Poor WASH (Water, Sanitation, and Hygiene) Conditions Are Associated with Leprosy in North Gondar, Ethiopia.

Access to safe water, sanitation, and hygiene (WASH) is critical for preventing the spread of neglected tropical diseases (NTDs) including leprosy. WASH-related transmission factors remain largely unexplored in the leprosy transmission cycle. The aim of this project is to better understand WASH exposures among leprosy cases through a case-control study in North Gondar, Ethiopia. We hypothesized that leprosy cases were more likely to have inadequate WASH access and were more likely to have concurrent schistosomiasis, as schistosomiasis immune consequences may facilitate leprosy infection. Forty leprosy cases (forty-one controls) were enrolled, tested for Schistosomamansoni, administered a demographic and WASH survey, and assigned a WASH index score. WASH factors significantly associated with leprosy on adjusted analyses included open defecation (aOR = 19.9, 95% CI 2.2, 176.3) and lack of access to soap (aOR = 7.3, 95% CI 1.1, 49.9). S. mansoni was detected in 26% of participants and in stratified analysis those with leprosy had a 3.6 (95% CI (0.8, 15.9)) greater odds of schistosomiasis in districts bordering the lake, compared to 0.33 lower odds of schistosomiasis in districts not bordering the lake (95% CI (0.09, 1.2)). Overall, results suggest that leprosy transmission may be related to WASH adequacy and access as well as to schistosomiasis co-infection.

[The visitor : Roald Dahl on phobic anxiety of infections and delusion of hygiene]. / Der Besucher : Roald Dahl über Krankheitsfurcht und Hygienewahn.

In his both highly amusing and thrilling story Roald Dahl describes an adventure of his fictive uncle Oswald Hendryk Cornelius, a snobby Englishman and womanizer, suffering from delusional anxiety of infections and hygienic compulsions. Forced by the breakdown of his car in the Sinai desert, he accepts the invitation of a noble Arab to spend the night in his palace, situated like a mirage in the middle of the desert. Oswald is plagued by erotic obsessions at the sight of the beautiful wife as well as the likewise beautiful daughter. The night rewards him with the desired amorous adventure but without knowing with whom he had spent the night. Oswald's satisfaction changes to pure horror when, the next morning, the owner of the house reveals that the visitor during the night was neither his wife nor daughter.

Crusted nipple and areola: A new aetiology of secondary hyperkeratosis of the nipple and areola.

Hyperkeratosis of the nipple and areola is a rare condition first described by Tauber in 1923. Less than 100 cases have been reported in the literature. Hyperkeratosis of the nipple and areola presents as hyperkeratotic, hyperpigmented plaques on the nipple and areola. It is more common in females. An 18-year-old female patient presented with hyperkeratotic, plaque-like, hard crusts on both nipples and areolas. The examining physician could successfully remove this crust using his finger. The crust had accumulated as a result of the patient's reluctance to touch or clean the breast area due to psychological issues. A crusted nipple and areola may occur as a secondary condition due to a patient's reluctance to touch or clean their breasts.

A prospective study of the epidemiological and clinical patterns of recurrent dermatophytosis at a tertiary care hospital in India.

BACKGROUND: Recurrent and clinically unresponsive dermatophytosis is being increasingly encountered in our country. It runs a protracted course with exacerbations and remissions. However, there is little information regarding the extent of the problem and the characteristics of recurrent dermatophytosis in published literature. AIMS: We sought to determine the prevalence, risk factors and clinical patterns of recurrent dermatophytosis in our institution. We also investigated the causative dermatophyte species and antifungal susceptibility patterns in these species. METHODS: One hundred and fifty patients with recurrent dermatophytosis attending the outpatient department of the Postgraduate Institute of Medical Education and Research, Chandigarh, India were enrolled in the study conducted from January 2015 to December 2015. A detailed history was obtained in all patients, who were then subjected to a clinical examination and investigations including a wet preparation for direct microscopic examination, fungal culture and antifungal susceptibility tests. RESULTS: Recurrent dermatophytosis was seen in 9.3% of all patients with dermatophytosis in our study. Trichophyton mentagrophytes was the most common species identified (36 patients, 40%) samples followed by T. rubrum (29 patients, 32.2%). In-vitro antifungal susceptibility testing showed that the range of minimum inhibitory concentrations (MIC) on was lowest for itraconazole (0.015-1), followed by terbinafine (0.015-16), fluconazole (0.03-32) and griseofulvin (0.5-128) in increasing order. LIMITATION: A limitation of this study was the absence of a suitable control group (eg. patients with first episode of typical tinea). CONCLUSION: Recurrence of dermatophytosis was not explainable on the basis of a high (MIC) alone. Misuse of topical corticosteroids, a high number of familial contacts, poor compliance to treatment over periods of years, and various host factors, seem to have all contributed to this outbreak of dermatophytosis in India.

[Notes for a History of Hygiene taken from the Bible]. / Notas para una Historia de la Higiene tomadas de la Biblia.

Reading once more the Gospels, we found a discussion between Jesus and the Pharisee about the hand washing, this golden rule of medicine, and then, with the help of Thomas Mann, we began a search for other notes on hygiene in the Bible. For the return from Egypt to the Promised Land, Moses established several rules for his people, some of them disguised as religious principles, concerning elimination of excreta, healthy and poisonous foods, isolation in case of contagious diseases (leprosy, gonorrhea), decontamination of clothes and houses, and many others that now seem to us ahead his time.

Notas para una Historia de la Higiene tomadas de la Biblia / Notes for a History of Hygiene taken from the Bible

Reading once more the Gospels, we found a discussion between Jesus and the Pharisee about the hand washing, this golden rule of medicine, and then, with the help of Thomas Mann, we began a search for other notes on hygiene in the Bible. For the return from Egypt to the Promised Land, Moses established several rules for his people, some of them disguised as religious principles, concerning elimination of excreta, healthy and poisonous foods, isolation in case of contagious diseases (leprosy, gonorrhea), decontamination of clothes and houses, and many others that now seem to us ahead his time.

Leyendo una vez más los Evangelios, encontramos una discusión de Jesús con los fariseos sobre el lavado de manos antes de comer, que sus discípulos no respetaban. Como Jesús pareciera minimizar la utilidad de esta regla de oro para la medicina actual, fuimos a buscar otras notas bíblicas sobre las disposiciones higiénicas de aquellos tiempos, siguiendo una revisión que hiciera Thomas Mann para una de sus obras menores. Aparecen, fundamentalmente en el Levítico, numerosas recomendaciones, disposiciones y reglas que Moisés, invocando la autoridad de Yahvé, entregó al pueblo que salía de Egipto en pos de la Tierra Prometida, comprendiendo eliminación de excretas, alimentos recomendables y no recomendables, y aislamiento de enfermos en el caso de enfermedades que consideraban contagiosas, como lepra y gonorrea. También se detallaban en ellas la descontaminación de ropas y de casas, al igual que de otros objetos que habían estado en contacto con elementos estimados impuros, como cadáveres. Algunas de estas disposiciones, entre ellas las relativas al aislamiento de los enfermos, hoy nos parecen adelantadas a su época.

Clinico-bacteriological profile of primary pyodermas in Kashmir: a hospital-based study.

Pyodermas are a common group of infectious dermatological conditions on which few studies have been conducted. This study aimed to characterise the clinical and bacteriological profile of pyodermas, and to determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) infection in primary pyodermas in a dermatology outpatient department in Kashmir. Methods We conducted a hospital based cross-sectional study in the outpatient Department of Dermatology, Sexually Transmitted Diseases and Leprosy of Shri Maharaja Hari Singh Hospital, Srinagar, Jammu and Kashmir, India. Patients presenting with primary pyodermas were included in the study. A detailed history and complete physical and cutaneous examination was carried out along with microbiological testing to find aetiological microorganisms and their respectiveantimicrobial susceptibility patterns. Antimicrobial susceptibility testing, including that for methicillin resistance, was carried out by standard methods as outlined in the current Clinical and Laboratory Standards Institute guidelines. Results In total, 110 patients were included; the age of the study population ranged from 3 to 65 years (mean age 28 years); 62% were male. Poor personal hygiene was noted in 76 (69%). Furunculosis (56; 51%) was the most common clinical presentation. Staphylococcus aureus was isolated in 89 (81%) of cases, and MRSA formed 54/89 (61%) of Staphylococcus aureus isolates. All MRSA strains were sensitive to vancomycin. Conclusion The prevalence of MRSA was high in this sample of communityacquired primary pyodermas. It is therefore important to monitor the changing trends in bacterial infection and their antimicrobial susceptibility patterns and to formulate a definite antibiotic policy which may be helpful in decreasing the incidence of MRSA infection.

Qualidade da água utilizada na higienização dos tanques de granelização de leite cru do município de Rio Pomba, MG / Quality of water used in cleaning tanks of raw milk from Rio Pomba, MG

O objetivo deste trabalho foi avaliar a qualidade da água utilizada na higienização dos tanques de resfriamento de leite cru do Município de Rio Pomba, MG. Amostras de água provenientes de 15 tanques de expansão individuais e comunitários foram coletadas as septicamente no período de maio a agosto de 2010 e transportadas para os laboratórios de análise físico-química e microbiologia do IF Sudeste MG, campus Rio Pomba. Foram realizadas análises microbiológicas de micro-organismos mesófilos aeróbios, coliformes termotolerantes e Escherichia coli e análises físico-químicas de pH, dureza, cloro residual, alcalinidade, cloretos, cor e turbidez. Verificou-se que a contagem de micro-organismos mesófilos aeróbios variou entre < 1,0 x 101 UFC/mL estimado e 1,2 x 103 UFC/mL, que 53,3% e 33,3%das amostras apresentaram, respectivamente, coliformes termo tolerantes e E. coli. Constatou-se também que 26,6% das amostras encontravam-se com valores de pH abaixo do recomendado. Além disso, verificou-se que todas as amostras apresentaram valores abaixo de 50 mg/L de CaC03 em relação à dureza e ausência de cloro residual. Em relação à alcalinidade, constatou-se variação entre 8 mg/L e 44 mg/L de CaC03. Na análise de cor, observou-se que todas as amostras de água apresentaram 5 unidades Hansen e em relação à turbidez, constatou-se que todas as amostras apresentaram-se dentro do limite estabelecido pela legislação. Portanto, torna-se imprescindível o tratamento da água a fim de obter leite de qualidade, bem como a implantação de programas que visem o treinamento dos produtores para aplicação de boas práticas higiênicas na propriedade rural.

The aim of this study was to evaluate the quality of water used in cleaning of cooling tanks of rawmilk from Rio Pomba, Minas Gerais, Brazil. Water samples from 15individual and community expansion tanks were aseptically collected during the period from May to August 2010 and transported to the physical chemistry and microbiology laboratories of IF Sudeste MG. It was developed microbiologicalanalysis of mesophilic aerobic microorganisms, coliforms and Escherichia coli and physical chemical analyses of pH, hardness, residual chlorine, alkalinity, chloride, color and turbidity. It was verifiedthat count of mesophilic aerobic micro-organisms ranged from <1.0 x 10' CFU/mL estimated to 1.2 x 103CFU/mL, and that 53.3% and 33.3% of samples presented fecal coliform and E. coli, respectively. It wasalso found that 26.6% of samples presented pH values below recommendation. Besides, it was verifiedthat all samples had values below 50 mg/L CaCO3 in relation to hardness and absence of residual chlorine. In relation to alkalinity, it was detected variation between 8 mg/L to 44 mg/L CaCO3. In color analysis, it was found that all samples of water showed five Hansen units for turbidity, been within the limits of Brazil legislation. Therefore, it is essential to treat water in order to obtain milk of better quality, as well as implementation of programs that provide training to producers to implement good hygienic practices at the farm.

Orígenes de la cooperación sanitaria internacional / No disponible

Desde la aparición de las primeras pandemias de cólera en la tercera década del siglo XIX tuvieron lugar una gran cantidad de Conferencias Sanitarias de muy diversa índole. Debido a la importancia económica de las epidemias y a las regulaciones que afectaban al comercio internacional, la diplomacia impulsó el nacimiento de la salud pública y sustituyó las ramas por la negociación. De este modo, las potencias coloniales europeas perpetuaban su dominio sobre los cinco continentes y establecían medidas de control sanitario global. Esa fue la dimensión sanitaria de la génesis del comercio internacional. Reuniones de expertos sobre higiene y demografía, fiebre amarilla, cólera, tuberculosis, enfermedades venéreas, dieron paso a otras sobre las gotas de leche y la alimentación infantil, y auspiciaron los inicios de la estadística sanitaria y epidemiológica internacional. Tras el precedente de la Cruz Roja Internacional, al iniciarse el siglo XX, este movimiento sanitario internacional culminó con la fundación de la primera institución con sede permanente en París: l’Office Intérnational ed’Higiène Publique (1907). Su papel en los conflictos bélicos, las grandes catástrofes y crisis sociales, y la difusión de información sanitaria fue muy limitado, pero marca un precedente en la cooperación sanitaria internacional. Tras la Gran Guerra, la gran catástrofe demográfica y sanitaria, la hambruna y la epidemia de gripe de 1918 impulsaron, tras el Tratado de Versalles, la creación de la Organización de Higiene de la Sociedad de Naciones. Por aquellos años, la filantropía internacional se había difundido ampliamente por Europa y América de la mano del International Health Board de la Fundación Rockefeller, y la colaboraciónentre ambas organizaciones en aspectos como la lucha contra las enfermedades infecciosas (malaria, tuberculosis, venéreas...), la higiene rural, las deficiencias nutricionales, o los estándares de salud marcaron un referente internacional para las políticas de salud pública y el avance de la medicina social. Ambas impulsaron las Escuelas de Sanidad y los Institutos Nacionales de Higiene, así como la formación de expertos en salud pública y su permanente intercambio de información. A comienzos de los años 1940, la Segunda Guerra Mundial cambió el panorama e impulsó la creación de la ONU y el reforzamiento de un cooperativismo internacional que tenía en su dimensión sanitaria uno de los principales elementos de estabilización. Primero el UNRRA y más tarde la FAO y la OMS sustituyeron a las organizaciones anteriores y abrieron la cooperación sanitaria a la participación de las ONGs, en un contexto histórico bien distinto: el de la Guerra Fría y la descolonización (AU)

No disponible

Current regimen of pulse therapy for pemphigus: minor modifications, improved results.

BACKGROUND: If administered properly, dexamethasone cyclophosphamide pulse (DCP) therapy has the potential to effect lifelong recovery from pemphigus. AIMS: The objective of this paper is to highlight various parameters of DCP therapy and also, to report the effects of a few modifications in the regimen. METHODS: An analysis of 123 patients treated with the DCP/DP regimen over a period of five years (1998 to 2002) is presented here. Seventeen patients who did not start/continue the treatment and three patients who died during the treatment have been excluded from the analysis. Twenty patients who had not yet started families were given only dexamethasone pulses (DPs) while 103 patients received DCPs. Low dose (50 mg/day) cyclophosphamide was used as in the standard regimen. The three modifications introduced into the regimen were: (1) an additional daily dose of oral betamethasone sufficient to control the disease activity during phase I, which was progressively tapered off completely as the patient recovered, (2) use of systemic antibiotics if the patient had skin lesions, and oral anti-candida drugs if the patient had oral ulcers until complete healing, and (3) insistence on thorough cleaning of the skin and scalp with a normal soap and shampoo, and proper maintenance of oral hygiene in spite of skin/mucosal lesions. The regimen consisted of DCP/DP repeated in exactly 28-day cycles, along with 50 mg cyclophosphamide per day, insistence on completing the treatment and avoiding irregular pulses in all patients. The number of DCPs/DPs during phase I varied in different patients depending upon the dose of betamethasone used and the rate of recovery, but phase II (nine DCPs/DPs in exactly 28-day cycles along with 50 mg cyclophosphamide per day) and phase III (only 50 mg cyclophosphamide per day) was fixed at nine months each. This was followed by posttreatment follow-up (phase IV). RESULTS: At present, all the patients are in complete remission. The confirmed period of posttreatment, disease-free follow-up period has already been more than five years in 62 patients, 3-5 years in 41 patients, 2-3 years in three patients and less than two years in six patients. Eight DCP patients and three DP patients developed a relapse (the relapse rates thus being 7.7 and 15% respectively) and received a second course of pulse therapy. They are also in remission at present. The duration of phase I was three months in 62 patients, 4-5 months in 28 patients, 6-9 months in 13, 10-12 months in nine patients and more than 12 months in 11 patients. The maximum daily dose of betamethasone used in these patients was nil in 17 patients, 1-2 mg in 85, 3-4 mg in 16, and> 4 mg in five patients. CONCLUSIONS: The modifications employed in this study could ensure the cure of all pemphigus patients by using DCP therapy administered at a private clinic.

Eat dirt and avoid atopy: the hygiene hypothesis revisited.

The explosive rise in the incidence of atopic diseases in the Western developed countries can be explained on the basis of the so-called "hygiene hypothesis". In short, it attributes the rising incidence of atopic dermatitis to reduced exposure to various childhood infections and bacterial endotoxins. Reduced exposure to dirt in the clean environment results in a skewed development of the immune system which results in an abnormal allergic response to various environmental allergens which are otherwise innocuous. This article reviews the historical aspects, epidemiological and immunological basis of the hygiene hypothesis and implications for Indian conditions.

Pattern of skin diseases among migrant construction workers in Mangalore.

BACKGROUND: With increasing industrialization, the construction industry provides employment to a large number of skilled and nonskilled workers, many of them migrant workers. AIM: This study was undertaken to provide epidemiological data regarding various dermatoses among migrant construction workers in India as currently there is a paucity of the same. METHODS: One thousand construction workers, including 467 migrant laborers, were examined for various dermatoses. RESULTS: Most (88%) workers were males and 51.17% were in their third decade. Infective and noninfective dermatoses were seen in 89.72% and 53.74% of laborers respectively. Among infective dermatoses, fungal infections were the most common (46.25%) ones, followed by bacterial infections (24.83%), scabies (8.56%) and viral infections (6.42%). Contact dermatitis to cement was seen in 12.48% of the laborers. Masons had a significantly higher incidence of contact dermatitis to cement, viral infections and scabies than helpers. CONCLUSIONS: The pattern of dermatoses is an expression of poverty, overcrowding and the occupational hazards of the construction industry.

Socioeconomic, environmental, and behavioural risk factors for leprosy in North-east Brazil: results of a case-control study.

BACKGROUND: Brazil reports almost 80% of all leprosy cases in the Americas. This study aimed to identify socioeconomic, environmental, and behavioural factors associated with risk of leprosy occurrence in the endemic North-eastern region. METHODS: A case-control study in four municipalities. CASES: cases of leprosy diagnosed in the previous 2 years, with no other known, current, or past case of leprosy in the household or in the neighbourhood. CONTROLS: individuals presenting for reasons other than skin problems to the health unit where the case was diagnosed and who lived in the same municipality as the case with whom it was matched. For each case four controls were selected. A semi-structured questionnaire was used to collect demographic, socioeconomic, environmental, and behavioural data. A multivariate hierarchical analysis was performed according to a previously defined framework. RESULTS: 226 cases and 857 controls were examined. Low education level, ever having experienced food shortage, bathing weekly in open water bodies (creek, river and/or lake) 10 years previously, and a low frequency of changing bed linen or hammock (>or=biweekly) currently were all significantly associated with leprosy. Having a BCG vaccination scar was found to be a highly significant protective factor. CONCLUSIONS: Except for BCG vaccination, variables that remained significant in the hierarchical analysis are cultural or linked to poverty. They may act on different levels of the transmission of Mycobacterium leprae and/or the progress from infection to disease. These findings give credit to the hypothesis that person-to-person is not the only form of M. leprae transmission, and that indirect transmission might occur, and other reservoirs should exist outside the human body.

The anti-leprosy campaign in Colombia: the rhetoric of hygiene and science, 1920-1940.

Since the 1920s, the medical community realized that the strategy of leprosy control based on segregation and persecution of patients was inefficient and expensive. In the 1930s the new liberal government incorporated leprosy within the general sanitary institutions, by merging the Bureau of Lazarettos and the National Department of Hygiene. The disease-apart approach started to be replaced by a more general public health strategy, which involved controlling other illnesses. Prevention and research played a more influential role, and the new sanitary officials saw leprosy in the light of the economic rationality of expenditures, placing more emphasis on therapies and making them mandatory for all patients. Improvements in leprosy treatment became widely known and available. However, the image of leprosy as a special condition and the practice of segregation were deeply entrenched within the Colombian culture and institutions. The rhetoric changed, but to break with several decades of persecution was a difficult task.

The anti-leprosy campaign in Colombia: the rhetoric of hygiene and science, 1920-1940

Desde a década de 1920, a comunidade médica percebeu que o controle da hanseníase baseada na segregaçäo dos pacientes era ineficaz e dispendiosa. Na década de 1930, o novo governo, mais liberal, incorporou a hanseníase às instituiçöes sanitárias gerais, ao fundir o Serviço de Leprosários ao Departamento Nacional de Higiene. O isolamento começou a ser substituído por uma estratégia geral de saúde pública, que envolviq outras doenças...

The anti-leprosy campaign in Colombia: the rhetoric of hygiene and science, 1920-1940

Desde a década de 1920, a comunidade médica percebeu que o controle da hanseníase baseada na segregaçäo dos pacientes era ineficaz e dispendiosa. Na década de 1930, o novo governo, mais liberal, incorporou a hanseníase às instituiçöes sanitárias gerais, ao fundir o Serviço de Leprosários ao Departamento Nacional de Higiene. O isolamento começou a ser substituído por uma estratégia geral de saúde pública, que envolviq outras doenças...(AU)

Genetics and genomics of asthma and allergic diseases.

Asthma and eczema (atopic dermatitis) are characterized by a number of unexplained phenomena: the familial aggregation of disease, the initiation of disease by apparently trivial exposure to allergens, the preferential transmission of disease from affected mothers and the large increase in prevalence of disease in Westernized societies in the last century. A number of genes and chromosomal regions have been identified that consistently show linkage to asthma and its related phenotypes. Known loci modify the strength of the atopic response, nonspecific inflammation, the ability to respond to particular allergens and nonspecific airway reactivity. Eczema has been shown to be due to a different set of genetic loci that are shared with other skin diseases such as psoriasis and leprosy. Genetic and genomic studies both provide evidence that epithelial surfaces are active in the induction of allergic disease.