Dr. Jorge Paredes Vieyra
Coordinador de Posgrado e Investigación, Facultad de Odontología Tijuana, Licenciatura y Posgrado Responsable de Educacion Abierta, Centro de Educación Abierta (CEA) Universidad Autonoma De Baja California, Campus Tijuana, Mexico.



ISBN 978-93-89816-80-8 (Print)
ISBN 978-93-89816-81-5 (eBook)
DOI: 10.9734/bpi/cdhr/v1


This book covers all areas of disease and health. The contributions by the authors include Ginkgo biloba extract; cortisol; acute hyperglycemia; dystonia; strumpel disease; DYT 1; cavernous angioma; meningioma; anti-nutritional protein; dapsone resistance; dermatofibroma; leproma; lepromatous leprosy; thyroidectomy; giant goiters; anesthesia; endotracheal intubation; aetiology; anatomical location; steroid injection; surgical excision; thyroid pathology; giant goiter; subtotal thyroidectomy; local anesthesia; B-cell lymphoproliferative disorder; lymphoplasmacytic lymphoma; monoclonal gammopathy; plasma cell dyscrasias; mature B cell neoplasm; pediatrics; child; palliative care; hospice care; end of life care; health status; HIV/AIDS; T2DM (Type II Diabetes Mellitus); SUA (Serum Uric Acid); BMI (Body Mass Index); liver function improvement; NK cells activation; cytokine; liver cells proliferation; lowering lipid level; testicular cancer; bilateral cryptorchid; abdominopelvic; cognitive stimulation; multifactorial cognitive training; recognition memory; caregiver involvement; e-health; person-centered healthcare; electronic healthcare record; mHealth; telemedicine; intellectual decision support systems; digital hospital; pandemic (COVID-19) and unified medical information space etc. This book contains various materials suitable for students, researchers and academicians in the field of disease and health.


Effect of Ginkgo biloba Extract Ingestion on Plasma Total Cortisol Levels during an Oral Glucose Tolerance Test in Normal Glucose Tolerant Individuals: Recent Study

George B. Kudolo

Challenges in Disease and Health Research Vol. 1, , 11 July 2020, Page 1-8

Protracted periods of increased cortisol production, as may be seen in acute illness, may lead to transient hyperglycemia. Increasing evidence suggests that cortisol may then mediate insulin resistance and potentially lead to the development of diabetes. Evidence in animal studies also suggests that under conditions of stress Ginkgo biloba extract could reduce plasma cortisol production and so the primary aim of this study was to determine the effect of Ginkgo biloba extract ingestion on plasma cortisol production during an acute period of glucose challenge. Healthy normal glucose tolerant subjects (n=30, (10/20, M/F); age, 45.7±9.9 years old) completed a randomized, double-blind, placebo-controlled crossover study when they ingested Ginkgo biloba extract (120 mg/day as a single dose) or placebo during each 3-month arm. A standard 75 g oral glucose tolerance test was performed at the end of each cycle and blood was collected and used to measure plasma glucose, insulin, c-peptide and cortisol. Fasting plasma cortisol was significantly lower after the Ginkgo biloba cycle than the placebo cycle (9.7±4.4 vs. 11.8±5.4 mg/dl, respectively; p<0.05). The plasma cortisol area under the curve during the 2-hour test (AUC0-2) was also significantly lower after ingestion of the Ginkgo biloba cycle compared to the placebo (19.2±7.7 vs. 24.1±4.9 μg/dl/h, respectively; p<0.001). It is concluded that the ingestion of Ginkgo biloba extract has effect on the hypothalamic-pituitary-adrenal axis leading to reduced basal cortisol levels and reduced cortisol production in response to acute hyperglycemic challenge.

Tolerance of the Society to Dystonic Patients: Catamnesis of Two Rare Cases of Dystonia

Vadim Belenky

Challenges in Disease and Health Research Vol. 1, , 11 July 2020, Page 9-14

Catamnesis of neurologic patients, especially dystonic patients, features not only the natural history of certain disorder, but the social status of these cripples. Are they always grata in the country of healthy people? We report the catamnesis of two dystonic patients, that testify the society to turn them often into the pariah. Case one concerns with mixed geno – phenotype of generalized dystonia and Strumpel disease. Strumpel disease and dystonia are inherited disorders with clinical picture of spastic paraparesis and hyperkinesis respectively. We present a case of a patient born from parents with these diseases who developed neurologic phenomena uncharacteristic for the classical clinical picture of his parents’ disorders. Patient V., 12, born from father with generalized dystonia and mother with Strumpel disease, has flaccid lower paraplegia along with dystonic hyperkinesis in neck and arms. The flaccid lower paraplegia could be caused by anterior horn lesion. This phenomenon is unclear because anterior horn lesions were not diagnosed in the proband’s parents. When we got in touch with his family to check the progress of the treatment, we were terrified to reveal the brutal murder of his father with generalized dystonia. And when we proceeded to catamnesis of the rest of studied group of patients, it became clear that such violent outcome seems to be rather the rule than exception. Case two concerns with cervical dystonia patient with angioma of the frontal lobe and her terrible death. Structural lesions of CNS, reported to be associated with torticollis, are mostly restricted to cerebellum, brain stem and basal ganglia. In fact, we know only about two documented frontal lobe mass lesions – meningiomas, associated with torticollis. Our observation of frontal lobe cavernous angioma associated with clinical picture of torticollis confirms the role this area could play in the pathophysiology of involuntary movements. We report a case of patient with torticollis associated with cavernous angioma of the right frontal lobe and presuppose causative role of angioma in the development of our patient’s torticollis. These both cases are the observation of very important neurologic phenomena from one side and the contemporary social attitudes to hyperkinetic patients from another.

Bt Detection, Protein, Lipids and Toxic Antinutritional Substances in Mexican Maize

Peña Betancourt Silvia Denise, Posadas Manzano Eduardo

Challenges in Disease and Health Research Vol. 1, , 11 July 2020, Page 15-21

The maiz (Zea mays L.) can contain polyphenols and mycotoxins; therefore, the genetic engineering technology has developed Bt maize which has recombinant proteins without risky substances chemical. The aflatoxins are the most toxic mycotoxins capable of producing cancer and decreasing the immune response in humans. Tannins affect the nutritional value of maize and hepatic and renal disfunction in high levels. The aim of this study was to identify the presence of Bt maize events and compare the content of aflatoxins and soluble polyphenol compounds.

Twenty-five samples of maize grain were collected, 12 hybrid maize and 13 local varieties, from Hidalgo, Mexico and Morelos. Samples were analyzed for Cry1Ab/Cry1Ac, using lateral flow strip method, crude protein and lipids by standard methods. Aflatoxins were assessed by commercial Elisa kit, and 30 samples maize from Mexico City were identified by HPLC-FD and polyphenol compounds by UV-Vis spectrophotometry method. The data were grouped in a completely random model and an analysis of variance was performed. The results indicated that 44.5% of hybrid maize were positive to Bt-Cry1Ab/1Ac proteins, containing 9.02% ± 2.5 lipids and 11.33% ±2.2 crude protein, 189 ± 0.92 mg/g of polyphenol compounds and 6.36 ± 3.3 µg·g aflatoxins. The local maize samples (55.5%) were negative to Bt-Cry1Ab/Cry1Ac, containing 8.68%±0.90, 6.14% lipids ± 2.3, 273 ± 0.40 mg/g polyphenol compounds and 7.15 ± 3.3 µg·kg of aflatoxins. In 13 hybrid maize from Mexico City, we found 5.43 µg/kg in a range of 0 to 10.45 µg/kg and 3.35 µg/kg (0-7.91) in local varieties. 

In conclusion, we observed an improvement of lipids and protein content (nutritional composition) in hybrid maize positive to Bt proteins, with a decrease in polyphenol compounds content comparing with some local varieties without Bt proteins.  The effectiveness of Bt maize expressing the Cry1Ab/ Cry1Ac in reducing aflatoxin contamination was not observed, therefore, additive effects of aflatoxins contamination in maize Bt-Cry need to be further investigated in chronic disease development.

Recent Perspective of Denovo Histoid Leprosy

Bhawna Sethi, Deepak Dimri, Yogesh Kumar

Challenges in Disease and Health Research Vol. 1, , 11 July 2020, Page 22-26

Leprosy is a chronic inflammatory disease caused by Mycobacterium leprae and Mycobacterium lepromatosis. Histoid leprosy, a rare clinicopathological form of leprosy, poses a diagnostic challenge to even astute clinicians. We report the case that occurred de novo in an elderly who presented with small to large lesions all over the body. A fresh focus on histoid leprosy is the primary objective of this article, especially in the context of the postglobal leprosy elimination era.

Critical Study on Subtotal Thyroidectomy for Giant Goiters under Local Anesthesia: Experience with 15 Nigerians

B. A. Eke, B. A. Ojo, W. T. Yongu, C. Ahachi, P. Denen-Akaa, V. I. Ugwu, P. Abayol, E. O. Umobong

Challenges in Disease and Health Research Vol. 1, , 11 July 2020, Page 27-33

Thyroid surgery is performed by majority of surgeons using general anesthesia with endotracheal intubation. In resource poor countries, the paucity of equipment and Anesthetists limit such procedure needing endotracheal intubation. We describe our experiences with 15 Nigerians who presented with giant goiters and were operated using local anesthesia. We conclude that subtotal thyroidectomy under local anesthesia is safe and cost effective. It should be encouraged in resource- poor countries and save the patients from living with the stigmata of goiters when they are not able to pay their ways to centers that use general anesthesia with endotacheal intubation for such procedure.

Five Year Retrospective Study on Keloid Management: Critical Overview

P. Denen Akaa, N. C. Ahachi, A. R. Vhriterhire, E. Agada, A. A. Jenrola, D. Dzuachii

Challenges in Disease and Health Research Vol. 1, , 11 July 2020, Page 34-49

Aim: Keloid morbidity is mostly associated with the psychosocial effects of the cosmetically unsightly scars. The study was carried out to highlight the availability of different treatment modalities and the effectiveness of our treatment strategies.

Materials and Methods: A 5 year retrospective study of all patients treated with keloid from March 2012 to February 2017. In this study all patients with keloids attending the plastic surgery clinic at Federal Medical Centre Makurdi and Benue State University Teaching Hospital Makurdi and receiving any form of treatment were included.

Results: Thirty one patients were included in our study. Keloids represented 7.2% of benign skin lesions. Keloids were twice more common in females than males. Young patients particularly belonging to the 21–30 year old group were mostly affected. Head and neck area was the predominantly affected anatomic site. All patients received some form of treatment and most (90.3%) were treated with the combination of surgery and intralesional triamcinolone acetonide with excellent results. Recurrence was noted in 25.8% of patients.    

Conclusion: our study highlights the excellent results of the combination of surgery. With intralesional triamcinolone acetonide, even in patients with difficult keloids like patients from African descent.

Histopathological Pattern of Thyroid Diseases in Abuja, Nigeria Capital City: A Review of One Hundred and One Consecutive Cases: Advanced Study

B. A. Eke, B. A. Ojo, B. M. Duduyemi, I. V. Ugwu, E. O. Umobong, G. Shorun, I. Okolie

Challenges in Disease and Health Research Vol. 1, , 11 July 2020, Page 50-55

This study is a histopathological review of 101 consecutive thyroidectomy specimen processed and histologically diagnosed in Anatomic Pathology Department of Asokoro District Hospital, Abuja, Nigeria new capital city between 2010 and 2014. Nodular colloid goiter is the preponderance thyroid lesion seen constituting 75%, of all cases with a male to female ratio of 0.17:1. Neoplasms (11%) represent the second most common pathology with thyroid adenoma representing 8% of cases and thyroid carcinoma 3%, of cases. Seventy five percent of the adenoma was seen in females and all the carcinoma occurred in females. Other lesions are thyroglossal duct cyst (7%) and thyroiditis (7%).

The study reveals a higher incidence of papillary carcinoma over follicular carcinoma and this represents a reversal to findings in most African population-based study. There is also a high incidence of thyroiditis in comparison with other works in Africa. Because of the small size of our sample population, accurate inference on the gender division of various disorders may not be conclusive. There is a need for further study on the pathology of thyroid lesions in Abuja in order to elucidate the reasons for the disparity noted.

Study on Subtotal Thyroidectomy under Local Anesthesia in a Pregnant Woman Presenting with Giant Goiter: A Case Study

B. A. Eke, B. A. Ojo, A. O. Ojabo, M. T. Maanongun, V. I. Ugwu, E. O. Umobong, M. Ogiator, P. Abayol, M. Efu, Chukwukadibia N. Ahachi, Priscilla Denen Akaa

Challenges in Disease and Health Research Vol. 1, , 11 July 2020, Page 56-62

Thyroid surgery is performed by most surgeons in practice using general anesthesia. In resource poor developing nations with paucity of anesthetists, anesthetic drugs and equipment, it can be done under local anesthesia with acceptable results. We report a case of a 17 week pregnant woman who presented with giant goiter and respiratory obstructive symptoms. Post-op, she carried the pregnancy to term with safe delivery. She was followed up for two years with no morbidity recorded. Thyroidectomy using local anesthesia is safe and cost effective and applicable to a wide range of patients, including those who pose a general anesthetic risk like this one.

Waldenstrom Macroglobulinemia / Plasma Cell Leukemia: A Diagnostic Dilemma

Bhawna Sethi, Kalam Singh Butola, Yogesh Kumar

Challenges in Disease and Health Research Vol. 1, , 11 July 2020, Page 63-67

Waldenstrom macroglobulinemia (WM) is a subset of lymphoplasmacytic lymphoma and is categorized under mature B-cell lymphoid neoplasm. This lymphoproliferative disorder is characterized by infiltration of the bone marrow by a clonal lymphoplasmacytic infiltrate (≥10%) and an IgM monoclonal gammopathy. WM infiltrate comprises B–lineage cells with predominance of small lymphocytes, admixed with lymphoplasmacytoid cells, plasma cells and often increased mast cells. This similar spectrum of cells, which is present in the bone marrow, may be present in the peripheral blood as well. With marked plasmacytic differentiation, it may be challenging to differentiate it from plasma cell leukemia. However, this differentiation is crucial for prognostication and therapeutic decision-making. We present a case that manifested with fatigability and dyspnoea, and was misdiagnosed as plasma cell leukemia on peripheral blood film and bone marrow morphology. It finally turned out to be a case of Waldenstrom macroglobulinemia on cytoflorometry, highlighting the role of elaborated workup and ancillary techniques to direct the accurate diagnosis and management.

Critical Review of An Autonomous Model of Health Care: Are Third Parties Really Needed?

Elmar H. Frangenberg

Challenges in Disease and Health Research Vol. 1, , 11 July 2020, Page 68-81

The concept of an independent citizen carried health care system is explored. The core is a cooperative administrative business structure, which functions exclusively for the benefit of the individual and community health of its members. The participants contribute according to their means a percentage of their assets to a health care fund and determine in a democratic approach on a one vote-one member-basis the size of a pretax deduction for the sole purpose of health care coverage. Representatives of this newly created health care cooperative enter binding agreements with integrated health care provider organizations, consisting of physicians, nurses, hospitals, laboratories, drug companies and ancillary personnel. The resulting single payer guarantees standard service delivery and reimbursement. The overall goal is optimum individual and community health of all members of the health care cooperative without interference of any third parties. A close partnership between providers and prospective patients assures an affordable balance between investment in and value of health services. Employers are freed of their burden to contribute to the health care of their employees. The remaining roles of government are enforcement of tax collections and basic rules of conduct and justice. Underlying principles are elucidated for supporting and enhancing optimum societal reciprocity in human interaction to mutually promoting health and well being as a fundamental private and community good. The major weaknesses of the current American health care system, namely inequality of access and unsustainable cost increases, are addressed and potentially alleviated.

The Impact of Palliative Care on Health Status in HIV-Positive Children

Aabid A. Ahmed, Vasileios Margaritis, Aaron Mendelsohn, Hellen Kariuki

Challenges in Disease and Health Research Vol. 1, , 11 July 2020, Page 82-93

HIV-positive children in sub-Saharan Africa have numerous challenges to overcome. These challenges increase psychosocial stress as well as symptom burden including fatigue, weight loss, pain, and mental changes. The symptoms may persist even after initiation of antiretroviral therapy, so such children need additional care. Palliative care lays emphasis on holistic patient-centered care, including physical, psychological, social, and spiritual symptoms, alongside antiretroviral therapy. There is limited data on the impact of integrating palliative care with standard HIV care and treatment in children. The purpose of this study was to fill the gap in the literature by investigating the impact of palliative care on health status in HIV-positive children on antiretroviral therapy. The theoretical framework was based on the humanistic nursing theory. According to study results, children receiving palliative care alongside antiretroviral therapy have better physical and psychosocial health compared to children receiving only antiretroviral therapy. Increasing age was a contributing factor to better psychosocial and physical health in patients receiving palliative care. Emotional, social, and school functioning are important factors that determine treatment outcomes in children on antiretroviral therapy, and addressing those factors through palliative care will create a positive social change by improving treatment outcomes, quality of life, and longevity

Prevalence of Type II Diabetes Mellitus (T2DM) and Risk Factors among Rural Farmers: Critical Study

Ayuba Affi, Dalili Shabbal, Mercy Solomon, S. A. Longwam, A. Lukdem, T. Selowo, Ganiyu Amusa

Challenges in Disease and Health Research Vol. 1, , 11 July 2020, Page 94-102

Aim: To determine prevalence of T2DM and risk factors among rural farmers of Panyam in Plateau Central, Nigeria.

Background: Diabetes mellitus is one of the commonest metabolic disorder characterized by persistent hyperglycemia due to lack of insulin secretion or inactivity of insulin resulting in risk of microangiopathy and macroangiopathy [1,2].

Many lifestyle factors affect the incidence of Type II Diabetes Mellitus, which includes cigarette smoking, inactivity and heavy alcohol consumption that could cause hyperuriceamia. Other risk factors include obesity, age, family history.

Materials and Methods: The study population consisted of 200 adults above 40 years mainly farmers. Both females and males were recruited into the study.

Venous blood (2.5 ml) was collected into fluoride-oxalate and transported to the chemical pathology lab in JUTH within 2 using enzymatic uricase method for serum uric assay. The reference interval for SUA if 120-420 µmol/L. Glucose was determined by glucose oxidase method. The coefficient of variation of glucose is 6.4% at 5.6 mmol/L and 2.1% at 18.3 mmol/L. The reference interval for serum glucose is 3.5-5.9 mmol/L.

Results: The data obtained were coded and entered into State Software for analysis. The data are presented as mean ±S.D. comparison was done by student’s t-test for continuous variables. The overall crude prevalence of T2DM in Panyam farmers was 5.5% while for males and females prevalence was 4% and 6% respectively.

A BMI of >30 kg/m2 was found in 31 individuals giving a prevalence 15.5% and SUA prevalence of 41% with 32% being prevalence of hypertension.

Conclusion: It shows that the prevalence of Type II Diabetes Mellitus for the general population was 5.5 mmol/L with high uric acid levels. The associated risk factors such as lifestyle of alcoholism indulgence could explain this outcome.

The high prevalence of Type II Diabetes Mellitus warrant adequate preventive measures like dietary advice exercise and adjusting lifestyle with moderation or total abstinence from alcohol will go a long way in reducing this disease.

Although he present analysis is based on a limited number of diabetics, the evidence of consistently against interaction between diabetes and cardiovascular risk factors.

Calcite Type Fired Shell Powder of Bivalve Corbicula japonica Improved Mal-Functions of Liver in Animal and in Calcite-Ingested Clients

Sasaki Jin-Ichi, Minegishi Yoshinori, Someya Tetsunei

Challenges in Disease and Health Research Vol. 1, , 11 July 2020, Page 103-116

It has been inherited for a long preriod in a small village that the fired shell powder of bivalve Corbicula japonica has been working against liver disorder without any scientific evidences. Experiment was initiated by the village office requirement to ascertain an anti-hepatitis activity of the fired shell powder of the Corbicula japonica. Shell of the Corbicula japonica was fired to analyze a crystal structure by the X-ray diffraction apparatus, followed by animal tests by hepatitis model Long Evans Cinnamon (LEC) rat. In C57BL/6 mouse model additional biofunctions like immune activation, lipid controlling, anti-alcoholic damage activity and liver cells proliferation tests were evaluated. The fired shell powder of the Corbicula japonica (calcite type) fired at 500°C for 2 hrs demonstrated the liver function improving activity in LEC rat model via orally administerationt. The calcite type shell powder fed-LEC rats elongated survival times by the improving acute hepatitis symptoms, however, the Corbicula japonica aragonite and Ruditapes philippinarum calcite did not work effectively. Further Corbicula japonica calcite lowered AST(glutamic oxaloacetic transaminase) ALT (glutamic pyruvic transaminase), TBiI (total bilirubin) and IAP (immunosuppressive acidic protein) value in serum, and enforced cellular immune by increasing NK (natural killer) cells activity. Cytokines generation as TNF-α (tumor necrosis factor), IL-2 (interleukin) and IFN-γ (interferon) in spleen cells cultivation assay was not clearly admitted. In the alcohol-fed mouse test, the Corbicula japonica calcite reduced alcoholic caused damages in liver and lowered lipid level in serum.

An Unusual Presentation of Synchronous Seminoma in Abdominopelvic and Inguinal Testes

Bhawna Sethi, Neha Prabhakar, Arun Saxena

Challenges in Disease and Health Research Vol. 1, , 11 July 2020, Page 117-124

During their descent, the testes may get arrested anywhere along their tract. Risk of testicular cancer is higher in patients with undescended testes, abdominal testis being more prone than inguinal. Seminoma is the commonest cancer in undescended testis. However, synchronous seminoma involving bilateral cryptorchid testis is rare. Present case is uncommon due to synchronous involvement of abdominopelvic and inguinal testes in extended age and its unusual morphological features.

Multifactorial Cognitive Training can Slow down the Cognitive Decline in Early Alzheimer Patients: Advanced Study

Béatrice Alescio-Lautier, Nathalie Sambucchi, Bernard-François Michel, Caroline Chambon

Challenges in Disease and Health Research Vol. 1, , 11 July 2020, Page 125-138

Alzheimer’s disease (AD) is the most frequent dementia in the over 70-year-old people. Among the strategies examined to slow down the progression of AD, cognitive stimulation is underexplored. Yet, numerous studies showed that at early stage of AD, the brain is still able to show plasticity. Therefore, an adapted cognitive training can be considered as an efficient tool to fight the cognitive side of the pathology.

Objective: In the present study we investigate the potential of a memory and attention cognitive training to face the cognitive deficit observed in mild to moderate AD patients (n = 12; MMSE: 22.1 ± 0.9).

Methods: We proposed a training program (15 sessions from 90 to 120 min every two weeks) using a large set of memory and attentional tasks as well as various semantic tasks. Particular attention was given to the personalization of the difficulty level and content of the tasks as well as to the minimization of errors and negative experiences. Another important aspect of the training was the involvement of the caregiver in the training process during and between the sessions.

Results: Our results show a positive impact of our training program on one memory process, i.e., the recall, and one executive ability, i.e., verbal fluency. The impact on recall highlight that a memory training using recognition as retrieval mode can help improving recall in AD patients in the early stage as we already showed it in a MCI patients. The impact on verbal fluency shows that training the manipulation of semantic material through many different tasks may improve access to the lexicon.

Conclusion: The present results bring new data showing that at early stage of the disease, an adapted cognitive training program has the potential to slow down the cognitive decline of the disease.

E-Health Status and Horizons

B. A. Kobrinskii

Challenges in Disease and Health Research Vol. 1, , 11 July 2020, Page 139-145

The article reviews status and development potential of E-Health systems with modular formation Electronic Healthcare Record. The focus is on the person-centered healthcare. Intellectual decision support modules built into Health information systems provide new possibilities. Computer-assisted module should be available for physicians, working with Electronic Medical Record, including during telemedicine consultations. In the meetings for difficult cases, the physicians are able to quickly obtain information from regional Cloud Optimized Storage and Computing. Telemedicine and mHealth are considered as the important components of E-Health for consultations and personalized remote monitoring of patients. Personal portable devices, as well as an electronic stethoscopes and specialized video cameras for obtaining objective information by distant consultants are used to monitor vital body parameters. Smart (digital) hospitals using cyber-physical systems will proceed to an increasingly high level of intellectual support of clinical processes. In prospect, E-Health will provide a comprehensive analysis of the health status of the population by physicians from different countries, based on cross-border medicine.