Pre-exposure prophylaxis program in the Community of Madrid: Two years of experience.

INTRODUCTION: Pre-exposure prophylaxis (PrEP) against the human immunodeficiency virus (HIV) is an effective and safe preventive measure. However, it has not reached all target users who could benefit from it. The study aimed to understand the sociodemographic, clinical and behavioral baseline characteristics of PrEP users. As a secondary objective, the use of concomitant medication and drug consumption were described. METHODOLOGY: Observational, retrospective and descriptive study of the sociodemographic, clinical and behavioral characteristics of the users who were included in the PrEP program of the Community of Madrid during the first two years of experience. RESULTS: Two thousand two hundred fifty-six PrEP users were included, 99.0% men, with a mean age of 36.9 years (SD 8.68). 33.1% presented a sexually transmitted infection (STI) on the first visit, highlighting chlamydiasis and rectal gonococci. 70.4% reported using drugs associated with sex, and 42.4% participated in chemsex sessions in the last 3 months. A high percentage of users with concomitant medication was observed (37.6%), highlighting drugs related to mental health and alopecia. CONCLUSIONS: A multidisciplinary approach is required to cover all the needs of PrEP users, including mental health evaluation measures and addiction treatment with the clinical approach.

Incidence of sexually transmitted infections and screening models among pre-exposure prophylaxis users.

INTRODUCTION: There is discussion about the frequency of STI screening among pre-exposure prophylaxis (PrEP) users. The aim of this study was to analyse the incidence of STIs and to evaluate different screening models in order to optimise the follow-up. METHODOLOGY: A prospective study was conducted between 2017 and 2023, including 138 PrEP users in a STI clinic. Participants were tested for STIs every three months. Unscheduled visits were performed for those with STI-related symptoms or for people who were notified for an STI by a sexual partner. We performed a survival analysis of repeated events, estimating the cumulative incidence (CI) and incidence rate (IR). RESULTS: The overall CI by quarterly screening was 8.3 (95% CI: 7.6-9.1) infections per person over six years, with a decreasing trend. The most frequently diagnosed pathogen was Neisseria gonorrhoeae, with a IR of 0.76 (95% CI: 0.68-0.84). If the frequency of screening is reduced to every six months, the IR of STIs is reduced by (95% CI: 0.5-0.66) infections per user per year, and at 12 months by 0.82 (95% CI: 0.73-0.89). In the case of no pharyngeal or urethral screening, IR is reduced by 0.37 (95% CI: 0.32-0.42) infections per person per year and in those over 35 years of age by 0.33 (95% CI: 0.25-0.4). Eliminating unscheduled visits, the reduction in IR is 0.33 (95% CI: 0.24-0.42). CONCLUSIONS: The incidence of STIs among PrEP users is high, especially in the rectum, but it does not increase over time. STI screening could be optimised reducing the frequency of pharyngeal and urethral testing, particularly in those over 35 years of age. It is essential to redistribute health resources for unscheduled visits, which have been shown to be the most cost-effective screening.

Monkeypox outbreak in Madrid (Spain): Clinical and virological aspects.

BACKGROUND: Monkeypox is the most prevalent Orthopoxvirus zoonosis infection since the eradication of smallpox. The current multi-country outbreak involves five WHO regions affecting mainly Europe. Accurate clinical and virological aspects of the disease outside endemic areas are needed. METHODS: We performed an observational study of cases diagnosed in Madrid (Spain) (May/June 2022). Confirmation from vesicular lesions swabs, Orthopoxvirus real-time PCR, sequencing, phylogenetic analysis, and direct detection by Electron microscopy was performed. In addition, a structured epidemiological questionnaire was completed systematically to gather sociodemographic, clinical, and behavioral data from all confirmed cases. FINDINGS: We extracted data from 48 patients, all cisgender men. The median age was 35 years (IQR 29 - 44), and 87.5% were MSM. The most prevalent symptoms were the presence of vesicular-umbilicated and pseudo-pustular skin lesions (93.8%), asthenia (66.6%), and fever (52.1%). In addition, the location of the lesions in the genital or perianal area was related to the role in sexual intercourse (p<0.001). Sequencing analysis indicated the virus circulating in Spain belongs to the western African clade. Like the other European cases in the outbreak, the Spanish isolates are a direct descendant of viruses previously detected in Nigeria, the UK, Singapore, and Israel in 2017-2018. CONCLUSIONS: Monkeypox is an emerging infectious disease in Europe where community transmission is reported, mainly in MSM. The first symptom was skin lesions instead of classical fever and rash. The disease follows a self-limited course, and there have been no cases with a serious presentation or severe complications.

Breast abscess along with pulmonary mass found in an immunocompetent patient / Absceso de mama concomitante con masa pulmonar en paciente inmunocompetente

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Nódulos cutáneos. Un souvenir vacacional / Cutaneous nodules. A holiday souvenir

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Epidemiological studies on equine cestodes in central Spain: infection pattern and population dynamics.

An epidemiological study on equine cestodosis was carried out in central Spain. A total of 372 digestive tracts from equids slaughtered in abattoirs located in central Spain were studied from November 2001 to May 2004. Anoplocephala perfoliata was detected in 24% of the animals and Anoplocephala magna in 18%. Individual tapeworm burden was from 1 to 491 tapeworms for A. perfoliata and from 1 to 64 tapeworms for A. magna. Low tapeworm burdens (less than 30 cestodes) predominated significantly (p<0.01) in all seasons for both species. Seasonal prevalence of infection by A. perfoliata was significantly higher (p<0.01) in autumn (37.5%) and winter (32.3%) than in spring (9.2%) and summer (10.8%). Immature tapeworms were detected throughout summer (11%), autumn (23.4%) and winter (26.6%), signalling a summer to winter risk period for tapeworm infection in our conditions. Mature non-gravid tapeworms were collected in all seasons, with a decreasing pattern from summer (89%) to spring (6.7%). Conversely, gravid tapeworms showed an increasing pattern, from 0 in summer to a maximum (93.3%) in spring. Since prevalence of infection was significantly higher in winter than in spring, winter seems to be the season when more eggs would be available to be eaten by mites. A. perfoliata infection was detected in three different periods throughout the 3 year study: autumn 2001-winter 2002, summer 2002-spring 2003 and autumn 2003-spring 2004. This epidemiological pattern seems to describe the dependence of A. perfoliata to humidity in warm dry climate. In our conditions, A. perfoliata appears to follow a pattern of having only one generation per year, with a marked dependence on humidity. According to the results, autumn rainfall would influence the length, and late spring rainfall the appearance, of each annual generation. A. magna showed a different pattern. Infection was detected throughout the whole study period. Seasonal prevalence was higher in autumn (25.5%) than in winter (14.9%), spring (12.1%) and summer (10.5%), but the differences were not statistically significant. Non-gravid A. magna tapeworms could be detected almost throughout the year but percentages were significantly higher (p<0.01) in autumn (50.2%), indicating recent ingestion, than in the other seasons (30% in summer, 12.8% in winter and 0% in spring). However, data from spring were not enough to discard the season as a risk period for A. magna infection.

Experiencia de 1000 amnioinfusiones trascervicales en casos de ruptura prematura de membranas (RPM): utilidad, dificultades y relación con la reducción de cesáreas / Experience of one thousand transcervical amnioinfusion in cases of premature rupture of membranes PRM: Utility, difficulties and relationship with c-section reduction

OBJETIVO: Analizar los resultados de un estudio prospectivo y descriptivo de 1000 amnioinfusiones transcervicales, realizadas de 1993 a 1998, en el Hospital Civil de Belén de Guadalajara; así como describir sus indicaciones, dificultades técnicas, beneficios y complicaciones. MATERIAL Y MÉTODOS: Se seleccionaron del servicio de Obstetricia, 1000 pacientes con embarazo de término con ruptura prematura de membranas (RPM), con ocho horas o más de evolución y trabajo de parto irregular, para practicarles amnioinfusión transcervical.RESULTADOS: Tipos de amnioinfusiones : profilácticas (prevenir compresión de cordón umbilical) en 40.6 por ciento (n=406) y terapéuticas (remover líquido amniótico infectado y/o meconial del interior de la cavidad uterina) en 59 por ciento (n=590); fallidas 0.4 por ciento (n=4). De 124 con compresión de cordón; el 79 por ciento (n=98) mejoraron. 392 se efectuaron para sustituir líquido amniótico meconial por solución fisiológica y 71 para lavar la cavidad uterina por corioamnioítis. El 99.2 por ciento de las pacientes (n=992) regularizó la actividad uterina, de 5 a 20 minutos post-amnioinfusión. 93.1 por ciento de pacientes (n=931) parieron de 2 a 6 horas post-amnioinfusión. Se efectuaron 67 cesáreas (6.7 por ciento). Murieron dos productos transparto; por corioamnioítis severa. CONCLUSIONES: Se considera que la amnioinfusión es una alternativa terapéutica útil, fácil de aprender, sencilla, accesible, económica y disponible en cualquier hospital.

Intento de parto vaginal en 1000 pacientes con antecedente de una cesárea previa en el antiguo Hospital Civil de Guadalajara / Trying vaginal delivery in 1000 patients with one previous cesarean section at Antiguo Hospital Civil de Guadalajara

Debido a que una gran parte de las cesáreas que se realizan son por el antecedente de una cesárea previa y por el creciente número de cesáreas que se practican, realizamos esta investigación descriptiva y prospectiva para analizar factibilidad y seguridad del intento de parto vaginal después de una cesárea previa. Incluimos en nuestro estudio 1000 pacientes con antecedente de una cesárea previa, embarazo de término con evolución normal del mismo y pelvis apta; el manejo de trabajo de parto y parto fue expectante o bien utilizamos oxitocina, prostanglandinas, uteroinhibición y/o amnioinfusión según estuviera indicado. 679 pacientes tuvieron parto por vía vaginal, hubo: una rotura uterina (ésta no fue de la histerotomía previa), dos dehicencias de la histerectomía previa (sólo una requirió laparatomía la otra, observación), dos muertes fetales transparto (uno por hipercontractilidad uterina que no respondió a la uteroinhibición y otra por la rotura uterina). La factibilidad y seguridad del parto vaginal en pacientes con cesárea previa es otra alternativa estratégica razonable de reducir el número de cesáreas. Todo médico que intente un parto vaginal en pacientes con cesárea previa deberá tener en mente que ante cualquier duda de cesárea de repetición es obligada y que siempre en quirófano equipado deberá esta disponible