THE ABUNDANCE AND INFECTION STATUS OF ANOPHELES spp. MOSQUITOES AT THREE SITES IN LOUDOUN COUNTY, NORTHERN VIRGINIA

Malaria is a re-emerging infectious disease with approximately half of the world\u27s population at risk. In the US, since the 1950’s the Center for Disease Control (CDC) has been reporting between 1,000 and 1,500 cases of malaria every year. A majority of these cases were among US travellers and were attributed to Plasmodium falciparum. In August 2002, two cases of human malaria due to Plasmodium vivax were reported in Loudoun County, Northern Virginia. The Center for Disease Control and Prevention concluded that these cases were acquired locally. This was because of an absence of other risk factors such as international travel, and blood transfusion. Pools of Anopheles quadrimaculatus and Anopheles punctipennis collected in Loudoun County, Northern Virginia in 2002 tested positive for P. vivax subtype 210 indicating local transmission of malaria in the area. The purpose of this study is two-fold: 1) to determine the abundance of blood-fed Anopheles mosquitoes in the three sites close to the 2002 local transmission of human malaria in Loudoun County, Northern Virginia, and 2) to determine the infection status of the blood-fed Anopheles mosquitoes collected in the area. We observed a significant difference in the total abundance of Anopheles quadrimaculatus and Anopheles punctipennis at all the three sites, with Anopheles quadrimaculatus being more abundant. We also found a significant difference in the total abundance of Anopheles quadrimaculatus across the years at each of the three sites. All the pools collected in 2009 and 2010 tested negative for human Plasmodium parasites. The pools collected in 2010 tested negative for avian Plasmodium and Haemoproteus parasites. However, in 2009, 20 (28%) pools out of 71 tested positive for avian Plasmodium and Haemoproteus parasites. Four (20%) pools tested positive for avian Plasmodium, three of which were composed of Anopheles quadrimaculatus and were collected at Algonkian Regional Park while, one pool of Anopheles punctipennis was collected at Youngs Cliff. In addition, one (5%) pool composed of Anopheles quadrimaculatus and collected from Algonkian Regional Park tested positive for Haemoproteus. Eleven (55%) pools tested positive for both Haemoproteus and Plasmodium. Of these, four pools were composed of Anopheles quadrimaculatus and were collected from Algonkian Regional Park, two pools composed of Anopheles quadrimaculatus and one pool composed of Anopheles punctipennis were collected from Youngs Cliff. Lastly, four pools collected at Potomac Drive were composed of Anopheles quadrimaculatus. In summary, Algonkian Regional Park showed a high number of mosquitoes with malarial parasites. The maximum likelihood estimation (MLE) of mosquito infection rates based on the Biggerstaff (2006) method showed that among the three sites Youngs cliff had the overall highest infection rate (74.50%) for Anopheles mosquitoes compared to Algonkian Regional Park (53.86%) and Potomac drive (25.01%). An. quadrimaculatus had a higher infection rate compared at Algonkian Regional Park (57.95%) and Potomac drive (32.56%) compared to An. puncipennis (0%), while at Youngs cliff An. puncipennis had a higher infection rate (182.88%) compared to An. quadrimaculatus (56.06%)

Pain Management During COVID-19 and Scope of Ayurvedic Marijuana

During this novel corona virus outbreak, it is found that the most vulnerable population are the old age, especially with co-morbidities like Rheumatoid arthritis (RA) and other related pain diseases that are at greater risk of contracting SARS-CoV-2. This infection is because of their impaired immune systems due to use of corticosteroids and certain drugs.  Ayurvedic marijuana, as a safe remedy with phytochemicals known as cannabinoids have shown significant promise in basic experiments on pain management. Study shows leaves?of this plant have been found effective in alleviating pain and other symptoms in patients

Evaluation of cord bilirubin and hemoglobin analysis in predicting pathological jaundice in term babies at risk of ABO incompatibility

Background: Cord bilirubin and hemoglobin analysis helps not only in predicting the pathological jaundice in ABO incompatibility but also useful for early referral and intervention for better outcome. Aim of this study is to evaluate the cord blood bilirubin and hemoglobin analysis in predicting pathological hyperbilirubinemia in newborn at risk of ABO incompatibility.Methods: In this descriptive study conducted in Government Stanley medical college between January 2016-June 2016, A positive or B positive babies born to O positive mothers with birth weight >2.5 kgs and gestational age >37 weeks were included. A total of 191 babies were studied. Cord bilirubin, reticulocyte count, hemoglobin and fourth day bilirubin were evaluated and data was analysed using Pearson’s Chi square and ANOVA.Results: Out of 191 babies, 25 (13%) did not develop any jaundice, 122 (64%) developed physiological jaundice and 44 (23%) had pathological jaundice. The mean cord bilirubin and cord hemoglobin values of newborn who did not develop jaundice were 1.35mg/dl and 15.3g/dl while the values among pathological jaundice were 3.15mg/dl and 14.97g/dl. Conclusions: Babies with cord bilirubin >1.8mg/dl and hemoglobin <15.1gm/dl are more prone for pathological hyperbilirubinemia

Trial of vitamin D supplementation to prevent asthma exacerbation in children

Background: To assess the level of vitamin D in children with bronchial asthma and to study the effects of vitamin D supplementation in asthmatic children who had vitamin D deficiency in terms of asthma control test score and Number of exacerbations.Methods: This interventional study was conducted in Department of Paediatrics, KAPV Government medical college, Trichy, Tamil Nadu, India from September 2016 to February 2017. 96 asthmatic children of age group 5-12 years who attended outpatient department and admitted in ward for asthma exacerbation were selected. After assessing their Vitamin D level, Vitamin D supplementation given along with standard treatment for asthma. Outcomes measured were ACTS (Asthma control test score), number of emergency room visits, number of hospital admissions and reliever medication use.Results: Out of 96 children, 83 (86.4%) children had vitamin D deficiency. There was significant correlation between vitamin D level and absolute eosinophil count (p-value-0.037), asthma severity (p-value<0.001) and asthma control (p-value<0.001). Significant reduction in emergency room visits, (p-value<0.001) reliever medication use (p-value<0.001) and improvement in asthma control test score (p-value-0.008) occurs after vitamin D supplementation.Conclusions: There is a significant correlation between vitamin D level, asthma severity and its control. Asthma exacerbation in terms of emergency room visits and reliever medication use were further reduced by vitamin D supplementation

Sonographic Scoring for Operating Room Triage in Trauma

Objective: The focused assessment with sonography for trauma (FAST) exam is a routine diagnostic adjunct in the initial assessment of blunt trauma victims but lacks the ability to reliably predict which patients require laparotomy. Physiologic data play a major role in decision making regarding the need for emergent laparotomy versus further diagnostic testing or observation. The need for laparotomy often influences the decision to transfer the patient to a trauma center. We set out to derive a simple scoring system using both ultrasound findings and immediately available physiologic data that would predict which patients require laparotomy.Methods: We conducted a prospective observational study of victims of blunt trauma who presented to a Level 1 Trauma Center. We collected FAST findings, physiologic data, and lab values. A previously-developed ultrasound scoring system was applied to the FAST findings. Patients were followed to determine if they underwent laparotomy. We used logistic regression analysis to determine which variables correlated with laparotomy and developed a new scoring system.Results: We enrolled a convenience sample of 1,393 patients. A simple scoring system (range 0-6) was developed that included both FAST findings and vital signs (heart rate and blood pressure). Patients with a score of 0 or 1 had a less than 1% chance of requiring laparotomy.Conclusion: The combination of FAST findings with vital signs in our scoring system predicted which victims of blunt trauma did not undergo laparotomy. Applying this to trauma patients who present to non-trauma centers could help prevent unnecessary patient transfers. This derivation set must be validated prior to use in patient care. [West J Emerg Med. 2010; 11(2):138-143.

Uterine artery embolization for uterine arterio-venous malformation

Uterine arteriovenous malformations (AVM) as a cause of abnormal uterine bleeding are listed under “not otherwise classified” in Palm-Coein classification, is an abnormal communication between an artery and vein without an intervening capillary bed resulting in increased pressure and high velocity in the venous system. We report the case of heavy menstrual bleeding in a thirty-five-year-old primiparous lady for five years with fourteen weeks sized uterus and six gm hemoglobin. Ultrasound revealed an enlarged uterus with tubular spaces and color doppler showed tubular anechoic structures, both within the myometrium, with low resistance and high-velocity pattern suggestive of uterine arteriovenous malformations. Because of nonresponse to medical management, uterine artery embolization was carried out following which she had significant reduction in menstrual bleeding emphasizing it as a differential diagnosis in all cases presenting with heavy menses. Uterine artery embolization appears to be an effective modality of treatment especially in women whose wish to preserve fertility

The Importance of Cycle Threshold Values in the Evaluation of Patients with Persistent Positive PCR for SARS-CoV-2: Case Study and Brief Review

Some patients recovered from COVID-19 but the reverse transcription polymerase chain reaction (RT-PCR) for SARS-CoV-2 remains persistently positive. In the evaluation of these patients it is important to define the cycle threshold (Ct) value of the RT-PCR test. This article will present a case study, address relevant findings and interpretation of the RT-PCR test, and define the use of Ct values in defining when a healthcare working may return to work. Our current approach is to allow to return to work healthcare workers with persistently positive RT-PCR if the Ct values are greater than 35

A Review Of Quarantine Period In Relation To Incubation Period Of SARS-CoV-2

Introduction: The period, from exposure to a potential pathogen to the manifestation of symptoms i.e. incubation period, is time the virus spends replicating in the host. An estimation of this period and subsequent quarantine of the host can limit potential spread, particularly in asymptomatic carriers. Effective contact tracing, length of self-quarantine, repeat testing and understanding of disease transmission are all contingent on a true estimation of this incubation period. Methods: Articles in English from December 1st , on Google scholar, PubMed, Research gate along with bulletins from WHO and the CDC were queried for the keywords, “SARS-CoV-2”, “COVID-19”, “median incubation period”, “mean incubation period”, “symptom onset”, “quarantine” and “exposure interval’’ and reviewed independently by two authors to establish consensus. Travel to Wuhan, or in absence of travel, the earliest possible exposure, were used to calculate mean or median incubation period. Correspondingly, we reviewed the advised lengths of quarantine period. Results: Five studies with a combined sample size of 505 patients were reviewed for mean/median incubation period. Four studies recommended periods for self-quarantine, ranging from 2- 14 days. Linton et al. recommended the shortest estimate of the median incubation period at 4.3 days (95% CI 4.5-5.6), whereas the longest was by Backer et al. at 6.4 days (95% CI 4.5-5.8). Similarly, the shortest estimation of mean incubation period was by Liu et al. (n=16) at 4.8 days (95% CI 2.2-7.4) days while the longest at 5.5 days (95% CI 4.5-5.8) was by Lauer et al. (n=181). Although the range for quarantine in these four studies was 12.5 to 14 days, all four recommended 14 days as the optimum for self-quarantine. Conclusion: A precise estimate of incubation period is instrumental in outlining an effective quarantine measure. Calculation of the incubation period using mathematical models has established an accurate measure, albeit with uncertainty increasing towards the tail of each distribution. Based on a thorough review of these studies a quarantine period of 14 days can be recommended allowing 97.5% of the infected people to show symptoms. These symptomatic patients would be further evaluated based on their respective state health guidelines so that they may be effectively isolated and treated

A Genetic Algorithm for Learning Parameters in Bayesian Networks using Expectation Maximization

Abstract Expectation maximization (EM) is a popular algorithm for parameter estimation in situations with incomplete data. The EM algorithm has, despite its popularity, the disadvantage of often converging to local but non-global optima. Several techniques have been proposed to address this problem, for example initializing EM from multiple random starting points and then selecting the run with the highest likelihood. Unfortunately, this method is computationally expensive. In this paper, our goal is to reduce computational cost while at the same time maximizing likelihood. We propose a Genetic Algorithm for Expectation Maximization (GAEM) for learning parameters in Bayesian networks. GAEM combines the global search property of a genetic algorithm with the local search property of EM. We prove GAEM&apos;s global convergence theoretically. Experimentally, we show that GAEM provides significant speed-ups since it tends to select more fit individuals, which converge faster, as parents for the next generation. Specifically, GAEM converges 1.5 to 7 times faster while producing better log-likelihood scores than the traditional EM algorithm