Quality of life of Sudanese patients with benigan prostatic hyperplasia. The oblivious problem

Although the IPSS and QOL index are universally used, they can only quantify the severity of lower urinary tract symptoms suggestive of benign prostate hyperplasia [BPH] and evaluate treatment efficacy, but cannot fully reflect the overall quality of life. Moreover, because QOL scale depends on the culture background, it is necessary to develop a Sudanese version of the scale. To evaluate the impact of BPH on the quality of life by assessing the physical, mental and stress states among patients of BPH. This study was conducted on 424 patients with BPH in Gezira Hospital for Renal Disease and Surgery [GHRDS], Sudan. The study was cross-sectional, prospective small-scale hospital based study using simple random sampling technique. The subjects were limited to the Sudanese patients, who could hear and answer the questions of the questionnaire independently and that was done for accuracy and privacy. Taking the patient's educational level into account, all items were expressed in spoken language. The data collection tool was a questionnaire which was modified to twelve items from the BPH Quality of Life Index. The majority 386 patients, 91% were physically fit. The pattern of urination was bothering to their daily life of around 320 patients/75.5%, 225 patients/53.1% of patients were worried about the outcome of the disease, 259 patients/61.1% were not concerned of having prostate cancer and 332 patients/78.2% were satisfied with their sleep. The sexual life had been affected in 201 patients/47.4%. The physical state was assessed by the ability of the patient to pray Friday Jomaa at the mosque which was 85.8% and also by attending important Sudanese obliging social activities like condolence which was [91.9%] of the patients. The impact of BPH on quality of life was obviously significant in the three domains; physical, mental and stress state among patients of BPH in GHRD and S. There should be a validated scale for the BPH Quality of Life Index addressing the traditional strata for Sudanese patients

Appropriate induction of t regulatory cells and HBV tolerance: implications for immunotherapy of autoimmune diseases

Opposed to autoimmune diseases the immune tolerance to hepatitis B virus [HBV] has been related to inadequate HBV-specific immune response in addition to the high frequency and over expression of CD4+CD25+T regulatory cells [Treg]: however the exact mechanisms behind the induction of Treg cells in HBV infection are yet to be addressed. Generally Treg cells consist of diverse lymphocyte populations that include CD4+ cells, CD8+ cells, and other minor T cell populations. Several different mechanisms have been evolved to inhibit different immune responses, while many studies imply a cytokine-independent suppressive role of Treg cells in vitro, however accumulating evidence suggest the in vivo immunosuppressive activity of these cells against infection as well as autoimmunity needs cytokines. It is well documented that HBV Dane particles play a vital role in the immunopathogenesis of HBV infection and it has been associated with increased Treg cells which express various memory or activation markers. Based on that, alternative or indirect way of inducing Treg cells which could be a useful tool to ameliorate and/or treat autoimmune diseases is the top research priority. In this review we attempt to emphasize the role of HBV Dane particles[virions] on the induction of Treg cells and immune tolerance in HBV and we also discuss the relevance to search for new immunotherapeutic targets for autoimmune diseases

Evaluation of application of international prostate symptoms score in Sudanese patients with benign prostatic hyperplasia

The purpose of the present study is to assess the reliability and validity of IPSS in pre- and post treatment of Sudanese patients with BPH. In a descriptive prospective study, 350 Sudanese patients with LUTS attended the Urology Department of Gezira Hospital for Renal Diseases and Surgery from September 2003 to April 2006. They were interviewed by urologists and answered the International Prostate Symptom Score [IPSS] questionnaire. Clinical work up was done for all patients, only patients with benign hyperplasia were included in the analysis. Europeans guidelines were adopted in the management and the out come was also subjected to IPSS evaluation. The most common voiding symptoms were weak stream [93% of subjects], followed by intermittency [57%] and hesitancy [54%]. The most prevalence of storage symptoms was nocturia [87% of subjects], followed by frequency [73%], urgency [64%]. 64% of the study subjects presented with severe IPSS, 33% with moderate IPSS, while only 3% of the patients presented with mild IPSS. Digital rectal examination [DRE] was done to all study subjects. There was no significant correlation between DRE and IPSS reported. The postoperative IPSS post treatment follow up was mild in 87%, moderate in 4% and sever in 9% of the patients. Our study indicates that IPSS is informative and reproducible in assessment of patients with BPH

Prostate volume and PSA cutoff values as predictive indices for success of doxazocin treatment in BPH in GHRDS

Benign prostatic hyperplasia [BPH] is a non malignant enlargement of the prostate. This study was conducted to determine the pattern of presentation of BPH with and without acute urinary retention [AUR] and to determine the risk factors for acute urinary retention, in addition, to assess the results of doxazosin in the treatment of BPH with and without AUR. Ninety two patients were enrolled in this study. All patients presented to the emergency department and the referred clinic of the Gezira Hospital for Renal Disease and Surgery [GHRDS] with lower urinary tract symptoms with and without acute urinary retention suggestive of BPH were evaluated according to the European guidelines. All of them underwent transrectal ultrasound and measurement for the prostatic volume. Serum PSA level was estimated. Doxazosin was given to all patients and they were followed for twelve weeks. A trial without a catheter at the end of the first week was attempted for patients with acute urinary retention. The patients' mean age +/- SD at baseline was 67.8 +/- 7.7 and 69.4 +/- 9.9 for Non-AUR/BPH and AUR/BPH respectively. Comparing baseline clinical parameters of patients with and without acute urinary retention revealed that IPSS, prostate volume and PSA level are significantly different between the two groups with P< 0.01, 0.01 and 0.00 respectively. In the TWOC, 65% of patients passed urine spontaneously. By the end of the study, the overall response of patients showed 78.9% successful rate [n = 73] and 21.1% failure rate [n = 19]. Prostatic volume and PSA level were found to affect doxazosin treatment significantly. With cutoff values of 41cc and [3.45] ng/ml, prostatic volume and PSA level influenced doxazosin treatment failure. Serum PSA and prostate volume are powerful predictors of the risk of AUR. Alpha blockers are efficacious in treating retaining and non-retaining BPH patients. Knowledge of baseline serum PSA and/or prostate volume are useful tools to aid physicians and decision makers in predicting the risk of BPH-related outcomes and choosing dexazosin as therapy for BPH

Prostate specific antigen versus digital rectal examination as screening for ca prostate in Sudanese patients

The aim of this study is to compare the value of digital rectal examination [DRE] and prostate specific antigen [PSA] determination in the detection of prostate cancer among Sudanese patients presenting with lower urinary tract symptoms [LUTS]. A prospective study was carried out in Gezira Hospital for Renal Diseases and Surgery in the period of June 2003- May 2005. Patients presenting with LUTS, had been screened for prostate cancer using PSA and DRE examination.. Serum PSA and DRE were measured in all patients. Trans rectal biopsy was performed if the PSA was over 4ng and /or abnormal DRE. A total of 124 elderly male pa3ents presenting with lower urinary tract symptoms [LUTS], 140 of them were at last diagnosed as benign prostate hyperplasia [BPH] and 54 patients were been confirmed with prostate cancer [PCa]. Their mean age was 65 years [range 45-20]. Elevated level of PSA [> 4 ng/ml] was found in all the patients with prostate cancer [n= 54] and 68.6% [n= 26] of 4PH patients. The rate of prostate cancer detection showed to be 25.7% for PSA > 4ng/ml, 13.31% for abnormal [positive] finding of DRE, and 27.8% for combination of the positive DRE and PSA > 4 ng/ml. The rate of 4PH detec3on showed to be 68.6% for PSA > 4ng/ml, 28.6% for positive finding of DRE, and 4.1% for combination of the positive DRE and PSA > 4 ng/ml. It was found that PSA determination detects a considerable proportion of tumors missed by DRE. And the combination of PSA and DRE escalates the probability of prostate cancer detection

Detection of serum prostate specific antigen in lactating, pregnant, and advanced breast cancer Sudanese women

Although prostate-specific antigen [PSA] is the most valuable tumor marker for the diagnosis and management of prostate carcinoma, it is widely accepted that PSA is not prostate specific. The aim of this study is to address the possibility of using the PSA as marker for the sex assignment in different categories and relevance of this test in women problems. We have evaluated the measurement of serum total PSA for differentiation between Sudanese women with advanced breast cancer [n= 10], and those lactating [n=10], pregnant [n= 10] compared with 20 healthy women as control group. Serum total PSA [TPSA] was measured using immuno-radiometric assay [IRMA]. In this study the mean age was significantly higher in advanced breast cancer groups compared with lactating group [P<0.01]. The mean serum PSA levels in the healthy control women examined [n=20] was 0.72 +/- 0.55 vs. 1.18 +/- 0.92, 1.42 +/- 2.43 and 0.51 +/- 0.13 ng/ml in serum from advanced breast cancer [n=10], pregnant [n=10] and lactating women [n=10] respectively. A significant high level of total PSA in serum of advanced breast cancer compared with the normal group [P< 0.05]. These results indicated the possible use of total PSA to distinguish between healthy women and/or women with advanced breast cancer

Urological injuries during pelvic surgery in women, Gezira, central Sudan

Injuries to the ureter and bladder are common in female pelvic surgery, sometimes extremely common to be considered as traditional, This is a retrospective study conducted in Gezira Hospital for Renal Disease and Surgery, Medani Teaching Hospital and Medani Maternity Hospital, Wad Medani, Sudan. We included 82 patient's with urological injuries following obstetrical gynecology intervention in the previous 5 years. The interaoperative injuries constituted 20/82[24%], while the remote injuries were 62/82 [75.6%]. We conclude that the urological injuries are common complications during pelvic surgery, associated mainly with abdominal hysterectomies and Cesarean section

Semen analysis of infertile Sudanese males in Gezira state central Sudan

The aim of this study is to determine the major causes of infertility in Sudanese males based on the clinical and laboratory findings. The sample of 194 Sudanese males attending Gezira Hospital for Renal Diseases and Surgery, aged between 21-85 years were collected and analyzed. The method of masturbation after 3-5 days prior abstinence from sex before sample collection was applied. The samples were examined for semen volume, and microscopically as wet preparation for sperm motility, morphology and count. Of these men, 532% were primary infertile, while 46.8% were secondary infertile. The semen volume results showed that 89.7% were normal. In: the sperm morphology, 65.9% showed abnormal morphology. Azoospermia was present In 72 patients [37.1%], 13.4% had oligazospermia. This study reveals the main contribution of spernts abnormal morphology to infertility and it is important to abstain from sexual intercourse some days before collection of semen for analysis

Prostate specific antigen versus digital rectal examination as screening for CA prostate in Sudanese patients

Objectives: The aim of this study is to compare the value of digital rectal examination (DRE) and prostate specific antigen (PSA) determination in the detection of prostate cancer among Sudanese patients presenting with lower urinary tract symptoms (LUTS). Material and Methods: A prospective study was carried out in Gezira Hospital for Renal Diseases and Surgery in the period of June 2003- May 2005. Patients presenting with LUTS, had been screened for prostate cancer using PSA and DRE examination.. Serum PSA and DRE were measured in all patients. Trans rectal biopsy was performed if the PSA was over 4ng and /or abnormal DRE. Results: A total of 194 elderly male pa3ents presen3ng with lower urinary tract symptoms (LUTS), 140 of them were at last diagnosed as benign prostate hyperplasia (BPH) and 54 pa3ents were been confirmed with prostate cancer (PCa). Their mean age was 65 years (range 45-90). Elevated level of PSA (> 4 ng/ml) was found in all the patients with prostate cancer (n= 54) and 68.6% (n= 96) of BPH patients. The rate of prostate cancer detection showed to be 25.7% for PSA > 4ng/ml, 13.31% for abnormal (positive) finding of DRE, and 27.8% for combination of the positive DRE and PSA > 4 ng/ml. The rate of BPH detec3on showed to be 68.6% for PSA > 4ng/ml, 28.6% for posi3ve finding of DRE, and 4.1% for combination of the positive DRE and PSA > 4 ng/ml. Conclusion: It was found that PSA determination detects a considerable proportion of tumors missed by DRE. And the combination of PSA and DRE escalates the probability of prostate cancer detection,