RESUMO
BACKGROUND: The contribution of HIV to COVID-19 outcomes in hospitalized inpatients remains unclear. We conducted a multi-centre, retrospective matched cohort study of SARS-CoV-2 PCR-positive hospital inpatients analysed by HIV status. METHODS: HIV-negative patients were matched to people living with HIV (PLWH) admitted from 1 February 2020 to 31 May 2020 up to a 3:1 ratio by the following: hospital site, SARS-CoV-2 test date ± 7 days, age ± 5 years, gender, and index of multiple deprivation decile ± 1. The primary objective was clinical improvement (two-point improvement or better on a seven-point ordinal scale) or hospital discharge by day 28, whichever was earlier. RESULTS: A total of 68 PLWH and 181 HIV-negative comparators were included. In unadjusted analyses, PLWH had a reduced hazard of achieving clinical improvement or discharge [adjusted hazard ratio (aHR) = 0.57, 95% confidence interval (CI): 0.39-0.85, p = 0.005], but this association was ameliorated (aHR = 0.70, 95% CI: 0.43-1.17, p = 0.18) after additional adjustment for ethnicity, frailty, baseline hypoxaemia, duration of symptoms prior to baseline, body mass index (BMI) categories and comorbidities. Baseline frailty (aHR = 0.79, 95% CI: 0.65-0.95, p = 0.011), malignancy (aHR = 0.37, 95% CI 0.17, 0.82, p = 0.014) remained associated with poorer outcomes. The PLWH were more likely to be of black, Asian and minority ethnic background (75.0% vs 48.6%, p = 0.0002), higher median clinical frailty score [3 × interquartile range (IQR): 2-5 vs, 2 × IQR: 1-4, p = 0.0069), and to have a non-significantly higher proportion of active malignancy (14.4% vs 9.9%, p = 0.29). CONCLUSIONS: Adjusting for confounding comorbidities and demographics in a matched cohort ameliorated differences in outcomes of PLWH hospitalized with COVID-19, highlighting the importance of an appropriate comparison group when assessing outcomes of PLWH hospitalized with COVID-19.
Assuntos
COVID-19 , Infecções por HIV , COVID-19/epidemiologia , COVID-19/terapia , Inglaterra/epidemiologia , Feminino , Infecções por HIV/epidemiologia , Hospitalização , Humanos , Masculino , Pandemias , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Anecdotal evidence suggests the use of bolus tube feeding is increasing in the long-term home enteral tube feed (HETF) patients. A cross-sectional survey to assess the prevalence of bolus tube feeding and to characterise these patients was undertaken. Dietitians from ten centres across the UK collected data on all adult HETF patients on the dietetic caseload receiving bolus tube feeding (n 604, 60 % male, age 58 years). Demographic data, reasons for tube and bolus feeding, tube and equipment types, feeding method and patients' complete tube feeding regimens were recorded. Over a third of patients receiving HETF used bolus feeding (37 %). Patients were long-term tube fed (4·1 years tube feeding, 3·5 years bolus tube feeding), living at home (71 %) and sedentary (70 %). The majority were head and neck cancer patients (22 %) who were significantly more active (79 %) and lived at home (97 %), while those with cerebral palsy (12 %) were typically younger (age 31 years) but sedentary (94 %). Most patients used bolus feeding as their sole feeding method (46 %), because it was quick and easy to use, as a top-up to oral diet or to mimic mealtimes. Importantly, oral nutritional supplements (ONS) were used for bolus feeding in 85 % of patients, with 51 % of these being compact-style ONS (2·4 kcal (10·0 kJ)/ml, 125 ml). This survey shows that bolus tube feeding is common among UK HETF patients, is used by a wide variety of patient groups and can be adapted to meet the needs of a variety of patients, clinical conditions, nutritional requirements and lifestyles.
Assuntos
Nutrição Enteral/métodos , Nutrição Enteral/estatística & dados numéricos , Serviços de Assistência Domiciliar/estatística & dados numéricos , Inquéritos e Questionários , Adulto , Idoso , Idoso de 80 Anos ou mais , Paralisia Cerebral/terapia , Estudos Transversais , Feminino , Neoplasias de Cabeça e Pescoço/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Reino UnidoRESUMO
BACKGROUND: Lymphogranuloma venereum (LGV) has reestablished itself as an endemic sexually transmitted infection in the United Kingdom and elsewhere in Europe and North America over the last decade. Current guidelines suggest treatment with 21 days of doxycycline; however, the evidence base for LGV treatment including its duration is very limited. METHODS: We conducted a retrospective review in 2 central London genitourinary medicine clinics of men who have sex with men (MSM) with LGV in whom less than 21 days of doxycycline was used initially. RESULTS: Sixty MSM were treated initially with less than 21 days of doxycycline, of whom 50 (83%) were prescribed a 7-day course. Fifty percent of patients were asymptomatic, with the rest having rectal or other symptoms. Fifty-nine (97%) of 60 had a negative test of cure for LGV at a median of 31 days (7-200 days). Reinfection as opposed to treatment failure was considered likely in the patient testing positive. A second test of cure at a median of 139 days later (37-638 days) was completed in 30 patients, of whom 28 (93%) were negative for LGV. CONCLUSIONS: Seven to 14 days of doxycycline is effective in most cases of LGV with negative TOCs in 59 of 60 patients. These data suggest that 7 days of doxycycline is effective in achieving cure of rectal LGV in most MSM. There is a case for a randomized controlled trial of LGV treatment including a 7-day regimen of doxycycline.
Assuntos
Antibacterianos/uso terapêutico , Doxiciclina/uso terapêutico , Homossexualidade Masculina , Linfogranuloma Venéreo/tratamento farmacológico , Doenças Retais/tratamento farmacológico , Adulto , Antibacterianos/administração & dosagem , Chlamydia trachomatis/efeitos dos fármacos , Doxiciclina/administração & dosagem , Esquema de Medicação , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Retais/microbiologia , Estudos Retrospectivos , Infecções Sexualmente Transmissíveis/tratamento farmacológico , Infecções Sexualmente Transmissíveis/microbiologia , Falha de TratamentoRESUMO
Introduction: Globally, B-mode ultrasound is the most common modality used for the diagnosis of hepatic steatosis. We aimed to assess the correlation between qualitative liver ultrasound parameters, attenuation imaging (ATI) and histopathology-diagnosed steatosis grade obtained from liver biopsy. Our secondary aim was to examine the interobserver variability of qualitative ultrasound features. Methods: A retrospective cohort study was performed which included adult patients (age ≥ 18 years) who had same-day liver ultrasound, ATI and liver biopsy for grading hepatic steatosis severity between 2018 and 2022. The qualitative US features for hepatic steatosis were independently scored by three radiologists and interobserver variability was examined. Histologic steatosis grade, ATI and qualitative ultrasound parameters were compared. Results: Ninety patients were included; 67% female with a median age of 54 (IQR 39-65) years. The radiologist's overall impression had the highest correlation (very strongly correlated) with histologic steatosis grade (r = 0.82, P < 0.001). ATI coefficient and all qualitative ultrasound B-mode features except for liver echotexture and focal fat sparing were strongly correlated with histologic steatosis grade (r ≥ 0.70, P < 0.001). Most qualitative ultrasound features had good agreement between observers (Kappa statistic 0.61-1.0, P < 0.001), (Kendall coefficient 0.92, P < 0.001). Conclusion: The examined qualitative ultrasound parameters and ATI had good-excellent performance for diagnosing clinically significant hepatic steatosis; however, the radiologist's overall impression had the best correlation with histologic steatosis grade. Our findings suggest an ongoing role for qualitative liver ultrasound assessment of hepatic steatosis despite the emergence of newer quantitative measures.
RESUMO
Buprenorphine and methadone are both effective for the control of the acute signs and symptoms of opiate withdrawal, but it is not known if there are differences between these two medications for other important clinical outcomes. This observational, non-randomized study evaluated completion rates of patients over a 13-month period when buprenorphine replaced methadone as the medication used for short-term inpatient opiate detoxification. Of the 644 patients in the study, the 303 treated with buprenorphine were more likely to complete detoxification than the 341 treated with methadone (89% vs. 78%; P < .001). Improvement in completion rates coincided with the introduction of buprenorphine. We conclude that as compared to methadone, buprenorphine is associated with greater rates of completion of inpatient detoxification.
Assuntos
Buprenorfina/administração & dosagem , Metadona/administração & dosagem , Entorpecentes/administração & dosagem , Transtornos Relacionados ao Uso de Opioides/reabilitação , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Adolescente , Adulto , Feminino , Seguimentos , Hospitais de Ensino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , New York , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Centros de Tratamento de Abuso de Substâncias , Síndrome de Abstinência a Substâncias/reabilitaçãoRESUMO
We describe the case of a HIV-positive patient treated for visceral leishmaniasis who developed uveitis as part of a leishmaniasis immune reconstitution syndrome. Visceral leishmaniasis is increasingly found in HIV-positive adults. Its ophthalmic manifestations can range from relatively minor to complicated anterior uveitis, leading to secondary glaucoma and loss of vision. Clinicians caring for people living with HIV should be alert to the complications of leishmaniasis that can occur before and during treatment.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/complicações , Infecções por HIV/complicações , Homossexualidade Masculina , Síndrome Inflamatória da Reconstituição Imune/complicações , Leishmaniose Visceral/complicações , Uveíte/etiologia , Adulto , Fármacos Anti-HIV/uso terapêutico , Febre/etiologia , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Humanos , Leishmania donovani/isolamento & purificação , Leishmaniose Visceral/diagnóstico , Leishmaniose Visceral/tratamento farmacológico , Masculino , Esplenomegalia/etiologia , Resultado do Tratamento , Uveíte/diagnóstico , Uveíte/tratamento farmacológicoAssuntos
Infecções por Coronavirus/diagnóstico , Infecções por HIV/tratamento farmacológico , Pneumonia por Pneumocystis/diagnóstico , Pneumonia Viral/diagnóstico , Antibacterianos/uso terapêutico , Fármacos Anti-HIV/uso terapêutico , Asma/complicações , Betacoronavirus , COVID-19 , Teste para COVID-19 , Técnicas de Laboratório Clínico , Infecções por Coronavirus/complicações , Infecções por Coronavirus/terapia , DNA Bacteriano , Diagnóstico Diferencial , Emtricitabina/uso terapêutico , Glucocorticoides/uso terapêutico , Infecções por HIV/complicações , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase Multiplex , Oxigenoterapia , Pandemias , Pneumocystis carinii , Pneumonia por Pneumocystis/complicações , Pneumonia por Pneumocystis/tratamento farmacológico , Pneumonia Viral/complicações , Pneumonia Viral/terapia , Prednisolona/uso terapêutico , RNA Viral , Raltegravir Potássico/uso terapêutico , Reação em Cadeia da Polimerase em Tempo Real , SARS-CoV-2 , Tenofovir/uso terapêutico , Tomografia Computadorizada por Raios X , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Carga ViralRESUMO
BACKGROUND: Approximately 700,000 women in the reproductive age group are victims of sexual assault in the United States per year. Between 1% and 5% of sexual assaults result in pregnancy, for a total of 32,000 pregnancies per year. Of these, 14,000 are aborted because of incest or rape. OBJECTIVE: To determine the percent of emergency departments in the state of Pennsylvania offering routine counseling and provision of emergency contraception to victims of sexual assault. Secondary objectives were to compare provision practices for Catholic versus non-Catholic hospitals, and to compare these practices with other services, such as sexually transmitted disease prophylaxis and sexual assault counseling. METHODS: A 15-item survey instrument was designed to determine the volume of sexual assault patients seen per year, routinely offered services, and emergency contraception protocols. Three telephone callers administered surveys, using a pre-designed script for each call. RESULTS: Of the 165 eligible hospitals, 125 (76%) replied. Less than half (42%) of all hospitals routinely offer emergency contraception counseling, and 16% of the hospitals did not offer any counseling regarding emergency contraception. CONCLUSION: Provision of emergency contraception to victims of sexual assault is inconsistent and insufficient. It is important that sexual assault patients not be further victimized by a system that fails to meet their needs.
Assuntos
Anticoncepcionais Pós-Coito/uso terapêutico , Aconselhamento/estatística & dados numéricos , Vítimas de Crime , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitais Religiosos/estatística & dados numéricos , Estupro , Adulto , Catolicismo , Vítimas de Crime/estatística & dados numéricos , Feminino , Pesquisas sobre Atenção à Saúde , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Avaliação de Processos e Resultados em Cuidados de Saúde , Educação de Pacientes como Assunto , Pennsylvania , Garantia da Qualidade dos Cuidados de Saúde , Estupro/estatística & dados numéricos , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções Sexualmente Transmissíveis/prevenção & controle , Inquéritos e QuestionáriosRESUMO
Additional treatment after inpatient detoxification is recommended; however, many patients fail to initiate aftercare. The purpose of this observational study was to determine which patients hospitalized for alcohol or drug withdrawal subsequently fail to initiate recommended outpatient aftercare treatment by using existing data from medical records. Of 406 patients, 180 (44.3%) did not initiate outpatient aftercare treatment after hospitalization for detoxification. Compared with those who did initiate aftercare, those who did not were less likely to have education beyond high school (44% vs. 32%; P = 0.018), to be enrolled in a managed care health insurance plan (46% vs. 34%; P = 0.013), and to have a family history of chemical dependency (81% vs. 72%; P = 0.049). These values were similar with multiple regression analysis. Of the 406 patients, 11 of 56 (20%) without any of these risk factors, 145 of 314 (46%) with 1 or 2 risk factors, and 24 of 36 (67%) with all 3 of these risk factors did not keep scheduled outpatient appointment for aftercare. These findings suggest that some patients admitted for inpatient detoxification, identifiable by certain admission characteristics, are at risk for failure to link with appropriate outpatient aftercare treatment.