Clinical and laboratory evaluation of cured and non-cured patients with cutaneous leishmaniasis treated by Glucantime

BACKGROUND & OBJECTIVES

Insufficient treatment of cutaneous leishmaniasis (CL) by conventional drugs is a major barrier in control strategies. This study was aimed to evaluate Glucantime efficacy and the susceptibility of Glucantime unresponsive and responsive CL isolates in the field and laboratory.

METHODS

Chi-square test (x^[2]) was used to determine the significance of difference between proportions in Glucantime-treated patients. The inhibitory activity of various concentrations of Glucantime against Leishmenia tropica stages was evaluated by a colorimetric cell viability MTT and macrophage assays. Mixed model, t-test and ANOVA were performed to determine the significance of difference between various concentrations of Glucantime unresponsive or responsive isolates and untreated control group and p <0.05 was defined as significant level. Altogether, 89.8% of the patients were cured by Glucantime, whilst 10.2% remained non-cured.

RESULTS

The overall Glucantime efficacy in different age groups and genders was similar. The IC₅₀ values of promastigotes and amastigotes for Glucanime unresponsive isolates were 2.1 and 2.6 times higher than the equivalent rates obtained for responsive cases, respectively. The overall mean number of amastigotes within macrophages in unresponsive isolates was significantly higher (32.68 ± 1.24) than that in responsive ones (18.68 ± 1.52, p <0.001). Glucantime unresponsive and responsive field isolates of anthroponotic CL (ACL) caused by L. tropica strongly correlated to in vitro assays.

INTERPRETATION & CONCLUSION

Monitoring of Glucantime unresponsiveness by the health surveillance system is extremely important, where anthroponotic transmission occurs in humans. Hence, physicians should be aware of such clinical unresponsive presentations with ACL for antimonial therapeutic failure to improve management of disease in endemic regions.

Evaluation of the usefulness of maternal mortality ratio for monitoring long-term effects of a disaster: case study on the Bam earthquake

The maternal mortality ratio is an important indicator of socioeconomic conditions in a country or area. This study in Kerman province aimed to compare maternal mortality ratios from different data sources and examine deficiencies in vital data collection in the Islamic Republic of Iran in the context of the Bam earthquake disaster (December 2003). Annual data were collected from documents before and after the earthquake and interviews were conducted with key informants. There was a large difference in maternal mortality ratios in the year of the earthquake and the year after the earthquake comparing the 2 main data sources (the family unit under the supervision of the Ministry of Health and Medical Education and the civil registry under the supervision of the Ministry of Interior). The reasons for this are discussed. This study also highlighted problems in collaboration between international aid agencies that hindered routine data collection.

Health information systems in the Islamic Republic of Iran: a case study in Kerman Province

Health information systems provide information for decision-making at all levels, from planning and management to evaluation of health services. Registration of vital events is the most basic level of any health information system. This case study used in-depth interviews, observations and examination of documents to explore the system of births and deaths registration in Kerman province. The findings were evaluated under 3 headings: data input, data processing and data usage. A range of problems were identified concerning legal requirements, staffing, data checking and publication of data. Different approaches are suggested to strengthen the system, such as introducing regulations to oblige different data sources to provide data and allocating sufficient resources, including human resources, and an improved technology infrastructure.

Patient satisfaction and related factors in Kerman hospitals

To determine the level of patient satisfaction in hospitals in Kerman and to determine the factors affecting satisfaction, we did an analytic cross-sectional study on 3017 patients from March 2002 to March 2003. We used a 4-part questionnaire covering demographics, satisfaction, patients' needs and mental health status. Just over 50% of the patients were female. Mean age was 37.4 years (range 1-99 years). Just under 50% of patients were satisfied. There was a significant relationship between satisfaction and type of hospital (P < 0.001), ward (P < 0.006), education level (P < 0.004), history of hospitalization (P < 0.001), need for medical services (P < 0.001), health status (P < 0.001) and duration of hospitalization (P < 0.002).