Malaria Vector Surveillance, Prevalence, Diversity, Behavioural Patterns and Their Implications to Tourist Activities in Akwa Ibom State, Nigeria | Chapter 13 | Current Trends in Medicine and Medical Research Vol. 1

Aims: Malaria poses a medical and public health challenge in Nigeria. The burden of the disease has been a major source of concern to tourists in Uyo. Knowledge on the biting behaviour and the Human Biting Rates (HBR) are needed to assess the epidemiology of the disease and in estimating the vector – human contact.         

Study Design: A six months study was carried out in Uyo, Nigeria where no information exists on the major malaria vectors associated with human malaria. Sample collection was carried out between May and October 2013 using Knockdown and Human Landing Catches (HLC) techniques.

Methodology: Adults mosquitoes were collected in two areas in Ewet Offot Community. Nine households were randomly selected in each location using Simple Random Sampling Method. Mosquitoes belonging to the Anopheles gambiae complex were further characterized and identified by a molecular method using Polymerase Chain Reaction (PCR).

Results: Two anophelines species were collected by the sampling methods consisting of 21(23.3%) Anopheles nili and 69(76.7%) Anophele gambiae complex. A Polymerase Chain Reaction (PCR) based test on the An. gambiae complex identified 66(96.0%) as An. gambiae sensu stricto. The study also revealed that the resting behaviour of An. gambiae complex species in this area is endophilic whereas the resting behaviour of An. nili is exophagic/exophilic. The peak biting activity of An. gambiae complex species occurred at 11 pm (indoor) and 7 pm (outdoor) in July whereas that of An. nili occurred at 10 pm (indoor) and 6 pm (outdoor) in June. The Human Biting Rates (HBR) recorded for An. gambiae was higher than An. nili and the total number An. gambiae collected was more than An. nili.

Conclusion: Better understanding of the behaviour of the sibling species within the complex is important to help identify their roles in disease transmission and to facilitate vector control.

Biography of author(s)

Inyang A. Atting

Department  of  Medical  Microbiology  and  Parasitology,  Faculty  of  Clinical  Sciences,  College  of  Health  Sciences,  University  of Uyo, Uyo, Nigeria.

Mfonobong E. Akpan

Department  of  Medical  Microbiology  and  Parasitology,  Faculty  of  Clinical  Sciences,  College  of  Health  Sciences,  University  of Uyo, Uyo, Nigeria

Nsima Ibanga G. Udoidung

Department of Animal and Environmental Biology, Faculty of Science, University of Uyo, Uyo, Nigeria.

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Public’s Attitude toward Organ Donation in Egypt: A Conceptual and Social Framework | Chapter 12 | Current Trends in Medicine and Medical Research Vol. 1

It is now well established that organ donation (OD) in Egypt gains utmost official support both from Islamic and Christian authorities. Yet, some social and behavioral obstacles may often obviate the full benefit of cadaver donors.

Aim: To identify and analyze determinants influencing the public’s awareness and attitude toward organ donation (OD) in Egyptian population.

Methods: At an outpatient setting of Qena University hospital (QUH), Qena, Egypt, care seekers were interviewed.

Results: Participants mean age was 42.9±8.17y years. More than half (56%) of participants are aware of the presence of OD programs in Egypt. However such awareness was not significant as to improve OD knowledge score. Otherwise, the same score significantly increased by educational level [F(df 3, 812= 3.61, p=0.0002]. Importantly too, the participants’ OD attitude score significantly improved by education [F(df 3, 805) = 4.52, p=0.038]. Media was most accessible as an individual source of information about OD (16.5%), and the knowledge score varied by source of OD information (14.6% with Internet source, 13.3±3 healthcare source, 5.6±1.9 friends source, 38% more than one source) [F(df 6, 809)= 3.10, p=0.0016]. Only 43.6% of participants were willing to donate an organ after death. Conceptualizing OD as an anti-religious behavior was reported by 16.9% of participants. Conclusion: The current knowledge fabric toward OD among Egyptian bears a mix of negative and positive potentials. Improving OD knowledge standard assures propagating positive attitude toward OD and hence enhanced survival opportunities for organ failure victims.

Biography of author(s)

Raouf M. Afifi

International Management-Health Services Institute (ITM-HS), Community Health Research, Indianapolis, Indiana, USA and Health Care Excellence Research Center, Cairo, Egypt.

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Mathematics and Examples for Avoiding Common Probability Fallacies in Medical Disciplines | Chapter 11 | Current Trends in Medicine and Medical Research Vol. 1

This chapter presents and explores many ‘fallacies’ about probability encountered in medical fields. These include the Arithmetic Fallacies, the Inverse Fallacy, the Favorable-Event Fallacy, the Conditional-Marginal Fallacy, Simpson’s Paradox, the Conjunction Fallacy, the Appeal-to-Probability Fallacy, the Base-Rate Neglect, and the Representative-Sampling Fallacy. We allude to simple mathematical and visual representations as well as to demonstrative calculations to understand these fallacies, their detrimental effects, and their possible remedies. We pay a special attention to the computation of the posterior probability of disease given a positive test. Besides exposing fallacies that jeopardize such a computation, we offer an approximate method to achieve this computation under justified typical assumptions, and we present an exact method for it via the normalized two-by-two contingency matrix. Our tutorial exposition herein should hopefully be of significant help to our intended audience in the medical community, including medical students and medical practitioners alike. It might ensure that they acquire the necessary knowledge of elementary probability, but it does not demand that they gain too much knowledge that might distract them from their genuine (vital and critical) subject matter. It also attempts to remedy the notorious and grave ramifications of probabilistic fallacies residing as permanent misconceptions in their “private” knowledge databases. As an offshoot, the pedagogical nature of the chapter could also be of benefit to probability educators who deliberately want to engage their students in the learning process, i.e., to guide them to be active learners. There are many reasons why ‘active learning’ is beneficial. However, we believe that the single most important reason why it is so is the fact that it is the most effective method for unraveling misconceptions and eradicating fallacies.

Biography of author(s)

Rufaidah Ali Muhammad Rushdi

Department of Pediatrics, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, 11562, Arab Republic of Egypt.

Ali Muhammad Ali Rushdi

Department of Electrical and Computer Engineering, King Abdulaziz University, Jeddah 21589, Saudi Arabia.

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Aerosolized Coal Fly Ash: Risk Factor for COPD and Respiratory Disease | Chapter 10 | Current Trends in Medicine and Medical Research Vol. 1

Aim: Aerosolized coal fly ash (CFA) from unfiltered exhaust by coal-burning utilities is a significant contributor to ambient air pollution in India and China. Evidence is consistent with aerosolized CFA also being the main particulate-matter jet-sprayed into the troposphere for covert geoengineering purposes. Members of the public chronically exposed to aerosolized CFA are likely to have an increased incidence of respiratory disease, including chronic obstructive pulmonary disease (COPD). Our objective is to review the multiple chemical constituents of aerosolized CFA in connection with their potentiality to cause COPD and respiratory disease.

Methods: We review the interdisciplinary medical, public health, and scientific literature.

Results: Tropospheric geoengineering is and has been undertaken since the beginning of the 21st century, with increasing frequency and duration, without public discussion and without disclosure of the particulate matter composition being placed into the air we breathe, or its effects on biota including humans. Published data is consistent with the primary constituent being CFA, the toxic waste-product of coal-burning. We review the medical/scientific literature that bears on the health risks posed by particulate matter, and especially CFA, aerosolized in industrial settings and in the troposphere during geoengineering activities and to consider in particular the potential consequences on chronic obstructive pulmonary disease (COPD) and respiratory disease.

Conclusion: Aerosolized CFA, a particularly hazardous form of deliberate air pollution. Ultrafine particles and nanoparticles found in coal fly ash can be inhaled into the lungs and produce many toxic effects including decreased host defenses, tissue inflammation, altered cellular redox balance toward oxidation, and genotoxicity. Oxidative stress and chronic inflammation can predispose to chronic lung disease. Recognition and public disclosure of the adverse health effects of geoengineering activities taking place in our skies, and their concomitant cessation will be necessary to prevent an ever-widening epidemic of COPD and other respiratory illnesses.

Biography of author(s)

J. Marvin Herndon

Transdyne Corporation, 11044 Red Rock Drive, San Diego, CA 92131, USA.

Mark Whiteside

Florida Department of Health in Monroe County, 1100 Simonton Street, Key West, FL 33040, USA.

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Importance of Unenhanced CT as a Screening Tool for Cerebral Venous Sinus Thrombosis | Chapter 09 | Current Trends in Medicine and Medical Research Vol. 1

Background: Cerebral venous sinus thrombosis (CVST) is being diagnosed clinically and by non- invasive imaging techniques early in its course for better prognosis and non-fatal outcomes. It hinders proper drainage of deoxygenated blood from brain resulting in drastic hemodynamic changes which can be fatal. It is more common in younger age group and women of child bearing age. Over the past decade, epidemiology of CVST has significantly changed and is not a rare disorder anymore.

Methods: After obtaining institutional ethical review committee approval, retrospective data collection of Magnetic resonance venogram (MRV) and CT Brain were performed between January 2007 and December 2016. Hounsfield units were obtained from dural sinuses on CT only in cases that were positive for sinus thrombosis on MRV.

Results: Total 554 positive venous sinuses in 350 patients as well as 2246 negative sinuses were analysed in the same cohort. Mean age was 37.46 ± SD 15.4 years, range: 72 years, minimum 4, and maximum 76 years. Only those cases were included who had MRV and non-contrast CT (NCT) within 24 hours of each other. The average Hounsfield units of vessels containing a thrombus was 60 ± 1.56 which was significantly higher than that of any other normal sinus in same patient  40 ± 0.28 (𝑝 < 0.05). Sensitivity, specificity, positive predictive value and negative predictive value were calculated as 99.6%, 89.05%, 69.17% and 99.9% respectively.

Conclusion: Hounsfield unit can be used as a good screening tool for CVST. CVST is increasingly common and highly treatable cause of stroke. The goal of imaging is to rapidly diagnose sinus thrombosis and provide a ground for early treatment for this condition to produce optimal clinical outcomes. Hounsfield unit is highly sensitive and specific for cerebral venous sinus thrombosis and can be used as a good screening tool in patient suspected of CVST.

Biography of author(s)

Fatima Mubarak

Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan.

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An Evaluation of QuantiFERON-TB Gold in-Tube and Immunological Tests for TB Diagnosis in Iraqi Patients | Chapter 08 | Current Trends in Medicine and Medical Research Vol. 1

Introduction: Mycobacterium is a genus of Gram-positive bacilli that demonstrates the staining characteristic of acid-fastness. Its most important species, Mycobacterium tuberculosis, is the most common etiologic agent of tuberculosis. Tuberculosis causes ill-health among millions of people each year and ranks as the second leading cause of death from an infectious disease worldwide. Between 2003 and 2012, the TB case detection rate gradually and consistently increased to reach thousands cases in 2012 particularly pulmonary type. Latent tuberculosis infection (LTBI), a non-communicable asymptomatic condition, persists in some, who might develop tuberculosis disease months or years later.

Aims: Tuberculosis is an infectious disease caused by the bacillus Mycobacterium tuberculosis and other related species. It typically affects the lungs (pulmonary TB) but can affect other sites (extra-pulmonary TB). A profusion of articles have been published on the accuracy and uses of interferon-gamma releasing assays for detection of this disease.

Experimental Design: A prospective study.

Place and Duration of Study: This study was done in Kirkuk city between November 2012 to February 2013.

Methodology: The present study included 50 individuals (40 suspected tuberculosis patients and 10 healthy controls). The patient were examined for the presence of TB by using QuantiFERON-TB Gold In-Tube(QFT-GIT) assay, polymerase chain reaction (PCR) and compared them with certain new and routine tests like AFB smear, OnSite TB rapid test, erythrocyte sedimentation rate and chest X-ray.

Results: The present study showed a relation between QFT-GIT and OnSite TB rapid test, and they were positive in 25(86%) at the same time; QFT-GIT positive and OnSite TB rapid test were negative in 4(14%) of patients; QFT-GIT negative and OnSite TB rapid test positive were seen in 5(45%); while QFT-GIT and OnSite TB rapid test were negative in 6(55%) of patients. In the control group only one QFT-GIT positive but it was OnSite TB test negative. 9(100%) of individuals for both tests were negative, 29 were males and 21 were females.

Conclusion: The study highlighted the sensitivity of IGRAs for diagnosis of active TB in combination with the rapid IgM/lgG tests for TB.The QFT assay appeared to be a more specific indicator of latent TB infection than TST. The association with blood groups and vaccination is also significant. Blood group ABO and rhesus typing were found to be the most prevalent in pulmonary TB patients with blood group O +ve. Seroprevalence of Mycobacterium tuberculosis antibodies was relatively high in IgG antibody. QuantiFERON TB Gold in Tube high sensitivity and specificity compared to TST, and requires only one visit. In close contacts which were BCG-vaccinated, the QFT assay appeared to be a more specific indicator of latent TB infection than TST.

Biography of author(s)

Mohemid M. Al-Jebouri

Department of Microbiology, College of Medicine, University of Tikrit, Tikrit, Iraq

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Molecular Mechanism of Metformin in DM2- A New Hypothesis | Chapter 07 | Current Trends in Medicine and Medical Research Vol. 1

Metformin, the antihyperglycaemic drug, though in use since 1957 eluded as to its mechanism of action till date. There is some truth but not the whole truth, in even the much-favoured mechanisms of AMP-stimulated protein kinase (AMPK) stimulation and inhibition of complex 1 of  Electron  Transport  Chain (ETC), as there are objections, unresolved, as yet. Subsequent innovative mechanisms,  like gut- mediated responses-involving glucagon-like peptide  {GLP 1 ) and sodium-glucose transporter protein ( SGLT 1) or signalling pathways involving transcription factors like a mammalian target of repamycine (mTOR C2), sirtuin  1 (SIRT 1) etc., and the recently proposed brain-gut- liver axis fared no better. The obvious truth to be accepted is that probably no single mechanism can explain all the observed phenomena. An attempt is made to rope in all mechanisms into one, invoking the glucagon signalling pathway, by a non-AMPK, non-Complex1 inhibitory mechanism by the proposed hypothesis. To this extent, new concepts like gate control concept and Warburg- like effect in diabetes mellitus type2 (DM2) are proposed. It is conceptualised that deranged glycolysis is at the root cause of the disturbed energy metabolism in DM 2 and the answer to restore the same lies in a reversal of the factors that lead to derailed glycolysis. Besides, a brief recapitulation of what is known is attempted, with emphasis on the bottlenecks of each of these mechanisms.

Biography of author(s)

A. S. V. Prasad

Department of Internal Medicine, G.I.T.A.M Dental Collage, Rishikonda, Visakhapatnam, Andhra Pradesh, India.

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Aerosolized Coal Fly Ash: Risk Factor for Lung Cancer | Chapter 06 | Current Trends in Medicine and Medical Research Vol. 1

Introduction: Coal is burned by electric utilities, about 10% remains as ash. The heavy ash settles, while the light coal fly ash (CFA) condenses and accumulates in the flue gases. In India and China CFA is usually allowed to exit smokestacks, but in Western nations it is trapped and sequestered for public health reasons. Epidemiological evidence indicates that aerosolized particulate pollution in the size range ≤ 2.5 µm is associated with numerous risks to health including, but not limited to lung cancer.

Aim: Coal fly ash (CFA) is a major contributor to ambient air pollution in China and India, but it is trapped and sequestered in Western nations. Members of the public chronically exposed to aerosolized CFA are likely to have an increased incidence of respiratory disease, including lung cancer. Our objective is to review the multiple carcinogenic constituents of aerosolized coal fly ash in connection with their potentiality to cause lung cancer.

Methods: We review the interdisciplinary scientific and medical literature.

Results: CFA contains a variety of potentially carcinogenic substances including aluminosilicates, an iron oxide-containing magnetic fraction, several toxic trace elements, nanoparticles, and alpha-particle-emitting radionuclides.  Silica, arsenic, cadmium, and hexavalent chromium are found in CFA and all have been associated with increased lung cancer risk.  Radical generation catalyzed by transition metals associated with the particulate matter in CFA can result in a cascade of cell signaling, transcription factor activation, and mediator release. Ferric iron in the aluminum-silicate glass phase of CFA is a source of bioavailable iron. There is emerging evidence that reactive iron induces cancer stem cells and aggressive phenotypes in lung cancer. The potential pulmonary toxicity and carcinogenicity of aerosolized CFA is suggested by studies of asbestos, a fibrous silicate that also contains iron oxide. CFA contains an abundance of ultrafine particles and nanoparticles, including magnetite (Fe3O4). These tiny particles are toxic to lung cells, capable of producing oxidative stress, cytotoxicity, and genotoxicity. Radioactive elements are concentrated in CFA. CFA can settle deep in the lungs where its alpha-particle-emitting radionuclides pose significant risk factors for lung cancer.

Conclusion: Considering the well-known and manifold toxicities of CFA, the public should be made aware of the potential risks for lung cancer and severe respiratory disease posed by aerosolized CFA including its use in climate alteration activities. CFA contains a plethora of potentially carcinogenic agents likely to have cumulative additive and/or synergistic interactions with long-term exposure. The CFA industry can be diligent about minimizing the likelihood of CFA aerosolization for sake of workers and those living in the proximity of CFA dumps. Jet-spraying of CFA into the regions where clouds form represents a potential global and previously unrecognized long-term risk factor for respiratory disease and lung cancer, especially in vulnerable populations.

Biography of author(s)

J. Marvin Herndon

Transdyne Corporation 11044 Red Rock Drive, San Diego, CA 92131, USA.

Mark Whiteside

Florida Department of Health in Monroe County, 1100 Simonton Street, Key West, FL 33040, USA.

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Tuberculosis of the Ankle Joint: An Uncommon Presentation of Skeletal Tuberculosis | Chapter 05 | Current Trends in Medicine and Medical Research Vol. 1

Skeletal tuberculosis constitutes 1 to 3% of extra pulmonary tuberculosis, and involvement of foot bones is rare. It is therefore unlikely that diagnosis of tuberculosis of the ankle joint will be rapidly made in a healthy looking patient who presents with difficulty with walking, right ankle pain and swelling and fever a week prior to presentation.

We present a case of tuberculosis of the right ankle joint which was difficult to diagnose until histopathology of the synovial biopsy specimen showed features of infection with Mycobacterium tuberculosis and medical treatment with anti-tubercle bacilli agents completely resolved symptoms within two weeks.

Fever, joint pain and swelling in any patient should attract the suspicion of tuberculosis of that joint irrespective of the past medical history. The main stay of diagnosis is histopathology of the synovial biopsy. Joint aspirations should not only be for microscopy, culture and sensitivity; cytology and culture for tubercle bacilli should also be done whenever possible.  CT scan and MRI of the affected joint may provide additional information particularly in early cases but requires further evaluation.

Biography of author(s)

Christopher Edet Ekpenyong

Associate professor at the College of Health Sciences University of Uyo, Uyo, Nigeria.

Udoinyang Clement Inyang

Fellow of the West African College of Surgeons, a Senior Lecturer at the University of Uyo and Chief Consultant Orthopaedic Trauma/Spine Surgeon at the University of Uyo Teaching Hospital, Uyo, Nigeria.

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Aerosolized Coal Fly Ash: Risk Factor for Neuro-Degenerative Disease | Chapter 04 | Current Trends in Medicine and Medical Research Vol. 1

Introduction: Burning coal accounts for one-third of global energy utilization and 40% of the electricity generated throughout the world. The heavy coal ash settles beneath the burner, while the light ash, called coal fly ash (CFA), condenses and accumulates in the vapors above the burner, and exits with the exhaust gases. Being a concentrate of the toxins originally present in the coal, in Western nations, CFA is electrostatically trapped and sequestered. Air pollution is one of the great killers of our age. It is increasing at an alarming rate and is currently the fourth leading cause of death world-wide. Exposure to air pollution is known to be associated with respiratory, cardiovascular, and stroke-related morbidity and mortality.

Aims: Coal fly ash (CFA), the major waste product of coal-burning utilities, is trapped and contained in Western nations, but not generally in India and China, where it is a major component of air pollution. In Western nations, the CFA trapping is inefficient, exposing downwind populations to the toxic aerosols. Similarly, CFA industry workers and those living downwind of coal ash piles may be exposed to the wind-blown toxins. Aerosolized coal fly ash, especially as used for climate manipulation, is a particularly hazardous form of air pollution. Our objective is to review the multifold components of coal fly ash, linked to neurodegenerative disease, which is rapidly increasing world-wide.

Methods: We review the interdisciplinary scientific and medical literature.

Results: The recent finding of spherical exogenous magnetite (Fe3O4) nanoparticles in the brain tissue of persons with dementia suggests an origin in air pollution produced by coal fly ash. The primary components of coal fly ash, iron oxides and aluminosilicates, are all found in the abnormal proteins that characterize Alzheimer’s dementia. The presence of these substances in brain tissue leads to oxidative stress and chronic inflammation. Energy absorbed by magnetite from external electromagnetic fields may contribute to this neuropathology.

Conclusions: Considering the well-known and manifold toxicities of CFA, the public should be made aware of the potential risks for neurodegenerative disease posed by aerosolized CFA, including its use in climate alteration activities. Air pollution is linked to neurodegenerative disease and dementia, which is reaching pandemic proportions. This recent finding of exogenous magnetite nanoparticles in brain tissue is like a “smoking gun,” indicating a strongly supported relationship between pollution formed by combustion and neurodegenerative disease. Among several sources of exogenous neurologically damaging magnetite pollution, we have shown that the size and morphology of these particles is most consistent with an origin in coal fly ash. The principal components of coal fly ash, i.e., aluminosilicates and magnetite, are all found in in the abnormal protein material that characterizes Alzheimer’s Dementia. Magnetite is extremely sensitive to external electromagnetic fields and this fact hints at a synergistic role of electromagnetic fields in producing neurodegeneration. Additional research is urgently needed to confirm and further investigate these findings. There is no effective regulation or monitoring of the principal elements (e.g., Al, Si, and Fe) in aerosolized coal fly ash. The ultrafine and nanoparticles

Biography of author(s)

Mark Whiteside, M.D., M.P.H.
Florida Department of Health in Monroe County, 1100 Simonton Street Key West, FL 33040, USA.

J. Marvin Herndon, Ph.D.
Transdyne Corporation, 11044 Red Rock Drive, San Diego, CA 92131, USA.

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