Oriana Ramirez-Rubio

• MD, MPH, PhD
• Instituto de Salud Global de Barcelona

Mesoamerican nephropathy (MeN) is a progressive kidney disease found on the Pacific coast of Central America primarily in young male agricultural workers without typical kidney disease risk factors. While it is generally accepted that environmental exposures contribute to MeN, we hypothesized that there was also an important genetic component. We p...

Introduction Mesoamerican nephropathy (MeN) is a chronic kidney disease (CKD) which may be caused by recurrent acute kidney injury (AKI). We investigated urinary quinolinate-to-tryptophan ratio (Q/T), a validated marker of nicotinamide adenine dinucleotide (NAD+) biosynthesis that is elevated during ischemic and inflammatory AKI, in a sugarcane wor...

Background: Chronic kidney disease of a nontraditional etiology (CKDnt) is responsible for high mortality in Central America, although its causes remain unclear. Evidence of kidney dysfunction has been observed among youth, suggesting that early kidney damage contributing to CKDnt may initiate in childhood. Methods: Urine specimens of Nicaraguan...

Background: Heat stress is associated with adverse health outcomes among workers, including acute kidney injury. We aimed to estimate the incidence of acute kidney injury over the course of the work shift and the association with heat stress among agricultural workers in Spain, where summer temperatures are high and heatwaves are expected to be fr...

BACKGROUND: Heat stress is associated with adverse health outcomes among workers, including acute kidney injury. We aimed to estimate the incidence of acute kidney injury over the course of the work shift and the association with heat stress among agricultural workers in Spain, where summer temperatures are high and heatwaves are expected to be fre...

An ongoing epidemic of chronic kidney disease of uncertain etiology (CKDu) afflicts large parts of Central America and is hypothesized to be linked to heat stress at work. Mortality rates from CKDu appear to have increased dramatically since the 1970s. To explore this relationship, we assessed trends in maximum and minimum temperatures during harve...

Objectives: Nicaraguan sugarcane workers, particularly cane cutters, have an elevated prevalence of chronic kidney disease of unknown origin, also referred to as Mesoamerican nephropathy (MeN). The pathogenesis of MeN may include recurrent heat stress, crystalluria, and muscle injury with subsequent kidney injury. Yet, studies examining the freque...

While Digital contact tracing (DCT) has been argued to be a valuable complement to manual tracing in the containment of COVID-19, no empirical evidence of its effectiveness is available to date. Here, we report the results of a 4-week population-based controlled experiment that took place in La Gomera (Canary Islands, Spain) between June and July 2...

La Agenda 2030 cuenta con un Objetivo de Desarrollo Sostenible (ODS) específico relacionado con la salud y el bienestar, el ODS3, que aspira a garantizar una vida sana y a promover el bienestar para todas las personas. El enfoque de salud en todas las políticas propuesto por la Organización Mundial de la Salud (OMS), insta a considerar las repercus...

Background An epidemic of CKD in Central America predominantly affects males working in certain industries, including sugarcane. Urinary tract infections are commonly diagnosed among men in Nicaragua, who often receive antibiotics and nonsteroidal anti-inflammatory drugs for urinary symptoms. Methods We followed 251 male Nicaraguan sugarcane worke...

Metals are suspected contributors of autoimmune disease among indigenous Americans. However, the association between metals exposure and biomarkers of autoimmunity is under-studied. In Nicaragua, environmental exposure to metals is also largely unexamined with regard to autoimmunity. We analyzed pooled and stratified exposure and outcome data from...

Background Mesoamerican Nephropathy (MeN), a form of chronic kidney disease of uncertain etiology, is a leading cause of death in Central America. The disease often presents in young adult male agricultural workers and progresses rapidly. Given the young age at presentation, we hypothesized that children in Central America experience subclinical ki...

Background: Cities are an important driving force to implement the Sustainable Development Goals (SDGs) and the New Urban Agenda. The SDGs provide an operational framework to consider urbanization globally, while providing local mechanisms for action and careful attention to closing the gaps in the distribution of health gains. While health and we...

Background: Spain needs to increase the number of new known cases in order to achieve the goal of eliminating hepatitis C virus (HCV) by 2030. The aim of this study was to estimate the number of HCV cases among the migrant population in Spain and propose different scenarios for micro-elimination strategies, targeting the most relevant migrant grou...

A chronic kidney disease of unknown etiology (CKDu) has been killing workers in Central America. Occupational heat stress is thought to play an important role. Leptospirosis and hantavirus have been suggested as additional possible risk factors. In a case-control study in a Nicaraguan mining community, a structured survey was administered to adults...

Rationale & objective: Mesoamerican nephropathy (MeN), a form of chronic kidney disease (CKD) of unknown cause in Central America, affects young individuals working in physically strenuous occupations. Repeated episodes of work-related kidney injury may lead to CKD in this setting. We aimed to better understand the burden and natural history of ac...

Background: Leptospirosis is postulated as a possible cause of Mesoamerican Nephropathy (MeN) in Central American workers. Objectives: Investigate job-specific Leptospira seroprevalence and its association with kidney disease biomarkers. Methods: In 282 sugarcane workers, 47 sugarcane applicants and 160 workers in other industries, we measured anti...

Background: Mesoamerican nephropathy (MeN) is a kidney disease of unknown cause that mainly affects working-age men in Central America. Despite being a major cause of morbidity and mortality in this region, its clinical characteristics have not been well defined. Study design: Cross-sectional family-based study. Setting & participants: 266 mem...

Background: In Central America, an epidemic of chronic kidney disease of unknown cause disproportionately affects young male agricultural workers. Study design: Longitudinal cohort study. Setting & participants: 284 sugarcane workers in 7 jobs were recruited from one company in northwestern Nicaragua. Blood and urine samples were collected bef...

An epidemic of chronic kidney disease (CKD) of non-traditional aetiology has been recently recognized by health authorities as a public health priority in Central America. Previous studies have identified strenuous manual work, agricultural activities and residence at low altitude as potential risk factors; however, the aetiology remains unknown. B...

To analyse knowledge, attitudes and sexual practices on HIV/AIDS, and estimate HIV prevalence among residents of Sucre (Bolivia). Population-based survey of residents aged 15-49 randomly selected during 2008/2009. Blood samples were collected on Whatman-filter paper and tested with enzyme-linked immunosorbent assay. Knowledge on HIV/AIDS, sexual ri...

Background: There is an epidemic of chronic kidney disease (CKD) of unknown etiology in Central American workers. Objectives: To investigate changes and job-specific differences in kidney function over a 6-month sugarcane harvest season, explore the potential role of hydration, and measure proteinuria. Methods: We recruited 284 Nicaraguan suga...

Background: In the context of an European Centre for Disease Prevention and Control (ECDC) research project, our objective was to describe current recommendations regarding HIV testing and counselling targeting migrants and ethnic minorities in the European Union/European Economic Area/European Free Trade Association (EU/EEA/EFTA) Member States....

Background Northwestern Nicaragua has a high prevalence of chronic kidney disease (CKD) of unknown cause among young adult men. In addition, frequent occurrence of urinary tract infections (UTI) among men and a dysuria syndrome described by sugarcane workers as “chistata” are both reported. This study examines health professionals´ perceptions rega...

This article describes the involvement of women from rural Costa Rica, where tourism is predominant, in the creation of HIV/AIDS awareness materials that are appropriate for families and peers. The project was conducted in four towns in the Monteverde Zone, a region that has experienced a transition from an economy based on agriculture and dairy fa...

Background: The barriers to HIV testing and counselling that migrants encounter can jeopardize proactive HIV testing that relies on the fact that HIV testing must be linked to care. We analyse available evidence on HIV testing and counselling strategies targeting migrants and ethnic minorities in high-income countries. Methods: Systematic litera...

Paracoccidioidomycosis is the most important systemic mycosis in South America. In Europe the disease is very rare and only found in returning travelers. Here we report on a 56-year-old Spanish missionary with respiratory symptoms but no other affected systems. Diagnosis was made based on serology and PCR for Paracoccidioides brasiliensis.

Bundles are groups of interventions to reduce nosocomial infection rates. We evaluated the current status of ventilatorassociated pneumonia bundle compliance in our hospital to propose an improvement plan on the basis of the results. Bundle includes: raising the head of the bed (30°, daily assessment of sedation requirements, peptic ulcer disease a...

IntroductionBundles are groups of interventions to reduce nosocomial infection rates. We evaluated the current status of ventilatorassociated pneumonia bundle compliance in our hospital to propose an improvement plan on the basis of the results.