Congenital syphilis in Roraima and Venezuelan migration: analysis of cases at the state maternity hospital in the 2017/2018 and 2020/2021 biennia / Sífilis congênita em Roraima e a migração venezuelana: análise de casos na maternidade estadual nos biênios 2017/2018 e 2020/2021 / Sífilis congénita en Roraima y migración venezolana: análisis de casos en la maternidad estatal en los bienios 2017/2018 y 2020/2021

Background and objectives: in 2017 and 2018, Roraima experienced the most significant increase in congenital syphilis incidence rates among all federal units. This phenomenon occurred in parallel with the significant Venezuelan migration to the region. The study aimed to analyze the relationship between the increase in cases of congenital syphilis registered at the Hospital Materno Infantil Nossa Senhora de Nazareth and the Venezuelan migratory crisis. Methods: this is a document-based, descriptive research, covering the 2017/2018 and 2020/2021 periods, developed from data collected in copies of congenital syphilis report/investigation forms from the hospital. Results: in the 2017/2018 biennium, the peak of Venezuelan migration in Roraima, fewer cases of syphilis occurred than when the migratory flow declined. In the 2020/2021 biennium, there was a decrease in the migratory flow due to the closing of the border and the acceleration of the interiorization process. Although it is the period with the highest number of reports of congenital syphilis among Venezuelan mothers, the percentage is considerably lower than that recorded among Brazilian women. The incidence rate was higher among the group of Brazilian mothers (7.5/1,000 live births, in the 2017/2018 period, and 11.5/1,000 live births, in the 2020/2021 period). Conclusion: Venezuelan migration, although it may have eventually exerted some influence on the total number of cases of congenital syphilis, cannot be considered the determining factor for the increase in cases of the disease in the hospital in the defined period, and other factors deserve to be assessed as decisive in this case.(AU)

Justificativa e objetivos: em 2017 e 2018, Roraima apresentou o aumento mais significativo nas taxas de incidência de sífilis congênita entre todas as unidades federativas. Este fenômeno ocorreu paralelamente à significativa migração venezuelana para a região. O estudo teve como objetivo analisar a relação entre o aumento de casos de sífilis congênita registrados no Hospital Materno Infantil Nossa Senhora de Nazareth e a crise migratória venezuelana. Métodos: trata-se de uma pesquisa documental, descritiva, abrangendo os períodos 2017/2018 e 2020/2021, desenvolvida a partir de dados coletados em cópias de fichas de notificação/investigação de sífilis congênita do hospital. Resultados: no biênio 2017/2018, pico da migração venezuelana em Roraima, ocorreram menos casos de sífilis do que quando o fluxo migratório diminuiu. No biénio 2020/2021, registou-se uma diminuição do fluxo migratório devido ao encerramento da fronteira e à aceleração do processo de interiorização. Embora seja o período com maior número de notificações de sífilis congênita entre mães venezuelanas, o percentual é consideravelmente inferior ao registrado entre as brasileiras. A taxa de incidência foi maior entre o grupo de mães brasileiras (7,5/1.000 nascidos vivos, no período 2017/2018, e 11,5/1.000 nascidos vivos, no período 2020/2021). Conclusão: A migração venezuelana, embora possa eventualmente ter exercido alguma influência no total de casos de sífilis congênita, não pode ser considerada o fator determinante para o aumento de casos da doença no hospital no período definido, e outros fatores merecem ser destacados. ser considerada decisiva neste caso.(AU)

Antecedentes y objetivos: en 2017 y 2018, Roraima experimentó el aumento más significativo en las tasas de incidencia de sífilis congénita entre todas las unidades federales. Este fenómeno se produjo en paralelo con la importante migración venezolana a la región. El estudio tuvo como objetivo analizar la relación entre el aumento de casos de sífilis congénita registrados en el Hospital Materno Infantil Nossa Senhora de Nazareth y la crisis migratoria venezolana. Métodos: se trata de una investigación descriptiva, documental, que abarca los períodos 2017/2018 y 2020/2021, desarrollada a partir de datos recolectados en copias de formularios de informe/investigación de sífilis congénita del hospital. Resultados: en el bienio 2017/2018, pico de migración venezolana en Roraima, ocurrieron menos casos de sífilis que cuando el flujo migratorio disminuyó. En el bienio 2020/2021 se produjo una disminución del flujo migratorio debido al cierre de fronteras y la aceleración del proceso de interiorización. Si bien es el período con mayor número de reportes de sífilis congénita entre madres venezolanas, el porcentaje es considerablemente menor que el registrado entre las mujeres brasileñas. La tasa de incidencia fue mayor entre el grupo de madres brasileñas (7,5/1.000 nacidos vivos, en el período 2017/2018, y 11,5/1.000 nacidos vivos, en el período 2020/2021). Conclusión: La migración venezolana, si bien eventualmente pudo haber ejercido alguna influencia en el número total de casos de sífilis congénita, no puede considerarse el factor determinante del aumento de casos de la enfermedad en el hospital en el período definido, y otros factores merecen ser considerados. considerarse decisivo en este caso.(AU)

Complications of hymenoplasty.

We present the case of a woman in her late 20s who consulted our gynaecology emergency department due to dyspareunia and vaginal penetration issues. She had undergone a 'virginity reconstruction' procedure 10 days before her wedding in Africa. Clinical examination revealed suture of the inferior part of inner labia (labia minora), narrowing of the vaginal introitus and abnormal vaginal discharge. We performed an inferior defibulation procedure and removed the sutures under general anaesthesia. Postoperative care included systemic metronidazole, counselling, vaginal dilators and topical estrogens for 1 month. There were no complications during the postoperative follow-up, and a month later, the woman confirmed a satisfactory outcome. The aim of this paper is to discuss the practice of so-called 'virginity reconstruction', currently classified among female cosmetic genital surgeries despite being very similar to what is defined as female genital mutilation, and the care that can be provided to women in such cases.

Health of migrants and other vulnerable populations across Asian countries: Build Forward Better beyond the COVID-19 pandemic.

Global migration has been increasing since before the COVID-19 pandemic. The pandemic has clearly shown a lack of preparedness for the next public health emergency when it comes to vulnerable populations including migrants. To include the issues of migration and health in the current global health agenda, it is important to establish/strengthen a network for collaboration among various stakeholders from both the migrant-sending and host countries of migrants especially in the Asian-Pacific region. As the initial step for networking in Asia, in March 2023, a hybrid style international symposium was held in Japan and agreed on a goal and five pillars: surveillance and monitoring, risk communications, community engagement, access to health and social protection services, and supportive environments. Considering the transition of context from the COVID-19 crisis to 'Build Forward Better', through the Asian network, we will envisage the better world, where vulnerable populations including migrants will not be left behind from health security.

Isolated pulmonary hydatid cyst.

Echinococcosis is primarily a disease of developing nations with poor medical infrastructure, where cohabitation with domesticated animals is common. These conditions, in conjunction with the inherent chronicity of the disease, lead to low rates of diagnosis and high morbidity. Robust surveillance is not readily available in communities with the highest disease burden.WHO classifications assist in diagnostic and treatment endeavours especially in countries where this disease is not commonly encountered. However, the understanding of the pathophysiology of echinococcosis and optimal treatment are still lacking in certain patient populations.We present the case of a female from Central Asia with an isolated pulmonary hydatid cyst. She was diagnosed several months after she had an uncomplicated pregnancy and gave birth to a healthy baby girl. Due to a delay in surgical intervention, our patient received a prolonged course of treatment which resulted in a significant reduction in the size of the cyst. Given her improvement, we questioned the current guidelines set by the WHO regarding surgical resection of pulmonary hydatid cysts, compared with an extended course with albendazole in patients with an unusual and protracted course of the disease. Furthermore, we discuss the possible role of pregnancy in exacerbating symptoms of underlying pulmonary hydatid disease.

A surgeon's trial success of curing pedal eumycetoma.

Mycetoma is a chronic infection of underlying fungal (eumycetoma) or bacterial (actinomycetoma) origin. It is characterised by a clinical triad of tumour-like swelling, actively draining sinuses and macroscopic grains of characteristic colours.We the case of a 66-year-old woman on immunosuppressive therapy presenting with eumycetoma of the foot (Madura foot). The fungal organism cultured was Acrophialophora fusisporaThis case was managed with a combination of extensive surgical debridement, and packing with calcium sulfate (Stimulan) beads impregnated with vancomycin and voriconazole. As far as the authors are aware, this is a novel adjunct to the surgical treatment of deep fungal infection in the foot.Eumycetoma treated with surgery and oral antifungal therapy leads to cure rates of 25%-35%. This novel treatment seems to bear further investigation for the potential to improve cure rates. At 8 months follow-up, our patient appears to be making good progress with no current signs of recurrence.

Outbreak of imported diphtheria with Corynebacterium diphtheriae among migrants arriving in Germany, 2022.

From July 2022, cases of imported diphtheria with toxigenic Corynebacterium diphtheriae remarkably increased among migrants arriving in Germany. Up to 30 September 2022, 44 cases have been reported to the national public health institute, all laboratory-confirmed, male, and mainly coming from Syria (n = 21) and Afghanistan (n = 17). Phylogeny and available journey information indicate that most cases (n = 19) were infected along the Balkan route. Active case finding, increased laboratory preparedness and epicentre localisation in countries along this route are important.

Disseminated strongyloidiasis after prolonged treatment with corticosteroids.

Strongyloides stercoralis is a helminth found in the soil and transmitted to humans through larval penetration of the skin. It is endemic across most of the tropical regions of the world. Infection with S. stercoralis commonly causes minimal or mild symptoms. This case report describes an interesting final diagnosis for a woman presenting with persistent nausea, vomiting and epigastric pain. Her evaluation included imaging and oesophagogastroduodenoscopy with biopsy. Her biopsy results revealed oesophageal candidiasis and disseminated strongyloidiasis. Important historical clues in this case included previous prolonged treatment with steroids, recent diagnosis of gram-negative bacteraemia, prior residence in Rwanda, and unknown predeparture treatment for S. stercoralis She was ultimately treated with fluconazole and ivermectin with marked improvement in her symptoms.

Unstable gynaecological patient with an ankle monitor: implications of US Immigration and Customs Enforcement's Alternatives to Detention programme in the healthcare setting.

We review the case of an unstable gynaecological patient in the USA who presented with profuse vaginal bleeding after spontaneous miscarriage and was ultimately diagnosed with a uterine arteriovenous malformation managed with interventional radiology embolisation of her uterine artery. Her case was complicated by the presence of an ankle monitoring device which had been placed by US Immigration and Customs Enforcement as part of the Alternatives to Detention programme in which she was enrolled during her immigration proceedings. The device prompted important considerations regarding the potential use of cautery, MRI compatibility and device-related trauma, in addition to causing significant anxiety for the patient, who was concerned about how the team's actions could affect her immigration case. Discussion of her course and shared perspective highlights the unique clinical and medicolegal considerations presented by the expanded use of ankle monitoring devices for electronic surveillance (or 'e-carceration') of non-violent immigrants and others.

Cystic echinococcosis in a Moroccan boy: a silent and neglected disease among refugee and migrant children.

We report the unusual case of a 5-year-old migrant boy from a rural area of Morocco with an almost-giant lung hydatid cyst that was an incidental finding on a chest X-ray performed during routine visa procedures. Echinococcus granulosus serology test was initially negative with subsequent positive seroconversion. Albendazole was started at 4 weeks before surgery and maintained for 4 months, with a favourable outcome. Cystic echinococcosis (CE) is considered a neglected tropical disease and affects more than one million people worldwide, mostly from a lower socioeconomic background. Preventive measures have been limited in underdeveloped regions. Children with CE are especially vulnerable, due not only to the high pathogenic potential of the disease but also to their frequent involvement in challenging socioeconomic situations, including migration. The incidence of CE is increasing in Europe because of high immigration flows from endemic countries. Nevertheless, CE is not covered by current migrant screening protocols.

5. Now is the time to consider ! - Leave no migrants behind, 5-1 Why now? - migration and health, 5-2. Global situation on migration and health, 5-3. Migration and health for ‘Leave no one behind’: real situation of those under provisional release, asylum seekers, and undocumented migrants in Japan, 5-4. The historical transition of Japanese Immigrants and elderly care in Hawaii, 5-5. Foreign community approach to leave no patient with limited Japanese proficiency behind / 国際保健医療

  As global migration has been increasing rapidly, the Japan Association for International Health (JAIH) established the committee for migration and health in early 2021. This committee, which aims to challenge the health issues of migrants inside and outside Japan, held the first kick-off symposium in the 36th Congress of JAIH on 27 November 2021. Five symposiasts were invited and had presentations from the viewpoints of human rights and culture, which were recognized as the common keywords. This article was written by all symposiasts and chairpersons as the report of the kick-off symposium.

Approach for tuberculosis-associated immune reconstitution inflammatory syndrome in an HIV-negative patient.

A male refugee from the Middle East was diagnosed with pulmonary tuberculosis and Pott's disease with paravertebral abscess. After starting the standard regimen, the sputum culture converted to negative and the patient's general condition improved. Six weeks later, the patient presented with clinical worsening of known symptoms, new appearance of focal neurological deficits and progress of radiological features showing progression of the paravertebral abscess. Immune reconstitution inflammatory syndrome with Mycobacterium tuberculosis (TB-IRIS) was presumed, and treatment with high-dose steroids was started. Due to recurrent relapses while tapering, corticosteroids had to be given over a prolonged period. After treatment completion, the patient was in a good general condition, abscesses had decreased and neurological deficits were in complete remission. This case presents the rare manifestation of TB-IRIS in HIV-negative patients and its management in a high-income country.

Congenitally corrected transposition of the great arteries (CCTGA).

A 33-year-old man presented with a 3-week history of breathlessness and cough. He disclosed that he was informed regarding a heart defect as a child in his home country but was unaware of its nature and was never followed up. Examination revealed a pansystolic murmur (loudest at the apex), a hyperdynamic, displaced apex, and pulmonary oedema. An ECG showed atrial fibrillation with a regular broad-complex ventricular rhythm. Following electrical cardioversion, the ECG revealed complete heart block, therefore explaining the regular atrial fibrillation. An urgent transthoracic echocardiography (TTE) confirmed the anatomy of congenitally corrected transposition of the great arteries (CCTGA) with torrential tricuspid regurgitation and impaired systemic right ventricle. Cardiac MRI identified a ventricular septal defect which was not visible on TTE. The patient showed a transient improvement following fluid offloading and ACE inhibition, with a more definitive improvement after cardiac resynchronisation therapy (CRT).

Surviving violent, traumatic loss after severe political persecution: lessons from the evaluation of a Venezuelan asylum seeker.

In July 2019, the United Nations High Commissioner for Refugees (UNHCR) released a report urging the Venezuelan government to take immediate action to address the 'grave violations of economic, social, civil, political and cultural rights' occurring in the country. This case study highlights the human rights violations occurring in Venezuela through the case of a Venezuelan woman who experienced political persecution and traumatic loss resulting from her opposition to the ruling socialist party. As the clinical team of evaluators explored the mental health effects of surviving threats on her own life and the politically motivated assassination of her husband, it was agreed that the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition did not fully capture the extent of her suffering. Case discussion broadens the lens beyond the client's experiences of posttraumatic stress disorder (PTSD) and depression to include persistent complex bereavement disorder, and emphasises the importance of addressing the sequelae of traumatic loss in a multifaceted way that broadens understanding of emotional functioning postmigration.

Atenção Primária em Saúde para imigrantes bolivianos no Brasil / Atención Primaria de Salud para inmigrantes bolivianos en Brasil / Primary Health Care for Bolivian immigrants in Brazil

Trata-se de uma pesquisa qualitativa que utilizou entrevistas semiestruturadas, realizadas com trinta bolivianos e com 49 profissionais de saúde que os atendem na Unidade Básica de Saúde do Bom Retiro, bairro de São Paulo, Brasil. Essas entrevistas foram analisadas por meio de cinco categorias temáticas, utilizando o método de análise de conteúdo. Os resultados mostraram que a garantia do acesso não é o bastante para que o cuidado em saúde à população imigrante aconteça. Os atores políticos e os sujeitos sociais precisam estar envolvidos, organizados e preparados para que esse serviço realmente ocorra. (AU)

Se trata de una investigación cualitativa que utilizó entrevistas semiestructuradas, realizadas con treinta bolivianos y con 49 profesionales de salud que los atienden en la Unidad Básica de Salud de Bom Retiro, barrio de São Paulo, Brasil. Esas entrevistas fueron analizadas por medio de cinco categorías temáticas, utilizando el método de análisis de contenidos. Los resultados mostraron que la garantía del acceso no es suficiente para que se realice el cuidado de salud a la población inmigrantes. Los actores políticos y los sujetos sociales precisan estar envueltos, organizados y preparados para que ese servicio ocurra realmente. (AU)

This is a qualitative research that used semi-structured interviews, conducted with thirty Bolivians seeking healthcare services and with 49 healthcare professionals who treat them in the Basic Health Unit of Bom Retiro, a neighborhood located in São Paulo, Brazil. These interviews were analyzed according to five thematic categories, using the content analysis method. The results showed that access guarantee is not enough for the immigrant population to actually receive health care. Political actors and social subjects must be involved, organized, and prepared for this service to actually take place. (AU)

Symptomatic relapse and long-term sequelae of COVID-19 in a previously healthy 30-year-old man.

Much has been reported on the clinical course of severe COVID-19, but less is known about the natural history and sequalae of mildly symptomatic cases and the prospects of reinfection or recurrence of symptoms. We report a case of a patient with mildly symptomatic PCR-confirmed COVID-19 who, after being symptom-free for 2 weeks, redeveloped symptoms and was found to be PCR-positive again >4 weeks from original testing. Surprisingly, IgG and IgM antibody testing was negative 2 months after reinfection. Although no negative testing was performed between the two symptomatic bouts, this case raises the possibility of reinfection after controlling the virus and highlights the long period with which a patient can shed virus and experience symptoms after initial infection. Characterising variations in clinical symptoms and length of viral shedding after improvement is essential for informing recommendations on patients safely resuming contact with others.

Narrow band imaging in the diagnosis of bladder schistosomiasis.

A 23-year-old man presented to us with multiple episodes of visible haematuria associated with dysuria, but no other symptoms suggestive of infection. His physical examination was completely unremarkable. On detailed evaluation of history, it was noted that he was treated for urinary schistosomiasis as a child in Sudan. A diagnostic flexible cystoscopy, with both white light and narrow band imaging (NBI), was done among other tests as a further diagnostic tool to investigate possible causes. This revealed the characteristic features of bladder schistosomiasis. Urine microscopy for S chistosoma haematobium eggs was negative, and this could have caused the diagnosis to be missed. He was treated with praziquantel for chronic bladder schistosomiasis. This is the first time that the use of NBI as an adjunct to white light imaging in the diagnosis of bladder schistosomiasis has been reported.

"Left behind": why implementing migration-aware responses to HIV for migrant farm workers is a priority for South Africa.

Like many other countries, South Africa (SA) has committed to the Sustainable Development Goals that aim to "leave no-one behind", in efforts towards universal health coverage, and meeting the UNAIDS 90-90-90 targets through the implementation of universal test and treat (UTT) interventions. SA is associated with high levels of international and internal migration that, in certain contexts, are known to (1) increase the risk of acquiring HIV and (2) present challenges to HIV treatment access and continuity. Despite this, migration and mobility are not adequately considered in responses to HIV. As SA rolls out UTT programmes and antiretroviral treatment as prevention (TasP) interventions, including pre-exposure prophylaxis (PreP), there is an urgent need to ensure that these are migration-aware and mobility-competent. In SA, a key population that experiences a disproportionate HIV burden is international migrant farm workers living and working on commercial farms along the border with Zimbabwe. In this article, a social determinants of health approach is applied to explore the context within which this population struggles to access positive determinants of health, including the public health care system, and the implications of this for HIV programming. It is argued that, unless policies and programming become migration-aware and mobility-competent, UTT and TasP interventions will struggle to address the high burden of HIV among this population and, as a result, progress towards global health targets will be limited.

Responding to the health needs of migrant farm workers in South Africa: Opportunities and challenges for sustainable community-based responses.

Reflecting global trends, migrant farm workers in South Africa experience challenges in accessing healthcare. On the commercial farms in Musina, a sub-district bordering Zimbabwe, Medécins sans Frontières and the International Organization for Migration both implemented migration-aware community-based programmes that included the training of community-based healthcare workers, to address these challenges. Using qualitative data, this paper explores the experiences that migrant farm workers, specifically those involved in the programmes, had of these interventions. A total of 79 semi-structured interviews were completed with migrant farm workers, farm managers, NGO employees and civil servants between January 2017 and July 2018. These data were supplemented by a review of grey and published literature, as well as observation and field notes. Findings indicate that participants were primarily positive about the interventions. However, since the departure of both Medécins sans Frontières and the International Organization for Migration, community members have struggled to sustain the projects and the structural differences between the two programmes have created tensions. This paper highlights the ways in which local interventions that mobilise community members can improve the access that rural, migrant farming communities have to healthcare. However, it simultaneously points to the ways in which these interventions are unsustainable given the realities of non-state interventions and the fragmented state approach to community-based healthcare workers. The findings presented in this paper support global calls for the inclusion of migration and health in government policy making at all levels. However, findings also capture the limitations of community-based interventions that do not recognise community-based healthcare workers as social actors and fail to take into account their motivations, desires and need for continued supervision. As such, ensuring that the ways in which migration and health are included in policy making are sustainable emerges as a necessary element to be included in global calls.

Accelerated silicosis with bone marrow, hepatic and splenic involvement in a patient with lung transplantation.

Chronic silicosis is an entity widely described in literature. However, other types such as accelerated, acute, complicated and extrapulmonary silicosis are little documented. We present a case of accelerated extrapulmonary silicosis in a lung transplant patient in whom the diagnosis of systemic silicosis was made incidental to non-respiratory complications that occurred during follow-up. The appearance of cytopenia and liver failure led to diagnostic tests that documented the presence of silicotic granulomas in those locations. Taking into account the intensity, time of exposure, onset and development of the disease, we found a highly atypical case of accelerated extrapulmonary silicosis in which inorganic particles (presumably silica) were documented inside granulomas and macrophages of the bone marrow. With these findings, we reflect on the lack of consideration of these entities within clinical practice, their probable under diagnosis and the need to study other pathophysiological mechanisms of acquisition and dissemination of silicosis.

Together for Health: An Initiative to Access Health Services for the Hispanic/Mexican Population Living in the United States.

A disproportionately small percentage of the Hispanic/Mexican population in the United States has adequate access to health services, which decreases quality of life at both the individual and community levels. In addition, it increases risk for preventable diseases through insufficient screening and management. The Mexican Section of the U.S./Mexico Border Health Commission, in efforts to address barriers to accessing preventive health care services for vulnerable populations, launched the initiative Juntos por la Salud (JPLS) that offers health promotion and disease prevention services to Hispanics living in and around 11 U.S. metropolitan cities via mobile health units. This paper presents a descriptive analysis of the JPLS initiative and potential positive impact it has had in reducing barriers faced by the Hispanic population. JPLS screens and provides referrals to primary care services to establish a medical home and has the potential to reduce health care costs in a high-risk population through education and timely health screenings.