Browsing by Author "Palmieri, James R."
Now showing 1 - 6 of 6
Results Per Page
Sort Options
- Application and Evaluation of Teledermatology In An Underserved Area of HondurasBaze, Michael Ray (Virginia Tech, 2011-08-02)Since the 1800's, technological advances have extended the foundation on which telemedicine could build. With its evolution, telemedicine has proven to be a means of offering effective health care interventions, from a multitude of disciplines. Teledermatology, a specialty application of telemedicine, offers great potential in improving the standard of dermatologic care by bridging the gap between the expert opinion of dermatologists and those without access to basic dermatologic care, particularly in developing nations, where skin disease continues to be a major public health problem. In Honduras, the setting for this study, and other developing nations, technology to support telemedicine is available. Dermatologic disease is among the most common disease presentations in the developing world, which left untreated due to a lack of access to adequate medical care, can progress causing increased morbidity or even death. A potential but untested solution is teledermatology. Teledermatology offers great potential in improving the standard of dermatologic care by bridging the gap between the expert opinion of dermatologists and those without access to basic dermatologic care. The purpose of this study was to evaluate the prevalence and types of dermatologic conditions and the feasibility of a store-and-forward teledermatology system in an underserved area of Honduras, so as to potentially provide more timely diagnosis and treatment, implementation of preventative measures, and offer long term solutions.so as The justification and significance of this study was the potential of store-and-forward teledermatology to improve the standard of dermatologic care by improving access of populations in underserved areas to dermatology specialists through affordable technology. The methodology of this study was primarily case study descriptive. This study was conducted at a public primary care clinic (JMA Clinic) and satellite sites in underserved areas of Francisco Morazán, Honduras. During a four week period in Spring 2011, patients with dermatologic conditions were examined and photos taken of condition. The patient information was sent to 3 U.S. board certified dermatologists, who provided diagnosis and treatment within 24 hours, which allowed the clinic physician sufficient time to review recommendations before patient follow-up. Patients would receive follow-up within 48 hours of initial visit. Diagnostic agreement, image quality, and user satisfaction were evaluated. IRB forms were submitted and clearance given. The data was analyzed with SPSS using descriptive statistics. The primary findings were the types of dermatologic conditions, interobserver agreement, image quality, and patient and physician satisfaction. The findings of this study substantiate the need for dermatologic care, as approximately 1 out of every 5 patients of the JMA Clinic presented with a dermatologic condition. The majority of these patients were children or women in their late 20s and early 30s; many of whom had their condition for more than a year and most had not received prior therapy. The types of dermatologic conditions observed were typical of that seen at a dermatology clinic in the U.S., yet inclusive of tropical and regional differences. Dermatitis, infectious and pigmentary conditions were the most common presentations. The interobserver diagnostic agreement achieved was 78%, and improved when considering differential diagnoses. Image quality received high ratings. Patients and physicians recorded a high level of overall satisfaction. Physicians indicated improved knowledge of teledermatology. Because of the unique environment and circumstances, the results are limited to the setting in which the study occurs. This project was a pilot study limited to 4 weeks of data collection and will be limited in significance by its duration and small sample size with respect to the conclusions that can be drawn about the prevalence and types of dermatologic conditions. This study illustrates that teledermatology is a viable means of providing dermatologic care to those in an underserved area of Honduras, where a lack of or limited access to general healthcare or specialty dermatologic care exists. The data offers insights to draw conclusions and recommendations on the potential for similar models to be implemented in underserved areas throughout Honduras and other similar regions.
- Automatic Detection and Characterization of Parasite Eggs by Image ProcessingOstergaard, Lindsey Eubank (Virginia Tech, 2013-08-26)The accurate identification of parasites allows for the quick diagnosis and treatment of infections. Current state-of-the-art identification techniques require a trained technician to examine prepared specimens by microscope or other molecular methods. In an effort to automate the process and better facilitate the field identification of parasites, approaches are developed to utilize LabVIEW and MATLAB, which are commercially available image processing software packages, for parasite egg identification. The goal of this project is to investigate different image processing techniques and descriptors for the detection and characterization of the following parasite eggs: Ascaris lumbricoides, Taenia sp., and Paragonimus westermani. One manual approach and four automated approaches are used to locate the parasite eggs and gather parasite characterization data. The manual approach uses manual measurements of the parasite eggs within the digital images. The four automated approaches are LabVIEW Vision Assistant scripts, MATLAB separation code, MATLAB cross-section grayscale analysis, and MATLAB edge signature analysis. Forty-four separate measurements were analyzed through the four different approaches. Two types of statistical tests, single factor global Analysis of Variance (ANOVA) test and Multiple Comparison tests, are used to demonstrate that parasite eggs can be differentiated. Thirty-six of the measurements proved to be statistically significant in the differentiation of at least two of the parasite egg types. Of the thirty-six measurements, seven proved to be statistically significant in the differentiation of all three parasite egg types. These results have shown that it is feasible to develop an automated parasite egg detection and identification algorithm through image processing. The automated image processing techniques have proven successful at differentiating parasite eggs from background material. This initial research will be the foundation for future software structure, image processing techniques, and measurements that should be used for automated parasite egg detection.
- Case Report Chronic Microsporidial Enteritis in a Missionary from MozambiquePalmieri, James R.; Elswaifi, Shaadi F.; Lindsay, David S.; Junko, Gretchen; Callahan, Cathy (American Society for Tropical Medicine & Hygiene, 2010-11-01)Microsporidiosis often occurs in immunocompromised persons but may also occur in those who are immunocompetent. Infection by Microsporidia involves a variety of organs and systems, most notably, intestine, lung, kidney, brain, sinuses, muscle, and eyes. Enterocytozoon bieneusi and Encephalitozoon intestinalis are associated with gastroenteritis, and Enterocytozoon hellem and Encephalitozoon cuniculi are associated with keratoconjunctivitis. We report a case of chronic microsporidiosis in a 28-year-old woman missionary from Mozambique who came to our diagnostic laboratory with nausea, lower abdominal pain, and frequent bowel movements. Over two years, the patient was clinically assessed and treated for malaria and giardiasis without laboratory diagnosis while in Mozambique. Identification of the causative agent of her condition was not attempted during the course of her illness in Mozambique. Furthermore, adverse effects of malaria and giardiasis medications may have exacerbated the chronic illness in this patient and mimicked chronic microsporidiosis.
- Risk Factors Contributing to Transmission Rates of Chlamydia trachomatis and Neisseria gonorrhoeae Among Women in Veron, Dominican RepublicHenson, Camille Jeanette (Virginia Tech, 2011-02-04)Background: Selected factors place Dominican female adolescent and adults at risk for sexually transmitted infections (STIs) such as Chlamydia, causative organism Chlamydia trachomatis, and Gonorrhea, causative organism Neisseria gonorrhoeae. The purpose of this study was to determine the prevalence of Chlamydia and Gonorrhea among adolescent and adult females that utilize the clinic in Veron, Dominican Republic. Clinical standards of care for these STIs and educational programs for prevention were developed from the data gathered from this study. Significance at 0.05 ά of the relationship of educational level, management of risk factors and other selected independent variables on prevalence rate of Chlamydia and Gonorrhea in the clinic population of Veron, Dominican Republic were determined. The objectives of the study were to 1) determine the prevalence of adolescent and young adult females diagnosed with Gonorrhea and Chlamydia who visit the clinic for prenatal visits, annual pap smear exams and gynecological complaints; 2) determine the extent to which educational level is a predictor of positive diagnosis or risk for infection of Chlamydia and Gonorrhea and; 3) determine which selected demographic and risk factors are associated with positive test results for Gonorrhea and Chlamydia. Methods: All adolescent and adult females ages 15 years and older visiting the clinic in Veron for prenatal exams, pap smear exams and gynecological complaints between January 28, 2008 – March 3, 2008 were invited to participate in this prevalence study. Of the 90 invited, the accepting sample was 90 who signed an informed consent form. Prior to STI testing each patient completed a verbal interview and questionnaire on sociodemographic characteristics as well as knowledge, attitudes, and beliefs related to Chlamydia and gonorrhea, sexual experiences and behaviors and illicit drugs use. Specimens collected from the endocervical canal of each female were tested and results provided within two hours, followed by immediate treatment by a licensed Dominican physician and follow-up care based on the guidelines and standards of care. The data were analyzed using descriptive statistics, chi square, t-test and logistic regression. Results: A total of ninety women participated in the study. Chlamydia was detected in 6.7% of the patient population and Gonorrhea was detected in 22.2% of the patient population. Co-infection of both Chlamydia and Gonorrhea was present in 2 cases. Among the positive Chlamydia tests results, 50% had less than a six-year education and 50% had more then six years of education. In addition, 83.3% of the patients with positive Chlamydia results answered "yes", they could read and 16.6% stated they could not read, while 83.3% of the patients with positive Chlamydia results stated they could write and 16.6% stated they could not write (P>0.05). Among the patients that tested positive for Gonorrhea, 55% stated they had less than six years of formal education and 45% had more than six years of formal education (P>0.05). There were 75% of the patients that tested positive for Gonorrhea that stated they could read and 25% who stated they could not read (P>0.05); while 85% of the patients with positive Gonorrhea results stated they could write and 15% stated they could not write (P> 0.05). Conclusion: Educational level and other selected demographic characteristics and risk factors in this study are not a significant predictor of positive diagnosis or risk of infection for Chlamydia or Gonorrhea. We cannot conclude that specific risk factors are associated with positive test results for Gonorrhea and Chlamydia. For the physicians involved in the clinical decision-making regarding the female patients at the Veron clinic, more data are needed to determine appropriate populations for screening of Gonorrhea and Chlamydia as well as appropriate educational tools on sexually transmitted infections.
- A Survey of the Prevalence of Gastrointestinal Parasites and Associated Risk Factors in Children in a Rural City of the Dominican RepublicChilders, Kristin Anne Geers (Virginia Tech, 2014-08-22)Gastrointestinal parasites impose a great and often silent burden of morbidity and mortality on poor populations in developing countries. Veron, Dominican Republic (DR), is a rural city in the southeastern corner of the country where many Dominicans and Haitians migrate to for work in support and expansion of the tourist industry of Punta Cana. Few studies of the prevalence of gastrointestinal (GI) parasitic infections have been published in the DR. Presently, there is a high prevalence of gastrointestinal parasitic infections throughout the poorest areas of the DR and Haiti. This study investigated the prevalence of GI protozoan and helminth parasites from children at the Rural Clinic of Veron during 2008. Participants provided a fecal sample that was examined microscopically for protozoan and helminth parasites using the fecal flotation technique to concentrate and isolate helminth ova and protozoan cysts. Of 108 fecal samples examined, 107 were positive for one or more parasites. Participant ages ranged from 2 to 15 years; 52 were males and 56 were females. Percent infection rates were 48.2% for Ascaris lumbricoides, 13.9% for Enterobius vermicularis, 24.1% for Entamoeba histolytica, and 22.2% for Giardia intestinalis. 9.3% had double infections. A survey of subject characteristics and risk factors was completed by each parent/guardian. Any plan to reduce GI parasites in children of this region will require a determined effort between international, national, and local health authorities combined with improved education of schools, child care providers, food handlers, and agricultural workers. A special effort must be made to reach out to immigrants and those not part of the public education system and to address microbial water quality.
- The Veron Community Scabies Education and Eradication ProgramWhite, Jeremy Jason (Virginia Tech, 2009-01-26)Skin infections by the ectoparasitic mite Sarcoptes scabiei are a preventable source of morbidity worldwide. While scabies affects all socioeconomic sectors, it is especially prominent in the developing world where crowding, poor hygiene, and limited access to basic health care are commonplace. Mass eradication efforts of this parasite have historically been hampered by delivery and compliance issues surrounding topical standards of care. There have been advances in eradication over the last decade due to the expanded use of oral Ivermectin for the treatment and prevention of ectoparasites such as scabies. Previous research focused on various treatment aspects of the disease, yet most identified the need for basic scabies health education to accompany future studies to improve program sustainability and the overall health literacy of target populations. The Virginia College of Osteopathic Medicine sponsors a public health clinic in Veron, Dominican Republic that reports a high prevalence of scabies infections among its general patient population. The lack of any means of direct measurement, proper intervention, or control raises concerns that long-term infection may lead to multiple other secondary disease sequelae. The Veron Scabies Eradication and Education Program was designed to address this deficiency and build on previous studies related to this problem by using a novel treatment and education protocol. The purpose of this research was to identify, treat, and prevent primary and secondary health problems due to long-term scabies infection in the community of Barrio Nuevo, Veron, Dominican Republic in order to provide long-term sustainable eradication through a researcher-designed health education program and medical service protocol. Participants continued typical daily life while interventions and education were monitored to detect change over a 9-month timeline using selected measurement intervals to test multiple scabies disease and knowledge objectives and related hypotheses. Following this basic protocol, the following scabies markers were evaluated at baseline: subject demographics, scabies diagnosis and treatment history, baseline treatments and reported side effects, and scabies education pre-test results. The following scabies markers were also assessed at baseline and reassessed at 2 weeks, 1 month, 2 months, 8 months, and 9 months: risk and prevention behaviors, symptomatology, skin exam findings, and scabies education post-test results. There was a statistically significant post-intervention improvement in scabies markers when compared to pre-intervention values (p<0.05). This study demonstrated that a community scabies program involving large-scale treatment and education can provide rapid and long lasting improvements to the health of a highly endemic population. Community-wide scabies eradication is possible with the appropriate level of structure and support using low cost medication available to the health care system that serves Veron, Dominican Republic. Given the efficacy and safety profile of Ivermectin demonstrated in this study and substantiated by others, it is recommended that the Dominican Republic Ministry of Health consider adopting Ivermectin as the standard of care for scabies treatments and enforce an existing formal ban on Lindane products. The protocol from this research should be considered for adoption to provide a sustainable, practical, self-sufficient model for improved health outcomes, health behaviors, and health literacy. Future studies should replicate this research to determine validation in other settings, cultures and situations, build on the findings by exploring additional variables related to environmental risk factors, and continue to develop interventions that promote health education and enhance clinical practices.