Assessment of water, sanitation, and hygiene among women living in precarious households in a Turkish urban area.

BACKGROUND: This study aimed to identify the determinants of water, sanitation, and hygiene (WASH) behaviors and conditions among women in poor neighborhoods in Izmir, Turkey, and to develop a scale for assessing WASH behaviors and conditions that is specifically designed for use in precarious urban areas. METHODS: The study used a cross-sectional design, as well as a methodological feature for developing the scale. The sample size was calculated as 243 households out of 2667 households in the Basmane neighborhood, with a 95% confidence interval and a 6% margin of error, and a woman who was responsible for cleaning was invited to participate from each household. The scales for WASH behaviors and conditions, which served as dependent variables, were developed in a four-stage process, yielding two distinct scales. The WASH-Behaviors Scale had 14 items about hand, body, and home hygiene, whereas the WASH-Conditions in Households Scale included 16 items about variables like area per capita, physical structure, and cleaning tool availability. Age, ethnicity, number of children, education, work status, and income were among the independent variables. Data was collected through household visits. The scales' validity was evaluated using exploratory factor analysis. Linear logistic regression analysis was employed to assess the determinants of WASH behaviors. RESULTS: The women, with an average age of 40.65 ± 14.35 years, faced economic challenges, as a substantial portion earned an income below the minimum wage. More than half of them were uninsured, and 72.6% were identified as migrants or refugees. Factor analysis confirmed the compatibility of both scales (KMO = 0.78-0.80, p < 0.05), elucidating 52-54% of the total variance. Factors such as ethnicity, number of children, husband's education level, income perception, and WASH conditions explained 48% of WASH behaviors. CONCLUSIONS: WASH-Behaviors and WASH-Conditions in Households scales met the validity criterion, and their scores were related to basic sociodemographic and economic characteristics like education, income, household size, and ethnicity. The scale development process emphasized the importance of considering both behaviors and household conditions, albeit using different techniques. The findings indicated that WASH conditions are more problematic than behaviors, and that behavioral interventions will not work unless the conditions are corrected.

Comparison of the multi-epitope recombinant antigen DIPOL and hydatid fluid for the diagnosis of patients with cystic echinococcosis.

The use of serological tests containing multiple immunodominant antigens rather than single antigens have the potential to improve the diagnostic performance in Cystic Echinococcoses (CE) as a complement tool to clear the inconclusive imaging data. Here, we comparatively evaluated the diagnostic value of Hydatid Fluid (HF) and the recently described recombinant multi-epitope antigen DIPOL in IgG-ELISA in a clinically defined cohort of CE patients. The serum samples from 149 CE patients were collected just before surgical or Percutaneous- Aspiration- Injection- Reaspiration (PAIR) procedures. Additionally, serum samples of patients with other parasitic infections (n=49) and healthy individuals (n=21) were also included in the study as controls. To investigate the association between the genotype of the parasite and DIPOL, cyst materials from 20 CE patients were sequenced. In terms of overall sensitivity, HF was higher than DIPOL (82.55%,78.52%, respectively). However, while the sensitivity of HF was higher than DIPOL in patients with active and transitional cysts (83.3%, 75.4%, respectively), sensitivity of DIPOL in inactive cysts was higher compared to HF (95.6%, 78.3%, respectively). The sensitivity of DIPOL depending on cyst stage was statistically significant (P= 0.041). In terms of specificity, DIPOL was found to be better than HF (97.71%, 91.43%, respectively). By genotyping, the majority of 20 patients showed G1 genotype (80%). All patients harboring G3 and G1/G3 cyst genotypes were positive with both antigens, while 87.5% of patients with G1 genotype were seropositive with HF and 75% with DIPOL. The overall sensitivity and high specificity of DIPOL suggest that this recombinant protein containing immunodominant epitopes is a potential substitute for the HF by serological tests for the diagnosis of CE.

Comparison of the New Multiepitope Recombinant Peptide Antigen with Cyst Fluid Antigen in the Follow-up of Patients with Cystic Echinococcosis

Objective: The follow-up of patients with cystic echinococcosis (CE) offers the opportunity of evaluating the prognosis of the infection as well as detecting relapse. This study aimed to evaluate the performance of the new multiepitope recombinant peptide (recDipol) antigen in the follow-up of CE patients treated by surgery or percutaneous aspiration injection respiration. Methods: A total of 137 blood samples from 28 patients were evaluated by IgG-ELISA method using recDipol and hydatid fluid (HF) antigens. The patients were simultaneously checked for recurrence by ultrasonography. Results: The seropositivity rate of the 28 patients varied considerably during the follow-up. When the first blood of the patients was evaluated, 4 (14.28%) were seronegative by HF-ELISA and 9 (32.14%) were recDipol-ELISA. During the entire follow-up, only 1 (3.5%) and 6 (21.4%) patients were seronegative by HF-ELISA and recDipol ELISA, respectively. Conclusion: We found that recDipol did not perform as expected in the follow-up due to the higher number of seronegative patients compared to HF-ELISA in the first blood and during the entire follow-up. Our results suggest that imaging methods are gold standards in the diagnosis and that, in parallel, longer-term patient follow-up is required with recombinant antigens that have an improved diagnostic performance.

Comparison of Skin Scraping and Standard Superficial Skin Biopsy in the Laboratory Diagnosis of Scabies

Objective: Scabies is diagnosed based on the presence of burrows on the skin, Sarcoptes scabiei adult, egg, or scybala in skin scrapings. The laboratory diagnosis of scabies poses various challenges. We aimed to compare the analytical performance of skin scraping and standard superficial skin biopsy (SSSB) and to investigate the correlation with false negative results in the laboratory diagnosis of scabies. Methods: Skin scraping and SSSB were applied from July 1 to December 31, 2018 on 42 patients whose burrows were marked using dermatoscopy, as obtained from the laboratory information system. Results: The number of patients who tested positive for scabies with skin scraping was 18 (42.9%) and 24 (57.1%) with SSSB, and the difference was significant (p=0.003). Sensitivity was 42.9% for skin scraping and 57.1% for SSSB. The number of positive cases with both techniques was 15 (35.7%). The number of patients positive with only skin scraping was 3 (7.1%) and only SSSB was 9 (21.4%). Conclusion: To date, it has seemed impossible to diagnose scabies using a single clinical or laboratory test. According to our results, SSSB is an inexpensive and easy-to-apply method with high sensitivity for obtaining skin samples for scabies laboratory diagnosis.

Human myiasis in patients with diabetic foot: 18 cases.

BACKGROUND: Myiasis complication of diabetic foot ulcer has only been presented in a few case reports. Therefore, there is a need for additional data on this infestation. OBJECTIVE: Evaluate clinical characteristics of human myiasis in patients with diabetic foot. DESIGN: Case series. SETTINGS: A tertiary referral healthcare institution and a diabetic foot center. PATIENTS AND METHODS: Patients with diabetic foot infection com.plicated by myiasis who were admitted between June 2012 and July 2017. MAIN OUTCOME MEASURES: Bacterial infection rate, accompanying bacterial agents, amputation (morbidity) and mortality rate. SAMPLE SIZE: 18. RESULTS: Eight (44.4%) of the patients were female. Sixteen (88.9%) had moderate-to-severe infections; 15 (83.3%) had necrotic tissue. Larval debridement therapy was performed on all patients at the bed.side in consecutive sessions. A third-stage larva of Calliphora was detected in one case (5.6%). Second- and third-stage larvae of Lucilia sericata were detected in 5 (27.8%) and 7 (38.9%) patients, respectively. All the patients had a bacterial infection with myiasis. Twelve (66.7%) patients underwent amputation. Three (16.7%) patients died. Myiasis was more frequent in the months of May, June and July. CONCLUSION: To our knowledge, this is the largest reported series of cases of diabetic foot with myiasis. The most common parasitic agent was Lucilia sericata. Bacterial soft tissue infections were observed in all cases. Poor hygienic conditions were noteworthy and all patients were in need of radical surgery. Myiasis complication of diabetic foot is more frequently seen in the spring and summer. LIMITATIONS: Insufficient follow-up time for analysis of possible confounding factors. CONFLICT OF INTEREST: None.

Parasitic Diseases that can Infect Travelers to Africa.

Travel is important in the spread of diseases, and the number of travelers is increasing daily. Therefore, the importance of the diseases that occur during or after travel is increasing. In underdeveloped countries in particular, parasitic diseases are epidemic or endemic, and these diseases lead to high numbers of deaths. People traveling from developed to underdeveloped countries have a higher risk of transmission of parasitic diseases during travel. Fifteen percent of the world's population lives in Africa. In terms of geography, economics, and development, the continent is divided into four regions: East Africa, South Africa, North Africa, and West Africa. In recent years, international travels to Africa have been increasing. During these travels, there is a risk of contracting parasitic diseases, such as malaria, schistosomiasis, trypanosomiasis (African sleeping disease), onchocerciasis, lymphatic filariasis, and leishmaniasis. Before traveling to Africa, it is vital to take measures against diseases in the region.

Parasitic Infections in Individuals Travelling to America and Precautionary Measures.

Over the past decade, the number of international travels has increased. Hence, the risk of transmission of parasitic diseases has also increased. One of the risk infections is malaria; Plasmodium vivax and P. falciparum species can be transmitted. The distribution of leishmaniasis cases has been reported from the south of USA to the north of Argentina. Approximately 57,000 cases of cutaneous and mucocutaneous leishmaniasis occur annually, and approximately 4000 visceral leishmaniasis cases are observed. It is reported that Chagas disease is endemic in 21 countries, and approximately 6 million people are affected every year. In this continent, 25 million people are at a risk of schistosomiasis, and most (90%) are living in Brazil. According to the World Health Organization, individuals travelling to Ecuador, Colombia, Brazil, Guatemala, Mexico, and Venezuela are at a risk of onchocerciasis as well as infecting approximately 12.6 million individuals with lymphatic filariasis (80% in Haiti). Significant mortality and morbidity can be observed in cases where necessary precautions are not taken in individuals travelling to these regions and where appropriate prophylactic drugs are not administered.

The Prevalance of Blastocystosis among Patients with Gastrointestinal and Dermatologic Complaints and Effects of Blastocystis spp. Density on Symptomatology.

OBJECTIVE: Blastocystosis has been linked with non-specific symptoms, such as diarrhea, abdominal pain, and distention. In this study, we evaluated the relationship between Blastocystis spp. with urticaria and intestinal symptoms. METHODS: The results of the stool examinations of the patients who were referred to Ege University Medical Faculty Hospital's Medical Parasitology Department Direct Diagnosis Laboratory with gastrointestinal (GIS) and/or dermatologic symptoms between January 2011 and July 2016 were retrospectively scanned. RESULTS: Of the evaluated 37108 stool samples, 2573 (6.93 %) were identified to be positive for Blastocystis spp. The patients with gastrointestinal complaints comprised 68.4% of Blastocystis spp. positive samples (1.761 samples) while 30.1% of patients had dermatologic symptoms (urticaria) (776 samples). Blastocystis spp. density in the non-amplified (without using any stool concentration technique) stool samples of the patients with GIS and dermatological symptoms was as follows: 2.47%, 1.35% rare, 21.73%, 22.17% few, 49.65%, 54.29% medium, 26.27%, and 22.17% dense, respectively. CONCLUSION: 75.92% and 76.46% of the patients with GIS and dermatological complaints had medium to dense parasite densities in their stool samples respectively. This suggests a positive correlation between parasite density and GIS and dermatologic symptomatology.

[The comparison of microscopy and real time polymerase chain reaction methods for the diagnosis of Pneumocystis Jirovecii pneumonia: evaluation of clinical parameters]. / Pneumocystis jirovecii pnömonisi tanisinda mikroskopi ve gerçek zamanli polimeraz zincir reaksiyonu yöntemlerinin karsilastirilmasi: Klinik bulgular ile yorumlanmasi.

INTRODUCTION: Pneumocystis jirovecii pneumonia (PCP) causes serious infections, especially in patients with immunosuppressive diseases. In this study, it was aimed to evaluate the results of samples obtained from PCP suspected patients using two different methods together with clinical data. MATERIALS AND METHODS: Microscopy and real time polymerase chain reaction (real time PCR) methods were performed with bronchoalveolar lavage (BAL) samples sended to Ege University Medical Faculty Direct Parasitology Diagnostic Laboratory between March 2009 and June 2010. Demographic characteristics, clinical and laboratory data were also recorded retrospectively. The data were evaluated using the SPSS 16.0 program. RESULT: A total of 42 BAL samples collected from patients (24 males, mean age: 31.49 ± 26.14) were included. There were totally 16 P. jirovecii positives either one of the tests. Sixteen and three samples were detected positive by real time PCR and microscopy, respectively. Trimethoprim-sulfamethoxazole was prescribed in 11 PCP diagnosed cases and 6 of them died. CONCLUSIONS: Today, despite the growing opportunities in diagnosis and treatment, PCP pneumonia is associated with high mortality. Careful examination of clinical data and immune status of the patients are important. Multidisciplinary approach is required for early PCP diagnosis.

Screening of Returned Travelers.

Travel-related health problems have been reported in 22-64% of travelers to developing countries. Approximately 8% of these patients are moderately ill and are referred to health facilities. Post-travel infections are usually symptomatic in the early stages, but they may last for up to months or even years, depending on the incubation period. It has been reported that it is not necessary to have extensive knowledge on tropical diseases to be able to make a clinical evaluation after the trip. All post-travel consultations should be performed by physicians and should include travel-related illness identification, timely medical intervention, and, if necessary, referral to a senior hospital. Situations that should be taken into consideration by physicians when evaluating a possible patient with travel-related health problems are as follows: the severity of illness, the route travelled, the time between illness and travel, the underlying disease, vaccine and prophylaxis history, and exposure history. The most common clinical syndromes after travel to developing countries are systemic febrile illness, acute diarrhea, dermatological disorders, respiratory disorders, and eosinophilia. This review summarizes the approach to possible clinical situations among returned travelers.

Travel-Related Parasitic Infections in Travellers to Southeast Asia and Western Pacific Countries.

In the last decades, there has been a significant increase in international human mobility with increase in the prosperity, travel possibilities, and number of refugees. In the first half of 2016, the Asian continent showed the fastest growth in the number of tourists. Such increase is seen due to the interest in Asian history, culture, and cuisine. In the globalizing world, human mobility causes changes in the epidemiology of diseases and the spread of various infections across continents. Parasitic infections that may pose a risk for travellers to the Asia-Pacific are malaria, leishmaniasis, filariasis, foodborne trematode infections, schistosomiasis, soil-transmitted infections, and tourist diarrhea. Consulting a travel medical expert and using health services such as pre-travel vaccination and chemoprophylaxis will reduce the risk of infectious diseases among travelers.

Differentiation of Entamoeba histolytica/Entamoeba dispar by the polymerase chain reaction in stool samples of patients with gastrointestinal symptoms in the Sanliurfa Province.

OBJECTIVE: We aimed to diagnose amebiasis and also identify Entamoeba histolytica (E. histolytica) and Entamoeba dispar (E. dispar) in patients with gastrointestinal symptoms in an endemic region in Turkey. METHODS: Stool samples obtained from 181 patients with gastrointestinal symptoms from the Harran University Hospital of Sanliurfa were examined for the diagnosis of amebiasis by the three methods which are as follows:- In house polymerase chain reaction (PCR) targeting the 135 base pair region located on the small-subunit ribosomal RNA (SSU rRNA) gene to differentiate E. histolytica from E. dispar; and the commercial kit, RIDASCREEN® stool ELISA, that identifies Entamoeba sensu lato antigen and microscopical examination of Trichrome stained smears of stool samples. RESULTS: Positivity for E. histolytica/E. dispar complex was found to be 79 (43.6%) by microscopy versus 83 (45.9%) by PCR out of 181 stool samples. A total of 45 patients were found to be positive by the antigen detection method. PCR and microscopy were both positive in 59 samples. The number of patients infected with E. dispar (39.8%) was found to be higher than E. histolytica (3.3%) while 5 patients (2.8%) had mixed E. histolytica+E. dispar infections according to PCR results. CONCLUSION: Routine diagnosis of amebiasis by a combination of microscopy and antigen detection technique should be complemented with a PCR assay as a reference test for sensitive differentiation of both species.

[Approach to the patient with scabies]. / Uyuzlu hastaya yaklasim.

Scabies is an ectoparasitosis caused by Sarcoptes scabiei. Clinical types can be highly variable. There might be a problem in diagnosis due to difficulty in detecting the parasite and atypical clinical features. Delayed diagnosis may be the cause of outbreaks for people living in overcrowded places such as poorhouses, orphanages and barracks. The different types of treatment have been discussed as well as rules for prevention.