Management of TB in the private sector in Khartoum, Sudan: quality and impact on TB control

IntroductionSudan has a large and growing private health sector. No survey was done in Sudan to show the extent of the use of private health care services by the population. Also precise data on tuberculosis (TB) diagnosis and treatment in the private sector are not available.Material and methodsA facility-based cross-sectional survey was carried out during February2007-June 2007 in Khartoum state, whereby consented private physicians working in the all private clinics (n=110) were interviewed.ResultsThis study showed that a large private sector exist in the country and deliver care to TB patients and reported the non-adherence of this sector to National Tuberculosis Program (NTP) guidelines. 59.1% of the interviewed physicians correctly mentioned the TB treatment regimens, only 8(12.3%) physicians that reported management of TB patients actually prescribed these regimens to their patients. Similarly, only 10(15.4%) physicians requested sputum smear examination for TBdiagnosis.ConclusionA considerable proportion of cases is inadequately managed by the private sector and is not notified to NTP. The information delivered by this study can be used to develop a workable Public-private mix (PPM) model with the private sector.Key words: Isoniazid, Rifampicin, Pyrazinamide, Ethambutol

Sudan Federal Ministry of Health. 3. World Health Organization, Khartoum, Sudan 4. Sudan Federal Ministry of Health. 5. World Health Organization

Abstract: Introduction Sudan has a large and growing private health sector. No survey was done in Sudan to show the extent of the use of private health care services by the population. Also precise data on tuberculosis (TB) diagnosis and treatment in the private sector are not available. Material and methods A facility-based cross-sectional survey was carried out during February2007-June 2007 in Khartoum state, whereby consented private physicians working in the all private clinics (n=110) were interviewed. Results This study showed that a large private sector exist in the country and deliver care to TB patients and reported the non-adherence of this sector to National Tuberculosis Program (NTP) guidelines. 59.1% of the interviewed physicians correctly mentioned the TB treatment regimens, only 8(12.3%) physicians that reported management of TB patients actually prescribed these regimens to their patients. Similarly, only 10(15.4%) physicians requested sputum smear examination for TB diagnosis. Conclusion A considerable proportion of cases is inadequately managed by the private sector and is not notified to NTP. The information delivered by this study can be used to develop a workable Public-private mix (PPM) model with the private sector

Effect of Different Growth Conditions on Certain Biochemical Parameters of Different Cyanobacterial Strains

Aims: Variation in the traditional growth medium conditions to enhance the production of lipids, carbohydrates, protein and the free amino acids content of three cyanobacterial species. Methodology and Results: Three species of cyanobacteria (Anabaena laxa, Anabaena fertilissima and Nostoc muscorum) were collected from the culture collection of Soils, Water and Environment Research Institute, Agriculture Research Center, Giza, Egypt, to investigate their biochemical composition under different growth conditions, using BG110 (nitrogen free) as growth medium. These conditions were represented by control medium, static glucose medium with (1%, w/v), aerated medium (aerated by bubbling technique depending on CO2 normally existed in air with a concentration of 0.03%), molasses medium (0.7%, v/v) and aerated medium enriched with glucose (1%, w/v). Lipid content, total carbohydrates, soluble proteins and free amino acids were determined at the previous conditions. Glucose at 0.7% (w/v) was the most favorable for lipid production in A. laxa, where it exhibited the highest lipid content (427 μg/g fresh wt.). Increasing molasses concentration up to 0.7% (v/v) produced an increase in lipid contents of the tested cyanobacterial strains. The highest lipid content of both N. muscorum (366.2 μg/g fresh wt.) and A. laxa (357.4 μg/g fresh wt.) were recorded at molasses concentrations of 0.1 and 0.7% (v/v), respectively. A. laxa expressed high significant values for both proteins (31.6 μg/mL) and free amino acids (40.5 mg/g dry wt.) after 6 days of incubation period under aerated enriched glucose condition (1%, w/v). Also, at the same growth conditions, A. fertilissima exhibited high significant values for carbohydrates at 4th day (876.8 mg/g dry wt.). Conclusion, significance and impact of study: Aerated enriched glucose medium (1%, w/v) was the best growth medium condition used in the present study

A Comparative Study of Prediction Techniques for Supersonic Missile Aerodynamic Coefficients / Loai A. El-Mahdy … [et al.]

Evaluating the aerodynamic coefficients of flying vehicles such as missiles is a key step in their design and development procedures. In practice, the aerodynamic coefficients can be estimated using experimental measurements, numerical simulations, or using empirical and semi-empirical engineering tools. In the present paper, these three approaches are compared in the context of examining the aerodynamic coefficients of a fin-stabilized tactical missile. Supersonic flight conditions up to Mach 4 at incidence up to 18 degrees are considered. Lift and drag coefficients as well as the centre of pressure locations based on the three approaches are compared. The flow features around the missile are explored based on the numerical simulations

Beyond the Pandemic: The Interplay and Biological Effects of COVID-19 on Cancer Patients -A Mini Review

This article delves into the relationship between COVID-19 and cancer. The challenges and effects of the COVID-19 pandemic on cancer patients are highlighted, along with an explanation of the most crucial strategies that must be adhered to avoid this virus. Explaining the importance of healthcare systems in providing services to patients and assisting them to improve their health condition. This article concentrates on recent studies and clinical observations as it allows for an accurate and comprehensive understanding of the effects of this pandemic on cancer patients. The main issues will be focused on the impact of viral infections on cancerous tumours while clarifying the long-term consequences on patients’ lives. The main goal of this article is to inform healthcare workers, physicians, and researchers about the impact and seriousness of COVID-19 on cancer patients

Can Bcl-XL expression predict the radio sensitivity of Bilharzial-related squamous bladder carcinoma? a prospective comparative study

<p>Abstract</p> <p>Background</p> <p>Local pelvic recurrence after radical cystectomy for muscle invasive bilharzial related squamous cell carcinoma accounts for 75% of treatment failures even in organ confined tumors. Despite the proven value of lymphadenectomy, up to 60% of patients undergoing cystectomy do not have it. These factors are in favor of adjuvant radiotherapy reevaluation. objectives: to evaluate the effect of adjuvant radiotherapy on disease free survival in muscle invasive bilharzial related squamous cell carcinoma of the urinary bladder and to test the predictability of radio-sensitivity using the anti apoptotic protein Bcl-XL.</p> <p>Methods</p> <p>The study prospectively included 71 patients, (47 males, 24 females) with muscle invasive bilharzial related squamous cell carcinoma of the bladder (Stage pT2a-T3N0-N3M0) who underwent radical cystectomy in Assiut university hospitals between January 2005 and December 2006. Thirty eight patients received adjuvant radiotherapy to the pelvis in the dose of 50Gy/25 fractions/5 weeks (Group 1), while 33 patients did not receive adjuvant radiotherapy (group 2). Immunohistochemical characterization for bcl-xL expression was done. Follow up was done every 3 months for 12 to 36 months with a mean of 16 ± 10 months. All data were analyzed using SPSS version 16. Three years cumulative disease free survival was calculated and adjusted to Bcl-XL expression and side effects of the treatment were recorded.</p> <p>Results</p> <p>The disease free cumulative survival was 48% for group 1 and 29% for group 2 (log rank p value 0.03). The multivariate predictors of tumor recurrence were the positive Bcl-XL expression (odd ratio 41.1, 95% CI 8.4 - 102.3, p < 0.0001) and radiotherapy (odd ratio 0.19, 95% CI 0.05 - 0.78, p < 0.02). With Cox regression, the only independent multivariate predictor of radio-sensitivity was the Bcl-XL expression with odd ratio 4.6 and a p value < 0.0001. All patients tolerated the treatment with no life threatening or late complications during the period of follow up.</p> <p>Conclusions</p> <p>Adjuvant radiotherapy for muscle invasive bilharzial related squamous cell carcinoma of the urinary bladder has potential effectiveness and minor side effects. Moreover, Bcl-XL expression is a valuable tool for predicting those who might not respond to this adjuvant treatment.</p

HBV and HIV/HBV Infected Patients Have Distinct Immune Exhaustion and Apoptotic Serum Biomarker Profiles

Background: Hepatitis B virus (HBV) infection is a leading cause of chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma worldwide. Due to their shared routes of transmission, approximately 10% of HIV-infected patients worldwide are chronically coinfected with HBV. Additionally, liver disease has become a major cause of morbidity and mortality in HBV/HIV coinfected patients due to prolonged survival with the success of antiretroviral therapy. The relationship between immune exhaustion markers (PD-1/PD-L1) and apoptotic markers such as Fas/FasL, TGFβ1, TNF-α, and Th1/Th2 cytokines are not clearly delineated in HBV/HIV coinfection. Methods: Levels of soluble Fas/FasL, TGFβ1, TNF-α, and sPD-1/sPD-L1 as well as Th1 and Th2 cytokines were evaluated in the sera of HBV-monoinfected (n=30) and HBV/HIV-coinfected (n=15) patients and compared to levels in healthy controls (n=20). Results: HBV-monoinfected patients had significantly lower levels of the anti-inflammatory cytokine IL-4 (P < 0.05) and higher levels of apoptotic markers sFas, sFasL, and TGFβ-1 (P < 0.001) compared to healthy controls. Coinfection with HIV was associated with higher levels of sFas, TNF-α, and sPD-L1 (P < 0.005), and higher levels of the pro-inflammatory cytokines IL-6, IL-8, and IL-12p70 (P < 0.05) compared to healthy controls. Patients with HBV infection had a unique biomarker clustering profile comprised of IFN-γ, IL12p70, IL-10, IL-6, and TNF-α that was distinct from the profile of the healthy controls, and the unique HIV/HBV profile comprised GM-CSF, IL-4, IL-2, IFN-γ, IL12p70, IL-7, IL-10, and IL-1β. In HBV monoinfection a significant correlation between sFasL and PD1(r = 0.46, P= < 0.05) and between sFas and PDL1 (r = 0.48, P= < 0.01) was observed. Conclusion: HBV-infected and HBV/HIV-coinfected patients have unique apoptosis and inflammatory biomarker profiles that distinguish them from each other and healthy controls. The utilization of those unique biomarker profiles for monitoring disease progression or identifying individuals who may benefit from novel immunotherapies such as anti-PD-L1 or anti-PD-1 checkpoint inhibitors appears promising and warrants further investigation

Dietary Behaviour Pattern and Physical Activity in Overweight and Obese Egyptian Mothers: Relationships with Their Children's Body Mass Index

BACKGROUND: Obesity and related morbidity increase in Egyptian women and their children. A better understanding of dietary and activity patterns is needed to reduce obesity prevalence.AIM: The present study aimed to assess dietary patterns and physical activity in Egyptian overweight and obese mothers and to explore its relationships with their children's body mass index (BMI).SUBJECTS AND METHODS: This descriptive case-control study was conducted at the National Research Center. The study included a sample of 64 overweight and obese mothers and 75 children, compared with apparently healthy non-obese mothers and their children of matched age and social class. Tested questionnaires were used to collect information of the studied subjects.RESULTS: A statistically significantly higher incidence of unemployment, large family size was observed in overweight &amp; obese women compared to controls (P &lt; 0.05). Those women who consumed vegetables more than 3 times a week were less likely to be overweight or obese (P &lt; 0.05). No significant association were detected between mothers' physical activity, dietary behaviour variables and children’s BMI except for consuming beverages with added sugar (95%CI = 0.074-0.985, P&lt;0.05).CONCLUSION: Improper dietary patterns, nonworking mothers and big family size are associated with obesity among Egyptian women. Emphasis should be given to increasing physical activity and encourage healthier diets among Egyptian mothers and their children

Feasibility and acceptability of home-based management of malaria strategy adapted to Sudan's conditions using artemisinin-based combination therapy and rapid diagnostic test

<p>Abstract</p> <p>Background</p> <p>Malaria remains a major public health problem especially in sub-Saharan Africa. Despite the efforts exerted to provide effective anti-malarial drugs, still some communities suffer from getting access to these services due to many barriers. This research aimed to assess the feasibility and acceptability of home-based management of malaria (HMM) strategy using artemisinin-based combination therapy (ACT) for treatment and rapid diagnostic test (RDT) for diagnosis.</p> <p>Methods</p> <p>This is a study conducted in 20 villages in Um Adara area, South Kordofan state, Sudan. Two-thirds (66%) of the study community were seeking treatment from heath facilities, which were more than 5 km far from their villages with marked inaccessibility during rainy season. Volunteers (one per village) were trained on using RDTs for diagnosis and artesunate plus sulphadoxine-pyrimethamine for treating malaria patients, as well as referral of severe and non-malaria cases. A system for supply and monitoring was established based on the rural health centre, which acted as a link between the volunteers and the health system. Advocacy for the policy was done through different tools. Volunteers worked on non-monetary incentives but only a consultation fee of One Sudanese Pound (equivalent to US$0.5).</p> <p>Pre- and post-intervention assessment was done using household survey, focus group discussion with the community leaders, structured interview with the volunteers, and records and reports analysis.</p> <p>Results and discussion</p> <p>The overall adherence of volunteers to the project protocol in treating and referring cases was accepted that was only one of the 20 volunteers did not comply with the study guidelines. Although the use of RDTs seemed to have improved the level of accuracy and trust in the diagnosis, 30% of volunteers did not rely on the negative RDT results when treating fever cases. Almost all (94.7%) the volunteers felt that they were satisfied with the spiritual outcome of their new tasks. As well, volunteers have initiated advocacy campaigns supported by their village health committees which were found to have a positive role to play in the project that proved their acceptability of the HMM design. The planned system for supply was found to be effective. The project was found to improve the accessibility to ACTs from 25% to 64.7% and the treatment seeking behaviour from 83.3% to 100% before- and after the HMM implementation respectivly.</p> <p>Conclusion</p> <p>The evaluation of the project identified the feasibility of the planned model in Sudan's condition. Moreover, the communities as well as the volunteers found to be satisfied with and supportive to the system and the outcome. The problem of treating other febrile cases when diagnosis is not malaria and other non-fever cases needs to be addressed as well.</p

Clinicopathological and prognostic significance of RECQL5 helicase expression in breast cancers

RECQL5 is a member of the RecQ family of DNA helicases and has key roles in homologous recombination, base excision repair, replication and transcription. The clinicopathological significance of RECQL5 expression in breast cancer is unknown. In the current study we have evaluated RECQL5 mRNA expression in 1977 breast cancers, and RECQL5 protein level in 1902 breast cancers [Nottingham Tenovus series (n=1650) and ER- cohort (n=252)]. Expression levels were correlated to aggressive phenotypes and survival outcomes. High RECQL5 mRNA expression was significantly associated with high histological grade (p=0.007), HER2 overexpression (p=0.032), ER+/HER2-/high proliferation genefu subtype, integrative molecular clusters (intClust 1and 9) and poor breast cancer specific survival (BCSS) (ps<0.0001). In sub-group analysis, high RECQL5 mRNA level remains significantly associated with poor BCSS in ER+ cohort (p<0.0001) but not in ER- cohort (p=0.116). At the protein level, in tumours with low RAD51, high RECQL5 level was significantly associated with high histological grade (p<0.0001), higher mitotic index (p=0.008), de-differentiation (p=0.025), pleomorphism (p=0.027) and poor BCSS (P=0.003). In sub-group analysis, high RECQL5/low RAD51 remains significantly associated with poor BCSS in ER+ cohort (p=0.010), but not in ER- cohort (p=0.628). In multivariate analysis, high RECQL5 mRNA and high RECQL5/low RAD51 nuclear protein co-expression independently influenced BCSS (p=0.022) in whole cohort and in the ER+ sub-group. Pre-clinically, we show that exogenous expression of RECQL5 in MCF10A cells can drive proliferation supporting an oncogenic function for RECQL5 in breast cancer. We conclude that RECQL5 is a promising biomarker in breast cancer