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Introduction Le nirmatrelvir-ritonavir (NR) a démontré son efficacité et sa sécurité pour prévenir la survenue de formes sévères de COVID-19 chez les patients à risque de progression. Néanmoins, peu de données existent chez les greffés rénaux. De plus, le ritonavir interagit avec de nombreux médicaments, notamment avec les inhibiteurs de la calcineurine (IC). Description Nous avons inclus dans cette étude monocentrique rétrospective tous les patients traités par NR entre le 28/04/2022 et le 03/06/2022. Méthodes Le traitement par NR était de 5jours (jour 1 à jour 5) à la dose recommandée. Le traitement usuel (notamment immunosuppresseur) était adapté selon les recommandations de la Société Française de Pharmacologie et Thérapeutiques. Un suivi standardisé biologique et clinique a été réalisé. Résultats Quatorze patients ont été inclus (Tableau 1). Comparées à celles du jour 0 (veille de l’initiation du NR), les concentrations médianes de créatinine plasmatique et les charges virales de SARS-CoV-2 au jour 7 étaient respectivement similaires (p=0,866) et fortement diminuées (p=0,002). Deux patients ont eu une insuffisance rénale aigue rapidement résolutive dans un contexte de diarrhée et de sepsis urinaire. Les concentrations résiduelles d’IC sont restées relativement stables avec néanmoins 5 patients qui ont présenté des taux supra-thérapeutiques au premier dosage post reprise de l’IC. Après un suivi médian de 34jours, aucun patient n’est mort ni n’a présenté de pneumonie virale. Deux patients ont dû être hospitalisés pour sepsis urinaire (au jour 2 et 11). Nous avons néanmoins observé 2 cas de récidive précoce de symptômes associée à une réaugmentation de la charge virale après traitement par NR (au jour 10 et 21). Conclusion L’utilisation du NR est possible chez les greffés rénaux sous condition d’un respect strict des adaptations thérapeutiques recommandées. 14 % de la cohorte a présenté une récidive précoce en cours d’investigation.
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Background: Patients with coronavirus disease (COVID-19) can develop severe hypoxemia. Meeting the soaring demands of oxygen may be a challenge. Objective: To test the efficacy of an easily handmade system, the double-trunk mask (DTM), in reducing oxygen consumption while maintaining patient's oxygenation level. Methods: Hospitalized adults with COVID-19 and hypoxemia treated with low-flow oxygen therapy we recruited. The standard oxygen delivery system was replaced by the DTM with nasal cannula for 30 minutes with an oxygen output adapted to maintain an identical oxygen saturation by pulse oximetry. The standard oxygen delivery system was then reinstated for 30 minutes. Primary outcome was the absolute change in oxygen flow between the standard delivery systems and the DTM. Secondary outcomes were changes in blood gases, vital parameters and patient comfort. Results: Eleven patients were analyzed (mean age 61 years;27% male). Compared with standard delivery systems, the oxygen output was significantly reduced with the DTM (median, 5 vs 1.5 L/min (95% CI -4 to -1.5, p=0.003)) when oxygen saturation and arterial oxygen tension remained stable. The DTM was also associated with a significant but slight increase in arterial carbon dioxide tension (median, 36 mmHg vs 37 mmHg, p=0.006), and respiratory rate (median, 26 vs 30 breaths/min, p=0.05). Other parameters were unaltered. The DTM was generally judged less comfortable than the baseline oxygen delivery system, especially in patients requiring low oxygen flow at baseline. Conclusions: The DTM is a simple and efficient system to reduce oxygen consumption. This may have clinical implications in places where oxygen supplies are limited.
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BACKGROUND: Healthcare workers (HCWs) are at high risk of acquiring COVID-19 and could play a role in nosocomial transmission. Since 4th February 2020, Belgian Health authorities reported more than 90,568 cases, of which 8.3% were HCWs. Data on clinical characteristics, sources of infection and humoral immune response of HCWs with COVID-19 remain scarce. AIM: To analyse the clinical characteristics, humoral immune response, sources of contamination, and outcomes among HCWs with COVID-19. METHODS: This retrospective study included 176 HCWs with laboratory-confirmed COVID-19 in a teaching hospital in Belgium. Between 1st March and 31st May 2020, all HCWs with symptoms suspected of COVID-19 were tested by reverse transcription polymerase chain reaction on a nasopharyngeal swab. Serological testing was performed between 55 and 137 days after the onset of symptoms. FINDINGS: Median age was 40.8 years and 75% were female. Median delay between onset of symptoms and diagnosis was 4.39 days. Most frequent symptoms were cough and headache (both 75%). Fever accounted for 68.7%. Most represented professions were nurses (42%). HCWs were mainly infected by patient contact (32.9%); 7.6% required hospitalization and 1.7% were admitted to the intensive care unit. Unfortunately, one HCW died (0.5%). Total antibodies were positive in 109/126 (86.5%). CONCLUSIONS: Clinical presentation of COVID-19 in HCWs does not differ from the general population. However, outcomes were more favourable with a mortality rate lower than that reported in Belgian COVID-19 patients in general (16%). The main source of infection was the hospital setting. Our positive antibodies rate was high but lower than previously reported.