Khartoum Teaching Hospital Research Articles

Evaluation of Different Thromboplastins and Coagulometers on International Normalize Ratio (INR) Readings for Patients under Stable Oral Anticoagulant Therapy

Background: Variations between various thromboplastin preparations have in the past led to decreased accuracy of INR readings. Because thromboplastin reagents vary widely in composition and manner of preparation, their sensitivity in monitoring oral anticoagulant therapy also vary widely. This study aimed to evaluate different thromboplastins and coagulometers on INR reading for patients under stable oral anticoagulant therapy. Materials and Methods: This was descriptive cross-sectional study; it was conducted in three hospitals (Alshaab teaching hospital, Khartoum teaching hospital, and Turkish hospital). A total of 50 citrated platelets poor plasma samples were collected from 50 Sudanese patients under stable oral anticoagulant therapy then prothrombin time (PT) and INR measurements were performed on three separated laboratories, using different coagulometers and thromboplastins reagents. Results: INR results showed that there was significant difference between INR of the three laboratories (P value=0.00), inspite of there was significant difference observed between INR in Khartoum hospital and Alshaab hospital, also between Alshaab and Turkish hospital (p-value=0.00). There was insignificant difference between INR in Khartoum hospital and Trukish hospital (p-value=0.178). Discussion and Conclusion: our investigation showed that some further efforts are needed to achieve harmonization of INR results among different laboratories because variation would most probably induce the clinician to make a change in warfarin dose. Standardization of instruments, reagents, and controls is warranted to decrease this variation.

Estimation of Radiation Dose Received in Knee Joint x-ray Examination

Abstract Background: Diagnostic X-ray examinations play an important role in the health care of the population. These examinations may involve significant irradiation of the patient and probably represent the largest manufactured source of radiation exposure for the population. Purpose: This study performed to assess the effective dose (ED) received in lumbosacral radiographic examination in order to analyze effective dose distributions among radiological departments under study. Materials and Methods: The study was performed in Khartoum teaching hospital, covering two x-ray units and a sample of 50 patients. The following parameters were recorded age, weight, height, body mass index (BMI) derived from weight (kg) and (height (m)) and exposure factors. The dose was measured for knee joint x-rays examination. For effective dose calculation, the entrance surface dose (ESD) values were estimated from the x-ray tube output parameters for knee joint AP and lateral examinations. The ED values were then calculated from the obtained ESD values using IAEA calculation methods. Effective doses were then calculated from energy imparted using ED conversion factors proposed by IAEA. Results: The results of ED values calculated showed that patient exposure were within the normal range of exposure. The mean ED values calculated were 2.49 +0.03 and 5.60 + 0.22 for knee joint AP and lateral examinations, respectively. Conclusion: Further studies are recommended with more number of patients and using more two modalities for comparison.

Comparative Study on Management of Vitiligo with Psoralen plus Steroid (Oxabet Formula) Alone VS Psoralen Formula plus Narrow Band of Ultraviolet B 311 nm in Khartoum Teaching Hospital of Dermatology and Venereology (KTHDV)

A comparative study and management has been conducted in (KTHDV). For some patients who attend the out patients clinic concern on treatment of the vitiligo with a new formula (Oxabet) alone VS Oxabet (oxpsolaren plus betamethasone) formula plus NB. UVB311 is during a period from (Jan 2011-Jan 2013). The study sample includes different age groups of both sexes. The study revealed that the formula alone gives good results. The localized vitiligo has a good response to the formula than generalized one. The early lesions have good responses than the old ones. The continuations of applying the treatment and the follow up of the patients enhance the efficacy of the treatment.

Incidence of complications following open mesh repair for inguinal hernia

Background: Traditional suture repair of inguinal hernia is fast giving way to routine tension-free mesh repair. In many countries, mesh repair is now more common than suture repair. Objective: To study mesh related complications in the early postoperative period in patient with inguinal hernia. Methods: This cross-sectional study was conducted at Khartoum teaching hospital. One hundred and three patients who had mesh repair for inguinal hernia were the base for this study between January and December 2011 using a structured questionnaire. Results: The mean age of the patients is 43.203 14.41 years (STD). There were 95.1% males (n=98) and 4.9% females (n=5). Tension-free mesh repair was done for 103 patients, 12 patients (11.3%) developed wound hematoma, another 12 patients (11.3%) developed numbness at the site of operations, 11 patients (10.7%) developed scrotal swelling, nine patients (8.7%) developed seroma and four patients (3.9%) developed neuralgia at the site of operations. Conclusion: Mesh repair of inguinal hernias is not free of complications. A larger sample size and further studies are needed to compare outcome of mesh repair in our environment more objectively with traditional inguinal hernia repair. Keywords: Inguinal Hernia; Mesh Repair; Complications.

Extensive Quantitative Analysis of Gallstones

Background: The chemical composition of gallstones is essential to study aetiopathogenesis of gallstone disease. Objective: To determine the composition of gallstones in a Sudanese population. Patients and methods: It describes an extensive quantitative analysis of gallstones from patients presented with symptomatic gall stone disease and treated by cholecystectomy after the acceptance of the pre-given informed consent in Khartoum teaching hospital in the period between Jan 2010 and Dec 2010. Using a pretested questionnaire data collected from and analyzed statistically by SPSS computer program version 21. Results: Data are analyzed from 94 patients (six males and 88 females). Cholesterol stones showed a significantly higher cholesterol content than pigment stones (p = 0.0042), though not significantly higher than mixed stones. Their phospholipids content and inorganic phosphates were higher than in the other types of stones and oxalate content was significantly elevated in comparison with mixed stones (p = 0.0402). In mixed stones, the cholesterol, bile acids, and bilirubin were intermediate between cholesterol and pigment stones, whereas triglycerides were significantly more than pigment stones (p = 0.0007). Bilirubin (p = 0.0021) and bile acids (p = 0.0016) were significantly higher than cholesterol stones (p = 0.0001) and (p = 0.0001) respectively. However, they contained the lowest amounts of sodium, potassium, magnesium, and oxalate. In pigment stones, bilirubin was significantly higher (p = 0.0001) than both groups. Conclusion: Collaborations between surgeons, nutritionists, biochemists, and physicians should be stimulated in future studies to define the different types of gall stones in different areas in Sudan and the relevancy of such types with diets’ traditions.

Identification of varied Sudanese infants ages (at birth, day 4, and 8 weeks) by determination of ossification pattern in the anterior skull base using computed tomography scan (A qualitative postmortem study)

Medico legally this study identify certain Sudanese infants ages (at birth, day 4, and 8 weeks) through description of ossification pattern in the anterior skull base using computed tomography (CT) scan. Also, it is describing the normal anatomical pattern of ossification. So this study will explain and reveals the Sudanese own skull base bony print. Total number of selected cases for study are 12 died children admitted to Mortuary of Khartoum between July\2011 and November\2011, and all cases of known age, sex and nationality (Sudanese) according to police records, confirmed medico legally by evaluation of external signs of live. All cases were examined in Khartoum teaching hospital at January\2012 that explained the skull base development and ossification by direct coronal CT scans, 1 mm and wide window (bone) settings of Para Nasal Sinuses (PNS) protocol. The used CT scan machine is TOSHIBA-Asteion. The observations of day 1, 4 and 8 weeks explained that each determined age has its own skull base bony pattern. Also observations of those ages revealed that the development of the forming parts of skull base which include orbital plates and its extension over lateral ethmoidal air cells, roof of ethmoid complex, cribriform plate, perpendicular plate of ethmoid and ethmoidal air cells was progressively increasing with age except; the perpendicular plate of ethmoid bone which doesn't meet the vomer in the posterior septum at any of these certain ages although vomer was ossified at those varied ages. And the Crista galli neither ossified nor fused with ethmoidal labyrinths at all. Also, the Ethmoidal air cells have never been extended above the plane of the cribriform plate. Observed ages and patterns of ossification was different somewhat from that reported in prior radiologic and anatomic studies in the ethmoidal complex and its extension over the cribriform plate of ethmoid bone also in the crista, galli which was seen ossified as early as 2 months of age in previous study.

Clinical presentation, treatment and outcome of paraphenylene-diamine induced acute kidney injury following hair dye poisoning: a cohort study.

IntroductionIn Africa and Asia hair dye is applied together with henna to decorate the hands and feet. Paraphenylene-diamine (PPD), a highly toxic constituent of hair dye can lead to acute kidney injury (AKI).MethodsA cohort study was conducted during the period from April 2012 to March 2013 in Khartoum Teaching Hospital, Sudan. It targeted adults presenting acutely with an evident history and clinical features of hair dye poisoning, together with AKI as per the RIFLE criteria. Analysis of data was done using SPSS.Results30 adults were included, their mean age was 25.6 ± 4.2 years, 93.3% were females. Exposure to PPD was suicidal in 86.7%. The mean duration to onset of renal symptoms was 34.8 ± 7.6 hours, maximum median serum creatinine was 8.6 ± 2.3 mg/dl, 86.7% had loss of kidney function as per the RIFLE classification and required dialysis. Initial renal recovery was seen after a mean duration of 9.8 ± 2.2 days. One patient died, 3.3%; all others, 96.7%, recovered normal kidney function. The amount of ingested PPD correlated significantly to the severity of symptoms, number of dialysis sessions required and time for renal recovery with P values < 0.05.ConclusionHair dye poisoning was associated with prolonged hospital stay, requirement of dialysis and increased morbidity. The severity of symptoms directly correlates to the dose of PPD ingested, with the kidney damage being reversible in almost all survivors.

Misuse of prophylactic antibiotics and prevalence of postoperative wound infection in obstetrics and gynecology department in a Sudanese hospital

Purpose: This study was conducted to audit prophylactic antibiotic use and to quantify the rate of wound infection. Methods: Across-sectional prospective study was conducted in the Obstetrics and Gynecology Department in Khartoum Teaching Hospital, Sudan during March 1st to 31st October 2010. All Patients (aged >18 years) were included. Results: Overall 725 patients were included. The performed surgical procedures were 751; of these 578 (76.9%) were Caesarean sections. Overall rate of wound infection was 7.8%. The rate of wound infection among patients operated on for caesarean section and abdominal hysterectomy was 8.3%, and 9.2%, respectively. Multivariate logistic analysis showed that body mass index [BMI] ≥ 30 kg/m2 OR 2.1, 95% CI (1.1 - 4.0), (P = 0.019) was the major independent risk factor for occurrence of wound infection. Evaluation of prescriptions’ parameters against the stated criteria showed that 113 (15.8%) patients were given antibiotics with adequate spectrum of activity, 611 (85.3%) given sub-dose/s, 83 (11.6%) received the first preoperative dose/s in a proper time window, and 716 (100%) had prophylaxis for extended duration. Overall conformity to the stated criteria for the evaluation of prescription’s parameters was not achieved in all prescriptions. Conclusions: In this setting, antibiotics were irrationally used and wound infection rate was high, and the situation calls for multiple interventions to correct the situation, through the activation of the infection control committee in the hospital and development of antimicrobial subcommittee to develop policies for the use and auditing of prophylactic antibiotics.

Frequency of H. pylori Antibodies among Patients with Gastrointestinal Symptoms Attending Khartoum Teaching Hospital- Sudan

A total of 90 patients with gastrointestinal symptoms, and who attended Khartoum Teaching Hospital during the period from April to October 2012, were enrolled in this study. Out of them 35 (38.9%) were males and 55 (61.1%) were females, their age ranges from 15-60 years with mean (33.2). The aim of this study was to detect frequency of Helicobacter pylori IgM, IgG antibodies, and to determine the relationship between the presence of antibodies and certain factors such as (sex, age and genetic susceptibility). 90 serum specimens were collected from patients, and analyzed by ELISA technique. The results showed that 19 (21.1%), 57 (63.3%) were positive for IgM antibody and IgG respectively, while 15 (16.7%) were positive for both. Females were more affected than males, high frequency of positive results was observed among 15-30 age groups. Statistical analysis showed that there was insignificant correlation between age, gender, genetic susceptibility and presence of Helicobacter pylori antibodies (P >0.05).

Assessment of Serum Levels of Calcium and Phosphorous in Sudanese Patients with Hypothyroidism

Objective: Thyroid hormones play an important role in homeostasis of Calcium and Phosphorous levels by their direct action on bone turnover. The importance of this study was that the thyroid hormones inter in calcium & phosphorous metabolism and it frequently disturbed in thyroid dysfunction. It is very important to monitor changes in the levels of serum calcium & phosphorous in thyroid disorder. The objective of the present study is to assess the levels of serum calcium and phosphorus in Sudanese patients with hypothyroidism in comparison with apparently healthy controls. Materials & Methods: A clinical-based descriptive study was conducted during the period from February 2012 to June 2013. Fifty patients with Hypothyroidism (25 males and 25 females) were selected as a test group compared to fifty (25 males and 25 females) apparently healthy control from the Khartoum Teaching Hospital in Khartoum state, Sudan. Blood specimens were collected from both groups and serum levels of Calcium, Phosphrous, Thyroid stimulating hormone, Thyroxin and Tri-Iodothyronine were estimated. Results : In this study the results shows a significant decrease in the mean of serum levels of Calcium in the test group compared with the control group (p >0.0001) and a significant increase in the mean of serum levels of phosphorus in the test group compared with the control group (p >0.0001). Conclusion: The serum calcium & phosphorous levels are significantly altered in hypothyroid disorders. It is important to check the levels of these minerals in hypothyroidisms patients. Treatment of the primary cause and if necessary supplementation of minerals should be done in order to prevent further bone complications.

Post-discharge surveillance of wound infections by telephone calls method in a Sudanese Teaching Hospital

Surveillance of wound infections has been shown to be a powerful preventive tool, and feedback to the clinical staff reduces wound infection rates. The main objectives of this study were to identify the applicability of telephone calls as a method of post-discharge wound infection surveillance, and to identify patients and procedures characteristics associated with loss for follow-up after hospital discharge. This was a prospective cohort study conducted in Khartoum Teaching Hospital, Sudan. Patients, aged >18 years admitted for elective clean and clean-contaminated surgery during March 1st to 31st October 2010 were recruited. 1-month surveillance of wound infections was conducted with telephone interviews. Overall 3656 patients were operated on. Of them 1769 (48.4%) were eligible {mean age 37.8+14 years; females, n=1472 (83.3%)}. The performed surgical interventions were 1814. Of these 1277 (70.4%) were clean-contaminated and 537 (29.6%) were clean. Patients who successfully completed the follow-up were 1387 (78.4%), while 368 (20.8%) were lost, and 14 (0.8%) died. The percentage of male patients (85.3%) who successfully completed the follow-up was significantly higher than females (77.8%); (P=0.002). Wound infection was detected in 15 (0.8%) cases during hospital stay and 110 (6.2%) others after hospital discharge. The majority of wound infections in the current study appeared in post-discharge period; this emphasis the need for establishment of surveillance program in the hospital. Surveillance of wound infections using telephone calls is applicable in this setting and can be used as an alternative method to clinic-based diagnosis of wound infections.

Prevalence of Extended-spectrum β-Lactamases-producing Escherichia coli from Hospitals in Khartoum State, Sudan

This study aimed to determine the prevalence and assess antimicrobial susceptibility of extended- spectrum β-lactamase-producing Escherichia coli isolated from clinical specimens of patients at hospitals in Khartoum State, Sudan. During April to August 2011, a total of 232 E. coli isolates were collected from various clinical specimens of patients. Isolates were identified, tested for antimicrobial susceptibility and screened for ESBL production as per standard methods. The double-disk diffusion method was used to confirm ESBL production using antimicrobial disks of ceftazidime (30 μg), cefotaxime (30 μg), with or without clavulanic acid (10 μg). A zone difference of >5 mm between disks was considered indicative of ESBL production. Out of 232 E. coli isolates, 70 (30.2%) were found to be positive for ESBL by the applied phenotypic methods. ESBL-producing isolates yielded high resistance rates for trimethoprim-sulfamethoxazole (98.6%), tetracycline (88.6%), nalidixic acid (81.4%) and ciprofloxacin (81.4%). The highest antimicrobial activities of ESBL-producing isolates were observed for amikacin (95.7%), followed by tobramicin (74.3%) and nitrofurantoin (68.6%). Resistance to quinolones, aminoglycosides, trimethoprim-sulfamethoxazole, tetracycline, nitrofurantoin and chloramphenicol was higher in ESBL than non-ESBL isolates (p<0.05). The frequency of ESBL-producing isolates varied among hospitals (18.2% to 45.1%), although a high prevalence was recorded as 45.1% at Khartoum Teaching Hospital. Wound specimens were the most common source of ESBL-producing isolates. The proportion of ESBL-producing E. coli did not differ significantly between adults and children (31% vs. 27%). The prevalence of ESBL-producing E. coli detected in this study is of great concern, which requires sound infection control measures including antimicrobial management and detection of ESBL-producing isolates.

Prophylactic Antibiotics and Wound Infection

Surgical site infections account for 14%-25% of all nosocomial infections. The main aims of this study were to audit the use of prophylactic antibiotic, to quantify the rate of post-operative wound infection, and to identify risk factors for its occurrence in general surgery. A cross-sectional study was conducted in the General Surgery Department in Khartoum Teaching Hospital- Sudan. All Adult patients (age ≥18 years) admitted during March 1(st) to 31(st) October 2010 were recruited. Multivariable logistic analysis was done to identify wound infection risk factors. Prescriptions were audited against predetermined criteria. A total of 540 patients were recruited; (females73.7% of total ). The performed surgical procedures were 547. The rate of wound infection was 10.9%. Multivariable logistic analysis showed that; ASA score ≥ 3; (p= <0.001), wound class (p= 0.001), and laparoscopic surgical technique; (p= 0.002) were significantly associated with prevalence of wound infection. Surgical prophylaxis was unnecessarily given to 311 (97.5%) of 319 patients for whom it was not recommended. Prophylaxis was recommended for 221 patients; of them 218 (98.6 %) were given preoperative dose in the operating rooms. Evaluation of prescriptions for those patients showed that; spectrum of antibiotic was adequate for 160 (73.4%) patients, 143 (65.6%) were given accurate doses, only 4 (1.8%) had the first preoperative dose/s in proper time window, and for 186 (85.3%) of them prophylaxis was extended post-operatively. Only 36 (6.7%) prescriptions were found to be complying with the stated criteria. The rate of wound infection was high and prophylactic antibiotics were irrationally used. Multiple interventions are needed to correct the situation.

Effect of a Second Dose of Thiopentone on Haemodynamic Response to Laryngoscopy and Intubation

Objectives This observational study was designed to assess the effect of a second dose of _______________________________ Corresponding author Sitt El-Nissa Said Ahmed Consultant of Anaesthesia and Intensive Care, Faculty of Medicine, University of Khartoum, Khartoum, Sudan Email: sittelnissa@googlemail.com thiopentone on the haemodynamic response to laryngoscopy and intubation. The study was conducted in Soba University and Khartoum Teaching Hospital, in the period from January to May 2006. One hundred patients were selected and divided into two groups (group 1 and group 2) with 50 patients each. Group 1 was given 4mg/kg of thiopentone initially, to induce anaesthesia, and another 4mg/kg of the same drug, following the administration of 1mg/kg of suxamethonium to facilitate endotracheal

Histological pattern of primary glomerular diseases among adult Sudanese patients: A single center experience

In Sudan, like most developing countries, the incidence and histologic patterns of primary glomerulonephritis (GN) remains undetermined. A cross-sectional hospital-based prospective study was performed to determine the pattern of primary GN among adult Sudanese patients. The study was conducted at Khartoum Teaching Hospital from September 2010 to August 2011. It included all adult patients with suspected primary glomerular disease and who underwent native kidney biopsy. A total of 83 adult patients were biopsied with 71 patients (85.5%) being diagnosed as having primary GN. Among those with primary GN the mean age was 34.6 ± 18 years and males represent 54.9%. In 46.5% kidney biopsy was indicated by the presence of nephrotic syndrome, whereas in 33.8% biopsies were performed due to unexplained elevations in renal parameters. Primary focal segmental glomerulosclerosis (FSGS) was diagnosed in 29.6% of patients, followed by membrano-proliferative glomerulonephritis (MPGN) in 26.8% and minimal change disease in 16.9%. IgA nephropathy was observed in 5.6%. Complications following kidney biopsies were reported in 9.6% of biopsied patients. Nephrotic syndrome in an adult was the most common indication for kidney biopsy in our unit. A large number of patients were biopsied due to elevated renal parameters, which reflected the increasing awareness toward thoroughly diagnosing patients with suspected reversible kidney damage. In conclusion, FSGS and MPGN make the most common causes of primary GN among Sudanese adults. Creation of a national renal registry is essential for obtaining more specified epidemiological data.

Complications and management of hair dye poisoning in Khartoum

Introduction: Paraphenylenediamine (PPD) is the major cause of intoxication in Sudan with high morbidity and mortality rate among the intoxicated victims. We here PPD poisoning studied in terms of mode of poisoning, case fatality rate, clinical presentation, management and complications. Methodology: This is a retrospective prospective study on 200 patients with hair dye poisoning who presented to Khartoum teaching hospital in the period from June 2008 to December 2008. Results: We reached to results that in the sample of 200 patients studied, (80.5%) were females and (19.5%) males. The ages of these patients ranged between 6 month - 57 years. Most of them were from Khartoum state (98.5%) and most of them were single (74%). About 51% had history of psychological problems. Most of them arrived immediately to the hospital (90%). Oral route is common route of administration of PPD (96%). The main causes of poisoning were suicidal attempts which occurred in (76%), accidental (22.5%) and homicidal (1.5%). The accessibility of dye to those patients was from local market accounts for about (47.9%), home (23.5%), relatives (22%) and other places (7.5%). Types of dye used were Indian (38.5%), Stone (42%) and Began account about (19.5%). PPD was detected in urine in (36%). There was impairment of renal function test using urea in (22%). Creatinine was abnormal in (23%). Serum electrolytes (sodium, potassium, Calcium) were abnormal in (11%).Uric acid was abnormal in (19.5%) and those who developed renal failure were (20.5%). The most common presentations were ingestion of dye (85.5%), tachycardia in (58%), tachypnea in (31.5%), vomiting in (31%), angioneuratic edema in (22.5%), abdominal pain (22%), enlarge tongue (18%), facial edema (14%) and loin pain in (7%) of the cases. The complications were respiratory distress in (22.5%), acute renal failure in (20.5%), cardiac problem in (1%) and liver problem in (0.5%). The medical treatment and emergency tracheostomy tend to decrease the mortality rate to only (3.5%). Relationship too many parameters were discussed. Recommendation: We recommended that may assist in decreasing the number of cases as health education about the danger of Hair dye that should be provided at the level of the community through all methods of mass media. Restriction should be made on the trade of Hair dye with more support analytical equipments in hospitals.

Clinical Presentation of Pott?s disease of the Spine in Adult Sudanese Patients

Tuberculosis (TB) of the spine (Pott’s disease) is the commonest and most dangerous form of skeletal TB. Delay in establishing diagnosis and management can cause spinal cord compression and spinal deformity resulting in serious neurological deficit and bad prognosis. This was a prospective hospital-based study investigating the data on hundred cases of Pott’s disease presented to Khartoum Teaching Hospital during the period from 2008 to 2010. 60 patients were females and 40 were males. The mean age of our patients was ± 41. The course of the disease was progressive and of gradual onset in the majority of the cases. 76% of our study group was presented with neurological deficits ranging from lower limb anesthesia, numbness, trunk weakness, root pain, muscle pain and flexion spasm.

An audit of prophylactic surgical antibiotic use in a Sudanese Teaching Hospital

Antibiotic prophylaxis is effective at reducing the risk of postoperative infection for nearly all types of surgery. Objective To audit the use of prophylactic antibiotics for elective surgery. Khartoum Teaching Hospital, Sudan, a 1,000 bed tertiary level hospital. A prospective study was conducted over a 9 month period; patients admitted for elective surgery were included consecutively. The use and administration of prophylactic antibiotics for elective surgery. A total of 1,768 patients with mean age 37.8 ± 14 years were recruited (females, 83.3 % of total) who underwent 1,814 surgical interventions. Of these 1,277 (70.4 %) of procedures were clean-contaminated. A total of 1,758 patients (99.4 % of total) received antibiotics for prophylaxis; 1,730 patients (97.9 %) were given antibiotics in the operating room; for 1,288 (74.5 %) of cases the antibiotics were considered 'recommended', while for 442 (25.5 %) they were not. Out of the patients for whom prophylaxis was recommended and was given, 725 (56.3 %) of patients received a broad spectrum antibiotic or unnecessary combination, 913 (70.9 %) received a sub-therapeutic dose, 120 (9.3 %) were given the first preoperative dose within the proper time window, and 1,250 (97 %) of patients had an extended duration of prophylaxis. Compliance with all stated criteria was achieved in only 47 (2.7 %) of observed prescriptions. This audit showed a wide gap between international standards and local practices; the authors call for urgent action to correct this situation through the development and implementation of local clinical guidelines.

English

To perform moleular detection of Chlamydia trachomatis among gynecological patients attending Khartoum Teaching Hospital. 200 endocerical smears were collected randomly from out-patient infertile women attending the Department of Obsetrcs and Gyencology, Khartoum Teaching Hospital (Sudan). Detection of C. trachomatis was performed by the polymerase chain reaction (PCR) technique. About 191 out of 200 patients having vaginal discharge were investigated, 43 (22.5%) of them were found positive for C. trachomatis by PCR test. Most positive cases were in the age range 26-40 years, whereas negative cases were in the age range 61 years and above. The age range (20-40) years, is a risk factor that exposes sexually-active women to C. trachomatis infection. Also, C. trachomatis infection in pregnant women may be associated with abortion and pelvic inflammatory disease.C. trachomatis infection is becoming a public health problem in Khartoum due to its highest frequency among infertile Sudanese women. Key words: Chlamydia trachomatis, polymerase chain reaction, Sudanese women.

Prevalence and predictors of wound infection in elective clean and clean/contaminated surgery in Khartoum Teaching Hospital, Sudan

Background: Surgical site infections are the second most common cause of hospital acquired infections. The objectives of this study were to quantify the rate of wound infection and to identify risk factors associated for its prevalence among patients admitted for elective surgery in Khartoum Teaching Hospital in Sudan. A prospective study was conducted. All patients, aged >18 years admitted during March 1st 2010 to 31th October 2010 were recruited. Baseline data was collected before patient's operations on. Patients were followed up to one month for detection of wound infection using bedside and post-discharge surveillance. A total of 1387 patients were included with a mean age of 35±14 years. 1138(82%) were females. More than three quarters were healthy (79.3%) and 1367(98.6%) patients were operated on conventionally. The total number of the performed surgical procedures was 1426. The rate of wound infection was found to be 9%. Univariate analysis revealed that five variables were significantly associated with the prevalence of wound infection; namely patient’s body mass index (P=0.041), co-morbidity (P=0.006), presence of diabetes (P=0.010), ASA score (P=0.000) and surgical technique (P=0.007). Multivariate logistic analysis showed that ASA score 2 and ASA score > 3, {adjusted OR, 1.9 (1.2-3.0), P =0.006 and adjusted OR, 3.6 (2.0-6.7); P<0.001 respectively}, laparoscopic surgical technique {adjusted OR, 5.5 (2-14.8); P=0.001} were mostly significantly associated with the prevalence of wound infection. The rate of wound infection was high with patient’s physical status and use of the laparoscope technique being strong predictors of infection.