Important Public Health Hazard Research Articles

Integrating Health Data-Driven Machine Learning Algorithms to Evaluate Risk Factors of Early Stage Hypertension at Different Levels of HDL and LDL Cholesterol.

Purpose: Cardiovascular disease (CVD) is a major worldwide health burden. As the risk factors of CVD, hypertension, and hyperlipidemia are most mentioned. Early stage hypertension in the population with dyslipidemia is an important public health hazard. This study was the application of data-driven machine learning (ML), demonstrating complex relationships between risk factors and outcomes and promising predictive performance with vast amounts of medical data, aimed to investigate the association between dyslipidemia and the incidence of early stage hypertension in a large cohort with normal blood pressure at baseline. Methods: This study analyzed annual health screening data for 71,108 people from 2005 to 2017, including data for 27 risk-related indicators, sourced from the MJ Group, a major health screening center in Taiwan. We used five machine learning (ML) methods—stochastic gradient boosting (SGB), multivariate adaptive regression splines (MARS), least absolute shrinkage and selection operator regression (Lasso), ridge regression (Ridge), and gradient boosting with categorical features support (CatBoost)—to develop a multi-stage ML algorithm-based prediction scheme and then evaluate important risk factors at the early stage of hypertension, especially for groups with high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) levels within or out of the reference range. Results: Age, body mass index, waist circumference, waist-to-hip ratio, fasting plasma glucose, and C-reactive protein (CRP) were associated with hypertension. The hemoglobin level was also a positive contributor to blood pressure elevation and it appeared among the top three important risk factors in all LDL-C/HDL-C groups; therefore, these variables may be important in affecting blood pressure in the early stage of hypertension. A residual contribution to blood pressure elevation was found in groups with increased LDL-C. This suggests that LDL-C levels are associated with CPR levels, and that the LDL-C level may be an important factor for predicting the development of hypertension. Conclusion: The five prediction models provided similar classifications of risk factors. The results of this study show that an increase in LDL-C is more important than the start of a drop in HDL-C in health screening of sub-healthy adults. The findings of this study should be of value to health awareness raising about hypertension and further discussion and follow-up research.

Acute Accidental Exposure to Chlorine Gas: Clinical Presentation, Pulmonary Functions and Outcomes

To study the clinical presentation, pulmonary functions and outcomes in subjects who were accidentally exposed to chlorine gas. Prospective observational study of 64 patients who sustained acute accidental exposure to chlorine gas during a leak in the chlorination system of the public bathing pool of a temple. The major presenting symptoms and signs included acute dyspnoea (100%), chest discomfort (100%), cough (97%), eye irritation (88%), giddiness (72%), vomiting (46%), and heaviness in the head (44%); tachycardia (100%), tachypnoea (96%) and polyphonic wheezing (28%). All patients were managed in the emergency room with humidified oxygen inhalation and beta-2 agonist nebulisation and 52 were discharged within six hours. Twelve patients were severely affected and required hospitalisation; three of them were admitted into the intensive care unit. Three patients developed pulmonary oedema six to eight hours following admission. Pulmonary function testing (n = 12) at presentation revealed obstructive defect in eight and mixed obstructive-cum-restrictive defect in four patients. The mean duration of hospital stay was 5.1 +/- 2.1 days. None of the patients died. Reactive airway dysfunction syndrome (RADS) was observed in three of the 12 hospitalised patients, who complained of manifested persistent cough that lasted for three months period following discharge. Serial pulmonary functions recovered to normal range by the end of the six months in all patients and remained so at one-year follow-up. Acute exposure to chlorine gas is an uncommon, but important public health hazard and can cause RADS, acute lung injury and pulmonary function abnormalities, which are reversible on prompt and appropriate management.

Naira note: Potential Environmental Material for Transmitting Bacterial Pathogens among Food Dealers in Umuahia, Nigeria

Inanimate objects can serve as environmental vehicles for transmitting pathogenic bacteria among individuals in the population. Our study revealed that of the 72 naira notes examined, 58 samples representing 80.6% had bacterial contaminants. The bacterial isolates were Staphylococcus aureus (70.8%), Salmonella spp. (51.4%), Escherichia coli (44.4%), Shigella spp. (22.2%), Pseudomonas aeruginosa. (18.1%), and Proteus spp. (1.4%). The naira notes examined were all obtained from food dealers particularly fish sellers, food vendors, and meat sellers. The presence of these bacterial pathogens on naira notes handled by those food dealers is an important public health hazard as they can contaminate food leading to foodborne diseases and intoxications. Our study found that lower denominations of currency notes (naira), were mostly contaminated by these pathogens and this could be as a result of their frequent use in daily transactions.

The Utility of Dreissena polymorpha for Assessing the Viral Contamination of Rivers by Measuring the Accumulation of F-Specific RNA Bacteriophages

River water that receives treated wastewater can be contaminated by pathogens including enteric viruses due to fecal pollution, which may represent an important public health hazard. There is a great diversity of enteric viruses and fecal bacteriophages, especially F-specific RNA bacteriophages (FRNAPHs), are commonly proposed as indicators of viral pollution due to a variety of characteristics such as their structural similarities to the main enteric viruses, their high concentrations in raw wastewater and their environmental survival rate, which is better than other cultivable enteric viruses. However, evaluating the viral contamination of water on the basis of FRNAPH concentration levels continues to present a challenge. This is because the quality of detection is strongly dependent on the quantity of viral particles, high spatio-temporal variabilities and the physico-chemical conditions of the water during sampling. To overcome these limitations, the present study aims to evaluate whether the bivalve mollusk Dreissena polymorpha (zebra mussel) could be considered a suitable experimental model for assessing the viral contamination of rivers. In order to determine this, the capacity of D. polymorpha to accumulate FRNAPHs and assimilate them into their soft tissue was studied. This provided a proof of concept for the use of D. polymorpha to evaluate the viral contamination of surface water. Two experiments were conducted: (1) an in situ experiment to confirm that zebra mussels naturally accumulated FRNAPHs and (2) a laboratory experiment to determine the accumulation and depuration kinetics of FRNAPHs in D. polymorpha tissue. The study highlights the capacity of the mussels to accumulate infectious FRNAPHs both on a laboratory scale under controlled conditions as well as in situ at different sites that are representative of different bodies of water. An analysis of the mussels’ soft tissue showed that they were capable of reflecting the water’s contamination level very quickly (within less than 24 h). Moreover, the soft tissue retained the viral load much longer than the water due to a low depuration rate. The analysis of FRNAPH concentrations in mussels exposed in situ suggested that there were differences in contamination levels between sites. These preliminary results underline the potential utility of zebra mussels in assessing viral contamination by measuring the accumulation of FRNAPHs in their tissue. This may ultimately enable stakeholders to use zebra mussels as a means of monitoring viral pollution in surface water.

Epidemiology of Hepatitis C Virus Infection Among 1,959 Patients in Shiraz, Southern Iran, Between 1991 and 2016

Background: Hepatitis C virus (HCV) infection is an important public health hazard, with approximately 71 million chronically HCV-infected individuals around the world. Objectives: This study was designed to provide epidemiologic information on HCV, evaluate the possible route of transmission and its associated risk factors, and characterize the prevalence and distribution of HCV genotypes among HCV-infected patients in Fars Province, Southern Iran. Methods: This cross-sectional descriptive-analytical study was performed with the medical records of patients with HCV infection who had referred to the Gastroenterohepatology Research Center, Shiraz, Iran. The extracted data had been gathered from 1991 to 2016. The data included the time of diagnosis, demographic information, information on the course of the disease (including symptoms at disease onset), history of exposure to possible routes of transmission, risk factors, HCV genotype (if available), and family history of HCV infection. The relationship between two categorical variables was determined using the chi-square or Fisher’s exact tests. The relationship between categorical and quantitative variables was tested by one-way ANOVA. The Kendall-tau test was used to show the changing trends of risk factors regarding age and year groups. Univariate analysis was done and odds ratios were calculated to determine the relationship between genotypes and possible routes of HCV transmission. Results: From the total of 1,959 patients, 1,748 (88.20%) were males. An analysis of the trend of possible risk factors showed that the prevalence of cupping, intravenous drug use (IVDU), non-intravenous drug use (non-IVDU), penetrating trauma, tattooing, and high-risk sexual behaviors significantly increased over the study period. A significant reduction was observed in the rate of major thalassemia. The most prevalent HCV genotype was genotype 1 (49.3%), followed by genotype 3 (39.6%). Multivariate analysis of the possible routes of transmission revealed that cupping was associated with the increased risk of HCV genotype 1 infection. Conclusions: This study reports non-IVDU as the most common associated risk factor and genotype 1 as the most prevalent genotype in patients infected with HCV. Knowing risk factors can lead to making better policies and implement more effective interventions to prevent the spread of HCV infection.

Knowledge assessment of snake antivenom among healthcare practitioners involving educational intervention in northern Nigeria: a study protocol.

IntroductionSnakebite envenoming (SBE) is an important occupational and public health hazard especially in sub-Saharan Africa. For optimum management of SBE, adequate knowledge of Snake antivenom (SAV) is very critical among the healthcare practioners in this region. Information related to the knowledge of SAV use in the management of SBE, as well as SAV logistics is scarce among the Health Care Professionals (HCPs) in Nigeria, particularly in the northern region. We therefore aimed to develop, validate and utilize a tool to assess the SAV knowlegde among HCPs in northern Nigeria. We also sought to implement and evaluate an intervention that could improve the SAV knowledge among the HCPs.MethodsThe proposed study will be conducted in three phases: Phase I will involve the development of the item-pool to be included in the tool, followed by a face, content validity and construct validity. The tool reliability, readability and difficulty index will be determined. Phase II will involve the utilization of the tool to assess baseline SAV knowledge among the HCPs followed by an educational intervention. Multiple Linear Regression analysis will be used to determine the factors associated with SAV knowledge among the HCPs. Lastly, Phase III which will be a repeat of Phase II to assess and evaluate the knowledge after the intervention.DiscussionThe study design and findings may guide future implementation and streamline the intervention of improving SAV knowledge in HCPs training and practice.Lay Summary Knowledge assessment and educational intervention of snake antivenom among healthcare practitioners in northern Nigeria: a study protocol Snakebite envenoming (SBE) is an important occupational and public health hazard especially in sub-Saharan Africa. For optimum management of SBE, adequate knowledge of snake antivenom (SAV) is very critical among the healthcare practitioners. The baseline knowledge SAV dosage, mode of administration, availability, and logistics is very relevant among healthcare professionals, particularly those that are directly involved in its logistics. It is paramount that SAV is handled and used appropriately. The efforts and advocacy for the availability for more SAV will be in vain if not handled appropriately before they are used. This study protocol aims to develop a tool, to assess SAV knowledge and effects of educational interventions among healthcare professionals (HCPs) in northern Nigeria. This protocol suggests conducting studies in three phases: (a) Development and validation of SAV knowledge assessment tool, (b) Baseline assessment of SAV knowledge assessment tool among HCPs, and (c) Development, implementation and evaluation of an educational intervention to improve SAV knowledge among HCPs in northern Nigeria.

MON-021 Patterns of Sharps Handling and Disposal Among Insulin Using Patients with Diabetes

Background: Nearly 7 million patients with diabetes mellitus (DM) in the U.S. use insulin. Both Insulin therapy and self-monitoring of blood glucose (SMBG) have the potential to generate a large volume of biohazardous waste via use of “sharps” (needles and lancets). Unless safely disposed of these sharps could present a public health risk, placing unaware individuals at risk of needle sticks. However, there is a paucity of data on whether patients safely handle and dispose of used insulin needles and lancets. Objective: Assess patterns of sharps use and disposal among a clinic and hospital based population of DM patients on insulin therapy. Method: A survey was administered to a convenience sample of adult insulin treated DM patients recruited from an outpatient endocrinology clinic and an inpatient hospital setting. Patients were asked about patterns of sharps use (frequency of daily SMBG and insulin injections), how often sharps were used prior to disposal, sharp disposal technique, and education received regarding safe sharp disposal. Results: The survey was completed by 142 patients (94 outpatients and 48 inpatients). Mean age was 56 years, self-reported DM duration 20 years, hemoglobin A1c was 8.4%, and BMI 30.2 kg/m2; 57% were men and 75% were white. No differences in characteristics (p>0.1) were seen between outpatient and inpatient respondents. The average number of insulin injections was 3/day, and frequency of SMBG was 3.5/day. A minority (22%) used an insulin needle 2 or more times, and 32% threw the needles directly into the garbage as opposed to a sealable or red sharps container. Most (56%) respondents used a lancet 2 or more times, sometimes changing the lancet once only every few months. Around a third (35%) threw used lancets directly into the garbage; one patient flushed them down the toilet. No differences were seen between outpatients and inpatients (p> 0.3) in patterns of needle use, lancet use, or disposal method. The majority (63%) of respondents indicated they had never received instruction on safe disposal of sharps. Conclusion: In this population of both outpatients and inpatients, repeated use of the same insulin needle and lancet was noted. Moreover, nearly a third of respondents disposed of their sharps in an unsafe manner. If similar data are confirmed in broader studies, this could translate into a large number of insulin using patients improperly disposing of their sharps waste—a potentially important public health hazard. With the rising prevalence of DM and need for insulin, further study is needed to determine sharps disposal practices of these patients. Improved education is needed on both a population and patient level regarding proper handling of these biohazardous materials.

Evaluation of the General Organization of Veterinary Services control program of animal brucellosis in Egypt: An outbreak investigation of brucellosis in buffalo.

Background and Aim:Brucellosis is a major constraint to livestock production in Egypt as well as many developing countries worldwide. Bovine brucellosis is an economically important disease with reproductive failure as a principal manifestation resulting in abortion, premature birth and decreased milk production in females, and orchitis and epididymitis in males. In spite of the efforts of Egyptian veterinary services to overcome brucellosis, the disease is still prevalent in both animals and humans and represents one of the most important public health hazards in Egypt. The aim of the present work was to investigate the efficacy of the control program implemented by the General Organization of Veterinary Services in Brucella infected buffalo farm on serological, molecular, cultural, and histopathological basis. Brucella melitensis biovar 3 was recovered from 6 buffalo-cows.Materials and Methods:Blood samples were collected from a total of 750 non-vaccinated lactating buffalo-cows. These animals were proved positive for Brucella by the Egyptian brucellosis national program. Sera were tested using buffered acidified plate antigen test and rose Bengal test as screening tests and complement fixation test as a confirmatory test. Positive animals were separated for slaughtering under the supervision of the Egyptian veterinary authorities. Remaining animals were tested every 3 weeks with slaughtering of positive cases and this continued until the remaining animals revealed three successive negative serological tests. Different lymph nodes (prescapular, prefemoral, mediastinal, retropharyngeal, and supramammary) were collected from 11 Brucella seropositive buffalo-cows slaughtered after being confirmed serologically as Brucella infected cases. Samples were collected and processed for bacterial isolation and nucleic acid detection using polymerase chain reaction (PCR). Parts of these specimens were fixed in 10% neutral buffered formalin for 48 h then processed by paraffin embedding technique.Results:“Test and slaughter” policy was applied on Brucella infected dairy buffalo farm. The program continued for 6 months with slaughtering of positive cases until the herd was proved Brucella free. B. melitensis biovar 3 could be recovered from six buffalo-cows. Universal PCR confirmed Brucella on genus level and Bruce-ladder multiplex, PCR confirmed the presence of B. melitensis on the species level. Histopathological examination of Brucella-infected lymph nodes revealed massive rarified and depleted lymphoid areas of both sub-capsular and deep cortical lymphoid follicles, macrophage cells granulomatous reaction, as well as fat, infiltrates, and chronic vasculitis. The chronic nature of Brucella lesions has been confirmed in this study as indicated by the chronic vasculitis and collagen deposition.Conclusion:Freedom status from brucellosis in this study required 6 months which are considered long time allowing the spread of infection to other localities especially under unhygienic conditions, husbandry system favoring mixed populations of different ages, sex, aborted and pregnant, and lack of controlled movement of animals. Therefore, effective control of animal brucellosis requires surveillance to identify infected animal herds, elimination of the reservoirs, and vaccination of young heifers. B. melitensis biovar 3 is the cause of the Brucella outbreak in buffalo which still remains the prevalent type of Brucella in Egypt. The disease runs a chronic course allowing further spread of infection.

Acute Pituitary Apoplexy following Snake Bite: A Rare but Treatable Complication

AbstractPoisonous snake bite is one of the important public health hazards in developing countries, such as India, where majority of the population resides in rural areas. Among various poisonous species of snakes, Russell's viper venom causes neurotoxicity, myotoxicity, hemolysis, and coagulopathies leading to shock and acute kidney injury. Pituitary apoplexy causing acute hypopituitarism is an extremely rare but treatable complication following viper bite. Here in, we report the case of a 14-year-old boy admitted with Russell's viper bite complicated by disseminated intravascular coagulation (DIC), acute kidney injury, and pituitary apoplexy with secondary acute hypopituitarism.

Sütle Gelen Tehdit: Aflatoksin M1

Başta çocuk gelişimi olmak üzere insan beslenmesinde önemli birer yer tutan süt ve süt ürünleri, halk sağlığını tehdit eden tehlikeleri de beraberinde getirmektedir. Karsinojenik etkileri ile bilinen ve özellikle hayvan yemlerinde bulunuşu ile dikkat çeken Aflatoksin B1 (AFB1) ve bunun canlı organizmadaki metabolizma ürünü olan Aflatoksin M1 (AFM1), karsinojenik, nörotoksik, nefrotoksik, hepatotoksik ve immunsupresif etkileri ile bilim çevrelerinde gündemde kalmaya devam etmektedir. AFM1' in başlıca atılım yolunun süt oluşu ve süte uygulanan pastörizasyon ve sterilizasyon gibi işlemlerden etkilenmeyişi, araştırmacıları detoksifikasyon konusunda yeni yollar aramaya teşvik etmektedir. Sorunla mücadelede, hâlihazırda gıdalarda toksine yönelik olarak kullanılan zaman alıcı ve maliyetli saptama yöntemlerine alternatif geliştirmek ve böylece yasal düzenlemelerde belirtilen limitlere uygunluğunu titizlikle denetlemek, bunun yanında gıdayı toksin açısından daha güvenli hale getirmek anahtar rolü oynamaktadır. Bu nedenle bu derleme ile hem AFM1' in dünya genelinde gıdalardaki yaygınlığına ışık tutmak hem de saptama ve detoksifikasyon yöntemlerindeki gelişmelere dikkat çekmek amaçlanmıştır.

Rapid and specific detection of Mycobacterium tuberculosis directly from sputum specimens using IS6110 and pncA through multiplex-PCR

Tuberculosis (TB), an infectious disease caused by Mycobacterium tuberculosis complex, is the second leading cause of death. One third of the world’s population is infected with TB. Every day more than 23000 people develop active TB and nearly 5000 die. Approximately 20-50% of patients with TB are smear negative, accounting for as much as 17% of TB transmission, posing an important public health hazard. In the objective of improved TB diagnosis and rapid detection of M. tuberculosis complex species particularly from paucibacillary sputum specimens, the sensitivity of Polymerase Chain Reaction (PCR) using IS6110 and pncA as genetic targets was compared with the conventional fluorescent microscopy. The study also aimed to check the sensitivity of two different genetic markers IS6110 and pncA for the detection of M. tuberculosis. Sputum specimens were collected from TB suspected subjects (N= 200; males=108; females=92; mean age=47±18.4) attending outpatient department at Fatima Jinnah General and Chest Hospital, Quetta. All the samples were decontaminated using N-acetyl-L-cysteine (NALC)-NaOH method and were subjected to auramine-O fluorescent microscopy and multiplex PCR using TB1 and TB2 primers specific for M. tuberculosis complex and pncATB-1.2 and pncAMT-2 primers specific to M. tuberculosis. Out of 200 specimens, M. tuberculosis around 15 (7.5%) was detected by fluorescent microscopy and 33 (16.5%) were detected through PCR, respectively. Whereas 18 smear negative specimens were found to be positive by PCR. Statistically significant difference between fluorescent microscopy and PCR was observed (p 0.05). Similarly, age was not found to be associated (p>0.05) with the increased risk of TB, however, the disease incidence was more prevalent (20.89%) in patients aged 41–60 years. Multiplex PCR showed increased sensitivity as compared to fluorescent microscopy for TB diagnosis and will bea useful tool in detecting smears negative TB. Further, it can also be concluded that both genetic markers IS6110 and pncA showed similar sensitivity in the detection of M. tuberculosis. Keywords: Quetta; Tuberculosis; Paucibacillary; Diagnosis; Genetic markers http://dx.doi.org/10.19045/bspab.2017.60052

Pattern of ocular trauma in Gusau, north west Nigeria

Background: Ocular trauma is an important public health hazard especially in the developing countries. The objective of the study was to determine the pattern of ocular injuries in patients who presented at the eye clinic of Federal Medical Center, Gusau, Zamfara State, Nigeria. Materials and Methods: A prospective study was conducted between 1st January and 31st December, 2008. All consecutive, consenting patients with ocular trauma were interviewed with the aid of an interviewer-administered questionnaire and underwent a detailed eye examination. Results: There were 121 patients in the study with 101 (83.4%) males and 20 (16.6%) females. The most common location of ocular trauma was more on the road (32.2%); road traffic accident (RTA), followed by home/domestic injury (23.1%) and at work in 15.8%. The most common anatomical site of injury was the cornea (40.6%) followed by the lids (17.5%) and the iris (14%). Conclusion: In this study, RTA was the most common cause of ocular trauma followed by domestic injuries. There is need for community education on preventive measures such as use of safety seat belts while driving and importance of supervising playing children at home.

A Profile of Fatal Two Wheeler Accidents in North Karnataka

Road traffic accidents (RTAs) are important causes of mortality and morbidity due to the increasing number of vehicles, changes in lifestyle and the risk behaviors among general population. With the aim of exploring various characteristics of fatal two wheeler RTAs, this retrospective analysis of medico-legal autopsies was conducted between January 2012 and December 2014 in a tertiary care hospital of north Karnataka. The information was collected from retrospective analysis of post-mortem registers and inquest documents received from the investigating officers. The collected information was analyzed using SPSS version 17.0. Among the 100 autopsies conducted on fatal two wheeler accidental deaths during the study period. 85 were males and 15 were females. Majority of the male victims belonged to the age group 21–30 years. Bike riders (40) were the most common victims of two wheeler RTAs. The head injuries were responsible for more than half of deaths. Majority of victims died on the spot of accident. Based on results of our study we conclude that fatal two wheeler RTAs are important public health hazards and should be addressed through strengthening of emergency healthcare, stricter enforcement of traffic laws and public awareness.

HEART-TYPE FATTY ACID BINDING PROTEIN VERSUS CARDIAC TROPONIN I IN EARLY DETECTION OF MYOCARDIAL INJURY INDUCED BY SCORPION STING

Background: Scorpion envenomation is an important public health hazard in tropical and sub- tropical regions. Envenomation by scorpions can result in a wide range of clinical effects, including, cardiotoxicity, neurotoxicity and respiratory dysfunction. Biomarkers play an important role in the early diagnosis and management of patients with the cardiotoxicity related to scorpion sting. Diagnosis of myocardial injury at an early stage in the emergency department is often difficult. A recently proposed biomarker, heart fatty acid binding protein (H-FABP) has been found to appear in the circulation superior to that of cardiac troponins in the early hours of scorpion sting. Objective: The objective of this study was to evaluate the clinical reliability of heart-type fatty acid-binding protein (h-FABP) in identifying patients with the cardiotoxicity in the early hours following scorpion sting. Methods: troponin I (in laboratory) and H-FABP were performed on 246 patients who presented with scorpion sting with duration since onset ranging from 20 minutes to 2 hours. Results: Data of the 246 patients were analyzed. H-FABP had a higher sensitivity of 76.40% and a specificity of 96.10% compared with 58.30% and 98% for troponin I respectively (at first 6 hours).Conclusion: H-FABP was found to be a better biomarker of cardiac necrosis in the early hours in the diagnosis of non-conclusive ECG in patients with scorpion sting

Atlantic Bottlenose Dolphins (Tursiops truncatus) as A Sentinel for Exposure to Mercury in Humans: Closing the Loop.

Mercury (Hg) is a ubiquitous global contaminant with important public health implications. Mercury is released from a variety of anthropogenic, industrial processes, enters the earth's atmosphere and is re-deposited onto the earth’s surface in rainfall. Much of this Hg enters the oceans which cover the majority of the earth’s surface. In the marine environment, inorganic Hg is converted to the most toxic form of the element, methylmercury, and biomagnified through the trophic levels of the food web. The bottlenose dolphin (Tursiops truncatus) is the apex predator in many estuarine and coastal ecosystems. Due to their long life span and trophic position, bottlenose dolphins bioaccumulate high concentrations of contaminants including Hg, thus making them an important sentinel species for ecosystem and public health. Bottlenose dolphins in Florida bioaccumulate high concentrations of Hg in their blood, skin and internal organs. The concentrations of Hg in blood and skin of bottlenose dolphins of the Indian River Lagoon, FL (IRL) are among the highest reported world-wide. In previous studies, we demonstrated associations between concentrations of total Hg in the blood and skin of IRL dolphins and markers of endocrine, renal, hepatic, hematologic and immune system dysfunction. The predominant manifestation of exposure to mercury in humans is neurotoxicity. During the 1950s and 1960s, residents of Minamata bay, Japan were exposed to high concentrations of methyl mercury as the result of ingestion of fish and shellfish that had become contaminated in this infamous environmental disaster. Affected adults had severe motor and sensory abnormalities often leading to death. Methyl mercury crosses the placenta during pregnancy. Children exposed in utero were born with multiple congenital anomalies and also suffered from neurologic disorders. Significantly, local cats that consumed Hg contaminated fish developed severe signs of neurotoxicity which led to their subsequent description as the “dancing cats of Minamata bay”. Unfortunately, the cause of these strange manifestations in cats was not recognized in time to prevent hundreds of additional cases from occurring. More recent studies have shown that exposure to mercury as a result of seafood consumption during pregnancy may result in multiple cognitive and neurodevelopmental effects in children. The levels of mercury found in bottlenose dolphins and the health effects we identified alerted us to the possibility of an important public health hazard. The IRL occupies 40 percent of the east coast of Florida and is bordered by counties with approximately 2.5 million human inhabitants. Therefore, we hypothesized that local inhabitants in communities bordering the IRL could be at risk of exposure to Hg from the consumption of fish and shellfish. We measured hair Hg in 135 local residents and found a mean concentration of 1.53 µg/g which was higher than that from previous studies of sport fishermen and coastal residents in other states. Over 50% of participants had a hair Hg concentration which exceeded the U.S. EPA exposure guideline. Hair Hg concentration was directly related to the frequency of seafood consumption and to the proportion of fish and shellfish obtained from local recreational sources. This study clearly exemplifies the importance of an animal sentinel in identifying a public health hazard and is virtually unique in “closing the loop” between animal and human health.

Organophosphate poisoning: A 10-year experience at a tertiary care hospital in the kingdom of saudi arabia

Introduction: Toxicity resulting from pesticides is an important global public health hazard concern, particularly in developing countries. The objectives of this retrospective study were to determine the presenting clinical features, complications and length of stay of patients poisoned with organophosphates (OP). Materials and Methods : The medical records of all OP poisoning patients admitted to King Fahd Hospital of the University in the period between 2000 and 2010 were reviewed. Results: There was a total of 50 patients: Thirty-four males (68%) and 16 females (32%), 39(78%) of whom were >18 years of age. The most common route of exposure was ingestion, which was observed in 20 patients; vomiting was the most common clinical presentation. Thirteen patients were intubated at the Emergency Department on account of respiratory failure. Thirty-two patients required admission to the Intensive Care Unit and the mean length of stay in the hospital was 5 days. Two patients had cardiac arrest. Conclusion: This relatively high prevalence of OP poisoning makes it necessary to have tighter governmental controls and awaken public awareness to this problem.

Antibiotic resistance status of Escherichia coli isolated from healthy pigs from some piggery farms in Ibadan, Nigeria

Antimicrobial resistance among Escherichia coli isolated from both healthy and infected farm animals is common, and such pathogens constitute important public health hazard because they can transfer drug resistant strains to other pathogens, both of animal and human origin. In this study, antibiotic profiles of 137 E. coli isolates from 256 apparently healthy pigs from 5 different piggeries in Ibadan, Oyo State, Nigeria were evaluated. Isolates were grown aerobically at breakpoint concentrations for ciprofloxacin, cefepime, chloramphenicol, tetracycline, ampicillin, kanamycin, streptomycin and nalidixic acid (all obtained from SIGMA-ALDRICH, USA) according to standard methods specified by Clinical Laboratory Standards Institute.The highest resistance of 91% was observed for tetracycline, followed by 87.6% and 86.9% for kanamycin and nalidixic acid, respectively. The following percentage resistance of 72.3, 64.9, 43.1, 29.2 and 28.4% were observed for ampicillin, chloramphenicol, ciprofloxacin, cefepime and streptomycin, respectively. Of all the antibiotics included in the study, streptomycin was the most sensitive with 71.5% sensitivity followed closely by cefepime with 70.8% sensitivity. The research revealed a high level of antibiotic resistance among E. coli. The percentage of resistance observed for the antibiotics included in this study reflected the degree of their respective uses in pig production in the study area. This work further supports the need for prudent use of each of the antibiotics in animal production in Nigeria.Keywords: Healthy pigs, Antibiotics, Resistance

Venomics and antivenomics of Bothrops erythromelas from five geographic populations within the Caatinga ecoregion of northeastern Brazil.

The Caatinga lancehead, Bothrops erythromelas, is a medically relevant species, responsible for most of the snakebite accidents in most parts of its distribution range in northeastern Brazil. The spectrum and geographic variability of its venom toxins were investigated applying a venomics approach to venom pools from five geographic areas within the Caatinga ecoregion. Despite its wide habitat, populations of B. erythromelas from Ceará, Pernambuco, Juazeiro, Paraiba, and Ilha de Itaparica exhibit highly conserved venom proteomes. Mirroring their compositional conservation, the five geographic venom pools also showed qualitatively and quantitatively overlapping antivenomic profiles against antivenoms generated in Vital Brazil (BR) and Clodomiro Picado (CR) Institutes, using different venoms in the immunization mixtures. The paraspecificity exhibited by the Brazilian SAB and the Costa Rican BCL antivenoms against venom toxins from B. erythromelas indicates large immunoreactive epitope conservation across genus Bothrops during the last ~14 million years, thus offering promise for the possibility of generating a broad-spectrum bothropic antivenom. Biological Significance Accidental snakebite envenomings represent an important public health hazard in Brazil. Ninety per cent of the yearly estimated 20-30,000 snakebite accidents are caused by species of the Bothrops genus. Bothrops erythromelas, a small, moderately stocky terrestrial venomous snake, is responsible for most of the snakebite accidents in its broad distribution range in the Caatinga, a large ecoregion in northeastern Brazil. To gain a deeper insight into the spectrum of medically important toxins present in the venom of the Caatinga lancehead, we applied a venomics approach to define the proteome and geographic variability of adult B. erythromelas venoms from five geographic regions. Although intraspecific compositional variation between venoms among specimens from different geographic regions has long been appreciated by herpetologists and toxinologists as a general feature of highly adaptable and widely distributed snake species, the five B. erythromelas populations investigated exhibit highly conserved venom proteomes. The overall toxin profile of the Caatinga lancehead's venom explains the local and systemic effects observed in envenomations by B. erythromelas. The five geographic venom pools sampled also showed qualitatively and quantitatively overlapping antivenomic profiles against antivenoms generated using different bothropic venoms in the immunization mixtures. The large immunoreactive epitope conservation across genus Bothrops offers promise for the generation of a broad-spectrum bothropic antivenom.

English

Ocular trauma is an important public health hazard. A study done at a teaching referral hospital in Haldwani revealed 14.54% of blindness to be attributed to trauma alone. The objective of the study was to determine the pattern of ocular trauma among patients presenting in Dr. Sushila Tiwari Government Hospital, Haldwani. A 1 year retrospective review of records of 165 patients with ocular trauma seen from 1st Feb 2011 to 31st Jan 2012 was done using a structured format. Association between variables were checked by Chi square test and significance was considered when p<0.05. Ocular trauma accounted for s165 (1.03%) of the 15, 970 ocular patients seen at OPD and Emergency in the aforementioned 1 year period. Of the studied 165 cases, 93 patients were below 30 years of age. M: F ratio was 10:1.21(12.7%) patients presented to hospital within 2-7 days of injury. Duration of presentation has significant association with the presence of infection & other complication (p<0.05). The cause of injury were road traffic accidents, sports playing & recreational activities and occupational in 54(32.7%), 42(25.5%) and 33(20%) respectively. Closed globe injuries accounted for 54(32.7%) and open globe for 75(45.4%) and adnexal injuries constituted 36(21.8%). Delay in presentation was associated with complications.

Acute hypopituitarism - a rare complication of vasculotoxic snake bite: A case report

Venomous snake bite is an important public health hazard in tropical countries including India. Vasculotoxic snake bites are well known to cause local cellulitis, local tissue necrosis, bleeding manifestations, disseminated intravascular coagulation (DIC), acute kidney injury (AKI), shock, cardiac arrhythmia, neurotoxicity, coma, and death. We present the case of a 30-year-old female who was bitten by a Russell's viper snake and complicated by AKI, DIC, and acute hypopituitarism during her hospital course. Acute hypopituitarism as a complication of snake bite is a rare entity.