ABSTRACT
Schistosomiasis-associated pulmonary arterial hypertension (Sch-PAH) is categorized as WHO Group I PAH because its clinical manifestations, laboratory and hemodynamic features share with PAH of other etiologies, such as idiopathic, heritable, HIV and autoimmune disorders. Sch-PAH is usually a life-threatening complication of hepatosplenic schistosomiasis characterized by changes in the vascular wall, remodeling and vasoconstriction with lesions primarily located in the precapillary segments of the pulmonary vasculature, which may result in a marked and sustained increase in pulmonary vascular resistance, right ventricular failure and ultimately death. Although egg deposition into lung and subsequent inflammatory cascades are key factors in the pathogenesis of Sch-PAH, the exact pathogenesis, course of disease and treatment of Sch-PAH remain largely uncertain. This review mainly discusses the pathophysiological and immunological mechanisms of Sch-PAH, so as to provide insights into the clinical diagnosis and treatment of Sch-PAH.
ABSTRACT
The etiology, pathology, clinical features and prognosis of megalosplenic advanced schistosomiasis have their specific features, and therefore, the perioperative management of this disorder has special countermeasures. The review analyzes the difficult problems in the perioperative management of megalosplenic advanced schistosomiasis, including ultra - low platelet counts, extensive and severe adhesive splenomegaly, massive hemorrhage during surgery and portal vein thrombosis, and proposes countermeasures to tackle these problems, with aims to guide the clinical treatment and cure of schistosomiasis, thereby improving the prognosis, reducing complications and improving the quality of life.
ABSTRACT
Objective To predict the changes in the prevalence of Schistosoma japonicum infections in humans and livestock in Hunan Province using the exponential smoothing model and the ARIMA model. Methods The data pertaining to S. japonicum infections in humans and livestock in Hunan Province from 1957 to 2015 were collected, and the exponential smoothing model and the ARIMA model were created using the software Eviews and PASW Statistics 18.0. In addition, the effectiveness of these two models for the prediction of S. japonicum infections in humans and livestock in Hunan Province from 2016 to 2018 was evaluated. Results The exponential smoothing model and the ARIMA model had a high goodness of fit for prediction of S. japonicum infections in humans and livestock in Hunan Province from 1957 to 2015. There was a linear trend in the prevalence of S. japonicum infections in humans and livestock in Hunan Province from 1957 to 2015. The prevalence of S. japonicum infections in humans predicted with the Brown’s linear trend and the prevalence of S. japonicum infections in livestock predicted with the Holt’s linear trend in Hunan Province from 2016 to 2018 fitted better the actual data than the ARIMA model; however, prediction of the ARIMA model indicated that the endemic situation of schistosomiasis remained at a low level in Hunan Province. Conclusion At a low epidemic level, development of highly sensitive tools for monitoring schistosomiasis is urgently needed in Hunan Province to fit the current endemic situation, and the schistosomiasis control measures should be intensified to consolidate the control achievements.
ABSTRACT
Objective To examine the effect of the integrated schistosomiasis control measures in Hunan Province from 2004 to 2019, so as to provide insights into the development of the schistosomiasis elimination strategy. Methods The integrated schistosomiasis control measures implemented by the health, agriculture, water resources, forestry, land and resources sectors were retrospectively collected in Hunan Province from 2004 to 2019, and the completion of each measure, cost of control measures, Schistosoma japonicum infections in humans and bovines, and snail status were analyzed each year. An index system for assessing the integrated schistosomiasis control effect was constructed using the Delphi method to calculate the integrated schistosomiasis control effect index. In addition, a cost-effect analysis was performed in terms of the decline in the prevalence of S. japonicum infections in humans and bovines, areas with snails in inner embankments, and areas with infected snails. Results A total of 7 110 926 500 Yuan were invested into the integrated schistosomiasis control program of Hunan Province from 2004 to 2019. During the 16-year period, a total of 277 437.12 hm2 snail habitats received molluscicidal treatments, 6 927 230 person-times given expanded chemotherapy, 2 116 247 bovine-times given expanded chemotherapy, 954 850 harmless toilets built, 290 359 bovines fenced, 136 666 bovines eliminated, 141 905 machines used to replace bovines, 39 048.63 hm2 water lands improved as dry lands, 724.12 km irrigation regions improved, 3 994 300 populations covered with safe water, 191 102.89 hm2 forests planted and 38 535.27 hm2 lands leveled. The prevalence of S. japonicum infections was 4.29% in humans and 4.48% in bovines in Hunan Province in 2004, with 2 449.37 hm2 snail habitats in inner embankments and 3 423.74 hm2 infected snail areas. In 2019, the prevalence of S. japonicum infections reduced to 0 in both humans and bovines, and areas of snail habitats reduced to 540.92 hm2 (77.92% reductions), while the areas with infected snails reduced to 0. The overall integrated schistosomiasis control effect index appeared a tendency towards a rise over years since 2004, and the integrated schistosomiasis control effect index was 97.35 in 2019; the annual mean costs for a 1% reduction in the prevalence of S. japonicum infections in 100 populations and 100 bovines were 70.11 Yuan and 4 204.78 Yuan, and the annual mean costs for a 1% reduction in the snail areas in inner embankments and infected snail areas were 2 010.20 Yuan and 1 298.09 Yuan, respectively. Conclusions The integrated control measures achieve remarkable effectiveness for schistosomiasis control in Hunan Province, with a remarkable decline in the prevalence of S. japonicum infections in humans and bovines and great shrinking of snail areas in inner embankments and infected snail areas. Adequate fund investment is required to improve the integrated schistosomiasis control measures and consolidate the control achievements.
ABSTRACT
This paper describes the current epidemic characteristics and endemic status of schistosomiasis, analyzes the main challenges of schistosomiasis control and proposes the emphasis and interventions for future schistosomiasis control activities in Hunan Province, so as to provide insights into the elimination of schistosomiasis in Hunan Province.
ABSTRACT
The culture of schistosomiasis control is specific in the history of Chinese culture. Broadly speaking, the culture of schistosomiasis control is a summary of specific social mood, social consciousness and material culture created by Chinese populations during the progress of schistosomiasis control since the founding of the People’s Republic of China. Narrowly speaking, the culture of schistosomiasis control is the spiritual culture that is jointly created and nurtured by schistosomiasis control workers since the founding of the People’s Republic of China. The spiritual features of Chinese schistosomiasis control culture are characterized by the patriotism and care about the people, the matter-to-fact attitude, the pioneering and enterprising spirit, and the spirit of sacrifice and dedication. The ultimate goal of the research on the culture of schistosomiasis control is to facilitate the achievement of the strategic goal of Healthy China 2030 as scheduled, accelerate the progress towards elimination of schistosomiasis, and to promote the sustainable development of schistosomiasis control in China.
ABSTRACT
Advanced schistosomiasis is the most serious clinical type of schistosomiasis. Its diagnosis and treatment are related to many special departments, such as gastroenterology, general surgery, neurology, endocrinology, radiology, traditional Chinese medicine, blood purification, endoscopy, intervention, and ICU. It is necessary to apply a multidisciplinary treatment (MDT) mode. However, the mode has no universal standard and guide in practice. It is very important for the implementation of MDT mode of advanced schistosomiasis to form a treatment expert team, formulate the formal working procedures, and standardize the treatment schedules. The standardized implementation of MDT mode will be important to provide a more effective clinical decision on advanced schistosomiasis.
Subject(s)
Patient Care Team/organization & administration , Schistosomiasis/therapy , HumansABSTRACT
The medical assistance to advanced schistosomiasis patients established by the Chinese government is a major public facility for patients with advanced schistosomiasis. Since the medical assistance to advance schistosomiasis patients in Hunan Province started ten years ago, a set of mature and operable programs with whole program management and related technologies has been developed. The author investigated the data on medical assistance to advanced schistosomiasis patients in Hunan Province during the last 10 years (from 2006 to 2015) retrospectively, and found that the program had high therapeutic effect and high satisfaction degree of both patients and the society. In order to improve the management of the medical assistance to advanced schistosomiasis patients and share our experiences of the whole program management and related technologies with the colleagues of other provinces, this paper mainly illustrates the experiences of the program, as well as the existing problems and related strategies.
Subject(s)
Medical Assistance/statistics & numerical data , Schistosomiasis/therapy , Adult , Aged , China/epidemiology , Female , Humans , Male , Middle Aged , Outcome Assessment, Health Care , Patient Satisfaction , Prognosis , Schistosomiasis/diagnosis , Schistosomiasis/epidemiology , Young AdultABSTRACT
Advanced schistosomiasis, encompassing a wide range of pathologic entities and multi-complications, poses a serious threat on the patients' health. Through comprehensive analysis and evaluation on related aspects regarding clinical classification, main methods of auxiliary examination and treatment (including types of surgical procedure) of advanced schistosomiasis, we think that the individual based multidisciplinary comprehensive treatment according to varying conditions of patients is the most optimal treatment mode of advanced schistosomiasis. It is further proposed that multidisciplinary collaborative diagnosis and treatment system should be undoubtedly established, multidisciplinary case discussions be regularly organized, and treatment expert teams be stably formed, in order to significantly improve the level of diagnosis and treatment of advanced schistosomiasis, so as to reduce the misdiagnosis and improve the therapeutic effect in advanced schistosomiasis control.
Subject(s)
Patient Care Team , Schistosomiasis/therapy , Diagnostic Errors , HumansABSTRACT
OBJECTIVE: To understand the direct medical expense for surgical patients with splenomegalic advanced schistosomiasis and its influencing factors, so as to provide evidences for relevant departments to improve the rescue strategy of advanced schistosomiasis. METHODS: The data about the expenses of patients with splenomegalic advanced schistosomiasis hospitalized in Xiangyue Hospital affiliated to Hunan Institute of Schistosomiasis Control from January 2010 to August 2014 were collected, the hospitalization expense and hospital stays of the patients were analyzed, and the factors influencing the hospital expenses were analyzed by the univariate and multi-factor analyses. RESULTS: From January 2010 to August 2014, totally 249 cases were hospitalized in the hospital, their average hospital stays and hospital expenses were 28.92 d and 18 896.13 Yuan, and both of them were increased year by year. Among all the kinds of expenses, the constitution ratios of the medicine expenses were the highest, and those in the 5 years were all above 44%. The results of the univariate and multi-factor analyses showed that the hospital stays, the amount of intraoperative bleeding, liver function classification, postoperative complications, age, portal hypertensive gastropathy were the influencing factors of the hospital expenses. CONCLUSIONS: Presently, the burden of the direct hospital expenses of the patients with splenomegalic advanced schistosomiasis is still heavy. The government should further improve the proportion of the compensation of medical assistance and perfect the medical aid scheme. Meanwhile, the hospitals should strengthen the management and standardize medical behavior to reduce the hospitalization expenses of the patients.
Subject(s)
Health Expenditures/statistics & numerical data , Schistosomiasis/complications , Splenomegaly/complications , Splenomegaly/surgery , Adult , Aged , Female , Hospitalization/economics , Humans , Male , Middle Aged , Multivariate Analysis , Retrospective Studies , Young AdultABSTRACT
This paper summarizes the clinical diagnosis and treatment of imported African schistosomiasis, in order to make the therapeutic standards. Imported African schistosomiasis includes mainly schistosomiasis haematobia and schistosomiasis mansoni in China. In order to set up the operational standards, enhance diagnostic and cure rates, and reduce the complications, we review the related literature combined with our experience over years, and summarize, in this paper, the pathogenic mechanism, and key points of clinical diagnosis and treatment of schistosomiasis haematobia and schistosomiasis mansoni, so as to provide the reference for clinical doctors.
