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ItemAcute kidney injury among critically ill Patients admitted at intensive care unit in Omdurman Military Hospital Using e-GFR(University of Khartoum, )Background:Acute kidney injury is a common complication in critically ill patients admitted to intensive care units with acute kidney injury (AKI) requiring renal replacement therapy (RRT) developing in about5% to 10% patients. A thorough understanding of the clinical spectrum of the disease is needed in order to device methods to prevent and improve the final outcome of this problem. So accurate assessment of kidney function in critically ill patients plays an important role in diagnosis of acute kidney injury (AKI), in appropriate prescription and dosing of drugs whose elimination depend on renal function. The aim of the present study was to analyze the clinical spectrum, causes , risk factors and final outcome of AKI in the setting of ICU using an e-GFR for the assessment of renal function. Material and Method: This is aprospective hospital based study in which 60 patients with acute kidney injury were included. Patients were admitted at the intensive care unit ( ICU) in Omdurman Military Hospital during the period between September 2015 to November 2015. Following through explanation and consent the clinical and laboratory data were collected from 60 patients at admission. Venous blood samples were collected and the measurement of serum creatinine concentrations undertaken using an auto-analyzer (Cobus Integra). Data recorded included: patient characteristics, underlying medical conditions responsible for ICU admission, laboratory resultsof renal function test. These data were analyzed for predicting the development of AKI at the setting of ICU using Statistical Package for Social Sciences Software ( SPSS) analysis system. Results: Acute kidney injury in the study group was found to be 25%. There was strong relationship between old age and low levels of an estimated glomerular filtration rate (e-GFR) (P value 0.001) which was considered to be highly significant. The gender of the studied patients did not significantly affect their e-GFR. There was a strong relationship between the reasons of admission and low e-GFR, where sepsis was found be the most common cause leading to decrease in an e-GFR (45%), followed by hypertensive heart disease, infective heart disease , heart failure and cardiac surgery as a second common cause (35%).More than 60% of the patients had associated co morbidities, with type 2 diabetes, hypertension and coronary artery disease being the three most common. Conclusion: e-GFR levels significantly assess the renal function test of critically ill patients admitted at an intensive care unit (ICU).. Themajority of the patients did not require renal replacement therapy (RRT) and were treated conservatively. About/ 60% of the patients recovered normal renal function, with about 3% developing chronic kidney injury(CKI).
ItemAssessment of the Pre- analytical Stage in the Haematology Laboratory at Soba University Hospital(University of Khartoum, )Background: Data for monitoring laboratory medicine including haematology in the Sudan is deficient. Audits of practices in haematology laboratories are important in order to provide a sufficient practice and devise strategies that would result in improved quality of health care services. The aim of this study was to assess the pre-analytical stage of laboratory investigations including phlebotomist procedures, Laboratory request forms, specimen handling and processing in the haematology laboratory. Methods: This descriptive cross sectional study was done in August 2014 at haematology laboratory (Soba University Hospital) on 1008 laboratory request forms and blood containers. An international standard checklist was used as guidance for completion of data required . Both interviews and observations to detect defects in the pre analytical phase were conducted. Results :Age and sex of the patients were missing in 12.3% and 13.7% of the forms respectively. Hospital location of the patients was missing in12.2% of the request forms . No clinical details were provided in 39.2% of the forms. Doctors signature( 80.5% ) were more available than doctors name (65.6%).Labeling of specimens was poorly done by phlebotomists/clinicians in all of the specimens containers. 8.2% of the blood samples delivered in the hematology laboratory did not contain the recommended volume of blood, and no use of standardized methods according to International Organization of standardization concerning handling and transportation . Conclusion: This study demonstrated that, the standards of completion of most request forms and blood specimen containers were poor. Essential information required on the forms was often missing. This can lead to limited advice given by the pathologist and may increase the potential for errors. On the other hand; provision of all the information needed on the forms and containers will aid laboratory diagnosis, enhance patient care and save time and resources. There should be closer interaction between clinicians and laboratory personnel to improve quality of services. Rejection of incomplete request forms and samples should be applied, Education of laboratory staff on standard guidelines is recommended.