Life-Saving Drugs in Sudan: A Matter of Defi nitions and Concepts

Background: Drugs are one of the most crucial pillars in the provision of healthcare services and achieving Universal Health Coverage (UHC). Life-Saving Drugs (LSDs) are the drugs that save someone’s life, require immediate administration in most of the cases, as they sustain life, and prevent complications. They are top priority healthcare needs, which required to be available and aff ordable at all time in adequate quantities and low cost for the whole population and thus achieving equity. Since pharmaceutical sector in Sudan is highly fragmented, this study is conducted to determine the degree of stakeholders’ knowledge about the defi nition of LSD, whether there is a policy governing them, if they have a standard list and their availability status in Sudan. Methods: G rounded theory qualitative (exploratory) study design. The theory is grounded from the actual data after being collected and analysed. Results: Only essential medicines is the well-known term for the stakeholders -mainly at the governance level- with its policy and list. The other LSDs terminologies were found to be ambiguous, with no policies or standard lists. The status of the availability of the diff erent LSDs terminologies (as it perceived by each stakeholder) was found to be poor and there is a signifi cant shortage mainly due to the economic issues. Conclusions: Unifi cation of pharmaceutical organization in Sudan is a must and a priority issue due to its ultimate importance in the provision of healthcare services. Consensus and participation of all the relevant stakeholders in designing policies is an important input for a well-designed health system governance. Further researches in diff erent areas must be conducted, and awareness of policymakers and service providers must be raised.

A Pilot Study: Metal-Induced Immunotoxicity and Deaths of the 100 Vaccinees in the Republic of Korea for 2 Months of 2020 Flu Vaccination

Summary: More than 100 persons died within 7 days of infl uenza vaccination by November 2020 (for two months of 2020 fl u vaccination) in the Republic of Korea (South Korea). The current study was conducted to allocate properly any possible causality by examining the presence of heavy metals in a vaccine and metal-induced immunotoxic lesions after fl u vaccinations in the experimental mice. It detected cadmium 0.12 ppb (parts per billion = μg/L) and mercury 1.77 ppb in one of the cost-free infl uenza vaccinees (Lot Number: A14720017) distributed by the Korean government. Lungs of the undiluted-vaccine-injected mice showed signifi cantly more diff use infl ammatory damages than lungs of the 1:4 dilutedvaccine-injected mice which showed no to mild infl ammatory changes (p < 0.027 by the method 1, and p < 0.001 by the method 2). Based on this study, it can be presumed that the metals-induced immunotoxicity of type IV hypersensitivity or of psuedoallergy would have caused death in some of persons who coincidentally died within 7 days of vaccinations. Background : A 17-year-old man died within three days of infl uenza vaccination (Lot Number: A14720007), a 77-year-old woman died within a day (Lot Number: A14720016), and more than 100 persons died within 7 days of infl uenza vaccination by November 2020 (for two months of 2020 fl u vaccination) in the Republic of Korea (South Korea). Singapore authorities halted two of the seven brands of fl u vaccinees even though there was no report of death after fl u vaccinations in Singapore. This raises a possibility that there can be a diff erence between the excipients of the fl u vaccinees used in Singapore and in Korea. Our assumptions were that there would have been immunotoxic metals in the fl u vaccinees, the metals would have induced type IV hypersensitivity or Complement Activation-Related Psuedoallergy (CARPA), and would have caused some deaths of 100 persons who incidentally died within 7 days after fl u vaccinations. Methods: In this study, we analyzed twice for the presence of any metal components of aluminum, indium, cadmium, gallium, and mercury in the infl uenza vaccine. Analysis of the metal contents of the 1:29 diluted fl u vaccine was assessed by the Inductively Coupled Plasma Mass Spectrometry (ICP-MS) method. Simultaneously, total 10 BALB/c mice were used to analyze any pathological changes after 7 days of fl u vaccination. Animals were divided into two groups: one group of 5 mice were injected intraperitoneally with 0.1 ml of 1:4 diluted fl u vaccine with injectable distilled water; and the other group of 5 mice were injected intraperitoneally with 0.1 ml of undiluted fl u vaccine. They were freely reared for 7 days in a Polycarbonate cage (400 x 255 x 180 mm). The mice were sacrifi ced after CO2 short-acting gas anesthesia. Brains, hearts, lungs, livers, and kidneys were harvested, prepared with H & E stain, and observed for any histopathological changes. Findings : In one of the cost-free infl uenza vaccinees (Lot Number: A14720017), which were distributed by the Korean Government, the current study detected cadmium 0.12 ppb (parts per billion = μg/L), and mercury 1.77 ppb. But neither aluminum, gallium, nor indium was detected. Both experimental groups showed no demonstrable infl ammatory changes in the specimens of brains, hearts, livers, and kidneys. However, lungs of the undiluted-vaccine-injected group showed signifi cantly more diff use damages than lungs of the 1:4 diluted-vaccine-injected group which showed no to mild infl ammatory changes. The semiquantitative scores of the diluted-vaccine-injected group and the undiluted-vaccine-injected group were 0.7 ± 0.3 and 1.9 ± 0.3, respectively by method one ([a street-view], mean ± SE, p = 0.027 <0.05); and 9.0 ± 1.1 and 18.6 ± 1.6, respectively by method two ([a sky-view], mean ± SE, p < 0.001). Interpretation: Mercury (1.77 ppb) and cadmium (0.12 ppb) were found in the freely distributed infl uenza vaccine by the Korean Government for the season of 2020-2021. Infl ammatory damages in the lungs of experimental mice, which occurred within 7 days after infl uenza vaccination, could be caused by metal-induced type IV hypersensitivity ( delayed-type, T-cell-mediated hypersensitivity) or metal nanoparticle-induced CARPA. In application, metal-induced delayed-type hypersensitivity or metal nanoparticle-induced CARPA could explain some deaths of the 100 persons who unintentionally died within 7 days of infl uenza vaccination by the November 2020 and of the 1,531 persons who coincidentally died within 7 days after Infl uenza vaccination from the fall of 2019 to the spring of 2020 in South Korea, and of the persons who fortuitously died within one week after infl uenza vaccinations in the United States-23.2persons/100,000 vaccinees of an age of over 75 and 11.3 persons/100,000 vaccinees of an age between 65 and 75. The results may be helpful for the causal identifi cation of some deaths of COVID-19 vaccinees.

Prevalence and Levels of Forward Head Posture among School Going Children

Introduction: Exposure of overloaded bag packs and early usage of digital gadgets amongst school going children alters the cervical spine posture. The present research work intends to study the prevalence of forward head posture in school going children. The study also elucidates the ranges to consider for mild, moderate and severe forward head posture prevalence. Methods: A total of 100 school students (50 males and 50 females) were recruited for cross-sectional study. Assessment of forward head posture was done using plumb line. The students were made to stand at a point marked 25 cm distance away from the plumb line. The researcher, from the side view, using a meter scale, measured the distance between the tragus of the ear and plumb line and record it. The weight of the school bag was measured using the weighing machine and the time for which gadgets were used was recorded as per the subject/parents feedback. Results: The mean values for age, height, weight and BMI are 13.67 ± 0.55 years, 158.56 ± 7.71 cms, 46.47 ± 10.50 kgs and 18.40 ± 3.48 kg /m2 respectively. The mean values for gadgets time use, distance plumb line and weight bag are 130.50 ± 67.07 min, 1.96 ± 1.19 cm and 4.32 ± 1.70 kgs respectively. About ~27% children having mild or no FHP (less than or equal to 1 cm), ~37% children having moderate FHP (ranging between 1.01 cm to 2.49 cm) and ~36% children found to have severe FHP (more than or equal to 2.5 cm). Conclusion: The study showed that the FHP is developing at early stage in the school going children and it has the potential of altering cervical spine biomechanics. Early screening is much essential aspect to prevent FHP. The ergonomic based awareness programs should be organized to sensitize children about the right posture and to indulge them in physical activity.

Prevalence of Malaria among Febrile Patients attending Government Hospitals in Ondo State, South-West Nigeria

Background: The use of malaria infection prevalence among febrile patients is a valuable epidemiological surveillance tool. In this study, a cross sectional study was conducted among febrile patients in selected government Hospitals in Ondo State for malaria prevalence. Results: Plasmodium falciparum is the only encountered malaria parasite with prevalence values of 82.72% (426/515) and 80.19% (413/515) were obtained for microscopy and RDTs respectively. The prevalence of malaria among the males (86.59%) was higher than the females (80.65%), all age groups in this study were vulnerable with highest infection rate of 89.66% among age group 11-20 years. The parasites densities ranged between 209 and 22310 parasites/μl with a mean parasitaemia of 5522.17 ± 183.30 parasites/μl. The prevalence of malaria among the febrile participants that have taken antimalarial drug before visiting the hospital is 82.94% (389/469) with the mean parasitaemia of 4615.21 ± 188.14 parasites/μl while among the participants that have taken herbs before visiting the hospital the prevalence is 85.03% (142/167) with the mean parasitaemia of 4913.81 ± 330.20 parasites/μl. Conclusion: There was high prevalence of malaria among febrile patients and this fi nding will help improve the diagnosis and treatment of other febrile (non-malaria) infections, limit antimalarial usage to only malaria parasite-based test true positives and serve as a guide to combat malaria drug resistance in the study area.

COVID-19 Vaccines-Safety First, Alleged “Greater Good” Last

Some experts say that mandatory COVID-19 vaccinations will be necessary when COVID-19 vaccines are ready. But a red fl ag was raised when one of the fi ve core candidates of Operation Warp Speed Vaccines of COVID-19 [1] showed a transverse myelitis-like case in its third vaccine trial [2].

Evaluation of the Lockdowns for SARS-CoV-2 Epidemic in South Eastern Nigeria

The novel SARS-CoV-2, the causative agent of COVID-19, a pandemic of great public health concern. COVID-19 was fi rst reported in Wuhan, China in December, 2019 and declared a pandemic by the World Health Organization on March 11, 2020. The fi rst case of COVID-19 in Nigeria was confi rmed on the 27th of February, 2020 and has since spread to 36 states and the Federal Capital Territory, Abuja, bringing total confi rmed cases in Nigeria to 25,694, 9,746 recoveries and 590 deaths as at 30th June, 2020. This was therefore designed to examine the impact of the lockdowns and border closures of states on the spread of SARS-CoV-2 in the fi ve states of South Eastern, Nigeria. COVID-19 data of the fi ve South Eastern States of Abia, Anambra, Ebonyi, Enugu and Imo between April 1st and 30th June were retrieved from the Nigerian Center for Disease Control (NCDC) microsites and analyzed using GraphPad software, Version 5.01. Results showed that the South Eastern states recorded a total of 1,415 COVID-19 cases between April when all the fi ve states had their fi rst cases and June, 30th with Ebonyi with a total of 438(31.0%) producing the highest confi rmed cases. The highest rate of infection was observed in the month of June with Ebonyi recording the highest (28.1%), followed by Abia and Imo with 21.2% and 20.9% respectively. The use of face masks, social distancing, community lockdown and other containment measures are necessary to prevent further upsurge in the rate COVID-19 infection in the South East, and indeed the whole Nigeria.