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BACKGROUND: The trauma mortality rate is higher in the elderly compared with younger patients. Ageing is associated with physiological changes in multiple systems and correlated with frailty. Frailty is a risk factor for mortality in elderly trauma patients. We aim to provide evidence-based guidelines for the management of geriatric trauma patients to improve it and reduce futile procedures. METHODS: Six working groups of expert acute care and trauma surgeons reviewed extensively the literature according to the topic and the PICO question assigned. Statements and recommendations were assessed according to the GRADE methodology and approved by a consensus of experts in the field at the 10th international congress of the WSES in 2023. RESULTS: The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage, including drug history, frailty assessment, nutritional status, and early activation of trauma protocol to improve outcomes. Acute trauma pain in the elderly has to be managed in a multimodal analgesic approach, to avoid side effects of opioid use. Antibiotic prophylaxis is recommended in penetrating (abdominal, thoracic) trauma, in severely burned and in open fractures elderly patients to decrease septic complications. Antibiotics are not recommended in blunt trauma in the absence of signs of sepsis and septic shock. Venous thromboembolism prophylaxis with LMWH or UFH should be administrated as soon as possible in high and moderate-risk elderly trauma patients according to the renal function, weight of the patient and bleeding risk. A palliative care team should be involved as soon as possible to discuss the end of life in a multidisciplinary approach considering the patients directives, family feelings and representatives desires, and all decisions should be shared. CONCLUSIONS: The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage based on assessing frailty and early activation of trauma protocol to improve outcomes. Geriatric Intensive Care Units are needed to care for elderly and frail trauma patients in a multidisciplinary approach to decrease mortality and improve outcomes.

Abstract Ibogaine and its main metabolite noribogaine provide important molecular prototypes for markedly different treatment of substance use disorders and co-morbid mental health illnesses. However, these compounds present a cardiac safety risk and a highly complex molecular mechanism. We introduce a class of iboga alkaloids – termed oxa-iboga – defined as benzofuran-containing iboga analogs and created via structural editing of the iboga skeleton. The oxa-iboga compounds lack the proarrhythmic adverse effects of ibogaine and noribogaine in primary human cardiomyocytes and show superior efficacy in animal models of opioid use disorder in male rats. They act as potent kappa opioid receptor agonists in vitro and in vivo, but exhibit atypical behavioral features compared to standard kappa opioid agonists. Oxa-noribogaine induces long-lasting suppression of morphine, heroin, and fentanyl intake after a single dose or a short treatment regimen, reversal of persistent opioid-induced hyperalgesia, and suppression of opioid drug seeking in rodent relapse models. As such, oxa-iboga compounds represent mechanistically distinct iboga analogs with therapeutic potential.

IntroductionHealth information systems (HISs) should provide accessible and high-quality information to patients. However, the challenge lies in understanding patients’ trust preferences for health information. This study explores how different information sources (e.g., online platforms, interpersonal sources) are trusted under varying health conditions, focusing on symptom intensity and disease type.MethodsUsing a 2 × 2 × 4 between-subject design, 243 participants from a US college were presented with vignettes of acute or chronic diseases with varying symptom intensities and information sources. Participants rated their trust levels, including both cognitive and behavioral trust, in the health information and recommendations provided by one of the information sources, which was randomly assigned. Logistic regression and ANOVA were employed for the statistical analysis.ResultsThe analysis results revealed that trust is generally higher for interpersonal sources like doctors and family/friends compared to online sources like WebMD and Wikipedia when patients are making health decisions. Doctors are the most trusted source during health-related decision making. However, there are no significant differences in cognitive trust among interpersonal sources or among online sources. Furthermore, symptom intensity and disease type did not significantly alter trust levels across various information sources. These findings suggest that people prefer professional medical advice regardless of their health conditions.DiscussionThe study highlights the need for HIS to incorporate features that provide “doctor-verified” information and promote interactive engagement to enhance patients’ trust in information source. Additionally, it distinguishes between cognitive and behavioral trust, revealing distinct trust patterns that can inform the strategic development of HIS for varied health conditions. Understanding these trust dynamics can inform the design of effective, patient-centered HIS that better support health education, information seeking, and decision-making.

Uvod: Uporaba naprednega procesa zdravstvene nege predstavlja za medicinske sestre v praksi velik izziv, zato so bile za njih organizirane učne delavnice za uvedbo standardiziranih jezikov zdravstvene nege. Namen raziskave je bil ugotoviti izkušnje medicinskih sester z zvedenim izobraževanjem. Metode: Uporabljena je bila kvalitativna deskriptivna metoda. Instrument za zbiranje podatkov je bil evalvacijski list s tremi odprtimi vprašanji. V priložnostni vzorec je bilo vključenih 160 medicinskih sester, ki so se udeležile serije učnih delavnic v letih 2020 in 2021. Kvalitativna analiza zapisov je bila izvedena s tematsko mrežo. Rezultati: Na osnovi analize zapisov je bilo oblikovano tematsko omrežje »izkušnje udeležencev z učno delavnico« z dvema skupnima temama: »izvedba učne delavnice« in «uporaba v praksi«. V okviru prve skupne teme so bile izkušnje udeležencev večinsko pozitivne, negativno je bilo ocenjeno le gradivo. V okviru druge skupne teme so prevladovali predlogi za uvedbo naprednega procesa zdravstvene nege v prakso, negativne izkušnje so se nanašale na zahtevnost vsebine, pozitivne pa na vpogled v znanja prihodnosti. Diskusija in zaključek: Udeleženci učnih delavnic so bili v večini zadovoljni z izvedbo učnih delavnic za uvedbo naprednega procesa zdravstvene nege, hkrati so izrazili tudi skrb o utemeljenosti uvajanja standardiziranega jezika v prakso v trenutni okoliščini pomanjkanja medicinskih sester. Nadaljevati je treba s sistematičnim formalnim, kot tudi neformalnim izobraževanjem medicinskih sester, ki delujejo v klinični praksi, pri čemer je za doseganje večjega učinka in večje motiviranosti treba uporabiti udeležencem prilagojene načine izobraževanja.

The forest floor is covered with tree canopy, and the forest canopy gap is a larger or smaller area of the floor that is not covered by the canopy of the dominant tree layer. The size of the gap affects tree species rejuvenation, as well as the vertical and horizontal structure of the forest. In the Pohorje area (Pahernik’s forest estate), which is characterized by forests where trees of different diameters and ages occur in small areas, we analyzed the possibilities of automatic gap detection based on data from the Laser Scanning of Slovenia (LSS) and the Cyclic Aerial Survey of Slovenia (CAS). We used Canopy Height Models (CHM) derived from both data sources. The overall detection accuracy even for the smallest gaps (smaller than 50 m2) was 94.4% based on the LSS data and 83.1% based on the CAS data. A larger number and area of gaps can be detected based on the LSS data, and the gaps derived from the LSS data are more disaggregated and elongated. The detection of gaps with CAS data and LSS data is more comparable with a minimum gap area of 100 m²; the accuracy of detecting such gaps is 85.4 and 94.4 % respectively. The results of the study show that in the absence of LSS data, the use of CAS data to detect forest canopy gaps on a large scale is useful when gaps with an area of more than 100 m² are detected.

Abstract Background The trauma mortality rate is higher in the elderly compared with younger patients. Ageing is associated with physiological changes in multiple systems and correlated with frailty. Frailty is a risk factor for mortality in elderly trauma patients. We aim to provide evidence-based guidelines for the management of geriatric trauma patients to improve it and reduce futile procedures. Methods Six working groups of expert acute care and trauma surgeons reviewed extensively the literature according to the topic and the PICO question assigned. Statements and recommendations were assessed according to the GRADE methodology and approved by a consensus of experts in the field at the 10th international congress of the WSES in 2023. Results The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage, including drug history, frailty assessment, nutritional status, and early activation of trauma protocol to improve outcomes. Acute trauma pain in the elderly has to be managed in a multimodal analgesic approach, to avoid side effects of opioid use. Antibiotic prophylaxis is recommended in penetrating (abdominal, thoracic) trauma, in severely burned and in open fractures elderly patients to decrease septic complications. Antibiotics are not recommended in blunt trauma in the absence of signs of sepsis and septic shock. Venous thromboembolism prophylaxis with LMWH or UFH should be administrated as soon as possible in high and moderate-risk elderly trauma patients according to the renal function, weight of the patient and bleeding risk. A palliative care team should be involved as soon as possible to discuss the end of life in a multidisciplinary approach considering the patient’s directives, family feelings and representatives' desires, and all decisions should be shared. Conclusions The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage based on assessing frailty and early activation of trauma protocol to improve outcomes. Geriatric Intensive Care Units are needed to care for elderly and frail trauma patients in a multidisciplinary approach to decrease mortality and improve outcomes. Graphical abstract

Otroci in mladostniki zaradi različnih izkušenj, pričakovanj, kognitivnih sposobnosti in razumevanja zdravstvene obravnave, le to pogosto odklanjajo in se na različne pristope zdravstvenega osebja lahko odzovejo agresivno. Kadar je otrok ali mladostnik v slabem telesnem stanju, prestrašen, pod vpli-vom psihopatološkega doživljanja ali različnih psihoaktivnih snovi, je verjetnost za agresiven odziv večja. Obravnava zato zaposlenim predstavlja kompleksen izziv, ki zahteva individualen in celosten pristop. Najpomembnejši cilj zdravstvene nege je vzpostavitev varnega okolja. Ta pripomore, da otrok ali mladostnik ostane nepoškodovan, oziroma da se prepreči poslabšanje trenutnega psihičnega stanja, zaradi katerega je bil sprejet na enoto. Varnost se zagotavlja z vrsto sočasno potekajočih intervencij zdravstvene nege. Na Enoti za intenzivno otroško in adolescentno psihiatrijo so v ta namen prostori tehnično prilagojeni. Med obravnavo zaposleni uporabljajo deeskalacijske tehnike, s katerimi ustvarjajo terapevtsko okolje, ki omogoča otrokom in mladostnikom izraziti stisko na varen način. V pomoč so tudi lestvice za ugotavljanje napovednih dejavnikov za pojav avto ali heteroagresivnega vedenja. Po navodilu zdravnika se ob stopnjevanju agresivnega vedenja aplicira zdravilo in/ali v skrajnem primeru uvede posebni varovalni ukrep. Ta je definiran v Zakonu o duševnem zdravju in se izvede v skladu s Standardom zdravstvene nege in Nacionalnim protokolom Zbornice zdravstvene in babiške nege Slovenije.

Children and adolescents often reject healthcare interven-tions due to various experiences, expectations, cognitive abilities and understanding of medical treatment. They may respond aggressively to different approaches from healthcare staff. The likelihood of an aggressive response is particularly high when a child or adolescent is in poor physical condition, frightened, under the influence of psychopathological experiences or psychoactive substances. Managing such situations poses a complex challenge for healthcare professionals, requiring an individualized and holistic approach. The goal of healthcare is to establish a safe environment. This ensures that the child or adolescent remains uninjured and it prevents worsening of the current mental state for which they were admitted. Safety is ensured through a series of concurrent nursing interventions. The facilities at the Unit for Intensive Child and Adolescent Psychiatry are therefore technically adapted. During treatment, staff employ de-escalation techniques to create a therapeutic environment, allowing children and adolescents to express distress in a safe manner. Predictive factor scales for the occurrence of auto or heteroaggressive behavior are also used. Following the doctor's instructions, medications are administered in cases of escalating aggressive behavior, and/or in extreme cases, a specific protective measure is implemented in accordance with legal standards and nursing protocols.

U članku je analizirano na koji način je u javnom prostoru bosanskohercegovačkog entiteta Republika Srpska artikulisan odnos prema zločinu u Srebrenici iz jula 1995. godine, koji je odlukama Međunarodnog suda pravde i Međunarodnog suda za bivšu Jugoslaviju okvalifikovan kao zločin genocida. Predstavljeno je preplitanje samostalnih inicijativa i aktivnosti lokalnih zajednica na obeležavanju rata 1992–1995, sa zaključcima tri zvanična izveštaja o Srebrenici: Biroa vlade RS za odnose sa Haškim tribunalom vlade Republike Srpske (2002), Komisije za istraživanje događaja u i oko Srebrenice od 10. do 19. jula 1995. godine (2004) i Nezavisne međunarodne komisije za istraživanje stradanja svih naroda u srebreničkoj regiji u periodu 1992–1995. godine (2021).

Soil water repellency (SWR) significantly affects plant growth, along with surface and subsurface hydrology, posing a challenge for agricultural productivity and environmental sustainability. Nowadays, the occurrence of microplastics (MP) in the environment, particularly from agricultural practices, raises concerns about MP impact on soil properties. Among them, SWR is affected by hydrophobicity of MP particles detected in soils. This study introduces a method and presents results of a screening test to assess the effects of MP on SWR, utilizing Water Drop Penetration Time (WDPT) analysis under controlled laboratory conditions in destructed soil samples. We compared SWR of two soil types differing in portion of sand, loam and clay. Soils were mixed with three different types of MP originating from agricultural mulch films: low-density polyethylene (LDPE), biodegradable polybutylene adipate terephthalate (PBAT), and starch-based biodegradable plastics (Starch). The MP were milled to a uniform size range of some 10 to 300 μm and mixed with the soil samples. WDPT measurements were taken immediately after mixing and recorded for up to 60 s in order to find MP concentration levels at which strongly or more severely water repellency is inducted on soil samples. Our findings reveal that both, soil type and MP type significantly influence SWR, where there are notable differences observed between bio-based (Starch based) and non-bio-based (LDPE and PBAT) plastics’ effects on SWR in the two tested soil types. Data highlights the distinct behaviour of Starch in altering soil hydrophobicity, prominently different from the impact of both PBAT and LDPE. The measurement technique we have developed for quantifying SWR levels could be used for both research applications and the dissemination of findings. It can significantly enhance decision-making processes regarding the selection of optimal plastic alternatives for agricultural use.

BackgroundUrogenital schistosomiasis caused by Schistosoma haematobium is highly endemic in the municipality of Cubal in Angola. Currently, diagnosis is based on the observation of S. haematobium eggs in urine samples by microscopy but this method has low sensitivity. Few studies have been performed using molecular techniques in high-prevalence areas for the detection of S. haematobium. The objective of this study is to evaluate the usefulness of real-time PCR as a diagnostic technique for urogenital schistosomiasis among preschool-age children and its correlation with morbidity data.MethodsA cross-sectional study was conducted in Cubal, Angola, involving 97 urine samples from preschool-age children analyzed by the dipstick test, microscopic examination of filtered urine, and real-time PCR. The diagnosis of urogenital schistosomiasis was based on microscopy and/or real-time PCR results. Clinical and ultrasonography evaluation was performed to rule out complications of schistosomiasis.ResultsWe detected a total of 64.95% of samples positive by real-time PCR and 37.11% by microscopy. The sensitivity of parasitological diagnosis of urogenital schistosomiasis by real-time PCR and microscopy was 95.45% and 54.55%, respectively, and the sensitivity of real-time PCR compared with microscopy was 91.67%. A positive real-time PCR result was significantly related to older age (mean = 3.22 years), detection of eggs by microscopy, and abnormal urine dipstick results (18.56% with proteinuria, 31.96% with leukocyturia, and 31.96% with microhematuria) (p-valueConclusionsReal-time PCR is a more sensitive technique than microscopy for urinary schistosomiasis diagnosis in preschool-age children in Cubal. This increase in sensitivity would allow earlier diagnosis and treatment, thus reducing the morbidity associated with schistosomiasis in its early stages.

The use of modern irrigation systems and monitoring of soil water status can help improve crop performance and water use efficiency. The influence of different irrigation treatments on soil water content dynamics and olive oil yield was studied over two growing seasons using a surface drip irrigation system in an olive grove in northern Mediterranean climate. Irrigation treatments included optimal irrigation, sustained deficit irrigation (33 % of optimal irrigation), and rainfed treatment. Based on the water applied, we calculated the percentage of replenished estimated evapotranspiration (ETc*) for each treatment using the Penman-Monteith method. Soil water content dynamics were monitored with capacitive probes at five depths (10 to 50 cm). The increase in soil water content at a depth of 30 to 50 cm, which was only achieved with optimal irrigation, resulted in a significantly higher olive oil yield. In contrast, deficit irrigation, despite the addition of water, did not lead to an increase in soil water in the layers below 30 cm, so that the yield was equal to that of rainfed treatment. In irrigated olive groves, it is beneficial to monitor the water content of the soil at several depths to ensure that a sufficient amount of water has been applied.

In Slovenia, the National Forest Inventory (NFI) is used to monitor the state and development of forests at the national level. In this paper, we analysed the diversity of tree and shrub species and assessed the presence of non-native tree species in Slovenian forests. According to the literature, Slovenia hosts 71 autochthonous tree species, of which 60 were found among the trees measured on the 2 x 2 km NFI density plot grid. The highest average number of trees and shrubs, as well as the Shannon-Wiener index of species diversity, were observed in sample plots located in the Pre-Alpine Ecological Region (H’ = 0.85), while the lowest values were found in the Alpine Ecological Region (H’ = 0.58). The total growing stock of trees and shrubs in Slovenia is 330.7 m3/ha ± 2.1%, with the growing stock of small trees and shrubs (less than 10 cm DBH for trees and shrubs) estimated at 9.7 m3/ha ± 5.9%. Common beech (Fagus sylvatica) (31.9%) and Norway spruce (Picea abies) (28.2%) dominate the growing stock of tree and shrub species, while common hazel (Corylus avellana) (85.0%) represents the highest proportion of shrub species. Ten different non-native tree species were identified across 138 NFI plots, with the highest distributions in the Sub-Mediterranean and Pre-Pannonian Ecological Regions. Black locust (Robinia pseudoacacia) dominates the growing stock of non-native tree species. Among small trees (those with a DBH of less than 10 cm), common beech represents 32.4%, with Norway spruce and manna ash (Fraxinus ornus) each contributing more than 10.0%. The growing stock of small shrub species (shrubs with a DBH of less than 10 cm) is dominated by common hazel (Corylus avellana) with 78.3%, while more than 2% is also represented by cornel (Cornus mas), old man’s beard (Clematis vitalba) and elderberry (Sambucus nigra). The results show that the combination of a panel system, a large number of sample plots (3027) and an improved coding system enabled the first comprehensive and objective assessment of tree and shrub species diversity, as well as the presence of non-native species in Slovenian forests.

Tourniquets have traditionally been used in orthopaedic surgery to control bleeding and increase visibility in the intraoperative surgical field (1, 2, 3, 4). An increasing body of evidence has grown regarding the potential risks associated with their use. This is somewhat foreseeable given their mechanism of action: sustained circumferential pressure to occlude arterial flow resulting in reduced perfusion distal to the site of application. Laboratory research and studies in the adult population have shown that tourniquet use triggers changes in blood pressure and heart rate (5, 6), cerebral perfusion (7), coagulation (8, 9, 10), and core temperature (11). Local adverse effects include injury to muscle, blood vessels, nerves, and skin (2, 12, 13, 14, 15). Tourniquet use has also been associated with increased post-operative pain (16, 17, 18), longer length of hospital stay (16, 19), increased risk of wound infection and wound complications (19, 20), thromboembolic events (16, 18, 20), and compartment syndrome (16, 21). If not carefully sealed off, the accumulation of antiseptic surgical wash beneath the tourniquet during limb preparation can result in soft tissue damage and chemical burns (22).

BACKGROUND: Patients presenting with acute abdominal pain that occurs after months or years following bariatric surgery may present for assessment and management in the local emergency units. Due to the large variety of surgical bariatric techniques, emergency surgeons have to be aware of the main functional outcomes and long-term surgical complications following the most performed bariatric surgical procedures. The purpose of these evidence-based guidelines is to present a consensus position from members of the WSES in collaboration with IFSO bariatric experienced surgeons, on the management of acute abdomen after bariatric surgery focusing on long-term complications in patients who have undergone laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass. METHOD: A working group of experienced general, acute care, and bariatric surgeons was created to carry out a systematic review of the literature following the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) and to answer the PICO questions formulated after the Operative management in bariatric acute abdomen survey. The literature search was limited to late/long-term complications following laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass. CONCLUSIONS: The acute abdomen after bariatric surgery is a common cause of admission in emergency departments. Knowledge of the most common late/long-term complications (> 4 weeks after surgical procedure) following sleeve gastrectomy and Roux-en-Y gastric bypass and their anatomy leads to a focused management in the emergency setting with good outcomes and decreased morbidity and mortality rates. A close collaboration between emergency surgeons, radiologists, endoscopists, and anesthesiologists is mandatory in the management of this group of patients in the emergency setting.

The brown marmorated stink bug, Halyomorpha halys Stål, is an invasive Pentatomidae species that causes damage to economically important agricultural crops. It originated in East Asia but has successfully spread to many European countries. It has been present in Croatia since 2017, and its first mass emergence was detected in a soybean field in 2019. Therefore, the aim of this study was to determine the occurrence and population size of H. halys in perennial crops in important fruit growing areas in Croatia. According to the monitoring data, H. halys was detected in all surveyed areas and crops (apple, apricot, cherry, fig, grapevine, pear, plum, olive, and hazelnut). The largest population size was detected for hazelnut in the locality of Tovarnik, Vukovar-Syrmia County (79 individuals), for pear in the locality of Marijanci, Osjek-Baranja County (31 individuals), and for apple in the locality of Staro Čiče, Zagreb County (25 individuals). In view of the fact that the weekly catches at some monitoring sites exceeded the established treatment threshold, control measures must be taken to prevent an increase in the population and significant damage in the future. In addition to hazelnuts, crops such as pears, apples and cherries are particularly threatened by this pest.

Abstract Genome duplication is essential for the proliferation of cellular life and this process is generally initiated by dedicated replication proteins at chromosome origins. In bacteria, DNA replication is initiated by the ubiquitous DnaA protein, which assembles into an oligomeric complex at the chromosome origin (oriC) that engages both double-stranded DNA (dsDNA) and single-stranded DNA (ssDNA) to promote DNA duplex opening. However, the mechanism of DnaA specifically opening a replication origin was unknown. Here we show that Bacillus subtilis DnaAATP assembles into a continuous oligomer at the site of DNA melting, extending from a dsDNA anchor to engage a single DNA strand. Within this complex, two nucleobases of each ssDNA binding motif (DnaA-trio) are captured within a dinucleotide binding pocket created by adjacent DnaA proteins. These results provide a molecular basis for DnaA specifically engaging the conserved sequence elements within the bacterial chromosome origin basal unwinding system (BUS).

Skin and soft-tissue infections (SSTIs) encompass a variety of pathological conditions that involve the skin and underlying subcutaneous tissue, fascia, or muscle, ranging from simple superficial infections to severe necrotizing infections.Together, the World Society of Emergency Surgery, the Global Alliance for Infections in Surgery, the Surgical Infection Society-Europe, The World Surgical Infection Society, and the American Association for the Surgery of Trauma have jointly completed an international multi-society document to promote global standards of care in SSTIs guiding clinicians by describing reasonable approaches to the management of SSTIs.An extensive non-systematic review was conducted using the PubMed and MEDLINE databases, limited to the English language. The resulting evidence was shared by an international task force with different clinical backgrounds.

In this study, we pioneered the synthesis of nanoflower-shaped TiO2-supported Au photocatalysts and investigated their properties. Au nanoflowers (Au NFs) were prepared by a Na-citrate and hydroquinone-based preparation method, followed by wet impregnation of the derived Au NFs on the surface of TiO2 nanorods (TNR). A uniform and homogeneous distribution of Au NFs was observed in the TNR + NF(0.7) sample (lower Na-citrate concentration), while their distribution was heterogeneous in the TNR + NF(1.4) sample (higher Na-citrate concentration). The UV-Vis DR spectra revealed the size- and shape-dependent optical properties of the Au NFs, with the LSPR effect observed in the visible region. The solid-state EPR spectra showed the presence of Ti3+, oxygen vacancies and electron interactions with organic compounds on the catalyst surface. In the case of the TNR + NF(0.7) sample, high photocatalytic activity was observed in the H2-assisted reduction of NO2 to N2 at room temperature under visible-light illumination. In contrast, the TNR + NF(1.4) catalyst as well as the heat-treated samples showed no ability to reduce NO2 under visible light, indicating the presence of deformed Au NFs limiting the LSPR effect. These results emphasized the importance of the choice of synthesis method, as this could strongly influence the photocatalytic activity of the Au NFs.

Abstract We conducted a nationwide longitudinal observational study to estimate the incidence of syphilis in a cohort of male persons living with HIV (MLWH) in Croatia in the pre-COVID-19 and COVID-19 years. Data were reviewed and extracted from the clinical database. We analyzed 1187 MLWH (≥ 18 years) in care in Croatia from 2018 to 2021 and used Poisson regression to calculate rates. We observed a 91.4% increase in incidence between 2019 and 2020; the overall rate was 6.0/100 person-years, and the annual rate ranged from 3.3/100 person-years in 2018 to 9.3/100 person-years in 2021. We found higher rates in men who have sex with men, MLWH with a baseline history of syphilis, MLWH with a more recent HIV diagnosis, and a lower rate in those who had clinical AIDS. The rate of syphilis serological testing was 3.5% lower in 2020 compared to 2019. Recurrent syphilis was more likely asymptomatic compared to the first episodes. In conclusion, during the COVID-19 epidemic years, there was a huge increase in syphilis. Results highlight the need for enhanced and novel prevention interventions.