Flavonoids of Chromolaena odorata (L.) R.M.King & H.Rob. as potential leads for treatment against tuberculosis.

Tuberculosis (TB) is currently rated as the 13th leading cause of mortality and the second leading cause of death after COVID-19, and above AIDS. Existing challenges relating to the development of multidrug-resistant strains and dangerous side effects of currently used drugs add impetus to the search for additional TB treatments. Hence, interest has grown in the use of medicinal plants as a source of bioactive preparations with efficacy against TB-causing organisms, and also with the ability to ameliorate the negative effects of TB drugs. This study aimed to evaluate the antimycobacterial and hepatoprotective potentials of extracts and isolated flavonoid compounds from invasive Chromolaena odorata. Test organisms used were pathogenic Mycobacterium bovis and M. tuberculosis H37RV, and the fast-growing M. aurum, M. fortuitum and M. smegmatis. The selectivity index (SI) values of the test substances were determined through cytotoxicity assays to promote these extracts and compounds as leads for the development of effective and safe anti-tubercular drugs. The antimycobacterial activity was evaluated using a serial microdilution method, and the SI was calculated from the 50% lethal concentrations calculated from cytotoxicity tests. Hepatoprotective activity was determined using HepG2 liver cells treated with rifampicin as a toxin. The extracts and compounds had a range of antimycobacterial activity with minimum inhibitory concentration (MIC) values ranging from 0.031 to 2.5 mg/mL. Two flavonoid compounds, 5,7,4'-trimethoxy flavanone and 5­hydroxy-3,7,4'-trimethoxyflavone showed promising antimycobacterial potential, and minimal toxicity was observed, as most SI values were higher than 1. The flavonoid compound 5,7,4'-trimethoxy flavanone had the highest SI (6.452), which was against M. tuberculosis H37RV. The HepG2 cells were reduced to 65% due to toxicity by rifampicin, however, the flavonoid compounds were able to improve cell viability to between 81 and 89% at different concentrations tested. Results obtained indicate that C. odorata may serve as a lead for the development of safe and effective antimycobacterial and hepatoprotective drugs.

Anthelmintic and antimycobacterial activity of fractions and compounds isolated from Cissampelos mucronata.

ETHNOPHARMACOLOGICAL RELEVANCE: Cissampelos mucronata A. Rich., a perennial climber belonging to the family Menispermaceae, has been used traditionally to treat parasites and tuberculosis-related symptoms. Co-infection of helminth parasites and tuberculosis-causing pathogens heightens the risk of developing active tuberculosis. AIM OF THE STUDY: The aim was to isolate and characterize antimycobacterial compounds from Cissampelos mucronata and to investigate their antibiofilm and anthelmintic efficacy as well as cytotoxicity. MATERIALS AND METHODS: The acetone extract of C. mucronata leaves and stems was fractionated by vacuum liquid chromatography using hexane, ethyl acetate, acetone and methanol:chloroform (3:7). Separation of the active ethyl acetate fraction by column and preparative thin layer chromatography led to the isolation and identification of five compounds using NMR and LC-MS, as well as GC-MS for non-polar compounds. The anthelmintic, antimycobacterial, antibiofilm, antioxidant and anti-inflammatory effects as well as cytotoxicity of the fractions and compounds were determined. RESULTS: The ethyl acetate fraction had the best antimycobacterial activity (MIC = 0.015-0.08 mg/ml). The fractions were relatively non-toxic to Vero cells (0.03-0.79 mg/ml) and had good anti-inflammatory and antibiofilm effects. Five compounds were identified as stigmasterol, hentriacontane, simiarenol, nonacosene and carbonic acid. Nonacosene had moderate anthelmintic effects but poor antimycobacterial activity (MIC = 0.375 mg/ml). Nonacosene and hentriacontane had good biofilm inhibitory effect (90-100%). CONCLUSIONS: This study reveals that C. mucronata is a potential source of promising compounds with a range of useful bioactivities that support its use in traditional medicine. Development of plant-based remedies may assist in reducing the impact of co-infections with helminth parasites and tuberculosis-causing mycobacteria.

Differentiation of Tarchonanthus camphoratus L. and Tarchonanthus parvicapitulatus P.P.J. Herman (Asteraceae) using electron microscopy, and comparison of their biological activities.

ETHNOPHARMACOLOGICAL RELEVANCE: Tarchonanthus camphoratus L. complex has numerous medicinal uses amongst the sub-Saharan African populace, including treatment for bronchospasm. This study focused on providing scientific rationale for the traditional use of the extracts of T. camphoratus and T. parvicapitulatus. T. camphoratus L. complex has been published under diverse names by various taxonomists. Tarchonanthus parvicapitulatus was one of the newly described taxa, leaving Tarchonanthus camphoratus L. sens. strict. as a homogenous taxon. However, some of the morphological characters used tend to overlap, making it difficult to identify the different taxa. AIMS: The aim of this study was to evaluate the bronchodilatory, antioxidant and toxicological properties of the leaves of T. camphoratus L. and T. parvicapitulatus. This study also aimed to use scanning electron microscopy (SEM) to assess the differences between T. camphoratus L. and T. parvicapitulatus. MATERIALS AND METHODS: Thin layer chromatography (TLC) with vanillin as visualizing agent was used to qualitatively compare the phytoconstituents of the plant acetone extracts. The free radical scavenging antioxidant qualitative assay was done by spraying TLC plates with DPPH free radical. The bronchodilatory effects of the aqueous extracts were assessed using pre-contracted guinea pig trachea. The effects of the extracts of T. camphoratus L. and T. parvicapitulatus on superoxide and ATP production was also investigated on isolated human neutrophils. A micromorphology study was done using scanning electron microscopy to study the leaves. RESULTS: Different compounds were visualized on the TLC plates with more than 40 compounds of intermediate polarity. The TLC plates sprayed with DPPH revealed the presence of 20 and 23 antioxidant compounds for T. camphoratus and T. parvicapitulatus respectively. Upon pre-contraction of the tracheal smooth muscles, the aqueous extracts of T. parvicapitulatus significantly relaxed the trachea while the relaxation observed for T. camphoratus was not significant. All the tested concentrations had a dose dependent inhibitory effect on superoxide production. The crude extract of T. parvicapitulatus at the highest concentration (10 mg/ml) significantly decreased ATP production while a non-significant increase in ATP production was observed for T. camphoratus at the highest concentration (10 mg/ml) when compared with the control. The micromorphology study was useful in revealing the presence of trichomes on the upper leaf surface of the studied taxa. CONCLUSIONS: The results obtained from this study showed that the studied plant extracts had bronchodilatory effects on contracted guinea pig trachea and could also inhibit the production of free radicals including superoxide anions. To the best of our knowledge, this is the first report on the bronchodilatory activity of T. camphoratus and T. parvicapitulatus. The micromorphological studies were useful in distinguishing between the two species, confirming that T. camphoratus L. and T. parvicapitulatus are different taxa. This study provides evidence to support the traditional use of T. camphoratus and T. parvicapitulatus in managing bronchospasm.

Life Style Intervention Improves Retinopathy Status-The Finnish Diabetes Prevention Study.

The aim of the study was to find out whether participation in earlier intervention had an effect on the occurrence of retinopathy in study participants. We also examined risk factors (age, sex, weight, fasting and 2 h glucose, fasting insulin, blood pressure, serum lipids) for early retinal changes. The study included 522 individuals (mean 55 years old, range 40-64 years) with impaired glucose tolerance who were randomized into intervention (weight loss, healthy diet, and physical activity, N = 265) and control groups (N = 257). Intervention lasted for median of four years in 1993-2000, after which annual follow-up visits at study clinics were conducted. In the years 2002-2006 (at least five years after stopping intervention), fundus photography was offered for all study participants in four of five study clinics. Photographs were assessed by two experienced ophthalmologists (A.A. and K.K.), masked for the group assignment. After exclusion of poor quality photographs, the data of 211 individuals (N = 113 for intervention and N = 98 for control group) were included in the present study. The occurrence of microaneurysms was significantly higher in the control (37/98, 38%) than in the intervention group (27/113, 24%; p = 0.029). In the model, including age, sex, diabetes diagnosis before the retinal assessment, body mass index (BMI), and treatment group, the odds ratio for microaneurysms was markedly lower in intervention group (OR 0.52; 0.28-0.97, p = 0.039). The only risk factor that predicted the occurrence of microaneurysms was serum triglycerides at baseline (mean ± SD 1.9 ± 0.9 vs. 1.6 ± 0.7, mmol/L, with and without microaneurysms, respectively, p = 0.003). Triglycerides associated with decreased microaneurysms in regression analysis for age, sex, fasting glucose, and intervention group (OR 1.92, p = 0.018). Lifestyle intervention in overweight and obese individuals with impaired glucose tolerance showed decreased occurrence of retinal microaneurysms. Elevated serum triglycerides were associated to the development of early diabetic microangiopathy.

Effect of Calendula officinalis cream on achilles tendon healing.

In recent years, the scientific community has undertaken research on plant extracts, searching for compounds with pharmacological activities that can be used in diverse fields of medicine. Calendula officinalis L. is known to have antioxidant, anti-inflammatory, antibacterial, and wound healing properties when used to treat skin burns. Therefore, the purpose of this study was to analyze the effects of C. officinalis on the initial phase of Achilles tendon healing. Wistar rats were separated in three groups: Calendula (Cal)-rats with a transected tendon were treated with topical applications of C. officinalis cream and then euthanized 7 days after injury; Control (C)-rats were treated with only vehicle after transection; and Normal (N)-rats without tenotomy. Higher concentrations of hydroxyproline (an indicator of total collagen) and non-collagenous proteins were observed in the Cal group in relation to the C group. Zymography showed no difference in the amount of the isoforms of metalloproteinase-2 and of metalloproteinase-9, between C and Cal groups. Polarization microscopy images analysis showed that the Cal group presented a slightly higher birefringence compared with the C group. In sections of tendons stained with toluidine blue, the transected groups presented higher metachromasy as compared with the N group. Immunocytochemistry analysis for chondroitin-6-sulfate showed no difference between the C and Cal groups. In conclusion, the topical application of C. officinalis after tendon transection increases the concentrations of collagen and non-collagenous proteins, as well as the collagen organization in the initial phase of healing.

Tuberculosis awareness in Gezira, Sudan: knowledge, attitude and practice case-control survey.

This case-control study aimed to assess tuberculosis (TB) awareness and its associated sociodemographic characteristics in Gezira, Sudan. New smear-positive TB patients registered in Gezira in 2010 (n = 425) and age-matched controls who attended the same health facilities for other reasons (n = 850) formed the study sample. Awareness was measured using a modified standard World Health Organization TB knowledge, attitude and practice instrument. There was no significant difference between TB cases and the controls in overall levels of TB awareness. About two-thirds of TB cases and controls had good TB awareness. Respondents' sex was associated with awareness among the controls. Age, level of education, type of residence and type of occupation were significantly associated with TB awareness, whereas marital status had no effect. The good level of TB awareness found among TB cases and controls is a baseline for further TB awareness-raising among the Gezira population.

Tuberculosis awareness in Gezira, Sudan:knowledge, attitude and practice case-control survey

This case control study aimed to assess tuberculosis [TB]awareness and its associatedsociodemographic characteristics in Gezira, Sudan.New smear-positive TB patients registered in Gezira in 2010 [n - 425]and age-matched controls who attended the same health facilities for other reasons [n = 850]formed the study sample.Awareness was measured using a modified standard World Health Organization TB knowledge, attitude and practice instrument.There was no significant difference between TB cases and the controls in overall levels of TB awareness.About two-thirds of TB cases and controls had good TB awareness.Respondents' sex was associated with awareness among the controls.Age, level of education, type of residence and type of occupation were significantly associated with TB awareness, whereas marital status had no effect.The good level of TB awareness found among TB cases and controls is a baseline for further TB awareness-raising among the Gezira population

تهدف دراسة الحالات والشواهد هذه إلى تقييم مدى الوعي بالسل، والسمات الاجتماعية والديموغرافية المصاحبة له في الجزيرة بالسودان. واعتمدت عينة الدراسة على مرضى السل الجدد إيجابيي اللطاخة المسجلين في ولاية الجزيرة بالسودان في عام 2010 [العدد = 425]والشواهد الذين يضاهون الحالات في السن ممن حضروا إلى المرافق الصحية نفسها لأسباب أخرى [العدد = 850]. وتم قياس مدى الوعي باستخدام المقياس المعدل لمنظمة الصحة العالمية لقياس المعارف والمواقف والممارسات. ولم يكن هناك أي فروق يعتد بها بين حالات السل والشواهد من حيث المستوى الكلي للوعي بالسل. ولقد اتضح أن ثلثي حالات السل والشواهد لديها مستوى جيد من الوعي بالسل. وأن جنس المستجيب للدراسة يؤثر على مدى الوعي بين الشواهد. فالسن، ومستوى التعليم ونمط الإقامة ونوع المهنة كلها من الأمور التي ترتبط بشكل كبير بمدى الوعي بالسل، في حين نجد أن الحالة الزواجية لم يكن لها أي أثر. ومن ثم فإن مستوى الوعي الجيد بالسل لدى الحالات المصابة به ولدى الشواهد تمثل خط الأساس لإذكاء المزيد من الوعي بالسل لدى سكان ولاية الجزيرة

La présente étude cas-témoin visait à évaluer la sensibitisation à la tubercutose et les caractéristiques sociodémographiques associées dans l'état de Gézira [Soudan]. L'échantillon de l'étude était compose de nouveaux patients a frottis positifs pour la tuberculose au Gézira en 2010 [n = 425]et de témoins appariés pour l'âge qui consultaient dans les mêmes établissements de santé pour d'autres motifs [n = 850]. Le degré de sensibilisation à la maladie a été mesuré à l'aide de l'instrument standard modifié de l'Organisation mondiale de la Santé évaluant les connaissances, les attitudes et les pratiques en matière de tuberculose.Aucune différence significative n'a été observée entre les patients tuberculeux et les témoins dans les niveaux généraux de sensibilisation à la tuberculose.Environ deux tiers des patients tuberculeux et des témoins avaient un niveau de sensibilisation à la tuberculose satisfaisant.Dans le groupe des témoins, les hommes et les femmes n'avaient pas le même niveau de sensibilisation à la question.L'âge, le niveau d'études, le type de résidence et la profession étaient des facteurs nettement corrélés à la sensibilisation à la tuberculose, contrairement à la situation matrimoniale.Le niveau satisfaisant de sensibilisation à la tuberculose observé chez les patients atteints de tuberculose est un point de départ pour l'augmentation de la sensibilisation à cette maladie dans la population du Gézira

Effect of the Arrabidaea chica extract on collagen fiber organization during healing of partially transected tendon.

AIMS: After undergoing lesions, tendons have disorganized collagen fibers compared to undamaged tendons. Arrabidaea chica leaves have the aglycones carajurin and carajurone, components of the antocyanins, with a strong pharmacological potential due to their healing properties. Thus, the aim of this study was to investigate the effect of topical application of A. chica extract during tendon healing. MAIN METHODS: The calcaneal tendon of Wistar rats was partially transected with subsequent treatment with A. chica extract (2.13 g/mL) followed by excision on the 7th, 14th and 21st days. Control rats received only saline treatment. KEY FINDINGS: Transmission electron microscopy analysis showed the presence of a large amount of small segments of collagen fibrils in the transected region of the tendons on the 7th day in both the control and plant-treated groups. Considering the organization of the collagen fibers, higher values of birefringence were observed under polarization microscopy in the tendons of the plant-treated group on the 14th day compared to the control group. A larger quantity of dermatan sulfate was also detected after plant treatment in the same period. However, lesser dermatan and chondroitin sulfate were detected in the plant-treated group than in the control group on the 21st day. No differences were found in the values of birefringence between these groups. Intense metachromasy was observed in both transected groups on the 21st day. SIGNIFICANCE: In conclusion, the use of A. chica extract improves collagen organization and increases the quantity of dermatan sulfate on the 14th day of the tendon healing.

Domestic violence against women in Kersa, Oromia region, eastern Ethiopia.

Intimate partner violence is common in rural areas of Ethiopia. The aim of this study was to assess the knowledge and prevalence of domestic violence among women in Kersa district of Oromia region and identify the types, perpetuators and triggers for violence. A community-based cross-sectional interview-based survey was conducted in 2008 on 858 women of reproductive age. Only 39.7% of women reported that they recognized that violence against women was a problem in their area. Ever experience of violence by an intimate partner was reported by 166 women (19.6%) and 70.3% of the perpetuators were husbands. Ever experience of domestic violence among women was significantly related to Amhara ethnicity and age group 30-49 years. Only 33 (19.9%) women who ever experienced violence had reported it to the legal authorities. Women's reasons for failing to report to the legal system were not wanting to expose the issue and not knowing where to go.

Tuberculosis stigma in Gezira State, Sudan: a case-control study.

OBJECTIVE: To evaluate the prevalence of tuberculosis (TB) stigma and to determine the relation between socio-demographic characteristics and TB stigma among TB cases and their controls in Gezira State, Sudan. METHODS: A case-control study design was used. New smear-positive TB patients registered in Gezira State in 2010 (n = 425) and controls who attended the same health facility for other reasons (n < 850) formed the study population. Stigma was measured using a standard modified World Health Organization TB KAP (knowledge, attitudes, practice) instrument. RESULTS: TB stigma did not differ between TB cases and controls; mild stigma was found in both groups. The higher degree of stigma among both groups was significantly associated with higher age, lower level of education, residence in rural areas, unemployment and poor TB awareness, while sex had no association with the degree of stigma in either group. CONCLUSION: Although TB stigma among the Gezira population was found to be mild, it can affect treatment adherence. Empowering both TB patients and communities by increasing their knowledge through proper education programmes could effectively contribute to the effort of controlling TB in the state.

Arrabidaea chica extract improves gait recovery and changes collagen content during healing of the Achilles tendon.

INTRODUCTION: Tendon lesions are still a serious clinical problem. The leaves of the Bignoniaceae Arrabidaea chica (Humb. & Bonpl.) B. Verlot. (syn. Bignonia chica (Bonpl.)) have been used in traditional medicine and described in the literature for its healing properties. However, no study has shown the effects of A. chica during tendon healing. The aim of this study was to investigate the healing properties of the A. chica leaves extract on tendons after partial transection. METHODS: A partial transection in the tension region of the Achilles tendon of rats was performed with subsequent posterior topical application of A. chica extract (2.13g/mL in 0.85% saline solution) at the site of the injury. The animals (n=154) were separated into 7 groups: N - rats with tendons without transection; S7, S14 and S21 - rats with tendons treated with topical applications of saline for 7 days and sacrificed on the 7th, 14th and 21st days after surgery, respectively; A7, A14 and A21 - rats with tendons treated with topical applications of the plant extract. The transected regions of the tendons were analyzed through biochemical, morphological and functional analyses. To evaluate the type and concentration of collagen, Western blotting for collagen types I and III was performed, and the hydroxyproline concentration was determined. The participation of metalloproteinases (MMP)-2 and -9 during tendon remodelling was investigated through zymography. Gait recovery was analyzed using the catwalk system. The organization of the extracellular matrix and morphometry were detected in sections stained with haematoxylin-eosin. RESULTS: The application of A. chica extract in the region of tendon injury led to an increase in the amount of hydroxyproline (mg/g tissue) on the 7th (91.5±18.9) and 21st (95.8±11.9) days after the tendon lesion relative to the control groups treated with saline (S7: 75.2±7.2; and S21: 71.9±7.9). There were decreases in collagen types I and III (as determined by densitometry) in the groups treated with the plant extract 7 days after injury (type I: 103.9±15.9; type III: 206.3±8.1) compared to the saline-treated groups (type I: 165.2±31.1; type III: 338.6±48.8). The plant extract stimulated the synthesis of MMP-2 on the 21st day after the lesion and decreased the amount of latent and active isoforms of MMP-9 on the 14th day. Analysis by the catwalk system (max contact intensity) showed that the A. chica extract improved the gait of rats on the 7th day of the healing process when compared to the saline group. CONCLUSIONS: The use of A. chica extract during the healing process of the tendon leads to an increase in collagen content and improved gait recovery. Further studies will be performed to analyze the effect of this plant extract on the organization of the collagen bundles of tendons after lesions and to study its probable anti-inflammatory effect.

Domestic violence against women in Kersa, Oromia region, eastern Ethiopia

Intimate partner violence is common in rural areas of Ethiopia. The aim of this study was to assess the knowledge and prevalence of domestic violence among women in Kersa district of Oromia region and identify the types, perpetuators and triggers for violence. A community-based cross-sectional interview-based survey was conducted in 2008 on 858 women of reproductive age. Only 39.7% of women reported that they recognized that violence against women was a problem in their area. Ever experience of violence by an intimate partner was reported by 166 women [19.6%] and 70.3% of the perpetuators were husbands. Ever experience of domestic violence among women was significantly related to Amhara ethnicity and age group 30-49 years. Only 33 [19.9%] women who ever experienced violence had reported it to the legal authorities. Women's reasons for failing to report to the legal system were not wanting to expose the issue and not knowing where to go

Perceived discrimination among people living with HIV in Nepal.

BACKGROUND: HIV is one of the major public health problems in Nepal, fuelled by several socio-economic factors. The objective of this study was to explore perceived discrimination among people living with HIV in their own family, society and health facilities. METHODS: A qualitative descriptive cross-sectional study was conducted with semi-structured face-to-face in-depth interview of 18 people (10 men, 8 women) living with HIV in four districts of Nepal. RESULTS: Perceived discriminations among people living with HIV were found among family, society and health facilities. In families, the major forms of perceived discrimination were restriction to go outside, exposure to media and use of different utensils for eating purpose. Female HIV positive perceived more violence at household level than males. Financial restriction was also found imposed upon some respondents by the family for being HIV positive. Similarly, restriction to participate in social work, restriction to buy from shops, social harassment and insult were the main forms of discrimination. Perceived discrimination experienced in the health facility yielded very bitter experiences to some respondents, while many had refused treatment because of their HIV status. CONCLUSIONS: People living with HIV faced different forms of perceived discrimination within family, society and health facility which are thought to be crucial in supporting a person at the time of crisis. Intensive programs that can reduce social stigma and discrimination faced by people living with HIV are a most.

Structural and biochemical alterations during the healing process of tendons treated with Aloe vera.

AIMS: The tendon is composed of highly organized collagen fibers that form a complex supramolecular structure. After lesions, the organization and composition of the tendon are not completely restored. Our purpose was to evaluate if the application of Aloe vera improves tendon healing, considering the effectiveness in the stimulus of collagen synthesis. MAIN METHODS: The calcaneal tendon of male Wistar rats was partially transected with subsequent topical application of A. vera ointment at the injury. The animals were separated into groups with tendons treated with the A. vera extract for 7days and excised on the 7th, 14th and 21st days after surgery; control rats received only ointment base without plant extract. KEY FINDINGS: Morphological analysis using polarization microscopy showed that the entire tendon undergoes a remodeling process, with disorganized collagen fibers by days 7 and 14 in plant-treated and non-treated groups and with a higher birefringence in tendons of the plant-treated group on the 21st day. A higher concentration of hydroxyproline was found in plant-treated tendons on days 7 and 14 compared with their controls. Western blots showed lower amounts of type I collagen in the plant-treated group on day 14 compared with the control. MMP-9 diminished 14days after lesion and the active isoform of MMP-2 increased on day 21 in plant-treated groups. SIGNIFICANCE: The present study indicates a beneficial effect of A. vera in the tissue reorganization in the transected region of the tendon 21days after injury and is supported by an increase of active MMP-2.

Assessment of core activities and supportive functions for the communicable diseases surveillance system in Khartoum state, Sudan, 2005-2007.

We conducted a descriptive, retrospective, cross-sectional study to assess the core activities and supportive functions of the communicable diseases surveillance system (CDSS) in Khartoum state, Sudan, for the period 2005-2007. This is the first assessment conducted for CDSS in Khartoum state. The CDSS was studied in terms of core activities and supportive functions. We found that knowledge of the system was 100% at all levels. Data reporting was over the recommended standard of 80% at all levels. Data analysis, epidemic preparedness and feedback were below the recommended standard. All assigned CDSS staff members were trained. Lower levels lacked modern technologies for data reporting and analysis. The CDSS system in Khartoum state is centralized; moreover, the system has not been updated, it is poorly documented and has a shortage of staff at lower levels.

Feasibility of implementing recommendations to improve communicable diseases surveillance--a modified Delphi study.

BACKGROUND: Effective control of communicable diseases requires an effective disease surveillance system (CDSS) which provides information for action on priority communicable diseases. It is the basis for public health decision-making worldwide. Implementation of any public health recommendations for improving a disease surveillance system depends on the acceptability of such recommendations by the relevant stakeholders and the feasibility of implementing the recommendations in practice. OBJECTIVES: The aim of this study was to assess the acceptability and the feasibility of recommended improvements in CDSS among relevant stakeholders in Khartoum state. METHODS: A Delphi consensus process was used in the form of three analytical written rounds and individual face-to-face discussions among relevant stakeholders in Khartoum state to study the feasibility of the recommended improvements in CDSS in Khartoum state. RESULTS: The stakeholders in Khartoum state agreed with most of our statements to improve the CDSS core activities, supportive functions and quality in Khartoum State, and that the existing CDSS in Khartoum state needs to be strengthened with more effective coordination at different levels. Regarding the feasibility of implementing our recommendations, the results of our Delphi survey suggest neither expanding CDSS system, nor including vertical programmes; formulation of updated objectives; improving data management and feedback; strengthening epidemic management, as well as the quality of the system in terms of timeliness, completeness and acceptability. CONCLUSION: This study added strength to our recommendations, based on two previous studies assessing the CDSS in Khartoum state. The Ministry of Health in Khartoum state can implement our consensus recommendations to improve the CDSS system in the future in order to achieve its targeted goals.

Staff views about the quality of the Communicable Diseases Surveillance System in Khartoum State, Sudan, 2005-2007: a qualitative study.

Surveillance staff are vital to the success of surveillance of infectious diseases. In this study, we interviewed staff of the Communicable Diseases Surveillance System (CDSS) in Khartoum state individually and in focus groups to assess their views about the quality of the system for the years 2005-07. The quality of CDSS was considered poor because the system was not representative as it included neither the private nor military sectors nor the important teaching hospitals. It also lacked timeliness due to poor documentation, was inflexible since it did not rapidly respond to emerging and re-emerging diseases such as SARS and avian flu in its notification lists, and it did not use the data collected to apply interventions for control and prevention of communicable diseases on a routine basis. While staff were committed to the surveillance system and felt they worked hard, they were also demotivated and in the long run this might affect their performance.

Long-term effect of betaine on risk factors associated with the metabolic syndrome in healthy subjects.

BACKGROUND/OBJECTIVES: To examine the effects of betaine on serum lipid profile, plasma homocysteine concentration and hemostatic factors in healthy subjects. SUBJECTS/METHODS: Altogether, 63 volunteers (27 ± 8 years, body mass index 22.6 ± 2.4 kg/m(2)) participated in a placebo-controlled, randomized, parallel double-blinded study. The intervention lasted for 6 months during which the subjects consumed mineral water 500 ml/day with (betaine group, n = 32) or without (control group, n = 31) a 4-g betaine supplementation. RESULTS: There was a significant interaction of time and group (general linear model) in serum total and low-density lipoprotein (LDL)-cholesterol concentrations and total-to-high-density lipoprotein (HDL)-cholesterol ratio without a significant difference between or within the groups. Concentrations of serum HDL-cholesterol, triglycerides or oxidized LDL did not change during the study. Plasma homocysteine concentration did not change in either of the groups. Plasma plasminogen activator inhibitor 1 concentration increased in the betaine group (P = 0.028) and decreased in the control group (P = 0.006). There was a significant interaction of time and group (general linear model) in plasma fibrinogen and blood hemoglobin concentration without a significant difference between or within the groups. There were no changes in parameters regarding the function of the liver or kidney. CONCLUSIONS: Betaine had no effect on serum lipid profile in long term in young healthy subjects. The lowering effect on plasma homocysteine concentration was weak.

Staff views about the quality of the communicable diseases surveillance system in Khartoum state, Sudan, 2005-2007: a qualitative study

Surveillance staff are vital to the success of surveillance of infectious diseases. In this study, we interviewed staff of the Communicable Diseases Surveillance System [CDSS] in Khartoum state individually and in focus groups to assess their views about the quality of the system for the years 2005-07. The quality of CDSS was considered poor because the system was not representative as it included neither the private nor military sectors nor the important teaching hospitals. It also lacked timeliness due to poor documentation, was inflexible since it did not rapidly respond to emerging and re-emerging diseases such as SARS and avian flu in its notification lists, and it did not use the data collected to apply interventions for control and prevention of communicable diseases on a routine basis. While staff were committed to the surveillance system and felt they worked hard, they were also demotivated and in the long run this might affect their performance

Prevalence of menopause symptoms and their association with lifestyle among Finnish middle-aged women.

BACKGROUND AND AIM OF THE STUDY: The aim of this study is to report the prevalence of menopausal symptoms by severity among the Finnish female population and the association of their symptoms with lifestyle (smoking, use of alcohol, physical activity) and body mass index (BMI). MATERIAL AND METHODS: Health 2000 is a nationally representative population-based study of Finnish adults. Data were collected by home interview, three self-administered questionnaires and a clinical examination by a physician. This study included women aged 45-64 years (n=1427). All symptoms included menopause-specific symptoms. Both univariate analysis and a factor analysis based on symptom factors were performed by menopausal group. Multiple regression analysis included each symptom factor as a dependent variable and confounding and lifestyle factors (age, education, smoking, alcohol use, physical activity, BMI, use of hormonal replacement therapy (HRT) and chronic disease status). RESULTS: Over one-third (38%) of the premenopausal, half of the perimenopausal, and 54% of both postmenopausal and hysterectomized women reported bothersome symptoms. The difference between pre- and perimenopausal women was largest and statistically most significant in the case of back pain and hot flushes. Physically active women reported fewer somatic symptoms than did women with a sedentary lifestyle. Smoking was not related to vasomotor symptoms. CONCLUSION: Bothersome symptoms are common in midlife, regardless of menopausal status. Inverse association between physical activity and menopausal symptoms needs to be confirmed in randomized trials.