Plasma fatty acid abnormality in Sudanese drug-resistant epileptic patients.

Intervention studies have demonstrated that the n-3 fatty acids, docosahexaenoic and eicosapentaenoic acids, ameliorate seizure frequency in patients with drug-resistant epilepsy (DRE). There is a scarcity of fatty acid status of patients with epilepsy. We have investigated blood fatty acids of patients with DRE and assessed the indices of elongase and desaturase activities. DRE patients (n = 83) and healthy controls (n = 31) were recruited form Soba University Hospital Neurology Referral Clinic and Ibn-Auf paediatric Teaching Hospital Neurology Referral Clinic, Khartoum, Sudan. Fatty acid composition of plasma total lipids, phosphatidylcholine and neutral lipids were analysed. The patients compared with their healthy counterparts had higher levels of C14:0, C16:0, C18:0, C20:0, C22:0 (p<0.05) and C24:0, and total saturates (p<0.05). Similarly, the proportions of C16:1n-7, 18:1n-7, C18:1n-9, C20:1n-9, C24:1n-9 and total monounsaturated fatty acids; p<0.005) were higher in the drug-resistant patients. Conversely, the patients had lower levels of n-6 (C18:2n-6, C18:3n-6, C20:4n-6, n-6 metabolites and total n-6; p<0.005 and C20:2n-6 and C20:3n-6; p<0.05) and n-3 (C20:5n-3, C22:5n-3, C22:6n-3, ∑EPA and DHA, n-3 metabolites and total n-3; p<0.05) fatty acids. Indices of elongase and desaturase activities - The plasma total lipid ratios of C16:0/C14:0 (p = 0.001), C18:0/C16:0 (p = 0.001), C16:1n-7/C16:0 (p = 0.027), C18:1n-9/C18:0 (p = 0.022) and C22:4n-6/C20:4n-6 (p = 0.008) were higher and C18:3n-6/C18:2n-6 (p = 0.05), C20:4n-6/C20:3n-6 (p = 0.032) and C20:4n-6/C18:2n-6 (p>0.05) lower in the patients with drug-resistant epilepsy than in the healthy control subjects. DRE is associated with blood fatty acid perturbation and abnormal activities of long-chain fatty acid elongase (ELOVL-6), stearoyl-coenzyme A desaturase-1 (SCD-1), delta 6-fatty acid desaturase (D6D) and delta 5 fatty acid desaturase (D5D). N-3 fatty acids are known to ameliorate seizures frequency and dampen neuronal hyperexcitability. Therefore, patients with DRE should be regularly monitored and, if necessary, supplemented with n-3 fatty acids.

Milk of northern Sudanese mothers whose traditional diet is high in carbohydrate contains low docosahexaenoic acid.

AIM: The suckling neonates and infants are reliant primarily on the mother for optimal supply of docosahexaenoic acid (DHA). The richest source of preformed DHA is cold-water oily fish. Although there is paucity of data, existing evidence suggest women with restricted access to these foods have low or marginal DHA status. The aim of the study was to investigate milk fatty acids of Sudanese mothers whose traditional diet is high in carbohydrate and low in fat and gain some insight into the provision of DHA to the suckling offspring. METHODS: Colostrum (n =26), transitional (n=20) and mature (n=14) milk samples were obtained from Northern Sudanese women (NSW) recruited prior to delivery from Ibrahim Malik and Khartoum Teaching Hospitals. RESULTS: The arachidonic acid content of the colostrum (0.87±0.28%) and transitional (0.89± 0.29%) and mature (0.48±0.12%) milk of the NSW were broadly comparable with published international values. In contrast, the DHA level (colostrum 0.13±0.07%, transitional 0.13±0.06% and mature milk 0.06±0.05%) was very low. CONCLUSION: The study reveals breast milk of NSW, whose traditional diet is almost devoid of fish and fish products, is unlikely to provide sufficient DHA to support optimal postnatal neuro-visual development.

Erythrocyte omega-3 and omega-6 fatty acids profile in Sudanese women with pre-eclampsia.

A case-control study was conducted in Khartoum hospital, Sudan to compare omega-3 and omega-6 fatty acids profile in three phospholipid fractions (phosphatidylethanolamine, phosphatidylcholine and sphingomyelin) using gas chromatography in erythrocytes from 65 pre-eclamptic women and well-matched 60 healthy control pregnant women, both in the third trimester of pregnancy. While levels of arachidonic acid (omega-6 fatty acid) was significantly higher in women with pre-eclampsia in the sphingomyelin fraction only, the levels of eicosapentaenoic and docosahexaenoic acid (omega-3 fatty acid) in the three phospholipids fractions were significantly higher in women with pre-eclampsia than in the control group. Both omega-3 and omega-6 fatty acids profiles were not significantly different between patients with mild (diastolic blood pressure (DBP) <110 mmHg) and severe (DBP > or = 110 mmHg) pre-eclampsia.

A comparison of the efficacy of artesunate plus sulfadoxine-pyrimethamine with that of sulfadoxine-pyrimethamine alone, in the treatment of uncomplicated, Plasmodium falciparum malaria in eastern Sudan.

In an open, randomized, clinical trial, conducted in New Halfa, eastern Sudan, in September-October 2004, the efficacies and adverse effects of artesunate plus sulfadoxine-pyrimethamine (SP), in the treatment of uncomplicated, Plasmodium falciparum malaria, were compared with those of SP alone. Patients were randomized to receive either artesunate (4 mg/kg. day) on days 0-2 plus SP (25 mg sulfadoxine/kg) on day 0 or the SP alone, and then followed-up for 28 days. Sixty patients completed follow-up. Compared with the 30 given artesunate plus SP (ASP), the 30 given SP alone were much more likely to be febrile (30% v. 3.3%; P=0.006) and parasitaemic (50% v. 6.7%; P<00001) on day 1. By day 3, 16.7% of the patients given SP alone were still febrile and 6.7% of them were still parasitaemic, although all the patients given ASP were then afebrile (P=0.02) and aparasitaemic (P=0.1). Five (16.7%) of the patients treated with SP alone but none of those given ASP appeared to be treatment failures (P<0.05). Parasite genotyping revealed that four of the five apparent treatment failures were true recrudescences but the other represented a re-infection detected on day 28. The true frequencies of cure by day 28 were therefore 100% for ASP and 86.7% for SP alone (P=0.02). Adverse effects of treatment (nausea, itching and giddiness) were observed with similar frequencies in the two treatment arms (10.0% of the patients given ASP v. 13.3% of the patients given SP alone; P>0.05). The frequencies of gametocytaemia during follow-up were, however, much lower in the ASP arm than in the SP-only (0.0% v. 23.3%; P=0.005).Thus, although the problems posed by adverse effects were similar in the two treatment arms, ASP appeared markedly better, in terms of fever- and parasite-clearance times and the prevalence of post-treatment gametocytaemia, than SP alone.

Efficacies of mefloquine alone and of artesunate followed by mefloquine, for the treatment of uncomplicated, Plasmodium falciparum malaria in eastern Sudan.

In late 2003, the efficacies of mefloquine monotherapy and of an artesunate-mefloquine combination, for the oral treatment of uncomplicated, Plasmodium falciparum malaria, were investigated and compared in New Halfa, in eastern Sudan. Of the patients who completed the 28 days of follow-up, 40 were treated only with single-dose mefloquine (at a dose of 25 mg/kg), and 38 with artesunate (at 4 mg/kg. day) for 3 days followed by single-dose mefloquine (at 15 mg/kg), given on the third day. Compared with those given the combination, the patients given mefloquine alone were more likely to suffer nausea, vomiting and dizziness (25.0% v. 2.6%; P=0.005) and to be found gametocytaemic (12.5% v. 0%; P=0.02) after treatment, and more likely to be found febrile (i.e. with a temperature >37.5 degrees C) on day 2 (25.0% v. 2.6%; P=0.005), although no patients were found febrile on day 3. Six of the patients--three (7.5%) of those given mefloquine only and three (7.9%) of those given the combination (P>0.05)--appeared to be treatment failures. Parasite genotyping indicated, however, that, although five of these six patients had true recrudescences, one (who had been treated with the combination) had been re-infected during the follow-up. The true frequencies of cure were therefore 92.5% after mefloquine alone and 94.7% after the combination (P>0.05). Thus, although the treatments appeared equally effective in clearing parasitaemias, the combination was better at clearing gametocytaemias and was less likely to cause adverse side-effects. It remains unclear why mefloquine given alone was almost 10-fold more likely to trigger adverse effects than treatment with a combination that contained the same drug. This may be a reflection of the different mefloquine doses and, for the patients given the combination, of the use of artesunate before the mefloquine treatment.

Efficacy of sulfadoxin pyrimethamine for uncomplicated Plasmodium falciparum malaria in a small sample of Sudanese children.

A prospective clinical trial was carried out to determine in vivo efficacy of sulfadoxine/pyrimethamine for the treatment of uncomplicated Plasmodium falciparum malaria in children in New Halfa. Forty patients were enrolled; 31 completed the 28-day follow-up. Six (19.4%) patients showed recurrence of parasitaemia during follow-up, while the rest (80.6%) cleared the parasites and responded fully to treatment. All the failures were late treatment failures. Parasite genotyping showed that 1 (16.7%) of the 6 cases of late parasitaemia was due to reinfection while the rest (83.4%) were due to true recrudescence. During the follow-up period 22.6% of patients showed gametocytaemia. The high level of treatment failure as well as gametocytaemia necessitates the introduction of artesunate in this combination therapy.

Comparison of intramuscular artemether and intravenous quinine in the treatment of Sudanese children with severe falciparum malaria.

OBJECTIVES: To compare the efficacy of intramuscular artemether and intravenous quinine in the treatment of severe falciparum malaria. DESIGN: An open randomized controlled clinical trial. SETTING: New Halfa Teaching Hospital, Eastern Sudan, in the period November 2001-January 2002. SUBJECTS: Forty one male and female children; 21 on artemether and 20 on quinine. MAIN OUTCOME MEASURES: Fever clearance time, parasite clearance time, coma resolution time and side effects of the two drugs. RESULTS: The two groups (artemether and quinine) were well matched in the admission variable. The mean +/- (SD) fever clearance time was 30.5 +/- (20.9) hours in the artemether group, while it was 18.0 +/- (8.1) hours in the quinine group; the difference was highly significant (P=0.02). The mean parasite clearance time was shorter in the artemether group than in the quinine group, but it was not statistically significant, (16.0 vs. 22.4 hours; p>0.05). In comatose patients (three in the artemether group, three in the quinine group) the time of recovery from coma was significantly shorter in artemether group than in quinine group (12.5 vs. 20.16 hours; P<0.05). Recrudescence of P. falciparum (confirmed by polymerase chain reaction) occurred in one out of fifteen patients (6.6%) in the quinine group seen on day 28, which was successfully treated by sulphadoxine-pyrimethamine. In the quinine group, one patient died and one patient developed hypoglycaemia. CONCLUSION: Artemether caused faster parasite clearance than quinine, but quinine lowered the temperature in shorter time than artemether. The results obtained show that artemether can be used as safe and effective alternative drug for the treatment of severe falciparum malaria in the wake of the growing resistance to quinine in Sudan.