Despite its usefulness in the diagnosis of tuberculous lymphadenitis, fine needle aspiration cytology (FNAC) faces several limitations, and its sensitivity and specificity are not well established. The diagnostic accuracy and limitations of FNAC were studied in comparison with conventional microbiological methods and polymerase chain reaction (PCR). Sixty patients with lymphadenopathy and a clinical diagnosis of tuberculous lymphadenitis were subjected to FNA. The aspirate was used for cytological examination, Ziehl-Neelsen staining, mycobacterial culture and PCR. PCR was performed using two sets of oligonucleotide primers for Mycobacterium tuberculosis and a single primer for M. bovis species. The results of FNAC, microbiological methods and PCR correlated with the clinical outcome after follow-up for an average period of 24 months. Twenty-five cases (41.6%) were treated and responded well to anti-tuberculosis therapy, among them 17 were correctly diagnosed by FNAC (68%), eight by microbiological methods (32%) and 24 by PCR (96%). When PCR is considered the gold standard, FNAC predicted the correct diagnosis in 62% of cases with a high false negative rate (38%) due to the absence of granuloma/necrosis in smears from cases of early tuberculosis. In the latter group PCR proved to be the most valuable and a diagnostic success of 100% was achieved when FNAC and PCR were combined. In addition, PCR allowed immediate characterization of M. tuberculosis in the vast majority (96.2%) of cases in the study population.

Viral sequences analyzed indicate recent virus movement and support the need for surveillance.

Malarial splenic rupture (MSR) occurs in a subset of patients and can be an acute surgical emergency. MSR is a well-known entity for more than 100 years, yet there are no well-structured studies in the literature that systematically evaluate this complication. While it has become increasingly recognized that splenic salvage can be vital to the long term immunity and health of these patients, there are few data to guide a safe approach to non-operative management of these patients. Current knowledge of spontaneous rupture of the spleen has been gained largely though reported cases. We present 2 cases of MSR and a review of the literature of the management of MSR. We present an algorithm for the management of MSR. Of the 60 cases of MSR in the literature 31 were managed with splenectomy, 21 were managed non-operatively, and 8 early deaths occurred during initial presentation. The most common presenting symptoms were fever (67%) and abdominal pain (51%). Seventy-two percent of patients were hypotensive and tachycardic on presentation. Fifteen (71%) of 21 patients had successful non-operative management for MSR. Of the six patients that failed non-operative treatment, 4 patients eventually needed splenectomy, and 2 patients died without operation. We recommend that patients presenting with fever, abdominal pain, hypotension, and spenomegaly receive urgent resuscitation, ultrasonography (where available) to evaluate for blood in the abdomen, and surgical consultation. Patients who are hemodynamically stable before or after resuscitation can be selectively chosen for non-operative management.

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PurposeSince 1980s, human enterovirus-71 virus (HEV-71) is one of the common infectious disease in Asian Pacific region since late 1970s without effective commercial antiviral or protective vaccine is unavailable yet. The work examines the role of vaccine adjuvant particle size and the route of administration on postvaccination antibody response towards HEV-71 vaccine adsorbed to calcium phosphate (CaP) adjuvant.Materials and MethodsFirst, CaP nano-particles were compared to a commercial micro-size and vaccine alone. Secondly, intradermal reduced dosage was compared to the conventional intramuscular immunization. Killed HEV-71 vaccines adsorbed to CaP nano-size (73 nm) and commercial one of micro-size (1.7 µm) were administered through intradermal, intramuscular, rabbits received vaccine alone and unvaccinated animals.ResultsCaP nano-particles adsorbed HEV-71 vaccine displayed higher antibody than the micro-size or unadsorbed vaccine alone, through both parenteral immunization routes. Moreover, the intradermal route (0.5 µg/mL) of 0.1-mL volume per vaccine dose induced equal IgG antibody level to 1.0-mL intramuscular route (0.5 µg/mL).ConclusionThe intradermal vaccine adsorbed CaP nano-adjuvant showed safer and significant antibody response after one-tenth reduced dose quantity (0.5 µg/mL) of only 0.1-mL volume as the most suitable protective, cost effective and affordable formulation not only for HEV-71; but also for developing further effective vaccines toward other human pathogens.

Objective To assess whether the extent of female genital mutilation (FGM) influences the risk of acquiring sexually transmitted infections (STIs).Design Hospital-based case-control study.Setting Two obstetric/gynaecological outpatient clinics in Khartoum, Sudan, 2003Sudan, -2004 Population A total of 222 women aged 17-35 years coming to antenatal and gynaecological clinics.Methods Women recruited for the study were divided into cases with seropositivity for Neisseria gonorrhoeae (gonococcal antibody test), Chlamydia trachomatis (enzyme immunoassay) or Treponema pallidum (Treponema pallidum haemagglutination assay) (n = 26) and controls without antibodies to these species (n = 196). Sociodemographic data were obtained and physical examination including genital examination was performed in order to classify the form of FGM. Cases and controls were compared using logistic regression to adjust for covariates.Main outcome measures Extent of FGM and seropositivity for C. trachomatis, N. gonorrhoeae or T. pallidum.Results Of the cases, 85% had undergone the most severe form of FGM involving labia majora compared with 78% of controls (n.s.). Thus, there was no association between serological evidence of STIs and extent of FGM. The only factor that differed significantly between the groups was the education level, cases with STIs having significantly shorter education (P = 0.03) than controls.Conclusions There is a little difference between cases and controls in regard to FGM. Having in mind the relatively small sample size, the results still indicate that FGM seems neither to be a risk factor for nor protective against acquiring STIs. This is important as argument against traditional beliefs that FGM protects against pre/extramarital sex.

BackgroundThis study was carried out to detect human cytomegalovirus (HCMV) IgG and IgM antibodies using an Enzyme-linked immunosorbent assay (ELISA) in renal transplant patients in Khartoum state, Sudan and to improve the diagnosis of HCMV through the introduction of Real-time Polymerase Chain Reaction (PCR) testing. A total of 98 plasma samples were collected randomly from renal transplant patients at Ibin Sina Hospital and Salma Centre for Transplantation and Haemodialysis during the period from August to September 2006.ResultsAmong the 98 renal transplant patients, 65 were males and 33 females. The results revealed that HCMV IgG was present in all patients' plasma 98/98 (100%), while only 6/98 (6.1%) had IgM antibodies in their plasma. HCMV DNA viral loads were detected in 32 patients 32/98 (32.7%) using Real-time PCR.ConclusionsThe HCMV IgG results indicate a high prevalence of past HCMV infection in all tested groups, while the finding of IgM may reflect a recent infection or reactivation. HCMV detection by real-time PCR in the present study indicated a high prevalence among renal transplant patients in Khartoum. In conclusion, the prevalence of HCMV in Khartoum State was documented through detection of HCMV-specific antibodies. Further study using various diagnostic methods should be considered to determine the prevalence of HCMV disease at the national level.

In its occult form, hepatitis B virus infection can only be detected using molecular techniques such as polymerase chain reaction, increasing the cost of the screening process. Certain population subgroups are considered to have a higher risk of transmission and reactivation of occult hepatitis B virus infection (OBI). This review aims to estimate the prevalence of OBI among these high-risk groups in Sudan. It was conducted under the PRISMA guidelines, targeting the literature available in MEDLINE/ PubMed, ScienceDirect, Google Scholar, and Cochrane Library databases. Full-text articles published in the last 10 years that provide prevalence estimates of OBI in Sudan were examined for fulfillment of eligibility criteria. Quality assessment of selected articles was performed using the critical appraisal tool reported by Munn et al. Publication bias was assessed by visual examination of the funnel plot. Metaanalysis using the random-effects model with 95% confidence interval was used to calculate the overall and subgroup pooled prevalence of OBI. Literature search yielded a total of 717 studies, of which only 11 articles fulfilled all selection criteria. The overall pooled prevalence of OBI was found to be 15.51%, with a high level of heterogeneity. Subgroup analysis demonstrated a prevalence of 16.48% among blood donors, 13.36% among hemodialysis patients, and 12.59% among febrile patients. Evidence for possible publication bias was detected. This review provides crucial evidence for health authorities in Sudan, outlining the necessity for re-evaluation of the current screening strategies, especially among these high-risk groups.