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Mpox is a viral disease caused by an orthopoxvirus called monkeypox virus. It experienced a significant increase in cases in 2022 worldwide, mostly with sexual transmission. The possibility of hidden circulation of this infection among asymptomatic individuals remains unclear. This is a multi-centre, observational cross-sectional study conducted in a sexually transmitted infections (STIs) clinic in its referral hospital between July and October 2023 in Madrid, Spain. Pharyngeal and rectal swab samples were collected from each participant and processed to detect bacterial STIs and mpox. Socio-demographic, clinical and behavioural data were collected, and a descriptive analysis was performed. A total of 343 asymptomatic participants were included. The prevalence of asymptomatic mpox infection was 0.3% (n = 1) and the only positive case developed symptoms shortly after sampling, ruling out a fully asymptomatic infection. The percentage of vaccinated individuals was 36.1%. 13.2% had previously contracted mpox. Other STIs were detected in 21.6% of participants. Although routine screening for asymptomatic bacterial sexually transmitted infections is strongly recommended in at-risk individuals, testing for asymptomatic mpox should be evaluated based on the specific context and population. Additionally, the ongoing cases of mpox in Spain are likely not related to the presence of asymptomatic carriers.

This work is part of the research project Ship 4 Blue supported by the 2016 SODERCAN(Society for Cantabria Regional Development) program dedicated to R and D projects in marine renewable energies. Raúl Guanche also acknowledges financial support from the Ramón and Cajal Program (RYC-2017-23260) of the Spanish Ministry of Science, Innovation and Universities.

Introduction. Currently available outcome data for cataract surgery include mostly patients from public health systems. The purpose of this study was to report the visual and refractive outcomes of cataract procedures performed during one year in a private practice center, which may include a different spectrum of patients. Methods. Our center’s database was used to identify all isolated cataract procedures performed during 2017. The electronic records were reviewed to collect the preoperative information, presence of intra- or postsurgical complications, and visual and refractive outcomes one month after surgery. Results. In 2017, 2714 eyes of 1543 patients underwent cataract surgery in our center. Mean patient age was 70.42 years. 775 eyes (28.55%) had prior ophthalmic pathologies, and 113 eyes (4.16%) had undergone previous surgical procedures. Surgical complications developed in 35 eyes (1.29%), including 9 posterior capsule tears (0.33%) and 3 cases of dropped lens fragments (0.11%). A toric or multifocal intraocular lens was implanted in 45.6% of eyes. As regards postoperative complications, 59 eyes (2.17%) required a return to the operating theater, including 29 eyes (1.07%) requiring reinterventions due to an unexpected refractive result. There were no cases of endophthalmitis. Mean LogMAR-corrected distance visual acuity (CDVA) improved from 0.25 (SD 0.34) preoperatively to 0.04 (SD 0.17) postoperatively; 86.5% of eyes achieved a CDVA ≤0.0, with 97.5% achieving ≤0.3. In 86.4% of eyes, the difference between target and residual spherical equivalent difference was of 0.50 D or lower; 88% of eyes had a spherical equivalent ±0.50 D. Conclusions. The visual and refractive outcomes of cataract surgery in a private practice setting were excellent, well over the benchmarks set by the ESCRS. The safety profile was also within expected standards. This study provides information for ophthalmologists in private practice on expected outcomes.

IntroductionThe objectives of the study are: to design and implement a pilot intervention to offer self-sampling kits to detect HIV, Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Treponema pallidum (TP) among gay, bisexual and other men who have sex with men and transgender women users of pre-exposure prophylaxis (PrEP) as part of PrEP follow-up. To evaluate if the pilot intervention causes a reduction of the retention to PrEP follow-up among the target population. To analyse the capacity of the intervention to reduce the healthcare burden on the PrEP service. To evaluate the acceptability of the intervention among PrEP users and PrEP service healthcare workers and; to validate dried blood samples for treponemal and non-treponemal antibody detection using the Dual Path Platform syphilis screening and confirmatory assay compared with blood drawn by venous puncture.Methods and analysisWe will perform a non-blinded randomised controlled non-inferiority trial among PrEP users on follow-up. Participants on the control arm will follow the usual follow-up protocol with quarterly face-to-face visits where they will be tested for HIV and sexually transmitted infections (STIs). Participants in the experimental arm will alternate face-to-face meetings with online screening of HIV and STIs. The website https://testate.org/ will include a module for online follow-up visits of participants. Participants of the experimental arm will order self-sampling kits for HIV, CT, NG and TP through the website, will send the samples to the laboratory and check their results online. We will compare the retention to follow up and the healthcare burden in both arms. The acceptability of the intervention among participants and healthcare workers will be assessed.Ethics and disseminationThe project has been approved by the CEIC-HUGTIP (Reference: PI-22-051). Subjects will be included after giving their informed consent. Final conclusions and recommendations will be shared with stakeholders. Two publications in peer-reviewed journals are expected.Trial registration numberNCT05752643.

In May, 2022, several European countries reported autochthonous cases of monkeypox, which rapidly spread globally. Early reports suggest atypical presentations. We aimed to investigate clinical and virological characteristics of cases of human monkeypox in Spain. This multicentre, prospective, observational cohort study was done in three sexual health clinics in Madrid and Barcelona, Spain. We enrolled all consecutive patients with laboratory-confirmed monkeypox from May 11 to June 29, 2022. Participants were offered lesion, anal, and oropharynx swabs for PCR testing. Participant data were collected by means of interviews conducted by dermatologists or specialists in sexually transmitted infections and were recorded using a standard case report form. Outcomes assessed in all participants with a confirmed diagnosis were demographics, smallpox vaccination, HIV status, exposure to someone with monkeypox, travel, mass gathering attendance, risk factors for sexually transmitted infections, sexual behaviour, signs and symptoms on first presentation, virological results at multiple body sites, co-infection with other sexually transmitted pathogens, and clinical outcomes 14 days after the initial presentation. Clinical outcomes were followed up until July 13, 2022. 181 patients had a confirmed monkeypox diagnosis and were enrolled in the study. 166 (92%) identified as gay men, bisexual men, or other men who have sex with men (MSM) and 15 (8%) identified as heterosexual men or heterosexual women. Median age was 37·0 years (IQR 31·0–42·0). 32 (18%) patients reported previous smallpox vaccination, 72 (40%) were HIV-positive, eight (11%) had a CD4 cell count less than 500 cells per μL, and 31 (17%) were diagnosed with a concurrent sexually transmitted infection. Median incubation was 7·0 days (IQR 5·0–10·0). All participants presented with skin lesions; 141 (78%) participants had lesions in the anogenital region, and 78 (43%) in the oral and perioral region. 70 (39%) participants had complications requiring treatment: 45 (25%) had a proctitis, 19 (10%) had tonsillitis, 15 (8%) had penile oedema, six (3%) an abscess, and eight (4%) had an exanthem. Three (2%) patients required hospital admission. 178 (99%) of 180 swabs from skin lesions collected tested positive, as did 82 (70%) of 117 throat swabs. Viral load was higher in lesion swabs than in pharyngeal specimens (mean cycle threshold value 23 [SD 4] vs 32 [6], absolute difference 9 [95% CI 8–10]; p<0·0001). 108 (65%) of 166 MSM reported anal-receptive sex. MSM who engaged in anal-receptive sex presented with proctitis (41 [38%] of 108 vs four [7%] of 58, absolute difference 31% [95% CI 19–44]; p<0·0001) and systemic symptoms before the rash (67 [62%] vs 16 [28%], absolute difference 34% [28–62]; p<0·0001) more frequently than MSM who did not engage in anal-receptive sex. 18 (95%) of 19 participants with tonsillitis reported practising oral-receptive sex. The median time from onset of lesions to formation of a dry crust was 10 days (IQR 7–13). In our cohort, monkeypox caused genital, perianal, and oral lesions and complications including proctitis and tonsillitis. Because of the variability of presentations, clinicians should have a low threshold for suspicion of monkeypox. Lesion swabs showed the highest viral loads, which, combined with the history of sexual exposure and the distribution of lesions, suggests close contact is probably the dominant transmission route in the current outbreak. None.

Mpox is a viral illness for which the MVA-BN vaccine was authorized during the 2022 global outbreak. Although initial studies reported high immunogenicity, real-world evidence on vaccine effectiveness (VE) remains scarce. This study aimed to estimate the real-world VE of at least one dose of the MVA-BN vaccine against symptomatic mpox in adults tested at a tertiary hospital in Barcelona, Spain. We conducted a test-negative case-control study between July 2022 and December 2023. Adults tested for mpox by PCR were included. Cases were PCR-positive; controls were PCR-negative. Vaccine effectiveness of at least one dose was calculated as (1 − adjusted odds ratio) × 100 %, using multivariable logistic regression. Among 301 participants, 126 were cases and 175 controls. Crude VE of ≥1 dose ≥14 days before testing was 47 % (95 % CI: −17 % to 77 %). After adjusting for sex, age, testing center, sexually transmitted infection (STI) testing in the last year and risk criteria for mpox VE increased to 74 % (95 % CI: 38 % to 90 %) but decreased to 44 % (95 % CI: −52 % to 79 %) when additionally adjusting for epidemiological weeks. Similar patterns were observed in a subgroup of men with at least one risk criteria for mpox. Our study provides context-specific evidence on the effectiveness of a single MVA-BN vaccine dose against symptomatic mpox in a real-world setting. Vaccine effectiveness estimates varied depending on adjustment strategy, highlighting the importance of accounting for epidemiological weeks to avoid overestimation.

Background Today, patients often expect to achieve spectacle independance after cataract surgery. New trifocal intraocular lenses have been developed to try and fullfill this demand. The purpose of this study is to report the short-term visual outcomes of a new trifocal intraocular lens (AcrySof PanOptix™). Methods Consecutive adult patients undergoing cataract surgery with bilateral implantation of the study intraocular lens in a private practice clinic were considered for inclusion. Exclusion criteria were the presence of other ocular pathologies or preoperative astigmatism >1.5 diopters (D). Patients with intraoperative complications were excluded from analysis. One month after surgery patients underwent: monocular defocus curve; monocular and binocular uncorrected visual acuity in photopic and mesopic conditions, for far (4 m), intermediate (60 cm) and near (33 cm) distances and binocular contrast sensitivity. Patients completed a visual satisfaction questionnaire between 9 and 12 months after surgery. Results One hundred and sixteen eyes of fifty-eight patients receiving bilateral implantation of the study intraocular lens were analysed. Mean binocular uncorrected visual acuity in photopic conditions was 0.03 LogMAR for far, 0.12 for intermediate and 0.02 for near distances. All patients achieved a binocular uncorrected visual acuity better than 0.3 LogMAR (20/40 Snellen equivalent) for distance and near vision and 94.8% of patients for intermediate vision. Mesopic binocular uncorrected visual acuity values were similar to photopic values. The monocular defocus curves showed that the best visual acuity was reached at a vergence of 0.00D. Visual acuity dropped slightly at −1.00D and peaked again at −2.00D. Visual acuities better than 0.2 LogMAR were maintained between −2.50D and +0.50D. Contrast sensitivity was high and similar in photopic and mesopic conditions. As regards patient-evaluated outcomes, only 2 patients (3.4%) were fairly dissatisfied with their sight after surgery. Three patients (5.1%) reported the need for spectacle correction for certain activities. All other patients (94.8%) reported never using spectacle correction. Conclusions The PanOptix trifocal IOL provides good short-term visual outcomes, with good intermediate performance and excellent patient-reported satisfaction. The similar values achieved in mesopic and photopic conditions in binocular uncorrected visual acuity and contrast sensitivity suggest low pupillary dependence for light distribution. Trial registration number ISRCTN60143265 , retrospectively registered on the 24th of April 2017.

Purpose To report visual outcomes and patient-perceived satisfaction after trifocal or extended depth-of-focus (EDOF) intraocular lens (IOL) implantation in a real-world scenario. Methods Three months after bilateral cataract surgery, corrected and uncorrected visual acuity for far, intermediate and near distances and binocular defocus curves and contrast sensitivity were measured. The patients also completed the Catquest SF-9 questionnaire and reported on dysphotopsia and spectacle use. Results There were 23 patients in the Symfony, 32 patients in the Finevision and 36 patients in the Panoptix group. The percentage of eyes receiving a toric IOL was 41.2%. There were no differences in uncorrected binocular visual acuities, save for near vision, which was lower in the Symfony group. Binocular defocus curves for the trifocal IOLS were almost identical, while vision achieved with the Symfony IOL was significantly lower starting at − 1.5 D defocus. Contrast sensitivity, as well as the perception of halos and glare and the difficulty for night-driving was similar for all groups, except for contrast sensitivity at 6 cycles per degree, which was lower in the Symfony group compared to both Finevision and Panoptix. For near vision, only 47.6% of the Symfony patients reported being completely spectacle-free, compared to 93.3% and 94.4% for the Finevision and Panoptix groups. Conclusions Clinically relevant differences were only detected for near vision, with lower values for EDOF IOLs. In order to achieve patient satisfaction, it is imperative to explain the results expected with each IOL; for EDOF IOLs, patients should be advised that they may require near-spectacle correction.

This study compares the prevalence of drug use and the typologies of polydrug use (PDU) in men who have sex with men (MSM) and general population men (GPM). Participants were men aged 16–64, living in the provinces of Madrid and Barcelona: 1720 were recruited in a GPM survey, and 2658 were HIV-negative MSM from HIV/STIs diagnosis services. Lifetime and last-year prevalence of drug use and prevalence ratios (PRs) of MSM to GPM for the different drugs were calculated using Poisson regression. Latent class analysis (LCA) was performed to identify typologies of PDU. Lifetime use of the drugs considered was higher in MSM, and even higher for drug use in the last-year: PRs for cannabis, hallucinogens and cocaine ranged from 2–5; for amphetamine, ecstasy and methamphetamine 12–16; and above 60 for ketamine, GHB/GBL, inhalants and mephedrone. In the LCA for lifetime PDU four classes arose from the GPM (No-PDU (79.6%); Conventional PDU (13.8%); Intensive conventional PDU (4.9%); Heavy PDU (1.8%)) and four among MSM (No-PDU (57.7%); Conventional PDU plus poppers (18.8%); PDU preferring chemsex drugs (6.4%); Heavy PDU (17.2%)). For PDU during the last-year, three classes arose in the GPM: No-PDU (94.7%); Conventional PDU (4.3%); Heavy PDU (0.9%). For MSM, we identified four classes: No-PDU (64.7%); Conventional PDU plus poppers (15.6%); PDU preferring chemsex drugs (6.2%); Heavy PDU (13.5%). MSM should be considered a priority group for the prevention of the use of all drugs but the heterogeneity of PDU typologies regarding users’ preference towards conventional and/or sexualised drugs needs to be taken into account.

Purpose: To analyze the refractive accuracy of a novel swept‐source optical coherence biometer (SS‐OCT), that uses individual refractive indices to measure axial length, in short and long eyes implanted with monofocal intraocular lenses (IOLs). Methods: This retrospective comparative study considered eyes with short axial length (AL) (< 22.5 mm) or long AL (> 26 mm) bilaterally implanted with the Acrysof IQ monofocal IOL. All eyes were preoperatively analyzed with the Argos biometer and IOL calculations were made using the Barrett Universal II (BUII). One month after the surgery, refractive and visual outcomes and refractive prediction errors were calculated. Furthermore, a back calculation of the prediction errors based on the Barrett True Axial Length (BTAL) formula was also performed and the results of both formulas were compared. Results: Sixty eyes of 60 patients (30 with AL < 22.5 mm (short) and 30 with AL > 26 mm (long)) were included. After surgery, monocular UDVA was 0.03 ± 0.10 and 0.10 ± 0.15 logMAR for short‐eye and long‐eye groups, respectively. For short eyes, mean prediction error (MPE) with BUII and BTAL were 0.19 ± 0.34 D and 0.00 ± 0.35 D, respectively ( p   <  0.001). Mean absolute error (MAE) was 0.32 ± 0.22 D with the BUII and 0.29 ± 0.20 D with the BTAL formula ( p = 0.21). For long eyes, MPE with BUII was −0.15 ± 0.35 D and −0.13 ± 0.36 D with BTAL ( p = 0.08), while MAE was 0.31 ± 0.21 D and 0.32 ± 0.20 D with BUII and BTAL, respectively ( p = 0.33). The percentage of eyes with a prediction error within ±0.5 D predicted postop spherical equivalent was > 75% for both groups and both formulas ( p > 0.05 for all situations). Conclusions: The novel SS‐OCT biometer using individual refractive indices to measure AL showed an overall good refractive accuracy using the BUII. The results were similar or better with the optimized BTAL formula, suggesting that formulas purposely designed for biometric measurements with this novel technology are a promising tool for eyes with extreme AL.