Tumor necrosis factor α (TNF-α) is an inflammatory mediator overexpressed in the skin as a response to ultraviolet radiation, as well as in chronic non-healing wounds. On the other hand, senescent fibroblasts have been shown to accumulate in the skin under these stressful conditions. Accordingly, here we assessed the putative implication of TNF-α in the induction of premature senescence of human adult dermal fibroblasts. We showed that TNF-α led to a rapid transient p38 MAPK activation, while elevation of reactive oxygen species (ROS) only occurred after a chronic exposure to TNF-α. Furthermore, in contrast to the majority of previous reports using various cell models and experimental settings, it was a long-term treatment with TNF-α that resulted in the premature senescence of human dermal fibroblasts, as shown by the reduced proliferative potential and the increased senescence associated β-galactosidase staining of the cells. TNF-α-senescent cells displayed a permanent phosphorylation of p38 MAPK and an inflammatory and catabolic phenotype. Increased ROS levels were also observed, possibly attributed to the weakened anti-oxidative response evidenced by the underexpression of the Nrf2-regulated genes encoding HO-1 and NQO1. These traits and the overall senescent phenotype were significantly reversed using the known anti-oxidant N-acetyl-L-cysteine or a specific p38 MAPK inhibitor, suggesting the participation of oxidative stress and of the p38 MAPK pathway in TNF-α-triggered premature senescence. Even more, the observed blockade of ROS accumulation in senescent skin fibroblasts by p38 MAPK inhibition indicates a possible link between these two separate events during the manifestation of TNF-α-induced senescence.
Introduction
This study explored the differences on the level of medical care required by camp and non-camp resident patients during utilisation of the health services in Mae La refugee camp, Tak province, Thailand during the years 2006 and 2007.
Methods
Data were extracted from camp registers and the Health Information System used during the years 2006 and 2007 and statistical analysis was performed.
Results
The analysis showed that during 2006 and 2007 non-camp resident patients, coming from Thailand as well as Myanmar, who sought care in the outpatient department (OPD) of the camp required at a significantly higher proportion admission to the inpatient department (IPD) or referral to the district hospital compared to camp resident patients. Although there was a statistically significant increased mortality of the non-camp resident patients admitted in the IPD compared to camp resident patients, there was no significant difference in mortality among these two groups when the referrals to the district hospital were analysed.
Conclusion
Non-camp resident patients tended to need a more advanced level of medical care compared to camp resident patients. Provided that this it is further validated, the above observed pattern might be potentially useful as an indirect indicator of unaddressed health needs of populations surrounding a refugee camp.
Interpreters are an integral part of a proper refugee reception system. They should be included in authorities planning where mass gatherings of refugees are expected. Appropriate training may be needed for interpreters to develop skills useful in mass gatherings and similar prehospital settings in order to better coordinate with the medical team. Alexakis LC Papachristou A Baruzzi C Konstantinou A . The use of interpreters in medical triage during a refugee mass-gathering incident in Europe. Prehosp Disaster Med. 2017;32(6):684-687.
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