Efficiency of Diagnostic Test for SARS-CoV-2 in a Nursing Home.

BACKGROUND: there is no consensus on how to optimally use diagnostic tests in each stage of COVID-19 pandemic. The objective of this research is to determine the efficiency of sorting positive antibody test quarterly. METHODS: this research uses a retrospective, observational study. COVID-19 diagnostic tests performed and avoided refer to a Spanish nursing home. POPULATION: 261 employees and 107 residents. A quarterly antibody test was performed on subjects who had tested positive during the first wave of coronavirus, and a antibody rapid test on the remaining subjects. RESULTS: during the first wave, 24.0% of the employees and 51.4% of the residents had a positive antibody test. Seronegativization was observed in 7.6% of employees and 1.6% of residents. An employee was infected with COVID-19 in September 2020, followed by a nursing home outbreak in October: 118 Polymerase Chain Reactions tests were avoided in residents and 18 in employees, which in turn prevented 15 workers from going on sick leave and the quarantine of 59 residents. This represents savings of about $15,000. CONCLUSIONS: our study supports the need to know and apply the strategies for early detection, surveillance and control of COVID-19 for future outbreaks. We conclude that surveillance for positive COVID-19 serology among long-term care staff and residents may be a cost-effective strategy during a pandemic.

Anakinra for severe forms of COVID-19: a cohort study.

BACKGROUND: Coronaviruses can induce the production of interleukin (IL)-1ß, IL-6, tumour necrosis factor, and other cytokines implicated in autoinflammatory disorders. It has been postulated that anakinra, a recombinant IL-1 receptor antagonist, might help to neutralise the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related hyperinflammatory state, which is considered to be one cause of acute respiratory distress among patients with COVID-19. We aimed to assess the off-label use of anakinra in patients who were admitted to hospital for severe forms of COVID-19 with symptoms indicative of worsening respiratory function. METHODS: The Ana-COVID study included a prospective cohort from Groupe Hospitalier Paris Saint-Joseph (Paris, France) and a historical control cohort retrospectively selected from the Groupe Hospitalier Paris Saint-Joseph COVID cohort, which began on March 18, 2020. Patients were included in the prospective cohort if they were aged 18 years or older and admitted to Groupe Hospitalier Paris Saint-Joseph with severe COVID-19-related bilateral pneumonia on chest x-ray or lung CT scan. The other inclusion criteria were either laboratory-confirmed SARS-CoV-2 or typical lung infiltrates on a lung CT scan, and either an oxygen saturation of 93% or less under oxygen 6 L/min or more, or aggravation (saturation ≤93% under oxygen 3 L/min) with a loss of 3% of oxygen saturation in ambient air over the previous 24 h. The historical control group of patients had the same inclusion criteria. Patients in the anakinra group were treated with subcutaneous anakinra (100 mg twice a day for 72 h, then 100 mg daily for 7 days) as well as the standard treatments at the institution at the time. Patients in the historical group received standard treatments and supportive care. The main outcome was a composite of either admission to the intensive care unit (ICU) for invasive mechanical ventilation or death. The main analysis was done on an intention-to-treat basis (including all patients in the anakinra group who received at least one injection of anakinra). FINDINGS: From March 24 to April 6, 2020, 52 consecutive patients were included in the anakinra group and 44 historical patients were identified in the Groupe Hospitalier Paris Saint-Joseph COVID cohort study. Admission to the ICU for invasive mechanical ventilation or death occurred in 13 (25%) patients in the anakinra group and 32 (73%) patients in the historical group (hazard ratio [HR] 0·22 [95% CI 0·11-0·41; p<0·0001). The treatment effect of anakinra remained significant in the multivariate analysis (HR 0·22 [95% CI 0·10-0·49]; p=0·0002). An increase in liver aminotransferases occurred in seven (13%) patients in the anakinra group and four (9%) patients in the historical group. INTERPRETATION: Anakinra reduced both need for invasive mechanical ventilation in the ICU and mortality among patients with severe forms of COVID-19, without serious side-effects. Confirmation of efficacy will require controlled trials. FUNDING: Groupe Hospitalier Paris Saint-Joseph.

Validation Prognostic of the Baylor Profound Mental Status Examination.

BACKGROUND: There are no validated prognostic instruments to evaluate severe Alzheimer's disease (AD) patients. OBJECTIVE: To validate the prognostic value of the Baylor Profound Mental Status Examination (BPMSE). METHODS: We selected 200 patients with severe AD. The following prognostic variables were collected: hospitalization, use of the emergency room, death, and prescription of drugs. ROC curve analysis was performed to see the overall behavior of the test when predicting the adverse event. We analyzed the AUC ROC and the best cut point was determined, and by using contingency tables, the risk was calculated. RESULTS: For a BPMSE ≥16 points, there was a risk of 1.8 (95% CI 0.9-3.4) of prescription of psychotropic drugs in 12 months. For memantine in 12 months, for a BPMSE ≥16 points, there was a risk of 2.9 (95% CI 1.1-7.2). Emergency room visits, for a BMPSE ≤15 points, showed a risk of 1.7 (95% CI 1-3.2). The risk of hospitalization at 12 months, for a BPMSE ≤15, was 1.4 (95% CI 0.8-2.6). When comparing medians, patients with a higher BPMSE were prescribed more drugs at 12 months. CONCLUSIONS: BPMSE has a limited predictive value for the variables studied.

Peripheral arterial disease and systematic detection of circulating tumor cells: rationale and design of the DETECTOR prospective cohort study.

BACKGROUND: Smoking is a strong risk factor for cancer and atherosclerosis. Cancer mortality, especially from lung cancer, overtakes cardiovascular (CV) death rate in patients with peripheral arterial disease (PAD). Only a few patients with lung cancer after PAD management may benefit from surgical excision. Circulating tumor cells (CTC) associated with low-dose chest CT (LDCT) may improve early cancer detection. This study focuses on a screening strategy that can address not only lung cancer but all tobacco-related cancers in this high-risk population. METHODS: DETECTOR Project is a prospective cohort study in two French University hospitals. Participants are smokers or former smokers (≥30 pack-years, quitted ≤15 years), aged ≥55 to 80 years, with atherosclerotic PAD or abdominal aortic aneurysm. After the first screening round combining LDCT and CTC search on a blood sample, two other screening rounds will be performed at one-year interval. Incidental lung nodule volume, volume doubling time and presence of CTC will be taken into consideration for adapted diagnostic management. In case of negative LDCT and presence of CTC, a contrast enhanced whole-body PET/CT will be performed for extra-pulmonary malignancy screening. Psychological impact of this screening strategy will be evaluated in population study using a qualitative methodology. Assuming 10% prevalence of smoking-associated cancer in the studied population, a total of at least 300 participants will be enrolled. DISCUSSION: Epidemiological data underline an increase incidence in cancer and related death in the follow-up of patients with PAD, compared with the general population, particularly for tobacco-related cancers. The clinical benefit of a special workup for neoplasms in patients with PAD and a history of cigarette smoking has never been investigated. By considering CTCs detection in this very high-risk selected PAD population for tobacco-induced cancer, we expect to detect earlier pulmonary and extra-pulmonary malignancies, at a potentially curable stage. TRIAL REGISTRATION: The study was registered in the French National Agency for Medicines and Health Products Safety (No N° EUDRACT_ID RCB: 2016-A00657-44) and was approved by the ethics Committee for Persons Protection (IRB number 1072 and n° initial agreement 2016-08-02; ClinicalTrials.gov identifier NCT02849041).

Validation of the Spanish version of the Baylor Profound Mental Status Examination.

BACKGROUND: There are no short valid instruments to evaluate cognitive status in severe Alzheimer's disease (AD) patients in the Spanish language. OBJECTIVE: To validate the Spanish version of the Baylor Profound Mental Status Examination (BPMSE-Sp). METHODS: The Baylor Profound Mental Status Examination (BPMSE) was translated to Spanish and back translated. Validation was conducted in 100 patients with severe probable AD with a Mini-Mental State Examination (MMSE) <12. We assessed internal consistency (Cronbach's alpha), concurrent validity (Pearson's correlations) with the MMSE, Severe Impairment Battery (SIB), Neuropsychiatric Inventory Short Form (NPI-Q) and the Functional Assessment Staging and reliability. RESULTS: The mean age of patients was 84.9; 74% were female; 64% were institutionalized. The mean MMSE was 5.6; the mean BPMSE-Sp was 13.6; the mean BPMSE-Sp behavior was 1.2; the mean SIB was 42.2; and the mean NPI-Q was 4.7. BPMSE-Sp presented good internal consistency (Cronbach α= 0.84). There were significant correlations between the BPMSE-Sp and MMSE (r = 0.86, p <  0.001), and between the BPMSE-Sp and SIB (r = 0.92, p <  0.001). Inter-rater and test-retest reliability were in both cases excellent, ranging between 0.96 and 0.99 (p <  0.001). BPMSE-Sp had fewer floor and ceiling effects than the MMSE. CONCLUSIONS: The BPMSE-Sp is a valid tool for use in daily practice and research in the evaluation of cognitive function of patients with severe AD.

Adenocarcinoma of the lung in Down syndrome: first clinical report.

Lung cancer is rare in persons with Down syndrome, and the clinical presentation of the disease has not been described in adults with intellectual disability. We report the first detailed clinical observation of a 33-year-old man with Down syndrome who developed an adenocarcinoma of the lung 30 years after an acute lymphoblastic leukemia in infancy. Despite advanced disease at initial presentation and extensive tumor spreading during the course of the disease, he presented with unusually mild symptoms. The scarcity of lung cancer in people with intellectual disability, and particularly those with Down syndrome, is due, in part, to reduced tobacco use. However, cytogenetic and molecular studies suggest that genes mapping to chromosome 21 may protect against lung cancer. Numerous reports also suggest that, in persons with Down syndrome and other intellectual disability, cancers are often discovered late, leading to loss of the chance of cure and recovery.

Mechanical properties of tracheal smooth muscle are impaired in the rabbit with experimental cardiac pressure overload.

UNLABELLED: STUDY OBJECTIVES/DESIGN: Impaired function of striated and arterial smooth muscle is known to occur in humans and animals with various forms of cardiac diseases, but limited information is available on the mechanical behavior of airway smooth muscle. We tested the hypothesis that the baseline mechanical properties of tracheal smooth muscle (TSM) were impaired at an early stage of cardiac overload. ANIMALS: We used a model of cardiac hypertrophy induced by surgical abdominal aortic stenosis (AS) in adult rabbits. Twelve animals with AS and 8 sham-operated control rabbits were studied 12 weeks after surgery. In rabbits with AS, the heart weight/body weight ratio was higher than in control rabbits (2.36 +/- 0.43 g/kg vs 1.98 +/- 0.20 g/kg, p < 0.05) [mean +/- SD], attesting to moderate cardiac hypertrophy. No clinical signs of congestive heart failure were observed. MEASUREMENTS: Isolated TSM strips were electrically stimulated at 37 degrees C, 2.5 mM [Ca(2+)](0), against 8 to 10 load levels, from zero load to full isometry. Force-velocity relationship was elicited using the conventional afterloaded isotonic method. RESULTS: Peak isometric tension was lower in rabbits with AS than in control rabbits (25 +/- 11 mN/mm(2) vs 34 +/- 14 mN/mm(2), p < 0.05), whereas maximum unloaded shortening velocity, maximum extent of muscle shortening, and relaxation parameters did not differ between groups. The curvature of the force-velocity relationship (which reflects the myothermal economy of force generation) and peak mechanical efficiency were lower in rabbits with AS than in control rabbits. CONCLUSIONS: These results indicate that the contraction of isolated rabbit TSM was less powerful and less economical in cardiac hypertrophy, attesting to early impairment of the mechanical properties of TSM during cardiac overload.

[Severe acute asthma]. / Asthme aigu grave.

A severe acute asthma attack is defined by the presence of clinical signs of severity and/or a value of peak expiratory flow (PEF) < 30% predicted. The treatment is based mainly on inhaled beta 2 agonists and systemic corticosteroids. Nebulization is the route of administration of choice, because of its simplicity, its efficacy and its tolerability. Anticholinergics are indicated in association with nebulised beta 2 agonists. Response to treatment must be evaluated within an hour, permitting the early detection of "responders" or "non-responders" to the initial treatment. The great majority of deaths from acute asthma are avoidable, underlining the importance of preventive measures. Prevention is based on the control of the asthma by personalized ongoing treatment based on long-term inhaled corticosteroids and the use of oral corticosteroids in the treatment of exacerbations. However, a severe acute asthma attack can appear at any stage of severity of asthma, including controlled asthma, justifying the utilisation of action plans to treat exacerbations.

Impulsividad cognitiva en menores maltratados: factores influyentes / Cognitive impulsivity in abuse children: influencing factors

Aunque la impulsividad es un constructo que se ha trabajado dese hace tiempo en diferentes escuelas psicológicas, ha sido en las últimas décadas, en España, cuando ha adquirido un mayor interés. Los numerosos estudios del grupo de investigación de Buela-Casal pueden apuntarse como ejemplo de este creciente interés, motivado por su importancia en el rendimiento escolar y por su vinculación con el tema de la violencia y que algunas investigaciones muestran su relación con las conductas agresivas. En este estudio centrado en el continuo reflexividad-impulsividad (R-I), se muestran la diferencias de la R-I que presentan los menores maltratados acogidos en centros de protección, respecto a una población sin maltrato. Además se ha estudiado la influencia o relación con diversos factores como la escolarización, los años de institucionalización o la impulsividad conductual. Se ha seguido una conceptualización congnitivo-conductual y se ha utilizado el MMF20 como instrumento para medición del constructo en estudio. Los resultados muestran una correlación entre el número de errores cometidos y el maltrato, asi como cierta correlación negativa entre errores y años de escolarización