scholarly journals 376. COVID-19 Severity in HIV+ Patients Receiving Tenofovir

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S258-S258
Author(s):  
Nora Homsi ◽  
Kendra Vermeulen ◽  
Mitchell Snyder ◽  
David J Cennimo ◽  
Alexandra Sonyey
Keyword(s):  
Severe Disease ◽  
Cd4 Count ◽  
World Health ◽  
Hiv Viral Load ◽  
Hiv Patients ◽  
Cd4 Cell Count ◽  
Mild Disease ◽  
Presenting Symptoms ◽  
Group 2 ◽  
Health Organization

Abstract Background Early in the COVID-19 pandemic, tenofovir (TAF/TDF) was identified as a potential agent for SARS-CoV-2 due to binding to RNA-dependent RNA polymerase similarly to remdesivir. This led to the hypothesis that TAF/TDF may be lessening the severity and improving outcomes of COVID-19 infection. COVID-19 Severity COVID-19 Infection Outcomes Methods Patients were identified by searching for HIV infection and SARS-CoV2 PCR testing. Type of antiretroviral therapy (ART), CD4+ cell count, HIV viral load (VL), comorbidities, presenting symptoms, severity of COVID infection, and outcomes were analyzed. COVID disease was classified as mild, moderate, severe, or critical based on World Health Organization criteria. We primarily sought to determine the effect of TAF/TDF on the severity of COVID infection. The secondary endpoint was to determine the effect of low CD4 count and HIV VL on the severity of infection. Results 39 HIV+ patients were tested at least once for SARS-CoV2 by PCR at VA NJ Health Care System. 18 of 39 patients were PCR positive. In those, common presenting symptoms included: fever (15/18), cough (7/18), and lethargy/fatigue (6/18). 16 of the 39 HIV+ patients’ ART included TAF/TDF; 8 of 18 COVID+ and 8 of 21 COVID-. In the COVID- group, 2 patients had CD4 count < 200 cells/mm3, 3 patients had HIV VL >200, and 19 of 21 had at least 1 comorbidity. In the COVID+ group, 3 had CD4 count < 200 cells/mm3, none had detectible HIV viremia, and all but one had comorbidities. Of COVID+ infections, 7 were mild, 3 moderate, 8 severe, and 5 patients died. 4 of the 5 patients that did not survive were in non-TAF/TDF group. All 3 patients with CD4 count < 200 cells/mm3 had severe disease. 6 out of 8 patients developed mild disease in TAF/TDF group vs. 1 out of 10 patients in non-TAF/TDF group. 1 out of 8 and 7 out of 10 patients had severe or critical disease in TAF/TDF vs non-TAF/TDF groups respectively. Conclusion In this sample of 18 HIV+ patients with COVID-19 infection, patients receiving TAF/TDF were more likely to develop mild disease and have full recovery than those who were on TAF/TDF-free regimens (75% vs. 10% and 87.5% vs. 50%, respectively). Patients not on TAF/TDF-based regimens had a higher rate of developing severe and critical COVID-19 disease (40% vs. 0% and 30% vs. 12.5%, respectively). Disclosures All Authors: No reported disclosures

scholarly journals PaO2/FiO2 ratio forecasts COVID-19 patients’ outcome regardless of age: a cross-sectional, monocentric study

2021 ◽  
Author(s):  
Gaia Sinatti ◽  
Silvano Junior Santini ◽  
Giovanni Tarantino ◽  
Giovanna Picchi ◽  
Benedetta Cosimini ◽  
...  
Keyword(s):  
Prognostic Score ◽  
Severe Disease ◽  
World Health ◽  
Index Test ◽  
Predictive Index ◽  
Clinical Trial Registration ◽  
Cross Sectional ◽  
Mild Disease ◽  
Reliable Parameter ◽  
Health Organization

AbstractWe studied the predictive value of the PaO2/FiO2 ratio for classifying COVID-19-positive patients who will develop severe clinical outcomes. One hundred fifty patients were recruited and categorized into two distinct populations (“A” and “B”), according to the indications given by the World Health Organization. Patients belonging the population “A” presented with mild disease not requiring oxygen support, whereas population “B” presented with a severe disease needing oxygen support. The AUC curve of PaO2/FiO2 in the discovery cohort was 0.838 (95% CI 0.771–0.908). The optimal cut-off value for distinguishing population “A” from the “B” one, calculated by Youden’s index, with sensitivity of 71.79% and specificity 85.25%, LR+4.866, LR−0.339, was < 274 mmHg. The AUC in the validation cohort of 170 patients overlapped the previous one, i.e., 0.826 (95% CI 0.760–0.891). PaO2/FiO2 ratio < 274 mmHg was a good predictive index test to forecast the development of a severe respiratory failure in SARS-CoV-2-infected patients. Moreover, our work highlights that PaO2/FiO2 ratio, compared to inflammatory scores (hs-CRP, NLR, PLR and LDH) indicated to be useful in clinical managements, results to be the most reliable parameter to identify patients who require closer respiratory monitoring and more aggressive supportive therapies. Clinical trial registration: Prognostic Score in COVID-19, prot. NCT04780373 https://clinicaltrials.gov/ct2/show/NCT04780373 (retrospectively registered).

scholarly journals Potential Prophylactic Treatments for COVID-19

Viruses ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 1292
Author(s):  
Noam Ben-Zuk ◽  
Ido-David Dechtman ◽  
Itai Henn ◽  
Libby Weiss ◽  
Amichay Afriat ◽  
...  
Keyword(s):  
World Health ◽  
Pharmaceutical Drugs ◽  
Mild Disease ◽  
Clinical Background ◽  
Repurposed Drugs ◽  
Prophylactic Use ◽  
Health Organization ◽  
Medical Indications ◽  
Respiratory Droplets ◽  
Near Future

The World Health Organization declared the SARS-CoV-2 outbreak a Public Health Emergency of International Concern at the end of January 2020 and a pandemic two months later. The virus primarily spreads between humans via respiratory droplets, and is the causative agent of Coronavirus Disease 2019 (COVID-19), which can vary in severity, from asymptomatic or mild disease (the vast majority of the cases) to respiratory failure, multi-organ failure, and death. Recently, several vaccines were approved for emergency use against SARS-CoV-2. However, their worldwide availability is acutely limited, and therefore, SARS-CoV-2 is still expected to cause significant morbidity and mortality in the upcoming year. Hence, additional countermeasures are needed, particularly pharmaceutical drugs that are widely accessible, safe, scalable, and affordable. In this comprehensive review, we target the prophylactic arena, focusing on small-molecule candidates. In order to consolidate a potential list of such medications, which were categorized as either antivirals, repurposed drugs, or miscellaneous, a thorough screening for relevant clinical trials was conducted. A brief molecular and/or clinical background is provided for each potential drug, rationalizing its prophylactic use as an antiviral or inflammatory modulator. Drug safety profiles are discussed, and current medical indications and research status regarding their relevance to COVID-19 are shortly reviewed. In the near future, a significant body of information regarding the effectiveness of drugs being clinically studied for COVID-19 is expected to accumulate, in addition to information regarding the efficacy of prophylactic treatments.

scholarly journals Health and fertility in World Health Organization group 2 anovulatory women

2012 ◽  
Vol 18 (5) ◽  
pp. 586-599 ◽  
Author(s):  
◽  
D. T. Baird ◽  
A. Balen ◽  
H. F. Escobar-Morreale ◽  
J. L. H. Evers ◽  
...  
Keyword(s):  
World Health Organization ◽  
World Health ◽  
Group 2 ◽  
Health Organization

scholarly journals 526. Clinical Presenting Characteristics of Pediatric COVID-19 Infection in a Tertiary Care Children’s Hospital in Detroit

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S330-S330
Author(s):  
Jocelyn Y Ang ◽  
Nirupama Kannikeswaran ◽  
Basim Asmar
Keyword(s):  
Mechanical Ventilation ◽  
Severe Disease ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Signs And Symptoms ◽  
Pediatric Emergency ◽  
Study Cohort ◽  
Mild Disease ◽  
Presenting Symptoms ◽  
Patient Disposition

Abstract Background There is limited data regarding the presenting clinical characteristics of COVID-19 in children. Our objective is to describe the clinical presentations and outcomes of COVID-19 infection early in the pandemic at our institution. Methods We performed a retrospective chart review of children up to 18 years who underwent testing for SARS CoV-2 from March 1st to May 10th 2020 at our pediatric emergency department. We abstracted patient’s demographics, clinical presentation, diagnostic studies and patient disposition. We classified the severity of clinical illness based on published criteria. We excluded patients diagnosed with Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19. Results SARS CoV-2 testing was performed on 481 patients of whom 43 (8.9%) tested positive. Of these, 4 were diagnosed with MIS-C. Data of 39 patients were analyzed. Patients’ demographics, co-morbidities, presenting signs and symptoms and disposition are shown in Table 1. Age range was 47 days – 18 years. Infants representing one third (14/39; 35.9%) of our study cohort. There was equal sex distribution. Asthma or obesity was present in 17 (44%). The most common presenting symptoms included fever, cough, shortness of breath and diarrhea. Chest radiograph showed pneumonia in 12 (30.8%) patients. Two thirds (27/39; 69.2%) were asymptomatic or had mild disease; six patients (15.4%) had severe or critical illness (Figure 1). Nineteen (48%) patients were admitted to the general pediatric service. Eleven (28%) were admitted to the Intensive Care Units (ICU). The characteristics, presenting symptoms and interventions performed in the PICU cohort are shown in Table 2. Half of these patients required mechanical ventilation. There was one death in a 3 month old infant unrelated to SARS CoV-2. Majority of the infants required hospitalization (12/14; 85.7%), including 4 to the PICU (one each for non accidental trauma, ingestion, seizure and pneumonia). Table 1. Patient demographics, signs and symptoms of COVID-19 infection in Children Table 2: PICU patients: Characteristics, Interventions and pharmacotherapy Figure 1: Severity of Ill ness in the study cohort Conclusion Majority (17; 43%) of our children with COVID-19 had a mild disease. Eleven (28%) including 4 infants required critical care; 5 required mechanical ventilation. There was no COVID-19 related mortality. Larger studies are needed to further define the spectrum of COVID- 19 and risk factors associated with severe disease in children. Disclosures All Authors: No reported disclosures

scholarly journals When to resume bariatric surgery after COVID-19 pandemic?: results of patients’ and surgeons’ survey

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Alicja Dudek ◽  
Michał Wysocki ◽  
Maciej Walędziak ◽  
Jacek Szeliga ◽  
Monika Proczko-Stepaniak ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Body Mass Index ◽  
World Health ◽  
Online Surveys ◽  
The World ◽  
Bariatric Patients ◽  
Group 2 ◽  
Health Organization ◽  
Current Body Mass Index ◽  
Group 1

Abstract Background Coronavirus Disease 2019 is affecting most countries around the world, including Poland. In response, all elective surgeries have been postponed. We asked patients and surgeons when they want bariatric surgery to resume after pandemic. The main aim of the study was to determine patients’ and surgeons’ expectations about when to resume bariatric surgery regarding COVID-19 pandemic state. Methods The study was conducted in two groups: Group 1—bariatric patients; Group 2—bariatric surgeons. Two online surveys were distributed. Results A total of 895 patients, 299 before, 596 after surgery and 32 surgeons took part in survey. All patients and surgeons declared willingness to resume bariatric surgeries after pandemic and responded that they should be resumed immediately the World Health Organization announces end of pandemic (42%). The majority of patients before surgery answered that bariatric procedures should be resumed immediately the number of daily incidents begins to decrease (53%). In the patient group, current body mass index (p < 0.001) and contact with COVID+/quarantined persons (p < 0.001) had impact on the response to resumption of bariatric procedures. Conclusions Patients opted to wait for bariatric surgery until the oncological queue has become shorter. Surgeons presented a readiness to resume both procedures in parallel.

scholarly journals When to Resume Bariatric Surgery after COVID-19 Pandemic? – Results of Patients’ and Surgeons’ Survey.

2020 ◽  
Author(s):  
Aicja Dudek ◽  
Alicja Dudek ◽  
Michał Wysocki ◽  
Maciej Walędziak ◽  
Jacek Szeliga ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Body Mass Index ◽  
World Health ◽  
Online Surveys ◽  
The World ◽  
Bariatric Patients ◽  
Group 2 ◽  
Health Organization ◽  
Current Body Mass Index ◽  
Group 1

Abstract BackgroundCOVID-19 is affecting most countries around the world, including Poland. In response, all elective surgeries have been postponed. We asked patients and surgeons when they want bariatric surgery to resume after pandemic. The main aim of the study was to determine patients’ and surgeons’ expectations about when to resume bariatric surgery regarding COVID-19 pandemic state.MethodsThe study was conducted in two groups: Group 1 – bariatric patients; Group 2 – bariatric surgeons. Two online surveys were distributed.Results A total of 895 patients, 299 before, 596 after surgery and 32 surgeons took part in survey. All patients and surgeons declared willingness to resume bariatric surgeries after pandemic and responded that they should be resumed immediately the World Health Organization announces end of pandemic (42%). The majority of patients before surgery answered that bariatric procedures should be resumed immediately the number of daily incidents begins to decrease (53%). In the patient group, current body mass index (p<0.001) and contact with COVID+/quarantined persons (p<0.001) had impact on the response to resumption of bariatric procedures.ConclusionsPatients opted to wait for bariatric surgery until the oncological queue has become shorter. Surgeons presented a readiness to resume both procedures in parallel.

scholarly journals Prevalence and Mortality of Cryptococcal Disease in Adults with Advanced HIV in an Urban Tertiary Hospital in Sierra Leone: A Prospective Study

2019 ◽  
Author(s):  
Sulaiman Lakoh ◽  
Hannah Rickman ◽  
Momodu Sesay ◽  
Sartie Kenneh ◽  
Rachael M. Burke ◽  
...  
Keyword(s):  
Sierra Leone ◽  
Tertiary Hospital ◽  
Cross Sectional Study ◽  
Cd4 Count ◽  
Sub Saharan Africa ◽  
World Health ◽  
Categorical Variables ◽  
Hiv Patients ◽  
Cross Sectional ◽  
Cryptococcal Disease

Abstract Background The global annual estimate for cryptococcal disease related deaths exceeds 180,000, with three fourth occurring in sub-Saharan Africa. The World Health Organization (WHO) recommends cryptococcal antigen (CrAg) screening in all HIV patients with CD4 count <100/µl. As there is no previous published study on the burden and impact of cryptococcal disease in Sierra Leone, research is needed to inform public health policies. We aimed to establish the seroprevalence and mortality of cryptococcal disease in adults with advanced HIV attending an urban tertiary hospital in Sierra Leone. MethodsA cross-sectional study design was used to screen consecutive adult (18 years or older) HIV patients at Connaught Hospital in Freetown, Sierra Leone with CD4 count below 100 cells/mm3 from January to April, 2018. Participants received a blood CrAg lateral flow assay (IMMY, Oklahoma, USA). All participants with a positive serum CrAg had lumbar puncture and cerebrospinal fluid (CSF) CrAg assay, and those with cryptococcal diseases had fluconazole monotherapy with eight weeks followed up. Data were entered into Excel and analysed in Stata version 13.0. Proportions, median and interquartile ranges were used to summarise the data. Fisher’s exact test was used to compare categorical variables. Results A total of 170 patients, with median age of 36 (IQR 30-43) and median CD4 count of 45 cells/mm3 (IQR 23-63) were screened. At the time of enrolment, 54% were inpatients, 51% were newly diagnosed with HIV, and 56% were either ART-naïve or newly initiated (≤ 30 days). Eight participants had a positive blood CrAg, giving a prevalence of 4.7% (95% CI: 2.4-9.2%). Of those with a positive CrAg, CSF CrAg was positive in five (62.5%). Five (62.5%) CrAg-positive participants died within the first month, while the remaining three were alive and established on ART at eight weeks. ConclusionA substantial prevalence of cryptococcal antigenaemia and poor outcome of cryptococcal disease were demonstrated in our study. The high mortality suggests a need for the HIV programme to formulate and implement policies on screening and pre-emptive fluconazole therapy for all adults with advanced HIV in Sierra Leone, and advocate for affordable access to effective antifungal therapies.

scholarly journals Mucocutaneous disorders in HIV/AIDS at a tertiary care hospital in Nepal: An observational study

2021 ◽  
Vol 12 (2) ◽  
pp. 101-105
Author(s):  
Prabhat Singh Rajput ◽  
Anil Kumar Das ◽  
Upama Paudel ◽  
Sudip Parajuli
Keyword(s):  
Viral Infections ◽  
Fungal Infections ◽  
Seborrheic Dermatitis ◽  
Cd4 Count ◽  
World Health ◽  
Care Hospital ◽  
Hiv Patients ◽  
Oral Ulcers ◽  
The Mean ◽  
Hiv Aids

Background: Mucocutaneous manifestations in HIV infections are common. However, they have not, so far, been studied in Nepal. The aim of this study was, therefore, to describe mucocutaneous manifestations in Nepalese HIV patients. Materials and Methods: The following is a hospital-based, descriptive, cross-sectional study conducted in the Department of Dermatology and Venereology and Antiretroviral Treatment (ART) Center of Tribhuvan University Teaching Hospital (TUTH) from May 2017, through October 2018. Patients aged 16 years and above diagnosed with HIV were included in the study, for whom history and clinical examinations were performed. The study variables were age, sex, a clinical diagnosis of dermatological problems, clinical stages of HIV/AIDS, as per the World Health Organization (WHO) classification criteria, and the CD4 count. Results: A total of 52 patients were included in the study. The mean age upon presentation was 38.77 ± 10.9 years. The mean CD4 count was 464.27 ± 255.13. Females were more affected than males (female:male = 1.4:1). Mucocutaneous manifestations were the following: fungal infections (10; 19.3%), viral infections (6; 11.6%), parasitic infestations (3; 5.8%), bacterial infections (4; 7.7%), sexually transmitted infections (2; 3.8%), seborrheic dermatitis (3; 5.8%), idiopathic pruritus (3; 5.8%), recurrent oral ulcers (3; 5.8%), urticaria (3; 5.8%), pruritic papular eruptions (2; 3.8%), eczemas (2; 3.8%), acne (2; 3.8%), angular cheilitis (2; 3.8%), xerosis cutis (2; 3.8%), and others (5; 9.6%). Conclusions: The study showed that fungal infections are common in HIV patients, followed by viral infections and parasitic infestations. Seborrheic dermatitis, idiopathic pruritus, recurrent oral ulcers, and urticaria were found to be common inflammatory skin diseases in HIV.

scholarly journals Comparative Analysis of Pediatric COVID-19 Infection in Southeast Asia, South Asia, Japan, and China

2021 ◽  
Author(s):  
Judith Ju Ming Wong ◽  
Qalab Abbas ◽  
Soo Lin Chuah ◽  
Ririe Fachrina Malisie ◽  
Kah Min Pon ◽  
...  
Keyword(s):  
Risk Factors ◽  
South Asia ◽  
Cultural Practices ◽  
Severe Disease ◽  
Clinical Manifestations ◽  
World Health ◽  
Logistic Regression Models ◽  
Clinical Presentations ◽  
The Common ◽  
Health Organization

There is a scarcity of data regarding coronavirus disease 2019 (COVID-19) infection in children from southeast and south Asia. This study aims to identify risk factors for severe COVID-19 disease among children in the region. This is an observational study of children with COVID-19 infection in hospitals contributing data to the Pediatric Acute and Critical Care COVID-19 Registry of Asia. Laboratory-confirmed COVID-19 cases were included in this registry. The primary outcome was severity of COVID-19 infection as defined by the World Health Organization (WHO) (mild, moderate, severe, or critical). Epidemiology, clinical and laboratory features, and outcomes of children with COVID-19 are described. Univariate and multivariable logistic regression models were used to identify risk factors for severe/critical disease. A total of 260 COVID-19 cases from eight hospitals across seven countries (China, Japan, Singapore, Malaysia, Indonesia, India, and Pakistan) were included. The common clinical manifestations were similar across countries: fever (64%), cough (39%), and coryza (23%). Approximately 40% of children were asymptomatic, and overall mortality was 2.3%, with all deaths reported from India and Pakistan. Using the multivariable model, the infant age group, presence of comorbidities, and cough on presentation were associated with severe/critical COVID-19. This epidemiological study of pediatric COVID-19 infection demonstrated similar clinical presentations of COVID-19 in children across Asia. Risk factors for severe disease in children were age younger than 12 months, presence of comorbidities, and cough at presentation. Further studies are needed to determine whether differences in mortality are the result of genetic factors, cultural practices, or environmental exposures.

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