Prevalence of sickle cell gene in Yemen.

To determine the prevalence of the sickle cell gene (HbS) in Yemen and amongst people from different regions of the country living in the capital, Sana'a City, cord blood samples from 1500 consented mothers were collected from hospitals in Sana'a City between July and December 2001. The names and original homes of the parents were recorded. Cationic HPLC analysis was used for screening while isoelectric focusing (IEF) and DNA- PCR were used to confirm haemoglobin S (HbS). Thirty-three samples were found to show Hb FAS giving an overall likely Hb S gene frequency of 0.011. The Hb S gene frequency varied with the part of the country from which the parents came. Amongst people from Taiz and Haja in the west the gene frequency was more than 0.04 but less than 0.004 amongst people from Ibb, adjacent to the governorate of Taiz. Of 66 chromosomes from babies carrying HbS, only 1.5% additionally carried the presence of-158 (C→T) G-gamma globin gene Xmm I site compared with 16.1% of 168 chromosomes from babies without Hb S from the same regions of the sickle cell trait samples identified in this study indicated that the beta S haplotype in not that associated with a milder course found in east Saudi Arabia. In addition to the absence of both Hind III/Ggamma and Hind III/Agamma beta globin polymorphic sites in 26 sickle cell trait samples suggesting the predominant of the African sickle cell haplotype (Benin) in Yemen. The results of this study thus show a higher Hb S gene frequency in the western coastal part of Yemen than in the central mountainous and eastern desert areas. The incidence of affected homozygous births may therefore reach 20/10,000 in the western coastal part of Yemen. A survey to evaluate health care of sickle cell patients was performed using 86 patients attending hospitals in Sanaa City, Yemen. The results showed that the clinical services provided to the sickle cell patients in Yemen were generally very poor. Limited health resources can best be invested in developing a program of (Education, screening and health care initially prioritising those communities residing in the western areas of Yemen with the highest Hb S gene frequency

Knowledge and Attitudes of Sana'a University Medical Students towards Premarital Screening

Objectives: To assess the knowledge and attitudes of Sana’a University medical students towards premarital screening (PMS). Methods: A cross-sectional study was conducted among the students of the Faculty of Medicine and Health Sciences, Sana’a University, during the academic year 2012/2013. A self-administered questionnaire was distributed to 516 Yemeni students. The questionnaire was composed of three parts; the first part was about socio-demographic data, the second part was about the students’ knowledge about PMS and the third part was about their attitudes towards the PMS. Results: Most of the respondents (92%) knew that PMS reduces hereditary and sexually-transmitted diseases, believed that it is important to carry out and agreed to do it. Making PMS mandatory and legal prevention of marriage in case of positive results were accepted by 82% and 62% of the respondents, respectively. Conclusions: Although the majority of Sana’a University medical students favored PMS and had a fair knowledge about most of its aspects, a small proportion of them refused its mandating or legally preventing at-risk marriages. These negative attitudes could be reversed by health education of medical students on PMS

Prevalence of Clostridium difficile colonization among healthcare workers

BackgroundClostridium difficile infection (CDI) has increased to epidemic proportions in recent years. The carriage of C. difficile among healthy adults and hospital inpatients has been established. We sought to determine whether C. difficile colonization exists among healthcare workers (HCWs) in our setting.MethodsA point prevalence study of stool colonization with C. difficile among doctors, nurses and allied health staff at a large regional teaching hospital in Geelong, Victoria. All participants completed a short questionnaire and all stool specimens were tested by Techlab&reg; C.diff Quik Check enzyme immunoassay followed by enrichment culture.ResultsAmong 128 healthcare workers, 77% were female, of mean age 43 years, and the majority were nursing staff (73%). Nineteen HCWs (15%) reported diarrhoea, and 12 (9%) had taken antibiotics in the previous six weeks. Over 40% of participants reported having contact with a patient with known or suspected CDI in the 6 weeks before the stool was collected. C. difficile was not isolated from the stool of any participants.ConclusionAlthough HCWs are at risk of asymptomatic carriage and could act as a reservoir for transmission in the hospital environment, with the use of a screening test and culture we were unable to identify C. difficile in the stool of our participants in a non-outbreak setting. This may reflect potential colonization resistance of the gut microbiota, or the success of infection prevention strategies at our institution.<br /

Ridinilazole: A novel therapy for Clostridium difficile infection

Clostridium difficile infection (CDI) is the leading cause of infectious healthcare-associated diarrhoea. Recurrent CDI increases disease morbidity and mortality, posing a high burden to patients and a growing economic burden to the healthcare system. Thus, there exists a significant unmet and increasing medical need for new therapies for CDI. This review aims to provide a concise summary of CDI in general and a specific update on ridinilazole (formerly SMT19969), a novel antibacterial currently under development for the treatment of CDI. Owing to its highly targeted spectrum of activity and ability to spare the normal gut microbiota, ridinilazole provides significant advantages over metronidazole and vancomycin, the mainstay antibiotics for CDI. Ridinilazole is bactericidal against . C. difficile and exhibits a prolonged post-antibiotic effect. Furthermore, treatment with ridinilazole results in decreased toxin production. A phase 1 trial demonstrated that oral ridinilazole is well tolerated and specifically targets clostridia whilst sparing other faecal bacteria. Phase 2 and 3 trials will hopefully further our understanding of the clinical utility of ridinilazole for the treatment of CDI

WSES guidelines for management of Clostridium difficile infection in surgical patients

In the last two decades there have been dramatic changes in the epidemiology of Clostridium difficile infection (CDI), with increases in incidence and severity of disease in many countries worldwide. The incidence of CDI has also increased in surgical patients. Optimization of management of C difficile, has therefore become increasingly urgent. An international multidisciplinary panel of experts prepared evidenced-based World Society of Emergency Surgery (WSES) guidelines for management of CDI in surgical patients.Peer reviewe

Thalassaemia and glucose-6-phosphate dehydrogenase deficiency in sickle-cell disorder patients in Taiz, Yemen ‫اليمن‬ ‫تعز،‬ ‫يف‬ ‫املنجلية‬ ‫اخلاليا‬ ‫داء‬ ‫مرىض‬ ‫لدى‬ ‫فات‬ ْ ‫س‬ ُ ‫ف‬ -6-‫الغلوكوز‬ ‫هيدروجني‬ ‫نازعة‬ ‫ز‬ َ ‫و‬ ‫وعَ‬ ‫الثالسيميا‬

ABSTRACT A pilot study was conducted to determine the prevalence and haematological characteristics of the interaction between thalassaemia or/and glucose-6-phosphate dehydrogenase (G6PD) deficiency in patients with sickle-cell disorder (SCD) in Taiz city, Yemen, where the prevalence of sickle-cell trait (HbAS) is 8.2%. Blood samples were collected from 31 SCD patients. Complete blood count and haemoglobin electrophoresis, G6PD activity and serum ferritin were determined. Thalassaemia was found in 6 patients (19.4%) and G6PD deficiency (6 mild and 1 severe) was detected in 7 patients (22.6%). The frequency of thalassaemia and/or G6PD deficiency with SCD was high and this may have an effect on the severity of the clinical course of SCD in Taiz. The study should be repeated with DNA analysis to define the nature of the globin gene defect and to clarify its role in the severity of SCD. 1 Department of Haematology, Faculty of Medicine and Health Sciences, Sana&apos;a University, Sana&apos;a, Yemen (Correspondence to H.A. Al-Nood: [email protected] RÉSUMÉ Une étude pilote a été conduite pour déterminer la prévalence de la thalassémie et/ou du déficit en glucose-6-phosphate déshydrogénase (G6PD) chez des patients atteints de drépanocytose et pour analyser les caractéristiques hématologiques de leur interaction avec la drépanocytose dans la ville de Taïz au Yémen, où la prévalence du trait drépanocytaire (HbAS) est de 8,2 %. Des échantillons de sang ont été prélevés chez 31 patients atteints de drépanocytose. Des analyses ont été réalisées pour déterminer les résultats d&apos;une numération formule sanguine, d&apos;une électrophorèse de l&apos;hémoglobine, de l&apos;activité de la glucose-6-phosphate déshydrogénase et de la ferritine sérique. Le diagnostic de thalassémie a été posé chez six patients (19,4 %) et celui de déficit en glucose-6-phosphate déshydrogénase chez sept patients (22,6 %), parmi lesquels six patients étaient atteints d&apos;une forme modérée et un patient d&apos;une forme sévère. La fréquence de l&apos;association de la thalassémie ou/ et du déficit en glucose 6 phosphate déshydrogénase à la drépanocytose était élevée et pourrait influer sur la sévérité de l&apos;évolution clinique de la drépanocytose à Taïz. Il serait souhaitable de reconduire la présente étude en analysant l&apos;ADN pour définir la nature de l&apos;anomalie du gène de la globine et pour clarifier son rôle dans le degré de sévérité de la drépanocytose. ‫املتوسط‬ ‫لرشق‬ ‫الصحية‬ ‫املجلة‬ ‫عرش‬ ‫السابع‬ ‫املجلد‬ ‫اخلامس‬ ‫العدد‬ 40

Glucose-6-Phosphate Dehydrogenase Deficiency among Male Blood Donors in Sana’a City, Yemen

 Objectives: To determine the prevalence of Glucose-6-phosphatedehydrogenase (G-6-PD) deficiency among Yemeni people fromdifferent regions of the country living in the capital city, Sana’a,giving an indication of its overall prevalence in Yemen.Methods: A cross-sectional study was conducted among Yemenimale blood donors attending the Department of Blood Bank atthe National Centre of the Public Health Laboratories in thecapital city, Sana’a, Yemen. Fluorescent spot method was used forscreening, spectrophotometeric estimation of G-6-PD activityand separation by electrophoresis was done to determine the G-6-PD phenotype.Results: Of the total 508 male blood donors recruited into thestudy, 36 were G-6-PD deficient, giving a likely G-6-PD deficiencyprevalence of 7.1�20None of these deficient donors had history ofanemia or jaundice. Thirty-five of these deficient cases (97.2�howed severe G-6-PD deficiency class II (<10�0of normalactivity), and their phenotyping presumptively revealed a G-6-PDMediterraneanvariant.Conclusion: The results showed a significant presence of G-6-PD deficiency with predominance of a severe G-6-PD deficiencytype in these blood donors in Sana’a City, which could representan important health problem through occurrence of hemolyticanemia under oxidative stress. A larger sample size is needed todetermine the overall prevalence of G-6-PD deficiency, and shouldbe extended to include DNA analysis to identify its variants in Yemen