Background
In Louisiana, deaths related to COVID-19 have disproportionately occurred in Black persons. Granular data are needed to better understand inequities and develop prevention strategies to mitigate further impact on Black communities.
Methods
We conducted a retrospective study of patients admitted to an urban safety-net hospital in New Orleans, LA with reactive SARS-CoV-2 testing from March 9-31, 2020. Clinical characteristics of Black and other racial/ethnic group patients were compared using Wilcoxon rank-sum test and Fisher’s exact tests. The relationship between race and outcome was assessed using Day-14 status on an ordinal scale.
Results
This study included 249 patients. Median age was 59, 44% were male, 86% were age ≥65y or had ≥1comorbidity. Overall, 87% were Black, relative to 55% Black patients typically hospitalized at our center. Black patients had longer symptom duration at presentation (6.41 versus 5.88 days, p=0.05), and were more likely to have asthma (p=0.008), but less likely to have dementia (p=0.002). There were no racial differences in initial respiratory status or laboratory values except higher LDH in Black patients. Patient age and initial oxygen requirement, but not race (adjusted proportional odds ratio = 0.92, 95%CI: 0.70-1.20), were associated with worse Day-14 outcomes.
Conclusion
Our results demonstrate minor racial differences in comorbidities or disease severity at presentation, and Day-14 outcomes were not different between groups. However, Black patients were disproportionately represented in hospitalizations, suggesting that prevention efforts should include strategies to limit SARS-CoV-2 exposures and transmission in Black communities as one step towards reducing COVID-19 related racial inequities.
Risk of type 1 diabetes at 3 years is high for initially multiple and single Ab+ IT and multiple Ab+ NT. Genetic predisposition, age, and male sex are significant risk factors for development of Ab+ in twins.
BackgroundTrimethoprim-sulfamethoxazole (TMP-SMX) is widely considered the initial drug of choice for the treatment and prophylaxis of Pneumocystis jiroveci (PCP) in HIV infected patients as well as non-HIV infected patients peritransplantation and post solid organ transplantation. However, there are no published data regarding safe and effective TMP-SMX desensitization regimens in non-HIV, immunocompetent patients with renal failure. We present a safe and successful TMP-SMX desensitization protocol peritransplantation for a patient with renal failure and a history of generalized pruritis and maculopapular rash after consumption of TMP-SMX.MethodsA 41-year-old woman with end-stage renal disease secondary to lupus and TMP-SMX hypersensitivity was desensitized via a 2-day protocol based on the patient's creatinine clearance. The starting dose given was 0.001 mg of TMP-SMX orally, increasing the dose ever 30 minutes until the therapeutic dose of 400 mg orally once daily was achieved.ResultsTryptase levels were drawn before desensitization and after completion of the protocol and these levels remained within normal limits. The patient tolerated the procedure well, experiencing only one episode of pruritis that lasted 5 minutes on day one of desensitization, which resolved without intervention. She was able to continue her TMP-SMX at therapeutic doses before and after her renal transplant without incident.ConclusionThis case report demonstrates successful desensitization with TMP-SMX in a non-HIV, immunocompetent patient with end-stage renal disease. This helped to enable the patient to have optimal PCP prophylaxis, minimize morbidity and mortality, and undergo a successful kidney transplant.
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