ABSTRACT
A hospital case-control study in Isfahan, Islamic Republic of Iran, compared the psychological features of 200 patients with low-back pain with 350 matched controls. The control group scored lower than patients in all dimensions of the Symptom Checklist-90 checklist. Female patients were more psychologically affected by low-back pain than males. In both groups, grudge, general complaints, anxiety, depression, obsessive-compulsive behaviours, somatization and phobia varied with level of education. Patients' levels of depression and anxiety were related to occupational background. Longer duration of illness was accompanied by higher levels of anxiety, depression, obsessive-compulsive behaviours and somatization.
Subject(s)
Anxiety/epidemiology , Depression/epidemiology , Low Back Pain/complications , Obsessive-Compulsive Disorder/epidemiology , Phobic Disorders/epidemiology , Psychophysiologic Disorders/epidemiology , Adolescent , Adult , Age Distribution , Aged , Anxiety/etiology , Case-Control Studies , Depression/etiology , Female , Hospitals, University , Humans , Inpatients/psychology , Iran/epidemiology , Low Back Pain/epidemiology , Low Back Pain/psychology , Male , Middle Aged , Obsessive-Compulsive Disorder/etiology , Occupations , Phobic Disorders/etiology , Population Surveillance , Psychiatric Status Rating Scales , Psychophysiologic Disorders/etiology , Severity of Illness Index , Sex Distribution , Surveys and Questionnaires , Time FactorsABSTRACT
A hospital case - control study in Isfahan, Islamic Republic of Iran, compared the features of 200 patients with low - back pain with 350 matched controls. The control group psychological scored lower than patients in all dimensions of the Symptom Checklist - 90 checklist. Female patients were more psychologically affected by low - back pain than males. In both groups, grudge, general complaints, anxiety, depression, obsessive - compulsive behaviours, somatization and phobia varied with level of education. Patients' levels of depression and anxiety were related to occupational background. Longer duration of illness was accompanied by higher levels of anxiety, depression, obsessive - compulsive behaviours and somatization
Subject(s)
Anxiety , Case-Control Studies , Surveys and Questionnaires , Sex Factors , Educational Status , Depression , Low Back PainABSTRACT
Exfoliative cytology smears from the lesions of 179 patients with cutaneous leishmaniasis due to Leishmania tropica were studied with specific reference to cellular reactions and their effect on the parasite. Aggregates of the parasite (so-called Leishmania Donovan bodies) were present within macrophages and in some fibroblasts. The nature of the inflammatory reaction to the disease was studied by performing differential counts of the inflammatory cells present in the smears. These were correlated with the number of Leishman Donovan bodies. There was an inverse relationship between the number of Leishman Donovan bodies and the percentage of small lymphocytes, neutrophils, and type I macrophages. It is postulated that aggregates of activated macrophages (designated types II and III) and the Leishmanian milieu (sticky matrix) protect the amastigote Leishmania parasites from being eradicated by the inflammatory and immune reaction. The cytoplasmic blebbing of the parasitophorous vacuoles and cell to cell connection of the activated histiocytes could be shown by the CD-68 immunostaining of the tissue biopsy.
Subject(s)
Leishmania tropica/pathogenicity , Leishmaniasis, Cutaneous/pathology , Adolescent , Adult , Animals , Antigens, CD/metabolism , Antigens, Differentiation, Myelomonocytic/metabolism , Child , Child, Preschool , Cytodiagnosis , Cytoplasm/pathology , Female , Fibroblasts/parasitology , Fibroblasts/pathology , Humans , Immunity, Cellular , Infant , Leishmania tropica/immunology , Leishmania tropica/isolation & purification , Leishmaniasis, Cutaneous/immunology , Leishmaniasis, Cutaneous/metabolism , Leukocyte Count , Macrophages/parasitology , Macrophages/pathology , Male , Middle Aged , Skin/metabolism , Skin/parasitology , Skin/pathology , Ulcer/parasitology , Ulcer/pathologyABSTRACT
BACKGROUND: A vaccine consisting of a single dose of whole-cell autoclave-killed Leishmania major (ALM) mixed with BCG was assessed in comparison with BCG alone against anthroponotic (human to human transmission) cutaneous leishmaniasis in a randomised double-blind trial in Bam, Iran. METHODS: 3637 schoolchildren, aged 6-15 years, with no history of cutaneous leishmaniasis and no response to a leishmanin skin test, were randomly assigned to receive 1 mg ALM mixed with BCG (n = 1839), or BCG alone (n = 1798). Safety of the vaccine and the incidence of confirmed cases of cutaneous leishmaniasis were followed up for 2 years. FINDINGS: Side-effects were those usually associated with BCG vaccination, but tended to persist longer in the ALM + BCG group. After exclusion of four cases occurring within 80 days of vaccination (one in the ALM + BCG group and three in the BCG group), the 2-year incidence of cutaneous leishmaniasis did not differ significantly between vaccine and BCG groups: 2.8% vs 3.3%, respectively (total cases 112). A sex-stratified analysis showed that in boys the vaccine conferred a protective efficacy of 18% and 78% for the first and second years, respectively--a crude 2-year overall protection of 55% (95% CI 19-75%, p < 0.01). In the first 9 months after vaccination, there was a non-significant excess of cases in the ALM + BCG group (25 vs 16), whereas the incidence of cutaneous leishmaniasis thereafter was significantly reduced in the ALM + BCG group (27 vs 44, p < 0.05). INTERPRETATION: A single dose of ALM + BCG was safe and more immunogenic than BCG alone, as measured by leishmanin skin test. The exact reason for the apparent protective effect of the vaccine in boys is unknown, and may be a chance finding. However, since boys are more exposed to the infection, which is indicated by higher disease prevalence in boys in this study population, the preferential protective effect in boys may have resulted from a greater booster effect produced by repeated exposure to infected sandflies. Booster injections or alternative adjuvants should be tried to improve the potential efficacy of this vaccine.
