المقالات العلمية – كلية الطب
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Item Rheumatoid arthritis and anti-CCP(Al Neelain Medical Research Centre, 2011) Ahmed Bolad, Yousif Osman; Shaaban KhudairItem Diagnostic value of Autoantibodies to GAD65 and IA-2 in Patients with Latent Autoimmune Diabetes in Adult (LADA)(Omdurman Islamic University, 2011) Ahmed Bolad, Razan Abdelmageed; Mustafa Khidir ElnimeiriBackground: Latent autoimmune diabetes in adults (LADA) accounts for 11% of all cases of diabetes and often misdiagnosed as type 2diabetes. LADA resembles type 1diabetes and shares common physiological characteristics of type 1 but it does not affect children and has been classified distinctly as being separate from juvenile diabetes. Autoantibodies against glutamic acid decarboxylase 65 (GADA) and tyrosine phosphatase (IA-2) are found frequently in patients with LADA. The presence of these autoantibodies in LADA predicts inevitable β cell failure and poor response to oral hypoglycemic therapy i.e., patients with LADA do not respond to oral hypoglycemic therapy. Objective: To determine an immunological marker to diagnose patients not responding to oral hypoglycemic therapy. Patients and methods: A facility-based cross sectional study was conducted in Jabbir Abu Eliz Diabetes Center, located at Khartoum 2. Venous blood samples were obtained from the study patients. They were divided into three groups, group1 included 27 diabetic patients treated with insulin, group2 included 15 diabetic patients of type 2 diabetes as controls, and group3 included 15 newly diagnosed patients older than 35 years at onset of diabetes. A standardized pre-tested administered questionnaire was used for data collection and the collected data were analyzed. Results: Males encountered in the study were 28 (49.1%). On patient recently diagnosed to have type 2 diabetes mellitus (T2DM) was positive for autoantibodies to GDA/IA-2. These autoantibodies were also positive in 15 patients with diabetes mellitus type 1 (T1DM) Conclusions: Autoimmune diagnostics is of particular importance in adults to discriminate between type 1 and type 2 diabetes and to assess the diagnosis of latent autoimmune diabetes in adults. The current study results revealed that autoantibodies to GAD/IA-2 are good marker for diagnosis of latent onset DM type 1. On the other hand, data indicate that the vast majority of cases of type 1 diabetes may be considered as immune-mediated, that multiple autoantibody to GAD/IA-2 analysis are of prognostic value to predict complications e.g., retinopathy. The current study recommends using of anti-GAD/IA-2 antibodies as marker for diagnosis of latent autoimmune diabetes in adults (LADA) who are not responding to oral hypoglycemic and may be at risk for getting complications. On the other hand, the study recommends using of anti-GAD/IA-2 antibodies for prognosis of the clinical progression of diabetes type 1 for prediction of insulin dependence.Item Sequestrated Plasmodium falciparum parasites in human infections: different genotype distribution in placental as compared to that in the peripheral circulation(Al Neelain Medical Research Centre, 2011) Ahmed Bolad, Alamin Abdulkareem Alamin,; Imad Mohammed Fadl-ElmulaABSTRACT Introduction: In regions highly endemic for malaria, the prevalence of placental malaria ranges from 30% to 60% and has been associated with increased risk of adverse infant outcomes, particularly in primigravidae. Objectives: The study was conducted on mothers after delivery to detect sequestered Plasmodium falciparum (P. falciparum) parasite by using PCR based genotyping technique. Materials and methods: The study was conducted during the period of January 2009 to September 2011. 5ml of venous and placental blood were obtained from 75 mothers after delivery, attended to Omdurman Maternity Hospital. Genomic DNA was extracted from peripheral and placental blood samples using modified phenol chloroform technique. The msp-1 allele (MAD20,) and msp-2 allele A1, A2, B1 and B2, plasmodium falciparum primers were used for PCR. The PCR product was analyzed on 1.5% Agarose gel and visualized by gel documentation system after ethidium bromide staining. Results: The results revealed that the overall malaria detection rate in peripheral blood and placental blood using ICT was 10.7%. With the PCR (msp-1 alleles) the detection rate of malaria in peripheral blood was found to be 9.3%, while in placental blood the same technique showed a detection rate of 10.7%. For PCR (msp-2 alleles), the detection rate of malaria in peripheral blood was 12%, while in placental blood the same technique showed detection rate of 21.3% malaria. Conclusion: In the vast majority of cases, some sequestered genotypes remain hidden, undetected in the peripheral circulation, indicating that analysis of peripheral parasites generates a partial picture of a P. falciparum infection. The cord blood must be collected from the umbilical cord to detected placental P. falciparum infection particularly in primigravidaeItem Prevalence of Schistosomiasis among School Children-South Kordofan State(Al-Neelain Medical Research Centre, 2012) Ahmed Bolad, Mustafa Khidir; Mustafa ElnimeiriItem Cytokines as Immunological Markers for Follow up of Disease Activity During the Treatment of Pulmonary Tuberculosis(Omdurman Islamic University, 2012) A Bolad, A Elhaj, A ElagibBackground: Cytokines play a major role in protection against Mycobacterium tuberculosis infection and regulate the immune responses at a cellular level. Cytokine profile determines clinical outcome of the disease and responses to treatment as well. A T helper 1 (Th1) cytokine interferon gamma (IFN-U) is one of the most important cytokines which activate the macrophages to produce tumor necrosis factor-alpha (TNF-V). Excessive production of TNF-V have been implicated in immunopathogenesis of tuberculosis. A T helper 2 (Th2) response leads to release of IL-4, and IL-10 promoting an anti-inflammatory macrophage response. Interleukin-4(IL-4), has been implicated to down-regulate IFN-U, and thus has a harmful effect on TB patients. IL10 cytokine has the capacity to inhibit Th1 activation and thus terminates cell mediated immune responses. Objective:The objective of the present study was to determine Th1 and Th2 cytokine profile in patients with tuberculosis to identify immunological marker for follow up of the disease activity, and to study the outcome of treatment. Methods: To examine this, blood samples were collected from newly diagnosed HIV negative pulmonary tuberculosis patients and from apparently healthy individuals as controls following an informed consent. Blood samples were as well collected at several intervals during the treatment with anti-tuberculosis drugs. Levels of IFN-U, TNF-V, IL-4 and IL-10 were measured pre and during treatment using commercial available enzyme-linked immune-sorbent assay (ELISA). Data were analyzed using SPSS 20. Receiver Operating Characteristic (ROC) Curve analysis has been carried out to assess their discriminative power and to determine cut-off values. Analysis has been carried out further by calculating other measures of diagnostic test accuracy. Results: The median serum level of IL-4 was 20 and 35 pg/ml higher in new cases (untreated patients) and in patients under treatment with oral anti-tuberculosis, respectively, compared with that of controls (p=001). Levels of TNF- were significantly increased in patients before and after the treatment than those in control (p=0.001). New cases had the highest median level (10pg/ml) followed by those under treatment group (6pg/ml). Levels for IFN-U were not statistically different between patients and controls (p=0.351). Median levels of IL10 were similar in both controls and new cases groups (35pg/ml), but lower in patients under treatment group (20pg/ml). Increase in levels of IL-4 during treatment showed that Th2 immune responses still present and may indicate active disease and thus IL4 cytokine may be a possible marker for the disease activity. Conclusion: serum levels of TNF- in TB patients is useful in the evaluation of the disease activity during therapy, not replacing clinical parameters of disease activity in TB. Similar to TNF-, IL-4 can also be used as marker for TB severity. On the other hand IL-4test can be used to diagnose TB in highly exposed suspects where a positive result is more likely to indicate TB.Item Clarithromycin-Resistant Helicobacter Pylori Strains among Dyspeptic Patients in Sudan(Al-Neelain Medical Research Centre, 2012) Ahmed Bolad, Nazar Abdalazeem; Hassan Abdul-Aziz, Adam Ahmed Adam; Waleed Hussein OmerIntroduction: The study aimed at characterizing the mutations in 23S rRNA gene related to Clarithromycin-resistant Helicobacter pylori strains among dyspeptic patients in Khartoum State. Methods: Two hundred gastric biopsies were obtained by endoscopy from 200 patients with dyspepsia. DNA was extracted from culture isolated and relevant mutations in 23S rRNA gene were detected. Results: Out of the 200 biopsies, H. pylori was isolated from 48 (24%) biopsies. Twelve of them were found to be resistant to Clarithromycin. Eight of the resistant strains had both A2143G and A2142G by using restriction enzymes Bsa1and Bbs1. Sequencing the remaining four isolates by PCR detected A2140G mutation. Conclusions: In conclusion, Clarithromycin-resistant H. pylori in Sudan may be the main cause of treatment failure aiming at eradication of the bacterium from patients. Such a finding may necessitate the need for other treatment regimens. More collaborated research in this field is needed.Item Family and Community Support of TB Patients-Jebel Awleyah Locality-Khartoum Sudan-2011(AlNeelain Center for Medical Research, 2012) Ahmed Bolad, Mustafa Khidir; Mustafa ElnimeiriItem Do Patients with Psychiatric Diseases Tend to Have Positive SLE Reactive autoantibodies and Vitamin B12 deficiency(AlNeelain Center for Medical Research, 2013) Ahmed K Bolad, Atif A Elagib; Ezeldine K AlturabiBackground: the relationship between neuropsychiatric manifestations and systemic lupus erythematosus (SLE) reactive autoantibodies, VitaminB12 and Folate levels are controversial and were not investigated before in Sudanese psychiatric patients. Aim: to determine the association between psychiatric manifestations and several SLE reactive autoantibodies, Vitamin B12 and Folate levels. Material and Methods: the study involved a test group of one hundred psychiatric patients and age/gender matched control group of one hundred apparently healthy subjects. Antinuclear antibodies (ANA), anti-double stranded DNA (anti-dsDNA) antibodies and ANA profile, Vitam. B12 and Folate levels were measured for each studied subject using ELISA method. The association between various SLE reactive antibodies and psychiatric illnesses were assessed using Mid-P extract test. P < 0.05 was considered significant. The association between Vitam.B12 or folate deficiencies and psychiatric illness were assessed using fisher extract test. P<0.05 was consider significant. Results: all subjects in the control group were ANA and dsDNA negative, however, only one (1%) was positive for anti-histone antibody (ANA profile). Regarding patients with psychiatric diseases, 6% were ANA positive, 2% were dsDNA and 6% ANA profile positive. In contrast to dsDNA, there were significant associations between psychiatric diseases and ANA and/or ANA مجلة النيلين الطبية – العدد العاشر 2013 June NMJ profile antibodies (P = 0.007 for ANA, P = 0.0125 for dsDNA and P = 0.033 for ANA profile). Significant association was found in the levels of Vitam.B12 deficiency and psychiatric diseases. No significance was found in the folate level. Conclusion: Sudanese patients with psychiatric diseases tend to have positive SLE reactive autoantibodies especially for ANA and ANA profile antibodies and Vit B12 deficiency.Item Levels of tumor necrosis factor-alpha (TNF-α) and Interferon gamma (IFN-γ) s During Tuberculosis treatment(Al Neelain Medical Research Centre, 2013) Ahmed Bolad, Amal Elhaj; Atif ElagibCytokines play a major role in protection against Mycobacterium tuberculosis infection and regulate the immune responses at a cellular level. A T helper 1 (Th1) cytokine interferon gamma (IFN-γ) is one of the most important cytokines which activate the macrophages to produce tumor necrosis factor-alpha (TNF-α). At physiological levels, TNF-α has anti-microbial activities through the apoptotic effect. Excessive production of TNF-α have been implicated in immunopathogenesis of tuberculosis. The aim of the present study was to determine Th1 cytokine profile in patients with tuberculosis to identify immunological marker for follow up of the disease activity, and on the other hand, to study the outcome of anti-tuberculosis treatment. To examine this, blood samples were collected at several intervals before and during the treatment with anti-tuberculosis drugs. Levels of IFN-γ, TNF-α pre and during treatment using commercial available enzyme-linked immune-sorbent assay (ELISA). Data were analyzed using SPSS 20. Receiver Operating Characteristic (ROC) Curve analysis has been carried out to assess their discriminative power and to determine cut-off values. Analysis has been carried out further by calculating other measures of diagnostic test accuracy.The results showed that the levels of TNF- were significantly increased in patients before and after the treatment than those in control (p=0.001). Levels for IFN-γ were not statistically different between patients and controls (p=0.351). A decrease in TNF-α levels dose not conflict with the finding that IFN-γ had highest level in patients under treatment as the difference between those and newly diagnosed patients was not statistically different. TNF-α can be used as a marker for TB severity, having that the area under the curve (AUC) for TNF-α is .824 (95% CI: .737 - .912). For the chosen cut-off level of 5pg/ml, it has a sensitivity of 85% and a lower specificity of 70%. TNF-α test is most beneficial where prevalence is very low or very high.Item Antibodies to the Plasmodiumfalciparum antigen Pf332 cooperated with human monocytes inhibit parasitegrowth by inducing intraerythrocytic abnormal parasite forms in vitro(2013) Lili Xu, Ahmed Bolad; Nina-Maria Vasconcelo, Nancy Awah; Asok Chaudhuri, Klavs BerzinsIntraerythrocyticPlasmodium parasite proliferation istightly related to disease seriousness. Intraerythrocytic parasite developmentis fundamental to the proliferation of the malaria parasite which is affectedby many factors. Antibodies inhibiting intraerythrocytic parasite growth ordevelopment have been long indicated in protective immune mechanisms, particularly in cooperation with human monocytes. Here, we show that the developmentP. falciparum intraerythrocyticparasite was significantly disturbed by antibodies reactive with ...