H Abu-Aisha

Plasma 25-hydroxy cholecalciferol (25-OH vitamin D) concentrations were measured in 31 adult Saudi Arabian women who presented with acute minor illness. Patients with chronic diseases, malignancy and overt metabolic bone disease were excluded from this study. The median plasma 25-OH vitamin D concentration was 6 ng/ml (range: 2-18 ng/ml). Only three subjects had a concentration within the normal range (10-55 ng/ml). Plasma 25-OH vitamin D concentrations were significantly lower in subjects living in apartments than in those living in villas or rural areas (P less than 0.02). When direct questioning was used to assess exposure to sunlight, plasma 25-OH vitamin D concentrations were significantly lower in those subjects whose average exposure was less than 30 min daily than those whose exposure was more than 30 min daily (P = 0.002). Our findings confirm the importance of inadequate exposure to sunlight in the aetiology of vitamin D deficiency. Social customs may contribute to this deficiency in spite of abundant sunshine. Direct questioning to assess the adequacy of sunlight exposure is an essential part of history taking in cases of suspected vitamin D deficiency.

INTRODUCTION: Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in hemodialysis (HD) patients are associated with adverse outcomes, especially after kidney transplantation. REVIEW: In the HD setting, cross-contamination to patients via environmental surfaces, supplies, equipment, multiple-dose medication vials and staff members is mainly responsible for both HBV and HCV transmission. The incidence and prevalence of HBV in HD centers have dropped markedly as a result of isolation strategy for HBsAg positive patients, the implementation of infection control measures and the introduction of HBV vaccine. The incidence and prevalence of HCV infection among HD patients remain higher than the corresponding general population. There is ongoing debate as to whether isolation of HCV infected patients is needed to combat high anti-HCV seroconversion rates. The current guidelines do not recommend isolation or the use of dedicated machines for HCV infected patients, and rely on strict adherence to infection control measures for the prevention of HCV transmission in the HD setting. Investigations of dialysis associated outbreaks of HCV infection indicate that transmission most likely occurs because of inadequate infection control practices. Routine screening of anti-HCV negative patients, with HCV-antibody testing, and monthly monitoring of ALT levels is recommended to monitor transmission within centers. CONCLUSION: Prevention of transmission of HBV and HCV in the HD setting warrants a multi-faceted approach. Not enough stress can be placed on the importance of adequate infection control practices for the prevention of both infections. Prevention of HBV transmission is augmented by correct implementation of isolation strategies and the universal vaccination of susceptible patients.

Introduction: Despite an early start, the provision of renal replacement therapy (RRT) in Sudan is constrained by economic factors. This report describes the ESRD population and the available renal replacement therapy (RRT) services in Sudan in 2009. Current status: In June 2009, there were 2858 patients on hemodialysis (HD) in Sudan, 122 patients on continuous ambulatory peritoneal dialysis (CAPD), and 1168 kidney transplant recipients. The overall prevalence of treated ESRD was 106 patients per million population. All forms of RRT were funded by the government. The mean age of HD, CAPD and kidney transplant patients was 46±17, 42±22 and 39±13 years respectively. Males constituted 66%, 67.7% and 79.5% and children constituted 3.9%, 25.3% and 6.6% of HD, CAPD and kidney transplant patients respectively. The commonest reported cause of kidney failure was hypertension (26.1%), followed by diabetes mellitus (DM) (10.4%), obstructive uropathy (7.6%), glomerulonephritis (GN) (5.5%), polycystic kidney disease (2.6%), and pyelonephritis (1.1%). The majority of HD patients (83.8%) are offered twice-weekly HD, 83.6% had a functioning arterio-venous (AV) fistula, 6.4% were positive for hepatitis B virus (HBV) infection, 6.5% were positive for hepatitis C virus (HCV) infection, and 0.7% were positive for both HBV and HCV. Target blood pressure, hemoglobin and phosphorus levels were achieved by 26.5%, 23.1% and 28.5% of HD patients compared to 41.8%, 20.6% and 63.5% of CAPD patients respectively. Kidney transplant recipients had their transplant operation performed in Sudan (33.1%), Egypt (20.7%), KSA (18.2%), Jordan (14.8%), Pakistan (8.4%) and other countries. Conclusion: The prevalence of RRT in Sudan remains low. Hypertension and diabetes mellitus are the most commonly reported cause of kidney failure. Keywords: End stage renal disease; Hemodialysis; Kidney transplant; Peritoneal dialysis; Renal replacement therapy; Sudan

Seventy-four patients who were maintained on chronic haemodialysis in King Khalid University Hospital, Riyadh, Saudi Arabia were tested using the recently available ELISA to determine the prevalence of antibodies to hepatitis C virus (anti-HCV) in a haemodialysis unit. The prevalence rate of anti-HCV antibodies of 41.9% in the haemodialysis patients was significantly higher than the rate of 3.9% detected in 488 asymptomatic blood donors who were similarly tested. In the haemodialysis patients, anti-HCV positivity was related to previous blood transfusion (greater than 5 units of blood) and to the duration of haemodialysis (greater than 4 years); but was unrelated to sex, age, positive HBV markers or to past or current elevation of serum ALT. The results indicate a relatively higher prevalence of anti-HCV antibodies in our patients compared to rates of 1-20% reported from Europe and the U.S.A. An effective control strategy for HCV infection in this high risk group is urgently indicated.