A holistic approach to the mycetoma management.
A holistic approach to the mycetoma management.
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DOI：
10.1371/journal.pntd.0006391
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发表时间：
2018-05
影响因子：
3.8
通讯作者：
El Amin HM
中科院分区：
文献类型：
--
作者：
Bakhiet SM;Fahal AH;Musa AM;Mohamed ESW;Omer RF;Ahmed ES;El Nour M;Mustafa ERM;Sheikh A Rahman ME;Suliman SH;El Mamoun MAG;El Amin HM
足菌肿是一种被严重忽视的热带疾病，是一种局部慢性肉芽肿性炎性疾病，其特征是无痛性皮下肿块和形成多个鼻窦，产生脓性分泌物和颗粒。如果早期和适当的治疗，它通常会扩散到影响深层结构和骨骼，导致大规模的损伤，畸形和残疾。它还可以通过血液和血液传播，导致与高发病率和死亡率相关的遥远的次级卫星。迄今为止，尽管足菌肿研究取得了进展，但在足菌肿发病机制和流行病学方面仍存在巨大的知识缺口，导致缺乏客观有效的控制方案。目前，可用的疾病控制方法是早期发现病例和适当管理。然而，大多数患者晚期表现为巨大的疾病，对他们中的许多人来说，英雄的实质性变形手术切除或截肢是唯一的主流治疗选择。在这封信中，苏丹的足菌病研究中心（MRC）分享了它在实施一种新的整体方法来管理当地村庄一级的足菌病患者方面的经验。MRC与苏丹塞纳尔州卫生部合作，在该州一个地方性足菌病村庄建立了一个地区足菌病中心。病人在该中心接受当地治疗，当地医疗和保健人员接受了早期病例发现和管理方面的培训，当地社区接受了宣传足菌病和改善环境条件方面的培训。这种综合方法还解决了患者的社会经济制约因素，这些因素阻碍了早期就诊和治疗。这一办法还包括地方卫生当局、社区和民间社会的积极参与和贡献，以提供最佳管理。这种对足菌肿患者的整体管理方法被证明是有效的早期病例发现和管理，最佳的治疗和治疗结果以及良好的疾病预后。在研究期间，大面积病变患者人数和截肢率下降，减轻了患者和家庭的疾病医疗和社会经济负担。足菌病具有被忽视的热带病的所有特征。它经常影响到偏远地区贫困社区的最贫困者。受影响人口的社会经济地位低，能见度低，政治和社会发言权低，因此受到忽视。这种疾病被认为是一种社会耻辱，特别是在妇女和儿童中，因此他们往往会长期隐瞒这种疾病，当他们被迫寻求医疗护理时，病情已经到了晚期。足菌病患者有许多经济上的限制，阻碍他们寻求医疗和保健。在偏远的足菌病流行地区，卫生和医疗设施薄弱，患者很难到达地区卫生中心，因此大多数患者都是晚期疾病。为克服这些治疗困难，医务委员会采取了这种全面管理方法，分散病人的护理，提高对疾病的认识和宣传，在乡村一级提供免费的医疗和外科治疗，并改善受影响村庄的环境和卫生条件。在这封信中，MRC报告了这一独特的经验，讨论了它所面临的优势和困难，并提出了改进建议，供全世界采用。回顾医学文献发现，没有报告这种管理方法的足菌肿患者，因此值得报告。
Mycetoma, one of the badly neglected tropical diseases, it is a localised chronic granulomatous inflammatory disease characterised by painless subcutaneous mass and formation of multiple sinuses that produce purulent discharge and grains. If untreated early and appropriately, it usually spread to affect the deep structures and bone resulting in massive damage, deformities and disabilities. It can also spread via the lymphatics and blood leading to distant secondary satellites associated with high morbidity and mortality. To date and despite progress in mycetoma research, a huge knowledge gap remains in mycetoma pathogenesis and epidemiology resulting in the lack of objective and effective control programmes. Currently, the available disease control method is early case detection and proper management. However, the majority of patients present late with immense disease and for many of them, heroic substantial deforming surgical excisions or amputation are the only prevailing treatment options. In this communication, the Mycetoma Research Center (MRC), Sudan shares its experience in implementing a new holistic approach to manage mycetoma patients locally at the village level. The MRC in collaboration with Sennar State Ministry of Health, Sudan had established a region mycetoma centre in one of the endemic mycetoma villages in the state. The patients were treated locally in that centre, the local medical and health personals were trained on early case detection and management, the local community was trained on mycetoma advocacy, and environmental conditions improvement. This comprehensive approach had also addressed the patients’ socioeconomic constraints that hinder early presentation and treatment. This approach has also included the active local health authorities, community and civil society participation and contributions to deliver the best management. This holistic approach for mycetoma patients’ management proved to be effective for early case detection and management, optimal treatment and treatment outcome and favourable disease prognosis. During the study period, the number of patients with massive lesions and the amputation rate had dropped and that had reduced the disease medical and socioeconomic burdens on patients and families. Mycetoma enjoys all the neglected tropical diseases (NTDs) characteristics. It frequently affects the poorest of the poor in poor communities in remote regions. The affected population are of low socio-economic status, of low visibility and low political and social voice and hence they are neglected. The disease is considered as a social stigma in particularly among females and children thus they tend to hide it for prolong period and when they are compelled to seek medical care the condition is then at a late stage. The mycetoma patients have many financial constraints that hinder them from seeking medical and health care. In the remote mycetoma endemic areas, the health and medical facilities are meagre, and it is difficult for the patients to reach the regional health centres and thus the majority of patients present with late advanced disease. To overcome these treatment difficulties, the MRC had adopted this holistic management approach to decentralised the patient's care, improve the disease awareness and advocacy, provide free medical and surgical treatment locally at the village level, and to improve the affected villages environmental and hygienic conditions. In this communication, the MRC is reporting on this unique experience, discussing the advantages and difficulties faced it and suggesting recommendations to improve it to be adopted worldwide. Reviewing the medical literature revealed, no report on such management approached for mycetoma patients and thus it worth reporting it.
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影响因子：
1.4
作者：
Fahal, A. H.;van de Sande, W. W. J.
通讯作者：
van de Sande, W. W. J.
影响因子：
5
作者：
Abd El Bagi, ME
通讯作者：
Abd El Bagi, ME
影响因子：
3.8
作者：
Fahal, Ahmed;Mahgoub, El Sheikh;Zijlstra, Eduard E.
通讯作者：
Zijlstra, Eduard E.
影响因子：
2.4
作者：
Fitzgerald E;Mlotha-Mitole R;Ciccone EJ;Tilly AE;Montijo JM;Lang HJ;Eckerle M
通讯作者：
Eckerle M
DOI：
10.1016/j.trstmh.2010.11.008
发表时间：
2011-03-01
影响因子：
2.2
作者：
Fahal, A. H.;Rahman, I. A.;Zijlstra, E. E.
通讯作者：
Zijlstra, E. E.