May Measurement Month 2017: an analysis of blood pressure screening in Sudan-Northern Africa and Middle East

Elevated blood pressure (BP) is a growing burden worldwide, leading to over 10 million deaths each year. Sudan has the second highest prevalence of hypertension in North Africa. One in four people with a non-communicable disease has hypertension. May Measurement Month (MMM) is a global initiative, aimed at raising awareness of high BP to act as a temporary solution to the lack of screening programs worldwide. The MMM screening survey provided an opportunity to correlate between unique risk factors and BP levels among Sudanese population. Such an approach allows for directing efforts towards setting the appropriate preventive measures as opposed to disease treatment. An opportunistic cross-sectional survey of volunteers aged ≥18 was carried out in May 2017. Blood pressure measurement, the definition of hypertension and statistical analysis followed the standard MMM protocol. The study was conducted at 100 sites distributed in four states: Khartoum, Gezira, Blue Nile, and Kassala. Overall, a total of 44 413 participants were enrolled in the survey. After imputation, 7332 out of 44 118 participants with an available mean of the second and third readings had hypertension (16.6%). A total of 6956 (15.9%) participants were found to have hypertension of the 43 742 who were not receiving treatment. Among participants who were on treatment, 155 out of 374 (41.3%) had uncontrolled BP. After adjusting for age and sex, systolic and diastolic BP's were significantly higher in those receiving antihypertensive treatment, with a previous history of stroke and with elevated body mass index. Systolic BP was significantly higher in people with diabetes and with previous myocardial infarction. Smoking was associated with increased diastolic BP and decreased systolic BP. Alcohol intake as well as BP measurement on left vs. right arm had no association with BP reading. The MMM17 was the largest BP screening campaign ever held in the country. A considerable percentage of detected hypertensives were not on treatment with a significant proportion of uncontrolled hypertension among those on treatment. These results suggest that opportunistic screening can identify significant numbers with raised BP.

Differential expression of cytokine genes among sickle-cell-trait (HbAS) and normal (HbAA) children infected with Plasmodium falciparum

The human immune response to Plasmodium falciparum infection involves the release of cytokines that may contribute to the control of the parasites' replication. These cytokines are also involved in the pathogenesis of the malaria caused by the infection, leading to the appearance of symptoms of varying severity. In a cross-sectional study, the expression of the genes that code for pro-inflammatory cytokines (tumour necrosis factor, interferon-gamma, interleukin-6 and interleukin-12) and anti-inflammatory cytokines (interleukin-10 and interleukin-4) among 80 children infected with P. falciparum (from a malaria-endemic area of Sudan) and five healthy controls (from a non-endemic area) was explored. The infected children were either non-sicklers, with severe malaria (18 children), mild malaria (30) or no symptoms of malaria (18), or asymptomatic sicklers (14). Interleukin-12 was found to be weakly expressed by all the groups of children. In general, compared with the other groups, the asymptomatic non-sicklers had lower expression of all the cytokines studied. The asymptomatic sicklers had significantly lower expression of tumour necrosis factor than the non-sicklers with severe malaria, but these two groups showed similar expression of interferon-gamma, interleukin-4 and interleukin-6. Gene expression of the regulatory cytokine, interleukin-10, by the asymptomatic sicklers was significantly lower than that by the non-sicklers with severe malaria but higher than that recorded in the non-sicklers with mild malaria. Their regulation of cytokine release appears to protect sicklers from clinical malaria.

Correlation between fungi isolated from burn wounds and burn care units

A comparison was made prospectively between fungal isolates from patients and burn care units. Aspergillus niger was the most frequent isolate in both patients and burn care units whereas Ulocladium was the commonest isolate in the control group. Aspergillus terreus, Penicillium and Zygomycetes, which were recovered from burned patients, were also found more frequently in the burn care units than in the control group (other areas in the hospital). These findings indicate a potential risk of fungal infection which can be acquired from the immediate surroundings of patients in burn care units. Periodical burn ward decontamination is therefore recommended.

Isolation of dermatophytes and other keratinophilic fungi from surface sediments of the Shatt Al-Arab River and its creeks at Basrah, Iraq

Twenty-five sediment samples were taken from randomly selected sites in the Shatt Al-Arab River and its creeks and analysed for dermatophytes and related keratinophilic fungi. The results revealed that out of 25 samples only 13 (52%) yielded dermatophytes and related keratinophilic fungi. A total of nine species in four genera were isolated. The most frequent genera isolated in this study were Chrysosporium and its teleomorph Aphanoascus. The species most frequently found were Aphanoascus fulvescens, A. durus, Chrysosporium crassitunicatum, Chr. keratinophilum and Chr. tropicum (each n = 3). Microsporum was represented by two species, namely M. fulvum and M. gypseum. Trichophyton was represented by one species, T. verrucosum. The occurrence of these fungi illustrates that sediments may act as a reservoir for potentially pathogenic fungi for human and animals.

Cord and maternal glycosylated haemoglobin levels: a study in Sudanese pregnant diabetic women

Blood glucose and glycosylated haemoglobin levels measured at delivery in 27 normal and 19 diabetic women were compared with those of the corresponding fetuses and their birthweights. In both groups, neonatal blood glucose levels were significantly higher (p much less than 0.001) than the maternal levels despite significantly lower (p much less than 0.001) glycosylated haemoglobin values in the neonates. In the control group, there was a significant correlation of maternal glycosylated haemoglobin with both cord glycosylated haemoglobin and birthweight ratio (p less than 0.01). The same was not obtained in the diabetic group, suggesting a dissociation in glucose homeostasis between the diabetic pregnant mother and her fetus.

Glycated haemoglobin and other biochemical parameters in Sudanese diabetics

Fasting levels of glycated haemoglobin, cholesterol and triglycerides were studied in 44 patients with non-insulin-dependent diabetes mellitus (NIDDM), 31 patients with insulin-dependent diabetes mellitus (IDDM) and 28 healthy Sudanese individuals. Results confirmed previous observations showing correlation of glycated haemoglobin with fasting blood glucose in NIDDM (r = 0.634; P less than 0.001), and with cholesterol in IDDM (r = 0.355; P less than 0.05). No correlation of glycated haemoglobin with triglycerides was observed in either group of diabetics. A negative correlation was demonstrated between glycated haemoglobin and the duration of diabetes (r = -0.552; P less than 0.01) in IDDM. It seemed that control improved in these patients as their diabetes progressed, probably through self-education.

Glycosylated hemoglobin levels in Sudanese sickle cell anemia patients

Glycosylated hemoglobin was measured, by a colorimetric method, in 49 patients with sickle cell anemia attending Khartoum Teaching Hospital. The level obtained (4.9%, SD 1.3) was significantly lower than the control value (5.6%, SD 0.2; p less than 0.0025). Expressed as percentage of the control value, the glycosylated hemoglobin level in these patients was 81%. This falls midway between the 90% reported in a benign form of sickle cell anemia in Saudi Arabia and the 58% reported in a severe form in an American Black group, which gives support to the observed heterogeneity of sickle cell anemia. Alternatively, glycosylated hemoglobin level in 27 subjects with sickle cell trait (5.6%, SD 0.2) was identical to that of the controls. The state of hemolysis in the sickle cell anemia patients, as indicated by bilirubin levels, did not correlate with the glycosylated hemoglobin values. Although glycosylated hemoglobin measurement is affected by red cell survival, it does not reflect the state of ongoing hemolysis.