Cutaneous Larva Migrans as a frequent problem in travellers.

Dermatological disorders are among the most common complaints of patients seeking medical assistance after returning from trips to tropical countries. Among exotic dermatoses, one of the frequently encountered diagnoses is Cutaneous Larva Migrans (CLM), primarily caused by the nematodes Ancylostoma braziliense and A. caninum. Cats and dogs, which serve as the definitive hosts for these nematodes, excrete with their stool parasite eggs into the environment, where they transform into larvae. Human infection occurs through the invasive form of the larvae, which penetrate the skin, causing itching and the characteristic serpiginous, slightly raised, and enlarging lesion at the site of invasion. Diagnosis is made based on the highly characteristic clinical presentation, although in non-endemic countries, diagnostic errors and delays in initiating effective causal treatment are relatively common. Effective therapy includes oral albendazole and ivermectin. Prevention of CLM involves avoiding skin contact with potentially contaminated soil by wearing shoes and using towels and mats on the beach. Due to the high interest in travel and the risk of importing exotic diseases, it is important to promote knowledge of tropical medicine among healthcare professionals as well as the travellers.

Platelet-rich Plasma Stimulates Collagen Type I Synthesis in the Human Skin: A Placebo-controlledin vivo Study.

Platelet-rich plasma (PRP) is used in medicine as a source of autologous growth factors in different indications. At present, PRP is applied increasingly frequently in aesthetic medicine with the aim of skin revitalization. Until now, the mechanisms of PRP effects in healthy human skin treated with aesthetic goals have not been identified in detail. This study aimed to examine PRP effects on the synthesis of procollagen type I in human skin. This study was a prospective, single-center, single-dose, open-label, non-randomized controlled clinical study. The study was conducted on a group of 10 volunteers in whom forearm skin was injected with PRP, while the placebo control group received injections of 0.9% NaCl. Expression of procollagen type I was examined after 21 days using immunohistochemistry. The study demonstrated that skin fragments subjected therapy using PRP demonstrated a significantly higher expression of procollagen than that which was observed in placebo controls. The study demonstrated that PRP stimulated collagen expression in healthy human skin.

Misdiagnosis and inappropriate treatment of cutaneous leishmaniasis: a case report.

BACKGROUND: Leishmaniasis is a widespread disease in tropical and subtropical countries, except for Australia and Oceania. In Poland, tourists, migrants and travellers from leishmaniasis-endemic countries may carry Leishmania. CASE PRESENTATION: We present a case of undiagnosed cutaneous leishmaniasis in a patient who received many weeks of inadequate antibiotic treatment. Ulceration in the right submandibular region was thought to be a purulent complication after laser surgery. Six weeks before the ulcer developed, the patient had visited the jungle (Guatemala). Cutaneous leishmaniasis was finally diagnosed after nine months based on a proper history and a polymerase chain reaction (PCR) assay. Treatment with antimony derivatives was administered. After three months, the ulcer healed but left a scar. CONCLUSION: A lack of knowledge about tropical diseases among doctors and an incomplete medical history were the reasons for many weeks of erroneous treatment of cutaneous leishmaniasis with antibiotics. This is the first reported case of cutaneous leishmaniasis misdiagnosed as a complication after an aesthetic medical procedure.

The impact of lifestyle upon the probability of late bacterial infection after soft-tissue filler augmentation.

Purpose: Little is known about the influence of lifestyle-related factors upon the risk of late bacterial infection (LBI) emerging at the site of soft-tissue filler augmentation. The aim of this study was to analyze the impact of some such factors on the risk of LBI by comparing their respective prevalence between two groups of previously healthy women: a group in which infection occurred at a site of cross-linked hyaluronic acid (HA) augmentation and a second group which did not have such an infection. Patients and methods: The infection group featured 25 women who developed LBI at a site of cross-linked HA augmentation; the control group featured 92 women who did not experience complications during a 24-month period of observation after the same procedure. Data was analyzed statistically using Chi-square tests and logistic regression. Results: The two groups did not differ significantly in terms of age. However, the frequency of antibiotic therapy, household pet ownership, occupation, hormone replacement therapy or contraception use, and attendance at a swimming pool, sauna, or gym attendance were found to vary with statistical significance, P<0.05. Conclusions: Women in the control group practiced a more active lifestyle. Antibiotic therapy in the year preceding cross-linked HA augmentation was a factor which rendered a patient predisposed towards the development of LBI. Pet ownership was more prominent among women who did not suffer LBI than within the group in which soft tissue filler-related complications had occurred.

Dehydration of a diver during a hyperbaric chamber exposure with oxygen decompression.

Objective: An analysis of factors that may indicate both the type and degree of dehydration of a diver's body following a dry chamber hyperbaric exposure. Methods: The study was participated by 63 men - professional divers, with extensive diving experience, aged 24-51 years (average age 32.6). The subjects underwent two hyperbaric exposures, one to a pressure of 0.3 MPa and one to a pressure of 0.6 MPa, with oxygen decompression. The exposures were carried out in a hyperbaric chamber pursuant to the decompression tables of the Polish Navy, with the observance of a 24-hour interval between exposures. Blood samples were collected from the participants in order to perform a blood morphology test. Body weight was measured with the bioelectrical impedance method using the Maltron BioScan 920 device.The results were subjected to statistical analysis. The following blood morphology parameters were analyzed: hematocrit (Ht), erythrocyte size (MCV), color index (MCHC) and body weight composition: total water (TBW), extracellular water (ECW), intracellular water (ICW). Results: The studies have shown that during a hyperbaric exposure in the chamber the diver's body becomes dehydrated, with observable loss of both intracellular water as evidenced by the reduction of hematocrit content and erythrocyte size, as well as extracellular water, with the accompanying increase in the color index. Conclusions: Hyperbaric conditions are conducive to the dehydration of the diver's body, however to a degree which does not lead to an occurrence of health hazards. Good care for one's health through proper nutrition and hydration are sufficient preventive and protective measures.

Treatment of late bacterial infections resulting from soft-tissue filler injections.

PURPOSE: Late bacterial infections (LBIs) after esthetic facial augmentation using hyaluronic acid (HA) fillers are relatively rare yet severe complications that are difficult to treat. No adequate treatment standards have hitherto been formulated. We have bridged this gap by formulating a treatment scheme based on the principles of treating foreign-body implantation-related infections and treating bacterial growth in the form of biofilm. The objective of this study was to evaluate the efficacy of a comprehensive scheme for treating LBI complications after facial augmentation using cross-linked HA fillers. METHODS: A total of 22 patients with LBI symptoms at a site of cross-linked HA injection underwent treatment and observation. The comprehensive treatment scheme formulated by Marusza and Netsvyetayeva (M&N scheme) comprised draining the lesion, dissolution of cross-linked HA with hyaluronidase, broad-spectrum antibiotic combination therapy, and use of probiotics. While 17 patients underwent the M&N scheme, the remaining five were treated with other schemes. Statistical analysis of the data was performed using Mann-Whitney U and χ2 nonparametric tests with SAS 9.4 software. RESULTS: All 17 patients who underwent the M&N scheme experienced resolution of symptoms, with no recurrence of infection at the HA-injection sites. CONCLUSION: To treat LBI at a site of cross-linked HA administration, the principles applicable to infections resulting from implantation of a foreign body must be followed. The treatment period should be sufficiently long for complete resolution of symptoms. The efficacy of treatment is considered proven if 2 months have elapsed without recurrence since the symptoms resolved. The M&N scheme is recommended for use as the first therapeutic option for treating LBI related to soft-tissue fillers.

Imported cutaneous leishmaniasis: a 13-year experience of a Polish tertiary center.

INTRODUCTION: Leishmaniasis is a vector-borne infection endemic in 98 countries. Its cutaneous form (CL) causes skin lesions on exposed parts of the body and may lead to scarring. The numbers of imported cases of CL are increasing in Europe but the incidence of CL importation in Poland is unknown. MATERIAL AND METHODS: A list of all patients diagnosed with CL at the Department in the years 2005-2017 was obtained. The study presents their data including age, sex, areas visited, purpose of travel, time from the onset of symptoms to correct diagnosis, appearance of lesions, results of impression smears and PCR, and superinfection, if detected, as well as treatment methods and their outcomes. RESULTS: Altogether, 14 cases of cutaneous leishmaniasis were identified. The study demonstrates an increase in the number of cases of imported CL at our center over the last 5 years. The time to correct diagnosis was long in spite of the fact that the lesions had usually an appearance typical of CL. CONCLUSIONS: Intensified education of physicians and travelers, as well as improvement in the access to travel medicine services and to the diagnosis and treatment methods appropriate for CL, are needed in our country. In our opinion, surveillance of leishmaniasis should be introduced in Poland.

[Recommendations of the polish society of aesthetic and anti-aging medicine concerning the application of fillers in difficult areas: eye, glabella and temple].

Aesthetic medicine is a dynamically developing field of medicine and filling techniques are currently an important and widely used procedure in modern therapeutic methods of facial rejuvenation. The aim of the PTMEiAA Recommendation is to improve patient safety, standardize procedures performed in aesthetic medicine and define minimum quality requirements during individual procedures. This is particularly important in the situation where there are more and more reports of the performance of treatments by unauthorized persons in places that do not meet the sanitary and epidemiological requirements to provide health services. The present study concerns the use of fillers in difficult facial areas: around the eye, glabella and temples.

Influence of exposure in hyperbaric chambers on selected parametersof oxidative stress in professional divers.

PURPOSE: This study evaluated the influence of hyperbaric exposure chambers on selected parameters of oxidative stress in divers' blood. METHODS: 25 healthy men (non-smoking experienced divers) ages 18-40 took part in the experiment. Subjects were exposed to hyperbaric conditions similar to those at 30 meters of depth while diving. A control group consisted of 20 healthy men who have never dived or been exposed to hyperbaric conditions. Blood was drawn from the cubital vein after overnight fasting. Superoxide dismutase (SOD-1) activity and malondialdehyde (MDA) concentration were marked in red blood cells (RBCs), carbonyl group concentration marked in serum proteins, and nitrate/nitrite concentrations were estimated in plasma. RESULTS: Statistically significant differences were found between the divers and the control group in MDA concentration in erythrocytes and carbonyl group concentration in serum proteins. Nitrite/nitrate concentrations in plasma plus SOD-1 activity in RBCs decreased significantly in the diver group compared with the control group. After hyperbaric exposure MDA concentration in erythrocytes increased considerably in the test group and a significant increase in SOD-1 activity was observed. A significant increase of nitrite/nitrate concentration was noted in plasma as well as an increase in the carbonyl group in serum proteins. CONCLUSION: Considerably weak enzymatic antioxidative defense was observed in the RBCs of individuals exposed to hyperbaric pressures versus those in normobary. This issue indicates that a diver's system has a larger susceptibility for negative effects from oxidative stress. The results also indicate that hyperbaric conditions can intensify reactions via free radicals.

Skin bacterial flora as a potential risk factor predisposing to late bacterial infection after cross-linked hyaluronic acid gel augmentation.

INTRODUCTION: Cross-linked hyaluronic acid (HA) gel is widely used in esthetic medicine. Late bacterial infection (LBI) is a rare, but severe complication after HA augmentation. The aim of this study was to determine whether patients who underwent the HA injection procedure and developed LBI had qualitatively different bacterial flora on the skin compared to patients who underwent the procedure without any complications. METHODS: The study group comprised 10 previously healthy women with recently diagnosed, untreated LBI after HA augmentation. The control group comprised 17 healthy women who had a similar amount of HA injected with no complications. To assess the difference between the two groups, their skin flora was cultured from nasal swabs, both before and after antibiotic treatment in the study group. RESULTS: A significant increase in the incidence of Staphylococcus epidermidis was detected in the control group (P=0.000) compared to the study group. The study group showed a significantly higher incidence of Staphylococcus aureus (P=0.005), Klebsiella pneumoniae (P=0.006), Klebsiella oxytoca (P=0.048), and Staphylococcus haemolyticus (P=0.048) compared to the control group. CONCLUSION: The bacterial flora on the skin differed in patients with LBI from the control group. The control group's bacterial skin flora was dominated by S. epidermidis. Patients with LBI had a bacterial skin flora dominated by potentially pathogenic bacteria.

Risk factors increasing health hazards after air dives.

The aim of the present study was to determine the effect of postprandial hypertriglyceridemia on the risk of decompression stress following hyperbaric air exposures. The study involved 55 male individuals aged 20-48 years (31.47 ± 5.49 years), body mass index 20.3-33.2 kg/m2 (25.5 ± 2.58 kg/m2). Blood was sampled two hours after a meal each participant had in accordance with individual dietary preferences to determine the following parameters: blood cell counts, activity of aspartate aminotransferase (AST) and alanine ammotransterase (ALT), concentrations of total cholesterol and triglycerides. After each hyperbaric exposure, the presence and intensity of decompression stress were assessed using the Doppler method. Decompression stress was found in 30 individuals. Postprandial hypertriglyceridemia and hypercholesterolemia increased the risk of decompression stress after hyperbaric air exposures.

Acceptance of illness and satisfaction with life among malaria patients in rivers state, Nigeria.

BACKGROUND: Health condition is one of the basic factors affecting satisfaction with life, and the level of illness acceptance. The purpose of the study was to analyse the level of illness acceptance, the level of satisfaction with life among malaria patients, and the level of trust placed in the physician and the nurse. METHODS: The study employs the method of diagnostic survey based on standardised AIS and SWLS scales, as well as Anderson and Dedrick's PPTS and PNTS scales. RESULTS: The average AIS level was 12 points, while the average level of SwL at the SWLS scale was 16.5 points. The average level of trust in the physician and the nurse amounted to 50.6 points and 51.4 points, respectively. The correlation between the level of illness acceptance and self-evaluated satisfaction with life was statistically significant, with R = 0.56. The marital status influenced the level of illness acceptance with p < 0.05 and the level of satisfaction with life with p < 0.05. The employment status affected the level of satisfaction with life with p < 0.05 and the level of illness acceptance with p < 0.05. CONCLUSIONS: The majority of malaria patients did not accept their illness, while the level of satisfaction with life was low. The majority of respondents trusted their physician and nurse. There is a statistically significant correlation between the level of illness acceptance and the self-evaluated satisfaction with life. The marital status had a statistically significant effect on the acceptance of illness and the satisfaction with life. The individuals who had a job demonstrated higher levels of quality of life and illness acceptance.

The influence of high-fat diets on the occurrence of decompression stress after air dives.

INTRODUCTION: In hyperbaric air exposures, the diver's body is subjected to an increased gas pressure, which simulates a real dive performed in water with the presence of hydrostatic pressure. The hyperbaric effect depends on pressure, its dynamics and exposure time. During compression, physical dissolution of inert gas in body fluids and tissues takes place. The decompression process should result in safe physiological disposal of excess gas from the body. However, despite the correct application of decompression tables we observe cases of decompression sickness. The study aim was to find factors affecting the safety of diving, with a particular emphasis on the diet, which thus far has not been taken into account. METHODS: The study subjects were 56 divers. Before hyperbaric exposure, the following data were collected: age, height and weight; plus each divers filled out a questionnaire about their diet. The data from the questionnaires allowed us to calculate the approximate fat intake with the daily food for each diver. Moreover, blood samples were collected from each diver for analysis of cholesterol and triglycerides. Hyperbaric exposures corresponded to dives conducted to depths of 30 and 60 meters. After exposures each diver was examined via the Doppler method to determine the possible presence of microbubbles in the venous blood. RESULTS AND DISCUSSION: Decompression stress was observed in 29 subjects. A high-fat diet has a direct impact on increasing levels of cholesterol and triglycerides in the blood serum. A high-fat diet significantly increases the severity of decompression stress in hyperbaric air exposures and creates a threat of pressure disease.

Quality of life and satisfaction with life of malaria patients in context of acceptance of the disease: quantitative studies.

BACKGROUND: Health status is one of the basic factors of a high quality of life and the problem of the acceptance of illness is important for adaptation to the limitations imposed by it. The purpose of the study was the evaluation of the quality of life, satisfaction with life and the acceptance of illness by malaria patients, as well as the discovery of a relationship between studied parameters. METHODS: The study was undertaken in August 2010, on 120 Nigerian patients with confirmed malaria. A method of diagnostic survey, based on standardized scales - Acceptance of Illness Scale, The Satisfaction With Life Scale and a standardized survey questionnaire World Health Organization Quality of Life/BREF - was used in this study. Descriptive statistics, variability range, 95% confidence interval, correlation analysis, Spearman's non-parametric correlation coefficient, Mann-Whitney test and Kruskal-Wallis test were applied and the, so called, test statistics was calculated, followed by the calculation of the test probability p. Results of analyses were presented in a box graph, and a graph of dispersion. RESULTS: A dominating share in the adjective scale of the AIS scale was the category of "no acceptance", given by 71.7% of respondents. The average level of a "somatic domain" was 41.7, and of a "social domain" was 62.8. The mean satisfaction of life evaluation in the SWLS scale was 18 points. The correlation between acceptance of the disease and quality of life for the psychological domain was 0.39***, and between acceptance of the disease and satisfaction with life was 0.40***. The correlation between satisfaction with life and quality of life for the psychological domain was 0.65***, and between satisfaction with life and quality of life for the environment domain was 0.60***. The mean level of AIS for the studied population of men was 16.5, and test probability: p = 0.0014**, and for the environment domain the level was 50, and the test probability: p = 0.0073**. For quality of life in the social sphere the test probability: p = 0.0013** in relatively older individuals. CONCLUSION: The majority of people do not accept their condition. Evaluation of the quality of life was the highest in the social domain, and the lowest in the somatic domain. There is a statistically significant correlation between the level of acceptance of illness and the quality of life and satisfaction with life. The strongest correlation is found between satisfaction with life and the evaluation of the quality of life in psychological and environmental domains. Men evaluate their quality of life in the environmental domain higher and demonstrate a higher acceptance of their disease. There is a correlation regarding a significantly higher quality of life in the social sphere in relatively older people.

Probable biofilm formation in the cheek as a complication of soft tissue filler resulting from improper endodontic treatment of tooth 16.

Injectable filling agents offer the promise of a better appearance without surgery and, among them, hyaluronic acid is the most commonly used. Although complications are rare, it is necessary to know the possible side effects and complications in order to be prepared for their management. That is why many researchers have been focusing on the interactions between hyaluronic acid and pathogens, inflammatory mediators, the immune system, and markers of oxidative stress to achieve efficient drug delivery, given that hyaluronic acid has widening applications in the field of nanomedicine. Here we report the case of a 37-year-old female patient who returned to our clinic with an abscess in her left cheek 3 months after a deep injection of 1 mL of stabilized hyaluronic acid in both cheeks. Steroid and antibiotic therapy was initiated without success, and abscess drainage was performed. Extraction of tooth 16 was performed 11 days after insertion of drains into the abscess. Laboratory blood tests showed acute inflammation of presumed bacterial etiology. Microbiological examination of pus was negative. Bacterial cultures were found in the extracted tooth. After antibiotic therapy, a complete reversal of the pathological process was observed. The present report highlights the need to assess periodontal problems prior to any aesthetic facial treatment. Analyses of further case reports and clinical studies are necessary to understand the potential role of hyaluronic acid in the formation of biofilm, and how to avoid this complication, thereby increasing the safety of hyaluronic acid-based procedures.

Activation of platelets and fibrinolysis induced by saturated air dives.

INTRODUCTION: The Doppler technique is currently the usual method for detection of bubbles in the circulation following decompression. However, cases of decompression sickness (DCS) frequently occur in the absence of detectable bubbles, so that other markers for increasing risk of DCS would be welcome. This study assessed the hemostatic effects of compressed-air saturation dives that conformed to the "safe" limits of accepted decompression tables. METHODS: We measured coagulation times, thrombin generation, platelets, and fibrinolysis in 21 male divers who were subjected to saturated hyperbaric exposures to 0.28-0.3 MPa (corresponds to 18-20 msw). Each diver did one dive. RESULTS: Pooled before- and after-dive data for all exposures showed after decompression, statistically significant changes included decrease of the mean platelet count after, increased induced platelet aggregation and number of platelet aggregates, increased number of P-selectin (CD62P) positive platelets and CD62P density on platelets, increase of platelet derived microparticles in the blood of the divers, decrease of factor XII, X, and fibrinogen concentrations, and marked increase of plasmin-antiplasmin complex concentration. Thrombin activation markers and coagulation times did not change significantly. CONCLUSIONS: Saturated hyperbaric exposures followed by nominally safe decompression led to activation of platelets and the fibrinolytic system. The probable mechanism for the activation of platelets and fibrinolysis is contact with the surface of evolved bubbles in the divers' circulation.

Metabolomic approach with LC-MS reveals significant effect of pressure on diver's plasma.

Professional and recreational diving are growing activities in modern life. Diving has been associated with increased prevalence of stroke, hypertension, asthma, diabetes, or bone necrosis. We evaluated the effect of increased pressure equivalent to diving at 30 and 60 m for 30 min in two groups of divers using an untargeted approach with LC-MS fingerprinting of plasma. We found over 100 metabolites to be altered in plasma post exposure and after the corresponding decompression procedures. Among them, a group of lysophosphatidylcholines and lysophosphatidylethanolamines were increased, including lysoplasmalogen, a thrombosis promoter, together with changes in metabolic rate-associated molecules such as acylcarnitines and hemolysis-related compounds. Moreover, three metabolites that could be associated to bone degradation show different intensities between experimental groups. Ultimately, this nontargeted, short-term study opens the possibility of discovering markers of long-term effect of pressure that could be employed in routine health control of divers and could facilitate the development of safer decompression procedures.

[The incidence of sexually transmitted diseases among Polish soldiers serving in U.N. military forces in the Middle East and south-east Asia]. / Zachorowaniana choroby przenoszone droga plciowa wsród Polskich zolnierzy pelniacych sluzbe w Silach Zbrojnych ONZ na Bliskim Wschodzie i w azji Poludniowo-Wschodniej.

The results of own studies concerning the incidence of sexually transmitted diseases in the population of Polish soldiers serving in U.N. Military Forces in Lebanon (UNIFIL) and Cambodia (UNTAC) are presented in the article. The epidemiological analysis was based on the medical documentation of the patients treated in UNIFIL Hospital from 1993 to 2000 and in UNTAC medical centers from 1992 to 1993. The research showed that among the military personnel of U.N. peace mission in Lebanon sexually transmitted diseases caused no epidemiological problem. On the other hand, venereal diseases in Cambodia made up one of the main causes of morbidity in the population of Polish soldiers. The main reason of treatment of sexually transmitted diseases in the analyzed period was gonorrhea.