I. Gasim

Severe Plasmodium vivax malaria among sudanese children at New Halfa Hospital, Eastern Sudan

BackgroundThere are few published reports on severe Plasmodium vivax malaria in Africa.MethodsClinical pattern/manifestations of severe P. vivax were described in children admitted at New Halfa Hospital in Sudan between September 2009-December 2011.ResultsEighteen children were admitted at the hospital during the study period with different manifestations of severe P. vivax malaria namely: severe anaemia (6, 33.3%), jaundice (5, 27.8%), thrombocytopenia (4, 22.2%), hypotension (3, 16.7%), cerebral malaria (2, 11.1%), epistaxis (2, 11.1%), renal impairment (1, 5.5%), hypogylcaemia and more than one manifestation (5, 27.8%).By day 2, all patients were asymptomatic, a parasitaemic and had started oral quinine and primaquine. There was no death among these patientsConclusionSevere P. vivax malaria is an existing entity in eastern Sudan. Further studies are required to understand emergence of severe P. vivax malaria.

Artesunate plus sulfadoxine/pyrimethamine versus praziquantel in the treatment of Schistosoma mansoni in eastern Sudan

The efficacy and safety of oral artesunate+sulfadoxine/pyrimethamine (AS+SP) (4 mg/kg AS for 3 consecutive days+25 mg sulfadoxine on Day 0) in the treatment of Schistosoma mansoni infections were compared with those of praziquantel (PZQ) (40 mg/kg) among infected schoolchildren (46 in each study arm) in eastern Sudan. The cure rate at 28 days was 58.6% in the AS+SP group and 100% in the PZQ group (P<0.001). While drug-related adverse effects (headache, dizziness, nausea and diarrhoea) were not significantly different between the two groups, significantly more children suffered abdominal pain in the PZQ group than in the AS+SP group (P=0.001). Thus, AS+SP has poor efficacy in the treatment of S. mansoni compared with PZQ.

Schistosoma haematobium infections among schoolchildren in central Sudan one year after treatment with praziquantel

BackgroundChemotherapy with praziquantel (PZQ) is the mainstay of schistosomiasis control. However, there are recent concerns about tolerance or resistance to PZQ, so that monitoring its efficacy in different settings is required.MethodsA longitudinal study was conducted to evaluate the impact of PZQ for the treatment of Schistosoma haematobium infection among schoolchildren at Al Salamania, Central Sudan. Parasitological examinations for S. haematobium were performed in a cohort of schoolchildren (6–15 years of age) before and 1 year after treatment with a single dose of PZQ 40 mg/kg.ResultsOut of 562 (309 boys and 253 girls) schoolchildren recruited from three elementary schools, 420 completed one longitudinal dataset that comprised of data from two time points; baseline, and follow-up 1 year after treatment with a single dose of PZQ 40 mg/kg for S. haematobium infection. A single dose of PZQ significantly reduced the prevalence of S. haematobium infection by 83.3% (from 51.4% to 8.6%) and the geometric mean intensity of infection of positive individuals by 17.0% (from 87.7 to 72.8 eggs/10 ml of urine) 1 year after treatment. While there was no significant difference in the reduction of the prevalence of S. haematobium infection between the gender or age groups, there was a significantly higher reduction of intensity of S. haematobium infection among girls in comparison with boys.ConclusionThere was a significant reduction of S. haematobium infection 1 year after PZQ treatment in this setting.

Hepatitis B and C virus infections among pregnant women in Arab and African countries.

INTRODUCTION The epidemiology of viral hepatitis during pregnancy is of paramount importance for health planners and program managers. Data on viral hepatitis during pregnancy are not readily available in many African and Arab countries. Both regions have their own unique geography, and comprise over 59 states with crossover and interaction of different cultures. METHODOLOGY A systematic electronic search of the published literature was conducted and data on epidemiology and risk factors of maternal hepatitis B virus (HBV) infection and hepatitis C (HCV) infection in Arab and African countries were extracted from relevant studies. RESULTS The serology of hepatitis viruses varies greatly among these countries, with different viral genotype patterns. Such a variation in prevalence could be explained by the different risk factors involved. Sexual contact, perinatal infection, blood and its derivatives, hemodialysis, intravenous and percutaneous drug use, and occupational, habitual, and social behavior have been identified as risk factors for hepatitis transmission in various settings in these countries. CONCLUSIONS Infection from hepatitis B and C viruses imposes major socioeconomic and even political burdens on such young and dynamic societies. Thus strategies and clear policies of intervention are required to combat the consequences of hepatitis B and C at both the regional and national levels.

Epidemiology of hepatitis B and hepatitis C virus infections among hemodialysis patients in Khartoum, Sudan

The epidemiology of hepatitis B virus (HBV) and hepatitis C virus (HCV) is important for health planners and service providers. A cross‐sectional study was conducted to investigate the seroprevalence and associated risk factors for markers of HBV (HBsAg) and anti‐HCV among hemodialysis patients at the Ahmed Gasim hemodialysis unit, Sudan. Structured questionnaires were used to obtain socio‐demographic data and sera were tested for hepatitis B surface antigen (HBsAg) and antibody to HCV (anti‐HCV). Of the 353 patients enrolled in the study, HBsAg and anti‐HCV were detected in 16 (4.5%) and 30 (8.5%) patients, respectively. None of the patients were co‐infected with HBV and HCV. Multivariate analysis showed that duration of dialysis was significantly associated with anti‐HCV seropositivity [OR = 1.1, 95% CI = 1.2–1.3; P = 0.024]. No other socio‐demographic or clinical characteristics (age, sex, level of education, history of surgery, and number of units of blood transfused) were significantly associated with HBsAg or anti‐HCV seropositivity. The results of this study suggest that HBsAg and anti‐HCV have low prevalence among hemodialysis patients in Khartoum. Longer duration of dialysis was a risk factor for anti‐HCV. J. Med. Virol. 84:52–55, 2011.

Accuracy of tympanic temperature measurement using an infrared tympanic membrane thermometer

BackgroundDuring investigation and diagnosis of patients, accurate temperature measurement is of great importance. The advantages of tympanic membrane thermometry are speed (temperature reading available within seconds), safety, and ease of use. The aim of this study was to compare the accuracy of infrared tympanic thermometers in comparison to mercury thermometers in measurement of body temperature.MethodsAxillary and tympanic temperature was measured simultaneously in consecutive patients using mercury glass and infrared tympanic thermometers at Omdurman Hospital, Sudan during October 2012.ResultsIn total, temperature was measured in 174 patients, 95 of whom (54.6%) were male. The mean (SD) patient age and weight was 33.18 (25.07) years and 52.13 (69.85) kg. There was no significant difference in mean (SD) temperature measurement between mercury and infrared tympanic membrane thermometers, 37.29°C (0.91) versus 37.38°C (0.95), P = 0.373, respectively. There was a significant positive correlation between axillary and tympanic body temperature measurements (r = 0.697, P < 0.001). The mean difference between the two readings (with limits of agreements) was - 0.093 (−0.20; 0.02) °C.ConclusionIn this study, tympanic membrane thermometry is as reliable and accurate as axillary mercury glass thermometry. Thus, tympanic thermometry can be used in clinical practice, especially in the emergency setting, where ease of use and speed of obtaining the temperature reading are important.

Red blood cell distribution width and iron deficiency anemia among pregnant Sudanese women

BackgroundIron deficiency anemia (IDA) is a major health problem during pregnancy and it has adverse effects on the mother and the newborn. Red cell distribution width (RDW), which is a quantitative measure for red cell size variation (anisocytosis), is a predictor of IDA. Little is known regarding RDW and IDA during pregnancy.MethodsA cross sectional study was conducted at the antenatal clinic of Khartoum Hospital, Sudan, to determine the performance of RDW in the diagnosis of IDA using serum ferritin as a gold standard.ResultsAmong 194 pregnant women with a gestational period of 21.4 ± 6.5 weeks, 57 (29.4%) had IDA according to serum ferritin levels (<15 μg/l) and 61 (31.4%) had IDA according to RDW (>14.5). The sensitivity, specificity, positive predictive value, and negative predictive value of RDW where serum ferritin was the gold standard were 43.8% (95% CI: 31.4–57.0%), 73.7% (95% CI: 65.8–80.5%), 41.0% (95% CI: 29.2–53.6%), and 76.0% (95% CI: 68.1–82.6%), respectively.ConclusionsIn this study, we found that RDW has a poor performance in diagnosing IDA among pregnant women compared with serum ferritin as the gold standard.Virtual slidesThe virtual slides for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1721072967826303

Antenatal iron and folic acid supplementation use by pregnant women in Khartoum, Sudan

BackgroundAnaemia during pregnancy can lead to adverse maternal and perinatal outcomes. The WHO recommends that all pregnant women in areas where anaemia is prevalent receive supplements of iron and folic acid. However, due to many factors, the use of iron and folic acid supplementation is still low in many countries. This study was conducted to assess the rates of iron-folic supplementation and the associated factors during pregnancy and the effects of taking iron-folic acid supplementation on rates of maternal anaemia and low birth weight (LBW) infants.MethodsA cross-sectional study was conducted at Khartoum Hospital, Sudan. Enrolled women answered a questionnaire on socio-demographics characteristics, their pregnancy and delivery.ResultsOf 856 women, 788 (92.1%) used iron-folic acid supplementation during pregnancy and 65.4% used folic acid. While place of residence, occupation and level of education were not associated with iron-folic acid usage, older age (OR = 3, CI = 1.4–6.3) and use of antenatal care (OR = 14.3, CI = 7.4–27.5) were associated with iron-folic acid use. Primiparity (OR = 3.8, CI = 1.9–7.6), maternal employment (OR = 3.9, CI = 2.25–6.77) and use of antenatal care (OR = 7.9, CI = 4.1–15) were the factors associated with folic acid. Using iron-folic acid was protective against anaemia (OR = 0.39, CI = 0.2–0.7) and LBW infants (OR = 0.3, CI = 0.17–0.68).ConclusionThere was a high rate of iron-folic acid supplementation use among pregnant women in Khartoum, Sudan, which was beneficial in preventing anaemia in expectant mothers and infants of LBW.

Red blood cell distribution width is not correlated with preeclampsia among pregnant Sudanese women

BackgroundPreeclampsia is a leading cause of maternal and perinatal mortality worldwide. The exact etiology of preeclampsia is unknown, but the inflammatory process is postulated as one of the etiologies. Red blood cell distribution width (RDW) is a measure of anisocytosis (variation of red cell size) and is associated with hypertension and diabetic ketoacidosis. There are few data on the association between RDW and preeclampsia. This study aimed to investigate the association between RDW and preeclampsia.MethodsA case–control study was conducted at Khartoum Hospital, Sudan, during June to August 2012. Cases were women with preeclampsia and healthy women were controls. Sociodemographic characteristics, obstetrics, and clinical data were recorded. The complete blood count, including RDW, was measured using an automated hematology analyzer.ResultsThe cases and controls (65 women in each arm) were matched in their basic characteristics. There was no difference in the mean (SD) RDW between women with preeclampsia and controls (14.5 ± 1.8% vs. 14.4 ± 1.4%, P = 0.710). There was also no difference in the mean RDW between women with mild and severe preeclampsia (14.7 ± 1.9% vs. 13.9 ± 1.4%, P = 0.144. In logistic regression, there was no association between RDW and preeclampsia (OR = 0.9, CI = 0.7–1.1, P = 0.952).ConclusionsRDW levels are not associated with the presence or severity of preeclampsia.Virtual slidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1206247718115175

Hepatitis B virus in the Arab world: Where do we stand?

The epidemiology of viral hepatitis is of great importance for planning and managing health provision for all the countries in the Arab world. However, data on viral hepatitis are not readily available in a large percentage of Arab countries. Hepatitis B virus (HBV) is considered to be one of the most important causes of chronic hepatitis, cirrhosis and hepatocellular carcinoma. A systematic electronic search of published literature was conducted to extract data on epidemiology and risk factors for the analysis of HBV infection among the countries in the Arab world. The prevalence of chronic HBV infection was found to be decreasing in some Arab countries although it was still unacceptably high. This was particularly evident in the Arabian Gulf region, in Lebanon, Egypt and Libya. The age-specific prevalence varied from country to country with decline in prevalence being noted among children in the Gulf States and among Libyan women. These declines in prevalence are most likely to be related to the Expanded Immunization Programme. The alarmingly high prevalence of chronically infected patients in some areas and the widespread differences in HBV prevalence between Arab nations may be explained by the variation in risk factors involved. This situation calls for targeted approaches to tackle HBV-related mortality and morbidity. Precise HBV infection prevalence data are needed at the national and the sub-national level to estimate the disease burden, guide health intervention programmes and evaluate vaccine efficiency.