28 research outputs found
An immunocompetent migrant presenting with neurosyphilis with an unusual unilateral papillitis: a case report
Get PDFUnilateral papillitis caused by Treponema pallidum was found in an immunocompetent homosexual patient with severe vision loss who had received previous antibiotics treatment. Syphilis-related ocular manifestation is more common in the early stages of the disease and it can be associated with a central nervous system localization. In this patient, neurosyphilis was diagnosed on the basis of clinical and laboratory findings. Optical examination revealed unilateral papillitis in the left eye and no relative afferent pupillary defects. The patient underwent visual field examinations with conventional perimetry using the 30-2 program of the Humphrey Visual Field Analyzer, which indicated a blind spot enlargement in the left eye. Optical coherence tomography, visual evoked potentials (VEP), and fluorescein angiograms revealed inflammation of the optic nerve head with edematous and blurred margins. A reactive T. pallidum hemagglutination assay with low rapid plasma reagin (RPR) serum titer was performed; an HIV antibody test and MRI of the orbits and head with contrast gave negative results. Resolution of the ocular inflammation after intravenous penicillin treatment was obtained. The reported case illustrates the importance of early recognition of this treatable disease. The rise of syphilis, especially in urban areas, necessitates a high level of suspicion when dealing with patients with intraocular inflammation of unknown origin. Lues serology should be incorporated into routine laboratory diagnostics to aid in the detection of such cases. Considering the re-emergence of syphilis, screening of migrants from countries with high syphilis seroprevalences should be recommended
Hepatocellular Carcinoma in a non-Cirrhotic Liver of a HCV-Positive Woman with Sustained Viral Response
Get PDF<html />
Migration and determinants of health : clinical epidemiological characteristics of migrants in Malta (2010-11)
Get PDFBackground Over recent years Malta has experienced a growing influx of migrants from Africa. With the aim of defining demographic characteristics and assessing the prevalence of conditions of public health significance among asylum seekers in Malta, a clinical research study was implemented in the framework of the European Union project âMare nostrumâ. Methods From August 2010 to June 2011 a dermatologist and an infectious diseases specialist performed general and specialist health assessment of migrants hosted in open centres. Results Migrants included in the study were 2216, 82.7% were males, their mean age was 25 years and 70.1% were from Somalia. Out of the total females, 42.5% had undergone some type of Female Genital Mutilation/Cutting. A total of 5077 diagnoses were set, most common were skin diseases (21.9%), respiratory diseases (19.8%) and gastro-enteric diseases (14.2%), whereas 31% of migrants reported good health conditions. Conclusions Immigrants have a lower morbidity burden compared with their fellow countrymen living in the origin country. However, living conditions during the journey, in transit countries and after arrival can influence their health status. The present study provides a comprehensive picture of this growing population that is in need for health promotion, mental health services and fair policy planning.peer-reviewe
Hepatitis C Virus Infection Among non-IDU HIV-Infected and Uninfected Men who Have Sex with Men
Get PDFIn the Mediterranean countries, hepatitis C virus infection affect nearly 45% of HIV-1 infected individuals, consistently to the high proportion of patients with a history of intravenous drug use and exposed to the two viruses by parenteral route. Even in association with HIV-infection, HCV infection is rarely transmitted through sexual intercourse due to the lower efficiency of mucosal exposure to virus than that blood-borne. Thus, the incidence and prevalence of HCV infection are far lower among the non-intravenous drug users (IDU) at risk of sexually transmitted infections (STI). Two hypotheses may be taken in account to explain the lower prevalence rates observed in our seroprevalence study. The MSMs participating to our study could have less sexual contacts with IDU-MSMs than other gay community residents in other western countries. The non-IDU MSMs recruited in this study could have a lower frequency of at-risk sexual practices for HCV then the non-IDU MSMs enrolled in other studies
Prevalence of latent tuberculosis, syphilis, hepatitis B and C among asylum seekers in Malta
Get PDFBackground: In the last few years, Malta has witnessed increasing immigration flows from the Libyan coasts. Public health policies are focused on screening migrants for tuberculosis, whereas no systematic actions against STIs are implemented. The aim of this study is to define the epidemiological profile of asylum seekers in Malta as regards syphilis, hepatitis B, C and latent tuberculosis, thus supporting screening policies. Methods: Five hundred migrants living in open centres were screened between December 2010 and June 2011. Results: 83.2% of people was from Somalia, 81.2% males, average age 26.5 years. The tuberculin skin test (TST) was positive in 225 migrants (45%). Latent syphilis was diagnosed in 11 migrants, hepatitis C in 3 and 31 migrants were HBsAg positive. Conclusion: Systematic screening for asymptomatic migrants in Malta is not recommended for hepatitis C and syphilis, given the low prevalence observed. On the contrary, it should be considered for hepatitis B. TST could be indicated as the first step of a two step screening for migrants from countries with high TB incidence. Efficacy and cost-effectiveness could be achieved by further targeting screening to specific subgroups at higher risk of reactivation, such as people living with HIV and subjects affected by chronic diseases.peer-reviewe
Cohort profile: the Italian Network of Longitudinal Metropolitan Studies (IN-LiMeS), a multicentre cohort for socioeconomic inequalities in health monitoring.
Get PDFPURPOSE: The Italian Network of Longitudinal Metropolitan Studies (IN-LiMeS) is a system of integrated data on health outcomes, demographic and socioeconomic information, and represents a powerful tool to study health inequalities. PARTICIPANTS: IN-LiMeS is a multicentre and multipurpose pool of metropolitan population cohorts enrolled in nine Italian cities: Turin, Venice, Reggio Emilia, Modena, Bologna, Florence, Leghorn, Prato and Rome. Data come from record linkage of municipal population registries, the 2001 population census, mortality registers and hospital discharge archives. Depending on the source of enrolment, cohorts can be closed or open. The census-based closed cohort design includes subjects resident in any of the nine cities at the 2001 census day; 4 466 655 individuals were enrolled in 2001 in the nine closed cohorts. The open cohort design includes subjects resident in 2001 or subsequently registered by birth or immigration until the latest available follow-up (currently 31 December 2013). The open cohort design is available for Turin, Venice, Reggio Emilia, Modena, Bologna, Prato and Rome. Detailed socioeconomic data are available for subjects enrolled in the census-based cohorts; information on demographic characteristics, education and citizenship is available from population registries. FINDINGS TO DATE: The first IN-LiMeS application was the study of differentials in mortality between immigrants and Italians. Either using a closed cohort design (nine cities) or an open one (Turin and Reggio Emilia), individuals from high migration pressure countries generally showed a lower mortality risk. However, a certain heterogeneity between the nine cities was noted, especially among men, and an excess mortality risk was reported for some macroareas of origin and specific causes of death. FUTURE PLANS: We are currently working on the linkage of the 2011 population census data, the expansion of geographical coverage and the implementation of the open design in all the participating cohorts
Anthropological study on Chagas Disease: Sociocultural construction of illness and embodiment of health barriers in Bolivian migrants in Rome, Italy.
No full textIntroductionChagas Disease (CD) is endemic in many Latin-American countries, Bolivia in particular. It is now spreading in Italy as a host country for transcontinental migrants and becoming an emerging health problem. This anthropological action-research, as part of a wider medical project on Neglected Tropical Diseases, has the purpose of analyzing the sociocultural construction of CD and its representation in Bolivian people living in Rome as well as barriers, such as the stigma about the illness, to access the National Health Service for those potentially affected.MethodsThe ethnographic study was carried out from 2016 to 2018 by a medical anthropologist at the National Institute for Health, Migration and Poverty (INMP) on 72 Bolivian migrants (47 women and 25 men) living in Rome. The study was carried out through: a territorial mapping of Bolivian networks and communities aimed at recruiting people, participant observation, and application of semi-structured and unstructured interviews. The interviews were hold in Spanish and proposed to all participants before or during medical examination, or during events organized by the Bolivian community in Rome. The interview consisted of 16 items and covered four macro areas: personal and migration history, health status, access to the Italian National Health Service and knowledge about CD; plus 5 items for those who received a diagnosis of Chagas Disease in Italy.ResultsThe sociocultural construction and the deep stigma about the illness built by participants and their families could hinder both diagnosis and treatment. Institutional barriers also contributed to reduce adherence to screening tests: often, opening hours of the outpatient clinic were incompatible with participants' precarious employments. To guarantee participant's access to public health services and their adherence to the diagnostic protocol, we implemented a profound revision of our cultural and institutional approach to them.ConclusionsThe analysis evidenced the limitations of the conventional approach applied by the Italian National Health Service to this migrant community, such as the absence of socio-cultural and linguistics competences that can help understanding patients' perception and representation of the illness. The multidisciplinary approach instead-with clinicians using the ethnographic results to adjust their work to the participants' needs-was a successful attempt to ensure therapeutic alliance
Platelet Derivatives and the Immunomodulation of Wound Healing
No full textBesides their primary role in hemostasis, platelets contain a plethora of immunomodulatory molecules that profoundly affect the entire process of wound repair. Therefore, platelet derivatives, such as platelet-rich plasma or platelet lysate, have been widely employed with promising results in the treatment of chronic wounds. Platelet derivatives provide growth factors, cytokines, and chemokines targeting resident and immigrated cells belonging to the innate and adaptive immune system. The recruitment and activation of neutrophils and macrophages is critical for pathogen clearance in the early phase of wound repair. The inflammatory response begins with the release of cytokines, such as TGF-β, aimed at damping excessive inflammation and promoting the regenerative phase of wound healing. Dysregulation of the immune system during the wound healing process leads to persistent inflammation and delayed healing, which ultimately result in chronic wound. In this review, we summarize the role of the different immune cells involved in wound healing, particularly emphasizing the function of platelet and platelet derivatives in orchestrating the immunological response
The variation in the health status of immigrants and Italians during the global crisis and the role of socioeconomic factors
No full textAbstract Background The effects of the recent global economic and financial crisis especially affected the most vulnerable social groups. Objective of the study was to investigate variation of self-perceived health status in Italians and immigrants during the economic global crisis, focusing on demographic and socioeconomic factors. Methods Through a cross-sectional design we analyzed the national sample of multipurpose surveys âHealth conditions and use of health servicesâ (2005 and 2013) conducted by the Italian National Institute of Statistics (ISTAT). Physical Component Summary (PCS) and Mental Component Summary (MCS) scores, derived from SF-12 questionnaire, were assumed as study outcome, dichotomizing variables distribution at 1st quartile. Prevalence rate ratios (PRR) were estimated through log-binomial regression models, stratified by citizenship and gender, evaluating the association between PCS and MCS with surveysâ year, adjusting for age, educational level, employment status, self-perceived economic resources, smoking habits, body mass index. Results From 2005 to 2013 the proportion of people not employed or reporting scarce/insufficient economic resources increased, especially among men, in particular immigrants. Compared with 2005 we observed in 2013 among Italians a significant lower probability of worse PCS (PRRâ=â0.96 both for males and females), while no differences were observed among immigrants; a higher probability of worse MCS was observed, particularly among men (Italians: PRRâ=â1.26;95%CI:1.22â1.29; immigrants: PRRâ=â1.19;95%CI:1.03â1.38). Self-perceived scarce/insufficient economic resources were strongly and significantly associated with worse PCS and MCS for all subgroups. Lower educational level was strongly associated with worse PCS in Italians and slightly associated with worse MCS for all subgroups. Being not employed was associated with worse health status, especially mental health among men. Conclusions Our findings support the hypothesis that economic global crisis could have negatively affected health status, particularly mental health, of Italians and immigrants. Furthermore, results suggest socioeconomic inequalities increase, in economic resources availability dimension. In a context of public health resourcesâ limitation due to financial crisis, policy decision makers and health service managers must face the challenge of equity in health
