Biomedical subjects
Publications and source records attributed to A Ibrahim.
We studied prospectively 18 patients with sodium-losing nephropathy. In 12 patients (66.7 per cent) the sodium-losing nephropathy was owing to obstructions, challenging the hitherto existing concept that the most common cause of the condition is pyelonephritis. The diagnosis of sodium-losing nephropathy is important in urological practice since sodium repletion in these cases shortens significantly the hospitalization and preoperative waiting time.
This prospective study confirms the previously reported high incidence of uric acid lithiasis in the Sudan. Despite this fact urinary pH in patients in whom stones formed was not significantly different from controls (p greater than 0.05). However, a significantly high serum uric acid level (p less than 0.01) was associated with recurrent and/or bilateral stones. In patients with single episodes of stones significant hyponatremia (p less than 0.001) may indicate excessive sweating. The resulting low urine output supersaturated with crystals may explain lithogenesis in this group of patients.
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In this paper the first record of the medically important nematode parasite, Angiostrongylus cantonensis, is made from Egypt. A survey of eight species of freshwater gastropods collected from natural water courses and of three species of wild rats caught from the same areas revealed respectively, that the ampullarid snail Lanistes carinatus acts as the intermediate host transmitting this parasite, and that the rat Rattus norvegicus is its definitive host. The life cycle of the parasite was successfully completed through experimental infection of laboratory bred albino rats with third-stage larvae, obtained from the above mentioned snail intermediate host. A morphological description of the adult worms and of all larval stages of the parasite is given.
Amino acids and proteins in whole saliva of normal and malnourished Egyptian infants and young children were investigated. 16 amino acids, 7 of them are essential, could be detected in saliva of normal infants. Electrophoretic analysis revealed the existence of 10 protein components in saliva of either normal or malnourished infants. In oedematous cases, salivary aminoacids, particularly the essential ones, were increased as well as most of the protein components. In non-oedematous cases, the pattern was more or less normal, but in 3rd grade marasmus, amino acid and protein components of saliva were somewhat increased. The conclusion was drawn that such increase is mainly due to tissue degeneration which is more marked in oedematous than non-oedematous form of the disease.
Urine produced by obstructed kidneys was analysed in 35 cases. In the absence of infection by urea splitting organisms, estimation of urinary pH of hydroephrotic kidneys was found to be a reliable method for determination of recovery potential. After removal of obstruction, radiological recovery was almost complete when the pH was lower than 6. Obstructed kidneys producing urine with a pH between 6-7.1 showed only partial radiological recovery after surgical correction. All kidneys that showed no function on IV urography and those found at operation to possess only a very thin shell of cortex to justify nephrectomy were found to have urinary pH near 7.3 or more, implying inability of those kidneys to acidify urine. Urinary specific gravity and sodium concentration of obstructed kidneys were not reliable in prediction of renal recovery.
Nine hundred and ninety-seven Sudanese patients presenting to a urological unit in Khartoum were divided into a group consisting of 144 patients with a history or evidence of urinary bilharziasis and a second group of 853 patients with no history or evidence of this disease. Thirty-one per cent of the patients with bilharziasis and 32% of those without were found to have urinary calculi. In the bilharzial group there were recurrent stones in 7% compared with 12.4% in the non-bilharzial group. In the bilharzial group the stones were renal in 63.6%, ureteric in 27.3% and vesical in 9.1%, while in the non-bilharzial group 57% were renal, 30% ureteric and 13% vesical. Comparison of the incidence, rate of recurrence and site of stones in both groups suggests that urinary bilharziasis does not contribute to the high incidence of urolithiasis in the Sudan.
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This is a prospective study on 24 patients with chronic renal failure. Thirteen of them had evidence of acute uraemic encephalopathy. Of those 9 patients were found to have dilutional hyponatraemia, two patients severe salt and water depletion and one patient septicaemia. Hyponatraemia was associated with pulmonary oedema in 3 patients. Correction of salt and water disturbances and treatment of heart failure improved cerebral functions in 10 (77%) patients. It is therefore concluded that dilutional hyponatraemia probably leading to cerebral oedema is a reversibe major factor in the development of acute uraemic encephalopathy. This, if left uncorrected, may prove fatal especially in tropical countries.
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Iatrogenic injury to the distal esophagus and gastric cardia with subsequent fistula formation may occur at times following repeated direct operative attempts to control reflux esophagitis. At re-operation when this problem occurs, the indirect operative procedure of Roux-en-Y diversion is a safe, effective and preferable method to control persistent reflux esophagitis.
Fifty-seven per cent of Urinary Calculi in the Sudan contain Uric Acid, 20 per cent in the pure form and 37 per cent mixed with other constituents mainly calcium oxalate. The peak age presentation of urolithiasis is 30-40 years with more prediliction to males than females. An earlier study documented a high incidence of hyperuricaemia in Sudanese people. It is probable that "voluntary dehydration" and hyperuricaemia acting together may help in the formation of uric acid stones on the surface of which other crystals mainly calcium oxalate may be deposited to form the bigger calculi which are commonly encountered in this country.
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