Prevalence of depression and associated factors among elderly sudanese: a household survey in Khartoum State.

We assessed depression among 300 elderly Sudanese (age 60+ years). We conducted a cross-sectional household survey in 3 localities in Khartoum State. A 2-stage stratified sampling was carried out to select the localities and then the areas using simple random sampling; then systematic random sampling was used to select households. The prevalence of depression was 47.5%. Depression was significantly associated with age (P = 0.002), level of education (P = 0.015), occupation (P < 0.001), the problems of everyday living (P = 0.026), and social problems (P < 0.001). After controlling for confounders using multiple logistic regression, we found that depression was 4 times greater among the elderly retired compared to the elderly working, 3 times greater among the elderly with social problems and those who were suffering from urine incontinence and 2 times greater among the elderly with living problems.

Prevalence and causes of childhood blindness in camps for displaced persons in Khartoum: results of a household survey.

The prevalence and causes of visual impairment and blindness were determined in 29 048 children < 16 years in all households of 5 camps for internally displaced people in Khartoum State, Sudan. After house-to-house visits by trained health care workers, 916 children received further assessment, 2.7% of whom were found to be blind, 1.6% to be severely visually impaired and 5.5% to be visually impaired, according to World Health Organization criteria. The prevalence of blindness in children in the camps was estimated as 1.4 per 1000 children. The leading causes of blindness were found to be corneal opacities (40.0%), mainly due to vitamin A deficiency, followed by amblyopia (32.5%).

Prevalence and causes of childhood blindness in camps for displaced persons in Khartoum: results of a household survey

The prevalence and causes of visual impairment and blindness were determined in 29 048 children < 16 years in all households of 5 camps for internally displaced people in Khartoum State, Sudan. After house-to-house visits by trained health care workers, 916 children received further assessment, 2.7% of whom were found to be blind, 1.6% to be severely visually impaired and 5.5% to be visually impaired, according to World Health Organization criteria. The prevalence of blindness in children in the camps was estimated as 1.4 per 1000 children. The leading causes of blindness were found to be corneal opacities [40.0%], mainly due to vitamin A deficiency, followed by amblyopia [32.5%]

Clinical and epidemiological features of severe malaria in children in four hospitals in Sudan.

We assessed the clinical and epidemiological features of severe malaria cases before admission, management in hospital and outcome and associated factors in 4 hospitals in different areas of Sudan over a 5-month period in 2000. There were 543 children admitted representing 21% of all paediatric admissions. Median age was 36 months. Treatment at home was the first action taken by 57.5% of families. Case fatality rate was 5/1000 and 93% of the children who died were under 9 years. Highest risk of death was associated with delay in seeking treatment and severity of illness before admission. Omdurman Hospital in Khartoum had the best case-management performance index compared to the other hospitals.

Clinical and epidemiological features of severe malaria in children in four hospitals in Sudan

We assessed the clinical and epidemiological features of severe malaria cases before admission, management in hospital and outcome and associated factors in 4 hospitals in different areas of Sudan over a 5- month period in 2000. There were 543 children admitted representing 21% of all paediatric admissions. Median age was 36 months. Treatment at home was the first action taken by 57.5% of families. Case fatality rate was 5/1000 and 93% of the children who died were under 9 years. Highest risk of death was associated with delay in seeking treatment and severity of illness before admission. Omdurman Hospital in Khartoum had the best case- management performance index compared to the other hospitals

[Treatment, follow up and prevention of colorectal carcinoma: strategies and controversies in the year 2005]. / Therapie, Nachsorge und Prävention des kolorektalen Karzinoms: Strategien und Kontroversen im Jahr 2005.

Colorectal carcinomas are common, so efficient strategies in their prevention and treatment will significantly lower mortality. Life style changes are an efficient primary prevention, but mass screening of the population can reduce morbidity and mortality even further. Complete resection is the clue to cure in colorectal carcinomas. Total mesorectal excision and laparoscopic operations have been established as effective interventions that may also improve patients' quality of life. Adjuvant therapy reduces recurrence rates and is recommended in stage II and III rectal carcinoma and stage III colon carcinoma. The optimal strategies for adjuvant therapy are currently being redefined. The availability of new drugs has extended the therapeutic options in metastatic disease, improving response rates and overall survival in the palliative situation. Sequential therapies with different drug combinations seem to be the most effective strategy. The operative resection of localized metastases to the liver or lung can cure some patients with metastatic disease.

Niveles séricos preoperatorios del CEA y pronóstico en el cáncer colorrectal / Preoperative serum levels of the carcinoembrionary antigen (cea) and prognosis in colorectal cancer

Objetivo: Analizar el valor pronóstico de los niveles séricos preoperatorios del antígeno carcinoembrionario (CEA) en el cáncer colorrectal primario. Material y métodos: Se analizaron los niveles séricos preoperatorios del CEA en 275 pacientes con carcinoma colorrectal, que fueron sometidos a un período mínimo de seguimiento clínico de cinco años, o hasta su fallecimiento. Resultados: El porcentaje de positividades para los niveles séricos preoperatorios del CEA (> 6 ng/ml) estuvo positiva y significativamente asociado con el estadio tumoral (A: 10,5 por ciento; B: 38,8 por ciento; C: 32,2 por ciento; y D: 72 por ciento; p < 0,0001). Además, los valores séricos elevados del antígeno estuvieron significativamente asociados, en el análisis univariante, con una supervivencia corta en el conjunto de los pacientes (p < 0,0001). Sin embargo, el análisis multivariante tan solo demostró valor pronóstico independiente del CEA en el subgrupo de pacientes con tumores en estadio C. Conclusiones: Los valores séricos preoperatorios del CEA tienen valor clínico para predecir la extensión de la enfermedad, así como para predecir el pronóstico de pacientes con cáncer colorrectal con estadio tumoral C. (AU)

Emotional reactivity and debilitating beliefs during hospitalization predict future adjustment to first myocardial infarction in men.

Research efforts are being made to identify personality and cognitive variables predictive of poor adjustment following myocardial infarction. Sixty-two male patients were examined after a first and uncomplicated myocardial infarction to determine whether dispositional emotional reactivity and debilitating beliefs measured during hospitalization can predict work engagement, social activities involvement, and ambulation/independence six months later. A structural model with direct paths between emotional reactivity, debilitating beliefs, and the above outcomes, as well as partial mediation of emotional distress and illness preoccupation, was tested using the CALIS procedure. The model explained 33%, 48% and 82% of the variance in the three outcomes, respectively. Work engagement was indirectly related through emotional distress to earlier emotional reactivity and debilitating beliefs. Social activities involvement was both directly and indirectly related through emotional distress to debilitating beliefs; and also indirectly related through emotional distress to emotional reactivity. Ambulation/independence was directly and negatively related to debilitating beliefs. Prolonged emotional distress was predicted by emotional reactivity and debilitating beliefs. Illness preoccupation turned out to be an independent outcome that was positively related to emotional reactivity. Thus, measuring dispositional emotional reactivity and debilitating beliefs at the hospitalization stage may be helpful in detecting patients at risk of poor future adjustment.

Peripheral monocytosis following acute myocardial infarction: incidence and its possible role as a bedside marker of the extent of cardiac injury.

Infiltration by mononuclear cells, mostly monocytes, into necrotic myocardial tissue can be detected beyond the 3rd day after the onset of infarction. These monocytes, mobilized by an unknown mechanism, initiate phagocytosis of necrotic tissue. We observed in patients having sustained an acute myocardial infarction (AMI) a significant increase in monocyte count 2-3 days following presentation, possibly representing peripheral recruitment of monocytes to the injured myocardium. To establish this observation, we prospectively documented monocyte and neutrophil counts throughout hospitalization in 186 consecutive patients (118 patients having sustained an AMI, 34 patients with angina, and 34 patients admitted for nonischemic reasons). Average monocyte count, which rose on the 2nd day and reached a peak on day 3, was significantly elevated in these patients compared with control subjects (p < 0.001). Neutrophil count exhibited a similar phase-shifted response. Peak monocyte count exceeded 800/mm3 (upper limit of normal range) in 69 (58%) of AMI patients but in only 3 of the 68 (4%) non-AMI patients, yielding a sensitivity and specificity of 58 and 95%, respectively, for the diagnosis of AMI by this criterion. A significant correlation between maximal creatine kinase (CK) representing the extent of myocardial necrosis and peak monocyte count was shown (r = 0.51, p < 0.0001). A correlation between CK and monocyte count sum of days 1-3 (r = 0.51, p < 0.001) was found in a substudy of 25 patients with AMI. Similarly, a correlation was shown with cardiac function score as evaluated by 2-dimensional echocardiography (p < 0.001 and p < 0. 008 for difference between CK sum and monocyte count sum of high and low echo score groups, respectively). Hence, the peak monocyte count recorded during the immediate postinfarction period provides a bedside marker of the extent of myocardial damage that is the preponderant prognostic determinant. If validated in future studies this phenomenon may have diagnostic and prognostic implications.