Socio-cultural determinants and impact of HIV infection in the Sudan

Background: Sudan, among the Subsaharan African countries has a low prevalence of HIV infection particularly in the North of the predominantly Muslim population. The peace agreement (2005) which stopped the civil war in the South opened the boarders with the HIV-high prevalence countries of Central and West Africa. This is expected to increase the transmission of HIV in the whole of Sudan. Methods and results: The present study interviewed 635 HIV positive individuals reporting for testing in three voluntary counseling and treatment (VCT) centres in Khartoum. Socio-cultural determinants of the infection showed that the young adults less than 50 years constitute 66.1% of all infected, with 60% males, 40% females and majority 64.9% are either illiterate or had minimum level of education. 61% of them were Muslims and 39% were Christians or non believers, 50.1% were married. The quality of life changed in 89% of individuals.Conclusion: It is concluded that the infection with HIV in Sudan may increase and health education messages need to be tailored according to the sociocultural determinants of the infection in a multicultural, multi-religious country like the Sudan. Muslims will not be protected against HIV infection unless they adhere to the code of Islam.Keywords: human immuno-deficiency virus, Muslims, Subsahara

Treatment of pre-school children under 6 years of age for schistosomiasis: safety, efficacy and acceptability of praziquantel

BackgroundThe World Health Organization (WHO) recommends praziquantel for the control and treatment of schistosomiasis, with no real alternative. Pre-school children are excluded from population treatment programs mainly due to paucity of safety data on this age group.Objectives: This study investigated safety, efficacy and acceptability of praziquantel for the treatment of S. haematobium and S. mansoni infections among pre-school children aged <6years. The study also investigated the burden of schistosomiasis in this age group.Methods: Pre-school children (n=188) from Sudan were included in the study. The children were treated with praziquantel tablets at a single dose of 40 mg/kg body weight. Adverse events were assessed at 24 hours and 7 days later, via questionnaire administration to parents and guardians.Efficacy of treatment was assessed at 1, 3 and 6 months by examining stool and urine samples for schistosome eggs. Acceptability was determined by the number of children spitting or vomiting during administration of the drug.Results: The burden of schistosomiasis among pre-school children aged <6 years was high (31.1%), and this was comparable to that observed among school children-aged 6 years (32%). Praziquantel treatment achieved high cure rates (egg negative) for both S. haematobium and S.mansoni infections when assessed at 1 month after treatment (89.6-92.1%) and remained high for S. haematobium (89.6-100%) up to 6 months. However, cure rate dropped from 90.5% at one month to 58.8% and 69.2% at 3 and 6 months among S. mansoni-treated children.  Praziquantel treatment decreased egg counts considerably with  post-treatment geometric mean egg reductions rates ranging from 96.4% to 99.4% at 1 month. Acceptability of praziquantel treatment was high, only for one child the dose had to be repeated after initial spitting. Treatment resolved haematuria and improved weight of the children. There were no drug-related adverse events in all the treated children duringfollow-up at 24 hours and 7 days.Conclusions: Praziquantel is safe, effective and acceptable among children aged <6 years. Preschool children represent a high risk group for schistosomiasis and should be included in population treatment programs.Keywords:Schistosomiasis,Praziquantel, Safety,Young Children

Phytochemical, antimicrobial and cytotoxicity screening of ethanol extract of Acacia ehrenbergiana Hayne grown in Jazan Region of Saudi Arabia

Purpose: To explore the phytoconstituents of Acacia ehrenbergiana Hayne as well as its biological effects. Methods: Determination of phytoconstituents of ethanol extract of the plant was performed by gas chromatography-mass spectrometry (GC-MS) technique. Antibacterial screening was conducted against the isolates of Gram-positive and Gram-negative microbes while the anti-carcinogenic properties of the ethanol extract on cancerous cells were investigated by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) cytotoxicity assay against breast MCF7, ovary cancer A2780 and colon cancer HT29 cells, respectively, in addition to normal MRC5 fibroblast cells. Results: GC-MS analysis identified 15 different phytochemicals in the ethanol extract. The extract exerted significant antimicrobial activity with the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) in the range 1.56 - 6.25 and 3.12 – 12.5 mg/L, respectively, against all test bacterial strains. Cytotoxic activity, obtained by MTT assay, was 28.81 ± 0.99, 12.50 ± 2.50, 23.90 ± 0.74 and 50.58 ± 3.24 μg/mL, against the three cancer cell lines and normal fibroblast, respectively. MTT cytotoxicity results was further confirmed by clonogenic survival assay on MCF7 cells. Conclusion: This study highlights the potential interesting ethnopharmacological applications of Acacia ehrenbergiana Hayne to treat drug-resistant pathogens as standardized extract. Keywords: Acacia ehrenbergiana, Phytochemistry, Antimicrobial, Cytotoxicit

The Pharmacokinetics and Interactions of Ivermectin in Humans—A Mini-review

Ivermectin is an antiparasitic drug with a broad spectrum of activity, high efficacy as well as a wide margin of safety. Since 1987, this compound has a widespread use in veterinary medicine and it use has been extended in humans. Here we present a brief review of the information availabile regarding the pharmacokinetics and interactions of ivermectin in humans. Awareness of these characteristics could improve the clinical efficacy of Ivermectin. All Authors declare that they do not have any Conflict of interest and that the work is original. All Authors agree that the contents of the manuscript are confidential and will not be copyrighted, submitted, or published elsewhere (including the Internet), in any language, while acceptance by the Journal is under consideration

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Integrated Mapping of Neglected Tropical Diseases: Epidemiological Findings and Control Implications for Northern Bahr-el-Ghazal State, Southern Sudan

Integrated control of neglected tropical diseases (NTDs) is being scaled up in a number of developing countries, because it is thought to be more cost-effective than stand-alone control programmes. Under this approach, treatments for onchocerciasis, lymphatic filariasis (LF), schistosomiasis, soil-transmitted helminth (STH) infection, and trachoma are administered through the same delivery structure and at about the same time. A pre-requisite for implementation of integrated NTD control is information on where the targeted diseases are endemic and to what extent they overlap. This information is generated through surveys that can be labour-intensive and expensive. In Southern Sudan, all of the above diseases except onchocerciasis require further mapping before a comprehensive integrated NTD control programme can be implemented. To determine where treatment for which disease is required, integrated surveys were conducted for schistosomiasis, STH infection, LF, and loiasis, throughout one of ten states of the country. Our results show that treatment is only required for urinary schistosomiasis and STH in a few, yet separate, geographical area. This illustrates the importance of investing in disease mapping to minimize overall programme costs by being able to target interventions. Integration of survey methodologies for the above disease was practical and efficient, and minimized the effort required to collect these data