RÉSUMÉ
The authors reviewed outpatients in a tertiary dermatology clinic in Botswana to expand knowledge on patterns of skin disease in this population with a high prevalence of human immunodeficiency virus (HIV). Approximately one-third of new and follow-up patients were HIV positive. Common dermatologic conditions included eczematous eruptions, viral and fungal infections, malignant neoplasms, vascular disorders, disorders of pigmentation, and mechanical/physical injury-related disorders. HIV has impacted patterns of dermatologic disease in Botswana, with Kaposi sarcoma being the most frequently biopsied condition. Given the shortage of dermatology specialists, resources should be allocated toward education and management of these most prevalent skin conditions.
Sujet(s)
Dermatite/épidémiologie , Infections à VIH/épidémiologie , Infections de la peau/épidémiologie , Dermatoses vasculaires/épidémiologie , Tumeurs cutanées/épidémiologie , Adolescent , Adulte , Sujet âgé , Biopsie/statistiques et données numériques , Botswana/épidémiologie , Enfant , Enfant d'âge préscolaire , Dermatite/diagnostic , Dermatite/thérapie , Eczéma atopique/diagnostic , Eczéma atopique/épidémiologie , Eczéma atopique/thérapie , Femelle , Humains , Nourrisson , Lupus érythémateux chronique/diagnostic , Lupus érythémateux chronique/épidémiologie , Lupus érythémateux chronique/thérapie , Mâle , Adulte d'âge moyen , Névrodermite/diagnostic , Névrodermite/épidémiologie , Névrodermite/thérapie , Prévalence , Études rétrospectives , Sarcome de Kaposi/diagnostic , Sarcome de Kaposi/épidémiologie , Sarcome de Kaposi/thérapie , Maladies de la peau/diagnostic , Maladies de la peau/épidémiologie , Maladies de la peau/thérapie , Infections de la peau/diagnostic , Infections de la peau/thérapie , Dermatoses vasculaires/diagnostic , Dermatoses vasculaires/thérapie , Tumeurs cutanées/diagnostic , Tumeurs cutanées/thérapie , Centres de soins tertiaires , Verrues/diagnostic , Verrues/épidémiologie , Verrues/thérapie , Jeune adulteRÉSUMÉ
On the basis of Covid-19-induced pulmonary pathological and vascular changes, we hypothesized that the anti-VEGF drug bevacizumab might be beneficial for treating Covid-19 patients. We recruited 26 patients from 2-centers (China and Italy) with confirmed severe Covid-19, with respiratory rate [≥] 30 times/min, oxygen saturation [≤] 93% with ambient air, or partial arterial oxygen pressure to fraction of inspiration O2 ratio (PaO2/FiO2) >100mmHg and [≤] 300 mmHg, and diffuse pneumonia confirmed by chest radiological imaging. This trial was conducted from Feb 15 to April 5, 2020, and followed up for 28 days. Relative to comparable control patients with severe Covid-19 admitted in the same centers, bevacizumab showed clinical efficacy by improving oxygenation and shortening oxygen-support duration. Among 26 hospitalized patients with severe Covid-19 (median age, 62 years, 20 [77%] males), bevacizumab plus standard care markedly improved the PaO2/FiO2 ratios at days 1 and 7 (elevated values, day 1, 50.5 [4.0,119.0], p<0.001; day 7, 111.0 [85.0,165.0], p<0.001). By day 28, 24 (92%) patients showed improvement in oxygen-support status, 17 (65%) patients were discharged, and none showed worsen oxygen-support status nor died. Significant reduction of lesion areas and ratios were shown in chest CT or X-ray analysis within 7 days. Of 14 patients with fever, body temperature normalized within 72 hours in 13 (93%) patients. Lymphocyte counts in peripheral blood were significantly increased and CRP levels were markedly decreased as shown in available data. Our findings suggested bevacizumab plus standard care was highly beneficial for treating patients with severe Covid-19. Clinical efficacy of bevacizumab warrants double blind, randomized, placebo-controlled trials. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04275414, URL: https://clinicaltrials.gov/ct2/show/NCT04275414.