Materno-foetal leptin and insulin-like growth factor in low birth weight neonates.

Low birth weight (LBW) is a health concern in developing countries. Leptin and insulin-like growth factor-I (IGF-I) are factors that influence LBW. A case-control study was conducted at Medani hospital, Sudan. Cases were women who had LBW deliveries ( 2,500 g) and controls were women with normal-weight babies ( 2.500 ­ 4,000 g). Sociodemographic and obstetrical characteristics were gathered from both groups and leptin and IGF-I levels were measured by ELISA. Cases and controls (45 in each arm) were matched in their basic data. The median (interquartile) of maternal leptin levels [9.9 (1.9 ­ 21.8) vs. 16.0 (9.6 ­ 20.8), ng/ml; P0.001] and IGF-I [1.6 (0.7 ­ 20.0) vs. 6.1 (4.3 ­ 7.1) ng/ml ; P 0.001] were significantly lower in cases than in controls. Likewise, cord serum leptin [5.8 (2.1 ­ 12.6) vs. 20.0 (5.1 ­ 37.8) ng/ml; P0.001] and cord serum IGF-I [1.7 (1.3 ­ 2.0) vs. 6.9 (5.9 ­ 7.4) ng/ml; P0.001] levels were significantly lower in cases than in controls. Significant positive correlation was found between birth weight and cord leptin ( r0.398), maternal ( r0.795) and cord ( r0.863) IGF-I levels. Maternal and cord leptin and IGF-I levels were significantly lower in LBW babies.

Zinc and selenium levels in women with gestational diabetes mellitus at Medani Hospital, Sudan.

Gestational diabetes is a common medical disorder in pregnancy. There is a growing body of evidence of the association between zinc, selenium status and diabetes mellitus during pregnancy. A case-control study was conducted at Medani Hospital, Sudan, to compare zinc and selenium levels in pregnant women with gestational diabetes and normal pregnant women (controls). The two groups (31 in each arm) were well-matched in age, parity, gestational age, haemoglobin and body mass index. Zinc and selenium levels were measured using atomic absorption spectrophotometry. There were no significant differences in the median (interquartile) zinc (498.9 [395-703] vs 486.4 [404-667] µg/l, p = 0.905) and selenium (164.4 [61-415] vs 204 [68-541] µg/l, p = 0.838) values between the two groups. There were no significant correlations between zinc and selenium, or between these trace elements and body mass index, gestational age and blood glucose levels.

Prevalence and distribution of ocular onchocerciasis in three ecological zones in Nigeria.

The African Programme for Onchocerciasis Control (APOC) sponsored a baseline study in Nigeria between 1998 and 1999 on the prevalence and distribution of Onchocerciasis. The randomly selected 1,064 subjects in the baseline study underwent detailed eye examination in Cross River (rain forest), Taraba (savanna) and Kogi (forest-savanna) States. This paper compares and contrasts the public health significance of ocular onchocerciasis in these ecological zones. A blindness prevalence of 2.4% was recorded in the study, onchocerciasis being responsible for 30.2% of the bilaterally blind subjects. Onchocerciasis-induced blindness prevalence was relatively high in the rain forest and forest savanna zones of Cross River and Kogi States, Cross River having the highest site-specific prevalence (50.0%), followed by Kogi (41.7%). Taraba recorded only 27.3%. Other conditions identified included glaucoma, optic nerve disease and cataract rates of which were also found to be high among the population (6.9%, 6.5 % and 8.9% respectively). Anterior segment onchocercal lesions, punctate and sclerosing keratitis were the predominant features of the infection in the savanna zone (14.1% and 6.3% respectively), while posterior segment lesions were much more common in the forest zone. The need to sustain the present efforts to control onchocerciasis through mass ivermectin treatment is recommended.

Morbidity and Mortality Pattern of Neonates Admitted into Nursery Unit in Wad Medani Hospital; Sudan

Background: Neonatal outcome is an important indicator of obstetrics and health care. Few or no published data are available concerning neonatal morbidity and mortality in Sudan. Objectives: To study morbidity and mortality pattern amongst inborn neonates admitted into nursery unit in Wad Medani Hospital; Sudan during the period Jan-June; 2009. Results: A total of 1211 (29.5) out of 4098 in-born neonates were admitted during study period. The major indications for neonatal admission were; infections 300 (24.8); low birth weight (LBW) 307(25.4) and asphyxia 130(10.7). There were 133(11) neonatal deaths; preterm delivery; LBW and birth asphyxia were the major causes of death among these neonates. Conclusion: neonatal infection; preterm birth and LBW were the common causes of neonatal morbidity and mortality. There is an urgent need for more research throughout the country concerning these common causes of morbidity and mortality

Safety of artemisinins during early pregnancy, assessed in 62 Sudanese women.

Between June 2006 and October 2008, the safety of artemisinins during early human pregnancy was assessed in central-eastern Sudan. Pregnant women in the first or second trimester who were attending antenatal-care clinics at the Wad Medani, Gadarif and New Halfa hospitals were interviewed. Each was asked if they had had malaria in the first trimester of the index pregnancy and, if so, what treatment they had received. The women who had received artemisinins were then followed-up until delivery and their babies were followed-up until they were 1-year-olds. Overall, 62 of the pregnant women reported receiving artemisinins - artemether injections (48), artesunate plus sulfadoxine-pyrimethamine (11) or artemether plus lumefantrine (three) - during the first trimester. Medical records were available for 51 (82%) of these 62 women, and, in each case, these records showed the reported treatment and that malaria had been confirmed. Only nine (15%) of the 62 women given artemisinins had not known that they were pregnant when treated. Two of the treated women (both given artemether injections in the first trimester) had miscarriages, one at 20 weeks of gestation and the other at 22 weeks, each while receiving quinine infusions for a second attack of malaria. The other 60 women who had received artemisinins delivered apparently healthy babies at full term. No congenital malformations were detected, there was no preterm labour, no maternal deaths were recorded during the follow-up, and none of the babies died during their first year of life. It therefore appears that artemisinins may be safe to use during early pregnancy, although further study is clearly needed.

Cortisol, prolactin, cytokines and the susceptibility of pregnant Sudanese women to Plasmodium falciparum malaria.

Understanding the hormonal and cytokine interactions that underlie susceptibility to the disease should be helpful in elucidating the pathogenesis of malaria during pregnancy. The current study was conducted in the Wad Medani hospital, in an area of central Sudan that is characterised by unstable malarial transmission. Its aims were to investigate the roles and interactions of cortisol, prolactin, interferon-gamma (IFN-gamma), interleukin-4 (IL-4) and interleukin-10 (IL-10) in pregnant women with Plasmodium falciparum malaria. The 82 pregnant subjects who were enrolled either had uncomplicated, P. falciparum malaria (the 47 cases) or were apparently uninfected and healthy women (the 37 controls) who were similar to the cases in terms of their mean age, weight, gravidity, gestational age and haemoglobin concentration. Compared with the controls, the cases were found to have significantly higher serum concentrations of total cortisol and IL-10 and significantly lower levels of prolactin and IFN-gamma (but similar concentrations of IL-4). The hormone and cytokine concentrations measured in the infected primigravidae were similar to those recorded in the infected multigravidae. Among the cases, there was a significant positive correlation between serum cortisol and IL-10 (r=0.188; P=0.025) and significant negative correlations between prolactin and both IL-4 (r=-0.175; P=0.038) and IL-10 (r=-0.186; P=0.027) but no significant correlation between prolactin and cortisol. During pregnancy, immune responses appear to be influenced by P. falciparum infections, irrespective of parity. Cortisol, prolactin and some cytokines appear to be key mediators in the host response to P. ?falciparum infection, although further research on this subject is clearly needed.

Detection of serum prostate specific antigen in lactating, pregnant, and advanced breast cancer Sudanese Women

Introduction: Although prostate-specific antigen (PSA) is the most valuable tumor marker for the diagnosis and management of prostate carcinoma; it is widely accepted that PSA is not prostate specific. Objectives: The aim of this study is to address the possibility of using the PSA as marker for the sex assignment in different categories and relevance of this test in women problems. Method: We have evaluated the measurement of serum total PSA for differentiation between Sudanese women with advanced breast cancer (n= 10); and those are lactating (n=10); pregnant (n=10) compared with 20 healthy women as control group. Serum total PSA (TPSA) was measured using immuno-radiometric assay (IRMA). Results: In this study the mean age was significantly higher advanced breast cancer groups compared with lactating group (P0.01). The mean serum PSA levels in the healthy control women examined (nsignificant high level of total PSA in serum of advanced breast cancer compared with the normal group (P 0.05). Conclusion: These results indicated the possible use of total PSA to distinguish between healthy women and/or women with advanced breast cancer

APOC's strategy of community-directed treatment with ivermectin (CDTI) and its potential for providing additional health services to the poorest populations. African Programme for Onchocerciasis Control.

Since its inauguration in 1995, the African Programme for Onchocerciasis Control (APOC) has made significant progress towards achieving its main objective: to establish sustainable community-directed treatment with ivermectin (CDTI) in onchocerciasis-endemic areas outside of the remit of the Onchocerciasis Control Programme in West Africa (OCP). In the year 2000, the programme, in partnership with governments, non-governmental organizations and the endemic communities themselves, succeeded in treating 20,298,138 individuals in 49,654 communities in 63 projects in 14 countries. Besides the distribution of ivermectin, the programme has strengthened primary healthcare (PHC) through capacity-building, mobilization of resources and empowerment of communities. The community-directed-treatment approach is a model that can be adopted in developing other community-based health programmes. The approach has also made it possible to bring to the poor some measure of intervention in some other healthcare programmes, such as those for malaria control, eye care, maternal and child health, nutrition and immunization. CDTI presents, at all stages of its implementation, a unique window of opportunity for promoting the functional integration of healthcare activities. For this to be done successfully and in a co-ordinated manner, adequate funding of CDTI within PHC is as important as an effective sensitization of the relevant policy-makers, healthworkers and communities on the value of integration (accompanied by appropriate training at all levels). Evaluation of the experiences in integration of health services, particularly at community level, is crucial to the success of the integration.

Methyldopa versus no drug treatment in the management of mild pre-eclampsia.

OBJECTIVES: To evaluate the efficacy of methyldopa in the treatment of mild pre-eclampsia, to prevent its progress and to investigate its effect on the pregnancy outcomes. DESIGNS: Randomised clinical trial. SETTING: Wad Medani Hospital in the central Sudan. SUBJECTS: Seventy primigravidae with single, alive baby of 28-36 weeks gestational age suffering from true mild pre-eclampsia were enrolled. The patients were randomised in two groups, treatment group who received methyldopa 750-4000 mg/day (n=34) and a control group who received no treatment (n=36). All the (treatment and control) patients were drug followed as in-patients till the delivery, seen with their babies on the days 7, 42 after the delivery. MAIN OUTCOMES MEASURES: The outcomes examined were, rise of the diastolic blood pressure to 110 mm Hg or more, occurrence of imminent eclampsia or the eclampsia, if the maturity could be achieved, occurrence of intrauterine growth retardation, abruptio placentae, mode of delivery, birth weight, placental weight, perinatal death, Apgar score and referral of the babies to the pediatrician. RESULTS: Three out of 34 (8.8%) of the treatment group had a rise in the diastolic blood pressure of 110 mm Hg, 18/36 (50%) of the control had a rise in the diastolic blood pressure of 110 mmHg (p < 0.05). Three out of thirty four (8.8%) of the treatment group developed imminent eclampsia, while 10/36 (27.8) of the control group developed imminent eclampsia (p < 0.05). The maturity was achieved in 82.3% and 88.8% of the treatment and the control, respectively (p > 0.05). There were ten (14.2%) perinatal deaths, four of them in the treatment group, while six in the control (p > 0.05). There was no difference regarding birth weight, occurrence of intrauterine growth retardation, placental weight, mode of delivery, Apgar score, referral of the babies to the paediatrician. No patient developed eclampsia or abruptio placenta; there was no maternal death in both groups. CONCLUSION: Methyldopa can prevent the progress of the mild pre-eclampsia to severe pre-eclampsia, without affecting the maturity, birthweight or the neonatal outcomes.

Trypanosomosis and reproduction: II. Effect of Trypanosoma vivax infection on pregnancy and post-partum cyclicity in ewes.

The effect of infection with Trypanosoma vivax on pregnancy and post-partum cyclicity in ewes was investigated. Of the 5 ewes infected in the first trimester, 3 died without aborting and 2 after aborting. Intrauterine infection occurred in 2 of the foetuses removed at post mortem. Of the 5 infected in the third trimester, one ewe died without aborting, one lambed prematurely and 3 at term. Intrauterine infection occurred in one of the lambs born at term. None of the lambs were viable. The termination of pregnancy may be as a result of stress. The ewes infected in the third trimester commenced irregular cyclicity 13 to 23 days post partum.

Trypanosomosis and reproduction: I. Effect of Trypanosoma vivax infection on the oestrous cycle and fertility in the ewe.

Ten West African Dwarf ewes were inoculated with Trypanosoma vivax and, at varying intervals, treated subcuratively with diminazene aceturate to maintain the infection. Soon after infection all ewes had anoestrus for 40 to 96 days and 5 died by day 110 post infection. Compared to control animals, infected ewes had prolonged low levels of plasma progesterone until recovery or death. However, no gross or histological lesions were detected in the endocrine or reproductive organs. Of the survivors, the 5 that were aparasitaemic subsequently became pregnant and had normal gestations.

Enamel defects in primary canines related to traditional treatment of teething problems in Sudan.

In parts of Sudan and some other countries, teething is thought to be the cause of severe health problems in infants, and a traditional treatment involves lancing the alveolar process over the unerupted canines with a heated needle, a procedure known as 'haifat'. Three hundred and ninety-eight children aged 4-8 years were examined for the presence of enamel defects on primary canines, and their parents or guardians were questioned regarding past teething problems and their treatment. Two hundred and fifty-eight (65%) of the children had experienced health problems that had been attributed to teething, and 89 (22%) had been subjected to 'haifat'. 'Haifat' had been practised by all socio-economic groups, but was most prevalent in the lower groups. Enamel defects on the buccal surface of the primary canines were found in 25 (28%) of the children in the 'haifat' group and in 25 (8%) of the other children.

Effects of infection with Trypanosoma brucei brucei on different trimesters of pregnancy in ewes.

The effects of Trypanosoma brucei brucei infection during the first, second or third trimesters of pregnancy in 13 ewes were studied. All infected ewes were anaemic with the anaemia being most severe, moderate and least in ewes infected in the second, third and first trimesters, respectively. Weight loss occurred in all infected ewes but was most severe in ewes infected in the third trimester. Three of the four ewes infected in the first trimester died without aborting while one aborted and later died. Of the four ewes infected in the second trimester, three died without aborting while one lambed and later died. In the third trimester ewes, one aborted, two lambed and all three later died while one died without aborting. None of the lambs was viable. The control ewe lambed normally. The infection resulted in 16.7% abortion, 100% death and 33.3% neonatal deaths. This study demonstrates that T. brucei brucei has a devastating effect on pregnancy irrespective of the trimester of infection.

Reproductive disorders in African trypanosomiasis: a review.

Reproductive disorders are frequently seen in human beings and in animals infected with tsetse-transmitted (African)trypanosomiasis. The disorders include irregular menstrual (or oestrus) cycle, infertility, abortion and impotence. Intrauterine infections occasionally occur, resulting in still birth or neonatal mortality. The changes are essentially reversible after treatment, although recovery may take several months.