Psychological disorders and quality of life among Sudanese dialysis patients and renal transplant recipients

Psychiatric illness is common among patients with chronic disorders, particularly in those with end-stage renal disease on renal replacement therapy [RRT]. Patients with a functioning renal allograft have an improved quality of life [QOL] compared to patients on dialysis. To evaluate the psychological disorders and QOL among dialysis patients and renal transplant recipients. This is a prospective cross-sectional study that included 168 patients on RRT. Their psychological health status was assessed through clinical examination and relevant designed questionnaires. The data obtained were fed to the SPSS for analysis. Significance was assume at P<0.05. Out of 168 ESRD Sudanese patients, 43 [25.6% received renal allograft. The frequency of depression was 90 [72%] and nine [25.6%] of patients on dialysis; and kidney transplant recipients respectively. Anxiety was reported with significant difference [p< 0.001] in the dialyzed patients compared to kidney transplant recipients. Sleep disorders were experienced by 81 [64.8%] of dialyzed, and nine [20.9%] of kidney transplant recipients [P < 0.001]. Psychological disorders in dialyzed ESRD patients have significant effect on the quality of life and may have a tremendous impact on mortality and morbidity. For this reason, supportive management by psychologist and or psychiatrist is recommended for early detection and alleviation of symptoms of mood and mind disturbances. For most patients with ESRD kidney transplantation offers the greatest potential for restoring healthy productive life

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