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.

Conjunctival bacterial and fungal flora and cutaneous fungal flora in healthy domestic rabbits (Oryctolagus cuniculus).

OBJECTIVES: To determine the normal conjunctival bacterial and fungal flora in healthy rabbits, to compare the fungal flora from the conjunctival sac with periocular cutaneous fungal flora and to evaluate potential changes in type of micro-organisms over time. MATERIALS AND METHODS: Samples from 50 pet rabbits with a normal ophthalmic examination were obtained from conjunctival sacs using sterile cotton swabs and from the interpupillary skin space using a piece of sterile carpet. Samples were collected twice, 4 weeks apart, and cultured to evaluate bacterial and fungal populations. RESULTS: Bacteria were recovered from 35.9% of conjunctival swabs. Corynebacterium species (32.4%), Staphylococcus species (18.3%), Pasteurella species (9.9%) and Moraxella species (8.5%) were the most frequently isolated organisms. Fungi were recovered from 14.6% of conjunctival swabs. The most common fungal genera were Aspergillus (37%), Scopulariopsis (14.8%) and Penicillium (11.1%). Fungal cultures from periocular integument yielded positive results in 96.3% of samples; the same fungal organism was isolated in both conjunctival and cutaneous culture in nine of 20 rabbits (45%). When comparing results 4 weeks apart in 32 of 50 animals, only three rabbits with a positive bacterial culture and one rabbit with a positive fungal culture had the same result at the subsequent test. CLINICAL SIGNIFICANCE: Fungi and bacteria isolated from the conjunctival sac of rabbits may represent transient seeding from the environment. To our knowledge, this is the first report of fungal composition of the conjunctival sac of rabbits and evaluation of the potential transient nature of both bacterial and fungal composition of this conjunctival flora.

Assessment of a blood preservation protocol for use in ferrets before transfusion.

Blood transfusion has been described in ferrets as a treatment for oestrus-associated anaemia and as a life-saving therapy following trauma, iatrogenic (usually surgery-induced) anaemia, autoimmune haemolytic anaemia and pure red cell aplasia. Although blood banking is a common method for storage of feline and canine blood it is not currently done with ferret blood. The aim of this study was to determine the shelf-life of ferret blood using the anticoagulant citrate-phosphate-dextrose-solution with adenine (CPDA). Two male ferrets were used as blood donors. From each ferret, 6 ml of blood was taken from the cranial vena cava and stored in 10 ml polyethylene terephthalate (PET) blood tubes containing 1 ml of CPDA solution. Blood was taken from each ferret once per month for five months. These 10 blood samples were stored in a laboratory refrigerator at 4°C for four weeks. Biochemical (glucose, pH, lactate, potassium, sodium) and haematological (haematocrit, light microscopic blood smear examination) analyses were performed on the stored blood at days 0, 7, 14, 21 and 28. Biochemical analyses revealed a progressive decrease from day seven in the stored blood pH, glucose and sodium, with a concomitant increase in lactate and potassium. These results are attributable to the ongoing metabolism and deterioration of the red blood cells (RBC) while in storage, and are more rapid than described for human or canine stored blood. Haematological analyses revealed a progressive elevation of the haematocrit due to the appearance of hypochromic red blood cells and echinocytes beginning at day 7. Haemolysis was observed in the microhaematocrit capillary tube sample by day 21, and microscopic clots were visible on the blood smear by day 28. The low blood pH and the appearance of many hypochromic RBCs and some echinocytes from day 7 in CPDA-stored ferret blood, suggest stored ferret blood has a short shelf-life when compared with stored human or canine blood. We recommend that ferret blood stored in CPDA should not be used for transfusion after seven days of storage at 4°C.

Early control of HIV replication in primary HIV-1 infection treated with antiretroviral drugs and pegylated IFN alpha: results from the Primoferon A (ANRS 086) Study.

IFN alpha has both antiviral and immunostimulating properties. The ANRS086 Primoferon A Study evaluated in 12 patients with primary HIV infection the tolerance and efficacy of an early and transient administration of pegylated IFN alpha, in addition to highly active antiretroviral therapy. Tolerance was good, and this regimen allowed the early control of HIV replication and rapid decay of the viral reservoir. These results support the initiation of comparative studies with pegylated INF alpha in primary HIV infection.