José M. Ramos

Childhood and adult tuberculosis in a rural hospital in Southeast Ethiopia: a ten-year retrospective study

BackgroundMany DOTS experiences in developing countries have been reported. However, experience in a rural hospital and information on the differences between children and adults are limited. We described the epidemiology and treatment outcome of adult and childhood tuberculosis (TB) cases, and identified risk factors associated with defaulting and dying during TB treatment in a rural hospital over a 10-year period (1998 to 2007).MethodsRetrospective data collection using TB registers and treatment cards in a rural private mission hospital. Information was collected on number of cases, type of TB and treatment outcomes using standardised definitions.Results2225 patients were registered, 46.3% of whom were children. A total of 646 patients had smear-positive pulmonary TB (PTB), [132 (20.4%) children]; 816 had smear-negative PTB [556 (68.2%) children], and 763 extra-PTB (EPTB) [341 (44.8%) children]. The percentage of treatment defaulters was higher in paediatric (13.9%) than in adult patients (9.3%) (p = 0.001). The default rate declined from 16.8% to 3.5%, and was independently positively associated with TB meningitis (AOR: 2.8; 95% CI: 1.2-6.6) and negatively associated with smear-positive PTB (AOR: 0.6; 95% CI: 0.4-0.8). The mortality rate was 5.3% and the greatest mortality was associated with adult TB (AOR: 1.7; 95% CI: 1.1-2.5), TB meningitis (AOR: 3.6; 95% CI:1.2-10.9), and HIV infection (AOR: 4.3; 95% CI: 1.9-9.4). Decreased mortality was associated with TB lymphadenitis (AOR: 0.24; 95% CI: 0.11-0.57).Conclusion(1) The registration of TB cases can be useful to understand the epidemiology of TB in local health facilities. (2) The defaulter and mortality rate of childhood TB is different to that of adult TB. (3) The rate of defaulting from treatment has declined over time.

Bibliometric analysis of leishmaniasis research in Medline (1945-2010)

BackgroundPublications are often used as a measure of success of research work. Leishmaniasis is considered endemic in 98 countries, most of which are developing. This article describes a bibliometric review of the literature on leishmaniasis research indexed in PubMed during a 66-year period.MethodsMedline was used via the PubMed online service of the US National Library of Medicine. The search strategy was Leishmania [MeSH] or leishmaniasis [MeSH] from 1 January 1945 until 31 December 2010. Neither language nor document type restrictions were employed.ResultsA total of 20,780 references were retrieved. The number of publications increased steadily over time, with 3,380 publications from 1945-1980 to 8,267 from 2001-2010. Leishmaniasis documents were published in 1,846 scientific journals, and Transactions of the Royal Society of Tropical Medicine and Hygiene (4.9%) was the top one. The USA was the predominant country by considering the first author’s institutional address (16.8%), followed by Brazil (14.9%), and then India (9.0%), however Brazil leads the scientific output in 2001-2010 period (18.5%), followed by the USA (13.5%) and India (10%). The production ranking changed when the number of publications was normalised by population (Israel and Switzerland), by gross domestic product (Nepal and Tunisia), and by gross national income per capita (India and Ethiopia). For geographical area, Europe led (31.7%), followed by Latin America (24.5%).ConclusionsWe have found an increase in the number of publications in the field of leishmaniasis. The USA and Brazil led scientific production on leishmaniasis research.

Drug resistance mutations in patients infected with HIV-2 living in Spain

BACKGROUNDnIn contrast with HIV-1, information about drug resistance in HIV-2 is scarce and mainly derived from small series of patients failing antiretroviral therapy.nnnMETHODSnThe spectrum of changes in the reverse transcriptase (RT), protease (PR) and integrase (INT) genes was examined in HIV-2 individuals enrolled in the HIV-2 Spanish register.nnnRESULTSnFrom a total of 236 HIV-2-infected individuals registered in Spain from 1989 to June 2010, 53 PR, 44 RT and 8 INT sequences were obtained. Low plasma viraemia precluded collection of this information from most of the remaining cases. No major mutations associated with drug resistance in HIV-1 were recognized in 29 PR, 20 RT and 5 INT sequences from antiretroviral-naive HIV-2 individuals, although natural polymorphisms with potential effects on susceptibility to PR inhibitors were recognized at 10 positions (L10V/I, V32I, M36I, M46I, I47V, Q58E, A71V/I, G73A, V82I and L89I/V) and for nucleoside reverse transcriptase inhibitors at three positions (T69N, V75I and K219E). In 24 antiretroviral-experienced patients with virological failure the most frequent major RT resistance mutations were M184V (58%), Q151M (33%) and K65R (21%), which are rarely seen thymidine analogue mutations. In PR the most frequent major changes were V47A (17%), I54M (17%), I82F (13%), L90M (29%) and L99F (29%). Two of the three patients who failed on raltegravir had N155H in the INT region.nnnCONCLUSIONSnDrug resistance mutations in HIV-2 are selected at the same positions as in HIV-1, although with different frequency. Polymorphisms in the RT and PR associated with drug resistance in HIV-1 as compensatory changes are common in untreated HIV-2 subjects. These findings highlight the need for specific guidelines for interpreting genotypic resistance patterns in HIV-2 infection.

Change in Epidemiology of Malaria Infections in a Rural Area in Ethiopia

We describe a change in epidemiology of 3,615 cases of malaria in a rural area in Ethiopia (from September 11, 1998, through September 10, 2003). The Plasmodium falciparum infection increased from 40.9% in the first year to 73.4% in the last year, and the Plasmodium vivax infection decreased from 54.7% to 22.4% (p < .001).

Estudio epidemiológico de la patología cutánea en la población inmigrante de Alicante

BACKGROUNDnThe influx of a large number of immigrants has altered the sociodemographic profile in Spain. To date, few studies of the skin diseases of immigrants to Spain have been done.nnnOBJECTIVEnTo determine the frequency of visits by immigrants to our dermatology clinic, to describe their skin complaints, and to compare them to those of the autochthonous Spanish population.nnnPATIENTS AND METHODSnProspective, descriptive, analytic study, with an observational substudy of cases and controls from a cross-section of the population. We included all immigrant patients seen at the dermatology clinic between February 2005 and February 2006.nnnRESULTSnVisits by immigrants to the dermatology clinic accounted for 4.1% of the caseload. Their most frequent complaints were eczematous dermatitis (18.4%), viral warts (6.4%), and acne (6.3%). Comparison between the immigrant and autochthonous patient populations showed that eczematous dermatitis, alopecia, melasma, ringworm, scabies, Herpes simplex infection, keratosis pilaris, and xerosis were significantly more frequent among immigrant patients, whereas viral warts, actinic keratosis, hidradenitis suppurativa, lupus, melanoma, and squamous cell carcinoma were significantly less frequent (P < .05).nnnCONCLUSIONSnThe immigrant population consults the dermatologist about skin conditions that are already well represented in our routine practice. As the infectious skin diseases of immigrants are also common in our environment, these patients are unlikely to transmit serious tropical skin diseases to the local population.

Dermatological scientific production from European Union authors (1987-2000)

To evaluate the contribution to international dermatological literature made by authors from European Union (EU) countries. Using MedLine, a selection was made of articles by EU authors published between 1987 and 2000 in 32 dermatological journals, classified as such by the Institute for Scientific Information. Overall 19,225 documents were published by European authors in the selected dermatological journals from 1987 to 2000. The leading countries in terms of output were the United Kingdom, Germany, Italy and France. The leading countries in number of articles after taking into account the gross domestic product and the population were Denmark, Finland and Sweden. The main journals were the British Journal of Dermatology(14.5% of articles from European authors), Contact Dermatitis (13.7%), Journal of Investigative Dermatology (7.3%),Journal of American Academy of Dermatology (6.4%), andActa Dermato-Venereologica (6.1%). The country with the highest output of papers by journal was the United Kingdom (11 journals) followed by Germany (9 journals), Italy (6 journals), France (3 journals), Spain (2 journals) and Sweden (1 journal). In conclusions: the scientific production of European Union research on dermatology is highest in northern countries.

Tetanus in a rural Ethiopian hospital.

SUMMARY Despite the widespread availability of a safe and effective vaccine, tetanus continues to be a significant public health problem in the developing countries.

Estudio bibliométrico de la revista Actas Dermo-Sifiliográficas (1984-2003). Análisis de la producción (I)

Resumen Objetivo Analizar los articulos cientificos publicados en actas dermo-sifiliograficas (AD) entre 1984 y 2003. Los principales parametros bibliometricos analizados han sido: numero de articulos, extension y tipologia documental, areas tematicas fundamentales, autoria de los documentos, principales centros productores, areas departamentales y distribucion geografica de los articulos. Material y metodos Se revisaron manualmente todos los articulos cientificos publicados en los numeros ordinarios de la revista AD entre 1984 y 2003 (dos decadas), lo que corresponde a los volumenes 75 a 94. Resultados En el periodo de estudio se publicaron en la revista AD un total de 2.604 articulos, con una media anual de 130. El caso clinico o nota clinica fue el principal tipo documental (66,2 %), seguido de los articulos originales (23,5 %) y los articulos de revision (4,7 %). La extension de los documentos vario entre 1 y 33 paginas, con una media de 4,55 paginas. Las cuestiones mas abordadas en los documentos del periodo fueron dermatopatologia (15,9 %) y tratamiento (15,4 %). Se contabilizo un total de 11.667 autorias, y el numero de autores distintos fue de 2.907. El indice de colaboracion medio del periodo se situo en el 4,48. Un 56,7 % de autores lo fue de forma ocasional (firmo un unico documento), mientras a un 3,5% se les considero maximos productores por haber firmado 20 o mas trabajos a lo largo del periodo. Siete comunidades autonomas concentraron el 85,5 % de la produccion. La comunidad de Madrid fue, con diferencia, la gran productora (917 documentos; 35,2%), seguida de Andalucia (422; 16,2 %), Cataluna (240; 9,2 %) y Castilla y Leon (221; 8,5 %). Un total de 293 centros distintos firmaron los 2.604 documentos del estudio y dieron lugar a 2.977 colaboraciones. La mayoria de estas colaboraciones pertenecian a grandes hospitales o complejos hospitalarios entre los que destacaron los madrilenos Hospital 12 de Octubre (281 colaboraciones) y Hospital Clinico San Carlos (153), asi como el Hospital Universitario San Cecilio de Granada (149). La dermatologia fue la especialidad que firmo un mayor numero de documentos (90,8% como primer firmante). La gran colaboradora de la dermatologia fue la anatomia patologica que participo en un 28,5 % de articulos. Conclusiones El analisis de la productividad de la revista AD durante dos decadas permite aproximarnos a la actividad cientifica dermatologica nacional dada la importancia cuantitativa y cualitativa de la revista en el contexto de la dermatologia espanola.

Prevalence of HTLV-1/2 Infections in Spain: A Cross-Sectional Hospital-Based Survey

The presence of antibodies to human T-lymphotropic virus (HTLV) types 1 and 2 was examined in 5742 sera belonging to consecutive adult outpatients attended during June 2008 at 13 different hospitals across Spain. Overall, 58.8% were female. Foreigners represented 8% of the study population. Seven individuals were seropositive for HTLV-2 (overall prevalence 0.12%). No cases of HTLV-1 infection were found. All HTLV-2(+) subjects were Spanish natives, of whom six were coinfected with HIV-1 and five with hepatitis C virus (HCV). Moreover, all but one of the HTLV-2(+) subjects had been intravenous drug users. In summary, this cross-sectional survey suggests that the rate of HTLV infection in Spain is low, and is mostly represented by HTLV-2. Infected individuals are generally Spanish natives with a prior history of intravenous drug use and are coinfected with HIV-1 and/or HCV.

Schistosomiasis in european travelers and migrants: Analysis of 14 years tropnet surveillance data

Schistosomiasis remains one of the most prevalent parasitic diseases worldwide and the infection is frequently found in travelers and migrants. The European Network for Tropical Medicine and Travel Health conducted a sentinel surveillance study on imported schistosomiasis between 1997 and 2010. This report summarizes epidemiological and clinical data from 1,465 cases of imported schistosomiasis. Direct pathogen detection and serology were the main diagnostic tools applied. Of these, 486 (33%) cases were identified among European travelers, 231 (16%) among long-term expatriates, and 748 (51%) among non-European immigrants. Overall, only 18.6% of travelers had received pretravel advice; 95% of infections were acquired in the African region. On species level, Schistosoma mansoni was identified in 570 (39%) and Schistosoma haematobium in 318 (22%) cases; 57.5% of patients were symptomatic. Acute symptoms were reported in 27% of patients leading to earlier presentation within 3 months. Praziquantel was used in all patients to treat schistosomiasis. Many infections were detected in asymptomatic patients. In 47.4% of asymptomatic patients infection was detected by microscopy and in 39% by serology or antigen testing. Schistosomiasis remains a frequent infection in travelers and migrants to Europe. Travelers should be made aware of the risk of schistosomiasis infection when traveling to sub-Saharan Africa. Posttravel consultations particularly for returning expatriates are useful given the high potential for detecting asymptomatic infections.