Kaposi's sarcoma associated with HIV/AIDS

Introducción: entre los principales problemas de salud a nivel mundial está el síndrome de inmunodeficiencia adquirida (SIDA), el cual favorecen la producción de afecciones dermatológicas resistentes al tratamiento como lasinfecciones oportunistas y los tumores malignos.Objetivo: presentar un caso de sarcoma de Kaposi en un paciente joven con diagnóstico de VIH/SIDA.Presentación del caso: paciente de 32 años, blanco, masculino con diagnóstico de infección por el VIH desde hace ocho años, con inadecuado control de su enfermedad, que acude a consulta dermatológica por presentar lesiones en la piel que se han extendido rápidamente, en forma de placas sobreelevadas de tamaño variable, amarronadas o eritematovioláceas, sin síntomas subjetivos asociados. Se sospecha el diagnóstico de Sarcoma de Kaposi por la clínica y se confirma por estudio histopatológico. El paciente se trata con terapia antirretroviral y quimioterapia, pocas semanas después se complica con un sangramiento digestivo alto y fallece.Conclusiones: resulta esencial el cumplimiento de la terapia antirretroviral y el adecuado seguimiento y control del paciente que vive con VIH/SIDA, para reducir la incidencia de infecciones y enfermedades oportunistas que pueden acelerar el desenlace fatal.Introduction: Acquired immunodeficiency syndrome (AIDS) represents one of the main public health problems in the world and favors the development of treatment-resistant dermatological conditions such as opportunistic infections and malignant tumors.Objective: to present a case of Kaposi's sarcoma in a young patient diagnosed with HIV/AIDS.Case presentation: 32-year-old, white, male patient diagnosed with HIV infection for 8 years, with inadequate control of his disease, who attended a dermatological consultation for presenting skin lesions that had spread rapidly, in the form of raised plaques of variable size, brownish or erythematous-violaceous, with no associated subjective symptoms. The diagnosis of Kaposi's sarcoma is suspected on clinical grounds and confirmed by histopathology. The patient was treated with antiretroviral therapy and chemotherapy, a few weeks later he developed complications with upper gastrointestinal bleeding and died.Conclusions: Adherence to antiretroviral therapy and adequate follow-up and control of the patient living with HIV/AIDS is essential to reduce the incidence of opportunistic infections and diseases that can accelerate the fatal outcome

Characterization of patients diagnosed with vulvar lichen sclerosus

Introducción: el liquen escleroso vulvar es una dermatosis inflamatoria crónica y progresiva, infradiagnosticada y subtratada, con tendencia a la malignización. El diagnóstico oportuno y tratamiento precoz son fundamentales.Objetivo: caracterizar las pacientes con diagnóstico de liquen escleroso vulvar.  Métodos: se realizó un estudio observacional, descriptivo, transversal, de serie de casos. La muestra coincide con el universo por lo que el muestreo fue no probabilístico de tipo intencional. Se incluyeron las mujeres con liquen escleroso vulvar, atendidas en el municipio Chambas desde enero de 2015 hasta septiembre de 2022, se excluyeron las pacientes con historias clínicas incompletas. Como medida de resumen de la información se utilizaron frecuencias absolutas y relativas (porcentaje).Resultados: existió predominio del grupo de edades 60 – 69 años (66,7 %) y color de piel blanca (71,4 %). El 52,4 % perteneció al área Julio Castillo. La media de edad fue de 64,8±6,217 años. El prurito vulvar e hipopigmentación estuvieron presentes en el 100 % de las pacientes. El 61,9 % de las mujeres desarrollaron una neoplasia vulvar intraepitelial diferenciada. En el 48,2 % de los casos el tiempo de evolución fue mayor de tres años. Recibieron tratamiento quirúrgico el 71,4 %.Conclusiones: la enfermedad predominó en la tercera edad; la hipopigmentación y el prurito vulvar fueron una constante en las pacientes estudiadas, la mayoría desarrolló una neoplasia intraepitelial vulvar diferenciada con más de tres años de evolución de las lesiones y el tratamiento quirúrgico fue la conducta más aplicada.Introduction: Vulvar lichen sclerosus is a chronic and progressive inflammatory dermatosis, underdiagnosed and undertreated, with a tendency to malignancy. Timely diagnosis and early treatment are essential.Objective: To characterize patients with a diagnosis of vulvar lichen sclerosus attended in the health areas of Chambas municipality, Ciego de Avila.Methods: An observational, descriptive, cross-sectional, case series study was conducted. The sample coincides with the universe so the sampling was intentional non-probabilistic. Women with vulvar lichen sclerosus, treated in Chambas municipality from January 2015 to September 2022, were included, patients with incomplete medical histories were excluded. Absolute and relative frequencies (percentage) were used as a summary measure.Results: There was a predominance of the age group 60-69 years (66,7 %) and white skin color (71,4 %). 52,4 % belonged to the white group. The 52,4 % belonged to the Julio Castillo area. The mean age was 64,8±6,217 years. Vulvar pruritus and hypopigmentation were present in 100 % of the patients. Differentiated vulvar intraepithelial neoplasia developed in 61,9 % of the women. In 48,2 % of the cases the time of evolution was longer than three years. They received surgical treatment 71,4 %.Conclusions: The disease predominated in the elderly; Hypopigmentation and vulvar pruritus were a constant in the patients studied, most developed a differentiated vulvar intraepithelial neoplasia with more than three years of evolution of the lesions and surgical treatment was the most applied behavior

Risk of COVID-19 after natural infection or vaccinationResearch in context

Background: While vaccines have established utility against COVID-19, phase 3 efficacy studies have generally not comprehensively evaluated protection provided by previous infection or hybrid immunity (previous infection plus vaccination). Individual patient data from US government-supported harmonized vaccine trials provide an unprecedented sample population to address this issue. We characterized the protective efficacy of previous SARS-CoV-2 infection and hybrid immunity against COVID-19 early in the pandemic over three-to six-month follow-up and compared with vaccine-associated protection. Methods: In this post-hoc cross-protocol analysis of the Moderna, AstraZeneca, Janssen, and Novavax COVID-19 vaccine clinical trials, we allocated participants into four groups based on previous-infection status at enrolment and treatment: no previous infection/placebo; previous infection/placebo; no previous infection/vaccine; and previous infection/vaccine. The main outcome was RT-PCR-confirmed COVID-19 >7–15 days (per original protocols) after final study injection. We calculated crude and adjusted efficacy measures. Findings: Previous infection/placebo participants had a 92% decreased risk of future COVID-19 compared to no previous infection/placebo participants (overall hazard ratio [HR] ratio: 0.08; 95% CI: 0.05–0.13). Among single-dose Janssen participants, hybrid immunity conferred greater protection than vaccine alone (HR: 0.03; 95% CI: 0.01–0.10). Too few infections were observed to draw statistical inferences comparing hybrid immunity to vaccine alone for other trials. Vaccination, previous infection, and hybrid immunity all provided near-complete protection against severe disease. Interpretation: Previous infection, any hybrid immunity, and two-dose vaccination all provided substantial protection against symptomatic and severe COVID-19 through the early Delta period. Thus, as a surrogate for natural infection, vaccination remains the safest approach to protection. Funding: National Institutes of Health

Risk of COVID-19 after natural infection or vaccinationResearch in context

Summary: Background: While vaccines have established utility against COVID-19, phase 3 efficacy studies have generally not comprehensively evaluated protection provided by previous infection or hybrid immunity (previous infection plus vaccination). Individual patient data from US government-supported harmonized vaccine trials provide an unprecedented sample population to address this issue. We characterized the protective efficacy of previous SARS-CoV-2 infection and hybrid immunity against COVID-19 early in the pandemic over three-to six-month follow-up and compared with vaccine-associated protection. Methods: In this post-hoc cross-protocol analysis of the Moderna, AstraZeneca, Janssen, and Novavax COVID-19 vaccine clinical trials, we allocated participants into four groups based on previous-infection status at enrolment and treatment: no previous infection/placebo; previous infection/placebo; no previous infection/vaccine; and previous infection/vaccine. The main outcome was RT-PCR-confirmed COVID-19 >7–15 days (per original protocols) after final study injection. We calculated crude and adjusted efficacy measures. Findings: Previous infection/placebo participants had a 92% decreased risk of future COVID-19 compared to no previous infection/placebo participants (overall hazard ratio [HR] ratio: 0.08; 95% CI: 0.05–0.13). Among single-dose Janssen participants, hybrid immunity conferred greater protection than vaccine alone (HR: 0.03; 95% CI: 0.01–0.10). Too few infections were observed to draw statistical inferences comparing hybrid immunity to vaccine alone for other trials. Vaccination, previous infection, and hybrid immunity all provided near-complete protection against severe disease. Interpretation: Previous infection, any hybrid immunity, and two-dose vaccination all provided substantial protection against symptomatic and severe COVID-19 through the early Delta period. Thus, as a surrogate for natural infection, vaccination remains the safest approach to protection. Funding: National Institutes of Health