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Introduction: Our aims were to investigate the adherence to national guidelines of initial antiretroviral therapy (ART) in the Spanish multicenter CoRIS cohort during the years 2010-2015, to identify the reasons for the prescription of nonrecommended treatments, and to explore the role of institutional constraints to guideline compliance. Methods: ART regimens were classified as recommended, alternative or nonrecommended according to the guidelines. Physicians were asked the reasons for prescribing nonrecommended regimens. Factors associated with the prescription of non recommended regimens were assessed using multivariable logistic regression. Results: During the study period, 586 (10.7%) of 5479 patients who started ART were given a regimen not recommended in the guidelines. The most frequent reasons for prescribing nonrecommended regimens were: enrolment in clinical trials (43.3%), comorbidities and/or interactions (10.2%), pregnancy (8.7%), and cost (7.7%). Among 37 participating centers, 16 (43%), treating 3561 patients, reported limitations related with the cost of ART, and 20 (54%), treating 1365 patients, reported restrictions for prescribing at least one recommended antiretroviral. In multivariable analysis, a higher risk of receiving nonrecommended regimens was associated with male gender, HIV acquisition by heterosexual transmission, low viral loads, initiation of treatment during the years 2011 to 2015, and initiation of treatment in a center with restricted access to at least one antiretroviral drug. Conclusions: Compliance to clinical guidelines was high. A high proportion of centres reported cost limitations for ART or restricted access to at least one recommended antiretroviral drug, with a significant impact on the choice of initial regimens. (C) 2019 Elsevier Espafia, S.L.U. and Sociedad Espaliola de Enfermedades Infecciosas y Microbiologia Clinica. All rights reserved.

Background Screening of anal cancer in HIV-infected MSM with anal cytology results in high rates of false positive results and elevated burden of high-resolution anoscopies. High-risk HPV upregulates p16 and Ki67 expression in epithelial cells. We assessed the usefulness of P16/Ki-67 immunostaining cytology for the diagnosis of precancerous anal lesions. Methodology Cross-sectional multicenter study. Concomitant anal liquid cytology with p16/Ki-67 immunostaining and HRA with biopsy of acetowhite lugol-negative lesions was performed in HIV-infected MSM. We compared the diagnostic performance of an abnormal anal cytology and p16/Ki-67 immunostaining relative to HRA-guided biopsy by logistic regression and comparison of ROC areas. Results We included 328 HIV-infected MSM. HSIL was histologically diagnosed in 72 subjects (25.1%), and 2 (0.6%) were diagnosed with anal cancer. An abnormal cytology showed a sensitivity of 95.6% and a specificity of 58.8% for the diagnosis of biopsy-proven HSIL. P16/Ki67 positivity was associated with the presence of biopsy-proven HSIL (P trend = 0.004) but with low sensitivity (41.2%) and specificity (71%). The combination of standard cytology with P16/Ki67 immunostaining did not increment the predictive value of standard cytology alone (AUC 0.685 vs. 0.673, respectively, P = 0.688). Conclusion In HIV-infected MSM P16/Ki67 immunostaining does not improve the diagnostic accuracy of anal cytology, which shows a high sensitivity yet poor specificity. Other approaches aimed at improving the diagnostic accuracy of current techniques for the diagnostic of precancerous HSIL are warranted.

A muchos españoles nos inquieta en modo creciente el grave declive de nuestra confianza en la democracia. Las incertidumbres racionales y emocionales que venimos arrastrando sin resolverlas, y sin apenas ponernos a ello, han crecido en opciones difícilmente conciliables. Lo que sigue es una reflexión, un estudio incompleto, sobre la libertad y la igualdad, su incidencia mutua y su relación con la justicia, la paz y el desarrollo económico y social. Se expone la necesidad primaria de la educación para la libertad y la solidaridad.

espanolObjetivo: Describir la frecuencia y caracteristicas de la uveitis asociada a la artritis idiopatica juvenil en un centro de referencia terciario en Espana. Metodos: Se estudiaron 205 ninos diagnosticados de artritis idiopatica juvenil en los ultimos 15 anos, de los cuales 26 desarrollaron uveitis anterior. Se clasifico a los pacientes segun su patron de evolucion, el momento de diagnostico de uveitis y la gravedad de la misma al diagnostico. Resultados: La prevalencia de uveitis entre los ninos con artritis idiopatica juvenil fue de 12,7%, de las cuales el 71% eran ninas. La edad media del diagnostico de artritis fue significativamente menor en el grupo de pacientes que desarrollaron uveitis (4 anos). No se observaron diferencias en la incidencia de uveitis en ninos/as ni en la afectacion pauci/poliarticular. Se encontraron ANA+ en el 84,6% de los pacientes con uveitis, presentando diferencias significativas con el grupo ANA-. La edad media de diagnostico de uveitis fue de 5,87 anos. El 48,1% de los pacientes desarrollaron la uveitis en los primeros doce meses del diagnostico de artritis. Este subgrupo de pacientes presento mas complicaciones en su evolucion. El 84,7% del total de pacientes con uveitis seguidos en consulta presentaron una agudeza visual media final >0,5. Conclusiones: En nuestro estudio el desarrollo de uveitis se asocia de manera significativa con la menor edad al diagnostico de artritis y con la presencia de ANA+. Se observa una mayor prevalencia de complicaciones en los casos que presentan un menor intervalo de tiempo entre el diagnostico de artritis y uveitis, y en aquellos que presentaron complicaciones al diagnostico. EnglishPurpose: The purpose of this paper is to describe the frequency and characteristics of uveitis associated with juvenile idiopathic arthritis at a tertiary referral centre in Spain Methods: Review of clinical records. 205 children diagnosed with chronic juvenile arthritis over the last 15 years, of whom 26 presented anterior uveitis. Patients were classified according to their pattern of evolution, the time the uveitis was diagnosed with respect to the onset of arthritis, and the severity of uveitis at diagnosis. Results: The prevalence of uveitis was 12.7%. Of the patients affected with uveitis 71% were girls. The average age at which the arthritis was diagnosed was significantly earlier in the group of patients who developed uveitis (4.06 years). No differences were observed in the incidence of uveitis in girls and boys, nor in pauci/polyarticular affectation. ANA positivity was found in 84.6% of the uveitis-affected patients, this being significantly different to the ANA- group. The average age at which uveitis was diagnosed is 5.87 years. 48.1% of uveitis patients develop uveitis within 12 months of the onset of arthritis. This group presented more complications during the evolution of the condition. A total of 84.7% of the uveitis-affected patients presented with a final visual acuity of >0.5 during the observation period. Conclusions: In our study, the development of uveitis was significantly associated with an earlier age of diagnosis of the arthritis and with the presence of ANA positivity. No differences were observed between boys and girls, or between pauci and polyarticular groups. A greater prevalence of complications was observed in cases presenting with a shorter time interval between the diagnosis of arthritis and uveitis and in those that presented with complications on diagnosis.

Objetivo: Describir la frecuencia y características de la uveítis asociada a la artritis idiopática juvenil en un centro de referencia terciario en España. Métodos: Se estudiaron 205 niños diagnosticados de artritis idiopática juvenil en los últimos 15 años, de los cuales 26 desarrollaron uveítis anterior. Se clasificó a los pacientes según su patrón de evolución, el momento de diagnóstico de uveítis y la gravedad de la misma al diagnóstico. Resultados: La prevalencia de uveítis entre los niños con artritis idiopática juvenil fue de 12,7%, de las cuales el 71% eran niñas. La edad media del diagnóstico de artritis fue significativamente menor en el grupo de pacientes que desarrollaron uveítis (4 años). No se observaron diferencias en la incidencia de uveítis en niños/as ni en la afectación pauci/poliarticular. Se encontraron ANA+ en el 84,6% de los pacientes con uveítis, presentando diferencias significativas con el grupo ANA-. La edad media de diagnóstico de uveítis fue de 5,87 años. El 48,1% de los pacientes desarrollaron la uveítis en los primeros doce meses del diagnóstico de artritis. Este subgrupo de pacientes presentó más complicaciones en su evolución. El 84,7% del total de pacientes con uveítis seguidos en consulta presentaron una agudeza visual media final >0,5. Conclusiones: En nuestro estudio el desarrollo de uveítis se asocia de manera significativa con la menor edad al diagnóstico de artritis y con la presencia de ANA+. Se observa una mayor prevalencia de complicaciones en los casos que presentan un menor intervalo de tiempo entre el diagnóstico de artritis y uveítis, y en aquellos que presentaron complicaciones al diagnóstico. Purpose: The purpose of this paper is to describe the frequency and characteristics of uveitis associated with juvenile idiopathic arthritis at a tertiary referral centre in Spain Methods: Review of clinical records. 205 children diagnosed with chronic juvenile arthritis over the last 15 years, of whom 26 presented anterior uveitis. Patients were classified according to their pattern of evolution, the time the uveitis was diagnosed with respect to the onset of arthritis, and the severity of uveitis at diagnosis. Results: The prevalence of uveitis was 12.7%. Of the patients affected with uveitis 71% were girls. The average age at which the arthritis was diagnosed was significantly earlier in the group of patients who developed uveitis (4.06 years). No differences were observed in the incidence of uveitis in girls and boys, nor in pauci/polyarticular affectation. ANA positivity was found in 84.6% of the uveitis-affected patients, this being significantly different to the ANA- group. The average age at which uveitis was diagnosed is 5.87 years. 48.1% of uveitis patients develop uveitis within 12 months of the onset of arthritis. This group presented more complications during the evolution of the condition. A total of 84.7% of the uveitis-affected patients presented with a final visual acuity of >0.5 during the observation period. Conclusions: In our study, the development of uveitis was significantly associated with an earlier age of diagnosis of the arthritis and with the presence of ANA positivity. No differences were observed between boys and girls, or between pauci and polyarticular groups. A greater prevalence of complications was observed in cases presenting with a shorter time interval between the diagnosis of arthritis and uveitis and in those that presented with complications on diagnosis.

Caso clínico: Paciente varón de 6 años con proptosis del ojo derecho. Las pruebas de imagen detectaron una masa en la pared medial de la órbita derecha que fue biopsiada; el diagnóstico histopatológico fue de tumor neuroectodérmico primitivo. El paciente recibió tratamiento quimioterápico. Tras 7 años en remisión el paciente presentó recidiva del tumor orbitario con metástasis sistémicas que fue tratada sin éxito con quimioterapia, radioterapia, y exenteración orbitaria. Discusión: La localización orbitaria de estos tumores es extremadamente rara. El diagnóstico diferencial debe realizarse con otros tumores de células pequeñas redondeadas, siendo fundamentales las técnicas inmunohistoquímicas y/o ultraestructurales. Case report: A six-year-old boy presented with proptosis of the right eye. Imaging studies detected a mass in the medial wall of the right orbit. This mass was biopsied revealing a histopathologic diagnosis of primitive neuroectodermal tumor, so chemotherapy treatment was given. After seven years in remission he presented with a recurrence of the orbital tumor and was found to also have systemic metastases. Treatment with chemotherapy, radiotherapy and orbital exenteration was unsuccessful. Discussion: The orbital occurrence of these tumors is extremely rare. Differentiation from other small round cell tumors requires immunohistochemical and ultrastructural techniques.

espanolCaso clinico: Paciente varon de 6 anos con proptosis del ojo derecho. Las pruebas de imagen detectaron una masa en la pared medial de la orbita derecha que fue biopsiada; el diagnostico histopatologico fue de tumor neuroectodermico primitivo. El paciente recibio tratamiento quimioterapico. Tras 7 anos en remision el paciente presento recidiva del tumor orbitario con metastasis sistemicas que fue tratada sin exito con quimioterapia, radioterapia, y exenteracion orbitaria. Discusion: La localizacion orbitaria de estos tumores es extremadamente rara. El diagnostico diferencial debe realizarse con otros tumores de celulas pequenas redondeadas, siendo fundamentales las tecnicas inmunohistoquimicas y/o ultraestructurales. EnglishCase report: A six-year-old boy presented with proptosis of the right eye. Imaging studies detected a mass in the medial wall of the right orbit. This mass was biopsied revealing a histopathologic diagnosis of primitive neuroectodermal tumor, so chemotherapy treatment was given. After seven years in remission he presented with a recurrence of the orbital tumor and was found to also have systemic metastases. Treatment with chemotherapy, radiotherapy and orbital exenteration was unsuccessful. Discussion: The orbital occurrence of these tumors is extremely rare. Differentiation from other small round cell tumors requires immunohistochemical and ultrastructural techniques.

Currently, ulcerative sexually transmitted infections, including syphilis, herpes simplex virus (HSV), lymphogranuloma venereum (LGV), chancroid, donovanosis and, more recently, monkeypox (MPOX), represent a growing challenge for health care professionals. The incidence of syphilis and LGV has increased in recent years in Spain. Additionally, HSV, syphilis and chancroid can also increase the risk of HIV acquisition and transmission. The population groups most vulnerable to these infections are young people, men who have sex with men (MSM) and commercial sex workers. It is important to make a timely differential diagnosis since genital, anal, perianal, and oral ulcerative lesions may pose differential diagnosis with other infectious and non-infectious conditions such as candidiasis vulvovaginitis, traumatic lesions, carcinoma, aphthous ulcers, Behçet's disease, fixed drug eruption, or psoriasis. For this reason, the dermatologist plays a crucial role in the diagnosis and management of sexually transmitted infections. This chapter presents the main epidemiological, clinical and therapeutic features associated with these infections., (Copyright © 2024 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)