ABSTRACT
Human immunodeficiency virus (HIV)-1, the virus that causes HIV infection and acquired immunodeficiency syndrome (AIDS), has caused cases of infection recognized in the United States since the late 1970s. As scientists seek a cure for HIV, much has been learned about the interaction of the virus and the immune system. Recent advances in therapies used as tools for HIV treatment and prevention have resulted in a worldwide decrease in new infections, and public health campaigns are aimed at reducing new cases to a level signaling the end of the HIV epidemic. While organs and tissue systems may be damaged not only by HIV but also by the treatment of HIV with antiretroviral medications, people living with HIV can live a normal life span with appropriate medical management. The new epidemic affecting humankind, the novel coronavirus disease that emerged in 2019 (COVID-19) caused by the severe acute respiratory syndrome (SARS) coronavirus-2 (CoV-2), is disrupting HIV treatment and prevention programs worldwide and has laid bare health and healthcare disparities and inequalities existing in rich and poor countries alike. The effects of the COVID-19 pandemic on the HIV epidemic have yet to be realized. © 2023 Elsevier Ltd. All rights reserved.
ABSTRACT
Introduction The Rockwood clinical frailty score (CFS) has been recommended for use in assessing patients during the COVID-19 pandemic. However, a recent cohort study has suggested it has little impact on the hazard of dying due to COVID-19,1 while use to inform escalation decisions has proven contentious. Method We identified patients hospitalised with COVID-19 from 11 March 2020 to 28 April 2020. Age, gender, key co-morbidities, inpatient mortality, length of stay, CFS, respiratory support, chest X-ray (CXR) appearance and C-reactive protein (CRP) were collected retrospectively from electronic records and medical notes. Multiple imputation used for missing values (CFS n= 1;CRP n= 5;CXR n= 9). Univariate relationships with in-hospital mortality were examined (Fisher's exact, T test and Mann-Whitney U as appropriate) and independent predictors of mortality were identified via backward stepwise logistic regression. CFS was verified in patients referred for CPAP/NIV on the Respiratory Support Unit (RSU;maximum level of care);mortality outcomes are separately shown. Results Among 414 patients;mean age was 73 (SD 14.297) years, 241 males (58%), 135 died (33%) and median CFS 4 (IQR 2.75-5.00). Older age (mean 69.90 [SD 15.122] vs. 79.40 [SD 9.616];p< 0.0001) and CFS (median 3 [IQR 2-4] vs. 5 [IQR 3-6];p< 0.0001) were significantly associated with mortality. Mortality was higher in those invasively (10/13, 76.9%, p= 0.001) and non-invasively (16/32, 50.0%, p= 0.027) ventilated. Independent predictors associated with mortality are shown in table 1. Among patients receiving CPAP/NIV on the RSU, mortality increased with each CFS category (1-3 n=6/17, 35.3%;4-5 n=9/14, 64.3%;6-7 n=5/6, 83.3%). Conclusion We report a large, single centre series of COVID-19 patients. Consecutive patients were identified, and missing data were few. CFS is a strong independent predictor of mortality in patients with COVID-19. This data would suggest that, in our population, the continuing use of CFS is important in our management and decision making in patients with COVID-19.
ABSTRACT
Measures to slow down the spread of Covid-19 have had profound effects on the food and nutrition security of poor and marginalised households and communities. This article provides an overview of the effects of Covid-19 on food systems across low-and middle-income countries using resilience and political economy lenses, before proposing approaches to build back resilient and equitable food systems. First, future interventions need to target structural issues that limit people’s agency in accessing nutritious and diverse food and production capital. Second, local innovation systems and institutions require investment to create a market environment that benefits domestic (small and medium) enterprises and agri-food supply chain workers without jeopardising the environment. Third, interventions need to be informed by a diverse set of opinions that include the voices of the most marginalised. © 2021 The Authors. IDS Bulletin © Institute of Development Studies.
ABSTRACT
S6 Table 1Independent predictors of mortality in COVID-19 patientsConclusionWe report a large, single centre series of COVID-19 patients. Consecutive patients were identified, and missing data were few. CFS is a strong independent predictor of mortality in patients with COVID-19. This data would suggest that, in our population, the continuing use of CFS is important in our management and decision making in patients with COVID-19.ReferenceRK Owen, SP Conroy, N Taub, et al. Comparing associations between frailty and mortality in hospitalised older adults with or without COVID-19 infection: a retrospective observational study using electronic health records. Age and Ageing. 2020. doi.org/10.1093/ageing/afaa167