Incidence and Risk Factors of Acute Kidney Injury in ICU Patients of Omdurman Teaching Hospital

Background: Acute kidney injury (AKI) is a common complication in critically ill patients and it is commonly associated with high mortality and morbidity with adverse short and long term outcome. Objectives: The main objective of this study was to determine the incidence of acute kidney injury in ICU patients in Omdurman teaching hospital, and to assess the risk factors associated with the development of acute kidney injury in a critically ill patient. We also intended to find out the impact of acute kidney injury on ICU outcomes. Methods: In this descriptive prospective, cohort hospital-based study, 211 patients were studied and followed up during admission in ICU from November 2019 until July 2020 in Omdurman teaching hospital. Results: 61 patients of the total 211 patients developed renal impairment during their stay in ICU. 64% (39 patients) were males and 36% (22 patients) were female, mean age was 41 ± 5, renal impairment developed after a mean of 5 days of admission and the most common cause was decreased level of consciousness and severe hypotension, sepsis accounting for 40% of the admission. The outcome in ICU showed that the mortality rate was high up to 41% in patients who developed acute kidney injury, Sepsis accounted for over 96% (24 patients) who have passed away. Conclusions: Development of AKI in ICU is an important risk factor for poor outcomes in critically setting. Prevention is the best method for avoiding AKI, with the early identification and recognition of high-risk patients.

Clinical Characteristics and Current Medical Practice in a Group of Sudanese Patients with Epilepsy: A Cross Sectional Hospital Based-Study

Introduction: The epilepsy classification in under developed countries faces many difficulties in reporting, work-up and management strategies. Exploring local practice in general hospitals will positively add to the welfare of patients with epilepsy. The objectives of this study were to assess the current medical practice in epilepsy work up and to study the selection of AEDs as per ILAE guidelines. Methods: This was a cross sectional-retrospective hospital based study, conducted between April and September 2016 in Omdurman Teaching Hospital, Khartoum, Sudan. Patients aged 18 years old and above were enrolled. Epilepsy was defined as having at least two non-provoked seizures in the least 6 months in a patient who was assessed by clinical review and electroencephalogram (EEG). Epilepsy was classified as generalized, focal or unclassified. Medications refer to all internationally licensed antiepileptic medications (AEDs) in 2016. Results: One hundred adult Sudanese patients were enrolled for this study. The most common event described during the ictal phase was tongue biting in 50% of participants followed by body stiffness in 46%. Epilepsy was classified as generalized in 84%, focal in 11% and unclassified in 5% patients. In generalized epilepsy, the MRI detected 23.3% abnormal findings higher than the CT which detected 14.8% (4/27), p value = 0.032. In focal epilepsy, the CT detected 75% abnormal findings higher than the MRI which detected 33.3%, p value = 0.02. The AEDs used were as follows: Carbamazepine (CBZ) 48%, Na valproate (VP) 33%, Lamotrigine (LMT) 2%, Levetricetan (LVT) 1%, CBZ + VP 14% and CBZ + Oxcarbazepine (OXC) 2%. Conclusion: The current medical practice in Omdurman teaching hospital should be modified to match the international league against epilepsy (ILAE) guidelines in workup, management, AEDs selection and classification of epilepsy.

Addition of Insulin to Treatment Regimen in Type 2 Diabetes: The Significance of Age and Duration among Sudanese Diabetic Patients

Background: Type 2 diabetes is a progressive disease and as the result of patient’s age and diabetes duration, β-cell ability for insulin secretion deteriorates continually and finally fails to meet body requirement. Intensification of treatment drug regimen including addition of insulin is critical to maintain glycemic target and reduce developing of long-term complications. Objective: The main purpose of this study was to investigate the effect of diabetes duration and patients’ age on addition of insulin to treatment regimen. Methods: A single centre, cross-sectional hospital-based study was done among 351 diabetes Mellitus (DM) patients visiting Ribat University Hospital Diabetic Clinic, Khartoum State, Sudan. Data was collected using constructed, validated and multiple-choice questionnaire. Results: From 351 patients enrolled in the study, female were 65.8% and male 34.2%. About 64.4% were on oral anti-diabetic;35.6% on insulin;about 31.6% shifted to insulin when their ages above 40 years;and 22.8% when diabetes duration was above 5 years. Co-morbidity was 54.4% and 60.2% of patients had hypertension. Conclusion: Interactions between age and longer duration of diabetes were mostly significant reasons for transferring patients to insulin. Percent of insulin users and co-morbidity was within international range.

Frequency and Associated Factors of Autonomic Dysfunction in Patients with Parkinson’s Disease in Khartoum State

Background: Autonomic dysfunction in idiopathic Parkinson disease is a frequent and disabling complication, with an estimated prevalence of 47% and has a significant impact on the patient’s quality of life. Objectives: The main objective of this study was to determine the frequency of autonomic dysfunction among Sudanese Parkinson patients and identify possible risk factors attribute to develop autonomic dysfunction and to assess the extent to which the progression of dysautonomia affects activities of daily living, health-related quality of life. Methods: In this descriptive perspective, cross-sectional hospital-based study, 51 patients were studied using standardized questionnaire including history and clinical examination. Results: A total of 51 patients have been examined: male to female ratio 1.5:1;mean age 55 ± 5 years;Parkinson disease duration, 7 ± 2 years. 47% of the patients had one or more symptoms of autonomic dysfunction with mean age 59 ± 10. Constipation and bloating were the most common symptoms where sweating abnormality was the least symptoms to observe. The symptom of autonomic dysfunction has been worse with disease progression in 50% of the patients and 47% of the patients reported that both motors and autonomic dysfunction symptoms were causing disability than autonomic dysfunction symptoms alone. Conclusions: The study demonstrates that autonomic dysfunction is not only common in Parkinson Disease, but it increases in severity with increasing disease stages. Older age with long disease duration was also considered along with advanced disease stages strong factors determining the presence of autonomic dysfunction. The study recommends that symptoms of autonomic dysfunction survey be a routine aspect of the evaluation of Parkinson disease patients, especially with advanced age.

Traumatic Splenic Injuries in Khartoum, Sudan

Background: Spleen injuries are most commonly associated with blunt abdominal trauma and represent a potentially life-threatening condition. Objectives: To study the pattern of splenic injuries of the patient, management instituted and its outcome at Khartoum. Patients and Methods: This is a prospective, analytic and hospital-based multicenteric study, conducted at the three main Teaching hospitals at Khartoum. The study was carried over a period from April 2012 to February 2013. It includes all patients, diagnosed as traumatic splenic injury. Excluded were patients with history of splenic disease, iatrogenic injury or spontaneous rupture. Results: The study included 47 patients: their mean age was 26.4 years (SD ± 14.5). Most of them 41 (87.2%) were in the first four decades of life. Males were predominant 41 (87.2%), with a male to female ratio of 6.8:1. The majority of our patients had blunt abdominal trauma 39 (83%), of whom, road traffic accident accounted for 51.1% and none reported cases of gunshot. Isolated splenic injury was found in 23 (48.9%), and Haemodynamic stability was seen in 27 (57.4%) on presentation. The initial haemoglobin assessment revealed <9 gram/dl in 53.2%. CT scan was performed to 24 (51.1%), of whom 66 patients were Grade I and II and none of our patients were diagnosed as Grade V. Blood transfusion was required in 42 (89.4%). Operative treatment was adopted in 66% (61.7% total splenectomy and 4.3% splenorrhaphy), while selective non-operative management was successful in 16 (34%) of the patients. Higher intra-operative grade of splenic injury was found to be significantly associated with blunt abdominal trauma, haemodynamic instability and associated intra-abdominal injuries. 44 patients (93.6%) were discharged home in a general good condition. The morbidity and mortality were seen in 8.5% and 6.4% respectively. Conclusion: Splenic injuries usually follow blunt abdominal trauma, particularly after road traffic accidents. It is common during the first four decades of life with males being frequently affected. The great success rate of adopting selective non-operative management is worthwhile.

Exercise as Component of Standard Diabetes Management, the Challenges to Improve Performance among Sudanese Type 2 Diabetes

Background: Exercise is important component of diabetes management. Regular exercise improves blood glucose, reduces hazard of cardiovascular diseases, decreases weight, increases insulin sensitivity and strengthens patients’ general health. Regular exercise can prevent or delay type 2 diabetes in those of high-risk populations. Although there are great benefits of regular exercise, unfortunately majority of people with type 2 diabetes are not active. Objectives: The main goal of this study was to assess patients adherence to regular exercise among type 2 diabetes Mellitus (T2DM) attending Ribat University Hospital Diabetic Clinic (RUHDC) Khartoum state, Sudan. Methods: Analytical cross sectional hospital based study was carried out among 351 patients from August 2012 to February 2013. Structured questionnaire and patients cards were used to collect data. Results: Out of 351 patients, female were 65.8% and male 34.2%. Patients older than 60 years 48.4%, illiterate 21.0%, only 44.2% had basic educational level, house wife 56.1% and retired 18.5%. Majority had irregular exercise program (80.1%), 12.1% specified lack of time whilst 87.9% did not specify any other reasons as barrier for regular exercise “no reason”. Daily activity was the main type of physical activity (59.8%). Although insignificant, irregular exercise was higher among female patients, their age above 60 years, patients had low education levels and those had financial problems. Conclusion: Regular exercise was low in this study. Lack of time, female, patients older than 60 years, had low education levels, and had financial problems, which were the main barriers of regular exercise. Family support, tailored patients’ education and reduction of patients’ use of technology and modern living can improve the patients’ activity.

Factors Affecting Medication Non Adherence in Type 2 Sudanese Diabetic Patients

Background: Medications non-adherence is responsible for treatment failure and a reason of higher cost of medical care. It had been proved that, in general, diabetic patients are non-adherent to their treatment and only a small number of them were found to be adhering with all aspects of diabetic care. Objectives: To assess and evaluate the most common factors associated with medications adherence among Type 2 Diabetes Mellitus (DM) patients attending Ribat University Hospital Diabetic Clinic (RUHDC) Khartoum state, Sudan. Methods: Single Centre Descriptive cross sectional hospital based study was carried out among 351 patients using structured questionnaire and patients cards. Results: A total of 351 patients were recruited in the study;65.8% were females. About 64.4% were on oral medications and 35.6% on insulin. Adherence to medications among total Type 2 DM patients was 45%. Main barriers to medication adherence were drugs unavailability (34.3%) and forgetfulness (30.7%). Medications knowledge was 41.2% for patients on oral medications and 38.4% for insulin users. Conclusion: Adherence to anti-diabetic drugs in this study was found to be sub-optimal but considered reasonable in comparison with that reported by many African countries. Poor medications knowledge, drug brand unavailability and forgetfulness were the main reasons for medications non adherence. Family support, improving healthcare system and changing patents’ behavior will be needed to improve medications adherence.

The Pattern of Neurological Disorders;Revisited Prevalence Data of a Dedicated Neurology Clinic in Sudan

Background: The diverse modes in geographical locations, environmental factors, genetic and racial characteristics play a complex role in determining the pattern of neurological disorders worldwide. Determining the pattern of neurological disorders enables health policymakers to plan evidently for service, training, and research priorities. Few prevalence studies in neurology were conducted in Sudan. Methods: This is a retrospective hospital-based study that reviewed the medical records of patients who attended a Dedicated Neurology Clinic (DNC) in Omdurman, the national Capital of Sudan, for 24 months, from January 2016 to January 2018. This study aimed to determine the DNC pattern of neurological disorders as a representative subset prevalence in Sudan. Neurologists conducted the medical workup for diagnosis after at least two visits. All patients have ethically consented. Results: The total number of patients was 1050. Only 749 patients (71.3%) fulfilled the inclusion criteria. The mean age was 46.5 ± 1.9, and males were 45.3%. 72% were from the Capital. The presenting symptoms were headache (16.6%), seizures (11.5%), limbs weakness (11.2%), and lower percentages for other neurological symptoms. The commonest diagnoses were Stroke 12.4%, Epilepsy 9.3%, Primary Headache 8.8%, Movement Disorders 7.3%, Peripheral Neuropathy 6%, Dementia 4% Neuroinfections 1.4%, Demyelinating Disorders 2.6%, Spinal Spondylotic Radiculopathy 2.6% and 1.7% for Cerebral Venous Thrombosis. Conclusion: The data from Sudan-DNC showed that the most common neurological disorders descendingly were Stroke, Epilepsy, Headache, Movement Disorders, Peripheral Neuropathy, Dementia, Infections, Demyelinating Disorders, Spinal Spondylotic Radiculopathy, and Cerebral Venous Thrombosis. The demyelinating disorders and peripheral neuropathy showed a higher percentage than our previous preliminary prevalence study in 2012 compared to the other conditions, which showed similar rates in that study.