Preliminary reports described a reduction in non-COVID admissions during the first wave of the pandemic including some of critical diseases such as cancer, myocardial and cerebral infarction.
The aim ...of our study was to evaluate the impact of the COVID-19 pandemic on non-COVID in-hospital admissions in a large academic center in Belgium.
We performed a retrospective study of non-COVID-19 in-hospital admissions during the first two waves of the COVID-19 pandemic. The average number of admissions per week in 2020 has been compared to that of the same period in 2019 and 2018. Comparisons were made first for all admissions, then by disease groups, using the classification of APRDRG, and then by diagnoses using ICD-10-CM classification.
Overall in-hospital admissions were reduced by around 39% and 29% during the first and the second waves of the COVID-19 pandemic respectively compared to 2018 and 2019. No significant difference was found between the average number of admissions in the early-COVID and the pre-COVID baseline period during the two waves. The average number of admissions was significantly reduced in the peak-COVID period compared to the baseline (first wave: 332 versus 763 admissions/week, p<0.01, -57%; second wave: 496 versus 788 admissions/week, p<0.01, -37%), as well as in the late-COVID period compared to the baseline (first wave: 412 versus 763 admissions/week, p<0.01, -46%; second wave: 470 versus 788 admissions/week, p<0.01, -40%). Cancer, myocardial and cerebral infarction admissions were not statistically reduced during the the two waves of COVID pandemic compared to the pre-COVID period.
Our study shows that non-COVID in-hospital admissions rates were substantially reduced during the first two waves of COVID-19 pandemic. In our study, cancer, myocardial and cerebral infarction admissions were not statistically reduced, which was not in accordance to what was described in the literature.
The neutrophil-to-lymphocyte ratio (NLR) could be a predictive factor of severe COVID-19. However, most relevant studies are retrospective, and the optimal NLR cut-off point has not been determined. ...The objective of our research was identification and validation of the best NLR cut-off value on admission that could predict high in-hospital mortality in COVID-19 patients.
Medical files of all patients admitted for COVID-19 pneumonia in our dedicated COVID-units between March and April 2020 (derivation cohort) and between October and December 2020 (validation cohort) were reviewed.
Two hundred ninety-nine patients were included in the study (198 in the derivation and 101 in the validation cohort, respectively). Youden's J statistic in the derivation cohort determined the optimal cut-off value for the performance of NLR at admission to predict mortality in hospitalized patients with COVID-19. The NLR cut-off value of 5.94 had a sensitivity of 62% and specificity of 64%. In ROC curve analysis, the AUC was 0.665 95% CI 0.530-0.801, p= 0.025. In the validation cohort, the best predictive cut-off value of NLR was 6.4, which corresponded to a sensitivity of 63% and a specificity of 64% with AUC 0.766 95% CI 0.651-0.881, p <0.001. When the NLR cut-off value of 5.94 was applied in the validation cohort, there was no significant difference in death and survival in comparison with the derivation NLR cut-off. Net reclassification improvement (NRI) analysis showed no significant classification change in outcome between both NLR cut-off values (NRI:0.012, p=0.31).
In prospective analysis, an NLR value of 5.94 predicted high in-hospital mortality upon admission in patients hospitalized for COVID-19 pneumonia.
Efavirenz (EFV) is characterized by interindividual pharmacokinetic variability causing inconsistent clinical responses. Previous studies have identified some possible genetic determinants of the ...variability in plasma concentrations. However, their impact on EFV intracellular pharmacokinetics remains mostly unexplored.
To confirm previous observations concerning the influence of genetic polymorphisms on EFV plasma concentrations and to assess their effect on the intracellular pharmacokinetics of EFV.
EFV concentrations in plasma (EFV(Cmin)) and in peripheral blood mononuclear cells (EFV(CC)) were determined in 50 HIV-infected patients. Subjects were genotyped for 13 polymorphisms in 5 different genes (CYP2A6, CYP2B6, CYP3A5, UGT2B7 and ABCB1). Relationships between genetic status and EFV(Cmin), EFV(CC) or EFV accumulation in peripheral blood mononuclear cells (EFV accumulation ratio or accumulation ration AR) were then evaluated.
CYP2B6 allelic status was associated with differences in EFV(Cmin) but also in EFV(CC). Patients carrying at least one mutated allele showed significantly higher EFV(Cmin) and EFV(CC) than homozygous wild-type (mutated homozygous m/m >heterozygous wt/m>homozygous wild-type wt/wt, p<0.001). ABCB1 rs3842T>C was significantly associated with higher EFV AR (p = 0.032). Finally, the ABCB1 3435C>T SNP was associated with a lower increase in CD4-cell count after EFV therapy initiation.
Our study corroborates previous findings indicating that knowledge of CYP2B6 genetic status should be taken into account for an EFV treatment. Our results also constitute the first demonstration of the significant influence of CYP2B6 genetic polymorphisms on EFV(CC) and suggest that ABCB1 SNPs may also influence the clinical impact of EFV treatment.
Acute acalculous cholecystitis (AAC) can occur without gallstones in critically ill or injured patients and has also been associated with various infectious agents.(1-4) We report here a case of AAC ...in a patient with Plasmodium falciparum malaria.
Background: Multicentric Castleman's disease (MCD) is a rare, non-clonal lymphoproliferative disorder characterized by constitutional symptoms, anaemia and generalised lymphadenopathy. Its incidence ...among the HIV-positive population seems to have increased during the past decades.
Aim: The present study intends to compare demographic features, clinical presentation, laboratory studies, imaging results as well as treatment regimens and outcome in our MCD patients to those of larger reported series.
Method: We reviewed the files of 920 HIV-1-infected patients from our AIDS Reference Centre. Data was collected from the operating software for the patients' medical records of our institution (Medical Explorer v3r3, Cliniques St Luc, 2008).
Results: We report a series of four cases of MCD among our HIV/AIDS patients' cohort. Three were of African origin. They were diagnosed after 2003, after a mean duration of 54 months of HIV-seropositivity (ranging from 7 to 120 months). All presented with characteristic clinical features and laboratory findings, and were started on HAART a few months before or upon MCD diagnosis. Three patients were treated with chemotherapy (ABV), and one with HAART only. One patient who was given ABV is in continuous remission after 3 years of follow-up. The remaining three are alive, with good symptom control, regardless of the treatment they received.
Conclusion: MCD is a rare, but rising issue among HIV-infected patients. The clinical and paraclinical features of our series of four patients are in keeping with those of larger reported series. Currently, treatment is mainly chemotherapy-based, but a wide variety of protocols have been used, mainly because of the lack of available evidence. New approaches such as anti-CD 20 antibodies seem highly effective, and the role of HHV-8 needs to be further investigated, as it might be an important target for future treatment. In light of this review, we are looking forward to offer these opportunities to our patients, despite unhelpful regulations.
This study is the first prospective study to assess the prevalence, epidemiology, and risk factors of HIV-1 drug resistance in newly diagnosed HIV-infected patients in Belgium. In January 2003 it was ...initiated as part of the pan-European SPREAD program, and continued thereafter for four inclusion rounds until December 2006. Epidemiological, clinical, and behavioral data were collected using a standardized questionnaire and genotypic resistance testing was done on a sample taken within 6 months of diagnosis. Two hundred and eighty-five patients were included. The overall prevalence of transmitted HIV-1 drug resistance in Belgium was 9.5% (27/285, 95% CI: 6.6-13.4). Being infected in Belgium, which largely coincided with harboring a subtype B virus, was found to be significantly associated with transmission of drug resistance. The relatively high rate of baseline resistance might jeopardize the success of first line treatment as more than 1 out of 10 (30/285, 10.5%) viruses did not score as fully susceptible to one of the recommended first-line regimens, i.e., zidovudine, lamivudine, and efavirenz. Our results support the implementation of genotypic resistance testing as a standard of care in all treatment-naive patients in Belgium.
Papillary necrosis results from ischemia of the renal medulla and papillae, induced by a variety of mechanisms. Papillary necrosis is a rare adverse effect of continuous protease-inhibitor therapy ...with indinavir.
We describe the case of a patient who developed bilateral papillary necrosis. It was reversible after treatment interruption and increased hydration.
This case shows the need to monitor kidney markers in patients under continuous treatment with indinavir.
La terapia anti-retroviral utilizada durante el embarazo en madres infectadas con VIH disminuye la transmisión perinatal del virus. Esto es válido para mono, bi y tri-terapia (HAART), siendo mayor el ...efecto de esta última. Sin embargo, cuando se utilizan dichas terapias se debe tener en consideración riesgos potenciales para la madre e hijo (hiperglicemia, acidosis láctica, toxicidad mitocondrial, rash cutáneo, daño hepático, síndrome hipertensivo y parto prematuro). La operación cesárea electiva reduce la transmisión perinatal del virus en pacientes sin terapia o monoterapia. Con tri-terapia este beneficio no está demostrado. Este artículo revisa la evidencia de efectos benéficos y adversos de la terapia anti-retroviral y de la operación cesárea y propone una pauta de manejo de las pacientes infectadas con VIH en el embarazo
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