Association Between Lipid Profile and Glyceamic Control in Sudanese Children with Type 1 Diabetes Mellitus at Gezira State, Sudan

Introduction: Diabetes mellitus describes a metabolic disorder of multiple aetiology characterized by chronic hyperglycemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both. Objectives This study aimed to assess the metabolic control of type 1 diabetes mellitus (T1DM) in Sudanese children. Methods: One hundred and seventy four children with type 1 diabetes mellitus were enrolled in this study; 56 healthy non-diabetic children served as a control group. Glycosylated hemoglobin (HbA1c), total cholesterol (TC), triacylglycerol (TG), low density lipoprotein-cholesterol (LDL-C), high density lipoprotein-cholesterol (HDL-C) were measured, very low density lipoprotein-cholesterol (VLDL), and LDL-C/HDL-C ratio were calculated. Results: HbA1c,TC, LDL-C LDL-C/HDL-C ratio and TG were significantly higher among diabetic group compared to non-diabetic group (P<0.001 and P<0.05 for TG).In the diabetic group, there was a positive significant correlation of: HbA1c with TC, TG, HDL- C, LDL-C, VLDL and LDL/HDL ratio; TC with TG, HDL- C, LDL-C, VLDL and LDL/HDL; TG with LDL- C, VLDL and LDL/HDL ratio; HDL-C with LDL-C;LDL-C with VLDL and LDL/ HDL;VLDL-C with LDL/HDL ratio. A significant negative correlation was observed between HDL- C and LDL/HDL ratio. Diabetic group with poor metabolic control (HbA1c level >8).had significantly higher levels of TC and LDL-C (P<0.001),TG and VLDL (P<0.01), HDL-C and LDL-C/ HDL-C ratio (P<0.05) compared with diabetic group with good metabolic control (HbA1c <8%). Conclusion: 85.63% of diabetic patients were found to have poor metabolic control (HbA1c level >8). يوصف مرض السكري بأنه من المسببات المرضية المتعددة التي تتميز بفرط  سكر الدم المزمن واضطراب في التمثيل الغذائي ( اضطرابات من الكربوهيدرات والدهون واستقلاب البروتين) الناتج عن نقص في إفراز الأنسولين، عمل الانسولين أو كليهما.هدفت هذه الدراسة لاستخدام التقييم الكيموحيوي لمعرفة مدي التحكم لضبط السكر عند مرضي السكري النوع الاول. إشتملت هذه الدراسه علي 174طفل مصابين مرض السكري و56 أصحاء من نفس العمر.تضمنت هذه الدراسة  القياسات الكيموحيويه الأتيه: خضاب الدم المسكر، الكوليستيرول ، ثلاثي أسيل الجليسرول و الكوليستيرول المرتبط  بالبروتينات الشحميه منخفضة وعاليه الكثافة والبروتينات الشحميه المنخفضة جدا ونسبة البروتينات الشحميه منخفضة الكثافة الي البروتينات الشحميه عالية الكثافة. وجد أن تركيز كل من خضاب الدم المسكر، الكوليستيرول ، الكوليستيرول المرتبط  بالبروتينات الشحميه منخفضة الكثافة ونسبة البروتينات الشحميه منخفضة الكثافة الي البروتينات الشحميه عالية الكثافة وثلاثي أسيل الجليسرول يرتفع إرتفاعا ذا معني عند مجموعة مرضي السكري.مستوي خضاب الدم المسكر يرتبط إرتباطا موجبا ذا معني مع كل من الكوليستيرول ، ثلاثي أسيل الجليسرول والبروتينات الشحميه عالية ومنخفضة الكثافة والبروتينات الشحميه المنخفضة جدا ونسبة البروتينات الشحميه منخفضة الكثافة الي البروتينات الشحميه عالية الكثافة، الكوليستيرول مع كل من ثلاثي أسيل الجليسرول والبروتينات الشحميه عالية و منخفضة الكثافة والبروتينات الشحميه المنخفضة جدا ونسبة البروتينات الشحميه منخفضة الكثافة الي البروتينات الشحميه عالية الكثافة ، يرتبط ثلاثي أسيل الجليسرول مع كل من البروتينات الشحميه منخفضة الكثافة والبروتينات الشحميه المنخفضة جدا ونسبة البروتينات الشحميه منخفضة الكثافة الي البروتينات الشحميه عالية الكثافة . كما أن  مستوي البروتينات الشحميه عالية الكثافة يرتبط إرتباطا ذا معني مع نسبة البروتينات الشحميه منخفضة الكثافة الي البروتينات الشحميه عالية الكثافة.طبقا لتقسيم مجموعة الدارسين لمرض السكري العالميه الأمريكيه أظهرت هذه الدراسه أن نسبة (85.63)  من المرضي يبلغ معدل خضاب الدم المسكر عندهم أكثر من  8% (ضبط غير مقبول) بينما  (%14.37) يبلغ معدل خضاب الدم المسكر عندهم أقل من  8% (ضبط مقبول).  وجدت هذه الدراسة ان مرضي السكري والذين لديهم ضبط غير مقبول لخضاب الدم المسكر ترتفع عندهم مستويات الكوليستيرول ، ثلاثي أسيل الجليسرول و الكوليستيرول المرتبط  بالبروتينات الشحميه منخفضة وعاليه الكثافة والبروتينات الشحميه المنخفضة جدا ونسبة البروتينات الشحميه منخفضة الكثافة الي البروتينات الشحميه عالية الكثافة ارتفاعا ذا معني مقارنة مرضي السكري والذين لديهم ضبط مقبول لخضاب الدم المسكر

Towards a digitized and integrated health information system in Sudan: assessment of readiness at state level

Background: A strong health information system able to generate timely and accurate information is essential to ensure effective and efficient performance. Sudan’s health information system is still paper-based and characterized by fragmentation and verticality. Efforts to overcome this have led to development of an integrated system to digitize the health information. For this to succeed the 18 states in Sudan need to be evaluated and assessed to identify the gaps in capacity and readiness for such important change. The aim of this paper is to assess the capacity and readiness of the health information system in Sudan at state level for the digitization of the health information system.Materials and Methods: This is a cross sectional institutional based study conducted in 2014 targeting the health information units in the 18 states ministries of health in Sudan. Quantitative data was collected using a pre-tested checklist and analyzed using SPSS version 20. Qualitative data was collected through semi-structured interviews with state managers and analyzed using the evaluation matrix.Results: All states ministries of health had health information units but this was believed inadequate in 27.8% and 72.2% had units at locality level. Data analysis units were not present in one third of the states. Basic statistical training was done in 15 states. Internet services was available in 14 states but was scarce at locality level (16.7%). Annual reports though produced by 17 states, one third admit not reporting to higher levels in a regular manner.Conclusion: There is a need to strengthen the health information system at state level. Challenges of ICT infrastructure, capacity building and coordination need to be addressed. This needs collaborative work and political commitment.Keywords: Health Information System, states, digitizatio

Estimating Wildfire-Generated Ozone over North America Using Ozonesonde Profiles and a Differential Back Trajectory Technique

An objective method, employing HYSPLIT back-trajectories and Moderate Resolution Imaging Spectroradiometer (MODIS) fire observations, is developed to estimate ozone enhancement in air transported from regions of active forest fires at 18 ozone sounding sites located across North America. The Differential Back Trajectory (DBT) method compares mean differences between ozone concentrations associated with fire-affected and fire-unaffected parcels. It is applied to more than 1100 ozonesonde profiles collected from these sites during the summer months June to August 2006, 2008, 2010 and 2011. Layers of high ozone associated with low humidity were first removed from the ozonesonde profiles to minimize the potential effects of stratospheric intrusions on the calculations. No significant influence on average ozone levels by North American fires was found for stations located at Arctic latitudes. The ozone enhancement for stations nearer large fires, such as Trinidad Head and Bratt\u27s Lake, was up to 4.8% of the TTOC (Total Tropospheric Ozone Column). Fire ozone accounted for up to 8.3% of TTOC at downwind sites such as Yarmouth, Sable Island, Narragansett, and Walsingham. The results are consistent with other studies that have reported an increase in ozone production with the age of the smoke plume

Invasive Hemodynamic Monitoring in Cardiogenic Shock Is Associated With Lower In-Hospital Mortality

Background: There is increasing utilization of cardiogenic shock treatment algorithms. The cornerstone of these algorithms is the use of invasive hemodynamic monitoring (IHM). We sought to compare the in-hospital outcomes in patients who received IHM versus no IHM in a real-world contemporary database. Methods and Results Patients with cardiogenic shock admitted during October 1, 2015 to December 31, 2018, were identified from the National Inpatient Sample. Among this group, we compared the outcomes among patients who received IHM versus no IHM. The primary end point was in-hospital mortality. Secondary end points included vascular complications, major bleeding, need for renal replacement therapy, length of stay, cost of hospitalization, and rate of utilization of left ventricular assist devices and heart transplantation. Propensity score matching was used for covariate adjustment. A total of 394 635 (IHM=62 565; no IHM=332 070) patients were included. After propensity score matching, 2 well-matched groups were compared (IHM=62 220; no IHM=62 220). The IHM group had lower in-hospital mortality (24.1% versus 30.6%, P\u3c0.01), higher percentages of left ventricular assist devices (4.4% versus 1.3%, P\u3c0.01) and heart transplantation (1.3% versus 0.7%, P\u3c0.01) utilization, longer length of hospitalization and higher costs. There was no difference between the 2 groups in terms of vascular complications, major bleeding, and the need for renal replacement therapy. Conclusions: Among patients with cardiogenic shock, the use of IHM is associated with a reduction in in-hospital mortality and increased utilization of advanced heart failure therapies. Due to the observational nature of the current study, the results should be considered hypothesis-generating, and future prospective studies confirming these findings are needed

Molecular detection of Epstein-Barr virus among Sudanese patients diagnosed with Hashimoto’s thyroiditis

Objectives: Hashimoto’s thyroiditis (HT) is the most common cause of hypothyroidism. The exact mechanism initiating the development of HT is not yet clear. This study aimed to investigate the correlation between HT and the presence of Epstein-Barr virus (EBV) in a Sudanese population. Results: EBV-LMP1 was detected in 11.1% of HT cases, which is consistent with previous studies. Studies have reported a wide range of frequencies indicating the presence of EBV in HT, and patients with autoimmune thyroiditis have increased titers of anti-EBV antibodies in their sera compared to healthy subjects. Intrathyroidal EBV-infected B cells may be responsible for the increased risk of development of B-cell lymphoma in the thyroid gland in patients with autoimmune thyroiditis. Our study suggests that regular follow-up is necessary for patients diagnosed with HT and are positive for EBV, as antiviral therapy is not applicable due to the risk of thyroid dysfunction. The study suggests an association between EBV and HT, but causation cannot be determined. The study also highlights the need for further research to determine the viral role and correlate it with the severity and progression of HT.</p

Molecular detection of Epstein-Barr virus among Sudanese patients diagnosed with Hashimoto’s thyroiditis

Objectives: Hashimoto’s thyroiditis (HT) is the most common cause of hypothyroidism. The exact mechanism initiating the development of HT is not yet clear. This study aimed to investigate the correlation between HT and the presence of Epstein-Barr virus (EBV) in a Sudanese population. Results: EBV-LMP1 was detected in 11.1% of HT cases, which is consistent with previous studies. Studies have reported a wide range of frequencies indicating the presence of EBV in HT, and patients with autoimmune thyroiditis have increased titers of anti-EBV antibodies in their sera compared to healthy subjects. Intrathyroidal EBV-infected B cells may be responsible for the increased risk of development of B-cell lymphoma in the thyroid gland in patients with autoimmune thyroiditis. Our study suggests that regular follow-up is necessary for patients diagnosed with HT and are positive for EBV, as antiviral therapy is not applicable due to the risk of thyroid dysfunction. The study suggests an association between EBV and HT, but causation cannot be determined. The study also highlights the need for further research to determine the viral role and correlate it with the severity and progression of HT.</p

Insecticide resistance in the sand fly, Phlebotomus papatasi from Khartoum State, Sudan

<p>Abstract</p> <p>Background</p> <p><it>Phlebotomus papatasi </it>the vector of cutaneous leishmaniasis (CL) is the most widely spread sand fly in Sudan. No data has previously been collected on insecticide susceptibility and/or resistance of this vector, and a first study to establish a baseline data is reported here.</p> <p>Methods</p> <p>Sand flies were collected from Surogia village, (Khartoum State), Rahad Game Reserve (eastern Sudan) and White Nile area (Central Sudan) using light traps. Sand flies were reared in the Tropical Medicine Research Institute laboratory. The insecticide susceptibility status of first progeny (F1) of <it>P. papatasi </it>of each population was tested using WHO insecticide kits. Also, <it>P. papatasi </it>specimens from Surogia village and Rahad Game Reserve were assayed for activities of enzyme systems involved in insecticide resistance (acetylcholinesterase (AChE), non-specific carboxylesterases (EST), glutathione-S-transferases (GSTs) and cytochrome p450 monooxygenases (Cyt p450).</p> <p>Results</p> <p>Populations of <it>P. papatasi </it>from White Nile and Rahad Game Reserve were sensitive to dichlorodiphenyltrichloroethane (DDT), permethrin, malathion, and propoxur. However, the <it>P. papatasi </it>population from Surogia village was sensitive to DDT and permethrin but highly resistant to malathion and propoxur. Furthermore, <it>P. papatasi </it>of Surogia village had significantly higher insecticide detoxification enzyme activity than of those of Rahad Game Reserve. The sand fly population in Surogia displayed high AChE activity and only three specimens had elevated levels for EST and GST.</p> <p>Conclusions</p> <p>The study provided evidence for malathion and propoxur resistance in the sand fly population of Surogia village, which probably resulted from anti-malarial control activities carried out in the area during the past 50 years.</p

Exploring the evidence base for national and regional policy interventions to combat resistance

The effectiveness of existing policies to control antimicrobial resistance is not yet fully understood. A strengthened evidence base is needed to inform effective policy interventions across countries with different income levels and the human health and animal sectors. We examine three policy domains—responsible use, surveillance, and infection prevention and control—and consider which will be the most effective at national and regional levels. Many complexities exist in the implementation of such policies across sectors and in varying political and regulatory environments. Therefore, we make recommendations for policy action, calling for comprehensive policy assessments, using standardised frameworks, of cost-effectiveness and generalisability. Such assessments are especially important in low-income and middle-income countries, and in the animal and environmental sectors. We also advocate a One Health approach that will enable the development of sensitive policies, accommodating the needs of each sector involved, and addressing concerns of specific countries and regions

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

Financing intersectoral action for health: a systematic review of co-financing models.

BACKGROUND: Addressing the social and other non-biological determinants of health largely depends on policies and programmes implemented outside the health sector. While there is growing evidence on the effectiveness of interventions that tackle these upstream determinants, the health sector does not typically prioritise them. From a health perspective, they may not be cost-effective because their non-health outcomes tend to be ignored. Non-health sectors may, in turn, undervalue interventions with important co-benefits for population health, given their focus on their own sectoral objectives. The societal value of win-win interventions with impacts on multiple development goals may, therefore, be under-valued and under-resourced, as a result of siloed resource allocation mechanisms. Pooling budgets across sectors could ensure the total multi-sectoral value of these interventions is captured, and sectors' shared goals are achieved more efficiently. Under such a co-financing approach, the cost of interventions with multi-sectoral outcomes would be shared by benefiting sectors, stimulating mutually beneficial cross-sectoral investments. Leveraging funding in other sectors could off-set flat-lining global development assistance for health and optimise public spending. Although there have been experiments with such cross-sectoral co-financing in several settings, there has been limited analysis to examine these models, their performance and their institutional feasibility. AIM: This study aimed to identify and characterise cross-sectoral co-financing models, their operational modalities, effectiveness, and institutional enablers and barriers. METHODS: We conducted a systematic review of peer-reviewed and grey literature, following PRISMA guidelines. Studies were included if data was provided on interventions funded across two or more sectors, or multiple budgets. Extracted data were categorised and qualitatively coded. RESULTS: Of 2751 publications screened, 81 cases of co-financing were identified. Most were from high-income countries (93%), but six innovative models were found in Uganda, Brazil, El Salvador, Mozambique, Zambia, and Kenya that also included non-public and international payers. The highest number of cases involved the health (93%), social care (64%) and education (22%) sectors. Co-financing models were most often implemented with the intention of integrating services across sectors for defined target populations, although models were also found aimed at health promotion activities outside the health sector and cross-sectoral financial rewards. Interventions were either implemented and governed by a single sector or delivered in an integrated manner with cross-sectoral accountability. Resource constraints and political relevance emerged as key enablers of co-financing, while lack of clarity around the roles of different sectoral players and the objectives of the pooling were found to be barriers to success. Although rigorous impact or economic evaluations were scarce, positive process measures were frequently reported with some evidence suggesting co-financing contributed to improved outcomes. CONCLUSION: Co-financing remains in an exploratory phase, with diverse models having been implemented across sectors and settings. By incentivising intersectoral action on structural inequities and barriers to health interventions, such a novel financing mechanism could contribute to more effective engagement of non-health sectors; to efficiency gains in the financing of universal health coverage; and to simultaneously achieving health and other well-being related sustainable development goals