Publications by authors named "Mohamed Salih"

26 Publications

  • Page 1 of 1

Outcomes of diabetic patients with end-stage heart failure listed for heart transplantation: A propensity-matched analysis.

Clin Transplant 2022 Jan 12:e14590. Epub 2022 Jan 12.

Division of Heart Failure and Transplant, University of Iowa Hospitals and Clinics, Iowa, Iowa, USA.

Background: We investigated the current trends and outcomes of diabetic patients listed for heart transplants in the U.S. and provided a method for risk-stratification.

Methods: Using data from the United Network for Organ Sharing (UNOS), we identified heart failure patients listed for heart transplants between 2010 and 2019. Diabetic patients were propensity-matched with non-diabetics, and waitlist mortality as well as post-transplant graft survival were compared between the two groups. Further risk-stratification of diabetic patients was done based on the risk factors that independently predict graft failure.

Results: 28,928 adult patients (30% diabetic) with end-stage heart failure were added to the waitlist over the study period. In the propensity-matched cohort, waitlist mortality was higher in diabetic patients compared to non-diabetics (HR = 1.13 (95% CI = 1.04-1.22, P = .002). Over the study period, 5739 patients with diabetes were transplanted. In the propensity-matched cohorts of transplant recipients, the rate of graft failure was significantly higher for diabetic patients (23.3%) compared to non-diabetics (20.4%); HR = 1.17, 95% CI = 1.08-1.26, P < .001. We identified 12 risk factors of graft failure among diabetic patients and developed a risk score that further risk-stratify these patients. Diabetic patients at low risk (score≤4) had similar graft survival as patients without diabetes (HR = .91, 95% CI = .82-1.01, P = .06). On the other hand, high-risk diabetic patients had worse graft survival compared to non-diabetics (HR = 1.52, 95% CI = 1.38-1.67, P < .001).

Conclusion: Among patients with end-stage heart failure, pre-existing diabetes was associated with higher waitlist mortality and worse graft survival. However, with careful patient selection, graft survival is similar to those without diabetes.
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http://dx.doi.org/10.1111/ctr.14590DOI Listing
January 2022

Determinant factors for the occurrence of tuberculosis after initiation of antiretroviral treatment among adult patients living with HIV at Dessie Referral Hospital, South Wollo, Northeast Ethiopia, 2020. A case-control study.

PLoS One 2021 16;16(3):e0248490. Epub 2021 Mar 16.

Department of Adult Health Nursing, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.

Introduction: Globally, tuberculosis takes the first rank for the ill-health of people living with HIV/AIDS. Despite the favorable outcome of antiretroviral therapy, the risk of tuberculosis remains higher among HIV patients. This obliges to identify factors for its occurrence and further prevention of drug-resistant tuberculosis. There is a contradiction between different studies and studies conducted in Ethiopia studied poorly the association between adherence to antiretroviral therapy and viral load with tuberculosis. Studies conducted in the study area were limited to cross-sectional study design. Therefore, this study claimed to identify factors determining the occurrence of tuberculosis after initiation of antiretroviral therapy.

Methods: This study was conducted at Dessie Referral Hospital by using a case-control study design on a sample of 565 with a control: case ratio of 3:1. Participants from controls were selected by systematic random sampling and from cases by consecutive random sampling. The data were collected by interviewing through structured questionnaires and from the medical record. The data were entered into Epi data version 3.1. In the multivariable analysis, variables with a P-value of ≤0.05 were anticipated as independent determinant factors.

Result: Patients without separate kitchen (AOR: 3.547, 95% CI: 2.137, 5.888), having opportunistic infection (AOR: 3.728, 95% CI: 2.058, 6.753), CD4 count of <350 cells/mm3 (AOR: 3.383, 95% CI: 1.520, 7.528), baseline WHO stage III (AOR: 3.321, 95% CI: 1.688, 6.534) or IV (AOR: 2.900, 95% CI: 1.251, 6.722), don't taking IPT (AOR: 3.701, 95% CI: 2.228, 6.147) and those who were poorly adherent (AOR: 2.626, 95% CI: 1.272, 5.423) or moderately adherent (AOR: 3.455, 95% CI: 1.885, 6.335) to anti-retroviral therapy were more likely to develop tuberculosis after anti-retroviral therapy initiation.

Conclusion: Poor housing conditions, having an opportunistic infection, low CD4 count, starting ART at the advanced HIV stage, don't take IPT, and being poorly adherent to antiretroviral therapy were associated with the occurrence of TB after initiation of ART. The institution should screen for TB as early as possible and strictly follow their drug adherence.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0248490PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7963039PMC
October 2021

Molecular detection of human papillomavirus-16 among Sudanese patients diagnosed with squamous cell carcinoma and salivary gland carcinoma.

BMC Res Notes 2021 Feb 9;14(1):56. Epub 2021 Feb 9.

Mycetoma Research Center, University of Khartoum, Khartoum, Sudan.

Objective: Human papillomavirus (HPV) gained momentum as a potential etiological factor for many types of cancers. Therefore, the aim of this study was to assess the prevalence of HPV-16 infection among Sudanese patients diagnosed with Squamous Cell Carcinoma (SCC) and Salivary Gland Carcinoma. A descriptive, hospital-based study was conducted. 150 formalin-fixed paraffin-embedded blocks were collected.

Results: The study population included a total of 150 patients aged between 18 to 87 years with a mean age of 48.8 ± 11.9 years. Based on gender, females constituted 46.7% while males constituted 53.3%. The 150 patients were classified into 40 (26.0%) esophageal, 30 (20.0%) nasopharyngeal, 18 (12.0%) conjunctival, 18 (12.0%) tongue 12 (8.0%) laryngeal, 8 (5.3%) lip, 6 (4.0%) oropharyngeal, 6 (4.0%) mucoepidermoid, and 6 (4.0%) adenoid cystic, and 6 (4.0%) myoepithelial carcinomas. Odds ratio for male and female diagnosed with carcinoma was 1.025 [0.439-2.394, 95% CI]. Molecular detection of HPV-16 revealed a prevalence of 26 (17.3%) patients were positive for HPV-16. According to cancer diagnosis, esophageal SCC patients showed a high proportion of HPV-16; 14/40 (35.0%). A statistically significant difference was seen for the distribution of HPV-16 positive patients based on cancer diagnosis, P value 0.001.
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http://dx.doi.org/10.1186/s13104-021-05471-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7871554PMC
February 2021

Protective effect of metformin on rat diabetic retinopathy involves suppression of toll-like receptor 4/nuclear factor-k B expression and glutamate excitotoxicity.

Int Immunopharmacol 2021 Jan 25;90:107193. Epub 2020 Nov 25.

Department of Pharmacology and Toxicology, Faculty of Pharmacy, Suez Canal University, Ismailia 41522, Egypt; Department of Pharmacology and Toxicology, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia. Electronic address:

Microvascular complications of diabetes mellitus are progressively significant reasons for mortality. Metformin (MET) is considered as the first-line therapy for type 2 diabetes patients, and may be especially beneficial in cases of diabetic retinopathy although the precise mechanisms of MET action are not fully elucidated. The current study was designed to inspect the antioxidant and modulatory actions of MET on DRET in streptozotocin-induced diabetic rats. The effect of MET on the toll-like receptor 4/nuclear factor kappa B (TLR4/NFkB), inflammatory burden and glutamate excitotoxicity was assessed. Twenty-four male rats were assigned to four experimental groups: (1) Vehicle group, (2) Diabetic control: developed diabetes by injection of streptozotocin (60 mg/kg, i.p.). (3&4) Diabetic + MET group: diabetic rats were left for 9 weeks without treatment and then received oral MET 100 and 200 mg/kg for 6 weeks. Retinal samples were utilized in biochemical, histological, immunohistochemical and electron microscopic studies. MET administration significantly decreased retinal level of insulin growth factor and significantly suppressed the diabetic induced increase of malondialdehyde, glutamate, tumor necrosis factor-α and vascular endothelial growth factor (VEGF). Further, MET decreased the retinal mRNA expression of NFkB, tumor necrosis factor-α and TLR4 in diabetic rats. The current findings shed the light on MET's efficacy as an adjuvant therapy to hinder the development of diabetic retinopathy, at least partly, via inhibition of oxidative stress-induced NFkB/TLR4 pathway and suppression of glutamate excitotoxicity.
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http://dx.doi.org/10.1016/j.intimp.2020.107193DOI Listing
January 2021

Intermediate and Late Outcomes With PCI vs CABG for Left Main Disease - Landmark Meta-Analysis of Randomized Trials.

Cardiovasc Revasc Med 2021 02 2;23:114-118. Epub 2020 Sep 2.

Department of Cardiothoracic Surgery, Alpert Medical School, Brown University, RI, USA.

PCI to improve survival is currently recommended as a reasonable alternative to CABG in patients with unprotected left main disease. However, RCTs to support this recommendation has generated mixed results and recently published EXCEL trial has sparked debate about differences in late mortality. To address this point, we performed landmark meta-analysis of 4 RCTs with 5 year follow up data - EXCEL, NOBLE, PRECOMBAT and SYNTAX LEFT MAIN. Overall, there was no significant difference in all-cause mortality between PCI and CABG at 5 years (RR = 1.03 [95% CI = 0.79-1.33]). However, there was apparent change in the direction of association before and after the 1 year landmark that underscores the need for long term follow up in these trials. In addition, we found that PCI was associated with significantly lower rate of intermediate stroke at 1 year (RR = 0.44 [0.24-0.82]) but higher rate of late MI after 1 year (3.31 [2.11-5.18]) compared to CABG.
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http://dx.doi.org/10.1016/j.carrev.2020.08.040DOI Listing
February 2021

Maternal and neonatal outcomes associated with COVID-19 infection: A systematic review.

PLoS One 2020 4;15(6):e0234187. Epub 2020 Jun 4.

Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia.

Background: COVID-19 has created an extraordinary global health crisis. However, with limited understanding of the effects of COVID-19 during pregnancy, clinicians and patients are forced to make uninformed decisions.

Objectives: To systematically evaluate the literature and report the maternal and neonatal outcomes associated with COVID-19.

Search Strategy: PubMed, MEDLINE, and EMBASE were searched from November 1st, 2019 and March 28th, 2020.

Selection Criteria: Primary studies, reported in English, investigating COVID-19-positive pregnant women and reporting their pregnancy and neonatal outcomes.

Data Collection And Analysis: Data in relation to clinical presentation, investigation were maternal and neonatal outcomes were extracted and analysed using summary statistics. Hypothesis testing was performed to examine differences in time-to-delivery. Study quality was assessed using the ICROMS tool.

Main Results: Of 73 identified articles, nine were eligible for inclusion (n = 92). 67.4% (62/92) of women were symptomatic at presentation. RT-PCR was inferior to CT-based diagnosis in 31.7% (26/79) of cases. Maternal mortality rate was 0% and only one patient required intensive care and ventilation. 63.8% (30/47) had preterm births, 61.1% (11/18) fetal distress and 80% (40/50) a Caesarean section. 76.92% (11/13) of neonates required NICU admission and 42.8% (40/50) had a low birth weight. There was one indeterminate case of potential vertical transmission. Mean time-to-delivery was 4.3±3.08 days (n = 12) with no difference in outcomes (p>0.05).

Conclusions: COVID-19-positive pregnant women present with fewer symptoms than the general population and may be RT-PCR negative despite having signs of viral pneumonia. The incidence of preterm births, low birth weight, C-section, NICU admission appear higher than the general population.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0234187PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7272020PMC
June 2020

Aortic Valve Replacement for Severe Aortic Stenosis Before and During the Era of Transcatheter Aortic Valve Implantation.

Am J Cardiol 2020 07 9;126:73-81. Epub 2020 Apr 9.

Center for Heart Valve Disease, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.

Recent positive results of transcatheter aortic valve replacement (TAVI) in clinical trials have sparked debate on whether TAVI should be first line for all patients with aortic stenosis. However, limited evidence exists on the clinical impact of TAVI on a national level. Using the national inpatient sample (NIS) of hospital discharges in the United States from 2001 to 2016, we evaluated the rate of AVR and associated in-hospital outcomes in pre-TAVI and TAVI era. Hierarchical mixed effect modeling was used to assess for trend and calculate risk adjusted estimates. Annual volume of AVR increased from 49,357 in 2001 to 100,050 in 2016 (103% increase). Compared with the pre-TAVI era, mean annual change in volume of AVR was higher in the TAVI era (+2.9% vs +9.4%, respectively, p <0.001). In contrast, rate of in-hospital mortality decreased from 5.4% in 2001 to 2.7% in 2016 (50% decrease). Compared with the pre-TAVI era, magnitude of mean annual change in mortality was higher in TAVI era (-4.0% vs -6.7%, respectively, p = 0.04). Unlike SAVR for which risk-adjusted rate for most outcomes seems to have plateaued, TAVI demonstrated significant improvement from 2012 to 2016 for mortality (4.6% to 1.8%), acute kidney injury (15.1% to 2.6%) and nonroutine home discharge (63.6% to 44.6%). However, no significant change in the rate of stroke (2.4% to 2.1%) and pacemaker implantation remained high (8.1% to 9.4%). Lastly, median length of stay was shorter for TAVI compared with isolated SAVR (3 vs 8 days, respectively). In conclusion, the adoption of TAVI has led to increase in volume of AVR for severe aortic stenosis in the United States with favorable short-term outcome.
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http://dx.doi.org/10.1016/j.amjcard.2020.03.038DOI Listing
July 2020

Human umbilical cord-mesenchymal stem cells: a promising strategy for corneal epithelial regeneration.

Regen Med 2020 03 7;15(3):1381-1397. Epub 2020 Apr 7.

Regenerative Medicine Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, [email protected], Kepala Batas, Penang 13200, Malaysia.

As a strategy to improve the outcome of cultivated corneal epithelial transplantation, the role of human umbilical cord-derived mesenchymal stem cells (hUC-MSCs) is investigated in promoting corneal epithelial growth and functions. Human telomerase-immortalized corneal epithelial cells were characterized and its functions evaluated by scratch migration assay, cellular senescence, HLA expression and spheres formation with hUC-MSC. Expression of corneal epithelial markers was influenced by the duration and method of co-culture. Indirect co-culture improved cellular migration and delayed senescence when treated after 3 and 5 days. hUC-MSC downregulated expression of HLA Class I and II in IFN-γ-stimulated human telomerase-immortalized corneal epithelial cells. hUC-MSC promote corneal epithelial growth and functions after treatment with hUC-MSC.
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http://dx.doi.org/10.2217/rme-2019-0103DOI Listing
March 2020

A Concise Review on Mesenchymal Stem Cells for Tissue Engineering with a Perspective on Ocular Surface Regeneration.

Curr Stem Cell Res Ther 2020 ;15(3):211-218

Regenerative Medicine Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Penang, Malaysia.

Organ and tissue transplantation are limited by the scarcity of donated organs or tissue sources. The success of transplantation is limited by the risk of disease transmission and immunological- related rejection. There is a need for new strategies and innovative solutions to make transplantation readily available, safer and with less complications to increase the success rates. Accelerating progress in stem cell biology and biomaterials development have pushed tissue and organ engineering to a higher level. Among stem cells repertoire, Mesenchymal Stem Cells (MSC) are gaining interest and recognized as a cell population of choice. There is accumulating evidence that MSC growth factors, its soluble and insoluble proteins are involved in several key signaling pathways to promote tissue development, cellular differentiation and regeneration. MSC as multipotent non-hematopoietic cells with paracrine factors is advantageous for regenerative therapies. In this review, we discussed and summarized the important features of MSC including its immunomodulatory properties, mechanism of homing in the direction of tissue injury, licensing of MSC and the role of MSC soluble factors in cell-free therapy. Special consideration is highlighted on the rapidly growing research interest on the roles of MSC in ocular surface regeneration.
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http://dx.doi.org/10.2174/1574888X15666200129145251DOI Listing
December 2020

Radiological study of anatomical bony arrangement of the clubfoot deformity and its correlation with the Pirani clinical scoring system: A multicenter study.

Sudan J Paediatr 2019 ;19(2):101-109

Department of Paediatrics and Child Health, Faculty of Medicine University of Gezira, Wad Medani, Sudan.

Club foot or congenital talipes equinovarus (CTEV) is a common developmental disorder of the foot, affecting 1 per 1,000 live births. The main goal of this study is to evaluate the anatomical bony arrangement of the clubfoot deformity radiologically and to correlate this arrangement with the Pirani clinical scoring system. This descriptive, analytical study was conducted in three centres in Sudan. It recruited all the patients of both sexes with CTEV attending these centres, and excluding children on conservative cast and those who already had surgery. Data were collected using structured questionnaire. Pirani clinical scoring system, a reliable clinical assessment method, was applied. Four angles were used to measure each component of the deformity and correlate this with the Pirani score. Feet radiology was performed to assess the bone anatomy. The index cases number was 25 with male-to-female ratio of 1.6:1. Both feet were involved simultaneously in about half of the cases. Only the dorsoplanter (DP) and lateral (L) views talo-1st metatarsal angle was used to describe the forefoot adduction and mid-foot cavus, respectively. These correlated significantly with the clinical score of Pinari, whereas the other two measures for the equinus and varus did not. The results matched with the demographic description of the deformity found in the literature. Further studies are warranted that combine both the clinical assessment and the X-ray measurements in one score to classify the severity of the deformity and guide the management options.
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http://dx.doi.org/10.24911/SJP.106-1573461977DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6962271PMC
January 2019

Severe Right Atrial Dilation in a Case of Severe Rheumatic Mitral Stenosis.

Circ Cardiovasc Imaging 2020 01 20;13(1):e009562. Epub 2020 Jan 20.

Department of Cardiology, Cleveland Clinic Abu Dhabi, Heart and Vascular Institute, UAE (R.F., G.G., M.S., H.G., F.B.).

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http://dx.doi.org/10.1161/CIRCIMAGING.119.009562DOI Listing
January 2020

Drug Utilization Evaluation of Vancomycin among Patients in Jafar Ibn Auf Pediatric Hospital, 2018.

F1000Res 2019 1;8:1708. Epub 2019 Oct 1.

Department of Pediatrics, Faculty of Medicine, National Ribat University, Khartoum, Khartoum, 11111, Sudan.

Vancomycin is an antibiotic of growing importance in the treatment of hospital-acquired infections; with a particular emphasis on its value in the fight against Methicillin-resistant . Increasing reports of Vancomycin resistance have raised concerns about the effectiveness of this drug. Drug utilization evaluation has an important role in controlling rational use of antibiotics to prevent the emergence of resistance. We conducted a retrospective 6-months study at Jafar Ibn Auf pediatric hospital. Data including patient's demographics, diagnosis, Dosage regimen, and treatment duration were reviewed. The concordance of practice with the Hospital Infection Control Practices Advisory Committee (HICPAC) guidelines and principles of antibiotic therapy was assessed. 127 medical records were reviewed in this study. Sepsis (29%) and Pneumonia (19.6%) were the most common indications. Culture test was requested in 20.5% of patients. Monitoring of serum creatinine was carried in 81.1% of patients. Based on HICPAC guidelines vancomycin was administered appropriately in 67.7% percent of cases. Considering the infusion rate, most of patients with specific order were received vancomycin in 1 hour. The results showed that vancomycin was used empirically without subsequent adjustment of the antimicrobial agent according to culture and sensitivity data and lack of paying enough attention to the infusion rate and serum creatinine monitoring.
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http://dx.doi.org/10.12688/f1000research.19370.2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8579476PMC
October 2019

The differential effects of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) on seizure frequency in patients with drug-resistant epilepsy - A randomized, double-blind, placebo-controlled trial.

Epilepsy Behav 2018 10 28;87:32-38. Epub 2018 Aug 28.

Faculty of Medicine, University of Khartoum, Khartoum, Sudan; Lipidomics and Nutrition Research Centre, London Metropolitan University, London, UK; Sancilio Pharmaceuticals Company, FL, USA; Center of Molecular Biology and Biotechnology (CMBB), Florida Atlantic University (FAU), USA. Electronic address:

Objectives: The omega-3 (n-3) fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are known to play an important role in maintenance and modulation of neuronal functions. There is evidence that omega-3 fatty acids may have anticonvulsant effects. The effect of DHA and EPA on seizure rate in patients with drug-resistant epilepsy (DRE) was investigated.

Methods: A double-blind, randomized, placebo-controlled clinical trial included ninety-nine (n = 99) subjects with DRE, aged 5-16 years (n = 85) and 17-45 years (n = 14). After randomization, subjects were given two, four, or six capsules per day of DHA (417.8 mg DHA and 50.8 mg EPA/capsule, n = 33), EPA (385.6 mg EPA and 81.2 mg DHA/capsule, n = 33), or placebo (high oleic acid sunflower oil, n = 33) for one year. The primary endpoint was the effect of treatment on rate of seizure. Random-effects negative binomial regression models were fitted to model the patients' total count of seizures per month. The treatment effects on seizure incidence rate ratio (IRR) were tested after controlling for the covariate effects of gender, age, rate of seizure per week at enrollment, type of seizure, and number of antiepileptic drug (AED) combinations used at enrollment.

Results: Fifty-nine subjects (n = 59) completed the study (59.6%). The average number of seizures per month were 9.7 ± 1.2 in the EPA group, 11.7 ± 1.5 in the DHA group, and 16.6 ± 1.5 in the placebo group. Age, gender, and seizure-type adjusted seizure IRRs of the EPA and DHA groups compared with the placebo group were 0.61 (CI = 0.42-0.88, p = 0.008, 42% reduction) and 0.67 (CI = 0.46-1.0, p = 0.04, 39% reduction), respectively. There was no difference in IRR between the EPA and DHA groups (p = 0.56). Both treatment groups had a significantly higher number of seizure-free days compared with the placebo group (p < 0.05).

Significance: This study demonstrates that EPA and DHA are effective in reducing seizure frequency in patients with DRE.
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http://dx.doi.org/10.1016/j.yebeh.2018.08.016DOI Listing
October 2018

Major Threat to Malaria Control Programs by Plasmodium falciparum Lacking Histidine-Rich Protein 2, Eritrea.

Emerg Infect Dis 2018 03;24(3):462-470

False-negative results for Plasmodium falciparum histidine-rich protein (HRP) 2-based rapid diagnostic tests (RDTs) are increasing in Eritrea. We investigated HRP gene 2/3 (pfhrp2/pfhrp3) status in 50 infected patients at 2 hospitals. We showed that 80.8% (21/26) of patients at Ghindae Hospital and 41.7% (10/24) at Massawa Hospital were infected with pfhrp2-negative parasites and 92.3% (24/26) of patients at Ghindae Hospital and 70.8% (17/24) at Massawa Hospital were infected with pfhrp3-negative parasites. Parasite densities between pfhrp2-positive and pfhrp2-negative patients were comparable. All pfhrp2-negative samples had no detectable HRP2/3 antigen and showed negative results for HRP2-based RDTs. pfhrp2-negative parasites were genetically less diverse and formed 2 clusters with no close relationships to parasites from Peru. These parasites probably emerged independently by selection in Eritrea. High prevalence of pfhrp2-negative parasites caused a high rate of false-negative results for RDTs. Determining prevalence of pfhrp2-negative parasites is urgently needed in neighboring countries to assist case management policies.
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http://dx.doi.org/10.3201/eid2403.171723DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5823352PMC
March 2018

Phenotypic and Genotypic Analysis of Multidrug-Resistant Isolates from Sudanese Patients.

Tuberc Res Treat 2017 18;2017:8340746. Epub 2017 Jan 18.

Department of Microbiology, Faculty of Medical Laboratory Sciences, University of Khartoum, Khartoum, Sudan; Department of Microbiology and Parasitology, College of Medicine, University of Bisha, Bisha, Saudi Arabia.

Currently, mutations in , , and genes and promoter were considered to be involved in conferring resistance to rifampicin, isoniazid, and streptomycin in (MTB). The aims of this study were to detect the prevalence of first-line tuberculosis (TB) drug resistance among a group of previously treated and newly detected TB patients, to determine the association between prevalence of multidrug resistance (MDR) and demographic information (age and sex), to explain genes correlated with MDR , and to characterize MTB via 16S ribosomal RNA (16S rRNA) analysis. A hundred MTB isolates from Sudanese pulmonary TB patients were included in the study. The proportional method of drug susceptibility test was carried out on Löwenstein-Jensen media. Multiplex PCR of and genes and promoter was conducted; then genes were amplified by conventional PCR and were sequenced. The sequences of the PCR product were compared with known gene sequences in the GenBank database by multiple sequence alignment tools. The prevalence of MDR was 14.7% among old cases and 5.3% among newly diagnosed cases. Mutations in could be considered as a diagnostic marker.
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http://dx.doi.org/10.1155/2017/8340746DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5286464PMC
January 2017

Adult Intussusception.

Saudi J Med Med Sci 2017 Jan-Apr;5(1):65-66. Epub 2016 Nov 16.

Department of General Surgery, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia.

Adult intussusception is rare. We report the case of an elderly female patient with an ileocecal intussusception who underwent resection and ileocolic anastomosis. The histology revealed chronic inflammation of the ileum and cecum and there was no evidence of malignancy. There was no evidence of malignancy. The appendix showed fibrous obliteration of the lumen.
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http://dx.doi.org/10.4103/1658-631X.194254DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6298289PMC
November 2016

Immunizing nomadic children and livestock--Experience in North East Zone of Somalia.

Hum Vaccin Immunother 2015 12;11(11):2637-9. Epub 2015 Sep 12.

a UNICEF Eastern and Southern Africa Regional Office , Nairobi , Kenya.

Nomads and pastoralists represent around 30% of the population of North East zone of Somalia (Puntland) and have very limited access to basic health including immunization. During the 2013-2014 polio outbreak in Somalia, an increase number of polio cases notified health services among these underserved communities highlighted the urgent need to devise innovative strategies to reach them. Harnessing the high demand for veterinary services among pastoralist communities, the Ministry of Health and the Ministry of Livestock, with support from UNICEF, WHO and FAO launched an integrated human and animal vaccination campaign on 19 October 2014. Over 30 days, 20 social mobilizers conducted shelter to shelter social mobilization and interpersonal communication for nomadic/pastoralist hamlets, 20 human vaccination teams, accompanied by local community elders, traveled with animal vaccination teams to administer polio and measles vaccination to pastoralist communities in the 5 regions of Puntland. 26,393 children (0 to 10 years) received Oral Polio Vaccine (OPV) out of which 34% for the first time ever; 23,099 were vaccinated against measles. and 12,556 Vitamin A. Despite various operational challenges and a significantly higher operational cost of $6.2 per child reached with OPV, the integrated human and animal vaccination campaign was effective in reaching the unvaccinated children from nomadic and pastoralist communities of Somalia.
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http://dx.doi.org/10.1080/21645515.2015.1038682DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4685689PMC
August 2016

Candidate gene analysis supports a role for polymorphisms at TCF7L2 as risk factors for type 2 diabetes in Sudan.

J Diabetes Metab Disord 2015 1;15. Epub 2016 Mar 1.

Institute of Endemic Disease, University of Khartoum, P. O. Box 102 Khartoum, Sudan.

Background: Genetic susceptibility to type 2 diabetes (T2D) is multifactorial. A growing number of genes have been identified as risk factors for T2D across multiple ethnicities in trans-ancestry meta-analysis of large-scale genome-wide association studies. Few studies have looked at these genes in Sub-Saharan African populations. This study was undertaken to look for associations between T2D and single nucleotide polymorphisms (SNPs) in a number of the top candidate genes in a selected Sudanese population.

Methods: A total 240 T2D cases and 128 unrelated healthy control subjects were included in this study. Age, sex, weight and height were recorded, blood pressure and biochemical profiles of glucose and lipids were analysed. Single nucleotide polymorphism (SNP) genotyping was performed using the Sequenom MassARRAY® system. Fourteen SNPs were selected across 7 genes: CAPN10 (rs2975760 and rs5030952), PPARG (rs17036314 and rs1801282), IGF2BP2 (rs4402960 and rs1470579), CDKAL1 (rs9465871), HHEX (rs1111875), TCF7L2 (rs7903146, rs11196205 and rs12255372), and KCNJ11 (rs5215, rs1800467 and rs5219). Allelic and haplotype association analyses were performed under additive models in PLINK. P ≤ 0.007 (=0.05/7 genes) was the P-value required to achieve correction for multiple testing.

Results: A significant genetic association between the SNPs rs7903146 (odds ratio 1.69, 95 % confidence interval 1.21-2.38, P = 0.002) and rs12255372 (odds ratio 1.70, 95 % confidence interval 1.20-2.41, P = 0.003) at TCF7L2 and T2D was found in Sudanese population. These associations were retained after adjusting for age, sex and BMI (e.g. rs7903146: odds ratio 1.70, P adj:age/sex/BMI = 0.005). The strongest haplotype association (odds ratio 2.24; P adj:age/sex/BMI = 0.0003) comprised the two point haplotype T_C across rs7903146 and rs11196205. Stepwise logistic regression demonstrated that SNP rs7903146 added significant main effects to rs11196205 or rs12255372, whereas the reverse was not true, indicating that the main effect for association with T2D in this population is most strongly tagged by SNP rs7903146. Adjusted analyses also provided support for protection from T2D associated with minor alleles at SNPs rs2975760 at CAPN10 (odds ratio 0.44, 95 % confidence interval 0.20-0.97, P adj:age/sex/BMI = 0.042) and rs1111876 at HHEX (odds ratio 0.60, 95 % confidence interval 0.39- 0.93, P adj:age/sex/BMI = 0.022).

Conclusions: Multiethnic associations between T2D and SNPs at TCF7L2, CAPN10 and HHEX extend to Sub-Saharan Africa, specifically Sudan.
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http://dx.doi.org/10.1186/s40200-016-0225-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4774008PMC
March 2016

Insights into the possible role of IFNG and IFNGR1 in Kala-azar and Post Kala-azar Dermal Leishmaniasis in Sudanese patients.

BMC Infect Dis 2014 Dec 3;14:662. Epub 2014 Dec 3.

Institute of Endemic Disease, University of Khartoum, P. O. Box 102, Khartoum, Sudan.

Background: Little is known about the parasite/host factors that lead to Post Kala-azar Dermal Leishmaniasis (PKDL) in some visceral leishmaniasis (VL) patients after drug-cure. Studies in Sudan provide evidence for association between polymorphisms in the gene (IFNGR1) encoding the alpha chain of interferon-γ receptor type I and risk of PKDL. This study aimed to identify putative functional polymorphisms in the IFNGR1 gene, and to determine whether differences in expression of interferon-γ (IFNG) and IFNGR1 at the RNA level are associated with pathogenesis of VL and/or PKDL in Sudan.

Methods: Sanger sequencing was used to re-sequence 841 bp of upstream, exon1 and intron1 of the IFNGR1 gene in DNA from 30 PKDL patients. LAGAN and SYNPLOT bioinformatics tools were used to compare human, chimpanzee and dog sequences to identify conserved noncoding sequences carrying putative regulatory elements. The relative expression of IFNG and IFNGR1 in paired pre- and post-treatment RNA samples from the lymph nodes of 24 VL patients, and in RNA samples from skin biopsies of 19 PKDL patients, was measured using real time PCR. Pre- versus post-treatment expression was evaluated statistically using the nonparametric Wilcoxon matched pairs signed-rank test.

Results: Ten variants were identified in the 841 bp of sequence, four of which are novel polymorphisms at -77A/G, +10 C/T, +18C/T and +91G/T relative to the IFNGR1 initiation site. A cluster of conserved non-coding sequences with putative regulatory variants was identified in the distal promoter of IFNGR1. Variable expression of IFNG was detected in lymph node aspirates of VL patients before treatment, with a marked reduction (P = 0.006) in expression following treatment. IFNGR1 expression was also variable in lymph node aspirates from VL patients, with no significant reduction in expression with treatment. IFNG expression was undetectable in the skin biopsies of PKDL cases, while IFNGR1 expression was also uniformly low.

Conclusions: Uniformly low expression of IFN and IFNGR1 in PKDL skin biopsies could explain parasite persistence and is consistent with prior demonstration of genetic association with IFNGR1 polymorphisms. Identification of novel potentially functional rare variants at IFNGR1 makes an important general contribution to knowledge of rare variants of potential relevance in this Sudanese population.
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http://dx.doi.org/10.1186/s12879-014-0662-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4265480PMC
December 2014

Genistein improves liver function and attenuates non-alcoholic fatty liver disease in a rat model of insulin resistance.

J Diabetes 2009 Dec 21;1(4):278-87. Epub 2009 Jul 21.

Department of Biochemistry and Biotechnology, Rajah Muthiah Medical College, Annamalai University, Annamalai Nagar, Tamil Nadu, India.

Background: The high fructose-fed rat is widely used as a model of insulin resistance. Genistein, a soy isoflavone, has been shown to improve insulin sensitivity in this model. The present study investigated whether genistein could prevent fatty liver disease in this model.

Methods: Male Wistar rats were fed a diet containing starch (control) or 60% fructose (insulin-resistant model). Fifteen days later, rats in each dietary group were divided into two groups and were treated with either genistein (1 mg/kg per day) in dimethylsulfoxide (DMSO) or 30% DMSO alone. After 60 days, markers of liver injury, oxidative stress, interleukin (IL)-6, tumor necrosis factor (TNF)-α, lipids, lipoprotein profile, nitrite, and nitrosothiol in the plasma and liver were quantified. Liver sections were examined for 3-nitrotyrosine (3-NT) expression and pathological lesions.

Results: Fructose-fed rats displayed hyperlipidemia, significant changes in plasma lipoprotein profile, and increases in IL-6 and TNF-α levels compared with control. In addition, the accumulation of lipids, liver injury, a decline in liver function, inactivation of the glyoxalase system, depletion of antioxidants, and increased 3-NT expression were observed in the fructose-fed group. Administration of genistein to fructose-fed rats significantly reduced these biochemical and histological abnormalities.

Conclusions: Genistein activates the antioxidant profile, decreases IL-6 and TNF-α concentrations, prevents oxidative damage, and ameliorates fatty liver in insulin-resistant rats.
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http://dx.doi.org/10.1111/j.1753-0407.2009.00045.xDOI Listing
December 2009

Developing an integrated organ/system curriculum with community-orientation for a new medical college in jazan, saudi arabia.

J Family Community Med 2007 Sep;14(3):127-36

Medical Education Unit, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia.

Background: Jazan province is located in the south-west of the Kingdom of Saudi Arabia. The province is offlicted with a wide spectrum of diseases and therefore have a special need for more health services. The Faculty of Medicine at Jazan has been following the traditional curriculum since its inception in 2001. The traditional curriculum has been criticized because of the students inability to relate what they learned in the basic sciences to medicine, thus stifling their motivation. It was felt that much of what was presented in preclinical courses was irrelevant to what the doctor really needed to know for his practice. The College therefore, decided to change to an integrated curriculum.

Design: The study was conducted in 2004-2005 in the Faculty of Medicine, Jazan University. It began with a literature survey/search for relevant information and a series of meetings with experts from various institutions. A Curriculum Committee was formed and a set of guiding principles was prepared to help develop the new curriculum. A standard curriculum writing format was adopted for each module. It was decided that an independent evaluation of the new curriculum was to be done by experts in medical education before submission for official approval. There were several difficulties in the course of designing the curriculum, such as: provision of vertical integration, the lack of preparedness of faculty to teach an integrated curriculum, and difficulties inherent in setting a truly integrated examination.

Curriculum: The program designed is for 6 years and in 3 phases; pre-med (year 1), organ/system (years 2 and 3), and clinical clerkship (years 4, 5, and 6). This is to be followed by a year of Internship. The pre-med phase aims at improving the students' English language and prepare them for the succeeding phases. The organ/ system phase includes the integrated systems and the introductory modules. The curriculum includes elective modules, early clinical training, behavioral sciences, medical ethics, biostatistics, computer practice, and research methods. The curriculum provides active methods of instruction that include: small group discussion/ tutorials, problem-based learning (PBL), case-study/ clinical presentations, seminars, skills practice (clinical skill lab), practical, demonstration, and student independent learning. Methods of evaluating students include continuous and summative assessment.

Conclusion: The new curriculum adopted by the Jazan Faculty of Medicine is an integrated, organ/ system based, community-oriented, with early clinical skills, elective modules, and innovative methods of instructions.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3410155PMC
September 2007

Changing the prescribing patterns of sexually transmitted infections in the White Nile Region of Sudan.

Sex Transm Infect 2005 Oct;81(5):426-7

Department of Pharmacology, Faculty of Pharmacy, University of Khartoum, Sudan.

Background: The number of inappropriate prescriptions for sexually transmitted infections (STIs) in Sudan is suspected to be high. Simple multifaceted interventions directed at prescribers may improve prescribing patterns in the Sudan.

Objective: To evaluate the effect of multifaceted interventions on prescribing for STIs in the White Nile State, Sudan.

Methods: The study involved 20 health centres randomly assigned to four different multifaceted interventions to improve prescribing.

Results: Prescriber targeted interventions involving audit and feedback together with academic detailing and practice guidelines reduced the number of inappropriate prescriptions by 50% (p < 0.001). Audit and feedback together with seminars and practice guidelines reduced inappropriate prescriptions by 43% (p < 0.001). Audit and feedback alone reduced inappropriate prescriptions by 16% (p = 0.127).

Conclusion: Prescribing for STIs in the White Nile State of Sudan needs improving. Multifaceted interventions appear effective in improving prescribing.
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http://dx.doi.org/10.1136/sti.2004.014001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1745049PMC
October 2005

Prevalence of minor psychiatric illnesses among attendants of a Primary Health Care Center in Northwestern Saudi Arabia.

Neurosciences (Riyadh) 2005 Apr;10(2):186-7

Department of Family Medicine, North West Armed Forces Hospital, PO Box 100, Tabuk, Kingdom of Saudi Arabia. Tel. +966 (4) 4411088. Fax. +966 (4) 4412124. E-mail:

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April 2005

Prevalence of minor psychiatric morbidity among female teachers in girls secondary schools in tabuk city, saudi arabia.

J Family Community Med 2003 May;10(2):31-6

Department of Family Medicine, North-West Armed Forces Hospitals Programme, Tabuk, Saudi Arabia.

Objectives: Teachers are at the risk of developing minor psychiatric morbidity (MPM) because of the stressfulness of their job. This may lead to a significant decrease in their teaching effectiveness and to the development of serious health problems, if not detected early and managed appropriately. The objectives of this study were to determine the prevalence of MPM among female teachers in girls' secondary schools in Tabuk, and to analyze certain important associated demographic characteristics.

Methods: This was a cross-sectional study. First, a proportional cluster sample was selected randomly from the three sectors of schools in Tabuk, from which female teachers (198 out of a total of 517) in the selected schools were included in the study. Data on MPM and demographic characteristics were collected by means of the General Health Questionnaire 30 (GHQ30), a validated and extensively used instrument for identifying MPM RESULTS: Out of 198 participants, 187 completed the GHQ30 giving a response rate of 94.4%. The prevalence of MPM among them was 59.4% (111 participants). The variables with a statistically significant association with MPM were as follows: young age, nationality, positive participant psychiatric history, family history of medical and/or psychiatric problems, and divorced and widowed. No statistically significant associations were found with participants' medical problems or their mental status, either single or married, housing type, monthly income, the number of children in a family, and the number of family members.

Conclusion: The finding of a high prevalence of MPM (59.4%) indicates that all participants may be at risk. Hence, appropriate and timely management, as well as social support are needed. Studies focusing on the causes and how to manage them will also be required.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3425764PMC
May 2003

Does the management of bronchial asthma by family physicians meet standards of the national protocol?

J Family Community Med 2002 Sep;9(3):21-5

North-West Armed Forces Hospital, Tabuk, Saudi Arabia.

Objectives: Asthma is a common disease that is sometimes fatal. Its prevalence, morbidity and mortality are increasing. The objective of this paper was to evaluate the proficiency of primary care physicians in general knowledge, diagnosis, classification of severity and management of asthma along the guidelines of the Saudi National Asthma Protocol, and to analyze the association of their proficiency level with certain professional standards.

Methods: This was a cross-sectional study conducted in the Department of Family Medicine and the Main Air Base Clinic at the North-West Armed Forces Hospital in Tabuk City, Saudi Arabia from the 1(st) to the 29(th) of June 2001. All 44 primary care physicians working there at the time were enrolled in the study. A self-administered true/false questionnaire prepared by the Saudi National Asthma Scientific Committee was completed by all physicians. The Passing score was ≥ 50%.

Results: Only 39% of the physicians passed the test as a whole, with 66% passed in general knowledge, 70% in diagnosis, 48% in the classification of severity and 59% in the management of asthma. There was an association between significant achievement and Family Medicine Board Certification as well as some knowledge of the National Asthma Protocol (p ≥ 0.05). No association was observed with attendance of asthma training courses. There was positive significant correlation between the knowledge score, the management scores and the total scores of physicians.

Conclusion: The level of awareness of the National Asthma Protocol among the primary care physicians was low (52%). Their proficiency in general knowledge, diagnosis, classification of severity and management was also low. A higher standard was associated with Family Medicine Board Certification. Further studies to identify the reasons for these deficiencies need to be carried out so that measures could be taken to rectify the situation.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3430164PMC
September 2002
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