Psycho-social impacts, experiences and perspectives of patients with Cutaneous Leishmaniasis regarding treatment options and case management: An exploratory qualitative study in Tunisia

Although non-fatal and mostly self-healing in the case of Leishmania (L.) major, cutaneous leishmaniasis (CL) is mainly treated to reduce lesion healing time. Less attention is paid to the improvement of scars, especially in aesthetically relevant areas of the body, which can dramatically affect patients’ wellbeing. We explored patients’ perspectives about treatment options and the social and psychological burden of disease (lesion and scar). Individual in-depth interviews were conducted with ten confirmed CL patients at two L. major endemic sites in Southern Tunisia (Sidi Bouzid and Gafsa). Participants were selected using a sampling approach along a spectrum covering e.g. age, sex, and clinical presentation. Patients’ experiences, opinions and preferences were explored, and their detailed accounts gave an insight on the impact of CL on their everyday lives. The impact of CL was found to be considerable. Most patients were not satisfied with treatment performance and case management. They expected a shorter healing time and better accessibility of the health system. Tolerance of the burden of disease was variable and ranged from acceptance of hidden scars to suicidal thoughts resulting from the fear to become handicapped, and the stress caused by close relatives. Some believed CL to be a form of skin cancer. Unexpectedly, this finding shows the big gap between the perspectives of patients and assumptions of health professionals regarding this disease. This study provided valuable information for better case management emphasizing the importance of improving communication with patients, and accessibility to treatment. It generated context-specific knowledge to policy makers in Tunisia to implement effective case management in a country where access to treatment remains a challenge due to socio-economic and geographic barriers despite a long tradition in CL control.

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Influence of Obesity on Clinical Manifestations and Response to Therapy in Cutaneous Leishmaniasis caused by Leishmania braziliensis

Clinical Infectious Diseases ◽

10.1093/cid/ciab236 ◽

2021 ◽

Author(s):

Tainã Lago ◽

Lucas Carvalho ◽

Mauricio Nascimento ◽

Luiz H Guimarães ◽

Jamile Lago ◽

...

Keyword(s):

Cutaneous Leishmaniasis ◽

Clinical Presentation ◽

Clinical Manifestations ◽

Healing Time ◽

Response To Therapy ◽

Leishmania Braziliensis ◽

Cutaneous Lesions ◽

Cytokine Levels ◽

Cure Rates ◽

The Impact

Abstract Background Cutaneous leishmaniasis (CL) caused by L. braziliensis is characterized by a single ulcer or multiple cutaneous lesions with raised borders. Cure rates below 60% are observed in response to meglumine antimoniate therapy. We investigated the impact of obesity on CL clinical presentation and therapeutic response. Methods A total of 90 age-matched CL patients were included (30 obese, 30 overweight and 30 with normal BMI). CL was diagnosed through documentation of L. braziliensis DNA by PCR or identification of amastigotes in biopsied skin lesion samples. Serum cytokine levels were determined by chemiluminescence. Antimony therapy with Glucantime (20mg/kg/day) was administered for 20 days. Results Obese CL patients may present hypertrophic ulcers rather than typical oval, ulcerated lesions. A direct correlation between BMI and healing time was noted. After one course of Antimony, cure was achieved in 73% of patients with normal BMI, 37% of overweight subjects, yet just 18% of obese CL patients (p<0.01). Obese CL cases additionally presented higher leptin levels than overweight patients or those with normal BMI (p<0.05). Conclusions Obesity modifies the clinical presentation of CL and host immune response, and is associated with greater failure to therapy.

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Hidradenitis Suppurativa in a Large Cohort of Italian Patients: Evaluation of the Burden of Disease

Dermatology ◽

10.1159/000517412 ◽

2021 ◽

pp. 1-11

Author(s):

Gabriella Fabbrocini ◽

Giulia Ruina ◽

Giulia Giovanardi ◽

Valentina Dini ◽

Beatrice Raone ◽

...

Keyword(s):

Partial Response ◽

Burden Of Disease ◽

Hidradenitis Suppurativa ◽

Disease Burden ◽

Severe Disease ◽

Well Being ◽

The Body ◽

Italian Population ◽

Activity Impairment ◽

The Impact

Background: Hidradenitis suppurativa (HS) is a chronic, inflammatory, recurrent, debilitating skin disease of the hair follicle that usually occurs after puberty with painful, deep-seated, inflamed nodules and sinus tracts in the apocrine gland-bearing areas of the body, most commonly the axillae and inguinal and anogenital regions, with a relevant impact on patients’ quality of life (QoL). Objective: To evaluate how the burden of HS disease impacts on patient well-being and working activities in a large Italian population over a period of 9 months. Methods: A multicenter, prospective, epidemiologic cohort study was conducted in adult Italian patients with HS. HS severity was assessed through Hurley stage and HS Physician’s Global Assessment (HS-PGA), clinical improvement by HS Clinical Response (HiSCR) and partial response, and disease burden through QoL questionnaires (HIDRAdisk, Skindex-16, Dermatology Life Quality Index [DLQI]), and Work Productivity and Activity Impairment – General Health (WPAI:GH). Results: A total of 308 patients (56.2% women; mean age 35.2 ± 12.9 years) were enrolled in 27 dermatologic clinics. Men were older (37.4 years vs. 33.5), more smoking addicted (74.1% vs. 60.1%), and alcohol consumer (34.1% vs. 13.9%), while more women were obese (34.10% vs. 22.22%). At baseline, most patients had a Hurley severity stage of 2 (43.9%), a moderate HS-PGA score (57.1%), and poor QoL (HIDRAdisk: 65.7 ± 23.3, Skindex-16: 60.3 ± 26.9, and DLQI: 10.8 ± 8.1). Patients with more severe disease showed worse QoL. Mean values for the variables related to HS severity decreased during the study period. The achievement of HiSCR and partial response increased during the study. Conclusion: This study offers insight into the disease burden of HS in an Italian population. Our results underline the impact of QoL evaluation, also with the use of the HIDRAdisk, in clinical routine as a support to validated severity clinical and instrumental indexes for a “360-degree” assessment of HS patient’s burden of disease.

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Detailed Analysis of the Influencing Parameters on the Self-Healing Behavior of Dynamic Urea-Crosslinked Poly(methacrylate)s

Molecules ◽

10.3390/molecules24193597 ◽

2019 ◽

Vol 24 (19) ◽

pp. 3597 ◽

Cited By ~ 2

Author(s):

Abend ◽

Zechel ◽

Schubert ◽

Hager

Keyword(s):

Detailed Analysis ◽

Mechanical Performance ◽

Healing Process ◽

Polymer Networks ◽

Healing Time ◽

The Self ◽

Self Healing ◽

Influencing Parameters ◽

The Impact

For this paper, the self-healing ability of poly(methacrylate)s crosslinked via reversible urea bonds was studied in detail. In this context, the effects of healing time and temperature on the healing process were investigated. Furthermore, the impact of the size of the damage (i.e., area of the scratch) was monitored. Aging processes, counteracting the self-healing process, result in a decrease in the mechanical performance. This effect diminishes the healing ability. Consequently, the current study is a first approach towards a detailed analysis of self-healing polymers regarding the influencing parameters of the healing process, considering also possible aging processes for thermo-reversible polymer networks.

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The Impact of Childhood Trauma and Depressive Symptoms on Body Mass Index

Global Psychiatry ◽

10.2478/gp-2019-0008 ◽

2019 ◽

Vol 2 (1) ◽

pp. 97-106

Author(s):

Lara N. Schulze ◽

Sandra Van der Auwera ◽

Deborah Janowitz ◽

Johannes Hertel ◽

Katharina Wittfeld ◽

...

Keyword(s):

Body Mass Index ◽

Depressive Symptoms ◽

Childhood Trauma ◽

Body Mass ◽

Childhood Maltreatment ◽

The Body ◽

Psychotherapeutic Treatment ◽

Childhood Trauma Questionnaire ◽

Psychological Burden ◽

The Impact

AbstractObjectivesObesity is associated with several somatic diseases and increased psychological burden. This study focused on two potential psychological predictors of the body mass index (BMI), childhood trauma and depressive symptoms.MethodsWe used three independent populations: two general population samples (Study of Health in Pomerania, SHIP-2, N = 1,657; SHIP-TREND-0, N = 3,278) and one patient sample (GANI_MED, N = 1,742). Childhood trauma was measured with the childhood trauma questionnaire (CTQ) and depression with the Beck Depression Inventory (BDI-II) in SHIP-2 and the Patient Health Questionnaire (PHQ-9) in SHIP-TREND-0 and GANI_MED. We investigated the impact of childhood trauma and depression on BMI. Furthermore, we used mediation analysis to assess whether depression was a significant mediator on the path from childhood trauma to adult BMI in each of the three samples.ResultsIn all the three populations, depressive symptoms exhibited a significant association towards higher BMI (p < 0.05). Childhood trauma was positively associated with BMI with significant associations in SHIP-TREND-0 (p < 0.001) and GANI_MED (p = 0.005). The relationship between CTQ and BMI was significantly partially mediated (p < 0.05) by depressive symptoms in SHIP-TREND-0 (38.0%) and GANI_MED (16.4%), in SHIP-2 results pointed in the same direction. All the trauma sub-dimensions, except sexual abuse, exhibited at least one significant association towards increased BMI in one of the samples.ConclusionsChildhood trauma and depressive symptoms may be considered as causes of obesity. These results suggest that psychological treatments against obesity should address childhood maltreatment as well as depressive symptoms in their diagnostic assessment and could facilitate psychotherapeutic treatment when necessary.

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Higher overall survival in metastatic pancreatic cancer: the impact of where and how treatment is delivered

Einstein (São Paulo) ◽

10.1590/s1679-45082015ao3303 ◽

2015 ◽

Vol 13 (3) ◽

pp. 347-351 ◽

Cited By ~ 5

Author(s):

Pedro Luiz Serrano Usón Junior ◽

Monique Sedlmaier França ◽

Heloisa Veasey Rodrigues ◽

Antônio Luiz de Vasconcellos Macedo ◽

Alberto Goldenberg ◽

...

Keyword(s):

Pancreatic Cancer ◽

Overall Survival ◽

Median Survival ◽

Metastatic Cancer ◽

Treatment Options ◽

Advanced Pancreatic Cancer ◽

Stage Iv ◽

Tumor Location ◽

Access To Treatment ◽

The Impact

Objective To determine the overall survival of patients with advanced pancreatic cancer and evaluate factors that impact prognosis in a private cancer center.Methods Data from the Hospital Cancer Registry at Hospital Israelita Albert Einstein were retrospectively collected. The patients enrolled had metastatic cancer at diagnosis or earlier staging and subsequent recurrence. Cases of neuroendocrine tumors were excluded.Results A total of 65 patients were evaluated, including 63 with adenocarcinoma. The median overall survival for patients in all stages was 20.7 months (95%CI: 15.6-25.7), while the overall survival of metastatic disease was 13.3 months. Among the 33 cases with stage IV cancer, there was no evidence of a statistically significant association between median survival and CA19-9 dosage (p=0.212), tumor location (p=0.482), first treatment performed (p=0.337), lymphovascular invasion (p=0.286), and age (p=0.152). However, the number of lines of chemotherapy was significantly associated with survival (log-rank p=0.013), with an estimated median survival of 10.2 months for patients who received up to two lines of treatment and 23.5 months for those receiving more than two lines of chemotherapy.Conclusion The survival of patients treated was longer than that reported in the literature. The only statistically significant factor related to increased survival was higher number of lines of chemotherapy received. We believe that the higher socioeconomic status of patients surveyed in this study, as well as their greater access to treatment options, may have influenced their overall survival.

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PECULIARITIES OF MANIFESTATION OF THE SKIN FORM OF LEISHMANIASIS OF MAXILLOFACIAL LOCALIZATION

Ukrainian Dental Almanac ◽

10.31718/2409-0255.2.2020.10 ◽

2020 ◽

pp. 63-66

Author(s):

M.G. Skikevych ◽

L.I. Voloshyna

Keyword(s):

Cutaneous Leishmaniasis ◽

Disease Risk ◽

Treatment Options ◽

Local Treatment ◽

Geographical Location ◽

Skin Lesions ◽

The Body ◽

Mononuclear Phagocytes ◽

Superficial Skin ◽

The Face

Leishmaniasis is a vector-borne disease in humans. Simple intracellular parasites cause the disease. Risk factors: socio-economic conditions, poverty. The disease is associated with malnutrition, with population displacement, with poor housing conditions, with a weak immune system, poor sanitary conditions, and lack of waste disposal. Up to 1 million new infections and up to 65,000 deaths from this disease occur annually. About 95% of cases of skin form disease occur in the countries of the American continent. Leishmaniasis occurs in Uzbekistan and Turkmenistan. The carriers of this disease are female mosquitoes. In the mosquito, parasites are in flagellate form. The natural reservoirs of Leishmania can be around 70 species of animals and humans. Infection occurs through mosquito saliva. After a bite, the parasite invades human mononuclear phagocytes. There may be infection of a person in contact with ulcers and other types of damage. Veterinarians have noted a dramatically increasing number of cases of disease in domestic animals. The following forms are clinically distinguished: cutaneous, mucocutaneous, diffuse cutaneous and visceral forms of leishmaniasis. After the disease develops, a stable immunity to this particular type of leishmaniasis develops. Cutaneous leishmaniasis is the most common form. Ulcers form in open areas of the body. Typical places of localization: face, ears, knees, elbows. Some nodules may have a warty surface or resemble xanthomas, keloids. After healing of these ulcers, scars remain for life. The nasopharynx, oral cavity, or nasal mucosa can be affected without destroying the nasal septum. For cutaneous leishmaniasis, the formation of an infectious granuloma is also characteristic. Treatment of cutaneous leishmaniasis can be local or systemic, depending on the damage and pathogen. Local treatment is suitable for minor and uncomplicated lesions. Local treatment options: heat therapy, cryotherapy. Systemic therapy is used in patients with multiple extensive rashes. Patient K. turned to the maxillofacial department. The patient came home to Ukraine for the purpose of diagnosis and treatment. The patient works in Poland at a construction site. According to the patient, several courses of treatment. The treatment had no result. The pharmacotherapy of our Polish colleagues is not known to us. Clinically: superficial skin lesions on the face. On the face are three ulcers of different sizes. Two ulcers on the cheeks and one on the nose. Palpation of the edges of the ulcers is very painful. Diagnostic search for the etiology of this process. Consultation of a rheumatologist ̶ the goal of eliminating Wegener's disease, rheumatological diseases. Hematologist consultation ̶ exclude hematology. Infectionist consultation ̶ rule out parasitic diseases. Laboratory examination: biochemical blood test, immunogram, rheumatic tests. CT scan of the abdomen. Consultation of a parasitologist. The diagnosis was not in doubt.The patient refused examination and treatment in the infectious diseases hospital. The further fate of this patient is not known to us. We want to draw the attention of doctors to the need for a thorough history taking. An epidemiological history is crucial in such cases. Treatment of leishmaniasis is long and toxic. No method of treatment gives 100% of the result. The choice of treatment method will depend on the type of pathogen and the geographical location of the infection.This disease can be brought by tourists, students from relevant countries of the world to Ukraine.

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Surgery for Lung Cancer and the Consequences for the Swallow

Perspectives of the ASHA Special Interest Groups ◽

10.1044/persp1.sig13.162 ◽

2016 ◽

Vol 1 (13) ◽

pp. 162-168

Author(s):

Pippa Hales ◽

Corinne Mossey-Gaston

Keyword(s):

Lung Cancer ◽

Treatment Options ◽

Vocal Cord Palsy ◽

Subsequent Treatment ◽

Physiological Reserve ◽

Palliative Phase ◽

And Function ◽

The Impact ◽

Swallow Function

Lung cancer is one of the most commonly diagnosed cancers across Northern America and Europe. Treatment options offered are dependent on the type of cancer, the location of the tumor, the staging, and the overall health of the person. When surgery for lung cancer is offered, difficulty swallowing is a potential complication that can have several influencing factors. Surgical interaction with the recurrent laryngeal nerve (RLN) can lead to unilateral vocal cord palsy, altering swallow function and safety. Understanding whether the RLN has been preserved, damaged, or sacrificed is integral to understanding the effect on the swallow and the subsequent treatment options available. There is also the risk of post-surgical reduction of physiological reserve, which can reduce the strength and function of the swallow in addition to any surgery specific complications. As lung cancer has a limited prognosis, the clinician must also factor in the palliative phase, as this can further increase the burden of an already compromised swallow. By understanding the surgery and the implications this may have for the swallow, there is the potential to reduce the impact of post-surgical complications and so improve quality of life (QOL) for people with lung cancer.

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The Impact of Shariah Governance and Corporate Governance on the Risk Management Practices: Evidence from Local and Foreign Islamic Banks in Malaysia

The Journal of Muamalat and Islamic Finance Research ◽

10.33102/jmifr.v15i2.174 ◽

2018 ◽

Vol 15 (2) ◽

pp. 1-20

Author(s):

Sabri Embi ◽

Zurina Shafii

Keyword(s):

Risk Management ◽

Corporate Governance ◽

Management Practices ◽

Principal Component ◽

T Test ◽

The Body ◽

Primary Data ◽

Islamic Banks ◽

Shariah Governance ◽

The Impact

The purpose of this study is to examine the impact of Shariah governance and corporate governance (CG) on the risk management practices (RMPs) of local Islamic banks and foreign Islamic banks operating in Malaysia. The Shariah governance comprises the Shariah review (SR) and Shariah audit (SA) variables. The study also evaluates the level of RMPs, CG, SR, and SA between these two type of banks. With the aid of SPSS version 20, the items for RMPs, CG, SR, and SA were subjected to principal component analysis (PCA). From the PCA, one component or factor was extracted each for the CG, SR, and RMPs while another two factors were extracted for the SA. Primary data was collected using a self-administered survey questionnaire. The questionnaire covers four aspects ; CG, SR, SA, and RMPs. The data received from the 300 usable questionnaires were subjected to correlation and regression analyses as well as an independent t-test. The result of correlation analysis shows that all the four variables have large positive correlations with each other indicating a strong and significant relationship between them. From the regression analysis undertaken, CG, SR, and SA together explained 52.3 percent of the RMPs and CG emerged as the most influential variable that impacts the RMPs. The independent t-test carried out shows that there were significant differences in the CG and SA between the local and foreign Islamic banks. However, there were no significant differences between the two types of the bank in relation to SR and RMPs. The study has contributed to the body of knowledge and is beneficial to academicians, industry players, regulators, and other stakeholders.

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Influence of DAFS-25+polizon composition on blood and functional state of liver of steers at fattening

Veterinaria Kubani ◽

10.33861/2071-8020-2020-1-15-18 ◽

2020 ◽

pp. 15-18

Author(s):

Inna R. Kilmetova ◽

◽

Igor A. Rodin ◽

Nazira I. Khayrullina ◽

Nikolay G. Fenchenko ◽

...

Keyword(s):

Functional State ◽

White Blood Cells ◽

Live Weight ◽

The Body ◽

Farm Animals ◽

Control Group ◽

Standard Diet ◽

The Impact ◽

Experimental Group ◽

Stimulation Of

Summary. The disbalanced feeding and the uneven distribution of micro- and macroelements in the environment leads to a trace element, in particular hypomelanosis. To accelerate the growth and preservation of young farm animals include in the diet of various biological additives and drugs, which include selenium. For stimulation of weight gain in the livestock industry, as well as for the prevention and treatment of pathological processes in addition to micro - and macrouse amino acids, primarily methionine. The aim of this work was to study the influence of composition of DAFS-25+Polizon on morpho-biochemical parameters of blood and functional state of the liver in fattening bulls of black-motley breed in the conditions of the Republic of Bashkortostan. Experiments using were conducted on bull-calves of black-motley breed of the properties in the properties age from 6 to 15 months. The first experimental group during the experiment was additionally given the composition of DAFS-25+Polizon at a dose of 2 mg/kg, the animals of the control group received a standard diet. To assess the impact of the composition DAFS-25+Polizon on metabolism cattle studied morphological and biochemical indicators of blood and conducted histological examination of the liver. It is established that the use of the composition of DAFS-25+Polizon at a dose of 2 mg/kg increases the number of erythrocytes and hemoglobin in the experimental group and reduces the amount of white blood cells. The serum content of total protein, phosphorus and calcium increases in the group of experimental animals. Microscopic examination of the liver revealed no changes in the structure of the organ and hepatocytes in the experimental group, whereas in the control group hemodynamic disorders and dystrophic changes in liver cells were observed. Thus, the use of the composition DAFS-25+Polizon at a dose of 2 mg/kg of live weight in fattening bulls black-and-white breed contributes to the increase of redox processes in the body, stimulation of metabolism, prevent the development of liver disorders of cellular mechanisms of metabolism, optimizes the structure of the liver, which generally provides higher productivity.

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Comparative assessment of morphological mechanisms of maintaining structural liver homeostasis in the dynamics of exposure to coal-rock dust and sodium fluoride on the body

Russian Journal of Occupational Health and Industrial Ecology ◽

10.31089/1026-9428-2020-60-3-189-194 ◽

2020 ◽

pp. 189-194

Author(s):

M. S. Bugaeva ◽

O. I. Bondarev ◽

N. N. Mikhailova ◽

L. G. Gorokhova

Keyword(s):

Sodium Fluoride ◽

Morphological Changes ◽

The Body ◽

System Level ◽

Production Factor ◽

Coal Rock ◽

The Impact ◽

Structural Homeostasis ◽

Rock Dust

Introduction. The impact on the body of such factors of the production environment as coal-rock dust and fluorine compounds leads to certain shift s in strict indicators of homeostasis at the system level. Maintaining the relative constancy of the internal environment of the body is provided by the functional consistency of all organs and systems, the leading of which is the liver. Organ repair plays a crucial role in restoring the structure of genetic material and maintaining normal cell viability. When this mechanism is damaged, the compensatory capabilities of the organ are disrupted, homeostasis is disrupted at the cellular and organizational levels, and the development of the main pathological processes is noted.The aim of the study is to compare the morphological mechanisms of maintaining structural homeostasis of the liver in the dynamics of the impact on the body of coal-rock dust and sodium fluoride.Materials and methods. Experimental studies were conducted on adult white male laboratory rats. Features of morphological mechanisms for maintaining structural homeostasis of the liver in the dynamics of exposure to coal-rock dust and sodium fluoride were studied on experimental models of pneumoconiosis and fluoride intoxication. For histological examination in experimental animals, liver sampling was performed after 1, 3, 6, 9, 12 weeks of the experiment.Results. The specificity of morphological changes in the liver depending on the harmful production factor was revealed. It is shown that chronic exposure to coal-rock dust and sodium fluoride is characterized by the development of similar morphological changes in the liver and its vessels from the predominance of the initial compensatory-adaptive to pronounced violations of the stromal and parenchymal components. Long-term inhalation of coal-rock dust at 1–3 weeks of seeding triggers adaptive mechanisms in the liver in the form of increased functional activity of cells, formation of double-core hepatocytes, activation of immunocompetent cells and endotheliocytes, ensuring the preservation of the parenchyma and the general morphostructure of the organ until the 12th week of the experiment. Exposure to sodium fluoride leads to early disruption of liver compensatory mechanisms and the development of dystrophic changes in the parenchyma with the formation of necrosis foci as early as the 6th week of the experiment.Conclusions. The study of mechanisms for compensating the liver structure in conditions of long-term exposure to coal-rock dust and sodium fluoride, as well as processes that indicate their failure, and the timing of their occurrence, is of theoretical and practical importance for developing recommendations for the timely prevention and correction of pathological conditions developing in employees of the aluminum and coal industry.The authors declare no conflict of interests.

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