The addition of a sagittal image fusion improves the prostate cancer detection in a sensor-based MRI /ultrasound fusion guided targeted biopsy

Background To explore the diagnostic benefit of an additional image fusion of the sagittal plane in addition to the standard axial image fusion, using a sensor-based MRI/US fusion platform. Methods During July 2013 and September 2015, 251 patients with at least one suspicious lesion on mpMRI (rated by PI- RADS) were included into the analysis. All patients underwent MRI/US targeted biopsy (TB) in combination with a 10 core systematic prostate biopsy (SB). All biopsies were performed on a sensor-based fusion system. Group A included 162 men who received TB by an axial MRI/US image fusion. Group B comprised 89 men in whom the TB was performed with an additional sagittal image fusion. Results The median age in group A was 67 years (IQR 61–72) and in group B 68 years (IQR 60–71). The median PSA level in group A was 8.10 ng/ml (IQR 6.05–14) and in group B 8.59 ng/ml (IQR 5.65–12.32). In group A the proportion of patients with a suspicious digital rectal examination (DRE) (14 vs. 29%, p = 0.007) and the proportion of primary biopsies (33 vs 46%, p = 0.046) were significantly lower. The rate of PI-RADS 3 lesions were overrepresented in group A compared to group B (19 vs. 9%; p = 0.044). Classified according to PI-RADS 3, 4 and 5, the detection rates of TB were 42, 48, 75% in group A and 25, 74, 90% in group B. The rate of PCa with a Gleason score ≥7 missed by TB was 33% (18 cases) in group A and 9% (5 cases) in group B; p-value 0.072. An explorative multivariate binary logistic regression analysis revealed that PI-RADS, a suspicious DRE and performing an additional sagittal image fusion were significant predictors for PCa detection in TB. 9 PCa were only detected by TB with sagittal fusion (sTB) and sTB identified 10 additional clinically significant PCa (Gleason ≥7). Conclusion Performing an additional sagittal image fusion besides the standard axial fusion appears to improve the accuracy of the sensor-based MRI/US fusion platform

Control of Tungiasis through Intermittent Application of a Plant-Based Repellent: An Intervention Study in a Resource-Poor Community in Brazil

Tungiasis is a parasitic skin disease caused by the female sand flea Tunga penetrans. The disease is frequent in resource-poor communities in South America and sub-Saharan Africa and affects the poorest of the poor. Sand flea disease is associated with a considerable morbidity and may lead to tetanus in non-vaccinated individuals. The degree of morbidity depends on the intensity of infestation, i.e., the number of embedded sand fleas a person has. Since tungiasis is a zoonosis involving a host of animal reservoirs, and because an effective treatment is not at hand, in resource-poor settings elimination is not feasible. Preventing morbidity to develop is therefore the only means to protect exposed individuals from sand flea disease. Similar to other arthropods, sand fleas can be repelled before they penetrate into the skin. In this study we show that the intermittent application of a plant-based repellent, of which the major component is coconut oil, reduces the intensity of infestation dramatically during the whole transmission season and prevents tungiasis-associated morbidity from developing. The prevention can be performed at the household level by the affected individuals themselves with minimal input from the health sector

Clinical pathology and prevention of Tungiasis in a shantytown in Northeast Brazil

Hintergrund: Die Tungiasis stellt ein häufiges Gesundheitsproblem in ökonomisch schwachen Bevölkerungen tropisch und subtropischer Länder in Südamerika, der Karibik und in Afrika südlich der Sahara dar 1, 2, 3, 4, 5. Das Ziel der Arbeit bestand darin, den Einfluss einer Intervallapplikation des Repellents Zanzarin® auf die Infestationsintensität und klinische Pathologie der Tungiasis in einer Feldinterventionssstudie zu untersuchen. Eine weitere Zielsetzung war, die topographische Verteilung penetrierter Sandflöhe bei Wistar-Ratten und beim Menschen zu vergleichen. Methoden: In einem Armenviertel in Fortaleza (Nordost-Brasilien) wurde eine randomisierte kontrollierte Interventionsstudie mit einem gegen Sandflöhe wirksamen Repellent (Zanzarin ®) durchgeführt. Zu Beginn wurden die demographischen und sozioökonomischen Charakteristika der 142 Teilnehmer erhoben und Infestationsintensität, die klinische Pathologie und die topographische Verteilung der Sandflohläsionen bestimmt. Zum Vergleich der topographischen Verteilung der penetrierten Sandflöhe bei Mensch und Ratte wurden 80 Wistar- Ratten in Käfigen auf dem Erdboden platziert und zwei Wochen lang täglich auf neue Tungiasis-Läsionen untersucht. In der ersten Studienphase der Interventionsstudie wurde vier Wochen lang, zweimal täglich das Repellent auf die Füße der Teilnehmer der Studie aufgetragen, um die Infestationsintensität auf Null zu senken. Dann wurden die Partizipanten in drei Gruppen (A, B und C) randomisiert. Teilnehmer aus der Gruppe A erhielten jede zweite Woche, Teilnehmer der Gruppe B jede vierte Woche, für jeweils eine Woche das Repellent. Gruppe C wurde nicht behandelt und diente als Kontrollgruppe. Die Infestationsintensität und Tungiasis-assoziierte klinische Pathologie wurden im Wochenabstand dokumentiert. Ergebnisse: 64,7 % der Haushalte hatten ihre Häuser aus recyceltem Material konstruiert und 50,7 % der Häuser verfügten über keinen festen Boden (Holz, Beton, Stein). 97 % der Haushalte hatten Anschluss an das Stromnetz, 83 % der Haushalte waren an die öffentliche Wasserversorgung angeschlossen. Das mittlere monatliche Einkommen lag bei 119 Real (Interquartilabstand 60 – 200 Real), ungefähr 52 € (Interquartilabstand 25 – 81 €). Der Altersmedian lag bei acht Jahren (Minimum 1 – Maximum 66). 48 % der Teilnehmer waren männlichen und 52 % weiblichen Geschlechts. Bei der Basisuntersuchung war die Tungiasis-assoziierte klinische Pathologie sehr ausgeprägt. Bei 93 % der Teilnehmer fanden sich Ödeme an Füßen, 70,9 % der Teilnehmer hatten Fissuren und Schmerzen beim Laufen und 99,3 % zeigten Nageldeformationen. Es fanden sich insgesamt 3,445 T. penetrans Läsionen (Median 17 Läsionen, Minimal 5, Maximal 98 Läsionen). Nach 14 Tagen Exposition waren 59 von 80 Tieren (74 %) infestiert. Pro Tier penetrierten im Median zwei Sandflöhe (Interquartilabstand 1 – 6). Die topographische Verteilung der penetrierten Sandflöhe war bei Wistar-Ratten und Patienten nahezu identisch. Die Patienten hatten 70.2 % der Läsionen an den Zehen, und die Wistar-Ratten 65,7 % an den Phalangen (p = 0.79). Zeh und Digitus 1 und 5 waren signifikant häufiger betroffen als die anderen Zehen (p=0.004 und p=0.002). Während der fünfmonatigen Intervallapplikation des Repellents lag die Infestationsintensität in Gruppe A im Median bei 4 (Interquartilabstand 1 – 9). In Gruppe B fand sich im Vergleich zu Gruppe A eine zweimal so hohe Infestationsintensität: Median = 8 (Interquartilabstand 9 – 16; p = 0.0035), und in Kontrollgruppe C eine dreieinhalbfach erhöhte Infestationsintensität: Median = 14 (Interquartilabstand 7 – 26; p = 0.004). Der Index für akute Tungiasis-assoziierte klinische Pathologie (SSAT) sank in der Gruppe A während der gesamten Intervention auf einen Median Wert von 2 (Interquartilabstand 1 – 4, Ausgangswert 12, p < 0.001). Im Vergleich zu Gruppe A blieb der Medianwert des SSAT-Index in Gruppe B zweieinhalbmal so hoch: 5 (Interquartilabstand 3 – 7; p < 0.001) und in der Kontrollgruppe C mehr als dreimal so hoch: 6.5 (Interquartilabstand 4 – 8; p < 0.001). Zusammenfassung: Es zeigte sich, dass in einem Armenviertel einer brasilianischen Großstadt die Tungiasis mit einer ausgeprägten klinischen Pathologie assoziiert ist. Durch die zweiwöchentliche Intervallapplikation von Zanzarin® wurden die Tungiasis-assoziierte klinische Pathologie und die Infestationsintensität der Tungiasis signifikant reduziert. Die Anwendung des Repellents jede vierte Woche in Gruppe B reichte nicht aus, um die Infestationsintensität und klinische Pathologie angemessen zu senken. Die topographische Verteilung der penetrierten Sandflöhe ist bei Patienten und Wistar-Ratten nahezu identisch.Background: Tungiasis, an ectoparasitosis caused by the female sand flea Tunga penetrans, is an important health problem in many impoverished communities in the tropics 1, 2, 3, 4, 5. In this study we investigated, whether the intermittent application of a plant based repellent (Zanzarin ®) keeps the infestation rate at an acceptable low level, and prevents severe clinical pathology to develop. Another aim was to compare the topographic distribution of embedded sand fleas in humans and Wistar rats. Methodology: 142 inhabitants of a shantytown in Fortaleza/Brazil, who had an elevated parasite load, were identified. The number of lesions, localization, staging and clinical pathology and the demographic and socioeconomic characteristics were recorded. We compared the topographic distribution of lesions in patients with the distribution of penetrated sandfleas in 80 laboratory raised Wistar rats. The rats were placed in cages for a period of 14 days and examined daily for the presence of new sand flea lesions. The patients were randomized into three cohorts. Initially, during a period of four weeks, the repellent was applied twice daily to the feet of all cohort members, to reduce the infestation intensity to 0. Thereafter members of cohort A applied the repellent every second week twice daily for one week, members of cohort B every fourth week for one week. Members of cohort C did not receive any treatment and served as controls. Infestation intensity and tungiasis-associated morbidity were monitored during five months. Results: 64,7% of households had constructed their homes from recycled material and 50.7% of the houses possessed no solid ground (wood, concrete, stone). 97% of households had connection to the electricity network, 83% of households were connected to the public water supply. The average monthly wage was 119 Real (interquartile range 60-200 Real), which corresponded to the time of study 52 € (interquartile range 25-81 €). The median age was eight years (minimum 1 - maximum 66). 48% of the participants were male and 52% female. In 93% of the participants we found edema of the feet, 70.9% of participants had fissures and pain when walking and 99.3% had nail deformities. A total of 3,445 T. penetrans lesions were found (median 17 lesions, minimum 5, maximum 98 lesions). After 14 days of exposure 59 of 80 animals (74%) were infested. Per animal penetrated median two sand fleas (interquartile range 1-6). The topographical distribution of the penetrated sand fleas was almost identical in Wistar rats and patients. The patients had 70.2% of the lesions on the toes, and the Wistar rats, 65.7% in the phalanges (p = 0.79). Toe and Digitus 1 and 5 were affected significantly more often than the other toes (p = 0.004 and p = 0.002). During the five-month interventional study the infestation intensity in cohort A was reduced to a median of 4 lesions (Interquartile Range 1 - 9). Compared to cohort A in cohort B the infestation intensity remained twice as high (median 8 lesions, Interquartile Range 9 - 16; p = 0.0035) and in the control cohort C 3.5 times as high (median 14 lesions; Interquartile Range 7 - 26; p = 0.004). Tungiasis-related acute pathology remained very low in cohort A (median severity score 2; Interquartile Range 1 - 4; Baseline severity score 12, p < 0.001). Compared to cohort A, the median severity score in Cohort B remained more than three times as high: 5 (Interquartile Range 3 - 7; p < 0.001) and control cohort C even more than tripple as high: 6.5 (Interquartile Range 4 - 8; p < 0.001). Conclusions/Significance: Our data show that tungiasis was associated with severe morbidity. We also show that in a setting with intense transmission infestation intensity and tungiasis-associated morbidity can be controlled through the intermittent application of a plant-based repellent. The application every fourth week is not sufficient to reduce the tungiasis- associated morbidity and infestation intensity in cohort B acceptably. The Wistar rat model mirrors human tungiasis in topographic distribution

Additional file 2: Table S2. of The addition of a sagittal image fusion improves the prostate cancer detection in a sensor-based MRI /ultrasound fusion guided targeted biopsy

Cancer Detection Rate and Gleason pattern in Group A and B excluding men with abnormal DRE and including only men with prior negative biopsy. (DOCX 19 kb

Tungiasis: a neglected disease causing severe morbidity in a shantytown in Fortaleza, state of Ceará

The parasitic skin disease tungiasis, caused by the jigger flea Tunga penetrans, is endemic in low-income communities in Brazil. In this study, inhabitants of a shantytown in Fortaleza, northeastern Brazil, who had an elevated parasite load, were identified. The number of lesions, localization, staging and associated diseases were recorded. The 142 individuals identified were living in extremely precarious housing conditions. A total of 3,445 lesions located on the feet were counted (median = 17 lesions; maximum = 98 lesions). Almost without exception, the individuals had nail deformation and edema, and more than 70% presented with pain and fissures. There was nail loss in 46%; deformation of the digits in 25%; abscesses in 42%; and complaints of walking difficulty in 59%. Our data show that tungiasis in this low-income urban community typical of northeastern Brazil was associated with severe morbidity. Tungiasis needs to be recognized as a public health problem in this study area and other similar endemic areas