Cribado ampliado de Trypanosoma cruzi en la descendencia de mujeres infectadas en la zona metropolitana norte de Barcelona, Cataluña (España), 2005-2016 / Extended screening of Trypanosoma cruzi among the offspring of infected women. Barcelona North metropolitan area, Catalonia (Spain), 2005-2016

INTRODUCCIÓN: Existen escasos datos sobre el cribado serológico extenso, familiar, de Trypanosoma cruzi a partir de un infectado-índice. Por tratarse de una parasitosis con posibilidad de transmisión materno-fetal, el estudio de la descendencia de mujeres crónicamente infectadas posee una especial relevancia. MÉTODOS: Estudio observacional por método de captura-recaptura que valora el estado serológico en la descendencia de las mujeres diagnosticadas de infección por T. cruzi en el área metropolitana norte de Barcelona durante el periodo 2005-2016. RESULTADOS: Se identificaron 238 mujeres son serología positiva para T. cruzi. De ellas, se pudieron localizar 117 (49,2%) y sus 300 descendientes. Entre los descendientes, 192 (64%) tenían registro de serología, con 23 positivas para T. cruzi (11,98%; IC 95%: 8,1-17,3). Hubo 53 niños nacidos en el área de estudio, con 5 casos de transmisión vertical (9,8%; IC 95%: 4,2-20,9). Todos los nacidos a partir de la implementación del programa de cribado materno (en 2010) tenían registro serológico. CONCLUSIONES: La población de descendientes de mujeres con serología positiva para T. cruzi muestra una tasa elevada de seropositividad. La prevalencia de transmisión vertical es notablemente alta, pero comparable a la obtenida en otros estudios europeos. La principal fuente de pérdidas lo constituyen las mujeres ilocalizables. Es razonable incluir la determinación serológica familiar extensa en los protocolos de cribado de enfermedad de Chagas. A fin de evitar pérdidas, se debería implementar un eventual cribado en el momento del diagnóstico materno

INTRODUCTION: To date, very little data is available on the extensive, familiar, serological screening of Trypanosoma cruzi from infected-index cases. As it is a parasite with possibility of mother-to-child fetal transmission, the study of the offspring of chronically infected women has a special relevance. METHODS: An observational study using a capture-recapture method that evaluates the offspring serological status of women diagnosed with T. cruzi infection (positive serology) in the northern metropolitan area of Barcelona during 2005-2016. RESULTS: A total of 238 women with positive serology for T. cruzi were identified. Of these, 117 (49.2%) could be localized. Their offspring summarized 300 individuals, of which 192 (64%) had serology records, with 23 positive for T. cruzi (11.98%; CI95%: 8.1-17.3). Among the 53 children born within the study area, 5 (9.8%, CI95%: 4.2-20.9) cases of vertical transmission were recorded. All children born as of 2010 (the starting year of mother screening) had serological outputs. CONCLUSIONS: Offspring of T. cruzi-seropositive women showed a high rate of seropositivity. The prevalence of vertical transmission is also remarkably high but comparable to that obtained in other European studies. The main source of loss was non-accessible women. It is reasonable to formaly include extensive, familiar, serological assessment in Chagas screening guidelines. In order to avoid losses, any eventual screening should be implemented at the time of the maternal diagnosis

Extended screening of Trypanosoma cruzi among the offspring of infected women. Barcelona North metropolitan area, Catalonia (Spain), 2005-2016. / Cribado ampliado de Trypanosoma cruzi en la descendencia de mujeres infectadas en la zona metropolitana norte de Barcelona, Cataluña (España), 2005-2016.

INTRODUCTION: To date, very little data is available on the extensive, familiar, serological screening of Trypanosoma cruzi from infected-index cases. As it is a parasite with possibility of mother-to-child fetal transmission, the study of the offspring of chronically infected women has a special relevance. METHODS: An observational study using a capture-recapture method that evaluates the offspring serological status of women diagnosed with T. cruzi infection (positive serology) in the northern metropolitan area of Barcelona during 2005-2016. RESULTS: A total of 238 women with positive serology for T. cruzi were identified. Of these, 117 (49.2%) could be localized. Their offspring summarized 300 individuals, of which 192 (64%) had serology records, with 23 positive for T. cruzi (11.98%; CI95%: 8.1-17.3). Among the 53 children born within the study area, 5 (9.8%, CI95%: 4.2-20.9) cases of vertical transmission were recorded. All children born as of 2010 (the starting year of mother screening) had serological outputs. CONCLUSIONS: Offspring of T. cruzi-seropositive women showed a high rate of seropositivity. The prevalence of vertical transmission is also remarkably high but comparable to that obtained in other European studies. The main source of loss was non-accessible women. It is reasonable to formaly include extensive, familiar, serological assessment in Chagas screening guidelines. In order to avoid losses, any eventual screening should be implemented at the time of the maternal diagnosis.

Enfermedades infecciosas importadas asociadas a los desplazamientos internacionales de inmigrantes adultos en visita a familiares y amigos / Imported infectious diseases associated with international trips by adult immigrants to visit family and friends

Objetivo: Valorar las enfermedades infecciosas importadas por inmigrantes que realizaron visitas a familiares y amigos (VFA). Métodos: Estudio transversal descriptivo de todas las enfermedades infecciosas importadas en pacientes adultos 01/2001-12/2008. Los grupos de estudio definidos fueron: a) inmigrantes VFA; b) turistas, y c) inmigrantes no viajeros. Las enfermedades se clasificaron según su tipo en cosmopolitas y endémicas tropicales; según su gravedad en a) leves, b) graves, y c) potencialmente letales. Resultados: Se analizaron 761 individuos; edad: 31,7 (DE: 12,4) años; inmigrantes VFA=90, turistas=269, inmigrantes no-viajeros=402. Los inmigrantes VFA acudieron menos a las Consultas de Consejo a Viajeros que los turistas (32,2% frente a 57,2%; p <0,001) y viajaron con mayor frecuencia a África subsahariana (33,3% frente a 20,4%; p=0,01). Las enfermedades potencialmente letales fueron más frecuentes en inmigrantes VFA con OR = 5,16 (IC95%: 2,08–12,8) en relación a turistas y OR=7,17 (IC95%: 2,82–18,2) a inmigrantes no viajeros. Conclusiones: Los inmigrantes VFA viajaron con más frecuencia al África subsahariana e importaron más enfermedades de curso agudo potencialmente letal (AU)

Objective: To describe the infectious diseases imported by immigrants visiting friends and relatives in their countries of origin. Methods: We performed a cross-sectional descriptive study of all imported infectious diseases among adult patients between 01/2001-12/2008. The study population was classified in 3 groups: a)immigrants visiting friends and relatives; b) tourists, and c) non-travelling immigrants. Diseases were classified as (a) cosmopolitan or (b) tropical endemic, and, according to their severity as (a) mild, (b) serious, and (c) potentially lethal. Results: A total of 761 patients were analyzed. The mean age was 31.7 (SD: 12.4) years. Of these, there were 90 immigrants visiting friends and relatives, 269 tourists and 402 non-travelling immigrants. Immigrants visiting friends and relatives attended International Health Centres prior to travel significantly less than tourists (32.2% vs. 57.2%; p <0.001) and more frequently travelled to sub-Saharan Africa (33.3% vs. 20.4%; p=0.01). Imported diseases considered as potentially lethal were more likely among immigrants visiting friends and relatives than tourists [OR=5.16 (95%CI: 2.08–12.8)] and non-travelling immigrants [OR=7.17 (95%CI: 2.82–18.2)]. Conclusions: Immigrants visiting friends and relatives travelled more to sub-Saharan Africa and more frequently imported potentially lethal acute diseases (AU)

[Imported infectious diseases associated with international trips by adult immigrants to visit family and friends]. / Enfermedades infecciosas importadas asociadas a los desplazamientos internacionales de inmigrantes adultos en visita a familiares y amigos.

OBJECTIVE: To describe the infectious diseases imported by immigrants visiting friends and relatives in their countries of origin. METHODS: We performed a cross-sectional descriptive study of all imported infectious diseases among adult patients between 01/2001-12/2008. The study population was classified in 3 groups: a) immigrants visiting friends and relatives; b) tourists, and c) non-travelling immigrants. Diseases were classified as (a) cosmopolitan or (b) tropical endemic, and, according to their severity as (a) mild, (b) serious, and (c) potentially lethal. RESULTS: A total of 761 patients were analyzed. The mean age was 31.7 (SD: 12.4) years. Of these, there were 90 immigrants visiting friends and relatives, 269 tourists and 402 non-travelling immigrants. Immigrants visiting friends and relatives attended International Health Centres prior to travel significantly less than tourists (32.2% vs. 57.2%; p <0.001) and more frequently travelled to sub-Saharan Africa (33.3% vs. 20.4%; p=0.01). Imported diseases considered as potentially lethal were more likely among immigrants visiting friends and relatives than tourists [OR=5.16 (95%CI: 2.08-12.8)] and non-travelling immigrants [OR=7.17 (95%CI: 2.82-18.2)]. CONCLUSIONS: Immigrants visiting friends and relatives travelled more to sub-Saharan Africa and more frequently imported potentially lethal acute diseases.

[Prevalence of diabetes mellitus in young Asian Indian immigrants in Santa Coloma de Gramenet (Spain)]. / Prevalencia de diabetes mellitus en inmigrantes indostánicos jóvenes en Santa Coloma de Gramenet, España.

BACKGROUND AND OBJECTIVE: There is a general agreement to consider Asian Indian subjects, specially those who immigrated to Western countries, as a high-risk population to develop type 2 diabetes mellitus (DM2). This could be mainly explained by reasons based on the immigration changes, particularly the metabolic impact of a westernized diet (environmental hypothesis) or reasons based in the presence of tissue resistance to insulin (genetic hypothesis). The aim of the study was to estimate the prevalence of DM2 in 3 populations of Asian Indian immigrants, non-Asian Indian immigrants and autochthonous subjects. POPULATION AND METHOD: An observational multicenter study was performed in 3 primary care centers from Santa Coloma de Gramenet (Barcelona, Spain). Subjects from Asian Indian, non-Asian Indian and autochthonous origin born between 1948-73 were compared. Their DM2 prevalence as well as sociodemographic and clinical data among diabetic patients were analyzed. RESULTS: The overall prevalence of DM2 was 4.6 %. The prevalence of DM2 was higher among Asian Indian immigrants (20.9%, 95% CI, 12.1-29.1) compared with autochthonous (3.6%; 95% CI, 2.9-9.3; p < 0.001) and non-Asian Indian immigrants (9.7%; 95% CI, 5.3-14.1; p = 0.013). Nevertheless, differences between autochthonous and non-Asian Indian immigrants were found (p < 0.001). Asian Indians subjects had an earlier diagnosis age, especially those younger than 44 years, than those of non-Asian Indian immigrants and autochthonous groups (p < 0.002 and p < 0.006, respectively). CONCLUSIONS: Taken together, these results suggest that young immigrant populations have a higher prevalence of DM2 compared with autochthonous ones. Indeed, the prevalence of DM2 among immigrant Asian Indians represents the highest reported in the European Union so far and shows differences with non-Asian Indian immigrants. In spite of this, these differences are not totally conclusive in statistical terms; further studies are needed to compare both populations.

Prevalencia de diabetes mellitus en inmigrantes indostánicos jóvenes en Santa Coloma de Gramenet, España / Prevalence of diabetes mellitus in young Asian Indian immigrants in Santa Coloma de Gramenet (Spain)

Fundamento y objetivo: Hay un acuerdo general en considerar que la población de origen indostánico, sobre todo los inmigrantes de países occidentales, tiene un riesgo especialmente elevado a desarrollar diabetes mellitus tipo 2 (DM2). Para explicarlo se han defendido argumentos basados en el impacto de los cambios debidos a la inmigración, especialmente el atribuible a la adopción de una dieta occidental (hipótesis ambiental) o debidos a la presencia de resistencia tisular a la insulina (hipótesis genética). El objetivo principal del estudio es valorar la prevalencia de DM2 en tres poblaciones de inmigrantes: indostánicos, inmigrantes no indostánicos y autóctonos. Población y método: Estudio transversal y multicéntrico realizado en 3 centros de atención primaria de Santa Coloma de Gramenet (Barcelona, España). Se estudiaron tres poblaciones nacidas entre 1948 y 1973 según su origen: indostánico, no indostánico y autóctono. Se analizó la prevalencia de DM2 y la relación de variables sociodemográficas y de comorbilidad entre los pacientes diabéticos. Resultados: Se estudió a 2.690 individuos de los que un 4,6% tenía DM2. La prevalencia de DM2 fue superior en el grupo de indostánicos (20,9%, intervalo de confianza [IC] del 95%, 12,1-29,1) en relación con el grupo de autóctonos (3,6%, IC del 95%, 2,9-4,3; p < 0,001) y a la de inmigrantes no indostánicos (9,7%, IC del 95%, 5,3-14,1; p = 0,013). No obstante, la prevalencia de los inmigrantes no indostánicos también fue estadísticamente significativa respecto a los autóctonos (p < 0,001). Los indostánicos presentaron una edad de diagnóstico más temprana (por debajo de los 44 años) comparado con la de los inmigrantes no indostánicos y los autóctonos (p < 0,002 y p < 0,006, respectivamente). Conclusiones: Se observa una mayor prevalencia de DM2 en población inmigrante joven en relación con la población autóctona. La prevalencia de DM2 en inmigrantes indostánicos es la más alta de las registradas en la Unión Europea y superior a la de los inmigrantes no indostánicos, después son necesarios subsiguientes estudios que comparen ambas poblaciones

Bakground and objective: There is a general agreement to consider Asian Indian subjects, specially those who immigrated to Western countries, as a high-risk population to develop type 2 diabetes mellitus (DM2). This could be mainly explained by reasons based on the immigration changes, particularly the metabolic impact of a westernized diet (environmental hypothesis) or reasons based in the presence of tissue resistance to insulin (genetic hypothesis). The aim of the study was to estimate the prevalence of DM2 in 3 populations of Asian Indian immigrants, non-Asian Indian immigrants and autochtonous subjects. Population and method: An observational multicenter study was performed in 3 primary care centers from Santa Coloma de Gramenet (Barcelona, Spain). Subjects from Asian Indian, non-Asian Indian and autochtonous origin born between 1948-73 were compared. Their DM2 prevalence as well as sociodemographic and clinical data among diabetic patients were analyzed. Results: The overall prevalence of DM2 was 4.6 %. The prevalence of DM2 was higher among Asian Indian immigrants (20.9%, 95% CI, 12.1-29.1) compared with autochtonous (3.6%; 95% CI, 2.9-9.3; p < 0.001) and non-Asian Indian immigrants (9.7%; 95% CI, 5.3-14.1; p = 0.013). Nevertheless, differences between autochtonous and non-Asian Indian immigrants were found (p < 0.001). Asian Indians subjects had an earlier diagnosis age, especially those younger than 44 years, than those of non-Asian Indian immigrants and autochthonous groups (p < 0.002 and p < 0.006, respectively). Conclusions: Taken together, these results suggest that young immigrant populations have a higher prevalence of DM2 compared with autochtonous ones. Indeed, the prevalence of DM2 among immigrant Asian Indians represents the highest reported in the European Union so far and shows differences with non-Asian Indian immigrants. In spite of this, these differences are not totally conclusive in statistical terms; further studies are needed to compare both populations