Prevalence of hepatitis B virus infection in the Gezira state of central Sudan.

AIM: This is a cross-sectional study to determine the prevalence and risk factors for transmission of hepatitis B virus (HBV) infection in the Gezira state of central Sudan prior to the introduction of blood screening and vaccination against HBV. MATERIALS AND METHODS: The study was carried out on the population of Um Zukra village in Gezira state of Central Sudan. The village was surveyed on five consecutive days in Dec 2000. Epidemiological characteristics were recorded and participants were interviewed for risk factors of viral hepatitis. Blood samples were then collected and tested for HBsAg and HBcAb. RESULTS: A total of 404 subjects were screened with a mean age of 35 years; 54.9% were females, HBsAg and HBcAb were reactive in 6.9% and 47.5% of the studied population, respectively. Exposure to HBV increased with increasing age. The only significant risk factor for transmission of infection was a history of parenteral antischistosomal therapy. CONCLUSION: This study shows that prevalence of HBV infection is high in the studied population and it is hoped that introduction of blood screening and vaccination against HBV would decrease the carrier pool in the next few years.

No evidence for a major effect of tumor necrosis factor alpha gene polymorphisms in periportal fibrosis caused by Schistosoma mansoni infection.

Hepatic periportal fibrosis (PPF), associated with portal hypertension, is a major pathological consequence of infections with Schistosoma mansoni and Schistosoma japonicum. Indeed, affected subjects may die from portal hypertension. Previous studies have indicated that tumor necrosis factor alpha (TNF-alpha) may aggravate fibrosis. We therefore investigated whether PPF was associated with certain polymorphisms of the TNF-alpha gene. Four polymorphisms (TNF-alpha -376 G/A, -308 G/A, -238 G/A, and +488 G/A) were investigated in two Sudanese populations living in an area in which S. mansoni is endemic. These polymorphisms were analyzed for 105 Sudanese subjects with various grades of PPF, from mild to advanced; all subjects were from two neighboring villages (Taweela and Umzukra). They were then analyzed for 70 subjects with advanced liver disease and for 345 matched controls from the Gezira region. We found no evidence of associations between these four polymorphisms and PPF in both of these studies. Thus, these four polymorphisms, two of which (TNF-alpha -376 and -308) were found to increase TNF-alpha gene transcription, are unlikely to have a major effect on PPF progression in these populations. However, this result does not exclude the possibility that these polymorphisms have a minor effect on PPF development.

A simplified management of diabetic pregnant woman.

OBJECTIVE: To evaluate a simplified management of diabetic pregnant women. METHODS: A prospective study of the management of all diabetic pregnant women (74) during 2 years from March 1995-March 1997 was carried out in the Department of Obstetrics & Gynecology, Wad Medani Teaching Hospital, Sudan. Diabetes was diagnosed by an oral glucose tolerance test according to the World Health Organization criteria. Patients were controlled by insulin and monitored by urine for glucose and pre-prandial blood sugar. They were delivered by induction of labor or cesarean section at 38 weeks. Basic resuscitation was carried out for all babies. Intravenous glucose was given to babies when hypoglycemia was diagnosed. Early breast feeding was the rule. Babies who developed complications were managed at the special care unit in the Children's Hospital. RESULTS: Seventy one patients completed the management, 2 ended in abortion and 69 proceeded to 30 weeks or more. There was one maternal death and 14 perinatal deaths. The main causes of perinatal deaths--Wigglesworth classification--were macerated stillbirth (5), congenital malformation (4) and intrapartum asphyxia (5). A reasonable control of diabetes (pre-prandial 179 or less) was achieved in 56 patients (79%). Seventy percent of the patients were delivered by cesarean section and the main indications were big baby (16 cases) and a previous cesarean section (20 cases). Fifty four percent of all the patients had a history of perinatal death, 28% had a history of repeated abortions and there was a definite family history of diabetes in 53%. Sixty nine percent of the patients were at the age 30 years or more and 50% of them were of the parity 5 or more. CONCLUSION: This simplified management of diabetic pregnant women is satisfactory and feasible under our present circumstances. It is hoped that improvement in ante-natal care, delivery care and control of diabetes around the time of conception and care of the newborn will reduce the perinatal mortality rate.

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.

Viral hepatitis in pregnancy.

Fifty pregnant women with viral hepatitis were compared with 31 non-pregnant women with viral hepatitis in a prospective case-control study. The two groups were matching except for the serum bilirubin level and area of residence. Seven pregnant women died while none of the control patients died and the difference between the two groups was significant. More than 80% of the deaths occurred in the third trimester and most of them were post-partum deaths. Except for a higher incidence of pre-term birth, the outcome of pregnancy in the case group was not affected. It is concluded that pregnancy is a risk factor which increases the mortality of viral hepatitis and that viral hepatitis does not affect the outcome of pregnancy except for pre-term birth.

PIP: 50 pregnant women and 31 nonpregnant women (age 15-40 years) with viral hepatitis admitted to Wad Medani Teaching Hospital, Sudan, during the period January 1987-January 1990 were compared in a prospective case control study. The mean serum bilirubin level was higher in the control group and the difference was statistically significant (p = 0.0084). Significantly more case came from rural settings (76%) compared with control patients (48%) (p 0.01). The criteria for admission were the presence of symptoms and signs of hepatitis and bilirubin in the urine. Almost all patients admitted to the study had viral hepatitis caused by type A virus, type B virus, or non-A, non-B viruses, however, a very small number of diseases of patients could be attributed to rare viruses like EB or cytomegalovirus. No specific medication was given and patients were managed by bed rest and parenteral multivitamins (Parentrovit). All patients were kept in the hospital until they became asymptomatic and serum bilirubin dropped to less than 2 mg/100 ml. All cases and controls were followed up for 6 weeks. All the control patients were discharged after recovery and none of them died or developed recurrence of disease. Out of the 50 pregnant women, 7 died, giving a maternal mortality rate of 14%; the rest recovered and none of them developed recurrence of disease during the follow-up period. The difference between the 2 groups was statistically significant (p = 0.04). The estimated relative risk of death in viral hepatitis with pregnancy was 9.93. Among 5 deaths that occurred after delivery during the 3rd trimester 1 was at term and the baby was normal; 4 were preterm deliveries. Out of the 50 pregnant women, 1 died before delivery and 1 delivered at home. The outcome of pregnancy in the remaining 48 was: 2 abortions (4.2%), 10 preterm (20.8%), and 36 (75%) term deliveries. There were 2 stillbirths (4.2%) one at term and one at 34 weeks.