Environmental Disease

Use of World Health Organization susceptibility test for malaria vector control in South-Eastern Nigeria: A discourse Joel D Akilah, Ibanga Eyo Ekong Environmental Disease 2019 4(2):29-32 Background: With growing evidence of mosquito vector resistance to pyrethroids and other classes of insecticides globally, we employed one of the two important tools for the monitoring of insecticide resistance in selected states in southeastern part of Nigeria via the World Health Organization (WHO) susceptibility test. Aim: This study tested the effectiveness of WHO susceptibility test for the use in identifying and monitoring the resistance of Anopheles and Aedes mosquitoes which transmit malaria and arbovirus-related diseases in Nigeria. Methods: Larval sampling of mosquitoes was embarked upon with ovitraps set in various study sites; eggs were hatched and reared and subsequently subjected to susceptibility tests according to the WHO test procedures. Summary and Conclusion: Resistance to dichloro diphenyl trichloroethane and the pyrethroids has been established to a large extent. The loss of efficacy of pyrethroids may result in operational failure of disease control programs.

Primary prevention of snakebite envenoming in resource-limited settings Joel Noutakdie Tochie, Frank-Leonel Tianyi, Diego Nitcheu Tchouakam, Armand Seraphin Nkwescheu Environmental Disease 2019 4(2):33-34

Loss of productivity interfering with the attainment of universal health coverage in African nations Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava Environmental Disease 2019 4(2):35-36

Primary prevention of snakebite envenoming in resource-limited settings: A narrative review Godpower Chinedu Michael, Ibrahim Aliyu, Bukar Alhaji Grema Environmental Disease 2019 4(2):37-44 Background: Snakebite envenoming is a neglected tropical disease that accounts for preventable morbidity and mortality, especially in resource-limited settings. This review aimed at examining the snake and human behaviors that facilitate snake-human encounters and highlighting the primary preventive measures for snakebite and the resultant envenoming. Materials and Methods: Google Scholar, Medline (via PubMed), and African Journal Online were searched from January 1959 to April 2019 for peer-reviewed studies addressing primary prevention of snakebite. We extended our search to grey literature from conference proceedings, documents from organizations, book chapters, and thesis. Results: We found few studies in medical literature on community knowledge of the intrinsic characteristics of snakes (e.g., its unique venom apparatus for nutrition, defense and competition, and its habitat and activities); however, there is appreciable amount of studies on human activities associated with snakebite envenoming. Deservedly, more studies appear to focus on snakebite management (secondary and tertiary prevention) with inadequate emphasis on primary prevention of snakebite (which may be the only intervention in some resource-limited settings). Conclusion: Synergy of efforts toward improving community knowledge of human behaviors associated with snakebite and snake behaviors may generate appropriate environmental and behavioral responses to curtail human-snake encounters. Hence, intensive promotion of primary prevention may be a useful approach toward reducing snakebite burden in resource-limited settings.

Effects of low-molecular-weight heparin and unfractionated heparin on patients with exertional heat stroke with thrombocytopenia: A prospective study Li Cheng, Eric Allen Klomparens, De Lin Liu, Min Na Wang, Xiao Xue Yin, Wei Liu, Yuan Liu, Qi Feng Zhang, Gang Ye Environmental Disease 2019 4(2):45-49 Background: Thrombocytopenia often occurs in patients with exertional heat stroke (EHS). We aimed to investigate the effect of low-molecular-weight heparin sodium (LMWH) and unfractionated heparin (UFH) on coagulation and prognosis in the treatment of EHS with thrombocytopenia. Methods: In a prospective cohort study, 64 patients admitted to the emergent intensive care unit (ICU) were studied between July 2015 and October 2018. Patients were randomized to receive LMWH or UFH. Thirty-three patients were given LMWH 4000 IU twice a day for 5 days, by subcutaneous injection. Thirty-one patients were given UFH 5&#8211;10 U/kg &#215; h for 5 days, by 24-h continuous intravenous infusion. Demographic and clinical data (platelets [PLTs] counts, activated partial thromboplastin time [aPTT], prothrombin time [PT], fibrinogen [FIB], D-dimer, presence of diffuse intravascular coagulation [DIC]), and mortality in the ICU were recorded along with the 28-day survival rate. The acute physiology and chronic health evaluation (APACHE) II score was calculated within 24 h of admission and used to indicate the severity of disease. Results: There were no significant differences in sex, age, APACHE II score, and core temperature between the two groups (P > 0.05). PLT and FIB were significantly increased after treatment in both groups (P < 0.05), while aPTT, PT, and D-dimer were significantly decreased after treatment in both groups (P < 0.05). No significant differences between the two groups were found in the incidence of DIC or ICU mortality (P > 0.05), but the incidence of bleeding in the LMWH group was significantly lower than in the UFH group (P < 0.05). There was not a significant difference in the 28-day survival rate between the two groups (P > 0.05). Conclusions: The results of this study support that the efficacy of LMWH and UFH in the prevention of thrombosis is equivalent. However, the incidence of bleeding was lower in LMWH group. LMWH and UFH had statistically similar rates of ICU mortality, 28-day mortality, and incidence of DIC. Our results suggest that LMWH may be safer than UFH for use in patients with EHS with thrombocytopenia.

Effect of conbercept or ranibizumab in the treatment of wet age-related macular degeneration Dawei Zhang, Zahrah Khan, Tao Chai Environmental Disease 2019 4(2):50-54 Objective: The aim of this study was to investigate the effects of conbercept or ranibizumab in the treatment of wet age-related macular degeneration (AMD) and to explore the influence on central retinal thickness (CRT), visual acuity, and choroidal neovascularization (CNV) permeation. Patients and Methods: A total of 85 patients (85 eyes) with wet AMD were enrolled in this study. All patients were treated by intravitreal injection of anti-vascular endothelial growth factor and were randomly divided into two groups. Patients in Group A were treated by intravitreal injection of conbercept, whereas those in Group B were treated by intravitreal injection of ranibizumab once a month for 3 consecutive months. The best-corrected visual acuity (BCVA) was measured. Subfoveal choroidal thickness (SFCT) and CRT of affected eyes and healthy eyes were examined with optical coherence tomography. Fundus fluorescein angiography was performed, and the area of CNV permeation was calculated. Results: BCVA (logarithm of the minimum angle of resolution) of affected eyes in the two groups was significantly better at 1 month, 2 months, and 3 months after treatment as well as at the end of follow-up than that of before treatment. Meanwhile, CRT was obviously decreased. SFCT of affected eyes was significantly smaller than that of before treatment, which was also remarkably smaller when compared with that of healthy eyes. At 3 months after treatment and at the end of follow-up, the areas of CNV permeation in the two groups were significantly decreased. In addition, the average times of injection in Group A were significantly less than that of Group B. Conclusions: Intravitreal injection of conbercept and ranibizumab significantly decreased SFCT of affected eyes. However, the length of conbercept medication injection time was lower than that of ranibizumab.

Alexandros Sfakianakis
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