Epidemic meningitis in Khartoum State, Sudan: an epidemiological study of the 1999 epidemic

Sudan is part of the sub-Saharan meningitis belt with major epidemics expected to occur every 8- 10 years cycles. This paper aims to through some light on the 1999 epidemic in Khartoum state with discussion of vaccination strategy. Active reporting of all suspected cases of meningitis in Khartoum state was established early during the course of epidemic. For each case demographic information and data of disease onset was collected. Lumbar puncture was performed in a proportion of patients. Case reports from localities and provinces were compiled and data was collated and analysed using Excel and Epi-Info software. A total of 3232 cases were reported in Khartoum State from week 7 [February 13th 19th] to week 25 [June 26th - July 2nd] of the year 1999. The overall attack rate was 65.7/100 000 population. The highest numbers of cases were reported from Umbada and Jabal Awlia provinces. Most of cases [81.1%] were from 2 to 29 years old and the most at risk group was 15-29 year's old with an attack rate of 105.2/100 000 population. A total of 282 deaths were reported, giving an overall case fatality rate of 8.7%. The epidemic was caused by N. meningitidis serogroup A, clonal III-I. Over 3 millions "A+C" vaccination doses were administered with an estimated coverage of 73.9%. Conclusions: The 1999 epidemic in Khartoum demonstrated the typical pattern of meningococcal outbreaks in the African meningitis belt. The analysis of data presented in this study emphasizes the need for effective surveillance, improved laboratory facilities and the determination of the most appropriate thresholds to initiate mass vaccination. Close microbiological surveillance is of utmost importance especially with increasing threat of N. meningitidis serogroup W-135

Work stress among a group of nurses at Zagazig University Hospitals; a cross sectional study

Nursing is an extremely stressful occupation. This study was conducted to determine the prevalence and the possible risk factors of work stress and to identify some of its physical and psycho-behavioral health effects among nurses at Zagazig University Hospitals. 108 nurses were randomly selected from four different departmental strata, where each stratum had nearly the same working conditions, and a control group composed of 100 apparently healthy subjects were selected from the administrative departments of the Faculty of Medicine, Zagazig University. All subjects were interviewed using a pre-constructed questionnaire; furthermore, they were investigated by measuring their blood pressure and random blood glucose level during work time. The highest percent of the studied nurses were found to have moderate stress [65.7%]; moreover, a very remarkable percent of them [13.9%] suffered from severe stress according to the Expanded Nursing Stress Scale. Working at Causality, Intensive Care, and Emergency Departments, problems with supervisors, excess work load as well as excess working hours, young age, residing away from the hospitals, rotatory work shifts, and low job rank along with short duration of employment with insufficient experience were found to be the most significant risk factors associated with stress among the studied nurses. Moreover, the studied nurses showed a significantly higher prevalence of both short and long term physical and psycho-behavioral stress health effects compared to the control group. It could be concluded that work stress is a major and progressive problem that endangers the health of nurses and the quality of health care provided to the clients at Zagazig University Hospitals, which points to the importance of applying a suitable stress reduction program for proper control

Role of serum CIQ and beta 2-microglobulin in the pathogenesis of dialysis related amyloidosis

The aim of this work was to study the serum levels of B2m and Clq in hemodialysis [HD] patients and their relation to carpal tunnel syndrome [CTS] as a manifestation of dialysis related amyloidosis [DRA] and to investigate the role of B2m in the development of DRA. Clq and B2m were studied in the sera of 32 uremic patients on regular HD treatment. They were divided into two groups: Group I included 12 HD patients with clinical and electrophysiological manifestations of CTS and in whom amyloid deposition was identified during release surgery, group II comprised 20 HD patients with no evidence of clinical or electrophysiological CTS and group three included ten healthy control subjects. The results showed that serum levels of both B2m and Clq were significantly elevated in all HD patients in the two groups when compared with the controls. Serum Clq was significantly higher in HD patients of group I than in patients of group II, while serum B2m was elevated in both groups of I and II without a statistical difference. Serum B2m in patients of group I and II was 30.7 mg/L +/- 2.8 and 29.6 mg/L +/- 2.2, respectively. Immunohistochemical assay of biopsies taken during decompression surgery was positive for B2m in all patients of group I. The results suggested that Clq may contribute to DRA and serum Clq may be a reliable predictor for the diagnosis of DRA

Cross-reaction between skin and skin streptococcus pyogenes antigens

Human skin contains precipitinogens and complement dependent antigen. Almost all Streptococcus pyogenes strains isolated from skin lesions [97%] possess cross complement dependent antigen which is reactive with the skin antiserum. A smaller number of the nasal strains and to a lesser extent the throat strains of the some patients [75% and 37.5% respectively] possess a similar antigen. Streptococcus group A strains isolated from nose [25%] and from tonsils [6%] of asymptomatic children contained the same complement dependent antigen Group C streptococci staphylococcus aureus and strains of gram negative bacilli all lacked this antigen. The antigen is a trypsin sensitive protein