Selection and Comlications of Donor Nephrectomy in Gezira Hospital for Renal Diseases and Surgery

Background: Though various renal replacement therapies are endorsed for the long treatment of ESRD yet the transplantation remains the gold standard. Objectives: generally  to assist in auditing of the programme of renal transplantation in Sudan and specifically to determine the degree of matching between donors and recipients ,to determine the effect of age, sex, relation, occupation and education in donor nephrectomy and to  estimate the incidence of complications in donor nephrectomy. Methods: In this study we reviewed open donor nephrectomy performed in GHRD and S from January 2005 to December 2011 in a descriptive retrospective and prospective study. Around 90 living kidney donors were enrolled in this study, followed for one year. Data concerning the work up, clinical strata, the thematic operative conditions and postoperative follow up sheets were recorded in the platform of the patient sheets and retrieved completely through the master sheet of the study and evaluated via SPSS package version 11.5, every complication was dealt with according to EUA guidelines, the mortality recorded was one patient in this study. Results: of these donors41 were males46% and (49) were females (54%) the minimum age was 18 years and maximum 57 and mean age 30,3years. We noted that donors were found satisfying the EAU criteria of donor’s selection. The complications recorded were anesthetic problems in 2.2%, vascular complications in 2.2%, wound infection in 6.6%, pneumonia in 4.4% and the mortality in the study was 1.1%. Conclusion: 1-selection for living donor nephrectomy is consistent with the international criteria and. 2-The incidence of complications in donors in GHRD and S was found to be comparable to the literature with slight inclination to upper limit

EVALUATION OF APPLICATION OF INTERNATIONAL PROSTATE SYMPTOMS SCORE IN SUDANESE PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA

Objectives: The purpose of the present study is to assess the reliability and validity of IPSS in pre- and treatment of Sudanese patients with BPH. Material and methods: 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 only patients with benign hyperplasia were included in the analysis .Europeans guideline was adopted in the management and the out come was also subjected to IPSS evaluation. Results: The most common voiding symptoms was a 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%) and 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.   Conclusion: Our study indicates that IPSS is informative and reproducible in assessment of patients with BPH. &nbsp

Urine Cytology for Detection of Bladder Carcinoma: Experience of Gezira Hospital for Renal Disease and Surgery(GHRDS)

Background: Urine cytology has been and remains the standard in the initial evaluation of lower urinary tract lesions to rule out bladder cancer. Objectives:  To evaluate the significance of urine cytology as a diagnostic tool for bladder cancer and a to assess the cytological pattern in voided and washed urine. Methodology: This was a cross-sectional descriptive hospital-based study. A total of 43 patients who were suspected to have bladder tumors based on both clinical and radiological findings. Pre-cystoscopy voided urine specimens and post-cystoscopy bladder wash specimens were collected. Three stains were used in preparation of cytological smears Hematoxylin / Eosin, Diff-Quik and May-Grünwald Giemsa, whenever possible equivalent histopathological diagnosis was obtained. Results: This study included 86 urine cytology specimens obtained from a total of 43 cases of suspected bladder cancer. Muscle invasive cases had the higher percentage (37.2%) with more prominent features of malignancy in cytology than the earliest stages. In 30.2% of voided urine specimens were excellent, while 79.1% of bladder wash specimens had excellent quality with more cellularity and preservation of cells in cytological smears. Conclusion: Urine cytology is a reliable method in the diagnosis of bladder cancer. The quality of washed urine is better than voided urine in cytological results

Surgical Complications of Arteriovenous Fistula as Permanent Vascular Access in Patients with End Stage Renal Disease at Gezira Hospital for Renal Disease and Surgery. Revisited

Background: Vascular access (VA) is a mainstay to perform an efficient hemodialysis (HD) procedure. Objectives: To evaluate the surgical complications of AV fistula as permanent vascular access in a patient of end stage renal disease (ESRDS) at Gezira hospital for renal diseases and surgery (GHRDS). Methods: Retrospective, prospective cross sectional hospital based study, done in 237 patients with end stage renal disease who underwent arteriovenous fistula.In 206 patients of the study sample done retrospectively and 31 patients of the study sample done prospectively,and they were followed for 1year. Study was conducted from September 2010 to September 2016. Data was collected using questionnaire.  Results: Sixty eight percent of study sample were males, with 42% above 50 years and 0.8% less than 10 years. Most of the patients (52.3%) were diagnosed as ESRD from the first presentation, 43.5% were diagnosed as chronic renal failure (CRF) on regular followup, while the minor rest of the patients were due to acute renal failure(ARF) which progressed to end stage renal disease.The complications rate was 32.8% (n=82), perioperative complications were 9.3% (n=22) represented as infections 3.8% (n=9), bleeding 3.0% (n=7), stenosis 1.7% (n=4), thrombosis 0.8% (n=2). The late complications were 23.18% (n= 60) the commonest was pseudo aneurysmal 19.4% (n=46) followed by venous HTN 0.8% (n=2) and steal syndrome 0.4%(n=1), skin necrosis 0.4%(n=1), idiopathic stop function 2.1% (n=5), thrombosis 0.4% (n=1). Conclusion: Permanent arteriovenous fistula is the best option for haemodialysis in patients with end stage renal disease. The commonest complication was puncture site pseudo aneurysm

Molecular identification of different Theileria and Babesia species infecting sheep in Sudan

The epidemiological aspects of sheep piroplasmosis in Sudan are poorly studied, and further investigations using sensitive and precise techniques are required. In this study, the Reverse Line Blot (RLB) hybridization assay was used to detect and simultaneously differentiate between Theileria and Babesia species. DNA was extracted from blood collected on filter paper (n=219) from apparently healthy sheep from six different geographical localities in Sudan. Results indicated that Theileria ovis (88.6%), T. separata (20.1%), T. lestoquardi (16.4%) and T. annulata (16.4%) DNA could be detected in the blood samples. Single and mixed Theileria infections were detected in 74 (33.8%) and 124 (56.6%) respectively and T. ovis being the most prevalent species in the country. T. ovis and T. separata were reported for the first time in sheep in Sudan.University of Elimam Elmahadi, Ministry of High Education and Scientific Research, Sudanhttp://www.bioone.org/loi/copaam2016Veterinary Tropical Disease

Quality of life of Sudanese Patients with Benigan Prostatic Hyperplasia. The Oblivious Problem

Background: 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. Objective: To evaluate the impact of BPH on the quality of life by assessing the physical, mental and stress states among patients of BPH. Methodology: 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. Results: 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. Conclusion: 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&S.There should be a validated scale for the BPH Quality of Life Index addressing the traditional strata for Sudanese patients.           &nbsp

Primary Fibrosarcoma of the Testicle with Puzzling Post-surgery Presentation: Mimicking Recurrence

Sarcomas of the testis are extremely rare tumors, their incidence being difficult to assess accurately. The authors report a case of a 21-year-old male, presented with painless scrotal swelling that increased in size insidiously within three months. The examination revealed a 10 cm right testicular swelling—hard, not tender and oval in shape. Testicular ultrasound revealed right heterogenous testicular mass. Tumor markers (Human chorionic gonadotrophin (HCG) and alpha fetoprotein) were normal. CT chest and abdomen were normal. Radical orchidectomy was done through an inguinal approach. Histopathology showed testicular fibrosarcoma with spindle cells. After one month, the patient noticed reappearance of a swelling in the right hemiscrotum. Right inguinal exploration with massive resection of the recurrent scrotal mass was done. Histopathology revealed inflammatory process dominated by stitch granuloma. In conclusion, the recurrence rate of testicular sarcomas is high following radical orchidectomy, but still there was a place of non-malignant massthat looks like recurrence; it might occur like nonspecific inflammatory mass and stich granuloma

Physicochemical and sensory properties of corn starch custard soured with tamarind, soursop and lime

Custard is a convenient food product, similar to ogi in appearance and viscosity, but lacks the sour taste typical of ogi. In this study, extracts (10% w/w) from tamarind, soursop and lime was added to custard samples and the physicochemical and sensory properties of the mixture was analysed. Corn gruel was included as the reference sample. Carbohydrate was the major component of the corn gruel (61.72%) and custard samples (66.27-74.42%). Corn gruel had substantially higher protein content (18.03%) than custard samples (8.03-8.62%). Custard samples were more dispersible in water, showed higher swelling power and significantly higher peak and final viscosities than the corn flour sample. However, the addition of souring agent did not significantly alter the cooking time and pasting temperature of custard. Custard may be soured with lime, tamarind and soursop to improve dispersibility, consistency, appearance, viscosity and sourness without significant changes in the overall acceptability of the product