Thyroid Dysfunctions in Sudanese Patients with Vitiligo

Introduction: Vitiligo is a chronic acquired skin condition that causes loss of pigment, resulting in irregular pale patches of skin. The precise cause of vitiligo is not fully understood. The autoimmune base of the disease is supported by the frequent observation that several autoimmune disorders,particularly thyroid diseases, are associated with vitiligo.Objective: To determine the frequency of thyroid dysfunctions in Sudanese patients with vitiligo. Methods: Two groups, i.e. vitiligo patients and control, were collected with simple random collection. The control group included individuals free of vitiligo. 5 ml of venous blood was takenfrom every individual in both groups and the ELISA test was done for thyroid hormones, i.e. T3, T4 and TSH, using the DRG-USA kits.Results: The number of patients with vitiligo in the study was 46, while the control group was 45. Nine (19.56%) patients were found to have abnormal levels of thyroid hormones. No abnormal levels in the control group. Mean T3 level in patients was 1.463ng/l, while in control group it was 1.467ng/l. Mean T4 level in patients was 102.761 nmol/l, while in control group it was 90.844 nmol/l. Mean TSH level in patients was 0.841 μIU/l, while in control group it was 1.50 μIU/l. The t-test was done to determine the significance of difference between means of T3, T4, and TSH between the patients and control groups. The P-values were found to be significant.Conclusion: There is a strong pathogenetic relationship between vitiligo in Sudanese patients and thyroid dysfunctions.Keywords: T3 Triiodothyronin, T4 Tetraiodothyronin, TSH Thyroid stimulating hormon

A study on Prevalence of Drug Resistance in Drug Default Pulmonary Tuberculosis

Background: The emergence of resistance to drugs used to treat tuberculosis (TB), and particularly multidrug-resistant TB (MDR-TB), has become a significant public health problem in a number of countries and an obstacle to effective global TB control.Method: This is a prospective randomized cross sectional study to estimate the magnitude of MDR tuberculosis in two hospitals in Khartoum, Sudan. 111 patients who had defaulted their tuberculosis treatment on previous occasions and had presented to the hospital with several symptoms were studied. All patients provided sputum, which was examined for the presence of acid fast bacilli (AFB) by Ziehl- Neelsen stain. Sputa were also sent to the reference laboratory for mycobacterial culture and drug susceptibility testing. All culture positive sputa had drug sensitivity tested to the first line anti-TB drugs used in Sudan namely Streptomycin, Isoniazid, Rifampicin and Ethambutol.Results: Out of the 111 patients, 29.7% (n=33) were AFB sputum smear positive and 40.5% (n=45) were sputum culture positive for  mycobacterium. Sensitivity testing revealed that 48.9% (n=22) were resistant to Streptomycin, 62.2% (n=28) were resistant to Isoniazid, 55.6% (n=25) were resistant to Rifampicin and 37.8% (n=17) were resistantto Ethambutol. 42% ( n=19) of the patients were resistant to Rifampicin and Isoniazid only, while 26.6% (n=12) were resistant to all the first line drugs (Streptomycin, Isoniazid, Rifampicin and Ethambutol).Conclusion: This study showed that the prevalence of MDR tuberculosis among the defaulters in Khartoum is much higher than what was reported previously. This study highlights the extent of the problem of drug resistance in Khartoum and emphasises the need for proper treatment andstrengthening of the short course direct observed therapy strategy

The Socio-demography and Clinical Profile of Vitiligo in Sudan.

Introduction: Vitiligo is a chronic skin disease that causes loss of pigment, resulting in irregular pale patches of skin. The precise cause of vitiligo is complex and not fully understood. There is some evidence suggesting it is caused by a combination of auto-immune, genetic, and environmental factors. The population incidence worldwide is considered to be between 0.1% and 2%. The disease has different clinical types but generally, it consists of areas of macular depigmentation, commonly on extensor aspects of extremities, on the face or neck, and in skin folds. Age of onset is often in young adulthood and the condition tends to progress gradually with lesions enlarging and extending until a quiescent state is reached. Objective: To define the socio-demography and clinical profile of vitiligo in Sudan. Study design: This study is a cross-sectional, clinico-epidemiological and hospital-based study, done in Khartoum Dermatologic Hospital (KDH). The data were collected between June 2007 and November 2007. Results: The total number of patients with vitiligo in the study was 113. Male patients were 47 (42%). Children were 13 (11%), adults were 90 (80%) and elderlies were 10 (9%). The mean age of onset of the disease was found to be 11.5 yrs in 22.5% of the patients. Patients with acute (< 1 yr) disease were 6 (5.4 %), while those with chronic (b 1 yr) disease were 107 (94.6 %). The most commonly affected tribe was Algaa\'liyeen tribe (27 %). The commonest precipitating factor for vitiligo has been found to be emotional disturbances (in 27 % of patients). Commonest symptom of the disease was depigmented patch/es (64.8 %). Severe (b10 %) involvement of skin surface area was found in 59 % of patients, while mild

The psychological impact of vitiligo in adult Sudanese patients

Objective: Vitiligo is a chronic skin disease that causes loss of pigment, resulting in irregular pale patches of skin. The disease has profound psychological consequences. These effects range from mild embarrassment to a severe loss of self-confidence and social anxiety, especially for those who have lesions on exposed skin. The study sought to determine the psychological impact of vitiligo in Sudanese patients. Method: This study is a cross-sectional, clinical-epidemiological and hospital-based study, underatken in Khartoum Dermatologic Hospital (KDH). The data was collected between June 2007 and November 2007. 111 adult patients were enrolled sequentially during the study period and they were tested using the 12-item General Health Questionnaire (GHQ-12). Results: Psychological disturbances as a consequence of vitiligo were found in 36 (31 %) adult patients. Patients with mild psychological disturbances were found in 20 of these patients and severe disturbances in 16. Conclusion: Psychological consequences are common in patients with vitiligo.Key words: Vitiligo; Stress; Psychological; Suda

Knowledge, attitudes and practices among people in Saudi Arabia regarding COVID-19: A cross-sectional study

Background: The general population’s compliance with preventive measures and legislation is mainly influenced by their knowledge level, attitude, and practices. This study assessed the knowledge, attitude, and practices of public residents towards corona virus disease-2019 preventive measures in Saudi Arabia.&nbsp;Design and Methods: This is a cross-sectional study; it used a validated cross-sectional online survey that received responses from 13 Saudi administrative regions.&nbsp;Results: There were 1513 participants who completed the study (55% females; 77.7%, university education). Knowledge level, attitude, and practices towards corona virus disease-2019 were 81.3%, 86.6%, and 81.9%, respectively. The knowledge subscales showed that 1496 (98.9%) participants knew the system targeted by the virus, 96.2% and 97.3% knew the causative agent and symptoms, 783 (52.2%) participants knew the transmission modes, and 696 (46.0%) participants knew about the complications. The attitude subscales included 1465 (96.5%) participants who had dealt with an infected person, 1451 (95.9%) participants who isolated in a health facility, 1195 (97.0%) participants who knew about hand washing, and 1387 (91.7%) participants who thought the virus spread through home delivery. The practice subscales included 1505 (99.5%) participants who properly disposed of gloves and tissues and 1347 (89.0%) participants who reported safe practices when coughing or sneezing.Conclusions: This study showed satisfactory knowledge, attitude, and practice towards corona virus disease-2019 in Saudi Arabia. The educational level is a dominant influencing factor for knowledge, attitude, and practice

HbA1c as a marker to reduce lower limb amputation in patients with type 2 diabetes mellitus

Background: Diabetes mellitus is one of the most serious and prevalent chronic diseases worldwide. One of the most common complications of diabetes in the lower extremity is the diabetic foot ulcer which is the precursor to ~85% of lower extremity amputations in persons with diabetes. Materials and Subjects: This is a case- control study which was carried out at Jabir Abu-Aliz Specialized Center, Khartoum State, Sudan between October 2006 and April 2007. Forty type 2 diabetes cases with septic foot (group 1 cases), 40 type 2 diabetes cases without septic foot (group 2 cases), and 40 healthy controls participated in this study. Their demographic data were collected. Serum HbA1c levels were estimated by affinity chromatography method. Results: The level of HbA1c was 9.947±1.40%, 7.908±0.45% and 6.462±0.07%. in group 1, group 2, and the healthy control respectively. There was significant increase in percentage level of HbA1c in group 1 cases compared to group 2 cases and healthy control (p = 0.002, 0.001 respectively). We found very low correlation between fasting blood sugar and HbA1c in group 1 cases (r = + 0.331; p=0.042). Conclusion: This study indicates that the progression to the complication of foot ulcer in type 2 diabetic patients was correlated to the level of HbAlc. These data may suggest a beneficial effect of considering measurement of HbA1c as a routine test especially for elderly diabetic patients with diabetes for long period. This may help to maintain blood glucose levels in the normal or near normal range and to provide an opportunity for patients to live out their normal life expectancies with minimal complications. Keywords: glycohemoglobin, neuropathy, septic foot, glycemic control.Sudan Journal of Medical Sciences Vol. 3 (3) 2008: pp. 227-23

Cellular and molecular pathology of age-related macular degeneration: Potential role for proteoglycans

Age-related macular degeneration (AMD) is a retinal disease evident after the age of 50 that damages the macula in the centre of retina. It leads to a loss of central vision with retained peripheral vision but eventual blindness occurs in many cases. The initiation site of AMD development is Bruch&#039;s membrane (BM) where multiple changes occur including the deposition of plasma derived lipids, accumulation of extracellular debris, changes in cell morphology, and viability and the formation of drusen. AMD manifests as early and late stage; the latter involves cell proliferation and neovascularization in wet AMD. Current therapies target the later hyperproliferative and invasive wet stage whilst none target early developmental stages of AMD. In the lipid deposition disease atherosclerosis modified proteoglycans bind and retain apolipoproteins in the artery wall. Chemically modified trapped lipids are immunogenic and can initiate a chronic inflammatory process manifesting as atherosclerotic plaques and subsequent artery blockages, heart attacks, or strokes. As plasma derived lipoprotein deposits are found in BM in early AMD, it is possible that they arise by a similar process within the macula. In this review we consider aspects of the pathological processes underlying AMD with a focus on the potential role of modifications to secreted proteoglycans being a cause and therefore a target for the treatment of early AMD

Platelet-derived growth factor-stimulated versican synthesis but not glycosaminoglycan elongation in vascular smooth muscle is mediated via Akt phosphorylation

Proteoglycans are associated with the initiation of atherosclerosis due to their binding of apolipoproteins on lipid particles leading to retention in the vessel wall. The signaling pathways through which growth factors regulate the synthesis and structure of proteoglycans are potential therapeutic targets. Platelet-derived growth factor (PDGF) is present in atherosclerotic plaques and activates phosphorylation of the serine/threonine kinase Akt. We have investigated the role of Akt in the signaling pathways for proteoglycan core protein expression and elongation of glycosaminoglycan chains on proteoglycans secreted by human vascular smooth muscle cells. The pharmacological inhibitor of Akt phosphorylation, SN30978, blocked PDGF stimulated phosphorylation of Akt. SN30978 caused concentration dependent inhibition of PDGF stimulated radiosulfate incorporation into secreted proteoglycans and the response was blocked by the PDGF receptor antagonists Ki11502 and imatinib. Analysis of the size of the biglycan molecules by SDS-PAGE showed that PDGF increased the apparent size of biglycan but this effect on glycosaminoglycan chain elongation was blocked by Ki11502 but not by SN30978. PDGF also stimulated total protein core protein synthesis assessed as 35S-methionine/cysteine incorporation and specifically the expression of versican mRNA. Both of these responses were blocked by SN30978. This data shows that PDGF-stimulated proteoglycan core protein synthesis but not glycosaminoglycan chain elongation is mediated via Akt phosphorylation. These data identify potential pathways for the development of agents which can pharmacologically regulate individual components of the synthesis of proteoglycans

TGF-β stimulates biglycan core protein synthesis but not glycosaminoglycan chain elongation via Akt phosphorylation in vascular smooth muscle

Transforming growth factor-b (TGF-b) can mediate proteoglycan synthesis via Smad and non-Smad signalling pathways in vascular smooth muscle (VSM). We investigated whether TGF-b-mediated proteoglycan synthesis is via PI3K/Akt. TGF-b induced a rapid phosphorylation of Akt that continued upto 4 h. Akt phosphorylation was blocked by Akt1/2 inhibitor SN30978; however, it did not block Smad2 phosphorylation at either the carboxy or linker regions indicating that TGF-bmediated Akt phosphorylation is independent of Smad2 signalling. The role of Akt in TGF-b-mediated proteoglycan synthesis was investigated. Treatment with SN30978 showed a concentration-dependent decrease in TGF-b-mediated [35S]- sulphate and [35S]-Met/Cys incorporation into secreted proteoglycans; however, SDS-PAGE showed no change in biglycan size. In TGF-b-treated cells, biglycan mRNA levels increased by 40-100% in 24 h and was significantly blocked by SN30978. Our findings demonstrate that Akt is a downstream signalling component of TGF-b-mediated biglycan core protein synthesis but not glycosaminoglycan chain hyper-elongation in VSM

Safety and immunogenicity of an autoclaved Leishmania major vaccine

Objective: To test the safety and immunogenicity of two doses of autoclaved L.major (ALM) vaccine mixed with BCG.Setting: Kala-azar endemic area of eastern Sudan.Design: This was a randomised, double blind and BCG controlled phase I/II study.Subjects: Eighty healthy volunteers (forty children and forty adults) with no past history of kala-azar, no reactivity to leishmanin antigen and with a reciprocal direct agglutination test (DAT) titre o