%], gastro intestinal [15.3%] and cerebral [4%], while the leading causes of sudden natural death were pneumonia [20%], myocardial infarction [17.3%] and tuberculosis [14%]. Sudden natural death occurred in slightly higher ratio in the age group 40 years and below [50.1%], males were dominating [83%]. The commonest causes of sudden natural death, which were pneumonia, myocardial infarction and tuberculosis, were different from the literature in which the commonest causes were myocardial infarction followed by pulmonary embolism. The study highlighted the importance of respiratory diseases besides myocardial infarction as leading causes of sudden natural death, and the need for further researches in this issue

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

Community and individual factors influencing the health seeking behavior of tuberculosis defaulters, Sudan

This study was carried out in Sudan, in three areas; Abu Anga Hospital, which represented urban areas, Al Gadarif State, stood for rural areas and Mayo Farm represented displaced population, in the period from June-December 2002. The objective is to determine the health seeking behavior of tuberculosis defaulters, and to assess patients' knowledge about tuberculosis, treatment, and mode of spread. Prospective cohort study of 409 new tuberculosis cases, visiting the outpatient chest clinics in the general health services in the three selected areas during March to May 2001, patients were followed up after their registration for six months. Out of the 409 tuberculosis patients included in the study, 107 [26.2%] were defaulters; 36 [33.6%] from Abu Anja hospital, 33 [30.8%] from Al Gedarif State and 38 [35.5%] from Mayo Farm clinic. The majority of defaulters were males [64.5%] compared to 35.5% females. Analysis of results reflected that 64% of defaulters compared to 60% of non-defaulters thought that TB is not infectious. Others had misconception about adverse reactions duration of treatment and other wrong information regarding the management of tuberculosis, which was 31.8% among defaulters to compare to 21.3% among non defaulters. Defaulters came to consultation in severe conditions, and usually did not inform their families about their illness. They tended to seek health care with more period of delay compared to non-defaulters. The main cause of delay in seeking the treatment and defaulting was financial problems, this insists on the role of the ministry of finance to alleviate poverty. The knowledge of both defaulters and non-defaulters about the disease was not sufficient, strengthening of health education activities by the National Tuberculosis program is essential

Levels of circulating soluble cell adhesion molecules in diabetics and in impaired glucose tolerance patients: correlation to stiffness index beta of the common carotid and femoral arteries

The current work was conducted to study the possible relationship between endothelial activation as assessed by the level of circulating soluble VCAM-1, ICAM-1, and E-selectin concentrations and atherosclerotic disease as assessed by the stiffness index 13 of the common carotid and femoral arteries in type 2 diabetic patients and patients with impaired glucose tolerance and the correlation of stiffness index beta of the common carotid artery and femoral artery with the degree of insulin resistance. Subjects and This study entailed 20 patients with type 2 diabetes meilitus, representing group I [GI], and 20 patients with impaired glucose tolerance, representing group II [GII] and 20 healthy subjects of matched age and sex as a control group, III [GIII]. All subjects were subjected to complete history taking and thorough clinical examination including body mass index [BMI]. Routine Laboratory investigations included oral glucose tolerance test [OGTT], glycosylated hemoglobin [HbA[1c]], serum uric acid, serum triglycerides, total serum cholesterol, high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C], as well as liver and renal function tests were carried out by using standard commercial methods. The level of urinary microalbumin in GI, and insulin sensitivity assessment through OGTT, in all groups were carried out. Serum levels of the circulating adhesion molecules ICAM-1, VCAM-1 and E-selectin were measured in GI, II, and III by an enzyme-linked immunosorbent assay. All subjects were subjected also to radiological measurement of stiffness indexes beta of the common carotid and femoral arteries by high-resolution ultrasonography. sVCAM was found to be 681.2 +/- 81.8, 551.7 +/- 33.5, 453.4 +/- 28.4 ng/ml in GI, GII, and GIII, respectively. sICAM was found to be 339.4 +/- 18.8, 301 +/- 19.3, 197.8 +/- 9.2 ng/ml in GI, GII, and GIII, respectively. E-selectin was found to be 90.4 +/- 5.7, 69.8 +/- 6.8, 51.1 +/- 6.6 ng/ml in GI, GII, and GIII, respectively. Using LSD, sVCAM, sICAM, and E-selectin were found to be significantly increased in GI when compared to GII and GIII and to be significantly increased in GII when compared to Gill. Concerning stiffness index of carotid artery, it was found to be 28.7 +/- 8.3, 14.7 +/- 1.4, 12.1 +/- 1.6 in GI, GII, and GIII respectively. Using LSD, stiffness index of carotid artery was found to be significantly increased in GI when compared to GII and controls. With reference to stiffness index of femoral artery, it was found to be 30.3 +/- 7.1, 15.4 +/- 1.4, 12.7 +/- 2.4 in GI, GII, and GIII, respectively. Using LSD, stiffness index of the femoral artery, it was found to be significantly increased in GI when compared to GII and controls. It could be concluded that cAMs can be used as a marker of the stiffness index beta of both common carotid and femoral arteries due to the noted significant positive association. Stiffness index beta of both common carotid and femorai arteries are exacerbated in type 2 diabetic patients than in patients with impaired glucose tolerance and controls. The stiffness index beta of both common carotid and femorai arteries are associated with insulin resistance in type 2 diabetes meilitus. Further prospective studies should be carried to ascertain whether insulin resistance may induce the early changes of atherosclerosis in diabetes

Stiffness index beta of the common carotid and femoral arteries: relation to insulin resistance

This work was intended to study the association between arterial wall stiffness indexes beta of the common carotid and femoral arteries and insulin resistance in type 2 diabetic patients as well as patients with imparied glucose tolerance compared with age and sex matched control subjects. The study included 60 subjects classified into 3 groups; I] included 20 patients with type 2 diabetes, II] included 20 patients with IGT and III] included 20 matched controls. All patients and controls were subjected to the followings: complete history taking, thorough clinical examination, laboratory investigations including HBA1C, uric acid, complete lipid profile, microalbumin assay, renal and liver function tests. Measurement of insulin sensitivity by oral glucose tolerance test. Stiffness indexes beta of the common carotid and femoral arteries were measured by high resolution ultrasonography. The results of the present work can be summarized as follows: the stiffenss index beta [SI] of the common carotid and femoral arteries was significantly higher in diabetic group than those with IGT and controls [P< 0.001] for each], still those with IGT was insignificantly higher than controls [P < 0.05]. Also, stiffness index [SI] of the common carotid and femoral arteries was positively and significantly correlated with relative insulin resistance, total cholesterolm serum tryglycerides, LDL-C, uric acid, age and the duration of diabetes [P < 0.05]. Our results suggest that the stiffness indexes beta of the common carotid and femoral arteries were associated with insulin resistance in type 2 diabetic patients and such insulin resistance plays an important role in the pathogenesis of these sclerotic changes