Background: The coronavirus disease 2019 (COVID-19) pandemic has disrupted health care systems worldwide. This is due to both to the reallocation of resources toward COVID-19 patients as well as concern for the risk of nosocomial severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposure. The interruption of routine care is especially problematic for patients with chronic conditions requiring regular follow-up, such as lung transplant (LTx) recipients. Introduction: New methods such as telemedicine are needed to bridge the gap in follow-up care caused by the pandemic. Materials and Methods: A retrospective analysis of video consultations (VCs) in comparison with on-site visits (OSVs) was performed during a 6-week period in an LTx center in Germany. VC included a structured work-up questionnaire and vital sign documentation. Results: During the 6-week study period, 75 VCs were performed for 53 patients and 75 OSVs by 51 patients occurred. By the end of our study period, 77% of physician-patient contacts occurred through VC. Physician-patient consultations were reduced by 47% compared with the equivalent time frame in 2019. In 62% of cases, VC resulted in a concrete clinical decision. One COVID-19 patient in home quarantine was admitted due to respiratory failure detected by VC. Patient satisfaction with VC was high. Discussion: Implementation of VC helped to reduce the need for OSV and thus the risk of SARS-CoV-2 exposure in our patient cohort. This technology can be adopted to provide care for a wide range of chronic illnesses. Conclusions: VC can preserve access to specialist care while reducing SARS-CoV-2 exposure for patients with chronic illnesses during the pandemic.

Background. Everolimus-based quadruple low calcineurin inhibitor (CNI) maintenance immunosuppression has been shown to be effective in preserving short-term renal function without compromising efficacy or safety after lung transplantation; however, long-term benefit remains unknown. Methods. An investigator-initiated 5-y follow-up analysis of the 4EVERLUNG study (NCT01404325), comparing everolimus-based quadruple low CNI with standard triple regimen, was performed. Patients who remained on the randomized drug regimen until the end of the 5-y observation were analyzed as the per protocol (PP) population. Patients in whom the assigned regimen was switched were analyzed as the intention-to-treat (ITT) population. Results. In total, 123 patients (95%) from the core study were analyzed. During the observation period in 11 patients (19%) of the standard triple regimen and in 30 patients (46%) of the quadruple low CNI regimen, the assigned immunosuppressive regimen was switched (P = 0.002). Estimated glomerular filtration rate at 5-y follow-up did not differ between the groups in both the ITT (56 [48–73] versus 58 [48–69] mL/min; P=0.951) and PP (59 [50–73] versus 59 [48–69] mL/min; P = 0.946) populations. Thromboembolic events occurred more frequently in the quadruple low CNI regimen (ITT: 11% versus 24%, P = 0.048; PP: 11% versus 22%, P = 0.162). There was a trend for a higher chronic lung allograft dysfunction–free survival for the quadruple low CNI regimen in the PP population (P = 0.082). No difference in the graft survival was found. Conclusions. Initiation of an early everolimus-based quadruple low CNI regimen may have no long-term benefit on renal function. The immunosuppressive efficacy and safety profile seems comparable with the standard triple regimen.

Majority of African countries have high stigma index(HSI) and are mostly populated by rural dwellers with high levels of illiteracy/ignorance. Therefore, poor education and knowledge of human immune deficiency virus(HIV) infection might be key drivers of stigmatization. Eight countries with a stigma index(STI) >40%(Niger, Guinea, Ghana, Sierra Leone, Liberia, Mali, Togo, and Democratic Republic of Congo) of 32 African countries with listed STI by UNAIDS, and three (Rwanda, Zambia, and Namibia), with a low stigma index (LSI) of 20%, were descriptively analyzed. Four knowledge classes(≤25%-class one;>25%≤50%-class two; >50%≤75% class three; >75%-class four), and categories of stigmatisation score (< 0.5-class one; 0.5< 1.0-class two; 1.0< 1.5-class three and >1.5-class four -signifying little, medium, high and very high tendency to stigmatize, respectively), were created based on respondents 'answers to twelve questions assessing knowledge of HIV, and four questions assessing stigmatisation of HIV-positive people, respectively. Data were characterized and evaluated by frequency tables using IBM SPSS Software. Respondents in knowledge classes three and four, mainly comprised urban dwellers in both LSI (98.0%urban vs 96.5%rural), and HSI (80.3%urban vs 64.5%rural) countries. Females had higher educational attainment than males in countries with LSI (98.35%females vs 97.6%males) than his (79.8% females vs 81.6% males). However, males expressed positive views (< 0.5-class one) about having an HIV-positive teacher, continuing to teach (i.e. least tendency for social stigmatization), and would buy vegetables from an HIV-positive vendor (i.e. least tendency for physical stigmatization), than females. Meanwhile, 48% of respondents would not buy vegetables from an infected vendor, yet they knew that HIV will not be transmitted by sharing food with an infected person. Impact factors of positive attitudes towards HIV are urbanization, educational attainment, and knowledge about HIV. LSI countries are distinguished from HSI countries by higher female educational attainment and knowledge about HIV than male, which may impact HIV stigmatization, and could be of socio-cultural significance. Lesser tendency to stigmatize among males than females may suggest that socio-cultural factors which enable stigmatization may be gender-related. The greater tendency towards physical than social stigmatization may reflect respondents' perception that physical contact enables HIV transmission. The contradiction between knowledge and belief was evident hence almost half of those who knew the mode of transmission of HIV, had a negative attitude towards an infected vendor.

Despite advances in lung transplantation (LTx), morbidity, and mortality are high. We hypothesized that pleural effusions requiring thoracocentesis lead to poor outcomes after LTx. We performed a single‐center retrospective analysis of thoracocenteses after initial hospital discharge in LTx patients between March 2008 and September 2020 to identify risk factors, etiologies, and outcomes. Of the 1223 patients included, 113 patients (9.2%) required a total of 195 thoracocenteses. The cumulative incidence of thoracocentesis was 10.6% at 1 year and 14.2% at 5 years after transplantation. We observed a bimodal distribution of pleural effusion onset with a threshold at 6 months. Late‐onset effusions were mostly of malignant or cardiac origin. We observed a high rate of nonspecific effusions (41.5%) irrespective of the timepoint post‐transplantation. Patients with late‐onset effusions had significantly lower survival compared to a matched controlled group (HR 2.43; 95% CI (1.27–4.62). All pulmonary function parameters were significantly decreased in patients requiring thoracocentesis compared to matched controls. Male sex and re‐transplantation were risk factors for pleural effusions. In conclusion, pleural effusions requiring thoracocentesis occur frequently in LTx patients and lead to a reduced long‐term allograft function. Late‐onset effusions are associated with a lower survival.