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EFFICACY OF ONCE-DAILY AMLODIPINE IN THE CONTROL OF 24-HOUR BLOOD PRESSURE USING AMBULATORY BLOOD PRESSURE MONITORING
(1995-11-11) Hasan Abu-Aisha; SAMEER HURAIB; AKRAM ASKAR; JAMAL AL-WAKEEL; AHMAD MITWALLI; SULIMAN AL-MAJED
To evaluate the efficacy, tolerance, and acceptance of once-daily amlodipine in the control of 24-hour blood pressure (BP), we conducted an open-label, uncontrolled trial in 20 patients (17 men and 3 women) with mild-to-moderate hypertension and without evidence of secondary hypertension except as a result of nephropathy. A 2-week washout placebo period was followed by a 12-week period of active treatment. The starting dose of amiodipine was 5 mg once daily; this was increased to 10 mg once daily if BP was not controlled within 6 weeks of starting treatment. Clinic and ambulatory BP measurements were obtained before starting active treatment (week 0) and then at 6 and 12 weeks after the start of treatment. The mean age (±SD) was 49.2 ± 13.7 years. Mean clinic systolic BP fell from 162.4 ± 15.4 mm Hg at week 0 to 136.8 ± 8.7 mm Hg at week 12. Clinic diastolic BP fell from 102.8 ± 5.1 mm Hg at week 0 to 81.3 ± 6.1 mm Hg at week 12, Ambulatory systolic BP fell from 147.8 ± 8.8 mm Hg at week 0 to 136.0 ± 10.6 mm Hg at week 12. Ambulatory diastolic BP fell from 90.4 ± 4.5 mm Hg at week 0 to 81.0 ± 5.0 mm Hg at week 12. There was a significant reduction in systolic BP between week 0 and week 6 (P -- 0.0001), as well as between week 0 and week 12 (P = 0.0008). Similarly, significant reductions were obtained in diastolic BP between week 0 and week 6 (P = 0.0002), as well as between week 0 and week 12 (P = 0.001). The drug amlodipine was well tolerated and well accepted by patients. The results indicate that monotherapy with amlodipine 5 mg once daily is effective in controlling BP over a 24-hour period.
Missed Renal Infarction Presenting as the Nephrotic Syndrome: a Case Report
(2002) Hassan Abu-Aisha; Nauman Tarif; Ahmed Hasan Mitwalli; Jamal Saleh Al-Wakeel; Pravin Chandra Patel; Saleh Ali Al-Smayer; Hani Kamal Najm; Abdoo Qudsi
Aortic dissection may be associated with renal disease. The presentation, especially in the later stages of the process, includes proteinuria, hematuria and impairment of renal function. Thus the clinical picture may be confused with glomerulonephritis or hypertension. . We present a case of ischemic nephropathy resulting from involvement of the right kidney by an aortic dissection. The pateint presented with the nephrotic syndrome some two and a half months after the probable time when the aortic disection had occurred. At that time the initial back and flank pains had disappeared. Ultrasound examination revealed a smaller right kidney, compared to the left one. Imaging techneques, initaited for suspected renal artery stenosis, revealed aortic dissection involving the right renal artery starting from the descending aorta, distal to the origin of the left subclavian artery and extending down to the right common iliac artery; occluding the right renal artery. The medical literature is reviewed for patients presenting with ischemic nephropathy and the mechanisms of proteinuria discussed. We conclude that ischemic nephropathy can clinically mimic glomerulonephritis and can be missed if it is not included in the differential diagnosis of patients who present with heavy proteinuria and hypertension.
Immunochemotherapy of persistent post-kala-azar dermal leishmaniasis: a novel approach to treatment
(Elsevier, 2007) Ahmed Mudawi Musa; Eltahir Awad Gasim Khalil; Fawzi Abd Elrahim Mahgoub; Sara Hamad Hassab Elgawi; Farroukh Modabber; Abd Elgadir Mohamed Yousif Elkadaru; Mona Hussein Aboud; Sassan Noazin; Hashim Warsma Ghalib; Ahmed Mohamed El-Hassan
Post-kala-azar dermal leishmaniasis (PKDL) is a recognized dermatosis that follows successful treatment of visceral leishmaniasis in the Sudan. This randomized and doubleblind study aimed to assess safety, immunogenicity and curative potentials of a novel immunochemotherapy regimen in patients with persistent PKDL. Following informed consent, 30 patients were randomized to receive alum-precipitated autoclaved Leishmania major (Alum/ALM) vaccine + Bacille Calmette-Gu´erin (BCG) and sodium stibogluconate (SSG) or vaccine diluent and SSG. The SSG+Alum/ALM+BCG proved safe with minimal local adverse events. In the SSG+vaccine group, 87% of the patients were cured by day 60 compared with 53% in the SSG alone group (SSG+vaccine efficacy = 71%, 95% CI for risk ratio 0.7—1.16). On day 90 of follow-up there were two relapses in the SSG alone arm and none in the SSG+vaccine arm. Pretreatment cytokines showed high IFN- or high IFN- /IL-10 levels and leishmanin skin test (LST) non-reactivity, while healing/clinical improvement were associated with LST reactivity and low
Patterns of "Severe Acute Renal Failure" in a referral center in Sudan: Excluding intensive care and major surgery patients
(Saudi Center for Organ Transplantation, 2007) Hasan Abu-Aisha; Babikir G. Kaballo; Mohamed S. Khogali; Eman H. Khalifa; Eltahir A. G. KhaIiI; Ahmed M. EI-Hassan
Acute renal failure (ARF) is a common health problem worldwide. There is limited data on the pattern of ARF in Sudan. Moreover, glomerular diseases, which are a well-known cause of ARF, have not been accurately and adequately diagnosed previously. A retrospective study on the patterns of ARF was carried out in a general nephrology referral center in Sudan during the period from February 2003-February 2004. Patients from intensive care units with ARF and those who developed ARF after massive surgery were excluded from the study. Renal biopsy was performed when indicated and studied with light and immunofluorescent microscopy. Eighty-nine patients (57 (64%) cases were males, and mean age was 39±19.4 years) fulfilled the criteria for the diagnosis of advanced renal failure requiring renal function replacement therapy. Acute tubular necrosis (ATN) was diagnosed in 50 (56%) patients; 33 (66%) ATN patients had renal failure as a complication of volume depletion, fulminant infections (particularly malaria and typhoid fever) or snakebites, and 12 (13.4%) patients ingested paraphenylene-diamine (PPD) (hair/Henna dye) in suicidal attempts. Eight (9%) patients of the total study group had glomerular diseases and 11 (12.3%) had obstructive uropathy associated with ARF; the cause of ARF could not be determined in 17 (19%) patients. Fifty-three (60%) patients recovered their renal function, six (6.7%) patients progressed to chronic kidney disease (CKD), 16 (18%) died and 14 (16%) were lost to follow-up. In conclusion, patients with ARF associated with ATN had a favorable prognosis except when ATN was associated with PPD poisoning.
Evaluation of Polymerase Chain Reaction for Direct Detection of Escherichia coli Strains in Environmental Samples
(Academic Journals, 2007) Safa A. Sherfi; Hamid A. Dirar; Badr E. Hago; Mohamed E. Ahmed; Hassan A. Musa; Hassan Abu Aisha; Imadeldin E. Aradaib
The potential of the Polymerase Chain Reaction (PCR), as a means of detecting Escherichia coli (E. col’) DNA in suspected environmental samples, was studied. Using a pair of outer primers Pl and P2, selected from wdA gene, which encodes £. coli glucuronidase, the PCR-based assay resulted in amplification of a 486 base pair (bp) PCR product. £. cofi strains from different environmental sources including recycled and drinking water as well as stagnant water were detected by this nested PCR-based assay. Amplification products were visualized on ethidium bromide-stained agarose gel. The sensitivity of the PCR assay was 100 fg of bacterial DNA with ethidium bromide-stained agarose gels. Using a pair of internal (nested) primers P3 and P4, the nested PCR produced a 186 bp PCR product. The nested PCR increased the sensitivity of the PCR assay by 1,000 times and specific PCR products were detected from 0.1 fg of bacterial DNA. Amplification product was not detected when the nested PCR-based assay was applied to DNA from other related bacteria including, Salmonella, Pseudomonas and Proteus or nucleic acid-free water. Application of this nested PCR-based assay to environmental samples resulted in direct detection of Z. coli DNA from sewage water, tap water, drinking water at Shambat Campus, University of Khartoum, Sudan. This nested PCR-based assay should provide a rapid, sensitive and specific assay for direct detection and quantification of £. cofi in environmental samples suspected to contain the organism.
Rates and Causes of Peritonitis in a National Multicenter Continuous Ambulatory Peritoneal Dialysis Program in Sudan: First-year Experience
(Saudi Center for Organ Transplantation, 2007-11) Hasan Abu-Aisha; Elwaleed A. Elhassan; Ammar H. Khamis; Haleema Fedail; Babikir Kaballo; M. Babbikir Abdelraheem; Tigani Ali; Safaa Medani; Layla Tammam; Ihsan Basheir2
This is a cumulative report of all patients in six centers in Greater Khartoum, all three cities that comprise the capital of Sudan, covering the first year of operation of the National Program. This study evaluates the rates, mechanisms, causative agents and clinical outcomes of peritonitis. We included the data of all 60 patients who underwent CAPD from June 2005 to June 2006. There were 15 episodes of peritonitis in 323 patient-months, which equates to an overall peritonitis rate of one episode every 21.5 months (0.55 episodes per year at risk). The individual center rates varied. There was a statistically significant age difference, with peritonitis being more common in the youngsters. All patients presented with abdominal pain and had cloudy effluents but none had a significant exit site or tunnel infection. Fluid cultures were available in 11 out of the 15 episodes of peritonitis. The cultures were positive for organisms in only 3 out of 11 (27%) cases. Two patients were infected by Pseudomonas aerogenosa and one patient by Staphylococcus aureus. Thus, the culture-negative peritonitis rate was 8/11 (73%). Touch contamination was the likely mechanism in 7/15 (46.7%) of the episodes. There were three cases of refractory peritonitis and only one case of relapsing peritonitis. None of the patients had a catheter removed because of peritonitis. We conclude that the first year of operation of the Sudan National Multi-centered PD program has proven that it is a promising project with multifaceted success. The cumulative peritonitis incidence is acceptable although there are several areas for improvement. Standardized laboratory techniques need to be implemented and pursued, particularly in the microbiology area.
Encysted Fluid Collections after Catheter Removal for Peritonitis in Peritoneal Dialysis Patients
(2008) Hasan Abu-Aisha; Elwaleed A M Elhassan; Maha A Hummeida; Osman-mahir M A Mahir; Hisham M Ali; Aymun I Mobarak; Jamal Abdel-Raheem; Um-Alhasan Mohamed; Hassan A Musa
Introduction: Peritonitis is a frequent complication of continuous ambulatory peritoneal dialysis (CAPD). This case series describes episodes of peritoneal dialysis (PD) related fungal or Pseudomonas peritonitis that were complicated by the formation of encysted intra abdominal fluid collections despite prompt catheter removal and appropriate therapy. Case series: The first patient presented with fever and abdominal pain two weeks after removing his PD catheter because of fungal peritonitis. Examination revealed fluid collection in the former catheter tunnel. This turned out to be pus on surgical drainage. Abdominal computed tomography (CT) scan revealed another extensive encysted extra-peritoneal fluid collection that was aspirated and found to be clear transudate fluid. The second patient presented with abdominal pain and distention seven weeks after removing her PD catheter because of fungal peritonitis. She had a large intra abdominal encysted fluid collection that was drained under ultra sound guidance. The third patient presented with painless abdominal distention one month after removing the PD catheter because of Pseudomonas peritonitis. He had two encysted extra peritoneal fluid collections that were aspirated under ultra sound guidance. This occurred despite three weeks of treatment with oral fluconazole in the case of the first two patients and appropriate antibiotic therapy in the case of the third patient. Conclusion: In fungal and Pseudomonas peritonitis, other measures besides immediate initiation of appropriate therapy and prompt removal of the catheter may be necessary to prevent such late complications. Suggested measures include continued intraperitoneal antibiotics by a fresh PD catheter, in addition to systemic antifungal treatment
Renal Replacement Therapy Resources in Africa
(2008) Hasan Abu-Aisha; Aziz El Matri; Elwaleed AM Elhassan
Background: Africa is the world’s second-largest and most-populous continent. It is also the world’s poorest inhabited continent. Regarding chronic kidney disease (CKD), there are no reliable statistics in most African countries. However, there is a general impression that it is at least three to four times more frequent than in more developed countries Methods: a survey on renal replacement therapy in Africa was conducted in the context of the African Association of Nephrology (AFRAN) Congress 2007. A questionnaire was sent to leading African nephrologists, and data were also collected from the main dialysis supply companies and by personal communication. Data have been obtained from 32 out of 54 countries, representing 89% of the total population. Results: There are no reliable statistics regarding CKD in most African countries. The total number of nephrologists in the continent is 1154 (1-4 pmp). The total number of patients on hemodialysis (HD) is just over 60000 patients (<50 pmp in many countries). Peritoneal dialysis (PD) is only available in 12 African countries, and the total number of PD patients is around 2000. Renal transplantation is performed in 10 of the 53 countries, and only five countries have sustained programs that perform more than 50 cases per year. Conclusion: CKD is an under-recognized health challenge in Africa. Research should be encouraged to gauge the exact incidence and prevalence of CKD in African countries and define its regional risk factors. Efforts are needed to train physicians in this specialty, and strategies for judicious resources allocation should be implemented.
Hypertension and obesity in police forces households in Khartoum, Sudan: A pilot report - part of the "Police Forces Hypertension, Diabetes, Renal Insufficiency, and Thyroid Derangements (HyDRIT) Study", Sudan)
(2008-01) Hasan Abu-Aisha; Elwaleed AM Elhassan; Ammar Hassan Khamis; Adil Abu-Elmaali
Premature mortality from cardiovascular diseases could be prevented by the effective control of hypertension (HTN). Excess weight is associated with increased rate of death from all-causes. Nationwide data for the status of hypertension and excess weight in the Sudanese population are not available. All the consenting 426 inhabitants of two police housing-complexes were included. Blood pressure (BP), anthropometric measurements as well as blood samples were taken. Standard interviewing procedures were used to record medical history, socio-demographic and lifestyle characteristics. The data was analysed through univariate and multivariate regressions. The overall prevalence of hypertension (based on two BP measurements) was 27%. Less than a third (29.8%) of the hypertensive subjects were aware of their disease. Pharmacotherapy among those aware of their disease was prescribed in 94.1%. However, 59.4% of them were compliant with their prescribed medicines and 28.1% attained effective BP control. Prevalence of hypertension was significantly higher in older individuals (> 50 years of age), overweight (body mass index, (BMI) > 25) and those who had better education (> 10 years of schooling). The cumulative prevalence of overweight (BMI 25-29.9 kg/m2) was 30% while that for obesity (BMI ≥ 30 kg/m2) was 19.2%. Abdominal obesity was observed in 19.5% of males and 46.2% of females. Overweight subjects were more than twice likely to be hypertensive than their non-overweight counterparts (odds ratio 2.33 [1.49-3.64]). In the sample examined, the prevalence of hypertension and excess weight seemed to be comparable to other countries; this makes them a public health priority.
Six Cases of Fungal Peritonitis Complicating Peritoneal Dialysis in a Single Center in Sudan
(2009-05) Hasan Abu-Aisha; Elwaleed A M Elhassan; Maha A Hummeida; Osman-mahir M A Mahir; Hisham M Ali; Aymun I Mobarak; Jamal Abdel-Raheem; Um-Alhasan Mohamed; Hassan A Musa
Introduction: A national program of continuous ambulatory peritoneal dialysis (CAPD) has only recently been established in Sudan. In the head center of this national program, six of the 67 peritonitis episodes that were diagnosed during its 30 months of function were fungal in origin (9% of all episodes, 0.12 episode per year at risk). Here we describe the clinical features, predisposing factors, and outcomes of these six cases. Case series: Clinical presentation of fungal peritonitis did not differ from other cases of peritonitis. Among the six cases that were diagnosed in our center, five cases were due to Candida species and only one was due to Aspergillus. All patients had received antibiotic therapy within one month of diagnosing fungal peritonitis; five of them had received intraperitoneal (IP) antibiotics for a previous episode of bacterial peritonitis and one patient had received a course of oral antibiotics for exit site infection. Two of the patients were diabetic. All patients were treated with oral fluconazole, 200 mg daily, for three weeks, and all had their dialysis catheter removed. One patient died, and the others were transferred permanently to hemodialysis (HD). Two patients developed encysted intra-abdominal fluid collections 15 and 48 days after catheter removal. Conclusion: Fugal peritonitis complicating CAPD is not uncommon in our center, which serves a major portion of the CAPD population in the Sudan. Most patients responded to oral fluconazole treatment and catheter removal, but two of them suffered from late complications.
Ethnic distribution and clinical features of systemic lupus erythematosus in the Sudan
(2009-05) Hasan Abu-Aisha; Babikir G Kaballo; Abubakr A Wahab; Musa M Nur; Karar A Modawi; Elnazir EM; Omer H
Background Systemic lupus erythematosus (SLE) is a multisystem chronic inflammatory autoimmune disease characterized by periods of remissions and relapses. It is thought to develop when genetically predisposed individuals are exposed to one or more environmental triggers. The ethnically mixed population of the Sudan offers an opportunity to look into the effect of ethnicity on the distribution and systemic expression of the disease. Patients and methods Eighty seven consecutive patients fulfilling the clinical and laboratory criteria for the diagnosis of SLE were prospectively interviewed and examined using a unified protocol in three medical clinics in different parts of Khartoum. Appropriate investigations, including renal biopsies were carried out when indicated. Results Eighty three of the 87 patients (95.4%) were females (female to male ratio 20.6:1). Mean age at diagnosis was 31.89 years (range 21- 30). The disease was most frequently seen in tribes of mixed ethnicity (Afro-Arabs) and least common in pure African tribes. Thus, subjects with Afro-Arab ancestry constituted 94.3% of the sample seen whereas, subjects from Nubian ancestry (descendents from ancient tribes living in central and northern Sudan) were 5.7% of the group and no subjects from the black tribes of Southern and Western Sudan were represented. Conclusion The disease affected multiple systems as seen elsewhere. Most of the patients (96.6%) were antinuclear antibodies (ANA) positive while (51.1%) were antidouble stranded dioxyribonucleic acid (Anti-dsDNA) positive. The clinical features of SLE in our patients are comparable to what has been studied in the region. However, there was an overwhelming tendency of the disease to affect subjects of mixed ethnicity and less affection of subjects of pure African ancestry. The study is in support of the observation that SLE is rare in Black Africans living in Africa, however, it is not uncommon in subjects with Afro-Arab genetic admixture.
Chronic Kidney Disease in Police Forces Households in Khartoum, Sudan: Pilot Report
(2009-05) Hasan Abu-Aisha; Elwaleed AM Elhassan; Ammar Hasan Khamis; Adil Abu-Elmaali
Introduction: In the Police Forces Hypertension, Diabetes, Renal Insufficiency and Thyroid Derangement (HyDRIT) pilot study we explored the prevalence, risk factors, awareness, treatment adequacy and complications of chronic kidney disease (CKD) and other non-communicable diseases among adult Police Forces households in two housing complexes in Khartoum, Sudan. Methods: Serum creatinine measurements and urine dipstick testing were performed for 273 individuals. The glomerular filtration rate (GFR) was estimated using the standardized Cockroft-Gault and the four variable MDRD formulas. CKD was defined as an estimated GFR of less than 60 ml/min/1.73m2 and/or proteinuria. Results: The overall prevalence of CKD was 11% (30/273) using the standardized Cockroft-Gault equation and 7.7% (21/273) using the four variable MDRD equation. According to the standardized Cockroft-Gault formula, 14 subjects had reduced GFR with negative urine dipstick testing, two subjects had both proteinuria and reduced GFR, and 14 subjects had proteinuria without reduction in GFR. None of those subjects was aware of his kidney problem. According to the standardized Cockroft-Gault formula, 14 of the identified CKD cases were hypertensive (46.7%); eight of them (57.1%) had a prior diagnosis of hypertension but none achieved therapeutic targets. Four of the identified CKD cases were diabetic (13.3%), three of whom had a prior diagnosis of diabetes mellitus with reasonably controlled blood sugar levels. Only age above 50 years and low educational level proved to be independent risk factors for CKD in multivariate analysis. Conclusion: The prevalence of CKD in the study population seems to be comparable to other countries.
Leishmania donovani: a model of unresponsiveness to sodium stibogluconate
(University of Khartoum, 2010) Hamad SH; Khalil EAG; Musa AM; Ibrahim ME; El-Hassan AM
Objective:To develop a model of sodium stibogluconate (SSG)-unresponsive L. donovani. Design: Experimental study. Setting:Institute of Endemic Diseases, University of Khartoum. Subjects:Isolates of L. donovani from visceral leishmaniasis endemic areas in eastern Sudan. Methods: Thirty leishmania donovani complex isolates were made unresponsive to sodium stibogluconate (SSG) by exposure to increasing concentrations of the drug in a cell-free system. Results: The initial drug concentrations that inhibited the growth of 50% and 90% (IC50 and IC90) of the isolates were calculated as 0.4±0.04 mg/ml and 0.8±0.1 mg/ml respectively. Following induction of resistance, IC50 and IC90 rose to 50 and 35 folds of the initial values respectively (p<0.05). The time and the number of passages required for the isolates to recover to early log phase following exposure to SSG increased initially with increasing SSG concentrations and later declined despite continued increasing concentrations. SSG unresponsiveness was abolished when the SSG concentration was increased to three folds. Conclusion:In vitro resistance to SSG was successfully induced in L. donovani isolates that can serve as a model for studying underlying molecular basis of SSG-unresponsiveness. SSG-unresponsiveness probably develops in the wild over time as a result of repeated exposure to low SSG concentrations.
Leishmania donovani: Genetic diversity of isolates from Sudan characterized by PCR-based RAPD
(Elsevier, 2010-03-25) S.H. Hamad; E.A.G. Khalil; A.M. Musa; M.E. Ibrahim; B.M. Younis; M.E.E. Elfaki; A.M. El-Hassan
Drug unresponsiveness in patients with visceral leishmaniasis (VL) is a problem in many endemic areas. This study aimed to determine genetic diversity of Leishmania donovani isolates from a VL endemic area in Sudan as a possible explanation for drug unresponsiveness in some patients. Thirty clinically stibogluconate (SSG)-sensitive isolates were made SSG-unresponsive in vitro by gradually increasing SSG concentrations. The sensitive isolates and their SSG-unresponsive counterparts were typed using mini-circle kDNA and categorized using PCR–RAPD. All the isolates were typed as L. donovani, the resulting PCR– RAPD characterization of the SSG-sensitive isolates gave three distinct primary genotypes while, the SSG-unresponsive isolates showed only a single band. L. donovani isolates from eastern Sudan are diverse; this probably resulted from emergence of new L. donovani strains during epidemics due to the pressure of widespread use of antimonials. In this communication the possible role of isolates diversity in antimonial unresponsiveness and the in vitro changing PCR–RAPD band pattern in SSG-unresponsive strains were discussed.
Renal Replacement Therapy in Sudan, 2009
(2010-05) Hasan Abu-Aisha; Sarra Elamin; Wafaa Obeid
Introduction: Despite an early start, the provision of renal replacement therapy (RRT) in Sudan is constrained by economic factors. This report describes the ESRD population and the available renal replacement therapy (RRT) services in Sudan in 2009. Current status: In June 2009, there were 2858 patients on hemodialysis (HD) in Sudan, 122 patients on continuous ambulatory peritoneal dialysis (CAPD), and 1168 kidney transplant recipients. The overall prevalence of treated ESRD was 106 patients per million population. All forms of RRT were funded by the government. The mean age of HD, CAPD and kidney transplant patients was 46±17, 42±22 and 39±13 years respectively. Males constituted 66%, 67.7% and 79.5% and children constituted 3.9%, 25.3% and 6.6% of HD, CAPD and kidney transplant patients respectively. The commonest reported cause of kidney failure was hypertension (26.1%), followed by diabetes mellitus (DM) (10.4%), obstructive uropathy (7.6%), glomerulonephritis (GN) (5.5%), polycystic kidney disease (2.6%), and pyelonephritis (1.1%). The majority of HD patients (83.8%) are offered twice-weekly HD, 83.6% had a functioning arterio-venous (AV) fistula, 6.4% were positive for hepatitis B virus (HBV) infection, 6.5% were positive for hepatitis C virus (HCV) infection, and 0.7% were positive for both HBV and HCV. Target blood pressure, hemoglobin and phosphorus levels were achieved by 26.5%, 23.1% and 28.5% of HD patients compared to 41.8%, 20.6% and 63.5% of CAPD patients respectively. Kidney transplant recipients had their transplant operation performed in Sudan (33.1%), Egypt (20.7%), KSA (18.2%), Jordan (14.8%), Pakistan (8.4%) and other countries. Conclusion: The prevalence of RRT in Sudan remains low. Hypertension and diabetes mellitus are the most commonly reported cause of kidney failure.
Non-infectious Complications of Peritoneal Dialysis among Sudanese Patients: Five Years Experience
(2011-01) Hasan Abu-Aisha; Hanan Al-Sanousi; Sarra Elamin; Babikir J Kaballo; Layla Tammam; Hisham H Abdelwahab; Safaa A Medani; Ammar H Khamis; Maysoon O Mekki; Haleema M Fedail; Eltigani M A Ali; Mohammed B Abdelraheem
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
Prevention of Hepatitis B Virus and Hepatitis C Virus Transmission in Hemodialysis Centers: Review of Current International Recommendations
(2011-01) Hasan Abu-Aisha; Sarra Elamin
Introduction: Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in hemodialysis (HD) patients are associated with adverse outcomes, especially after kidney transplantation. Review: In the HD setting, cross-contamination to patients via environmental surfaces, supplies, equipment, multiple-dose medication vials and staff members is mainly responsible for both HBV and HCV transmission. The incidence and prevalence of HBV in HD centers have dropped markedly as a result of isolation strategy for HBsAg positive patients, the implementation of infection control measures and the introduction of HBV vaccine. The incidence and prevalence of HCV infection among HD patients remain higher than the corresponding general population. There is ongoing debate as to whether isolation of HCV infected patients is needed to combat high anti-HCV seroconversion rates. The current guidelines do not recommend isolation or the use of dedicated machines for HCV infected patients, and rely on strict adherence to infection control measures for the prevention of HCV transmission in the HD setting. Investigations of dialysis associated outbreaks of HCV infection indicate that transmission most likely occurs because of inadequate infection control practices. Routine screening of anti-HCV negative patients, with HCV-antibody testing, and monthly monitoring of ALT levels is recommended to monitor transmission within centers. Conclusion: Prevention of transmission of HBV and HCV in the HD setting warrants a multi-faceted approach. Not enough stress can be placed on the importance of adequate infection control practices for the prevention of both infections. Prevention of HBV transmission is augmented by correct implementation of isolation strategies and the universal vaccination of susceptible patients.
Tuberculous Lymphadenitis: Skin Delayed-Type Hypersensitivity Reaction and Cellular Immune Responses
(2011-05) E. A. G. Khalil; A. A. Elnour; A. M. Musa; A. A. Elagib; S. H. Hassab Elgawi; W. M. A. Ismail; K. E. ELzaki
BACKGROUND: Tuberculous lymphadenitis (TL) is the commonest form of extra-pulmonary tuberculosis in tropical countries. OBJECTIVE: This study aimed to characterize in vivo and in vitro cellular immune responses to Mycobacterium PPD in TL patients as markers of disease and healing. METHODS: Following informed consent, 36 TL patients, 40 patients with pulmonary tuberculosis (TB) and 20 apparently healthy individuals were enrolled when they met specific selection criteria. The tuberculin skin test (TST) and peripheral blood mono-nuclear cells (PBMCs) culture were conducted using PPD. The cytokines were measured using commercial kits. RESULTS: The mean TST was 24.6 ±8.0 mm for TL patients. The TST was variable in pulmonary TB patients and healthy individuals. It was reactive in a third of pulmonary TB patients with a mean of 20 ±3.0 mm and reactive in half of the healthy individuals with a mean of 12.6 ±3.2 mm. Pre and posttreatment interferon gamma (IFN-g) mean levels were 498.6 ±905.8 pg/ml and 710.0 ±844.6 pg/ml respectively (p=0.0001) for TL patients, while IL-10 mean levels were 93.0 ±136.0 pg/ ml and 32.4 ±31.7 pg/ml respectively (p= 0.0001). TST-reactive Pulmonary TB patients had significantly higher IFN-g (851 ±234.4 pg/ml) compared to TBLNT patients (p = 0.0001), while pulmonary TB patients had significantly lower IL-10 compared to TBLNT patients (p=0.0001). Apparently healthy individuals had significantly lower IFN-g and IL-10 levels compared to TBLNT and pulmonary TB patients (p=0.003). CONCLUSION: Strong TST reactivity, high IFN-g and IL-10 levels are good surrogate markers of active TBLNT, while increasing IFN-g levels and decreasing IL-10 levels mark healing. Tuberculosis Skin Test reactivity although a good diagnostic marker does not disappear with treatment.
Leishmania: Probable genetic hybrids between species in Sudanese isolates
(Academic Journals, 2011-06) Hamad S. H.; Ahmed M. Musa; Eltahir A. G. Khalil; Tamrat Abebe; Brima M. Younis; Mona E. E. Elthair; Ahmed M. EL-Hassan; Asrat Hailu; Aldert Bart
Reaching Target Hemoglobin Level and Having a Functioning Arteriovenous Fistula Significantly Improve One Year Survival in Twice Weekly Hemodialysis
(2012-05) Hasan Abu-Aisha; Sarra Elamin
Introduction: This is a prospective study of a cohort of 1011 patients maintained on regular hemodialysis (HD) in Khartoum, Sudan, studied in the year 2009 and reevaluated one year later. Their survival rates in November 2010 were related to their baseline characteristics. Methods: Demographic and clinical data of studied patients was collected by direct patient interviews and dialysis records revision. Survival rates were calculated using the Kaplan Meier method. Results: Patients had a median age of 45 years and a median duration on dialysis of 25 months. Two thirds of patients were males and 4.2% were children. Studied patients had a one-year survival rate of 86%. Most patients (74.8%) received twice weekly HD, and their survival rate was lower than patients receiving thrice weekly HD (85% versus 89%, P = 0.06). The strongest independent predictors of mortality were lack of a documented measure of dialysis adequacy (HR = 2.7, P = 0.00), poor functional capacity (HR = 2.4, P = 0.00), lack of a functioning AV fistula (HR = 2.0, P = 0.00), age ≥ 65 years (HR = 1.6, P = 0.02) and cardiovascular disease (HR = 1.5, P = 0.04). Patients with hemoglobin level < 10 g/dl had significantly lower survival rates (81% versus 92%, P = 0.00) compared to other patients. HD patients’ perception of their own general health was also significantly correlated to their survival rates (P = 0.00). Conclusion: Patients on thrice weekly HD did marginally better than those on twice weekly HD. In the latter group, however, having an AV fistula and a hemoglobin level of > 10 g/dl appeared to have a positive effect on their survival. Twice weekly HD could be acceptable for many patients provided other aspects of renal care are cared for adequately.

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