Mustafa I. Elbashir

Background: The association between physical activity and vitamin D status is not yet fully understood. This study aims to investigate the prevalence of physical inactivity and its associated factors, including serum 25-hydroxyvitamin D (25[OH]D) concentration, among adolescents in Northern Sudan. Methods: A school-based cross-sectional study was conducted in Almatamah, River Nile State, Sudan, and a questionnaire was used to collect sociodemographic data. Standardized methods were used to measure physical activity and serum 25(OH)D levels. Physical activity was expressed as metabolic equivalent minutes per week (MET-min/week). A multivariate binary regression was performed. Results: Three hundred and thirteen adolescents [159 (50.8%) males and 154 (49.2%) females] were enrolled in the study. The median (interquartile, IQR) values for age, 25(OH)D, and physical activity were 15.1 (14.0–16.2) years, 20.2 (9.6–31.2) ng/mL, and 1080 (495–3360) MET-min/week, respectively. The median (IQR) physical activity score was higher in males than in females [3287.5 (1680.0–4659.0) MET-min/week vs. 495.0 (314.3–990.0) MET-min/week]. Of the enrolled adolescents, 220 (70.3%) had inadequate physical activity levels (<3000 MET-min/week). Serum 25(OH)D level was significantly lower in adolescents with inadequate physical activity than in those with adequate physical activity levels [17.7 (7.8–28.0) ng/mL vs. 26.4 (17.3–36.8) ng/mL]. In the multivariable binary analysis, female sex (adjusted odds ratio [AOR]: 35.0; 95% CI: 13.89–88.08), a lower paternal education level (AOR: 2.812; 95% CI: 1.39–5.70), and having a skilled father (AOR: 2.08; 95% CI: 1.05–4.12) were factors associated with inadequate physical activity among adolescents, whereas 25(OH)D levels were inversely associated with insufficient physical activity (AOR: 0.97; 95% CI: 0.95–0.99). Conclusions: Interventions are needed to address the high level of physical inactivity among adolescents in Northern Sudan, particularly among girls. Programs that promote physical activity both at home and school help ensure that children and adolescents maintain adequate physical activity and 25(OH)D levels.

The level of association between 25-hydroxyvitamin D (25[OH]D) levels and students’ academic performance has not yet been established. The current study aimed to investigate the association between serum 25(OH)D levels and academic performance among schoolchildren in Sudan. A cross-sectional study was conducted among schoolchildren during the 2021/2022 academic year from four randomly selected schools in Almatamah, River Nile State, northern Sudan. Sociodemographic data were collected using a questionnaire. Anthropometric measurements were performed in accordance with standard procedures. Academic performance was obtained from school records. Serum 25(OH)D levels were measured, and regression (multiple linear regression and multivariate logistic) analyses were performed. A total of 241 participants were enrolled in this study, of whom 129 (53.5%) were female. The mean standard deviation (SD) of the participants’ ages was 15 ± 1.6 years. In multiple linear regression tests, being female, age, employment, and serum 25(OH)D level were positively associated with academic performance. The average overall academic score was 33.74%. Of the 241 participants, 95 (39.4%) and 149 (61.6%) had good and poor academic performances, respectively. In multivariable logistic regressions, age and 25(OH)D level were inversely associated with poor academic performance and vitamin D deficiency was associated with poor performance. The current study revealed a positive association between 25(OH)D levels and adolescents’ academic performance. Effective interventional programs are needed to maintain sufficient vitamin D levels during childhood and adolescence and, as a consequence, to improve academic performance.

Background: Preeclampsia is a global health problem and it is the main cause of maternal and perinatal morbidity and mortality. Breastfeeding has been reported to be associated with lower postpartum blood pressure in women with gestational hypertension. However, there is no published data on the role that breastfeeding might play in preventing preeclampsia. The aim of the current study was to investigate if breastfeeding was associated with preeclampsia in parous women. Method: A case-control study was conducted in Saad Abualila Maternity Hospital in Khartoum, Sudan, from May to December 2019. The cases (n = 116) were parous women with preeclampsia. Two consecutive healthy pregnant women served as controls for each case (n = 232). The sociodemographic, medical, and obstetric histories were gathered using a questionnaire. Breastfeeding practices and duration were assessed. Results: A total of 98 (84.5%) women with preeclampsia and 216 (93.1%) women in the control group had breastfed their previous children. The unadjusted odds ratio (OR) of preeclampsia (no breastfeeding vs breastfeeding) was 3.55, 95% confidence interval (CI) 1.64,7.70 and p value = 0.001 based on these numbers. After adjusting for age, parity, education level, occupation, history of preeclampsia, history of miscarriage, body mass index groups the adjusted OR was 3.19, 95% CI 1.49, 6.82 (p value = 0.006). Conclusion: Breastfeeding might reduce the risk for preeclampsia. Further larger studies are required.

Background: Dengue fever (DF) is an arthropod-borne disease caused by dengue virus (DENV). DENV is a member of the genus Flavivirus in the family Flaviviridae. Recently, DENV has been reported as an important emerging infectious viral pathogen in Sudan. Multiple outbreaks and sporadic cases of DF have been frequently reported in the eastern region of Sudan. The present study was conducted to confirm DENV outbreak in Kassala State, eastern Sudan, 2019, and to provide some information on the molecular characterization of the DENV isolate associated with the disease outbreak. Methods: A hundred serum samples were collected during the outbreak from residents of Kassala State, Sudan, 2019. ELISA was used to detect DENV non structural protein NS1 (DENV-NS1) in acute phase sera sampled during the disease outbreak. RT-PCR assays were used to amplify a fragment of the capsid/pre-membrane region (CprM) of the viral polyprotein gene. The PCR products of the amplified CprM region of the viral polyprotein gene were purified and partial sequences were generated and used to confirm the specificity of DENV sequences and to identify the virus serotype. Phylogenetic tree was constructed to determine the genotype of DENV associated with the outbreak. Results: Using DENV-NS1 ELISA assay, DENV infection was confirmed in 23% sampled sera. The detection of DENV RNA was made possible using group-specific RT-PCR assay. The virus was serotyped as DENV serotype 3 (DENV-3) using DENV serotype-specific RT-PCR assay. Phylogenetic analysis of the partial CprM sequences of the viral polyprotein gene indicates that the virus belonged to genotype III of DENV-3. Conclusion: The scientific data presented in this investigation confirmed that genotype III of DENV-3 was associated with the disease outbreak in eastern Sudan, 2019. The study represents the first report on molecular characterization of DENV-3 in Sudan.

Infantile neuroaxonal dystrophy (INAD) is a rare hereditary neurological disorder caused by mutations in PLA2G6. The disease commonly affects children below 3 years of age and presents with delay in motor skills, optic atrophy and progressive spastic tetraparesis. Studies of INAD in Africa are extremely rare, and genetic studies from Sub Saharan Africa are almost non-existent. Two Sudanese siblings presented, at ages 18 and 24 months, with regression in both motor milestones and speech development and hyper-reflexia. Brain MRI showed bilateral and symmetrical T2/FLAIR hyperintense signal changes in periventricular areas and basal ganglia and mild cerebellar atrophy. Whole exome sequencing with confirmatory Sanger sequencing were performed for the two patients and healthy family members. A novel variant (NM_003560.2 c.1427 + 2 T > C) acting on a splice donor site and predicted to lead to skipping of exon 10 was found in PLA2G6. It was found in a homozygous state in the two patients and homozygous reference or heterozygous in five healthy family members. This variant has one very strong (loss of function mutation) and three supporting evidences for its pathogenicity (segregation with the disease, multiple computational evidence and specific patients’ phenotype). Therefore this variant can be currently annotated as “pathogenic”. This is the first study to report mutations in PLA2G6 gene in patients from Sudan.

It has been reported that patients with SCD do have an abnormal coagulation profile. Coagulopathy is thought to be one of the key factors that contribute to the vaso-occlusive crisis that characterises sickle cell disease (SCD). In this study, we investigated whether Sudanese sickle cell patients have an abnormal coagulation profile. In addition, the effect of treatment with either omega-3 fatty acids or hydroxyurea on coagulation profile was assessed. Homozygous SCD patients untreated (n = 52), omega-3 treated (n = 44), hydroxyurea (HU) treated (n = 8) and healthy (HbAA) controls (n = 52) matched for age (4–20 years), gender and socioeconomic status were enrolled. Patients on omega-3 fatty acids, according to age, received one to four capsules containing 277.8 mg DHA and 39.0 mg eicosapentnoic. Patients on Hydroxyurea were in on dosage more than 20 mg/kg/day. The steady state levels of the coagulation parameters and the effect of the treatments with either HU or omega-3 fatty acids on markers of coagulation were investigated. Compared to the healthy controls, treated and untreated HbSS patients had lower hemoglobin, plasma Protein C, proteins S and higher white blood cell count (WBC), platelets count (PLTs) and plasma D-dimer levels,(p < 0.05). In comparison to untreated HbSS, treatment with neither omega-3 nor HU had effect on the WBC, plasma proteins C and S, (p > 0.05). HU treated group had a lower PLTs count compared to HbSS untreated group (p < 0.5). The prothrombin and activated partial thromboplastin times and international normalized ratio (INR) of untreated patients are significantly higher than n-3 treated, HU-treated patients and health controls, (p < 0.05). Patients treated with omega-3 had lowered D-dimer levels in comparison to HU-treated and untreated HbSS patients, (p < 0.001). This study provides evidence that Sudanes patients have abnormal coagulation profile and treatment with either HU or omega-3 fatty acids might partially ameliorate SCD-associated chronic coagulopathic state.

Blood platelet levels are being evaluated as predictive and prognostic indicators of the severity of malaria infections in humans. However, there are few studies on platelets and Plasmodium falciparum malaria during pregnancy.

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.

Background: Maternal immunity is thought to play a major role in the increased susceptibility of pregnant women toPlasmodium falciparummalaria. Few studies exist on immunohistochemical characterization of the placental inflammatory infiltrate. The current study was conducted in Gadarif hospital in an area characterized by unstable malaria transmission in eastern Sudan.Method: Ninety three placentae were investigated for malaria histological changes and immunohistochemical study for monocytes and macrophages (CD68).Results: While 1(1.1%), 2(2.2%) and 20(21.5%) of the 93 placentae had acute, chronic and past malaria infections, 70(75.2%) had no malaria infections. Monocytes and macrophage (CD 68) were detected in 29 (31.2%) of these 93 placentae. Significantly higher rate of monocytes and macrophage were detected in placentae with malaria infections [11/23 (47.8%) vs. 18/70 (25.7%);P= 0.047] especially in placentae with past malaria infections. Placental malaria infections and monocytes and macrophages cells infiltration were not different between primiparae and multiparae. There was no significant difference in the birth weight between the women with placental malaria infections/monocytes and macrophages cells infiltration and those who had no placental malaria infections/cellular infiltrations.Conclusion: Significantly higher rate of monocytes and macrophage were detected in placentae with malaria infections. Neither placental malaria infections nor cellular infiltrates were associated with parity or lead to reduction of birth weight.

Placental malaria and pre-eclampsia occur frequently in women in tropics and are leading causes of maternal and perinatal morbidities and mortality. Few data exist concerning the interaction between placental malaria and pre-eclampsia.