Toxoplasma gondii Infection and ABO Blood Group Association Among Pregnant Sudanese Women: A Case Study.

Purpose: ABO blood group glycol-conjugate expression may influence human susceptibility to infection caused by Toxoplasma gondii. This study aimed to assess the relationship between blood group phenotypes as risk factors for toxoplasmosis and to correlate the prevalence of the disease with other risk factors. Materials and Methods: A total of two-hundred serum samples were collected from pregnant women referred for routine rotary examination in Rabak Teaching Hospital, White Nile State, Sudan, and examined for the parasite Toxoplasma gondii using the latex agglutination test. Results: The overall prevalence of toxoplasmosis in pregnant women (IgG positivity for T. gondii in the absence of IgM) was 41% (82/200). A higher prevalence of the infection was detected in women with blood group type AB 5 (55.6%) among the females in the AB blood group and the lowest in those with blood group type B 11 (35.5%). Those with a history of direct contact with cats reported the possibility of eating undercooked meat and soil-related potential risk factors (working in a garden with bare hands, eating unwashed vegetables and fresh fruits, poor handling of food) recorded 70 (82.4%), 59 (65.6%), 58 (77.3%), 73 (55.7%) and 70 (73.7%) of positive cases, respectively. Statistical analysis revealed a significant difference between Toxoplasma gondii infection and these risk factors. Conclusion: The study concluded that the ABO blood group system was not related to the absence or presence of anti-T. gondii antibodies in pregnant women in the study area. Contact with cat feces, raw meat consumption, and farming were identified as possible important risk factors for T. gondii infection within the study area.

Malaria infection and associated risk factors in pregnant women attending antenatal care clinics in Al Jabalian Locality, White Nile state, Sudan.

Pregnant women are more susceptible to malaria which is associated with adverse effects on pregnancy. It is one of the leading causes of maternal mortality in Sudan. The main aim of this study was to determine the prevalence rate of malaria in pregnant women. This cross sectional descriptive study was carried out in Al Jabalian and Kenana hospitals, White Nile State, Sudan. The data of the present study has been collected from 400 Sudanese pregnant women, during a period extending from 16th July 2018 to 25th October 2018. The overall the prevalence of malaria was 38.5% (154), Plasmodium falciparum was only malaria parasite observed in all samples. From 154 pregnant women infected with malaria, the third trimester had higher prevalence 53.9% (83), followed by the second trimester 31.8% (49) and the first trimester was 14.3% (22), P<0.0001. The multigravida had high infection with prevalence of 54.5% (84), secondgravida was 24.7% (38) and primigravida was 20.8% (32), P<0.0001. Significant association was noticed between the malaria parasite infection and occupation, ANC attendance and utility of mosquito net, P-value 0.05, 0.0024, 0.0010, respectively. However, no significant association was observed with education level and malaria infection. The study was recommended to promote diagnosis during pregnancy, take anti-malarial medicine as routine care to pregnant women and improve environmental sanitation.

Nosocomial or not? A combined epidemiological and genomic investigation to understand hospital-acquired COVID-19 infection on an elderly care ward.

BACKGROUND: COVID-19 has the potential to cause outbreaks in hospitals. Given the comorbid and elderly cohort of patients hospitalized, hospital-acquired COVID-19 infection is often fatal. Pathogen genome sequencing is becoming increasingly important in infection prevention and control (IPC). AIM: To inform the understanding of in-hospital SARS-CoV-2 transmission in order to improve IPC practices and to inform the future development of virological testing for IPC. METHODS: Patients detected COVID-19 positive by polymerase chain reaction on Ward A in April and May 2020 were included with contact tracing to identify other potential cases. Genome sequencing was undertaken for a subgroup of cases. Epidemiological, genomic, and cluster analyses were performed to describe the epidemiology and to identify factors contributing to the outbreak. FINDINGS: Fourteen cases were identified on Ward A. Contact tracing identified 16 further patient cases; in addition, eight healthcare workers (HCWs) were identified as being COVID-19 positive through a round of asymptomatic testing. Genome sequencing of 16 of these cases identified viral genomes differing by two single nucleotide polymorphisms or fewer, with further cluster analysis identifying two groups of infection (a five-person group and a six-person group). CONCLUSION: Despite the temporal relationship of cases, genome sequencing identified that not all cases shared transmission events. However, 11 samples were found to be closely related and these likely represented in-hospital transmission. This included three HCWs, thereby confirming transmission between patients and HCWs.

Cryptosporidium infection among hemodialysis patients attending to the dialysis center at Kosti Teaching Hospital, Sudan.

Cryptosporidiosis is an illness caused by a protozooan parasite Cryptosporidium. Cryptosporidium species are an opportunistic pathogens cause a diarrheal disease worldwide, and can be more severe in immunocompromized patients. Until now, a little data have been available on its prevalence rate among haemodialysis patients in Sudan. Therefore, this article was designed to examine the prevalence of Cryptosporidium among hemodialysis Sudanese patients attending hemodialysis center at Kosti Teaching Hospital. A case-control study including one-hundred and twelve hemodialysis patients between November 2016 and January 2017 have been conducted. For the control group, we include one-hundred and twelve normal population. A total of two-hundred and twenty-four stool samples were collected. The stool samples were processed and examined using the modified Ziehl-Neelsen (ZN) staining method. High Cryptosporidium prevalence of 14/112 (12.5%) was detected in hemodialysis patients compare to the normal individuals 3/112 (2.7%). There was no correlation between the prevalence of Cryptosporidium infection with the age, sex, and the duration of dialysis (P>0.05). Therefore, an early detection and prompt treatment of Cryptosporidium infected hemodialysis patients is crucial.

Bisphosphonate-Induced Deterioration of Osteomalacia in Undiagnosed Adult Fanconi Syndrome.

We describe two women with a misdiagnosed fracturing bone disease who were treated erroneously with i.v. zoledronate. Over the next year, they suffered marked clinical and radiographic deterioration in skeletal disease. Both were eventually diagnosed with hypophosphatemic osteomalacia secondary to acquired Fanconi syndrome (caused by light-chain myeloma in one case and tenofovir treatment in the other). Appropriate treatment with phosphate supplementation was instituted with clinical improvement. These cases illustrate the importance of not missing osteomalacia in adults presenting with fractures, and the potentially damaging effects of treatment with long-acting inhibitors of bone resorption in these circumstances. © 2020 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.

Effect of using cinnamon oil encapsulated in maltodextrin as exogenous flavouring on flavour quality and stability of biscuits.

The flavour quality of biscuits could be lost during baking and storage. Therefor, the impact of using cinnamon essential oil (EO) encapsulated in maltodextrin (CO-MD), as exogenous flavour, on the flavour quality and stability of biscuits was evaluated. The results were compared with those of using cinnamon oil dissolved in propylene glycol (CO-PG), as a delivery solvent. The main volatile compounds in cinnamon oil were used as markers to monitor its stability in biscuits flavoured with CO-MD and CO-PG during baking and storage. The volatile components generated in flavoured biscuits and nonflavoured biscuits (control) were analyzed by headspace solid phase microextraction and gas chromatography-mass spectrometry. The retention of cinnamaldehyde, eugenol and ß-caryophyllene in biscuits flavoured with CO-MD was significantly (P < 0.05) higher, over the shelf life test, than in biscuits flavoured with CO-PG. The Maillard reaction products showed the highest retention in biscuits flavoured with CO-MD compared with those flavoured with CO-PG and control sample. However, all of them showed a gradual decrease during storage. The lipid degradation products showed an opposite trend. Storage for 90 days revealed a gradual decrease in the overall acceptability for both samples. The results of aroma sensory analysis confirmed those of instrumental analysis. This study demonstrated that microencapsulated cinnamon EO affects positively the overall qualities of biscuits.

Adaptation of Plasmodium falciparum to its transmission environment.

Success in eliminating malaria will depend on whether parasite evolution outpaces control efforts. Here, we show that Plasmodium falciparum parasites (the deadliest of the species causing human malaria) found in low-transmission-intensity areas have evolved to invest more in transmission to new hosts (reproduction) and less in within-host replication (growth) than parasites found in high-transmission areas. At the cellular level, this adaptation manifests as increased production of reproductive forms (gametocytes) early in the infection at the expense of processes associated with multiplication inside red blood cells, especially membrane transport and protein trafficking. At the molecular level, this manifests as changes in the expression levels of genes encoding epigenetic and translational machinery. Specifically, expression levels of the gene encoding AP2-G-the transcription factor that initiates reproduction-increase as transmission intensity decreases. This is accompanied by downregulation and upregulation of genes encoding HDAC1 and HDA1-two histone deacetylases that epigenetically regulate the parasite's replicative and reproductive life-stage programmes, respectively. Parasites in reproductive mode show increased reliance on the prokaryotic translation machinery found inside the plastid-derived organelles. Thus, our dissection of the parasite's adaptive regulatory architecture has identified new potential molecular targets for malaria control.

Progress toward malaria elimination in Jazan Province, Kingdom of Saudi Arabia: 2000-2014.

BACKGROUND: The draft Global Technical Strategy for malaria aims to eliminate malaria from at least 10 countries by 2020. Yemen and Saudi Arabia remain the last two countries on the Arabian Peninsula yet to achieve elimination. Over the last 50 years, systematic efforts to control malaria in the Kingdom of Saudi Arabia has successfully reduced malaria cases to a point where malaria is now constrained largely to Jazan Province, the most south-western area along the Red Sea. The progress toward elimination in this province is reviewed between 2000 and 2014. METHODS: Data were obtained from the Ministry of Health case-reporting systems, activity reports, unpublished consultants reports, and relevant scientific published papers. Sub-provincial population data were obtained the national household censuses undertaken in 2004 and 2010. Rainfall data were obtained from the Meteorological Department in Jazan. RESULTS: Between 2000 and 2014 there were 5522 locally acquired cases of malaria and 9936 cases of imported malaria. A significant reduction in locally acquired malaria cases was observed from 2000 to 2014, resulting in an average annual incidence (2010-2014) of 0.3 cases per 10,000 population. Conversely imported cases, since 2000, remain consistent and higher than locally acquired cases, averaging between 250 and 830 cases per year. The incidence of locally acquired cases is heterogeneous across the Province, with only a few health districts contributing the majority of the cases. The overall decline in malaria case incidence can be attributed to coincidental expansion of control efforts and periods of exceptionally low rainfall. CONCLUSIONS: Jazan province is poised to achieve malaria elimination. There is a need to change from a policy of passive case detection to reactively and proactively detecting infectious reservoirs that require new approaches to surveillance. These should be combined with advanced epidemiological tools to improve the definitions of epidemiological receptive and hotspot malaria risk mapping. The single largest threat currently remains the risks posed by imported infections from Yemen.

A study of microemulsions as prolonged-release injectables through in-situ phase transition.

Microemulsions (MEs) have been studied extensively as colloidal carriers for the delivery of both water-soluble and lipid-soluble drugs. Our previous study showed that addition of water to ME formulations resulted in phase transition to either liquid crystal (LC) or coarse emulsion (CE). The aim of this study was to investigate whether these MEs could be used as drug delivery vehicles for prolonged release through in-situ phase transition following extravascular injection. Three ME formulations from the same pseudo-ternary phase diagram were investigated with respect to their phase transition behavior, and in-vivo drug release; a coarse emulsion-forming ME (CE-ME), an oil rich LC-forming ME (LC-ME1), and an oil poor LC-forming ME (LC-ME2). CE-ME was a W/O ME and both LC-MEs were O/W type. The release profiles of (99m)Tc labeled MEs following subcutaneous (SC) injection in rabbits were investigated with gamma-scintigraphy. The CE-ME dispersed readily in water, forming a CE, whereas the LC-forming MEs formed 'depots' in water. Polarized microscopy revealed a LC boundary spontaneously formed at the water/ME interface for the LC-MEs with the LC-ME2 forming a substantially thicker LC layer. The CE resulting from the water-induced transition of the CE-forming ME had a higher viscosity than the MEs, but lower than the LCs resulted from LC-MEs. Compared to LC-ME1, LC-ME2 underwent more rapid phase transition and the resultant LC had significant higher viscosity. The LCs formed from both ME formulations exhibited pseudoplastic properties; increasing the shear rate decreased the apparent viscosity exponentially. Following SC injection into the animal thigh, the LC-MEs had more prolonged release of (99m)Tc in a first-order manner, than CE-ME. The oil poor LC-ME2 had the slowest release with a t1/2 of 77min, 2.3 times longer than the oil rich LC-ME1; consistent with the thickness of LC layer formation observed in-vitro and their relative viscosities. In conclusion, the present in-vivo study has demonstrated the application of MEs as extravascular injectable drug delivery systems for sustained release. The retention of the vehicles at the injection site and the release rate were determined predominantly by their phase transition rather than ME type or oil content.

Genetic Diversity of Plasmodium falciparum Field Isolates in Central Sudan Inferred by PCR Genotyping of Merozoite Surface Protein 1 and 2.

BACKGROUND: Characterization of Plasmodium falciparum diversity is commonly achieved by amplification of the polymorphic regions of the merozoite surface proteins 1 (MSP1) and 2 (MSP2) genes. AIMS: The present study aimed to determine the allelic variants distribution of MSP1 and MSP2 and multiplicity of infection in P. falciparum field isolates from Kosti, central Sudan, an area characterized by seasonal malaria transmission. MATERIALS AND METHODS: Total 121 samples (N = 121) were collected during a cross-sectional survey between March and April 2003. DNA was extracted and MSP1 and MSP2 polymorphic loci were genotyped. RESULTS: The total number of alleles identified in MSP1 block 2 was 11, while 16 alleles were observed in MSP2 block 3. In MSP1, RO33 was found to be the predominant allelic type, carried alone or in combination with MAD20 and K1 types, whereas FC27 family was the most prevalent in MSP2. Sixty two percent of isolates had multiple genotypes and the overall mean multiplicity of infection was 1.93 (CI 95% 1.66-2.20). Age correlated with parasite density (P = 0.017). In addition, a positive correlation was observed between parasite densities and the number of alleles (P = 0.022). CONCLUSION: Genetic diversity in P. falciparum field isolates in central Sudan was high and consisted of multiple clones.

Malaria infection by sporozoite challenge induces high functional antibody titres against blood stage antigens after a DNA prime, poxvirus boost vaccination strategy in Rhesus macaques.

BACKGROUND: A DNA prime, poxvirus (COPAK) boost vaccination regime with four antigens, i.e. a combination of two Plasmodium knowlesi sporozoite (csp/ssp2) and two blood stage (ama1/msp142) genes, leads to self-limited parasitaemia in 60% of rhesus monkeys and survival from an otherwise lethal infection with P. knowlesi. In the present study, the role of the blood stage antigens in protection was studied in depth, focusing on antibody formation against the blood stage antigens and the functionality thereof. METHODS: Rhesus macaques were immunized with the four-component vaccine and subsequently challenged i.v. with 100 P. knowlesi sporozoites. During immunization and challenge, antibody titres against the two blood stage antigens were determined, as well as the in vitro growth inhibition capacity of those antibodies. Antigen reversal experiments were performed to determine the relative contribution of antibodies against each of the two blood stage antigens to the inhibition. RESULTS: After vaccination, PkAMA1 and PkMSP119 antibody titres in vaccinated animals were low, which was reflected in low levels of inhibition by these antibodies as determined by in vitro inhibition assays. Interestingly, after sporozoite challenge antibody titres against blood stage antigens were boosted over 30-fold in both protected and not protected animals. The in vitro inhibition levels increased to high levels (median inhibitions of 59% and 56% at 6 mg/mL total IgG, respectively). As growth inhibition levels were not significantly different between protected and not protected animals, the ability to control infection appeared cannot be explained by GIA levels. Judged by in vitro antigen reversal growth inhibition assays, over 85% of the inhibitory activity of these antibodies was directed against PkAMA1. CONCLUSIONS: This is the first report that demonstrates that a DNA prime/poxvirus boost vaccination regimen induces low levels of malaria parasite growth inhibitory antibodies, which are boosted to high levels upon challenge. No association could, however, be established between the levels of inhibitory capacity in vitro and protection, either after vaccination or after challenge.