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•A lower COVID-19 mortality rate was observed in HIV patients.•Similar hospitalization and ICU admission rates were observed in HIV patients.•Age and comorbidities also represent the ...main poor COVID-19 prognostic factors in PLHIV.•HIV severity or type of antiretroviral treatment does not influence the COVID-19 outcome.
Information on how COVID-19 affects people living with HIV (PLHIV) remains scarce.
An observational study was conducted in four public hospitals in Madrid. All HIV patients with confirmed or suspected COVID-19 were included and compared with COVID-19 patients without HIV infection.
Sixty-three patients with HIV infection and confirmed or suspected COVID-19 were analyzed. The median age was 46 years (IQR: 37–56 years), and 88.9% were men. The median duration of HIV infection was 10.8 years (IQR: 6.5–16.8 years), and 96.8% were on antiretroviral therapy. 84.1% had previous comorbidities. The most common symptoms were fever (66.1%), cough (66.1%) and dyspnea (46.8%). Pneumonia was found in 47.5%, 28.6% of patients had severe disease, and 32.3% were admitted to hospital. The ICU admission rate and the mortality rate were both 3.17%. A significant association was observed between age, arterial hypertension, overweight, and diabetes mellitus and the severity of COVID-19. No association was observed between HIV-related factors and the severity of COVID-19. The rate of COVID-19 in HIV-patients was 1.68%. Similar hospitalization (31.74% vs 32.57%) and ICU admission (3.17% vs 2%) rates were observed with non-HIV infected patients. A lower mortality rate during hospitalization (10% vs 21.37%) and a lower global mortality rate (3.17% vs 6.96%) were also observed.
Established poor prognostic factors for COVID-19 patients, such as age and comorbidities, remain the main determinants for PLHIV. Neither the HIV severity nor the type of ARV treatment seem to influence the outcome of COVID-19. Large prospective cohorts are needed in order to establish the differences between HIV-positive and HIV-negative patients.
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•The survival rate is high (94% vs 72%) if tocilizumab is administered with a FiO2 ≤0.5%.•There are very limited side effects and secondary infections.•A significant decrease in the ...median serum ferritin and the median HSCRP was observed.
Tocilizumab (TCZ) is an interleukin-6 receptor antagonist, which has been used for the treatment of severe SARS-CoV-2 pneumonia (SSP), which aims to ameliorate the cytokine release syndrome (CRS) induced acute respiratory distress syndrome (ARDS). However, there are no consistent data about who might benefit most from it.
We administered TCZ on a compassionate-use basis to patients with SSP who were hospitalized (excluding intensive care and intubated cases) and who required oxygen support to have a saturation >93%. The primary endpoint was intubation or death after 24 h of its administration. Patients received at least one dose of 400 mg intravenous TCZ from March 8, 2020 to April 20, 2020.
A total of 207 patients were studied and 186 analyzed. The mean age was 65 years and 68% were male patients. A coexisting condition was present in 68% of cases. Prognostic factors of death were older age, higher IL-6, d-dimer and high-sensitivity C-reactive protein (HSCRP), lower total lymphocytes, and severe disease that requires additional oxygen support. The primary endpoint (intubation or death) was significantly worst (37% vs 13%, p < 0·001) in those receiving the drug when the oxygen support was high (FiO2 >0.5%).
TCZ is well tolerated in patients with SSP, but it has a limited effect on the evolution of cases with high oxygen support needs.
Abstract
Background
Fast initiation of ART has been associated with higher rates of retention in HIV care and viral suppression at 48 weeks and with lower mortality rates. However, scarce evidence ...exists in our setting, where diagnosis and treatment are carried out in different contexts.
Methods
An observational retrospective study evaluating efficacy and safety of ART prescribed at the first specialist appointment, without baseline laboratory data, in a tertiary hospital in downtown Madrid. Individuals with a new diagnosis of HIV infection who initiated treatment at their first appointment with an infectious diseases specialist before receiving baseline laboratory results were included, irrespective of the ART regimen chosen.
Results
One hundred and eight participants were included. The majority (99.1%) were MSM who had acquired infection during sexual intercourse. The efficacy of ART, without baseline laboratory results at the time of initiation, was 85.2% (92/108) in the ITT analysis and 91.7% (99/108) in the treatment-related discontinuation equals failure analysis. All but nine patients presented an undetectable viral load (<50 copies/mL) at 48 weeks from starting ART. No serious adverse effects associated with the strategy were observed. In total, 101 participants continued care at 48 weeks with retention in HIV care rate of 93.5% (101/108).
Conclusions
Initiating ART at the first available opportunity without baseline laboratory data does not reduce efficacy or safety of ART and achieves rapid virological control with high rates of retention in HIV care.
Use of closed systems in the Hospital Pharmacy Pérez-Minayo, María Forte; Bazán, Eva Castillo; Segurado, Marta Hernández ...
Farmacia hospitalaria,
03/2016, Volume:
40, Issue:
2
Journal Article
Peer reviewed
Open access
In the setting of the increasing use of closed systems for reconstitution and preparation of these drugs, we intend to analyze the correct use of these systems in the Hospital Pharmacy, with the ...objective to minimize the risks of exposure not only for those professionals directly involved, but also for all the staff in the unit, taking also into account efficiency criteria.
Since some systems protect against aerosol formation but not from vapours, we decided to review which cytostatics should be prepared using an awl with an air inlet valve, in order to implement a new working procedure. We reviewed the formulations available in our hospital, with the following criteria: method of administration, excipients, and potential hazard for the staff handling them. We measured the diameters of the vials. We selected drugs with Level 1 Risk and also those including alcohol-based excipients, which could generate vapours.
Out of the 66 reviewed formulations, we concluded that 11 drugs should be reconstituted with this type of awl: busulfan, cabazitaxel, carmustine, cyclophosphamide, eribulin, etoposide, fotemustine, melphalan, paclitaxel, temsirolimus and thiotepa; these represented an 18% of the total volume of formulations.
The selection of healthcare products must be done at the Hospital Pharmacy, because the use of a system with an air valve inlet only for those drugs selected led to an outcome of savings and a more efficient use of materials. In our experience, we confirmed that the use of the needle could only be avoided when the awl could adapt to the different formulations of cytostatics, and this is only possible when different types of awls are available. Besides, connections were only really closed when a single awl was used for each vial. The change in working methodology when handling these drugs, as a result of this study, will allow us to start different studies about environmental contamination as a future line of work.
En el contexto del auge de los sistemas cerrados para la reconstitución y preparación de estos fármacos, se propone analizar el uso correcto de estos sistemas en el servicio de farmacia, con el objetivo de minimizar los riesgos de exposición no solo de los trabajadores expuestos, sino de todos los trabajadores del servicio, atendiendo también a criterios de eficiencia.
Puesto que algunos sistemas protegen frente a la formación de aerosoles pero no frente a vapores, decidimos revisar qué citostáticos debían prepararse con un punzón que constase de una válvula de admisión de aire para implementar un nuevo procedimiento de trabajo. Se revisaron las presentaciones disponibles en nuestro hospital atendiendo a: vía de administración, excipientes y riesgo para el personal manipulador, y se midieron los diámetros de los viales. Se seleccionaron tanto los fármacos de riesgo 1 como aquellos cuyos excipientes incluyesen vehículos alcohólicos, susceptibles de formar vapores.
De las 66 presentaciones revisadas, un total de 11 fármacos debían reconstituirse con este tipo de punzón: busulfán, cabazitaxel, carmustina, ciclofosfamida, eribulina, etopósido, fotemustina, melfalán, paclitaxel, temsirolimús y tiotepa; representando un 18% respecto al volumen total de presentaciones.
La selección de los productos sanitarios debe realizarse desde los servicios de farmacia, ya que la utilización de un sistema con válvula de admisión de aire para tan solo los fármacos seleccionados supuso un ahorro y un empleo más eficiente del material. Desde nuestra experiencia comprobamos que el uso de la aguja solo podía relegarse si el punzón se adaptaba a las diferentes presentaciones de citostáticos, y esto solo se consigue disponiendo de varios tipos de punzones. Además, las conexiones solo estaban realmente cerradas si se utilizaba un punzón por cada vial. Con el cambio en la metodología de trabajo a la hora de manipular estos fármacos, producida como resultado de este estudio, se pretenden realizar estudios de contaminación ambiental en una línea de trabajo futuro.
We describe the case of a young child with multidrug-resistant tuberculosis, treated with linezolid. The child developed severe neutropenia after 5 months of treatment. Filgrastim was used, a drug ...that officially is not indicated for non-cytostatic drug-induced neutropenia. This allowed the fast recovery of the patient’s neutrophil-count. However, more experience with the off-label use of filgrastrim is needed in the pediatric population.
Use of closed systems in the Hospital Pharmacy Forte Pérez-Minayo, María; Castillo Bazán, Eva; Hernández Segurado, Marta ...
Farmacia hospitalaria : organo oficial de expresion cientifica de la Sociedad Espanola de Farmacia Hospitalaria,
2016-Mar-01, Volume:
40, Issue:
2
Journal Article
In the setting of the increasing use of closed systems for reconstitution and preparation of these drugs, we intend to analyze the correct use of these systems in the Hospital Pharmacy, with the ...objective to minimize the risks of exposure not only for those professionals directly involved, but also for all the staff in the unit, taking also into account efficiency criteria.
Since some systems protect against aerosol formation but not from vapours, we decided to review which cytostatics should be prepared using an awl with an air inlet valve, in order to implement a new working procedure. We reviewed the formulations available in our hospital, with the following criteria: method of administration, excipients, and potential hazard for the staff handling them. We measured the diameters of the vials. We selected drugs with Level 1 Risk and also those including alcohol-based excipients, which could generate vapours.
Out of the 66 reviewed formulations, we concluded that 11 drugs should be reconstituted with this type of awl: busulfan, cabazitaxel, carmustine, cyclophosphamide, eribulin, etoposide, fotemustine, melphalan, paclitaxel, temsirolimus and thiotepa; these represented an 18% of the total volume of formulations.
The selection of healthcare products must be done at the Hospital Pharmacy, because the use of a system with an air valve inlet only for those drugs selected led to an outcome of savings and a more efficient use of materials. In our experience, we confirmed that the use of the needle could only be avoided when the awl could adapt to the different formulations of cytostatics, and this is only possible when different types of awls are available. Besides, connections were only really closed when a single awl was used for each vial. The change in working methodology when handling these drugs, as a result of this study, will allow us to start different studies about environmental contamination as a future line of work.
Purposeful species introductions offer opportunities to inform our understanding of both invasion success and conservation hurdles. We evaluated factors determining the energetic limitations of brown ...trout (
Salmo trutta
) in both their native and introduced ranges. Our focus was on brown trout because they are nearly globally distributed, considered one of the world's worst invaders, yet imperiled in much of their native habitat. We synthesized and compared data describing temperature regime, diet, growth, and maximum body size across multiple spatial and temporal scales, from country (both exotic and native habitats) and major geographic area (MGA) to rivers and years within MGA. Using these data as inputs, we next used bioenergetic efficiency (BioEff), a relative scalar representing a realized percentage of maximum possible consumption (0-100%) as our primary response variable and a multi-scale, nested, mixed statistical model (GLIMMIX) to evaluate variation among and within spatial scales and as a function of density and elevation. MGA and year (the residual) explained the greatest proportion of variance in BioEff. Temperature varied widely among MGA and was a strong driver of variation in BioEff. We observed surprisingly little variation in the diet of brown trout, except the overwhelming influence of the switch to piscivory observed only in exotic MGA. We observed only a weak signal of density-dependent effects on BioEff; however, BioEff remained <50% at densities >2.5 fish/m
2
. The trajectory of BioEff across the life span of the fish elucidated the substantial variation in performance among MGAs; the maximum body size attained by brown trout was consistently below 400 mm in native habitat but reached ∼600 mm outside their native range, where brown trout grew rapidly, feeding in part on naive prey fishes. The integrative, physiological approach, in combination with the intercontinental and comparative nature of our study, allowed us to overcome challenges associated with context-dependent variation in determining invasion success. Overall our results indicate "growth plasticity across the life span" was important for facilitating invasion, and should be added to lists of factors characterizing successful invaders.
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