Tocilizumab plus dexamethasone versus dexamethasone in patients with moderate-to-severe COVID-19 pneumonia: A randomised clinical trial from the CORIMUNO-19 study group.

Background: In moderate-to-severe COVID-19 pneumonia, dexamethasone (DEX) and tocilizumab (TCZ) reduce the occurrence of death and ventilatory support. We investigated the efficacy and safety of DEX+TCZ in an open randomized clinical trial. Methods: From July 24, 2020, through May 18, 2021, patients with moderate-to-severe COVID-19 pneumonia requiring oxygen (>3 L/min) were randomly assigned to receive DEX (10 mg/d 5 days tapering up to 10 days) alone or combined with TCZ (8 mg/kg IV) at day 1, possibly repeated with a fixed dose of 400 mg i.v. at day 3. The primary outcome was time from randomization to mechanical ventilation support or death up to day 14, analysed on an intent-to-treat basis using a Bayesian approach. ClinicalTrials.gov number, NCT04476979. Findings: A total of 453 patients were randomized, 3 withdrew consent, 450 were analysed, of whom 226 and 224 patients were assigned to receive DEX or TCZ+DEX, respectively. At day 14, mechanical ventilation or death occurred in 32/226 (14%) and 27/224 (12%) in the DEX and TCZ+DEX arms, respectively (hazard ratio [HR] 0·85, 90% credible interval [CrI] 0·55 to 1·31). At day 14, the World health Organization (WHO) clinical progression scale (CPS) was significantly improved in the TCZ+DEX arm (OR 0·69, 95% CrI, 0·49 to 0.97). At day 28, the cumulative incidence of oxygen supply independency was 82% in the TCZ+DEX arms and 72% in the DEX arm (HR 1·36, 95% CI 1·11 to 1·67). On day 90, 24 deaths (11%) were observed in the DEX arm and 18 (8%) in the TCZ+DEX arm (HR 0·77, 95% CI 0·42-1·41). Serious adverse events were observed in 25% and 21% in DEX and TCZ+DEX arms, respectively. Interpretation: Mechanical ventilation need and mortality were not improved with TCZ+DEX compared with DEX alone. The safety of both treatments was similar. However, given the wide confidence intervals for the estimate of effect, definitive interpretation cannot be drawn. Funding: Programme Hospitalier de Recherche Clinique [PHRC COVID-19-20-0151, PHRC COVID-19-20-0029], Fondation de l'Assistance Publique - Hôpitaux de Paris (Alliance Tous Unis Contre le Virus) and from Fédération pour la Recherche Médicale" (FRM). Tocilizumab was provided by Roche.

[Systemic lupus erythematosus: a French general hospital experience]. / Lupus systémique : quels patients et quelle prise en charge en Centre Hospitalier Général ?

Objectives: Systemic lupus erythematosus (SLE) is a disease requiring long-term follow-up. Most studies published in the literature concerned teaching hospitals. We wanted to study a population of SLE patients, their follow-up and therapeutic modalities in a general hospital in order to evaluate professional practices.Methods: We performed a descriptive and retrospective study with SLE patients followed at Centre Hospitalier Intercommunal Robert Ballanger in Aulnay sous Bois (Seine Saint-Denis) between March 2013 and March 2015.Results: Thirty-nine patients were included with various forms of the disease: 77% presented arthritis, 67% had skin involvement, 44% had haematological disorders, 26% had serosal involvement, 13% had kidney involvement, 13% had neuropsychiatric disorders, 8% had digestive tract involvement and 2% had myocarditis. Thirty-five patients were treated with hydroxychloroquine and 12 were treated with immunosuppressive or biotherapy. Patients were seen 3 or 4 times a year as outpatients; 19 were hospitalized at least once in conventional wards and 27 were admitted at least once to a day hospital. Advice from a teaching hospital colleague was required for 6 patients, but only one patient was permanently followed in another hospital.Conclusion: Our patients had similar clinical features to those reported in large series, except for a lower prevalence of renal injuries. Therapeutic management was in accordance with guidelines, with frequent discussion with teaching hospitals. We identified measures to improve our follow-up?: more cardiovascular prevention, more vaccinations and adjustment of hydroxychloroquine monitoring.

Multiple liver amoebic abscesses detected on FDG PET/CT.

We report a case of liver amoebic abscesses in a 58-year-old man referred for a FDG PET/CT with an initial diagnosis of secondary hepatic lesions. This patient, coming from Sri Lanka, presented with fever and shivers, pain in the right flank, vomiting, and diarrhea for a month. The FDG PET/CT showed a hepatic heterogeneous uptake with multiple cold lesions surrounded by a faint hypermetabolism. As this result was not typical of hepatic metastases, a hepatic biopsy was performed leading to the diagnosis of amoebic abscess.

[Highly pathogenic influenza pandemic: results of a feasibility study in a general practice (SIMUGRIP-MG2)]. / Pandémie grippale à virus hautement pathogène : étude de faisabilité en cabinet (SIMUGRIP-MG2).

The French Pandemic Influenza Plan ("Plan National de Prévention et de Lutte Pandémie Grippale") places general practitioners at the heart of the provision of care to patients through consultations and house calls. The purpose of this study was to determine whether GP practices are able to provide treatment to flu patients within their premises in the event of a highly pathogenic influenza pandemic. A simulation exercise conducted in a GP practice (SIMUGRIP-MG2) was carried out in the autumn of 2009. 3 general practitioners, the practice secretary, 33 patients and care staff took part in the exercise during a half day of practice. The study found that the quality of some hygiene practices and procedures was inadequate: the duration of handwashing was too short (mean: 11.8 seconds), gloves were not worn, and FFP2 masks were often handled. The study found that the implementation of these procedures required increased effort and attention from GPs. It was also found that this type of consultation requires additional preparation time (refitting, supply of materials) and generates additional costs (linked, for example, to storage issues). In seeking to improve the quality of care provided to infected patients in the event of an influenza pandemic, several factors must be considered, including recent data on the effectiveness of countermeasures, additional training to improve hygiene practices, and infrastructure modernization to improve ergonomics in GP practices.

[A simulation exercise in a flu clinic]. / Exercice sur le terrain dans un Centre de Consultation Dédié à la grippe (SIMUGRIP-MG1).

A simulation exercise aimed at assessing the management and provision of ambulatory care in the context of a highly pathogenic influenza pandemic was conducted in a specifically dedicated consultation center (Centre de Consultation Dédié (CCD) à la grippe) based on official French guidelines. The exercise was carried out in a school in Paris equipped to simulate a "flu clinic". 3 practitioners provided treatment lasting 2 hours to nursing students acting as patients. The exercise highlighted a number of major organizational issues. Staff were found to be unable to manage the center and to perform patient transfers; face masks were not routinely and consistently worn by doctors and patients; and communication between professionals within the clinic was limited. The exercise showed that much remains to be done to ensure that "flu clinics" are effective and functional. The results suggest that the exercise will need to be repeated on a larger scale and over a longer period.