WEIGHT LOSS AND BEYOND, ASSESSMENT OF QUALITY OF LIFE AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY USING BAROS IN PATIENTS WITH OBESITY IN TURKEY

Context

Sleeve gastrectomy is an effective method for management of obesity. The Bariatric Analysis and Reporting Outcome System (BAROS) is a comprehensive and standard system for the assessment of outcomes of weight loss surgery. It is consisted of weight loss, changes in obesity-related comorbidities and quality of life measurements. We investigated results of the sleeve gastrectomy based on the BAROS.

Material and Methods

Outcomes of laparoscopic sleeve gastrectomy surgery was studied in 45 patients with obesity (11 male, 34 female), after 45 months in Turkey.

Results

Total weight loss was 26.4±0.1% of body weight at 45 months. Weight regain was seen in 97.8% of the patients with an average 14.5 kg and 13.7% body mass index points. The surgery caused 76% decrease in incidence of obstructive sleep apnea, 73% decrease in type 2 diabetes, 63% decrease in hyperlipidemia and 62% decrease in hypertension. Significant improvement is observed in all quality-of-life parameters. The final score of the BAROS was 4.23±1.02.

Conclusion

Based on BAROS, sleeve gastrectomy provides significant improvements in weight loss, incidence of medical comorbidities and quality of life after surgery. Future studies should address prevention of weight regain after the surgery.

Strain relief and disorder in commensurate water layers formed on Pd(111)

Water adsorbs and desorbs intact on Pd(111), forming a hydrogen-bonded wetting layer whose structure we examine by low energy electron diffraction (LEED) and He atom scattering (HAS). LEED shows that water forms commensurate (√3 × √3)R30° clusters that aggregate into a partially ordered, approximately (7 × 7) superstructure as the layer completes. HAS indicates that the water layer remains disordered on a local (approximately 10 Å) scale. Based on workfunction measurements and density functional theory simulations we propose that water forms small, flat domains of a commensurate (√3 × √3)R30° water network, separated by disordered domain boundaries containing largely H-down water. This arrangement allows the water layer to adapt its density and relieve the lateral strain associated with adsorbing water in the optimum flat atop adsorption site. We discuss different possibilities for the structure of these domain walls and compare this strain relief mechanism to the highly ordered, large unit cell structures formed on surfaces such as Pt(111).

Implementation of the reaching every district (RED) approach: experience from North Sudan

The purpose of this evaluation was to assess the extent and quality of implementing the Reaching Every Distrtic (RED) approach in North Sudan and its impact on immunization coverage. The evaluation was conducted in all 70 districts of North Sudan, excluding Darfur. District RED implementation data for 2006 were collected from district staff and used to quantify implementation by calculating Implementation Scores (IS) using a 10-point scale, with 10 being fully implemented. Overall RED IS ranged from 1.6 to 8.9. The percentage of districts with diphtheria-pertussis-tetanus (DPT) 3 coverage > or = 80% increased as the overall RED IS increased, 78%, 87%, and 96% in low-, medium- and high-scoring groups respectively. The degree of RED implementation varied across districts. Although it is not possible to directly attribute the overall increase in DPT3 coverage to RED implementation, RED implementation quality might be associated with improved DPT3 coverage.

Rat islet cell aggregates are superior to islets for transplantation in microcapsules

AIMS/HYPOTHESIS

Islet transplantation is a promising treatment for type 1 diabetes but is hampered by a shortage of donor human tissue and early failure. Research on islet cell transplantation includes finding new sources of cells and immunoisolation to protect from immune assault and tumourigenic potential. Small islet cell aggregates were studied to determine if their survival and function were superior to intact islets within microcapsules because of reduced oxygen transport limitation and inflammatory mediators.

METHODS

Islet cell aggregates were generated by dispersing rat islets into single cells and allowing them to re-aggregate in culture. Rat islets and islet cell aggregates were encapsulated in barium alginate capsules and studied when cultured in low (0.5% or 2%) or normal (20%) oxygen, or transplanted into mice.

RESULTS

Encapsulated islet cell aggregates were able to survive and function better than intact islets in terms of oxygen-consumption rate, nuclei counts, insulin-to-DNA ratio and glucose-stimulated insulin secretion. They also had reduced expression of pro-inflammatory genes. Islet cell aggregates showed reduced tissue necrosis in an immunodeficient transplant model and a much greater proportion of diabetic xenogeneic transplant recipients receiving islet cell aggregates (tissue volume of only 85 islet equivalents) had reversal of hyperglycaemia than recipients receiving intact islets.

CONCLUSIONS/INTERPRETATION

These aggregates were superior to intact islets in terms of survival and function in low-oxygen culture and during transplantation and are likely to provide more efficient utilisation of islet tissue, a finding of importance for the future of cell therapy for diabetes.

Melaena as the presenting symptom of gastric mucosal injury due to blunt abdominal trauma

Blunt abdominal trauma is a common cause of admission to the typical trauma centre. Hollow viscus injury from blunt trauma, however, is unusual and rarely involves the stomach. A 15 year old boy sustained a bicycle handle bar injury to the abdomen and presented to the casualty department four days later with melaena. A computed tomography (CT) scan of the abdomen showed normal findings but endoscopy revealed two "kissing" areas of mucosal ulceration on the anterior and posterior wall of the gastric antrum. The patient received a blood transfusion for anaemia but was otherwise treated conservatively and made a full recovery. The authors believe this to be the first reported case of melaena as the primary presenting symptom of gastric ulceration secondary to blunt abdominal trauma. Diagnosis of hollow viscus injuries due to blunt abdominal trauma requires a high index of suspicion and thorough investigation, particularly if the presentation is delayed.

Field evaluation of latex agglutination test for detecting urinary antigens in visceral leishmaniasis in Sudan

A latex agglutination test to detect urinary antigens for visceral leishmaniasis [VL] was studied. In 204 patients with suspected VL, KAtex had a sensitivity of 95.2% with good agreement with microscopy smears but poor agreement with 4 different serology tests. It was also positive in 2 confirmed VL cases co-infected with HIV. In all KAtex-positive confirmed cases actively followed up after treatment, the test became negative 1 month after completion of treatment. While KAtex had a specificity of 100% in healthy endemic and non-endemic controls, the direct agglutination test [DAT] was positive in 14% of the KAtex-negative healthy endemic controls. KAtex is a simple addition to the diagnostics of VL particularly at field level and as a complementary test for the diagnosis of VL in smear-negative cases with positive DAT results

Field evaluation of latex agglutination test for detecting urinary antigens in visceral leishmaniasis in Sudan

A latex agglutination test to detect urinary antigens for visceral leishmaniasis (VL) was studied. In 204 patients with suspected VL, KAtex had a sensitivity of 95.2% with good agreement with microscopy smears but poor agreement with 4 different serology tests. It was also positive in 2 confirmed VL cases co-infected with HIV. In all K4tex-positive confirmed cases actively followed up after treatment, the test became negative 1 month after completion of treatment. While IC4tex had a specificity of 100% in healthy endemic and non-endemic controls, the direct agglutination test (DAT) was positive in 14% of the KAtex-negative healthy endemic controls. KAtex is a simple addition to the diagnostics of VL particularly at field level and as a complementary test for the diagnosis of VL in smear-negative cases with positive DAT results.

A guided tour: small RNA function in Archaea

In eukaryotes, the C/D box family of small nucleolar (sno)RNAs contain complementary guide regions that are used to direct 2'-O-ribose methylation to specific nucleotide positions within rRNA during the early stages of ribosome biogenesis. Direct cDNA cloning and computational genome searches have revealed homologues of C/D box snoRNAs (called sRNAs) in prokaryotic Archaea that grow at high temperature. The guide sequences within the sRNAs indicate that they are used to direct methylation to nucleotides in both rRNAs and tRNAs. The number of sRNA genes that are detectable within currently sequenced genomes correlates with the optimal growth temperature. We suggest that archaeal sRNAs may have two functions: to guide the deposition of methyl groups at the 2'-O position of ribose, which is an important determinant in RNA structural stability, and to serve as a molecular chaperones to help orchestrate the folding of rRNAs and tRNAs at high temperature.

Complete protection of islets against allorejection and autoimmunity by a simple barium-alginate membrane

We describe a new technique for microencapsulation with high-mannuronic acid (high-M) alginate crosslinked with BaCl(2) without a traditional permselective component, which allows the production of biocompatible capsules that allow prolonged survival of syngeneic and allogeneic transplanted islets in diabetic BALB/c and NOD mice for >350 days. The normalization of the glycemia in the transplanted mice was associated with normal glucose profiles in response to intravenous glucose tolerance tests. After explantation of the capsules, all mice became hyperglycemic, demonstrating the efficacy of the encapsulated islets. The retrieved capsules were free of cellular overgrowth and islets responded to glucose stimulation with a 5- to 10-fold increase of insulin secretion. Transfer of splenocytes isolated from transplanted NOD mice to NOD/SCID mice adoptively transferred diabetes, indicating that NOD recipients maintained islet-specific autoimmunity. In conclusion, we have developed a simple technique for microencapsulation that prolongs islet survival without immunosuppression, providing complete protection against allorejection and the recurrence of autoimmune diabetes.

C-peptide responses after meal challenge in mice transplanted with microencapsulated rat islets

AIMS/HYPOTHESIS

This study aimed to assess a response of microencapsulated rat islets to a meal challenge after being transplanted intraperitoneally into diabetic mice.

METHODS

Microencapsulated rat islets or control naked syngeneic mouse islets were transplanted intraperitoneally into mice with streptozotocin-induced diabetes. Meal challenges were done 3, 6 and 9 weeks after transplantation. Glucose-induced insulin secretion from microencapsulated islets before and after transplantation was assessed in vitro.

RESULTS

Within the first week, all animals transplanted with either microencapsulated rat islets or with syngeneic murine islets became normoglycaemic (< 11 mmol/l). At 4 and 6 weeks, body weight was less than normal in the non-diabetic control mice. Mice with the encapsulated rat islets had lower fasting glucose concentrations and more rapid glucose clearance after a meal challenge than the control mice. The group of mice with transplanted syngeneic islets had similar glucose profiles to control mice, except for slightly accelerated glucose clearance. The C peptide responses of mice with either microencapsulated or naked islets were clearly lower than the controls. An increase of C peptide appeared as early as 20 min in the plasma of the group with encapsulated islets, but this was considerably slower than in the other two groups. Microencapsulated rat islets retrieved 9 weeks after transplantation did not lose their ability to respond to glucose, but their output was less than half of the pretransplant control islets.

CONCLUSION/INTERPRETATION

The delivery of C peptide and presumably the accompanying insulin are delayed by restrictions of the capsules and the peritoneal location. However, this delay in reaching peripheral target organs does not prevent microencapsulated grafts from efficiently clearing glucose after a meal.

Human peritoneal adhesions are highly cellular, innervated, and vascularized

Peritoneal adhesions are a major complication of healing following surgery or infection and can lead to conditions such as intestinal obstruction, infertility, and chronic pain. Mature adhesions are the result of aberrant peritoneal healing and historically have been thought to consist of non-functional scar tissue. The aim of the present study was to analyse the cellular composition, vascularity, and extracellular matrix distribution of human peritoneal adhesions, to determine whether adhesions represent redundant scar tissue or are dynamic regenerating structures. Furthermore, the histological appearance of each adhesion was correlated with the clinical history of the patient, to determine whether maturity or intraperitoneal pathology influences adhesion structure. Human peritoneal adhesions were collected from 29 patients undergoing laparotomy for various conditions and were prepared for histology, immunocytochemistry, and transmission electron microscopy. All adhesions were highly vascularized, containing well-developed arterioles, venules, and capillaries. Nerve fibres, with both myelinated and non-myelinated axons, were present in adhesions from nearly two-thirds of the patients, with increased incidence in those with a malignancy. Approximately one-third of the adhesions contained conspicuous smooth muscle cell clusters lined by collagen fibres of heterogeneous size. Adipose tissue was a consistent feature of all the adhesions, with some areas displaying fibrosis. There appeared to be no correlation between the estimated maturity or site of each adhesion and its histological appearance. However, intraperitoneal pathology at the time of surgery did influence the incidence of some histological features, such as the presence of nerve fibres, clusters of smooth muscle cells, and inflammation. This study challenges previous concepts that adhesions represent non-functional scar tissue and clearly demonstrates that established adhesions are highly cellular, vascularized, and innervated, features more consistent with dynamic, regenerating structures.

Rehabilitation of the expanded programme on immunization in Sudan following a poliomyelitis outbreak

In 1993 a large outbreak of paralytic poliomyelitis occurred in Sudan as a result of an accumulation of large numbers of susceptible children that was accelerated by faltering immunization services. The extent of the outbreak led to the rapid rehabilitation of Sudan's Expanded Programme on Immunization (EPI); the government began financing vaccine purchase, operational aspects of EPI were decentralized, vaccine delivery was changed from a mobile to a fixed-site strategy, a solar cold chain network was installed, inservice training was resuscitated, and social mobilization was enhanced. National immunization days (NIDs) for poliomyelitis eradication were conducted throughout the country, including the southern states during a cease fire in areas of conflict. Measles immunization coverage was increased by offering measles vaccine during the second round of NIDs and subsequently through routine immunization services. Supplemental tetanus toxoid immunization of women of child-bearing age began in three provinces at high risk for neonatal tetanus. From 1994 to 1996 reported immunization coverage increased and the incidence of all EPI target diseases fell. Trends in coverage, disease incidence, financing, and the implementation of WHO-recommended disease-control strategies suggest that more sustainable immunization services have been re-established in Sudan.

Surgical treatment of chronic fissure-in-ano: a prospective randomised study

A prospective randomised study compared anal dilatation (n = 37), posterior internal sphincterotomy (n = 21) and lateral sphincterotomy (n = 20) in the surgical treatment of chronic anal fissures in 78 consecutive patients. All the operations were performed under general anaesthesia using standard techniques. Anal dilatation relieved anal pain early (immediate relief in 57% of patients; the mean pain-days +/- SD of 3.2 +/- 5.4 days). Anal fissures after this operation healed in a mean time +/- SD of 20.3 +/- 12.5 days, coming in second place to lateral sphincterotomy. Anal dilatation was followed by insignificant wound infection but its main disadvantage was a high rate of post operative anal incontinence (in 24.3% of patients). Fissurectomy and posterior internal sphincterotomy was followed by the longest period of post operative anal pain (mean +/- SD of 32.4 +/- 10 days) as compared to the other two operations. It was the least favourable operation. Lateral sphincterotomy was followed by early relief of pain (immediate relief in 95% of patients). It was not followed by wound infection. It had the quickest healing time for the fissures (a mean +/- SD of 14.7 +/- 8.7 days). It was followed by anal incontinence in only one patient. In conclusion lateral sphincterotomy was the most favourable operation and it is perhaps the operation of choice to perform in patients with chronic anal fissures needing surgical treatment.

Muscle glutamine concentration and protein turnover in vivo in malnutrition and in endotoxemia

A comparison of the changes in the concentration of glutamine [Gln] in skeletal muscle in a variety of catabolic states with the attendant changes in rates of protein synthesis and degradation indicates a number of substantial correlations which provide insight into both the way in which [Gln] is regulated in muscle and possible regulatory influences of [Gln] on protein balance. There is a striking direct correlation between [Gln] and the rate of protein synthesis in the whole data set. Further examination of this relationship in protein deficiency shows that the changes in [Gln] correlate mainly with the reductions in ribosomal concentration (RNA/protein) and with the decrease in the rate of protein degradation. Because the fall in [Gln] in protein deficiency is also correlated with the decrease in free T3 concentrations, it is suggested that in this case the correlations of [Gln] with rates of protein turnover may be incidental, reflecting thyroidal influences on both protein turnover and glutamine transport. In contrast, in endotoxemia the changes in [Gln] were highly correlated with the ribosomal activity, kRNA, and in this case [Gln] was inversely correlated with the rate of protein degradation. Similar correlated changes occur in starvation and in response to glucocorticoids, and it is suggested that the reductions in [Gln] in endotoxemia could be causally related to the development of insulin resistance and the inhibition of the translational phase of protein synthesis which occurs in these circumstances. The mechanism of the reduction in [Gln] and any linked inhibition of protein synthesis is unknown, but it is shown to be independent of prostaglandin production.(ABSTRACT TRUNCATED AT 250 WORDS)

Prevalence of thalassaemias in ethnic Saudi Arabians

A study of the prevalence of alpha- and beta-thalassaemia and the sickle cell gene was carried out on 840 healthy adult male Saudi Arabians of different tribal origins. Complete blood count, haemoglobin electrophoresis and HbA2 estimation were carried out on all. Globin biosynthetic analysis was carried out on all 85 subjects with microcytic red cells and on 180 randomly selected subjects with normal red cell indices. The results showed prevalence of beta-thalassaemia of 3.0%, alpha/beta thalassaemia of 0.9%, alpha-thalassaemia of 43.3% and sickle trait of 5.7%. There were tribal variations in the prevalence of both alpha-thalassaemia and the sickle gene.

Benzylpenicillin-induced neutropenia

Neutropenia is a potentially serious complication of parenteral benzylpenicillin administration. It is thought to occur more frequently in patients receiving infusions of stored penicillin solutions. We report three cases of neutropenia produced after bolus injections of freshly prepared benzylpenicillin. Twenty-five other cases were reviewed from the literature and the data summarized.

Association of red cell glucose-6-phosphate dehydrogenase with haemoglobinopathies

A total of 1,112 randomly selected Saudi Arabs, of both sexes, living in Jeddah and the surrounding areas were screened for the phenotypic distribution of red cell glucose-6-phosphate dehydrogenase (G6PD) and 6-phosphogluconate dehydrogenase (6PGD). They were also investigated for haemoglobin and for thalassaemia. Phenotyping of the haemoglobins and the red cell enzymes was carried out by starch gel electrophoresis and the dye-decolouration screening test, while the investigation for thalassaemia was carried out by globin-chain biosynthesis, followed by column chromatography. The red cell Gd- alleles were significantly associated with the sickle-cell gene in both the males (chi 2(1): AS-28.80; SS-4.89) and females (chi 2(1): AS-10.99; SS-13.16). A similar association was also observed between G6PD deficiency and thalassaemias in males (chi 2(1): alpha-thalassaemia - 3.13; beta-thalassaemia - 11.06) and females (chi 2(1): alpha-thalassaemia - 6.63). However, no such association was detected between red cell 6PGD types and haemoglobin genes. The results suggest that the red cell G6PD deficiency, sickle-cell and thalassaemia genes might have evolved as a result of the same ecological factor, probably malaria.

A study of alpha thalassaemia families in western Saudi Arabia

In Saudi Arabia there are three alpha globin chain alleles alpha alpha/, -alpha/, alpha alpha T/-producing six genotypes. In this study of 12 alpha thalassaemia families, the phenotypic expression of these six genotypes is determined. Globin chain biosynthesis gave five non overlapping ratios of 0.9 +/- 0.05, 0.69 +/- 0.06, 0.5 +/- 0.03, 0.38 +/- 0.04 and 0.23 +/- 0.06. The five groups are shown to be normal, alpha thal 2 trait with genotype -alpha/ alpha alpha, mild alpha thal 1 with -alpha/-alpha and alpha alpha/alpha alpha T as genotypes, severe alpha thal 1 with genotype -alpha/alpha alpha T and Hb H disease. The red cell indices MCV, MCH and MCHC of the groups show a step ladder fall. Hb H inclusions in red cells are slight in the mild alpha thal 1 and rises to gross in Hb H disease. The latter disease also shares typical red blood cell appearances with severe alpha thal 1. Hb H disease is relatively mild with no gross bony changes.

Non-benign sickle cell anaemia in western Saudi Arabia

Seventy-one Saudi and Yemeni Arabs with sickle cell anaemia from western Saudi Arabia aged between 1 1/2 and 42 years were studied. The mean steady state haemoglobin concentration of 8.1 g/dl was lower than that of 10.7 g/dl reported previously for sickle cell anaemia in eastern Saudi Arabia. The patients were divided into an SSLF group with fetal haemoglobin (HbF) of 10.0% or below (44 patients) and an SSHF group having HbF above 10.0% (27 patients). No significant differences were found in the haemoglobin concentrations, haematological indices and incidences of bone changes of the two groups. SSLF patients were significantly more prone to infections (P less than 0.01), however. Also, there was an overall high incidence of hepatomegaly (69.0%) and splenomegaly (54.9%) and hepatomegaly was significantly more common in the SSLF group (P less than 0.02). Many of the patients, even with HbF levels over 10.0%, did not follow a benign course and suffered from severe anaemia, infections of the respiratory and urinary tracts, bone pains and infarcts, or bossing of the skull. Rarer complications included hepatic crisis, chest syndrome, retinal haemorrhage, epistaxis and hemiplegia. It is therefore apparent that Saudi Arabian sickle cell anaemia, even in patients with raised haemoglobin F levels, may be as clinically severe as in African patients.

Respiratory insufficiency in a severe autosomal recessive form of muscular dystrophy

In a large Sudanese kindred of 176 individuals, 15 children developed a brief respiratory illness in the course of a severe autosomal recessive muscular dystrophy (MD) and eight of them died. The type of MD in this kindred delineates a newly recognized entity which has been described from Sudan, Tunisia, Libya and Qatar . To assess the role of pulmonary insufficiency in the fatal outcome of this disease, pulmonary function was studied in six of the survivors. Values of lung volume were grossly abnormal and revealed a restrictive pattern. The degree of lung volume restriction varied from 50 to 76% of predicted total lung capacity (TLC) and 31-55% of predicted forced vital capacity (FVC). The high FEV1/FVC ratio (80-100%) in all patients excluded airway obstruction and the elevated ratio of residual volume (RV) to TLC (51-68%) reflected loss of inspiratory capacity. FVC showed no correlation with the degree of muscular disability and did not seem to be affected by the mild scoliosis seen in five children. These results are discussed in view of similar studies in a variety of neuromuscular disorders.

The inter- and intra-tribal distribution of red cell G6PD phenotypes in Sudan

1,416 males and 564 female subjects from four Negroid and five Arab tribes and a group of mixed tribes of the Sudan were investigated for the phenotypic distribution of red cell glucose-6-phosphate dehydrogenase by starch gel electrophoresis. In general, the tribes of Negroid origin had higher frequency of GdA compared to the tribes of Arab ancestry. However, the Nilotes showed a lower frequency of GdA allele and the Mahass tribe claiming an Arab origin had a higher frequency of GdA. The immigrant groups from the neighbouring African countries also had a higher frequency of GdA. GdB (Khartoum) was present in low frequencies in both the Arab and Negroid tribes. A great deal of intratribal variation in the phenotypic distribution of G6PD was observed in the Nuba and Gáali tribes from different localities.

Quantitative expression of G6PD activity of different phenotypes of G6PD and haemoglobin in a Sudanese population

597 unrelated persons, comprising of 401 males and 196 females, were investigated for glucose-6-phosphate dehydrogenase (G6PD) and haemoglobin phenotypes by starch gel electrophoresis. The levels of G6PD activity were assayed in order to study the quantitative expression of G6PD phenotypes and the influence of haemoglobin phenotypes on such expression. There was no significant different in the levels of G6PD activity in subjects with GdA or GdB. The mean levels of the enzyme activity were 165.5 +/- 33.7 and 164.8 +/- 33.8 IU/10(12) red cells in males and 159.3 +/- 27.8 and 163.4 +/- 33.5 IU/10(12) red cells in females, respectively. 14 subjects with Gd(+) "Khartoum" had significantly (p less than 0.001) higher level of enzyme activity with a mean above 200 IU/10(12) red cells. On the other hand, 20 subjects with GdB(int) (demonstrated by visual comparison of starch gel) showed significantly (p less than 0.001) lower levels of enzyme activity (107.6 +/- 23.5 IU/10(12) red cells). The heterozygotes GdAB also had slightly, but not significantly lower levels of enzyme activity than either GdA or GdB. The mean level of activity for GdAB was 140.1 +/- 29.4 IU/10(12) red cells.

Louse-borne relapsing fever in the Sudan. A historical review and a clinico-pathological study

A small outbreak of louse-borne relapsing fever in Khartoum (May-June 1974) provided material for a clinico-pathological study. The history of the disease in the Sudan is reviewed and the clinical and laboratory findings in 32 patients are presented. Fever, headache, jaundice, epistaxis and hepatosplenomegaly were the commonest clinical findings; thrombocytopenia was detected in 93% of cases. Although elevated levels of fibrin degradation products were found in most patients, disseminated intravascular coagulation could not be diagnosed. Hepatocellular derangement was found in 68% of cases, while 78% had high blood urea. In five autopsied bodies there was bronchopneumonia, interstitial edema with focal myocardial fibrosis, hepatic necrosis, splenic infarcts, increase in size and cellularity of the glomeruli and brain edema and congestion. Intracranial haemorrhage was found in three of the autopsied cases.

Haemoglobin and erythrocytic glucose-6-phosphate dehydrogenase variants among selected tribes in Western Saudi Arabia

638 subjects from six tribes in Western Saudi Arabia were tested for haemoglobin and G-6-PD variants. In the bedouins of Harbi and Sahafi tribes there was no sickling but a low frequency of both G-6-PD deficiency (1.7%) and the Gd A+ variant (1.7%) in Harbi. In Mograbi and Mowallad tribes who immigrated recently from Africa, the frequency of Hb S was 4.1 and 3.5%, G-6-PD deficiency 7.5 and 8.5% and the Gd A+ variant 15.1 and 8.5% respectively, which are higher than in bedouins. In Ghamid tribe 4% had Hb S and there was a low frequency of both G-6-PD deficiency (4.8%) and Gd A+ variant (1.6%). However a new B slow variant is common among the Ghamid (16.1%). Hb S frequency in Zahran tribe was 2.6%. Six of the 12 g-6-PD deficient (screening) were found to be positive on starch gel electrophoresis.

A study of some genetic characteristics of the population of the Sudan

300 random blood samples collected from residents of Khartoum, Sudan, were analysed for 5 blood group systems, 4 serum proteins, 9 red cell enzymes, abnormal haemoglobins and beta-thalassaemia. The results suggest varying degrees of admixture of the local tribes by migration from the surrounding regions. Two samples showed a probable new variant of glucose 6-phosphate dehydrogenase (? GdB Khartoum) with normal red cell activity. In spite of the presence of a high degree of consanguinity in the population, there was no significant deviation from Hardy-Weinberg equilibrium in any of the polymorphic systems.

Morphology of the spleen and lymph nodes in fatal visceral leishmaniasis

Histological appearances of the spleen and lymph nodes were analysed in twenty fatal cases of human visceral leishmaniasis from Sudan. Marked atrophy of the splenic white pulp was associated with necrosis and fibrosis of thymus-dependent area, accumulation of parasite-containing histiocytes and plasma cell hyperplasia. Depletion of small lymphocytes in the paracortical areas of the lymph nodes was accomplained by proliferation of plasma cells and histiocytes in the paracortex. Depletion of small lymphocytes in thymus-dependent regions of lymph nodes and spleen is viewed as arising from immune suppression associated with antigen overloading or other factors, which may impair those aspects of lymphocyte-macrophage cooperation that are presumably necessary to kill the invading parasites.

The pathology of schistosomiasis in Sudan

The pathology of schistosomiasis in an autopsy material consisting of medico-legal cases and unclaimed bodies in the Sudan is described. The limitations of this type of study are pointed out. S. mansoni-infection and S. haematobium-infection occurred with a frequency of 14.3 per cent and 4.5 per cent of autopsies respectively. There was a geographical difference in the severity of S. mansoni-infection in two endemic areas in the country; it was particularly severe in patients coming from Bor area in the Southern Sudan. In autopsies with S. mansomi-infection intestinal polyposis and cor pulmonale were rarely encountered. The distribution of eggs in the tissues, using digestion studies, and the relationship of tissue egg load to pathology are reported and discussed.

Louse-borne relapsing fever: I. A clinical and laboratory study of 363 cases in the Sudan

Louse-borne relapsing fever seems to have become endemic in the southern Sudan. The epidemic history of the disease in the Sudan is reviewed. We have studied 363 Sudanese patients involved in an outbreak of louse-borne relapsing fever in Khartoum (Sudan) between January and June 1974. 318 of the 363 patients were new immigrants from the soughern Sudan to Khartoum. The clinical presentation varied. The common clinical fetures of the disease were: fever (94%), headache (85%), hepatosplenomegaly (74%), body and joint pains (66%), abdominal pain and tenderness (63%), jaundice (46%) and epistaxis (40%). Thrombocytopenia was common. Biochemical evidence of hepatocellular and renal damage was present in most patients. The mortality rate was 5-5% with treatment. Post-mortem examination was performed on six cases. The organs predominantly involved were the liver, spleen, brain and lungs. The common causes of death were severe hepatic damage, lobar pneumonia, subarachnoid haemorrhage and splenic rupture.