Tungiasis-related life quality impairment in children living in rural Kenya

BACKGROUND

Tungiasis (sand flea disease) is a neglected tropical skin disease caused by female sand fleas (Tunga spp.) embedded in the skin of the host. The disease is common in sub-Saharan Africa and predominantly affects children living in impoverished rural communities. In these settings tungiasis is associated with important morbidity. Whether tungiasis impairs life quality has never been studied.

METHODS

The study was performed in 50 children with tungiasis, living in resource-poor communities in coastal Kenya. Based on the Dermatology Life Quality Index (DLQI) a tool was developed to determine life quality impairment associated with tungiasis in children, the tungiasis-related Dermatology of Life Quality Index (tungiasis-related-DLQI). Pain and itching were assessed using visual scales ranging from 0-3 points. The intensity of infection and the acute and chronic severity of tungiasis were determined using standard methods.

RESULTS

Seventy eight percent of the patients reported a moderate to very large effect of tungiasis on life quality at the time of the diagnosis. The degree of impairment correlated with the number of viable sand fleas present in the skin (rho = 0.64, p < 0.001), the severity score of acute clinical pathology (rho = 0.74, p < 0.001), and the intensity of pain (rho = 0.82, p < 0.001). Disturbance of sleep and concentration difficulties were the most frequent restriction categories (86% and 84%, respectively). Four weeks after curative treatment, life quality had improved significantly. On the individual level the amelioration of life quality correlated closely with the regression of clinical pathology (rho = 0.61, p < 0.001).

CONCLUSION

The parasitic skin disease tungiasis considerably impairs life quality in children in rural Kenya. After effective treatment, life quality improves rapidly.

Direct parasitologial diagnosis of infection with Hysterothylacium aduncum in a patient with epigastralgia

Anisakis parasitization has been on the rise because some factors, like increased interest in dishes consisting of raw fish. We report a case of epigastralgia with direct diagnosis by endoscopy, which futher study pointed out H. Aduncum as causal agent, a anisakis which is rarely involved in human anisakiasis.

Depression among injured workers receiving vocational rehabilitation: contributions of work values, pain, and stress

INTRODUCTION

Work-related injuries or disabilities result in significant negative consequences to physical, economic, social, and psychological well-being. Depression has been shown to increase post-injury and to contribute to poor return to work outcomes. The primary goals of the study were to test known correlates of depression in a sample of injured workers receiving vocational rehabilitation and to assess the unique contribution of work values in injured worker depression.

METHOD

Scores on depression, stress, pain, work values, and demographic information were obtained from an archived sample of 253 injured workers receiving vocational rehabilitation.

RESULTS

Hierarchical multiple linear regression was used for analyses, resulting in a final model with a "large" effect size (R (2) = 0.42). The accepting vs. investigative work value dimension accounted for variance in depression scores beyond that accounted for by covariates and other significant correlates. Of the study variables, significant regression coefficients were found for pain, psychosocial stress, an interaction between pain and stress, and having an accepting work value.

CONCLUSIONS

Injured workers experiencing higher levels of pain and stress and who prefer to avoid workplace challenges may be vulnerable to experiencing depression. Results suggest that the presence of pain, stress, and the accepting work value dimension should be monitored in injured workers, and that the role of work values in injured worker depression may be a fruitful area for further research.

Conceptualizing and testing random indirect effects and moderated mediation in multilevel models: new procedures and recommendations

The authors propose new procedures for evaluating direct, indirect, and total effects in multilevel models when all relevant variables are measured at Level 1 and all effects are random. Formulas are provided for the mean and variance of the indirect and total effects and for the sampling variances of the average indirect and total effects. Simulations show that the estimates are unbiased under most conditions. Confidence intervals based on a normal approximation or a simulated sampling distribution perform well when the random effects are normally distributed but less so when they are nonnormally distributed. These methods are further developed to address hypotheses of moderated mediation in the multilevel context. An example demonstrates the feasibility and usefulness of the proposed methods.

Extraocular muscle cysticercosis - a clinical challenge to the ophthalmologists

PURPOSE

To report our experience with extraocular myocysticercosis, to highlight the role of ultrasound and orbital computerized tomography (CT) scan in these cases and to discuss the management.

METHODS

This is retrospective study of 35 cases of orbital myocysticercosis confirmed on ultrasound and CT scan of the orbit.

RESULTS

There were 18 males and 17 females. The average age of these patients was 19.6 years. The most common presenting feature was restricted ocular motility with diplopia and recurrent pain and redness. Ultrasound examination and CT scan of the orbit done for all these patients identified the cyst and the affected muscle. All extraocular muscles were noted to be involved in myocysticercosis. However the lateral rectus, medial rectus and the superior oblique were affected to a greater extent. All cases dramatically improved on treatment with albendazole and oral steroids. Surgical excision of cyst was done in 6 cases.

CONCLUSION

A high index of suspicion should be entertained for extraocular muscle cysticercosis, especially in cases of acquired ocular motility disorder with recurrent ocular congestion. Ultrasound and CT scans of orbit play a vital role in diagnosis. Medical therapy with albendazole under cover of steroids is effective in most of the cases.

Parasitic manifestation of testicular pain

Genital filariasis is common in endemic areas of the world. However, filariasis cannot be eliminated from the differential diagnosis of scrotal swellings, as international travel is more frequent. We report a case in a patient in London, UK.

[Fascioliasis of the common bile duct: endoscopic ultrasonographic diagnosis and endoscopic sphincterotomy]

Two cases of biliary fasciolasis are reported. The patients presented with biliary pain and/or acute pancreatitis. Pre-operative ultrasound endoscopy showed main bile duct dilation and linear elongated echogenic structures in the common bile duct lumen. Endoscopic retrograde cholangiography and endoscopic sphincterotomy were performed. Parasites were endoscopically removed resulting in disappearance of symptoms and biological abnormalities. Serological tests and pathological examination confirmed the presence of Fasciola hepatica. During follow-up, stool examination failed to show any Fasciola hepatica eggs, and in one case, serology became negative. This report emphasizes the value of ultrasound endoscopy in the diagnosis of unsuspected biliary fasciolasis. This report also confirms the therapeutic role of endoscopic sphincterotomy in patients with obstructive biliary fasciolasis.

[Vertebral hydatidosis: three case reports]

PURPOSE OF THE STUDY

Vertebral hydatidosis, the most frequent localization of skeletal hydatidosis, has an ominous prognosis with the risk of progressive but permanent neurological damage. There is no consensus on appropriate management. Treatment is often unsuccessful with frequent recurrence. The purpose of this study was to assess our experience with this rare disease to identify diagnostic, therapeutic and prognostic features.

MATERIAL AND METHODS

We reviewed the charts of three patients with vertebral hydatidosis treated at the department of orthopedics at the Casablanca children's hospital between January 1989 and January 1998. Diagnosis was made early in the first patients, allowing complete excision of the hydatid cyst. Follow-up was uneventful 10 years after surgery. The second patient presented after a long disease course and had definitive neurological complications despite treatment. The lesions were extensive in the third patient and cure could not be achieved although the patient remained asymptomatic.

DISCUSSION

Vertebral hydatidosis is a severe disease causing frequent neurological complications. Surgical treatment, though difficult, is the only efficient option. Complete recovery can be achieved after surgical excision of lesions diagnosed early. Prevention is the best therapeutic strategy in endemic areas.

[Unusual radiologic signs of bone echinococcosis in children]

The authors report 2 cases of 2 children aging 11 and 12-years-old presenting hydatitosis in the upper extremity of 2 long bones femur and tibia. In 2 cases, radiological appearances were atypical. In the femur, plain radiographs revealed multiple lucencies, irregular, located in the superior extremity with a periostal reaction. The CT scan confirmed these data and showed a cortical rupture, extension to soft tissue with contrast enhancement. In the tibia, plain radiographys showed delimitated lucencies, confluent with a rim condensation in the proximal epiphyseal-metaphyseal area. Echography and CT are helpful when radiological appearances are unusual.

[Bilateral hydatid cyst of the fallopian tubes: a case report]

We report an exceptional case of bilateral hydatid cysts that developed solely in the fallopian tubes of a young girl. The diagnosis was suggested by the clinical history, the patient's residence in an endemic area, and the ultrasound findings and was confirmed peroperatively. Due to the extensive damage bilateral salpingectomy was required compromising future reproduction potential. We discuss the pathogenesis of pelvic localizations and the ultrasound aspects of pelvic hydatid cysts.

[Ear myiasis. Two case reports]

The authors report two cases of aural myiasis. This pathology rarity induced us to search after epidemiologic, clinic and therapeutic peculiarity of this parasitical disease.

Clinical characteristic of amoebic liver abscesses in the North of Iraq

OBJECTIVE

The purpose of the study was to find out the clinical characteristic of amoebic liver abscesses in this area, the simplest method for diagnosis and to determine the effectiveness of treatment by metronidazole therapy proved by disappearance of symptoms and regression in the size of the abscesses by ultrasound.

METHODS

We studied prospectively all cases of suspected liver abscesses admitted to our unit over 2 years (1990 & 1991). A special case sheet was prepared. Daily follow up of patients was carried out in hospital for at least 10 days. Patients were later followed up by ultrasound after discharge. We compared the rate of infection from the hospital records over the last 9 years up to the end of 1998.

RESULTS

We found the clinical features of the disease similar to those mentioned in essential text books of medicine, except that pain is not always epigastric while fever may be absent and hepatomegaly is not marked. Ultrasound is a simple, cheap diagnostic test, which is available. Metronidazole is an effective treatment and none of the patients required an invasive method for diagnosis or treatment. None had secondary bacterial infection.

CONCLUSION

Amoebic liver abscess if untreated is a grave disorder. We concluded that recognizing the disorder clinically and proving it by ultrasound is the main method for diagnostic confirmation. Following the hospital records of the last 9 years, it seems that the rate of infection is declining in this area.

[Preliminary evaluation of usable indicators during a control program for urinary bilharziosis in Niger]

The performance of several indirect screening tests was evaluated during the start-up phase of a urinary schistosomiasis control program in Niger. Urine tests were carried out on a total of 354 children attending 3 primary schools on five consecutive days. Tests included filtration of 10 ml of urine, search for microscopic hematuria using reagent strips, and gross examination of urine. In addition a questionnaire was administered on the first day to identify signs of dysuria and hematuria. Repeat testing had a strong effect on the epidemiological profile of urinary schistosomiasis in the 3 schools. Although day-to-day counts varied greatly, egg excretion could be considered as high in all infected subjects. The screening sensitivity of urine filtration was low when the level of endemicity was moderate (up to 55 p. 100). Microscopic hematuria was common. However the sensitivity of this method was overestimated in comparison with urine filtration alone and use of reagent strips can be inconvenient. Using carefully defined diagnostic criteria, gross examination of urine was as effective as urine filtration and easier to perform. The value of the questionnaire for evaluation of morbidity was low despite relatively good performance of the diagnostic techniques. The children's responses concerning hematuria were not objective and questions concerning dysuria were poorly understood and time-consuming. In the next phase of study, these findings will be validated by ultrasound imaging.

Neural blockade for diagnosis and prognosis. A review

On the basis of the published material reviewed above, we conclude that there are many limitations that weaken the theoretic basis for neural blockade as a diagnostic or prognostic tool. In addition, these procedures in general lack thorough documentation of clinical usefulness. Reasonable employment of diagnostic neural blockade, therefore, requires not only care in technique and confirmation of effects, but also caution in interpretation and application of the results. This critical evaluation needs to be tempered, however, by two further observations. Experienced and observant clinicians have found these procedures may, on certain occasions, provide information that is helpful in guiding subsequent therapy, so we should not be in haste to dismiss the accumulated judgment of practitioners. Finally, the confusion and complexity that typifies diagnosis in chronic pain may justify the selective use of diagnostic blocks that make anatomic and physiologic sense, even if their validity is incompletely proved.