martes, 14 de junio de 2022

WHAT IS THE CURRENT MANAGEMENT PERSPECTIVE AND SITUATION OF LYMPHATIC FILARIASIS & PODOCONIOSIS? - Lymphostatic Elephantiasis - Primary/Secondary Lymphedema – Best First Line Treatment – Complete Decongestive Therapy (CDT)

Lymphostatic elephantiasis (Stage III lymphedema) is considered to be one of the main neglected diseases worldwide, but is predominantly seen in areas with poor social conditions and deficient sanitary infrastructure and health care coverage. Many individuals affected in these areas receive incomplete information about the disease and its treatment, sometimes alleging that patients have low cultural and educational levels. For the control or elimination strategies regarding any given disease to be successful, the population involved firstly needs to be aware and correctly instructed by healthcare professionals and community health agents about the disease and its correct treatment.

Regarding lymphatic filariasis (this is Secondary lymphedema) communities need to be made aware by healthcare professionals regarding prevention, the good use, benefit, and even the potential adverse reactions of medication, and also need to be educated about the benefits of correct safe compression treatment regarding chronic lymphedema. In endemic areas, popular awareness of clinical LF is common with regard to its chronic forms (i.e. swelling of limbs and genitalia), however, most people are unaware or have not been informed of the important role of daily compression to prevent the advance of the disease. Incomplete information and treatment will not help to improve the present situation or achieve the goal of eliminating the elephantiasis stage worldwide.

Patient compliance or non-compliance regarding treatment options, many times goes hand in hand and is directly related to treatment options and results. With reference to low-cost management strategies without the inclusion of the necessary compression garments for the prevention and treatment of stage elephantiasis, little or nothing can be expected with regard to the reduction and maintenance of edema volume. Without compression garments, simple hygiene measures such as the washing of limbs will not halt the edema progression, and limb elevation is only effective in early-stage lymphedema according to the ISL(International Society of Lymphology). Likewise, with regard to podoconiosis, the isolated use of footwear without compression garments will not halt the progression of the disease in terms of the consequently established lymphatic dysfunction. 

On the other hand, it should be assumed that the majority of individuals affected by lymphedema cannot devote all hours of the day to exercise and limb elevation to retain the progression of edema, for they also need to attend to their daily chores and jobs, and this can only be achieved by wearing compression garments. The daily use of standard bandages is not practical, for they tend to loosen and slip off when undertaking work that requires continuous physical activity, and likewise, soiled bandages can also be an important source of infection. For the maintenance phase of lymphedema management, compression is the most important intervention. Compression garments are easy to use and achieve significant improvements in most patients without causing much discomfort. The beneficial value of applying compression stockings in the treatment of venous and lymphatic disease is supported by recommendations rated as Grade 1 evidence.

National health systems should contribute to educational campaigns and strategies for drug distribution to prevent filariasis, but also increase the economic investment for the coverage of clinical care and compression garments for established lymphatic dysfunction, thus optimizing health-related actions and resources in the long run. Without improved healthcare coverage, the frequency of individuals exhibiting chronic manifestations of the elephantiasis stage will continue to increase worldwide.


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