Heartlands Hospital

Despite accessible and effective HIV treatment, the health and wellbeing of people with HIV can be negatively affected by social and economic disadvantage and stigma. We assessed needs and unmet needs for health and welfare services among people with HIV in the UK. Positive Voices 2022 is a questionnaire study of 4622 adults, conducted between April 11, 2022, and March 31, 2023, at 101 clinics in the UK. Participants self-completed a confidential questionnaire, including questions on sociodemographics, HIV-related factors, lifestyle factors, mental and physical health, and health and social care service needs; we included participants who provided sociodemographic data, year of HIV diagnosis, and at least one response about health care and other needs (4326 [93·6%] of 4622). 27 health and welfare services were grouped into five categories: HIV-related services; mental health services; welfare services; lifestyle services; and drug services. We assessed the association of sociodemographic factors with those who reported a service need, and those with an unmet need among those with a service need, using logistic regression, adjusted for age group, sociodemographic group, and year of HIV diagnosis. For the 4326 participants, the median age was 53 years (IQR 44-60) and 996 (22·3%) were diagnosed with HIV between 2014 and 2023. The study population was predominantly gay, bisexual, and other men who have sex with men ([GBMSM] 2564 [59·3%]) and men of any sexual orientation (3237 [74·8%]). 260 (6·0%) were Black African heterosexual men and 360 (8·3%) were heterosexual men of other ethnicity. Of the 1031 women, 574 (13·3%) were Black African women, 457 (10·6%) were women of other ethnicities; and 2·6% (111) people were from other or undisclosed gender identities or sexualities. The most common reported needs were HIV-related (2779 [64·2%]), followed by mental health services (1877 [43·4%]), lifestyle (1492 [34·4%]), and welfare services (1492 [34·4%]). Need for drug services was lower (305 [7·1%]). For each area, service need was greater for younger people, those facing financial hardship, and those not in employment (compared with those who were employed or retired). GBMSM had lower need for HIV-related, welfare, and lifestyle services than most other sociodemographic groups but higher need for drug services. Heterosexual men had the lowest need for mental health services. Among those with a service need, unmet need was lower for HIV-related services (1153 [41·5%] of 2779) than other service categories (from 66·2% to 70·3%), and was associated with younger age, financial hardship, and demographic group. A substantial proportion of people with HIV who have mental health, welfare, and lifestyle needs in the UK are not receiving these services. Regular assessment of such needs, with referral and service signposting to appropriate services, should be implemented to benefit the wellbeing of this population. UK National Institute for Health Research.

» Chronic Charcot arthropathy results from the convergence of genetic predisposition (OPG/RANKL/RANK polymorphisms), metabolic disturbances (AGEs, vitamin D deficiency affecting 84.2% of patients), and inflammatory dysregulation (RANKL/OPG axis, IL-17 family cytokines), explaining why only 0.08-1% of diabetic neuropathy patients develop this devastating complication.» The receptor activator of nuclear factor kappa-B ligand (RANKL)/receptor activator of nuclear factor kappa-B (RANK)/osteoprotegerin (OPG) axis dysregulation drives excessive osteoclastogenesis and bone resorption in the acute phase, while impaired Wnt/β-catenin signaling and advanced glycation end products-modified collagen compromise healing quality in the chronic phase, resulting in malunion and permanent deformity.» Magnetic resonance imaging is the best non-invasive imaging modality for differentiating chronic Charcot from osteomyelitis (single bone involvement beneath ulcer, sinus tract, and abscess favor infection; periarticular distribution favors Charcot), though bone biopsy remains the gold standard when diagnostic uncertainty persists.» Current management relies primarily on mechanical interventions (accommodative footwear, bracing, surgical reconstruction for unbraceable deformities), but emerging molecular therapies targeting RANKL (denosumab), pro-inflammatory cytokines (IL-17 inhibitors), and Wnt pathway (romosozumab) show promise for disease modification.» Integrated risk stratification models combining genetic risk scores, serum biomarkers (RANKL/OPG ratio, vitamin D levels), and clinical factors can identify high-risk individuals (AUC 0.89), enabling targeted preventive interventions including vitamin D supplementation, prophylactic off-loading, and potentially pharmacological prevention.

Background Chronic disease in young adults is associated with poor healthcare engagement, poor health-related outcomes, and high-risk behaviours. However, there is minimal data regarding the outcomes of young adults with severe asthma. In this study we aimed to assess asthma characteristics and outcomes in young adults aged 16–25 years compared to older age-groups. Methods Using the UK Severe Asthma Registry, we undertook a retrospective observational analysis, comparing baseline assessment and annual follow-up data in young adults against other age-groups. We investigated differences in medication use, healthcare utilisation, exacerbation rates, lung function, airway inflammation, quality of life and co-morbidities using univariate and multivariable analysis. Results Registry data from 2812 participants was included, including 236 (8.4%) young adults. This age-group had the lowest levels of adherence and highest fractional exhaled nitric oxide, highest rates of emergency department attendance and hospitalisation, the second highest rate of intubation, and most frequently reported anxiety and depression. Data from the first annual review confirmed this age-group still had the highest rate of emergency department attendance, hospitalisation and the smallest improvement in asthma control. Conclusion In this cohort, young adults with severe asthma were at a higher risk of poor clinical outcomes, when compared to other age-groups. The higher rates of emergency treatment, admission and higher levels of airway inflammation suggest that they may experience more severe exacerbations, the reasons for which require further investigation. If a causative link is supported by further work, these findings suggest that age-specific management strategies should be explored towards improving clinical outcomes.

Recent advancements in artificial intelligence (AI) have enabled the creation of highly realistic videos demonstrating skin biopsy techniques for dermatology education. This study evaluates the visual realism and clinical accuracy of AI-generated videos, highlighting their potential as educational tools while recognizing significant anatomical inaccuracies that currently limit their clinical reliability. Integration of expert clinical input is essential to optimize the use of such technologies in training environments.

Tumefactive multiple sclerosis (TMS) is a rare variant of multiple sclerosis that presents large demyelinating lesions, often mimicking neoplasms or stroke. We report the case of a 32-year-old man who presented with progressive right-sided weakness, facial involvement and cranial nerve deficits. Neuroimaging revealed a demyelinating lesion in the left pons with additional older plaques. Despite initial treatment with high-dose corticosteroids, the patient showed no improvement. Subsequent plasma exchange led to significant neurological recovery and ocrelizumab was initiated for relapse prevention. This case highlights the diagnostic challenge of TMS presenting as a brainstem syndrome and the effective role of plasma exchange followed by ocrelizumab maintenance therapy.

<bold>Introduction:</bold> Remission is now an aspiration for asthma patients on biologics, although there is no agreed definition. Predicting the likelihood of remission at an early stage on treatment would improve precision therapy. <bold>Aims:</bold> To identify the characteristics at 4 and 16 weeks on treatment associated with remission at 1 year in a real-world asthma cohort on benralizumab. <bold>Methods:</bold> BenRex is a multicentre study of exacerbations on benralizumab for severe eosinophilic asthma. We defined remission at 1 year as meeting all of: no OCS for asthma (for maintenance/exacerbation); ACQ <1.5 and FEV1 ≥ 80% predicted and/or ≥ 10% higher than baseline FEV1% predicted. Forest plots of associations between early changes at 4 and 16 weeks and remission at 1 year were derived from logistic regression models. <bold>Results:</bold> 36 of 136 subjects (26.5%) met remission criteria. Subjects achieving remission were older (p=0.04). Male and female participants achieved remission at similar rates (p=0.84). Fig 1 shows predictors of remission using changes from baseline at 4 and 16 weeks. FEV1 and SGRQ improvement are strongly associated with subsequent remission. <bold>Conclusion:</bold> An improvement in FEV1 of ≥100 ml and SGRQ change of double the MCID at 4 and 16 weeks on benralizumab are strongly associated with clinical remission at one year. <fig><object-id>erj;66/suppl_69/PA4619/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig>