Selection of pfdhfr/pfdhps alleles and declining artesunate/sulphadoxine-pyrimethamine efficacy against Plasmodium falciparum eight years after deployment in eastern Sudan.

BACKGROUND: Artesunate/sulphadoxine-pyrimethamine (AS/SP) has been the first-line treatment for falciparum malaria in Sudan since 2004. The impact of this combination on anti-malarial resistance-associated molecular markers has not been investigated. In this study, an evaluation of the efficacy and prevalence of drug resistance alleles (pfcrt, pfmdr1, pfdhfr and pfdhps) eight years after the adoption of AS/SP in eastern Sudan is reported. METHODS: A 28-day follow-up efficacy trial of AS/SP was conducted in eastern Sudan during the 2012 transmission season. Blood smears were collected from patients on days 0, 1, 2, 3, 7, 14, 21 and 28. Blood spots on filter paper were obtained pre-treatment and on the day the patient was parasite positive by microscopy. Genotyping of alleles was performed by qPCR (pfcrt 72-76 and pfmdr1 copy number) and direct sequencing of pfmdr1, pfdhfr and pfdhps. RESULTS: Sixty-three patients out of 68 (93%) completed the 28-day follow-up, adequate clinical, and parasitological response occurred in 90.5% and 85.3% of the patients in the per-protocol and intent-to-treat analyses, respectively. PCR corrected per-protocol efficacy was 93.7%. The enrolment prevalence of pfcrt-CVMNK was 30.2% and pfmdr1-N86 was 40.3%. The pfmdr1 haplotype NFD occurred in 32.8% of pre-treatment samples and was significantly higher than previous reports (Fisher's exact p = 0.0001). The pfdhfr-51I/108N combination occurred in all sequenced isolates and 59R was observed in a single individual. pfdhps substitutions 436A, 437G, 540E, 581G and 613S were observed at 7.8, 77.3, 76.9%, 33.8% and 0.0%, respectively. Treatment failures were associated with the pfdhps haplotype SGEGA at these five codons (OR 7.3; 95% CI 0.65 - 368; p = 0.048). CONCLUSION: The decrease of CQR associated genotypes reflects the formal policy of complete removal of CQ in Sudan. However, the frequency of markers associated with SP failure is increasing in this study area and may be contributing to the treatment efficacy falling below 90%. Further monitoring of AS/SP efficacy and of post-treatment selection of pfdhfr and pfdhps alleles in vivo is required to inform future treatment guidelines

Neonatal mortality in Sudan: analysis of the Sudan household survey, 2010

BACKGROUND: Sudan is classified as having insufficient progress in achieving the Millennium Development Goal (MDG-4), where the levels of child and infant mortality are among the highest in the region and the world. This study investigated factors associated with neonatal mortality in Sudan. Neonatal death is defined as death within the first 28 days of life. METHODS: This study analysed data from the Sudan Household Health Survey 2nd round, which was carried out in 2010. Total of 6,198 live-born infants delivered within the two years preceding the survey were included as the study population. Multivariate logistic regression was used to model neonatal mortality as a function of maternal health parameters, socioeconomic indicators and the sex of the child. RESULTS: There were 189 neonatal deaths out of 6,198 live births (3.0%). In the multiple logistic regression, the factors associated with neonatal mortality were advanced maternal age (≥ 40 years; OR = 2.4; 95% CI: 1.21, 4.78, p = 0.012), poor household wealth index (OR = 1.6; 95% CI: 1.18, 2.47, p = 0.005), male child (OR = 1.8; 95% CI: 1.31, 2.42, p < 0.001), delivery of baby by Caesarean section (OR = 1.6; 95% CI: 1.78, 2.42, p = 0.013) and delivery complications (OR = 1.4; 95% CI: 1.18, 2.15, p = 0.002). CONCLUSION: Public health interventions which target neonatal mortality reduction should adopt a risk-factor-based approach to detect pregnancy complications early and once identified, the health system should be strengthened so that these complications can be dealt with adequately

Anemia During Pregnancy

Anemia during pregnancy is a considerable health problem, with around two-fifths of pregnant women worldwide being anemic. Many gynecological and infectious diseases are predisposing factors for anemia during pregnancy. Anemia during pregnancy—especially the severe form—can lead to various maternal and perinatal adverse effects such as preterm labor, low birth weight, and intrauterine fetal death. It is one of the leading causes of maternal mortality. Therefore, preventive measures are needed if anemia and its adverse effects are to be prevented. Iron and folic acid supplements are the cornerstone for the prevention of anemia during pregnancy and one of the earliest preventive measures adopted in antenatal care. Other measures to prevent anemia during pregnancy include the fortification of principle foods with iron, increasing health and nutritional awareness, combating parasitic infections, and improvement in sanitation. There is a controversy concerning the benefit of other elements such as zinc, copper, and magnesium, so the use of these elements is not widely adopted for the prevention of anemia

Malaria, Schistosomiasis, and Related Anemia

Parasitic infections (e.g., malaria and helminthiases) have a huge impact on public health in endemic areas. Moreover, parasitic infestations are prominent causes of anemia in the tropics and subtropics, further perpetuated by malnutrition, inflammatory, and genetic diseases. Anemia-associating parasitic infections vary depending on the requirements and pathophysiology of the parasites. There is an interplay between different factors that can be segregated as host and parasite factors, resulting in severe anemia accompanying these parasitic infestations. The pathophysiological mechanisms leading to anemia associated with the different parasites vary greatly, including hemolysis, anemia of inflammation, bone marrow suppression, and micronutrients deficiency. The major means to deal with this anemia include prevention and treatment of such infestations

Abdominal Wall Mycetoma Presented as Obstructed Incisional Hernia of Cesarean Section in Eastern Sudan

Mycetoma a worldwide disease frequently occurs in the tropics with the highest prevalence being in Africa. Madurella mycetomatis is the main causative organism of human eumycetoma in Sudan. The legs and feet were commonly the sites of the infection. A 22-year-old lady was presented with painful abdominal swelling around a previous caesarian section scar. A provisional diagnosis of obstructed incisional hernia was put. Histopathological examination revealed macroscopically four masses of soft tissue. Microscopic sections showed grains of Madurella mycetomatis

Vaginal Delivery after Cesarean Section

Cesarean delivery is needed (indicated) for many reasons such as failure to progress, cephalopelvic disproportion, antepartum hemorrhage, preeclampsia, and repeated cesareans. The increase of the cesarean delivery rate is accompanied with an increase in the maternal and perinatal morbidities and increase in maternal mortality such as complications of anesthesia, injury to the nearby structure, respiratory distress syndrome, childhood allergy and childhood obesity. Vaginal delivery after cesarean section (VBAC) is one of the tools that aimed to reduce the rate of cesarean delivery. Here in this chapter we would like to highlight the different guidelines for VBAC, the success rate of VBAC, the determinant of the success rate, maternal and perinatal outcomes of VBAC. Then the arena of using oxytocic drugs in VBAC is discussed in details too

Finite element analysis of prestressed pretension concrete T-Beam

Prestressed concrete constructions become a one of the famous constructions method. The stresses occurred in concrete and reinforcement became kind of complex due to prestressing and applying loads. And in reasons of costs and time for lab tests, Three-dimensional nonlinear finite element model of prestressed reinforced concrete T-beam had been developed in this study. This lead to the requirement by codes of practice to obtain design parameters for each new system by extensive fullscale testing. According to the high costs and time consuming for laboratory tests. Many researchers tried to propose alternative methods of small-scale testing and finite element models. These methods are still being refined to make them more accurate and practical for use in design offices. In this study we are going to develop a model to simulate a model had been tested at lab of structure in Universiti Teknologi Malaysia and to obtain the best method of modeling the specimen. At the end of this study it should be aim to develop a 3D finite element model of prestressed concrete T-beams and analyzed them using finite element software, ANSYS package. Interface elements will be used for modeling bond interaction between concrete, reinforcement and prestressed force in tendons. And by applying loads up to ultimate loads and plot the graph of loads verses displacement in linearity region, and by increasing loads up to non-linearity region will be illustrated in the criteria of flexure behavior. The results was be verified against published experimental data for test on T-beam done in Universiti Teknologi Malaysia. It is expected that, by using the mentioned combination, a more accurate model was be achieved as compared to result out from tests

ANEMIA IN PREGNANT WOMEN OF EASTERN SUDAN

&nbsp;It has been estimated that over half of all women in the world experience anemia during pregnancy with 95% occurring among women in the developing counteries1. Many risk factors for anemia were identified in pregnancy 2. In a community-based study we have recently reported that around 26% of the women of Eastern Sudan were anaemic, as well as we have shown that anaemia is one of the risk factors for deep venous thrombosis in the Sudanese pregnant women 3,4. However no proper published data exist for anaemia, its epidemiology and the risk factors during pregnancy in Sudan.&nbsp;&nbsp; We performed a prospective study to estimate the incidence, timing and the risk factors for anemia during pregnancy in a population of Sudanese women in Eastern Sudan. Pregnant women attended antenatal care clinic at New Halfa Teaching Hospital were approached for participation in the study during September- November 2003. After a verbal consent a fixed questionnaire containing sociodemographic characters, obstetrical history as well as the known risk factors for anemia was filled (history of abortion, lack of iron supplementation, oral contraceptive pills (OCP) use and pica). All patients were examined clinically to detect signs of anemia–if present. Spleen was palpated and the gestational age was confirmed by Ultrasound in cases of discrepancy. Hemoglobin was estimated by colorimeter (WPA, U.K) and blood films for malaria were prepared using Geimsa stain. A well-trained technician who was blinded about the women’s data did the laboratory investigations. Data was entered in microcomputer using SPSS for windows the students, t-test, compared the mean ± SD of the age, gestational age, and hemoglobin. Relative risk was calculated for the possible factors. P &lt; 0.05 was considered significant. &nbsp

Editorial – War in Sudan: The Impact on Maternal and Perinatal Health

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