Dissertations / Theses on the topic 'Skin Diseases, epidemiology'

Abstract Skin diseases are common: one in every three of all general practice patients have at least one dermatological problem. However, epidemiological studies addressing the overall prevalence of skin diseases are sparse. The skin is the largest organ in the body and it has several vital and immunological functions. Cutaneous signs are often the first manifestation of many systemic diseases. The aim of this study was to determine the overall prevalence, and the distribution according to sex and socioeconomic status, of skin diseases in an adult population. The study particularly focused on multiple melanocytic naevi and their risk factors because multiple melanocytic naevi are the strongest risk factor for melanoma. A further aim was to analyse the association between cutaneous disorders and systemic conditions; specifically to determine whether abnormal skin findings in toe webs have an association with abnormal glucose metabolism and whether skin diseases have a relationship with systemic low-grade inflammation. For these purposes a comprehensive dermatological evaluation was performed as a part of the 46-year follow-up survey of the Northern Finland Birth Cohort 1966. Data on this cohort have been collected since birth. Numerous laboratory tests were also performed cross-sectionally during the 46-year follow-up survey, including an oral glucose tolerance test and the measurement of fasting plasma glucose and glycated haemoglobin fraction. High sensitivity C-reactive protein was measured as a marker of low-grade inflammation. Over half (60%) of the 1 932 individuals examined had at least one skin disorder requiring further treatment. The need for treatment was more common in males and those with lower socioeconomic status. Multiple melanocytic naevi were found in 12% of individuals; high educational level, male sex and fair skin type increased the risk. Abnormal skin findings in toe web spaces was associated with undiagnosed type 2 diabetes. Atopic eczema, rosacea and onychomycosis were associated with low-grade inflammation. This unique study with nearly 2 000 subjects reports for the first time the overall prevalence of skin diseases in an unselected Finnish population. Its findings support the previous postulate that skin diseases are common in adults and suggest that skin evaluation should be an essential part of routine medical examinations in clinical practice
Tiivistelmä Ihotaudit ovat yleisiä, ja jopa 30 %:lla yleislääkärin potilaista on jokin ihoon liittyvä ongelma. Väestötason tutkimuksia ihotaudeista on kuitenkin niukasti. Iho on ihmisen suuri elin, ja sillä on useita tärkeitä tehtäviä, kuten osallistuminen immunologiseen puolustukseen. Monet yleissairaudet voivat näkyä iholla jo ennen taudin puhkeamista ja ihoilmentymät voivat olla varhaisia merkkejä piilevästä sairaudesta. Tämän tutkimuksen tarkoituksena oli määrittää ihotautien esiintyvyys aikuisväestössä sekä ihotautien jakautuminen sukupuolen ja sosiaalisen aseman suhteen. Lisäksi tarkoituksena oli selvittää runsasluomisuuden (yli 50 pigmenttiluomea) esiintyvyyttä ja sen riskitekijöitä, sillä runsasluomisuus on melanooman merkittävin riskitekijä. Tutkimuksen tavoitteena oli myös selvittää ihotautien yhteyttä yleissairauksiin, kuten poikkeavien varvasvälilöydösten yhteyttä häiriintyneeseen sokeriaineenvaihduntaan sekä matala-asteisen tulehduksen ja ihotautien välistä yhteyttä. Osana Pohjois-Suomen syntymäkohortti 1966:n 46-vuotistarkastusta tehtiin kokonaisvaltainen ihon tutkiminen yhteensä 1 932:lle tutkimushenkilölle vuosina 2012–13. Samassa yhteydessä tutkittavilta määritettiin paastoverensokeri ja pitkäaikainen verensokeri sekä tehtiin sokerirasitustesti sokeriaineenvaihdunnan häiriön toteamiseksi. Matala-asteisen tulehduksen arvioimiseksi määritettiin herkkä C-reaktiivinen proteiini. Tutkimusjoukon pitkäaikaiset taustatiedot perustuivat syntymäkohortin aiempiin aineistoihin. Tutkittavista 60 %:lla todettiin jokin hoitoa vaativa ihotauti. Hoidon tarve oli suurempaa miehillä ja matalammissa sosiaaliluokissa. Runsasluomisuutta esiintyi 12 %:lla, ja korkea koulutustaso, miessukupuoli ja vaalea ihotyyppi lisäsivät riskiä. Varvasväleissä esiintyvät muutokset liittyivät diagnosoimattomaan diabetekseen. Atooppinen ihottuma, ruusufinni ja kynsien sieni-infektioon sopivat muutokset olivat yhteydessä matala-asteiseen tulehdukseen. Tämä lähes 2 000 henkilön koko ihon kliiniseen tutkimukseen perustuva työ raportoi ensimmäistä kertaa ihotautien yleistä esiintyvyyttä suomalaisessa, valikoitumattomassa väestössä. Tutkimus tukee aiempaa oletusta, jonka mukaan ihotaudit ovat aikuisväestössä yleisiä; ihon tutkiminen tulisi olla oleellinen osa potilaan kliinistä perustutkimusta

Background: Cutaneous melanoma is an aggressive form of skin cancer, arising in cutaneous melanocytes. The transcription factor PAX3 is critical for the proper development of neural crest lineages including melanocytes. Melanocytic cells show continued PAX3 expression from melanoblast formation in the neural crest to their differentiation into melanocytes. While many studies clarify the importance of PAX3 in embryonic development of melanocytes, less well understood, and more perplexing, is the continued PAX3 expression in adult skin melanocytes. By contrast PAX3 is frequently found in melanomas and naevi, and its expression correlates with melanoma staging. In this study we explore the multiple roles of PAX3 in melanocyte genesis and melanoma progression. While PAX3 is known to regulate melanocyte differentiation, survival, proliferation and migration during embryonic development, it is not clear if these same functions are maintained in adult melanocytes or melanoma cells. Drawing on evidence from development, we propose here a more encompassing theory that PAX3 is a key regulator of the myriad steps in melanocytic cell determination and function. We discuss the possibility that these roles may be accomplished by differential association with cofactors, via alternate transcripts or posttranslational protein modification(s). Moreover, we consider its possible roles in melanoma and provide a comprehensive consideration of the significance of PAX3 expression in melanoma.

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Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES
In Brazil, epidemiological studies on canine dermatopathies are scarce and the literature point out several gaps in knowledge about. The aim of this study was to describe the profile of canine population with dermatopathies attended by the Section of Dermatology, Rural Federal University of Rio de Janeiro, testing associations with variables inherent to animals, eating habits, hygiene and in relation to concurrent dermatopathies. The records of all animals attended between January 2005 and December 2010 were organized in a database using the software Epi Info? version 3.5.1. The Chi-square ?? test or Fisher?s exact test, the prevalence ratios and their confidence intervals, the ?? test for linear trend and the respective Odds ratios were used to evaluate the associations. The level of significance adopted was 5%. We reviewed the records of 2,280 dogs, with a total of 3,433 diagnostics, and 113 types of dermatopathies were identified. The population studied was composed predominantly of females (55.2%), adults (58.3%) and defined breed animals (67.32%). The categories of dermatopathies more prevalent were: allergic (41.35%), bacterial (23.94%) and endocrines (22.41%). The categories not zoonotic (94.12%) predominated over zoonotic diseases (5.88%). The more prevalent dermatitis were: atopic dermatitis - AD (31.67%), hypothyroidism (20.75%), bacterial folliculitis (8.42%), demodicosis (8.29%), flea infestation (7.67%) otitis by M. pachydermatis (6.14%), bacterial otitis (5.92%) and flea allergic dermatitis ? FAD (5.8%). Sex was significantly associated with AD, hepatoid adenoma, acute moist dermatitis - AMD, hypothyroidism, hyperadrenocorticism and demodicosis. Significant differences were observed in relation to age and AD, folliculitis, hypothyroidism, hyperadrenocorticism, scabiosis, demodicosis, dermatophytosis, systemic lupus erythematosus and neoplasms. The prevalence of AD, FAD, contact dermatitis, hypothyroidism, scabiosis, discoid lupus erythematosus, otohematoma and neoplasms varied with significant differences in relation to animal breed. In addition, there are statistical evidences of association between: AD and hypothyroidism, use of perfumes and cleaning products; FAD and AD, food allergic dermatitis and type of food; AMD and neutering, hair type and AD; hypothyroidism and neutering; demodicosis, hair type and neutering; sporotrichosis and contact with injuried animals. The study population is characterised by high prevalence of dermatopathies of the categories allergic, bacterial, endocrines, fungal and parasitic diseases and low prevalence of dermatozoonoses. The nosology of the population studied is consistent with the type of service offered by the Section of Dermatology, which is most seek for solving complex problems and in several occasions by private practitioners. It should be noted that the studied population was examined by a dermatologist from an University Veterinary Hospital where the technology could overcome the private clinics. Therefore, despite the validity of results, these should not be extrapolated without care for other populations. The variety of the diagnostics performed indicates that the diagnosis and management of dermatopathies must receive higher attention from graduates and specialists
No Brasil, estudos epidemiol?gicos sobre dermatopatias caninas s?o escassos e a literatura aponta v?rias lacunas no conhecimento. O objetivo deste estudo foi descrever o perfil da popula??o canina atendida no Setor de Dermatologia da Universidade Federal Rural do Rio de Janeiro, e das dermatopatias, testando-as quanto ?s associa??es com vari?veis inerentes aos animais, seus h?bitos alimentares, higi?nicos e em rela??o ?s dermatopatias concorrentes. Os dados de todos os prontu?rios de animais atendidos no per?odo de janeiro de 2005 a dezembro de 2010 foram armazenados em um banco de dados elaborado no programa Epi Info? vers?o 3.5.1. O teste ?? ou exato de Fisher, as raz?es de preval?ncias e seus respectivos intervalos de confian?a, o ?? de tend?ncia linear e as respectivas odds ratio foram empregados na avalia??o da associa??o. O n?vel de signific?ncia adotado foi de 5%. Foram revisados os prontu?rios de 2.280 c?es, nos quais foram realizados 3.433 diagn?sticos e identificadas 113 dermatopatias diferentes. A popula??o estudada foi composta predominantemente por f?meas (55,2%), adultos (58,3%) e animais com ra?a definida (67,32%). As categorias de dermatopatias mais prevalecentes foram: as al?rgicas (41,35), as bacterianas (23,94%) e as end?crinas (22,41%). As categorias n?o zoon?ticas (94,12%) prevaleceram sobre as zoon?ticas (5,88%). As dermatites mais prevalecentes foram: dermatite at?pica- DA (31,67%), hipotireoidismo (20,75%), foliculite bacteriana (8,42%), demodicose (8,29%), infesta??o por pulga (7,67%) otite por M. pachydermatis (6,14%), otite bacteriana (5,92%) e dermatite al?rgica por picada de pulga- DAPP (5,8%). O sexo esteve associado significativamente a DA, ao adenoma hepat?ide, a dermatite ?mida aguda- DUA, ao hipotireoidismo, ao hiperadrenocorticismo e ? demodicose. Diferen?as significativas foram observadas em rela??o ? idade e a DA, ? foliculite, ao hipotireoidismo, ao hiperadrenocorticismo, ? escabiose, ? demodicose, ? dermatofitose, ao l?pus eritematoso sist?mico, e as neoplasias. As preval?ncias de DA, DAPP, dermatite por contato, hipotireoidismo, escabiose, l?pus eritematoso disc?ide, otohematoma e neoplasias variaram com diferen?as significativas em rela??o ? ra?a. H? evid?ncias estat?sticas de associa??o entre: DA e hipotireoidismo, uso de perfumes e produtos de limpeza; DAPP e DA, dermatite al?rgica alimentar e tipo de alimento; DUA e castra??o, tipo de pelagem e DA; hipotireoidismo e castra??o; demodicose, tipo de pelagem e castra??o; esporotricose e contactantes com les?o. A popula??o estudada caracteriza-se por apresentar altas preval?ncias de dermatopatias nas categorias al?rgicas, bacterianas, end?crinas, parasit?rias e f?ngicas e baixas preval?ncias de dermatozonoses. O quadro nosol?gico da popula??o ? coerente com o tipo de servi?o oferecido pelo setor de dermatologia, que ? mais procurado para resolver problemas complexos e em muitas ocasi?es por indica??o de cl?nicos gerais. Deve-se ressaltar que popula??o estudada foi examinada por dermatologista em Hospital Veterin?rio de uma Universidade onde a capacidade tecnol?gica pode superar a da maioria das clinicas privadas. Portanto, apesar da validade interna dos resultados obtidos, estes n?o devem ser extrapolados sem os devidos cuidados para outras popula??es. A variedade de diagn?sticos realizados indica que o diagn?stico e o manejo das dermatopatias devem receber maior aten??o por parte dos graduandos e especialistas

Abstract Bullous pemphigoid (BP) is an autoimmune skin disease predominantly found in elderly people, which causes blistering of the skin and severe itching. The incidence of BP reported by previous studies has varied greatly between 0.05 and 42.8 per 1 million persons per year. Higher incidences have been reported in Western Europe and the USA, while countries around the Mediterranean have reported lower rates. However, the epidemiology of BP has not previously been studied in any Scandinavian country. The one-year mortality of BP is highly variable with estimates between 11% and 41% worldwide. As for comorbidities, the previous studies have shown that BP is associated with neurological disorders. The aim of this study was to investigate the incidence and mortality of BP in Finland, to assess the treatments used for BP, and the potential contribution of systemic glucocorticoid treatment to the high mortality rate found in BP patients. A further aim was to obtain more specific information about the neurological diseases associated with BP, and to clarify the less studied association with psychiatric disorders. For these purposes, we collected the records of all immunologically confirmed BP patients diagnosed in the Oulu University Hospital between 1985 and 2012, and, for a sub-study III, data for all patients diagnosed with BP in Finnish hospitals between 1987 and 2013. We found that the incidence of BP in Northern Finland has increased over the past two decades to approximately 27 new BP cases per 1 million persons per year. The one-year mortality of BP patients is 17%, and the standardized mortality ratio (SMR) is 7.6. Common comorbidities found in the sample of BP patients were: cardiovascular diseases (76%), neurodegenerative diseases (41%), skin conditions other than BP (37%) and type 2 diabetes (23%). Many neurodegenerative diseases of the central nervous system were associated with BP, as were many psychiatric disorders. The association was strongest between multiple sclerosis (MS) and BP, with MS patients having almost a 6-fold higher risk of BP than controls. The present study reports for the first time the incidence and mortality of BP in Finland, and provides new information about the association between BP and neurological and psychiatric disorders
Tiivistelmä Rakkulainen pemfigoidi (josta jatkossa käytetään nimitystä pemfigoidi) on autoimmuunisairaus, joka esiintyy yleensä iäkkäillä, ja aiheuttaa ihon rakkulointia ja hankalaa kutinaa. Aiemmissa tutkimuksissa pemfigoidin ilmaantuvuus on vaihdellut 0,05:sta 42,8:aan tapaukseen miljoonaa ihmistä kohden vuodessa. Ilmaantuvuuden on havaittu olevan korkeampi Länsi-Euroopassa, kun taas Välimeren ympäristössä ilmaantuvuus on matalampi. Pemfigoidia sairastavien kuolleisuus vuoden kuluessa diagnoosista vaihtelee noin 11-41%:n välillä. Aiemmat tutkimukset ovat myös osoittaneet, että pemfigoidi liittyy neurologisiin sairauksiin. Pemfigoidin epidemiologiaa ei ole kuitenkaan tutkittu Suomessa tai muissa Pohjoismaissa. Tämän tutkimuksen tarkoituksena oli selvittää pemfigoidin ilmaantuvuus ja kuolleisuus Suomessa, tutkia sen hoitoon käytettyjä lääkkeitä sekä arvioida systeemisen glukokortikoidihoidon osuutta korkeaan kuolleisuuteen. Lisäksi tavoitteena oli saada yksityiskohtaista tietoa pemfigoidiin liittyvistä neurologisista sairauksista ja selvittää lisää aiemmissa tutkimuksissa ristiriitaiseksi jäänyttä yhteyttä psykiatrisiin sairauksiin. Tätä varten keräsimme tiedot kaikista Oulun yliopistollisessa sairaalassa diagnosoiduista, immunologisesti varmennetuista pemfigoiditapauksista vuosilta 1985-2012. Kolmannessa osatyössä käytimme kansallista aineistoa, joka sisälsi kaikkialla Suomessa diagnosoidut pemfigoidia sairastavat potilaat vuosilta 1987-2013. Pemfigoidin ilmaantuvuus kasvoi seuranta-aikana ollen nykyisin Pohjois-Suomessa noin 27 tapausta miljoonaa ihmistä kohden vuodessa. Kuolleisuus vuoden kuluessa diagnoosista oli 17% ja vakioitu kuolleisuussuhde (standardized mortality ratio) 7,6. Yleisiä oheissairauksia pemfigoidia sairastavilla olivat sydän- ja verisuonisairaudet (76%), neurodegeneratiiviset sairaudet (41%), muut ihosairaudet (37%) sekä tyypin 2 diabetes (23%). Tutkimuksessa todettiin, että monet neurogeneratiiviset sairaudet ja monet psykiatriset sairaudet liittyvät pemfigoidiin. Yhteys oli vahvin pesäkekovettumataudin (MS-tauti) ja pemfigoidin välillä, ja MS-tautia sairastavilla riski sairastua pemfigoidiin oli lähes 6-kertainen verrattuna kontrollipotilaisiin. Tämä tutkimus on ensimmäinen, joka raportoi pemfigoidin ilmaantuvuuden ja kuolleisuuden Suomessa. Tutkimus antaa lisäksi uutta tietoa pemfigoidin yhteydestä neurologisiin ja psykiatrisiin sairauksiin

Background: A landmark study suggested that wide excision of intermediate-thickness melanoma with sentinel lymph node biopsy (SLNB) and subsequent completion lymph node dissection (CLND) for regional disease may improve prognostication and disease-free survival (DFS) compared with those undergoing wide excision alone. However, these benefits were relatively small and not associated with an improvement in disease-specific survival (DSS). It remains unknown if SLNB and subsequent treatments are beneficial in elderly patients who have a decreased overall (OS) due to other causes. Methods: Adults ≥ 70 years of age, who underwent surgical intervention for intermediate-thickness cutaneous melanoma from 2000-2013 were identified from a prospectively-maintained database. Clinicopathologic variables measured included age, gender, anatomic site, histologic type, tumor thickness, ulceration, receipt and result of SLNB, completion of CLND, OS, and DFS. Results: Ninety-one patients underwent excision of an intermediate-thickness melanoma. Forty-nine patients (54%) received a SLNB. Seven of these biopsies (14%) were positive, and five patients went on to receive CLND. Five-year OS was 41% in patients who did not receive SLNB and 52% in patients who did receive SLNB (p=0.11). DFS was similar between groups independent of receipt of SLNB. Conclusion: Among elderly patients with intermediate-thickness melanoma, patients who received SLNB had similar 5-year OS and DFS compared with those who did not receive SLNB. Routine SLNB for intermediate-thickness melanoma patients may not significantly change outcomes for this age group, and clinical decision-making should consider individual patient comorbidities and goals of care.

Background: A landmark study suggested that wide excision of intermediate-thickness melanoma with sentinel lymph node biopsy (SLNB) and subsequent completion lymph node dissection (CLND) for regional disease may improve prognostication and disease-free survival (DFS) compared with those undergoing wide excision alone. However, these benefits were relatively small and not associated with an improvement in disease-specific survival (DSS). It remains unknown if SLNB and subsequent treatments are beneficial in elderly patients who have a decreased overall (OS) due to other causes. Methods: Adults ≥ 70 years of age, who underwent surgical intervention for intermediate-thickness cutaneous melanoma from 2000-2013 were identified from a prospectively-maintained database. Clinicopathologic variables measured included age, gender, anatomic site, histologic type, tumor thickness, ulceration, receipt and result of SLNB, completion of CLND, OS, and DFS. Results: Ninety-one patients underwent excision of an intermediate-thickness melanoma. Forty-nine patients (54%) received a SLNB. Seven of these biopsies (14%) were positive, and five patients went on to receive CLND. Five-year OS was 41% in patients who did not receive SLNB and 52% in patients who did receive SLNB (p=0.11). DFS was similar between groups independent of receipt of SLNB. Conclusion: Among elderly patients with intermediate-thickness melanoma, patients who received SLNB had similar 5-year OS and DFS compared with those who did not receive SLNB. Routine SLNB for intermediate-thickness melanoma patients may not significantly change outcomes for this age group, and clinical decision-making should consider individual patient comorbidities and goals of care.

La dermatose nodulaire contagieuse (DNC) est une des maladies virales les plus importantes économiquement chez les bovins en Ethiopie. Elle est causée par le virus LSD (Lympy skin disease virus) appartenant au groupe des Capripoxvirus. L'objectif de cette thèse est de mieux comprendre l'épidémiologie de cette maladie afin de proposer des méthodes de contrôle et de prévention efficaces et applicables sur le terrain. Cette thèse est construite en cinq chapitres. Le premier chapitre fait une description générale du système de production agricole en Ethiopie et présente nos connaissances actuelles sur ce virus et cette maladie. Le second chapitre est consacré à l'évaluation d'un test d'immunofluorescence indirecte (IFI) pour le diagnostic sérologique à l'aide de méthodes sans gold standard. Le test de séroneutralisation virale a été utilisé comme second test de comparaison. L'analyse à l'aide d'un modèle bayesien a montré que l'IFI présentait une bonne sensibilité (92%) et une bonne spécificité (88%) ce qui suggère que ce test peut être utilisé pour le diagnostic et le dépistage de masse de la Dermatose Nodulaire Contagieuse avec une relativement faible proportion d'erreurs. La possibilité de tester un grand nombre de sérums en IFI est un autre avantage de cette technique pour conduire des études épidémiologiques de grande envergure. La sensibilité et la spécificité de la séroneutralisation virale (SNV) étaient respectivement de 78% et de 97%. En conséquence, le test IFI sera préféré pour un dépistage de masse en raison de sa meilleure sensibilité tandis que le test SNV sera réservé à la confirmation. Une étude épidémiologique transversale a été menée pour estimer la prévalence de la Dermatose Nodulaire Contagieuse Bovine à l'échelle du troupeau et de l'individu et pour définir les facteurs de risque associés à cette maladie dans le contexte particulier de l'Ethiopie. C'est l'objet de la troisième partie de cette thèse. Un total de 330 questionnaires d'enquêtes a été collecté de 44 associations paysannes situées dans 15 districts. La prévalence moyenne de la DNC à l'échelle du troupeau était de 42,8% (IC à 95% : 37,5 – 48,3). Elle était significativement plus élevée dans les zones d'altitude moyenne 55,2% (IC à 95% : 47,5 – 62,6) que dans les zones de basse altitude (22,3%) ou les zones de haute altitude (43,5%). La prévalence de la DNC et la mortalité due à cette maladie, observées à l'échelle de l'animal, étaient de 8,1% et de 2,12% respectivement. A nouveau, elles étaient plus élevées dans les zones d'altitude moyenne (10,4% et 3,2% respectivement) que dans les zones de basse et haute altitude (P < 0,05). L'analyse de facteurs de risque a montré que trois variables étaient significativement associées avec la prévalence de la DNC : l'effet de la zone agroclimatique, la conduite de troupeaux différents sur les mêmes pâtures et les mêmes lieux d'abreuvement et l'introduction de nouveaux animaux. L'incidence maximale de la DNC était concomitante de l'augmentation des populations d'insectes hématophages : cette association dans le temps était significative (coefficient de Spearman de 0,88 ; 0,79 et 0,79 respectivement pour les zones de haute, moyenne et basse altitude). L'évaluation de la faisabilité financière et des bénéfices espérés de la vaccination ont constitué la quatrième partie de la thèse
Lumpy skin disease (LSD) is one of economically important viral diseases of cattle in Ethiopia caused by Lumpy skin disease virus in the member of the genus Capripox viruses. The objective of this thesis is to better understand the epidemiological features of the disease in order to propose practical and applicable control and prevention options. The thesis is classified in five chapters. The first chapter describes the general agricultural production system in Ethiopia and relates the current knowledge on the virus and the disease as given by the literature.The second chapter deals with the performance of indirect fluorescence antibody test (IFAT) as a serological diagnostic and screening tool that was evaluated using methods without gold standard. Virus neutralization test (VNT) was used as the second test for comparison. The analysis of conditional dependent Bayesian model showed that the IFAT had good accuracy both in sensitivity (92%) and specificity (88%) parameters indicating that it could be used for LSD diagnosis and screening (epidemiological studies, epidemiosurveillance) with less misclassification. Its capacity to run large number of samples per plate just like ELISA could be also taken as an advantage for large epidemiological studies. The sensitivity and specificity of VNT was 78%, 97% respectively. The two tests IFAT and VNT were found conditionally independent on the disease status of the animal. Thus, higher sensitivity and throughput for IFAT would render the test being selected for screening purposes and higher specificity performance of VNT would qualify it to be used as a confirmation test. A cross sectional study was then conducted to estimate the prevalence of LSD at herd and animal-levels and to analyze the risk factors associated with the disease occurrence in Ethiopia. It is presented in the third chapter. A total of 330 questionnaire surveys were collected from 44 peasant associations (PA) distributed in 15 districts. The average herd level LSD prevalence was 42.8% (95% CI: 37.5–48.3) and it was significantly higher in the midland agro-climate 55.2% (95% CI: 47.5–62.6) than in lowland and highland agro-climate zones (22.3% and 43.5%, respectively). The observed LSD prevalence and mortality at animal level were 8.1% and 2.12% respectively which were still higher in the midland zone (10.4% and 3.2%, respectively) than in lowland and highland zones (P< 0.05). The risk factor analysis showed that three variables: the effect of agro-climates, communal grazing/watering management and introduction of new animals were significantly associated with LSD occurrence. The temporal association between LSD occurrence and increase in the biting-fly population was also positively correlated by Spearman rank correlation coefficient (0.88, 0.79 and 0.79 for highland, midland and lowland zones, respectively) and statistically significant. The need to evaluate the financial feasibility and benefit possibly expected of vaccination led us to the fourth component of the thesis

Dermatology is definitely one of the most important specialties in small animal veterinary medicine, as the skin is the largest organ of the body, it is exposed to the environment, therefore possibility to be affected is high and it is also an indicator of the animal’s general health. As the majority of the dermatological cases are complicated, in many of them, there is need of complementary exams in the form of biopsy and histopathological findings. Skin biopsy is getting more and more importance in the field of veterinary dermatology. In this work is presented the importance of skin biopsy, indications and contraindications of the technique, detailed explanation of the skin biopsy technique, critical points, as well as shipment of the material to laboratory. It also explains the role and importance of a pathologist for the clinical cases, as well as brief histopathological terminology used in the results. A retrospective epidemiological study is presented, based on the results of the skin biopsies of dogs and cats, obtained from INNO laboratory in Portugal between years 2010- 2016. Main goal of this study is to gain information about the final diagnosis based on underwent skin biopsies, and to gain knowledge about the most common dermatological diseases of pets in Portugal. The majority of the biopsies received came from male dogs, with an average age of 7,3 years. The 5 most affected breeds are Labrador Retriever, Boxer, German Shepherd, Cocker Spaniel and undetermined breed. In total, 74 different types of breeds were present. The 3 most common diseases, which dogs suffer from are neoplastic, allergic and infectious diseases. Considering cats, females are more predisposed to suffer from dermatological diseases. The average age of affected cats is 7,5 years. The 2 most affected breeds are European shorthair cat and undetermined breed. In total, skin biopsies were obtained from 5 different types of breeds. The 3 most common diseases in cats are allergic, neoplastic and infectious diseases.

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2016
Background: Skin conditions frequently motivate Emergency Department(ED) visits. While most are benign in course, some will present as true dermatological urgencies/emergencies, requiring admission. Objective: To present data on the skin diseases most frequently found in the ED, and those most frequently requiring admission at a Portuguese tertiary teaching hospital. To explore association between epidemiological variables and frequency of diagnoses in this context. Methods: A retrospective study was conducted, including all patients observed during 2012 in the Dermatology Emergency Consultation (DEC), in Hospital de Santa Maria (HSM) Lisbon, Portugal. Association between epidemiological variables (gender and age of patients, and season of the year) and frequency of diagnoses was searched. Results: 8620 patients were observed by a dermatologist during 2012, in the ED, constituting 3.9% of all ED Consults in HSM. Overall, 333 diagnoses were made, the most frequent of which was Eczema Non-Otherwise-Specified (9.4%). However, infectious and parasitic diseases constituted the leading motive for DEC visit (31.5%). Only 264 patients were admitted, with 65 diagnoses motivating admission. Nine diagnoses alone constituted 60% of all motives for admission: Cellulitis (20.5%), Erysipelas (7.5%), Drug Induced Eruption (7.1%), Psoriasis (6.3%), Bullous Pemphigoid (4.3%), Erythroderma (4.3%), Lymphoma (3.5%), Herpes Zoster (2.8%) and Eczema (2.4%). Infectious and parasitic diseases constituted the leading cause to admission (34.7%). Association between frequency of diagnoses and gender, age, and season of the year was found. Conclusion: Despite the variety of dermatologic pathologies, only a restrict group of diseases is responsible for most of the true dermatological urgencies/emergencies. Therefore, where a dermatologist isn’t readily available, knowledge on these entities, as well as the demographic and environmental data, may add to the management of these patients.
Introdução: As dermatoses constituem uma causa frequente de recurso aos Serviços de Urgência (SU). Apesar de a maioria destas situações não ser potencialmente grave, alguns casos constituem verdadeiras urgências/emergências, necessitando de internamento. Objectivos: Apresentar dados sobre as dermatoses mais frequentes no SU de um hospital terciário universitário em Lisboa, bem como aquelas que mais frequentemente necessitam de internamento. Explorar a associação entre variáveis epidemiológicas e a frequência dos diagnósticos, neste contexo. Métodos: Conduziu-se um estudo retrospectivo, incluindo todos os doentes observados na Consulta de Urgências de Dermatologia (CUD), durante o ano de 2012, no Hospital de Santa Maria em Lisboa. Procurou-se associação estatística entre variáveis epidemio-demográficas e a frequência de diagnósticos. Resultados: Em 2012, 8620 pacientes foram observados por um Dermatologista, no SU, constituindo 3.9% de todos os episódios do SU. No total, encontraram-se 333 diagnósticos diferentes, sendo o mais frequente o Eczema Sem Outra Especificação (9.4%). Contudo, as causas infecciosas constituiram o principal motivo de recurso às CUD (31.5%). Apenas 264 pacientes foram internados, com 65 diagnósticos a motivar internamento. Nove diagnósticos foram responsáveis por 60% dos internamentos: Celulite (20.5%), Erisipela (7.5%), Toxidermia (7.1%), Psoríase (6.3%), Penfigóide Bulhoso (4.3%), Eritrodermia (4.3%), Linfoma (3.5%), Herpes Zoster (2.8%) e Eczema (2.4%). As causas infecciosas constituiram o principal motivo de internamento (34.7%). Encontrou-se associação entre o género e idade do doente, e estação do ano, e a frequência dos diagnósticos. Conclusões: Apesar da diversidade de dermatoses encontrada nos SU, apenas um grupo restrito de patologias constitui verdadeiras urgências dermatológicas. Assim, onde não existam dermatologistas disponíveis para avaliar estes doentes, o reconhecimento destas entidades, bem como a ponderação de variáveis epidemiológicas simples, pode auxiliar na orientação diagnóstica e terapêutica destes doentes.

Vaccination is one of the most successful public health interventions in history, and is estimated to save lives of 3 million children globally each year. Ongoing surveillance is warranted to identify further evolution of the epidemiology of vaccine preventable diseases, and to evaluate the effects of vaccines provided. This dissertation aims to explore the impact of vaccines on disease burden, and effectiveness of diagnostic tools for two important infectious diseases; pneumonia and tuberculosis (TB). The first study employed a large electronic health record data, Massachusetts Health Disparities Repository (MHDR), to evaluate impact of 13-valent conjugated pneumococcal vaccine (PCV13) on all-cause pneumonia among children who receive primary care at Boston Medical Center (BMC). We extracted all-cause pneumonia cases diagnosed at both inpatient and outpatient settings among children younger than 8 years of age. Using interrupted time-series regression analysis monthly rates estimated for years after (2011–2013) implementation of PCV13 were compared to expected rates calculated from pre-PCV13 era (2007–2009). The year of PCV13 introduction (2010) was excluded. We also extracted cases of urinary tract infection and evaluated as control outcome. At the end of 2013 compared to prePCV13 era, among children younger than 2 years of age there was a 35.3% (95% CI 5.4–65.3) reduction in all-cause pneumonia cases. In children with comorbidity, pneumonia declined by 38.8% (95% CI 11.1 to 65.4) in those younger than 2 years of age, and 28.7% (95% CI 2.9 to 54.5) in those 2 to 8 years of age. The results of this study contribute to the growing body of evidence supporting the benefit of indirect protection with conjugated vaccines, and emphasize the importance of high sustainable vaccine coverage rates. The second and the third studies used data from the Tuberculosis Epidemiologic Studies Consortium (TBESC) Study-1, a 10-site collaboration of academic institutions and state and local TB control programs that is funded and administered by the Division of Tuberculosis Elimination at the Centers for Disease Control and Prevention (CDC). The second study evaluated the impact of Bacille Calmette Guérin (BCG) vaccination, which continues to be the only vaccine available for prevention of TB, on tuberculin skin testing (TST) results. Using the data collected TBESC Study-1 between September 2012 and September 2014, we examined the association between BCG vaccination and TST positivity. Logistic regression models were used to calculate adjusted prevalence ratios (PR) and 95% confidence intervals (CI). Prior BCG vaccination had no impact on the TST results once adjusted for history of household contacts (adjusted PR 1.0, 95% CI 0.4–1.5). The results of this study add further evidence that BCG vaccination has little impact on TST results in children, particularly in older age groups. The third study examined the cost-effectiveness of three different screening strategies compared to no screening for latent tuberculosis infection (LTBI) in a population with high proportion of foreign-born individuals who have different risk levels for developing TB. In this study, everyone was tested with using all available tools for LTBI: TST, and interferon-gamma release assays (IGRAs) during their enrollment visit. We used decision tree analysis and Markov models to compare TST only, IGRA only, TST followed by IGRA among those who were TST positive, and no screening strategies. Regardless of the assumptions and tests used, screening provided better health outcomes such as less TB cases and less TB related mortality compared to no screening. The incremental cost-effectiveness ratio (ICER) of TST followed by IGRA compared to no screening was $75,094 per QALY gained. The results of this study suggest that prioritizing certain groups for targeted LTBI screening such as foreign-born individuals, and using TST followed by IGRA can maximize the impact of public health resources allocated to eradicate TB in the U.S. The findings from these studies will contribute to the further understanding of the impact of the vaccines and the changing epidemiology of vaccine-preventable diseases providing more insight to formulate new strategies to improve overall health of children.

碩士
國立臺灣大學
流行病學研究所
88
Residents in the arseniasis-endenmic area in southwestern Taiwan has started to use tap water sine 1970, the cancer mortality of them remains higher than the general population in Taiwan. The high incidence of arsenic-induced skin cancer suggests the existence of the effects of genetic damage induced by arsenic exposure in early years. The prevalence of skin cancer in this area is about 5.9 per 1,000, the low prevalence suggests the individual variation in susceptibility to arsenic- induced cancer. The specific aim of this study is to examine the association with arsenic induced skin cancer for genetic polymorphisms of glutathione S-transferase(GST) and DNA repair enzymes. A total of 309 subjects aged 30 years and older were studied. They included 67 cases of arsenic-induced skin cancer and 242 unaffected controls. The polymerase chain reaction (PCR) with/without restriction fragment length polymorphisms (RFLPs) were used to determine genotypes. Unconditional logistic regression models were used for data analysis to assess the independent and interactive effects of DNA repair genes(XPD,XRCC1) and GST M1,T1 and P1on the development of arsenic-induced skin cancer. Those who had at least one null or variant gene types of GST M1, T1 and P1 had an increased risk of arsenic-induced skin cancer with an odds ratio of 5.7 (95%CI, 1.65-19.94). DNA repair enzyme XPD exon6 AC or AA genotype was associated with an increased risk compared with the genotype CC showing an odds ratio of 2.13 (95%CI, 0.95-4.76). The combination of DNA repair enzyme XRCC1 exon9 genotype Arg/Arg and XPD exon6 genotypes AC or AA was found to be associated with an increased risk of arsenic-induced skin cancer showing an odds ratio of 2.58 (95%CI, 0.91-7.31) compared with the combination XRCC1 exon9 genotypes of His/His or Arg/His and XPD exon6 genotype CC. When analyzing the risk associated with the number of susceptible genotypes of XRCC1,XPD and GST’s those who had two and three susceptible genotypes had age-sex-adjusted odds ratios of 2.65 (95%CI, 0.57-12.49) and 5.87 (95%CI, 1.31-26.37),respectively, compared with those who had none or one susceptible genotypes.