Immune responses associated with mpox viral clearance in men with and without HIV in Spain: a multisite, observational, prospective cohort study.

BACKGROUND: Since the emergence of the global mpox outbreak in May, 2022, more than 90 000 cases have been diagnosed across 110 countries, disproportionately affecting people with HIV. The durability of mpox-specific immunity is unclear and reinfections have been reported. We aimed to compare mpox immune responses up to 6 months after diagnosis in participants with and without HIV and assess their effect on disease severity and viral clearance dynamics. METHODS: This study was embedded within a prospective, observational, multicentre cohort study of viral clearance dynamics among people with mpox in Spain (MoViE). We included women and men aged 18 years or older, who had signs of mpox, and reported having symptom onset within the previous 10 days at the moment of mpox diagnosis from three sex clinics of the Barcelona metropolitan area. Samples from skin ulcers were collected weekly to estimate the time to clear monkeypox virus (MPXV) from skin lesions. Blood samples were taken at diagnosis, 29, 91, and 182 days later for immune analysis. This included quantifying IgG and IgA against three mpox antigens by ELISA, evaluating in-vitro neutralisation, and characterising mpox-specific T-cell responses using interferon γ detecting enzyme-linked immunospot (ELISpot) assay and multiparametric flow cytometry. FINDINGS: Of the 77 originally enrolled participants, we included 33 participants recruited between July 19, and Oct 6, 2022. Participants without HIV (19 [58%] participants) and participants with HIV (14 [42%] participants) had similar clinical severity and time to MPXV clearance in skin lesions. Participants with HIV had a CD4+ T-cell count median of 777 cells per µL (IQR 484-1533), and 11 (78%) of 14 were virally suppressed on antiretroviral therapy. Nine (27%) of 33 participants were age 49 years or older. 15 (45%) of 33 participants were originally from Spain, and all participants were men. Early humoral responses, particularly concentrations and breadth of IgG and IgA, were associated with milder disease and faster viral clearance. Orthopoxvirus-specific T cells count was also positively correlated with MPXV clearance. Antibody titres declined more rapidly in participants with HIV, but T-cell responses against MPXV were sustained up to day 182 after diagnosis, regardless of HIV status. INTERPRETATION: Higher breadth and magnitude of B-cell and T-cell responses are important in facilitating local viral clearance, limiting mpox dissemination, and reducing disease severity in individuals with preserved immune system. Antibodies appear to contribute to early viral control and T-cell responses are sustained over time, which might contribute to milder presentations during reinfection. FUNDING: Fundació Lluita contra les Infeccions, IrsiCaixa, and Consorcio Centro de Investigación Biomédica en Red, Instituto de Salud Carlos III, Ministerio de Ciencia, Innovación e Universidades.

Oral linezolid compared with benzathine penicillin G for treatment of early syphilis in adults (Trep-AB Study) in Spain: a prospective, open-label, non-inferiority, randomised controlled trial.

BACKGROUND: Management of syphilis, a sexually transmitted infection (STI) with increasing incidence, is challenged by drug shortages, scarcity of randomised trial data, an absence of non-penicillin alternatives for pregnant women with penicillin allergy (other than desensitisation), extended parenteral administration for neurosyphilis and congenital syphilis, and macrolide resistance. Linezolid was shown to be active against Treponema pallidum, the causative agent of syphilis, in vitro and in the rabbit model. We aimed to assess the efficacy of linezolid for treating early syphilis in adults compared with the standard of care benzathine penicillin G (BPG). METHODS: We did a multicentre, open-label, non-inferiority, randomised controlled trial to assess the efficacy of linezolid for treating early syphilis compared with BPG. We recruited participants with serological or molecular confirmation of syphilis (either primary, secondary, or early latent) at one STI unit in a public hospital and two STI community clinics in Catalonia (Spain). Participants were randomly allocated in a 1:1 ratio using a computer-generated block randomisation list with six participants per block, to receive either oral linezolid (600 mg once per day for 5 days) or intramuscular BPG (single dose of 2·4 million international units) and were assessed for signs and symptoms (once per week until week 6 and at week 12, week 24, and week 48) and reagin titres of non-treponemal antibodies (week 12, week 24, and week 48). The primary endpoint was treatment response, assessed using a composite endpoint that included clinical response, serological response, and absence of relapse. Clinical response was assessed at 2 weeks for primary syphilis and at 6 weeks for secondary syphilis following treatment initiation. Serological cure was defined as a four-fold decline in rapid plasma reagin titre or seroreversion at any of the 12-week, 24-week, or 48-week timepoints. The absence of relapse was defined as the presence of different molecular sequence types of T pallidum in recurrent syphilis. Non-inferiority was shown if the lower limit of the two-sided 95% CI for the difference in rates of treatment response was higher than -10%. The primary analysis was done in the per-protocol population. The trial is registered at ClinicalTrials.gov (NCT05069974) and was stopped for futility after interim analysis. FINDINGS: Between Oct 20, 2021, and Sept 15, 2022, 62 patients were assessed for eligibility, and 59 were randomly assigned to linezolid (n=29) or BPG (n=30). In the per-protocol population, after 48 weeks' follow-up, 19 (70%) of 27 participants (95% CI 49·8 to 86·2) in the linezolid group had responded to treatment and 28 (100%) of 28 participants (87·7 to 100·0) in the BPG group (treatment difference -29·6, 95% CI -50·5 to -8·8), which did not meet the non-inferiority criterion. The number of drug-related adverse events (all mild or moderate) was similar in both treatment groups (five [17%] of 29, 95% CI 5·8 to 35·8 in the linezolid group vs five [17%] of 30, 5·6 to 34·7, in the BPG group). No serious adverse events were reported during follow-up. INTERPRETATION: The efficacy of linezolid at a daily dose of 600 mg for 5 days did not meet the non-inferiority criteria compared with BPG and, as a result, this treatment regimen should not be used to treat patients with early syphilis. FUNDING: European Research Council and Fondo de Investigaciones Sanitarias.

Riesgos laborales en trabajadores de barberías y peluquerías de economía informal: Caracas, Venezuela / Occupational hazards in barbershops and hairdressers workers of informal economy: Caracas, Venezuela

En Venezuela el sector informal de barberías y peluquerías constituye una fuente de absorción de mano de obra desocupada, que tiene algunas ventajas respecto a ingresos y flexibilización laboral, pero por otro lado es un sector desprotegido y con accesos limitados o nulos a servicios de seguridad y salud laboral, lo que dificulta la inclusión en programas de prevención de accidentes de trabajo y enfermedades ocupacionales. En este estudio observacional transversal y descriptivo se aplicó "la encuesta de las condiciones de trabajo y salud en América Latina del Center for International Health" y se analizaron las actividades de 40 trabajadores de barberías y peluquerías: 50% del género masculino y 50% femenino, 85% con edades comprendidas entre 20-49 años. De ellos, 65% manipulaban productos químicos, 62,5% utilizaban el secador y/o máquina de afeitar, 87,5% habían sufrido al menos una lesión en su área de trabajo y 100% refirió adoptar bipedestación prolongada, hacer movimientos repetitivos y presentar algún tipo de trastorno músculo-esquelético, cuyos síntomas más frecuentes fueron dorsalgias y lumbalgias con 37,5% y 32,5% respectivamente. Por otro lado, las várices en miembros inferiores fueron la segunda causa de morbilidad reportada.

Some of the barbershops and hair saloons -belonging to the informal sector- are a source of employment which takes in unoccupied work force. This workers have some advantages concerning to income and work flexibility, but in the other hand it is an unprotected sector with limited or nonexistent access to Occupational, Safety and Health services. This situation makes difficult to include them in labor accident occupational disease prevention programs. A cross-sectional and descriptive study was carried out in which 40 barbershop and hair saloon workers were surveyed. Their activities were analyzed, employing the "survey of work and health conditions in Latin America of the Center for International Health". Of these workers, 50% were male and 50% female, and 85% were between 20 to 49 years old. 65% used chemical products, 62,5% used hair dryers and/or shaving machines, 87,5% had suffered some form of workplace injury, and all of them admitted to have adopted prolonged standing postures, to make repetitive movements, suffering at least from any musculoskeletal disorder. The second disease reported were varicose veins.

Tumores carcinoides del yeyunoileon / Carcinoid tumors of the jejunoileum

Se presenta una serie de 12 tumores carcinoides del intestino delgado. Tres fueron hallazgos de necropsia. Ocho fueron operados de urgencia y 1 fue un hallazgo casual. En ninguno se realizó el diagnóstico correcto en el preoperatorio. La causa más frecuente de cirugía fue la obstrucción intestinal, casi siempre debida a la fibrosis peritumoral. De 4 enfermos seguidos en el postoperatorio 2 fallecieron a los 6 y 10 años respectivamente por recidiva de la enfermedad. Se describen detalles técnicos a tener en cuenta durante la cirugía de los pequenos carcinoides