Novel mutations in genes of the IL-12/IFN-γ axis cause susceptibility to tuberculosis.

BACKGROUND: The IL-12/23/ISG15-IFN-γ pathway is the main immunological pathway for controlling intra-macrophagic microorganisms such as Mycobacteria, Salmonella, and Leishmania spp. Consequently, upon mutations in genes of the IL-12/23/ISG15-IFN-γ pathway cause increased susceptibility to intra-macrophagic pathogens, particularly to Mycobacteria. Therefore, the purpose of this study was to characterize the mutations in genes of the IL-12/23/ISG15-IFN-γ pathway in severe tuberculosis (TB) patients. METHODS: Clinically suspected TB was initially confirmed in four patients (P) (P1, P2, P3, and P4) using the GeneXpert MTB/RIF and culturing techniques. The patients' Peripheral blood mononuclear cells (PBMCs) were then subjected to ELISA to measure Interleukin 12 (IL-12) and interferon gamma (IFN-γ). Flow cytometry was used to detect the surface expressions of IFN-γR1 and IFN-γR2 as well as IL-12Rß1and IL-12Rß2 on monocytes and T lymphocytes, respectively.The phosphorylation of signal transducer and activator of transcription 1(STAT1) on monocytes and STAT4 on T lymphocytes were also detected by flow cytometry. Sanger sequencing was used to identify mutations in the IL-12Rß1, STAT1, NEMO, and CYBB genes. RESULTS: P1's PBMCs exhibited reduced IFN-γ production, while P2's and P3's PBMCs exhibited impaired IL-12 induction. Low IL-12Rß1 surface expression and reduced STAT4 phosphorylation were demonstrated by P1's T lymphocytes, while impaired STAT1 phosphorylation was detected in P2's monocytes. The impaired IκB-α degradation and abolished H2O2 production in monocytes and neutrophils of P3 and P4 were observed, respectively. Sanger sequencing revealed novel nonsense homozygous mutation: c.191 G>A/p.W64 * in exon 3 of the IL-12Rß1 gene in P1, novel missense homozygous mutation: c.107 A>T/p.Q36L in exon 3 of the STAT1 gene in P2, missense hemizygous mutation:: c.950 A>C/p.Q317P in exon 8 of the NEMO gene in P3, and nonsense hemizygous mutation: c.868 C>T/p.R290X in exon 8 of CYBB gene in P4. CONCLUSION: Our findings broaden the clinical and genetic spectra associated with IL-12/23/ISG15-IFN-γ axis anomalies. Additionally, our data suggest that TB patients in Pakistan should be investigated for potential genetic defects due to high prevalence of parental consanguinity and increased incidence of TB in the country.

Role of polycystic ovarian syndrome in developing psychological burden in Saudi Arabian females: A case control study.

It is well known that polycystic ovarian syndrome (PCOS) may elevate psychological problems in patients, but there is a scarcity of the studies among Saudi Arabian population. This research was designed to investigate the influence of PCOS on the development of psychological load in terms of depression, anxiety, and stress in comparison to normal women who have no PCOS. Further, a correlation of psychological distress in PCOS females was done with their educational level. This is case-control research carried out in one of Riyadh's multispecialty hospitals. In the PCOS patients and control groups (each with 84 samples), samples were collected using convenience sampling and a simple random approach, respectively. The psychological burden was determined using DASS-21. The data obtained were analyzed using SPSS-IBM 25. Most participants (52.9%) were between the ages of 26 and 35 and had a university education (68.4%). A significantly higher percentage of PCOS patients (P = 0.001) had irregular menses, hirsutism, infertility, and acne in comparison to the mothers without PCOS. There was a significantly higher possibility of depression (P = 0.003), anxiety (P = 0.016), and stress (P = 0.001) among PCOS patients than in control subjects. Among the psychological domain tested in the study, the risk of developing stress (odds ratio, OR = 8.32) was high when compared to depression (OR = 3.12) and anxiety (OR = 2.127) in PCOS patients. Furthermore, when compared to PCOS females with less education, a significantly lower number of university-educated PCOS females developed depression. The study demonstrates a high prevalence of psychological burden among the PCOS population. Higher education has been shown to help in alleviating depression in PCOS females. Meeting PCOS women's psychological needs will improve their overall health status.

Seroprevalence of IgM and IgG Against SARS-CoV-2 after Two Doses of Pfizer-BioNTech COVID-19 Vaccine in Women with Breast Cancer.

BACKGROUND: This study evaluates the seroprevalence of immunoglobulin M (IgM) and G (IgG) antibodies against SARS-CoV-2 after two doses of Pfizer-BioNTech COVID-19 vaccination from women with breast cancer in Jazan city Kingdom of Saudi Arabia, antibody detections were performed one month and three months after the administration of the second dose. METHODS: Overall, 103 breast cancer patients were included. Individuals who had had two doses of Pfizer-BioNTech vaccine, patients who were earlier diagnosed with COVID-19 infection, had not finalized immunization plan, or who received the second dose recently were excluded from the study. The antibodies detection test was run according to the manufacturer's directions of Viva Diag™ SARS-CoV-2 IgM/IgG Rapid Test (COVID-19 IgM/IgG Rapid Test). RESULTS: This study included 62 (60.2%) and 41 (39.8%) patients with invasive ductal carcinoma and invasive lobular carcinoma, respectively. The age, median and interquartile range (IQR) was 54.0 (26) years. Regarding reactivity of antibodies, after one month IgM antibody showed 64 (62.1%) positive and 39 (37.9%) negative while IgG antibody showed positive results in all patients. After three months IgM antibody showed 44 (42.7%) positive and 59 (57.3%) negative, while IgG showed 87 (84.5%) positive and 16 (15.5%) negative. There were significant differences in the IgM and IgG seropositivity. There were 19.3% patients with ductal carcinoma who were positive and then turned negative versus 17.7% who were positive and then turned negative, respectively (p < 0.001). There were significant differences in IgM antibody positivity among different age groups. CONCLUSIONS: Our results recommend the importance of screening for an antibody response for breast cancer patient after immunization in order to reveal persons who need early and late extra enhancing vaccine dose. Upcoming studies recommended to estimate different methods that raise cancer patients' immune response.

Satisfaction of psychologically impaired patients with health-care services: A Saudi Arabian perspective.

Psychological problems affect a sizable portion of the population, and they require special care. In the current study, we aimed to assess patient satisfaction with the healthcare system at one of the multispecialty hospitals in Riyadh, Saudi Arabia, as well as to identify potential factors that can have an impact on patient satisfaction. A validated pre-tested questionnaire including features to evaluate general hospital services (HS-6 items), nursing services (NS-3 items), pharmacy services (PS-7 items), and a standard patient satisfaction questionnaire (PSQ-18 item) was administered to patients who had been receiving therapy for their psychological disease for the past 3 months. Using binary and multiple regression analysis, the strengths of the associations between sociodemographic factors and patient satisfaction measures were evaluated. The results were expressed as adjusted odds ratios (AOR), which were deemed significant when the P value was < 0.05. Sixty-six percent of the 258 study participants were men, and sixty percent of them were between the ages of 18 and 35 years. The bulk of survey respondents (74%) were employed, married, and well-educated. Our research revealed that those who were employed (AOR, HS-2.5; NS-2.65, PS-2.32), have a higher education (AOR, HS-2.23, NS-2.63, PS-2.82), male gender (AOR, HS-1.12, NS-1.08, PS-1.86) and between the ages of 18 and 35 years (AOR, HS-1.48, NS-1.53, PS-1.67) were more likely to be satisfied with general hospital, nursing, and pharmacy services. Further, those who were married had 1.43 and 1.21 times more chance of satisfaction with the pharmacy and nursing services, respectively, compared to singles. Additionally, those with employment had odds of being satisfied that were 2.4 times higher, highly educated individuals had odds that were 2.1 times higher, participants between the ages of 18 and 35 had odds that were 1.51 times higher, and men had odds that were 1.41 times higher on the patient satisfaction questionnaire scale (PSQ-18). Overall, the study participants' satisfaction with general hospital, nursing, and pharmacy services was 70, 76.3, and 83.3%, respectively, compared to only 61.2% on the PSQ-18. Participants in the survey awarded the hospital amenities, pharmacy services, and nursing care high ratings. The medical care, however, fell short of expectations. The study's findings suggest that action needs to be taken to enhance healthcare system services, particularly in the psychological departments of the medical organization.

Antidepressant Effect of Crocin in Mice with Chronic Mild Stress.

This study aimed to investigate the antidepressant property of crocin (Crocetin digentiobiose ester) using a chronic mild stress (CMS)-induced depression model in experimental mice. The tail suspension test (TST) and the sucrose preference test were used to evaluate the antidepressant effect on albino mice of either sex after three weeks of CMS. The period of immobility in the TST and percentage preference for sucrose solution were recorded. By monitoring brain malondialdehyde (MDA) level, catalase (CAT) activity, and reduced glutathione (GSH) level, the antioxidant potential was assessed. Three dosages of crocin (4.84, 9.69, and 19.38 mg/kg) were evaluated. When compared to controls, animals that received crocin administration during three periods of CMS had considerably shorter immobility times during the TST. Crocin treatment also raised the percentage preference for sucrose solution in a dose-dependent manner, bringing it to parity with the conventional antidepressant, imipramine. Animals that received a high dose of crocin had a much greater spontaneous locomotor activity. Furthermore, a high dose of crocin remarkably lowered plasma corticosterone and nitrite levels brought on by CMS. Additionally, high doses of crocin given during CMS greatly enhanced reduced glutathione levels while considerably reducing the brain's MDA and catalase activities. In conclusion, high doses of crocin may have an antidepressant effect in an animal model through several mechanisms. However, further studies should be carried out to explore the role of neurotransmitters for their antidepressant property.

Evaluation of CD4+:CD8+ Ratio in Patients With Cervical Cancer and the Levels of Inflammatory Markers.

BACKGROUND/AIM: Cervical cancer remains a major public health concern. The ratio of CD4+:CD8+ T-cells is used to evaluate the immune system function. This study aimed to explore the CD4+:CD8+ T-cell ratio in relation to the glycemic status, inflammatory markers, vitamin D, and vitamin B12 in patients with early diagnosed cervical cancer. PATIENTS AND METHODS: This is a cross-sectional study. Blood samples were collected for flow cytometry analysis. Information regarding Papanicolaou (Pap) smears and colposcopy investigations were collected from 152 women with type 2 diabetes admitted to East Jeddah Hospital, Jeddah, Saudi Arabia, between January 2018 and January 2021. RESULTS: Patients with early cervical carcinoma and a higher CD4+:CD8+ ratio (>1.2) had a higher C-reactive protein (CRP) level than those with a lower CD4+:CD8+ ratio (Mean±SD=13.75±13.3 vs. 10.85±8.1; p-value=0.034). Patients with early cervical carcinoma, diabetes, and higher CD4+:CD8+ ratio (>1.2) had a higher blood HbA1c percent than those with a lower CD4+:CD8+ ratio. CONCLUSION: A high CD4+:CD8+ T-cells ratio was associated with an increased HbA1c% and CRP levels in women with diabetes diagnosed with early cervical carcinoma, which can induce inflammation in early diagnosed patients with cervical cancer.

Histomorphometric study of placental blood vessels of chorion and chorionic villi vascular area among women with preeclampsia.

INTRODUCTION: The direction of blood movement in normal and abnormal placenta is curious from a morphometric point of view. Once pregnancy is compromised by an illness like hypertension, maternal and foetal distress can lead to negative outcomes. The quantitative variations in the blood vessels within the chorion and the chorionic villi in placentas from pregnancies are complicated by preeclampsia (PE) and are poorly defined. The purpose of this study was to calculate and explore the morphometric measurement of blood vessels involved in the progress of hypertension through pregnancy within the chorion and the chorionic villi among normotensive women (n = 39) versus a preeclamptic group (n = 35). METHODS: Measurements used a computerized morphometry system and a Vascular Medicine Institute (VMI) calculator. RESULTS: Our data showed a significant decrease in vessel area (VA), wall area (WA), lumen area (LA), mean wall thickness-boundary (MWTB), mean wall thickness-rosette (MWTR), mean diameter-rosette (MDR), mean wall thickness-skeleton (MWTS), and external diameter-skeleton (EDS) in preeclampsia women compared to normotensive women. There were no significant differences between preeclampsia and control group in lumen area. DISCUSSION: We concluded that preeclamptic chorion and chorionic villi vessels are linked with significant structural discrepancies; future studies should address morphological events that occur throughout pregnancy including associations between arterial elastic properties-mainly collagen and structural proteins in hypertensive patients. A more integrated approach involving parallel analysis of the effects of potential vasoactive factors on the morphology of foetal vessel alteration is also needed.

Incidence of Epstein-Barr Virus Among Women With Breast Cancer Using Monoclonal Antibodies for Latent Membrane Protein 1 (LMP1).

BACKGROUND/AIM: Breast cancer is a common type of cancer in Sudan. Numerous studies propose viral oncogenesis as an etiological factor for breast cancer. The aim of the study was to analyze the presence of the Epstein-Barr virus (EBV) using monoclonal antibodies against latent membrane protein 1 (LAMP1) and determine the correlation between the presence of EBV and clinicopathological characteristics. PATIENTS AND METHODS: This study used immunohistochemistry to analyze the presence of EBV in 202 samples from Sudanese women diagnosed with breast cancer. Clinicopathological data were collected from patient records from the Radiation and Isotopes Centre in Khartoum State, Republic of Sudan. RESULTS: This study included 202 patients 168 (83.2%), 16 (7.9%), and 18 (8.9%), diagnosed with invasive ductal carcinoma, invasive lobular carcinoma, and papillary carcinoma, respectively. Axillary lymph node metastasis was present in 57 (28.2%) of cases, while 11 patients (5.4%) tested positive for EBV. The mean age of patients was 48.14±14.4 years. EBV infection was more frequently detected in invasive ductal carcinoma cases, and EBV positivity was not associated with cancer type, grade, progesterone levels, and HER2 expression. On the other hand, a statistically significant association was found between EBV presence and lymph node involvement, estrogen receptor status, and age group. CONCLUSION: EBV may not play a vital role in the pathogenesis of breast carcinoma in Sudanese women.

Prognostic Significance of p16 Protein Expression in Breast Cancer.

BACKGROUND/AIM: Breast cancer is the most common cancer in Sudan. The p16 protein plays a vital role in the regulation of the cell cycle. PATIENTS AND METHODS: This study analysed the protein expression of p16 in 202 paraffin blocks from Sudanese women with breast cancer using immunohistochemistry. RESULTS: This study included 168 (83.2%), 16 (7.9%), and 18 (8.9%) patients with invasive ductal carcinoma, invasive lobular carcinoma, and papillary carcinoma, respectively. There were 95 cases (47.0%) with grade III, 70 cases (34.6%) with grade II, and 23 cases (11.4%) with grade I breast cancer. The hormone receptor status was available for 119 of the cases, and 31 (15.3%), 25 (12.4%), and 63 (31.2%) cases were positive for oestrogen, progesterone, and HER2 receptors, respectively. CONCLUSION: p16 protein expression was associated with high histologic grade, lymph node metastasis, and poor prognosis. p16 protein expression may potentially be used as a prognostic marker.

Prostanoid Receptor Subtypes and Its Endogenous Ligands with Processing Enzymes within Various Types of Inflammatory Joint Diseases.

A complex inflammatory process mediated by proinflammatory cytokines and prostaglandins commonly occurs in the synovial tissue of patients with joint trauma (JT), osteoarthritis (OA), and rheumatoid arthritis (RA). This study systematically investigated the distinct expression profile of prostaglandin E2 (PGE2), its processing enzymes (COX-2), and microsomal PGES-1 (mPGES-1) as well as the corresponding prostanoid receptor subtypes (EP1-4) in representative samples of synovial tissue from these patients (JT, OA, and RA). Quantitative TaqMan®-PCR and double immunofluorescence confocal microscopy of synovial tissue determined the abundance and exact immune cell types expressing these target molecules. Our results demonstrated that PGE2 and its processing enzymes COX-2 and mPGES-1 were highest in the synovial tissue of RA, followed by the synovial tissue of OA and JT patients. Corresponding prostanoid receptor, subtypes EP3 were highly expressed in the synovium of RA, followed by the synovial tissue of OA and JT patients. These proinflammatory target molecules were distinctly identified in JT patients mostly in synovial granulocytes, in OA patients predominantly in synovial macrophages and fibroblasts, whereas in RA patients mainly in synovial fibroblasts and plasma cells. Our findings show a distinct expression profile of EP receptor subtypes and PGE2 as well as the corresponding processing enzymes in human synovium that modulate the inflammatory process in JT, OA, and RA patients.

Awareness of human papillomavirus infection complications, cervical cancer, and vaccine among the Saudi population. A cross-sectional survey.

OBJECTIVES: To determine human papillomavirus (HPV) infection, cervical cancer, and vaccine awareness among the Saudi population. METHODS: This cross-sectional study of a convenience sample comprising 1033 participants (males and females) from different parts of Kingdom of Saudi Arabia was conducted between August 2018 and January 2019 using a web-based questionnaire. This self-administrated questionnaire was distributed to all participants. Collected data included age groups, cervical cancer, Papanicolaou (Pap) smear, and HPV vaccine awareness. RESULTS: The response rate was 95%. Approximately 50% of the participants were 15-22 years old, less than 3% were more than 46 years old, and less than 10% had heard of HPV. Awareness and previous knowledge of the Pap smear as a screening tool was variable with male (5.9%) and female (27.9%) participants, having knowledge of the test. There were no statistically significant differences (p more than 0.05) between males and females in their knowledge of HPV's role in cervical and penile cancers, the HPV vaccine availability in the hospital, its role in cervical cancer prevention, and suggestions that this vaccine should be provided to married and non-married women. CONCLUSION: There is a lack of knowledge and misinformation regarding cervical cancer, Pap smears, HPV, and HPV association with cervical cancer. These data can be used as a basis to formulate effective population awareness programs.

Placental growth factor, vascular endothelial growth factor, and hypoxia-inducible factor-1α in the placentas of women with pre-eclampsia.

BACKGROUND: Although the exact mechanism of pre-eclampsia - high blood pressure and proteinuria after 20 gestational weeks - is not yet fully understood, placental growth factor (PLGF), vascular endothelial growth factor (VEGF), and hypoxia-inducible factor (HIF) are known to play important roles in vascularization and in the pathology of pre-eclampsia. METHODS: PLGF, VEGF, and HIF-1α were evaluated by immunohistochemistry in the placentas of Sudanese women with mild or severe pre-eclampsia, and in normal controls. RESULTS: Sixty-two women had severe pre-eclampsia, 102 had mild pre-eclampsia and 101 women served as healthy controls. Immunohistochemical staining of PLGF was significantly lower in placentas of women with severe pre-eclampsia (16%) compared with those with mild pre-eclampsia (8.8%) and placentas of normotensive women (40.6%; p < .001). Significantly more of the pre-eclamptic placentas expressed VEGF: in 32%, 17.6%, and 14.9% (p = .020) of the placentas of women with severe or mild pre-eclampsia and in controls, respectively. Significantly more of the pre-eclamptic placentas expressed HIF-1α: in 15%, 10.8%, and 5.0% of the placentas of women with severe or mild pre-eclampsia, and in controls, respectively (p = .044). CONCLUSION: The current study showed that PLGF, VEGF, and HIF-1α are involved in the pathophysiology of pre-eclampsia.

Haematological parameters, haemozoin-containing leukocytes in Sudanese children with severe Plasmodium falciparum malaria.

INTRODUCTION: Haemozoin -containing leucocytes (HCL) can be used to predict severe malaria. METHODOLOGY: A case -control study was conducted in Singa, Sudan, to investigate the haematological values and HCL in children with severe Plasmodium falciparum malaria. The cases were children with severe P. falciparum malaria (67). The two groups of controls were patients with uncomplicated P. falciparum malaria (63) and healthy children (50). RESULTS: The mean (±SD) age was 5.5 (±3.8) years. In comparison with children with uncomplicated P. falciparum malaria, children with severe P. falciparum malaria had significantly lower haemoglobin and platelet counts, and significantly higher lymphocyte counts, red cell distribution width (RDW), and platelet distribution width (PDW). The rate of haemozoin -containing monocytes (percentage of children positive for this parameter in each group) was 91.0%, 84.6% and 50.0%, P<0.001 in children with severe P. falciparum, uncomplicated P. falciparum malaria and negative controls, respectively. Receiver Operating Characteristic (ROC) curves for blood parameters and HCL were plotted and the areas under the curve (AUC) were calculated for the prediction of severe P. falciparum malaria infection. The ROC curve analysis, showed a fair predictability of malaria for haemoglobin (AUC = 0.74, sensitivity = 76.0% and specificity  = 60.3%, cut-off  = 9.7g/dl), lymphocytes (AUC = 0.71, sensitivity = 71.3% and specificity  = 62.2%, cut-off  = 1.95×103/mm3), PDW (AUC = 0.69, sensitivity = 80.1% and specificity = 66.3%, cut-off  = 15.34 %) and haemozoin in the monocytes (AUC = 0.68, sensitivity = 68.2% and specificity = 65.2%, cut-off =5.5 %). CONCLUSION: RDW, PDW and HCL could be used to predict severe malaria in this setting.

Pregnant women carrying female fetuses are at higher risk of placental malaria infection.

BACKGROUND: The pathophysiology of the placental malaria is not fully understood. If there is a fetal sex-specific susceptibility to malaria infection, this might add to the previous knowledge on the immunology, endocrinology and pathophysiology of placental malaria infections. AIMS: This study was conducted to assess whether the sex of the fetus was associated with placental malaria infections. SUBJECTS AND METHODS: A cross-sectional study was performed including a secondary analysis of a cohort of women who were investigated for prevalence and risk factors (including fetal sex) for placental malaria in eastern Sudan. Placental histology was used to diagnose placental malaria infections. RESULTS: Among 339 women enrolled, the mean (SD) age was 25.8 (6.7) years and parity was 2.7 (2.2). Among the new born babies, 157 (46.3%) were male and 182 (53.7%) were female. Five (1.5%), 9 (2.7%) and 103 (30.4%) of the 339 placentas had active, active-chronic, past-chronic malaria infection on histopathology examination respectively, while 222 (65.5%) of them showed no malaria infection. Logistic regression analyses showed no associations between maternal age or parity and placental malaria infections. Women who have blood group O (OR = 1.95, 95% CI = 1.19-3.10; P = 0.007) and women who had female new born were at higher risk for placental malaria infections (OR = 2.55, 95% CI = 1.57-4.13; P< 0.001). CONCLUSION: Fetal gender may be a novel risk factor for placental malaria. In this work the female placentas were at higher risk for malaria infections than the male placentas.

Cervical cytopathological changes among women with vaginal discharge attending teaching hospital.

AIMS: To find cytology changes among women attending obstetrics and gynaecology clinic with complaints of vaginal discharges. SETTINGS AND DESIGN: This descriptive hospital-based cytological study was conducted at the outpatient clinic of the obstetrics and gynaecology department. MATERIALS AND METHODS: Two hundred women with complaints of vaginal discharge were selected. Their detailed histories were documented on a special request form. Pap smears were then obtained and sent for cytological examination to the cytopathology department. All low-grade squamous intraepithelial lesion (LSIL) cases were advised to follow-up with Pap smears in the next 6-12 months. Those with high-grade squamous intraepithelial lesion (HSIL) were further investigated by a cervical biopsy and managed accordingly. STATISTICAL ANALYSIS USED: The statistical analysis was performed using, the Statistical Package for Social Science (SPSS). Chi-square and cross-tabulation were used in this study. RESULTS: The cytological examination of Pap smears showed no changes (i.e. negative findings) in 88 (44%) cases, while Candida species infection was the most prevalent, which was found in 67 (33.5%) of the cases. Bacterial vaginosis was found in 39 women (19.5%); 6 women (3%) were reported with dyskaryotic changes. Two cases were found to have LSIL and 4 women had HSIL. CONCLUSION: Infection is common among the illiterate group of women. Women with vaginal discharges should undergo screening tests for evaluation by cervical smear for the early detection of cervical precancer conditions. There is an urgent need to establish a screening program for cervical cancer in Sudan.

CD20, CD3, placental malaria infections and low birth weight in an area of unstable malaria transmission in Central Sudan.

BACKGROUND: Malaria during pregnancy is the main cause of low birth weight (LBW) in the tropics. There are few studies concerning B and T lymphocyte infiltrates in placental malaria infections or their potential association with LBW babies. METHODS: A case-control study was conducted at the Medani Hospital, Central Sudan. Cases were women who had LBW deliveries (infants weighed < 2,500 g) and controls were parturient women with normal birth weight babies. Sociodemographic and medical characteristics were gathered from both groups of women using questionnaires. Cases and controls were investigated for malaria using microscopic blood film analysis, placental histology, and immunohistochemistry for detection of B (CD20) and T lymphocytes (CD3). RESULTS: The two groups (97 in each arm) were well matched in their basic characteristics. There were no malaria-positive blood films in either the cases or the controls. Twenty-nine (30.0%) vs. 24 (24.7%), P = 0.519 of the cases vs. the controls had placental malaria infections on histological examination. Three (3.1%), two (2.1%) and 24 (24.7%) vs. two (2.1%), two (2.1%) and 20 (20.6%) of the placentae showed evidence of acute, chronic and past malarial infections on histopathological examination of the two groups (case-control), respectively, while 68 (70.1%) vs. 73 (75.3%) of them showed no signs of infection; P = 0.420. Women with placental malaria infections had significantly fewer CD20 cell infiltrates [6 (11.3% vs. 95 (67.4%), P < 0.001)] and higher numbers of CD3 cell infiltrates [50 (94.3%) vs. 42 (29.8%), P < 0.001] than those without placental malaria infection. Logistic regression analysis showed that neither placental malaria infections nor CD3 or CD20 were associated with LBW. CONCLUSIONS: Significantly higher rates of CD3 T cells and lower rates of CD20 B cells were found in women with placental malaria infections compared with those without such infections. Neither placental malaria infection nor CD3 or CD20 are associated with LBW. VIRTUAL SLIDES: http://www.diagnosticpathology.diagnomx.eu/vs/6879723961063755.

Submicroscopic Plasmodium falciparum malaria and low birth weight in an area of unstable malaria transmission in Central Sudan.

BACKGROUND: Malaria, which frequently occurs in pregnant women in the tropics, is a leading cause of maternal anaemia and low birth weight (LBW) in infants. Few data exist concerning malaria infections that are present at submicroscopic levels during pregnancy and their LBW delivery in babies. METHODS: A case-control study (87 in each group) was conducted at the Medani Hospital, Central Sudan. Cases were women who had LBW deliveries where the infants weighed < 2,500 g. Controls were parturient women without having LBW babies. Obstetrical and medical characteristics were gathered from both groups through structured questionnaires. Both cases and controls were investigated for malaria using microscopic blood film analysis, placental histology and polymerase chain reaction (PCR). Microscopic and PCR analyses were conducted on maternal peripheral blood, placenta, and umbilical cord samples. Infant weights were recorded immediately after birth. RESULTS: Plasmodium falciparum-positive blood films were not obtained from any of the women (cases or controls). Twenty-seven (31.0%) versus 22 (25.3%) (P = 0.500) of the cases and controls, respectively, had placental malaria infections as determined by histological examination. In comparison to the controls, the submicroscopic malaria infection prevalence rates were significantly higher in the cases; 24 (27.6%) vs six (7.0%), P < 0.001. Multivariate analysis showed that while malaria infection of the placenta (based on histology) was not associated with LBW, submicroscopic P. falciparum infection (OR = 6.89, 95% CI = 2.2-20.8; P = 0.001), or a combination of histologically determined and submicroscopic infections (OR = 2.45, 95% CI = 1.2-4.9; P = 0.012), were significantly associated with LBW. CONCLUSION: In Central Sudan, pregnant women were at a higher risk of having an LBW delivery if they had submicroscopic infections rather than a histological diagnosis of placental malaria.

Decreased susceptibility to placental malaria in anaemic women in an area with unstable malaria transmission in central Sudan.

The interaction between iron level, iron supplementation, and susceptibility to infection, including malaria, remains a concern. A cross-sectional study was conducted at Medani hospital in central Sudan to investigate the relationship between anaemia and placental malaria. Obstetrical history was obtained; haemoglobin levels were determined. Placental tissue was obtained and malaria histology classified as active, chronic, past or no malaria infection. Among 324 women investigated, 7 (2·2%), 4 (1·2%), and 44 (13·6%) of the placentae showed active, chronic and past infection on histology examination respectively, while 269 (83·0%) of them showed no infection. Anaemia (haemoglobin <11 g/dl) was less frequent in women with placental Plasmodium falciparum infection, 27/55 (49·1%) vs 174/269 (64·7%), P=0·02. Anaemia was associated with a decreased risk for placental malaria, and the odds ratio for placental malaria (in both primiparae and multiparae group) was 0·2, 95% CI: 0·1-0·6, P=0·002 and it was 0·2, 95% CI: 0·03-0·7; P=0·02 for primiparae group. Thus, there is a strong relationship between anaemia and the absence of placental malaria.

Frequency of Candida species in Papanicolaou smears taken from Sudanese oral hormonal contraceptives users.

The aim of our study was to compare the numbers of Candida detected in Pap smears from Sudanese users of oral contraceptives (OCs) with non-users of OCs. The frequency of Candida observed in Pap smears was assessed among 158 Sudanese women of whom 108 were OCs users, subsequently termed cases, and the remaining 50 who were not OCs users, subsequently termed controls. Of the 158 smears, Candida were observed in 28 (17%) of the study subjects of whom 27 (25%) were OCs users compared to 1 (2%) among non-OCs users. We concluded that OCs may increase the number of Candida present, which suggests that OCs users may be more prone to infection by cervico-vaginal Candida compared to non-OCs users. The exact role of OCs use as a risk factor for candidiasis requires further assessment using a larger sample size and more precise mycological techniques.

Polymerase chain reaction and histology in diagnosis of placental malaria in an area of unstable malaria transmission in Central Sudan.

BACKGROUND: Prevalence of placental malaria has been widely used as a standard indicator to characterize malaria infection in epidemiologic surveys. Placental malaria poses a greater diagnostic challenge, accurate and sensitive diagnostic tool for malaria infections in pregnancy is needed. METHODS: A cross sectional study was conducted at Medani Hospital, which serves catchment area which is characterized by unstable malaria transmission. One hundred and seven placentae were investigated for malaria infection using polymerase chain reaction (PCR) and histology. RESULTS: out of 107 investigated placentae, 33 (30.8%) and 34 (31.8%) were positive for malaria by histology (two (2%) and 31(29.0%) were acute and past infections, respectively) and PCR, respectively. Out of 33 positive by histology, 15 were positive by the PCR while 18 were negative. The sensitivity of the PCR was 45.5% (95% CI: 29.2%- 62.5%). Out of 74 which were negative by histology, 19 were positive by the PCR. This is translated in specificity of 74.3% (95% CI: 63.5%- 83.3%). Of those tested positive by the PCR, 15 were positive by the histology, while 19 were negative. This is translated into a positive predictive value of 44.1% (95% CI: 28.3%- 61.0%). Of those 73 tested negative by the PCR, 55 were negative according to histology while 23 were positive. This is translated into a negative predictive value of 75.3% (95% CI: 64.5%-84.2%). CONCLUSION: PCR had low sensitivity and specificity in comparison to placental histology, perhaps because the vast majority of the placental infections were past infections. Further research is needed.