Estudio retrospectivo acerca de la evolución y el desarrollo de resistencias antimicrobianas en casos diagnosticados de gonorrea en un hospital de nivel terciario en Portugal durante 10 años / Gonorrhea in a Tertiary Care Portuguese Hospital: A 10-year Retrospective Study of the Evolution of Cases and Drug Resistance of the Isolates

INTRODUCCIÓN: Las infecciones de transmisión sexual siguen siendo un problema mundial de salud pública. Aunque tradicionalmente se considera una infección tratable, la aparición de resistencias de la Neisseria gonorrhoeae (N. gonorrhoeae) a los agentes antimicrobianos se ha convertido en un tema de vital importancia. El objetivo del presente estudio fue valorar tanto la incidencia como la resistencia frente a los agentes antimicrobianos desarrollada por las cepas de N. gonorrhoeae en un hospital portugués durante 10 años. MÉTODOS: Se incluyeron aquellos casos con confirmación en laboratorio de infecciones por N. gonorrhoeae diagnosticados entre los años 2009 y 2018. Se estudió además la sensibilidad frente a la penicilina, las tetraciclinas, el ciprofloxacino, la azitromicina y la cefotaxima, así como las características clínicas y demográficas relacionadas. RESULTADOS: Desde el año 2009 al 2018, en nuestro centro fueron detectados un total de 440 casos de infecciones por N. gonorrhoeae, evidenciándose además un incremento anual significativo en el número de casos (p < 0,05). La mayoría de los casos se observaron en pacientes del sexo masculino (97,9%), con una media de edad de 25 años. En el 88,7% de los casos el tratamiento utilizado fue la asociación de ceftriaxona con azitromicina. La resistencia objetivada frente a la penicilina, las tetraciclinas y el ciprofloxacino permaneció elevada durante todo el período del estudio. CONCLUSIONES: La resistencia antimicrobiana de la infección por N. gonorrhoeae apareció al poco tiempo después de la introducción del tratamiento antimicrobiano. Para poder combatir esta situación es necesario implantar una mayor vigilancia, así como realizar más estudios que busquen combinar tanto datos epidemiológicos como de sensibilidad. En nuestra población, la N. gonorrhoeae sigue siendo muy sensible a los tratamientos antibióticos que se recomiendan actualmente. Sin embargo, el tratamiento con ciprofloxacino, azitromicina (en monoterapia) y la penicilina se deben de evitar como tratamiento empírico

BACKGROUND: Sexually Transmitted Infections remain a major public health concern worldwide. Although traditionally considered treatable, the emergence of Neisseria gonorrhoeae resistance to antimicrobials is currently a serious problem. The goal of this study was to evaluate the incidence and trends of antimicrobial resistance over the last 10 years in N. gonorrhoeae isolates from a Portuguese Centre. METHODS: Laboratorial confirmed N. gonorrhoeae infections diagnosed between 2009 and 2018 were evaluated. Susceptibilities to penicillin, tetracycline, ciprofloxacin, azithromycin and cefotaxime were studied, along with demographic and clinical characteristics. RESULTS: From 2009 to 2018, 440 cases of N. gonorrhoeae infection were diagnosed in our center, with a significant yearly increase (p < 0.05). Most cases occurred in males (97.9%), with a median age of 25 years. In 88.7% of the cases, treatment with ceftriaxone plus azithromycin was used. Resistances to penicillin, tetracycline and ciprofloxacin remained high throughout the study period. CONCLUSIONS: Antimicrobial resistance of N. gonorrhoeae appeared shortly after the introduction of antimicrobials. To combat this problem, improved surveillance and more studies combining susceptibility and epidemiological data are needed. In our population, N. gonorrhoeae remains highly susceptible to the antibiotics currently recommended for its treatment, whereas ciprofloxacin, azithromycin (in monotherapy) and penicillin should be avoided as empirical treatment

Gonorrhea in a Tertiary Care Portuguese Hospital: A 10-year Retrospective Study of the Evolution of Cases and Drug Resistance of the Isolates. / Estudio retrospectivo acerca de la evolución y el desarrollo de resistencias antimicrobianas en casos diagnosticados de gonorrea en un hospital de nivel terciario en Portugal durante 10 años.

BACKGROUND: Sexually Transmitted Infections remain a major public health concern worldwide. Although traditionally considered treatable, the emergence of Neisseria gonorrhoeae resistance to antimicrobials is currently a serious problem. The goal of this study was to evaluate the incidence and trends of antimicrobial resistance over the last 10 years in N. gonorrhoeae isolates from a Portuguese Centre. METHODS: Laboratorial confirmed N. gonorrhoeae infections diagnosed between 2009 and 2018 were evaluated. Susceptibilities to penicillin, tetracycline, ciprofloxacin, azithromycin and cefotaxime were studied, along with demographic and clinical characteristics. RESULTS: From 2009 to 2018, 440 cases of N. gonorrhoeae infection were diagnosed in our center, with a significant yearly increase (p<0.05). Most cases occurred in males (97.9%), with a median age of 25 years. In 88.7% of the cases, treatment with ceftriaxone plus azithromycin was used. Resistances to penicillin, tetracycline and ciprofloxacin remained high throughout the study period. CONCLUSIONS: Antimicrobial resistance of N. gonorrhoeae appeared shortly after the introduction of antimicrobials. To combat this problem, improved surveillance and more studies combining susceptibility and epidemiological data are needed. In our population, N. gonorrhoeae remains highly susceptible to the antibiotics currently recommended for its treatment, whereas ciprofloxacin, azithromycin (in monotherapy) and penicillin should be avoided as empirical treatment.

Extra-facial melasma: clinical, histopathological, and immunohistochemical case-control study.

BACKGROUND: Extra-facial melasma is a prevalent dermatosis in some populations with special characteristics in relation to its clinical aspects and probable etiopathogenic factors. Few studies have attempted to address this alteration of pigmentation, which has become a challenge in clinical Dermatology. OBJECTIVE: To assess the clinical histopathological and immunohistochemical characteristics of extra-facial melasma, comparing affected, and unaffected sites. METHODS: Case-control study with 45 patients in each group (melasma and disease-free volunteers), assessing their clinical characteristics. In 36 patients, biopsies were performed on the lesion and the normal perilesional skin. Specimens were stained with HE and Fontana-Masson, and melanocytes analysed by immunohistochemistry. Objective measurements were accomplished by a specifically designed image analysis software. RESULTS: The melasma group had a mean age ± SD of 56.67 ± 8 years, the majority of them were women (86.7%) and 82.1% of the female cases had reached menopause. There were no significant differences between groups in terms of presence of comorbidities, use of medications or hormone therapies. For extra-facial melasma patients, family history of this dermatose and of previous facial melasma was significantly higher than in the control group (P < 0.05). The HE staining showed increased rectification and basal hyperpigmentation, solar elastosis, and collagen degeneration in the pigmented area (P < 0.05). There was a significant increase in melanin density in melasma biopsies, but the immunohistochemical tests did not detect a difference between the groups in terms of number of melanocytes. CONCLUSION: Extra-facial melasma appears to be related to menopause, family history, and personal history of facial melasma, in the studied population. Histopathology revealed a pattern similar to what has been described for facial melasma, with signs of solar degeneration, and a similar number of melanocytes, when comparing patients, and controls, suggesting that the hyperpigmentation is most likely the result of abnormal melanin production or distribution.

Sexually transmitted infections and related sociodemographic factors in Lisbon's major Venereology Clinic: a descriptive study of the first 4 months of 2007.

OBJECTIVES: To assess the prevalence of sexually transmitted infections (STI) and relationships between them and sociodemographic/behavioural data in the major Venereology Clinic in Lisbon. METHODS: Every patient attending this STI clinic for the first time in the first 17 weeks of 2007 was enrolled in this study. Early syphilis, Chlamydia trachomatis infection, gonorrhoea, human immunodeficiency virus (HIV) first diagnosed and genital warts were considered for the study of statistical associations with sociodemographic/behavioural variables or other STI. Data were analysed with an exact significance level of 5%. RESULTS: A total of 743 patients were included. In women (n = 296), the only significant associations found were for C. trachomatis and being non-Caucasian (OR = 2.13, CI 1.17-3.9) or being younger than 25 years (OR = 1.9, CI 1.31-2.79). Men who have sex with men (176 of the 447 male patients) contributed to 39% of the STI, although more than half of the early syphilis, gonorrhoea and HIV cases were diagnosed in this group. CONCLUSIONS: Despite its limitations, our study allows some insight into the relationships between sociodemographic factors and STI in a selected population attending Lisbon's major Venereology Clinic. The results were similar to those of other European studies and to recent trends in STI, but differ in the association between C. trachomatis infection and non-Caucasian women, which is similar to cities with significant African minorities. Attention should be given to the associations found between men who have sex with men and STI such as gonorrhoea, syphilis and HIV, as these associations can lead to serious difficulties in the control of HIV infection in Portugal.