BackgroundTungiasis is a parasitic skin disease caused by penetrating female sand fleas. By nature, tungiasis is a self-limiting infection. However, in endemic settings re-infection is the rule and parasite load gradually accumulates over time. Intensity of infection and degree of morbidity are closely related.Methodology/principal findingsThis case series describes the medical history, the clinical pathology, the socio-economic and the environmental characteristics of very severe tungiasis in five patients living in traditional Amerindian communities in the Amazon lowland of Colombia. Patients had between 400 and 1,300 penetrated sand fleas. The feet were predominantly affected, but clusters of embedded sand fleas also occurred at the ankles, the knees, the elbows, the hands, the fingers and around the anus. The patients were partially or totally immobile. Patients 1 and 3 were cachectic, patient 2 presented severe malnutrition. Patient 3 needed a blood transfusion due to severe anemia. All patients showed a characteristic pattern of pre-existing medical conditions and culture-dependent behavior facilitating continuous re-infection. In all cases intradomiciliary transmission was very likely.Conclusion/significanceAlthough completely ignored in the literature, very severe tungiasis occurs in settings where patients do not have access to health care and are stricken in a web of pre-existing illness, poverty and neglect. If not treated, very severe tungiasis may end in a fatal disease course.
Objectives To describe compliance rates of compression therapy in a cohort of patients with chronic venous disease and also to describe frequent causes of non-compliance. Methods A total of 889 patients with primary chronic venous disease were prescribed compression therapy after being evaluated by vascular surgeons. Subjects had a first visit during which time compression therapy was prescribed in addition to a follow-up visit. Strength of compression, type, prescription duration, and reasons of non-compliance were queried at follow-up. Results Only 31.8% of the patients reported wearing compression therapy as prescribed, 31.4% reported wearing compression most days, 28.3% reported wearing compression intermittently, and 8.5% of the patients reported not wearing compression at all. The main reasons of non-compliance were: uncomfortable (49.4%), too difficult to put on (34.5%), skin problems (itching) (21.5%), and unattractive (19.8%). Conclusions Compliance with compression therapy in chronic venous disease is still a subject of concern as most patients are not using compression therapy as prescribed.
Background: Given the devastating impact that COVID-19 can have on the lung, it is reasonable to fear for patients with underlying chronic lung conditions. Recent studies have shown that there is an excess risk of contracting the infection, as well as developing severe symptoms and worst outcomes for some of these conditions. We present a single center experience of the characteristics and outcomes of patients admitted due to with confirmed SARS-CoV-2 infection and chronic lung disease. Methods: Retrospective medical records review of patients with chronic lung conditions (COPD, asthma, interstitial lung disease, pulmonary hypertension, and lung cancer) and SARS-CoV-2 infection between January 1, 2020 and December 1, 2020 at Beth Israel Deaconess Medical Center, Boston, MA. Patients were identified from our institutional database. Demographics, baseline comorbidities, hospital say, ICU admission, and interventions performed were recorded. Results: 12.405 patients were diagnosed with SARS CoV-2 infection at BIDMC. From the total, 961 (7.8%) patients were admitted for further care with an age of 66 years (IQR 52-78), 464 (48.28%) males, and a BMI of 29.8 kg/m2 ). Regarding the comorbid conditions, 157 subjects (16.3%) had COPD, 157 (16.3%) asthma, 24 (2.50%) pulmonary hypertension, 14 (1.46%) ILD and 18 (1.87%) lung cancer. We found that patients with COPD (23.57% vs 14.68%, p=0.005) as well as lung cancer (38.89% vs 15.69%, p=0.016) died more often after hospital admission. Additionally, a logistic regression model for mortality showed an OR of 1.8 (95%CI 1.2-2.7, p=0.006) for COPD and an OR of 3.42 (95%CI 1.30-8.96, p=90.012) for lung cancer. Conclusion: Our review showed that patients hospitalized due to SARS CoV-2 infection, and a previous diagnosis of COPD or lung cancer, were more likely to die during the hospital stay.
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