Althaia

Abstract Background There is little evidence regarding the predictive factors associated with mucosal healing in patients with moderate ulcerative colitis (UC) treated with steroids. The aim of this study was to analyse the association between the speed of improvement in clinical variables with calprotectin levels and endoscopic mucosal healing once a conventional course of steroids has been completed. Methods All patients in the GETECCU prospective randomised CECUM clinical trial who completed the endoscopic assessment at eight weeks were included. Clinical variables were collected at 7 days, and at 4 and 8 weeks: presence of rectal bleeding, urgency and nocturnal stools, Mayo and Walmsley sub-scores, and faecal calprotectin levels. Endoscopic mucosal healing at week 8 was defined as an endoscopic Mayo score of 0. Group differences were compared and the association between early clinical response and final mucosal healing was analysed using descriptive statistics and logistic regression models adjusted for baseline clinical variables. Results Of the 75 patients included in the CECUM study, 58 underwent endoscopy at week 8. Forty-eight per cent were women with a median age of 49 (range 19–79), 98 per cent were non-smokers, 52 per cent had extensive colitis and 32 per cent had previously received steroids. The mucosal healing rate at eight weeks was 29% (17 of 58). In the univariate analysis, disappearance of rectal bleeding at week 4, use of topical therapy and calprotectin levels <250 at day 7 and <150 at 4 weeks were associated with mucosal healing (p < 0.05). In the multivariate logistic regression, independent factors associated with mucosal healing were topical treatment at 7 days (OR 9.96; 95% CI 1.51–65.83; p = 0.017), faecal calprotectin levels <250 µg/g at 7 days (OR 5.48; 95% CI 1.28–23.45; p = 0.022) and calprotectin levels <150 µg/g at 4 weeks (OR 5.15; 95% CI 1.13–23.32; p = 0.034). Conclusion Early normalisation of calprotectin and the use of topical treatment during the first week are independent predictors of mucosal healing in steroid-treated UC with moderate activity. These results reinforce the value of calprotectin as a non-invasive clinical decision marker and, furthermore, support the use of combined topical treatment when initiating oral steroids. Conflict of interest: Mañosa Ciria, Miriam: Personal Fees: Abbvie, FAES Pharma, Ferring, Jannsen, MSD, Pfizer, Tillots and Lilly Llao Guardia, Jordina: I have received financial support from AbbVie, Tillots, Adacyte, Jansen, Alfasigma and Lilly for educational activities. Piñero, Gisela Soledad: GP has served as a speaker or has received education funding or advisory fees from Adacyte, AbbVie, Kern Pharma, Ferring, Alfasigma. Calafat Sard, Margalida: No conflict of interest Martin Arranz, Eduardo: Personal Fees: Olympus and Janssen Non-financial Support: Support for conference attendance, education or research from Abbvie, Pfizer, Janssen Zabana, Yamile: Personal Fees: AbbVie, Adacyte Therapeutics, Alfa-Sigma, Amgen, Boehringer Ingelheim, Dr Falk Pharma, FAES Pharma, Fresenius Kabi, Ferring, Galapagos, Janssen-J & J, Kern Pharma, Lilly, MSD, Pfizer, Sanofi, Sandoz, Takeda, Tillots Pharma Non-financial Support: Shire, Otsuka, Almirall Navarro Llavat, Mercedes: No conflict of interest Teller, Marta: No conflict of interest Garcia Planella, Esther: No conflict of interest Busquets Casals, David: No conflict of interest Monfort Miquel, David: No conflict of interest Juan-Ramón , Pineda: No conflict of interest Gutiérrez Casbas, Ana: No conflict of interest Villoria Ferrer, Alberto: No conflict of interest Menchen Viso, Luis Alberto: No conflict of interest Bastida Paz, Guillermo: No conflict of interest Garcia Alonso, Francisco Javier: I have acted as a speaker for Abbvie, Lilly and Johnson and Johnson Rivero Tirado, Montserrat: No conflict of interest Chaparro, María: Grants: Pfizer, Janssen, Biogen, Abbvie, Lilly Personal Fees: Pfizer, Faes, Lilly, Abbvie, Janssen Riestra Menéndez, Sabino: No conflict of interest Merino Ochoa, Olga: No conflict of interest Rodríguez-Lago, Iago: No conflict of interest Barreiro-de Acosta, Manuel: MBA has been speaker, consultant and advisory member for or has received research funding from MSD, AbbVie, Janssen, Kern Pharma, Celltrion, Takeda, Alphasigma, Lilly, Pfizer, Sandoz, Biocon, Abivax, Fresenius, Faes Farma, Ferring, Tillots, Chiesi, Adacyte, Diasorin, Oncostellae and SunRock. Rodríguez-Fortúnez, Patricia: No conflict of interest Domènech Moral, Eugeni: Personal Fees: I have served as a speaker, or has received research or education funding or advisory fees from AbbVie, Adacyte Therapeutics, Biogen, Celltrion, Gilead, Janssen, Kern Pharma, MSD, Pfizer, Roche, Samsung, Takeda, Tillots. Other: I have served as a speaker, or has received research or education funding or advisory fees from AbbVie, Adacyte Therapeutics, Alfasigma/Galapagos Biogen, Celltrion, Ferring, Gilead, GoodGut, Imidomics, Janssen, Kern Pharma, Lilly, MSD, Pfizer, Roche, Takeda, Tillots.

Background:Charcot foot, characterized by progressive osseous and articular destruction, necessitates early diagnosis and a multidisciplinary approach to prevent severe complications. This study assessed the efficacy of an educational intervention in improving radiographic detection and referral for Charcot foot among health care professionals.Methods:Thirty health care professionals, including foot and ankle surgeons (FAs), orthopaedic/trauma specialists (OTs), and family physicians (FDs), participated in this quasi-experimental, pre-post study. Participants completed a baseline assessment and received an educational intervention (face-to-face/webinar or self-directed PDF), followed by a reassessment. Primary outcomes included changes in diagnostic and referral accuracy, evaluated through score improvements and Fleiss κ for interobserver agreement. Reliability in the Meary angle measurement was also assessed.Results:FA specialists demonstrated consistently high baseline scores. Following the intervention, OT and FD groups exhibited significant improvements in both diagnostic and referral scores. Fleiss κ increased from 0.463 to 0.700 for OT diagnosis, and from 0.439 to 0.723 for referral. Fleiss κ values for FD improved from 0.352 to 0.546 for diagnosis and from 0.071 to 0.608 for referral. Face-to-face/webinar training outperformed the PDF format, yielding higher scores and agreement rates. Interobserver reliability for the Meary angle was excellent (intraclass correlation coefficient = 0.988).Conclusion:Structured educational interventions significantly enhanced clinicians’ ability to diagnose and appropriately refer patients with Charcot foot. Face-to-face instruction proved more effective than self-directed formats.Level of Evidence:Level III, quasi-experimental pre-post study.

ABSTRACTBackgroundLimited data are available on the management and outcomes of postoperative Crohn's disease (CD) in older patients. We aimed to describe the management of CD in the postoperative setting and assess surgical postoperative recurrence (POR) in this population.MethodsThis was a case‐control study including all adult patients with CD from the ENEIDA registry who had undergone a first intestinal resection with ileo‐colonic anastomosis. Patients were grouped according to their age at the time of the first surgery in older (over 60 years) subjects and controls (between 18 and 60 years of age).ResultsA total of 3982 (535 older subjects and 3454 controls) underwent a first intestinal resection for CD with an ileo‐colonic anastomosis. Time from CD diagnosis to surgery was significantly longer in older patients (114 ± 128 vs. 93 ± 97 months; p < 0.001). Older patients also had a lower proportion of penetrating CD (25% vs. 39%; p < 0.0001) and perianal disease (14% vs. 25%; p < 0.0001). A significantly lower proportion of older patients started preventive therapies for POR (32% vs. 51%; p < 0.0001). The cumulative risk of surgical POR was 3.2%, 5.3% and 10.1% in the older group and 3.6%, 6.6% and 14.2% in the control group at three, five and 10 years, respectively (p = 0.093). In the multivariate logistic regression analysis, only prevention with thiopurines was associated with a lower risk of surgical POR.ConclusionsAlthough postoperative preventive therapy with immunomodulators or biologicals is prescribed less often in older patients after a first intestinal resection, they develop surgical POR as often as younger adult patients.

BACKGROUNDHIV screening strategies in alternative settings, such as emergency departments (EDs), aim to increase diagnosis of occult infections and achieve 95–95–95 targets for 2030.AIMTo assess the effectiveness of an opt-in HIV screening strategy in EDs based on six clinical scenarios from a 2020 Spanish consensus document, while examining patient characteristics and linkage to-care.METHODSThis descriptive, multicentre, retrospective study analysed epidemiological, clinical, and linkage-to-care data of individuals aged ≥ 18 years newly diagnosed with HIV between July 2021 and March 2024 in 17 EDs covering 73% of the population in Catalonia, Spain.RESULTSFrom 23,105 HIV serologies performed, there were 172 new diagnoses (positivity rate: 0.7%). Of these, 88.4% (152/172) were assigned male at birth, had a median age of 39 years (IQR: 30–50), and 47.9% (81/169) were Spanish. Sexual transmission was reported in 75.6% (130/172) of cases, with 55.5% (81/146) heterosexual. Fiebig stage data, available in 78.5% (135/172) of cases, showed 57.8% (78/135) had acute infection. Advanced HIV was found in 24.2% (30/124). Diagnoses related to the six clinical scenarios accounted for 54.6% (94/172) of cases. For all new diagnoses, 82.0% (137/167) were linked to specialised healthcare and started antiretroviral treatment within 9 days (IQR: 4–17), with no significant differences regarding urban/rural hospital coverage areas.CONCLUSIONAn opt-in HIV screening strategy in the ED is feasible and effective, especially in detecting highly transmissible patients with acute infection. However, one in five newly diagnosed individuals remained untreated, highlighting the need for improved linkage to care.

Aim Several measures have been described to prevent prosthetic joint infection in proximal femur fractures, such as personalized antibiotic prophylaxis. The use of antibiotic-loaded cement has also been proposed, although evidence remains limited, particularly in the context of local antimicrobial resistance patterns. The aim of this study was to evaluate the influence of antibiotic-loaded bone cement in the infection rates of partial hip prosthesis for intracapsular femoral fractures. Secondary, the mortality risk of infected patients was also assessed. Method This is a multicenter, quasi-experimental before-after intervention study conducted in three Catalan hospitals. All cemented partial hip prostheses implanted due to intracapsular femoral fracture during the study period were included. In the intervention group (January 2023–December 2024), preloaded cement with vancomycin and gentamicin was used. In the historical control group (January 2020–December 2022), cement without antibiotics (or with a single aminoglycoside) was used. The primary outcome was prosthetic joint infection as defined by EBJIS criteria. Pearson's Chi-square test was used to analyze the primary variable, and Student's t-test was used for demographic comparisons between groups. Results A total of 994 patients were included: 458 in the historical cohort and 536 in the intervention group (cement with vancomycin and gentamicin). No significant differences were found between groups regarding age (p=0.09), sex (p=0.07), BMI (p=0.196), or comorbidities such as diabetes mellitus (p=0.265) or chronic kidney disease (p=0.375), nor in complications during hospitalization (p=0.296). There were 24 infections in total (2.41%): 9 in the gentamicin and vancomycin group (1.7%) and 15 in the control group (3.3%) (p=0.145). The group cemented without antibiotics showed an increased risk of infections (p&lt;0,05) Overall mortality rate was 12.7%. One-year postoperative mortality was 41.7% among infected patients compared to 12.6% in non-infected patients (p=0.01). Conclusions The use of antibiotic-loaded bone cement for fixation of partial hip prostheses reduces the risk of periprosthetic infection in patients with intracapsular femoral fractures. Infection after hip fracture has an increased risk of mortality.