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Lymphatic filariasis is a mosquito born disease infecting over 120 million people globally. This is a community based cross-sectional study done to assess the prevalence of disease in Dumka District of Jharkhand. Three years data (2018-2020) were used to know the disease spectrum in this region. The disease mostly presented itself in its chronic forms. Prevalence of the disease has decreased in three years duration. Lymphedema cases were predominant as it was seen in both male and female. The study showed Lymphedema cases as 52% in 2018, 88% in 2019 and 98% in 2020. Overall disease is significantly higher in males than in female. But, Elephantiasis is more frequent in females. Present study reveals that there is remarkable impact of ELF program showing significant reduction in number of cases in three years duration. But the study indicates that the disease still continues to be the major cause of disability and poverty. Keywords: Lymphatic filariasis, Mass drug administration, Elimination of Lymphatic Filariasis.

Podoconiosis is a type of tropical lymphedema that is clinically distinguished from lymphatic filariasis (LF) because it is ascending and commonly bilateral but asymmetric. The disease is a result of a genetically determined inflammatory reaction to long-term exposure to mineral particles in irritant red clay soils derived mainly from volcanic soils. We conducted the first nationwide mapping of the prevalence and risk factors of podoconiosis in Kenya. We performed a population-based cross-sectional survey to determine the national prevalence of podoconiosis and included 6,228 individuals from 48 villages in 24 sub-counties across 15 counties. Participants answered a questionnaire about the history of symptoms compatible with podoconiosis, received a point-of-care antigen test, and underwent a physical examination if they had lymphedema. A confirmed case of podoconiosis was defined as a case in a resident of the study village who had lower limb bilateral and asymmetric lymphedema lasting more than 1 year, negative test results for Wuchereria bancrofti antigen, and other causes of lymphedema ruled out. Of all the individuals surveyed, 89 had lymphedema; of those, 16 of 6228 (0.3%; 95% confidence interval [CI], 0.1–0.5) were confirmed to have podoconiosis. A high prevalence of podoconiosis was found in western (Siaya, 3.1%; Busia, 0.9%) and central (Meru, 1.1%) regions, and a low prevalence was observed in northern (Marsabit, 0.2%), eastern (Makueni, 0.2%), and coastal (Tana River, 0.1%) regions. The identified risk factors were age 56 years or older (adjusted odds ratio [aOR], 5.66; 95% CI, 2.32–13.83; P < 0.001) and rarely wearing shoes (aOR, 18.92; 95% CI, 4.55–78.71; P < 0.001). These results indicated that the podoconiosis prevalence is low and localized in Kenya; therefore, elimination is achievable if appropriate disease prevention, management, and behavioral strategies are promoted.

INTRODUCTION Lymphatic filariasis (LF), also known as elephantiasis, has been recognized by the world health organization and the centers for disease control and prevention as one of the neglected tropical diseases. The huge prevalence and risk of manifestation to date reflect the poor management of this disease. The disease poses vast public health and socio-economic burdens and generates a dire need for the development of a prophylactic solution for mass administration. AREAS COVERED Vaccination has been a sought-out strategy for dealing with ever-evolving infectious diseases and can be duly tuned to become a cost effective means of disease control and eventual eradication. In this review, we highlight the epidemiology of LF with the current diagnosis and treatment modules. The need for the development of a potential vaccine candidates, and challenges are discussed. The evidence presented in this review aims to enlighten the readers regarding the essential factors governing LF and its management using prophylactic measures. EXPERT OPINION The complex nature of filarial parasites is evident from the absence of a single vaccine for LF. The development and selection of an appropriate preclinical model and its translation into clinical practice is deemed to be a major task needing in-depth evaluation to formulate an effective vaccine. Explorations of the existing vaccine platforms would serve to be an apt strategy in this direction.

Newbouldia laevis (L) plant is a medium sized angiosperm and it is from Bignoniaceae family. In Nigeria vernacular, it is called Aduruku. It is popularly known as the tree of life or fertility tree in Nigeria. The plant has been found to be effective in the treatment of elephantiasis, dysentery, rheumatic swellings, syphilis, constipation, pile and as a vermifuge to round worms. It has also been found useful for earache, sore feet, chest pain, epilepsy and children's convulsion. Previous chemical studies proved that it has flavonoids, tannins, terpenes, phenolics, saponins, cardiac glycosides and alkaloids.

Background Lymphatic filariasis is ranked as the second leading cause of disability world-wide. The current global programme to eliminate lymphatic filariasis is based on the interruption of transmission and the alleviation of disability and suffering. Objective to assess foot care practice and associated factors among lymphoedema patients in Boreda district, Gamo zone Southern Ethiopia. Methods a community based cross sectional study was employed from December 2020 to June 2021 in Boreda district. Simple random sampling technique was used for selecting participants. Pretested structured interviewer administered questionnaire was prepared in English and translated to local language. Findings a total of 280 lymphedema patients were involved in this study. More than half 153 (54.6%) had poor practice towards foot care practice with 95% CI (48.7, 60.4%). Patients who fetched 50 l of water or below and wore shoes at the age above 20 years were negatively associated with foot care practice, (AOR = 0.383, 95%CI: 0.155, 0.945) and (AOR = 0.261, 95%CI: 0.107, 0.63), respectively. Patients who owned only one pair and two pairs were negatively associated with foot care practice (AOR = 0.04, 95%CI: 0.009, 0.182) and (AOR = 0.27, 95%CI: 0.087, 0.85), respectively. On the other hand, attending LMMDP service and frequency of adenolymphangitis once and twice or more per month were positively associated with foot care practice (AOR = 3.339, 95%CI: 1.53, 7.285) and (AOR = 8.15, 95% CI: 3.157, 21.058) and (AOR = 9.35, 95% CI: 3.118, 28.059), respectively. Conclusion this study indicated foot care practice among lymphedema patients in Boreda district was poor. Number of litre of water collected per day, age at which footwear first worn, number of shoes owned, attending LMMDP and frequency of adenolymphangitis were significantly associated with foot care practice. Standard foot care practice should be emphasized to control progression of lymphedema. Foot care practices like skin care, exercise and elevation, washing legs, bandaging and massaging are important factors that influence in reduction of lymphedema volume and acute attacks among people who are suffering from the diseases.

Filariasis or elephantiasis is a disease caused by infection of filarial worms. This research studies the spread model of elephantiasis disease that is influenced by the birth rate, the natural mortality rate, the transfer rate of susceptible exposed mosquito to the exposure due to the interaction between susceptible mosquito and infected human population, the transfer rate of exposed mosquito to the infected, the transfer rate of vulnerable human to the exposure human populations as a result of the mosquito and susceptible human intraction, the transfer rate of exposed human population to the infected human population, and the transfer rate of the infected human population to chronically human population. Filariasis disease spread model is built in form of Susceptible - Exposed - Acute - Kronic (Seak). The model is a nonlinear differential equations system of dependent variables that are the vulnerable, exposed, infected human populations, and chronic and vulnerable exposed, and infected mosquito population. The model has a critical point namely that represents the free-disease conditions and the critical point that represents an endemic condition. The critical points is analyzed using the method of linearized stability and Routh Hurwitz criteria. is the vertical point stable while is unstable. The result indicates that the free- disease condition is settled, while the endemic will be left in a long time period. It could also be interpreted that the endemic have a chance be overcome.

Lymphatic Filariasis (LF) vector-borne, chronically disabling parasitic contamination inflicting elephantiasis, lymphoedema, and hydrocele, is a leading public strength convenience as nicely as serious socioeconomic trouble due to its morbid condition, social stigma, and massive financial loss in many creating nations, and this sickness has been ranked as the second primary purpose of long-term continual incapacity worldwide. World Health Assembly decision in 1997 for Eliminate of Lymphatic Filariasis (ELF) via 2020 made all the filaria endemic nations in the world put efforts for its removing with the aid of regularly decreasing and finally interrupting the transmission of Lymphatic Filariasis (LF). Another lookup is wished to aid efforts to ‘scale-up morbidity manipulation and incapacity alleviation programs at the countrywide stage and to report the extent to which anti-filarial drug cure influences the direction of filariasis associated disorder.

Background: A plethora of diseases manifest as acquired genital lymphangiectasias which clinically manifest as superficial vesicles. They range from infections such as tuberculosis to connective tissue diseases such as scleroderma and even malignancy. Amongst infectious etiologies, lymphatic filariasis leads as the cause for lymphatic obstruction. Despite this, acquired lymphangiectasias due to this cause are not commonly reported. An unusual case of acquired scrotal lymphangiectasia secondary to filariasis is detailed in this paper with dermoscopic and histologic findings. Methods: A 65-year-old male farmer presented with multiple, asymptomatic vesicles over the scrotum with thickened scrotal and penile skin that had occurred for six years. He gave past history of intermittent fever and milky urine, was diagnosed with filariasis and treated with diethylcarbamazine for a year, four years previously. Systemic complaints abated but the peno-scrotal lesions did not. Results: Polarized dermoscopy revealed multiple skin-colored nodules and translucent pale blue lacunae over the scrotum. A few radially arranged linear irregular vessels were noted over the nodules. On histopathology, multiple ectatic lymphatics were noted in the mid and upper dermis with acanthosis and superficial perivascular lymphocytes. Peripheral smear revealed eosinophils; however, microfilariae could not be detected despite repeated diethylcarbamazine provocation and night smears being taken. The findings were compatible with acquired scrotal lymphangiectasia secondary to treated lymphatic filariasis. Local hygiene was advised; however, procedural treatments were refused by the patient. Conclusion: Herein, we report an unusual case of acquired scrotal lymphangiectasia of the scrotum secondary to treated lymphatic filariasis. Very few similar reports exist. To the best of our knowledge, dermoscopic features of this condition have not been elucidated before. This case, detailing an uncommon manifestation of a common disease (filariasis), demonstrates the importance of careful history taking and examination. This was especially so in the present case since only circumstantial evidence of filariasis was noted in investigations. There is a need to heighten awareness of this unusual condition amongst physicians especially if the patient hails from an area endemic for filariasis.

Background and Aim: Lymphatic filariasis, also known as elephantiasis, still remains a problem in Indonesia. The primary causative species of this disease are the filarial worms Wuchereria bancrofti and Brugia spp. This study was conducted to identify the diversity of species and behavior of mosquitoes and to determine the mosquitoes that could be potential vectors of filariasis. Materials and Methods: Mosquito samples derived from Hulu Sungai Utara (HSU) district in the 2017 multicenter study conducted in Indonesia were used in this cross-sectional study. The diversity of mosquito species was analyzed using the Shannon–Wiener diversity index. Mosquitoes were identified based on their species, and their DNA was isolated by polymerase chain reaction (PCR). Transcription-insulated isothermal PCR method was used to detect microfilariae/filaria larvae in the mosquitoes. Results: Biodiversity was found in 14 species of mosquitoes belonging to five genera. The maximum number of mosquitoes was recorded from the species Mansonia dives, Culex vishnui, Culex quinquefasciatus, and Mansonia uniformis. W. bancrofti infection was detected in M. uniformis at an infectivity rate of 0.3% (n=311). Conclusion: To the best of our knowledge, this is the first report of M. uniformis species as a vector of W. bancrofti in HSU district, Indonesia. More efficient and accurate studies are required to aid in the lymphatic filariasis elimination programs in this subregion.

Background Podoconiosis is a form of leg swelling, which arises when individuals are exposed over time to red clay soil formed from alkaline volcanic rock. The exact causal agent of the disease is unknown. This study investigates associations between podoconiosis disease data and ground-sampled soil data from North West Cameroon. Methods The mineralogy and elemental concentrations were measured in the soil samples and the data were spatially interpolated. Mean soil values were calculated from a 3 km buffer region around the prevalence data points to perform statistical analysis. Analysis included Spearman's rho correlation, binary logistic regression and principal component analysis (PCA). Results Six elements, barium, beryllium, potassium, rubidium, strontium and thallium, as well as two minerals, potassium feldspar and quartz, were identified as statistically related to podoconiosis. PCA did not show distinct separation between the spatial locations with or without recorded cases of podoconiosis, indicating that other factors such as shoe-wearing behaviour and genetics may significantly influence podoconiosis occurrence and prevalence in North West Cameroon. Conclusion Several soil variables were statistically significantly related to podoconiosis. To further the current study, future investigations will look at the inflammatory pathway response of cells after exposure to these variables.

Background Podoconiosis, lymphatic filariasis (LF) and leprosy are neglected tropical diseases (NTDs) that cause lymphoedema. When left untreated, they lead to substantial disability. This study determined the quality of life (QOL) and depression associated with lymphoedema in patients with podoconiosis, LF and leprosy. The study was conducted in northwestern Ethiopia. Methods This baseline cross-sectional study, nested within an interventional, non-comparative, longitudinal study, included patients with lymphoedema. Depression and QOL were assessed using versions of the 9-item Patient Health Questionnaire and Dermatologic Life Quality Index (DLQI), respectively, that had been translated into Amharic and validated. Factors associated with depression and QOL were assessed using multivariate linear regression analysis. Results Of the 251 patients with lymphoedema included in the study, 119 (47.4%) had moderate to severe depression and overall QOL was poor (mean±standard deviation [SD] DLQI score: 11.4±4.2). Disability was significantly associated with depression (β=0.26 [95% confidence interval {CI} 0.19 to 0.33]). Currently receiving treatment (β=−3.05 [95% CI −5.25 to −0.85), disability (β=−0.08 [95% CI −0.15 to −0.01]) and social support (moderate support: β=−2.27 [95% CI −3.66 to −0.89] and strong support: β=−2.87 [95% CI −5.35 to −0.38]) were significantly associated with better QOL. Conclusion High levels of depression and low QOL were found among patients with lymphoedema due the three NTDs in Ethiopia.

Background Podoconiosis is a non-infectious geochemical lymphoedema of the lower legs associated with a significant burden of morbidity. There are historical reports of podoconiosis in India, but its current endemicity status is uncertain. In this investigation we aimed to prioritise the selection of districts for pilot mapping of podoconiosis in India. Methods Through a consultative workshop bringing together expert opinion on podoconiosis with public health and NTDs in India, we developed a framework for the prioritisation of pilot areas. The four criteria for prioritisation were predicted environmental suitability for podoconiosis, higher relative poverty, occurrence of lymphoedema cases detected by the state health authorities and absence of morbidity management and disability prevention (MMDP) services provided by the National Programme for Elimination of Lymphatic Filariasis. Results Environmental suitability for podoconiosis in India was predicted to be widespread, particularly in the mountainous east and hilly southwest of the country. Most of the districts with higher levels of poverty were in the central east and central west. Of 286 districts delineated by state representatives, lymphoedema was known to the health system in 189 districts and not recorded in 80. Information on MMDP services was unavailable for many districts, but 169 were known not to provide such services. We identified 35 districts across the country as high priority for mapping based on these criteria. Conclusions Our results indicate widespread presence of conditions associated with podoconiosis in India, including areas with known lymphoedema cases and without MMDP services. This work is intended to support a rational approach to surveying for an unrecognised, geographically focal, chronic disease in India, with a view to scaling up to inform a national strategy if required.

Background Podoconiosis is a neglected tropical disease that causes significant physical, emotional and financial suffering, especially among impoverished rural farmers. Sufficient physician training is integral to optimizing patient outcomes through timely diagnosis and appropriate management. Therefore we sought to characterize podoconiosis instruction offered to medical students in endemic African countries. Methods We invited faculty from 170 medical schools in all podoconiosis-endemic African countries to provide information about podoconiosis inclusion in medical curricula. Surveys were available in French and English and captured podoconiosis knowledge, quantity/quality of instruction, ranking of importance relative to other diseases and barriers for improvement. Respondents voluntarily shared responses online or by telephone. Results Study participants provided information about curricula at 97 medical schools across 14 countries. In total, 42.6% of schools across nine countries offered podoconiosis-specific instruction; most respondents felt that the quality (60.4%) and quantity (61.5%) of instruction was insufficient. Common barriers to sufficient training included exclusion from government curricula, prioritization according to caseload and scarce epidemiological data. Conclusions Our study demonstrates widespread neglect in podoconiosis training for physicians in endemic countries. Government support is needed to ensure curricula match the needs of health workers practicing in rural, low-income regions.

Background Many health conditions are associated with stigma due to beliefs about their causes and the physical changes experienced by patients. Among such conditions are several neglected tropical diseases (NTDs). Podoconiosis, classified as an NTD, is a form of lymphoedema caused by the co-influence of genetic and environmental factors. It is a major public health problem in Ethiopia and is associated with intense stigma. Despite this, little is known about the factors contributing to stigmatizing attitudes against patients with the disease. Methods A cross-sectional survey was conducted in southern Ethiopia to analyse the attitudes of rural youth and associated risk factors for stigmatizing attitudes towards patients with podoconiosis, with the aim of informing stigma reduction strategies. Results The survey included 336 randomly selected youth. Of the 177 (52.7%) youth who held more stigmatizing attitudes toward patients with podoconiosis, 105 (59.3%) were females and 171 (96.6%) did not have affected friends. Accurate knowledge about gene–environment influences and rejection of infectious causes of podoconiosis were associated with less stigmatizing attitudes. Conclusions Improving understanding of the gene–environment interaction and dispelling beliefs about infectious causes may reduce negative attitudes about podoconiosis. Affected youth may play an important role as agents of change to spread non-stigmatizing messages.

China used to be one of the most heavily endemic countries for lymphatic filariasis (LF) in the world. Bancroftian filariasis, which is caused by the filarioid nematode Wuchereria bancrofti, is the only filariasis in Shandong Province. A total of 864 endemic counties (cities) in 16 provinces/autonomous regions/municipalities with a total population of 330 million people were at risk of infection. Shandong Province was a highly LF-endemic area in the 1950s, the epidemiological investigation of LF conducted in 1957 indicated that the disease was endemic in 74 counties and the highest microfilaria rate was up to 26%. There were ∼5 million people in the province infected with LF; among which almost 2.5 million people had lymphedema, elephantiasis, or hydrocele. Through vigorous prevention and scientific research, Shandong Province was the first to propose to treat LF with fortified diethylcarbamazine salt, more than 25 million people in the province had taken the salt, and more than 3 million people took intermittent medication. After more than 50 years of unremitting efforts, Shandong Province basically eliminated LF in 1983 and became the first province in China that successfully eradicated LF in 2004, which has played an important role in accelerating the elimination of filariasis in the country in 2007 and has made tremendous contributions to social and economic development of China. Since 1980, Shandong Province has carried out extensive international cooperation as the WHO Collaborating Center for Lymphatic Filariasis. This article is intended to share the experience in eliminating LF to other parts of the world and improve public health capacity in regions such as Africa and Oceania where the disease is still endemic for interest.

We conducted an implementation research study to integrate a holistic package of physical health, mental health and psychosocial care for podoconiosis, lymphatic filariasis and leprosy into routine healthcare in Gusha cluster, Guagusa Shikudad district, northwest Ethiopia. The healthcare package included training patients in lower limb hygiene and skin care and provision of shoes, hygiene supplies and medication. The implementation activities included training events, workshops, awareness raising, self-help groups, supportive supervision, staff secondments and advisory board meetings. The cost of implementing the care package in Gusha cluster, with a population of 30 558 people, was 802 655 Ethiopian birr (ETB) (£48 159) and the cost of delivering care to 235 participants was 204 388 ETB (£12 263), or 870 ETB (£52) per person. There was a 35% decrease in the mean disability scores (measured using the World Health Organization Disability Assessment Schedule 2.0) and a 45% improvement in the dermatology-specific quality of life (measured using the Dermatology Life Quality Index) at the 3-month follow-up compared with baseline. There were reductions in the number of days with symptoms, days off usual activities/work and days with reduced activity due to illness, all of which were statistically significant. Our pilot suggests that integration of the care package into routine healthcare in Ethiopia may be effective in improving health-related quality of life and disability and reducing time out of economic activity due to illness.

Background: Lymphatic Filariasis (LF) is one of the incapacitating and mosquito-borne sicknesses that on progression may prompt a few recognizable types of clutters like extreme lymphedema, hydrocele, and elephantiasis. Methods: Antigenic preparations of B. malayi adult (BmA), S. cervi adult parasites and microfilariae (mf) total parasite extract were used to analyze the serological reactivity profile with human infectious sera collected from endemic areas of Bancroftian filariasis by performing Western blot and ELISA analysis. Sera from healthy human subjects were also included in the study to determine the variation incurred in the reactivity due to the filariasis infection. Gelelectrophoresis analysis of the crude-extract of BmA revealed seven protein bands while more than ten bands were recognized in S. cervi. Results: our results represent a clear variation in protein patterns among the crude-antigens. ELISA results showed highest prevalence of IgG, IgM and IgG4 antibodies against all antigen preparations when recorded among microfilaraemic chronic infected patients. In both the antigenic preparations, the positive reactions were in the order of microfilaraemic>endemic normal>chronic>acute>nonendemic normal subjects. All sera of Mf+ patients were uniformly positive, while sera of both chronic and endemic normal subjects showed less reactivity. Conclusion: In the present study, we endeavoured to establish the extent of cross-reactivity of antigens derived from animal filarial parasites such as B. malayi and S. cervi with W. bancrofti filariasis sera of human patients. Besides, we further analyzed antibody-isotype profile of IgG, IgG4 and IgM in various human infection sera of bancroftian filarial subjects reactive to heterologous parasite antigens derived from adult worms of S. cervi from bovine and B. malayi from bovine and jirds.

Elephantiasis is caused by parasite Wuchereria bancrofti transmitted through the bites of Culex pipiens, C. quinquefaciatus, C. fatigans, B.malayi, Aedes niveus in Andaman and Nicobar islands.mosquitoes. Diseased organisms body transmits the Wuchereria bancrofti to healthy person. Elephantiasis is also known as Filariasis.

Background Podoconiosis is a tropical lymphoedema of the leg resulting from barefoot exposure to irritant volcanic soils. Approximately 4 million people are affected, mainly in African highland regions. The pathogenesis of this neglected tropical disease is still largely unknown, although HLA class II (HLAII) polymorphisms are associated with the disease. Methods NanoString technology was used to assess expression of 579 immune-related genes in formalin-fixed and paraffin-embedded lymph node archival samples from podoconiosis patients and unaffected controls. Results Forty-eight genes were upregulated and 21 downregulated in podoconiosis samples compared with controls. Gene ontology analysis showed differentially expressed genes to be closely related to major histocompatibility complex protein, cytokine and TNF receptor binding genes. Pathway enrichment analysis revealed involvement of lymphocyte activation, adaptive immunity, cytokine signalling, antigen processing and the IL-12 pathways. Conclusions This exploratory study reports a multiplex gene expression analysis in podoconiosis and shows upregulation of pro-inflammatory transcripts compatible with the notion of local, chronic immune activation in this HLAII-associated disease. Implicated pathways will inform future research into podoconiosis immunopathogenesis.

Various socio-economic and environmental factors play a vital role in the transmission of many infectious diseases of which some are among the most important cause of mortality and morbidity in the developing countries. Filariasis is the disease of the poor people and has been neglected for more than 50 years in Bangladesh and it is endemic in 23 out of 64 districts of Bangladesh so far. The affected people are generally the poorest and most vulnerable segment of the country. This research article has been made to analyze the prediction of filariasis disease. It discusses how GIS technology can be utilized as an array of several databases and as an effective tool for integrating different sectoral and information of various significant decision-making processes. It utilizes the kriging and cokriging methods of ArcGIS Geostatistical Analyst to predict filariasis occurrences using various socio-economic and environmental parameters and comparing the predicted models for Bangladesh’s northern region which is highly filariasis prone. The resultant prediction model indicates that the probability of filariasis is higher in upazilas neighboring another upazila with high occurrences. The result also shows that the disease incidences decreases with increasing distance from the disease affected regions.

Background. Podoconiosis is one of the neglected tropical diseases, and it is a nonfilarial elephantiasis caused by prolonged barefoot exposure to irritant soil. This is manifested by slowly progressive swelling of the foot and lower leg which may lead to an irreversible disability among affected people. Podoconiosis is an entirely noncommunicable preventable disease with a low-cost preventive mechanism. This study is aimed at assessing the magnitude and factor affecting Podoconiosis in Waghmra zone, Amhara region, Ethiopia, 2019. Methods. A community-based cross-sectional study was conducted among 808 household members. A multistage sampling method was used to select study participants. A pretested semistructured questionnaire, observation, and clinical screening were used to collect data. The data were entered using EpiData version 4.2 and analyzed using SPSS version 24.0. Both bivariable and multivariable logistic regression models were fitted to identify factors associated with Podoconiosis. Odds ratio with 95% confidence interval was computed to determine the level of significance; in multivariable analysis, variables with a P value less than 0.05 were considered as statistically significant. Result. According this study’s results, 4.3% of study participants were affected by Podoconiosis. A family number of four and above [AOR=3.29, 95% CI (1.013-10.661)], family income of less than 500 ETB [AOR=3.69, 95% CI (1.271-10.727)], distance from a health facility greater than 3 km [AOR=6.69, 95% CI (1.610-27.863)], no shoe wearing habits [AOR=5.02, 95% CI (1.969-12.778)], age at first wearing of shoes at 10 and above [AOR=4.46, 95% CI (1.792-11.102)], and no feet washing habits [AOR=3.87, 95% CI (1.516-9.883)] are significant factors of Podoconiosis. Conclusion. Creating awareness about the importance of shoe wearing, feet hygiene, and building infrastructure such as a road, health facility, and water supply were essential preventive strategies. Training about early diagnosis and effective management of lymphedema, giving emphasis on hygiene education and sanitation program, and reporting any suspected Podoconiosis case as early as possible are some of the recommendations forwarded.

Mosquitoes are vectors of many biologic agents of infection that range from bacteria, viral and parasitic infection. They cause diseases with high rate of morbidity and mortality. Plasmodium species are transmitted by the female anopheles genus and is the etiologic agent of malaria which is the major cause of absenteeism from work, school, reduced productivity, reduction in labour supply, illness and death in the tropics. Burkitts lymphoma is a malignancy that is higher in malaria endemic region. The genus culex and mansonia are the vectors of nematodes in the filariodea family. They cause spectrum of diseases ranging from eosinophillia, allergic lymphadenitis, lymphoedema and persistent infection could cause “elephantiasis”. The vector of zika virus is Aedes species. It is responsible for microcephaly in fetus of pregnant women infected in pregnancy. Yellow fever is a viral haemorrhagic fever caused by a flavivirus and transmitted also by the aedes species. Vector control with proper cleaning of the environment, individual use of insecticide treated net, use of prophylactic and prompt treatment of diseases caused by them are methods that have been suggested to reduce the mortality associated with the diseases caused by these mosquitoes.

Background and Objectives: Lymphatic filariasis is a neglected tropical disease caused by infection with filarial worms that are transmitted through mosquito bites. Globally, 120 million people are infected, with nearly 40 million people disfigured and disabled by complications such as severe swelling of the legs (elephantiasis) or scrotum (hydrocele). Current treatments (ivermectin, diethylcarbamazine) have limited effects on adult parasites and produce side effects; therefore, there is an urgent to search for new antifilarial agents. Numerous studies on the antifilarial activity of pure molecules have been reported accross the recent literature. The present study describes the current standings of potent antifilarial compounds against lymphatic filariasis. Methods: A literature search was conducted for naturally occurring and synthetic antifilarial compounds by referencing textbooks and scientific databases (SciFinder, PubMed, Science Direct, Wiley, ACS, SciELO, Google Scholar, and Springer, among others) from their inception until September 2019. Results: Numerous compounds have been reported to exhibit antifilarial acitivity in adult and microfilariae forms of the parasites responsible for lymphatic filariasis. In silico studies of active antifilarial compounds (ligands) showed molecular interactions over the protein targets (trehalose-6-phosphate phosphatase, thymidylate synthase, among others) of lymphatic filariasis, and supported the in vitro results. Conclusion: With reference to in vitro antifilarial studies, there is evidence that natural and synthetic products can serve as basic scaffolds for the development of antifilarial agents. The optimization of the most potent antifilarial compounds can be further performed, followed by their in vivo studies.

Following the halt of mass drug administration (MDA) for lymphatic filariasis (LF), the WHO recommends at least 4 years of post-treatment surveillance (PTS) to confirm that transmission recrudescence or importation does not occur. The primary means of evaluation during PTS is repeated transmission assessment surveys (TASs) conducted at 2- to 3-year intervals after TAS-1 stop-MDA surveys. This study reports the results of TAS-2 and TAS-3 surveys in Plateau and Nasarawa states (pop. 6.9 million) of Nigeria divided into a minimum of seven evaluation units (EUs) per TAS. A total of 26,536 first- and second-year primary school children (approximately 6–7 years old) were tested for circulating filarial antigen (CFA) between 2014 and 2017. Of 12,313 children tested in TAS-2 surveys, only five (0.04%) were CFA positive, with no more than two positive samples from any one EU, which was below the critical value of 20 per EU. Of 14,240 children tested in TAS-3 surveys, none (0%) were CFA positive. These results indicate that LF transmission remains below sustainable transmission levels and suggest that elimination of transmission has been achieved in Plateau and Nasarawa, Nigeria.

Introduction: This study carried out as a part of the lymphedema (LE)—osteoarthritis project to know the feasibility and applicability of lower extremity functional scale (LEFS) and LE health-related quality of life (LEHRQoL) among filarial LE patients of the lower extremity. Materials and Methods: Following inclusion and exclusion criteria 30 LE patients and 30 controls were recruited in the study. After obtaining informed written consent, Tamil version of the two “self-reporting assessment tools” LEFS and LEHRQoL were applied to all the participants by two examiners independently. Feasibility was assessed by the time schedule. Internal consistency and the correlation between two examiners was assessed by calculating Cronbach's alpha and Karl Pearson correlation coefficient and Spearman rank correlation respectively. Results: The mean time taken for completing the LEFS and LEHRQoL questionnaire was 5 minutes and 2 seconds and 12 minutes and 8 seconds respectively. Internal consistency reliability assessment showed good internal consistency for both the examiners (Cronbach's alpha 0.816 and 0.812). There was a strong positive correlation for the cases (r = 0.956, p

Background and objectives Lymphatic Filariasis, also known as elephantiasis, is a neglected tropical disease causing chronic damage to the lymphatic system. The disease, due to its peculiar morphological manifestations and disfigurations, is associated with severe social stigma and results in severe economic and mental stress for the affected. India's National Health Policy (2002) was aiming at the elimination of Lymphatic Filariasis in the country by 2015 which was extended to 2017. Preventive chemotherapy using yearly one dose of DEC and albendazole through mass drug administration is the key strategy adopted for this. This study aims at assessing the coverage, compliance, and causes for noncompliance towards MDA in Bagalkot district and assessing the rates of directly observed treatment, the source of information on MDA and incidence of side effects related to MDA Programme. Methods A cross-sectional study was done in four randomly selected clusters in endemic Talukas of Bagalkot district of Karnataka. A total of 240 households with 1110 beneficiaries were evaluated during the study. The information was collected by directly interviewing one responsible adult member from each house using a structured proforma. The data obtained was then entered to Microsoft Excel 2013 spreadsheet and analyzed using SPSS version 22. Results Among the 1110 persons evaluated the coverage was found to be 93.9% and effective coverage rate (compliance) was 83.2%. The coverage compliance gap was 10.7%. The most common reason quoted by the beneficiaries for not consuming the tablet was lack of faith in the tablets. The incidence of adverse drug reactions was 14.68%. Conclusion The effective coverage rate of MDA programme in Bagalkot was well below the national target of 85%, recommended by the government of India. The major reason for the high coverage-compliance gap was the failure of effective IEC activities. Intensive IEC activities are needed for educating the beneficiaries against the misconceptions of filariasis and MDA programme.

Objective To evaluate the therapeutic efficacy of complex decongestive therapy in the treatment of elephantiasis of the lower extremities. Methods Seventeen patients with unilateral lower limb elephantiasis were included in the study (5 with primary lymphedema and 12 with secondary lymphedema). All patients were treated with one course (4 weeks) of complex decongestive therapy. Changes inextracellular fluid (ECF), BMI, circumferences, and skin properties including skin stiffness (SF), percent water content (PWC), and trans-epidermal water loss (TEWL) were measured before and after treatment. Results The “elephantiasis-like” appearance of the affected limb was greatly improved after treatment. The ECF, BMI, and circumferences were significantly decreased after treatment (P Conclusion Complex decongestive therapy is effective in the treatment of advanced stages of chronic lymphedema.

The range and burden of neglected tropical diseases, many of which are helminth-derived, remains enormous. Infections are rampant in poor districts and although efforts have been implemented over the years, there remains insufficient networks for disease control. In India, experts are encouraging the government to develop a functional public health infrastructure to manage diseases. India has 553 million people at risk for lymphatic filariasis (LF), one of the chronic filarial nematode infections that causes severe morbidity in humans. During coevolution, filariae have developed tactics to modulate the host’s immune system so that they can persist for many years. Therefore, most individuals remain asymptomatic and mansonellosis and loiasis are primarily thought of as nuisance infections. Nevertheless, pathology can develop into elephantiasis during LF and Onchocerca volvulus infections can lead to vision loss or skin pathology. Many filarial species require the endosymbiotic Wolbachia bacteria for development and maturation. Indeed, targeting Wolbachia via antibiotic therapy has provided an alternative therapeutic approach which, in contrast to drugs currently employed in mass drug administration programs, is highly macrofilaricidal. This chapter provides an overview about filarial agents drawing upon both their similarities and differences with regards to host immune reactions, ensuing pathologies and how infections alter response to vaccines and other diseases. All of these aspects have to be considered when implementing therapy, especially when adverse side effects may occur. These effects are synopsized in the final section alongside current success stories in terms of elimination and future strategies to control these public health problems.

Introduction An enlarged scrotum due to scrotal elephantiasis results in a poor quality of life. This condition is uncommon and challenging to manage for most urologists. We report a case of scrotal elephantiasis treated with resection and scrotal reconstruction. Case presentation A 57-year-old man was referred to our hospital with a 6-year history of scrotal swelling. The scrotum was 20 cm in diameter, stiff, and thick. He was diagnosed with chronic scrotal lymphedema and underwent scrotal resection. The skin and subcutaneous tissues of the scrotum were excised, and the suprapubic skin, which was stretched by the enlarged scrotum, was used for the scrotal reconstruction. The penis was pulled out from this hole in the skin. Conclusion Utilizing suprapubic skin flap for scrotal reconstruction is an effective treatment for scrotal elephantiasis that can result in functionally and cosmetically successful outcomes.

Background Ethiopia has one of the worst podoconiosis rates in the world, affecting >1.5 million patients. We present our ethnographic film ‘Tigist, the story of a girl with podoconiosis’ and its potential use in tackling podoconiosis. Methods We conducted visual ethnography, consisting of video-recorded participant observations and interviews with seven patients, three healthcare workers and two podoconiosis experts. Results We acquired video recordings of social moments, the state of podoconiosis patients’ bodies and minds, their emotions and the impact of poverty. Conclusions Our film allows for an intensified understanding of patients’ daily experiences with podoconiosis, potentially impacting care, awareness and medical teaching programs.

Background While morbidity attributable to podoconiosis is relatively well studied, its pattern of mortality has not been established. Methods We compared the age-standardised mortality ratios (SMRs) of two datasets from northern Ethiopia: podoconiosis patients enrolled in a 1-y trial and a Health and Demographic Surveillance System cohort. Results The annual crude mortality rate per 1000 population for podoconiosis patients was 28.7 (95% confidence interval [CI] 17.3 to 44.8; n=663) while that of the general population was 2.8 (95% CI 2.3 to 3.4; n=44 095). The overall SMR for the study period was 6.0 (95% CI 3.6 to 9.4). Conclusions Podoconiosis patients experience elevated mortality compared with the general population and further research is required to understand the reasons.

This research deals with the determinants of filariasis prevention (elephantiasis disease) in Lumut Maju Village, Lumut Sub-district, Central Tapanuli Regency. This research is a qualitative type of research with domain analysis. The study was conducted in Lumut Maju Village, Lumut Sub-district, Central Tapanuli Regency and work units related to the research problem. The results shows that In the context of filariasis prevention, the local government has not coordinated and established networks with relevant SKPDs and in partnership with relevant NGOs and academics. Handling of patients that aims to prevent and limit disability by providing care training to patients and families has not been done to the maximum. Control of risk factors does not work well because the patient is not maximally netted.

Culex pipiens is the most abundant mosquito in Al-Madinah Al-Munawwarah region, Saudi Arabia, transmitting several diseases like elephantiasis, avian malaria, and arboviruses. It has become resistant to several insecticides worldwide, and the search for new alternatives should be prioritized. Because of their biological profile and eco-friendly nature, ionic liquids (ILs) have recently attracted the attention of biologists. The present study was carried out to evaluate the effect of six ILs against C. pipiens larvae. Larval mortality, LC50, LC90, LT50 and residual activity of ILS were determined. Aqueous solutions of tested ILs showed up to 100% larval mortality 24 h after exposure. Significant concentration- and time-based differences in larval mortality were found for a given IL as well as between different ILs. Ultimately, the ILs tested in the current study could be arranged in descending order according to their toxicity against larvae as follows: IL7, IL5, IL4, IL1, IL2 and IL6.

A straightforward biography of Dr E W Price, the discoverer of podoconiosis, a medical missionary who was also the first to elucidate plantar ulcers in leprosy.

Background: Lymphedema is a disease of the skin and subcutaneous tissue resulting from a disturbance in lymph flow. Anyone can be affected, and causes include cancer therapy when lymph nodes are removed or irradiated, the parasitic disease lymphatic filariasis, and damage caused by exposure to irritant soils known as podoconiosis. Manifest lymphedema is progressive and a major contributor to disability, stigma, and social isolation for affected people. Although the pathogenesis of connective tissue changes in lymphedema will follow a similar course regardless of the disease of causation, several systems are used to stage progression. Disparity in these staging systems leads to inconsistency in reporting of the severity of lymphedema and prevents meta-analysis of research results. In the global health environment, integrated morbidity management for chronic illness is essential to meet the needs of affected people and to be sustainable for health care systems. Clinical descriptors for staging criteria within each system may assist clinicians in assessment and provide a format for consistency in reporting by lymphedema researchers. Methods and Results: Lymphedema staging systems used in oncology, filariasis, and podoconiosis settings were reviewed and the assessment techniques, diagnostic procedures, and clinical observations used by each system are described. The most commonly used staging systems are compared to identify similarities, and a matrix approach to lymphedema staging is proposed. Conclusion: A universal staging system would contribute to more consistent reporting of research on and clinical management of lymphedema arising from multiple causes.

A Man with Cough and Eosinophilia A 53-year-old man with hypertrophic obstructive cardiomyopathy was evaluated for cough that had developed 3 months earlier, shortly after he had returned from exte...

Background: Severe pretibial myxedema (PTM) can be difficult to manage, highlighting the need to investigate newer therapies. Rituximab (RTX) and intravenous immunoglobulin (IVIg) have been tried in Graves' orbitopathy. Since PTM and orbitopathy share a similar underlying pathophysiology, this study aimed to explore these therapies for progressive PTM. Methods: The electronic database was screened for PTM patients evaluated at the Mayo Clinic, Rochester, from 2002 to 2016, and three patients who received IVIg and five who received RTX are reported. PTM pattern was classified as non-pitting edema, plaque and induration, nodular/nummular, and elephantiasis. PTM was confirmed by biopsy in six patients. Results: The patients' median age was 53.8 years, 75% were female, and all but one patient were either active or former smokers. All patients were euthyroid and had progressed despite various therapies prior to starting these agents. Six patients had a plaque and induration pattern, and two had a nodular pattern with elephantiasis. After therapy, six (75%) patients had PTM stability or improvement both subjectively and objectively (80% with RTX and 66% with IVIg). The three patients (one in the IVIg group and two in the RTX group) who had subjective improvement had a plaque pattern. One patient with elephantiasis had a transient response to IVIg and another had stability after RTX. Thyrotropin receptor antibody values and orbitopathy also improved in patients who demonstrated PTM improvement. No serious adverse events were reported, but one patient each had transient hypertension and injection-site thrombophlebitis after IVIg. Conclusions: Immunomodulation therapy was followed by PTM improvement or stability in most patients, with a slightly better response after RTX compared to IVIg. A validated response assessment instrument and larger series of patients are required to determine if the underlying disease process could be curtailed with these agents.

Elephantiasic pretibial myxedema is an extremely rare condition, affecting patients with thyroid disease. The clinical manifestation is difficult to diagnosis, and the treatment is challenging. Herein, the authors report on a case of a patient with Graves’ disease, who had a long-standing enlargement of bilateral legs, and histopathologic studies confirmed the diagnosis as; pretibial myxedema. The patient was treated with an antithyroid drug, iodine-131 (131I) irradiation, a potent topical corticosteroid, with occlusion, and compression therapy, however, the patient’s skin condition remained unchanged. This report aims to demonstrate a rare form of pretibial myxedema, to review the clinical presentations, differential diagnosis as well as therapeutic options.

BACKGROUND Histoplasma capsulatum var. duboisii (H. duboisii) causes potentially fatal disease in the immunocompromised patient, and the literature on these cases is limited. The study was undertaken to describe the cases of H. duboisii seen in a resource-limited setting. METHODS A 5-year retrospective, laboratory-based histopathologic review of all H. duboisii cases. RESULTS A total of 24 patients were diagnosed with cutaneous H. duboisii infection. The male-to-female ratio was 1.4. All the patients were human immunodeficiency virus (HIV) positive, and 70.83% (17 of 24 patients) were on antiretroviral therapy. The clinically identified lesions were as follows: plaques, nodular plaques, papules, papulo-pustules, and umbilicated papules. Histopathological appraisal revealed organisms typical of H. duboisii. The commonest epidermal alterations were interface change, parakeratosis, spongiosis, ulceration, acanthosis, hyperkeratosis, transepidermal elimination, and exocytosis in decreasing order. The dermal changes included histiocytic pattern (n = 14), neutrophil-rich (n = 13), non-necrotizing granulomatous inflammation (n = 9), and karyorrhexis (n = 6). Histoplasma was confirmed in 53% (8 of 15 samples) of the tissue samples submitted for routine fungal culture. CONCLUSION This study showed the demographics, clinical and histopathology features of H. duboisii infection in a resource-limited setting. Further research on histopathological features of this rare infection is essential to expand on the knowledge base and support findings in this study.

Leprosy, podoconiosis, and lymphatic filariasis (LF) are among the priority neglected tropical diseases (NTDs) in Ethiopia. The disability, psychosocial, and mental health status of people affected by these NTDs are still overlooked in global NTD discourse. The objective of this systematic review was to synthesize the existing evidence describing the disability, psychosocial, and mental health status of people affected by leprosy, podoconiosis, and LF prior to developing a holistic physical and psychosocial care package for these individuals. We searched papers reporting on disability, psychosocial, and mental health status linked to these 3 NTDs. The protocol was registered in PROSPERO with registration number CRD42019128400. Peer-reviewed articles were searched and extracted from Medline, PsycINFO, Global Health, and Embase. Articles published in English, irrespective of the year of publication, using a quantitative study methodology, were included. Abstracts and full texts were reviewed by 2 reviewers. Data were extracted and narratively summarized, as the studies were heterogeneous and used different outcome measures. Out of 1,318 titles/abstracts screened and 59 full text studies reviewed, 24 fulfilled the inclusion criteria. Fourteen studies provided evidence of the disability associated with leprosy, podoconiosis, or LF. Ten studies provided evidence on the association between the 3 NTDs and mental health or psychosocial outcomes. The prevalence of grade 2 disability varied from 3.9% to 86%. The most commonly reported mental health impacts were depression and mental distress. A high burden of mental illness was reported, varying from 12.6% to 71.7%; the suicidal ideation was also high (18.5%). In conclusion, disability and poor psychosocial and mental health status are associated with leprosy, podoconiosis, and LF. For optimum management of these NTDs, holistic care including both physical and psychosocial interventions is vital., Author summary Podoconiosis, lymphatic filariasis (LF), and leprosy are neglected tropical diseases (NTDs) that are commonly found among disadvantaged rural and some poor urban communities. These diseases lead to disabilities of the leg, which may result in reduced productivity. The longer the duration of the disease, the more severe the disability. People affected by these diseases also commonly experience stigma and discrimination, which, in turn, affect health-seeking behavior. Due to this disability, stigma, and discrimination, people affected by these 3 NTDs have a poor quality of life. We also found a range of mental health problems related to these 3 NTDs. Among these, the most common were mental distress and depression. As all 3 NTDs are associated with poor physical, psychosocial, and mental health outcomes, management should be holistic, incorporating physical, psychosocial, and mental health interventions. Following this review, we are working on the development of a holistic integrated care package for people affected by leprosy, podoconiosis, and LF in northwestern Ethiopia.

Background Podoconiosis, lymphatic filariasis and leprosy are highly stigmatised neglected tropical diseases that cause lymphoedema. Their enormous impacts on health-related quality of life, mental health and economic productivity can be significantly reduced by morbidity management and disability prevention (MMDP) services, but to deliver such services requires appropriate training of healthcare professionals. The aim of this study was to assess the knowledge, attitudes and practices (KAP) of rural Ethiopian healthcare professionals towards people with lymphoedema as a way to assess training needs. Methods This study used questionnaires to quantitatively assess KAP towards people with lymphoedema among rural healthcare professionals in northwest Ethiopia before and 12 months after a short training intervention. Results Questionnaires were administered to 14 health professionals at baseline and 21 at follow-up. At baseline, 71% (10/14) were found to hold at least one stigmatising attitude towards lymphoedema patients, compared with 66% (14/21) at follow-up. Large gaps in knowledge were noted, with many unable to identify ways of treating/preventing the diseases. Conclusions This study showed high proportions of healthcare workers holding stigmatising views and lacking essential knowledge about lymphoedema. To maximise the impact of MMDP interventions, further research is urgently needed to understand how to address these issues.

Background Podoconiosis is a type of elephantiasis characterised by swelling of the lower legs. It is often confused with other causes of tropical lymphedema and its global distribution is uncertain. Here we synthesise the available information on the presence of podoconiosis to produce evidence consensus maps of its global geographical distribution. Methods and findings We systematically searched available data on podoconiosis in SCOPUS and MEDLINE from inception, updated to 10 May, 2019, and identified observational and population-based studies reporting podoconiosis. To establish existence of podoconiosis, we used the number of cases reported in studies and prevalence data with geographical locations. We then developed an index to assess evidence quality and reliability, assigning each country an evidence consensus score. Using these summary scores, we then developed a contemporary global map of national-level podoconiosis status. There is evidence of podoconiosis in 17 countries (12 in Africa, three in Latin America, and two in Asia) and consensus on presence in six countries (all in Africa). We have identified countries where surveillance is required to further define the presence or absence of podoconiosis. We have highlighted areas where evidence is currently insufficient or conflicting, and from which more evidence is needed. Conclusion The global distribution of podoconiosis is not clearly known; the disease extent and limits provided here inform the best contemporary map of the distribution of podoconiosis globally from available data. These results help identify surveillance needs, direct future mapping activities, and inform prevention plans and burden estimation of podoconiosis., Author summary The global distribution of podoconiosis is uncertain. With our current understanding of its distribution still incomplete, many of the countries suspected to be endemic for podoconiosis are based on expert opinion and lack published evidence of confirmed cases. In this study, we used multiple data sources and health metrics to identify countries with presence and absence of podoconiosis with appropriate uncertainties. After assembling a database of different evidence types we constructed a weighted score for each country called ‘evidence consensus scores’. We used these scores to measure the certainty of the presence and absence of podoconiosis. The maps produced help to identify evidence gaps and uncertainties in the current global distribution of podoconiosis. Countries with evidence of podoconiosis are mostly clustered in Africa, and a few in Asia and Latin America. We have also identified countries with indeterminate status on the presence and absences of podoconiosis. These countries are characterised by weak health systems and multiple co-endemic diseases causing lower leg swelling, potentially leading to misdiagnosis of podoconiosis. Given these challenges, we recommend intensified disease surveillance and active case searching be implemented in areas where evidence is lacking.

We hereby describe the case of a giant scrotal elephantiasis due to infection by Wuchereria bancrofti, imported in Belgium. We briefly discuss diagnostic methods, their subtlety, and therapeutic possibilities.

Locally tailored interventions for neglected tropical diseases (NTDs) are becoming increasingly important for ensuring that the World Health Organization (WHO) goals for control and elimination are reached. Mathematical models, such as those developed by the NTD Modelling Consortium, are able to offer recommendations on interventions but remain constrained by the data currently available. Data collection for NTDs needs to be strengthened as better data are required to indirectly inform transmission in an area. Addressing specific data needs will improve our modelling recommendations, enabling more accurate tailoring of interventions and assessment of their progress. In this collection, we discuss the data needs for several NTDs, specifically gambiense human African trypanosomiasis, lymphatic filariasis, onchocerciasis, schistosomiasis, soil-transmitted helminths (STH), trachoma, and visceral leishmaniasis. Similarities in the data needs for these NTDs highlight the potential for integration across these diseases and where possible, a wider spectrum of diseases.

Authors report their pluridecennial activity (from 1973 up to today) of research, clinical experience and development of lymphatic surgery in Genoa-Italy, in close collaboration with the worldwide centers of the International Society of Lymphology. Five thousand forty-six cases of patients affected by upper and/or lower limbs, primary and secondary lymphedemas and elephantiasis, between 1973 and 2020 underwent lymphatic microsurgery;and between 2012 and 2020, fibro-lipo-lymph-aspiration, according to lymph vessel sparing procedure (FLLA-LVSP), for latest stages of lymphedema/elephantiasis, previously treated by lymphatic microsurgery with partial improvement of the disease. In addition, also morbid obesity related elephantiasis, lipolymphedema/elephantiasis, chylous-lymphatic dysplastic gravitational reflux with complex related syndromes, were treated by tailored surgical procedures, properly combined with tailored medical and nutritional regimens. All patients were followed-up for a minimum of 5 years to over 20 years. Over 96% of patients with earlier stages of disease (initial lymphedema: Stage IB and increasing lymphedema: Stage IIA) progressively stopped using conservative therapies;and over 80% of patients with later stages (column shaped limb fibrolymphedema: Stage IIB, properly called elephantiasis: Stage IIIA, and extreme elephantiasis: Stage IIIB), significantly decreased the frequency of physical therapies and discontinued compressive garments or stockings. Dermato-lymphangio-adenitis attacks considerably reduced by over 95%. Staging-guided treatment of peripheral lymphedema, according to authors' Genoa protocol, carries out not only the best long-lasting treatment, but also the contextual target of primary (to avoid lymphatic injuries), secondary (early-stage treatment), and tertiary (late-stage treatment) prevention in the potential worsening of the disease.

Background Podoconiosis is entirely preventable, non-communicable disease with high potential of elimination. The prevalence of podoconiosis in Ethiopia was 7.45%. One of the pillars for elimination of podoconiosis is morbidity control and management. Therefore, the present study aimed to assess the knowledge, attitude, practices and associated factors of health professionals towards podoconiosis cause, prevention and treatments. Methods Facility based cross-sectional study was conducted. The source population was all health professionals currently working in public health facilities. The final estimated sample size was 349. A pretested self-administrated structured questionnaire was used to collect the data. The data were coded, entered, and cleaned by using Epi.info version7, and analyzed by using SPSS version 20. Result A total of 320 health professionals participated in the study. Sixty eight (23.1%) health professionals had poor knowledge towards podoconiosis. Seventy (21.9%) identified podoconiosis as infectious disease. Profession, address of health facility, service year and attitude of participants were significantly associated with knowledge towards podoconiosis. More than half (56%) had favorable attitude towards podoconiosis patients. Knowledge score (95%CI: 1.389, 4.059, p-value = 0.002) was the independent predictor for attitude status. Very few (11.6%) respondents treated podoconiosis patients. Age group 45 years old and above and training on lymphedema morbidity management and disability prevention were significantly associated with clinical experience in treating affected patients, (AOR = 17.345; 95%CI: 4.62, 65.119) and (AOR = 7.385; 95%CI: 2.5, 21.797), respectively. Conclusion Despite, high percent of good knowledge of health professionals towards podoconiosis, clinical experience of health professionals in treating podoconiosis patients was very low. In-service trainings will be given for health professionals to improve treatment. In podoconiosis endemic districts hygiene supplies and other referencing materials should be made available for podoconiosis case management.

Introduction: Hereditary Gingival Enlargement (HGF), a rare entity, is also known as familial elephantiasis, elephantiasis gingivae, diffuse fibromatosis. It is a benign, non-haemorrhagic fibrous enlargement of gingival tissue. It is frequently a component feature of many syndromes. Jones syndrome is one such syndrome, characterized by gingival overgrowth and progressive deafness. Case report: A 27-year-old male patient reported to the Department of Oral Medicine and Radiology with the chief complaint of swollen gums for the past 7 years. The patient also complained of bleeding gums on brushing. The medical history stated a concurrent gradual hearing loss 7 years back. An incisional biopsy was done to confirm the fibrous nature of the diagnosis. Conclusion: This reporting is of unique case that remained undiagnosed for almost a decade. It also emphasises the need of a multidisciplinary approach during diagnosis and treatment.