Non-infectious Complications of Peritoneal Dialysis among Sudanese Patients: Five Years Experience

Introduction: The technique of Continuous Ambulatory Peritoneal Dialysis (CAPD) is known to be associated with various infectious and non-infectious complications. The latter term includes anatomical/mechanical complications as well as hemoperitoneum, inflow pain, electrolyte disturbances, metabolic derangements and delayed gastric emptying. Methods: We retrospectively evaluated all patients who were maintained on CAPD for a minimum of 90 days in Sudan, in the period between May 2005 and Apr 2010. We examined the incidence of various non-infectious complications and their possible associations. Results: The analysis included 296 patients including 71 children (24%). Males constituted 62.2% of the study population and 13.9% were diabetic. The incidence per 100 patient-years of various non-infectious complications was as follows: hypokalemia (30.4), catheter dysfunction (10.8), dialysate leak (5.3), hernia (4.7), hemorrhagic effluent (4.7), inflow pain (2.3), upper gastrointestinal symptoms (2) and cuff extrusion (0.9). Catheter block and hernia were diagnosed with a median duration after catheter insertion of 6 and 7.5 months, respectively. Catheter block was significantly more prevalent among children (22.5% versus 9.3%; P = 0.006). A high body mass index (BMI) was the only identified independent predictor for leak (OR 1.4, P = 0.005). More than half of the 16 hernias were umbilical, and four of the five inguinal hernias were bilateral. Non-infectious complications were responsible for 32% of technique failures. Conclusion: Non-infectious complications were fairly common among our CAPD patients and led to catheter removal in a considerable number of patients. Care is, therefore, needed to screen CAPD patients for these complications in order to timely address and manage problems. Keywords: Peritoneal Dialysis; Non-infectious Complications; Sudan; Herni

Hepatitis B virus markers in patients with schistosomiasis, liver cirrhosis and hepatocellular carcinoma in Khartoum, Sudan.

Markers of hepatitis A and B virus were tested in 88 adult Sudanese subjects in Khartoum, Sudan. The subjects consisted of 25 control hospitalized patients, 21 volunteer blood donors, 23 patients with hepatosplenic schistosomiasis, 13 patients with liver cirrhosis and 6 patients with hepatocellular carcinoma (HCC). Antibody to hepatitis A virus was detected in 96% of the total. Hepatitis B surface antigen (HBsAg) was positive in 4, 24, 22, 31, and 67% of the subject groups, respectively. Antibody against hepatitis B core antigen (HBcAb) of undiluted serum was positive in 60, 57, 65, 77 and 83%, and there was no difference in incidence among the groups. It was positive in 200X diluted serum in 4, 24, 17, 23 and 60%. HBsAg and HBcAb (200X) were detected more often in HCC patients than in the control subjects (p less than 0.01). Hepatitis B virus is an important factor in the etiology of HCC in the Sudan.</p

Lansoprazole as part of triple therapy in eradication of H. pylori in Sudanese patients with gastro-duodenal inflammation

Background: Eradication of H. pylori is important goal in the management of uncomplicated peptic ulcer disease and other conditions associated with H.pylori. The survival capabilities of H. pylori in the stomach makes it difficult to eradicate and effective treatment requires multidrug regimens. Objectives: To study the efficacy of lansoprazole, Amoxicillin and metronidazole in the eradication of H. pylori. Methods: A total of 35 patients (22 males and 13 females) with gastro-duodenal inflammation and positive for H. pylori were studied. Gastro-duodenoscopy was repeated four weeks after completion of treatment to assess the healing of inflammation. Biopsies were taken from the stomach and tested for H. pylori before and after treatment. Results: Twenty eight patients (93%) reported improvement in symptoms. Eradication of H. pylori was confirmed with negative rapid urease test in 20(67%) patients. Complete healing of the gastro-duodenal inflammation was achieved in 22 patients (73%), partial healing in 6 patients, while only 2(7%) patients showed no healing. Conclusion: The reduced eradication rate of this drug combination in this study (67%) compared to a previous one (96%) could be explained partly by the development of antibiotic resistance (possibly to metronidazole) during the last few years. Keywords: ulcer, urease, endoscopy, metronidazole.Sudan Journal of Medical Sciences Vol. 3 (1) 2008: pp. 41-4