Stroke in Patients with Schistosomiasis: Review of Cases in Literature.

Introduction: Cerebral vascular comorbidities may occur in patients with schistosomiasis, as described in case reports. Aim and Methods. We have summarized general clinical and neurological features in patients with stroke associated with schistosomiasis, through a review of case reports in the literature. Investigation Outcomes. A total of eight case reports were retrieved. The mean age of patients was 36.42 ± 16.7 (19 to 56 years), four females, three males, and one anonymous sex. Eosinophilia was the most frequent feature at presentation, followed by cardiac abnormalities, confusion, fever, ataxia, hemiplegia, headache, urticaria, dysphasia, and memory impairment. Patients usually present with watershed infarction or intracranial vasculitis. In one case, extracranial carotid arteries presented with inflammation and stenosis. The patient's serology was positive on admission in five cases. Full neurological recovery was reported in three cases, and partial improvement in another three. In two cases, information on neurological outcomes was incomplete. Stroke in schistosomiasis can be caused by haemodynamic impairment, direct lesion to the arterial wall, vasa vasorum obliterative endarteritis, contiguity with a focus of inflamed tissue, or inflammatory intimal damage. Schistosomiasis needs to be included in the differential diagnosis of stroke in people living or coming back from endemic areas. Conclusions: Further studies addressing the noncommunicable comorbidity issues related to this condition are needed.

Aortic aneurysm lesions in Echinococcus infection. A review of cases in literature.

BACKGROUND: Parasitic infections are common in developing countries, due to poor sanitation and inadequate hygiene. Undiagnosed and untreated parasitic infections can have severe acute and chronic consequences, including cardiovascular lesions. Aortic aneurysms have been described in patients with disease of parasitological interest, including hydatidosis. AIM AND METHODS: We have described, through a review of case reports in literature, the occurrence of aortic aneurysm in patients with hydatidosis, analysing the specific clinical features, peculiarities of vascular involvement, treatment and outcome. RESULTS: A total of 9 case reports has been included. Mean age of patients was 41.7 ± 12.2 years (range 12-54). Vascular pathology presentation was chronic in the majority of cases, acute in three and subacute in one. The majority of lesions occurred in the descending thoracic aorta; one case involved the ascending aorta and arch, one the abdominal aorta. Open surgical intervention was reported in the majority of cases, endovascular treatment in two. Complications, reported twice at follow up, included one endograft stenosis and, in two cases, vertebral erosion. No deaths were reported. CONCLUSION: Aortic aneurysms can occur in patients with hydatidosis. The surgical vascular treatment of this non communicable complication of a disease of parasitological interest needs to take into account the specific clinical and surgical context in which occurs, to better target pharmacological and surgical treatment.

Community health worker interventions for older adults with complex health needs: A systematic review.

BACKGROUND/OBJECTIVES: The number of older adults with complex health needs is growing, and this population experiences disproportionate morbidity and mortality. Interventions led by community health workers (CHWs) can improve clinical outcomes in the general adult population with multimorbidity, but few studies have investigated CHW-delivered interventions in older adults. DESIGN: We systematically reviewed the impact of CHW interventions on health outcomes among older adults with complex health needs. We searched for English-language articles from database inception through April 2020 using seven databases. PROSPERO protocol registration CRD42019118761. SETTING: Any U.S. or international setting, including clinical and community-based settings. PARTICIPANTS: Adults aged 60 years or older with complex health needs, defined in this review as multimorbidity, frailty, disability, or high-utilization. INTERVENTIONS: Interventions led by a CHW or similar role consistent with the American Public Health Association's definition of CHWs. MEASUREMENTS: Pre-defined health outcomes (chronic disease measures, general health measures, treatment adherence, quality of life, or functional measures) as well as qualitative findings. RESULTS: Of 5671 unique records, nine studies met eligibility criteria, including four randomized controlled trials, three quasi-experimental studies, and two qualitative studies. Target population and intervention characteristics were variable, and studies were generally of low-to-moderate methodological quality. Outcomes included mood, functional status and disability, social support, well-being and quality of life, medication knowledge, and certain health conditions (e.g., falls, cognition). Results were mixed with several studies demonstrating significant effects on mood and function, including one high-quality RCT, while others noted no significant intervention effects on outcomes. CONCLUSION: CHW-led interventions may have benefit for older adults with complex health needs, but additional high-quality studies are needed to definitively determine the effectiveness of CHW interventions in this population. Integration of CHWs into geriatric clinical settings may be a strategy to deliver evidence-based interventions and improve clinical outcomes in complex older adults.