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Masin PS, Visentin HA, Elpidio LNS, Sell AM, Visentainer L, Lima Neto QAD, Zacarias JMV, Couceiro P, Higa Shinzato A, Santos Rosa M, Rodrigues-Santos P, Visentainer JEL. Genetic polymorphisms of toll-like receptors in leprosy patients from southern Brazil. Front Genet 2022; 13:952219. [PMID: 36313452 PMCID: PMC9596761 DOI: 10.3389/fgene.2022.952219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 09/14/2022] [Indexed: 11/17/2022] Open
Abstract
Leprosy is a chronic disease and also a global health issue, with a high number of new cases per year. Toll-like receptors can respond to mycobacterial molecules in the early stage of infection. As important components of the innate immune response, alterations in genes coding for these receptors may contribute to susceptibility/protection against diseases. In this context, we used a case-control study model (183 leprosy cases vs. 185 controls) to investigate whether leprosy patients and the control group, in southern Brazil, have different frequencies in TLR1 (TLR1 G>T; rs5743618), TLR2 (TLR2 T>C, rs1816702 and rs4696483), and TLR4 (TLR4 A>G, rs1927911) polymorphisms. Analysis of the TLR1 1805G>T polymorphism presented the G/G genotype more frequently in the control group. TLR2 T>C rs1816702 and TLR2 T>C rs4696483, the T/T and C/T genotype, respectively, were more frequent in the control group than in leprosy patients, suggesting protection from leprosy when the T allele is present (rs4696483). Haplotype analyses between TLR1 (rs5743618) and TLR2 (rs1816702 and rs4696483) polymorphisms suggest risk for the presence of the TCC haplotype and protection in the presence of the TCT haplotype. This study suggests that polymorphisms in TLR1 and TLR2 are factors that may contribute to development/resistance of leprosy.
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Affiliation(s)
- Priscila Saamara Masin
- Immunology Institute, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Immunogenetics Laboratory, Department of Basic Health Sciences, Post-Graduation Program in Biosciences and Phisiophatology, Maringá State University, Maringá, PR, Brazil
| | - Hugo Alves Visentin
- Immunogenetics Laboratory, Department of Basic Health Sciences, Post-Graduation Program in Biosciences and Phisiophatology, Maringá State University, Maringá, PR, Brazil
| | - Laíse Nayana Sala Elpidio
- Immunogenetics Laboratory, Department of Basic Health Sciences, Post-Graduation Program in Biosciences and Phisiophatology, Maringá State University, Maringá, PR, Brazil
| | - Ana Maria Sell
- Immunogenetics Laboratory, Department of Basic Health Sciences, Post-Graduation Program in Biosciences and Phisiophatology, Maringá State University, Maringá, PR, Brazil
| | - Lorena Visentainer
- Department of Medicine, Faculty of Medicine Science, Campinas State University, Campinas, SP, Brazil
| | - Quirino Alves De Lima Neto
- Immunogenetics Laboratory, Department of Basic Health Sciences, Post-Graduation Program in Biosciences and Phisiophatology, Maringá State University, Maringá, PR, Brazil
| | - Joana Maira Valentini Zacarias
- Immunogenetics Laboratory, Department of Basic Health Sciences, Post-Graduation Program in Biosciences and Phisiophatology, Maringá State University, Maringá, PR, Brazil
| | - Patrícia Couceiro
- Immunology and Oncology Laboratory, Center for Neurosciences and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal
- Center of Investigation in Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Center for Innovation in Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal
- Clinical Academic Centre of Coimbra (CACC), Coimbra, Portugal
| | - Andressa Higa Shinzato
- Immunogenetics Laboratory, Department of Basic Health Sciences, Post-Graduation Program in Biosciences and Phisiophatology, Maringá State University, Maringá, PR, Brazil
- *Correspondence: Jeane Eliete Laguila Visentainer, ; Jeane E. L. Visentainer, ; Andressa Higa Shinzato,
| | - Manuel Santos Rosa
- Immunology Institute, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Center of Investigation in Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Center for Innovation in Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal
- Clinical Academic Centre of Coimbra (CACC), Coimbra, Portugal
| | - Paulo Rodrigues-Santos
- Immunology Institute, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Immunology and Oncology Laboratory, Center for Neurosciences and Cell Biology (CNC), University of Coimbra, Coimbra, Portugal
- Center of Investigation in Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Center for Innovation in Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal
- Clinical Academic Centre of Coimbra (CACC), Coimbra, Portugal
| | - Jeane Eliete Laguila Visentainer
- Immunogenetics Laboratory, Department of Basic Health Sciences, Post-Graduation Program in Biosciences and Phisiophatology, Maringá State University, Maringá, PR, Brazil
- *Correspondence: Jeane Eliete Laguila Visentainer, ; Jeane E. L. Visentainer, ; Andressa Higa Shinzato,
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The impact of KIR/HLA genes on the risk of developing multibacillary leprosy. PLoS Negl Trop Dis 2019; 13:e0007696. [PMID: 31525196 PMCID: PMC6762192 DOI: 10.1371/journal.pntd.0007696] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 09/26/2019] [Accepted: 08/08/2019] [Indexed: 11/19/2022] Open
Abstract
Background Killer-cell immunoglobulin-like receptors (KIRs) are a group of regulatory molecules able to activate or inhibit natural killer cells upon interaction with human leukocyte antigen (HLA) class I molecules. Combinations of KIR and HLA may contribute to the occurrence of different immunological and clinical responses to infectious diseases. Leprosy is a chronic neglected disease, both disabling and disfiguring, caused mainly by Mycobacterium leprae. In this case–control study, we examined the influence of KIRs and HLA ligands on the development of multibacillary leprosy. Methodology/Principal findings Genotyping of KIR and HLA genes was performed in 264 multibacillary leprosy patients and 518 healthy unrelated controls (238 healthy household contacts and 280 healthy subjects). These are unprecedented results in which KIR2DL2/KIR2DL2/C1/C2 and KIR2DL3/2DL3/C1/C1 indicated a risk for developing lepromatous and borderline leprosy, respectively. Concerning to 3DL2/A3/A11+, our study demonstrated that independent of control group (contacts or healthy subjects), this KIR receptor and its ligand act as a risk factor for the borderline clinical form. Conclusions/Significance Our finding suggests that synergetic associations of activating and inhibitory KIR genes may alter the balance between these receptors and thus interfere in the progression of multibacillary leprosy. Leprosy is a neglected disease with the highest worldwide prevalence, and remains a public health problem in Brazil. The innate immune mechanisms are determinants in the management of leprosy and its different clinical manifestations. Accordingly, genetic association study provides information about the contribution of host genetic factors and the environment in which the individual lives on the development of leprosy. The individuals considered most affected and associated with a major risk for developing leprosy are household contacts with an intimate relation to patients living in crowded households. For this reason, we chose the contacts as one of our control groups, since they are more exposed to infection compared to the general population. We investigated the influence of KIR and HLA genes on the susceptibility to multibacillary leprosy. Our results reinforce the importance of host genetic background in the susceptibility to leprosy demonstrating that, independent from the control group (contacts or healthy subjects) the KIR and HLA act as risk factors in the development of lepromatous and borderline leprosy.
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Carballeira NM, Alequín D, Lotti Diaz LM, Matos VJ, Ferreira LLG, Andricopulo AD, Golovko MY, Reguera RM, Pérez-Pertejo Y, Balaña-Fouce R. Synthesis of a novel brominated vinylic fatty acid with antileishmanial activity that effectively inhibits the Leishmania topoisomerase IB enzyme mediated by halogen bond formation. PURE APPL CHEM 2019. [DOI: 10.1515/pac-2018-1113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Many marine derived fatty acids, mainly from sponges, possess vinylic halogenated moieties (bromine or iodine) but their assessment as antileishmanial candidates remains elusive. In this work, we undertook the first total synthesis of a novel series of 2-allyl-3-halo-2-nonadecenoic acids, which preferentially inhibit the Leishmania DNA topoisomerase IB enzyme (LTopIB) over the human topoisomerase IB enzyme (hTopIB). The synthesis of 2-allyl-3-bromo-2E-nonadecenoic acid (1a) and 2-allyl-3-chloro-2E-nonadecenoic acid (2a) was achieved through a palladium catalyzed haloallylation of 2-nonadecynoic acid (2-NDA) using either allyl bromide or allyl chloride in the presence of PdCl2(PhCN)2 in 57–83 % overall yields. Among the new halogenated synthetic compounds, 1a was the most inhibitory of LTopIB with an EC50 = 7 μM, while the shorter chain analogs 2-allyl-3-bromo-2E-dodecenoic acid (1b) and 2-allyl-3-chloro-2E-dodecenoic acid (2b), synthesized from 2-dodecynoic acid, were not inhibitory of LTopIB (EC50 > 100 μM) resulting in the overall order of inhibition 1a > 2-NDA > 2a > > 1b ≅ 2b. The acids 1a and 2a inhibit LTopIB by a Gimatecan-independent mechanism. The enhanced LTopIB inhibition of 1a was computationally rationalized in terms of a halogen bond between the bromine in 1a and a DNA phosphate (binding energy = − 4.85 kcal/mol). Acid 1a also displayed preferential cytotoxicity towards Leishmania infantum amastigotes (EC50 = 2.5 μM) over L. infantum promastigotes (EC50 > 25 μM).
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Affiliation(s)
- Néstor M. Carballeira
- University of Puerto Rico , Río Piedras Campus, 17 Ave Universidad STE 1701 , San Juan, PR 00925-2537 , USA , Tel.: (787)-764-0000 ext, 88561
| | - Denisse Alequín
- Department of Chemistry , University of Puerto Rico , Río Piedras Campus , San Juan, PR , USA
| | - Leilani M. Lotti Diaz
- Department of Chemistry , University of Puerto Rico , Río Piedras Campus , San Juan, PR , USA
| | - Victorio Jauregui Matos
- Department of Chemistry , University of Puerto Rico , Río Piedras Campus , San Juan, PR , USA
| | - Leonardo L. G. Ferreira
- Laboratory of Medicinal and Computational Chemistry, Center for Research and Innovation in Biodiversity and Drug Discovery, Physics Institute of Sao Carlos, University of Sao Paulo , Sao Carlos , SP 13563-120 , Brazil
| | - Adriano D. Andricopulo
- Laboratory of Medicinal and Computational Chemistry, Center for Research and Innovation in Biodiversity and Drug Discovery, Physics Institute of Sao Carlos, University of Sao Paulo , Sao Carlos , SP 13563-120 , Brazil
| | - Mikhail Y. Golovko
- Department of Biomedical Sciences , University of North Dakota School of Medicine and Health Sciences , 1301 N Columbia Road , Grand Forks, ND 58202-9037 , USA
| | - Rosa M. Reguera
- Department of Biomedical Sciences , University of León , Campus de Vegazana , León 24071 , Spain
| | - Yolanda Pérez-Pertejo
- Department of Biomedical Sciences , University of León , Campus de Vegazana , León 24071 , Spain
| | - Rafael Balaña-Fouce
- Department of Biomedical Sciences , University of León , Campus de Vegazana , León 24071 , Spain
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Villar JC, Herrera VM, Pérez Carreño JG, Váquiro Herrera E, Castellanos Domínguez YZ, Vásquez SM, Cucunubá ZM, Prado NG, Hernández Y. Nifurtimox versus benznidazole or placebo for asymptomatic Trypanosoma cruzi infection (Equivalence of Usual Interventions for Trypanosomiasis - EQUITY): study protocol for a randomised controlled trial. Trials 2019; 20:431. [PMID: 31307503 PMCID: PMC6631895 DOI: 10.1186/s13063-019-3423-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 05/10/2019] [Indexed: 12/05/2022] Open
Abstract
Background Either benznidazole (BZN) or nifurtimox (NFX) is recommended as equivalent to treat Trypanosoma cruzi infection. Nonetheless, supportive data from randomised trials is limited to individuals treated with BZN in southern cone countries of Latin America. Methods The goal of this randomised, concealed, blind, parallel-group trial is to inform the trypanocidal efficacy and safety of NFX and its equivalence to BZN among individuals with T. cruzi positive serology (TC+). Eligible individuals are TC+, 20–65 years old, with no apparent symptoms/signs or uncontrolled risk factors for cardiomyopathy and at negligible risk of re-infection. Consenting individuals (adherent to a 10-day placebo run-in phase) receive a 120-day BID blinded treatment with NFX, BZN or matching placebo (2:2:1 ratio). The four active medication arms include (1) a randomly allocated sequence of 60-day, conventional-dose (60CD) regimes (BZN 300 mg/day or NFX 480 mg/day, ratio 1:1), followed or preceded by a 60-day placebo treatment, or (2) 120-day half-dose (120HD) regimes (BZN 150 mg/day or NFX 240 mg/day, ratio 1:1). The primary efficacy outcome is the proportion of participants testing positive at least once for up to three polymerase chain reaction (PCR) assays (1 + PCR) 12–18 months after randomisation. A composite safety outcome includes moderate to severe adverse reactions, consistent blood marker abnormalities or treatment abandons. The trial outside Colombia (expected to recruit at least 60% of participants) is pragmatic; it may be open-label and not include all treatment groups, but it must adhere to the randomisation and data administration system and guarantee a blinded efficacy outcome evaluation. Our main comparisons include NFX groups with placebo (for superiority), NFX versus BZN groups and 60CD versus 120HD groups (for non-inferiority) and testing for the agent-dose and group-region interactions. Assuming a 1 + PCR ≥ 75% in the placebo group, up to 25% among BZN-treated and an absolute difference of up to ≥ 25% with NFX to claim its trypanocidal effect, 60–80 participants per group (at least 300 from Colombia) are needed to test our hypotheses (80–90% power; one-sided alpha level 1%). Discussion The EQUITY trial will inform the trypanocidal effect and equivalence of nitroderivative agents NFX and BZN, particularly outside southern cone countries. Its results may challenge current recommendations and inform choices for these agents. Trial registration ClinicalTrials.gov, NCT02369978. Registered on 24 February 2015. Electronic supplementary material The online version of this article (10.1186/s13063-019-3423-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Juan Carlos Villar
- Grupo de Cardiología Preventiva, Facultad de Ciencias de la Salud, Universidad Autónoma de Bucaramanga, Calle 157 No 19- 55, Campus el Bosque, Bucaramanga, Colombia. .,Departamento de Investigaciones, Fundación Cardioinfantil- Instituto de Cardiología, Bogotá, Colombia.
| | - Víctor Mauricio Herrera
- Grupo de Cardiología Preventiva, Facultad de Ciencias de la Salud, Universidad Autónoma de Bucaramanga, Calle 157 No 19- 55, Campus el Bosque, Bucaramanga, Colombia
| | - Juan Guillermo Pérez Carreño
- Departamento de Investigaciones, Fundación Cardioinfantil- Instituto de Cardiología, Bogotá, Colombia.,Dirección de Investigación e Innovación, Universidad del Rosario, Bogotá, Colombia
| | - Eliana Váquiro Herrera
- Departamento de Investigaciones, Fundación Cardioinfantil- Instituto de Cardiología, Bogotá, Colombia
| | - Yeny Zulay Castellanos Domínguez
- Grupo de Cardiología Preventiva, Facultad de Ciencias de la Salud, Universidad Autónoma de Bucaramanga, Calle 157 No 19- 55, Campus el Bosque, Bucaramanga, Colombia
| | - Skarlet Marcell Vásquez
- Grupo de Cardiología Preventiva, Facultad de Ciencias de la Salud, Universidad Autónoma de Bucaramanga, Calle 157 No 19- 55, Campus el Bosque, Bucaramanga, Colombia
| | - Zulma Milena Cucunubá
- Grupo de Parasitología, Instituto Nacional de Salud, Bogotá,, Colombia.,MRC Centre for Global Infectious Disease Analysis (MRC GIDA), Department of Infection Disease Epidemiology, Imperial College London, London, UK
| | - Nilda Graciela Prado
- Departamento de Clínica, Patología y Tratamiento, Instituto Nacional de Parasitología Mario Fatala Chabén, Buenos Aires, Argentina
| | - Yolanda Hernández
- Departamento de Clínica, Patología y Tratamiento, Instituto Nacional de Parasitología Mario Fatala Chabén, Buenos Aires, Argentina
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Affiliation(s)
- José Azoh Barry
- Investigación & Acción, A.C., General Escobedo, Nuevo León, Mexico
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Optimal dosing of miltefosine in children and adults with visceral leishmaniasis. Antimicrob Agents Chemother 2012; 56:3864-72. [PMID: 22585212 DOI: 10.1128/aac.00292-12] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Only anecdotal data are available on the pharmacokinetics (PK) of miltefosine in children suffering from visceral leishmaniasis (VL). While failure rates were higher in children with VL, steady-state concentrations appeared lower than those seen with adults. We hypothesized that the current linear dosage (in milligrams per kilogram of body weight) is too low for children and that a new dosing algorithm based on an appropriate body size model would result in an optimal exposure. A population PK analysis was performed on three historic pooled data sets, including Indian children, Indian adults, and European adults. Linear and allometric scaling of PK parameters by either body weight or fat-free mass (FFM) was evaluated for body size models. Based on the developed PK model, a dosing algorithm for miltefosine in children and adults was proposed and evaluated in silico. The population PK model employing allometric scaling fitted best to the pooled miltefosine data. Allometric scaling by FFM reduced between-subject variability, e.g., for drug clearance, from 49.6% to 32.1%. A new allometric miltefosine dosing algorithm was proposed. Exposure to miltefosine was lower in children than adults receiving 2.5 mg/kg/day: a C(max) of 18.8 μg/ml was reached by 90% of adults and 66.7% of children. The allometric daily dose resulted in similar levels of exposure to miltefosine for adults and children. The use of a new allometric dosing algorithm for miltefosine in VL patients results in optimal exposure to miltefosine in both adults and children and might improve clinical outcome in children.
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Gambhir M, Bockarie M, Tisch D, Kazura J, Remais J, Spear R, Michael E. Geographic and ecologic heterogeneity in elimination thresholds for the major vector-borne helminthic disease, lymphatic filariasis. BMC Biol 2010; 8:22. [PMID: 20236528 PMCID: PMC2848205 DOI: 10.1186/1741-7007-8-22] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Accepted: 03/17/2010] [Indexed: 11/25/2022] Open
Abstract
Background Large-scale intervention programmes to control or eliminate several infectious diseases are currently underway worldwide. However, a major unresolved question remains: what are reasonable stopping points for these programmes? Recent theoretical work has highlighted how the ecological complexity and heterogeneity inherent in the transmission dynamics of macroparasites can result in elimination thresholds that vary between local communities. Here, we examine the empirical evidence for this hypothesis and its implications for the global elimination of the major macroparasitic disease, lymphatic filariasis, by applying a novel Bayesian computer simulation procedure to fit a dynamic model of the transmission of this parasitic disease to field data from nine villages with different ecological and geographical characteristics. Baseline lymphatic filariasis microfilarial age-prevalence data from three geographically distinct endemic regions, across which the major vector populations implicated in parasite transmission also differed, were used to fit and calibrate the relevant vector-specific filariasis transmission models. Ensembles of parasite elimination thresholds, generated using the Bayesian fitting procedure, were then examined in order to evaluate site-specific heterogeneity in the values of these thresholds and investigate the ecological factors that may underlie such variability Results We show that parameters of density-dependent functions relating to immunity, parasite establishment, as well as parasite aggregation, varied significantly between the nine different settings, contributing to locally varying filarial elimination thresholds. Parasite elimination thresholds predicted for the settings in which the mosquito vector is anopheline were, however, found to be higher than those in which the mosquito is culicine, substantiating our previous theoretical findings. The results also indicate that the probability that the parasite will be eliminated following six rounds of Mass Drug Administration with diethylcarbamazine and albendazole decreases markedly but non-linearly as the annual biting rate and parasite reproduction number increases. Conclusions This paper shows that specific ecological conditions in a community can lead to significant local differences in population dynamics and, consequently, elimination threshold estimates for lymphatic filariasis. These findings, and the difficulty of measuring the key local parameters (infection aggregation and acquired immunity) governing differences in transmission thresholds between communities, mean that it is necessary for us to rethink the utility of the current anticipatory approaches for achieving the elimination of filariasis both locally and globally.
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Affiliation(s)
- Manoj Gambhir
- Department of Infectious Disease Epidemiology, Imperial College London, UK.
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Affiliation(s)
- Peter J. Hotez
- Department of Microbiology, Immunology, and Tropical Medicine, The George Washington University, Washington, D.C., United States of America
- Sabin Vaccine Institute, Washington, D.C., United States of America
- * E-mail: or (PJH); (GY)
| | - Gavin Yamey
- Public Library of Science, San Francisco, California, United States of America
- * E-mail: or (PJH); (GY)
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Manderson L, Aagaard-Hansen J, Allotey P, Gyapong M, Sommerfeld J. Social research on neglected diseases of poverty: continuing and emerging themes. PLoS Negl Trop Dis 2009; 3:e332. [PMID: 19238216 PMCID: PMC2643480 DOI: 10.1371/journal.pntd.0000332] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Lenore Manderson
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.
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Villafuerte-Galvez J, Curioso WH, Miranda JJ. The role of medical students in the fight to control neglected tropical diseases: a view from Peru. PLoS Negl Trop Dis 2008; 2:e292. [PMID: 18836555 PMCID: PMC2561065 DOI: 10.1371/journal.pntd.0000292] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Javier Villafuerte-Galvez
- Scientific Society of Medical Students (“SOCEMCH”), “Alberto Hurtado” School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Walter H. Curioso
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Medical Education and Biomedical Informatics, School of Medicine, University of Washington Seattle, Washington, United States of America
- * E-mail: (WHC); (JJM)
| | - J. Jaime Miranda
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail: (WHC); (JJM)
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Abstract
Among infections closely associated with poverty, lymphatic filariasis (LF) is a study in contrasts. It is both a consequence of and a contributor to poverty. Although rarely fatal, it is recognized as a leading global cause of lifelong disability as well as significant personal, social, and economic burdens coincident with disease. Infection is often considerably more prevalent in communities than the number of cases of overt pathology for which LF is best known (lymphedema, elephantiasis, and hydrocele). With an estimated 120 million to 130 million affected persons in 83 countries and 1.25 billion persons living in areas at risk, in some countries LF may be expanding its range, whereas in others, with economic development, it has disappeared with little if any targeted intervention. The transmission cycle is relatively inefficient, yet an association with pockets of deepest poverty remains tenacious. Thanks to scientific advances in diagnostic tools, and particularly in control strategies focused on large-scale drug donation and mass drug distribution programs, scientists and policy makers now consider LF eliminable. Together with new approaches for morbidity control, a hopeful tone surrounds a disease problem that as recently as two decades ago could easily have been categorized as among the most neglected of neglected diseases. Continued progress toward global LF elimination will require solutions to potential obstacles in the most challenging--that is, the poorest--endemic settings. This chapter reviews progress toward LF elimination and some of the remaining challenges from a perspective in Haiti, the only least developed country of the Americas.
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Affiliation(s)
- Thomas Streit
- Center for Global Health and Infectious Diseases, Department of Biological Sciences, University of Notre Dame, Notre Dame, IN 46556-0369, USA.
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Abstract
Doruk Ozgediz and Robert Riviello discuss the burden of premature death and disability and the economic burden of surgical conditions in Africa.
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Affiliation(s)
- Doruk Ozgediz
- Department of Surgery and Global Health Sciences, University of California San Francisco, San Francisco, California, United States of America.
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