Hepatitis B virus, hepatitis C virus and human immunodeficiency virus infections among pregnant women in central Sudan

The epidemiology of viral hepatitis and Human immunodeficiency virus [HIV] during pregnancy is of great importance for health planners and program managers. However, few published data on viral hepatitis and HIV are available in Sudan especially during pregnancy. The current study was conducted to investigate seropositivity of hepatitis B, hepatitis C, and HIV among pregnant women in central Sudan. A cross sectional study was conducted where 396 pregnant women were investigated for the presence of hepatitis B, C and HIV. Enzyme linked immunosorbent assay [ELISA] was used to detect HBsAg and anti-HCV. Antibodies to HIV were detected by three different methods as per Strategy III of the National AIDS Control Organization by utilizing different systems of testing to make a diagnosis of HIV. Twenty [5.1%], five [1.3%], and six [1.5%] women were seropositive for HBsAg anti- HCV antibodies and HIV, respectively. One [0.003 %] woman was seropositive for both HBsAg and anti-HCV antibodies. While age, parity, were not associated with seropostivtiy of HBsAg, home delivery was the only significant risk factor for seropostivtiy of HBsAg [OR=4.5 [95% CI=1.2-16.7] Prevalence of HBV and HCV among pregnant women in this setting is in the intermediate zone of endemicity. This is alarming and should draw medical authorities' attention if vertical transmission is to be reduced

Hysteroscopic endometrial resection in the management of abnormal uterine bleeding among Libyan women

Abnormal uterine bleeding [AUB] is a major health problem and it is a substantial cause of ill health in women. Medical treatment has a high failure rate and adverse effects. There are few published data on hysteroscopic endometrial resection [HER] in the management of patients with AUB. To investigate the efficacy and outcomes of hysteroscopic endometrial resection [HER] in patients with AUB. A descriptive hospital - based study was carried out at the departments of Obstetrics and Gynecology, Misurata and Sirt, Libya, during the period from January 2009 to December 2013. Women with AUB were recruited in the study. All women had a detailed medical and obstetrical history, physical examination and the hysteroscopic endometrial ablation and were followed-up for success or failure of the procedure which was assessed via symptoms [bleeding]. A total of 120 women with mean [SD] of age and parity of 42.3 [6.8] years and 3.8 [2.4], respectively were recruited in the study initially. Thirty [25%] of these women were lost of followup Therefore, only 70 women [50 with DUB, and 20 women with fibroids] were available for the final analysis. All women underwent hysteroscopic endometrial resection and 28 of them had hysteroscopic myomectomy. The success rate was 92.8% [65/70] after 2 years follow up. All the five women with failure of the procedure were younger [<40 years]; had bleeding with dysmenorrhea, bigger uterine size, thicker endometrium [> 7 mm] and they had fibroids. Endometrial resection is an effective procedure in the majority of women with AUB, especially in those over age of 40 and without an increase in uterine size and has no fibroids

Climatic variables and transmission of falciparum malaria in New Halfa, eastern Sudan

The study investigated the role of climatic variables and irrigated agricultural on the seasonality of malaria transmission in New Halfa, eastern Sudan. A time-series analysis was performed using monthly climatic variables, monthly water available for irrigation of crops and monthly slide positive rate of malaria during the period 1986-2002. Cases of malaria were reported every month of the year with a mean of 13.0/100 persons/month [95% CI: 11.9-14.2], and bimodal annual pattern in autumn and winter seasons. Rainfall was the significant climatic variable in the transmission of the disease, whereas heavy rainfall was found to initiate epidemics. Temperature, relative humidity and irrigation water were not significant factors

Functional capacity of autotransplanted versus homotransplanted canine kidney after sodium chloride load

Immunosuppressive therapy and uremia complicate the mechanisms involved in renal functional changes after kidney transplantation. Glomerular filtration rate [GFR] is attenuated after renal ischemia, whereas it increases after denervation, both are important factors in renal transplantation. A defect in renal handling of Na[+] in response to volume expansion in some reports of renal transplantation was also recorded. The aim of the present work was to study the functional capacity of auto-and homotransplanted canine kidneys after a sodium chloride load. Four groups each comprising six mongrel dogs were used in the present study: Group I: autotransplanted animals where GFR and kidney excretory functions were investigated immediately after transplantation. Group II: Like group I but the investigations were performed 5 days after autotransplantation. Group III: Animals with homotransplantation were subjected to the same investigation, as before, immediately after the operation. Group IV: The group of donors of the kidney to group III. And the remaining kidney served as the control for that of group III whose two kidneys were taken off just before the transplantation. Inulin was infused I. V. to study inulin clearance [C[IN], normal saline was also infused for 60 min then 5% NaCl solution for another 60 min. [Na[+] load. Arterial blood and urine samples were collected by catheter inserted in femoral artery and ureters of transplanted and control animal and the following parameters were investigated: Urinary excretion rate v C[IN] urinary excretion rate for Na[+], Cl[-] and K[+] [UE[Na]+, UE[cI-]- and UE[k], fractional excretion of Na[+] [FE[Na]+%] for group I, II, III and IV of animals [UK[Nn] or K[+] group I, II, III, IV of animals. Two collection periods were done, the first [60 min] with normal saline infusion and the second [60 min] with saline load. There were decreased values for v GFR [IN] UE[Na+] and UE[K+] FE[Na+%] compared to control in group I, III, UE[CI-] of group I showed no significant change. After 5 days of autotransplantation [gp II] UE[Na+] and FE[Na+]% were significantly increased compared to their control, v and GFR decreased and UE[CI-]- and UE[K+] did not change significantly from their control. After infusion of NaCl load v of group III increased there was insignificant change of UE[Na+] and UE[K+] for group II and increase of FE[Na+]% and significant increase of all parameters, of group I with the exception of C[IN] which decreased. There was significant decrease of all other parameters of the 3 groups as compared to their controls. Transplanted kidneys [auto or homo] behave functionally different from that after ischemia or denervation. Transplanted kidney can excrete a saline load and increase its GFR inspite of denervation and ischemia and this may be attributed to some humoral factors concerned with rennin angiotensin system [RAS] or atrial natriuretic peptide [ANP] or attenuation of sympathetic nervous system control. Care should be directed to the fluid and electrolytes [especially [K+]] infused to patients immediately following auto-or homotransplantation

Functional significance of lipid changes under the effect of inhalational anesthetics

Small concentrations of inhaled anesthetics can induce type II pneumocytes dysfunction and affect surfactant production and exacerbate oxidant mediated lung injury. The aim of the present work was to study the interrelationship between alveolar surfactant lipid composition and that of the lung tissue aiming to understand the sequence of events in the pathogenesis and pathophysiology of acute lung injury [ALI] after inhalation anesthesia. 60 albino rats were used in this study. Lipids were extracted from the lung tissue and alveolar surfactant obtained by bronchoalveolar lavage from rats which were subjected to 1-2% halothane or nitrous oxide anesthetics. The following parameters were determined on the extracted lipids: total lipids [TL], triglycerides [TG], total cholesterol [T-ch], total free fatty acids [FFA], total phospholipids [TPL], phospholipids fractions, lecithin [phosphatidyl cholin Pc], lysolecithin, cephalin [phosphatidyl ethanol amine PI] and sphingomyelin. I- Effect of halothane In the surfactant: Halothane decreased all parameters studied with the exception of FFA and sphingomyelin which was increased compared to controls. Cephalin did not change. However, in the lung FFA, lecithin and lysolecithin increased while all other parameters decreased. II- Effect of nitrous oxide [N[2]O]: In the surfactant: All parameters also decreased except lysolecithin, cephalin and sphingomyelin, which were increased. However, FFA did not change significantly from controls. In the lung: Lecithin, lysolecithin and FFA increased whereas the other parameters decreased. Halothane and N[2]O differ as regards their effect on the lipid profile of the surfactant or lung tissue. The functional significance of the alteration was discussed

Epidemiology of malaria in New Halfa, an irrigated area in eastern Sudan

A prospective study investigated the epidemiology of malaria in an agricultural area in eastern Sudan from November 1999 to June 2000 [1 irrigation and 1 dry season]. In monthly parasite surveys, 99/ 1539 blood films from 190 individuals were positive for malaria: 95% for Plasmodium falciparum, 3% P. vivax and 2% P. ovale. The slide positive rate [SPR] of malaria episodes ranged from 3.7% to 12.8% in different months of the survey, with a peak in January. There was no significant difference in SPR between irrigation and dry seasons [7.2% versus 5.1%]. SPR differed significantly by age group and was highest in under 5-year-olds. However, there was no significant difference in SPR between males and females. Transmission and intensity of malaria in this area is perennial and moderate rather than low

Quinine therapy in severe Plasmodium falciparum malaria during pregnancy in Sudan

A prospective study was carried out in an area of unstable malaria transmission in central Sudan to determine the efficacy and toxicity of quinine in pregnancy. Thirty-three pregnant women with severe Plasmodium falciparum malaria at mean 28.8 weeks gestational age were treated with quinine for 7 days. The mean body temperature on presentation for 3 patients who delivered prematurely was significantly higher than for those who delivered at term [39.2 +/- 0.7 degrees C versus 38.7 +/- 1.3 degrees C]. There were no significant difference between the 2 groups in other clinical or biochemical parameters. There were no clinically detectable congenital malformations and no auditory, visual or other neurological deficits in the babies at birth or 6 months later. Quinine may be safe in the treatment of severe falciparum malaria during pregnancy

Anopheles arabiensis: abundance and insecticide resistance in an irrigated area of eastern Sudan

The abundance of Anopheles arabiensis and its susceptibility to insecticides was studied in New Halfa, eastern Sudan, from March 1999 to June 2000. Of 4854 females anophelines collected, 4847 [99.9%] were An. arabiensis and 7 [0.1%] An. pharoensis. Female An. arabiensis were breeding throughout the year, with 2 peak densities, during the rainy [158.4 females/room/day and 84.7 larvae/10 dips] and irrigated seasons [136.8 females/room/day and 44.8 larvae/10 dips]. The mean biting activity was 28.8 bites/person/ night, found throughout the night, mainly outdoors. Susceptibility of An. arabiensis to insecticides dichloro-diphenyl-trichloroethane [DDT], malathion and fenitrothion was 97.8%, 96.3% and 100% respectively. An. arabiensis is the sole malaria vector in the area and is perennial rather than seasonal

Ceftriaxone versus ampicillin/cloxacillin as antibiotic prophylaxis in elective caesarean section

We carried out a prospective, r and omized, controlled clinical trial to evaluate the clinical efficacy of ceftriaxone and ampicillin/cloxacillin prophylaxis in decreasing the frequency of post-caesarean section infection-related morbidity. Two hundred patients randomly received either ceftriaxone [single dose] or ampicillin/cloxacillin [3 doses] intravenously at induction of anaesthesia. There was no statistical difference in incidence of endometritis [P = 0.34], wound infection [P = 0.44], or other febrile morbidity [P = 0.5]. Eleven babies had a low Apgar score [< 8] in the ceftriaxone group and 13 in the ampicillin/cloxacillin group [P = 0.82].There were 2 perinatal deaths in each group. One dose of ceftriaxone was as effective as ampicillin/ cloxacillin in preventing post-caesarean section complications and is easier to administer

Efficacy of sulfadoxine/pyrimethamine for uncomplicated Plasmodium falciparum malaria in a small sample of Sudanese children

A prospective clinical trial was carried out to determine in vivo efficacy of sulfadoxine/pyrimethamine for the treatment of uncomplicated Plasmodium falciparum malaria in children in New Halfa. Forty patients were enrolled; 31 completed the 28-day follow-up. Six [19.4%] patients showed recurrence of parasitaemia during follow-up, while the rest [80.6%] cleared the parasites and responded fully to treatment. All the failures were late treatment failures. Parasite genotyping showed that 1 [16.7%] of the 6 cases of late parasitaemia was due to reinfection while the rest [83.4%] were due to true recrudescence. During the follow-up period 22.6% of patients showed gametocytaemia. The high level of treatment failure as well as gametocytaemia necessitates the introduction of artesunate in this combination therapy

Low-dose quinine for treatment of chloroquine-resistant falciparum malaria in Sudanese pregnant women

Pregnant Sudanese women who presented at a hospital in eastern Sudan with chloroquine-resistant falciparum malaria were randomly allocated to one of two quinine regimens: low-dose [10 mg/kg 2 times/day] [18 patients] or st and ard [10 mg/kg 3 times/day] [24 patients]. Treatment was for 7 days and follow-up for 28 days. Significantly fewer patients in the low-dose group reported vomiting and abdominal pain than the st and ard regimen group. Hypoglycaemia, preterm labour and recrudescence were slightly but not significantly higher in patients in the st and ard group than low-dose group. There were no significant differences between the groups in the mean time from admission to remission of fever and parasite clearance. We tentatively advocate the use of quinine 2 times/day to reduce side-effects and improve compliance

Quinine for chloroquine-resistant falciparum malaria in pregnant Sudanese women in the first trimester

A prospective clinical study in eastern Sudan described the efficacy and toxicity of quinine in early pregnancy in mothers with chloroquine-resistant falciparum malaria. Twenty-six pregnant Sudanese women in their first trimester [mean gestational age 8.5 weeks] were given quinine 10 mg/kg 3 times per day for 7 days and followed up every 2 weeks until delivery. One patient aborted [3.8%] and 2 patients [7.7%] experienced threatened abortion but delivered term babies. Recrudescence or re-infection was observed on day 21 in 1 patient. One baby died aged 6 months. There were no detectable congenital malformations, no auditory or visual defects or any other neurological deficits in the remaining infants at birth or 1 year later. Quinine may be safe in the first trimester of pregnancy

Plasmodium falciparum infection during pregnancy in an unstable transmission area in eastern Sudan

A 1-year prospective community-based study of malaria during pregnancy was conducted in an area of seasonal and unstable malaria transmission in eastern Sudan. At a village antenatal clinic, 89 non-pregnant controls and 86 pregnant women were enrolled and followed every 2 weeks until 6 weeks after delivery. The incidence of Plasmodium falciparum infection was significantly higher among pregnant than control women [17.4% versus 5.6%] with no difference between primigravidae and multigravidae [22.2% versus 15.2%].There was no significant difference in the mean haemoglobin concentration between infected and uninfected mothers [9.1 +/- 1.3 versus 9.5 +/- 0.6 g/dL] but the mean birth weight of their babies was significantly lower [2.72 +/- 0.26 versus 2.95 +/- 0.05 kg] despite prompt case management of infected women

protective role of the angiotensin-converting enzyme inhibitor enalapril against gamma radiation induced organ toxicity in the rat

The present study was designed to evaluate the radioprotective efficacy of the angiotensin-converting enzyme inhibitor enalapril and the possible mechanisms of this radioprotection. This included the ability of prophylactic enalapril treatment to prevent or retard gamma radiation-induced organ toxicity and to protect tissue' antioxidant enzymes in the rat. Prior to irradiation rats were randomized to groups receiving enalapril or no treatment, in addition to a control group of non-irradiated, non-treated rats. Enalapril was administered intraperitoneally [0.1 mg/ kg body weight / day], 4 weeks before and 12 weeks after irradiation. Both groups were exposed to a single dose of 7GY gamma radiation. Irradiation induced significant elevations in the levels of blood urea nitrogen and serum creatinine and serum activities of lactate dehydrogenase [LDH], creatine kinase [CK], alanine amino transferase [ALT] and aspartate amino transferase [AST] compared to control values, indicative of renal, cardiac and hepatic injury. Also there was an increase in the serum levels of triglycerides, total cholessterol and LDL-cholesterol. On the contrary, HDL-cholesterol level was decreased. The heart, kidney and liver antioxidant enzymes including total glutathione peroxidase [total-GPX], glutathione reductase [GR] and superoxide dismutase [SOD] activities were inhibited, while malondialdehyde [MDA] level in these organs was elevated, indicative of increased lipid peroxidation. These data confirm the role of oxidative stress in radiation-induced organ toxicity and points to the possible antioxidative mechanisms of the radioprotective action of enalapril, which might be mediated by improving the balance between reactive oxygen species and antioxidant enzymes. Moreover, the beneficial effect of enalapril on serum lipid profile is suggested to be an additional mechanism of radioprotection

Protective effect of vitamin E on chronic liver damage induced by carbon-tetrachloride [ccl4] in rats

The objective of this study was undertaken to determine whether a sustained increase in hepatic vitamin E could prevent or reduce the extent of CCl4-induced chronic-liver damage and the cirrhotic process. Free radicals affect virtually all aspects of biological existence by reaction and modification of structural, metabolic and genetic material. Studies were performed to examine the mechanisms for the protective effect of free radicals scavengers and to investigate whether the oxidative damage produced in the liver exposed to CCl4 in rats and to find out the effect of antioxidant vitamin E and its ability to protect cell membrane from lipid peroxidation mediated damage and its synthetic derivatives is able to prevent the onset of cell damage consequent to the induction of oxidative stress in different systems in vitro and in experimental acute intoxication with CCl4. 4 groups of male albino rats were studied. The first served as control, the second was fed vitamin E supplemented diet, the third was treated with CCl4 and the last group was treated with CCl4 and after that was supplemented with vitamin E diet