Human herpes virus type-6 is associated with central nervous system infections in children in Sudan.

Background: Human herpes virus type-6 (HHV-6) is increasingly recognised as a febrile agent in children. However, less is known in sub-Saharan African countries, including Sudan. Objective: We investigated the involvement of HHV-6 in paediatric central nervous system (CNS) infections in Khartoum, Sudan. Methods: Febrile patients aged up to 15 years with suspected CNS infections at Omdurman Hospital for Children from 01 December 2009 to 01 August 2010 were included. Viral DNA was extracted from leftover cerebrospinal fluid (CSF) specimens and quantitatively amplified by real-time polymerase chain reaction (PCR) at Umeå University in Sweden. Results: Of 503 CSF specimens, 13 (2.6%) were positive for HHV-6 (33.0% [13/40 of cases with proven infectious meningitis]). The median thermal cycle threshold for all HHV-6-positive specimens was 38 (range: 31.9-40.8). The median number of virus copies was 281.3/PCR run (1 × 105 copies/mL CSF; range: 30-44 × 103 copies/PCR run [12 × 103 - 18 × 106 copies/mL CSF]). All positive patients presented with fever and vomiting; 86.0% had seizures. The male-to-female ratio was 1:1; 50.0% were toddlers, 42.0% infants and 8.0% teenagers. Most (83.0%) were admitted in the dry season and 17.0% in the rainy season. Cerebrospinal fluid leukocytosis was seen in 33.0%, CSF glucose levels were normal in 86.0% and low in 14.0%, and CSF protein levels were low in 14.0% and high in 43.0%. Conclusion: Among children in Sudan with CNS infections, HHV-6 is common. Studies on the existence and spread of HHV-6 chromosomal integration in this population are needed.

Sexually transmitted infections other than HIV/AIDS among women of low socio-economic class attending antenatal clinics in Khartoum, Sudan.

Sexually transmitted infections (STIs) are major health threats affecting people globally; however, the burden of STIs is greatest in low-income countries. Since they are physiologically more vulnerable, women are mostly affected. The risk is increased dramatically during pregnancy leading to serious health complications that may affect the newborn. Underprivileged pregnant women attending antenatal clinics for routine checkups in displaced camps, a women's prison and several peripheral health centres were clinically and laboratory screened for trichomoniasis, chlamydial infections, gonorrhea and syphilis. A total of 426 women with an age range of 14-45 years were included. Clinical data, blood, cervical and vaginal swabs were collected. Conventional bacteriological and serological methods were applied. All attendees were HIV1/2-negative. The prevalence of Trichomonas vaginalis, Chlamydia trachomatis, Neisseria gonorrhoeae and Treponema pallidum infections was found to be 7.8%, 4.9%, 0% and 5%, respectively. Although vaginal discharge, among other symptoms, is known to be the most significant indicator for STIs, our identified positive predictive value was only 14.1%. We conclude that use of syndromic approach for diagnosing and treating attendees of antenatal settings is of low clinical value and many easily curable STIs will be overlooked. Consequently, trichomoniasis, chlamydial infection and syphilis prevailed widely among this population.

Frequency of BCR-ABL fusion transcripts in Sudanese patients with chronic myeloid leukemia using real-time reverse transcription-polymerase chain reaction.

OBJECTIVE: To report the frequencies of BCR-ABL transcript variants studied in Sudanese patients with chronic myeloid leukemia (CML). METHODS: This is a descriptive cross-sectional study carried out in 112 CML patients who attended at different clinics of Khartoum state, Sudan from February 2007 to December 2010. Transcript analysis was successful in 109 venous blood and bone marrow samples using quantitative real-time-polymerase chain reaction (RT-PCR). RESULTS: The transcripts analysis of 109 patients showed that 32.1% (35/109) expressed one or both of the P210 BCR/ABL rearrangements (b2a2 and b3a2). Of those 35 (32.1%), 21 patients expressed b2a2, 6 expressed b3a2, and 8 expressed both transcripts b2a2/b3a2. The remaining 74 patients revealed transcripts combination of P190 BCR/ABL and P210 BCR/ABL (e1a2/b2a2/b3a2), of which 19 patients had all the transcripts (e1a2/b2a2/b3a2), 33 revealed 2 transcripts (e1a2/b2a2), and the remaining 22 patients had (e1a2/b3a2). CONCLUSION: The frequencies of BCR-ABL rearrangements in the Sudanese population demonstrated distinct profiles in contrast with the frequencies reported in similar studies conducted in other geographical regions.This might be due to the distinct ethnic group involved in this study which has been supported further by reported distinct genetic profiles in Sudanese patients with bladder and breast cancer.

Significance of serum total prostate specific antigen and digital rectal examination in the diagnosis of prostate cancer.

OBJECTIVE: To assess the significance of serum total prostate specific antigen (tPSA) and digital rectal examination (DRE) in the diagnosis of prostate cancer (PC). METHODS: One hundred and eighteen patients with serum tPSA ranging between 2.5 and 10 ng/ml with lower urinary tract symptoms presented at the Urology Clinic of Soba University Hospital, Khartoum, Sudan from August 2008 and January 2010 were included in the study. Serum tPSA was measured using enzyme immunoassay method, and accordingly, the patients were classified into 2 groups: patients that had tPSA between 2.5-4.0 ng/ml; and patients that had tPSA between 4.1-10 ng/ml. The DRE was performed on all patients by a qualified urologist, and were recorded as a group with suspicion of PC, and a group with no suspicion of PC. All patients underwent transrectal sextant prostate biopsy. RESULTS: The DRE alone showed 63.8% sensitivity and 68% specificity with 46.9% positive predictive value (PPV) for the diagnosis of PC. The tPSA test revealed 91.6% sensitivity and 24% specificity with PPV of 34%. However, when combining DRE and tPSA, the sensitivity reached 100% and the specificity increased to 92% with PPV of 49%. CONCLUSION: Combining DRE and tPSA test increases the sensitivity, specificity, and PPV of PC detection.

Age-specific reference range for serum prostate-specific antigen in Sudanese men.

OBJECTIVE: To determine age-specific prostate-specific antigen (PSA) reference values in a community-based sample of Sudanese men, aged 40-90 years. METHODS: This study was conducted in the Central Laboratory Services, Soba University Hospital, Khartoum, Sudan from January 2008 to May 2010. Total serum PSA in 3475 Sudanese men with no clinical evidence of lower urinary tract symptoms were measured using immunoenzometric assay. Out of the 3475, only 1051 men met the inclusion criteria. Those with total PSA<10 ng/ml and no recent urinary tract infection were included in this study. The data were analyzed using SPSS for Windows to define age-specific reference ranges of PSA. RESULTS: The geometric mean of total serum PSA in the study group of Sudanese men was 1.48 ng/ml. The 95th percentile total serum PSA ranges in the age groups was 0-3 ng/ml for 40-49 years, 0-3.02 ng/ml for 50-59 years, 0-3.8 ng/ml for 60-69 years and 0-8.7 ng/ml for 70-90 years. CONCLUSION: The currently adopted age-specific total PSA reference ranges are not appropriate for Sudanese men. Accordingly, our study indicates that the reference ranges of this study may be more suitable.