The history of leishmaniasis

In this review article the history of leishmaniasis is discussed regarding the origin of the genus Leishmania in the Mesozoic era and its subsequent geographical distribution, initial evidence of the disease in ancient times, first accounts of the infection in the Middle Ages, and the discovery of Leishmania parasites as causative agents of leishmaniasis in modern times. With respect to the origin and dispersal of Leishmania parasites, the three currently debated hypotheses (Palaearctic, Neotropical and supercontinental origin, respectively) are presented. Ancient documents and paleoparasitological data indicate that leishmaniasis was already widespread in antiquity. Identification of Leishmania parasites as etiological agents and sand flies as the transmission vectors of leishmaniasis started at the beginning of the 20th century and the discovery of new Leishmania and sand fly species continued well into the 21st century. Lately, the Syrian civil war and refugee crises have shown that leishmaniasis epidemics can happen any time in conflict areas and neighbouring regions where the disease was previously endemic

A historical overview of the classification, evolution, and dispersion of Leishmania parasites and sandflies

Background The aim of this study is to describe the major evolutionary historical events among Leishmania, sandflies, and the associated animal reservoirs in detail, in accordance with the geographical evolution of the Earth, which has not been previously discussed on a large scale. Methodology and Principal Findings Leishmania and sandfly classification has always been a controversial matter, and the increasing number of species currently described further complicates this issue. Despite several hypotheses on the origin, evolution, and distribution of Leishmania and sandflies in the Old and New World, no consistent agreement exists regarding dissemination of the actors that play roles in leishmaniasis. For this purpose, we present here three centuries of research on sandflies and Leishmania descriptions, as well as a complete description of Leishmania and sandfly fossils and the emergence date of each Leishmania and sandfly group during different geographical periods, from 550 million years ago until now. We discuss critically the different approaches that were used for Leishmana and sandfly classification and their synonymies, proposing an updated classification for each species of Leishmania and sandfly. We update information on the current distribution and dispersion of different species of Leishmania (53), sandflies (more than 800 at genus or subgenus level), and animal reservoirs in each of the following geographical ecozones: Palearctic, Nearctic, Neotropic, Afrotropical, Oriental, Malagasy, and Australian. We propose an updated list of the potential and proven sandfly vectors for each Leishmania species in the Old and New World. Finally, we address a classical question about digenetic Leishmania evolution: which was the first host, a vertebrate or an invertebrate? Conclusions and Significance We propose an updated view of events that have played important roles in the geographical dispersion of sandflies, in relation to both the Leishmania species they transmit and the animal reservoirs of the parasites

The clinical relevance of oliguria in the critically ill patient : Analysis of a large observational database

Funding Information: Marc Leone reports receiving consulting fees from Amomed and Aguettant; lecture fees from MSD, Pfizer, Octapharma, 3 M, Aspen, Orion; travel support from LFB; and grant support from PHRC IR and his institution. JLV is the Editor-in-Chief of Critical Care. The other authors declare that they have no relevant financial interests. Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Urine output is widely used as one of the criteria for the diagnosis and staging of acute renal failure, but few studies have specifically assessed the role of oliguria as a marker of acute renal failure or outcomes in general intensive care unit (ICU) patients. Using a large multinational database, we therefore evaluated the occurrence of oliguria (defined as a urine output 16 years) patients in the ICON audit who had a urine output measurement on the day of admission were included. To investigate the association between oliguria and mortality, we used a multilevel analysis. Results: Of the 8292 patients included, 2050 (24.7%) were oliguric during the first 24 h of admission. Patients with oliguria on admission who had at least one additional 24-h urine output recorded during their ICU stay (n = 1349) were divided into three groups: transient - oliguria resolved within 48 h after the admission day (n = 390 [28.9%]), prolonged - oliguria resolved > 48 h after the admission day (n = 141 [10.5%]), and permanent - oliguria persisting for the whole ICU stay or again present at the end of the ICU stay (n = 818 [60.6%]). ICU and hospital mortality rates were higher in patients with oliguria than in those without, except for patients with transient oliguria who had significantly lower mortality rates than non-oliguric patients. In multilevel analysis, the need for RRT was associated with a significantly higher risk of death (OR = 1.51 [95% CI 1.19-1.91], p = 0.001), but the presence of oliguria on admission was not (OR = 1.14 [95% CI 0.97-1.34], p = 0.103). Conclusions: Oliguria is common in ICU patients and may have a relatively benign nature if only transient. The duration of oliguria and need for RRT are associated with worse outcome.publishersversionPeer reviewe

Impact of direct substitution of arm span length for current standing height in elderly COPD

Chaicharn Pothirat, Warawut Chaiwong, Nittaya Phetsuk Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Background: Arm span length is related to standing height and has been studied as a substitute for current standing height for predicting lung function parameters. However, it has never been studied in elderly COPD patients. Purpose: To evaluate the accuracy of substituting arm span length for current standing height in the evaluation of pulmonary function parameters and severity classification in elderly Thai COPD patients. Materials and methods: Current standing height and arm span length were measured in COPD patients aged >60 years. Postbronchodilator spirometric parameters, forced vital capacity (FVC), forced expiratory volume in first second (FEV1), and ratio of FEV1/FVC (FEV1%), were used to classify disease severity according to global initiative for chronic obstructive lung disease criteria. Predicted values for each parameter were also calculated separately utilizing current standing height or arm span length measurements. Student’s t-tests and chi-squared tests were used to compare differences between the groups. Statistical significance was set at P<0.05. Results: A total of 106 COPD patients with a mean age of 72.1±7.8 years, mean body mass index of 20.6±3.8 kg/m2, and mean standing height of 156.4±8.3 cm were enrolled. The mean arm span length exceeded mean standing height by 7.7±4.6 cm (164.0±9.0 vs 156.4±8.3 cm, P<0.001), at a ratio of 1.05±0.03. Percentages of both predicted FVC and FEV1 values based on arm span length were significantly lower than those using current standing height (76.6±25.4 vs 61.6±16.8, P<0.001 and 50.8±25.4 vs 41.1±15.3, P<0.001). Disease severity increased in 39.6% (42/106) of subjects using arm span length over current standing height for predicted lung function. Conclusion: Direct substitution of arm span length for current standing height in elderly Thai COPD patients should not be recommended in cases where arm span length exceeds standing height by more than 4 cm. Keywords: chronic obstructive pulmonary disease, arm span, standing height, spirometry, severity&nbsp

Real-world comparative study of behavioral group therapy program vs education program implemented for smoking cessation in community-dwelling elderly smokers

Chaicharn Pothirat, Nittaya Phetsuk, Chalerm Liwsrisakun, Athavudh Deesomchok Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Background: Tobacco smoking is known to be an important contributor to a wide variety of chronic diseases, especially in older adults. Information on health policy and practice, as well as evaluation of smoking cessation programs targeting older people, is almost nonexistent. Purpose: To compare the real-world implementation of behavioral group therapy in relation to education alone for elderly smokers. Materials and methods: Elderly smokers ready to quit smoking were identified from a cohort who completed a questionnaire at a smoking exhibition. They were allocated into two groups, behavioral therapy (3 days 9 hours) and education (2 hours), depending on their preferences. Demographic data, the Fagerstrom test for nicotine dependence (FTND) score, and exhaled carbon monoxide level were recorded at baseline. Smoking status of all subjects was followed at months 3, 6, and 12. Statistical differences in continuous abstinence rate (CAR) between the two groups were analyzed using chi-square tests. Results: Two hundred and twenty-four out of 372 smoking exhibition attendants met the enrollment criteria; 120 and 104 elected to be in behavioral group therapy and education-alone therapy, respectively. Demographic characteristics and smoking history were similar between both groups, including age, age of onset of smoking, years of smoking, smoking pack-years, education level, and nicotine dependence as measured by the FTND scale. The CAR of the behavioral therapy group at the end of the study (month 12) was significantly higher than the education group (40.1% vs 33.3%, P=0.034). Similar results were also found throughout all follow-up visits at month 3 (57.3% vs 27.0%, P<0.001) and month 6 (51.7% vs 25%, P<0.001). Conclusion: Behavioral group therapy targeting elderly smokers could achieve higher short- and long-term CARs than education alone in real-world practice. Keywords: smoking cessation, behavioral, education, elderl

Misidentification of airflow obstruction: prevalence and clinical significance in an epidemiological study

Chaicharn Pothirat, Warawut Chaiwong, Nittaya Phetsuk, Chalerm Liwsrisakun Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Background: The fixed threshold criterion for the ratio of forced expiratory volume in the first second to forced vital capacity (FEV1/FVC) <0.7 is widely applied for diagnosis of airflow obstruction (AO). However, this fixed threshold criterion may misidentify AO, because thresholds below the fifth percentile of normal FEV1/FVC (lower limit of normal; LLN) vary with age. This study aims to identify the prevalence of AO misidentification and its clinical significance.Materials and methods: A cross-sectional population-based study was conducted to identify the prevalence of chronic respiratory diseases in adults older than 40 years of age who live in municipal areas of Chiang Mai province, Thailand. All randomly selected subjects underwent face-to-face interviews and examinations by pulmonologists, and received chest radiographs and post-bronchodilator spirometry. AO misidentification was classified into under- or overestimated AO subgroups. Underestimated AO was defined as ratio of FEV1/FVC greater than the fixed threshold, but below the LLN criteria. Overestimated AO was defined as the ratio of FEV1/FVC below the fixed threshold but greater than the LLN criteria. The clinical significance of each misidentified subject was then explored.Results: There were 554 subjects with a mean age of 52.9±10.1 years and a percent predicted FEV1 of 85.5%±15.4%. The prevalence of AO misidentification was 5.6% (31/554), and all subjects belonged to the underestimated subgroup. Clinical significance of underestimated subjects included clinical AO disease of 22.6% (7/31) (three subjects with chronic obstructive pulmonary disease [COPD] and four subjects with asthma); chronic respiratory symptoms of 54.8% (17/31) (mostly associated with chronic rhinitis, 70.6% [12/17]); and only 12.9% (4/31) were identified as non-ill subjects.Conclusion: The prevalence of AO misidentification in this population was significant, and all were underestimated subjects. Most underestimated subjects had clinical significance as related to obstructive airway diseases and chronic respiratory symptoms, mostly associated with rhinitis. Keywords: spirometry, airflow obstruction, chronic obstructive pulmonary disease, asthm

Comparative study on health care utilization and hospital outcomes of severe acute exacerbation of chronic obstructive pulmonary disease managed by pulmonologists vs internists

Chaicharn Pothirat, Chalerm Liwsrisakun, Chaiwat Bumroongkit, Athavudh Deesomchok, Theerakorn Theerakittikul, Atikun Limsukon Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Background: Care for many chronic health conditions is delivered by both specialists and generalists. Differences in patients’ quality of care and management between generalists and specialists have been well documented for asthma, whereas a few studies for COPD reported no differences. Objective: The objective of this study is to compare consistency with Global initiative for chronic Obstructive Lung Disease guidelines, as well as rate, health care utilization, and hospital outcomes of severe acute exacerbation (AE) of COPD patients managed by pulmonologists and internists. Materials and methods: This is a 12-month prospective, comparative observational study among 208 COPD patients who were regularly managed by pulmonologists (Group A) and internists (Group B). Clinical data, health care utilization, and hospital outcomes of the two groups were statistically compared. Results: Out of 208 enrolled patients, 137 (Group A) and 71 (Group B) were managed by pulmonologists and internists, respectively. Pharmacological treatment corresponding to disease severity stages between the two groups was not statistically different. Group A received care consistent with guidelines in terms of annual influenza vaccination (31.4% vs 9.9%, P<0.001) and pulmonary rehabilitation (24.1% vs 0%, P<0.001) greater than Group B. Group A had reduced rates (12.4% vs 23.9%, P=0.033) and numbers of severe AE (0.20±0.63 person-years vs 0.41±0.80 person-years, P=0.029). Among patients with severe AE requiring mechanical ventilation, Group A had reduced mechanical ventilator duration (1.5 [1–7] days vs 5 [3–29] days, P=0.005), hospital length of stay (3.5 [1–20] days vs 16 [6–29] days, P=0.012), and total hospital cost (863 [247–2,496] vs 2,095 [763–6,792], P=0.049) as compared with Group B. Conclusion: This study demonstrated that pulmonologists followed national COPD guidelines more closely than internists. The rates and frequencies of severe AE were significantly lower in patients managed by pulmonologists, and length of hospital stay and cost were significantly lower among the patients with severe AE who required mechanical ventilation. Keywords: chronic obstructive pulmonary disease, guidelines, specialization, managemen