Magdi M Salih

ABO blood group system and placental malaria in an area of unstable malaria transmission in eastern Sudan

BackgroundUnderstanding the pathogenesis of malaria in pregnancy and its consequences for both the mother and the baby is fundamental for improving malaria control in pregnant women.AimThe study aimed to investigate the role of ABO blood groups on pregnancy outcomes in an area of unstable malaria transmission in eastern Sudan.MethodsA total of 293 women delivering in New Half teaching hospital, eastern Sudan during the period October 2006–March 2007 have been analyzed. ABO blood groups were determined and placental histopathology examinations for malaria were performed. Birth and placental weight were recorded and maternal haemoglobin was measured.Results114 (39.7%), 61 (22.1%) and 118 (38.2%) women were primiparae, secundiparae and multiparae, respectively. The ABO blood group distribution was 82(A), 59 (B), 24 (AB) and 128 (O). Placental histopathology showed acute placental malaria infections in 6 (2%), chronic infections in 6 (2%), 82 (28.0%) of the placentae showed past infection and 199 (68.0%) showed no infection. There was no association between the age (OR = 1.02, 95% CI = 0.45–2.2; P = 0.9), parity (OR = 0.6, 95% CI = 0.3–1.2; P = 0.1) and placental malaria infections. In all parity blood group O was associated with a higher risk of past (OR = 1.9, 95% CI = 1.1–3.2; P = 0.01) placental malaria infection. This was also true when primiparae were considered separately (OR = 2.6, 95% CI = 1.05–6.5, P = 0.03).Among women with all placental infections/past placental infection, the mean haemoglobin was higher in women with the blood group O, but the mean birth weight, foeto-placental weight ratio was not different between these groups and the non-O group.ConclusionThese results indicate that women of eastern Sudan are at risk for placental malaria infection irrespective to their age or parity. Those women with blood group O were at higher risk of past placental malaria infection.

Placental malaria and lack of prenatal care in an area of unstable malaria transmission in eastern Sudan.

Abstract A cross-sectional study was conducted in Gadarif Hospital in eastern Sudan to determine the prevalence, and evaluate the risk factors, of placental malaria. Two hundred and thirty-six delivering women were enrolled in the study. Socio-demographic characteristics were gathered through questionnaires. Maternal hemoglobin was measured, ABO blood groups were determined, and placental histological examinations for malaria were performed. The birth weight of the newborn was also recorded. The mean (SD) maternal age was 25.5 (6.0) yr and the mean (SD) hemoglobin was 9.8 (0.9) g/dl. Placental histology showed acute malaria infections in 13 (5.5%) and chronic infections in 5 (2.1%) women; 28 (11.9%) of the placentas revealed past infection and 190 (80.5%) indicated no infection. Lack of prenatal care was significantly associated with placental infections (OR = 12.0, 95% CI = 2.3–16.2; P = 0.003). There was no significant association between placental malaria infections and maternal age, parity, and blood group. Thirty-two (13.5%) of these pregnancy outcomes resulted in low birth-weight babies. There was, however, no significant association between placental malaria and low birth weight (OR = 2.0, 95% CI = 0.4–4.1; P = 0.1). Thus, placental malaria infections affect pregnant women in this area of eastern Sudan regardless of their age or parity. Prenatal care should be encouraged to reduce malaria in the area. Much more research regarding malaria and pregnancy is needed.

Anaemia, folate and vitamin B12 deficiency among pregnant women in an area of unstable malaria transmission in eastern Sudan.

A cross-sectional study was carried out between October 2007 and January 2008 to investigate the prevalence and types of anaemia among pregnant women of eastern Sudan. Socio-demographic and obstetrical data were collected using a questionnaire. Haemoglobin (Hb), serum ferritin, serum folate and vitamin B(12) were assessed using standard laboratory methods. Two hundred and seventy-nine pregnant Sudanese women were recruited. Anaemia (Hb <11 gdl) and iron deficiency (ferritin <15 microg/l) were prevalent in 80.3 and 14.3% of the study sample, respectively. Of the total sample, 11.1% had iron-deficiency anaemia. Serum folate (<6.6 ng/ml) and vitamin B(12) (<150 pg/ml) deficiency was reported in 57.7 and 1%, respectively, and none of the women had both folate and vitamin B(12) deficiencies. Univariate and multivariate analyses showed that ferritin, serum folate and vitamin B(12) levels were not significantly associated with anaemia. Thus, there was a high prevalence of anaemia and folate deficiency. Measures to control these should be considered.

Malaria and pre-eclampsia in an area with unstable malaria transmission in Central Sudan

BackgroundPlacental malaria and pre-eclampsia occur frequently in women in tropics and are leading causes of maternal and perinatal morbidities and mortality. Few data exist concerning the interaction between placental malaria and pre-eclampsia.MethodsA case control study was conducted in Medani Hospital, which locates in an area of unstable malaria transmission in Central Sudan. Case (N = 143) were women with pre-eclampsia, which was defined as systolic blood presure≥140 mm Hg or diastolic blood pressure ≥ 90 mm Hg and proteinuria. Controls were parturient women (N = 143) without any blood pressure values > 139/89 mm Hg or proteinuria. Obstetrical and medical characteristics were gathered from both groups through structured questionnaires. Placental histopathology examinations for malaria were performed.ResultsTwenty-eight (19.6%) vs. 16 (11.2%); P = 0.04 of the cases vs. controls, had placental malaria infections. Five (2%), 1 (2%) and 22 (28.0%) vs. 1, 2 and 13 of the placentae showed acute, chronic and past infection on histopathology examination in the two groups respectively, while 115 (80.4%) vs.127 (88.8%) of them showed no infection, P = 0.04. In multivariate analysis, while there were no associations between age, parity, educational level, lack of antenatal care, blood groups and body mass index and pre-eclampsia; family history of hypertension and placental malaria (OR = 2.3, 95% CI = 1.0-5.2; P = 0.04) were significantly associated with pre-eclampsia.ConclusionPlacental malaria was associated with pre-eclampsia. Further research is needed.

Genotypes of human papilloma virus in Sudanese women with cervical pathology.

BackgroundKnowledge of the distribution of human papillomavirus (HPV) genotypes among women with cervical lesion and in invasive cervical cancer is crucial to guide the introduction of prophylactic vaccines. There is no published data concerning HPV and cervical abnormalities in Sudan. This study aimed to define the prevalence of HPV and its subtypes in the cervical smears of women presenting with gynecological complains at Omdurman Military Hospital, Sudan.During the period between March 2003 and April 2004, 135 cervical smears collected from these women, were screened using cytological techniques, and analysed by PCR for (beta)-globin and HPV DNA using gel electrophoresis and ELISA.ResultsOf these 135 smears, there were 94 (69.3%) negative, 22 (16.3%) positive for inflammation, 12(8.9) mild dyskaryosis, 5 (3.7) moderate dyskaryosis and 2 (1.8) severe dyskaryosis. There were 60.7% ß. globin positive samples for HPV indicating DNA integrity. HPV DNA was identified in three samples (2.2%) by gel electrophoresis and. was positive in four samples (2.9%) as single and multiple infections by PCR-ELISA. The high risk HPV types 16 and 58 were identified in one sample as a mixed infection. The low risk HPV types 40 and 42 were also found as a mixed infection in another patient. HPV types 58 and 42 were identified in the other two patients.ConclusionHPV type distribution in Sudan appears to differ from that in other countries. The HPV genotypes identified were not associated with cancer.

The effect of fixatives and temperature on the quality of glycogen demonstration

Abstract Glycogen is demonstrated in a number of lesions and is diagnosrically significant, particularly in certain tumors. To stain glycogen accurately, it is essential to choose a suitable fixative, temperature and staining method. We used rabbit liver to assess these variables. Specimens were fixed in three fixatives at two temperatures: 10% formalin, neutral buffered formalin (NBF) and Bouins solution at 37 and 4°C. Seventy-two paraffin sections were prepared and stained with periodic acid-Schiff (PAS), hexamine (methenamine) silver and Bests carmine methods. Negative control sections using diastase digestion were used for all methods to confirm the presence of glycogen. For the PAS reaction, Bouins fixative gave better results at both temperatures compared to the other fixatives. For hexamine (methenamine) silver, the quality of staining was improved for tissues fixed in both 10% formalin and NBF at 37°C compared to Bouins solution. Both 10% formalin and NBF at 4°C gave better results than Bouins solution. For Bests carmine, Bouins solution gave the best results for tissues fixed at 4°C. Fixation of tissues with NBF at 37°C gave the best quality staining. We concluded that the quality of glycogen staining in paraffin sections is greatly affected by both the fixative and the temperature of fixation.

Polymerase chain reaction and histology in diagnosis of placental malaria in an area of unstable malaria transmission in Central Sudan

BackgroundPrevalence of placental malaria has been widely used as a standard indicator to characterize malaria infection in epidemiologic surveys. Placental malaria poses a greater diagnostic challenge, accurate and sensitive diagnostic tool for malaria infections in pregnancy is needed.MethodsA cross sectional study was conducted at Medani Hospital, which serves catchment area which is characterized by unstable malaria transmission. One hundred and seven placentae were investigated for malaria infection using polymerase chain reaction (PCR) and histology.Resultsout of 107 investigated placentae, 33 (30.8%) and 34 (31.8%) were positive for malaria by histology (two (2%) and 31(29.0%) were acute and past infections, respectively) and PCR, respectively. Out of 33 positive by histology, 15 were positive by the PCR while 18 were negative. The sensitivity of the PCR was 45.5% (95% CI: 29.2%- 62.5%). Out of 74 which were negative by histology, 19 were positive by the PCR. This is translated in specificity of 74.3% (95% CI: 63.5%- 83.3%). Of those tested positive by the PCR, 15 were positive by the histology, while 19 were negative. This is translated into a positive predictive value of 44.1% (95% CI: 28.3%- 61.0%). Of those 73 tested negative by the PCR, 55 were negative according to histology while 23 were positive. This is translated into a negative predictive value of 75.3% (95% CI: 64.5%-84.2%).ConclusionPCR had low sensitivity and specificity in comparison to placental histology, perhaps because the vast majority of the placental infections were past infections. Further research is needed.

Monocytes and macrophages and placental malaria infections in an area of unstable malaria transmission in eastern Sudan

BackgroundMaternal immunity is thought to play a major role in the increased susceptibility of pregnant women to Plasmodium falciparum malaria. Few studies exist on immunohistochemical characterization of the placental inflammatory infiltrate. The current study was conducted in Gadarif hospital in an area characterized by unstable malaria transmission in eastern Sudan.MethodNinety three placentae were investigated for malaria histological changes and immunohistochemical study for monocytes and macrophages (CD68).ResultsWhile 1(1.1%), 2(2.2%) and 20(21.5%) of the 93 placentae had acute, chronic and past malaria infections, 70(75.2%) had no malaria infections. Monocytes and macrophage (CD 68) were detected in 29 (31.2%) of these 93 placentae. Significantly higher rate of monocytes and macrophage were detected in placentae with malaria infections [11/23 (47.8%) vs. 18/70 (25.7%); P = 0.047] especially in placentae with past malaria infections. Placental malaria infections and monocytes and macrophages cells infiltration were not different between primiparae and multiparae. There was no significant difference in the birth weight between the women with placental malaria infections/monocytes and macrophages cells infiltration and those who had no placental malaria infections/cellular infiltrations.ConclusionSignificantly higher rate of monocytes and macrophage were detected in placentae with malaria infections. Neither placental malaria infections nor cellular infiltrates were associated with parity or lead to reduction of birth weight.

Decreased susceptibility to placental malaria in anaemic women in an area with unstable malaria transmission in central Sudan

Abstract The interaction between iron level, iron supplementation, and susceptibility to infection, including malaria, remains a concern. A cross-sectional study was conducted at Medani hospital in central Sudan to investigate the relationship between anaemia and placental malaria. Obstetrical history was obtained; haemoglobin levels were determined. Placental tissue was obtained and malaria histology classified as active, chronic, past or no malaria infection. Among 324 women investigated, 7 (2·2%), 4 (1·2%), and 44 (13·6%) of the placentae showed active, chronic and past infection on histology examination respectively, while 269 (83·0%) of them showed no infection. Anaemia (haemoglobin <11 g/dl) was less frequent in women with placental Plasmodium falciparum infection, 27/55 (49·1%) vs 174/269 (64·7%), P = 0·02. Anaemia was associated with a decreased risk for placental malaria, and the odds ratio for placental malaria (in both primiparae and multiparae group) was 0·2, 95% CI: 0·1–0·6, P = 0·002 and it was 0·2, 95% CI: 0·03–0·7; P = 0·02 for primiparae group. Thus, there is a strong relationship between anaemia and the absence of placental malaria.

Frequency of Candida species in Papanicolaou smears taken from Sudanese oral hormonal contraceptives users.

The aim of our study was to compare the numbers of Candida detected in Pap smears from Sudanese users of oral contraceptives (OCs) with non-users of OCs. The frequency of Candida observed in Pap smears was assessed among 158 Sudanese women of whom 108 were OCs users, subsequently termed cases, and the remaining 50 who were not OCs users, subsequently termed controls. Of the 158 smears, Candida were observed in 28 (17%) of the study subjects of whom 27 (25%) were OCs users compared to 1 (2%) among non-OCs users. We concluded that OCs may increase the number of Candida present, which suggests that OCs users may be more prone to infection by cervico-vaginal Candida compared to non-OCs users. The exact role of OCs use as a risk factor for candidiasis requires further assessment using a larger sample size and more precise mycological techniques.