Periconceptional folic acid usage and its associated factors in eastern Sudan: A cross-sectional study.

BACKGROUND: Several countries poorly adhere to the World Health Organization's recommendation of folic acid supplementation in the periconceptional period, especially in limited-resource settings. OBJECTIVE: The objective of this study was to investigate the prevalence of and the factors associated with folic acid usage in the periconceptional period among pregnant women at Gadarif Maternity Hospital in eastern Sudan. STUDY DESIGN: This is a cross-sectional study. METHODS: This study was conducted in eastern Sudan from April to September 2022. A total of 720 pregnant women in their first trimester were enrolled. The sociodemographic characteristics and clinical and obstetrical data of pregnant women in their first trimester were assessed using a face-to-face questionnaire. In addition, multivariate regression analysis was performed. RESULTS: In this study, the median (interquartile range) of the age and gravidity of the enrolled women was 26.3 (24.14-29.52) years and 2 (1-4), respectively. Of these 720 women, 423 (58.8%) used folic acid during the periconceptional period, while 27 (3.7%) women used folic acid in the preconceptional period. None of the investigated factors (age, residence, education, employment, body mass index, or gravidity) were associated with periconceptional use of folic acid. CONCLUSION: The study revealed a low prevalence of folic acid usage in preconceptional period among pregnant women in eastern Sudan. Additional efforts are needed to promote folic acid usage in the preconceptional period as well as in the first trimester.

Green synthesis of CuO nanoparticles using Hibiscus sabdariffa L. extract to treat wastewater in Soba Sewage Treatment Plant, Sudan.

Looking for a cost-effective and ecofriendly method for wastewater treatment is a global challenge. Therefore, this study investigated the removal of wastewater pollutants using copper oxide nanoparticles (CuONPs). CuONPs synthesized by a green solution combustion synthesis (SCS) and characterized by ultraviolet-visible spectroscopy (UV-Vis), Fourier transform infrared (FT-IR), powder X-ray diffraction analysis (PXRD), and scanning electron microscopy (SEM) techniques. PXRD showed nanoparticle sizes ranging from 10 to 20 polycrystalline patterns indexed with two peaks corresponding to (111) and (113) reflections of the face-centered cubic CuO crystal. The energy-dispersive spectroscopy analysis obtained in conjunction with SEM analysis proved the presence of Cu and O atoms at 86.3 and 13.6%, respectively, confirming the reduction and capping of Cu with Hibiscus sabdariffa extract's phytochemicals. The CuONPs proved to be a promising decontaminant for wastewater found to reduce biochemical oxygen demand (BOD) and chemical oxygen demand (COD) by 56%, and very efficient in reducing both the total dissolved matter (TDS) and conductivity (σ) by 99%. The CuONPs removed simultaneously chromium, copper, and chloride with respective percentages of 26, 78.8, and 78.2%. Green synthesis of nanoparticles is a simple, rapid, cost-effective, and ecofriendly method that successfully removed contaminants from wastewater.

Quasi-experimental quantitative study of training programme for nurses and midwives regarding provision of neonatal resuscitation in selected governmental hospital, (Sudan), 2018.

AIMS: To measure the effectiveness of educational programmes for nurses regarding knowledge and practice of advanced resuscitation for newborn infants. DESIGN: This is a quasi-experimental study in (Sudan, White Nile state), to evaluate the effectiveness of designed guidelines regarding advanced neonatal resuscitation for midwives during the period November 2020-January 2021. METHODS: Data were collected using two tools: semi-structured questionnaire and checklist. The number of the respondents to the questionnaire is 75 nurses. Statistical analyses were conducted using SPSS (version 22). Data were expressed as percentages. The results show that the level of knowledge is improved significantly after training programme interventions, with safe practice reaching (98.70%) compared with a pre-test percentage of (11.5%). This indicates a steep rise in safe practice after the simulation section, a sharp decrease in unsafe practice after the practical section, followed by subsequent decrease in neonatal mortality rate. This paper has been guided by (STROBE, cohort study) checklist. RESULTS: The study concluded that the majority of nurses and midwives have some knowledge regarding advanced neonatal resuscitation but still, there is a practice gap because of a shortage of facilities and lack of training, However, training programmes do add value on knowledge and practice for nurses and eventually decrease neonatal mortality rate.

Africa-wide meta-analysis on the prevalence and distribution of human cystic echinococcosis and canine Echinococcus granulosus infections.

BACKGROUND: Echinococcosis is a neglected zoonosis of increasing public health concern worldwide. According to the World Health Organization, 19,300 lives and 871,000 disability-adjusted life-years are lost globally each year because of cystic echinococcosis. Annual costs associated with cystic echinococcosis were estimated at US$ 3 billion because of treatment of cases and losses in the livestock industry. METHODS: We performed the random-effects model of meta-analysis using 51-year (1970-2021) data available from AJOL, Google Scholar, PubMed, Science Direct, Scopus and Web of Science. We also applied the Joanna Briggs Institute critical appraisal instrument for studies reporting prevalence data, the Cochran's Q-test, Egger's regression test and the single study deletion technique to respectively examine within-study bias, heterogeneity, across-study bias and sensitivity. RESULTS: Thirty-nine eligible studies on human cystic echinococcosis (HCE) from 13 countries across the five African sub-regions showed an overall prevalence of 1.7% (95% CI 1.1, 2.6) with a statistically significant (P < 0.001) sub-group range of 0.0% (95% CI 0.0, 14.1) to 11.0% (95% CI 7.6, 15.7). Highest prevalences were observed in Eastern Africa (2.7%; 95% CI 1.4, 5.4) by sub-region and Sudan (49.6%; 95% 41.2, 58.1) by country. Another set of 42 studies on Echinococcus granulosus infections (EGI) in dogs from 14 countries across the five African sub-regions revealed an overall prevalence of 16.9% (95% CI 12.7, 22.3) with a significant (P < 0.001) variation of 0.4 (95% CI 0.0, 5.9) to 35.8% (95% CI 25.4, 47.8) across sub-groups. Highest prevalences of E. granulosus were observed in North Africa (25.6%; 95% CI 20.4, 31.6) by sub-region and Libya (9.2%; 95% CI 5.7, 13.9) by country. CONCLUSION: Human cystic echinococcosis and EGI are respectively prevalent among Africans and African dogs. We recommend a holistic control approach that targets humans, livestock, dogs and the environment, which all play roles in disease transmission. This approach should involve strategic use of anthelminthics in animals, standardized veterinary meat inspection in abattoirs, control of stray dogs to reduce environmental contamination and proper environmental sanitation. Mass screening of humans in hyper-endemic regions will also encourage early detection and treatment.

Genotoxic effects of Dukhan: A smoke bath from the wood of Acacia seyal used traditionally by Sudanese women.

ETHNOBOTANICAL RELEVANCE: Smoke from the wood of Acacia seyal Delile has been used by Sudanese women for making a smoke bath locally called Dukhan. The ritual is performed to relieve rheumatic pain, smooth skin, heal wounds and achieve general body relaxation. AIM OF THE STUDY: The present study was designed to investigate the in vitro anti-inflammatory effect of the smoke condensate using cyclooxygenase -1 (COX-1) and -2 (COX-2) as well as its potential genotoxic effects using the bacterial-based Ames test and the mammalian cells-based micronucleus/cytome and comet assays. MATERIAL AND METHODS: The smoke was prepared in a similar way to that commonly used traditionally by Sudanese women then condensed using a funnel. Cyclooxygenase assay was used to evaluate its in vitro anti-inflammatory activity. The neutral red uptake assay was conducted to determine the range of concentrations in the mammalian cells-based assays. The Ames, cytome and comet assays were used to assess its potential adverse (long-term) effects. RESULTS: The smoke condensate did not inhibit the cyclooxygenases at the highest concentration tested. All smoke condensate concentrations tested in the Salmonella/microsome assay induced mutation in both TA98 and TA100 in a dose dependent manner. A significant increase in the frequency of micronucleated cells, nucleoplasmic bridges and nuclear buds was observed in the cytome assay as well as in the % DNA damage in the comet assay. CONCLUSIONS: The findings indicated a dose dependent genotoxic potential of the smoke condensate in the bacterial and human C3A cells and may pose a health risk to women since the smoke bath is frequently practised. The study highlighted the need for further rigorous assessment of the risks associated with the smoke bath practice.

Antimicrobial Activity of Some Sudanese Medicinal Plants Against its Pollutant Isolated Bacteria.

<b>Background and Objective:</b> Medicinal plants have been known to cure many diseases due to the presence of active bio constituents, the goal of this study to detect and evaluate the effectiveness of antimicrobial activity of some Sudanese medicinal plants. <b>Materials and Methods:</b> Methanolic extracts of the following types of local medicinal plants <i>Artemisia herba-alba</i>,<i> Cyperus rotundus</i>,<i> Cymbopogon schoenanthus </i>sb<i> </i>sp.<i> Proximus</i>,<i> Trigonella foenum-graecum</i>,<i> Nigella sativa</i>,<i> Hyphaene thebaica</i>,<i> Nauclea latifolia</i> and <i>Ziziphus spina-christi</i> were tested against eight types of bacteria that were isolated from the same plants as their pollutants. Cup-plate method was used and then the inhibition zone of each plant was measured and compared with the inhibitory zone of some antibiotics used for the same isolates. <b>Results:</b> Methanol extracts of some plant species showed antibacterial activity against most of the studied bacterial species. <i>Cymbopogon schoenanthus </i>ssp.<i> Proximus </i>showed antibacterial activity against most isolated bacterial species in comparison with commercial antibiotics used. <b>Conclusion:</b> According to the findings of this research, severalmedicinal plants have efficacy and effect on certain types of bacteria and are superior or comparable to certain types of antibiotics. When compared to the other medicinal plants used in this study<i>, Cymbopogon schoenanthus </i>sbsp. <i>proximus </i>has the highest activity on most types of Gram-positive and Gram-negative bacteria, as well as the superiority of some antibiotics.

Determinants of Household Energy Choice for Cooking in Northern Sudan: A Multinomial Logit Estimation.

Traditional biomass utilization is connected with negative environmental and human health impacts. However, its transition to cleaner cooking fuels is still low where the household's fuels preferences play an important role in the process. To examine the factors that influence the household's cooking fuel choice in Northern Sudan, a multinomial logit model (MNL) was used to analyze data collected from Kassala state in two selected districts, New Halfa and Nahr Atabara. The findings show that the most utilized fuels are still firewood and charcoal, which are used by 63.4% of all respondents. The results also revealed that socioeconomic factors have an impact on household fuel choice, where one additional unit of credit access may boost the possibility of choosing LPG by 22.7%. Furthermore, one additional level of education would reduce 5.4% of charcoal users while simultaneously raising 10% of current liquefied petroleum gas (LPG) users. Therefore, the study suggests initiating mobilization and training programs to raise awareness and encourage the usage of cleaner fuels. This study will provide policymakers with information on household cooking energy utilization while designing and developing policies related to energy. It will also contribute to the expanding body of literature concerning the transition to clean cooking fuels from traditional biomass.

Hydrolyzable tannins (ellagitannins), flavonoids, pentacyclic triterpenes and their glycosides in antimycobacterial extracts of the ethnopharmacologically selected Sudanese medicinal plant Combretum hartmannianum Schweinf.

In Sudanese traditional medicine, decoctions, macerations, and tonics of the stem and root of Combretum hartmannianum are used for the treatment of persistent cough, a symptom that could be related to tuberculosis (TB). To verify these traditional uses, extracts from the stem wood, stem bark, and roots of C. hartmannianum were screened for their growth inhibitory effects against Mycobacterium smegmatis ATCC 14468. Methanol Soxhlet and ethyl acetate extracts of the root gave the strongest effects (MIC 312.5 and 625 µg/ml, respectively). HPLC-UV/DAD and UHPLC/QTOF-MS analysis of the ethyl acetate extract of the root led to the detection of 54 compounds, of which most were polyphenols and many characterized for the first time in C. hartmannianum. Among the major compounds were terflavin B and its two isomers, castalagin, corilagin, tellimagrandin I and its derivative, (S)-flavogallonic acid dilactone, punicalagin, and methyl-ellagic acid xylopyranoside. In addition, di-, tri- and tetra-galloyl glucose, combregenin, terminolic acid, cordifoliside D, luteolin, and quercetin-3-O-galactoside-7-O-rhamnoside-(2→1)-O-ß-D-arabinopyranoside were characterized. Luteolin gave better growth inhibition against M. smegmatis (MIC 250 µg/ml) than corilagin, ellagic acid, and gallic acid (MIC 500-1000 µg/ml). Our study justifies the use of C. hartmannianum in Sudanese folk medicine against prolonged cough that could be related to TB infection. This study demonstrates that C. hartmannianum should be explored further for new anti-TB drug scaffolds and antibiotic adjuvants.

Assessment of Micronutrient Situation among Reproductive-Age Women (15-49) and Under-Five Children in Sudan.

BACKGROUND: Micronutrient malnutrition is a form of undernutrition that causes diseases, and this is mainly due to insufficient intake of nutrients in daily foods. The status of micronutrients for people in Sudan remains scarce, and information is limited. The aim of this study is to highlight the status of micronutrients among women of reproductive age (15-49 years of age) and their children in Sudan. METHODS: This manuscript is a quantitative descriptive study, based on the data from Sudan Micronutrient Survey (SMS); it is part of the second round of the Simple Spatial Survey Method (S3M II) in Sudan (a total of 93,882 households). RESULTS: The level of consumption of vitamin A-rich foods was found to be moderate at 67.36% for reproductive-age women and low at 23.44% for under-five children. Similarly, consumption rate of vitamin B-rich foods among reproductive-age women was 62.13%, and low for children at 11.02%. The consumption of iron-, calcium-, and zinc-rich foods was moderate among women (66.75%, 47.69%, 69.72%, respectively) and very low in children (12.28%, 17.62%, 14.99%, respectively). The iron deficiency prevalence was 47% in non-pregnant women, 58% in pregnant women, and 54% in children. The prevalence of anemia was 30% in non-pregnant women, 37% in pregnant women, and 48% in children. Generally, urinary iodine concentration was inadequate in lactating and non-pregnant women as well as in pregnant women. Most indicators of micronutrients in Sudan for children and women of reproductive age were highly significant. Sudan needs more efforts to create an enabling environment through legislation, policies, and strategies to strengthen the nutrition-sensitive and specific interventions and improving status of micronutrients among women and children, focusing on food fortification, food supplements, and counseling on micronutrients intake for mothers during antenatal and postnatal services as well as raising community awareness.

Therapeutic outcomes evaluation of adjuvant hyperbaric oxygen therapy for non-healing diabetic foot ulcers among sudanese patients.

BACKGROUND AND AIMS: Diabetic foot ulcers (DFUs) are common complications of diabetes that frequently lead to amputation and disability. Despite some promising results in using hyperbaric oxygen therapy (HBOT) for DFUs treatment, its efficacy is still debatable. The aim of this study was to evaluate the therapeutic outcomes of adjuvant HBOT in non-healing DFUs treatment. METHODS: A descriptive, retrospective, hospital-based study was conducted at Al-Mo'alem Medical City-Khartoum, Sudan from August to December 2018. Medical records of Type 2 diabetic patients, treated with HBOT plus standard wound care for DFUs, were included in the study. Data were analyzed by simple descriptive statistics and logistic regression. P ≤ 0.05 was considered statistically significant. RESULTS: The study results showed that 51.7% of patients had Wagner grade-3 ulcers and 28.3% had complete loss of protective sensation. Almost 61% of patients achieved complete ulcer healing while 16.7% underwent amputation. Twenty percent of patients treated with HBOT experienced ear barotraumas as adverse effects. Protective sensation (OR = 6.00, 95% CI = 1.79-20.16, p = 0.004) and more sessions of HBOT (OR = 17.35, 95% CI = 4.51-66.73, p = 0.000) were positive predictors of complete ulcer healing. Loss of protective sensation (OR = 0.17, 95% CI = 0.05-0.63, p = 0.007) was an indicator of amputation. CONCLUSIONS: Treatment with adjuvant HBOT enhanced ulcer healing and reduced amputation rate in patients with non-healing DFUs. HBOT could be considered a relatively safe intervention.

The effectiveness of nifedipine/indomethacin combination therapy and nifedipine monotherapy for postponing preterm birth (25-34 weeks of gestation) in Sudanese women: a randomized clinical trial study protocol.

BACKGROUND: Preterm birth is the most common cause of neonatal morbidity and mortality. Tocolytics are considered a standard treatment for women with threatened preterm delivery to allow time for maternal steroid administration and transfer to referral centers with neonatal intensive care units. However, there is controversy about the best tocolytic therapy to be considered as the first choice. The aim of this study is to compare the tocolytic effectiveness and tolerability of combination therapy with nifedipine and indomethacin versus nifedipine monotherapy among Sudanese women with preterm labor (PTL) as well as to compare the possible neonatal outcomes associated with each drug. METHODS/DESIGN: This is a randomized controlled clinical trial to be conducted in the Medani Maternity Hospital, Sudan. Women aged 18-40 years that are diagnosed with preterm labor and have a gestational age between 25 and 34 weeks will be eligible to participate in this trial. The diagnosis of threatened PTL is defined as persistent uterine contractions "(four contractions every 20 min or eight contractions every 60 min)" with cervical changes "(cervical effacement ≤80% or cervical dilatation >two cm)". Patients will be eligible regardless of the presentation of the fetus. It will be randomly decided whether participants receive nifedipine/indomethacin combination therapy or nifedipine monotherapy. The primary outcome is the number of women who do not deliver and do not need alternative tocolytic drug (terbutaline). The secondary outcome is an estimated association with neonatal morbidity and mortality. The sample size will be 117 subjects in each arm of the study, according to a type I error of 0.05 and a study power of 80%. DISCUSSION: We expect higher effectiveness of the combination indomethacin/nifedipine tocolytic therapy compared with nifedipine monotherapy. We plan to suggest this combination therapy as the best option for postponing PTL. TRIAL REGISTRATION: Clinical trial registration: PACTR202004681537890 , date of registration: March 8, 2020.

Radiation Oncology in the Land of the Pyramids: How Sudan Continues to Push the Frontiers of Cancer Care in Eastern Africa.

When faced with illness, Sudanese patients have traditionally relied primarily on folklore healers. In the recent past, Sudan increased its health care spending and placed ever-greater importance on medical education. Although traditional remedies still play an important role, Sudanese patients increasingly consult conventional medicine. Not only infectious diseases but also a rising burden of noncommunicable conditions, including cancer, represent major health care challenges. Therefore, Sudan will need to make the best out of the limited resources available and further increase investment in health care to confront these trends successfully. Sudan was one of the first African countries to recognize the importance of radiation oncology in multidisciplinary cancer care and began investing in it in the 1960s. Today, there are 4 comprehensive cancer centers in the country, which offer radiation therapy and employ 10 radiation therapy machines for a population of about 45 million people. This proportion is an indication that Sudan still has an underfunded health care system with a lack of infrastructure and human resources. The present manuscript intends to provide a well-rounded overview of radiation oncology in Sudan today.

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.

Correspondence - A Proposal to Establish Acute Medicine Units in Sudan's Hospitals.

This proposal is the first to suggest the establishment of the new specialty of acute medicine in Sudan. Introducing this specialty will ensure that patients receive the best care in a timely fashion from a well-trained workforce and will aid in delivering optimum care to critically ill medical patients and securing faster, safer, and more effective services. It will provide a comprehensive training program for senior and junior doctors and attract employees by creating more jobs for different specialties (nurses, pharmacists, radiologists, etc.). Further, introducing acute care will help reduce the number of patients who require long-term admission, provide more accessible, holistic, emergency medical care for all socio-economic classes, and empower key stakeholders.

Comparative Physicochemical Evaluation of Starch Extracted from Pearl millet seeds grown in Sudan as a Pharmaceutical Excipient against Maize and Potato Starch, using Paracetamol as a model drug.

OBJECTIVES: The aim of the current study was to compare the physicochemical and disintegrant properties of pearl millet starch with other starches using paracetamol as model drug. METHODOLOGY: Determination of percentage yield, Physicochemical, micrometrics characteristics of starch/granules, drug excipients compatibility studies and evaluation of prepared paracetamol tablets were measured using official techniques. RESULTS: The yield of the millet starch ranged from 30 to 40%. Moisture content 8.77%, pH 5.7, Swelling capacity 1.2, Hydration capacity 1.748, Moisture uptake 11.8%, Amylose 24.6%, with poor flowability and compressibility. No significant difference in hardness, friability% & disintegration times for formulations containing millet starch to that containing potato and maize starch (P>0.05). CONCLUSION: From the study, Millet seeds locally cultivated in Sudan gave a high yield of starch, has same physicochemical properties as maize and potato starch so can be used as an alternative to those starches.

The use of traditional medicines among mycetoma patients.

BACKGROUND: Mycetoma patients frequently present with advanced disease, the cause of which is multi-factorial, but the use of traditional medicine modalities has been shown to be an important one. Traditional medicine is an integral part of the Sudanese culture and many mycetoma patients revert to it because it is accessible, cheap and available. METHODS: To confirm this anecdotal observation, the pattern and characteristics of traditional medicine use among a group of mycetoma patients seen at the Mycetoma Research Center in Khartoum, Sudan, were studied. RESULTS: In this descriptive, cross-sectional, hospital-based study, 389 mycetoma-confirmed patients were included. All of them had used traditional medicine at some stage of their mycetoma treatment. Among them, 66% had first consulted traditional healers for mycetoma treatment. In this study, 58% had consulted religious healers known as fakis, while the majority (72%) of those who consulted specialist healers had consulted herbalists. The most frequent type of traditional medicine received by patients from religious healers was al-azima (31%) and the most common treatment given by the specialist healers was herbal medicine (46%). CONCLUSION: Traditional medicine can lead to a delay in seeking medical care and serious complications. Collaboration with traditional healers, and training and educating them to refer mycetoma patients to specialised centres is vital to ensure that they receive proper treatment in a timely and efficient manner.

In vitro activities of Acacia nilotica (L.) Delile bark fractions against Oral Bacteria, Glucosyltransferase and as antioxidant.

BACKGROUND: Dental caries and periodontal disease are the most common chronic infectious oral diseases in the world. Acacia nilotica was commonly known in Sudan as Garad or Sunt has a wide range of medicinal uses. In the present study, antibacterial activity of oral bacteria (Streptococcus sobrinus and Porphyromonas gingivalis), inhibitory activity against glucosyltransferase (GTF) enzyme and antioxidant activity were assayed for methanolic crude extract of A. nilotica bark and its fractions. METHODS: Methanoilc crude extract of A. nilotica bark was applied to a Sephadex LH-20 column and eluted with methanol, aqueous methanol, and finally aqueous acetone to obtain four fractions (Fr1- Fr4). Furthermore, the crude extract and fractions were subjected to analytical high performance liquid chromatography (HPLC). The crude extract and its fractions were assayed for antibacterial activity against S. sobrinus and P. gingivalis using a microplate dilution assay method to determine the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC), as well as GTF inhibition and antioxidant activity using ABTS radical scavenging method. RESULTS: Fractions (Fr1 and Fr2) exhibited MIC values of 0.3 mg/ml against the P. gingivalis. Additionally, Fr2 displayed MBC value of 1 mg/ml against two types of bacteria. Fr4 showed an especially potent GTF inhibitory activity with IC50 value of 3.9 µg/ml. Fr1 displayed the best antioxidant activity with IC50 value of 1.8 µg/ml. The main compound in Fr1 was identified as gallic acid, and Fr2 was mostly a mixture of gallic acid and methyl gallate. CONCLUSIONS: The results obtained in this study provide some scientific rationale and justify the use of this plant for the treatment of dental diseases in traditional medicine. A. nilotica bark, besides their antibacterial potentiality and GTF inhibitory activity, it may be used as adjuvant antioxidants in mouthwashes. Further studies in the future are required to identify the rest of the active compounds.

Antimicrobial activity, phytochemical screening of crude extracts, and essential oils constituents of two Pulicaria spp. growing in Sudan.

The search for plant extracts with highly antimicrobial activity has been increased nowadays. This study evaluated the antimicrobial activity of Pulicaria crispa (Forsk.) Oliv., and Pulicaria undulata (L.) C.A.Mey., which have been used traditionally in Sudan as insect replants. The antimicrobial activity was evaluated against six pathogenic microorganisms, four bacteria (two Gram-positive; Bacillus subtilis and Staphylococcus aureus, two Gram-negative; Escherichia coli, and Pseudomonas aeruginosa), and two fungi (Aspergillus niger and Candida albicans) using disc diffusion method. The extraction of the crude extracts was done by maceration. The essential oils were extracted by hydro-distillation. Phytochemical screening was done using reference method. Essential oils were analyzed using Gas Chromatography Mass Spectrometry. The results indicated that all used the microorganisms were sensitive to the plants extracts. Results of the preliminary phytochemical screening showed the presence of saponins, comarins, tannins, sterols, and triterpenes, and absence of alkaloids, anthraquinones, and flavonoids. Twenty-eight and forty-five constituents were identified in P. crispa and P. undulata, essential oils, respectively. The main constituents in the essential oil of P. crispa were 1,4-ditert butylbenzene (22.81%), caryophyllene (13.19%), carvone (11.80%), and neryl(s)-2-methylbutanoate (10.33%), and for P. undulata were camphor (44.48%), and thymyl acetate (10.31%). Data from this study could be used for developing of natural bioactive agents to improve human health.

Multidrug-resistant Mycobacterium tuberculosis: a report of cosmopolitan microbial migration and an analysis of best management practices.

BACKGROUND: Tuberculosis (TB) control is a primary global health priority but the goal to eliminate TB is being threatened by the increase in incidence of multidrug-resistant tuberculosis (MDR-TB). With this series of seven MDR-TB cases in migrant patients with identical Mycobacterium tuberculosis strains we aim to illustrate the challenges encountered during therapy and follow-up: language barriers, access to care for migrant patients, depression due to isolation, adverse reactions to the treatment, management of pediatric TB, further contact tracing. We also discuss best practices for the management of complex MDR-TB cases in settings with low overall TB incidence focusing on modern diagnostic assays and an individualized and an interdisciplinary therapeutic approach. METHODS: We describe a case series of seven consecutively diagnosed MDR-TB patients, six of them treated at our tertiary care hospital between May 2018 and March 2020. Epidemiologic data was gained by semi-structured patient interviews and reconstruction of the migration route. The origin of the cluster was confirmed by genotyping of the TB-strains. RESULTS: Six related patients were diagnosed with pulmonary MDR-TB between May and August 2018. All had a positive Interferon-Gamma-Release Assay (IGRA), in five patients sputum microscopy was positive for acid-fast bacilli (AFB). The genetic and phenotypical drug susceptibility test did not match with MDR-TB strains from an East-African origin. The index patient was identified through genetical fingerprinting. By changing the therapy to a modern MDR-TB regime and using an interdisciplinary and culture-sensitive approach, all patients improved clinically and radiologically. CONCLUSION: Human migration plays an important role for the global spread of MDR-TB in low incidence countries. Early case detection and adequate treatment are key to prevention of outbreaks. Especially language barriers and complex migration routes make genotyping of TB-strains a crucial tool to identify cases clusters, the potential index patient and transmission dynamics. We are fortunate enough to experience times in which new TB-antibiotics were made available and in which molecular assays revolutionized TB-diagnostics. We need to take advantage of that and develop personalized therapies for patients suffering from drug resistant TB.

Access to oral rehydration solution and zinc supplementation for treatment of childhood diarrhoeal diseases in Sudan.

OBJECTIVES: The decline in diarrhoeal disease-related mortality globally has been attributed to the use of oral rehydration solution (ORS) and zinc supplementation. However, data on ORS and zinc supplementation in Sudan are scarce. We aimed to investigate the access to ORS and zinc treatments and the associated factors, through the analysis of the latest available data from Sudan-Multiple Indicator Cluster Survey (MICS)-2014 obtained from the United Nations Children's Fund (UNICEF). RESULTS: A total of 14,081 children were included in this analysis. During the 2 weeks preceding the survey, 29.3% of these children had a diarrhoeal disease. Only 18.9% and 14.8% of these children had received ORS and zinc supplements, respectively. Whereas children from the higher wealth index groups were more likely to receive ORS treatment (fourth group: AOR = 1.301; 95% CI 1.006-1.682), children from rural areas were less likely to receive ORS treatment (AOR = 0.666; 95% CI 0.552-0.803) and zinc supplements (AOR = 0.603; 95% CI 0.500-0.728). The results indicate the existence of unequal access to treatment of childhood diarrhoeal diseases among children under 5 years in Sudan.