Lack of efficacy of hydroxychloroquine and azithromycin in patients hospitalized for COVID-19 pneumonia: A retrospective study.

BACKGROUND: Hydroxychloroquine combined with azithromycin (HCQ/AZI) has initially been used against coronavirus disease-2019 (COVID-19). In this retrospective study, we assessed the clinical effects of HCQ/AZI, with a 28-days follow-up. METHODS: In a registry-study which included patients hospitalized for COVID-19 between March 15 and April 2, 2020, we compared patients who received HCQ/AZI to those who did not, regarding a composite outcome of mortality and mechanical ventilation with a 28-days follow-up. QT was monitored for patients treated with HCQ/AZI. Were excluded patients in intensive care units, palliative care and ventilated within 24 hours of admission. Three analyses were performed to adjust for selection bias: propensity score matching, multivariable survival, and inverse probability score weighting (IPSW) analyses. RESULTS: Overall, 203 patients were included: 60 patients treated by HCQ/AZI and 143 control patients. During the 28-days follow-up, 32 (16.3%) patients presented the primary outcome and 23 (12.3%) patients died. Propensity-score matching identified 52 unique pairs of patients with similar characteristics. In the matched cohort (n = 104), HCQ/AZI was not associated with the primary composite outcome (log-rank p-value = 0.16). In the overall cohort (n = 203), survival and IPSW analyses also found no benefit from HCQ/AZI. In the HCQ/AZI group, 11 (18.3%) patients prolonged QT interval duration, requiring treatment cessation. CONCLUSIONS: HCQ/AZI combination therapy was not associated with lower in-hospital mortality and mechanical ventilation rate, with a 28-days follow-up. In the HCQ/AZI group, 18.3% of patients presented a prolonged QT interval requiring treatment cessation, however, control group was not monitored for this adverse event, making comparison impossible.

Pulmonary embolism in intensive care units: More frequent or more Known? Prospective study of 75 cases.

PURPOSE: to evaluate the current rate of pulmonary embolism (PE) in our medico-surgical intensive care unit (ICU), to identify risk factors, and to determine the outcome of PE in ICU. METHODS: We performed a prospective cohort study of consecutive patients requiring intensive care admission during a one-year period. We included, in this prospective study, all the patients with confirmed PE admitted in ICU with more than 18 years of age, and expected to stay in ICU for more than 48 hours. Only the patients who had a clinical suspicion (unexplained hypoxemia and/or shock) for PE underwent diagnostic studies. RESULTS: During the study period, 842 patients were admitted in our ICU. One hundred and two patients were excluded. The diagnosis of PE was confirmed in 75 patients (10.1%). In our study, all patients (100%) had received some forms of pharmaceutical prophylaxis (PP) during ICU stay. The median time from ICU admission to diagnosis of PE was 6 days. The diagnosis of PE was made by spiral CT in 74 patients (98.7%), and by echocardiography in 1 case (1.3%). The mean ICU stay was 26.3 ± 26.5 days (median: 20 days). During their ICU stay, 73 patients (97.3%) developed one, or more, organ failure. Respiratory failure was the most observed (97.3%). Moreover, 38 patients (50.6%) developed nosocomial infections and 29 (38.6%) died. The multivariate analysis showed that the risk factors associated with mortality were the presence of shock the day of PE diagnosis and the presence of right ventricular dilatation on echocardiography. CONCLUSION: Our findings confirm that subjects in the ICU are at high risk of PE, due to a high number of risk-factors. PE was associated with higher ICU mortality and a significantly higher ICU LOS. Our results invite to revise the preventive strategies of deep venous thrombosis and PE in patients requiring ICU admission.

[An exceptional cause of peritonitis: ileal perforation due to a foreign body during reduction of an inguinal hernia]. / Une cause exceptionnelle des péritonites: une perforation iléale par un corps étranger lors de la réduction d'une hernie inguinale.

Secondary peritonitis is frequently reported in the literature. It is due to multiple causes. We report an exceptional cause of ileal perforation due to a foreign body during reduction of an inguinal hernia. It caused severe peritonitis with multiple organ failure.

[A rare complication of generalized tetanus: pulmonary embolism]. / Une complication exceptionnelle du tétanos généralisé: l'embolie pulmonaire.

Tetanus is a disease characterized by spastic paralysis and spasms. It is a serious pathology that requires treatment in the ICU. Mortality rate is primarily due to neurodegenerative and infectious complications. Thromboembolic complications are rare. To the best of our knowledge, pulmonary embolism has never occorred and been confirmed in patients with generalized tetanus. Our study reports the case of a patient with generalized tetanus complicated by fibrin, cruoric pulmonary embolism.