Ovarian cancer, because it often presents with vague symptoms, is a difficult disease to diagnose at the early stages, especially in developing countries. In Sudan, diagnosis is further complicated by additional factors and challenges. First, as in any developing country, access to treatment, facilities and medical staff is generally lacking. Secondly, Sudan is the second largest country in Africa: its very size presents difficulties for the implementation of a centralized health system. The two tertiary hospitals in or near the capital have long patient waiting lists. The lack of female education in sub-Saharan Africa, together with social and economic issues affecting women, is a further obstacle to disease diagnosis and management. Misdiagnosis, leading to inappropriate treatment, may result from the presence of comorbid diseases such as Tuberculosis (TB), which can mimic ovarian cancer and obstruct early detection. Most patients are identified at the later stages when the complications associated with invasive procedures and conventional chemotherapy make treatment much less effective. The early detection of biomarkers may prove to be a vital tool to indicate targets for immunotherapy treatment. Financial aid may help improve the outcomes for patients with ovarian cancer in the Sudan, assisting with diagnosing and management procedures including training medical staff. Research and development, documentation and updating the statistical register for the whole country are also important requirements for future improvements. Finally, there is a need to promote interdisciplinary work between surgeons and clinical oncologists to optimize international guidelines and protocols in accordance with the facilities available.
Background: 42-77% of exudative pleural effusions are due to malignant diseases (Marel et al., 1993) [1]. This study aimed to evaluate the value of biochemical parameters of the pleural aspirate in predicting success of chemical pleurodesis in adult patients with malignant pleural effusion.Patients and methods: This prospective study included 30 adult patients with malignant pleural effusion diagnosed by clinical examination, Chest CT scanning and closed pleurocentesis. Patient ages were mean of 60.4 ± 7.8 years, multiple sessions of closed pleurocentesis were carried out followed by insertion of an intercostal tube. The pleural aspirate was then sent for chemical analysis to detect Glucose, pH, and LDH. Pleurodesis was then done either by using Tetracycline (group A), or Bleomycin (group B). All patients were then followed up for success of the pleurodesis process within one month.Results: Within one month of follow-up, rates of clinical response to treatment in group A (Tetracycline) were successful in 40%; versus group B (73.3%). Complete response (CR) occurred in group A cases (20%); versus 33.3% in group B; whereas partial response (PR) occurred in 3 cases of group A; versus 6 cases of group B; and treatment failure (TF) occurred in 9 of group A cases versus 4 of group B cases. None of our patients died. Morbidity occurred in the form of mild-to-moderate.The success of the pleurodesis was closely-associated with higher glucose and pH levels together with a low LDH level in the pleural fluid.Conclusion: The success of pleurodesis is usually higher when the pleural fluid pH and glucose levels are high & the LDH level is low in MPE.
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