Diseases Of Subcutaneous Tissue Research Articles

Buruli ulcer surveillance in south-eastern Australian possums: Infection status, lesion mapping and internal distribution of Mycobacterium ulcerans.

Buruli ulcer (BU) is a neglected tropical disease of skin and subcutaneous tissues caused by Mycobacterium ulcerans. BU-endemic areas are highly focal, and M. ulcerans transmission dynamics vary by setting. In Victoria, Australia, BU is an endemic vector-borne zoonosis, with mosquitoes and native possums implicated in transmission, and humans incidental hosts. Despite the importance of possums as wildlife reservoirs of M. ulcerans, knowledge of BU in these animals is limited. Opportunistic necropsy-based and active trap-and-release surveillance studies were conducted across Melbourne and Geelong, Victoria, to investigate BU in possums. Demographic data and biological samples were collected, and cutaneous lesions suggestive of BU were mapped. Samples were tested for the presence of M. ulcerans DNA by IS2404 qPCR. The final dataset included 26 possums: 20 necropsied; 6 trapped and released. Most possums (77%) were common ringtails from inner Melbourne. Nine had ulcers, ranging from single and mild, to multiple and severe, exposing bones and tendons in three cases. M. ulcerans was confirmed in 73% (19/26) of examined possums: 8 with lesions and 11 without. Oral swabs were most frequently indicative of M. ulcerans infection status. Severely ulcerated possums had widespread systemic internal bacterial dissemination and were shedding M. ulcerans in faeces. The anatomical distribution of ulcers and PCR positivity of biological samples suggests possums may contract BU from bites of M. ulcerans-harbouring mosquitoes, traumatic skin wounds, ingestion of an unknown environmental source, and/or during early development in the pouch. Ringtail possums appear highly susceptible to infection with M. ulcerans and are important bacterial reservoirs in Victoria. Oral swabs should be considered for diagnosis or surveillance of infected possums. A One Health approach is needed to design and implement integrated interventions that reduce M. ulcerans transmission in Victoria, thereby protecting wildlife and humans from this emerging zoonotic disease.

Characteristics of inflammatory disease structure in the maxillofacial region among children of different age groups in Krasnodar Krai

Relevance. Acute purulent-inflammatory diseases of the maxillofacial region (APID-MFR) are the leading cause of pediatric referrals to the maxillofacial surgery department. The prevalence of APID-MFR requiring hospitalization among children in Krasnodar and Krasnodar Krai averaged 42.9% from 2017 to 2021.Objective. To investigate the nature and structure of odontogenic and non-odontogenic inflammatory processes in patients treated at the maxillofacial surgery department of the State Healthcare Institution "Children’s Regional Clinical Hospital" (CRCH), Krasnodar.Materials and methods. Medical records of patients with inflammatory diseases of the maxillofacial region, treated in the maxillofacial surgery department at CRCH, Krasnodar, from 2017 to 2021, were analyzed. The study focused on examining the structure and characteristics of the pathology in patients receiving inpatient care.Results. The most common pathology identified in children was periostitis (30.9%), which significantly differed (p = 0.007) from the second most prevalent condition, exacerbation of chronic periodontitis (26.1%). The third place was shared by lymphadenitis (13.6%) and inflammatory skin and subcutaneous tissue diseases, including boils and carbuncles (13.5%), both of which significantly differed from the top two conditions (p < 0.001) but not from each other (p > 0.05). In fourth, fifth, and sixth places were other inflammatory skin and subcutaneous tissue diseases: abscess (10.1%), phlegmon (4.8%), and adenophlegmon (1.0%), which also significantly differed from one another.Conclusion. The high prevalence of odontogenic APID-MFR in children highlights the insufficient prevention of caries-related complications and emphasizes the need for enhanced pediatric dental care. Early diagnosis and pre-vention of APID-MFR complications are crucial to improving outcomes in affected children.

Adverse drug reactions of intravesical instillation therapy for bladder cancer: based on FDA adverse event reporting system

ABSTRACT Background Intravesical chemotherapy and immunotherapy are common adjuvant treatments for non-muscle invasive bladder cancer post-surgery. Analyzing adverse events linked to these therapies, can assist in clinical decision-making and risk assessment. Study design and methods Disproportionality analysis was conducted to analyze data from the Food and Drug Administration Adverse Event Reporting System database from the first quarter of 2004 to the first quarter of 2024, exploring potential positive signals between Bacillus Calmette-Guérin, mitomycin-C, epirubicin, gemcitabine, and adverse events. Results The database retrieved 2018, 140, 31, and 85 adverse event reports associated with Bacillus Calmette-Guérin, mitomycin-C, epirubicin, and gemcitabine, respectively. Adverse reactions not mentioned in the label, such as aortic aneurysm and ocular congestion, were observed in preferred term level related to Bacillus Calmette-Guérin. Mitomycin-C exhibited specificity in skin and subcutaneous tissue diseases not reflected in the package insert. Gemcitabine-induced adverse drug reactions showed signals in vascular and lymphatic diseases meeting the screening criteria of all 4 indicators, with capillary leakage syndrome being the preferred term with the highest signal intensity. Conclusion This study observed new adverse event signals, providing important assistance for drug selection in adjuvant therapy for non-muscle invasive bladder cancer postoperatively.

Real-world study of adverse events associated with gepant use in migraine treatment based on the VigiAccess and U.S. Food and Drug Administration's adverse event reporting system databases.

This study aimed to investigate the real-world profile of adverse events (AEs) associated with gepant medications in the clinical treatment of migraines by analyzing data collected from the VigiAccess database and the U.S. Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) database. As novel migraine therapies, gepants act by targeting the calcitonin gene-related peptide (CGRP) pathway, demonstrating effective control of migraine attacks and good tolerability. Nonetheless, comprehensive real-world studies on the safety of gepants are still lacking, particularly regarding their safety in large populations, long-term use, and potential adverse reactions in specific groups, which necessitates further empirical research. Leveraging these two international adverse event reporting system databases, we systematically gathered and analyzed reports of AEs related to gepant medications, such as rimegepant. Our focus encompasses but is not limited to severe, new, and rare adverse reactions induced by the drugs, as well as safety issues pertaining to the gastrointestinal, cardiovascular, hepatic, and renal systems. Through descriptive statistical analyses, we assessed the incidence and characteristics of AEs, compared AEs among gepants, and uncovered previously unknown AE information, all with the goal of providing a reference for the selection of clinical treatment regimens and AE monitoring. By extracting all AE reports concerning "rimegepant", "atogepant", and "ubrogepant" from the VigiAccess and FAERS database since its establishment up to 31 March 2024, a retrospective quantitative analysis was conducted. The reporting odds ratio (ROR) method were used to compare AEs among the three gepants. In the VigiAccess and FAERS databases, 23542 AE reports in total, respectively, were identified as being related to gepant medications. Among gastrointestinal system AEs, rimegepant had the greatest proportion and greatest signal strength; nausea was most severe and had the strongest signal in rimegepant AEs, whereas constipation was most prominent and had the strongest signal in atogepant AEs. In skin and subcutaneous tissue disorders, rash and pruritus were more frequently observed with rimegepant, followed by ubrogepant. Alopecia emerged as a novel AE, being more severe in rimegepant and secondarily in atogepant. Regarding cardiac disorders, the three gepants showed comparable rates of cardiac AEs, yet rimegepant exhibited the strongest AE signal. In musculoskeletal and connective tissue AEs, ubrogepant presented the most positive signals for skeletal muscle AEs. Furthermore, among the rare blood and lymphatic system disorder AEs, rimegepant had the highest number of reports of Raynaud's phenomenon and the strongest signal. The study also revealed that while reports of AEs involving liver diseases were scarce across the three gepants, severe AEs were detected in clinical trials, highlighting the need for continued, enhanced monitoring of liver system AEs through large-scale datasets. Gepant medications exhibit similarities and differences in their safety profiles. Analysis of the two databases indicated the presence of AEs across various systems, including gastrointestinal disorders, skin and subcutaneous tissue diseases, musculoskeletal and connective tissue disorders, organ-specific effects, and liver diseases. However, each drug displays distinct incidences and signal intensities for these AEs. Additionally, the study revealed a rare AE in the form of Raynaud's phenomenon. These findings suggest that during clinical use, individualized medication selection and AE monitoring should be based on the patient's physiological condition and specific characteristics.

INPATIENT DISEASE PATTERNS AT PHAM NGOC THACH TRADITIONAL MEDICINE HOSPITAL LAM DONG

The article presents the disease pattern of inpatients at Pham Ngoc Thach Traditional Medicine Hospital in Lam Dong from 2021 to 2023. The study was conducted using a cross-sectional, retrospective descriptive method, utilizing data from the hospital's medical records system and statistical reports from 2021 stored in the hospital's archives. Information was collected from patient records following predefined selection criteria, encompassing all adequately documented cases during the inpatient treatment period from January 1st, 2021 to August 31st, 2023. The research findings revealed that the group of diseases related to musculoskeletal and connective tissue accounted for the highest proportion at 57.79%, followed by circulatory diseases at 24.18%, and nervous system diseases at 7.75%. Other groups of diseases such as digestive, trauma, and respiratory systems also appeared, albeit with lower proportions. Particularly, rare disease groups like ear and mastoid bone diseases, and skin and subcutaneous tissue diseases were noted. These results provide a comprehensive overview of the disease distribution, supporting decision-making and the development of effective treatment strategies for inpatients in the upcoming period.

Оптимизация лечения хронических экссудирующих ран и язв нижних конечностей: экономическое и клиническое обоснование новых подходов

Background: the Global Burden of Disease (GBD) study has shown a significant increase in the prevalence of cutaneous and subcutaneous tissue diseases. Despite the high prevalence of non-healing wounds, there are very few economic estimates of specific treatment methods, which makes this issue very relevant. Aim: to conduct a clinical and economic analysis concerning the Zetuvit Plus Silicone / Zetuvit Plus Silicone Border superabsorbent dressing for the treatment of moderately and severely chronic non-healing wounds and ulcers of the lower extremities versus standard therapy with other dressings. The target group consisted of patients with moderately and severely chronic non-healing wounds and ulcers of the lower extremities. Patients and Methods: the Markov model was applied during the clinical and economic analysis, conducted with regard to the Russian healthcare system. The horizon analysis corresponded to the mean treatment duration of 24 weeks (about 6 months). Results: simulation showed that the dressing cost for one patient in the group who used superabsorbent dressing (100.6 thousand rubles) was 192.2 thousand rubles less than with standard therapy (292.7 thousand rubles). At the same time, the total cost per patient when using superabsorbent dressing (319 thousand rubles) was 195.8 thousand rubles less than with standard therapy (514.8 thousand rubles). In terms of the projected number of patients (307.4 thousand people), the use of superabsorbent dressing instead of standard therapy will lead to a cost reduction of 60.2 billion rubles. Conclusion: based on the data obtained during the study, the use of Zetuvit Plus Silicone / Zetuvit Plus Silicone Border superabsorbent dressing in the treatment of moderately and severely chronic non-healing wounds and ulcers of the lower extremities is associated with lower costs for both dressing and medical care, which leads to budget savings. KEYWORDS: chronic non-healing wounds, venous trophic ulcers, Zetuvit Plus Silicone Border, Zetuvit Plus Silicone superabsorbent dressing, cost analysis, budget impact analysis, Markov model. FOR CITATION: Zhuravleva M.V., Kokushkin K.A., Luchinina E.V., Krysanova V.S., Luchinin E.A., Petrikov A.S., Lesovik V.S. Treatment optimization of chronic non-healing wounds and ulcers of the lower extremities: economic and clinical justification of new techniques. Russian Medical Inquiry. 2024;8(4):195–200 (in Russ.). DOI: 10.32364/2587-6821-2024-8-4-2.

Mycological profile of subcutaneous skin biopsy samples in suspected subcutaneous mycosis, Are we missing some fungi? A tertiary care hospital based study

Subcutaneous mycosis includes a heterogeneous group of fungal infections that develop at the site of transcutaneous trauma. A rise in surviving population of individuals with co-morbidities together with lapses in infection control practices especially in rural India has led to emergence of myriad species of fungi causing such infections in recent years. This poses a diagnostic challenge to the clinicians. We therefore felt a need to study the mycological profile of subcutaneous tissue biopsies suspected of fungal etiology in our hospital setup. This was a Retrospective cross-sectional observational study conducted for a period of 4 years from Jan 2015 to Jan 2019 in the Department of microbiology, Government medical College Srinagar. A total of 148 specimens of subcutaneous tissue biopsies of patients suspected of localized fungal Infection were processed by microscopy and culture for fungi. Among a total of 148 subcutaneous tissue biopsy samples 76 (51%) were positive for fungi on KOH and culture. Mycological profile revealed that majority of fungi were Dermatophytes (n=22; 29%) and Yeasts (n=21; 28%). Third most common causative fungi isolated were Chromoblastomycetes (n=8; 11%), Phaeohyphomycetes (n=8;11%) and Aspergilli (n=8;11 %) comprising, A.fumigatus (n=11) and A.terreus (n=03), followed by Hyalohypomycetes (n=4;5%), sporotrichosis (n=3;4%) and Zygomycetes (n=4 ;5.3%). : Dermatophytes and yeasts are emerging subcutaneous fungal infections. Active surveillance for all types of fungal infections should be done at all levels to address knowledge gaps that exist in etiology, pathogenesis and manifestations of fungal diseases of skin and subcutaneous tissue.

The dynamic and structural indicators of population morbidity of diseases of skin and subcutaneous fat: the scientific review

The diseases of skin and subcutaneous tissue represent consist medical and social problem due to their high prevalence. In the case of chronic course, dermatosis result in long-term temporary incapacity for work, disability and deterioration of quality of life of patients. The purpose of the study was based on analysis of scientific publications to assess level, structure and dynamics of morbidity of population, territorial features of prevalence of diseases of skin and subcutaneous tissue and risk factors for their occurrence. The scientific review of studies in Russian and English was carried out using information portals and platforms eLIBRARY.ru, PubMed, Web of Science and Scopus for the period 2010-2022. The selection included 47 publications that assessed levels of primary and general morbidity of population with diseases of skin and subcutaneous tissue and its dynamics over certain periods of time, as well as territorial features of prevalence of these diseases in the Russian Federation and risk factors of development of skin diseases. Many studies demonstrated decreasing in primary and general morbidity of population with diseases of skin and subcutaneous tissue. The rate of decreasing was more pronounced in 2018-2022. The level of primary and general morbidity differs significantly by Okrugs and Subjects of the Russian Federation, including particular nosologies. It is determined that there is wide spread of incidence rates across territories. The large proportion of publications reflects prevalence of psoriasis in population. The authors proposed measures of to improve registration of skin diseases and to decrease corresponding morbidity of population.

Lipedema Reduction Surgery Improves Pain, Mobility, Physical Function, and Quality of Life: Case Series Report.

Lipedema is a chronic inflammatory subcutaneous adipose-rich connective tissue disease affecting millions of women worldwide. Disproportionate fat accumulation on the extremities characterized by heaviness, tenderness, and swelling can affect function, mobility, and quality of life. Treatments include conservative measures and lipedema reduction surgery (LRS). Here, we report lipedema comorbidities and surgical techniques, outcomes measures, and complications after LRS. This is a single outpatient clinic retrospective chart review case series of comorbidities and complications in 189 women with lipedema. Bioelectrical impedance analyses, knee kinematics, gait, physical examinations, Patient-Reported Outcomes Measurement Information System, and RAND Short Form-36 questionnaires collected before and after LRS were analyzed for 66 of the 189 women. Hemoglobin levels were measured by transdermal hemoglobin monitor (Masimo noninvasive hemoglobin monitoring; Irvine, Calif.). Common comorbidities in 189 women were hypermobile joints (50.5%), spider/varicose veins (48.6/24.5%), arthritis (29.1%), and hypothyroidism (25.9%). The most common complication in 5.5% of these women after LRS was lightheadedness with a 2-g reduction or more in hemoglobin. After conservative measures and LRS in 66 women, significant improvements (P ≤ 0.0009) were found for: (1) knee flexion (10 degrees); (2) gait; (3) Patient-Reported Outcomes Measurement Information System T-score (16%); (4) mobility questions: gait velocity, rising from a chair, stair ascent; (5) RAND Short Form-36 scores: physical functioning, energy/fatigue, emotional well-being, social function, general health; (6) and Bioelectrical impedance analyses total and segmental body fat mass. LRS provided significant improvements to women with lipedema using direct physical measurements and validated outcome measures, comparable to those seen after total knee replacement.

Big data evidence of the impact of COVID-19 hospitalizations on mortality rates of non-COVID-19 critically ill patients

The COVID-19 virus caused a global pandemic leading to a swift policy response. While this response was designed to prevent the spread of the virus and support those with COVID-19, there is growing evidence regarding measurable impacts on non-COVID-19 patients. The paper uses a large dataset from administrative records of the Brazilian public health system (SUS) to estimate pandemic spillover effects in critically ill health care delivery, i.e. the additional mortality risk that COVID-19 ICU hospitalizations generate on non-COVID-19 patients receiving intensive care. The data contain the universe of ICU hospitalizations in SUS from February 26, 2020 to December 31, 2021. Spillover estimates are obtained from high-dimensional fixed effects regression models that control for a number of unobservable confounders. Our findings indicate that, on average, the pandemic increased the mortality risk of non-COVID-19 ICU patients by 1.296 percentage points, 95% CI 1.145–1.448. The spillover mortality risk is larger for non-COVID patients receiving intensive care due to diseases of the respiratory system, diseases of the skin and subcutaneous tissue, and infectious and parasitic diseases. As of July 2023, the WHO reports more than 6.9 million global deaths due to COVID-19 infection. However, our estimates of spillover effects suggest that the pandemic’s total death toll is much higher.

Lipedema stage affects adipocyte hypertrophy, subcutaneous adipose tissue inflammation and interstitial fibrosis.

Lipedema is a painful subcutaneous adipose tissue (SAT) disease characterized by adipocyte hypertrophy, immune cell recruitment, and fibrosis in the affected areas. These features are thought to contribute to the development and progression of the condition. However, the relationship between lipedema disease stage and the associated adipose tissue changes has not been determined so far. SAT biopsies of 32 lipedema patients, ranging across the pathological stages I to III, and 14 BMI- and age-matched controls were harvested from lipedema-affected thighs and non-symptomatic lower abdominal regions. Histological and immunohistochemical (IHC) staining and expression analysis of markers for adipogenesis, immunomodulation, and fibrosis were performed on the tissue biopsies. Lipedema patients showed increased adipocyte areas and a stage-dependent shift towards larger cell sizes in the thighs. Lipedema SAT was linked with increased interstitial collagen accumulation in the thighs, but not the lower abdominal region when compared to controls. There was a trend toward progressive SAT fibrosis of the affected thighs with increasing lipedema stage. Elevated gene expression levels of macrophage markers were found for thigh SAT biopsies, but not in the abdominal region. IHC staining of lipedema thigh biopsies confirmed a transiently elevated macrophage polarization towards an M2-like (anti-inflammatory) phenotype. In summary, lipedema SAT is associated with stage-dependent adipocyte hypertrophy, stage-progressive interstitial fibrosis and elevated proportion of M2-like macrophages. The character of the inflammatory response differs from primary obesity and may possess an essential role in the development of lipedema.

Semiautomated segmentation of lower extremity MRI reveals distinctive subcutaneous adipose tissue in lipedema: a pilot study.

Lipedema is a painful subcutaneous adipose tissue (SAT) disease involving disproportionate SAT accumulation in the lower extremities that is frequently misdiagnosed as obesity. We developed a semiautomatic segmentation pipeline to quantify the unique lower-extremity SAT quantity in lipedema from multislice chemical-shift-encoded (CSE) magnetic resonance imaging (MRI). Patients with lipedema () and controls () matched for age and body mass index (BMI) underwent CSE-MRI acquired from the thighs to ankles. Images were segmented to partition SAT and skeletal muscle with a semiautomated algorithm incorporating classical image processing techniques (thresholding, active contours, Boolean operations, and morphological operations). The Dice similarity coefficient (DSC) was computed for SAT and muscle automated versus ground truth segmentations in the calf and thigh. SAT and muscle volumes and the SAT-to-muscle volume ratio were calculated across slices for decades containing 10% of total slices per participant. The effect size was calculated, and Mann-Whitney test applied to compare metrics in each decade between groups (significance: two-sided ). Mean DSC for SAT segmentations was 0.96 in the calf and 0.98 in the thigh, and for muscle was 0.97 in the calf and 0.97 in the thigh. In all decades, mean SAT volume was significantly elevated in participants with versus without lipedema (), whereas muscle volume did not differ. Mean SAT-to-muscle volume ratio was significantly elevated () in all decades, where the greatest effect size for distinguishing lipedema was in the seventh decade approximately midthigh (). The semiautomated segmentation of lower-extremity SAT and muscle from CSE-MRI could enable fast multislice analysis of SAT deposition throughout the legs relevant to distinguishing patients with lipedema from females with similar BMI but without SAT disease.

Data mining for signal detection of adverse events for taxanes based on the food and drug administration adverse drug events reporting system database

ABSTRACT Background This study aimed to mine and compare the positive signals of adverse drug events (ADE) in paclitaxel, docetaxel, and nab-paclitaxel to evaluate the accuracy of current drug package information inserts and enable clinicians to select the appropriate treatment. Research design and methods ADE data reported from January 2006 to December 2020 were extracted from the Food and Drug Adverse Drug Events Reporting System (FAERS) database, and the reporting odds ratio (ROR) was used to detect the risk signals of the 3 taxanes. The definition relied on system organ class (SOCs) and preferred terms (PTs) by the Medical Dictionary for Regulatory Activities (MedDRA). Results A total of 39,163 case reports on paclitaxel, docetaxel and nab-paclitaxel involving 25 different system organ classes (SOCs) were retrieved from the database. The ADE paclitaxel and nab-paclitaxel reports mainly focused on ‘general disorders and administration site conditions’ and the docetaxel ADE reports focused on ‘skin and subcutaneous tissue diseases.’ Among the three taxanes, nab-paclitaxel had the highest positive signal for serious adverse events. Conclusions Overall, the most common ADE signals and ADE mapping systems obtained in this study were consistent with the package inserts. However, some inconsistencies were noted. Further research is recommended to confirm some of the strong risk signals for ADEs for taxanes before updating the drug package information inserts.

Hospitalizations for ambulatory care-sensitive conditions in children, Rondônia, Brazil, 2008-2019

This study aimed to define the profile of hospitalizations of children in public hospitals of 52 municipalities of the state of Rondônia, Brazil. We performed an ecological time series study using secondary data provided by the Hospital Information System. The annual trend of Hospitalizations was presented by age group and health region. Linear regression was performed using the Prais-Winsten technique of the statistical package Stata, version 11.0. Hospitalizations for gastrointestinal diseases were found to be decreasing in all age groups, just as those for vaccine-preventable diseases in children aged between 1 and 9 years. Hospitalizations for skin and subcutaneous tissue diseases were increasing in all ages, as well as those caused by epilepsies in children aged 1 to 9 and those caused by diseases related to childbirth and puerperium. Health regions showed a varied hospitalization profile. A stable trend was found in the Cone Sul, Madeira-Mamoré, Café, Vale do Guaporé, and Vale do Jamari regions, whereas a declining trend was found in the Central and Zona da Mata regions. The high rates of hospitalizations for ambulatory care-sensitive conditions in children show how inefficient strategies and investments in primary care have been in the state of Acre, Brazil.

Internações por condições sensíveis à atenção primária em crianças, Rondônia, Brasil, 2008-2019

Abstract This study aimed to define the profile of hospitalizations of children in public hospitals of 52 municipalities of the state of Rondônia, Brazil. We performed an ecological time series study using secondary data provided by the Hospital Information System. The annual trend of Hospitalizations was presented by age group and health region. Linear regression was performed using the Prais-Winsten technique of the statistical package Stata, version 11.0. Hospitalizations for gastrointestinal diseases were found to be decreasing in all age groups, just as those for vaccine-preventable diseases in children aged between 1 and 9 years. Hospitalizations for skin and subcutaneous tissue diseases were increasing in all ages, as well as those caused by epilepsies in children aged 1 to 9 and those caused by diseases related to childbirth and puerperium. Health regions showed a varied hospitalization profile. A stable trend was found in the Cone Sul, Madeira-Mamoré, Café, Vale do Guaporé, and Vale do Jamari regions, whereas a declining trend was found in the Central and Zona da Mata regions. The high rates of hospitalizations for ambulatory care-sensitive conditions in children show how inefficient strategies and investments in primary care have been in the state of Acre, Brazil.

Тhe structure of morbidity of fishermen working in different geographical regions

INTRODUCTION: The existing multiple factors of the ship’s environment, together with the climatic conditions of navigation, have a long and complex effect on the body of seamen. As a result, they often cause significant changes in the body. In turn, such changes can cause the emergence and development of many diseases.OBJECTIVE: To analyze the morbidity of trawl fleet fishermen working in different climatic regions, possible factors contributing to the occurrence of diseases, to develop recommendations for reducing diseases with disability of workers.MATERIALS AND METHODS: The morbidity of fishermen of the Arkhangelsk trawl fleet for the same period when working in the fishery in different climatogeographic regions was studied. 464 people of 4 crews of large freezing fishing trawlers aged 25–49 years (average age 41.8±9.5 years) and work experience from 3 to 10 years were under monitoring. The fishing area is the Norwegian Sea (northern climate zone, crew 237 people) and the Moorish Economic Zone (southern region, crew 217 people). The duration of the works ranged from 168 to 185 days. 10 voyage reports from on-board logbooks (5 times in each of the climatic regions) were used as sources of information on morbidity. Statistics: The McNemar criterion was used for comparative analysis between frequency indicators, and the MannWhitney criterion was used for absolute averages. The statistical significance level p<0.05 was regarded as proven statistically significant differences between the compared indicators.RESULTS: The morbidity of seafarers, according to the initial appeals, had statistically significant differences when working in different climatogeographic regions. The frequency of cases of temporary disability for people working in tropical regions turned out to be much higher in comparison with the northern ones. At the same time, the average duration of the disease in the absolute majority of nosological forms (except for skin and subcutaneous tissue diseases) had no statistically significant differences between the groups of sailors.DISCUSSION: Territorial features of fishing produce the characteristic of morbidity. Among them, the greatest contribution to the occurrence of diseases are frequent international contacts, peculiarities of processing of harvested fish, tension of adaptation mechanisms due to work in unusual conditions combined with hard work. The identified causes of morbidity among trawl fleet fishermen require the development of special measures to level them, prevent the development of chronic diseases.CONCLUSION: Is made about the need for constant monitoring of seafarers to determine adaptive changes during the voyage period and during the readaptation of the crew to coastal conditions. Within the framework of the medical support system for water transport workers, it is necessary to take into account the adverse factors of the professional environment in order to create high-quality and safe working conditions.

Self-reported clinical history of misdiagnosed leprosy cases in the State of Mato Grosso, Brzil, 2016-2019.

This study aimed to analyze the self-reported clinical history of patients misdiagnosed with leprosy in the State of Mato Grosso, Brazil. This is a cross-sectional study of new leprosy cases diagnosed in the State of Mato Grosso from 2016 to 2019, with individuals who were released from multidrug therapy due to misdiagnosis after starting treatment. Data were collected via telephone interviews. Over the study period, 354 leprosy cases were released from treatment due to misdiagnosis, of which 162 (45.8%) could be interviewed. All interviewees expressed dissatisfaction with their treatment, which prompted them to seek a reevaluation of their diagnosis before they were released due to "misdiagnosis". Among them, 35.8% received a final diagnosis of a musculoskeletal or connective tissue disease - mainly fibromyalgia and degenerative changes in the spine - followed by 13.6% with diagnoses of skin and subcutaneous tissue diseases. For 23.5% of the respondents, no alternative diagnosis was established, whereas 7.4% were later re-diagnosed with leprosy. Fibromyalgia and spinal problems were the most common alternative diagnoses for erroneous leprosy. Although the diagnosis of leprosy is usually clinical and does not require access to technical infrastructure in most cases, some more complex situations require diagnostic support via complementary tests, as well as close collaboration between primary care and reference services.

Necrotizing Fasciitis Associated with Hailey-Hailey Disease: A Rare Case.

Necrotizing fasciitis (NF) is a rare and life-threatening infection of soft tissue characterised by rapid and extensive destruction of the skin, subcutaneous fat, and fascia. Early diagnosis of NF is challenging, and it can be very difficult to distinguish NF from other infectious diseases of skin and subcutaneous tissue. Imaging studies and laboratory investigations are crucial diagnostic means for NF. We diagnosed a case of NF with multiple organ dysfunction and septic shock, and this is the first case of NF associated with Hailey-Hailey disease (HHD) to our knowledge. Clinicians should be alert to signs and symptoms of NF in HHD and other skin diseases with damaged skin barrier function such as pemphigus, pemphigoid, and all kinds of ulcers, especially in diabetic and immunosuppressed patients. Key Words: Necrotizing fasciitis, Genodermatosis, Hailey-Hailey disease.

Unspecific reactivity must be excluded in COVID-19 epidemiological analyses or virus tracing based on serologic testing: Analysis of 46,777 post-pandemic samples and 1,114 pre-pandemic samples.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of coronavirus disease 2019 (COVID-19). Serologic testing is complementary to nucleic acid screening to identify SARS-CoV-2. This study aimed to evaluate unspecific reactivity in SARS-CoV-2 serologic tests. Total anti-SARS-CoV-2 antibodies from 46,777 subjects who were screened for SARS-CoV-2 were retrospectively studied to evaluate the incidence and characteristics of the unspecific reactivity. A total of 1,114 pre-pandemic samples were also analysed to compare unspecific reactivity. The incidence of unspecific reactivity in anti-SARS-CoV-2 total antibody testing was 0.361% in 46,777 post-pandemic samples, similar to the incidence of 0.359% (4/1,114) in 1,114 pre-pandemic samples (p = 0.990). Subjects ≥ 19 years old had a 2.753-fold [95% confidence interval (CI), 1.130-6.706] higher probability of unspecific reactivity than subjects < 19 years old (p = 0.026). There was no significant difference between the sexes. The unspecific reactivity was associated with 14 categories within the disease spectrum, with three tops being the skin and subcutaneous tissue diseases (0.93%), respiratory system diseases (0.78%) and neoplasms diseases (0.76%). The percentage of patients with a titer ≥ 13.87 cut-off index (COI) in the unspecific reactivity was 7.69%. Our results suggest a unspecific reactivity incidence rate of 0.361% involving 14 categories on the disease spectrum. Unspecific reactivity needs to be excluded when performing serologic antibody testing in COVID-19 epidemiological analyses or virus tracing.

Role of socioeconomic factors in developing mycetoma: Results from a household survey in Sennar State, Sudan.

Mycetoma is a chronic, progressively destructive disease of subcutaneous tissues and bones caused by certain species of bacteria or fungi. We conducted a cross-sectional community-based study alongside mapping of mycetoma in five administrative units with high mycetoma endemicity in the Eastern Sennar Locality, Sennar State, Sudan. A household survey was administered which included questions about the household members, household characteristics, economic activity and history of mycetoma. A clinical examination was conducted on all members of the household. If mycetoma was suspected, an individual questionnaire was completed collecting demographic, clinical and epidemiological data as well as information on the use of health care and associated costs. Geographical coordinates and photos of the lesions were taken, and the affected persons were referred to the medical centre for confirmation of the diagnosis and treatment. We compared the characteristics of households with confirmed cases of mycetoma with those without confirmed cases, and individuals with confirmed mycetoma with those in whom mycetoma was not confirmed. In total 7,798 households in 60 villages were surveyed; 515 suspected cases were identified and 359 cases of mycetoma were confirmed. Approximately 15% of households with mycetoma had more than one household member affected by this disease. Households with mycetoma were worse off with respect to water supply, toilet facilities, electricity and electrical appliances compared to the survey households. Only 23% of study participants with mycetoma had sought professional help. Of these, 77% of patients travelled an average of six hours to visit a medical facility. More than half of patients had to pay towards their treatment. The estimated average cost of treatment was 26,957 Sudanese pounds per year (566 US dollars, exchange rate 2018). Results of this survey suggest that agricultural practices and reduced access to sanitation and clean water can be risk factors in developing mycetoma. Poor access to health care and substantial financial costs were barriers to seeking treatment for mycetoma.