Molecular typing of Mycobacterium spp. isolates from Yemeni tuberculosis patients

This study was done to characterize at the species level Mycobacterium spp. isolates from Yemeni pulmonary tuberculosis patients. Early-morning sputum samples were collected from 170 patients referred to the National Tuberculosis Institute in Sana'a city with suspected pulmonary tuberculosis. Samples were processed with Ziehl-Neelsen stain and cultured in Ogawa and Lowenstein-Jensen media. The rpoB gene target sequence was amplified using mutagenesis forward and reverse primers followed by Hindlll enzyme digestion. Of the 120 isolates analysed, 118 [98.3%] were identified as M. tuberculosis complex and 2 [1.7%] were identified as mycobacteria other than M. tuberculosis. The results showed that those 2 isolates were multi-drug resistant and the DMA sequencing analysis showed that the alignment of nucleic acid of DNAin isolates of mycobacteria other than M. tuberculosis was different from that of M tuberculosis complex

Cerebral malaria in adult patients in the Sudan: clinical presentation and outcome

In endemic areas adults are less vulnerable to cerebral malaria [CM] than children because of acquisition of partial immunity. This prevalence difference is one of the reasons why we see fewer epidemiological and case studies in adult CM. The objective of this study was to determine the clinical presentation and outcome of CM in adult Sudanese patients. A prospective hospital-based study was conducted in Khartoum Teaching Hospital. Thirty adult Sudanese patients presenting with CM conforming to the World Health Organization [WHO] definition of the disease were recruited. Their presenting features, laboratory investigations and clinical outcome were documented and studied. The mean age at presentation was 32.2 years +/- 15.4 SD. Nineteen patients [63.3%] were males and 11 [36.7%] were females. The predominant initial symptoms of CM were fever, excessive sweating, headache, nausea and vomiting. Before lapsing into coma, 15 patients [50%] manifested psychotic symptoms and 14 [46.7%] developed generalized convulsions. The neurological manifestations appeared after an average of six days from the onset of the febrile illness and reached its nadir within 24 hours. The level of coma was often deep, and 56.6% of patients had scored

Humoral immune IgG response to Plasmodium falciparum in adults: the role of subclass-IgG in clinical immunity to cerebral Malaria

Although antibodies are essential mediators of immunity, high levels of IgG antibodies against a wide range of blood-stage antigens of P. falciparum are poor predictors of clinical protection. It is the qualitative and the functional specificity of the antibodies to malaria antigens that predict the development of a clinically potent protective immunity. The objective of this work is to study the pattern of IgG sub-class in healthy and malaria-infected adults resident in a malaria-endemic area in Sudan. Total plasma IgG and IgG subclasses [IgG1, 2, 3 and 4] against the C-terminal region of the MSA-1[19] antigen of Plasmodium falciparum were measured by a quantitative enzyme-linked immunosorbent assay [ELISA] in 30 adult patients presenting to the emergency department with cerebral malaria [CM]. The levels of IgG antibody profile in CM patients were compared with those in patients with uncomplicated acute malaria [n=20] and in clinically healthy asymptomatic volunteers [n=20]. Total plasma IgG level was significantly higher in CM patients. The level of the sub-class IgG1 antibody against MSA-119 was significantly lower in patients infected with P. falciparum; the lowest values being observed in CM patients and the highest values in the clinically healthy volunteers. Our data suggest that acquisition of IgG1 antibody to MS A-1[19] is associated with a clinically protective immunity and that low production or defective IgG1 response may be associated with severe form of malaria in adults

Antifungal activity of calendula officinalis flowers

The in vitro antifungal activity of Calendula officinalis Linn, flowers extract [ethanol 95%] was studied against Candida albicans, Candida tropicalis, Aspergillus flavus, Aspergillus niger, Malassezia furfur [strain No. 1374], and Malassezia furfur [strain No. 1765]. The ethanol extract showed considerable and statistically significant activity against all test fungal strains. The inhibitory effect of the ethanol extract is very close and identical in magnitude and comparable with the standard antifungal agent used. Thus justifying its use as natural antifungal agent in traditional medicine

unusual case of mucosal leishmaniasis with cutaneous dissemination in Sudan and its epidemiological significance

Sudan is endemic for visceral, cutaneous and mucosal leishmaniasis. The latter is the least common of the three forms of leishmaniasis. It is caused by L. donovani, the same parasite that causes visceral leishmaniasis [VL] in the country. Most of the cases were reported from VL endemic areas, the majority in adults. The disease may be primary in the oral and or the upper respiratory mucosa or may follow or accompany visceral leishmaniasis. This paper is a report of a case of mucosal leishmaniasis of the nose and lips. It is unusual in several aspects: the disease was acquired in a village where no cases of VL or mucosal leishmaniasis were recorded within living memory, before an outbreak in 1981 during which the patient was infected; the patient was infected at the age of five years and the disease remained active for 22 years causing physical deformity and psychological trauma to the patient

Prognostic factors in the management of exacerbation of chronic obstructive pulmonary disease in Kuwait

To evaluate the clinical presentation and the factors of prognostic importance in the management of exacerbation of chronic obstructive pulmonary disease [COPD]. Subjects and One hundred and four patients who were hospitalized because of exacerbation of COPD between 1996 and 2000 were selected for further evaluation. Only patients who fulfilled the American Thoracic Society criteria for diagnosis of COPD were included. The factors examined included age, clinical features, duration of symptoms of exacerbation, severity of underlying disease, comorbid diseases, level of consciousness, previous hospitalization, intubation and assisted ventilation, hypercapnia, degree of acidemia and complications. Seventy-four of 104 [71%] hospitalized patients reviewed met the inclusion criteria for COPD. The mean age was 63.68 ' 12.6 years. There was a male:female ratio of 3:1. Fifty-eight patients [78%] had a baseline FEV1 <50% before hospitalization and 45 [64%] had previous hospitalization. Comorbid disease was found in 50% of the cases, while 78% had acidemia and 70% hypercapnia. Fourteen [19%] died on admission. Risk factors identified included severity of disease [p < 0.05]; presence of comorbid disease [p < 0.01]; acidemia [p < 0.0001]; hypercapnia [p < 0.0001]; previous hospitalization [p < 0.01], and assisted ventilation [p < 0.001]. This study revealed that the presence of comorbid disease, acidemia, previous hospitalization and assisted ventilation significantly contributed to mortality in patients with exacerbation of COPD.

Surgical treatment of thoracic and lumbar tuberculosis by anterior interbody fusion and posterior instrumentation

To evaluate the efficacy and clinical outcome of simultaneous or sequential anterior and posterior surgical approaches in the management of spinal tuberculosis in the form of anterior extirpation of the tuberculous lesion, strut bone grafting of the defect produced and posterior instrumentation for spinal fixation. Subjects and Twenty-two patients who had tuberculosis of the thoracic and lumbar spine with moderate to severe localized kyphosis and variable degrees of neurological deficits were treated at Al Razi Hospital [Kuwait] in the period from 1998 to 2000 by anterior debridement and autogenous strut bone grafting with simultaneous or staged posterior spinal fixation using either USS or SOCON spinal instrumentation. Appropriate antituberculosis treatment was given to all patients for 9-12 months. The postoperative follow-up period was 18 months. Of the 22 cases the average of preoperative kyphosis was 42°. The average of immediate postoperative correction was 27°. At the last follow-up the average correction was 24° and the loss of correction did not exceed 3°. Average fusion times were 5 months for one-segment fusions and 8 months for two-segment fusions. There was no recurrence of the disease in any of the cases. Posterior instrumental stabilization and anterior interbody fusion were found to be effective in arresting the disease, correcting kyphotic deformity and maintaining correction until solid spinal fusion

Antimony-resistant Leishmania donovani in eastern Sudan: incidence and in vitro correlation

A longitudinal study was done in a leishmaniasis -endemic region in eastern Sudan during the period November 2001-February 2003 to determine the incidence of failure of sodium stibogluconate treatment. We studied 820 confirmed visceral leishmaniasis patients. All were treated with sodium stibogluconate, 20 mg/kg body weight for at least 28 days. Parasites were isolated from lymph node aspirates from 22 participants identified as relapsed patients. All isolates were typed as Leishmania donovani based on polymerase chain reaction [PCR] amplification of parasite kDNA. Six parasites showed in vitro resistance to sodium stibogluconate using murine J774 macrophage amastigote testing method. The resistant isolates showed different restriction profiles when the amplified kDNA PCR products were digested with ALU1 restriction enzyme, indicating that resistance was mediated by different parasite clones

Effects of single-dose praziquantel on morbidity and mortality resulting from intestinal schistosomiasis

The long-term effect of single-dose praziquantel on morbidity and mortality from Schistosoma mansoni was investigated in surveys in 1987 and 1994 in central Sudan. Prevalence of infection dropped from 53% to 34%, and intensity of infection [400 eggs/g of faeces] from 31% to 18%. There was a reduction in hepatomegaly and hepatosplenomegaly, although splenomegaly alone was unchanged. Prevalence of periportal fibrosis decreased from 14% to 10%. Endoscopic investigation of patients with fibrosis showed a reduction in oesophageal varices from 47% to 30%. Mortality due to bleeding varices was high [community-wide, up to 11/100 infected patients with bleeding]. Thus praziquantel mass treatment can be spaced to a much longer period, reducing the expense of treatment, delivery and distribution

Down's syndrome with coexistent gout in 2 patients: Is the association under reported or is the prevalence actually increasing?

This report describes 2 patients diagnosed with Down's syndrome and who developed acute gouty arthritis. While hyperuricemia in gout is a well-known abnormality, association of gout with Down's syndrome has not been widely discussed. With increasing life expectancy in this syndrome, it is likely that more such cases will occur. For early diagnosis and proper management clinicians must be aware of this association

Comparative study between open cholecysectomy and laparoscopic cholecystectomy

In this study, the results of 350 patients underwent laparoscopic cholecystectomy [LC], were compared with those of 420 patients on whom open cholecystectomy [OC] was performed, in Banha University Hospital. Laparoscopic cholecystectomy patients included cases presented as symptomatic chronic calcular cholecystitis [96.3%] and acute cholecystitis [3.7%], while OC patients included cases with both chronic [74%] and acute cholecystitis [18.6%] and common bile duct stones [7.4%]. The mean operative time was significantly longer in LC. This procedure was completed in 325 out of 350 patients, while converted to open in 25 patients [7.1%], with fewer complications in 20 patients [5.7%]. The mean postoperative stay was significantly shorter in LC. No mortality was reported in both groups, while the complication rate was 5.7% in LC and 9% in OC