Impact of vaccination on COVID-19 severity during the second wave in Brunei Darussalam, 2021

@#Objective: Coronavirus disease (COVID-19) vaccinations have been shown to prevent infection with efficacies ranging from 50% to 95%. This study assesses the impact of vaccination on the clinical severity of COVID-19 during the second wave in Brunei Darussalam in 2021, which was due to the Delta variant. Methods: Patients included in this study were randomly selected from those who were admitted with COVID-19 to the National Isolation Centre between 7 August and 6 October 2021. Cases were categorized as asymptomatic, mild (symptomatic without pneumonia), moderate (pneumonia), severe (needing supplemental oxygen therapy) or critical (needing mechanical ventilation) but for statistical analysis purposes were dichotomized into asymptomatic/mild or moderate/severe/critical cases. Univariate and multivariable analyses were conducted to identify risk factors associated with moderate/severe/critical disease. Propensity score-matched analysis was also performed to evaluate the impact of vaccination on disease severity. Results: The study cohort of 788 cases (mean age: 42.1 + 14.6 years; 400 males) comprised 471 (59.8%) asymptomatic/mild and 317 (40.2%) moderate/severe/critical cases. Multivariable logistic regression analysis showed older age group (>45 years), diabetes mellitus, overweight/obesity and vaccination status to be associated with increased severity of disease. In propensity score-matched analysis, the relative risk of developing moderate/severe/critical COVID-19 for fully vaccinated (two doses) and partially vaccinated (one dose) cases was 0.33 (95% confidence interval [CI]: 0.16–0.69) and 0.62 (95% CI: 0.46–0.82), respectively, compared with a control group of non-vaccinated cases. The corresponding relative risk reduction (RRR) values were 66.5% and 38.4%, respectively. Vaccination was also protective against moderate/severe/critical disease in a subgroup of overweight/obese patients (RRR: 37.2%, P = 0.007). Discussion: Among those who contracted COVID-19, older age, having diabetes, being overweight/obese and being unvaccinated were significant risk factors for moderate/severe/critical disease. Vaccination, even partial, was protective against moderate/severe/critical disease.

Screening of hospital admissions for COVID-19 in Brunei Darussalam

@#From late December 2019, an outbreak of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) occurred in Wuhan, China and has spread globally resulting in a pandemic. Brunei Darussalam reported its first case of COVID-19 on 9 March 2020. Several measures were implemented to prevent a national outbreak. We report our experience with surveillance of patients requiring admission in all government hospitals. We detected one positive case, and through contact tracing two further cases were detected. Therefore, without this screening programme, these cases would likely have been missed, leading to further nosocomial and community spread.

Clinical efficacy of sevelamer hydrochloride in patients with end-stage renal disease: a retrospective study

<p><b>INTRODUCTION</b>Sevelamer hydrochloride (Renagel) is frequently used as a second-line phosphate binder in patients on renal replacement therapy. Many studies have shown that sevelamer can improve vascular calcification, serum uric acid and low-density lipoprotein (LDL) cholesterol levels. The main objectives of this study were to assess the efficacy of sevelamer against calcium-based phosphate binders, as well as its tolerability and side-effect profile.</p><p><b>METHODS</b>This was a retrospective study that included all patients on renal replacement therapy (between 2008 and 2011) who had previously received calcium-based binders for ≥ 6 months and were subsequently switched to sevelamer. Data collected from the patients' medical records included demographics, as well as renal parameters three months prior to sevelamer treatment, and at three and six months post treatment. The study excluded patients on multiple, concomitant phosphate binders or with functioning renal transplants, and those who were noncompliant or had inadequate follow-up blood investigations.</p><p><b>RESULTS</b>A total of 39 patients were included in the study. No major side effects were reported by any of the patients. There were improvements in calcium, phosphate, uric acid and LDL cholesterol levels at three and six months post-sevelamer treatment.</p><p><b>CONCLUSION</b>We found sevelamer to be superior to calcium-based phosphate binders in reducing serum calcium, phosphate, uric acid and LDL cholesterol levels in our patient population with advanced renal bone disease. Sevelamer also appears to be well tolerated with no significant side effects.</p>

Aluminium exposure in haemodialysis and peritoneal dialysis patients: Experience of a single centre

Introduction: Aluminium exposure and toxicity are uncommon in humans. However it may occur in patients on long term haemodialysis (HD) due to water exposure during treatment. We retrospectively assessed the extent of aluminium exposure in our HD and peritoneal dialysis (PD) patients from 2002 to 2008. Materials and Methods: The study population included 43 HD patients and 77 PD patients whose blood samples were collected at four monthly intervals. In addition, HD patients were also interviewed on lifestyle factors (aluminium cookware, diet, aluminium-containing medications and tap water consumption) that may impact on serum aluminium levels. Reverse osmosis (RO) water aluminium levels were also collected during this timeframe. Results: More patients on HD had readings above the accepted range (>0.01mg/L) than peritoneal dialysis (36.9% vs. 23.8%). The mean aluminium values for HD and PD patients were 63.35 ± 34.69μg/L and 38.34 ± 17.02μg/L respectively (p<0.05). Use of aluminium cookware was identified as a risk factor for high aluminium readings in HD patients. The trend of serum aluminium correlated with that of RO water aluminium during the studied period. There was no evidence of clinical toxicity in our patients during follow up. Conclusion: The study showed that HD patients are at a higher risk of aluminium toxicity compared to PD patients. Treated RO water aluminium should be analysed on a regular basis to prevent aluminium toxicity in HD patients. Lifestyle factors may have an impact on aluminium levels in patients with renal disease.