Impact of vaccination against COVID-19 on patients with cancer in ACHOC-C19 study: Real world evidence from one Latin American country.

Introduction: During the pandemic, it has been recommended that vaccination against COVID-19 be a priority for patients with cancer; however, these patients were not included in the initial studies evaluating the available vaccines. Objective: To define the impact of vaccination against COVID-19 in preventing the risk of complications associated with the infection in a cohort of patients with cancer in Colombia. Methods: An analytical observational cohort study, based on national registry of patients with cancer and COVID 19 infection ACHOC-C19, was done. The data was collected from June 2021, until October 2021. Inclusion criteria were: Patients older than 18 years with cancer diagnosis and confirmed COVID-19 infection. Data from the unvaccinated and vaccinated cohorts were compared. Outcomes evaluated included all-cause mortality within 30 days of COVID-19 diagnosis, hospitalization, and need for mechanical ventilation. The estimation of the effect was made through the relative risk (RR), the absolute risk reduction (ARR) and the number needed to treat (NNT). Multivariate analysis was performed using generalized linear models. Results: 896 patients were included, of whom 470 were older than 60 years (52.4%) and 59% were women (n=530). 172 patients were recruited in the vaccinated cohort and 724 in the non-vaccinated cohort (ratio: 1 to 4.2). The cumulative incidence of clinical outcomes among the unvaccinated vs vaccinated patients were: for hospitalization 42% (95% CI: 38.7%-46.1%) vs 29%; (95% CI: 22.4%-36.5%); for invasive mechanical ventilation requirement 8.4% (n=61) vs 4.6% (n=8) and for mortality from all causes 17% (n=123) vs 4.65% (n=8). Conclusion: In our population, unvaccinated patients with cancer have an increased risk of complications for COVID -19 infection, as hospitalization, mechanical ventilation, and mortality. It is highly recommended to actively promote the vaccination among this population.

Impact of COVID-19 Infection on Patients with Cancer: Experience in a Latin American Country: The ACHOCC-19 Study.

INTRODUCTION: The ACHOCC-19 study was performed to characterize COVID-19 infection in a Colombian oncological population. METHODOLOGY: Analytical cohort study of patients with cancer and COVID-19 infection in Colombia. From April 1 to October 31, 2020. Demographic and clinical variables related to cancer and COVID-19 infection were collected. The primary outcome was 30-day mortality from all causes. The association between the outcome and the prognostic variables was analyzed using logistic regression models and survival analysis with Cox regression. RESULTS: The study included 742 patients; 72% were >51 years. The most prevalent neoplasms were breast (132, 17.77%), colorectal (92, 12.34%), and prostate (81, 10.9%). Two hundred twenty (29.6%) patients were asymptomatic and 96 (26.3%) died. In the bivariate descriptive analysis, higher mortality occurred in patients who were >70 years, patients with lung cancer, ≥2 comorbidities, former smokers, receiving antibiotics, corticosteroids, and anticoagulants, residents of rural areas, low socioeconomic status, and increased acute-phase reactants. In the logistic regression analysis, higher mortality was associated with Eastern Cooperative Oncology Group performance status (ECOG PS) 3 (odds ratio [OR] 28.67; 95% confidence interval [CI], 8.2-99.6); ECOG PS 4 (OR 20.89; 95% CI, 3.36-129.7); two complications from COVID-19 (OR 5.3; 95% CI, 1.50-18.1); and cancer in progression (OR 2.08; 95% CI, 1.01-4.27). In the Cox regression analysis, the statistically significant hazard ratios (HR) were metastatic disease (HR 1.58; 95% CI, 1.16-2.16), cancer in progression (HR 1.08; 95% CI, 1.24-2.61) cancer in partial response (HR 0.31; 95% CI, 0.11-0.88), use of steroids (HR 1.44; 95% CI, 1.01-2.06), and use of antibiotics (HR 2.11; 95% CI, 1.47-2.95). CONCLUSION: In our study, patients with cancer have higher mortality due to COVID-19 infection if they have active cancer, metastatic or progressive cancer, ECOG PS >2, and low socioeconomic status. IMPLICATIONS FOR PRACTICE: This study's findings raise the need to carefully evaluate patients with metastatic cancer, in progression, and with impaired Eastern Cooperative Oncology Group status to define the relevance of cancer treatment during the pandemic, consider the risk/benefit of the interventions, and establish clear and complete communication with the patients and their families about the risk of complications. There is also the importance of offering additional support to patients with low income and residence in rural areas so that they can have more support during cancer treatment.

Neumonitis por docetaxel, discusión de un caso / Interstitial pneumonitis due to docetaxel

Resumen La neumonitis intersticial por docetaxel es un evento infrecuente, pero con alto potencial de mortalidad y puede ser potencialmente reversible con el uso de esteroides sistémicos; se considera importante en el diagnóstico diferencial del paciente bajo quimioterapia con síntomas respiratorios. A continuación, se presenta un caso de neumonitis fatal por docetaxel en un paciente con carcinoma de próstata avanzado. Paciente de 80 años de edad con historia de cáncer de próstata de 15 años de evolución, en progresión ósea y ganglionar, y que inició manejo con docetaxel. Después de la aplicación del tercer ciclo presenta disnea de esfuerzos, fiebre, tos seca y deterioro general. Se realizó diagnóstico de neumonitis por docetaxel y se descartaron otras entidades. La neumonitis intersticial por docetaxel es una entidad rara. Los pilares del tratamiento son la suspensión del medicamento, el soporte ventilatorio y el uso de glucocorticoides sistémicos.

Abstract Interstitial pneumonitis due to docetaxel is an infrequent event but with a high mortality potential; it can be potentially reversible with the use of systemic steroids and is considered important in the differential diagnosis of the patient undergoing chemotherapy with respiratory symptoms. We present a case of fatal pneumonitis due to docetaxel in a patient with advanced prostate carcinoma. An 80-year-old patient with a history of prostate cancer of15 years of evolution, with disease progression in bones and lymph nodes, in whom treatment with Docetaxel was started, after the application of the third cycle, he presented with dyspnea on exertion, fever, dry cough and general deterioration. A diagnosis of pneumonitis due to docetaxel was made, discarding other entities. Interstitial pneumonitis due to docetaxel is a rare entity. The pillars of the treatment are the suspension of the medication, the ventilatory support and the use of systemic glucocorticoids.

Epidemiología de la infección por el virus de inmunodeficiencia humana en pacientes hospitalizados en una institución de alta complejidad y enseñanza universitaria en Medellín, Colombia / Epidemiology of human immunodeficiency virus infection in inpatients in a teaching hospital of high complexity in Medellin, Colombia

Introducción: La prevalencia y mortalidad de la infección VIH/sida sigue siendo alta en Colombia, más aún cuando en nuestro sistema el acceso a los programas y terapia antirretroviral es limitado. Objetivo: Describir y analizar las características clínicas, epidemiológicas y sociodemográficas de pacientes hospitalizados con infección por VIH/sida. Metodología: Estudio descriptivo retrospectivo. Resultados: Se incluyeron 159 pacientes, con una edad promedio de 47 ± 13 años, 83% hombres. El 35% tenían antecedentes de promiscuidad sexual, el 27,6% eran homosexuales y el 20% tenían historia de tuberculosis. Al ingreso, un 66% tenía diagnóstico de sida, un 24% recuento de CD4 ≥ 200 cél/mm ³ y un 62% recibía tratamiento antirretroviral. Los principales síntomas al ingreso fueron gastrointestinales (50,3%), neurológicos (40,9%) y respiratorios (30%). En un 33,3% se documentaron infecciones oportunistas, siendo las principales: tuberculosis (37%), histoplasmosis (17%) y criptococosis (9,7%). En un 16,9% se diagnosticaron neoplasias; las más importantes fueron neoplasias de órgano sólido (6,9%), enfermedad linfoproliferativa (5,6%), enfermedad mieloproliferativa (2,5%) y sarcoma de Kaposi (1,8%). La estancia promedio fue de 12 ± 16 días; un 12,5% requirieron atención en UCI, y de estos, un 65% fueron sometidos a ventilación mecánica. La letalidad fue del 13,8%, y la mortalidad atribuible al VIH/sida, del 77,2%. Conclusiones: Las características de nuestra muestra son similares a las reportadas en otras series; difieren en el tipo de infecciones oportunistas y la alta letalidad y mortalidad atribuible a la infección VIH/sida. Las principales causas de hospitalización son infecciones oportunistas, seguidas de enfermedad neoplásica y quirúrgica. Mycobacterium tuberculosis es la infección oportunista más frecuente.

Introduction: The prevalence and mortality of HIV/AIDS infection still high in Colombia, due to a lack of access to HIV programmes and the limited coverage of antiretroviral therapy. Objective: To describe and analyse clinical, epidemiological and socio-demographic features of inpatients with HIV/AIDS infection. Methodology: Descriptive retrospective study. Results: A total of 159 patients were included; the average age was 47 ± 13 years and 83% were men. 35% had a history of sexual promiscuity, 27.6% were men who had sex with men and 20% had a history of tuberculosis. At admission, 66.6% had AIDS, 24% had CD4 ≥ 200 cells/mm ³ and 62% were taking antiretroviral therapy. The most common symptoms at admission were gastrointestinal (50.3%), neurological (40.9%) and respiratory (30%). In 33.3%, opportunistic infections were documented and the most frequent were: tuberculosis (37%), histoplasmosis (17%) and cryptococcosis (9.7%). Some 16.9% of patients had cancer, including 6.91% with a solid organ neoplasm, lymphoproliferative disease (5.6%), myeloproliferative disease (2.5%) and Kaposi's sarcoma (1.8%). The average length of hospitalisation was 12 ± 16 days; some 12.5% required ICU care and 65% required mechanical ventilation. Lethality was 13.8% and attributable mortality to HIV/AIDS infection was 77.2%. Conclusions: The characteristics of our population are similar to those described in other studies; however a high lethality and attributable mortality to HIV/AIDS infection were found. The most frequent causes of hospitalisation were opportunistic infections followed by neoplasms. Mycobacterium tuberculosis was the most common opportunistic infection.

Caracterización de pacientes hospitalizados con infecciones causadas por micobacterias no tuberculosas, en un hospital de alta complejidad en Colombia / Characteristics of inpatients with nontuberculous mycobacterial infections in a highly complex hospital in Colombia

Antecedentes: Las infecciones por micobacterias no tuberculosas (MNT) se describen en los últimos años con mayor frecuencia, especialmente en pacientes con inmunosupresión y en pacientes tratados por procedimientos estéticos. Las MNT incluyen especies del género Mycobacterium , diferentes del complejo Mycobacterium tuberculosis y Mycobacterium leprae . Objetivo: Describir las características demográficas y clínicas de pacientes hospitalizados con infecciones por MNT. Metodología: Estudio descriptivo retrospectivo. Resultados: De 187 pacientes con infección por micobacterias documentadas por cultivo, 17 (9,1%) tuvieron infección por MNT. Edad promedio de 38,4 ± 19,2 años. El 58,82% fueron hombres. Las principales comorbilidades fueron VIH/sida (41,17%), diabetes mellitus (23,53%), enfermedad renal crónica (17,64%), terapia inmunosupresora (17,64%) y neoplasias (17,64%). En los coinfectados con VIH el recuento de CD4 fue <50 en 85,71%. Las especies más frecuentes fueron complejo M. avium (CMA) 35,29%, M. abscessus (17,65%) y M. chelonae (11,76%). Las formas de infección fueron: diseminada (35,29%), pulmonar (23,53%), piel y tejidos blandos (17,64%) y gastrointestinal (11,76%). Estancia promedio de 22,1 días; un 23,53% requirió atención en UCI. La mortalidad general fue 23,53%. Conclusión: Las infecciones por MNT causan una serie de condiciones patológicas, los pacientes inmunocomprometidos son la población de mayor riesgo y las formas diseminada y pulmonar,las más frecuentes. La sospecha temprana así como la toma de muestras adecuadas y el uso de métodos diagnósticos apropiados son indispensables para su diagnóstico oportuno y tratamiento adecuado.

Background: Nontuberculous mycobacteria (NTM) infections has been described more frequently in recent years, especially in immunosuppression conditions and after cosmetic surgical procedures. The NTM include species of the genus Mycobacterium , other than Mycobacterium tuberculosis complex and Mycobacterium leprae. Objective: To describe the demographic and clinical characteristics of Colombian in-patientswith NTM infections. Methodology: A retrospective descriptive study. Results: In 187 patients with culture- confirmed mycobacterial infection, 17 (9,1%) had NTM.The mean age was 38,4 ± 19,2 and 58,82% were men. Major comorbidities were: HIV/AIDS(41,1%), diabetes mellitus (23,5%), chronic renal disease (17,6%), immunosuppressive therapy(17,6%) and neoplasms (17,6%). In patients co-infected with HIV, CD4 count was <50 in 85,7%.The most frequent species were M. avium complex (MAC) in 35,2%, M. abscessus in 17,6% and M. chelonae in 11,7%. Infections were disseminated (35,2%), pulmonary (23,5%), skin and soft tissue (17,6%) and in gastrointestinal system (11,7%). The average hospital stay was 22,1 day sand 23,5% required intensive care unit. Overall mortality was 23,5%. Conclusion: MNT infections cause a number of pathological conditions, being more frequent in immunocompromised patients. The disseminated and pulmonary forms were the most common. Early clinical suspicion and appropriate samples and diagnostic assays, are crucial for early diagnosis and treatment.

Síndrome antifosfolípido: descripción de una cohorte de pacientes colombianos y evaluación delos factores de riesgo para trombosis / Antiphospholipid syndrome: description of a cohort from Colombia and evaluation of thrombosis risk factors

Introducción: El síndrome antifosfolípido es una enfermedad autoinmune, caracterizada portrombosis vascular y morbilidad gestacional en presencia de anticuerpos antifosfolípidos. Se handescrito varios factores de riesgo para el desarrollo de trombosis en estos pacientes, pero losestudios son heterogéneos y no discriminan entre eventos arteriales y venosos.Objetivo: Describir las manifestaciones clínicas e inmunológicas del síndrome antifosfolípidoen una cohorte de pacientes colombianos y establecer los factores de riesgo para el desarrollode trombosis venosa y arterial.Materiales y métodos: Se condujo un estudio analítico de corte transversal. Criterio de inclusión:Consenso de Sydney de 2006 y clasificación del síndrome antifosfolípido como secundario, segúncriterios del American College of Rheumatology.Resultados: Se incluyeron 100 pacientes; 84 de ellos mujeres; edad promedio 37.6 años. El 59%de los pacientes correspondía a síndrome antifosfolípido secundario. La manifestación clínicamás frecuente inicial y durante el seguimiento fue la trombosis venosa (56.52% y 47%, respectivamente),seguida por “manifestaciones no criterio” (23.91%), especialmente neurológicas. Latrombosis venosa profunda fue recurrente en el 46%; 30% de los individuos presentó trombocitopeniasevera. La ausencia de autoanticuerpos específicos discriminó entre formas primariasy secundarias. La diabetes mellitus fue un factor de riesgo significativo para trombosis venosa(6.4% vs. 0%; OR 2.205, IC 95%: 1.772–2.742) y el tabaquismo para enfermedad cerebrovascular(33.3% vs. 6%, OR 7.9, IC 95%: 1.5–41.324).Conclusiones: Esta cohorte de pacientes colombianos con síndrome antifosfolípido presentaalto porcentaje de manifestaciones no incluidas en los criterios clasificatorios, con compromisoorgánico grave, atípico y recurrente.