Photodynamic Therapy in Dermatology

Fotodinamička terapija je novi oblik fototerapije koji uključuje fotokemijske reakcije nastale međudjelovanjem fotosenzibilizirajuće tvari, vidljivog svjetla i kisika. Fotodinamička terapija provodi se u dvije faze. Prva faza uključuje lokalnu ili sistemsku primjenu fotosenzibilizatora koji se nakuplja u ciljnim stanicama. Druga faza uključuje aktivaciju fotosenzibilizatora vidljivim svjetlom određene valne duljine uz prisutnost kisika te uništenje ciljnih stanica. U dermatologiji se rabi pretežno za onkološke indikacije: višestruke aktiničke keratoze, površinske bazocelularne karcinome i Bowenovu bolest. Prednosti ovog načina liječenja kod gore navedenih indikacija su: podjednaka učinkovitost kao kod klasičnih metoda liječenja, mogućnost liječenja više promjena odjednom, neinvazivnost, dobra podnošljivost, mogućnost ponavljanja bez kumulativnih toksičnih učinaka i dobri estetski rezultati.Photodynamic therapy is a new form of phototherapy which involves the use of photochemical reactions mediated through the interaction of photosensitizing agents, light and oxygen. Photodynamic therapy is a two step procedure. In the fi rst step, the photosensitizer is administered topically or systemically, and it accumulates in the target cells. The second step involves the activation of the photosensitizer in the presence of oxygen with a specifi c wavelength of visible light, and destruction of target cells. In dermatology, it is used mainly for oncological indications: multiple actinic keratoses, superfi cial basal cell carcinomas, and Bowen’s disease. The advantages of this treatment modality are: effi cacy comparable to that of standard treatment modalities; ability to treat multiple lesions simultaneously; it is noninvasive; good tolerance; repeated application will not result in cumulative toxicity, and good cosmetic results

Leishmaniasis: new approaches to disease control.

The leishmaniases afflict the world's poorest populations. Among the two million new cases each year in the 88 countries where the disease is endemic (fig 1), it is estimated that 80% earn less than $2 a day. Human infections with Leishmania protozoan parasites, transmitted via the bite of a sandfly, cause visceral, cutaneous, or mucocutaneous leishmaniasis. The global burden of leishmaniasis has remained stable for some years, causing 2.4 million disability adjusted life years (DALYs) lost and 59 000 deaths in 2001. Neglected by researchers and funding agencies, leishmaniasis control strategies have varied little for decades, but in recent years there have been exciting advances in diagnosis, treatment, and prevention. These include an immunochromatographic dipstick for diagnosing visceral leishmaniasis; the licensing of miltefosine, the first oral drug for visceral leishmaniasis; and evidence that the incidence of zoonotic visceral leishmaniasis in children can be reduced by providing dogs with deltamethrin collars. There is also hope that the first leishmaniasis vaccine will become available within a decade. Here we review these developments and identify priorities for research

ATYPICAL WOUNDS: DEFINITION AND CLASSIFICATION

Prema definiciji rana je prekid anatomskog i funkcionalnog kontinuiteta tkiva, a s obzirom na tijek cijeljenja rane mogu biti akutne i kronične. Kronične rane su one koje ne zarastaju unutar predviđenog razdoblja u korelaciji s etiologijom i lokalizacijom rane, a u najkraćem razdoblju od 6 tjedana. Kronične rane mogu biti tipične i atipične. u tipične rane ubrajaju se ishemijske rane, neuropatski ulkus, venski ulkus te dva posebna entiteta: dekubitus i dijabetičko stopalo. Kronične rane na potkoljenicama su u oko 80% slučajeva posljedica kronične venske insuficijencije, u 5-10% su arterijske etiologije, dok ostatak otpada uglavnom na neuropatske ulkuse. Atipične rane javljaju se u manje od 5% slučajeva i posljedica su nekih rjeđih uzroka. Atipične rane mogu biti uzrokovane autoimunim poremećajima, infektivnim bolestima, bolestima krvnih žila i vaskulopatijama, metaboličkim i genetskim bolestima, malignim bolestima, vanjskim uzrocima, psihičkim bolestima, reakcijama na lijekove i dr. također, atipične rane mogu nastati u sklopu mnogih sistemskih bolesti, gdje sistemska bolest može sama biti primarni uzrok nastanka rane (npr. Morbus Crohn) ili rana može nastati kao posljedica izmijenjenog imunološkog odgovora, a sistemska bolest je u podlozi (Pyoderma gangrenosum, paraneoplastični sindrom i dr.).Wound represents disruption of the anatomic and physiologic continuity of the skin. Regarding the healing process, wounds can be classified as acute or chronic wounds. A wound is considered chronic if healing does not occur within the expected period according to its etiology and localization. Chronic wounds can be classified as typical and atypical. Typical wounds include ischemic, neurotrophic and hypostatic ulcers and two separate entities: diabetic foot and decubitus ulcers. Eighty percent of chronic wounds localized on the lower leg are the result of chronic venous insufficiency, in 5-10 percent the cause is of arterial etiology, whereas the remainder is mostly neuropathic ulcer. Ninety-five percent of chronic wounds manifest as one of the above mentioned entities. Other forms of chronic wounds represent atypical chronic wounds, which can be caused by autoimmune disorders, infectious diseases, vascular diseases and vasculopathies, metabolic and genetic diseases, neoplasm, external factors, psychiatric disorders, drug related reactions, etc. Numerous systemic diseases can present with atypical wounds. The primary cause of the wound can be either systemic disease itself (Crohn’s disease) or aberrant immune response due to systemic disease (pyoderma gangrenosum, paraneoplastic syndrome)

Psychodidae (Diptera) del Perú I: Phlebotominae en Huánuco, Pasco y Cusco, su relación con la enfermedad de Carrión y la leishmaniosis tegumentaria

One hundred and twenty species had been reported up to 1999 and the following 11 are now added to Peruvian phlebotomine fauna: Brumptomyia quimperi, Evandromyia sallesi, Lutzomyia fispaili, L. scorzai, L. watsi, Micropygomyia longipennis, Trichophoromyia howardi, T. arevaloi, Trichopygomyia turelli, Warileya euniceae and W. leponti. A complete list of species in Huanuco, Pasco and Cusco departments is included and new records for Ayacucho, Amazonas, Cajamarca, Huancavelica, Junin, La Libertad, Loreto and San Martin are given. There appears to be epidemiological evidences of some phlebotomines of the subgenera Helcocyrtomyia and Pifanomyia as likely vectors of dermal leishmaniosis and Carrion's disease.A las 120 especies de flebotomíneos reportadas hasta 1999 para el Perú, se adiciona: Brumptomyia quimperi, Evandromyia sallesi, Lutzomyia scorsai, L. rispaili, L. wattsi, Micropygomyia longipennis, Trichophoromyia howardi, T. arevaloi, Trichopygomyia turelli, W. euniceae y W leponti, incrementando a 131 especies el número de flebotomíneos. Se da a conocer la distribución geográfica de flebotomíneos en los departamentos de Huánuco, Pasco y Cusco; además, se destaca nuevos reportes de flebotomíneos en los departamentos de Ayacucho, Amazonas, Cajamarca, Huancavelica, Junín, La Libertad, Loreto y San Martín. Así mismo, se presentan evidencias epidemiológicas de algunos flebotomineos de los subgéneros Helcocyrtomyia y Pifanomyia como probables vectores de agentes patógenos de la leishmaniosis tegumentaria y de la enfermedad de Carrión (verruga peruana)

Primjena azitromicina u neregistriranim indikacijama

Azitromicin je široko prihvaćen u liječenju infekcija dišnih putova, spolno prenosivih bolesti i infekcija kože i mekih česti. U posljednje vrijeme azitromicin se sve više rabi za profilaksu i liječenje rijetkih bolesti nejasne patogeneze i etiologije te u terapiji tropskih bolesti. Osim antibakterijskog mehanizma djelovanja, azitromicinu se često pripisuje i imunomodulacijsko djelovanje, zbog čega se rabi i kod niza bolesti u kojih postoji potreba za novim terapijskim modalitetima. Cilj ovoga sistematskog pregleda bio je prikazati djelotvornost azitromicina u neuobičajenim, tj. neregistriranim kliničkim indikacijama. U tu su svrhu pretražene postojeće baze podataka te su analizirana provedena ispitivanja

Primjena azitromicina u neregistriranim indikacijama

Azitromicin je široko prihvaćen u liječenju infekcija dišnih putova, spolno prenosivih bolesti i infekcija kože i mekih česti. U posljednje vrijeme azitromicin se sve više rabi za profilaksu i liječenje rijetkih bolesti nejasne patogeneze i etiologije te u terapiji tropskih bolesti. Osim antibakterijskog mehanizma djelovanja, azitromicinu se često pripisuje i imunomodulacijsko djelovanje, zbog čega se rabi i kod niza bolesti u kojih postoji potreba za novim terapijskim modalitetima. Cilj ovoga sistematskog pregleda bio je prikazati djelotvornost azitromicina u neuobičajenim, tj. neregistriranim kliničkim indikacijama. U tu su svrhu pretražene postojeće baze podataka te su analizirana provedena ispitivanja

Treatment of American tegumentary leishmaniasis in special populations : a summary of evidence

We aimed to assess and synthesize the information available in the literature regarding the treatment of American tegumentary leishmaniasis in special populations. We searched MEDLINE (via PubMed), EMBASE, LILACS, SciELO, Scopus, Cochrane Library and mRCT databases to identify clinical trials and observational studies that assessed the pharmacological treatment of the following groups of patients: pregnant women, nursing mothers, children, the elderly, individuals with chronic diseases and individuals with suppressed immune systems. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. The available evidence suggests that the treatments of choice for each population or disease entity are as follows: nursing mothers and children (meglumine antimoniate or pentamidine), patients with renal disease (amphotericin B or miltefosine), patients with heart disease (amphotericin B, miltefosine or pentamidine), immunosuppressed patients (liposomal amphotericin), the elderly (meglumine antimoniate), pregnant women (amphotericin B) and patients with liver disease (no evidence available). The quality of evidence is low or very low for all groups. Accurate controlled studies are required to fill in the gaps in evidence for treatment in special populations. Post-marketing surveillance programs could also collect relevant information to guide treatment decision-making

Factores asociados a la leishmaniasis cutánea atípica (LCA) en al comunidad de Rota, Malpaisillo, León, mayo -junio 2003

Analiza los factores asociados a la comunidad de Rota, Malpaisillo de mayo a junio del 2003. El objetivo general es identificar los factores asociados a la transmisión de la Leishmaniasis Cutánea atípica, describir la ecología del vector, así como el abordaje terapéutico de dichos pacientes y las posibles infecciones de Leishmaniasis Cutánea Atípica

Epidemiology and control of canine leishmaniasis in Peru and Brazil

The aims of the work presented in this thesis were two-fold: [i) to investigate whether domestic dogs are important reservoir hosts of ACL in a L. [Viannia]-endemic area where domestic transmission to humans has been reported [Part 1]; and [ii] to identify the shortcomings of currently practiced leishmaniasis dog control programmes and to evaluate whether topical insecticides could be used to control canine leishmaniasis [Part 2]. There is a growing belief that dogs [Canis familiaris] are peridomestic reservoirs of American cutaneous leishmaniasis [ACL] , as numerous studies have reported high ACL infection rates in dogs. The work described here is the first longitudinal study of ACL in dogs, and was carried out in 18 Leishmania [Viannia] -endemic villages of the Department of Huanuco, Peru. Over three years [1997-1999] a total 1104 dogs were surveyed, 104 of which prospectively. A polymerase chain reaction [PCR)] protocol to identify L. [Viannia] parasites in dogs was developed [Chapter 2], and, together with serology [ELISA. and IFAT], used to calculate prevalence and incidence of disease [Chapter 4]. The data was used to estimate the basic reproduction number [Ro] [Chapter 4] of canine ACL and to demonstrate a correlation between canine and human ACL incidences in the study villages [Chapter 5]. Several findings presented in Chapters 2-5 suggest that dogs are reservoir hosts of [peri-]domestic L. [Viannia] transmission in Huanuco, Peru. First, whereas the prevalence (3.8%) and incidence of clinical disease [4.2%] are low, the prevalence [25.6%] and incidence [29.0% per year] of L. [Viannia] infection in dogs is comparatively high. Second, the average duration of infection [2.2. years] can be as long as the mean life expectancy of an infected dog [2.5 years]. Third, L. [Viannia] parasites in dogs do not remain localised at the site of inoculation but are able to disseminate to both viscera and mucosa. Fourth, the detection of L. [Viannia] parasites by PCR in the blood of a high proportion of both symptomatic [32%] and asymptomatic [7.5%] dogs suggests that infected dogs are potentially infectious to sandfly vectors. Fifth, after controlling for inter-village differences in transmission rates, household dog ownership was shown to be a significant risk factor for human ACL. The results presented here show that if dogs were the main ACL reservoir host and if L. [Viannia] transmission were homogeneous, a dog control strategy (e.g. culling, insecticide-treated dog collars) in the study villages in Huanuco would be very feasible and effective, because the control effort [i.e. coverage] to reduce Ro<1 would be comparatively small [as low as 47%]. Domestic dogs are established reservoir hosts of ZVL caused by L. infantum. Hence, one of the approaches to reduce the incidence of human ZVL is to target infected dogs. The findings of a comparative study testing topical insecticides and applications to protect dogs from sandfly bites are presented in Chapter 7. It was shown that whilst permethrin and fenthion pour-on lotions had a more immediate effect on sandfly biting rates and mortality, deltamehtrin-impregnated collars [DMC] had a more prolonged protective effect, with the survival rate of bloodfed sandflies reduced by up to 86% after two months of deltamethrin collar application. In the work described in Chapter 8 the effectiveness of DMC to control canine ZVL was tested in a matched cluster intervention trial. Possible constraints associated with a community-wide implementation of a dog collar ZVL control strategy were also investigated using mathematical modelling. Although ZVL incidence was 32% lower in collared as compared to uncollared dogs after five months collar application, the difference was not significant. However, DMC did significantly reduce the odds (by 50%) of dogs increasing their anti-Leishmania antibody titre. Whether topical insecticides such as DMC will be effective as leishmaniasis control tools will depend on several factors. Firstly, the strategy will be most effective in those endemic areas where domestic dogs are the main ZVL reservoir and the epidemiological significance of wild reservoirs or stray dogs contributing to ZVL transmission is negligible. Secondly, in order to achieve a significant epidemiological impact on ZVL transmission, high dog collar coverage rates are essential. This will not only require the rapid replacement of lost collars, but also the collaring of new dogs recruited into the population; where population turnover rates are high, maintaining high coverage rates will be a greater logistic challenge, which invariably applies to dog populations in tropical, ZVL-endemic countries. Ultimately, the decision to replace the dog culling strategy with community-wide application of DMC will depend on [i] the relative cost of the interventions; and [ii] the practical applicability of DMC in the field [e.g. the willingness of the community to apply DMC and the efficiency with which they replace collars which have detached]. Clearly, the implementation of DMC on dogs is more likely to have the consent of the population at risk than the highly unpopular dog culling policy that continues to be practised in some ZVL-endemic countries.EThOS - Electronic Theses Online ServiceGBUnited Kingdo