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Biomedical subjects

M Homeida

Publications and source records attributed to M Homeida.

At least 19 recordsLinked to original sources
PubMed2003

A multi-centre study of community-directed ivermectin distributors' (CDDs') involvement in other healthcare and development programme activities in Cameroon, Togo, Sudan, Nigeria and Uganda.

A multi-centre study to determine whether community-directed distributors (CDDs) are capable of carrying out additional healthcare and developmental activities in their communities was carried out in Cameroon, Nigeria, Sudan, Uganda and Togo to ascertain the potential effects of their involvement on the implementation of community-directed treatment with ivermectin (CDTI). Both quantitative and qualitative methods were used to collect data from households, community-directed distributors, community leaders, and health workers. The results showed no major decrease in the CDDs' performance in CDTI: on the contrary, the involvement of CDDs in other health and development activities motivated them to perform their CDTI functions better. However, the results did not show any significant increase in therapeutic coverage of ivermectin distribution. The expansion of the CDDs' experience to include additional healthcare and development related activities would be of interest to onchocerciasis control programmes--it will strengthen CDTI sustainability through greater integration.

Cameroon↗
PubMed2002

APOC's strategy of community-directed treatment with ivermectin (CDTI) and its potential for providing additional health services to the poorest populations. African Programme for Onchocerciasis Control.

Since its inauguration in 1995, the African Programme for Onchocerciasis Control (APOC) has made significant progress towards achieving its main objective: to establish sustainable community-directed treatment with ivermectin (CDTI) in onchocerciasis-endemic areas outside of the remit of the Onchocerciasis Control Programme in West Africa (OCP). In the year 2000, the programme, in partnership with governments, non-governmental organizations and the endemic communities themselves, succeeded in treating 20,298,138 individuals in 49,654 communities in 63 projects in 14 countries. Besides the distribution of ivermectin, the programme has strengthened primary healthcare (PHC) through capacity-building, mobilization of resources and empowerment of communities. The community-directed-treatment approach is a model that can be adopted in developing other community-based health programmes. The approach has also made it possible to bring to the poor some measure of intervention in some other healthcare programmes, such as those for malaria control, eye care, maternal and child health, nutrition and immunization. CDTI presents, at all stages of its implementation, a unique window of opportunity for promoting the functional integration of healthcare activities. For this to be done successfully and in a co-ordinated manner, adequate funding of CDTI within PHC is as important as an effective sensitization of the relevant policy-makers, healthworkers and communities on the value of integration (accompanied by appropriate training at all levels). Evaluation of the experiences in integration of health services, particularly at community level, is crucial to the success of the integration.

Africa↗
PubMed1994

Propranolol reduces mortality in patients with portal hypertension secondary to schistosomiasis.

Although beta-adrenoceptor antagonists improve morbidity and mortality in patients with portal hypertension associated with cirrhosis, this has not been demonstrated in non-cirrhotic patients. In the present, double-blind, 24-month, prospective study of patients with endoscopically-proven varices and ultrasonographically-confirmed hepatic fibrosis, the effects of propranolol 160 mg LA and placebo on the incidence of rebleeding and mortality were compared in 82 patients with portal hypertension secondary to schistosomiasis. The results, analysed on intention-to-treat basis, indicated a reduction in rebleeding (median time to rebleeding 589 days for propanol v. 252 days for placebo; P < 0.02) and increased survival in the propranolol-treated patients (three deaths v. seven deaths on placebo; P < 0.02). Fifteen patients withdrew from the propranolol group and 18 from the placebo group. A positive prognostic indicator was a large portal vein diameter whereas a small liver size indicated a negative outcome.

Adult↗
PubMed1994

Pharmacokinetic interaction between praziquantel and albendazole in Sudanese men.

It has been suggested that praziquantel (40 mg/kg) and albendazole (400 mg) administered together may have a synergistic effect on intestinal parasites. In the present study, the pharmacokinetics of these agents, alone and in combination, were investigated in the presence and absence of food in two groups of Sudanese males. The results indicated that praziquantel pharmacokinetics were not effected by co-administration of albendazole although, in the presence of food, the area under the curve (AUC(0-infinity)) of praziquantel increased 2.6 fold. The AUC(0-infinity) of albendazole sulphoxide (the active metabolite of albendazole) increased 4.5-fold when administered with praziquantel, eight-fold when given with food and 12-fold when given with praziquantel and food. The balance between the therapeutic efficacy of this combination of drugs and its safety profile needs to be studied, especially with regard to albendazole.

Adult↗
PubMed1994

Liver morphology and function in visceral leishmaniasis (Kala-azar).

AIM: To study the morphology and function of the liver in visceral leishmaniasis (Kala-azar). METHODS: Percutaneous liver biopsy specimens from 18 patients with confirmed visceral leishmaniasis were examined under light and electron microscopy before and after treatment with pentovalent antimony. The tissue was also examined for hepatitis B surface and core antigens using immunoperoxidase staining. Liver function was investigated in nine patients before and after treatment. RESULTS: Specimens before treatment showed Kupffer cells and macrophages colonised by leishmania parasites in 40% of cases. A chronic mononuclear cell infiltrate had affected the portal tracts and lobules. Ballooning degeneration of the hepatocytes, fibrosis of the terminal hepatic venules, and pericellular fibrosis were common findings. The fibrosis was related to Ito cells transforming to fibroblast-like cells. None of the patients had hepatitis B infection. All patients had biochemical evidence of liver dysfunction before treatment. Liver function improved after treatment. CONCLUSION: Visceral leishmaniasis causes morphological and functional disturbance in the liver. Focal fibrosis rather than cirrhosis occurs. The exact aetiology of hepatic damage is unclear but may have an immunological basis.

Adolescent↗
PubMed1991

Oesophageal varices in a region of the Sudan endemic for Schistosoma mansoni.

In a field study of two villages in the Gezira, an area of the Sudan endemic for Schistosoma mansoni, liver ultrasonography was used to detect subjects with Symmers' hepatic periportal fibrosis, some of whom underwent oesophagoscopy to detect oesophageal varices. The prevalence of oesophageal varices in subjects undergoing oesophagoscopy was 54 per cent and 67 per cent respectively, occurring mainly in males aged about 30 years. The varices were usually asymptomatic. Symptomatic varices (with a positive history of haematemesis) occurred in 4 per cent and 3 per cent respectively of subjects with sonographic evidence of liver periportal fibrosis. By detecting oesophageal varices in an asymptomatic phase, hepatic ultrasonography and fibreoptic oesophagoscopy may elucidate the natural history of the varices and their response to periodic anti-schistosomal chemotherapy.

Adult↗
PubMed1990

Enzyme activities and protein concentrations in serum of patients with hepatosplenic schistosomiasis.

The hepatosplenic form of Schistosoma mansoni infection contributes considerably to morbidity and mortality in endemic areas. The present study investigated serum protein concentrations and serum enzyme activities of 58 Sudanese patients with hepatosplenic schistosomiasis. All of them had a history of infection with S. mansoni and one or several episodes of oesophageal bleeding due to portal hypertension. Diagnosis was based on clinical (n = 24), ultrasonographical (n = 18) and histological (n = 16) grounds. The control group consisted of 40 Sudanese healthy blood donors. Serum albumin was found to be significantly lower in patients with hepatosplenic schistosomiasis (median = 37 g/l) than in controls (median = 47 g/l). Serum enzyme analysis revealed only minimal alterations of cellular enzyme activities, but a marked decrease of cholinesterase activity. Serum albumin concentration correlated significantly with cholinesterase activity. We conclude that liver function in patients with schistosomiasis and portal hypertension is partially disturbed. Low serum albumin and low cholinesterase activity reflected an impaired protein synthesis of the liver. Destruction of parenchymal liver cells was mild or absent.

Adolescent↗
PubMed1989

Significance of eosinophiluria in urinary schistosomiasis. A study using Hansel's stain and electron microscopy.

Urine deposit smears of 58 patients with urinary schistosomiasis, 20 with acute glomerulonephritis, and 14 with urinary stones were stained with Hansel's stain. Eosinophiluria was seen in all cases of urinary schistosomiasis (median 0.73 [73%] of urinary white blood cells [WBCs]); 13 (65%) of those with acute glomerulonephritis (median 0.03 [3%] of urinary WBCs); and 2 (14%) patients with urinary stones (0.01 [1%] and 0.05 [5%] of urinary WBCs). Other features included the presence of ova and activated macrophages and giant cells in urinary schistosomiasis, an increased number of mononuclear cells and stained cellular casts in acute glomerulonephritis, and an increased number of neutrophils in urinary stones. In schistosomiasis, urine differential leukocyte counts were unrelated to those of the blood. Moreover, urine eosinophil percentages were always higher than those in the blood. Thus, in urinary schistosomiasis, eosinophiluria could be explained by exudation, sloughing of granulomata, as well as bleeding from the urinary tract surface. Electron microscopic examination confirmed that most of the leukocytes were eosinophils. Some of these were adherent and degranulating over ova with variable miracidial damage. Urine eosinophil and egg counts were not correlated to each other. Staining urine deposit smears, with the use of Hansel's stain, is useful in the investigation of hematuria. Heavy eosinophiluria and few mononuclear cells favor the diagnosis of urinary schistosomiasis rather than acute glomerulonephritis or urinary stones. These results diminish the value of eosinophiluria as corroborative evidence of drug-induced interstitial nephritis in areas of endemic urinary schistosomiasis.

Child↗
PubMed1988

Diagnosis of pathologically confirmed Symmers' periportal fibrosis by ultrasonography: a prospective blinded study.

Symmers' periportal fibrosis of the liver is the major cause of morbidity and mortality in Schistosoma mansoni infection. The diagnosis is best established definitively by a wedge biopsy of the liver. The ability of abdominal ultrasonography to diagnose this condition was prospectively compared with two independent pathological examinations of wedge biopsies of the liver. Both pathologists and the ultrasonographer were unaware of the clinical diagnosis and each other's findings. Twenty-eight of 41 patients had Symmers' fibrosis by pathological examination and all were diagnosed correctly by ultrasonography prior to surgery. Symmers' fibrosis was not diagnosed by ultrasound in any of 10 patients without Symmers' fibrosis on biopsy. In 3 patients the diagnosis of Symmers' fibrosis was uncertain because the pathologists disagreed as to its presence. These results confirm the findings of previous studies and establish that ultrasonography is at least as sensitive as wedge biopsy in diagnosing Symmers' fibrosis.

Double-Blind Method↗
PubMed1988

Morbidity associated with Schistosoma mansoni infection as determined by ultrasound: a study in Gezira, Sudan.

Previous studies demonstrated the usefulness of ultrasonography in diagnosing Symmers' periportal fibrosis. The prevalence and grade of Symmers' fibrosis was determined using ultrasonography in two villages in the Gezira region of Sudan and compared to standard clinical criteria. In El Dar 18% and Abu Jin 13% of the population had Symmers' fibrosis by ultrasonography. In contrast, only 6.3% in El Dar and 5.2% in Abu Jin with Symmers' fibrosis had splenomegaly, thus most of the population with Symmers' fibrosis would not have been diagnosed clinically. The degree of involvement was estimated by a set of previously defined criteria which ranged from mild (grade 1) to severe (grade 3). Involvement was greatest between 20-30 years and followed the age peak egg excretion rate by 5 years. The prevalence and degree of splenomegaly as well as the portal and splenic vein diameters increased with grade. The presence of hepatomegaly did not correlate with increasing grade. Ultrasonography is a much more sensitive technique than clinical evaluation in estimating the degree of Symmers' fibrosis in this population. A more accurate assessment of involvement will allow a more rational approach to the study of the pathophysiology of this complication and its eventual control.

Adult↗