Basic Clinical Characteristics and Hospital Outcomes of Acute Coronary Syndrome Patients-Sudan

Background: There are Variation in the presentation of the acute coronary syndrome between countries. The present study aimed to investigate the basic clinical characteristics and in-hospital outcomes among acute coronary syndrome patients in the Sudan.Material and Methods: A cross-sectional comparative study conducted among 202 consecutive acute coronary syndrome patients at a reference coronary care unit in Omdurman Teaching Hospital between July 2014 and August 2015. Participants signed a written informed consent, and then a case report form was filled. Information collected include vascular risk factors, vital signs, echocardiographic findings, and in Hospital complications. The local ethical committee approved the research, and the chi-square test was used to compare ST-segment Elevation (STSEACS) and None ST-Segment Elevation Acute coronary syndrome (NSTSEACS).Results: (out of 202 women (53.75%) in (NSEACS) P =0.009). Prior myocardial infarction, hypertension, diabetes mellitus, and, smoking were evident in 19.8%. 53.%, 30.2%, and 16.6% of acute coronary syndrome respectively, 97% of patients presented with chest pain, 54% presented to the hospital after 24 hours. Hypotension, heart failure, low ejection fraction, and in-hospital complications were more in (STSEACS) than (NSTSEACS), while (NSTEACS) patients received less Thrombolysis and Percutaneous coronary angioplasty P-value < 0.05Conclusions: Acute coronary syndrome patients were younger and had more complications than others in the West. ST-Segment Elevation Myocardial Infarction Patients are more likely to develop in-hospital complications and to receive reperfusion therapy. The limitation of the study is the lack of follow-up information after discharge

Prevalence of Depression among Sudanese Patients with type-2 Diabetes Mellitus

Background: Both diabetes mellitus and depression are common disorders, and when coexist; they lead to poor glycemic control that may ultimately increase the risk of both micro and macrovascular complications. In Sudan, few data are available regarding prevalence of depression among subjects with type -2 diabetes mellitus.Objectives: The aim of the study is to determine the prevalence of depression among Sudanese patients with type-2 diabetes mellitus.Materials and Methods: A cross-sectional descriptive study, carried out among Sudanese patients with type-2 diabetes mellitus who attended medical insurance clinic in Omdurman. The patients gave consent and HADS questionnaire was filled.Results: The study enrolled 400 patients with type 2 diabetes mellitus, 176 (44%) of them had depression. Among those with depression, 52.3% had mild depression, 29.5% and 18.2% of them, had severe and moderate depression, respectively. Sixty three percent of the study group were female. Their ages range from 30-79 years with a mean of 56.6 ±13.The average duration of diabetes was 10.3 years. 76% of patients were physically inactive and 16 (4%) of them were smokers. Fifty six (14%) had family history of psychiatric disorders, 170 (42.5%) of them showed lack of enjoyment, 77 (19.3%) of them lacked laughing, 81(20.3%) of them lost sensation of happiness, 68(17%) of them lost energy, 238 (59.5%) of them neglected their external appearance, 76 (19%) of them showed no enjoyment, and 62 (15.5%) of them lost enjoying reading or watching television.Conclusion: Depression is common among Sudanese patients with type -2 diabetes mellitus, therefore screening for depression should be part of routine clinical evaluation of these patients.Key words: Sudan, diabetes mellitus, depression

The spectra of selected functional gastrointestinal disorders in Sudanese university students according to the Rome III criteria

Background: The prevalence of functional gastrointestinal disorders  (FGIDs) including functional dyspepsia (FD), irritable bowel syndrome (IBS) and functional constipation (FC) was not studied in Sudan.Objectives: The aim of this study is to estimate prevalence of these disorders in Sudanese university students using Rome III criteria.Materials and Methods: A cross-sectional descriptive study was conducted among medical students in Omdurman Islamic University during the period from January to June 2012. The selected volunteers responded to a self-reported questionnaire based on Rome III criteria.Results: A total of 348 subjects were studied. Male: Female ratio was 0.6: 1. Prevalence of FD, IBS and FC were 21.6%, 12.9% and 10.3% respectively. IBS was more prevalent in females (16.4%) compared to males (7%). The most prevalent symptoms were postprandial fullness (74.1%), straining during .25% of defecation (43.9%) and lumpy or hard stools in .25% of defecations (37%).Conclusion: Functional gastrointestinal disorders are common in university students. Further studies are needed to characterize the epidemiology of FGIDs in Sudan.Key words: Functional gastrointestinal disorders, dyspepsia, irritable bowel syndrome, constipation, Sudan

Pattern of Endoscopic Findings of Upper Gastrointestinal Tract in Omdurman Teaching Hospital, Sudan

Background: The pattern of endoscopic findings of upper gastrointestinal tract (UGT) including gastro esophageal reflux (GERD), peptic ulcer diseases (PU), and upper gastrointestinal malignancies was not studied recently in Sudan.Objectives: The aim of this study is to know the pattern of endoscopic findings of upper gastrointestinal tract.Materials and Methods: This is a cross-sectional descriptive study which was conducted during the period from March to September 2013, at endoscopy unit in Omdurman Teaching Hospital. All patients referred for upper gastrointestinal endoscopy were included in the study.Results: A total of 390 subjects was enrolled in the study.56.4% were females; the male to female ratio was 1.3:1, their ages ranged from 11 to 80 years old with a mean age of 50.2 years. The most common endoscopic findings in the study group was Gastritis 54.9% followed by esophagitis 42%, peptic ulcer diseases 21%, esophageal varices 13.8% and upper gastrointestinal tumors (esophageal and gastric) 13.2 %. Normal findings were found in 3% of all patients in the study group.Conclusion: Upper gastrointestinal disorders are more common in Sudan compared to other countries. Esophageal varices and upper gastrointestinal malignancies are increasing compared to previous studies. Further studies are required to characterize abnormalities of upper gastrointestinal tract.Key words: Upper gastro-intestinal endoscopy, Gastritis, Esophagitis, Peptic ulcer, Sudan

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone