Diagnosing COVID-19; towards a feasible COVID-19 rule-out protocol.

INTRODUCTION: We present the results of the COVID-19 rule-out protocol at Ghent University Hospital, a step-wise testing approach which included repeat NFS SARS-CoV-2 rRT-PCR, respiratory multiplex RT-PCR, low-dose chest CT and bronchoscopy with BAL to confirm or rule-out SARS-CoV-2 infection in patients admitted with symptoms suggestive of COVID-19. RESULTS: Between 19 March 2020 and 30 April 2020, 455 non-critically ill patients with symptoms suspect for COVID-19 were admitted. The initial NFS for SARS-CoV-2 rRT-PCR yielded 66.9%, the second NFS 25.4% and bronchoscopy with BAL 5.9% of total COVID-19 diagnoses. In the BAL fluid, other respiratory pathogens were detected in 65% (13/20) of the COVID-19 negative patients and only in 1/7 COVID-19 positive patients. Retrospective antibody testing at the time around BAL sampling showed a positive IgA or IgG in 42.9 % of the COVID-19 positive and 10.5% of the COVID-19 negative group. Follow-up serology showed 100% COVID-19 positivity in the COVID-19 positive group and 100% IgG negativity in the COVID-19 negative group. CONCLUSION: In our experience, bronchoscopy with BAL can have an added value to rule-in or rule-out COVID-19 in patients with clinical and radiographical high-likelihood of COVID-19 and repeated negative NFS testing. Furthermore, culture and respiratory multiplex PCR on BAL fluid can aid to identify alternative microbial etiological agents in this group. Retrospective analysis of antibody development in this selected group of patients suggests that the implementation of serological assays in the routine testing protocol will decrease the need for invasive procedures like bronchoscopy.

Information systems for monitoring the burden of chronic diseases in public reference health facilities in Rwanda; Burundi and Eastern DRC

Chronic diseases are an increasingly important cause of death in sub-Saharan Africa. Diseases such as cancer; diabetes and arterial hypertension remained for years in the background; in the shadow of pandemics such as malaria; HIV / AIDS and tuberculosis. In the past 6 years; 4 reference hospitals of Kisangani; Bukavu; Kigali and Bujumbura implemented hospital information systems enabling sophisticated analysis of the diagnostic variance of out-patient visits and in-patient admissions. Important volumes of chronic disease data have been collected in a period between 2006 and 2012; demonstrating that the problem of chronic diseases also grows rapidly in the Great Lakes region and therefore urgent steps must be taken; both by governments (Rwanda; DRC and Burundi); by the international donor community and by local hospital boards

Posttransplantation hypomagnesemia and its relation with immunosuppression as predictors of new-onset diabetes after transplantation.

New-onset diabetes after transplantation (NODAT) is a frequent complication and has an impact on patient and graft survival. Hypomagnesemia is common in both renal transplant recipients and in diabetics. This study examines the relationship between hypomagnesemia, NODAT and the type of immunosuppression in renal transplant recipients. We conducted a retrospective single-center analysis (2002-2008) in order to assess NODAT the first year posttransplantation as defined by American Diabetes Association criteria. Serum magnesium (Mg) levels were defined as the median of all Mg levels registered during the first month posttransplantation. Patients with NODAT (N = 75; 29.5%) versus non-NODAT had lower Mg levels (p < 0.001). Patients with an Mg level < versus > or = 1.9 mg/dL showed a faster development of NODAT (log-rank p < 0.001). Mg levels were lower in patients on calcineurin inhibitors (CNI) versus no CNI patients (p < 0.001). Mg levels, albumin, BMI, triglycerides, posttransplantation hyperglycemia, tacrolimus levels and the use of sirolimus were predictors of NODAT in the multivariate analysis. Hypomagnesemia was an independent predictor of NODAT in renal transplant recipients. We confirm that the use of CNI is associated with NODAT, but, to a large extent, this effect seems attributable to the induction of hypomagnesemia. After adjustment for Mg, sirolimus was also associated with NODAT.

Acute central hemodynamic effects of peritoneal dialysis.

BACKGROUND: The supposed lack of a hemodynamic impact of peritoneal dialysis (PD) has been challenged recently in different studies, although the observed effects are still far below those seen on hemodialysis (HD), and the underlying mechanisms are unclear. METHODS: Literature overview based on Pubmed search with key words 'peritoneal dialysis, acute dwell, hemodialysis'. DISCUSSION: Hemodynamic effects of an acute PD dwell seem to be consistent, but rather limited. Increasing peritoneal pressure, causing enhanced preload and thus better cardiac output, and vasoactive reactions induced by incompatibility of the dialysis fluid seem to be the most prominent causes. The role of hyperglycemia is a matter of debate. In view of the repetitive character of the insults, especially during APD, more in depth investigation of this phenomenon is warranted.

The epidemic of cardio-vascular disease in renal failure: where does it come from, where do we go?

Cardio-vascular disease and death are among the most important medical and socio-economic challenges of the 21st century. Renal failure, a major medical problem per se, gives rise to an accelerated and strongly magnified model of atherogenesis and vascular damage. Already with a minor decrease in renal function, coronary and vascular risk are increased and play a role next to classical risk factors such as male gender, diabetes mellitus, hypercholesterolemia or smoking. The impact of renal failure on cardio-vascular risk remains present even after correction for these traditional risk factors. This suggests that factors specifically related to renal failure play a role. Atheromatosis is currently considered as an inflammatory disorder. Renal failure gives rise to enhanced inflammatory parameters. However, the atherogenic factors related to this inflammation remain largely unknown. Hence, the condition of renal failure may be helpful to answer this question. According to recent data from the USA, close to 5% of the general population (11% of those older than 65 without diabetes or hypertension) has a renal function which is decreased by at least 50%, but other analyses come up with even higher figures. Better identification of the factors at play in this population, optimized secondary preventive actions similar to those applied in diabetics, and timely screening and therapy will be helpful to improve quality of life and reduce socio-economic burden in this population.

Chronic kidney disease as cause of cardiovascular morbidity and mortality.

To make an evidence-based evaluation of the relationship between kidney failure and cardiovascular risk, we reviewed the literature obtained from a PubMed search using pre-defined keywords related to both conditions and covering 18 years (1986 until end 2003). Eighty-five publications, covering 552 258 subjects, are summarized. All but three studies support a link between kidney dysfunction and cardiovascular risk. More importantly, the association is observed very early during the evolution of renal failure: an accelerated cardiovascular risk appears at varying glomerular filtration rate (GFR) cut-off values, which were >/=60 ml/min in at least 20 studies. Many studies lacked a clear definition of cardiovascular disease and/or used a single determination of serum creatinine or GFR as an index of kidney function, which is not necessarily corresponding to well-defined chronic kidney disease. In six studies, however, chronic kidney dysfunction and cardiovascular disease were well defined and the results of these confirm the impact of kidney dysfunction. It is concluded that there is an undeniable link between kidney dysfunction and cardiovascular risk and that the presence of even subtle kidney dysfunction should be considered as one of the conditions necessitating intensive prevention of this cardiovascular risk.