Increasing emergency department admissions for chemsex-related intoxications in Barcelona, Spain, among people living with HIV: an observational study from 2018 to 2020.

BACKGROUND: Chemsex is a novel phenomenon referring to the use of drugs, including crystal methamphetamine, gammahydroxybutyric acid (GHB)/gamma-butyrolactone (GABA) and mephedrone, to facilitate, enhance, and prolong the sexual experience in men who have sex with men in large cities internationally. There is a growing concern about chemsex and fatal cases among people living with HIV on antiretroviral therapy. This study aimed to describe the clinical characteristics of chemsex-related intoxications. MATERIAL AND METHODS: An observational study was conducted in people living with HIV who were admitted for chemsex-related intoxications in an emergency department of a teaching hospital in Barcelona, Spain, from 2018 to 2020. Severe acute intoxications were defined according to the Poisoning Severity Score. RESULTS: One hundred and fifteen male patients with a median age of 35.6±7 years were included in the study:15 (13.1%) in 2018, 32 (27.8%) in 2019 and 68 (59.1%) in 2020. All patients had stable housing, 107(93.0%) were Spanish citizen and 32 (27.8%) had mental health disorders. Median CD4 lymphocyte count was 624 (500-765) cells/mm3 and 99 (86.1%) had HIV-1 RNA suppression. Poly-drug use was observed in 51(44.3%) cases and methamphetamine in 75(65,2%) and gammahydroxibutiric acid in 68 (59.1%) were the main drugs used. Potential drug interactions due to the inhibition of cytochrome P450 by antiviral therapy was determined in 36 (31.3%) patients. Severe intoxications cases affecting neurologic and respiratory systems were diagnosed in 12 (10.4%) patients and no patient died. CD4 cell counts ≤500 cells (O.R.:4.2; C.I.95%:1.2-14.6) and mental health disorders (O.R.: 2.9; C. I 95%: 0.8-9.9) were associated with severe acute drug intoxications in the bivariate analyses. CONCLUSIONS: Chemsex-related intoxications are an increasing clinical problem in people living with HIV. Chemsex should be routinely screened and addressed in clinical practice, particularly for people with mental illness and low CD4 cell counts, who are at higher risk for severe intoxications.

Changes of serum procalcitonin, lactate and lactic acid clearance in severe pneumonia and its clinical significance / 中国基层医药

Objective To investigate the changes of serum procalcitonin ( PCT ) , lactate and lactic acid clearance in severe pneumonia and its clinical significance .Methods Seventy patients with severe pneumonia were enrolled,including 16 cases with hospitalized pneumonia and 54 cases with community acquired pneumonia .All patients were exsanguinated early morning venous blood on day 1,4,7 after treatment,and transferred-out or before death.PCT and arterial lactic acid were measured and 24 -hour lactate clearance was calculated .According to the outcome , the patients were divided into survival group and death group .At different time points , the PCT and Lac levels were observed in the two groups .The patients were divided into high lactic acid clearance group and low lactic acid clearance group according to the 24h lactic acid clearance rate .The initial Lac and mortality were observed . Results All patients had 25 cases of deaths and 45 cases of survive.There were no statistically significant differences in PCT and Lac levels at the 1st day of treatment between the two groups (F=0.87,P=0.19;F=0.03,P=0.40). The PCT levels[(19.5 ±11.1)ng/L,(7.9 ±3.2)ng/L,(3.6 ±1.4)ng/L]and Lac values[(2.8 ±1.6)mmol/L, (2.2 ±1.1)mmol/L,(1.7 ±0.8)mmol/L]at the 4th,7th day of treatment and transferred -out in the survival group were significantly lower than those in the death group [PCT:(39.6 ±24.8) ng/L,(40.4 ±21.9) ng/L,(41.6 ± 38.3)ng/L,Lac:(6.8 ±3.2)mmol/L,(6.2 ±2.1)mmol/L,(7.7 ±2.8)mmol/L,F=3.84,P=0.003;F=7.38, P=0.00;F=4.95,P=0.00;F=5.86,P=0.00;F=6.05,P=0.00;F=10.48,P=0.00].In death group,the serum PCT value and lactic acid value were not significantly decreased with the treatment , and remained in the higher state at the 4th,7th day of treatment and before death ,and even higher than the first day of treatment .The mortality of the high lactic acid clearance group was 15.79％,which was significantly lower than 59.38％ in the low lactic acid clearance group (χ2 =14.37,P=0.00).The initial Lac and PCT of the two groups had no statistically significant differences ( t =0.17, P =0.43;t =0.41, P =0.34 ).Conclusion For the patients with severe pneumonia ,the detection of serum PCT and lactic acid levels and dynamic observation is helpful to judge the severity of the disease.The early lactic acid clearance rate may be of positive significance to the prognosis of patients .

Researching in doctor-patient communication courses for internship of medical students / 中华医学教育探索杂志

Currently medical students are short in ability of doctor-patient communication and lack of professional training in doctor-patient communication.It is essential to explore ways and means of teaching clinical doctor-patient communication for medical students.Clinical doctor-patient communication training courses were carried out with internships by way of explaining the establishment of a good doctordoctor-patient communication relationship,preparation and investigation analysis of doctor-patient communication information,doctor-patient communication skills,evaluation and adjustment of doctor-doctor-patient commu-nication,doctor-doctor-patient communication in the legal and regulatory issues.Medical students were trained in the good doctor-doctor-patient communication relationship building,information collection,infor-mation giving,respect and understanding,ending doctor-patient communication skills.And after the training medical students' doctor-patient communication ability obtained a certain improvement,which means this curriculum of clinical doctor-patient communication training courses is worthy of further promotion.

Diagnosis and treatment of pseudomyxoma peritonei in accidental discovery: a report of 8 cases / 国际外科学杂志

Objective To investigate the diagnosis and treatment of pseudomyxoma peritonei (PMP) and provide a reference for diagnosis and treatment of PMP.Methods The clinical features,laboratory examinations,treatment and outcomes of 8 PMP misdiagnosed cases were analyzed with recent relevant reference.Results Ultrasonography,CT,peritoneal cytological examination,tumor markers results are helpful for diagnosis of PMP.PMP will be confirmed and classified by pathological examination after operation.Complete cytoreductive surgery (CRS)or major debulking surgery (MDS) of the tumor combined intraperitoneal chemotherapy and systemic chemotherapy,eight patients in seven cases survived 4-71 month range,one patient died of respiratory failure of pulmonary infection after the third operation.Conclusions Ultrasonography,CT,peritoneal cytological examination,tumor markers tests help avoid misdiagnosis of PMP before operations.Intraoperative findings follow after PMP,CRS or MDS should be executed in the operation or the next time.Intraperitoneal chemotherapy and conventional chemotherapy can improve survival in patients with PMP and prolong their survival time.

Evaluation on the exploration of choledochus through cystic duct / 临床外科杂志

Objective To study the indication,method and value of choledochal exploration through cystic duct.Methods The cystic duct was cut 0.5～1 cm from choledochus and its edge was raised with a forceps and a bakes dilator was inserted to probe the bill duct.If the dilator can not pass the choledochus,palpation around the point of dilator would help to distinguish the stone tumor or narrow.Results In 51 patients with cholecystitis and cholelithiasis,36 were explorated,of which 6 had the explorative indications,4 were postive(66.6%);in 30 without the indications,3 were positive(10%).The total positvity was 19.4%.Conclusions This method is less traumatic,convenient and able to find choledochal disease accurately.The exploration would be done if the cystic duct is over 0.3 cm in diameter.

Influence of the methionine/valine-depleted enteral nutrition on tissue distribution,nucleic acids and protein metabolism in tumor-bearing rats / 肠外与肠内营养

Objectives:To investigate effect of the methionine/valine(Met/Val) depleted enteral nutrition on tissue distribution,RNA,DNA and protein metabolism in tumor bearing(TB) rats. Methods:SD rats underwent catheterization of jejunostomy.A suspension of Walker 256 sarcocarcinoma cells was subcutaneously inoculated.The TB rats were randomly divided into 4 groups:A,B,C and D.The TB rats received jejunostomy feedings supplemented with balanced amino acid,methionine/valine depleted nutnition for 6 days before injection of 7.4?10 5 Bq 3H methionine/vatine.The tissue uptake and 3H Incorporation rate of radioactity into RNA,DNA and proteins in tumor tissues at 0.5,1,2,4 h after injection were assessed. Results:①Uptakes of 3H by tumor tissues in group B at 2,4 h after injection were (8.09?0.12)% and (7.81?0.17)% respectively and they were (6.59?0.24)% and (6.16?0.06)% in group A( P

Influence of Imbalanced branched-chain Amino Acids on host nutritional and survival condition of tumor-bearing rats during chemotherapy / 肠外与肠内营养

Objective: To investigate the effects of the combination of imbalanced branched-chain amino acids and 5-fluorouracil (5-FU) on nutritional and survival condition of tumor-bearing rats. Methods: The SD rats were each given a catheterization of jejunostomy and an inoculation of Walker-256 carcinosarcoma cells subcutaneously. Forty-eight rats were randomized into 4 groups: Group A (balance amino acid + NS), Group B (balance amino acid + 5-FU), Group C (valine-depleted amino acid + 5-FU), and Group D (complex amino acid of valine-depleted and leucine-supplemented + 5-FU). The change of rat′s weight, main organ weights, serum prealbumin (PA) and transferrin (TF) concentration were investigated.In addition, rat′s survival time was observed. Results: The loss of rat′s weight in group C was significantly increased compared with group A and B (P

Diagnosis and prevention of fungal infection in severe acute pancreatitis / 中国普通外科杂志

ObjectiveTo study the early diagnosis and prevention of fungal infection in severe acute pancreatitis(SAP). Method 1.SAP patients from July 1998 to June 2002 were prospectively randomized into 3 groups: garlicin prevention group, fluconazole (low dosage) prevention group and control group, the incidence of fungal infection in SAP was compared between the groups. For fungal infection patients, the fungal clearance and mortality rate were observed. 2.Clinical data of SAP patients with fungal infection and with simple bacterial infection was compared by multivariate logistic regression, and clinical characters and risk factors of fungal infection were evaluated. Results 1.There were lower incidences of fungal infection in garlicin group (16% vs. 30%,P

Prevention and therapy of fungal infection in patients with severe acute pancreatitis / 中国普通外科杂志

Objective To determine the prevention and therapy of fungal infection in patients with severe acute pancreatitis (SAP). Methods Seventy patients with SAP admitted from July,1998 to June,2002 were randomly divided into 3 groups: garlicin prevention group, fluconazole (low dosage) prevention group and control group.The incidence of fungal infection, the fungal clearance and mortality after the treatment were compared. Results The incidence of fungal infection in garlicin group and fluconazole group was lower than that in control group. (16%∶30%,P

Effect of TNF-? and IL-1? on the evolution of pancreatic encephalopathy / 中国普通外科杂志

Objective To study the damaging effect of tumor necrosis factor-alpha (TNF-?) and Interleukin-1?(IL-1?) on brain of rats in acute pancreatitis(AP). Mothods AP pancreatitis model in rats was induced by retrograde injection of 5% sodium taurocholate into the pancreatobiliary duct(1ml/kg body weight), then pretreated with normal saline (NS) or TNF-??IL-1?, TNF-? plus IL-1? respectively. Animals were killed at 5 h after drugs administration. The changes of brain water contents, leukocyte accumulation and adhesion were measured, and pathological studies of pancreas and brain were also performed. Results In groups with inflammatory cytokines pretreated, brain water contents, leukocyte accumulation and adhesion increased more significantly than those in control group and in NS pretreated group(P0.05). Conclusions Inflammatory cytokines such as TNF-? and IL-1? play important roles in the formation and acceleration of the brain damage in acute pancreatitis.