117 research outputs found
Community-based wound management in a rural setting of Côte d'Ivoire
BACKGROUND: Wounds are a neglected health problem in rural communities of low-income countries, mostly caused by trauma and ulcerative skin diseases including Neglected Tropical Diseases (NTDs) and associated with systemic complications and disability. Rural communities have limited access to high quality health services-based wound care. METHODS: We conducted a prospective observational study on wound management at three levels-community (C), health centre (HC), district hospital (DH)-in a rural community of Cote d'Ivoire. Patients with skin wounds actively identified in a house-to-house survey and passively in the health services in a defined area of the Taabo Health and Demographic Surveillance System were asked to participate and followed-up longitudinally. Endpoints were proportion of wounds closed, time to wound closure, wound size over time, frequency of secondary bacterial infection, need for recapturing after follow-up interruption, and duration of treatment stratified by health service level and wound aetiology. RESULTS: We enrolled 561 patients with 923 wounds between May 2019 and March 2020. The observation period ended in March 2021. Median age was 10 years (IQR 7-15), 63.0% of patients were male. Almost all (99.5%, 870/874) wounds closed within the observation period, 5.3% (49/923) were lost to follow-up. Wounds primarily treated in C, HC and DH closed within a median time of 10, 16 and 170 days, respectively. Median time to acute wound and chronic wound closure was 13 and 72 days, respectively. Wounds treated in C, HC and DH presented with secondary bacterial infections in 10.3% (36/350), 31.0% (133/429) and 100% (5/5) of cases, respectively. Recapturing was required in 68.3% (630/923) of wounds with participants reporting wound closure as the main reason for not attending follow-up. CONCLUSIONS: We describe a wound management model based on national and WHO recommendations focusing on early identification and treatment in the community with potential for broad implementation in low-income countries. TRIAL REGISTRATION: Registration at ClinicalTrials.gov (NCT03957447)
Skin wounds in a rural setting of Côte d'Ivoire: population-based assessment of the burden and clinical epidemiology
BACKGROUND: Data on the burden and clinical epidemiology of skin wounds in rural sub-Saharan Africa is scant. The scale of the problem including preventable progression to chronic wounds, disability and systemic complications is largely unaddressed. METHODS: We conducted a cross-sectional study combining active (household-based survey) and passive case finding (health services-based survey) to determine the burden and clinical epidemiology of wounds within the Taabo Health and Demographic Surveillance System (HDSS) in rural Cote d'Ivoire. Patients identified with wounds received free care and were invited to participate in the wound management study simultaneously carried out in the survey area. The data were analysed for wound prevalence, stratified by wound and patient characteristics. RESULTS: 3842 HDSS-registered persons were surveyed. Overall wound prevalence derived from combined active and passive case finding was 13.0%. 74.1% (403/544) of patients were below the age of 15 years. Most frequent aetiologies were mechanical trauma (85.3%), furuncles (5.1%), burns (2.9%) and Buruli ulcer (2.2%). Most wounds were acute and smaller than 5 cm2 in size. 22.0% (176/799) of wounds showed evidence of secondary bacterial infection. 35.5% (22/62) of chronic wounds had persisted entirely neglected for years. Buruli ulcer prevalence was 2.3 per 1000 individuals and considerably higher than expected from an annual incidence of 0.01 per 1000 individuals as reported by WHO for Cote d'Ivoire at the time of the study. CONCLUSIONS: Skin wounds are highly prevalent in rural West Africa, where they represent a widely neglected problem. The HDSS-based survey with combined active and passive case finding adopted in this study provides a better estimate than school- and health institution-based surveys which underestimate the frequency of skin wounds and, particularly, of neglected tropical diseases of the skin, such as Buruli ulcer and yaws. A comparison with country-specific WHO data suggests underreporting of Buruli ulcer cases. TRIAL REGISTRATION: Registration at ClinicalTrials.gov NCT03957447
Cystic Echinococcosis: Chronic, Complex, and Still Neglected
Cystic echinococcosis is a most clinically neglected
parasitic disease that urgently needs attention.
A valuable tool for diagnosing,
staging, and following up patients, ultrasound,
is readily available. Four management
procedures, surgery, percutaneous
sterilization techniques, anti-parasitic
treatment, and watch & wait, have
‘‘evolved’’ over decades, and been recently
summarized, but without adequate
comparative evaluation of efficacy, effectiveness,
rate of adverse events, relapse
rates, and cost. Clinical decision making is
on even shakier ground for extrahepatic
and extrapulmonary locations, which are
rarer and numbers needed to build
comparative trials hard to come by. There
is an obligation to put at least what we
have on an appropriate evidence base by
conducting comparative clinical trials at
the scale and quality that allow answering
these important questions. As one of the
expected results, clear criteria for the
watch & wait option alone might already
save a substantial proportion of patients
from unnecessary interventions and save
health services money. Difficult chronic
diseases clustering in poor rural areas need
intelligent, creative approaches, and this
one urgently needs operational research
incorporating the particularities of resource-
poor settings into consideration
Hepatopulmonary hydatidosis in a ten-year-old girl: a case report
<p>Abstract</p> <p>Introduction</p> <p>Hydatid disease is a parasitic infection caused by the tapeworm <it>Echinococcus granulosus </it>and is characterised by cystic lesions in the liver and lungs. Concomitant pulmonary and hepatic localization of hydatid cysts in childhood is unusual and represents a distinct clinical entity called hepatopulmonary hydatidosis.</p> <p>Case presentation</p> <p>A ten-year-old Caucasian girl, a permanent resident of rural Greece, was admitted to hospital reporting a nonspecific symptomatology compatible with a diagnosis of viral infection. Chest radiography revealed a large homogenous circular opacity in the right lung field. On the basis of imaging studies, a diagnosis of hydatidosis was made with synchronous hepatic and pulmonary involvement, successfully managed through a single-stage transthoracic surgical approach.</p> <p>Conclusion</p> <p>This case report highlights the necessity of realizing that hydatid disease continues to be a public health problem, which often remains asymptomatic for years. Therefore, the presence of any homogeneous cystic spherical opacity on routine chest radiography should raise the suspicion of hydatid disease, mainly in endemic areas such as Greece. General practitioners and physicians involved in pediatric care need to be familiar with the diagnosis and management of the variable clinical manifestations of hydatid disease. Taking into consideration that hepatopulmonary hydatidosis represents a special entity that requires a different therapeutic approach may positively affect its economic and social-related burden.</p
Post-treatment follow-up study of abdominal cystic echinococcosis in Tibetan communities of northwest Sichuan Province, China
Background: Human cystic echinococcosis (CE), caused by the larval stage of Echinococcus granulosus, with the liver as the
most frequently affected organ, is known to be highly endemic in Tibetan communities of northwest Sichuan Province.
Antiparasitic treatment with albendazole remains the primary choice for the great majority of patients in this resource-poor
remote area, though surgery is the most common approach for CE therapy that has the potential to remove cysts and lead
to complete cure. The current prospective study aimed to assess the effectiveness of community based use of cyclic
albendazole treatment in Tibetan CE cases, and concurrently monitor the changes of serum specific antibody levels during
treatment.
Methodology/Principal Findings: Ultrasonography was applied for diagnosis and follow-up of CE cases after cyclic
albendazole treatment in Tibetan communities of Sichuan Province during 2006 to 2008, and serum specific IgG antibody
levels against Echinococcus granulosus recombinant antigen B in ELISA was concurrently monitored in these cases. A total of
196 CE cases were identified by ultrasound, of which 37 (18.9%) showed evidence of spontaneous healing/involution of
hepatic cyst(s) with CE4 or CE5 presentations. Of 49 enrolled CE cases for treatment follow-up, 32.7% (16) were considered
to be cured based on B-ultrasound after 6 months to 30 months regular albendazole treatment, 49.0% (24) were improved,
14.3% (7) remained unchanged, and 4.1% (2) became aggravated. In general, patients with CE2 type cysts (daughter cysts
present) needed a longer treatment course for cure (26.4 months), compared to cases with CE1 (univesicular cysts) (20.4
months) or CE3 type (detached cyst membrane or partial degeneration of daughter cysts) (9 months). In addition, the
curative duration was longer in patients with large (.10 cm) cysts (22.3 months), compared to cases with medium (5–
10 cm) cysts (17.3 months) or patients with small (,5 cm) cysts (6 months). At diagnosis, seven (53.8%) of 13 cases with CE1
type cysts without any previous intervention showed negative specific IgG antibody response to E. granulosus recombinant
antigen B (rAgB). However, following 3 months to 18 months albendazole therapy, six of these 7 initially seronegative CE1
cases sero-converted to be specific IgG antibody positive, and concurrently ultrasound scan showed that cysts changed to
CE3a from CE1 type in all the six CE cases. Two major profiles of serum specific IgG antibody dynamics during albendazole
treatment were apparent in CE cases: (i) presenting as initial elevation followed by subsequent decline, or (ii) a persistent
decline. Despite a decline, however, specific antibody levels remained positive in most improved or cured CE cases.
Conclusions: This was the first attempt to follow up community-screened cystic echinococcosis patients after albendazole
therapy using ultrasonography and serology in an endemic Tibetan region. Cyclic albendazole treatment proved to be
effective in the great majority of CE cases in this resource-poor area, but periodic abdominal ultrasound examination was
necessary to guide appropriate treatment. Oral albendazole for over 18 months was more likely to result in CE cure. Poor
drug compliance resulted in less good outcomes. Serology with recombinant antigen B could provide additional limited
information about the effectiveness of albendazole in CE cases. Post-treatment positive specific IgG antibody
seroconversion, in initially seronegative, CE1 patients was considered a good indication for positive therapeutic efficacy
of albendazole
Treatment Response of Cystic Echinococcosis to Benzimidazoles: A Systematic Review
Over the past 30 years, benzimidazoles have increasingly been used to treat cystic echinococcosis (CE). The efficacy of benzimidazoles, however, remains unclear. We systematically searched MEDLINE, EMBASE, SIGLE, and CCTR to identify studies on benzimidazole treatment outcome. A large heterogeneity of methods in 23 reports precluded a meta-analysis of published results. Specialist centres were contacted to provide individual patient data. We conducted survival analyses for cyst response defined as inactive (CE4 or CE5 by the ultrasound-based World Health Organisation [WHO] classification scheme) or as disappeared. We collected data from 711 treated patients with 1,308 cysts from six centres (five countries). Analysis was restricted to 1,159 liver and peritoneal cysts. Overall, 1–2 y after initiation of benzimidazole treatment 50%–75% of active C1 cysts were classified as inactive/disappeared compared to 30%–55% of CE2 and CE3 cysts. Further in analyzing the rate of inactivation/disappearance with regard to cyst size, 50%–60% of cysts <6 cm responded to treatment after 1–2 y compared to 25%–50% of cysts >6 cm. However, 25% of cysts reverted to active status within 1.5 to 2 y after having initially responded and multiple relapses were observed; after the second and third treatment 60% of cysts relapsed within 2 y. We estimated that 2 y after treatment initiation 40% of cysts are still active or become active again. The overall efficacy of benzimidazoles has been overstated in the past. There is an urgent need for a pragmatic randomised controlled trial that compares standardized benzimidazole therapy on responsive cyst stages with the other treatment modalities
Systems biologists seek fuller integration of systems biology approaches in new cancer research programs
Systems biology takes an interdisciplinary approach to the systematic study of complex interactions in biological systems. This approach seeks to decipher the emergent behaviors of complex systems rather than focusing only on their constituent properties. As an increasing number of examples illustrate the value of systems biology approaches to understand the initiation, progression, and treatment of cancer, systems biologists from across Europe and the United States hope for changes in the way their field is currently perceived among cancer researchers. In a recent EU-US workshop, supported by the European Commission, the German Federal Ministry for Education and Research, and the National Cancer Institute of the NIH, the participants discussed the strengths, weaknesses, hurdles, and opportunities in cancer systems biology
Muscle-Sparing Approach for Recurrent Hydatidosis of the Thigh and Psoas: Report of a Rare Case
Transmission dynamics of pulmonary tuberculosis between autochthonous and immigrant sub-populations
<p>Abstract</p> <p>Background</p> <p>The overall incidence of tuberculosis (TB) in Western Europe has been declining since the 19<sup>th </sup>Century. However, immigrant sub-groups from high-prevalence countries are slowing down this trend. The aim of this study was to describe how immigration influences TB transmission in Germany. For that we prospectively investigated the dynamics of TB transmission between TB high-prevalence immigrant and TB low-prevalence local populations with molecular epidemiological methods and conventional contact investigations. Besides, we assessed transmission in relation to social mixing using an innovative tool that measures the integration of immigrants into the local social environment.</p> <p>Methods</p> <p>A prospective study of confirmed culture positive cases of pulmonary TB and their contacts was carried out in a German federal state from 2003 to 2005. Data for the study included: 1) case data routinely collected by the local public health staff and transmitted to the state health office and the national surveillance centre, 2) a study questionnaire designed to capture social interactions of relevance for TB transmission and 3) molecular genotyping data (IS<it>6110 </it>DNA fingerprint and spoligotyping). The proportion of German cases caused by foreign-born cases, and vice versa, was estimated and an integration index was computed using a selected set of questions from the study questionnaire.</p> <p>Results</p> <p>A total of 749 cases of culture-positive pulmonary tuberculosis voluntarily enrolled in the study, representing 57.8% of all registered cases diagnosed over the study period. Data that included study questionnaire and DNA fingerprinting were available for 41% (n = 308) of the study participants. Forty-seven clusters, defined as a least two cases infected by the same TB strains, were identified by molecular methods and included 132 (17%) of the study participants. Epidemiological links were identified for 28% of the clusters by conventional epidemiological data. In mixed clusters, defined as clusters including German and foreign-born individuals, the probability of cases to be caused by foreign-born cases was estimated at 18.3%. We observed a trend to mixed clusters with increasing time spent by immigrants in the host country. This group also presented comparatively higher integration indexes than immigrants in immigrant-only clusters.</p> <p>Conclusion</p> <p>Our results confirm the findings of other studies that there is no significant TB transmission from TB high-prevalence immigrant to TB low-prevalence autochthonous population. This may be explained by the good performance of tuberculosis screening programmes for certain groups arriving in Germany from high- prevalence countries, by a low degree of mixing of immigrants with the local population or by a combination of both.</p
Cystic Echinococcosis in Spain: Current Situation and Relevance for Other Endemic Areas in Europe
Cystic echinococcosis (CE) remains an important health problem in many regions of the world, both where no control measures have been implemented, and where control programs have been incompletely successful with ensuing re-emergence of the disease. In Spain, official data on CE show an increase in the proportion of intermediate hosts with CE during the last few years, and autochthonous pediatric patients have been reported, a sign of active local transmission of disease. A similar picture emerges from data reported to the European Food Safety Authority by other European countries. Nevertheless, several crucial aspects related to CE that would help better understand and control the disease have not been tackled appropriately, in particular the emergence of infection in specific geographical areas. In this respect, while some data are missing, other data are conflicting because they come from different databases. We review the current situation of CE in Spain compared with areas in which similar problems in the CE field exist, and offer recommendations on how to overcome those limitations. Specifically, we believe that the introduction of national registries for CE with online data entry, following the example set by the European Registry for Alveolar Echinococcosis, would help streamline data collection on CE by eliminating the need for evaluating and integrating data from multiple regions, by avoiding duplication of data from patients who access several different health facilities over time, and by providing much needed clinical and epidemiological data that are currently accessible only to clinicians
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