Hematological picture of pediatric Sudanese patients with visceral leishmaniasis and prediction of leishmania donovani parasite load

BACKGROUND Visceral leishmaniasis(VL)is a systemic protozoan infection caused by Leishmania donovani(L.donovani)and transmitted by sand flies,causing macrophage invasion in the liver,spleen,and bone marrow.Diagnosis of VL is currently based on clinical signs,symptoms,and specific in-vitro markers and bone marrow investigations.However,VL's specific hematological and bone marrow manifestation in Sudanese pediatric patients is not well studied.AIM To examine the blood and bone marrow characteristics in pediatric patients from Sudan who have VL.METHODS This is a retrospective hospital-based study with a sample of 107 consecutive Sudanese pediatric patients.The data focused on hematological and bone marrow results.We included only the completed records of the pediatric patients with VL in the Tropical Disease Teaching Hospital in Khartoum,Sudan from the period of 2016 to 2020.RESULTS The majority of pediatric patients included in this study are below 5-years-old(n=59,55.2%).Moreover,anemia,thrombocytopenia,and leukopenia were among the prevalent characteristics in the population under study.To further analyze the data,we developed a machine learning model using boosted forest algorithms to predict L.donovani parasites load,with a mean accuracy of 0.88 for the training dataset and an accuracy of 0.46,0.50,and 0.74 for mild,moderate,and severe L.donovani parasite load in the validation dataset.CONCLUSION This study shows that the most common bone marrow change among Sudanese VL children was increased chronic inflammatory cells(n=88,82.2%)with present macrophage hemophagocytes(n=103,96.3%).While anemia and thrombocytopenia were the most common hematological changes.These results will hopefully lead to an early diagnosis and hence better management for Sudanese pediatric patients with suspected VL.

Review of the prevalence,diagnostics,and containment measures of the current mpox outbreak

Monkeypox(mpox),is a disease from the Poxviridae family that can cause several serious medical issues.This mini-review sought to analyze the existing literature regarding the current mpox outbreak with a focus on the prevalence,diagnostics,and containment measures.Mpox cases have been reported to World Health Organization(WHO)from 85 Member States in all six WHO regions during the period of January 1,2022,through August 3,2022.Standardized or optimized guidelines for the clinical care of patients with mpox are limited,particularly in low-resource settings.In an effort to achieve guidance and meet standards,special attention should be paid to this outbreak in order to eradicate such a rare infectious disease by analyzing prevention and control measures.Patient outcomes may also be poor,and their illnesses may last for a long time.The spectrum of clinical symptoms,including complications and sequelae,as well as aspects of the illness may be indicators of sickness severity and complications;therefore,its clinical presentation must be better understood to improve containment measures.In addition,it is important to create and evaluate a standard of care that takes a variety of parameters into account,including antiviral,immune therapies,and clinical metrics that are particular to mpox.The global emergence of mpox has presented new challenges for public health and has called for further investigation into its epidemiological profile across international contexts.

Antibody seropositivity and endemicity of chikungunya and Zika viruses in Nigeria

Mosquito-borne infections are of global health concern because of their rapid spread and upsurge,which creates a risk for coinfections.chikungunya virus(CHIKV),an arbovirus disease transmitted by Aedes aegypti or A.albopictus,and malaria,a parasitic disease transmitted by Anopheles gambiae,are prevalent in Nigeria and neighbouring countries,but their burden and possible coinfections are poorly understood.In this study,we investigated the antibody seropositivity and endemicity of chikungunya and Zika viruses(ZIKV)in three regions of Nigeria.A cross-sectional serosurvey was conducted on 871 participants.Samples were collected from outpatients by simple random sampling.Analyses of the samples were performed using recomLine Tropical Fever for the presence of antibody serological marker IgG immunoblot with CHIKV VLP(virus like particle),ZIKV NS1 and ZIKV Equad according to manufacturers’instructions and malaria RDT for malaria parasite.There was a significantly higher antibody seropositivity against CHIKV in the central region than in the northern and southern regions(69.5%,291/419),while ZIKV-seropositivity(22.4%,34/152)and CHIKV-ZIKV co-circulating antibody seropositivity(17.8%,27/152)were notably higher in the southern region than in the central and northern regions.This investigation revealed an unexpectedly high antibody seropositivity and concealed endemicity of CHIKV and ZIKV in three Nigerian regions.The seropositivity of detectable antibodies differed among the three geographical locations.

Universal Health Coverage in Somalia: Charting the Path to Equitable Healthcare Financing and Governance

Somalia is a country facing numerous challenges in achieving universal health coverage (UHC) and ensuring adequate healthcare financing, This article explores the complexities and obstacles that Somalia must overcome in its pursuit of UHC, the paper begins by providing an overview of the current healthcare landscape in Somalia, highlighting the lack of infrastructure, political instability, and limited financial resources that hinder the establishment of a comprehensive and equitable healthcare system. It then examines the role of international aid and non-governmental organizations (NGOs) in filling the healthcare gap, while emphasizing the need for a more sustainable, domestically financed solution. Drawing on a range of data sources and case studies, the article proposes a multi-faceted approach to strengthen healthcare governance, improve resource allocation, and foster local capacity building, the study delves into the unique obstacles that Somalia faces, including a lack of infrastructure, political instability, and limited financial resources, which hinder the establishment of a comprehensive and equitable healthcare system. The paper also examines the role of international aid and non-governmental organizations (NGOs) in filling the healthcare gap, while highlighting the need for a more sustainable, domestically financed solution. The findings underscore the importance of political commitment, international cooperation, and innovative financing mechanisms in advancing towards UHC in Somalia, providing valuable insights for other low resource, conflict affected settings.

Diabetes mellitus:An overview of the types,prevalence,comorbidity,complication,genetics,economic implication,and treatment

Diabetes is one of the deadliest diseases.Due to its effects on the lives of people,it has attracted a lot of attention recently.The causes of the various forms of diabetes,including type 1 and type 2,were discussed along with how they affect those who have the disease.Younger people are more prone to type 1 diabetes than older people,who are more likely to develop type 2.The treatment options and strategies for the two forms of diabetes were also discussed in addition to how the disease affects the quality of life of people.Among several factors that were explained,it has been shown that people from low and middle-income countries are more prone to having diabetes.Additionally,the condition is more likely to affect some races more than others.It is associated with obesity.According to statistics,those who are poor are more severely affected by the disease.The progression of the disease over time has been associated with an increase in disability and mortality.

Effect of SARS-CoV-2 infection on the liver

There have been numerous concerns about the disease and how it affects the human body since the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)pandemic began in December 2019.The impact of SARS-CoV-2 on the liver is being carefully investigated due to an increase in individuals with hepatitis and other liver illnesses,such as alcoholic liver disease.Additionally,the liver is involved in the metabolism of numerous drugs used to treat comorbidities and coronavirus disease 2019(COVID-19).Determining how SARS-CoV-2 affects the liver and what factors place individuals with COVID-19 at a higher risk of developing liver problems are the two main objectives of this study.This evaluation of the literature included research from three major scientific databases.To provide an update on the current impact of COVID-19 on the liver,data was collected and relevant information was incorporated into the review.With more knowledge about the effect of the disease on the liver,better management and therapeutics can be developed,and education can ultimately save lives and reduce the long-term impact of the pandemic on our population.

Validation of High Performance Liquid Chromatography with Fluorescence Detector Methods for Determination of Aflatoxins in Different Food and Animal Feed Samples

Method validation for quantitative analysis of aflatoxins, AFB1, AFB2, AFG1 and AFG2 in sorghum, peanut butter, groundnut and animals feed is presented. Aflatoxins were extracted with a mixture of methanol: acetonitrile: water (60:30:10) and cleaned with Alfa test IAC chromatography before analysis by High Performance Liquid Chromatography coupled with fluorescence detection (HPLC-FLD) by adopting an isocratic chromatographic system using a mobile phase consisting acetic acid: acetonitrile: methanol (59:14:27), the separation of the four aflatoxins was achieved in less than 15 minutes. Calibration curves were linear over the concentration range from 2 - 18 ng/mL for AFB1 and AFG1, 0.4 - 3.6 ng/mL for AFB2 and AFG2, respectively. The LOD and LOQ in spiked samples were found to be 0.02 and 0.05 μg/kg for both AFB1 and AFG1, 0.01 and 0.03 μg/kg for both AFB2 and AFG2. The mean recovery values were in range from 84.2% to 96.9% was obtained. Five samples were found to be contaminated with aflatoxins and the total aflatoxins ranged from 0.02 to 3.26 μg/kg were obtained. Nineteen different samples were found to be contaminated with aflatoxins;the total aflatoxins ranged from 0.27 to 10.48 μg/kg were obtained. The highest total aflatoxins value was obtained in animal feeds.

Retrospective Evaluation of Intussusception in Under-Five Children in Nigeria

Background: Assessment of the safety profile of the new rotavirus vaccines in Africa requires base-line epidemiological data on intussusception. Hence, this study was aimed at describing the prevalence and associated factors of intussusception in under-five children in Enugu, Southeast, Nigeria. Methods: This was a retrospective descriptive study involving the sixty reported cases of intussusception in under-five children admitted in a hospital in Enugu between 2007 and 2012. Cases of intussusception were selected using the Brighton collaboration intussusception working group level I diagnostic criteria. Information sought from the patients’ folders included demographic characteristics and clinical manifestations including history of previous rotavirus vaccination, duration of illness prior to presentation, diarrhoea, vomiting, passage of red currant jelly-like stool, abdominal mass and distension, method of diagnosis, treatment option(s) employed and their outcomes. The data was analyzed using SPSS version 17.0. Results: The majority of the cases were aged less than one year (53;88.3%) while the average incidence of intussusception was 0.1 per 1000. None of the cases had received rotavirus vaccinations. The common clinical presentations were vomiting, 55 (17.2%), passage of red currant stool 50 (15.6%), fever 50 (15.6%) and abnormal/absent bowel sound 43 (15.9%). Diagnosis was essentially with the aid of abdominal ultrasonography, 38 (63.3%) while surgery (laparotomy) was the treatment of choice in most cases 48 (80.0%). The case fatality rate was 3 (5.0%). Conclusion: None of the cases studied could be directly linked to rotavirus vaccinations. But seasonal peak incidence coincided with rotavirus diarrhea peak incidence. Efforts should be made to institute post-rotavirus vaccine licensure prospective surveillance study in order to fully determine any relationship between rotavirus vaccination and intussusception in Enugu, South east, Nigeria.

Erratum to “Retrospective Evaluation of Intussusception in Under-Five Children in Nigeria” [World Journal of Vaccines Vol.4 No.3 (August 2014) 123-132]

The original online version of this article (Tagbo, B. N., et al. 2014 “Retrospective Evaluation of Intussusception in Under-Five Children in Nigeria”, 2014, 4, 123-132, http://dx.doi.org/10.4236/wjv.2014.43015) was published in August 2014. The author wishes to correct the author’s name and the Table 3 in the text.

Epidemiology of extra pulmonary tuberculosis in Eastern Sudan

Objective: To investigate the epidemiological factors associated with extra pulmonary tuberculosis(EPTB) in Kassala, Eastern Sudan.Methods: Patients infected with TB(pulmonary and extra-pulmonary) documented at the hospital were interviewed with a structured questionnaire used to gather socio-demographic information. The diagnosis of EPTB cases was based on presence of tuberculous granulomas in the histological samples, positive PCR to DNA of mycobacterium tuberculosis, radiological i ndings and l uid analysis suggestive of EPTB and clinical diagnosis with adequate response to anti-tuberculous therapy.Results: A total of 985 patients with TB were enrolled in the study, including 761(77.3%) with PTB and 224(22.7%) with EPTB. The mean age(SD) of patients with PTB and EPTB was 33.2(15.4) and 34.7(14.6) years respectively. The prevalence of EPTB was at(22.7%), with TB lymphadenitis 79(35.3%), marking the frequent form of EPTB followed by peritoneal TB 27(12.05%). While residence and occupation were not associated with EPTB, those with lower level of education(OR = 0.3; coni dence intervals(CI) = 0.2-0.5; P < 0.001), female(OR = 8.7, CI = 4.9-15.1, P < 0.001), non vaccination(OR=70.3, CI = 34.2-144.3, P < 0.001), and non smoker(OR = 0.1; CI = 0.06-0.20; P < 0.001), were associated with high prevalence of EPTB. Conclusions: Around one quarter of patients with TB in this study were more likely to have EPTB. Therefore, ef ective strategic plans regarding diagnostic procedures and control measures are needed to reduce the burden of the disease in Sudan.

Scourge of intra-partum foetal death in Sub-Saharan Africa

Intra-partum foetal death has been variously defined.However, a definition adopted at a technical consultation in 2006 is employed in this review. The quality of intrapartum care is a crucial factor for pregnancy outcome for both mothers and new-borns. Intra-partum stillbirth is defined as late foetal death during labour, which clinically presents as fresh stillbirth. The largest proportion of the world's stillbirths occurs in the late preterm, term and intra-partum periods. The Western Pacific region has the greatest reduction in stillbirth with a 3.8% annual decline between 1995 and 2009; however, the annual decline in the African region is less than 1%. Caesarean delivery is still uncommon, especially in rural areas: 1% of births in rural Sub-Saharan Africa and 5% in rural South Asia are by caesarean delivery; 62% of stillbirths occurred during the intra-partum period; 61.4% of stillbirths are attributable to obstetrical complications. Preventive measures aimed at reducing the incidence of intra-partum foetal death entail all measures aimed at improving quality antenatal care and preventing intrapartum asphyxia. This review discusses intra-partum foetal deaths from a Sub-Saharan African perspective. It explores the contribution of research within the region to identifying its impact on new-born health and potential cost-effective policy interventions.

AIDS AS A CHALLENGE FOR THE DEVELOPMENT OF THETREATMENT OF OPIOID DEPENDENTS IN CHINA

Report on the 9^(th) National Conference on Drug Dependence,MMT and HIV Preventionin Sanya/Hainan (VR China),1-5 November 2006 Nearly 100 experts from all over China attended the Chinese National Conference on Drug Dependence in Sanya/Hainan.The participants came from drug abuse treatment centers,methadone clinics and drug research institutes.The conference's focus was on the question how drug abuse treatment shall and might be part of HIV prevention.

First-Line Drug Resistance Patterns of Mycobacterium tuberculosis Complex Isolates from Re-Treatment Patients from Sudan

Drug susceptibility testing (DST) plays a pivotal role in TB patients’ management leading to the selection of most effective drugs. This study aimed to determine resistance patterns to first line anti-TB drugs in Mycobacterium tuberculosis isolates from re-treated patients from Sudan. A total of 239 sputum specimens were collected from smear positive re-treatment TB patients during the period from July 2009 to July 2010. Specimens were pre-treated according to Petroff method. The recovered isolates were tested for sensitivity to first line anti-TB drugs by the 1% proportion method. One hundred and forty three (143/239, 59.8%) mycobacterial isolates were successfully recovered. The majority (98.6%, 141/143) of the isolates were Mycobacterium tuberculosis complex strains. Two strains (2/143, 1.4%) were identified as RIF/INH-resistant MOTT, while fifty four isolates (38.3%, 54/141) were MDR. Multi- drug resistant Mycobacterium tuberculosis complex (MDR-TB) among re-treatment patients from national referral centers for tuberculosis diagnosis and management was considerably high in the study isolates.

Managing Health Risks during the Balkans Floods

Floods have always had and will continue to have significant consequences for society. In May 2014, there was widespread flooding in the Balkans affecting Bosnia and Herzegovina, Croatia and Serbia. The aim of this article is to show that resilient and proactive health systems that anticipate needs and challenges are more likely to reduce risks and respond effectively during emergencies, saving lives and alleviating human suffering. The method draws on multiple sources of information, including a Balkan case study questionnaire survey with public health professionals involved in response to floods (n = 18) from three affected countries, and focus group discussion results (n = 43) presented at the meeting on “Prevention, preparedness and response to reduce or avoid health effects of flood events”, held in Bonn, Germany, in October 2015. The proposed range of measures to protect population health, organized around flood prevention, preparedness, response and recovery listed issues and considerations largely corresponds to the identified needs by Member State requests, following the Balkan country experiences. The consideration of lessons for early warning, preparedness and response and the integration of research results would lead to improved preparedness measures to better prevent flooding risks. Experiences in the WHO European Region point to a need to shift the emphasis from disaster response to long-term risk management.

Geo-Spatial Mapping of Tuberculosis Burden in Anambra State, South-East Nigeria

Background: Anambra state in south-east Nigeria is one of the high TB burden states in the country. Despite recent improvements in TB case notification, estimates from the National Prevalence survey suggest that there is still a significant pool of missed TB cases in the state. Although active TB case finding interventions are needed at community level, information on local TB transmission hotspots is lacking. The objective of this study was to map the geo-spatial location of all TB cases detected in the state in 2019. Findings from this secondary data analysis will help to target interventions appropriately with a view to achieving better program efficiency. Method: A de-identified dataset containing descriptive physical addresses of registered TB cases in 2019 was developed. The dataset was then deconstructed and restructured using Structured Query Language in a relational data base environment. The validated dataset was geocoded using ArcGIS server geocode service and validated using python geocoding toolbox, and Google geocoding API. The resultant geocoded dataset was subjected to geo-spatial analysis and the magnitude-per-unit area of the TB cases was calculated using the Kernel Density function. TB case notification rates were also calculated and Choropleth maps were plotted to portray the TB burden as contained in the dataset. Results: Five local government areas (LGAs) (Onitsha North, Onitsha South, Idemili North, Nnewi North, Ogbaru) had spots with “Extremely high” burden with two LGAs (Onitsha North and South) accounting for the largest spots. Eight LGAs had spots with “Very high” TB burden. Also, 24 hotspots across the state had “High” TB burden and two LGAs (Orumba North, Orumba South) had only “Low” TB burden areas. Conclusion: Visualizing the heat map of TB patients has helped to identify transmission hotspots that will be targeted for case finding interventions and effort should be made to increase sensitization of the people on certain behavioural attributes that may contribute to contracting Tuberculosis.

Molecular Characterization of Rotavirus Strains Circulating in Enugu Nigeria: 2011 to 2016

Rotavirus gastroenteritis is a major public health concern globally, estimated to cause 215,000 deaths among children < 5 years of age in 2013;with majority of mortality occurring in developing countries. In 2013, it was estimated that Nigeria was the second country with the highest number of rotavirus deaths. Monitoring of circulating rotavirus strains in Enugu, Nigeria is part of on-going rotavirus surveillance before the introduction of rotavirus vaccination. A total of 2694 stool samples were collected from enrolled under 5 years old children with diarrhoea between January 2011 and December 2016 and tested the virus using an antigen enzyme immunoassay. Randomly selected rotavirus positive samples were further characterized by rotavirus genotype methods to identify the G and P types circulating during the study period. Rotavirus was detected in 1242 (46%) of the 2694 samples collected over the six years period. Of these, 867 were randomly selected for genotyping. G and P types could be assigned for 832 samples (96%), while 31 (3.6%) could only be assigned either genotype G or P (partially typed) and 4 (0.4%) could not be assigned genotype G and P (untypeable). The most common G-genotypes detected during the entire study period were G12, G1 and G3 accounting for 27.6%, 21.0% and 16.3% respectively. Mixed G and P-genotypes were commonly detected. Ninety-one of the samples, representing 10.8% (91/839) had mixed G-genotype whilst 130 of the samples representing 15.2% (130/852) had mixed P-genotype. The most common P-genotypes detected were P[8], P[6] and P[4] representing 38.3%, 35.4% and 9.1% respectively. The predominant strain detected was G12P[8] (22.3%) followed by G3P[6] (14.5%), G1P[8] (9.2%) and G1P[6] (8.0%). These data are useful for making an informed decision about the introduction of rotavirus vaccine into the national routine immunization program and to monitor the impact of the vaccine post licensure.

Intestinal protozoa and intestinal helminthic infections among schoolchildren in Central Sudan

Objective:To determine the prevalence of intestinal parasitic infections and soil-transmitted helminths(STHs) among primary schoolchildren in El dhayga,Central Sudan.Methods:In this cross-sectional study,three fresh faecal samples were collected from each child,which were examined by direct wet mount,brine flotation,formalin-ether and Kato-Katz techniques.The intensity of each STH infection was expressed as the mean of eggs per gram counts of the three samples.Results:In total,142(90.4%) of 157 children harboured at least one type of intestinal parasite.Ascaris lumbricoides,Hymenolepis nana,Entamoeba histolytica and Giardia lamblia were the most common parasites found,with prevalence rates of 32.5%,30.6%,33.1%and 19.7%,respectively.Out of these 157 children,29(18.5%) harboured more than two intestinal parasitic infections.No cases of Schistosoma mansoni or Enterobius vermicularis were identified. Conclusions:The study demonstrates significant burden of intestinal protozoa and STH infections in this part of Sudan and highlights the need for preventive and intervention measures.

Using UNAIDS’s organizing framework to assess Nigeria’s national HIV monitoring and evaluation system

The Nigeria National Response Management Information System (NNRIMS), developed in 2004 as a framework for monitoring and evaluating the country’s response to HIV, does not function at an optimum level due to several challenges, including a confusing proliferation of vertical reporting systems, competition among sectors, and the nascent nature of the monitoring and evaluation (M&E) sub-systems within many institutions. An assessment of the existing M&E system was conducted to verify whether the system has the capacities to provide essential data for monitoring the epidemic and identifying critical programming gaps. Nigeria’s National Agency for the Control of AIDS (NACA) used an organizing framework for a national HIV M&E system developed by UNAIDS, to assess the strengths and weaknesses of the NNRIMS to generate data for evidence-based decisionmaking. The participatory approach used during an assessment workshop ensured that the process was country-led and -owned to build consensus and local capacity, and that it encouraged adoption of a single national-level multisectoral HIV M&E system. The assessment found an operable M&E system at the national level but a much weaker system at the state and local levels and across seven other sectors. There are multiple data collection and reporting tools at the facility level that lead to vertical reporting systems, which increases the burden of reporting at lower levels, especially by service providers. Human resources are being developed, but problems remain with the quantity and quality of staff. Data use, though evident at the national level, is still very weak among five of the seven sectors assessed. The assessment results have been used to develop a national costed M&E workplan to which all stakeholders contributed in a coordinated response to strengthen the system.

China's Oral Care System in Transition:Lessons to be Learned from Germany

Aim The objective of this discussion paper is to investigate whether the experience gained through the German paradigm shift in dental care can be of benefit in China＇s deliberations on the introduction of universal dental care for its people. Methodology A comparison of representative oral health outcome data from China and Germany, two countries at different stages in their development, is presented here in order to analyse whether the findings meet expected outcome and confirm the presumption that more developed countries perform better. Results The epidemiological comparison reveals surprising findings concerning the severity of dental diseases and, in particular, missing teeth per person in adults and rates of total edentulousness in seniors. In all of these areas German adults and seniors show significantly inferior outcomes compared with the Chinese population. The mainreason for these striking discrepancies, as it turned out, is the decisive role played by the treatment philosophies and strategies of German dentists. Conelusion and recommendations If dentists take a less interventionist approach, checking as well as treating dental diseases with preventive and strictly tooth-preserving methods, dental treatment results in oral health. Under these condi- tions it can be assumed that modem dentistry is generally good for the teeth. These findings are important for developing countries that are seeking to integrate dental care into their health care system. On the basis of long-term experience from highly industrialized Western countries and especially from Germany we will attempt to put forward proposals for creating an effective and efficient dental care system in China.