Efficacy of artemether-lumfantrine (Co-Artesianer) suspension in the treatment of uncomplicated Plasmodium falciparum malaria among children under 5 years in eastern Sudan

PURPOSE : the aim of the present study was to investigate the efficacy of artemether-lumfantrine (Co-Artesianer) suspension for the treatment of uncomplicated Plasmodium falciparum malaria in children (aged 6-59 months) in Kassala in eastern Sudan. METHOD: This was a prospective clinical trial where the artemether-lumfantrine (Co-Artesianer) suspension was given for three days and the patients were followed-up for 28 days. RESULTS: Forty-eight patients were enrolled in the study and 43 of them completed the 28-days follow-up. Treatment rapidly cleared parasitemia and fever. The overall 28-day cure rate was 100 percent and no clinical or parasitological failures were observed among these patients. Mild side effects were observed in three (7 percent) children. CONCLUSION: Artemether-lumfantrine (coartem) suspension appears to be efficacious and safe for the treatment of uncomplicated malaria

Cystic echinococcosis of livestock and humans in central Sudan.

New information was collected on cystic echinococcosis in livestock (camels, cattle and sheep) and humans in the central region of Sudan. The livestock data were collected in abattoir-based surveys in the towns of Omdurman, Tamboul and Wad Madani, between 1998 and 2001, and covered a total of 8205 animals. The highest prevalence of infection was found in the camels (44.6% of 242 infected), followed by the sheep (6.9% of 5595) and cattle (3.0% of 2368). Records were made of the sizes of the 1320 hydatid cysts detected in the livestock (907 in sheep, 71 in cattle, and 342 in camels), whether or not each cyst was fertile, and where it occurred in the body of the host. Cysts collected from cattle and camels where much more likely to be fertile (22% and 24%, respectively) than those from sheep (1%). Camels and cattle therefore appear to be the principal intermediate hosts for Echinococcus granulosus in central Sudan, whereas sheep apparently play a marginal role in transmission. In 2002, as a preliminary assessment of the public-health impact of the disease, 300 residents of a rural village 60 km west of Wad Madani were surveyed using a portable ultrasound scanner. Only one (0.33%) of the villagers investigated was found infected. The implications of these finding are discussed in terms of the various strains of E. granulosus and the role of each in human disease.

Psychiatric referrals. In primary care and general hospitals in Qassim Region, Saudi Arabia.

OBJECTIVE: From different perspectives, psychiatric symptoms have special significance in psychiatry. This study comparatively describes the psychopathological symptoms as noted in primary care (402) and general hospital (138) referrals. METHODS: Five hundred and forty psychiatric referrals, retrieved randomly, were reviewed extensively for collecting relevant data. RESULTS: Both hospital and primary care referrals were observed to have a variety of psychological and somatic symptoms of variable frequencies, which were suggestive of several psychopathological domains. Functional psychotic (19.5% versus 10%), mood (27.5% versus 23%) and psychosomatic (7% versus 2%) symptoms were significantly noted in hospital referrals as compared to primary care referrals while the later were observed to have significantly more somatic (34.5% versus 22.5%) and neurological (8% versus 4%) symptoms. Only a small proportion of primary care referrals (33/402, 8%] have symptoms of childhood psychiatric disorders. CONCLUSION: Psychiatric symptomatology differs in primary care and general hospital referrals. Both the general practitioners and clinicians are expected to record psychiatric symptoms in a comprehensive manner. Hence, they need condensed training courses on psychiatric symptomatology.

Susceptibility to periportal (Symmers) fibrosis in human schistosoma mansoni infections: evidence that intensity and duration of infection, gender, and inherited factors are critical in disease progression.

Lethal disease in Schistosoma mansoni infections is mostly due to portal hypertension caused by hepatic periportal fibrosis. To evaluate the factors that may determine severe disease, livers and spleens were examined by ultrasound in a Sudanese population living in a village where S. mansoni is endemic. Early (FI), moderate (FII), or advanced (FIII) fibrosis was observed in 58%, 9%, and 3% of the population, respectively. Although FI affected 50%-70% of the children and adolescents, FII prevalence was low in subjects

Severe hepatic fibrosis in Schistosoma mansoni infection is controlled by a major locus that is closely linked to the interferon-gamma receptor gene.

Lethal disease due to hepatic periportal fibrosis occurs in 2%-10% of subjects infected by Schistosoma mansoni in endemic regions such as Sudan. It is unknown why few infected individuals present with severe disease, and inherited factors may play a role in fibrosis development. Schistosoma mansoni infection levels have been shown to be controlled by a locus that maps to chromosome 5q31-q33. To investigate the genetic control of severe hepatic fibrosis (assessed by ultrasound examination) causing portal hypertension, a segregation analysis was performed in 65 Sudanese pedigrees from the same village. Results provide evidence for a codominant major gene, with.16 as the estimated allele A frequency predisposing to advanced periportal fibrosis. For AA males, AA females, and Aa males a 50% penetrance is reached after, respectively, 9, 14, and 19 years of residency in the area, whereas for other subjects the penetrance remains <.02 after 20 years of exposure. Linkage analysis performed in four candidate regions shows that this major locus maps to chromosome 6q22-q23 and that it is closely linked (multipoint LOD score 3.12) to the IFN-gammaR1 gene encoding the receptor of the strongly antifibrogenic cytokine interferon-gamma. These results show that infection levels and advanced hepatic fibrosis in human schistosomiasis are controlled by distinct loci; they suggest that polymorphisms within the IFN-gammaR1 gene could determine severe hepatic disease due to S. mansoni infection and that the IFN-gammaR1 gene is a strong candidate for the control of abnormal fibrosis observed in other diseases.

Characteristics of visitors to traditional healers in central Sudan.

Traditional healing is widespread in Sudan and traditional healers are well respected by the community. This study aimed to assess the characteristics of visitors attending traditional healers, the reasons for visits, the frequency of visits, satisfaction with visits and advantages and disadvantages of visits. The results showed that children under ten years did not take part in visits; most of the visitors were between 21 and 40 years (61%) and were women (62%). Visitors were less educated compared to the general population in the area. The main reasons given for attending traditional healers were treatment (60%) and blessing (26%). Visitors did not mention any disadvantages to visiting traditional healers.

Characteristics of visitors to traditional healers in central Sudan

Traditional healing is widespread in Sudan and traditional healers are well respected by the community. This study aimed to assess the characteristics of visitors attending traditional healers, the reasons for visits, the frequency of visits, satisfaction with visits and advantages and disadvantages of visits. The results showed that children under ten years did not take part in visits; most of the visitors were between 21 and 40 years [61%] and were women [62%]. Visitors were less educated compared to the general population in the area. The main reasons given for attending traditional healers were treatment [60%] and blessing [26%]. Visitors did not mention any disadvantages to visiting traditional healers

Prevalence of islet cell and thyrogastric autoantibodies in Sudanese patients with type 1 diabetes.

In this study, sera from 96 Sudanese patients with Type 1 diabetes and from 86 matched controls were tested for the following organ-specific antibodies: islet cell antibodies (ICA), thyroid microsomal antibodies (TMA), antithyroglobulin antibodies (ATA), and gastric parietal cell antibodies (PCA). In diabetic patients the prevalence rates of these antibodies were: ICA = 41.7%, ATA = 2.0%, TMA = 7.3%, PCA = 6.3%. All these rates were significantly higher than in controls except for ATA which showed similar low prevalence rates in patients and controls. The pattern of prevalence of these antibodies by age, sex, and duration of diabetes was assessed and compared with reports from other populations. The general pattern of these antibodies is similar to that reported in Caucasian populations, except for a slightly greater tendency for ICA to persist with increased duration of diabetes in our sample. Furthermore, the low prevalence of TMA in our population is comparable to that reported in Black American diabetic patients but significantly lower than rates reported in certain other racial groups.

HLA-DP polymorphism in Sudanese controls and patients with insulin-dependent diabetes mellitus.

Human leukocyte antigen (HLA) genes are candidates for susceptibility to insulin-dependent diabetes mellitus (IDDM). The association of IDDM with particular DR and DQ alleles has been reported in all populations studied, but its association with HLA-DP alleles has been controversial. To address this question we analyzed 19 DPB1 and 2 DPA1 alleles and their associations in well-characterized Sudanese (an admixture of Arab and Black) IDDM patients (n = 71) and ethnically matched controls (n = 86) using polymerase chain reaction-sequence specific oligonucleotide (PCR-SSO) typing. There were no significant differences between the patient and control groups in the DPB1 frequencies. DPB1*0201, *0401 and DPA1*01 were the most frequent alleles in both IDDM patients and control subjects. Significant positive and negative associations between DPB1 and DPA1 alleles were detected in both groups. A novel DPB1 allele included in DPB1*1701 was identified.

Identification of genetic susceptibility loci for insulin-dependent diabetes in Sudan.

In this study we report, for the first time, the molecular analysis of HLA-DR and DQ gene frequencies in a large cohort of well-characterized type 1 (insulin-dependent) diabetes mellitus (IDDM) patients (n = 72), and ethnically matched controls (n = 59) collected in sub-Saharan Africa. High molecular mass DNA was prepared and analysed in Southern blots and by oligonucleotide typing. We have shown a strong positive association between IDDM and the Asp 57- DQB1 allele *0201 (DQw2). A rare DR4, DQw2 haplotype was also identified at high frequency in the IDDM cohort. We can now confirm that the association between Asp 57- DQB1 alleles and IDDM, previously reported in ethnically diverse cohorts collected in Western Europe, North America, and South Asia, is also present in an IDDM cohort collected in Africa.

Analysis of HLA-DR and -DQ gene polymorphisms in Sudanese patients with type 1 (insulin-dependent) diabetes.

In this study we report for the first time, the molecular analysis of HLA-DR and -DQ gene frequencies in a large cohort of well characterized type 1 (insulin-dependent) diabetes mellitus (IDDM) patients (n = 72), and ethnically matched controls (n = 59) collected in sub-Saharan Africa. High molecular mass DNA was prepared and analyzed in Southern blots with DRB1, DQA1, and DQB1 probes. By identifying DR and DQ allele-specific restriction fragment length polymorphisms (RFLPs), we have shown a strong positive association between IDDM and the Asp 57- DQB1 allele *0201 (DQw2). A rare DR4, DQw2 haplotype was also identified at high frequency in the IDDM cohort. We can now confirm that the association between Asp 57-DQB1 alleles and IDDM, previously reported in ethnically diverse cohorts collected in Western Europe, North America, and South Asia, is also present in an IDDM cohort collected in Africa.