Insecticide resistance in malaria vectors in central Sudan

Malaria is the leading cause of mortality and morbidity in Sudan. The annual malaria cases and deaths are estimated at 7.5 million and 35, 000 respectively. One of the possible factors that have led to this situation is the development of insecticide resistance in the main malaria vector in Sudan, Anopheles arabiensis. This study therefore, was initiated to identify the malaria vectors in Gezira and Sennar states of central Sudan, determine their susceptibility levels to the different classes of insecticides used for malaria vector control, identify mechanisms of resistance, and determine the sporozoite infection rate and the blood meal sources in these populations. The polymerase chain reaction (PCR) for species identification revealed that An. arabiensis was the only member of the An. gambiae complex present in the study area. The blood meal analysis using ELISA showed high anthropophily with 89.2% feeding on humans. The overall sporozoite infection rate was 2.3 %. WHO susceptibility tests showed complete susceptibility of An. arabiensis to bendiocarb (100% mortality) and multiple resistance to permethrin (54-78%), DDT (55-66%) and malathion (76-78%). The kdr mutation analysis revealed the presence of the West African kdr allele with the majority of specimens being heterozygous (RS). The kdr in DDT/permethrin susceptible specimens were: 15% homozygous for the kdr mutation (RR), 64.2% heterozygous (RS) and 20.8% homozygous for the susceptible allele (SS). Amongst the DDT/permethrin resistant specimens, 13% were SS, 48.7% RS and 38.3% RR. The apparent lack of correlation between kdr and resistant phenotype strongly suggests that other resistance mechanisms are playing a role

Prevalence of Plasmodium vivax species in Elhajyosife area in Shergalnile locality in Khartoum State

Background: Plasmodium vivax malaria has been recognized as an important cause of morbidity in several African countries. The prevalence was previously estimated as 12.5% in Khartoum. These estimates are observed to be rising and spreading continuously. Aim: The present study was undertaken to investigate the situation of distribution of P. vivax malaria in Elhajyousiff area in Khartoum State-Sudan. Methods: Cross-sectional malaria surveys carried out in Elhajyousiff area (Khartoum State) during the period of August 2021 to September 2021 .Atotal number of 250 blood samples were examined by microscopical examination. The samples were collected from different centers in Elhajyousiff area (Albanjadeed Hospital, Almaygoma Health Center and Alsheeda Nada Health Center). All samples were examined by direct microscopy for plasmodium species using blood film (Thick and thin). Results: From 250 samples there were 241(96.4%) samples negative, 5(2.0%) samples were positive for P.falciparum and 4(1.6%) samples were positive for P.vivax. The P. falciparum showed as more common species in area. Conclusions: Even though malaria in Shergalnile locality is still largely recognized to Plasmodium falciparum, P. vivax has been growing with worrying proportions and spreading to new areas. The emergence and marked increase of P. vivax poses new challenges to malaria treatment and control in Elhajyousiff area

Awareness of Final-Year Medical Students of Omdurman Islamic University on Their Career Choices

Background: Medical students undergo a complex process as a student to make a career decision and pursue further specialization. This study explores the factors that influence the career choices of the two genders studying in the final year of medicine at Omdurman Islamic University.Methods: This institution-based cross-sectional study was conducted on 194 male and female fifth-year medical students studying at Omdurman Islamic University. The questionnaire contains 15 multiple-choice questions to determine the factors affecting students’ career choices – lifestyle, income, family impact,…etc. – and the association between gender and the specialties they choose to pursue.Results: The specialties were preferred in the following order: surgery by 22.9%, internal medicine by 18.3%, obstetric gynecology by 13.8%, and pediatric by 10% (limited to the four major specialties). The least chosen specialties were histopathology, emergency medicine, psychiatry, and anesthesia (all were 0.9%). Family medicine and forensics were not chosen by any participant. Females significantly preferred dermatology, obstetrics and gynecology, otolaryngology, and pediatrics compared to their male counterparts. Whereas, males compared to females significantly preferred orthopedics and surgery. The factors influencing change in students’ specialties based on their gender were family views and family obligations. Nearly 80% of students choose a career based on personal interest; lifestyle and financial reward were also seen to play an important role in choosing a specialty. About 91% of participants agreed that there is a need for guidance. A great proportion of final-year students (62%) preferred to specialize abroad and related it to a good lifestyle and financial stability.Conclusion: This study showed that the students’ awareness about specialty choices was limited to certain specialties as seen in the literature. The most preferred specialties were surgery (22.9%), internal medicine (18.3%), obstetrics and gynecology (13.8%), and pediatric (10%). There are many factors influencing the selection of specialties, however, the most common one is personal interest followed by lifestyle issues and financial reward. Additionally, there is a significant gender difference in career-choice decisions

LC-MS/MS Tandem Mass Spectrometry for Analysis of Phenolic Compounds and Pentacyclic Triterpenes in Antifungal Extracts of Terminalia brownii (Fresen)

Decoctions and macerations of the stem bark and wood of Terminalia brownii Fresen. are used in traditional medicine for fungal infections and as fungicides on field crops and in traditional granaries in Sudan. In addition, T. brownii water extracts are commonly used as sprays for protecting wooden houses and furniture. Therefore, using agar disc diffusion and macrodilution methods, eight extracts of various polarities from the stem wood and bark were screened for their growth-inhibitory effects against filamentous fungi commonly causing fruit, vegetable, grain and wood decay, as well as infections in the immunocompromised host. Ethyl acetate extracts of the stem wood and bark gave the best antifungal activities, with MIC values of 250 ug/mL against Nattrassia mangiferae and Fusarium verticillioides, and 500 ug/mL against Aspergillus niger and Aspergillus flavus. Aqueous extracts gave almost as potent effects as the ethyl acetate extracts against the Aspergillus and Fusarium strains, and were slightly more active than the ethyl acetate extracts against Nattrassia mangiferae. Thin layer chromatography, RP-HPLC-DAD and tandem mass spectrometry (LC-MS/MS), were employed to identify the chemical constituents in the ethyl acetate fractions of the stem bark and wood. The stem bark and wood were found to have a similar qualitative composition of polyphenols and triterpenoids, but differed quantitatively from each other. The stilbene derivatives, cis- (3) and trans- resveratrol-3-O-b-galloylglucoside (4), were identified for the first time in T. brownii. Moreover, methyl-(S)-flavogallonate (5), quercetin-7-b-O-di-glucoside (8), quercetin-7-O-galloyl-glucoside (10), naringenin-40-methoxy-7-pyranoside (7), 5,6-dihydroxy-30,40,7-tri-methoxy flavone (12), gallagic acid dilactone (terminalin) (6), a corilagin derivative (9) and two oleanane type triterpenoids (1) and (2) were characterized. The flavonoids, a corilagin derivative and terminalin, have not been identified before in T. brownii. We reported earlier on the occurrence of methyl-S-flavogallonate and its isomer in the roots of T. brownii, but this is the first report on their occurrence in the stem wood as well. Our results justify the traditional uses of macerations and decoctions of T. brownii stem wood and bark for crop and wood protection and demonstrate that standardized extracts could have uses for the eco-friendly control of plant pathogenic fungi in African agroforestry systems. Likewise, our results justify the traditional uses of these preparations for the treatment of skin infections caused by filamentous fungi.Peer reviewe

Knowledge, Attitudes, and Practice of Self-Medication among Medical Students at Sudan International University, Sudan

Background: Self-medication is a practice or action taken by individuals for themselves in order to achieve and maintain health, as well as to avoid and protect against disease. The aim of this study is to evaluate the knowledge, attitudes, and practice of self-medication among medical students at Sudan International University. Subjects & Methods: This was a prospective study that involved 288 out of 1000 students in the Faculty of Medicine at Sudan International University. Data were collected using a self-administered questionnaire from January to March 2022 to evaluate the self-medication knowledge, attitude, and practice among first, second, and third-year medical students. Result: The age groups of this study were arranged as follows; 197(17-20 year), 72(21-23 year) and 19(>23 year). Regarding the sex of the study population, the female group was 215(74.7%) while the male group was 73(25.3%). The classification of the population according to their academic levels; as follows; first year 124 (43.1%), second year 52 (18.1%) and third year 112(38.9%). The prevalence of self-medication was found to be a common practice by the majority of the students, since 279 (96.9 %) of the study group practiced self-medication, in contrast to only 9 (3.1%), who did not deal with any self-medication. Also, the result showed that the most common drugs were; vitamins 183 (65.6%) and analgesics 176 (63.1%) followed by antibiotics 172 (61.6%). Regarding the illnesses described by the student as an indication of self-medication, they are as follows; headache is the most common (93.2%), followed by common cold and cough 211(75.6%). Concerning the source of information used by the studied population for self-medication, pharmacists were found to be the main source of information 122 (42.4%) followed by parents of the students 102 (35.4%). Furthermore, the results revealed that the main reason given for practicing self-medication by the study group was that the illness was not serious is (69.5%). Conclusion: Self-medication was found to be widely practiced in 96.9% of cases, and the main reasons for self-medication were that the disease was not serious

Identification and characterization of microRNAs expressed in the African malaria vector Anopheles funestus life stages using high throughput sequencing

Background: Over the past several years, thousands of microRNAs (miRNAs) have been identified in the genomes of various insects through cloning and sequencing or even by computational prediction. However, the number of miRNAs identified in anopheline species is low and little is known about their role. The mosquito Anopheles funestus is one of the dominant malaria vectors in Africa, which infects and kills millions of people every year. Therefore, small RNA molecules isolated from the four life stages (eggs, larvae, pupae and unfed adult females) of An. funestus were sequenced using next generation sequencing technology. Results: High throughput sequencing of four replicates in combination with computational analysis identified 107 mature miRNA sequences expressed in the An. funestus mosquito. These include 20 novel miRNAs without sequence identity in any organism and eight miRNAs not previously reported in the Anopheles genus but are known in non-anopheles mosquitoes. Finally, the changes in the expression of miRNAs during the mosquito development were determined and the analysis showed that many miRNAs have stage-specific expression, and are co-transcribed and co-regulated during development. Conclusions: This study presents the first direct experimental evidence of miRNAs in An. funestus and the first profiling study of miRNA associated with the maturation in this mosquito. Overall, the results indicate that miRNAs play important roles during the growth and development. Silencing such molecules in a specific life stage could decrease the vector population and therefore interrupt malaria transmission.IS

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Abstract: Background: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions: The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown

PANC Study (Pancreatitis: A National Cohort Study): national cohort study examining the first 30 days from presentation of acute pancreatitis in the UK

Abstract Background Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment. Methods All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals. Results A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of acute pancreatitis. One in 20 patients were classed as having severe pancreatitis, as per the Atlanta criteria. The overall mortality rate was 2.3 per cent at 30 days, but rose to one in three in the severe group. Predictors of death included male sex, increased age, and frailty; previous acute pancreatitis and gallstones as aetiologies were protective. Smoking status and body mass index did not affect death. Conclusion Most patients presenting with acute pancreatitis have a mild, self-limiting disease. Rates of patients with idiopathic pancreatitis are high. Recurrent attacks of pancreatitis are common, but are likely to have reduced risk of death on subsequent admissions. </jats:sec

Analytical Techniques for Identification and Quantification of Polycyclic Aromatic Hydrocarbons

ABSTRACT Several analytical techniques have been developed and applied for identification and quantification of polycyclic aromatic hydrocarbons (PAHs) present in different samples. These analytical techniques include gas chromatography coupled with flame ionization detectior (GC/FID), gas chromatography coupled with a mass spectrometry (GC/MS), high performance liquid chromatography (HPLC) coupled with an ultraviolet or fluorescence detector, and thin-layer chromatography (TLC) with fluorescence detection. Since sensitive analytical techniques were essential in the determination of the presence and levels of these toxic compounds, some aspects of standard preparation and suitable instrumental condition for quantification of the sixteen PAHs listed by the U.S. environmental protection agency (EPA) have been reviewed in this article. The quantification performance of each technique has been comparable for different samples matrix