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Outcome of Renal Transplantation at Ahmed Gasim Cardiac and Renal Transplant Centre in sudan-2014

Open Journal of Nephrology 2023年第1期13卷 39-56页

作者： Luai Mohmmed Bashir Mohmmed Manar Bushra Mohammed Abdalla Sundos Hamza Fadul Modawey Alaaedeen Mohamed Ali Mansoor Mohamed Mohamed Hamedalneel Yousif Ali Department of Surgery Sudan Medical Specialist Board Khartoum Sudan Department of Surgery Alnaw Teaching Hospital khartoum Sudan sudan medical specialist board Khartoum Sudan

Background: Although not life-saving procedures like liver or heart transplantation, renal transplantation is the preferred treatment for many patients with end-stage renal disease because it improves patients’ quality of life, while other forms of renal replacement therapy (RRT) such as haemodialysis (HDX) shown to regain only 10% of the patient’s renal function [1]. Transplantation releases patients from the dietary and fluid restrictions and the physical constraints imposed by other forms of (RRT), patients become able to return to their normal activities. Patient’s 5-year survival is higher post transplant. Patients and methods: This is Descriptive, retro-prospective, cross sectional analytic and multicentre study done in Ahmed Gasim Cardiac and Renal Transplant Centre including 105 patients. After meeting the Inclusion Criteria and exclusion Criteria, then cases were selected and written in constructed questionnaire. The aim of the study was to evaluate the outcome of renal transplantation in sudan. Results: 105 cases were used with male predominate and ratio male to female ratio 3:1, the main age of presentation between 31 - 45 years, most of the patients discharge uneventful with good outcome. During one-year follow-up following renal transplantation. Patient survival 95.2 % graft survival 82.4%. Overall morbidity shows 70.5%. Conclusion: this study showed that the one-year patient survival of 95.2%. Actuarial one-year graft survival of 92.4%. Renal transplantation complications can be reduced by meticulous preoperative workup including good cardiovascular assessment, tissue mismatch and BMI good postoperative follow up for early detection of graft rejection and long-term complications and finally patient education.

关键词： Kidney Transplant Patient Survival Graft Survival Graft Rejection

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Neglected and Relapsed Clubfoot in Adults, the Functional Outcome of Acute Surgical Correction

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Open Journal of Orthopedics 2023年第2期13卷 41-49页

作者： Sami Nogdallah Hassan Mohamed Hassan ALaa Mohamed Mohamed Khairy Dafaalla Salih Hozifa Mohammed Ali Abd-Elmaged Montaser Fatooh Orthopedic Department Al Neelain University Khartoum Sudan Bashaer Teaching Hospital Khartoum Sudan sudan medical Specialization board Khartoum Sudan Alzaiem Alazhari University (AAU) Khartoum Sudan

Background: Neglected clubfoot in this series is defined as untreated equino-cavo-adducto-varus in older children or adults. Relapsed clubfoot is the residual deformity that remains after single or multiple surgical interventions. Severely neglected clubfoot rarely exists today in developed countries, except in some emigrants from low- and middle-income countries. Acute surgical management with corrective mid-foot osteotomy and elongation of the Achilles tendon has an excellent functional outcome. Objective: To assess the functional outcome of acute correction of neglected Talipes-quinoa-varus deformity in adults. Methods: This is a cross-sectional, hospital–based multi-centric study. Forty patients were included in this study. Midfoot osteotomy and elongation of the Achilles tendon were performed on all patients. Data was collected using a questionnaire and the functional outcome has been assessed using the American Orthopedic Foot and Ankle Society Score (AOFAS). This score was measured before surgery and one year after surgery. Results: the mean age was 19.9 ± 4.7 years. Males were 25 (62.5%) and females were 15 (37.5%). The mean preoperative AOFAS score was 37.7 ± 7.1 (poor). This score improved to 80.7 ± 13.7 (good to excellent), two years after surgery. However, this indicates a significant change in the functional outcome after the operation (p value Conclusion: acute correction of neglected and relapsed TEV with elongation of the Achilles tendon and single midfoot osteotomy has excellent functional outcome as assessed by AOFAS Score. The satisfaction with this procedure is impressive. The younger age population showed better outcomes with this procedure.

关键词： Neglected Relapsed Clubfoot Outcome Acute Surgical Correction

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Presentation and Management of Wilm’s Tumour in sudan (Three Centre Experience from 2014-2016)

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Open Journal of Urology 2021年第10期11卷 358-366页

作者： Ahmed Mohammed Atiaallah Mutaz Ogeal Osman Aamir Abdallah Hamza Mawadda Farah Omer Alamin Faculty of Medicine Red Sea University Port Sudan Sudan Faculty of Medicine University of Bahri Khartoum Bahri Sudan sudan medical Specializations board Khartoum Sudan National Elribat University Hospital Khartoum Sudan

Background: Wilm’s tumour is a cancer of the kidneys that typically occurs in children younger than fifteen years of age and rarely in adults. With an early diagnosis and proper management of Wilm’s tumour by Multi-modal approach, excellent outcome can be obtained. This study was designed to reflect the clinical presentations and focus on different management modalities with an outcome of Wilm’s tumour in sudan. Patients and methods: This descriptive, retro-prospective analytic study included all patients of Wilm’s tumour at Soba University Hospital, Gezira national paediatric surgery centre and Khartoum teaching Hospital from January 2014 to January 2016. Results: Thirty patients (pts) were included. Females were predominant in a ratio of 3: 1 to males. The mean age was 3.0 - 5.9 years. Those who came from central and western of sudan were more affected. Most patients presented with abdominal mass 28 pts (93.3%), followed by abdominal distension in 16 pts (53.3%), while the less frequent presentation was haematuria seen only in 2 pts (6.7%). The multimodal approach: surgery and chemotherapy used in 21 pts (70%) and single modality was used in nine patients: surgery alone in 6 pts (20%), or chemotherapy alone in 3 pts (10%). The patients discharged uneventfully 23 pts (76%). Morbidity was seen in two patients. Deaths were occurred in five patients in the study (16.7%). Conclusion: The finding of this study reflected that Wilm’s tumour has an excellent outcome when patient was managed by multimodal approach.

关键词： Wilm’s Tumour Multi-Modal Approach Nephrectomy Chemotherapy Outcome

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Miller Fisher Syndrome Induced by Chemotherapy in Known Case of Acute Lymphocytic Leukaemia: A Case Report

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Open Journal of Internal Medicine 2023年第2期13卷 114-119页

作者： Musab Eltayeb Musab Suliman Amna Hajalsayed Hisham Alamin Alnour Alagib University Hospital Limerick Limerick Ireland National Ribat University Khartoum Sudan sudan medical Specialisation board Khartoum Sudan National Ribat University Hospital Khartoum Sudan Karary University Khartoum Sudan Omdurman Military Hospital Khartoum Sudan

Introduction: Guillain-Barre Syndrome (GBS) is an acute-onset autoimmune-mediated neuropathy. Guillain-Barre Syndrome can be divided into three subtypes: acute inflammatory demyelinating poly-radiculo-neuropathy (AIDP), acute motor axonal neuropathy (AMAN), and acute motor sensory axonal neuropathy (AMSAN). About 20% of patients with GBS develop respiratory failure and require mechanical ventilation. We are presenting a variant of GBS (Miller Fisher Syndrome, or MFS), which has been confirmed by nerve conduction studies along with the triad of ophthalmoplegia, ataxia, and areflexia. The objective of this study is to present a rare case of chemotherapy-induced GBS. Important clinic findings: A 25-year-old gentleman with acute lymphocytic leukemia on active chemotherapy treatment presented with lower limb weakness. This weakness started after his fifth chemotherapy session. After the sixth chemotherapy, he developed complete paralysis of the left lower limb. Later, he developed right lower limb paralysis. He was also complaining of eye dryness and incomplete closure of both eyes. While inpatient, he developed upper-limb weakness. His chemotherapy consisted of MESNA, cyclophosphamide, doxorubicin, vincristine, cyorabine, and methotrexate. He had ptosis and ophthalmoplegia in the left abducent and right oculomotor regions. He had bilateral facial nerve palsy. He was hypotonic with power grade 3 in the upper limbs and grade 0 in the lower limbs with areflexia. His sensation was intact in the upper limbs but lost in the lower limbs. His planter reflexes were mute. Diagnoses and Management: Intravenous immunoglobulins were given for 5 days. A nerve conduction study showed severe demyelinating sensorimotor polyradoculoneuropathy with secondary axonal loss. The triad of ataxia, ophthalmoplegia, and areflexia was consistent with MFS. The patient improved over the course of the hospital stay but did not reach full recovery. Conclusion: Although GBS is uncommon, it must be take

关键词： Guillain-Barre Syndrome Variant Miller Fisher Syndrome Chemotherapy Acute Lymphocytic Leukaemia

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Cannabis Use among People with Mental Illness: Clinical and Socio-Demographic Characteristics

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Open Journal of Psychiatry 2018年第3期8卷 244-252页

作者： Sumia A. Al Azizi Abdelaziz A. Omer Amir A. Mufaddel sudan medical Specialization board Khartoum Sudan Department of Psychiatry University of Khartoum Sudan Department of Psychiatry Mediclinic Al Jawhara Hospital Al Ain United Arab Emirates

Background: Cannabis can be associated with short-term and long-term adverse effects such as psychotic states, risk of dependence, provoking relapse and aggravating existing psychotic symptoms. Aim: The current study is a descriptive cross-sectional hospital based study that aims to identify the prevalence and correlates of cannabis use among patients with mental illness. Methods: The study was conducted in two outpatient psychiatry clinics in Khartoum (sudan). The sample size was 348 consecutive patients over 2 months’ study period. Clinical and sociodemographic characteristics were documented. Descriptive statistics was used to describe the data variables, and tabulated tables were used to calculate chi-square test for categorical data and the significance was set at p Results: A total of 96 participants (27.6%) had history of cannabis abuse;all of them were male patients. The majority (51%) started to use cannabis between 10 - 19 years of age, and most of them (86.6%) had a duration of less than five years of using cannabis. Psychiatric symptoms occurred after starting cannabis use in 17.7% of cases. We found a statistically significant difference related to age when comparing the age of cannabis users and non-users (p = 0.0239). The majority of patients with comorbid mental illness and cannabis abuse (89.5%) were below the age of 40 years. There was also statistically significant association between educational level achieved and history of using cannabis (p = 0.00001). Those with history of cannabis are more likely to be manual laborers (46.9%), and those with no history of cannabis were mostly unemployed (44%), indicating significant influence of employment history (p = 0.0064). The relation between using cannabis and the clinical psychiatric diagnosis was not statically significant (p = 0.125). Conclusion: Cannabis use is highly prevalent among people with mental illness. It is related to age, educational level and type of work.

关键词： Cannabis Sociodemographic Psychiatric Disorders Schizophrenia Mood Disorders

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Hearing Assessment among sudanese Rheumatoid Arthritis Patients versus Non-Rheumatoid Arthritis Individuals

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International Journal of Otolaryngology and Head & Neck Surgery 2023年第3期12卷 187-196页

作者： Abdalla Mohamed Mohi Eldin Osman Mohamed Elmustafa Randa Awad Seedahmed ORL H&N Sudan Medical Specialization Board Khartoum Sudan ORL H&N Surgery University of Gezira Wad Medani Sudan Consultant Audiologist Ministry of Health Khartoum Sudan

Background: Rheumatoid arthritis (RA) disease is one of the most common chronic autoimmune diseases that affect many body systems including the auditory system. Objectives: To assess hearing thresholds and to ascertain types of hearing loss among sudanese rheumatoid arthritis patients attending rheumatology clinic in Omdurman military hospital and matching them with non-rheumatoid arthritis subjects. Methodology: This descriptive and analytic (comparative) hospital based cross sectional study conducted from October 2020 to April 2021 which include 66 RA patients with age range (21 - 60 years) matched with 41 non-rheumatoid arthritis group sharing same characteristics (nation, gender and age). Pure tone audiometry, tympanometry and acoustic reflexes were done for all RA patients and matched groups. Statistical analysis of the data was carried out using the association and correlation tests for associations and t-test for independent samples. Results: Thirty-six (54.5%) of RA patients had hearing impairment versus 9 (22%) non-RA in PTA test. Twenty-four RA cases (36.3%) showed asymmetrical hearing threshold and graph in PTA between right and left ears. Thirty-four (51.5%) right and 36 (54.5%) left ears were normal degree followed by 23 (34.8%) in the right and 24 (36.4%) in the left ears were mild degree hearing loss. Among hearing impaired RA patients;20 right ears (62.5%) and 19 left ears (65.5%) had sensorineural hearing loss (SNHL), conductive hearing loss 11 (34.4%) right ears and 9 (31%) left ears. Mixed HL was in 1 right ear (3.1%) and 1 left ear (3.5%). The most common degree of SNHL type was mild in (75%) and (78.9%) in right and left ears respectively, moderate and moderate severe were (20%) in the right and (15.7%) in the left ears. Fifty-eight right ears (87.9%) and 56 left ears (84.8%) had type A tympanogram while 7 (10.6%) right ears and 9 left ears (13.6%) were type As tympanogram, one right and one left ears had type Ad tympanogram. Acoustic reflex was

关键词： Rheumatoid Arthritis Sensorineural Hearing Loss Conductive Hearing Loss PTA Tympanometry Acoustic Reflex

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Management of Rhabdomyolysis and Acute Renal Failure Following Strenuous Exercise in Young Adult: A Case Report

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Open Journal of Internal Medicine 2023年第1期13卷 23-31页

作者： Musab Eltayeb Amna Sirag Hisham Alamin Alnour Elagib Department of Rheumatology University Hospital Limerick Limerick Ireland Department of Internal Medicine National Ribat University Khartoum Sudan Internal Medicine Sudan Medical Specialization Board Khartoum Sudan Internal Medicine Department Karary University Omdurman Sudan

Introduction: Rhabdomyolysis is severe and life threating condition in which skeletal muscles are damaged by dissolution of striped muscles. Acute kidney injury (AKI) has been widely reported (13% - 50%) as a complication of Rhabdomyolysis in which the main pathophysiological mechanisms are intra-renal vasoconstriction, intraluminal cast formation (Tamm-Horsefall) and direct myoglobin toxicity. In this report we are going to describe the management of Acute Kidney Injury due to Rhabdomyolysis that is not responding to vigorous rehydration. Objective: Reporting about acute renal failure induced by Rhabdomyolysis due to Excessive Exercise and dehydration in young patient. Case Report: A 20 years male came to the outpatient clinic complaining of sever lower limb pain, back pain and vomiting. He was anuric and hypertensive (BP = 150/90 mmHg) with serum creatinine and urea levels of 15.72 mg/dl and 235 mg/dl, respectively. The diagnosis was based on the laboratory finding of creatine kinase = 3127 IU/l. The patient, then, has been referred to the emergency department. The Management plan was based on two arms: Emergency Management with Urgent Hemodialysis for AKI and high fluid replacement therapy. Patient started to recover after three hemodialysis sessions but the peak of recovery was noted after starting manual fluid replacement therapy with a target urine output of greater than 2 ml/kg, a urine pH of greater than 6. Manual fluid replacement therapy consisted of loop diuretics, intravenous fluids and intravenous sodium bicarbonate 1.26%. Full recovery was noted after one month of hospital admission with inpatient care and regular follow-up. A follow-up after one month has been set to assess the patient progression and monitor his kidney functions. Relevance and Impact: Home messages and lessons are;Firstly, young adults are vulnerable to Rhabdomyolysis, second, the diagnosis of Rhabdomyolysis can be made on the clinical bases but a confirmatory laboratory test of Crea

关键词： Rhabdomyolysis Acute Kidney Injury Strenuous Exercise Case Report Manual Fluid Replacement Therapy

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Minimally Invasive Hind-Foot Fusion in Charcot Patients

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Open Journal of Orthopedics 2023年第11期13卷 477-484页

作者： Sami Nogdallah Mohanad Osman Ibrahim Abd-Elseed Alaa Mohamed Mohamed Khairy Osama Gamal Nubi Montaser Fatooh Hozifa Mohammed Ali Abd-Elmaged Department of Orthopedics Alneelain University Khartoum Sudan Department of Orthopedics Orthopaedic Registrar Sudan Medical Specialization Board Khartoum Sudan Department of Orthopedics Bashaer University Hospital MBBS Al Neelan University Khartoum Sudan Department of Orthopedics Alzaiem Alazhari University Khartoum Sudan

Background: Hindfoot fusion, is a fusion of the talonavicular, talocalcaneal, and calcaneocuboid joints and is commonly performed for patients complaining of pain, chronic instability and gross deformity as a result of hindfoot pathology. Objective: This study aimed to assess the functional outcomes of the patients underwent hindfoot fusion, the post-operative complications and patient’s satisfaction. Methodology: This study is a prospective cohort study was conducted in Future hospital, in Khartoum, sudan. It involved 30 patients from July 2015-July 2022. Data was collected by the primary researcher using data collection sheet, then it was cleaned and entered into Microsoft excel data sheet and was analysed using SPSS version 28 software. Results: 33.3% of the patients are aged 51 - 60 years, and >60 years. Male: Female equals 1:1. 56.7% are for the left side, only 23.3% developed complications. 63.3% patients are fully satisfied. There is a significant correlation between the AOFAS score before and after the operation. Also, a significant correlation between the means of AOFAS score after with the complications and the satisfaction of the patients. Conclusion: Minimally invasive tibio-talo-calcaneal is an alternative procedure for the treatment of severe Charcot arthropathy of the ankle. The expected functional outcome is impressive and comparable with the open surgery. However, the post-operative complications are prevalent in 23.3% of patients. Most candidates are fully satisfied with the procedure.

关键词： Ankle sudan Patient Satisfaction Arthropathy Neurogenic

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The Radiological Outcome of Surgical Correction of Hallux Valgus with Combined Scarf and Akin Osteotomies

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Open Journal of Orthopedics 2023年第3期13卷 84-96页

作者： Sami Nogdallah Mohamed Alhassan Osman Montaser Fatooh Alaa Mohamed Mohamed Khairy Hozifa Mohammed Ali Abd-Elmaged Osama Gamal Nubi Orthopedics Surgery Department Alneelain University Khartoum Sudan Bashaer Teaching Hospital Khartoum Sudan Orthopaedic Registrar sudan medical Specialization board Khartoum Sudan Orthopedics Surgery Department Alzaiem Alazhari University Khartoum Sudan Bashaer University Hospital MBBS Al Neelan University Khartoum Sudan

Background: Hallux valgus deformity is one of the most common chronic and progressive foot deformities. Surgical correction of the deformity plays a central role in the treatment of symptomatic hallux valgus. However, more than one hundred different surgical techniques have been described. Objective: To assess the radiological outcome of hallux valgus surgical correction using a scarf and akin osteotomies. Materials and methods: A cross-sectional hospital-based study was conducted on 25 adult patients (36 feet). Twenty-two females and two males with hallux valgus were treated with surgical correction using a scarf and akin osteotomies. All candidates were kept on regular postoperative, scheduled clinical follow-up programs for one year and assessed radiologically. Results: Twenty-five patients (36 feet) were included in this study. The hallux valgus angle significantly shifted to the normal range (less than 15°) after surgery, and the inter-metatarsal angle also improved to the normal range (less than 9°). Conclusion: Using scarf and akin osteotomies in treating moderate and severe hallux valgus deformity provides the satisfactory radiological outcomes in form of decreasing hallux valgus angle and inter-metatarsal angle.

关键词： Hallux Valgus Scarf Osteotomy Akin Osteotomy Valgus Angle Intermetatarsal Angle

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Atypical Presentation of Prostatic Cancer with Left Axillary and Supraclavicular Lymphadenopathy

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Open Journal of Urology 2022年第4期12卷 228-236页

作者： Mohamed Izeldeen Ibrahim Abdulgadir Elsunny Hamadelnil Mutaz Mohamed Rehab Osman Abdelrhman Tamir A. Mahmmoud Ahmed M. Elnour Hala Yagoub Lyla M. Alagab Ahmed Gaper Hamad Department of Urology Prince Osman Digna Referral Hospital Portsudan Sudan Department of Surgery Red Sea University Portsudan Sudan Department of General Surgery Ministry of Health Sudan Department of Radiology Port Corporation Hospital Portsudan Sudan sudan medical Specialization board Khartoum Sudan Prince Osman Digna Referral Hospital Portsudan Sudan

Introduction: The burden of prostatic cancer is rising in sudan. Usually, they present late in their disease with urinary tract obstruction, hematuria, bony pain, or cachexia because there is no screening program. Here we present a patient with prostatic cancer who presented with left axillary mass as his main concern. Case Description: 82-year-old sudanese male presented with a left axillary and left supraclavicular lymphadenopathy of a few months’ duration. He underwent a decisional biopsy which showed metastatic adenocarcinoma. Upper and lower GI endoscopy were performed but the latter was complicated by a sigmoid perforation with peritonitis. During laparatomy, multiple enlarged pelvic lymphnodes were encountered and a biopsy result suggested a metastatic prostatic neoplasm. Later, prostatic biopsy confirmed the diagnosis. The patient was treated with bilateral orchidectomy. Clinical discussion: Lymphatic metastasis to axillary lymph nodes is a very rare manifestation of prostate cancer and only a few cases have been reported in the literature. It can cause diagnostic difficulty since prostate cancer typically metastasis to the pelvic lymph node and very rarely involves he supradiaphragmatic lymph node. Conclusion: Metastatic prostatic carcinoma should be considered among the causes of supra-diaphragmatic lymph adenopathy. Careful physical and imaging examinations combined with PSA and pathological analysis are essential in the diagnosis of advanced prostate cancer with unusual presentation.

关键词： Prostatic Cancer Adenocarcinoma Axillary Metastasis Supraclavicular Metastasis Atypical Presentation

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