Maternal death due to delayed management of sigmoid volvulus at 32 weeks pregnancy

Colonic obstruction due to sigmoid colon volvulus during pregnancy is a rare but a serious complication with significant maternal and foetal mortality. We describe a case of sigmoid volvulus in a patient with 32 weeks of gestation that developed complete necrosis of the sigmoid colon who was admitted with 6 days of abdominal distension, vomiting, and the stoppage of the passage of gases and faeces with poor clinical conditions and signs of diffuse peritonitis. Abdominal ultrasound showed single viable foetus 32 weeks. Abdominal radiography showed severe dilation of the colon with horseshoe signal suggesting a sigmoid volvulus. The patient delivered vaginally 1.8 Kg male baby admitted to the nursery and passed later on from respiratory distress syndrome. With a diagnosis of complicated sigmoid volvulus, she underwent laparotomy where we found, an enormously distended sigmoid loop with gangrenous changes the sigmoid colon was resected and Hartman's procedure was performed. Poor postoperative recovery and the patient passed day 3 postoperativelyfrom septic shock

Changes in serum calcium, phosphate, albumin and parathyroid hormone before and after hemodialysis in Sudanese patients with end-stage renal failure

To determine the concentrations of serum parathyroid hormone [PTH] and bone minerals and their association before and after hemodialysis. A cross sectional study was done on patients with end-stage renal disease [ESRD] on treatment with maintenance hemodialysis [HD]. Levels of serum calcium, phosphate, urea, creatinine, albumin, and intact parathormone [iPTH] were measured. The total number of patients studied was 50 [40 males; 10 females], the mean age was 40.3 +/- 26.5 years, and the average duration on hemodialysis [HD] was 53 months. Serum PTH level was significantly lower after hemodialysis treatment; it was 945.8 +/- 995.9pg/ml and 781.7 +/- 928.1 pg/ml before and after HD respectively, but still over the normal range. Serum phosphate concentration was remarkably differ before and after HD [5.59 +/- 1.8 mg/ml vs 4.38 +/- 1.2 mg/ml respectively]. In contrast, the mean value of serum calcium concentration was changed significantly after HD [6.7 +/- 1.5 mg/dl] compared with the level before HD [5.6 +/- 6.7 mg/dl]. PTH correlated positively with phosphate [r=0.30, p=0.03], and negatively with calcium [r=-0.299, p=0.04] levels. A significant decrease in serum urea and creatinine levels was reported after HD. Serum albumin showed no significant difference before and after HD. PTH was remarkably decreased post dialysis in our patients with definite increased serum Ca[+]. There is no significant difference between PTH and patient's age, sex and duration in HD Sudanese patients

Renal transplantation Gezira hospital for renal disease and surgery [GHRDS]

Recent years have witnessed an explosive growth in the number of patients experiencing end stage renal disease [ESRD], as well as number of centers providing therapeutic modalities such as hemodialysis, peritoneal dialysis and renal transplantation. Algorithm: 1. To audit the practice of renal transplantation in Gezira hospital for renal disease and surgery [GHRDS]. 2. To recommend and contribute in some aspects that may reduce surgical complications and transplant-related deaths, and improve the outcome. 3. To assess the impact of preoperative co-morbid medical conditions of the recipient on the frequency of surgical complications of renal transplantation in GHRDS Patients and Methods: This is non-interventional descriptive retrospective review was made of all patients transplanted in the period June 2001-June 2008 in GHRDS. A total of 82 renal transplants were performed at GHRDS in our study period, all were adults and they are representing our study population group. Data was analyzed by computer program the SPSS. To determine the statistical significance of differences, the Pearson test was used and probability test [P. value] with p < 0.05 considered as significant. The incidence of surgical complications was correlated with several pretransplant, technical and post-transplant risk factors. Among the 82 patients underwent living donor renal transplantation in the GHRDS in the period 2001-2008 some surgical complications were occurred. These complications included hemorrhage in 9 patients, hematoma necessitating surgical exploration in 5 patients, urinary leakage in 7 patients, ureteric obstruction with clots in 3 patients, significant hematuria in 5 patients, wound dehiscence in 4 patients. The incidence of urological complications [ureteric obstruction and urinary leakage] was 8.1% and vascular complications 4.9%. There were 3 gastrointestinal complications [3.4%]. We lost 10 grafts [12.2%] and 9 recipients [10.9%]. The practice of renal transplant in GHRDS was found to be sound and comparable to the learning curve of the literature. The numbers of patients transplanted not yet paralleling the increasing numbers of patients with ESRD

Hemodialysis, plea of availability versus adequecy Gezira experience

This is a prospective cross sectional study carried out in Gezira Hospital for Renal Diseases and Surgery [Sudan] to assess the adequacy of hemodialysis in 206 patients with end stage kidney disease on regular hemodialysis twice per week using. Pre and post hemodialysis blood sample were obtained from the study group, spKt/V and urea reduction ratio were calculated. Mean Kt/v was found to be 1.19 and urea reduction ratio was 59.55%. None of the patients in this study group achieved the National Kidney Foundation Dialysis Outcomes Quality Initiative [K/DOQI] recommendations for adequate hemodialyis, since it requires three hemodialyis sessions per week and our patients are receiving two sessions per week. In order to improve the situation herewith we recommended increased number of sessions from two to three times per week and /or increase the duration of hemodialysis session, increase blood flow rate and dialysate flow rate. Moreover, decrease the number of patients on regular hemodialysis by encouraging the patients to take the other renal replacement therapy [peritoneal dialysis and renal transplantations]

anti-inflammatory properties of interleukin 18 binding protein in rheumatoid arthritis

Interleukin-18 binding protein [IL-18BP] is functioning as a natural anti-inflammatory and immunosuppressive molecule by neutralizing the effects of IL-18 during inflammation. This study aimed to identify the role of IL-18BPa in the regulation of immune responses associated with the pathogenesis of RA. 65 RA patients, 22 OA patients, and 40 sex and age matched healthy donors were enrolled in this study. Synovial specimens were obtained through synovectomy or arthroscopic procedures. SFMC and PBMC were prepared by using Ficoll-Hypaque separation procedure. Superarray analysis was used to measure the expression profile of immune-related genes in normal PBMC treated with recombinant human IL-18BPa. The mRNA levels of Th1 and Th2 cytokines were measured by Real-time PCR, and the protein levels of IFN-gamma, IL-4 were detected by ELISA. SuperArray analysis of immune related gene expression profile in normal PBMC treated with IL-18BPa indicated decreases in the gene expression of IFN- gamma and its regulatory molecules STAT-1 and STAT-2. This study pointed out that IL-18BPa has additional anti-inflammatory property through downregulating the expression of IFN- gamma and IL-12, at the same time, upregulating the expression of IL-4 and IL-10. Both IFN- gamma and IL-12 could upregulate the mRNA and protein levels of IL-18BPa in both the normal and RA subjects. Our results demonstrated the importance of IL-18BPa as an immune regulatory molecule and as a promising therapy for treating RA

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

Dental health service in Gezira locality, Sudan

This is a field survey aimed to assess the status of the present dental and oral health services at Gezira Locality. The facilities included were those in urban and rural areas including Wad Medani Dental Hospital, Wad Medani Military Hospital, El Gadaiea Health Centre and Marinjan Health Centre. The study tools were direct pre-coded questionnaires, and a checklist. The procedure involved dental clinics to estimate the dental health services by assessing status of personnel, equipment and materials. A checklist was used to assess the personnel, equipment and instruments. Thirty study sites in the rural area were chosen from five study councils which included Alhosh, Wad Alnaeem, Alhag Abdalla, Almadina Arab and Hantoub. They comprise 418 towns, villages and camps, of these only 118 with health services. In these there are only 4 dental units, three of them were incomplete; all of them were operated by dental assistants, while the only complete unit was operated by a medical assistant. This result revealed absolute lack of dental services in rural areas. The present units are old and most of them were not functioning. This was the reason that most of rural population seeks oral health services for periodontal diseases and dental caries in Wad Medani health institutions. Most of the patients irrespective of their residence, preferred treatment at private dental clinics because they expect better care due to good facilities. The results also revealed a poor level of oral health services reflected by the presence of a high level of decayed and missing component of DMFT. It is concluded that there is poor provision of dental services in both quantity and quality at Gezira Locality. It recommended that the dental services in Gezira Locality have to be restructured to improve their quantity, quality and efficiency

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

[Penile fracture epigrams from our experience in 15 Sudanese patients]

To review clinical pattern and outcome of fracture penis retrospectively from January 2000 to January 2008 in Gezira hospital for renal diseases and surgery, Sudan. Total number of patients were 75 and the range of age was 15-45 years with a mean age of 25 years. Diagnosis was established mainly through clinical work up. Most patients were subjected to a surgical intervention. The defects in the tunica was approximated by the used 2-0 proleine with inverted knot and/or delayed absorbable sutures and Foley catheter was routinely fixed after insurance of the integrity of the urethra. Most of cases presented with penile pain [13 patients, 87%], swelling due to extension of a haematoma [9 patients, 60%], bruises and detumescence [10 patients, 67%], curvature and fracture of erection were the presenting claim for the delayed patients [3 patients, 20%]. Most of them developed complications [8 patients, 53%], this included [4 patients, 27%] developed erectile, dysfunction, [2 patients, 13%] developed curvature and one patients [6%] developed calcification urethral stricture. We concluded that early surgical intervention, antibiotics administration and early seeking of medical advice are recommended in order to preserve penile function in cases of fracture penis. Investigations got minor role in the diagnosis of fracture penis

Dental Health Services in Gezira Locality; Sudan

Objectives: This is a field survey aimed to assess the status of the present dental and oral health services at Gezira Locality. The facilities included were those in urban and rural areas including Wad Medani Dental Hospital; Wad Medani Military Hospital; El Gadaiea Health Centre and Marinjan Health Centre. Material and methods: The study tools were direct pre-coded questionnaires; and a checklist. The procedure involved dental clinics to estimate the dental health services by assessing status of personnel; equipment and materials. A checklist was used to assess the personnel; equipment and instruments. Results: Thirty study sites in the rural area were chosen from five study councils which included Alhosh; Wad Alnaeem; Alhag Abdalla; Almadina Arab and Hantoub. They comprise 418 towns; villages and camps; of these only 118 with health services. In these there are only 4 dental units; three of them were incomplete; all of them were operated by dental assistants; while the only complete unit was operated by a medical assistant. This result revealed absolute lack of dental services in rural areas. The present units are old and most of them were not functioning. This was the reason that most of ruralpopulation seeks oral health services for periodontal diseases and dental caries in Wad Medani health institutions. Most of the patients irrespective of their residence; preferred treatment at private dental clinics because they expect better care due to good facilities. The results also revealed a poor level of oral health services reflected by the presence of a high level of decayed and missing component of DMFT. Conclusion: It is concluded that there is poor provision of dental services in both quantity and quality at Gezira Locality. It recommended that the dental services in Gezira Locality have to be restructured to improve their quantity; quality and efficiency

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; #ad Medani; Sudan. #e included $paetents 'ith urological injuries follo'ing obstetrical gynecology interveneton in the previous ( years. The interaoperaetve injuries consettuted; -.; 'hile the remote injuries 'ere 6+7(.6 -.. #e conclude that the urological injuries are common complications during pelvic surgery; associated mainly 'ith abdominal hysterectomies and Cesarean section

Malaria in pregnancy wad Medani maternity teaching hospital

This is a prospective hospital - base study carried out in Wad Medani Maternity Teaching Hospital [WMTH], during the period from 5th October 2003 to 30 December 2003. All pregnant women with malaria admitted to the hospital during that period were included in the study. Malaria was diagnosed by thick and thin blood film, Gemsa's stain. Severe falciparum malaria was diagnosed according to WHO criteria. The national protocol for treatment of malaria in pregnancy was adopted in the management of all women. The results were analyzed using SPSS. The total numbers of pregnant women included in this study were 210. The main results of the study were: [i] severe falciparum malaria [73.4%], [ii] anaemia [98.6%] of whom [1 1%] was very severe, [20%] was severe, [iii] hyperparasitaemia [46.7%], [iv] dehydration [33.3%] and [v] jaundice [20.59/0]. Complications on the fetus were: [i] preterm labor [44.1%], [ii] low Apgar's score < 7 [55.9%], [iii] low weight < 2.5 [44.1%] and [iv] perinatal death [5.5%]. Quinine was the main drug used. Conclusion: pregnant women admitted to the hospital need intensive care. Although there was no mortality but morbidity was high. The current protocol is adequate in reducing mortality