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

Neglected Tropical Diseases and the Millennium Development Goals-why the "other diseases" matter: reality versus rhetoric

Since 2004 there has been an increased recognition of the importance of Neglected Tropical Diseases (NTDs) as impediments to development. These diseases are caused by a variety of infectious agents - viruses, bacteria and parasites - which cause a diversity of clinical conditions throughout the tropics. The World Health Organisation (WHO) has defined seventeen of these conditions as core NTDs. The objectives for the control, elimination or eradication of these conditions have been defined in World Health Assembly resolutions whilst the strategies for the control or elimination of individual diseases have been defined in various WHO documents. Since 2005 there has been a drive for the expanded control of these diseases through an integrated approach of mass drug administration referred to as Preventive Chemotherapy via community-based distribution systems and through schools. This has been made possible by donations from major pharmaceutical companies of quality and efficacious drugs which have a proven track record of safety. As a result of the increased commitment of endemic countries, bilateral donors and non-governmental development organisations, there has been a considerable expansion of mass drug administration. In particular, programmes targeting lymphatic filariasis, onchocerciasis, schistosomiasis, trachoma and soil transmitted helminth infections have expanded to treat 887. 8 million people in 2009. There has been significant progress towards guinea worm eradication, and the control of leprosy and human African trypanosomiasis. This paper responds to what the authors believe are inappropriate criticisms of these programmes and counters accusations of the motives of partners made in recently published papers. We provide a detailed response and update the information on the numbers of global treatments undertaken for NTDs and list the success stories to date

Chronic hepatosplenomegaly in African school children: a common but neglected morbidity associated with schistosomiasis and malaria.

Chronic hepatosplenomegaly, which is known to have a complex aetiology, is common amongst children who reside in rural areas of sub-Saharan Africa. Two of the more common infectious agents of hepatosplenomegaly amongst these children are malarial infections and schistosomiasis. The historical view of hepatosplenomegaly associated with schistosomiasis is that it is caused by gross periportal fibrosis and resulting portal hypertension. The introduction of ultrasound examinations into epidemiology studies, used in tandem with clinical examination, showed a dissociation within endemic communities between presentation with hepatosplenomegaly and ultrasound periportal fibrosis, while immuno-epidemiological studies indicate that rather than the pro-fibrotic Th2 response that is associated with periportal fibrosis, childhood hepatosplenomegaly without ultrasound-detectable fibrosis is associated with a pro-inflammatory response. Correlative analysis has shown that the pro-inflammatory response is also associated with chronic exposure to malarial infections and there is evidence of exacerbation of hepatosplenomegaly when co-exposure to malaria and schistosomiasis occurs. The common presentation with childhood hepatosplenomegaly in rural communities means that it is an important example of a multi-factorial disease and its association with severe and subtle morbidities underlies the need for well-designed public health strategies for tackling common infectious diseases in tandem rather than in isolation