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Sánchez-González Á, López-Fando Lavalle L, Esteban-Fernández A, Ruiz M, Hevia V, Comeche B, Sánchez Conde M, Álvarez S, Lorca Álvaro J, Fraile Poblador A, Hevia Palacios M, Domínguez Gutiérrez A, Artiles Medina A, Sanz Mayayo E, Duque G, Gómez Dos Santos V, Moreno-Guillén S, Burgos Revilla J. What Should Be Known by a Urologist About the Medical Management of COVID-19's Patients? Curr Urol Rep 2020; 21:44. [PMID: 32870407 PMCID: PMC7459251 DOI: 10.1007/s11934-020-00995-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW The alarming number of confirmed COVID-19 cases put a strain on the healthcare systems, which had to reallocate human and technical resources to respond to the emergency. Many urologists became integrated into multidisciplinary teams, dealing with this respiratory illness and its unknown management. It aims to summarize the epidemiological, clinical, diagnostical, and therapeutical characteristics of COVID-19, from a practical perspective, to ease COVID-19 management to non-physician staff. RECENT FINDINGS We performed a narrative review of the literature regarding COVID-19, updated to May 8th, 2020, at PubMed and COVID resource platforms of the main scientific editorials. COVID-19, characterized by fever, myalgias, dyspnea, and dry cough, varies widely from asymptomatic infection to death. Arrhythmias and thrombotic events are prevalent. Lymphopenia and inflammatory reactant elevation on laboratory, as well as bilateral and peripheral ground-glass opacities or consolidations on X-Ray, are usually found in its assessment. Little is known about SARS-CoV-2 immunology. To date, no therapy has demonstrated efficacy in COVID-19. Of-level or compassionate-use therapies are prescribed in the context of clinical trials. We should become familiar with specific adverse events and pharmacological interactions. The COVID-19 pandemic has paralyzed the urological activity, and its long-term consequences are unpredictable. Despite not being used to deal with respiratory diseases, the urologists become easily qualified to manage COVID-19 by following protocols and being integrated into multidisciplinary teams, helping to overcome the pandemic.
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Affiliation(s)
- Álvaro Sánchez-González
- Urology Department, Ramón y Cajal University Hospital, IRYCIS, University of Alcalá, Madrid, Spain
| | - Luis López-Fando Lavalle
- Urology Department, Ramón y Cajal University Hospital, IRYCIS, University of Alcalá, Madrid, Spain.
| | - Alberto Esteban-Fernández
- Cardiology Service, Severo Ochoa University Hospital, Rey Juan Carlos University, Leganés (Madrid), Spain
| | - Mercedes Ruiz
- Urology Department, Ramón y Cajal University Hospital, IRYCIS, University of Alcalá, Madrid, Spain
| | - Vital Hevia
- Urology Department, Ramón y Cajal University Hospital, IRYCIS, University of Alcalá, Madrid, Spain
| | - Belén Comeche
- Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, University of Alcalá, Madrid, Spain
| | - Matilde Sánchez Conde
- Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, University of Alcalá, Madrid, Spain
| | - Sara Álvarez
- Urology Department, Ramón y Cajal University Hospital, IRYCIS, University of Alcalá, Madrid, Spain
| | - Javier Lorca Álvaro
- Urology Department, Ramón y Cajal University Hospital, IRYCIS, University of Alcalá, Madrid, Spain
| | - Agustín Fraile Poblador
- Urology Department, Ramón y Cajal University Hospital, IRYCIS, University of Alcalá, Madrid, Spain
| | - Manuel Hevia Palacios
- Urology Department, Ramón y Cajal University Hospital, IRYCIS, University of Alcalá, Madrid, Spain
| | - Ana Domínguez Gutiérrez
- Urology Department, Ramón y Cajal University Hospital, IRYCIS, University of Alcalá, Madrid, Spain
| | - Alberto Artiles Medina
- Urology Department, Ramón y Cajal University Hospital, IRYCIS, University of Alcalá, Madrid, Spain
| | - Enrique Sanz Mayayo
- Urology Department, Ramón y Cajal University Hospital, IRYCIS, University of Alcalá, Madrid, Spain
| | - Gemma Duque
- Urology Department, Ramón y Cajal University Hospital, IRYCIS, University of Alcalá, Madrid, Spain
| | | | - Santiago Moreno-Guillén
- Infectious Diseases Department, Ramón y Cajal University Hospital, IRYCIS, University of Alcalá, Madrid, Spain
| | - Javier Burgos Revilla
- Urology Department, Ramón y Cajal University Hospital, IRYCIS, University of Alcalá, Madrid, Spain
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Martínez Sanz J, Pérez Elías MJ, Muriel A, Gómez Ayerbe C, Vivancos Gallego MJ, Sánchez Conde M, Herrero Delgado M, Pérez Elías P, Polo Benito L, de la Fuente Cortés Y, Barea R, Sullivan AK, Fuster Ruiz de Apodaca MJ, Galindo MJ, Moreno S. Outcome of an HIV education program for primary care providers: Screening and late diagnosis rates. PLoS One 2019; 14:e0218380. [PMID: 31265464 PMCID: PMC6605851 DOI: 10.1371/journal.pone.0218380] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 05/31/2019] [Indexed: 12/16/2022] Open
Abstract
Background Late HIV diagnosis remains one of the challenges in combating the epidemic. Primary care providers play an important role in screening for HIV infection. Our study aims to evaluate the relationship between knowledge and barriers to HIV testing and screening outcomes. The impact of an education program for primary care providers, towards improving HIV testing and late diagnosis rates, is also assessed. Methods A self-administered questionnaire that was developed within the framework of the European project OptTEST was used to examine HIV knowledge and barriers to HIV testing scores before and after being involved in an HIV education program. A quasi-experimental design with pre- and post-intervention measures was performed to investigate its impact. We performed multivariable logistic regression analysis to assess the relationship between variables for the HIV testing offer. Results A total of 20 primary care centers and 454 primary care staff were included. Baseline OptTEST results showed that more knowledgeable staff offered an HIV test more frequently (OR 1.07; CI 95% 1.01–1.13; p = 0.027) and had lower barrier scores (OR 0.89; CI 95% 0.77–0.95; p = 0.005). Nurses had lower scores in knowledge-related items (OR 0.28; CI 95% 0.17–0.46; p<0.001), but higher scores in barrier-related items than physicians (OR 3.28; CI 95% 2.01–5.46; p<0.001). Specific centers with more knowledgeable staff members had a significant association with a greater level of new HIV diagnosis rates (OR 1.61; CI 95% 1.04–2.49; p = 0.032). After the intervention, we found that 12 out of 14 individual questions showed improved scores. In the 6 months after the training program, we similarly found a higher HIV testing rate (OR 1.19; CI 1.02–1.42; p = 0.036). Conclusions This study highlights the association between knowledge and barriers to HIV testing, including HIV testing rates. It shows that it is possible to modify knowledge and reduce perceived barriers through educational programs, subsequently improving HIV screening outcomes.
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Affiliation(s)
- Javier Martínez Sanz
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - María Jesús Pérez Elías
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
- * E-mail: ,
| | - Alfonso Muriel
- Biostatistics Unit, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Cristina Gómez Ayerbe
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | | | - Matilde Sánchez Conde
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | | | | | | | | | | | - Ann K. Sullivan
- Chelsea and Westminster Healthcare NHS Foundation Trust, London, United Kingdom
| | | | - María José Galindo
- Infectious Diseases Unit, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Santiago Moreno
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
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Micheloud D, Berenguer J, Bellón JM, Miralles P, Cosin J, de Quiros JCLB, Conde MS, Muñoz-Fernández MA, Resino S. Negative influence of age on CD4+ cell recovery after highly active antiretroviral therapy in naive HIV-1-infected patients with severe immunodeficiency. J Infect 2008; 56:130-6. [PMID: 18192020 DOI: 10.1016/j.jinf.2007.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2007] [Revised: 11/28/2007] [Accepted: 12/03/2007] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To study the effect of age on several outcomes among 187 antiretroviral-naive infected patients who started highly active antiretroviral therapy (HAART) with <or=200 CD4(+)/microl. METHODS We carried out a retrospective study to determine the hazard ratio (HR) to reach an outcome in patients who experienced a change from the baseline in CD4(+) counts of at least +100, +200, +300, +400 and +500 cells/microl at any moment during the follow-up and the odds ratio (OR) of achieving and maintaining a CD4(+) value above a certain setpoint during at least 6, 12 or 18 months. RESULTS The adjusted HR for an increase of +400 CD4(+)/microl and +500 CD4(+)/microl were 1.3 (95% CI: 1.1; 1.5) and 1.3 (95% CI: 1.1; 1.6) times slower for each additional 5 years of age at baseline. In addition, for every 5 years of extra age, the adjusted OR to achieve an absolute CD4(+) cell count >500/microl at 6, 12 and 18 months after the initiation of HAART were 2.2 (95% CI: 1.5; 3.2), 1.8 (95% CI: 1.2; 2.6), and 1.8 (95% CI: 1.2; 2.9) times less likely, respectively. We also found that patients >or=45 years old had worse complete CD4(+) recovery (CD4(+)>500 cells/microl) than patients <45 years old. CONCLUSION The CD4(+) recovery after HAART is a prolonged and continuous process which extends for several years. Age at baseline is inversely correlated with the magnitude and speed of CD4(+) recovery among HIV-1 infected patients.
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Affiliation(s)
- Dariela Micheloud
- Laboratorio de Inmuno-Biología Molecular, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Muñoz P, Alcalá L, Sánchez Conde M, Palomo J, Yáñez J, Pelaez T, Bouza E. The isolation of Aspergillus fumigatus from respiratory tract specimens in heart transplant recipients is highly predictive of invasive aspergillosis. Transplantation 2003; 75:326-9. [PMID: 12589152 DOI: 10.1097/01.tp.0000044358.99414.b8] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Prompt recognition of invasive pulmonary aspergillosis (IPA) after heart transplantation is essential for achieving a successful outcome. However, the significance of the isolation of from respiratory specimens in heart transplant recipients is not established. METHODS From 1990 to 1999, we analyzed first respiratory specimens with spp. growth from heart transplant patients in our institution. All specimens were cultured in both fungal and conventional media. Diagnosis of proven and probable IPA or colonization was made according to criteria of the Mycoses Study Group. RESULTS During the 10-year study period, spp. was recovered from 30 episodes from 27 heart transplant recipients (incidence: 10.5%). Three episodes were classified as indeterminate and were included in the analysis in a double way, first considering them as true positives and afterward as true negatives, so ranges were obtained. After applying diagnostic criteria, 18 of 30 episodes were proven or probable IPA, and 9 episodes were colonizations. Accordingly, 7 to 8% of heart transplant recipients suffered an IPA, and the overall positive predictive value (PPV) was 60% to 70%. When analyzed by species, the PPV of recovering was 78% to 91%, whereas it was 0% for other species. The PPV increased to 88% to 100% when was recovered from a respiratory specimen other than sputum and decreased to 50% to 67% when it was recovered from sputum. The sensitivities of fungal and conventional media for the recovery of spp. were 95% to 100% and 33% to 38%, respectively. CONCLUSION The isolation of from the respiratory tract of a heart transplant recipient is highly predictive of invasive aspergillosis.
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Affiliation(s)
- Patricia Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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