Hospital de Mataró

Ocular syphilis in the Iberian Peninsula shows a wide clinical spectrum and frequent posterior segment involvement. Most patients achieved favourable serological and visual outcomes. These findings support the effectiveness of standard therapies and highlight the need for early diagnosis, especially in high-risk populations.

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.

Acute studies have shown that TRPV1 agonists have improved both the biomechanics and neurophysiology of the swallowing response. The aim of this study was to assess the effect of a two-week treatment with capsaicin in older patients with oropharyngeal dysphagia (OD). A prospective, double-blind, randomized clinical trial was conducted. A total of 51 older patients with OD (PAS > 2) were included and treated for two weeks with 10 mL capsaicin 10 μM before meals (three times a day). Videofluoroscopy was used to examine swallowing biomechanics, and pharyngeal sensory (pSEP) and motor evoked potentials (pMEP) were used to assess neurophysiological responses. Salivary neuropeptides SP and CGRP were quantified using ELISA. The mean age of patients was 78.51 ± 6.04 years. The 32 patients treated with capsaicin showed a significant reduction in PAS score (4.7 ± 1.7 vs 3.9 ± 1.5, p = 0.02), time to LVC (405.3 ± 124.2 ms vs 366.6 ± 154.4 ms, p = 0.04), and latency of the N1 peak of pSEPs (88.3 ± 17.1 ms vs 74.4 ± 17.6 ms, p = 0.007) and had significant changes in brain activation. Improvement in time to LVC correlated significantly with N1 peak latency (p = 0.03), and salivary substance P increased by 75.8%. In contrast, the biomechanics and neurophysiology of the swallowing response in the 19 patients of the placebo group did not show significant improvement. Two weeks of capsaicin stimulation in older patients with OD were found to improve sensory and motor swallowing functions by enhancing pharyngeal sensitivity and reducing the time to LVC. Capsaicin administered over 2 weeks was found to improve swallowing safety and the biomechanics and neurophysiology of the swallowing response. TRPV1 agonists could be the basis of long-term pharmacological treatments for OD.

Background and ImportanceCalcinosis cutis is a rare, severe and chronic condition characterised by the deposition of insoluble calcium salts in the skin and subcutaneous tissue. These calcium salts cause reduced mobility, pain and chronic infections related to the development of ulcers. The preferred initial treatment is topical or intralesional sodium thiosulphate (STS). Intralesional administration is related to important adverse effects such infections and local pain, which make topical administration a preferred route.Aim and ObjectivesThe aim was to develop and use a topical formulation based on STS to treat skin calcifications, promoting wound re-epithelialisation and facilitating the removal of calcium deposits.Material and MethodsBased on existing literature a range of concentration of 10–25% STS formulations can be used. Zinc oxide was added due to its strong capacity to absorb exudates and skin secretions, as well as its wound healing and antiseptic properties. After testing various concentrations, the chosen formula was a 15% STS + 15% zinc oxide formulated in a water-in-oil (W/O) emulsion. According to the ‘Guía de buenas prácticas de preparación de medicamentos en servicios de farmacia hospitalaria’ (Guide to good practices for preparing medications in hospital pharmacy services) of the Spanish government, a beyond use date of 30 days at room temperature was established.ResultsThe described formula was successfully used in six patients. The 15% of STS was enough to dissolve calcium deposits and consequently, to facilitate the manual deposits withdrawal by nursing. Additionally, the use of zinc oxide accelerated ulcer healing, allowing the treatment of the periwound skin, where non-visible small calcium deposits may be present. Moreover, this formula allows to space topical therapy every 48 hours, reducing potential local irritation caused by STS.Conclusion and RelevanceSodium thiosulphate 15% + zinc oxide 15% W/O emulsion is an useful treatment in calcinosis cutis, improving wound healing and reducing potential complications associated to this process.References and/or AcknowledgementsConflict of InterestNo conflict of interest

BackgroundIn standard weaning from mechanical ventilation, a successful spontaneous breathing test (SBT) consisting of 30 min 8 cmH2O pressure-support ventilation (PSV8) without positive end-expiratory pressure (PEEP) is followed by extubation with continuous suctioning; however, these practices might promote derecruitment. Evidence supports the feasibility and safety of extubation without suctioning. Ultrasound can assess lung aeration and respiratory muscles. We hypothesize that weaning aiming to preserve lung volume can yield higher rates of successful extubation.MethodsThis multicenter superiority trial will randomly assign eligible patients to receive either standard weaning [SBT: 30-min PSV8 without PEEP followed by extubation with continuous suctioning] or lung-volume-preservation weaning [SBT: 30-min PSV8 + 5 cmH2O PEEP followed by extubation with positive pressure without suctioning]. We will compare the rates of successful extubation and reintubation, ICU and hospital stays, and ultrasound measurements of the volume of aerated lung (modified lung ultrasound score), diaphragm and intercostal muscle thickness, and thickening fraction before and after successful or failed SBT. Patients will be followed for 90 days after randomization.DiscussionWe aim to recruit a large sample of representative patients (N = 1600). Our study cannot elucidate the specific effects of PEEP during SBT and of positive pressure during extubation; the results will show the joint effects derived from the synergy of these two factors. Although universal ultrasound monitoring of lungs, diaphragm, and intercostal muscles throughout weaning is unfeasible, if derecruitment is a major cause of weaning failure, ultrasound may help clinicians decide about extubation in high-risk and borderline patients.Trial registrationThe Research Ethics Committee (CEIm) of the Fundació Unió Catalana d’Hospitals approved the study (CEI 22/67 and 23/26). Registered at ClinicalTrials.gov in August 2023. Identifier: NCT05526053.