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1.
BMC Health Serv Res ; 21(1): 1065, 2021 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-34625080

RESUMO

BACKGROUND: Neglected Tropical Diseases (NTDs) such as podoconiosis, lymphatic filariasis (LF) and leprosy mainly affect communities in low resource settings. These diseases are associated with physical disability due to lymphoedema as well as poor mental health and psychosocial outcomes. Integration of care across these NTDs at primary health care level, which includes mental health and psychosocial care alongside physical health care, is increasingly recommended. METHODS: A holistic integrated care package was developed and piloted as part of the EnDPoINT project in Gusha district, Awi zone, Ethiopia. The intervention was conducted at the health care organization, health facility and community levels. To assess the impact of the care package in terms of acceptability, scalability, sustainability and barriers to implementation, a qualitative study was conducted in January 2020. This included four focus group discussions (29 participants) and ten key informant interviews with decision makers, health professionals, patients, and community representatives. RESULTS: The integrated lymphoedema care package was found to be efficient compared to vertical programs in saving time and resources. It also resulted in improved awareness of the causes, treatment and prevention of lymphoedema, in marked improvements in the lymphoedema, and in reduced stigma and discrimination. The care package was found to be acceptable to patients, health professionals and decision makers. The barriers to integrated care were unrealistic patient expectations, inadequate dissemination across health workers, and poor transportation access. Health professionals, decision makers and patients believed the integrated lymphoedema care package to be scalable and sustainable. CONCLUSION: The integrated holistic care package was found to be acceptable to patients, health professionals and decision makers. We recommend its scale-up to other endemic districts.


Assuntos
Elefantíase , Linfedema , Atenção à Saúde , Etiópia , Humanos , Linfedema/terapia , Projetos Piloto
2.
BMJ Case Rep ; 14(10)2021 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-34706911

RESUMO

Scrotal elephantiasis (SE) is a condition considered rare in western industrialised countries but common in filaria prone regions. If no apparent causes are found for SE, it is called idiopathic SE. Medical and conservative therapies are ineffective against idiopathic SE, and surgical intervention is mandatory to treat this disabling condition. Nevertheless, it remains unclear whether surgical intervention improves quality of life among patients with idiopathic SE. Herein, we report a case of a 41-year-old man who underwent acute scrotal resection and reconstruction, secondary to haemorrhage from his idiopathic SE. The aim of this study was to describe the operative approach and assess patient satisfaction after surgical treatment. The patient had no recurrence of SE after surgical treatment at 6 months follow-up and had considerable improvements assessed by general and disease-specific quality of life questionnaires.


Assuntos
Elefantíase , Procedimentos Cirúrgicos Reconstrutivos , Adulto , Elefantíase/cirurgia , Humanos , Masculino , Recidiva Local de Neoplasia , Qualidade de Vida , Escroto/cirurgia
3.
PLoS Negl Trop Dis ; 15(7): e0009492, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34237079

RESUMO

Leprosy, podoconiosis, and lymphatic filariasis (LF) are among the priority neglected tropical diseases (NTDs) in Ethiopia. The disability, psychosocial, and mental health status of people affected by these NTDs are still overlooked in global NTD discourse. The objective of this systematic review was to synthesize the existing evidence describing the disability, psychosocial, and mental health status of people affected by leprosy, podoconiosis, and LF prior to developing a holistic physical and psychosocial care package for these individuals. We searched papers reporting on disability, psychosocial, and mental health status linked to these 3 NTDs. The protocol was registered in PROSPERO with registration number CRD42019128400. Peer-reviewed articles were searched and extracted from Medline, PsycINFO, Global Health, and Embase. Articles published in English, irrespective of the year of publication, using a quantitative study methodology, were included. Abstracts and full texts were reviewed by 2 reviewers. Data were extracted and narratively summarized, as the studies were heterogeneous and used different outcome measures. Out of 1,318 titles/abstracts screened and 59 full text studies reviewed, 24 fulfilled the inclusion criteria. Fourteen studies provided evidence of the disability associated with leprosy, podoconiosis, or LF. Ten studies provided evidence on the association between the 3 NTDs and mental health or psychosocial outcomes. The prevalence of grade 2 disability varied from 3.9% to 86%. The most commonly reported mental health impacts were depression and mental distress. A high burden of mental illness was reported, varying from 12.6% to 71.7%; the suicidal ideation was also high (18.5%). In conclusion, disability and poor psychosocial and mental health status are associated with leprosy, podoconiosis, and LF. For optimum management of these NTDs, holistic care including both physical and psychosocial interventions is vital.


Assuntos
Pessoas com Deficiência/psicologia , Filariose Linfática/psicologia , Elefantíase/psicologia , Hanseníase/psicologia , Elefantíase/terapia , Filariose Linfática/terapia , Humanos , Hanseníase/terapia , Saúde Mental , Doenças Negligenciadas/psicologia
5.
J Foot Ankle Res ; 14(1): 31, 2021 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-33853642

RESUMO

BACKGROUND: Podoconiosis is entirely preventable, non-communicable disease with high potential of elimination. The prevalence of podoconiosis in Ethiopia was 7.45%. One of the pillars for elimination of podoconiosis is morbidity control and management. Therefore, the present study aimed to assess the knowledge, attitude, practices and associated factors of health professionals towards podoconiosis cause, prevention and treatments. METHODS: Facility based cross-sectional study was conducted. The source population was all health professionals currently working in public health facilities. The final estimated sample size was 349. A pretested self-administrated structured questionnaire was used to collect the data. The data were coded, entered, and cleaned by using Epi.info version7, and analyzed by using SPSS version 20. RESULT: A total of 320 health professionals participated in the study. Sixty eight (23.1%) health professionals had poor knowledge towards podoconiosis. Seventy (21.9%) identified podoconiosis as infectious disease. Profession, address of health facility, service year and attitude of participants were significantly associated with knowledge towards podoconiosis. More than half (56%) had favorable attitude towards podoconiosis patients. Knowledge score (95%CI: 1.389, 4.059, p-value = 0.002) was the independent predictor for attitude status. Very few (11.6%) respondents treated podoconiosis patients. Age group 45 years old and above and training on lymphedema morbidity management and disability prevention were significantly associated with clinical experience in treating affected patients, (AOR = 17.345; 95%CI: 4.62, 65.119) and (AOR = 7.385; 95%CI: 2.5, 21.797), respectively. CONCLUSION: Despite, high percent of good knowledge of health professionals towards podoconiosis, clinical experience of health professionals in treating podoconiosis patients was very low. In-service trainings will be given for health professionals to improve treatment. In podoconiosis endemic districts hygiene supplies and other referencing materials should be made available for podoconiosis case management.


Assuntos
Atitude do Pessoal de Saúde , Elefantíase/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/psicologia , Adulto , Estudos Transversais , Etiópia/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Inquéritos e Questionários
6.
PLoS Negl Trop Dis ; 15(4): e0009332, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33878110

RESUMO

BACKGROUND: Neglected Tropical Diseases (NTDs) are a group of several communicable and non-communicable diseases prevalent in tropical and subtropical areas. The co-endemicity of these diseases, the similarity of their clinical signs, and the need to maximize limited financial and human resources suggest the importance of adoptingan integratedapproach to their prevention and treatment. AIMS: This study describes the development of a comprehensive package of physical, mental health and psychosocial care for people with lower-limb lymphoedema caused bypodoconiosis, lymphatic filariasis (LF)or leprosy as part of the EnDPoINT program in Ethiopia. METHOD: The care package was developed using a mixed-methods approach, consisting of a literature review, situational analysis, Theory of Change (ToC) workshops, qualitative research, and additional workshops to fine-tune the draft care package. The care package was developed between March 2018 and January 2020 in Addis Ababa and the implementation research site, Awi zone in the North-West of Ethiopia. RESULTS: The holistic care package includes components implemented at three levels of the health care system:health organization, facility, and community. Sections of the care package are directed at strengthening capacity building, program management, community engagement, awareness-raising, stigma-reduction, morbidity management, disability prevention, follow-up visits, referral linkage, community-based rehabilitation, and monitoring and evaluation. CONCLUSIONS: The study developed a holistic integrated care package for lower limb disorder and co-morbid mental health problems caused by podoconiosis, LF or leprosy. The approach has the potential to significantly reduce lower limb disorder-associated morbidity, disability, and psychosocial problems. It also standardizes a scalable approach appropriate for the Ethiopian setting and, most likely, other countries where these NTDs are present.


Assuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Filariose Linfática/prevenção & controle , Elefantíase/prevenção & controle , Hanseníase/prevenção & controle , Atenção Primária à Saúde , Etiópia , Feminino , Serviços de Saúde , Humanos , Extremidade Inferior , Masculino , Saúde Mental , Reabilitação Psiquiátrica , Pesquisa Qualitativa
7.
Acta Trop ; 219: 105918, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33839086

RESUMO

Podoconiosis is a non-filarial and non-communicable disease leading to lymphedema of the lower limbs. Worldwide, 4 million individuals live with podoconiosis, which is accompanied by disability and painful intermittent acute inflammatory episodes that attribute to significant disability adjusted life years (DALYs). Different risk factors like contact with volcanic red clay soil, high altitude (above 1000 m), high seasonal rainfall (above 1000 mm/year) and occupation (e.g., subsistence farmer) are associated with the risk of podoconiosis. Although podoconiosis was described to be endemic in 32 countries in Africa, parts of Latin America and South East Asia, knowledge about related genetics, pathophysiology, immunology and especially the causing molecule(s) in the soil remain uncertain. Thus, podoconiosis can be considered as one of the most neglected diseases. This review provides an overview about this non-filarial related geochemical disease and aim to present perspectives and future directions that might be important for better understanding of the disease, prospect for point-of-care diagnosis, achieving protection and developing novel treatment strategies.


Assuntos
Elefantíase , Elefantíase/diagnóstico , Elefantíase/epidemiologia , Elefantíase/etiologia , Humanos , Fatores de Risco , Solo/parasitologia
8.
Am J Case Rep ; 22: e930269, 2021 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-33714971

RESUMO

BACKGROUND In lymphedema, an imbalance in the formation and absorption of lymph causes accumulation of protein-rich fluid in the interstitium of the most gravity-dependent parts of the body. Diagnosis is usually made based on patient medical history and a physical examination showing a typical appearance of the affected body part. Differential diagnosis is confirmed by imaging. CASE REPORT Primary lymphedema is inherited in through an autosomal dominant pattern. Congestive cardiac failure and non-filarial infections predispose patients to the secondary form of lymphedema, elephantiasis nostras verrucosa (ENV). We present the case of a 65-year-old man with lymphedema praecox complicated by congestive cardiac failure. The patient was experiencing worsening left leg swelling and had a prior history of unilateral leg swelling at puberty. The condition was inherited through an autosomal dominant pattern, as his father, elder brother, and nephew were diagnosed with the same disease. The left leg showed non-pitting edema with indurated, woody skin and lichenification. The right leg had mild pitting edema. There were numerous verrucous folds and cobblestone-like nodules, and plaques and a painless ulcer on the left leg. Laboratory evaluation demonstrated an elevated B-type natriuretic peptide. He was treated with compression stockings and inelastic multi-layer bandaging and was administered limb decongestive treatment. After 1 week of therapy, his swelling had somewhat improved. CONCLUSIONS Various conditions can cause ENV and it can superimpose on any form of hereditary lymphedema. The most effective strategy for this condition seems to be a thorough workup of the underlying cause of the ENV and early intervention.


Assuntos
Elefantíase , Insuficiência Cardíaca , Linfedema , Idoso , Elefantíase/complicações , Elefantíase/diagnóstico , Insuficiência Cardíaca/etiologia , Humanos , Perna (Membro) , Linfedema/complicações , Linfedema/diagnóstico , Masculino
9.
Trans R Soc Trop Med Hyg ; 115(9): 1026-1038, 2021 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-33570141

RESUMO

BACKGROUND: Undertaking research and attaining informed consent can be challenging when there is political unrest and community mistrust. Rapid ethical appraisal (REA) is a tool that uses qualitative methods to explore sociocultural issues that may affect the ethical conduct of research. METHODS: We used REA in northeast Ethiopia shortly following a period of unrest, during which violence against researchers occurred, to assess stakeholder perceptions of research, researchers and the informed consent process. We held 32 in-depth interviews and 2 focus group discussions. RESULTS: Most community members had little awareness about podoconiosis or healthcare research. Convincing the community to donate blood for research is challenging due to association with HIV testing. The attack on researchers was mainly motivated by the community's mistrust of their intentions against the background of a volatile political situation. Social media contributed to the spread of misinformation. Lack of community engagement was also a key contributing factor. CONCLUSIONS: Using REA, we identified potential barriers to the informed consent process, participant recruitment for data and specimen collection and the smooth conduct of research. Researchers should assess existing conditions in the study area and engage with the community to increase awareness prior to commencing their research activities.


Assuntos
Elefantíase , Etiópia , Grupos Focais , Humanos , Consentimento Livre e Esclarecido , Pesquisa Qualitativa , Pesquisadores
11.
Sci Rep ; 11(1): 3285, 2021 02 08.
Artigo em Inglês | MEDLINE | ID: mdl-33558538

RESUMO

Podoconiosis, a debilitating lymphoedema of the leg, results from barefoot exposure to volcanic clay soil in genetically susceptible individuals. A previous genome-wide association study (GWAS) conducted in the Wolaita ethnic group from Ethiopia showed association between single nucleotide polymorphisms (SNPs) in the HLA class II region and podoconiosis. We aimed to conduct a second GWAS in a new sample (N = 1892) collected from the Wolaita and two other Ethiopian populations, the Amhara and the Oromo, also affected by podoconiosis. Fourteen SNPs in the HLA class II region showed significant genome-wide association (P < 5.0 × 10-8) with podoconiosis. The lead SNP was rs9270911 (P = 5.51 × 10-10; OR 1.53; 95% CI 1.34-1.74), located near HLA-DRB1. Inclusion of data from the first GWAS (combined N = 2289) identified 47 SNPs in the class II HLA region that were significantly associated with podoconiosis (lead SNP also rs9270911 (P = 2.25 × 10-12). No new loci outside of the HLA class II region were identified in this more highly-powered second GWAS. Our findings confirm the HLA class II association with podoconiosis suggesting HLA-mediated abnormal induction and regulation of immune responses may have a direct role in its pathogenesis.


Assuntos
Elefantíase , Grupos Étnicos/genética , Predisposição Genética para Doença/etnologia , Cadeias HLA-DRB1/genética , Polimorfismo de Nucleotídeo Único , Elefantíase/etnologia , Elefantíase/genética , Etiópia/etnologia , Feminino , Estudo de Associação Genômica Ampla , Humanos , Masculino
12.
PLoS Negl Trop Dis ; 15(2): e0009167, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33600453

RESUMO

A key issue for persons with leprosy-, lymphatic filariasis- and podoconiosis-related disabilities is the life-long need to practice self-management routines. This is difficult to sustain without regular encouragement and support of others. Family-based support may be a sustainable and feasible strategy to practice self-management routines. This proof of concept study aimed to develop and pilot a family-based intervention to support prevention and self-management of leprosy, lymphatic filariasis and podoconiosis-related disabilities in Ethiopia. We used a quasi-experimental pre/post intervention study design with a mixed methods approach. The study population included persons affected by leprosy, lymphatic filariasis and podoconiosis and their family members. All persons affected had visible impairments due to their condition. We collected physical impairment outcomes, data on activity limitations, stigma and family quality of life using the SALSA scale (range 0-80), the SARI stigma scale (range 0-63) and the Beach Centre Family Quality of Life scale (range 0-125) and conducted in-depth interviews and focus group discussions. Quantitative data were analysed using paired t-tests, unequal variances t-tests, linear regression and binary logistic regression. Qualitative data were coded using open, inductive coding and content analysis. The family-based intervention consisted of self-management of disabilities, awareness raising and socio-economic empowerment. The intervention was delivered over several monthly group meetings over the course of several months. A total of 275 (100%) persons affected attended at least one session with a family member, and 215 (78%) attended at least three sessions. There was no significant improvement in eye and hand problems after the intervention. However, foot and leg impairments, number of acute attacks, lymphedema and shoe wearing all significantly improved at follow-up. In addition, family quality of life significantly improved from 67.4 at baseline to 89.9 at follow-up for family members and from 76.9 to 84.1 for persons affected (p<0.001). Stigma levels significantly decreased from 24.0 at baseline to 16.7 at follow-up (p<0.001). Activity levels improved, but not significantly. This proof of concept study showed that the family-based intervention had a positive effect on impairments and self-management of disabilities, family quality of life and stigma. We recommend a large-scale efficacy trial, using a randomised controlled trial and validated measurement tools, to determine its effectiveness and long-term sustainability.


Assuntos
Pessoas com Deficiência , Filariose Linfática , Elefantíase , Hanseníase , Autogestão/métodos , Adulto , Etiópia , Família , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudo de Prova de Conceito , Qualidade de Vida , Estigma Social
13.
PLoS Negl Trop Dis ; 15(1): e0008935, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33406151

RESUMO

Brugia malayi is a human filarial nematode responsible for elephantiasis, a debilitating condition that is part of a broader spectrum of diseases called filariasis, including lymphatic filariasis and river blindness. Almost all filarial nematode species infecting humans live in mutualism with Wolbachia endosymbionts, present in somatic hypodermal tissues but also in the female germline which ensures their vertical transmission to the nematode progeny. These α-proteobacteria potentially provision their host with essential metabolites and protect the parasite against the vertebrate immune response. In the absence of Wolbachia wBm, B. malayi females become sterile, and the filarial nematode lifespan is greatly reduced. In order to better comprehend this symbiosis, we investigated the adaptation of wBm to the host nematode soma and germline, and we characterized these cellular environments to highlight their specificities. Dual RNAseq experiments were performed at the tissue-specific and ovarian developmental stage levels, reaching the resolution of the germline mitotic proliferation and meiotic differentiation stages. We found that most wBm genes, including putative effectors, are not differentially regulated between infected tissues. However, two wBm genes involved in stress responses are upregulated in the hypodermal chords compared to the germline, indicating that this somatic tissue represents a harsh environment to which wBm have adapted. A comparison of the B. malayi and C. elegans germline transcriptomes reveals a poor conservation of genes involved in the production of oocytes, with the filarial germline proliferative zone relying on a majority of genes absent from C. elegans. The first orthology map of the B. malayi genome presented here, together with tissue-specific expression enrichment analyses, indicate that the early steps of oogenesis are a developmental process involving genes specific to filarial nematodes, that likely result from evolutionary innovations supporting the filarial parasitic lifestyle.


Assuntos
Evolução Biológica , Brugia Malayi/genética , Carisoprodol , Elefantíase/genética , Células Germinativas , Animais , Caenorhabditis elegans , Filariose Linfática/genética , Feminino , Expressão Gênica , Genoma , Humanos , Oogênese , Análise de Sequência de RNA , Simbiose , Wolbachia/fisiologia
16.
PLoS Negl Trop Dis ; 15(1): e0009053, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33481805

RESUMO

BACKGROUND: In Ethiopia, severe lymphedema and acute dermato-lymphangio-adenitis (ADLA) of the legs as a consequence of podoconiosis affects approximately 1.5 million people. In some this condition may lead to woody-hard fibrotic nodules, which are resistant to conventional treatment. We present a series of patients who underwent surgical nodulectomy in a resource-limited setting and their outcome. METHODS: In two teaching hospitals, we offered surgical nodulectomies under local anaesthesia to patients with persisting significant fibrotic nodules due to podoconiosis. Excisions after nodulectomy were left to heal by secondary intention with compression bandaging. As outcome, we recorded time to re-epithelialization after surgery, change in number of ADLA episodes, change in quality of life measured with the Dermatology Quality of Live Index (DQLI) questionnaire, and recurrence rate one year after surgery. RESULTS: 37nodulectomy operations were performed on 21 patients. All wounds re-reepithelialised within 21 days (range 17-42). 4 patients developed clinically relevant wound infections. The DLQI values were significantly better six months after surgery than before surgery (P<0.0001). Also the number of ADLA episodes per three months was significantly lower six months after surgery than before surgery (P<0.0001). CONCLUSION: Nodulectomy in podoconiosis patients leads to a significant improvement in the quality of life with no serious complications, and we recommend this to be a standard procedure in resource-poor settings.


Assuntos
Procedimentos Cirúrgicos de Citorredução/métodos , Elefantíase/cirurgia , Qualidade de Vida , Doença Aguda , Adulto , Idoso , Procedimentos Cirúrgicos de Citorredução/estatística & dados numéricos , Elefantíase/diagnóstico , Elefantíase/tratamento farmacológico , Elefantíase/patologia , Etiópia , Feminino , Humanos , Linfedema/terapia , Masculino , Pessoa de Meia-Idade , Reepitelização , Recidiva , Estudos Retrospectivos , Cicatrização , Adulto Jovem
17.
Dermatol Clin ; 39(1): 147-152, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33228857

RESUMO

The concept of skin neglected tropical diseases has been widely adopted into the policy and strategy of various organizations, governments, nongovernmental organizations, and health agencies. By pooling information and resources across different diseases, whose primary manifestations affect the skin, it is possible to deliver integrated surveillance and control programs and promote advocacy and reduction of disability and stigma. A further key part of the skin neglected tropical diseases program is the development and validation of training methods for front-line health workers. Networks that allow those involved in this work to share and compare expertise are being developed through various organizations.


Assuntos
Atenção à Saúde , Dermatologia/métodos , Helmintíase/terapia , Doenças Negligenciadas/terapia , Dermatopatias Infecciosas/terapia , Medicina Tropical/métodos , Dermatologia/educação , Dermatologia/organização & administração , Gerenciamento Clínico , Elefantíase/diagnóstico , Elefantíase/terapia , Filariose Linfática/diagnóstico , Filariose Linfática/terapia , Helmintíase/diagnóstico , Helmintíase/fisiopatologia , Humanos , Linfedema/diagnóstico , Linfedema/terapia , Doenças Negligenciadas/diagnóstico , Esquistossomose/diagnóstico , Esquistossomose/terapia , Dermatopatias/diagnóstico , Dermatopatias/fisiopatologia , Dermatopatias/terapia , Dermatopatias Infecciosas/diagnóstico , Infecções por Trematódeos/diagnóstico , Infecções por Trematódeos/terapia , Medicina Tropical/educação , Medicina Tropical/organização & administração
18.
Trans R Soc Trop Med Hyg ; 114(12): 954-961, 2020 12 16.
Artigo em Inglês | MEDLINE | ID: mdl-33258944

RESUMO

BACKGROUND: Prior to carrying out clinical trials, it is important to assess the health status of the study participants to be able to interpret subsequent changes that may be related to the effects of the treatments during the follow-up of patients. This study presents the clinical, haematological and biochemical profiles of podoconiosis patients prior to their involvement in the PodoLEDoxy clinical trial. METHODS: All lower limb lymphoedema patients visiting the centre were screened and a podoconiosis diagnosis was based on clinical manifestation and detailed medical history. Patients who satisfied the eligibility criteria were enrolled in the study and their demographic data, vital signs and medical history were collected followed by biochemical and haematological examinations. RESULTS: Of the 222 participants enrolled in the study, 55.4% and 41.4% had either stage 3 or 2 podoconiosis as their highest stages, respectively. On physical examination, gastritis (46%) and poor vision (2.7%) were the most prevalent health issues identified. The majority of haematological and biochemical values were within the normal range except for mean platelet volume (47.7%), plateletcrit (58.1%), platelet distribution width (66.2%), mean corpuscular volume (67.6%) and red cell distribution width-standard deviation (79.3%), where >40% of the study participants had values out of the normal. CONCLUSION: The clinical, haematological and biochemical profiles of the study participants were largely within the normal range except for certain haematological parameters that might be worth investigating.


Assuntos
Elefantíase , Linfedema , Camarões/epidemiologia , Elefantíase/diagnóstico , Elefantíase/epidemiologia , Índices de Eritrócitos , Humanos , Linfedema/epidemiologia , Linfedema/etiologia
19.
An. Fac. Cienc. Méd. (Asunción) ; 53(3): 159-164, 20201201.
Artigo em Espanhol | LILACS | ID: biblio-1178006

RESUMO

La elefantiasis verrugosa nostra es una patología poco frecuente secundaria a linfedema crónico no filariásico, con la consecuente deformación y aumento de volumen del miembro afecto acompañado de un engrosamiento excesivo de la piel. Presentamos el caso de un paciente de sexo masculino con hiperplasia verrugosa en miembros inferiores secundaria a linfedema crónico por trastornos de la circulación venolinfática.


The elephantiasis nostra verrucosa is a rare pathology secondary to chronic non-filarial lymphedema, with the consequent deformation and volume increase of the affected limb accompanied by excessive thickening of the skin. We present the case of a male patient with verrucous hyperplasia in the lower limbs secondary to chronic lymphedema due to disorders of the venolymphatic circulation.


Assuntos
Sarcoma de Kaposi , Elefantíase , Linfedema não Filariídeo , Hiperplasia , Linfedema , Patologia , Pele
20.
Trans R Soc Trop Med Hyg ; 114(12): 899-907, 2020 12 16.
Artigo em Inglês | MEDLINE | ID: mdl-33169131

RESUMO

BACKGROUND: Podoconiosis is a neglected tropical disease that causes significant physical, emotional and financial suffering, especially among impoverished rural farmers. Sufficient physician training is integral to optimizing patient outcomes through timely diagnosis and appropriate management. Therefore we sought to characterize podoconiosis instruction offered to medical students in endemic African countries. METHODS: We invited faculty from 170 medical schools in all podoconiosis-endemic African countries to provide information about podoconiosis inclusion in medical curricula. Surveys were available in French and English and captured podoconiosis knowledge, quantity/quality of instruction, ranking of importance relative to other diseases and barriers for improvement. Respondents voluntarily shared responses online or by telephone. RESULTS: Study participants provided information about curricula at 97 medical schools across 14 countries. In total, 42.6% of schools across nine countries offered podoconiosis-specific instruction; most respondents felt that the quality (60.4%) and quantity (61.5%) of instruction was insufficient. Common barriers to sufficient training included exclusion from government curricula, prioritization according to caseload and scarce epidemiological data. CONCLUSIONS: Our study demonstrates widespread neglect in podoconiosis training for physicians in endemic countries. Government support is needed to ensure curricula match the needs of health workers practicing in rural, low-income regions.


Assuntos
Elefantíase , África/epidemiologia , Tomada de Decisões , Elefantíase/epidemiologia , Elefantíase/prevenção & controle , Humanos , Doenças Negligenciadas , Faculdades de Medicina
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