New Insights into Disease and Pathogen Research Vol. 5

Cancer Prevention and Control in Bangladesh: Mass Awareness is Needed

Kanchan Chakma — 2021-07-02

Here we discuss the mass population perception and life style practices on cancer in a group of Bangladeshi people. Based on our conducted survey findings, we highlighted the important issues to address for reducing the cancer incidence of the country. In 2016, we reported a cancer knowledge and perception survey findings conducted on Bangladeshi people. The survey questionnaire was developed based on the WHO country level cancer risk assessment report. A total of 407 respondents were invited randomly using social networks and personal communication to take part into the survey. We included 253 respondents with information of knowledge and current life style practices towards cancer prevention. We found that only one-third of the respondents irrespective of age groups- No vs. Yes: 96 (37.95%) vs. 157 (62.05%), p<0.00001 had known that cancer can be prevented by modifying life styles. Female respondents had remarkably lower level of knowledge and perception on specific cancer prevention knowledge compared to their male counterpart. Irrespective of age groups and gender, about 67% (n=169) and 45% (n=113) of the respondents knew about the impact of chewing or smoking tobacco and non-food grade preservatives, chemicals, ripening agents on developing cancer, respectively; however, only one-fourth (n=73, 28.65%) respondents knew that physical inability or obesity is a risk factor for cancer. Stopped/never smoking, avoid consuming food with food additives/preservatives, alcohol consumption were found the three most common practices among the respondents towards cancer prevention. The study provides important baseline information on preventable cancer risk perception in Bangladesh. In this chapter, we comprehend our survey findings in details including the cancer screening perception and practices of the respondents. Our results indicate that a comprehensive cancer awareness program is needed to reduce the cancer burden in Bangladesh.

Ocular Infections after Penetrating Keratoplasty

Prabhakar Srinivasapuram Krishnacharya — 2021-07-02

Context: Early diagnosis of ocular infections following penetrating keratoplasty (PK) facilitates the preservation of useful vision and furthermore prevents the progression of intraocular spread. This largely depends on the initial clinical presentation and preoperative extensive and laborious ancillary laboratory investigations.

Objectives of the Study: The aim of this research was to study donor and recipient risk factors for post-PK ocular infections

Population and Methods: This is an interventional prospective study conducted in 34 patients who underwent PK under peribulbar anesthesia from 2014 to 2016 at a tertiary based teaching hospital. Eyes with posterior segment pathology excluded with the inclusion of all other corneal disorders that caused opacification. Six patients developed signs and symptoms suspicious of postoperative infections. Statistical analysis performed with MS Excel software.

Results: The mean age was 53 (+/-18.04) years, ranging from 12 to 86 years with 24 (70.59%) males and 10 (29.41%) females. There were 24 (70.59%) right eyes and 10 (29.41%) left eyes. The mean age was 63.97 (+/-16.08) years among the donors. Six (17.64%) patients developed postoperative infections that included one patient with Pseudomonas aeroginosa keratoconjunctivitis, two patients with fusarium fungal keratitis and surprisingly, observed that failure to establish growth in the remaining three cases. Positive microbial identification by culture was possible only in three (8.82%) patients.

Conclusion: Confirming the microbial identification possible only in three patients, and the other three cases revealed no growth even after one week of incubation. The risk factors found among recipients were a vegetative injury, dust fall, and eye rubbing, as well as taking a very hot bath. Graft clarity restoration significantly improved after topical management with fortified antibiotics and antifungal agents.

Experiments on the Seroprevalences and Associated Factors of Viral Infections (HIV, Hepatitis B and C) among Pregnant Women Attending Antenatal Care at the Yaoundé Central Hospital

Florent Ymele Fouelifack — 2021-07-02

A viral infection is a proliferation of a harmful virus inside the body. HIV infection, viral hepatitis B (HBV) and C (HCV) constitute a public health problem. The objective of this study was to assess seroprevalences and associated factors of these infections among pregnant women. We carried out a cross-sectional and analytical study. We consecutively enrolled 360 women attending ANC. Blood samples were collected to screen for HIVAb, HBsAg and HCVAb through rapid diagnostic tests, and confirmed at the “Centre Pasteur” laboratory of Cameroon. The mean age was 27.99 +/- 5.63 years, ranging from 15 and 47 years. The prevalence of HIVAb, HBsAg and HCVAb were 13.1% (n = 47), 9.4% (n = 34) and 1.7% (n = 6) respectively. We had 1.4% and 0.6% of HIV/HBV and HIV/HCV co-infections respectively. Independent risk factors associated with HIV were: The level of primary study (OR: 7.97; 95% CI = 2.23 - 28.49; P = 0.001) and multiple sexual partners (OR: 4 79; 95% CI = 1.79 - 12.79, P = 0.002). Multiple sexual partners was the Independent risk factor associated with HBsAg (OR: 11.62; 95% CI = 5.057 - 26.731; P = <0.001). No factor was associated with HCVAb. Increased awareness, promotion of screening and / or treatment of infections and immunization against HBV in the general population and in women of childbearing age in particular, would reduce their impact and therefore prevent their horizontal and vertical transmission.

A Case Control Study on the Risk Factors of Genital Tract Lacerations at Yaoundé Central Hospital, Cameroon

Florent Ymele Fouelifack — 2021-07-02

Genital tract lacerations are lesions resulting from breakage of continuity of the lower genital tract during birth. The objective of this study was to determine the risk factors for genital tract lacerations. Once identified, women who had suffered genital tract lacerations were interviewed, after which they underwent physical examination aimed at identifying the laceration site and type. We paired these women to those of same age and parity who did not have genital tract laceration (control group). Data were collected using a questionnaire and analyzed with Epi info software version 3.5.1 with a significance level of P< 0.05. Out of 1250 deliveries, 150 women had genital tract laceration, giving the prevalence of 12%. But 14 has been excluded and retained 136 women as cases. Perineal tears accounted for 92.6% of genital tract lacerations, cervical tears 8.8% and vaginal tears 7.4%. Maternal risk factors were: past history of perineal tear (OR=5.05; 95% CI :1.9-13.7; p=0.00), length of the perineum < 4 cm (OR=33.72; 95% CI:17.2-66.02; p=0.00), duration of expulsion < 30 minutes (OR=3.16; 95%CI:1.9-5.2; p=0.00) and duration of active phase of labor < 6 hours (OR=5.01; 95% CI:2.8-8.9; p=0.00). Prior to delivery and in order to prevent trauma to the genital tract, the following risk factors should be sought out for: Past history of perineal tears, perineal lengths less than 4 cm, duration of the active phase of labour less than 6 hours, induction and augmentation of labor with newborn birthweights of more than 4000 g and expulsive phases lasting less than 30 minutes. Also, care providers are advised to perform episiotomies in women presenting these risk factors.

A Retrospective Study on Fetal Outcome of Deliveries among Teenagers in Centre Region of Cameroon

Florent Ymele Fouelifack — 2021-07-02

In order to inform public health action, we sought to compare the fetal outcome of adolescent pregnancies with the non-adolescent ones. A total of 6041 deliveries were compared using rates, proportions, means and OR, the fetal outcome of adolescent (10-19 years old) deliveries registered at the Yaoundé Central Hospital, to those in their non-adolescent counterparts.Referred deliveries were significantly higher in adolescent participants compared to their non-adolescent counterparts (6.4% versus 4.3%, OR 1.53 95% CI 1.07-2.20). Non-adolescent pregnancies lasted significantly longer than adolescent pregnancies (38.46±2.72 versus 38.13±3.19 weeks respectively, p=.007). The former group had significantly higher rates of premature and post-term: deliveries (29.3% versus 24.5%, p=.041 OR 1.28 95% CI 1.01-1.62 and 4.9 versus 2.4%, p=.014 OR 2.11 95% CI 1.46-3.87 respectively. Babies born of adolescent mothers weighed significantly less (irrespective of birth order) than those born of non-adolescent mothers (mean weights 2984.80±647.81 versus 3190.72±645.45 grams, p<.001). The odds of both apparent and perinatal deaths was significantly higher in the adolescent group (AOR 1.75, 95% CI 1.25-2.47 and AOR 1.69 95% CI 1.17-2.45 respectively). Adolescent pregnancies are associated with poor fetal outcome. There is need for counseling and provision of family planning services to reduce their incidence.

Turmeric (Curcumin) as a Supplement in the Reduction of Inflammation in a Collagen-induced Arthritis Rat Model

Srikumar Chakravarthi — 2021-07-02

Aims: To assess the therapeutic effect of turmeric (curcumin) supplementation in modulating the expression of NF-κB in the joints of collagen-induced arthritis (CIA) rats.

Place and Duration of Study: Department of Postgraduate Studies and Research, International Medical University, Malaysia, between July 2011 and May 2012.

Methodology: Arthritis was induced in each group of Dark Agouti (DA) rats, by intradermal injection with collagen emulsified in complete Freund’s adjuvant. Treatment groups which were induced with CIA were treated with: 500 mg/kg curcumin; 1000 mg/kg curcumin; 2000 mg/kg curcumin; 25 mg/kg aspirin. Combination treatment groups which were induced with CIA were treated with: 500 mg/kg curcumin and 25 mg/kg aspirin; 1000 mg/kg curcumin and 25 mg/kg aspirin; 2000 mg/kg curcumin and 25 mg/kg aspirin from day 25 to 38. Efficacy was assessed based on ability to reduce paw oedema, histopathological changes, NF-κB expression, serum tumour necrosis factor alpha (TNF-α), interleukin 1-beta (IL-1β) and gluthathione peroxidase (GPx) levels.

Results: Based on histopathological study, immunohistochemical scoring of NF-κB and ELISA analysis of TNF-α, IL-1β and GPx levels, our study found that curcumin given after arthritis in high doses, shows effects of healing and this results were comparable to positive control group, which is the arthritic group treated with 25 mg/kg aspirin. Curcumin given in combination with aspirin, showed better reduction in pathology in arthritic group compared to positive control group, especially with higher doses of curcumin.

Conclusion: Curcumin was effective in reducing inflammatory changes seen in CIA joints which were proved through histopathological, immunohistochemical and biochemical analysis, however only at high doses.

The Smouldering Attacks of Acute Viral Hepatitis Caused by Hepatitis A & E Virus: An Update from India

Sarwat Fatima — 2021-07-02

Introduction: Acute viral hepatitis [AVH] due to feco-oral group of hepatitis viruses is endemic in India. Till recently outbreaks of hepatitis E virus infection were more common than ones due to hepatitis A virus. A change in the epidemiology of these infections has been observed over the last decade.

Aim: The present study aimed at determining the seroprevalence of IgM antibodies to hepatitis A and E virus in clinically diagnosed acute viral hepatitis cases. And to determine the various epidemiologic factors associated with it.

Study Design: A cross sectional study was carried out on patients with acute viral hepatitis referred from paediatric and gastro enterology department of Princess Esra hospital.

Place and Duration of Study: Serum samples from one hundred and eight symptomatic subjects were analysed for anti IgM antibodies to hepatitis A and E virus and liver function test in the department of laboratory medicine for Microbiology and biochemistry at Princess Esra Hospital, Deccan College of Medical Sciences between January 2013 and January 2014.

Methodology: After obtaining informed consent, blood samples were collected from all the subjects under strict aseptic precautions and tested for anti- HAV and Anti-HEV IgM antibodies using capture Elisa from Diasorin [Italy]. Biochemical analyses included estimation of serum aminotransferases, alkaline phosphatase and bilirubin levels.

Results: An overall seropositivity of 54% was observed in the present study. More number of the subjects as 46.29% tested positive for anti HAV IgM than for anti HEV IgM as 7.4%. Co-infections due to both hepatitis A & E virus were nil. Acute viral hepatitis due to hepatitis A virus was more common in children in the age group 6-10 years followed by 11-15 years and least in 0-5 years of age indicating an epidemiological shift. Whereas infection with hepatitis E virus was more common in adolescent and adults. Males were more susceptible to both the infections than females. Liver function test results correlated well with viral markers indicating acute hepatic parenchymal inflammation and injury. The socioeconomic status of the individuals revealed that 95% of the subjects were from below poverty line and didn’t have access to proper drinking water and sanitary facilities. None were vaccinated against Hepatitis A virus. In the rest 46.31% of the cases of AVH the aetiology remained unspecified.

Conclusion: From the above data it is evident that more than 50% of the AVH cases in the present study were due to faeco-oral group of hepatitis viruses. A strategic approach for control and prevention of the same is required. It is envisaged that with the new national action plan [2019] in place to combat viral hepatitis as part of SDG 3.3 which aims at and ensures “health for all”. India will be able to successfully bring down the prevalence of acute viral hepatitis effectively if not completely by 2030.

Studies on Idiopathic Sclerosing Encapsulating Peritonitis Revealed by Intestinal Obstruction

Haithem Zaafouri — 2021-07-02

Sclerosing encapsulating peritonitis (SEP) is a very rare entity characterized by encasement of small intestine by a fibro collagenous membrane. It is divided into primary (idiopathic) which is named as abdominal cocoon and secondary forms. The preoperative diagnosis is difficult and most cases are diagnosed intraoperatively. A conservative treatment approach is the most suitable management strategy in asymptomatic idiopathic SEP.

In this paper, we aimed to present a case of idiopathic SEP revealed by intestinal obstruction.

Repair of Complex Vesicovaginal Fistula with Gracilis Muscle Interposition Flap

A. Sharma — 2021-07-02

Complex Vescico-vaginal Fistulas (VVF) are a common cause of morbidity especially in elderly patients. These can be one of the most troublesome complications of obstetric trauma and pelvic surgery and usually occur due to previous operative interventions and/or as a result of chronic diseases. These are difficult to repair because of the poor or almost no supporting tissue left at the perineum as a result of the previous insults. According to the principles of fistula closures, some form of vascular tissue should be applied as a graft for the successful repair of these complex fistulas. Despite many advances in the medical field, repair of complex VVF continues to present a major technical challenge for modern surgery. We describe Gracilis muscle interposition flap for repair of these complex VVFs.

Relationship between Oxidative Stress, Circadian Rhythms and AMD: Advanced Study

María Luisa Fanjul-Moles — 2021-07-02

This work reviews concepts regarding oxidative stress and the mechanisms by which endogenous and exogenous factors produce reactive oxygen species (ROS). It also surveys the relationships between oxidative stress, circadian rhythms, and retinal damage in humans, particularly those related to light and photodamage. In the first section, the production of ROS by different cell organelles and biomolecules and the antioxidant mechanisms that antagonize this damage are reviewed. The second section includes a brief review of circadian clocks and their relationship with the cellular redox state. In the third part of this work, the relationship between retinal damage and ROS is described. The last part of this work focuses on retinal degenerative pathology, age-related macular degeneration, and the relationships between this pathology, ROS and light. Finally, the possible interactions between the retinal pigment epithelium (RPE), circadian rhythms, and this pathology are discussed.

Diagnostic Efficiencies of the Partec CyScope® Rapid Test in Comparison to Light Microscopy for Malaria in Rural Tole, Southwest Cameroon: New Perspective

Judith Lum Ndamukong-Nyanga — 2021-07-02

Introduction/Aim: Malaria is a major public health problem and can lead to fatal consequences within few days if not diagnosed and promptly treated. The aim of this study was to determine the malaria parasite prevalence and assess the performance characteristics of the Partec CyScope^® rapid diagnostic test (RDT) in Tole.

Experimental Design, Place and Duration of Study: The study was a cross-sectional survey, carried out in Tole, Southwest Cameroon in July 2014.

Methodology: A total of 231 children were studied. Information on demographic data, temperature and malaria risk factors was recorded. Capillary blood was collected by finger pricking. Thick and thin blood films were prepared for malaria parasite detection and speciation. Ten µL of blood was added unto the DAPI coated slides and read under the Partec CyScope^®. Haemoglobin values were determined.

Results and Conclusion: The overall prevalences of malaria parasites, fever and anaemia were 66.2%, 35.9% and 86.6% respectively. Although not statistically significant, malaria parasite prevalence was highest in children aged 1 – 5 years, higher in females, those that had stagnant water and bushes around their homes as well as those who did not use insecticide-treated bed nets and insecticide residual spraying when compared with their respective counterparts. Overall geometric mean parasite density (GMPD) was 3691 (range = 100 - 48000) parasites/µL of blood). GMPD was significantly higher (P = 0.03) in febrile than afebrile children. Prevalence of anaemia was significantly higher (P = 0.01) in malaria positive (68.5%) than negative (45.2%) children. More cases of infections were detected by light microscopy than by Partec CyScope^®. The sensitivities and specificities of Partec CyScope^®were 87.6% (CI = 81.4-91.1%) and 94.9% (CI = 87.5-98.0%) respectively while the positive and negative predictive values were 97.1% and 79.6% respectively. Partec CyScope^®can therefore be used for mass malaria surveillance.

Socio-demographic and Environmental Factors Influencing Asymptomatic Malaria and Anaemia Incidence among School Children in Fako Division, South West Cameroon: Detailed Study

Judith Lum Ndamukong-Nyanga — 2021-07-02

Aim: This work was aimed to assess the influence of socio-demographic and environmental factors on the incidence of asymptomatic malaria and anaemia among pupils in Fako Division, southwest Cameroon.

Experimental Design: The study was a cross-sectional survey.

Place and Duration of Study: The study was carried out in Fako Division, southwest Cameroon -Bolifamba, Dibanda and Mutengene from February to March, 2013.

Methodology: A total of 316 pupils aged 4–15 years were studied. Data on socio-demographic and environmental factors was obtained from a semi-structured questionnaire. Blood samples were collected. Malaria parasite incidence and density were determined from Giemsa-stained thin and thick blood smears respectively. Haemoglobin (Hb) levels were determined using a haemoglobinometer.

Results: The overall incidence of asymptomatic malaria was 43.4% (CI=38-48.9). Malaria incidence was significantly highest (χ²=7,P=0.03) in pupils of 6-10 years age group (49.0%, CI=42.1-59.9) when compared with their counterparts. Although not significant, malaria parasite incidence was higher in males, pupils with fever, highest in pupils of Bolifamba and poor social status than their respective counterparts. Geometric mean parasite density (GMPD) was significantly highest (Kruskal Wallis test, *χ²=6.4, P=0.04) in Dibandathan other sites. Anaemia incidence was higher among inhabitants of Dibanda (56.7%) than other sites. Anaemia incidence was statistically higher (χ²=5.6, P=0.02) in malaria positive pupils, highest in Dibanda (χ²=27.244, P<0.001) and the middle class when compared with their respective counterparts. Mean HB was significantly higher in malaria negative (t=1-8, P=0.02), highest in the poor class (χ²=13.4, P=0.001) and Mutengene (F=21.2, P=0.0001) when compared with their respective counterparts.

Conclusion: Sensitization on effective malaria control strategies needs to be emphasized so that a reduction in malaria burden can be achieved.

The Details of Assessing the Performance Characteristics of the “CareStartTM Malaria HRP2 pf (CAT NO: G0141, ACCESSBIO)” Rapid Diagnostic Test for Asymptomatic Malaria in S.W. Region, Cameroon

Judith Lum Ndamukong-Nyanga — 2021-07-02

Aim: The aim of this study was to determine the prevalence and density of malaria parasites in asymptomatic school children in Mutengene and evaluate the performance characteristics of the ‘CareStart^TM Malaria HRP2 pf (CAT NO: G0141, ACCESSBIO)’ rapid diagnostic test (RDT) using light microscopy as a gold standard.

Study Design: The study was a cross-sectional survey.

Place and Duration of Study: The study was carried out in Mutengene, from February to March, 2013.

Methodology: A total of 406 pupils were studied. Demographic data was taken for each child and capillary blood was collected. Blood films were prepared for the assessment of parasite density and speciation. A drop of blood was used on the RDT to determine the malaria status.

Results: The mean age at 95% confidence interval (CI) was 8 ± 2 years (range = 4 -15 years) and the overall prevalence of malaria was 39.9% (162) by microscopy. The geometric mean parasite density (GMPD) was 2332.7 parasites/µL (range: 218 - 16000). Only 386 pupils were examined by both methods. More pupils were positive by microscopy (40.9%, CI = 36.1 - 45.9) than by RDT (27.9%, CI = 23.7 - 32.7) and the difference was statistically significant (χ²= 16.1, P <0.0001). The majority of those detected had high infection (≥ 5000 parasite/µL). Less than 50% of those with low (25.0%, CI = 12.0 - 44.9), moderate (40.7%, CI = 32.24-49.70) and high parasitaemia (75%, CI = 5.00-89.82) were positive by RDT and the difference was significant (χ²= 10.09, P = 0.006). The RDT showed a low sensitivity of 48.5% (CI = 40.3 – 56.9%) and specificity of 84.0% (CI = 80.0- 88.2%).

Conclusion: More research needs to be done on the RDT to improve on its performance characteristics before it could be used in mass surveillance programmes.