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Sarmadi M, Bagherian Z, Ahmadi-Soleimani SM, Rezaiemanesh MR, Khodamoradi F, Rahimi S, Azizi H. Environmental health risk factors and cutaneous leishmaniasis (CL): A case-control study in northeastern Iran. J Vector Borne Dis 2023; 60:372-381. [PMID: 38174514 DOI: 10.4103/0972-9062.374236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Abstract
Background & objectives Cutaneous leishmaniasis (CL) is one of the main causes of vector-born diseases in younger population. To evaluate the association of environmental health factors on the odds of CL incidence, a case-control study was conducted in northeastern Iran. Methods This study was conducted within 2020-2021 based on individual and household data from a tertiary referral center. Cases were patients diagnosed with CL by PCR method; controls were selected among the patients' relatives, and information was obtained from a health registry system. Demographic and socioeconomic data of 1871 subjects, included age, sex, household information and environmental health factors. Multivariable models with environmental factors in various conditions and CL were separately fit by univariate and mixed multiple unconditional logistic regression. Results Participants included 617 cases (mean [SD] age, 13.62[13.72] years; 58.20% male) and 1264 controls (mean [SD] age, 16.45[15.44] years; 50.40% male). Results revealed that the use of well-water sources compared to surface water is significantly associated with CL (odds ratio [OR]=0.204; 95%CI, 0.13-0.33;P<0.001). Muddy houses, ruined buildings or wastelands and stagnant water, canals and rivers near the houses were also associated with CL (OR=3.85; 95%CI, 1.66-8.89; P=.002; OR=2.47; 95%CI, 1.76-3.47; P<.001). Besides, existence of pine tree was found to be a risk factor (OR=3.25; 95%CI, 2.12-4.99; P<.001) and similarly for the use of waste collection system (OR=4.43; 95%CI, 3.32-7.51; P<.001). Interpretation & conclusion Environmental factors related to houses were significantly associated with CL and may represent the modifiable risk factors of CL disease.
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Affiliation(s)
- Mohammad Sarmadi
- Department of Environmental Health Engineering, School of Health; Health Sciences Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Zahra Bagherian
- Student Research Committee, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - S Mohammad Ahmadi-Soleimani
- Health Sciences Research Center; Department of Physiology, School of Medicine, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Mohammad Reza Rezaiemanesh
- Health Sciences Research Center; Department of Laboratory Sciences, School of Paramedical Sciences, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Farzad Khodamoradi
- Department of Biostatistics and Epidemiology, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Sajjad Rahimi
- Department of Environmental Health Engineering, School of Health; Health Sciences Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Hakim Azizi
- Department of Medical Parasitology, School of Medicine, Zabol University of Medical Sciences, Zabol, Iran
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Luo P, Shu L, Huang Z, Huang Y, Wu C, Pan X, Hu P. Utilization of Lyotropic Liquid Crystalline Gels for Chronic Wound Management. Gels 2023; 9:738. [PMID: 37754419 PMCID: PMC10530416 DOI: 10.3390/gels9090738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 09/07/2023] [Accepted: 09/09/2023] [Indexed: 09/28/2023] Open
Abstract
Management of chronic wounds is becoming a serious health problem worldwide. To treat chronic wounds, a suitable healing environment and sustained delivery of growth factors must be guaranteed. Different therapies have been applied for the treatment of chronic wounds such as debridement and photodynamic therapy. Among them, growth factors are widely used therapeutic drugs. However, at present, growth factor delivery systems cannot meet the demand of clinical practice; therefore new methods should be developed to meet the emerging need. For this reason, researchers have tried to modify hydrogels through some methods such as chemical synthesis and molecule modifications to enhance their properties. However, there are still a large number of limitations in practical use like byproduct problems, difficulty to industrialize, and instability of growth factor. Moreover, applications of new materials like lyotropic liquid crystalline (LLC) on chronic wounds have emerged as a new trend. The structure of LLC is endowed with many excellent properties including low cost, ordered structure, and excellent loading efficiency. LLC can provide a moist local environment for the wound, and its lattice structure can embed the growth factors in the water channel. Growth factor is released from the high-concentration carrier to the low-concentration release medium, which can be precisely regulated. Therefore, it can provide sustained and stable delivery of growth factors as well as a suitable healing environment for wounds, which is a promising candidate for chronic wound healing and has a broad prospective application. In conclusion, more reliable and applicable drug delivery systems should be designed and tested to improve the therapy and management of chronic wounds.
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Affiliation(s)
- Peili Luo
- College of Pharmacy, Jinan University, Guangzhou 511443, China; (P.L.); (L.S.); (C.W.); (P.H.)
| | - Lei Shu
- College of Pharmacy, Jinan University, Guangzhou 511443, China; (P.L.); (L.S.); (C.W.); (P.H.)
| | - Zhengwei Huang
- College of Pharmacy, Jinan University, Guangzhou 511443, China; (P.L.); (L.S.); (C.W.); (P.H.)
| | - Ying Huang
- College of Pharmacy, Jinan University, Guangzhou 511443, China; (P.L.); (L.S.); (C.W.); (P.H.)
| | - Chuanbin Wu
- College of Pharmacy, Jinan University, Guangzhou 511443, China; (P.L.); (L.S.); (C.W.); (P.H.)
| | - Xin Pan
- School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou 510006, China;
| | - Ping Hu
- College of Pharmacy, Jinan University, Guangzhou 511443, China; (P.L.); (L.S.); (C.W.); (P.H.)
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Assis TMD, Rabello A, Cota G. Economic evaluations addressing diagnosis and treatment strategies for neglected tropical diseases: an overview. Rev Inst Med Trop Sao Paulo 2021; 63:e41. [PMID: 34037157 PMCID: PMC8149103 DOI: 10.1590/s1678-9946202163041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 04/23/2021] [Indexed: 11/22/2022] Open
Abstract
Neglected tropical diseases (NTDs) are those affecting vulnerable people and
causing additional social and economic burden. The aim of this study was to
carry out a general overview of the health economic assessments involving the
diagnosis and treatment of six NTDs: cutaneous leishmaniasis (CL), Chagas
disease, cysticercosis, filariasis, schistosomiasis and visceral leishmaniasis
(VL). The literature search was based on two of the main medical literature
databases (Medline and SciELO) and identified 46 studies. Twenty-six studies
(57%) addressed therapeutic strategies, while other 20 (43%) assessed diagnostic
or both diagnostic and therapeutic approaches. The studies were published
between 1994 and 2021, and 57% of them (26/46) were carried out in four
countries. Cost-effectiveness analyses were conducted in 59% (27/46) of the
studies. Economic studies of NTDs have timidly increased in recent years.
Despite the improvement of analytical methods, completeness and accuracy of
information, there are few new technologies applied to NTDs and public health
systems. In addition, economic studies for NTDs are concentrated in a few
countries. Thus, this review points out the need for investment in research,
development and training of human resources dedicated to the economic analysis
in health, especially on NTDs, as a strategy to reduce inequalities by
optimizing the use of health resources.
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Affiliation(s)
- Tália Machado de Assis
- Fundação Oswaldo Cruz, Instituto René Rachou, Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias, Belo Horizonte, Minas Gerais, Brazil.,Centro Federal de Educação Tecnológica de Minas Gerais, Contagem, Minas Gerais, Brazil
| | - Ana Rabello
- Fundação Oswaldo Cruz, Instituto René Rachou, Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias, Belo Horizonte, Minas Gerais, Brazil
| | - Gláucia Cota
- Fundação Oswaldo Cruz, Instituto René Rachou, Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias, Belo Horizonte, Minas Gerais, Brazil
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Galvão EL, Assis TSMD, Pedras MJ, Cota GF, Simões TC, Rabello A. Economic impact of localized cutaneous leishmaniasis on adult patients of a referral service in Belo Horizonte, Minas Gerais State, Brazil. CAD SAUDE PUBLICA 2020; 36:e00136419. [PMID: 32696829 DOI: 10.1590/0102-311x00136419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 12/06/2019] [Indexed: 11/22/2022] Open
Abstract
Cutaneous leishmaniasis (CL) is a disease associated with low-income populations. Thus, in assessing the burden of this disease, it is important to include its economic impact on individuals. We aimed to evaluate CL economic impact on patients treated at a referral service in the State of Minas Gerais, Brazil. This is a cross-sectional study based on the analysis of interviews and medical records from which we assembled direct medical and non-medical costs related to CL, from a societal perspective. One hundred patients were included; 50% had a monthly per capita income of up to USD 259.60 and spent on average USD 187.32 with the disease, representing an average monthly impact of 22.5% (USD 133.80). The disease imposed direct medical costs, such as: private medical appointments, medications, medical exams, dressing material, and co-participation in health insurances. Direct non-medical costs were mainly related to patients' transportation to health centers (USD 4,911.00), but also included medically-necessary care, food, and domestic and business outsourcing services. Although the Brazilian public health system guarantees access to health care, CL still represents a substantial economic impact for patients. The main action to reduce the expenses with this disease is decentralizing services for CL diagnosis and therapeutic approach, as well as increasing their efficiency.
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Affiliation(s)
- Endi Lanza Galvão
- Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brazil
| | | | | | | | | | - Ana Rabello
- Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brazil
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Brito NC, Machado de Assis TS, Rabello A, Cota G. Intralesional infiltration versus parenteral use of meglumine antimoniate for treatment of cutaneous leishmaniasis: A cost-effectiveness analysis. PLoS Negl Trop Dis 2019; 13:e0007856. [PMID: 31805052 PMCID: PMC6917345 DOI: 10.1371/journal.pntd.0007856] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 12/17/2019] [Accepted: 10/17/2019] [Indexed: 01/11/2023] Open
Abstract
Cutaneous leishmaniasis (LC) is a complex and variable disease in terms of epidemiology, aetiology, pathology and clinical characteristics. The mainstay of treatment is still pentavalent antimony (Sbv) compounds administered systemically, despite their recognized toxicity. The advantages of antimony intralesional (IL) infiltration are the use of lower doses of Sbv and, therefore, less toxic effects. The objective of this study was to estimate the cost-effectiveness ratio of intralesional meglumine antimoniate therapy (IL-MA) compared with endovenous meglumine antimoniate therapy (EV-MA) for the treatment of CL in the context of the Brazilian National Health System (SUS). An analytical decision model (decision tree) was developed using TreeAge Pro 2018 software. Data from the open-label, uncontrolled phase II clinical trial evaluating IL-MA were used as a reference for posology, efficacy, and adverse event rates (AE). The same premises for the intravenous approach (EV-MA) were extracted from systematic literature reviews. Macro and micro calculations of spending were included in the analysis. The IL-MA and EV-MA strategies had a total cost per patient cured of US$330.81 and US$494.16, respectively. The intralesional approach was dominant, meaning it was more economic and effective than was endovenous therapy. The incremental cost-effectiveness ratio showed that IL-MA could result in savings of US$864.37 for each additional patient cured, confirming that the IL-MA strategy is cost effective in the context of the Brazilian public health scenario.
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Affiliation(s)
- Nayara C. Brito
- Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias-Centro de Pesquisas René Rachou-Fundação Oswaldo Cruz, Fiocruz, Belo Horizonte, Minas Gerais, Brazil
| | - Tália S. Machado de Assis
- Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias-Centro de Pesquisas René Rachou-Fundação Oswaldo Cruz, Fiocruz, Belo Horizonte, Minas Gerais, Brazil
| | - Ana Rabello
- Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias-Centro de Pesquisas René Rachou-Fundação Oswaldo Cruz, Fiocruz, Belo Horizonte, Minas Gerais, Brazil
| | - Gláucia Cota
- Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias-Centro de Pesquisas René Rachou-Fundação Oswaldo Cruz, Fiocruz, Belo Horizonte, Minas Gerais, Brazil
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Aerts C, Vink M, Pashtoon SJ, Nahzat S, Picado A, Cruz I, Sicuri E. Cost Effectiveness of New Diagnostic Tools for Cutaneous Leishmaniasis in Afghanistan. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2019; 17:213-230. [PMID: 30465319 PMCID: PMC6439180 DOI: 10.1007/s40258-018-0449-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND AND OBJECTIVES Cutaneous leishmaniasis is responsible for chronic and disfiguring skin lesions resulting in morbidity and social stigma. The gold standard to diagnose cutaneous leishmaniasis is microscopy but has a variable sensitivity and requires trained personnel. Using four scenarios, the objective of this study is to compare the cost effectiveness of microscopy with two new tools: Loopamp™ Leishmania Detection Kit (LAMP) and CL Detect™ Rapid Test (RDT). METHODS Data related to the cost and accuracy of these tools were collected at the clinic of the National Malaria and Leishmaniasis Control Program in Kabul, Afghanistan. The effectiveness estimates were measured based on the tools' performance but also indirectly, using the disability-adjusted life years. A decision tree was designed in TreeAge Healthcare Pro 2016, combined with a Markov model representing the natural history of cutaneous leishmaniasis. In addition to a deterministic analysis, univariate sensitivity and probabilistic analyses were performed to test the robustness of the results. RESULTS If the tools are compared at the National Malaria and Leishmaniasis Control Program level in a period of low incidence, microscopy remains the preferred option. LAMP becomes more appropriate during cutaneous leishmaniasis seasons or outbreaks when its capacity to process several tests (e.g. up to 48) at a time can be maximised. RDT has a cost similar to microscopy when used at the reference clinic but as it is relatively easy to use, it could be implemented at the peripheral level, which would become cheaper than employing microscopy at the reference clinic. Moreover, combining RDT with microscopy or LAMP at the reference clinic for the negative suspects is economically more interesting than directly performing LAMP or microscopy respectively on all cutaneous leishmaniasis suspects at the reference clinic. CONCLUSIONS When taking advantage of their respective strengths, LAMP and RDT can prove to be cost-effective alternatives to using microscopy alone at the reference clinic.
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Affiliation(s)
- Céline Aerts
- ISGlobal, Hospital-Clínic-Universitat de Barcelona, Carrer Rosselló 132, 08036, Barcelona, Spain.
| | - Martijn Vink
- Health Works (Formerly HealthNet TPO), Amsterdam, The Netherlands
| | | | - Sami Nahzat
- National Malaria and Leishmaniasis Control Program, Ministry of Public Health, Kabul, Afghanistan
| | - Albert Picado
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - Israel Cruz
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - Elisa Sicuri
- ISGlobal, Hospital-Clínic-Universitat de Barcelona, Carrer Rosselló 132, 08036, Barcelona, Spain
- Health Economics Group, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
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Yotsu RR. Integrated Management of Skin NTDs-Lessons Learned from Existing Practice and Field Research. Trop Med Infect Dis 2018; 3:E120. [PMID: 30441754 PMCID: PMC6306929 DOI: 10.3390/tropicalmed3040120] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 11/10/2018] [Accepted: 11/11/2018] [Indexed: 12/18/2022] Open
Abstract
Integration of neglected tropical diseases (NTDs) into the public health agenda has been a priority in global health for the last decade. Because a number of these diseases share not only the geographical distribution, but also a common feature which is skin involvement, bringing together a sub-group of 'skin NTDs' is one way forward to promote further integration among NTDs. With these diseases, which include leprosy, Buruli ulcer, yaws, mycetoma, lymphatic filariasis, and leishmaniasis, patients may be left with life-long deformities and disabilities when diagnosis and treatment are delayed. Stigma is another serious consequence of skin NTDs as it places a large barrier on the economic activities and social life of a patient. As a result, this creates a vicious cycle and obstructs a key goal of society, the elimination of poverty. Enhancement in surveillance systems as well as the further development of diagnostic methods, improvement in treatment and management, and identification of preventative measures for skin NTDs are therefore urgently needed. This article summarizes the existing practices and field research on skin NTDs and identifies potential synergies that could be achieved by adopting this integrated approach.
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Affiliation(s)
- Rie R Yotsu
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki 852-8102, Japan.
- Department of Dermatology, National Center for Global Health and Medicine, Tokyo 162-8655, Japan.
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