Skin changes in chronic lymphatic filariasis

Seventeen men and 31 women with unilateral lower limb lymphoedema attributed to chronic lymphatic filariasis were examined in the filarial out-patient clinic of the Government General Hospital, Madras, India. Skin changes such as skin fold thickening, hyperkeratosis, hypo-or hypertrichosis, pachydermia, pigmentary changes, chronic ulceration, epidermal and sub-epidermal nodules, and clinical intertrigo were observed and compared between the different lymphoedema grades. These lesions are not specific to chronic lymphatic filariasis, and have been described in other conditions displaying lymphostasis. They are thought to be favoured by secondary infections, which should be dealt with appropriately to prevent the progression of the disease and the onset of elephantiasi

Impact of trauma and torture on asylum-seekers

Background: Because most asylum seekers come from regions in which war and human rights violations are common, a systematic investigation of exposure to traumatic events and their psychological impact was conducted. Methods: Over an eight month period, 573 asylum-seekers were Interviewed shortly after arrival In Geneva, Switzerland, using a questionnaire to collect information on physical and psychological symptoms and previous exposure to traumatic events. Results: Sixty-two per cent reported exposure to one or more traumatic events, and 18% reported having been tortured. Overall, 37% reported at least one severe symptom during the previous week, most often of a psychological nature, such as sadness most of the time, insomnia, and anxiety. Persons who reported torture were more symptomatic than those who did not, and symptoms were consistent with diagnoses of depression and post-traumatic stress disorder. A follow-up visit was proposed to 28% of the entire sample, and to two thirds of those who reported torture. Conclusion: These findings suggest that a simple checklist such as the one used in this study may assist health professionals to identify asylum seekers In need of further assessment and care to reduce long-term post-traumatic psycho-social disability and strengthen coping capabilit

Mental and physical health of Kosovar Albanians in their place of origin: a post-war 6-year follow-up study

Purpose: Long-term outcome of traumatic experiences among war-exposed civilians living in their home country has been seldom documented. The present study examined change in posttraumatic stress disorder (PTSD) frequency and perceived physical and mental health in a cohort of Kosovar Albanians over 6years (2001-2007). Methods: Of 996 Albanian Kosovar civilians included in the 2001 survey, 551 subjects (55.3%) were recalled and interviewed in 2007. Diagnoses of PTSD and major depressive episode were assessed using the Mini International Neuropsychiatric Interview. Subjective physical and mental health were investigated using the Medical Outcomes Study 36-Item Short-Form (SF-36). A list of traumatic events adapted from the Harvard Trauma Questionnaire and other stressful life events was also considered. Results: Posttraumatic stress disorder was significantly less frequent in 2007 than in 2001 (14.5% vs. 23.2%, p<0.001). For 18.0, 5.3 and 9.3% of participants, PTSD remitted, persisted and developed over the 6-year follow-up period, respectively. Ill health without having access to medical care and major changes in responsibilities at work were associated with both persistence and new occurrence of PTSD. While the SF-36 mental component summary score significantly improved (mean change +4.5, p<0.001), the physical component summary score did not change between 2001 and 2007, after adjustment for age (mean change −0.8, p=0.14). Conclusions: Results point at the importance of economic and health system reconstruction programs with respect to public health in post-conflict countrie

Congenital Transmission of Chagas Disease in Latin American Immigrants in Switzerland

International migration has changed the epidemiologic patterns of Chagas disease. Recently, 2 cases of Chagas disease transmitted from Latin American women to their newborns were diagnosed in Geneva, Switzerland. A retrospective study to detect Chagas disease showed a prevalence of 9.7% among 72 Latin American women tested during pregnancy in Switzerland

Asylsuchende und Flüchtlinge in der medizinischen Poliklinik: Ein Vergleich zwischen den Polikliniken Basel, Bern und Genf

Zusammenfassung: Die vorliegende Querschnittsstudie beschreibt den Gesundheitszustand und die Gesundheitsversorgung von Asylsuchenden und Flüchtlingen aus der sicht der in den medizinischen Polikliniken Basel, Bern und Genf tätigen Ärzte. Durch den Vergleich von Polikliniken unterschiedlicher Struktur wird die Identifikation positiver und negativer Determinanten der Gesundheitsbetreuung unterstützt. Die Ergebnisse der Studie beruhen auf der Auswertung von Fragebogen, Monatsstatistiken und semi-strukturierten Interviews. Der Fragebogen wurde von allen in diesen Polikliniken tätigen Ärzten ausgefüllt (Basel: 10, Bern: 1, Genf: 36) Alle Konsultationen von Asylsuchenden und Flüchtlingen wurden während eines definierten Zeitraumes dokumentiert (Basel: 42, Bern: 93, Genf: 187). Mit den drei an den jeweiligen Polikliniken für die Studienkoordination zuständigen Ärzten wurden Interviews durchgeführt. Im Zeitraum der Studie waren hauptsächlich Asylsuchende und Flüchtlinge aus Ex-Jugoslawien, der Türkei, Sri Lanka, Somalia, Angola und Zaire in Behandlung. Das untersuchte Patientenklientel zeichnete sich durch eine hohe Diversität bezüglich Herkunftsländer, Sprachen, Kommunikationsvermögen sowie Schul-und Berufsausbildung aus. Niedrige Konsultationsfrequenzen pro Arzt könnten zahlreiche der beobachteten Probleme erklären: mangelnde Erfahrung in spezifischen Betreuungsformen, administrative Probleme und Schwierigkeiten hinsichtlich der Organisation von Übersetzerdiensten. Die wesentliche Voraussetzung für die Verbesserung der institutionellen gesundheitlichen Versorgung wird in der Betreuung durch kleine Ärzteteams gesehen. Auf diese Weise kann der einzelne Arzt genügend Erfahrung sammeln und organisatorische Fragen rationeller behandeln. Ausbildungs- und Forschungsansätze, die sich aus den Ergebnissen dieser Studie ergeben, werden diskutier

Spectrum of Illness in International Migrants Seen at GeoSentinel Clinics in 1997-2009, Part 2: Migrants Resettled Internationally and Evaluated for Specific Health Concerns

Of 7629 migrants, one third were infected with tuberculosis (22% active, 10% latent), one quarter with a variety of parasites (malaria 7%, schistosomes 6%, Strongyloides 5%, miscellaneous 5%), and 17% with chronic viral hepatitis (12% hepatitis B, 5% hepatitis C

Travel and migration associated infectious diseases morbidity in Europe, 2008.

BACKGROUND: Europeans represent the majority of international travellers and clinicians encountering returned patients have an essential role in recognizing, and communicating travel-associated public health risks. METHODS: To investigate the morbidity of travel associated infectious diseases in European travellers, we analysed diagnoses with demographic, clinical and travel-related predictors of disease, in 6957 ill returned travellers who presented in 2008 to EuroTravNet centres with a presumed travel associated condition. RESULTS: Gastro-intestinal (GI) diseases accounted for 33% of illnesses, followed by febrile systemic illnesses (20%), dermatological conditions (12%) and respiratory illnesses (8%). There were 3 deaths recorded; a sepsis caused by Escherichia coli pyelonephritis, a dengue shock syndrome and a Plasmodium falciparum malaria.GI conditions included bacterial acute diarrhea (6.9%), as well as giardiasis and amebasis (2.3%). Among febrile systemic illnesses with identified pathogens, malaria (5.4%) accounted for most cases followed by dengue (1.9%) and others including chikungunya, rickettsial diseases, leptospirosis, brucellosis, Epstein Barr virus infections, tick-borne encephalitis (TBE) and viral hepatitis. Dermatological conditions were dominated by bacterial infections, arthropod bites, cutaneous larva migrans and animal bites requiring rabies post-exposure prophylaxis and also leishmaniasis, myasis, tungiasis and one case of leprosy. Respiratory illness included 112 cases of tuberculosis including cases of multi-drug resistant or extensively drug resistant tuberculosis, 104 cases of influenza like illness, and 5 cases of Legionnaires disease. Sexually transmitted infections (STI) accounted for 0.6% of total diagnoses and included HIV infection and syphilis. A total of 165 cases of potentially vaccine preventable diseases were reported. Purpose of travel and destination specific risk factors was identified for several diagnoses such as Chagas disease in immigrant travellers from South America and P. falciparum malaria in immigrants from sub-Saharan Africa. Travel within Europe was also associated with health risks with distinctive profiles for Eastern and Western Europe. CONCLUSIONS: In 2008, a broad spectrum of travel associated diseases were diagnosed at EuroTravNet core sites. Diagnoses varied according to regions visited by ill travellers. The spectrum of travel associated morbidity also shows that there is a need to dispel the misconception that travel, close to home, in Europe, is without significant health risk.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are