May Measurement Month 2018: an analysis of blood pressure screening results from Sudan.

To raise awareness of high blood pressure (BP) levels and associated risk factors among the Sudanese population. A cross-sectional study was conducted in six Sudanese states during the period May-August 2018. The study area included public indoor and outdoor areas, institutes, and service facilities. A questionnaire for collecting the data was employed including demographic data, along with three consecutive BP measurements. Data were collected by trained volunteers. Hypertension (HTN) was defined as a systolic blood pressure ≥140 mmHg or a diastolic blood pressure ≥90 mmHg based on the mean of the second and third measurements, or in those on antihypertensive medication. The current study indicated a high prevalence of HTN (28.2%) among 40 779 participants and a low level of awareness (20.7%) amongst these participants. Of all, 18.2% of hypertensive participants were on medication and of these, 54.6% were controlled. Of all hypertensives, only 9.9% were controlled. Further action needs to be taken by all stakeholders for raising awareness and increasing screening provision of HTN, which are essential for the development of national health policies for control and management of HTN in Sudan.

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.

Development and evaluation of real-time loop-mediated isothermal amplification assay for rapid detection of cystic echinococcosis.

BACKGROUND: Cystic echinococcosis (CE) or hydatidosis, caused by the larval stage of Echinococcus granulosus (EG)-complex, is a neglected parasitic disease of public health importance. The disease is endemic in many African and Mediterranean countries including the Sudan. The objective of the present study was to develop and evaluate a real-time loop-mediated isothermal amplification (LAMP) assay for simple and rapid detection of CE in humans and domestic live stock in Sudan. METHODS: A set of six LAMP primers, designed from the mitochondrial NADH-1 gene of EG cattle strain of genotype 5 (G5), was used as a target for LAMP assay. The assay was performed at a constant temperature (63 °C), with a real-time follow-up using a LightCycler and fluorochrome dye. Following amplification cycles in a simple water bath, LAMP products were observed for color change by naked eye and were visualized under UV light source using agarose gel electrophoresis. RESULTS: The real-time LAMP assay identified a variety of hydatid cysts strains recovered in the Sudan, including Echinococcus canadenses (G6) and Echinococcus ortleppi (G5). Real-time LAMP positive results were detected by the presence of an amplification curve, whereas negative results were indicated by absence of fluorescence detection. Positive LAMP results appeared as a bluish-colored reaction as observed by naked eye, whereas negative LAMP results were observed as purple-colored reaction. The sensitivity studies indicated that the LAMP assay detected as little as a 10 fg of parasite DNA. There was 100 % agreement between results of the LAMP assay and our previously described nested PCR when testing 10-fold serial dilution of DNA extracted from EG-complex hydatid cyst. However, there was no cross-reactivity with other parasites including cysticercus bovis, Fasciola gigantica, and Schistosoma bovis and nucleic acid free samples. CONCLUSION: The developed LAMP assay would be expected to prove highly significant in epidemiological surveys of CE in developing countries or areas of resource-poor settings for both ease of use and cost.

First report on circulation of Echinococcus ortleppi in the one humped camel (Camelus dromedaries), Sudan.

BACKGROUND: Echinococcus granulosus (EG) complex, the cause of cystic echinococcosis (CE), infects humans and several other animal species worldwide and hence the disease is of public health importance. Ten genetic variants, or genotypes designated as (G1-G10), are distributed worldwide based on genetic diversity. The objective of this study was to provide some sequence data and phylogeny of EG isolates recovered from the Sudanese one-humped camel (Camelus dromedaries). Fifty samples of hydatid cysts were collected from the one- humped camels (Camelus dromedaries) at Taboul slaughter house, central Sudan. DNAs were extracted from protoscolices and/or associated germinal layers of hydatid cysts using a commercial kit. The mitochondrial NADH dehydrogenase subunit 1 (NADH1) gene and the cytochrome C oxidase subunit 1 (cox1) gene were used as targets for polymerase chain reaction (PCR) amplification. The PCR products were purified and partial sequences were generated. Sequences were further examined by sequence analysis and subsequent phylogeny to compare these sequences to those from known strains of EG circulating globally. RESULTS: The identity of the PCR products were confirmed as NADH1 and cox1 nucleotide sequences using the Basic Local Alignment Search Tool (BLAST) of NCBI (National Center for Biotechnology Information, Bethesda, MD). The phylogenetic analysis showed that 98% (n = 49) of the isolates clustered with Echinococcus canadensis genotype 6 (G6), whereas only one isolate (2%) clustered with Echinococcus ortleppi (G5). CONCLUSIONS: This investigation expands on the existing sequence data generated from EG isolates recovered from camel in the Sudan. The circulation of the cattle genotype (G5) in the one-humped camel is reported here for the first time.

Evaluation of the effects of VKORC1 polymorphisms and haplotypes, CYP2C9 genotypes, and clinical factors on warfarin response in Sudanese patients.

OBJECTIVE: African populations, including the Sudanese, are underrepresented in warfarin pharmacogenetic studies. We designed a study to determine the associations between the polymorphisms and haplotype structures of CYP2C9 and VKORC1 and warfarin dose response in Sudanese patients, one of the most genetically diverse populations in Africa. MATERIAL AND METHODS: The effect of the CYP2C9 polymorphisms (*2, *3, *5, *6, *8, *9, and *11), 20 VKORC1 tag SNPs and haplotypes, and clinical covariates were comprehensively assessed in 203 Sudanese warfarin-treated patients. RESULTS: Patients with the CYP2C9*2,*5,*6, or *11 variant required a daily warfarin dose that was 21% lower than those with CYP2C9*1/*1 (4.7 vs 5.8 mg/day, P < 0.001). SNPs around the VKORC1 and POL3S genes were divided into two haplotype blocks in Sudanese populations. According to multiple linear regression results, rs8050984, rs7294, and rs7199949 in the VKORC1 and POL3S genes (P <0.001, <0.001, <0.001, respectively), CYP2C9 genotype (*2, *5, *6, *11; P < 0.001), body weight (P = 0.04), target INR (P = 0.007), and concurrent medications (P = 0.029) could explain about 36.7% of the total warfarin dose variation. CONCLUSION: Our data revealed that VKORC1 and CYP2C9 polymorphisms are important factors that influence warfarin dose response in Sudanese patients. Our data suggest that combinations of the SNPs may improve predictions of warfarin dose requirements.

Cardiovascular Risk Among Patients ≥65 Years of Age with Parkinson's Disease (From the National Inpatient Sample).

In this study, we aimed to investigate the relationship between Parkinson's disease (PD) and vascular disease and risk factors using a nationally representative sample. The National Inpatient Sample was queried for all patients aged ≥65 who were diagnosed with PD during the year 2016. Patients were identified using the International Classification of Diseases-Tenth Revision (ICD-10) diagnosis code: "G20." Each patient diagnosed with PD was frequency-matched to controls at a 1:4 ratio by age and gender. Study outcomes were hypertension, hyperlipidemia, diabetes mellitus, coronary artery disease, and stroke. Outcomes were modeled using logistic regression analysis and further validation was obtained using a propensity score-matched analysis. A total of 57,914 patients (weighted: 289,570) with PD were included. Most patients were of Caucasian race (80.8%). Females were 42.4% and the mean age was 79 years, standard error of the mean (0.03). PD correlated with lower odds for hyperlipidemia adjusted odd ratio (a-OR): 0.77 (95% confidence interval [CI]: 0.75 to 0.79) p <0.001, diabetes mellitus a-OR 0.73 (95% CI 0.71 to 0.75) p <0.001, hypertension a-OR 0.68 (95% CI: 0.67 to 0.70) p <0.001, coronary artery disease a-OR 0.64 (95% CI: 0.63 to 0.66) p <0.001 and higher odds for stroke a-OR: 1.27 (95% CI: 1.24 to 1.31) p <0.001. Following propensity score matching, identical findings were found. In conclusion, patients with PD have a distinct cardiovascular profile with higher rates of stroke and lower rates of coronary artery disease and vascular disease risk factors.

Immunoassays for avian butyrylcholinesterase: Implications for ecotoxicological testing and clinical biomonitoring.

Limitations of using the cholinesterases as biomarkers for assessing organophosphate (OP) pesticides impact on avian wildlife are a matter of concern for both toxicologists and environmentalists. One limitation appears to be the assumption of proportionality between enzyme activity and enzyme protein content. However, this proportionality does not hold during exposure to OP pesticides which can cause changes in both factors. Therefore, RIA and ELISA were developed to investigate the relationship between BChE enzyme mass and activity during exposure to OP pesticides in birds. The sensitivity of RIA was 0.60ng protein/ml and of the competitive ELISA was 0.15ng protein/ml. A third enzyme-antigen immunoassay (EAIA) for measuring BChE catalytic activity was also developed to increase the specificity of cholinesterase assays by immunoprecipitation. Results also showed that although exposure of birds to malathion produced 47% (±6%) decrease in serum BChE activity, this inhibition was associated with a statistically significant (p<0.0001) increase in immunoreactive concentration of BChE in all exposed birds. The increased BChE concentration observed in the present study while its activity continued to be inhibited will diminish the apparent overall inhibition of the enzyme. Hence, the degree of exposure to OP pesticides will be underestimated if enzyme activity is the only biomarker used. There is now a case for measuring the "actual" specific activities of serum esterases as a rational diagnostic tool. This approach requires the simultaneous measurement of enzyme mass and enzyme activity.

Care of patients with haemoglobin abnormalities: nursing management.

This second of two articles on sickle cell disease (SCD) aims to provide advice on nursing care for patients. All health professionals should be aware of the various manifestations of the disease, the life-threatening complications and their optimal management. Prophylactic strategy is of paramount importance as it may avert many possible adverse outcomes. Recurrent episodes of acute, severe pain require frequent hospital admissions. The care of individuals with SCD must extend into the community and take account of domestic, employment and educational issues. Affected pregnant women should be looked after by units experienced in the care of women with this condition. The diagnosis of haemoglobin type is simple and inexpensive and a comprehensive national screening programme to detect SCD in pregnant women and newborn babies was started in April 2002 as part of the Government's broader aims to tackle inequalities in health and community.

Care of patients with haemoglobin abnormalities: history and biology.

Haemoglobinopathies refer to a range of genetically inherited disorders of red blood cell haemoglobin and include sickle cell disorders and thalassaemias. They occur most commonly in populations whose ancestors come from Africa, Asia, Mediterranean Islands, and the Middle and Far East. Haemoglobin (Hb) abnormalities (or haemoglobinopathies) are caused by (i) abnormalities of the protein structure; (ii) imbalanced globin chain production owing to reduced rate of synthesis of normal a or b globin chains; or (iii) a combination of the two. This article will focus on the biological basis of sickle cell disorders and will discuss the history and pathology of the conditions.

Peripheral arterial disease in diabetic patients selected from a primary care setting: Implications for nursing practice.

Although the care of patients with diabetes is increasingly provided in primary care, there is relatively little information on the prevalence and long-term progression of asymptomatic peripheral arterial disease (PAD) in diabetic populations selected from primary care settings. The aims of this study were to investigate prevalence and progression of PAD in 146 diabetic patients, and to compare mortality with 113 nondiabetic controls over a 7-year period. The prevalence of PAD in individual pedal arteries varied between 28.6% in the right posterior tibial artery to 48.8% in the left peroneal artery. During the 7-year period, 34.25% of the diabetic subjects died, and 17.5% moved to other locations. Of the remaining 70 patients, 35 (50%) showed no change in ankle-brachial index and 35 (50%) did show change. Comparison of risk factors between those who did and did not show evidence of progression revealed (1) a strong, significant, independent association between hyperglycemia (measured by plasma HbA1c) and progression of PAD among the diabetic population; and (2) a strong association between progression of the disease and family history of diabetes and ischemic vascular disease. There was a high death rate (34.25%) among the diabetic group, which was greater than for the age- and sex-matched nondiabetic controls (13.2%) drawn from the same practice. This high mortality was significantly related (P < .001) to the presence of PAD identified during first-year assessment. Once PAD develops in association with diabetes the long-term prognosis is poor and carries a high mortality rate mainly because of cardiovascular and cerebrovascular diseases. Both progression and mortality were significantly related to poor diabetic control. The role of the primary care nurse in assessing such patients by using Doppler-assisted measurements is one that should be expanded with the massive increase in the number of diabetic patients in the coming years.

Haemoglobinopathies and healthcare provision for ethnic minorities.

The level of training and competence in dealing with haemoglobinopathies (which mainly affect ethnic minorities in the UK) may not be totally adequate among nurses. Nurses indicated that they received little or no information in their teaching for working from a multiracial perspective and what they had learned was through experience and personal research since qualifying as nurses. Knowledge of the biological basis of inheritance, methods of acquisition of thalassaemia and sickle-cell anaemia and the ethnic profile of people affected by these conditions may not be totally adequate among nurses. Many nurses wanted more training, including those who had already received instruction, since this was described as "far too vague", "not constructive", "minimal", or "embarrassingly insufficient", recommending that instruction be given by a sickle-cell anaemia/thalassaemia counsellor with a contribution from patients. A combination of poor quality, or lack, of instruction, together with time and resource pressures, is responsible for this limited understanding, resulting in insufficient awareness of the health needs of ethnic minorities leading to inequalities in healthcare provision.

Application of Confocal Microscopy for 3D Assessment of Carotid Plaque Structure: Implications for Carotid Blood Flow and Stroke Research.

BACKGROUND: Little information is available on how forces resulting from fluid flow interact with structural stability of carotid atherosclerotic plaque and how such interactions may impact on stroke prevention; investigation of the 3D structure of plaque could help in such studies. The aim of this study was to investigate whether confocal microscopy can be used to obtain 3D visualization of the structure of atherosclerotic carotid plaques. METHODS: Carotid plaque specimens were collected from routine end-arterectomy surgical operations. Both bright-field microscopy and Laser Scanning Confocal Microscopy (LSCM) were used to generate 3D image data-sets and visualizations of surgically removed carotid plaques. RESULTS: Evidence of carotid plaque vulnerability was demonstrated by reduced fibrous cap thickness and large lipid-necrotic core with evidence of cracking. CONCLUSION: The generation of 3D images of carotid plaques could help in: (i) investigating key features that affect plaque structural stability; (ii) comparing 3D microstructure of the plaque with clinical imaging assessment and blood flow investigations; and (iii) developing markers to identify patients requiring clinical intervention.