Active Tuberculous Infection among Adult Sudanese Patients on Long Term Peritoneal Dialysis

Introduction: The prevalence of tuberculosis in Sudan is 209 cases per 100,000 populations. There are no reports available regarding the prevalence of tuberculosis among the end-stage kidney disease and dialysis populations.Methods: We reviewed the medical records of all adults who were on peritoneal dialysis (PD) in the Sudan Peritoneal Dialysis Program, during the period from June 2005 to December 2011. Those diagnosed ashaving active tuberculous infections were retrospectively studied regarding their demography, clinical presentation and outcomes.Results: Out of 350 patients in our program, 19 were diagnosed as having active tuberculosis (5.4%). All patients were diagnosed during their first year on peritoneal dialysis, 74% were males; the mean age was37 ± 11 years, extrapulmonary tuberculosis was seen in 16/19 (84%) patients and it was abdominal in nine of the 16 (47%) patients. In addition to high clinical suspicion, the diagnosis of active tuberculosis was supported by tissue biopsy findings in 16%, positive polymerase chain reaction in 26%, exudative ascites with suggestive radiological features in 21%, strongly positive tuberculin test in 21% and a favourable response to empirical antituberculous therapy in 26% of patients. HIV test wasnegative in all 19 patients and only one patient tested positive for hepatitis B viral infection. Antituberculous drugs side effects were seen in 68% of patients. Forty seven percent of patients showed complete recovery and continued on peritoneal dialysis. Our case fatality was 32%.Conclusion: Abdominal tuberculosis is common among PD patients and its diagnosis should always be considered in suspected patients

Renal diseases: caregivers' knowledge, attitude and practice in North Eastern Nigeria

Lack of awareness of renal diseases among the parents/ care givers of children can contribute to the development of childhood chronic kidney disease (CKD). Awareness of kidney disease by the care givers of children can improve their health seeking behaviour and reduce the significant economic and public health burden. We conducted a cross-sectional descriptive study to assess the knowledge, attitude and practice of renal diseases among the care givers of children attending University of Maiduguri Teaching Hospital. Management of CKD is very expensive especially in the third world where most care givers are poor and cannot afford the cost of renal replacement therapy like dialysis and renal transplant. This underscores the determination of knowledge, attitude and practice of parents/ care givers on childhood renal diseases. Objective: To assess the knowledge, attitude and practices on renal diseases among the care givers of children attending a tertiary hospital in north eastern Nigeria. Method: This cross-sectional study was conducted among mothers or caregivers of children receiving care in the department of Paediatrics of a Teaching Hospital, Borno state. Mothers/ caregivers were consecutively selected as they come to the hospital and 420 subjects were interviewed through a self-administered questionnaire. Each subject was interviewed on his or her knowledge, attitude and practice of childhood renal diseases and data was entered appropriately into the different sections of the study questionnaires. Data was analysed using Epi-info statistical software (version 7.0). Informed consent was obtained from the parents and confidentiality to any information disclosed by the mother was ensured. Results: The ages of the respondents ranged from 18 – 67 years with amean age of 37.2 (SD±13.6) years. Majority 140 (33.3%) of the respondents were aged 31 – 50 years; p<0.05. Among the respondents, were 255 (60.7%) females and 165 (39.3%) males with male to female ratio of 1: 1.5. The ages of the children ranged from 1 month to 15 years with 239 (56.9%) males and 181 (43.1%) females and male to female ratio of 1.3: 1. There were 267 (63.6%) Muslims and 153 (36.4%) Christians. There were 98 (23.3%) care givers from the upper social class, 120 (28.6%) from the middle social class and 202 (48.1%) from the lower social class. Most mothers (89.2%) had no factor preventing them from seeking medical care. Many (70.7%) of the caregivers took their children to health facilities once sick or developed any symptom of severe childhood disease. Conclusion: Although most of the care givers that participated in this study had knowledge of one form of kidney disease or the other, most had no knowledge of any treatment modality of these kidney diseases

Ribbon Crystals

A repetitive crystal-like pattern is spontaneously formed upon the twisting of straight ribbons. The pattern is akin to a tessellation with isosceles triangles, and it can easily be demonstrated with ribbons cut from an overhead transparency. We give a general description of developable ribbons using a ruled procedure where ribbons are uniquely described by two generating functions. This construction defines a differentiable frame, the ribbon frame, which does not have singular points, whereby we avoid the shortcomings of the Frenet-Serret frame. The observed spontaneous pattern is modeled using planar triangles and cylindrical arcs, and the ribbon structure is shown to arise from a maximization of the end-to-end length of the ribbon, i.e. from an optimal use of ribbon length. The phenomenon is discussed in the perspectives of incompatible intrinsic geometries and of the emergence of long-range order

Population‐based cohort study of outcomes following cholecystectomy for benign gallbladder diseases

Background The aim was to describe the management of benign gallbladder disease and identify characteristics associated with all‐cause 30‐day readmissions and complications in a prospective population‐based cohort. Methods Data were collected on consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing all‐cause 30‐day readmissions and complications were analysed by means of multilevel, multivariable logistic regression modelling using a two‐level hierarchical structure with patients (level 1) nested within hospitals (level 2). Results Data were collected on 8909 patients undergoing cholecystectomy from 167 hospitals. Some 1451 cholecystectomies (16·3 per cent) were performed as an emergency, 4165 (46·8 per cent) as elective operations, and 3293 patients (37·0 per cent) had had at least one previous emergency admission, but had surgery on a delayed basis. The readmission and complication rates at 30 days were 7·1 per cent (633 of 8909) and 10·8 per cent (962 of 8909) respectively. Both readmissions and complications were independently associated with increasing ASA fitness grade, duration of surgery, and increasing numbers of emergency admissions with gallbladder disease before cholecystectomy. No identifiable hospital characteristics were linked to readmissions and complications. Conclusion Readmissions and complications following cholecystectomy are common and associated with patient and disease characteristics

The Cholecystectomy As A Day Case (CAAD) Score: A Validated Score of Preoperative Predictors of Successful Day-Case Cholecystectomy Using the CholeS Data Set

Background Day-case surgery is associated with significant patient and cost benefits. However, only 43% of cholecystectomy patients are discharged home the same day. One hypothesis is day-case cholecystectomy rates, defined as patients discharged the same day as their operation, may be improved by better assessment of patients using standard preoperative variables. Methods Data were extracted from a prospectively collected data set of cholecystectomy patients from 166 UK and Irish hospitals (CholeS). Cholecystectomies performed as elective procedures were divided into main (75%) and validation (25%) data sets. Preoperative predictors were identified, and a risk score of failed day case was devised using multivariate logistic regression. Receiver operating curve analysis was used to validate the score in the validation data set. Results Of the 7426 elective cholecystectomies performed, 49% of these were discharged home the same day. Same-day discharge following cholecystectomy was less likely with older patients (OR 0.18, 95% CI 0.15–0.23), higher ASA scores (OR 0.19, 95% CI 0.15–0.23), complicated cholelithiasis (OR 0.38, 95% CI 0.31 to 0.48), male gender (OR 0.66, 95% CI 0.58–0.74), previous acute gallstone-related admissions (OR 0.54, 95% CI 0.48–0.60) and preoperative endoscopic intervention (OR 0.40, 95% CI 0.34–0.47). The CAAD score was developed using these variables. When applied to the validation subgroup, a CAAD score of ≤5 was associated with 80.8% successful day-case cholecystectomy compared with 19.2% associated with a CAAD score >5 (p < 0.001). Conclusions The CAAD score which utilises data readily available from clinic letters and electronic sources can predict same-day discharges following cholecystectomy