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1.
Medicine (Baltimore) ; 100(4): e24524, 2021 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-33530280

RESUMEN

ABSTRACT: This study aimed to evaluate the incidence of co-infection with different types of pathogens in patients with hypoxemic pneumonia due to coronavirus disease 2019 (COVID-19) in Reunion Island.This observational study using a prospectively collected database of hypoxemic pneumonia due to COVID-19 cases was conducted at Félix Guyon University Hospital in Reunion Island, France.Between 18 March 2020 and 15 April 2020, 156 patients were admitted to our hospital for COVID-19. A total of 36 patients had hypoxemic pneumonia (23.1%) due to COVID-19. Thirty of these cases (83.3%) were imported by travelers returning mainly from metropolitan France and Spain. Patients were screened for co-infection with other pathogens at admission: 31 (86.1%) by multiplex polymerase chain reaction (PCR) and 16 (44.4%) by cytobacteriological examination of sputum culture. Five patients (13.9%) were found to have co-infection: 1 with influenza virus A H1N1 (pdm09) associated with Branhamella catarrhalis, 1 with Streptococcus pneumoniae associated with Haemophilus influenzae, 1 with Human Coronavirus 229E, 1 with Rhinovirus, and 1 with methicillin-susceptible Staphylococcus aureus. Patients with co-infection had higher D-dimer levels than those without co-infection (1.36 [1.34-2.36] µg/mL vs 0.63 [0.51-1.12] µg/mL, P = .05).The incidence of co-infection in our cohort was higher than expected (13.9%). Three co-infections (with influenza virus A(H1N1) pdm09, Streptococcus pneumoniae, and Staphylococcus aureus) required specific treatment. Patients with hypoxemic pneumonia due to COVID-19 should be screened for co-infection using respiratory cultures or multiplex PCR. Whilst our study has a number of limitations, the results from our study suggest that in the absence of screening, patients should be commenced on treatment for co-infection in the presence of an elevated D-dimer.


Asunto(s)
/epidemiología , Coinfección/epidemiología , Neumonía/epidemiología , Neumonía/microbiología , Adulto , Femenino , Francia/epidemiología , Humanos , Hipoxia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
2.
BMC Infect Dis ; 21(1): 169, 2021 Feb 10.
Artículo en Inglés | MEDLINE | ID: mdl-33568097

RESUMEN

BACKGROUND: Our main objectives were to estimate the incidence of illnesses presumably caused by SARS-CoV-2 infection during the lockdown period and to identify the associated risk factors. METHODS: Participants from 3 adult cohorts in the general population in France were invited to participate in a survey on COVID-19. The main outcome was COVID-19-Like Symptoms (CLS), defined as a sudden onset of cough, fever, dyspnea, ageusia and/or anosmia, that lasted more than 3 days and occurred during the 17 days before the survey. We used delayed-entry Cox models to identify associated factors. RESULTS: Between April 2, 2020 and May 12, 2020, 279,478 participants were invited, 116,903 validated the questionnaire and 106,848 were included in the analysis. Three thousand thirty-five cases of CLS were reported during 62,099 person-months of follow-up. The cumulative incidences of CLS were 6.2% (95% Confidence Interval (95%CI): 5.7%; 6.6%) on day 15 and 8.8% (95%CI 8.3%; 9.2%) on day 45 of lockdown. The risk of CLS was lower in older age groups and higher in French regions with a high prevalence of SARS-CoV-2 infection, in participants living in cities > 100,000 inhabitants (vs rural areas), when at least one child or adolescent was living in the same household, in overweight or obese people, and in people with chronic respiratory diseases, anxiety or depression or chronic diseases other than diabetes, cancer, hypertension or cardiovascular diseases. CONCLUSION: The incidence of CLS in the general population remained high during the first 2 weeks of lockdown, and decreased significantly thereafter. Modifiable and non-modifiable risk factors were identified.


Asunto(s)
/epidemiología , Control de Enfermedades Transmisibles , Adolescente , Adulto , Anciano , Niño , Estudios de Cohortes , Comorbilidad , Tos , Femenino , Fiebre , Francia/epidemiología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo
3.
Med Oncol ; 38(3): 28, 2021 Feb 17.
Artículo en Inglés | MEDLINE | ID: mdl-33595732

RESUMEN

The SARS-CoV-2 pandemic has significantly impacted cancer patient management. National and local recommendations to reduce SARS-CoV-2 transmission have been applied in a comprehensive cancer center located in Northern France. We prospectively measured key indicators for three successive eight-week periods: directly before, during, and right after the containment (from 16 March to 10 May 2020). Overall, the number of newly diagnosed and referred cancer patients in our hospital steadily increased (1027; 1135 and then 1704; +11% during containment and +50% just after). To reduce patient transportation, teleconsultations were implemented. Teleconsulting activity steadily increased during the three periods (5, 2025, and 2351). However, a marked decrease in the number of surgical procedures was observed (448; 330 and 288; -26% during containment and -13% just after). We observed a slight decrease in the number of radiation therapy sessions (7761; 7328 and 7075; -6% during containment and -3% just after) and in day-hospital cycles of IV systemic treatment (2891; 2736 and 2717; -5% during containment and -1% just after). We observed an increase in the number of patients admitted to palliative care and a dramatic reduction in clinical trial enrollment. During this 24-week period, organizational changes were mainly characterized by an increase in newly diagnosed cancer patient referral and the implementation of protective measures, such as teleconsultations. Activities in cancer surgery have decreased while radiotherapy and chemotherapy activities were stable.


Asunto(s)
/epidemiología , Instituciones Oncológicas , Oncología Médica/tendencias , Neoplasias/epidemiología , Anciano , Francia/epidemiología , Humanos , Persona de Mediana Edad , Neoplasias/terapia , Cuidados Paliativos , Pandemias , Radioterapia , Derivación y Consulta , Telemedicina
4.
BMC Infect Dis ; 21(1): 198, 2021 Feb 22.
Artículo en Inglés | MEDLINE | ID: mdl-33618660

RESUMEN

BACKGROUND: Elderly people in nursing homes are particularly vulnerable to COVID-19 due to their age, the presence of comorbidities, and community living. On March 14, 2020, at the beginning of the first epidemic wave of COVID-19 in France, a cluster was reported in a nursing home in the Nouvelle-Aquitaine region. We monitored the outbreak as well as the infection prevention and control (IPC) measures implemented. METHODS: A confirmed case was defined as laboratory-confirmed COVID-19 in a resident or staff member present in the nursing home between March 7 and May 1, 2020; and a probable case as a person presenting an acute respiratory illness after contact with a confirmed case. Symptomatic inpatient residents and symptomatic staff members were systematically tested for SARS-CoV-2. In addition, two screening sessions were held on site. RESULTS: We identified 109 cases (98 confirmed, 11 probable). The attack rate was 66% among residents and 45% among staff. Half of all cases were identified during the screening sessions. One-quarter of cases had minor symptoms or were asymptomatic. The case fatality rate among residents was 29%. IPC measures were rapidly implemented such as the quarantine of residents, the reinforcement of staff personal protective equipment, and home quarantine of staff testing positive, which were supplemented in April by systematic controls at the entrance of the nursing home and the creation of additional staff break rooms. CONCLUSIONS: This outbreak confirmed the considerable health impact of SARS-CoV-2 transmission in a nursing home. In addition to the implementation of IPC measures, the early detection of cases through the screening of residents and staff is essential to identify asymptomatic and pre-symptomatic cases and limit the spread of the virus.


Asunto(s)
/epidemiología , Brotes de Enfermedades , Casas de Salud , Adulto , Anciano , Anciano de 80 o más Años , Brotes de Enfermedades/prevención & control , Femenino , Francia/epidemiología , Humanos , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Factores de Tiempo
5.
Quintessence Int ; 0(0): 0, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33533236

RESUMEN

OBJECTIVES: The spread of COVID-19 has posed significant challenges for dental professionals worldwide. The aims of the present study were twofold: (i) to study the attitudes, emotional responses, and worries among the dental personnel; and (ii) to look for the ability of dental personnel to experience posttraumatic self-growth as a result of the distress caused by the pandemic. METHOD AND MATERIALS: A cross-sectional online survey using an anonymous questionnaire was performed simultaneously in Israel, Canada, and France during the initial lockdown period. RESULTS: Israeli dental practitioners were less worried about their physical health, mental health, or relationships with family and friends than their Canadian and French counterparts. The Canadian dental practitioners were most committed and most willing to treat their patients, as well as most concerned about not being able to treat patients in the same personal way as before the lockdown. French dental practitioners showed the highest level of fear to treat patients. There were no differences in dental practitioners' levels of anxiety, depression, or posttraumatic growth among the countries. Dental practitioners' posttraumatic growth was significantly associated with worries regarding their physical health. CONCLUSION: Responses of dental personnel to the COVID-19 pandemic varied worldwide. Despite the differences, evidence exists that some of the dental practitioners' worries and concerns are associated with psychologic growth as a result of the pandemic. Better understanding and acknowledgment of dental personnel's worries and concerns can facilitate growth and enable positive functioning under the continuous situation of uncertainty.


Asunto(s)
Crecimiento Psicológico Postraumático , Ansiedad , Actitud , Canadá/epidemiología , Control de Enfermedades Transmisibles , Estudios Transversales , Odontólogos , Francia/epidemiología , Humanos , Israel/epidemiología , Pandemias , Rol Profesional
6.
Proc Natl Acad Sci U S A ; 118(8)2021 02 23.
Artículo en Inglés | MEDLINE | ID: mdl-33536313

RESUMEN

The characterization of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral kinetics in hospitalized patients and its association with mortality is unknown. We analyzed death and nasopharyngeal viral kinetics in 655 hospitalized patients from the prospective French COVID cohort. The model predicted a median peak viral load that coincided with symptom onset. Patients with age ≥65 y had a smaller loss rate of infected cells, leading to a delayed median time to viral clearance occurring 16 d after symptom onset as compared to 13 d in younger patients (P < 10-4). In multivariate analysis, the risk factors associated with mortality were age ≥65 y, male gender, and presence of chronic pulmonary disease (hazard ratio [HR] > 2.0). Using a joint model, viral dynamics after hospital admission was an independent predictor of mortality (HR = 1.31, P < 10-3). Finally, we used our model to simulate the effects of effective pharmacological interventions on time to viral clearance and mortality. A treatment able to reduce viral production by 90% upon hospital admission would shorten the time to viral clearance by 2.0 and 2.9 d in patients of age <65 y and ≥65 y, respectively. Assuming that the association between viral dynamics and mortality would remain similar to that observed in our population, this could translate into a reduction of mortality from 19 to 14% in patients of age ≥65 y with risk factors. Our results show that viral dynamics is associated with mortality in hospitalized patients. Strategies aiming to reduce viral load could have an effect on mortality rate in this population.


Asunto(s)
/mortalidad , Modelos Teóricos , Nasofaringe/virología , ARN Viral/análisis , Carga Viral , Anciano , Anticuerpos Antivirales/sangre , /epidemiología , Femenino , Francia/epidemiología , Hospitalización , Humanos , Cinética , Masculino , Pronóstico , Estudios Prospectivos , ARN Viral/genética , Factores de Riesgo , Tasa de Supervivencia
7.
BMJ ; 372: n37, 2021 02 03.
Artículo en Inglés | MEDLINE | ID: mdl-33536184

RESUMEN

OBJECTIVE: To assess the risk of meningioma associated with use of high dose cyproterone acetate, a progestogen indicated for clinical hyperandrogenism. DESIGN: Observational cohort study. SETTING: Data from SNDS, the French administrative healthcare database, between 2007 and 2015. PARTICIPANTS: 253 777 girls and women aged 7-70 years living in France who started cyproterone acetate between 2007 and 2014. Participants had at least one reimbursement for high dose cyproterone acetate and no history of meningioma or benign brain tumour, or long term disease status. Participants were considered to be exposed when they had received a cumulative dose of at least 3 g during the first six months (139 222 participants) and very slightly exposed (control group) when they had received a cumulative dose of less than 3 g (114 555 participants). 10 876 transgender participants (male to female) were included in an additional analysis. MAIN OUTCOME MEASURE: Surgery (resection or decompression) or radiotherapy for one or more intracranial meningiomas. RESULTS: Overall, 69 meningiomas in the exposed group (during 289 544 person years of follow-up) and 20 meningiomas in the control group (during 439 949 person years of follow-up) were treated by surgery or radiotherapy. The incidence of meningioma in the two groups was 23.8 and 4.5 per 100 000 person years, respectively (crude relative risk 5.2, 95% confidence interval 3.2 to 8.6; adjusted hazard ratio 6.6, 95% confidence interval 4.0 to 11.1). The adjusted hazard ratio for a cumulative dose of cyproterone acetate of more than 60 g was 21.7 (10.8 to 43.5). After discontinuation of cyproterone acetate for one year, the risk of meningioma in the exposed group was 1.8-fold higher (1.0 to 3.2) than in the control group. In a complementary analysis, 463 women with meningioma were observed among 123 997 already using cyproterone acetate in 2006 (risk of 383 per 100 000 person years in the group with the highest exposure in terms of cumulative dose). Meningiomas located in the anterior skull base and middle skull base, particularly the medial third of the middle skull base, involving the spheno-orbital region, appeared to be specific to cyproterone acetate. An additional analysis of transgender participants showed a high risk of meningioma (three per 14 460 person years; 20.7 per 100 000 person years). CONCLUSIONS: A strong dose-effect relation was observed between use of cyproterone acetate and risk of intracranial meningiomas. A noticeable reduction in risk was observed after discontinuation of treatment.


Asunto(s)
Antagonistas de Andrógenos/efectos adversos , Acetato de Ciproterona/efectos adversos , Neoplasias Meníngeas/inducido químicamente , Meningioma/inducido químicamente , Adolescente , Adulto , Anciano , Antagonistas de Andrógenos/administración & dosificación , Estudios de Casos y Controles , Niño , Acetato de Ciproterona/administración & dosificación , Bases de Datos Factuales , Relación Dosis-Respuesta a Droga , Femenino , Francia/epidemiología , Humanos , Incidencia , Estudios Longitudinales , Neoplasias Meníngeas/epidemiología , Meningioma/epidemiología , Persona de Mediana Edad , Medición de Riesgo , Adulto Joven
8.
J Frailty Aging ; 10(2): 94-102, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33575697

RESUMEN

BACKGROUND: The screening tool of the Integrated Care for Older People (ICOPE Step 1), designed to detect declines in the domains of intrinsic capacity, has been incipiently investigated in older adult populations. OBJECTIVES: To retrospectively estimate the frequency of priority conditions associated with declines in intrinsic capacity according to an adaptation of the screening tool ICOPE Step 1 among participants of the Multidomain Alzheimer Preventive Trial (MAPT). DESIGN: A cross-sectional retrospective analysis from the baseline assessment of the MAPT. SETTING: The data was gathered during a preventive consultation for cardiovascular risk factors in memory clinics in France. PARTICIPANTS: Seven hundred fifty-nine older adults aged 70-89 years with memory complaints, allocated to the multidomain groups of the MAPT study. MEASUREMENTS: Five domains of intrinsic capacity (cognition, locomotion, nutrition, sensorial, and psychological) were assessed using a screening tool similar to the ICOPE Step 1 (MAPT Step 1). The frequency of six conditions associated with declines in intrinsic capacity (cognitive decline, limited mobility, malnutrition, visual impairment, hearing loss, and depressive symptoms) was obtained for older adults with memory complaints participating in the MAPT study. RESULTS: Overall, 89.3% of the participants had one or more conditions associated with declines in intrinsic capacity. The overall frequency of each condition was: 52.2% for cognitive decline, 20.2% for limited mobility, 6.6% for malnutrition, 18.1% for visual impairment, 56.2% for hearing loss, and 39% for depressive symptoms. CONCLUSION: After being screened with an adaptation of the ICOPE step 1 (MAPT step 1) tool, 9/10 older adults had one or more conditions associated with declines in intrinsic capacity. The relative frequency differs across conditions and could probably be lower in a population without memory complaints. The frequency of screened conditions associated with declines in IC highlights how relevant it is to develop function-centered care modalities to promote healthy aging.


Asunto(s)
Disfunción Cognitiva , Prestación Integrada de Atención de Salud , Evaluación Geriátrica , Tamizaje Masivo , Anciano , Anciano de 80 o más Años , Disfunción Cognitiva/diagnóstico , Disfunción Cognitiva/epidemiología , Estudios Transversales , Francia/epidemiología , Humanos , Tamizaje Masivo/métodos , Estudios Retrospectivos , Factores de Riesgo
9.
PLoS One ; 16(2): e0246586, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33571264

RESUMEN

BACKGROUND: Previous studies have highlighted the increased risk of contracting the COVID-19 for health-care workers and suggest that oral health-care workers may carry the greatest risk. Considering the transmission route of the SARS-CoV-2 infection, a similar increased risk can be hypothesized for other respiratory infections. However, no study has specifically assessed the risk of contracting COVID-19 within the dental profession. METHODS: An online survey was conducted within a population of French dental professionals between April 1 and April 29, 2020. Univariable and multivariable logistic regression analyses were performed to explore risk indicators associated with laboratory-confirmed COVID-19 and COVID-19-related clinical phenotypes (i.e. phenotypes present in 15% or more of SARS-CoV-2-positive cases). RESULTS: 4172 dentists and 1868 dental assistants responded to the survey, representing approximately 10% of French oral health-care workers. The prevalence of laboratory-confirmed COVID-19 was 1.9% for dentists and 0.8% for dental assistants. Higher prevalence was found for COVID-19-related clinical phenotypes both in dentists (15.0%) and dental assistants (11.8%). Chronic kidney disease and obesity were associated with increased odds of laboratory-confirmed COVID-19, whereas working in a practice limited to endodontics was associated with decreased odds. Chronic obstructive pulmonary disease, use of public transportation and having a practice limited to periodontology were associated with increased odds of presenting a COVID-19-related clinical phenotype. Moreover, changes in work rhythm or clinical practice were associated with decreased odds of both outcomes. CONCLUSIONS: Although oral health-care professionals were surprisingly not at higher risk of COVID-19 than the general population, specific risk indicators could exist, notably among high aerosol-generating dental subspecialties such as periodontology. Considering the similarities between COVID-19-related clinical phenotypes other viral respiratory infections, lessons can be learned from the COVID-19 pandemic regarding the usefulness of equipping and protecting oral health-care workers, notably during seasonal viral outbreaks, to limit infection spread. IMPACT: Results from this study may provide important insights for relevant health authorities regarding the overall infection status of oral health-care workers in the current pandemic and draw attention to particular at-risk groups, as illustrated in the present study. Protecting oral health-care workers could be an interesting public health strategy to prevent the resurgence of COVID-19 and/or the emergence of new pandemics.


Asunto(s)
/epidemiología , Personal de Odontología , Odontólogos , Adulto , Odontología , Femenino , Francia/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Exposición Profesional/efectos adversos , Prevalencia , Factores de Riesgo , /aislamiento & purificación
10.
BMC Fam Pract ; 22(1): 36, 2021 02 14.
Artículo en Inglés | MEDLINE | ID: mdl-33583410

RESUMEN

BACKGROUND: The COVID-19 pandemic has shaken the world in early 2020. In France, General Practitioners (GPs) were not involved in the care organization's decision-making process before and during the first wave of the COVID-19 pandemic. This omission could have generated stress for GPs. We aimed first to estimate the self-perception of stress as defined by the 10-item Perceived Stress Score (PSS-10), at the beginning of the pandemic in France, among GPs from the Auvergne-Rhône-Alpes, a french administrative area severely impacted by COVID-19. Second, we aimed to identify factors associated with a self-perceived stress (PSS-10 ≥ 27) among socio-demographic characteristics of GPs, their access to reliable information and to personal protective equipment during the pandemic, and their exposure to well established psychosocial risk at work. METHODS: We conducted an online cross-sectional survey between 8th April and 10th May 2020. The self-perception of stress was evaluated using the PSS-10, so to see the proportion of "not stressed" (≤20), "borderline" (21 ≤ PSS-10 ≤ 26), and "stressed" (≥27) GPs. The agreement to 31 positive assertions related to possible sources of stress identified by the scientific study committee was measured using a 10-point numeric scale. In complete cases, factors associated with stress (PSS-10 ≥ 27) were investigated using logistic regression, adjusted on gender, age and practice location. A supplementary analysis of the verbatims was made. RESULTS: Overall, 898 individual answers were collected, of which 879 were complete. A total of 437 GPs (49%) were stressed (PSS-10 ≥ 27), and 283 GPs (32%) had a very high level of stress (PSS-10 ≥ 30). Self-perceived stress was associated with multiple components, and involved classic psychosocial risk factors such as emotional requirements. However, in this context of health crisis, the primary source of stress was the diversity and quantity of information from diverse sources (614 GPs (69%, OR = 2.21, 95%CI [1.40-3.50], p < 0.001). Analysis of verbatims revealed that GPs felt isolated in a hospital-based model. CONCLUSION: The first wave of the pandemic was a source of stress for GPs. The diversity and quantity of information received from the health authorities were among the main sources of stress.


Asunto(s)
Control de Enfermedades Transmisibles , Médicos Generales , Exposición Profesional , Salud Laboral/tendencias , Autoimagen , Estrés Psicológico , Adulto , Actitud del Personal de Salud , /prevención & control , Control de Enfermedades Transmisibles/instrumentación , Control de Enfermedades Transmisibles/organización & administración , Estudios Transversales , Autoevaluación Diagnóstica , Transmisión de Enfermedad Infecciosa/prevención & control , Femenino , Francia/epidemiología , Médicos Generales/psicología , Médicos Generales/estadística & datos numéricos , Humanos , Masculino , Exposición Profesional/efectos adversos , Exposición Profesional/prevención & control , Equipo de Protección Personal/provisión & distribución , Estrés Psicológico/diagnóstico , Estrés Psicológico/epidemiología , Estrés Psicológico/etiología
11.
Nat Commun ; 12(1): 1073, 2021 02 16.
Artículo en Inglés | MEDLINE | ID: mdl-33594076

RESUMEN

As countries in Europe implement strategies to control the COVID-19 pandemic, different options are chosen regarding schools. Through a stochastic age-structured transmission model calibrated to the observed epidemic in Île-de-France in the first wave, we explored scenarios of partial, progressive, or full school reopening. Given the uncertainty on children's role, we found that reopening schools after lockdown may increase COVID-19 cases, yet protocols exist to keep the epidemic controlled. Under a scenario with stable epidemic activity if schools were closed, reopening pre-schools and primary schools would lead to up to 76% [67, 84]% occupation of ICU beds if no other school level reopened, or if middle and high schools reopened later. Immediately reopening all school levels may overwhelm the ICU system. Priority should be given to pre- and primary schools allowing younger children to resume learning and development, whereas full attendance in middle and high schools is not recommended for stable or increasing epidemic activity. Large-scale test and trace is required to keep the epidemic under control. Ex-post assessment shows that progressive reopening of schools, limited attendance, and strong adoption of preventive measures contributed to a decreasing epidemic after lifting the first lockdown.


Asunto(s)
/epidemiología , Pandemias , Instituciones Académicas , /transmisión , Niño , Simulación por Computador , Francia/epidemiología , Humanos , Unidades de Cuidados Intensivos , Modelos Biológicos , Admisión del Paciente , Estudios Retrospectivos , /fisiología
12.
Crit Care ; 25(1): 72, 2021 02 18.
Artículo en Inglés | MEDLINE | ID: mdl-33602296

RESUMEN

BACKGROUND: The COVID-19 pandemic is responsible for many hospitalizations in intensive care units (ICU), with widespread use of invasive mechanical ventilation (IMV) which exposes patients to the risk of ventilator-associated pneumonia (VAP). The characteristics of VAP in COVID-19 patients remain unclear. METHODS: We retrospectively collected data on all patients hospitalized for COVID-19 during the first phase of the epidemic in one of the seven ICUs of the Pays-de-Loire region (North-West France) and who were on invasive mechanical ventilation for more than 48 h. We studied the characteristics of VAP in these patients. VAP was diagnosed based on official recommendations, and we included only cases of VAP that were confirmed by a quantitative microbiological culture. FINDINGS: We analyzed data from 188 patients. Of these patients, 48.9% had VAP and 19.7% experienced multiple episodes. Our study showed an incidence of 39.0 VAP per 1000 days of IMV (until the first VAP episode) and an incidence of 33.7 VAP per 1000 days of IMV (including all 141 episodes of VAP). Multi-microbial VAP accounted for 39.0% of all VAP, and 205 pathogens were identified. Enterobacteria accounted for 49.8% of all the isolated pathogens. Bacteremia was associated in 15 (10.6%) cases of VAP. Pneumonia was complicated by thoracic empyema in five cases (3.5%) and by pulmonary abscess in two cases (1.4%). Males were associated with a higher risk of VAP (sHR 2.24 CI95% [1.18; 4.26] p = 0.013). INTERPRETATION: Our study showed an unusually high incidence of VAP in patients admitted to the ICU for severe COVID-19, even though our services were not inundated during the first wave of the epidemic. We also noted a significant proportion of enterobacteria. VAP-associated complications (abscess, empyema) were not exceptional. REGISTRATION: As an observational study, this study has not been registered.


Asunto(s)
/terapia , Neumonía Asociada al Ventilador/epidemiología , Neumonía Asociada al Ventilador/microbiología , Respiración Artificial/efectos adversos , Anciano , Femenino , Francia/epidemiología , Hospitalización , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
13.
Eur Rev Med Pharmacol Sci ; 25(2): 1158-1162, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33577072

RESUMEN

OBJECTIVE: The COVID-19 epidemic has had a strong impact on the entire healthcare sector in France with priority being given to research for new therapeutic options for COVID-19. Nevertheless, continuity of care for patients suffering from other diseases represents a crucial challenge, and clinical research is no exception in this respect. This study aims to assess the impact of the strict Covid-19 lockdown on non-Covid-19 clinical research in the French University Hospital of Strasbourg. MATERIALS AND METHODS: Clinical research activity (non-Covid-19) from the point of view of pharmacy department was estimated and compared to the pre-lockdown period. The impact of lockdown was assessed through five indicators: site initiation visits, the initiation of experimental therapies in non-Covid-19 patients, the delivery of non-Covid-19 investigational medical products, the number of drug shipments to patients' homes, and the number of monitoring or closure visits. RESULTS: During the study period, the number of site initiation visits decreased by 90%, total inclusions by 72%, and delivery of investigational medical products by 30%. During the lockdown period, 15 treatments were sent to patients' homes. Monitoring activity decreased by 98%. CONCLUSIONS: Although the COVID-19 outbreak has created an incredible momentum in the field of clinical research, research not focused on SaRS-CoV-2 has suffered greatly from this situation. The impact on patients is difficult to estimate but should be further investigated.


Asunto(s)
Investigación Biomédica/tendencias , Ensayos Clínicos como Asunto , Hospitales Universitarios/tendencias , Pandemias , Cuarentena/tendencias , /prevención & control , Francia/epidemiología , Humanos , Estudios Retrospectivos
14.
Eur J Pediatr ; 180(2): 627-633, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33410942

RESUMEN

The primary objective of the study was to assess the prevalence of burnout among paediatric residents during the coronavirus disease 2019 (COVID-19) outbreak in France. The secondary objective was to identify risk factors associated with burnout in this population. In a nationwide, cross-sectional survey, a questionnaire was e-mailed to all paediatric residents in France in the first week of May 2020. The prevalence of burnout was assessed with the validated French-language version of the Maslach Burnout Inventory - Human Services Survey. The questionnaire also contained items on the residents' sociodemographic characteristics and professional situation. Three hundred and forty paediatric residents completed the questionnaire. The median age was 27 (interquartile range 25-28) and 285 (83.8%, 95% confidence interval (CI) [79.5-87.6]) of the residents were women. The prevalence of burnout was 37.4%, 95%CI [32.2-42.7]. There was no association between burnout and exposure to the consequences of COVID-19, which may be related to the low incidence of severe COVID-19 among children. In contrast, the hours worked per week and the anxiety scores were significantly associated with burnout.Conclusion: The level of burnout among French paediatric residents is a matter of concern for residents, and cannot be ascribed to the COVID-19 outbreak. Preventive actions should be implemented, with a reduction in working hours and support programs to help manage work-related anxiety. What is Known: • Burnout is a concern for both residents and the patients they care for. • Natural disasters disrupt the health care organizations and increase the burnout rate. What is New: • The prevalence of burnout among paediatric residents in France is 37.4%, 95%CI [32.2-42.7]. • COVID-19 outbreak is not associated with burnout in this population but anxiety and working hours per week might be modifiable risk factors.


Asunto(s)
Agotamiento Profesional/epidemiología , Educación de Postgrado en Medicina/métodos , Internado y Residencia/métodos , Pandemias , Pediatría/educación , Estudiantes de Medicina/psicología , Adulto , Agotamiento Profesional/psicología , Niño , Estudios Transversales , Femenino , Francia/epidemiología , Humanos , Masculino , Prevalencia
17.
Hypertension ; 77(3): 833-842, 2021 03 03.
Artículo en Inglés | MEDLINE | ID: mdl-33423528

RESUMEN

After initially hypothesizing a positive relationship between use of renin-angiotensin-aldosterone system inhibitors and risk of coronavirus disease 2019 (COVID-19), more recent evidence suggests negative associations. We examined whether COVID-19 risk differs according to antihypertensive drug class in patients treated by ACE (angiotensin-converting enzyme) inhibitors and angiotensin receptor blockers (ARBs) compared with calcium channel blockers (CCBs). Three exclusive cohorts of prevalent ACE inhibitors, ARB and CCB users, aged 18 to 80 years, from the French National Health Insurance databases were followed from February 15, 2020 to June 7, 2020. We excluded patients with a history of diabetes, known cardiovascular disease, chronic renal failure, or chronic respiratory disease during the previous 5 years, to only consider patients treated for uncomplicated hypertension and to limit indication bias. The primary end point was time to hospitalization for COVID-19. The secondary end point was time to intubation/death during a hospital stay for COVID-19. In a population of almost 2 million hypertensive patients (ACE inhibitors: 566 023; ARB: 958 227; CCB: 358 306) followed for 16 weeks, 2338 were hospitalized and 526 died or were intubated for COVID-19. ACE inhibitors and ARBs were associated with a lower risk of COVID-19 hospitalization compared with CCBs (hazard ratio, 0.74 [95% CI, 0.65-0.83] and 0.84 [0.76-0.93], respectively) and a lower risk of intubation/death. Risks were slightly lower for ACE inhibitor users than for ARB users. This large observational study may suggest a lower COVID-19 risk in hypertensive patients treated over a long period with ACE inhibitors or ARBs compared with CCBs. These results, if confirmed, tend to contradict previous hypotheses and raise new hypotheses.


Asunto(s)
Antagonistas de Receptores de Angiotensina/efectos adversos , Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Antihipertensivos/efectos adversos , Hipertensión/tratamiento farmacológico , Pandemias , Receptores Virales/efectos de los fármacos , /fisiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antagonistas de Receptores de Angiotensina/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Antihipertensivos/uso terapéutico , Bloqueadores de los Canales de Calcio/efectos adversos , Bloqueadores de los Canales de Calcio/uso terapéutico , Comorbilidad , Susceptibilidad a Enfermedades , Utilización de Medicamentos , Femenino , Estudios de Seguimiento , Francia/epidemiología , Mortalidad Hospitalaria , Hospitalización/estadística & datos numéricos , Humanos , Hipertensión/epidemiología , Intubación Intratraqueal/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto Joven
18.
Emerg Microbes Infect ; 10(1): 167-177, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33399033

RESUMEN

During routine molecular surveillance of SARS-CoV-2 performed at the National Reference Center of Respiratory Viruses (Lyon, France) (n = 229 sequences collected February-April 2020), two frameshifting deletions were detected in the open reading frame 6, at the same position (27267). While a 26-nucleotide deletion variant (D26) was only found in one nasopharyngeal sample in March 2020, the 34-nucleotide deletion (D34) was found within a single geriatric hospital unit in 5/9 patients and one health care worker in April 2020. Phylogeny analysis strongly suggested a nosocomial transmission of D34, with potential fecal transmission, as also identified in a stool sample. No difference in disease severity was observed between patients hospitalized in the geriatric unit infected with WT or D34. In vitro D26 and D34 characterization revealed comparable replication kinetics with the wild-type (WT), but differential host immune responses. While interferon-stimulated genes were similarly upregulated after infection with WT and ORF6 variants, the latter specifically induced overexpression of 9 genes coding for inflammatory cytokines in the NF-kB pathway, including CCL2/MCP1, PTX3, and TNFα, for which high plasma levels have been associated with severe COVID-19. Our findings emphasize the need to monitor the occurrence of ORF6 deletions and assess their impact on the host immune response.


Asunto(s)
/epidemiología , Infección Hospitalaria/virología , Variación Genética , Genoma Viral , Proteínas Virales/genética , Adulto , Anciano , Anciano de 80 o más Años , Secuencia de Bases , /virología , Infección Hospitalaria/epidemiología , Infección Hospitalaria/inmunología , Citocinas/inmunología , Femenino , Mutación del Sistema de Lectura , Francia/epidemiología , Hospitalización , Humanos , Inmunidad , Inflamación , Masculino , Filogenia , Eliminación de Secuencia , Proteínas Virales/inmunología
19.
Euro Surveill ; 26(3)2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33478625

RESUMEN

We report the strategy leading to the first detection of variant of concern 202012/01 (VOC) in France (21 December 2020). First, the spike (S) deletion H69-V70 (ΔH69/ΔV70), identified in certain SARS-CoV-2 variants including VOC, is screened for. This deletion is associated with a S-gene target failure (SGTF) in the three-target RT-PCR assay (TaqPath kit). Subsequently, SGTF samples are whole genome sequenced. This approach revealed mutations co-occurring with ΔH69/ΔV70 including S:N501Y in the VOC.


Asunto(s)
Secuencia de Bases , Genoma Viral , Eliminación de Secuencia/genética , Glicoproteína de la Espiga del Coronavirus/genética , Francia/epidemiología , Humanos
20.
Sci Rep ; 11(1): 2291, 2021 01 27.
Artículo en Inglés | MEDLINE | ID: mdl-33504824

RESUMEN

Coronavirus disease 2019 (COVID-19) pandemic is affecting millions of patients worldwide. The consequences of initial exposure to SARS-CoV-2 go beyond pulmonary damage, with a particular impact on lipid metabolism. Decreased levels in HDL-C were reported in COVID-19 patients. Since HDL particles display antioxidant, anti-inflammatory and potential anti-infectious properties, we aimed at characterizing HDL proteome and functionality during COVID-19 relative to healthy subjects. HDLs were isolated from plasma of 8 severe COVID-19 patients sampled at admission to intensive care unit (Day 1, D1) at D3 and D7, and from 16 sex- and age-matched healthy subjects. Proteomic analysis was performed by LC-MS/MS. The relative amounts of proteins identified in HDLs were compared between COVID-19 and controls. apolipoprotein A-I and paraoxonase 1 were confirmed by Western-blot analysis to be less abundant in COVID-19 versus controls, whereas serum amyloid A and alpha-1 antitrypsin were higher. HDLs from patients were less protective in endothelial cells stiumalted by TNFα (permeability, VE-cadherin disorganization and apoptosis). In these conditions, HDL inhibition of apoptosis was blunted in COVID-19 relative to controls. In conclusion, we show major changes in HDL proteome and decreased functionality in severe COVID-19 patients.


Asunto(s)
/sangre , Lipoproteínas HDL/sangre , Apolipoproteína A-I/sangre , Arildialquilfosfatasa/análisis , Arildialquilfosfatasa/sangre , /patología , Estudios de Casos y Controles , Cromatografía Liquida/métodos , Células Endoteliales/patología , Femenino , Francia/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Proteoma/metabolismo , Proteómica/métodos , Proteína Amiloide A Sérica/metabolismo , Espectrometría de Masas en Tándem/métodos , Factor de Necrosis Tumoral alfa/sangre , alfa 1-Antitripsina/sangre
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