Factors associated with hospital admission and adverse outcome for COVID-19: Role of social factors and medical care.

BACKGROUND: Beyond sex, age, and various comorbidities, geographical origin and socioeconomic deprivation are associated with Coronavirus Disease (COVID-19) morbidity and mortality in the general population. We aimed to assess factors associated with severe forms of COVID-19 after a hospital emergency department visit, focusing on socioeconomic factors. METHODS: Patients with laboratory-confirmed COVID-19 attending the emergency department of Béclère Hospital (France) in March-April 2020 were included. Postal addresses were used to obtain two geographical deprivation indices at the neighborhood level. Factors associated with hospitalization and factors associated with adverse outcomes, i.e. mechanical ventilation or death, were studied using logistic and Cox analyses, respectively. RESULTS: Among 399 included patients, 321 were hospitalized. Neither geographical origin nor socioeconomic deprivation was associated with any of the outcomes. Being male, older, overweight or obese, diabetic, or having a neuropsychiatric disorder were independent risk factors for hospitalization. Among 296 patients hospitalized at Béclère Hospital, 91 experienced an adverse outcome. Older age, being overweight or obese, desaturation and extent of chest CT scan lesions>25% at admission (aHR: 2.2 [95% CI: 1.3-3.5]) and higher peak CRP levels and acute kidney failure (aHR: 2.0 [1.2-3.3]) during follow-up were independently associated with adverse outcomes, whereas treatment with hydrocortisone reduced the risk of mechanical ventilation or death by half (aHR: 0.5 [0.3-0.8]). CONCLUSION: No association between geographical origin or socioeconomic deprivation and the occurrence of a severe form of COVID-19 was observed in our population after arrival to the emergency department. Empirical corticosteroid use with hydrocortisone had a strong protective impact.

Rheumatoid Factor and Disease Activity Are Independent Predictors of Lymphoma in Primary Sjögren's Syndrome.

OBJECTIVE: To define parameters predictive of lymphoma development in patients with primary Sjögren's syndrome (SS). METHODS: A multicenter case-control survey was performed to identify predictors of lymphoma. Cases were patients who developed lymphoma after diagnosis of primary SS and were mainly recruited through the Club Rhumatismes et Inflammation network. For each case, 2 controls (matched for disease duration and age) were randomly selected among patients with primary SS and without lymphoma. Cases and controls were compared using univariate analysis and then using multivariate analysis to identify independent predictors of lymphoma. RESULTS: One hundred one patients with primary SS and lymphoma were included. Eighty-seven patients were women (86.1%), and the mean ± SD age at lymphoma diagnosis was 57.4 ± 12.6 years. The most frequent histologic type was B cell non-Hodgkin's lymphoma (NHL) in 99 of 101 patients, with marginal-zone lymphoma in 76 of the 99 patients (76.8%) including 58 (58.6%) with lymphoma of the mucosa-associated lymphoid tissue type. Lymphomas were most frequently located in the salivary glands (43 patients). A specific treatment was initiated at diagnosis in 87 patients with B cell NHL, and 61 patients (61.6%) achieved complete sustained remission after the first line of treatment. In the multivariate analysis, salivary gland enlargement, the presence of rheumatoid factor (RF), low C4, cryoglobulinemia, lymphopenia, and disease activity according to the European League Against Rheumatism Sjögren's Syndrome Disease Activity Index (excluding the lymphoma domain) were found to be predictors of lymphoma. No previous treatment for primary SS was associated with any effect on lymphoma occurrence. CONCLUSION: In addition to previously known factors predictive of lymphoma occurrence, the independent roles of RF and disease activity were demonstrated in this case-control study of primary SS-associated lymphoma. Our findings highlight the roles of chronic antigenic stimulation and disease activity in the development of this severe complication.

Intra-vascular large B-cell lymphoma revealed by a nephrotic syndrome: a one year remission induced by a high frequency CHOP and rituximab.

Intra-vascular lymphoma is usually reported as a rare and fatal disorder. We describe here the first case of an intra-vascular lymphoma revealed by a nephrotic syndrome for which a durable remission has been obtained by 8 cycles of bi-mensual CHOP and Rituximab therapy. In this report, 18 fluorodesoxyglucose tomoscintigraphy is discussed as a tool for intra-vascular lymphoma extension and follow-up.

Interleukin-13 gene expression by malignant and EBV-transformed human B lymphocytes.

Expression of the IL-13 gene in malignant tissues from 26 human B-cell lymphoid malignancies was analyzed by reverse transcriptase-polymerase chain reaction (RT-PCR). A positive signal was detected in 16 cases, which included high grade B lymphomas, follicular lymphomas and B-cell chronic lymphocytic leukemias. IL-13 mRNA was also detected in the 9 malignant B cell lines and in the 6 lymphoblastoid cell lines tested, as well as in freshly isolated malignant B cells from 2 patients with a Burkitt's lymphoma. Two of 8 T-cell lymphomas and 2 of 4 T-cell lines expressed the IL-13 gene. In contrast, IL-13 gene expression was not detected in any of the 5 non-lymphoid cell lines tested. No specific binding of radiolabeled IL-13 was detected on B cell lines, suggesting an absence of IL-13 receptors on such cells. This conclusion was also supported by the inability of IL-13 or anti-IL-13 antibodies to affect the growth of malignant B cells. Taken together, these results show that both malignant and EBV-transformed B lymphocytes, either freshly isolated or maintained as cell lines, express the IL-13 gene. This raises the question of the role of B lymphocyte-derived IL-13, a B lymphocyte stimulating cytokine, on the in vivo function of normal B lymphocytes as well as on the in vivo behaviour of B lymphoid malignancies.

Effects on hearing during prolonged oral contraceptive use.

Different hearing defects have been attributed to prolonged use of oral contraceptives. The aim of the present investigation has been the evaluation by means of a number of audiological tests and of brain-stem evoked responses (BSER) of the possible incidence of subclinical pathology of the nervous hearing structures in these subjects. Twenty healthy subjects taking oral contraceptives from 9 to 30 months and 10 paired controls have been studied. No hearing loss was found but the study of BSER showed the presence of a significantly shorter latency of waves I and III which could be attributed to a functional alteration. Other, less significant, alterations are described and the conclusion is reached that prolonged oral contraception does not affect the hearing function, even if it is investigated with sophisticated techniques. However, the significant alterations of BSER responses and of the stapedial reflex might be considered as an initial non-organic sign of impairment of the central hearing pathways and therefore deserve further investigation.

PIP: Different hearing defects have been attributed to prolonged use of oral contraceptives. Sudden and progressive deafness attributed to oral contraception has been described in the literature. The relationship of the pill to arterial thrombosis has been well documented but the pathogenesis of hearing loss cannot always be attributed to a vascular mechanism. The aim of the present investigation has been the evaluation by means of a number of audiological tests and of brainstem evoked responses (BSER) of the possible incidence of subclinical pathology of the nervous hearing structures in these subjects. 20 healthy subjects taking oral contraceptives from 9-30 months and 10 paired controls have been studied. No hearing loss was found but the study of BSER showed the presence of a significantly shorter latency of waves I and III which could be attributed to a functional alteration. It is not easy to interpret these findings; although arterial microthrombosis and embolism may both cause progressive or sudden deafness, they should be accompanied by prolonged rather than shortened latencies in the BSER response. Other, less significant, alterations are described and the conclusion is reached that prolonged oral contraception does not affect the hearing function, even if it is investigated with sophisticated techniques. However, the significant alterations of BSER responses and of the stapedial reflex might be considered as an initial non-organic sign of impairment of the central hearing pathways and therefore deserve further investigation.

Late results and complications of tympanostomy tube insertion for prophylaxis of recurrent purulent otitis media in pediatric age.

We have evaluated from a clinical and functional point of view a total of 61 children (37 boys and 24 girls with a median age of 3 years, range 4 months to 6 years) who had been submitted before 1978 to insertion of tympanostomy tubes (in a total of 131 ears) for prophylaxis of recurrent purulent otitis media. Of these, 67.6% remained free from recurrencies after removal or extrusion of grommets, whereas in the remaining group discharge could be cured with local and/or general antibiotic treatment. Sixteen cases had tympanic calcifications, 6 an atrophic drum, and 10 a severe tympanic retraction, but only 8 out of these 32 cases had signs of conductive hearing loss (average loss 20 dB on frequencies from 500 to 2000 Hz). Further complications observed in this follow-up have been perforations (6 cases) and one case of migration of the tube into the tympanic cavity. No cholesteatoma has been observed in our series. A few considerations can be drawn from these observations: insertion of grommets, correctly performed in the anterior-inferior part of the drum appears to prevent a large percentage of recurrencies, and should therefore be considered, even in the long-term, an adequate prophylaxis for the otitis-prone child; complications as seen during a long follow-up period are relatively few, can be cured, and have a modest functional impact.

An evaluation of hearing maturation by means of auditory brainstem response in very low birthweight and preterm newborns.

A group of very low birthweight and/or preterm newborns has been studied and compared with a control group of healthy at term newborns, in order to evaluate hearing maturation processes by means of ABR. The wave-latencies have been found significantly higher in the study group, while no difference could be found in inter-peak latencies (IPL). Further, the study group has been split up in order to analyze the possible influence of variables like birthweight, cranial circumference, APGAR score and modality of delivery on ABR latencies. Basing upon these evaluations, it appears difficult to present clear cut conclusions, since ABR latencies' behaviour seems to be related to individual maturative variables and fails to produce an unequivocal model of maturation.

Word-initial voicing in the productions of stops in normal and preterm Italian infants.

It has been traditionally held that developmental anomalies in language acquisition are more frequent in neonatologically at-risk subjects. There is some suggestion that proficiency in phonology is correlated with motor control development. The purpose of this paper was to compare the patterns of acquisition of the control of the acoustic-phonetic cues for voicing in the speech of premature infants and controls. The measure studied was initial stop consonant voice onset time (VOT), which is known to be the most reliable acoustic cue for the distinction between voiced and voiceless stops. The total population of the study consisted of 7 infants born at less than 37 weeks gestation and a control group of 7 infants born full-term at normal weight; 7 adults, aged 24-26 years, also participated. Each child was recorded under standard recording conditions saying words contrasting labial, dental and velar voiced and voiceless initial stops. Elicited word productions were collected monthly from infants, at different age levels, ranging from 18 to 21 months. The results show that the subjects are more advanced in the acquisition of the appropriate VOT values for the voiceless than for the voiced consonants. This difficulty may be related to the increased neuromuscular control and more complex muscle activity necessary for maintaining voicing during the closure, especially for velar stops. It is important to recognize the possibility that increased variability in preterm children may be related to some neuromuscular immaturity.

Septum dislocation in the newborn: a long-term follow-up study of immediate reposition.

A report on the late outcome of reposition performed for septal dislocation present at birth. 42 cases have been examined 13 to 16 years after the intervention and it has been found that in the majority of patients (69%) the final esthetic and functional results have been satisfactory. Conversely, those cases (31%) where uni- or bilateral obstruction was still present at the time of late control had experienced a markedly increased incidence of upper respiratory infections. The different situations present at birth are indicated and it is stated that cases which tend to recur after repositioning requiring a second intervention and--possibly--unilateral packing are more likely to have an unsatisfactory late outcome.

[Uveitis: late complication of undiagnosed Whipple disease]. / Uvéite: complication tardive d'une maladie de Whipple méconnue.

We report a case of severe chronic bilateral uveitis in a 60-year-old white man without neurological manifestations. Spondylarthritis and isolated malabsorption suggested the diagnosis of Whipple's disease. A normal duodenal biopsy delated the diagnosis, who was secondarily demonstrated an adenopathy biopsy and macrophage study on vitrectomy sample (macrophage distended by periodic acid-Schiff positive material). With 1 year follow-up the uveitis was rapidly and completely cured by an antibiotic association (rifampicin and trimethoprim-sulfamethoxazol). The characteristics of ocular involvement in Whipple's disease and treatment of the disease are discussed.

[Thyroid hormone determination at the Public Assistance Hospital of Paris: ordering, costs and opinions of physicians qualified in endocrinology]. / Les dosages hormonaux thyroïdiens à l'Assistance Publique-Hôpitaux de Paris: prescriptions, coût et opinions des médecins qualifiés en endocrinologie.

OBJECTIVES: To determine the distribution of orders for hormonal tests assessing thyroid function in a hospital setting. To collect the opinion of physicians specialized in endocrinology concerning free triodothyronine (FT3) assessment. METHODS: Using a cross-sectional survey numbers of free thyroxine (FT4), total T4 (TT4), FT3, total T3 (TT3), and TSH tests were collected from the heads of laboratory assessing thyroid function in June 95 at the Assistance Publique-Hôpitaux de Paris (AP-HP). Cost for these tests was estimated. The physicians of the AP-HP specialized in endocrinology were asked through a questionnaire for circumstances justifying FT3 test ordering. RESULTS: Twenty-eight laboratories (93%) responded: 28455 measurements (TSH: 43%, FT4: 33%, TT4: 2%, FT3: 20%, TT3: 2%) were performed and were valued at 3.4 million French Francs. Proportions of T4 (36%) and T3 (20%) tests were lower in hospitals with an inpatient department of endocrinology than in hospitals with an outpatient clinic with specialists in endocrinology (T4: 36%; T3: 27%) or with no endocrinology unit (T4: 33%, T3: 27%); proportion of TSH tests was higher in hospitals with an inpatient endocrinology unit (respectively 44%, 40%, 32%). Forty-two endocrinologists (76%) from 21 departments answered. Follow-up of treatment with amiodarone and euthyroid sick syndrome were considered the only conditions justifying FT3 test ordering. CONCLUSION: Though the opinion of physicians specialized in endocrinology was not uniform regarding recommendations for TT3 or FT3 tests as a first-line measurement, the cost of these tests has been estimated at 650 thousand Francs for a month at the AP-HP.

Reducing the number of T3 orders in the Paris hospital network: towards better appropriatness of thyroid function test prescription.

In vitro thyroid function tests are among the most frequently prescribed laboratory procedures. Serum triiodothyronine (T3) tests are seldom necessary as a first-level measurement. Our objectives were to measure the proportion of T3 measurements relative to all in vitro thyroid function tests in a large hospital network and to investigate the contributions of various interventions to change prescribers'behavior. We performed two cross-sectional surveys in 1995 and 1998 in the 50 Paris University hospitals. Questionnaires were mailed to the heads of the 30 laboratories performing thyroid function tests. One-month orders of free and total thyroxine, free and total T3 and thyrotropin were recorded; changes in T3 measurement orders between the two periods were estimated and association with interventions were expressed as odds ratios and 95% confidence intervals. Twenty-five heads of laboratory responded to both surveys. In 1995, T3 measurements constituted 21% of in vitro thyroid function test ordering, which seems to us exceedingly high. The decrease in T3 measurement ordering observed in 1998 (15% of thyroid function test ordering) was independently associated with multiple behavioral changes: educational interventions, structured test form use and year of prescription.

[When should peripheral lymphadenopathy be biopsied?]. / Quand faut-il biopsier les adénopathies périphériques?

Excisional biopsy for lymphadenopathy is sometimes necessary to confirm the diagnosis of lymphoma or metastatic disease from an unknown primary site. Lymph node excision should be preceded by less invasive approaches which may confirm a benign pathology. Collaboration with medical and hematologic specialists will allow a well-reasoned diagnostic approach with complementary studies; excisional biopsy, if necessary, will then be done under the best conditions and in the most cost-efficient manner.

(18)F-FDG PET/CT in tuberculosis: an early non-invasive marker of therapeutic response.

OBJECTIVE: To evaluate the potential of (18)F-fluoro-deoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) for early therapeutic intervention in patients with probable or confirmed tuberculosis (TB). METHODS: Twenty-one consecutive human immunodeficiency virus negative patients were prospectively included. All patients underwent (18)F-FDG PET/CT before and after 1 month of anti-tuberculosis treatment. The maximum standardised uptake value (SUV(max)) of the most (18)F-FDG avid lesions was recorded. RESULTS: The median age of patients was 36 years (range 18-84); 33.3% were male, 80.9% were born in endemic countries, and 23.8% had a past history of TB. TB was confirmed on culture in 8, on histology in 9 and on the basis of clinical symptoms in 4 patients. (18)F-FDG PET/CT detected active pulmonary TB (n = 1), extra-pulmonary (n = 10) or both (n = 10). The second (18)F-FDG PET/CT showed reduced radiotracer uptake intensity in 19 of 21 patients, with a median percentage decrease of SUV(max) of 31% (range 2-84). Two patients showed no improvement. TB was ruled out in one patient during follow-up; the final diagnosis was a non-Hodgkin's lymphoma. The other patient was smear-positive for 3 months. CONCLUSION: (18)F-FDG PET/CT allows an easy evaluation of early therapeutic response in patients with TB, particularly extra-pulmonary TB.

[Behçet's disease in obstetrics and gynecology]. / Maladie de Behçet en gynécologie-obstétrique.

Behçet's disease is a multisystemic disease of unknown origin characterized by a recurrent bipolar aphtosis (oral and genital) associated with vascular, digestive or articular symptoms. Gynecologists can be faced to this disease at any time of the life of their patients, including during the pregnancy. Given that the first demonstrations of the disease can be genital, they are in the front line to evoke this diagnosis. They thus have to know the main characteristics of the disease to make the diagnosis and to organize a multidisciplinary management. During pregnancy, the treatment of the disease is to be adapted to avoid teratogenic drugs, and adapt the doses of the treatment.