Mapping evidence of the concomitant management of schistosomiasis by traditional health practitioners and health care professionals in communities with high prevalent infections: a systematic scoping review protocol.

BACKGROUND: Schistosomiasis is one of the most prevalent parasitic diseases in low- and middle-income countries (LMICs), being regarded as a neglected tropical disease in sub-Saharan Africa. Praziquantel is the conventional treatment recommended for schistosomiasis in mainstream healthcare systems. In many poor settings, while many people reportedly use both traditional medicine and public sector mainstream healthcare systems, little is known if those infected with schistosomiasis use both African traditional and prescribed antischistosomal medicines. This review aims to map evidence of the concomitant management of schistosomiasis by traditional health practitioners (THPs) and health care professionals (HCPs) in communities with a high prevalence schistosomiasis infection in LMICs. METHODS/DESIGN: Guided by Arksey and O'Malley scoping review framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), we will map the evidence from relevant studies dating from 2007 to 2019 published in LMICs. An electronic keyword search of the following databases will be conducted: PubMed, Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and MEDLINE via EBSCOhost, Google Scholar, and WILEY online Library. Peer-reviewed articles, gray literature sources, and reference lists will be included to identify eligible studies. Following title screening, two reviewers will independently screen the abstracts and full texts. Any study that focuses on managing schistosomiasis will be included. The data will be analyzed using thematic analysis with the help of NVIVO software version 12, with the Mixed Method Appraisal Tool (MMAT) being used to assess the quality of the included studies. DISCUSSION: This review will map the evidence in the literature of the concomitant management of schistosomiasis by THPs and HCPs in communities with a high prevalent infection in LMICs. The review findings will be important for policy makers across the healthcare continuum and be used to inform stakeholders' consensus process to explore the development of a generic set of patient-centered quality indicators that are applicable to multiple care settings. It will also identify research gaps in schistosomiasis management in LMICs and provide direction for future research. The results will be disseminated through a peer-reviewed publication and presented in relevant conferences. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42017078198.

[Effectiveness of clinical pathway for treatment of advanced schistosomiasis hepatic fibrosis].

Objective To assess the effectiveness of the clinical pathway for the treatment of advanced schistosomiasis hepatic fibrosis. Methods The duration of hospital stay, gross hospitalization expense, individual-paid expense, interior diameter of portal vein, levels of four serum hepatic fibrosis-related parameters (PIIIP, CIV, HA, and LN), and activities of ALT, AST and γ-GT were assessed and compared between the advanced schistosomiasis patients receiving the clinical pathway and ones receiving non-clinical pathway. Results There were 142 advanced schistosomiasis patients with hepatic fibrosis receiving the clinical pathway of anti-hepatic fibrosis. Compared with the patients receiving non-clinical pathway, the gross hospitalization expenses reduced by 11.2% (t = 6.310, P < 0.05), and the individual-paid expenses reduced by 16.1% (t = 4.326, P < 0.05). The mean HA level was twice higher than the normal range, with a positive rising from 70.4% to 83.1%, and the abnormal rates of CIV and γ-GT were 64.1% and 28.9% respectively. Conclusions The clinical pathway can drastically reduce the treatment expenses in advanced schistosomiasis patients with hepatic fibrosis. However, the patients have a trend towards the persistent disease progression. Therefore, the researches of more effective therapeutic methods for advanced schistosomiasis hepatic fibrosis are urgently needed.

Factors affecting illness in the developing world: chronic disease, mental health and traditional medicine cures.

This is a case report of a 24-year-old Ethiopian woman with a medical history of hepatosplenic schistosomiasis. She suffers from chronic liver failure and portal hypertension. She has been hospitalised for 'hysteria' in the past but did not receive follow-up, outpatient treatment or psychiatric evaluation. After discontinuing her medications and leaving her family to use holy water, a religious medicine used by many Ethiopians, she was found at a nearby monastery. She was non-communicative and difficult to arouse. The patient was rushed to nearby University of Gondar Hospital where she received treatment for hepatic encephalopathy and spontaneous bacterial peritonitis. Her illness is the result of neglected tropical disease, reliance on traditional medicine as opposed to biomedical services and the poor state of psychiatric care in the developing world.

[Discussion on multidisciplinary treatment mode of advanced schistosomiasis and its standardized implementation].

Advanced schistosomiasis is the most serious clinical type of schistosomiasis. Its diagnosis and treatment are related to many special departments, such as gastroenterology, general surgery, neurology, endocrinology, radiology, traditional Chinese medicine, blood purification, endoscopy, intervention, and ICU. It is necessary to apply a multidisciplinary treatment (MDT) mode. However, the mode has no universal standard and guide in practice. It is very important for the implementation of MDT mode of advanced schistosomiasis to form a treatment expert team, formulate the formal working procedures, and standardize the treatment schedules. The standardized implementation of MDT mode will be important to provide a more effective clinical decision on advanced schistosomiasis.

Thioredoxin glutathione reductase as a novel drug target: evidence from Schistosoma japonicum.

BACKGROUND: Schistosomiasis remains a major public health concern affecting billions of people around the world. Currently, praziquantel is the only drug of choice for treatment of human schistosomiasis. The emergence of drug resistance to praziquantel in schistosomes makes the development of novel drugs an urgent task. Thioredoxin glutathione reductase (TGR) enzymes in Schistosoma mansoni and some other platyhelminths have been identified as alternative targets. The present study was designed to confirm the existense and the potential value of TGR as a target for development of novel antischistosomal agents in Schistosoma japonicum, a platyhelminth endemic in Asia. METHODS AND FINDINGS: After cloning the S. japonicum TGR (SjTGR) gene, the recombinant SjTGR selenoprotein was purified and characterized in enzymatic assays as a multifunctional enzyme with thioredoxin reductase (TrxR), glutathione reductase (GR) and glutaredoxin (Grx) activities. Immunological and bioinformatic analyses confirmed that instead of having separate TrxR and GR proteins in mammalian, S. japonicum only encodes TGR, which performs the functions of both enzymes and plays a critical role in maintaining the redox balance in this parasite. These results were in good agreement with previous findings in Schistosoma mansoni and some other platyhelminths. Auranofin, a known inhibitor against TGR, caused fatal toxicity in S. japonicum adult worms in vitro and reduced worm and egg burdens in S. japonicum infected mice. CONCLUSIONS: Collectively, our study confirms that a multifunctional enzyme SjTGR selenoprotein, instead of separate TrxR and GR enzymes, exists in S. japonicum. Furthermore, TGR may be a potential target for development of novel agents against schistosomes. This assumption is strengthened by our demonstration that the SjTGR is an essential enzyme for maintaining the thiol-disulfide redox homeostasis of S. japonicum.

Letalidade do extrato de synadenium grantii hook. F. (Euphorbiaceae) frente a caramujos biomphalaria glabrata say, 1818 (gastropoda, planorbidae) / Letalidad del extracto de synadenium grantii hook. F. (Euphorbiaceae) contra caracoles biomphalaria glabrata say, 1818 (gastropoda, planorbidae) / Lethality of synadenium grantii hook. F. (Euphorbiaceae) extract to snails biomphalaria glabrata say, 1818 (gastropoda, planorbidae)

No Brasil, o caramujo Biomphalaria glabrata Say, 1818 (Gastropoda, Planorbidae) atua como principal vetor hospedeiro intermediário do helminto trematódeo Schistosoma mansoni (Schistosomatidae), agente etiológico da esquistossomose. O combate deste hospedeiro com substâncias moluscicidas é considerado uma das formas de redução do risco de transmissão da esquistossomose. Na busca por novos produtos naturais para controlar este vetor, o presente trabalho testou os extratos de algumas espécies vegetais exóticas consideradas tóxicas: Allamanda cathartica L. (Apocynaceae), Breynia nivosa (W. Bull) Small (Phyllanthaceae), Croton floribundus Spreng. (Euphorbiaceae), Dieffenbachia picta Schott (Araceae), Euphorbia milii des Mol. var. breonii (Euphorbiaceae), Jatropha curcas L. (Euphorbiaceae), Monstera deliciosa Liebm. (Araceae) e Synadenium grantii Hook. f. (Euphorbiaceae). Apenas a espécie S. grantii apresentou atividade moluscicida (CL50 = 40,0 µg mL-1) promissora, sendo este o primeiro relato desta atividade para espécies do gênero Synadenium.

In Brazil, Biomphalaria glabrata Say, 1818 (Gastropoda, Planorbidae) snail serves as the principal intermediate vector host of Schistosoma mansoni (Schistosomatidae) trematode helminth, the etiologic agent of schistosomiasis. A way of reducing transmission risk of schistosomiasis is the combat of this host with molluscicide substances. In the search for new natural products to control this vector, the present study tested the extracts of some exotic plant species considered toxic: Allamanda cathartica L. (Apocynaceae), Breynia nivosa (W. Bull) Small (Phyllanthaceae), Croton floribundus Spreng. (Euphorbiaceae), Dieffenbachia picta Schott (Araceae), Euphorbia milii des Mol. var. breonii (Euphorbiaceae), Jatropha curcas L. (Euphorbiaceae), Monstera deliciosa Liebm. (Araceae) and Synadenium grantii Hook. f. (Euphorbiaceae). Only the S. grantii species showed molluscicide activity promising (LC50 = 40.0 mg mL-1), and this is the first report of this activity to the genus Synadenium (Euphorbiaceae).

En Brasil, el caracol Biomphalaria glabrata Say, 1818 (Gastropoda, Planorbidae) actúa como principal vector hospedero intermediario del helmintos trematodo Schistosoma mansoni (Schistosomatidae), agente etiológico de la esquistosomiasis. El combate de este hospedero con sustancias molusquicidas es considerado una de las formas de reducción del riesgo de transmisión de la esquistosomiasis. En la búsqueda por nuevos productos naturales para el control de este vector, el presente estudio examinó los extractos de algunas especies exóticas de plantas consideradas tóxicas: Allamanda cathartica L. (Apocynaceae), Breynia nivosa (W. Bull) Small (Phyllanthaceae), Croton floribundus Spreng. (Euphorbiaceae), Dieffenbachia picta Schott (Araceae), Euphorbia milii des Mol. var. breonii (Euphorbiaceae), Jatropha curcas L. (Euphorbiaceae), Monstera deliciosa Liebm. (Araceae) y Synadenium grantii Hook. f. (Euphorbiaceae). Sólo la especie S. grantii presentó actividad molusquicida prometedores (CL50 = 40,0 ug mL-1) promisora, siendo éste el primer relato de esta actividad para especies del género Synadenium.

Intoxicação por salinomicina em equinos - estudo de um surto em 39 animais / Intoxicación por salinomicina en equinos - estudio de un brote en 39 animales / Salinomycin poisoning in horses - study of an outbreak in 39 animals

Este artigo relata um surto de intoxicação acidental por salinomicina em 39 equinos. Ao exame físico os animais apresentavam claudicação, taquipneia, ataxia, sudorese e fraqueza. Em alguns se observou também decúbito permanente, dispneia, cianose e morte. Em amostras de soro foi detectado aumento significativo nos níveis de AST (aspartato-aminotransferase) e CPK (creatina-fosfoquinase), e no hemograma observou-se neutrofilia com desvio à esquerda. Vinte e um animais morreram e 18 sobreviveram, sendo hidratados com solução de Ringer com lactato de sódio e solução de glicose a 5%, e medicados com dexametasona, flunixina meglumina e furosemida. O exame necroscópico revelou necrose muscular aguda generalizada, coração globoso, necrose de miocárdio, congestão pulmonar severa, hemorragia na mucosa intestinal, congestão renal e fígado com aparência de noz moscada. Amostras de ração foram submetidas a análises laboratoriais que mostraram a presença de salinomicina em 1.300 ppm, índice muito acima do suportável por equinos.

This article reports an outbreak of accidental poisoning by salinomycin in 39 horses. On physical examination, the animals showed lameness, tachypnea, ataxia, sweating and weakness. Permanent recumbency, dyspnea, cyanosis and death were observed in some animals. In serum samples, significant increase in the levels of AST and CPK was detected, and hematology showed neutrophilia with a left shift. Twenty-one animals died and 18 survived, being hydrated with Ringer?s lactate and 5% glucose solution, and treated with dexamethasone, flunixin meglumine and furosemide. Necropsy revealed acute generalized muscle necrosis, enlarged heart, myocardial necrosis, severe pulmonary congestion, hemorrhage in the intestinal mucosa, renal congestion and liver with nutmeg appearance. Food samples were subjected to laboratory tests which showed the presence of salinomycin in 1.300 ppm, far above the tolerable rate for horses.

Este artículo relata un brote de intoxicación accidental por salinomicina en 39 equinos. Al examen físico los animales presentaban claudicación, taquipnea, ataxia, transpiración y debilidad. En algunos se observó también decúbito permanente, disnea, cianosis y muerte. En muestras de suero se detectó elevación significante en los niveles de AST (aspartato ? aminotransferase) y CPK (creatina ? fosfoquinasa), y el hemograma mostró neutrofilia con desvío a la izquierda. Veintiuno animales murieron y dieciocho sobrevivieron, siendo hidratados con solución de Ringer con lactato de sodio y solución de glucosa a 5%, y medicados con dexametasona, flunixin meglumina y furosemida. El examen necroscópico reveló necrosis muscular aguda generalizada, corazón globoso, necrosis de miocardio, congestión pulmonar severa, hemorragia en la mucosa intestinal, congestión renal e hígado con apariencia de nuez moscada. Muestras de ración fueron sometidas a análisis en laboratorio, que mostraron presencia de salinomicina en 1.300 ppm, índice muy arriba del soportable por equinos.

Urinary tract infections in children: treatment.

Urinary tract infection is a frequent diagnosis in children who are referred to the urologist. Infections vary in scope and severity, warranting thoughtful consideration of appropriate therapy. Infections of the genitourinary system may include bacterial,viral, fungal, or parasitic microorganisms. Adequate therapy requires rapid detection and control of these conditions to prevent pyelonephritic renal scarring and its sequelae.

Schistosomiasis in two Nile delta villages: an anthropological perspective.

In the rapidly changing Nile delta villages, applied research for schistosomiasis control requires a holistic view of the social and environmental setting of the disease. An interdisciplinary, participatory study of two delta villages studied human behaviour in relation to disease transmission, knowledge and treatment using the insights and methods of social science, especially anthropology. Through primarily qualitative techniques such as focus group discussions and participant observation, we found that most people who used the canals for domestic, recreational or agricultural activities thought that they had little alternative but to do so, even though they knew of the risk of exposure to schistosomiasis. The knowledge and behaviour of villagers with regard to schistosomiasis affected their utilization of the local provisions for schistosomiasis diagnosis and treatment. Our monitoring of diagnosis and testing for schistosomiasis at a local health centre identified areas which could be upgraded, and we trained health staff to improve their knowledge of schistosomiasis. Our findings reinforce the need for integrated research and implementation strategies, taking into account the knowledge and capabilities of all those involved in schistosomiasis control at the village level, and the fostering of effective communication between villagers, both women and men, and the local staff in rural health centres.

Effects of Goyazensolide during in vitro cultivation of Schistosoma mansoni

Goyazensolide, a component extracted of Eremanthus goyazensis showed a significant inhibitory effect on egg-laying of Schistosoma mansoni during in vitro cultivation of this parasite. Motility of the worms was also reduced under treatment with goyazensolide and 90 per cent of mortality was reached with concentration up to 4 µg/ml. It has found that separated worms were more susceptible than worms pairing during drug exposition and female alone was significantly more susceptible than male worm in the same conditions of in vitro cultivation. Natural products isolated from plants represent potencial sources for the identification of structures useful for the design of alternative molecules to be used as new drug substances against several infectious deseases.

Disease concepts and treatment practices relating to schistosomiasis haematobium in Upper Egypt.

Disease concepts and medical treatment practices surrounding schistosomiasis haematobium were studied among males in Upper Egyptian villages and towns using interview methods. Most informants considered bilharzia to be a serious disease for which they commonly sought treatment. Its occurrence was attributed primarily to natural causes, particularly various aquatic worms and insects, dirts, excrement, dead animals, toxins and stagnant and vegetated waters, mostly large canals. Contact with water from the Nile river was generally thought to be quite safe. Drug treatment was weakly associated with amount of education. All groups reported use of antischistosomal drugs and plant medicines. Seventy-four per cent of the sample had a treatment history, 64% having taken oral drugs and/or injections, 40% plant medicines and 29% both. Drinking decoctions of damsissa (Ambrosia maritima) was the most commonly used household remedy. Plant materials were usually obtained from fields, gardens and local markets and patent medicines from nearby clinics and private physicians in towns. Recommendations are made for the national mass chemotherapy programme.

The relationship between serum carnitine levels and the nutritional status of patients with schistosomiasis.

Serum carnitine levels were investigated in a group of normal adults and two groups of patients with active schistosomiasis who also showed signs of malnutrition and vitamin deficiency. The first group consisted of 16 patients with Schistosoma mansoni and/or Schistosoma haematobium infection. They received an adequate diet supplemented with vitamin and iron therapy and received no treatment for their parasitic infection till their hemoglobin levels were restored to normal. The second group consisted of 12 patients with schistosomiasis as well as intestinal polyposis. They received the same diet as the first group but because of their poor condition were immediately treated for parasitic infection. Results showed that both groups of patients had subnormal levels of serum carnitine with the polyps patients (Group II) having a significantly lower level than patients with simple schistosomiasis (Group I). After nutritional repletion a significant increase was observed in the carnitine levels of most patients in group I indicating a relationship between the nutritional status of the patients and their serum carnitine levels. The patients with polyps also showed considerably increased carnitine levels after treatment and dietary repletion. The usefulness of serum carnitine measurement as an index of protein malnutrition in man is discussed.