Search

Aims: Livestock is the largest subsector of the Sudanese domestic economy and is a growing contributor to exports. Rift Valley fever (RVF) is an economically important arthropod-borne virus disease in Africa, primarily affecting sheep, goats, and cattle. RVF causes paramount loss in sheep industry in Sudan. The objective of this study was to detect RVF in sheep. Methodology: Five hundred and fifty-six sheep blood Serum from inoculated animals was collected from six study areas in the Gezira (Sudan)was evaluated for the presence of neutralizing antibodies using the diagnostic kit (ID. Vet.) for detecting antibodies directly against the RVFV nucleoprotein (NP) in serum and Reverse transcription (RT)-Polymerase Chain Reaction (PCR) protocol was used as standard test to diagnose and confirm RVFV among studied animals. Results: The ELISA test indicated that the highest Seroprevalence was found at Shikaira (38%), while samples from Albasabeir, Wad alnaem and Umalqura tested positive for antibodies against RVFV by 15%, 10% and 9% respectively. The lowest Seroprevalence found at Wad anor and Shabona (5% and 2%). The overall seroprevalence was 14.2% in the study sites, there is no significant difference among the six study sites with respect to seroprevalence. The Rt-PCR provided more sensitive and specific detection of RVFV in serum samples (sensitivity= 95% specificity = 80%). Conclusion: The results from this study showed the presence of anti-RVFV antibodies in all study sites, suggesting that RVFV is actively circulating among sheep in Gezira state. The high seroprevalence of RVFV infection in Gezira state indicates its endemicity. Test validation using ROC analysis was able to distinguished between ELISA (actual class) and the PCR (predicted class) and the AUC = 0.79 which indicate that the PCR is gold standard test. Thus Rt-PCR used in the present study is reliable to detect precisely the M segment of RVFV and it is valuable for Wide area survey, among both sheep and Aedes spp. Targeting the prevailing genotypes of RVF-M segment, especially at high-risk areas and as a confirmatory test that should be considered by reference laboratories in the region.

BackgroundThe travel distance from home to a treatment centre, which may impact the stage at diagnosis, has not been investigated for retinoblastoma, the most common childhood eye cancer. We aimed to investigate the travel burden and its impact on clinical presentation in a large sample of patients with retinoblastoma from Africa and Europe.MethodsA cross-sectional analysis including 518 treatment-naïve patients with retinoblastoma residing in 40 European countries and 1024 treatment-naïve patients with retinoblastoma residing in 43 African countries.ResultsCapture rate was 42.2% of expected patients from Africa and 108.8% from Europe. African patients were older (95% CI −12.4 to −5.4, pConclusionsFewer than half the expected number of patients with retinoblastoma presented to African referral centres in 2017, suggesting poor awareness or other barriers to access. Despite the relatively shorter distance travelled by African patients, they presented with later-stage disease. Health education about retinoblastoma is needed for carers and health workers in Africa in order to increase capture rate and promote early referral.

Neuroblastoma (NBL) is the most common malignant solid extracranial tumour in children. It accounts for about 8%-10% of overall childhood malignancies in developed countries and only 1%-3% in developing countries. We aim to study the clinical presentation and outcome of NBL in children treated at the National Cancer Institute (NCI), University of Gezira, Wad Madani, Sudan. This is a retrospective, descriptive, hospital-based study, where patients' records were reviewed from the years 2004-2015. During this period, 38 paediatric patients were treated in the Paediatric Oncology Unit at the NCI, accounting for about 4% of the overall childhood malignancies. Of them, 24 (63%) were males and 14 (37%) were females with a ratio of 1.7: 1. The age at presentation ranged between 2 months and 7 years with a mean age at the presentation of 3 years. Twenty-nine (76%) of them were classified as high-risk disease, no one received high-dose chemotherapy, 33(87%) died and only 5 (13%) achieved complete remission. This study reflects the poor outcome of NBL among Sudanese children which can be explained by the late presentation of the patients, lack of the diagnostic modalities and lack of the sophisticated treatment modalities for high-risk NBL.

Purpose The objective of this study was to compare tumor characteristics, biomarkers, and surrogate subtypes of breast cancer between Sudanese and German women. Methods Tumor characteristics and immunohistochemistry markers (estrogen receptor [ER], progesterone receptor [PR], and human epidermal growth factor receptor 2 [HER2]) were collected from the routine assessment of consecutive patients with invasive breast cancer diagnosed from 2010 to 2015 (Gezira University Pathology Laboratory, Gezira, Sudan) and from 1999 to 2013 (Breast Centre, Martin-Luther-University, Halle, Germany). Results A total of 2,492 patients (German [n = 1,932] and Sudanese [n = 560]) were included. Age at diagnosis ranged from 20 to 94 years. Sudanese women were, on average, 10 years younger than German women, with a mean (± standard deviation) age of 48.8 (13.5) and 58.6 (12.4) years, respectively. The Sudanese women had a higher grade, larger tumor, and more lymph node positivity compared with German women. ER-, PR-, and HER2-negative proportions were 55%, 61.8%, and 71.3%, respectively, for Sudanese women versus 22.7%, 32.3%, and 82.5%, respectively, for German women. The triple-negative subtype was more prevalent in Sudanese women (34.5%) than in German women (14.2%). The strongest factor associated with ER-negative disease was grade III (odds ratio, 19.6; 95% CI 11.6 to 33.4; P < .001). Sudanese patients were at higher risk for ER-negative breast cancer, with an odds ratio of 2.01 ( P = .001; adjusted for age, size, nodal status, histologic type, and grade). Stratified by grade, the influence of origin was observed in grade I and grade II tumors, but not in grade III tumors. Conclusion Sudanese women had more aggressive tumor characteristics and unfavorable prognostic biomarkers. After adjustment, Sudanese origin was still associated with hormone receptor–negative disease, especially in grade I and II tumors. These findings suggest differences in tumor biology among these ethnic groups.

Studies of epidemiology, treatment modalities, and outcomes of childhood central nervous system (CNS) tumors in Sudan are scarce. To address this shortcoming, we evaluated baseline information about the epidemiology, treatment types, and outcomes of childhood CNS tumors at the National Cancer Institute, University of Gezira (NCI-UG) in Wad Madani, Sudan. We performed a retrospective health facility-based study of children with CNS tumors who were treated at the NCI-UG from January 2000 to December 2015. A total of 62 (5.4% of all childhood cancers) pediatric patients with CNS tumors were identified over the study period. Tumors were more common among male children and involved the infratentorial compartment in 58% of cases. The median age at diagnosis was 9 years (range, 2–14 years). Approximately 60% (n = 37) of the study population had histology-determined diagnoses. Astrocytomas and medulloblastomas were the most common tumors in these cases. The mean time to diagnosis was 6 months (SD, 9). During the study period, the number of children with CNS tumors who were referred for treatment at the NCI-UG increased every year. Of the 37 patients who received surgical interventions, 8 received gross total resections, 20 received partial resections, and 24 received postoperative radiotherapy. The treatment abandonment rate was 11%. The 2-year and 5-year survival rates were 33% and 13%, respectively. Our findings reveal a high incidence of poor outcomes for patients with CNS tumors in Sudan, which is most likely due to many distinct factors.

Background: Epidemiological studies of paediatric cancer incidence in Sudan are rare.Objectives: The aim of this study was to provide baseline information about the epidemiology of childhood cancers in patients treated at the National Cancer Institute (NCI) in Wad Medani, Sudan.Methods: We performed a retrospective health facility–based study of cancer incidence and patient characteristics of children who were treated at the NCI from January 1999 to December 2015. The changing patterns of cancers incidence during the study period were also recorded.Results: Of 15 387 new patients with cancer who were registered at the NCI during the study period, 1159 (7.5%) were children (younger than 15 years). The mean age of the paediatric patients was 7 years, with standard deviation of 5. Most of the patients (36%) were 10 to 15 years old, 33% were 0 to 4 years old and 31% were 5 to 10 years old. Among the study population, 60% were males and 40% were females. Approximately 76% of children lived in rural areas in Sudan. Leukaemias (29%) and lymphomas (26%) comprised 55% of all paediatric cancers. Central nervous system (CNS) tumours constituted 6% of all paediatric tumours, whereas non-CNS embryonal tumours (i.e. nephroblastoma, neuroblastoma, hepatoblastoma and retinoblastoma) accounted for 20%. The average number of cases per year increased from 42 in 1999–2005 to 75 in 2006–2010 and 106 in 2011–2015.Conclusion: The number of patients seeking treatment for childhood cancers has increased every year in central Sudan. Leukaemias and lymphomas constitute more than half of these cancers. A population-based cancer registry is needed to determine the true incidence of childhood cancers in Sudan.

Background Breast cancer is the most common malignancy accounting for 25% of all cancers in females. In Africa, breast cancer prevalence and mortality are steadily increasing. Knowledge of hormone receptors and human epidermal growth factor receptor-2 (HER-2) expressions are vital for breast cancer management plans and decision making. There is wide regional variation in the proportion of these biomarkers, especially in African countries. Hormone receptors positivity in indigenous African and African American women is considered to be low and triple negative breast cancer is a dominant phenotype. There is paucity of data regarding hormone receptors (ER and PR) and HER2 expressions in North-eastern Africa (Eritrea and Sudan). The purpose of this study was to evaluate the expression of ER, PR and HER2 in Eritrean and Sudanese case series and correlate these biomarkers with the clinicopathological profile. Method Clinicopathologic data of patients were collected from clinical records. Immunohistochemistry biomarkers (ER, PR, and HER2) were assessed in consecutive female patients who had been diagnosed with invasive breast cancer from 2011 to 2015 in Gezira University Pathology Laboratory, the Sudan and National Health laboratory, Asmara, Eritrea. Results There were 678 cases involved in this study. The mean age was 48.8 years with ±0.53 standard error of the mean. Two-thirds of the case were ≤50 years. Invasive ductal carcinoma, no special type was the most dominant histologic type (86%) in both study groups. The majority of cases (70%) had tumour stage pT2 and pT3 and about 50% had lymph node involvement. Less than 5% of the cases had well-differentiated tumours. The ER, PR and HER2 positive rates were 45%, 32%, and 29%, respectively. The proportion of luminal-A like, luminal-B like, HER2 enriched and TNBC were 37%, 13%, 16% and 34%, respectively. Fisher extract analysis showed age (p = .015), tumour size (p = .041), and histologic grade (p = .000) were significantly associated with intrinsic subtypes. Furthermore, Logistic regression analysis stratified by origin, age, tumour size, lymph-node metastasis and grade indicated that younger women age (≤50 years) and grade III tumours were more likely to be diagnosed with ER negative breast cancer. Conclusion Most of Sudanese and Eritrean women were diagnosed at younger age and with unfavourable prognostic clinicopathologic prognostic markers. TNBC is more frequent in this cohort study; patients with grade III tumours and young age are more likely to be hormone receptors negative. Therefore, routine determination of hormone receptors is warranted for appropriate targeted therapy.

This study aimed at assessing the reactive thrombocytosis and erythrocyte sedimentation rate in patients with pulmonary tuberculosis living in Port Sudan City, Red Sea State, Sudan. This study covers the period from June 2006 up to December 2008 at Port Sudan Tuberculosis Diagnostic Center. Hundred newly discovered Ziehl Neelsen stain positive males (77%) and females (23%) were randomly selected to be the study sample and fifty apparently healthy adult males (76%) and females (24%) were also randomly selected to be the control group of the study. The ages of the patients ranged from 14 to 70 years old. Thrombocytosis was detected in 20% of the patients. The erythrocyte sedimentation rate (ESR) was increased in 100% of the patients. The changes in these parameters (platelets count and ESR) may reflect a reaction to the inflammatory condition. Therefore, in endemic areas, the presence of such hematological peripheral blood changes may raise the suspicion of pulmonary tuberculosis. Key words: Tuberculosis, thrombocytosis, erythrocyte sedimentation rate (ESR), Port Sudan.

To assess, within communities experiencing Ebola virus outbreaks, the risks associated with the disposal of human waste and to generate recommendations for mitigating such risks.A team with expertise in the Hazard Analysis of Critical Control Points framework identified waste products from the care of individuals with Ebola virus disease and constructed, tested and confirmed flow diagrams showing the creation of such products. After listing potential hazards associated with each step in each flow diagram, the team conducted a hazard analysis, determined critical control points and made recommendations to mitigate the transmission risks at each control point.The collection, transportation, cleaning and shared use of blood-soiled fomites and the shared use of latrines contaminated with blood or bloodied faeces appeared to be associated with particularly high levels of risk of Ebola virus transmission. More moderate levels of risk were associated with the collection and transportation of material contaminated with bodily fluids other than blood, shared use of latrines soiled with such fluids, the cleaning and shared use of fomites soiled with such fluids, and the contamination of the environment during the collection and transportation of blood-contaminated waste.The risk of the waste-related transmission of Ebola virus could be reduced by the use of full personal protective equipment, appropriate hand hygiene and an appropriate disinfectant after careful cleaning. Use of the Hazard Analysis of Critical Control Points framework could facilitate rapid responses to outbreaks of emerging infectious disease.Évaluer, au sein des communautés touchées par des flambées de maladie à virus Ebola, les risques liés à l'élimination des déchets et excreta humains et formuler des recommandations pour limiter ces risques.Une équipe expérimentée dans l'application de la méthode d'analyse des risques et maîtrise des points critiques (HACCP) a identifié les déchets issus des activités de soin prodiguées aux personnes infectées par le virus Ebola et a élaboré, testé et confirmé plusieurs diagrammes des opérations illustrant la génération de ces déchets. Après avoir répertorié les risques potentiels associés à chaque étape de chaque diagramme, l'équipe a mené une analyse des risques, identifié les points critiques pour leur maîtrise et préparé des recommandations pour réduire les risques de transmission à chaque point de maîtrise.La collecte, le transport, le nettoyage et l'utilisation partagée de fomites maculés de sang ainsi que l'utilisation partagée de latrines souillées par du sang ou des fèces contenant du sang semblent être associés à des niveaux de risque de transmission du virus Ebola particulièrement élevés. Des niveaux de risque plus modérés sont associés à la collecte et au transport d'équipements souillés par des fluides corporels autres que le sang, à l'utilisation partagé de latrines souillées par ce type de fluides, au nettoyage et à l'utilisation partagée de fomites souillés par ce type de fluides ainsi qu’à la contamination de l'environnement pendant la collecte et le transport de déchets tachés de sang.Le risque de transmission du virus Ebola par des déchets pourrait être réduit par l'utilisation d'équipements de protection individuelle complets, par une hygiène des mains appropriée et par l'application d'un désinfectant adapté après un nettoyage scrupuleux. L'utilisation de la méthode d'analyse des risques et maîtrise des points critiques (HACCP) pourrait aider à réagir rapidement en cas de flambée de maladies infectieuses émergentes.Evaluar, dentro de las comunidades que han sufrido brotes del virus del Ebola, los riesgos relacionados con la eliminación de los desechos humanos y redactar recomendaciones para mitigarlos.Un equipo con experiencia en el análisis de peligros en puntos críticos de control identificó productos de desecho generados por el cuidado de individuos infectados con el virus del Ebola y construyó, probó y confirmó diagramas de flujo que mostraban la creación de dichos productos. Tras redactar una lista de los potenciales peligros relacionados con cada paso de cada diagrama de flujo, el equipo realizó un análisis de peligros, determinó los puntos críticos de control y creó recomendaciones para mitigar los riesgos de contagio en todos los puntos de control.La recolección, el transporte, la limpieza y el uso común de fómites contaminados con sangre y el uso común de letrinas contaminadas con sangre o heces con sangre parecían estar relacionados con riesgos especialmente elevados de contagio del virus del Ebola. Unos niveles de riesgo más moderados se relacionaron con la recolección y el transporte de material contaminado con fluidos corporales distintos a la sangre, el uso común de letrinas sucias con dichos fluidos, la limpieza y el uso de fómites contaminados con dichos fluidos y la contaminación del entorno durante la recolección y el transporte de desperdicios impregnados en sangre.El riesgo de contagio del virus del Ébola en relación con los desechos podría verse reducido mediante el uso de un equipo de protección individual completo, una higiene de las manos adecuada y un desinfectante apropiado tras una limpieza exhaustiva. El uso del análisis de peligros en puntos críticos de control podría proporcionar una rápida respuesta ante brotes de enfermedades contagiosas emergentes.تقييم المخاطر المرتبطة بالتخلص من النفايات البشرية ووضع توصيات للتخفيف من مثل هذه المخاطر داخل المجتمعات التي تعاني من حالات تفشي فيروس الإيبولا.قام فريق من المتمرسين في التعامل مع إطار العمل الخاص بتحليل المخاطر في نقاط التحكم الحرجة بالإشارة إلى النفايات الناتجة عن الرعاية الصحية للمصابين بمرض فيروس الإيبولا باعتبارها مصدرًا للخطر، وقاموا برسم مخططات تدفق توضح نشوء هذه النواتج الخطرة، كما قاموا باختبار تلك المخططات والتأكيد عليها. وبعد سرد المخاطر المحتملة المرتبطة بكل خطوة في كل مخطط من مخططات التدفق، قام الفريق بإجراء تحليل المخاطر، وتحديد نقاط التحكم الحرجة، ووضع التوصيات التي من شأنها التخفيف من مخاطر العدوى في كل نقطة من نقاط التحكم.يبدو أن عمليات جمع الأدوات المعدية المتسخة بالدم ونقلها وتنظيفها والاستخدام المشترك لها، وكذلك الاستخدام المشترك للمراحيض الملوثة بالدم أو البراز المدمى ترتبط بحدوث ارتفاع ملموس في مستويات الخطر لانتقال فيروس الإيبولا. وعلى الجانب الآخر، كانت المستويات الأكثر اعتدالاً من المخاطر قد ارتبطت بعمليات جمع ونقل المواد الملوثة بسوائل الجسم الأخرى غير الدم، والاستخدام المشترك للمراحيض المتسخة بمثل هذه السوائل، وعمليات التنظيف والاستخدام المشترك للأدوات المعدية المتسخة بمثل هذه السوائل، وتلوث البيئة أثناء جمع ونقل النفايات الملوثة بالدم.يمكن خفض خطر انتقال فيروس الإيبولا المتعلق بالنفايات عن طريق استخدام معدات الحماية الشخصية الكاملة، والاهتمام بالنظافة المناسبة لليدين، ووضع مطهر مناسب بعد التنظيف بعناية. ولذلك، فمن الممكن أن يقود الاعتماد على إطار العمل الخاص بتحليل المخاطر في نقاط التحكم الحرجة إلى تيسير سبل الاستجابة السريعة لحالات تفشي الأمراض المعدية الناشئة.旨在评估埃博拉病毒爆发社区内，与人类废弃物处理相关的风险，并给出降低此类风险的建议。.具备关键控制点框架危害分析专业知识的专家团队，确定了护理埃博拉病毒患者产生的废弃物，并且构建出此类废弃物产生的流程图，同时对该流程图进行测试和确认。 列出与各流程图每一步骤相关的潜在危害之后，该团队展开危害分析，确定了关键控制点并给出了降低各控制点传播风险的建议。.收集、运输、清洁和共用被血液污染的传染物，共用被血液污染的厕所或血迹斑斑的粪便疑似与极高的埃博拉病毒传播风险尤为相关。 收集和运输体液而非血液污染的物质，共用被此类体液污染的厕所，清洁和共用此类体液污染的传染物，以及收集和运输血污染废弃物期间的环境污染与较低风险水平相关。.可通过使用全方位个人防护装备、仔细清洁后正确清洁手部和使用消毒剂，降低与废弃物相关的埃博拉病毒传播风险。 使用关键控制点框架危害分析可促进对新兴传染病疫情爆发的快速响应。.Провести оценку рисков в связи с утилизацией человеческих отходов в общинах, страдающих от вспышек эпидемии лихорадки Эбола, и составить рекомендации для снижения таких рисков.Группа специалистов, обладающих опытом в анализе риска на основе критических контрольных показателей, определила отходы, которые образуются в результате ухода за заразившимися вирусом Эбола, спроектировала и протестировала блок-схемы, иллюстрирующие образование таких отходов, и подтвердила их правильность. Перечислив потенциальные риски, сопряженные с каждым этапом каждой блок-схемы, группа специалистов осуществила анализ риска, определила критические контрольные показатели и составила рекомендации для снижения риска передачи по каждому контрольному показателю.Было определено, что сбор, транспортировка, очистка и коллективное использование загрязненных кровью фомитов и коллективное использование уборных, загрязненных кровью или калом с кровью, ассоциируются с чрезвычайно высоким риском передачи вируса Эбола. Менее высокий уровень риска был связан со сбором и транспортировкой материала, загрязненного биологическими жидкостями, отличными от крови, совместным использованием уборных, содержащих такие жидкости, очисткой и совместным использованием фомитов, загрязненных такими жидкостями, а также с загрязнением окружающей среды при сборе и транспортировке отходов, загрязненных кровью.Риск передачи вируса Эбола, присутствующего в отходах, может быть снижен путем использования полного комплекта средств индивидуальной защиты, следования правилам надлежащей гигиены рук и применения подходящего дезинфицирующего средства после тщательной очистки. Проведение анализа риска на основе критических контрольных показателей могло бы способствовать быстрому реагированию на вспышки эпидемии нового инфекционного заболевания.

Introduction: this is a cross sectional descriptive community-based study. The aim was to assess the prevalence of anaemia among quranic schoolchildren in khalawi Wad EL Magboul village, rural Rufaa, Gezira State, central Sudan. Methods: a sample of 180 male participants were included in the study. Informed consent was obtained. Venous blood samples were obtained to measure the hematological parameters and blood films for malaria parasites. Urine and stool analyses were also done. Data were analyzed using SPSS. Results: the mean age of participants was 12.31 years (SD +/- 2.26). The mean Hb value was 11.75g/dl and it was statistically significant correlation when compared with the mean Hb reference value (13.5g/dl) P value 0,000 (95% CI). Regarding period of stay in the khalwa up to the time of the study, 88 (49.28%) for one year, 54 (30.24%) for 2 years, 22 (12.32%) for 3 years and 16 (8.96%) for more than 3 years. About 77 students (42.78%) were pale on clinical examination. The Mean Cell Hemoglobin (MCH) mean value was 25.58 pg ( 3.55). Many conditions known to be associated with anemia were found; 49 students (27.2%) had a positive blood films for falciparum malaria, 14 students (7.8%) were found to have haematuria and ova of S. haematobium, In169 students (93.4%) stool examination was negative , while 11 students (6.6%) had intestinal worms (Enterobius vermicularis). Conclusion: majority of the study participants had iron deficiency anaemia, followed by haemolytic, macrocytic and sickle cell anaemia. This might have negative health and educational implications.The Pan African Medical Journal 2016;24

This descriptive, cross-sectional study of Sudanese medical schools aimed to describe and analyse the proportion of their curricula currently allocated for teaching of communicable diseases and to assess the teaching methods and student assessment tools. Qualitative and quantitative data were collected from heads of departments and students in 20 of the 27 medical faculties and from ministry of health staff at federal and state levels. Curriculum designs ranged from traditional to innovative, community-oriented programmes. Problems regarding student evaluations were identified. Major limitations included shortages of staff, reference materials and teaching aids. Poor knowledge of students about different aspects of diseases endemic in Sudan was found. Recommendations include curriculum development, staff recruitment and training, and improvement of teaching and training of students.

Summary Objectives Rapid diagnostic tests (RDTs) are promoted for the diagnosis of malaria in many countries. The question arises whether laboratories where the current method of diagnosis is microscopy should also switch to RDT. This problem was studied in Kassala, Sudan where the issue of switching to RDT is under discussion. Methods Two hundred and three blood samples were collected from febrile patients suspected of having malaria. These were subsequently analysed with microscopy, RDT (SD Bioline P.f/P.v) and PCR for the detection and identification of Plasmodium parasites. Results Malaria parasites were detected in 36 blood samples when examined microscopically, 54 (26.6%) samples were found positive for malaria parasites by RDT, and 44 samples were positive by PCR. Further analysis showed that the RDT used in our study resulted in a relatively high number of false positive samples. When microscopy was compared with PCR, an agreement of 96.1% and k = 0.88 (sensitivity 85.7% and specificity 100%) was found. However, when RDT was compared with PCR, an agreement of only 81.2 and k = 0.48 (sensitivity 69% and specificity 84%) was found. Conclusion PCR has proven to be one of the most specific and sensitive diagnostic methods, particularly for malaria cases with low parasitaemia. However, this technique has limitations in its routine use under resource-limited conditions, such as our study location. At present, based on these results, microscopy remains the best option for routine diagnosis of malaria in Kassala, eastern Sudan. Prendre des decisions eclairees avant de passer au TDR: Une comparaison de la microscopie, du test de diagnostic rapide et des techniques moleculaires pour le diagnostic et l’identification des parasites de la malaria a Kassala, dans l’est du Soudan Objectifs: Les tests de diagnostic rapide (TDR) sont promus pour le diagnostic de la malaria dans de nombreux pays. La question se pose de savoir si les laboratoires ou la methode habituelle de diagnostic est la microscopie devraient egalement passer au TDR. Ce probleme a eteetudiea Kassala, au Soudan, ou la question du passage au TDR est en cours de discussion. Methodes: 203 echantillons de sang ont ete preleves chez des patients febriles suspectes de malaria. Ils ont ete ensuite analyses par microscopie, TDR (SD Bioline Pf/Pv) et PCR pour la detection et l’identification des parasites du genre Plasmodium. Resultats: Les parasites de la malaria ont ete detectes dans 36 echantillons de sang lorsque examines au microscope, 54 (26,6%) echantillons ont ete trouves positifs pour les parasites de la malaria par TDR et 44 echantillons etaient positifs par PCR. Une analyse supplementaire a revele que le TDR utilise dans notre etude a menea un nombre relativement eleve d’echantillons faux positifs. Lorsque la microscopie a ete comparee a la PCR, une concordance de 96,1% avec un k = 0,88 (sensibilite: 85,7%, specificite: 100%) a ete trouvee. Toutefois, lorsque le TDR a ete comparea la PCR, une concordance de seulement 81,2% avec un k = 0,48 (sensibilite: 69%, specificite: 84%) a ete trouvee. Conclusion: La PCR s’est averee etre l’une des methodes les plus specifiques et sensibles pour le diagnostic, en particulier pour les cas de malaria avec une parasitemie faible. Cependant, cette technique a des limites dans son utilisation de routine dans des conditions de ressources limitees, telles que dans notre lieu d’etude. A l’heure actuelle, sur base de ces resultats, la microscopie reste la meilleure option pour le diagnostic de routine de la malaria a Kassala, dans l’est du Soudan. Mots-cles: malaria, diagnostic, Soudan, microscopie, TDR Toma de decision informada antes de cambiar a una prueba de diagnostico rapido: Una comparacion de microscopia, prueba de diagnostico rapido y tecnicas moleculares para el diagnostico y la identificacion de parasitos de malaria en Kassala, nororiente de Sudan Objetivos: Las pruebas de diagnostico rapidas (PDR) son promovidas como medio para el diagnostico de la malaria en muchos paises. La pregunta es si aquellos laboratorios en los que existe actualmente microscopia deberian tambien cambiarse a las PDR. Este problema ha sido estudiado en Kassala, Sudan, en donde se esta discutiendo actualmente la cuestion sobre si cambiar o no a las PDR. Metodos: Se recogieron 203 muestras de sangre de pacientes con fiebre y sospecha de malaria. Estos fueron analizados mediante microscopia, PDR (SD Bioline P.f/P.v) y PCR para la deteccion e identificacion de parasitos de Plasmodium. Resultados: Se detectaron parasitos de malaria en 36 muestras de sangre examinadas mediante microscopia, 54 (26.6%) muestras dieron positivas para parasitos de malaria mediante PDR, y 44 muestras dieron positivas por PCR. Analisis subsecuentes mostraron que las PDR utilizadas en nuestro estudio daban un numero relativamente alto de falsos positivos. Cuando se comparo la microscopia con las PCR, se observo una concordancia del 96.1%, k=0.88 (sensibilidad del 85.7%, especificidad del 100%). Sin embargo, cuando se compararon las PDR con las PCR, se observo una concordancia de tan solo 81.2%, k=0.48 (sensibilidad 69%, especificidad 84%). Conclusion: La tecnica de la PCR ha demostrado ser uno de los metodos diagnosticos mas especificos y sensibles, particularmente para los casos de malaria con baja parasitemia. Sin embargo, esta tecnica tiene limitaciones en su uso rutinario bajo condiciones con recursos limitados, tales como el emplazamiento de nuestro estudio. Por el momento, y basandose en estos resultados, la microscopia continua siendo la mejor opcion para el diagnostico rutinario de malaria en Kassala, Sudan. Palabras clave: Malaria, Diagnostico, Sudan, Microscopia, prueba de diagnostico rapido.

In 2004, Sudan adopted artesunate + sulfadoxine/pyrimethamine (SP) combination as the first-line drug, in response to the high level of falciparum resistance to antimalarials. In 2007, a molecular study on antimalarial resistance linked genes, pfcrt, pfmdr1, pfdhfr, pfdhps, and pfATPase6, was conducted on 198 isolates from central and eastern Sudan. We observed a high frequency of point mutations at almost all loci analyzed, mainly of pfcrt 76T (72.7%), pfdhfr 51I (75.3%), and pfdhfr 108N (72.7%) alleles. The MARK III in vitro test for chloroquine sensitivity in 45 P. falciparum isolates showed that 37.8% of the isolates were low resistant and 6.7% were fully resistant. This study represents the most recent molecular investigation on antimalarial resistance in this area after the adoption of artemisinin-based combination therapy (ACT), and underlines the importance of the analysis of SP resistance evolution to monitor the efficacy of ACT therapy in endemic areas.

We compared the present Arabic syllabus used in Gezira University Medical School with previous ones. We also surveyed students and Arabic professors in medical sciences on their views on the content and teaching/evaluation procedures and how these contributed to students' understanding of the medical science syllabus. The current syllabus was designed to provide students with Arabic language skills with particular reference to scientific language. The students' opinions differed regarding their understanding of clinical medicine and their interaction with patients and also the benefits to them of research procedures and reporting. The professors considered the syllabus was adequate to achieve its aims but emphasized the importance of varying teaching methods and evaluation.

The etiology of breast cancer in Africa is scarcely investigated. Breast cancer was responsible for 456/2,233 cancer patients (20.4%) ascertained between 1999 and 2004 at Gezira University, Central Sudan. Male breast cancer accounted for 16/456 patients (3.5%), 275/440 female patients (62.5%) were premenopausal and 150/440 cases (34%) occurred in women withor =5 childbirths. We characterized for germline BRCA1/2 mutations a one-year series of patients (34 females, 1 male) selected by diagnosis within age 40 years or male gender. Overall 33/35 patients were found to carry 60 BRCA1/2 variants, of which 17 (28%) were novel, 22 (37%) reported in populations from various geographic areas and 21 (35%) reported worldwide. Detected variants included 5 truncating mutations, one of which (in BRCA2) was in the male patient. The 55 non-truncating variants included 3 unclassified variants predicted to affect protein product and not co-occurring with a truncating mutation in the same gene. Patients were from different tribes but AMOVA showed that most BRCA1/2 variation was within individuals (86.41%) and patients clustered independently of tribe in a phylogenetic tree. Cluster analysis based on age at cancer diagnosis and reproductive variables split female patients in two clusters that, by factor analysis, were explained by low versus high scores of the total period occupied by pregnancies and lactation. The cluster with low scores comprised all 4 patients with truncating mutations and 3 of the 4 carriers of unclassified variants predicted to affect protein product. Our findings suggest that in Central Sudan BRCA1/2 represent an important etiological factor of breast cancer in males and young women less exposed to pregnancy and lactation. Factors other than BRCA1/2 may contribute to breast cancer in young highly multiparous women who breast-fed for prolonged periods.

Brucellosis is a multisystem disease which may present with broad spectrum clinical manifestations which often nonspecific. In Sudan it is one of the febrile illnesses affecting human welfare. In this study, blood samples were collected from 120 individuals who had clinical symptoms of Brucellosis from Gezira and Blue Nile states in Sudan, and 60 apparently healthy individuals as a control. For diagnosis we evaluated the blood culture and three serological tests, Rose Bengal Test (RBT), Serum Agglutination Test (SAT) and the spcific IgM and IgG immuno flow assay test. The results obtained revealed that, 12/120 (10%), 7/120 (6.8%) and 6/120(5.0%) were positive for Brucellosis by RBT, SAT and IgM and IgG flow assay test respectively and no correlation between the three tests, while the blood culture was done for 81/120(67.5%) of the cases, none yielded positive for brucella. This study concluded that the serological methods were superior to bacteriological method for diagnosing Brucellosis, especially IgM and IgG flow assay test and SAT.

One of the most important outcomes of globalization’s complex and debated processes is the possibility of promoting and upgrading services in geographically remote areas. Globalization yields the easiest means of transportation and communication, which makes networking a relatively simple process. Moreover, innovative sound technologies, such as tele-consultation, provide these networks with a solid base for continuation and further buildup. These possibilities apply to the field of Medicine in general, and Pathology in particular. These new opportunities are very promising in regard to the endeavor of building sustainable capacities for disease diagnosis in sub-Saharan Africa.

Retinoblastoma (RB) is a rare and unique cancer that affects the eyes of very young children. There are few reports on RB in Sudan.We performed a retrospective study of data from patients diagnosed with retinoblastoma between January 1999 and December 2009 at the National Cancer Institute in Gezira (NCI-Gezira).Of the 519 cases of childhood cancer treated at NCI-Gezira during the study period, 25 (4.8%) were retinoblastoma. Of these 25 patients with retinoblastoma, there were 13 boys and 19 cases were unilateral. The median age at diagnosis was 36 months (range, 8-60 months). The disease was localized in 9 patients, regional in 5 patients, and metastatic in 11 patients. The most frequent symptoms were enlarged eye (n = 14) and leukocoria (n = 8). Nine patients (36%) have been lost to follow-up; 9 were alive at last follow-up (7 in remission, 2 progressed); and 7 have died (5 from disease and 2 from unrelated causes). Twenty-two eyes were enucleated in 16 patients (6 bilateral and 10 unilateral). Pathologic examination of the enucleated eyes could only be completed in 11 patients. Diagnostic imaging in the form of computerized tomography scans or ultrasonography of the brain and orbit was done for 10 patients (40%).Although these findings are not surprising, and similar to reports from other developing countries, we hope our work will provide a foundation for strategies to improve outcome for retinoblastoma in our center such as proper training, public awareness, team approach, and twinning.

This paper describes an outbreak of dracunculiasis in Mazmum, a town in central Sudan. The study included collection of clinical and epidemiological data from 319 patients treated in hospital, a review of the hospital records, a house survey covering a sample of 757 subjects, a school survey covering 1390 schoolchildren, and examination of water sources. The overall incidence of the disease was 23.4%, with most cases appearing in the agricultural season (July-October). Incidence was highest in young females but most severe disability occurred in male patients aged > or = 20 years, of whom more than 60% were unable to work for more than 4 weeks. The disease is transmitted in shallow natural pools, artificial ponds and trenches in rocky hills that hold rain water. All these sources were found to be infested with Cyclops. The outbreak is attributed to deterioration in the structure and management of the water sources, together with a massive population influx from other endemic areas. These observations underscore the importance of co-ordinating efforts to eradicate the disease from African countries.

Khalid Dafaallah, Awadelkarim1, Ahmed Abdalla, Mohamedani2, Massimo Barberis31Department of Molecular Biology, National Cancer Institute, 2Department of Pathology, Faculty of Medicine, University of Gezira, Wad Medani, Sudan; 3Department of Pathology, European Institute of Oncology, Milan, ItalyAbstract: In sub-Saharan Africa there is an extreme shortage of pathology services and, when provided, they are of unacceptable standard. Specimen handling and storage are very poor, and render this important aspect of medicinal practice rudimentary. The situation on the ground reflects the full spectrum of the educational, cultural, political, and economical challenges that must be confronted in building basic scientific capabilities in the life sciences, including medicine, in such countries. It is a difficult and often discouraging situation, however, several constructive initiatives have been promoted to address this problem. In this paper we describe the current state of pathology services in sub-Saharan Africa, documenting our experience in Sudan. We also report some of the results obtained by others and our future goals, and propose how pathology-related problems could be addressed in sub-Saharan Africa, by focusing on specific critical points, which may also be considered for other developing countries outside Africa.Keywords: pathology, Africa, networks, standard operative procedures, telepathology

This work was designed to study the contribution of women in central Sudan in the control and management of malaria with particular emphasis on gender-related aspects that define women's role and participation. The Blue Nile Health Project (BNHP 1980-1990) was launched in 1980 mainly for control of water associated diseases in central Sudan. The BNHP model was chosen to conduct this work. The study showed that women were actively involved in the implementation of the BNHP strategies as health instructors (murshidat) who constituted 75% of the staff of BNHP unit of health education, as members of village health committees (VHC) where they constituted 40% of the VHC members and also as recipients of the project services. All murshidat were interviewed whereas multistage random sampling for VHC members and recipient women in 40 villages was used to select a sample which was interviewed. The results showed that the murshidat and VHC women members played a major role in the motivation, organization and health education of local communities prior to campaigns of environmental sanitation and vector control. Household commitments and difficulties in communication with the public were the main gender-related factors that contributed negatively to women's activities. Cases of malaria have more considerable socio-economic impact than other common diseases, especially with regard to women's household commitments and work. Recipient women were more concerned with aspects of self protection, management of family cases of malaria and health education programmes. They were less involved in drying mosquito breeding sites and spraying activities of insecticides which had been reluctantly accepted because of allergy and bad odour. Although the majority of women considered antimalarials to be less harmful than effects of malaria itself on pregnancy, they did not realize the role of malaria chemoprophylaxis during pregnancy. This needs more health education. The study showed that the BNHP programme was very successful in recruiting women in control and management programmes. Therefore, health planners are urged to persuade the subordinated communities of women in many African countries like Sudan to play a more active role in the health programmes and welfare of their communities.

A nested case-control hospital study and a midwife-based community cohort study were conducted in Central Sudan during 1989 and 1990 to assess the contribution of mesoendemic malaria to low birth weight. Malarial infection was determined by maternal history, parasitology, and histopathology. There were significant associations between a maternal history of malaria and low birth weight in the hospital study (adjusted odds ratio (OR) = 1.6, 95% confidence interval (CI) 1.2-2.1) and the community study (OR = 1.7, 95% CI 1.3-2.3). Attributable risk percentages were high and were comparable in the hospital study (22.2%) and the community study (24.5%). A significant trend of increased risk of low birth weight was observed with increasing number of reported malaria attacks, with attacks occurring earlier in pregnancy, and with higher parasitemia. In addition, the risk of low birth weight associated with malaria was higher among primiparous women than among multiparous women. The mean birth weight of infants whose mothers had malaria during pregnancy was significantly lower than the mean birth weight of infants whose mothers did not. Malaria treatment, chemoprophylaxis, and use of insecticides decreased the risk of low birth weight and are recommended as appropriate interventions. These measures should target primigravid women and should be initiated early in pregnancy.