Monkeypox outbreak in Spain: clinical and epidemiological findings in a prospective cross-sectional study of 185 cases.

BACKGROUND: Since May 2022, a new outbreak of monkeypox has been reported in several countries, including Spain. The clinical and epidemiological characteristics of the cases in this outbreak may differ from those in earlier reports. OBJECTIVES: To document the clinical and epidemiological characteristics of cases of monkeypox in the current outbreak. METHODS: We conducted a prospective cross-sectional study in multiple medical facilities in Spain to describe the cases of monkeypox in the 2022 outbreak. RESULTS: In total, 185 patients were included. Most cases started with primarily localized homogeneous papules, not pustules, in the probable area of inoculation, which could be cutaneous or mucous, including single lesions. Generalized small pustules appeared later in some of them. Heterogeneous lesions occurred during this generalized phase. All patients had systemic symptoms. Less common lesions included mucosal ulcers (including pharyngeal ulcers and proctitis) and monkeypox whitlows. Four patients were hospitalized, none died. Smallpox vaccination and well-controlled HIV disease were not associated with markers of severity. Contact during sex is the most likely mechanism of transmission. In this outbreak, cases have been described in men who have sex with men and are strongly associated with high-risk sexual behaviours. Seventy-six per cent of the patients had other sexually transmitted diseases upon screening. CONCLUSIONS: The clinical findings in this outbreak differ from previous findings and highly suggest contact transmission and initiation at the entry site. The characterization of the epidemiology of this outbreak has implications for control. What is already known about this topic? Monkeypox eruption is described as consisting of pustules. The roles of HIV and previous smallpox vaccination in the prognosis are unknown. The transmission route was initially described as respiratory droplets and was later suggested to be via sexual contact. What does this study add? Initial lesions at the probable inoculation area were homogeneous and papular (pseudopustules). Generalized small pustules appeared later in some of them. Heterogeneous lesions occurred during this generalized phase. All patients had systemic symptoms. Less common signs included mucosal ulcers (including pharyngeal ulcers and proctitis) and monkeypox whitlows. Well-controlled HIV and previous smallpox vaccination were not associated with severity. No patient died. The data support the hypothesis of transmission via contact during sex. Although this might change, the outbreak is currently limited mostly to men who have sex with men, with high-risk factors for sexually transmitted diseases.

Metastatic Basal Cell Carcinoma: Case Report and Review of the Literature.

Basal cell carcinoma (BCC) is the most commonly occurring carcinoma among humans. However, despite their overall frequency, cases of BCC featuring metastases are extremely rare. We present the case of a male patient with BCC located in the chest, measuring 10 cm and with an evolution of 15 years. After several years, an axillary recurrence developed as a tumor mass affecting the lymph nodes. After 14 months, a further lymph node recurrence was observed and resected. Six months later, a pulmonary nodule was detected, which was resected with tumor-free margins. Histopathological report revealed infiltration by BCC. After 13 years of follow-up (after the removal of the primary tumor), the patient remained alive and received close clinicoradiological monitoring. Taking advantage of this opportunity, we also provide a brief review of the corresponding literature.

Abnormal anal cytology in women: Risk factors and association with sexually transmitted infection / Atipia anal citológica en mujeres: factores de riesgo y asociación con infecciones de transmisión sexual

Objective: High-grade anal intraepithelial neoplasia is considered a precursor of anal cancer. It is necessary to identify risk factors for AIN in women who could benefit from screening. Material and methods: For this retrospective study, we recruited women who underwent anal cytology screening over a 6-year period. We analyzed data on sexual habits, substance use, and the association with sexually transmitted infections, human papillomavirus infection, and HIV infection. We also analyzed HPV-related anogenital neoplasms. The groups were compared according to the cytology results. Results: Dysplasia was detected in 56 of 105 women and was confirmed as high-grade in 33.9%. The variables associated with abnormal anal cytology findings were higher educational level (p=0.031), ≥2 HPV-associated cancers (p=0.031), and a history of genital herpes (p=0.001) were associated with abnormal anal cytology. Neither anal sex nor high-risk anal HPV was associated with anal dysplasia. Abnormal cytology was more common in HIV-positive women. Conclusions: Anal screening is necessary because anal atypia is common in women. Genital herpes was associated with atypia, which could be explained by the synergistic effect of both infections simultaneously. Although high-risk HPV and HIV infection are risk factors for anal dysplasia, prospective studies are needed to design new screening algorithms

Objetivo: las neoplasias intraepiteliales de ano de alto grado son precursores de cáncer de ano .Son necesarios estudios que estimen factores de riesgo de NIA en mujeres que se beneficiarían del cribado. Material y métodos: estudio de cohortes retrospectivas de mujeres a las que se les tomó una citología anal en un periodo de 6 años. Analizamos hábitos sexuales, tóxicos, asociación con ITS, virus de papiloma y VIH, neoplasias en relación con VPH y comparamos las dos poblaciones de acuerdo al resultado de la prueba. Resultados: cincuenta y seis mujeres de 105 presentaron algún grado de atipia. En el 33,9% de ellas fue informada de alto grado. El nivel de estudios superior (p=0,031), dos o más patologías oncogénicas por VPH (p=0,031) y el herpes genital (p=0,001) se relacionaron con la atipia anal. Ni el sexo anal ni el VPH de alto riesgo se relacionaron con la positividad de la prueba. En las mujeres VIH positivas la atipia anal fue más frecuente. Conclusiones: la atipia anal es frecuente en las mujeres por lo que el despistaje citológico estaría justificado. El herpes genital se asoció con la atipia, lo que se explicaría por el efecto sinérgico de los dos virus. Aunque la patología genital por VPH de alto riesgo y el VIH en mujeres son factores de riego de NIA, son necesarios estudios en los que apoyen nuevos protocolos de despistaje

Hyperbaric oxygen therapy: An alternative treatment for radiation-induced cutaneous ulcers.

Radiotherapy is a widely recognised treatment for non-melanoma skin cancer. We report three cases of radiation-induced skin ulcers in which hyperbaric oxygen therapy was administered in 90-min sessions, 5 days a week at 2.4 absolute atmospheres in a multiplace hyperbaric chamber. Hyperbaric oxygen therapy is an outpatient treatment that does not displace other classical treatments and may be used as an adjunct therapy.

Refractory acne keloidalis nuchae treated with radiotherapy.

Acne keloidalis nuchae (AKN) is difficult to treat, and the clinical response is usually poor. Few reports have been published about scarring alopecia treated with radiotherapy (RT). We report a case of AKN that had been refractory to various other treatments but which responded to RT with excellent clinical and cosmetic results.

Efectividad del genotipado del virus del papiloma humano frente a la citología anal en la identificación de neoplasia intraepitelial de alto grado / Effectiveness of human papillomavirus genotyping for detection of high-grade anal intraepithelial neoplasia compared to anal cytology

INTRODUCCIÓN: La neoplasia intraepitelial anal de alto grado (NIAAG) está en aumento en determinados grupos de riesgo y en su etiopatogenia están implicados algunos genotipos del virus del papiloma humano (VPH). El cribado de la NIAAG contempla el uso sistemático de la citología anal y más recientemente el genotipado de VPH. Nuestro objetivo fue determinar la sensibilidad y especificidad de ambas herramientas diagnósticas en la identificación de NIAAG. MATERIAL Y MÉTODO: Estudio de correlación entre los hallazgos citológicos y microbiológicos con respecto a la biopsia anal de una cohorte de pacientes con conductas de riesgo de desarrollar neoplasia intraepitelial anal atendidos en la consulta de infecciones de transmisión sexual del área de Dermatología del Hospital Costa del Sol desde enero de 2008 a diciembre de 2014. RESULTADOS: De los 151 pacientes sometidos al cribado, se seleccionaron aquellos pacientes con las tres pruebas de cribado realizadas (citología anal, genotipado y biopsia guiada por anoscopia), 92 en total, de los que el 62% presentaban infección por VIH. La sensibilidad y especificidad para identificar NIAAG fue 52,8 y 85,7% para la citología anal (k: 0,328), y 78 y 62,8% de la presencia de dos o más genotipos oncogénicos VPH (k: 0,417). La detección de VPH oncogénicos permitió clasificar correctamente 23 casos de NIAAG confirmados por biopsia guiada por anoscopia e infradiagnosticados con la citología anal, 14 de ellos con al menos 3 genotipos de riesgo. CONCLUSIÓN: La citología anal ha mostrado una sensibilidad insuficiente para la detección de NIAAG. El genotipado del VPH, aunque como única herramienta de cribado daría lugar a un sobrediagnóstico, es una herramienta que puede complementar el procedimiento de cribado, especialmente con el objetivo de identificar los casos de NIAAG

INTRODUCTION: The incidence of high-grade anal intraepithelial neoplasia (HGAIN) -with an aetiological based on high-risk types of human papillomavirus- is increasing in some high-risk groups. Screening for HGAIN includes routine anal cytology and, more recently, HPV genotyping. The main objective of this study was to determine the sensitivity and specificity of anal cytology and HPV genotyping for the detection of HGAIN. MATERIALS AND METHODS: This is a study to determine the correlation of cytological and microbiological findings with anal biopsy findings in a cohort of patients at high risk of developing AIN referred to the department of sexually transmitted infections of the Hospital Costa del Sol, Spain, between January 2008 and December 2014. RESULTS: Of the 151 patients subjected to screening, a total of 92 patients, all of them with the result of three screening test (anal cytology, genotyping and biopsy) were included in the study. Just under two-thirds (62%) of them were HIV-positive. The sensitivity and specificity of anal cytology to detect HGAIN were 52.8 and 85.7%, respectively (k: 0.328), and 78 and 62.8% to detect two or more HPV oncogenic genotypes (k: 0.417). The detection of oncogenic HPV genotypes allowed the identification of 23 new cases of HGAIN that had been underdiagnosed with anal cytology, with 14 cases containing at least three high-risk genotypes. CONCLUSION: Anal cytology did not show enough sensitivity in HGAIN screening. HPV genotyping has shown to be a useful tool to detect HGAIN cases, although it could lead to an over-diagnosis as a solitary screening procedure

[Effectiveness of human papillomavirus genotyping for detection of high-grade anal intraepithelial neoplasia compared to anal cytology]. / Efectividad del genotipado del virus del papiloma humano frente a la citología anal en la identificación de neoplasia intraepitelial de alto grado.

INTRODUCTION: The incidence of high-grade anal intraepithelial neoplasia (HGAIN) -with an aetiological based on high-risk types of human papillomavirus- is increasing in some high-risk groups. Screening for HGAIN includes routine anal cytology and, more recently, HPV genotyping. The main objective of this study was to determine the sensitivity and specificity of anal cytology and HPV genotyping for the detection of HGAIN. MATERIALS AND METHODS: This is a study to determine the correlation of cytological and microbiological findings with anal biopsy findings in a cohort of patients at high risk of developing AIN referred to the department of sexually transmitted infections of the Hospital Costa del Sol, Spain, between January 2008 and December 2014. RESULTS: Of the 151 patients subjected to screening, a total of 92 patients, all of them with the result of three screening test (anal cytology, genotyping and biopsy) were included in the study. Just under two-thirds (62%) of them were HIV-positive. The sensitivity and specificity of anal cytology to detect HGAIN were 52.8 and 85.7%, respectively (k: 0.328), and 78 and 62.8% to detect two or more HPV oncogenic genotypes (k: 0.417). The detection of oncogenic HPV genotypes allowed the identification of 23 new cases of HGAIN that had been underdiagnosed with anal cytology, with 14 cases containing at least three high-risk genotypes. CONCLUSION: Anal cytology did not show enough sensitivity in HGAIN screening. HPV genotyping has shown to be a useful tool to detect HGAIN cases, although it could lead to an over-diagnosis as a solitary screening procedure.

Tratamiento de la neoplasia vulvar intraepitelial con cidofovir tópico: presentación de un caso y revisión de la literatura / Treatment of vulvar intraepithelial neoplasia with topical cidofovir: a case report and literature review

La neoplasia vulvar intraepitelial (VIN) es una precursora del carcinoma vulvar invasivo. Aunque la cirugía es el tratamiento estándar, se están investigando nuevas terapias médicas con el fi n de mantener la anatomía y función sexual de la vulva. Nuestro objetivo es describir la utilidad del cidofovir tópico en la VIN. Presentamos una paciente con una VIN resistente a terapia fotodinámica e imiquimod tópico, que fue tratada con cidofovir tópico con respuesta completa a nivel vulvar y respuesta parcial a nivel perineal y perianal. El cidofovir puede ser una opción terapéutica en el manejo de la VIN. Se necesitan más ensayos futuros para investigar la eficacia y la posología más recomendada (AU)

Vulvar intraepithelial neoplasia (VIN) is a precursor of invasive vulvar carcinoma. Although the standard treatment is surgery, new medical therapies are under investigation to maintain the sexual anatomy and function of the vulva. Our objective was to describe the usefulness of topical cidofovir in VIN. We report a case of VIN resistant to photodynamic therapy and topical imiquimod, which was treated with topical cidofovir with complete response in the vulvar area and partial response in the perineal and perianal area. Cidofovir may be a therapeutic option in the management of VIN. Future trials are needed to investigate its efficacy and recommended dosage (AU)

Screening of anal intraepithelial neoplasia in risk groups: Descriptive study of sexual habits and other sexual transmitted infections

Introducción: La neoplasia intraepitelial anal se considera una lesión precursora del carcinoma escamoso anal. La población de mayor riesgo de padecer esta lesión son pacientes inmunodeprimidos, especialmente los infectados por el virus de la inmunodeficiencia humana (VIH), con prácticas de sexo anal. El objetivo de este estudio fue describir los hábitos sexuales de los pacientes atendidos en la consulta de infecciones de transmisión sexual (ITS) en nuestro servicio, a los que se les realizó una citología anal, así como la presencia de otras ITS. Material y métodos: Se realizó un estudio descriptivo de aquellos pacientes a los que, de acuerdo con nuestro protocolo, se les realizó una citología anal entre 2008 y 2011. Asimismo, se realizó una encuesta sobre hábitos sexuales y cribado de otras ITS. Finalmente, se llevó a cabo un estudio descriptivo y analítico bivariado valorando la distribución de la alteración citológica y el grado de displasia anal. Resultados: Se incluyeron un total de 347 citologías anales, con un 48,1% de citologías alteradas. Se encontraron diferencias estadísticamente significativas entre la presencia de condilomas perianales/endoanales, la infección por VIH, la infección por Chlamydia trachomatis y la presencia de alteración citológica. Conclusión: La displasia anal tiene una alta prevalencia en nuestro medio en determinados grupos con hábitos sexuales de riesgo, pero probablemente esté infradiagnosticada por su carácter subclínico y la falta de un protocolo de cribado bien establecido (AU)

Background: Anal intraepithelial neoplasia is considered a precursor lesion of anal squamous carcinoma. The population with increased risk of this conditions are immunocompromised individuals, especially HIV-infected, with anal sex practices. The aim of this study was to describe the sexual habits of patients who were seen in sexually transmitted infections (STIs) consult in our service in whom anal cytology was performed as well as the association of anal dysplasia to other STIs. Material and methods: We performed a retrospective cohort study that included those patients in whom, according to our protocol, anal cytology was performed between 2008 and 2011. Also we conducted a survey on sexual habits and screening for other STIs. Finally, we conducted a descriptive and analytical study assessing bivariate distribution of cytological alterations and grade of anal dysplasia. Results: A total of 347 anal cytologies were performed, and 48.1% were abnormal. Statistically significant differences were found between the presence of condylomata perianal/endoanal, HIV infection, Chlamydia trachomatis infection and the presence of cytologic alterations. Conclusion: There was a high incidence of anal dysplasia in our group of individuals with risky sexual habits; however, it is probably underdiagnosed due to its subclinical nature and lack of a well-established screening protocol (AU)

[Screening of anal intraepithelial neoplasia in risk groups: descriptive study of sexual habits and other sexual transmitted infections]. / Cribado de neoplasia intraepitelial anal en grupos de riesgo: estudio descriptivo sobre hábitos sexuales y otras infecciones de transmisión sexual.

BACKGROUND: Anal intraepithelial neoplasia is considered a precursor lesion of anal squamous carcinoma. The population with increased risk of this conditions are immunocompromised individuals, especially HIV-infected, with anal sex practices. The aim of this study was to describe the sexual habits of patients who were seen in sexually transmitted infections (STIs) consult in our service in whom anal cytology was performed as well as the association of anal dysplasia to other STIs. MATERIAL AND METHODS: We performed a retrospective cohort study that included those patients in whom, according to our protocol, anal cytology was performed between 2008 and 2011. Also we conducted a survey on sexual habits and screening for other STIs. Finally, we conducted a descriptive and analytical study assessing bivariate distribution of cytological alterations and grade of anal dysplasia. RESULTS: A total of 347 anal cytologies were performed, and 48.1% were abnormal. Statistically significant differences were found between the presence of condylomata perianal/endoanal, HIV infection, Chlamydia trachomatis infection and the presence of cytologic alterations. CONCLUSION: There was a high incidence of anal dysplasia in our group of individuals with risky sexual habits; however, it is probably underdiagnosed due to its subclinical nature and lack of a well-established screening protocol.