COVID-19 outcomes in people living with HIV: Peering through the waves

Abstract Objective To evaluate clinical characteristics and outcomes of COVID-19 patients infected with HIV, and to compare with a paired sample without HIV infection. Methods This is a substudy of a Brazilian multicentric cohort that comprised two periods (2020 and 2021). Data was obtained through the retrospective review of medical records. Primary outcomes were admission to the intensive care unit, invasive mechanical ventilation, and death. Patients with HIV and controls were matched for age, sex, number of comorbidities, and hospital of origin using the technique of propensity score matching (up to 4:1). They were compared using the Chi-Square or Fisher's Exact tests for categorical variables and the Wilcoxon for numerical variables. Results Throughout the study, 17,101 COVID-19 patients were hospitalized, and 130 (0.76%) of those were infected with HIV. The median age was 54 (IQR: 43.0;64.0) years in 2020 and 53 (IQR: 46.0;63.5) years in 2021, with a predominance of females in both periods. People Living with HIV (PLHIV) and their controls showed similar prevalence for admission to the ICU and invasive mechanical ventilation requirement in the two periods, with no significant differences. In 2020, in-hospital mortality was higher in the PLHIV compared to the controls (27.9% vs. 17.7%; p = 0.049), but there was no difference in mortality between groups in 2021 (25.0% vs. 25.1%; p > 0.999). Conclusions Our results reiterate that PLHIV were at higher risk of COVID-19 mortality in the early stages of the pandemic, however, this finding did not sustain in 2021, when the mortality rate is similar to the control group.

Dados de Vida Real sobre o Uso da Hidroxicloroquina ou da Cloroquina Combinadas ou Não à Azitromicina em Pacientes com Covid-19: Uma Análise Retrospectiva no Brasil / Real-Life Data on Hydroxychloroquine or Chloroquine with or Without Azithromycin in COVID-19 Patients: A Retrospective Analysis in Brazil

Resumo Fundamento Apesar da ausência de evidência mostrando benefícios da hidroxicloroquina e da cloroquina combinadas ou não à azitromicina no tratamento da covid-19, esses medicamentos têm sido amplamente prescritos no Brasil. Objetivos Avaliar desfechos, incluindo moralidade hospitalar, alterações eletrocardiográficas, tempo de internação, admissão na unidade de terapia intensiva, e necessidade de diálise e de ventilação mecânica em pacientes hospitalizados com covid-19 que receberam cloroquina ou hidroxicloroquina, e comparar os desfechos entre aqueles pacientes e seus controles pareados. Métodos Estudo multicêntrico retrospectivo do tipo coorte que incluiu pacientes com diagnóstico laboratorial de covid-19 de 37 hospitais no Brasil de março a setembro de 2020. Escore de propensão foi usado para selecionar controles pareados quanto a idade, sexo, comorbidades cardiovasculares, e uso de corticosteroides durante a internação. Um valor de p<0,05 foi considerado estatisticamente significativo. Resultados Dos 7850 pacientes com covid-19, 673 (8,6%) receberam hidroxicloroquina e 67 (0,9%) cloroquina. A idade mediana no grupo de estudo foi 60 (46-71) anos e 59,1% eram mulheres. Durante a internação, 3,2% dos pacientes apresentaram efeitos adversos e 2,2% necessitaram de interromper o tratamento. Alterações eletrocardiográficas foram mais prevalentes no grupo hidroxicloroquina/cloroquina (13,2% vs. 8,2%, p=0,01), e o prolongamento do intervalo QT corrigido foi a principal diferença (3,6% vs. 0,4%, p<0,001). O tempo mediano de internação hospitalar foi maior no grupo usando CQ/HCQ em relação aos controles (9,0 [5,0-18,0] vs. 8,0 [4,0-14,0] dias). Não houve diferenças estatisticamente significativas entre os grupos quanto a admissão na unidade de terapia intensiva (35,1% vs. 32,0%; p=0,282), ventilação mecânica invasiva (27,0% vs. 22,3%; p=0,074) ou mortalidade (18,9% vs. 18,0%; p=0,682). Conclusão Pacientes com covid-19 tratados com cloroquina ou hidroxicloroquina apresentaram maior tempo de internação hospitalar, em comparação aos controles. Não houve diferença em relação a admissão em unidade de terapia intensiva, necessidade de ventilação mecânica e mortalidade hospitalar.

Abstract Background Despite no evidence showing benefits of hydroxychloroquine and chloroquine with or without azithromycin for COVID-19 treatment, these medications have been largely prescribed in Brazil. Objectives To assess outcomes, including in-hospital mortality, electrocardiographic abnormalities, hospital length-of-stay, admission to the intensive care unit, and need for dialysis and mechanical ventilation, in hospitalized COVID-19 patients who received chloroquine or hydroxychloroquine, and to compare outcomes between those patients and their matched controls. Methods A retrospective multicenter cohort study that included consecutive laboratory-confirmed COVID-19 patients from 37 Brazilian hospitals from March to September 2020. Propensity score was used to select matching controls by age, sex, cardiovascular comorbidities, and in-hospital use of corticosteroid. A p-value <0.05 was considered statistically significant. Results From 7,850 COVID-19 patients, 673 (8.6%) received hydroxychloroquine and 67 (0.9%) chloroquine. The median age in the study group was 60 years (46 - 71) and 59.1% were women. During hospitalization, 3.2% of patients presented side effects and 2.2% required therapy discontinuation. Electrocardiographic abnormalities were more prevalent in the chloroquine/hydroxychloroquine group (13.2% vs. 8.2%, p=0.01), and the long corrected QT interval was the main difference (3.6% vs. 0.4%, p<0.001). The median hospital length of stay was longer in the HCQ/CQ + AZT group than in controls (9.0 [5.0, 18.0] vs. 8.0 [4.0, 14.0] days). There was no statistical differences between groups in intensive care unit admission (35.1% vs. 32.0%; p=0.282), invasive mechanical ventilation support (27.0% vs. 22.3%; p=0.074) or mortality (18.9% vs. 18.0%; p=0.682). Conclusion COVID-19 patients treated with chloroquine or hydroxychloroquine had a longer hospital length of stay, when compared to matched controls. Intensive care unit admission, invasive mechanical ventilation, dialysis and in-hospital mortality were similar.

Are the anatomical, clinical, and ultrasound characteristics of thyroid nodules with Bethesda III or IV cytology and ACR TI-RADS 3, 4, or 5 able to refine the indications for molecular diagnostic tests?

ABSTRACT Objective: To analyze the association of clinical, anatomical, and ultrasound (US) characteristics of malignancies in Bethesda III or IV (III-B or IV-B) thyroid nodules. Subjects and methods: The association between malignancies and the following variables were analyzed: III-B or IV-B, age < 55 years and ≥ 55 years, sex, family history of thyroid cancer, history of irradiation, nodule size, and ACR TI-RADS classification in 62 participants who underwent thyroidectomy. Results: Of the 62 participants, 87.1% (54/62) were women, 74.2% were < 55 years old, 95.2% had no family history of thyroid cancer, 56.5% had nodules < 2 cm in size, 62.9% were IV-B, and 69.4% were ACR TI-RADS 4. Thirty-two patients had thyroid carcinoma, and 30 had benign histology. Among all factors associated with malignancy, only ACR TI-RADS 5 classification on US was found to be statistically significant (p = 0.014), while III-B with architectural atypia cytological classification was the only one significantly associated with benign status (p = 0.004). Conclusion: Only a high risk of malignancy as assessed using US was able to refine the indication for molecular tests in a group of patients with indeterminate nodules. We found 85% (53/62) of III-B or IV-B thyroid nodules would benefit from available molecular diagnostic tests.

Radiofrequency versus scalpel incision for upper blepharoplasty: a clinicopathologic and photo documentation comparison / Radiofrequencia versus lâmina fria em blefaroplastia superior: comparação clinicopatológica e foto documentação

Abstract Objective: The aim of this study is to compare scar appearance and the histopathological aspects of inflammatory response induced by the use of radiofrequency [RF] incision and a cold-blade scalpel incision in upper blepharoplasty surgery. Methods: This is a comparative, prospective, double-blind study that recruited 10 Caucasian patients from Oculoplastic Sector of Ophthalmological Center of Minas Gerais (Belo Horizonte, MG, Brazil) aged 60-70 years, Fitzpatrick skin types 3 and 4, with upper eyelid dermatochalasis and indication for upper blepharoplasty. These patients underwent upper blepharoplasty using RF incision in one eyelid (10 eyelids in total) and cold-blade incision in the contralateral eyelid (10 eyelids in total). The two techniques were compared for clinical scar appearance and histopathology of the excised tissue materials (i.e., upper eyelid skin). To evaluate clinical scar appearance, we employed two distinct methods: photo-documentation and statistical analysis of the assessment performed by two masked observers (oculoplastic specialists) that examined all patients during all the follow-up based on Vancouver scar scale criteria, which includes attributes related to scar's vascularization, thickness, pigmentation, and elasticity. Follow-up was performed on days 30, 60, and 180 after surgery. After the follow-up period, the collected data were statistically analyzed by using the Wilcoxon signed-rank test. Results: The eyelids incised with a scalpel displayed thicker scars (hypertrophic scars), which differed significantly only in the first month after surgery (p = 0.022). The two surgical techniques did not show statistically significant difference in vascularity, elasticity, or pigmentation of the scar during the follow up period (sixth postoperative month). Regarding the histopathological evaluation, the excised skin fragments exhibited the same patterns, except the cautery effect that was observed at the edges of the skin excised with RF, which showed 0.20-0.30-mm thick thermal damage. Conclusion: The two techniques did not show statistically significant difference in terms of scar appearance after the sixth postoperative month.

Resumo Objetivo: Este estudo comparou o aspecto da cicatriz e histopatologia da resposta inflamatória induzidas pelo uso de radiofrequência [RF] e incisão fria em blefaroplastia superior. Métodos: Trata-se de um estudo comparativo, prospectivo, duplo-cego, no qual foram selecionados dez pacientes da raça branca do Departamento de Plástica Ocular do Centro Oftalmológico de Minas Gerais, na faixa etária entre 60-70 anos, fototipos 3 e 4 pela classificação Fitzpatrick, que apresentavam dermatocalase com indicação de blefaroplastia superior. Estes pacientes foram submetidos à blefaroplastia superior com a utilização da RF em uma pálpebra (total de 10 pálpebras) e de incisão fria na pálpebra contralateral (total de 10 pálpebras). As duas técnicas foram comparadas quanto ao aspecto clínico da cicatriz e avaliação histopatológica do material excisado (pele de pálpebra superior). Para avaliação do aspecto clínico da cicatriz optamos por dois métodos: a fotodocumentação e análise estatística da avaliação de dois observadores oculoplásticos mascarados que examinaram os pacientes durante todo o período de follow-up baseado na escala de cicatrização de Vancouver que inclui atributos relacionados à vascularização, espessura, pigmentação e elasticidade. O seguimento foi feito com 30, 60 e 180 dias de pós operatório. Após o follow-up, foi realizada análise estatística dos dados através do Teste de Pontos com Sinais de Wilcoxon. Resultados: As pálpebras operadas com bisturi apresentaram tendência a cicatrizes mais grossas (hipertróficas) com diferença estatisticamente significativa apenas para o primeiro mês de cirurgia (p=0.022). Não houve diferença estatisticamente significativa entre vascularização, elasticidade e pigmentação entre as duas técnicas de cirurgia avaliadas. Em relação à avaliação histopatológica, os fragmentos de pele excisados apresentaram o mesmo padrão inflamatório com a exceção do efeito de cautério nas bordas das peles excisadas com RF, que variaram de 0,20-0,30mm de espessura de dano térmico. Conclusão: As duas técnicas não mostraram diferença estatisticamente significativa no aspecto clínico da cicatriz após o sexto mês pós-operatório.

Prognosis of glaucoma in relation to blindness at a university hospital / Prognóstico dos glaucomas em relação à cegueira em um serviço universitário

Purpose: To assess the prognosis of different types of glaucoma in relation to unilateral and bilateral blindness at a University Hospital. Methods: Charts of glaucomatous patients which presented complete data of clinical history, visual acuity, visual field, fundus examinationand diagnosis were retrospectively analyzed. The patients were classifiedas: not blind, legally blind (best corrected visual acuity ≤20/200 and/orvisual field ≤20º), or totally blind (no light perception) in one or both eyes. Patients with blindness due to congenital glaucoma and other noglaucomatous causes, and incomplete charts were excluded. Results: 3,786 (76.3%) of 4,963 charts fulfilled the criteria. In 3,786 glaucomatous patients, 1,939 (51.2%) were not blind and 1,847 (48.8%) were blind. 1,359 patients (73.6%) were legally blind and 488 (26.4%) totally blind, 1,333 (72.2%) had unilateral blindness and 514 (27.8%), bilateral blindness. 1,564 patients (84.7%) were already blind (74.9% with legal blindness and 25.1% with total blindness) when they arrived at the Service and 283 (15.3%) became blind after their inclusion in the Service. Neovascular glaucoma presented the highest proportion (95.6%) of blindness. Postsurgical glaucoma was second causing blindness in 72.7% and thirdly, primary angle-closure glaucoma with 67.4%. Primary openangle glaucoma presented the lowest proportion (40.5%) of blindness.Conclusions: Neovascular glaucoma had the worst prognosis with the highest proportion of blindness. Primary angle-closure glaucoma caused blindness roughly 1.7 times more than primary open-angle glaucoma. Primary open-angle glaucoma presented the best prognosis. The proportion of patients that became blind after their inclusion in the Service was relatively low in relation to the proportion of patients who were blind when they arrived at the Service.

Objetivo: Avaliar o prognóstico de diferentes tipos de glaucoma como causa de cegueira monocular e binocular num Hospital Universitário. Métodos: Foram analisados retrospectivamenteos prontuários de portadores de glaucoma que possuíam dados completos de história clínica, acuidade visual, campo visual, fundo de olho e diagnóstico. Os pacientes foram classificados como: não portadores de cegueira e portadores de cegueira legal (melhor acuidade visual corrigida ≤0,1 e/ou campo visual ≤20º), ou total (ausência de percepção luminosa) em um ou ambos os olhos. Foram excluídos os pacientes com prontuários incompletos, com cegueira devida a glaucoma congênito e outras causas de cegueira não glaucomatosa. Resultados: Três mil setecentos oitenta e seis (76,3%) de 4.963 prontuários preencheram os critérios. De 3.786pacientes glaucomatosos, 1.939 51,2%) não apresentavam cegueira e 1.847 (48,8%) eram cegos. Mil trezentos cinquenta e nove pacientes (73,6%) apresentavam cegueira legal e 488 (26,4%) cegueira total, 1.333 (72,2%) tinham cegueira unilateral e 514 (27,8%), bilateral. Mil quinhentos sessenta quatro pacientes (84,7%) já eram cegos (74,9% com cegueira legal e25,1% com cegueira total) quando chegaram ao Serviço e apenas 283 (15,3%) tornaram-se cegos após a sua matrícula no Serviço. O glaucoma neovascular apresentou a maior proporção (95,6%) de cegueira. O glaucoma pós-cirúrgico foi o segundoque mais causou cegueira (72,7%) e, em terceiro lugar, o glaucoma primário de ângulo fechado com 67,4%. O glaucoma primário de ângulo aberto foi o que apresentou a menor proporção de pacientes com cegueira (40,5%). Conclusões: O pior prognóstico coube ao GNV (maior proporção de pacientescegos e com cegueira total), seguido pelo glaucoma póscirúrgico e pelo GPAF que causou cegueira aproximadamente1,7 vezes mais que o GPAA. O melhor prognóstico recaiu no GPAA (menor proporção de pacientes cegos)...