Valeska Padovese

Prevalence of latent tuberculosis, syphilis, hepatitis B and C among asylum seekers in Malta

BACKGROUND 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.

Epidemiological and geographical aspects of leishmaniasis in Tigray, northern Ethiopia: a retrospective analysis of medical records, 2005-2008

Leishmaniasis is one of the most neglected tropical diseases and epidemic outbreaks often occur worldwide. This paper reports some epidemiological features of the disease in Tigray, northern Ethiopia, with the aim of studying the disease distribution and the environmental factors that may have influenced it. Medical records from patients with Leishmania attending the Italian Dermatological Centre of Mekele in the period 2005-2008 were retrospectively reviewed. Age and gender distribution, clinical types, occupation, co-morbidity, urban/rural origin, altitude and rainfall were investigated. The result was 471 patients affected and the prevalent clinical form was cutaneous leishmaniasis (86%). Five main risk areas were identified in the Tigray highlands and only isolated cases were reported at altitudes below 1700m. The variables related to a higher risk of catching leishmaniasis were male gender, age over-14, poor education, outdoor activities and living at high altitudes. Climatic and environmental changes occurring in this region and land degradation are discussed as factors influencing leishmaniasis distribution. Further research including field missions and geomapping is needed to quantify the actual disease burden in the region.

Clinical‐epidemiological features of contact dermatitis in rural and urban communities in northern Ethiopia: correlation with environmental or occupational exposure

The widespread diffusion of low‐quality products as well as the local cultural habits could be a relevant cause of allergic diseases in developing countries. In the present observational study, we explored the prevalence of allergic contact dermatitis in both rural and urban settings in northern Ethiopia, where skin diseases represent a frequent cause of morbidity. Clinical features and specific reactivities in association with environmental or occupational exposure were investigated.

The diagnostic challenge of mapping elephantiasis in the Tigray region of northern Ethiopia

In Ethiopia, lymphatic filariasis and podoconiosis are the two neglected tropical diseases planned to be mapped together within the recently launched Ethiopian neglected tropical diseases master plan (2013–2015). However, other disorders cause tropical lymphedema, and this report aims to identify clinical epidemiological aspects of limb swelling in northern Ethiopia and to provide an algorithm orienting the clinical diagnosis.

Skin cancer risk assessment in dark skinned immigrants: the role of social determinants and ethnicity

ABSTRACT Objectives: Dark-skinned people have a lower incidence rate of skin cancer, in particular melanoma, which is detected at more advanced stages leading to poorer prognoses and long-term outcomes compared to whites. The gap in survival is due to some difficulty in melanoma detection, lack of attention from doctors and awareness by patients. This study aims to assess skin cancer risk awareness in dark-skinned immigrants and to determine the influence of socioeconomic factors and ethnic origin on behaviors. Design: This is a cross-sectional health facility based study carried out in a 12-month period. A semi-structured questionnaire to assess skin cancer risk awareness and a dermatological examination was offered to dark-skinned immigrants consecutively attending the dermatology department of the National Institute for Health, Migration and Poverty in Rome. Results: 147 dark-skinned immigrants were enrolled, of which 54.4% were males, coming from Africa (53.1%). They were mainly young, aged 18–34 (56.5%). The level of education and length of stay in Italy was significantly related to the awareness about skin cancer: people with a high educational level (OR: 8.1 95% CI: 3.2–23.4) or immigrated more than 4 years before the interview (OR: 2.1 95% CI: 1.0–4.4) have a greater knowledge about skin cancer. Conclusions: Education level is the strongest predictive factor of skin cancer awareness, whereas cultural behaviours and personal experience of sunburns are the main factors determining sunlight avoidance. Health promotion programs targeting immigrants must consider cultural differences related to ethnicity and country of origin, and adopt a transcultural approach.

The spectrum of genodermatoses and congenital cutaneous conditions in northern Ethiopia

Reports of congenital diseases in Africa are scanty, probably because of their rarity, the lack of knowledge among health workers, and the difficult political and social situation in different African countries. We describe here the spectrum of genetic and rare congenital cutaneous conditions encountered at the Italian Dermatological Center of Ayder referral hospital of Mekele, Ethiopia, over a 3‐year period. All patients attending the Italian Dermatological Center were registered in a database, and medical records of genetic and congenital disorders diagnosed from January 2008 to December 2010 were retrospectively analyzed. Over the total, 24 different genetic and congenital disorders affecting 122 individuals (0.4% of the total case load) were observed. In our case series, we did not report any patient affected by albinism, in contrast with literature from other African countries. To our knowledge, this is the first report from northern Ethiopia. A brief update on the commonest disorders is included.

Operational research on the correlation between skin diseases and HIV infection in Tigray region, Ethiopia

In Ethiopia, skin diseases are among the leading causes of outpatient attendance to primary health service. Correlation of skin diseases and HIV has long been recognized and used to guide medical management in resource‐limited settings. Therefore, this study aims to assess the correlation of skin diseases and HIV infection, to estimate epidemiological distribution in the study area, and to provide health workers of skin indicators for HIV early detection.

Darier's disease in Ethiopia: report of two cases

Darier’s disease (DD) is a rare genetic disease, autosomal dominant with a variable penetration. It is characterized by abnormal keratinization of epidermis, nails, and mucosae. The disease is caused by a loss-of-function mutation in the ATP2A2 gene on chromosome 12q23–24, which leads to an impaired cell-to-cell adhesion. DD may present as a generalized autosomal dominant condition as well as a localized or segmental post-zygotic condition. The clinical features of DD include warty papules and plaques in the seborrheic areas, dystrophic nails, palmoplantar pits, and papules on the dorsa of hands and feet. Hypopigmented 1–5 mm guttate macules are described as a feature in dark skin. Their frequency is not known because of scanty reports of the disease in dark skin populations. DD has rarely been described in sub-Saharan Africa. No reports from Ethiopia have been found. Here we report two patients with DD from northern Ethiopia, diagnosed over a 3-year period, and highlight its presence in the country and its social implications.