Dynamique de la prise en charge thérapeutique et préventive de la Covid-19 chez les patients adultes vulnérables / Dynamics of therapeutic and preventive management of Covid-19 in vulnerable adult patients

La pandémie à Covid-19 continue sa progression et interpelle aujourd'hui toute l'humanité particulièrement le corps médical. A la date du 30 Juin 2020, le monde entier compte 10185374 cas confirmés avec 563862 décès [1]. La recherche scientifique intense a pu rapidement séquencer ce virus à ARN, partager sur sa clinique et son évolution. Mais six mois après il persiste encore beaucoup d'inconnues concernant son pouvoir pathogène, sa physiopathologie mais surtout sa prise en charge thérapeutique particulièrement chez les sujets âgés ou ayant des facteurs de risqué qui ont une mortalité significativement plus élevée [1, 2, 3]. La Covid-19 pose ainsi un problème de prise en charge thérapeutique chez les sujets vulnérables. Cette situation préoccupante pour tous, justifie la poursuite de la réflexion, de la recherche et surtout le partage d'expériences pour une meilleure prise en chargechez ces patients à risque

First-onset mental disorders after cancer diagnosis and cancer-specific mortality: a nationwide cohort study.

BACKGROUND: The diagnosis of cancer is strongly associated with the risk of mental disorders even in patients with no previous history of mental disorders. Accumulating data suggest that mental distress may accelerate tumor progression. We hypothesized therefore that mental disorders after a cancer diagnosis may increase the risk of cancer-specific mortality. PATIENTS AND METHODS: We conducted a nationwide cohort study including 244 261 cancer patients diagnosed in Sweden during 2004-2009 and followed them through 2010. Through the Swedish Patient Register, we obtained clinical diagnoses of all mental disorders and focused on mood-, anxiety-, and substance abuse disorders (ICD10: F10-F16, F18-F19, F32-F33, F40-F41, and F43-45) that are commonly diagnosed among patients with cancer. We further classified the studied mental disorders into first-onset or recurrent mental disorders. We used Cox regression to estimate multivariable hazard ratios (HRs) with 95% confidence intervals (CIs) as a measure of the association between mental disorders after cancer diagnosis and cancer-specific mortality, adjusting for age, sex, calendar period, educational level, cancer stage, and cancer type at diagnosis. RESULTS: After cancer diagnosis, 11 457 patients were diagnosed with mood-, anxiety-, and substance abuse disorders; of which 7236 were first-onset mental disorders. Patients with a first-onset mental disorder were at increased risk of cancer-specific mortality (HR: 1.82, 95% CI: 1.71-1.92) while patients with a recurrent mental disorder had much lower risk elevation (HR: 1.14, 95% CI: 1.05-1.24). The increased cancer-specific mortality by first-onset mental disorders was observed for almost all cancer sites/groups and the association was stronger for localized cancers (HR: 2.00, 95% CI: 1.73-2.31) than for advanced cancers (HR: 1.49, 95% CI: 1.32-1.69). CONCLUSIONS: Patients with a first-onset common mood-, anxiety-, or substance abuse disorder after cancer diagnosis may be at increased risk of cancer-specific death.

Remarriage after divorce and depression risk.

As marriage is associated with lower depression rates compared with being single in men, we aimed to examine if remarriage compared with remaining divorced is also associated with a reduced depression risk. Swedish register data were used to define a cohort of men who were born between 1952 and 1956 and underwent a compulsory military conscription assessment in adolescence. This study population comprised men who were divorced in 1985 (n = 72,246). The risk of pharmaceutically treated depression from 2005 to 2009 was compared for those who remarried or remained divorced between 1986 and 2004. Cox proportional hazards analysis was used to estimate hazard ratios for the risk of depression identified by pharmaceutical treatment, with adjustment for a range of potential confounding factors including childhood and adulthood socioeconomic circumstances, cognitive, physical, psychological and medical characteristics at the conscription assessment. The results showed that, even though divorced men who remarried had markers of lower depression risk in earlier life such as higher cognitive and physical function, higher stress resilience and socioeconomic advantages than men who remained divorced, remarriage was associated with a statistically significant elevated risk of depression with an adjusted hazard ratio (and 95% confidence interval) of 1.27(1.03 1.55), compared with men who remained divorced. Remarriage following divorce is not associated with a reduced risk of depression identified by pharmaceutical treatment, compared with remaining divorced. Interpersonal or financial difficulties resulting from remarriage may outweigh the benefits of marriage in terms of depression risk.

Prevalence and incidence of diabetes mellitus: a nationwide population-based pharmaco-epidemiological study in Sweden.

AIM: To investigate the changes in prevalence and incidence of pharmacologically and non-pharmacologically treated diabetes in Sweden during 2005 to 2013. METHODS: We obtained data on gender, date of birth and pharmacologically and non-pharmacologically treated diabetes from national registers for all Swedish residents. RESULTS: During the study period a total of 240 871 new cases of pharmacologically treated diabetes was found. The age-standardized incidence during the follow-up was 4.34 and 3.16 per 1000 individuals in men and women, respectively. A decreasing time trend in incidence for men of 0.6% per year (0.994, 95% CI 0.989-0.999) and for women of 0.7% per year (0.993, 95% CI 0.986-0.999) was observed. The age-standardized prevalence increased from 41.9 and 29.9 per 1000 in 2005/2006 to 50.8 and 34.6 in 2012/2013 in men and women, respectively. This corresponds to an annually increasing time trend for both men (1.024, 95% CI 1.022-1.027) and women (1.019, 95% CI 1.016-1.021). The total age-standardized prevalence of pharmacologically and non-pharmacologically treated diabetes (2012) was 46.9 per 1000 (55.6 for men and 38.8 for women). This corresponds to an annually increasing time trend (2010-2012) for both men (1.017, 95% CI 1.013-1.021) and women (1.012, 95% CI 1.008-1.016). CONCLUSIONS: The prevalence of pharmacologically treated diabetes increased moderately during 8 years of follow-up, while the incidence decreased modestly. This is in contrast to the results reported by most other studies. The total prevalence of diabetes (both pharmacologically and non-pharmacologically treated) in Sweden is relatively low, from a global viewpoint.

[The primary pulmonary MALT lymphoma: a rare lung tumor]. / Le lymphome pulmonaire primitif de type MALT: une tumeur pulmonaire rare.

The primary pulmonary lymphoma is a rare disease, representing 0.5 to 1% of the malignant lung tumors. In our countries, in spite of the increasing prevalence of the pulmonary tumors, aggravated by smoking and environmental factors, any case report of the primary pulmonary lymphoma is notified. We report a confirmed case of MALT lung lymphoma that is managed in our hospital. Mr. S.B., 68-year-old man, not smoking, without particular professional exhibition, is admitted for a chronic cough with blood-streaked sputum, dyspnea, chest pain and loss of weight. His symptomatology is evolving for 4months. In the examination, the general health was passable and he presented a pulmonary condensation syndrome at right. The physical examination of others systems was normal. There was a biological inflammatory syndrome. The bacteriological examinations of the bronchial expectorations were negative. The chest CT showed bilateral alveolar opacities at the upper, with attraction of the fissures, without nodes. The bronchoscopy showed anomalies of the bronchial mucous membrane in 2 superior lobes. The perendoscopiques biopsies confirmed a MALT lung lymphoma. We did not find other localizations. Chemotherapy was proposed to our patient with favorable evolution. The MALT primary lung lymphoma must not be underestimated. Clinical manifestations and radiological characteristics are no specific and it's necessary to eliminate a lung cancer or tuberculosis in our countries. The difficulties of their diagnostic are intensified by the not availability of an adequate technical tray.

Suicide and suicide attempt after a cancer diagnosis among young individuals.

BACKGROUND: Data are scarce on the potential change in suicidal behavior among adolescents and young adults after receiving a cancer diagnosis. PATIENTS AND METHODS: We conducted a population-based cohort study including 7 860 629 Swedes at the age of ≥15 during 1987-2009. Among the cohort participants, 12 669 received a first diagnosis of primary cancer between the age of 15 and 30. We measured the relative risks (RRs) of suicidal behavior (defined as completed suicides or suicide attempts) after cancer diagnosis. We also carried out a case-crossover study nested within the cohort to adjust for unmeasured confounders. RESULTS: Twenty-two completed suicides (versus 14 expected) and 136 suicide attempts (versus 80 expected) were identified among the cancer patients. The RR of suicidal behavior was 1.6 [95% confidence interval (CI), 1.4-1.9] after a cancer diagnosis, compared with cancer-free individuals. Risk increase was greatest immediately after diagnosis; the RR was 2.5 (95% CI 1.7-3.5) during the first year after diagnosis and was 1.5 (95% CI 1.2-1.8) thereafter. This pattern was similar for completed suicide and suicide attempts. The elevated risks were evident for majority of the main cancer types, except for cancer in thyroid, testis and melanoma. The case-crossover analysis of suicidal behavior during the first year after cancer diagnosis revealed similar results. CONCLUSIONS: Adolescents and young adults receiving a cancer diagnosis are at substantially increased risk of suicidal behavior, particularly during the first year after diagnosis. Although the absolute excess risk is modest, these findings emphasize the need to support and carefully monitor this vulnerable population.

[Assessment of vaccination coverage among travelers to areas where yellow fever is endemic (Senegal)]. / Évaluation de la couverture vaccinale des voyageurs se rendant en zone d'endémicité amarile (Sénégal).

This prospective survey, conducted at the Dakar airport from August 18, 2011, to May 8, 2012, asked a sample of travelers living in France and returning there after a stay in Senegal to complete a questionnaire. The aim of the study was to assess the determinants of vaccination coverage against yellow fever. The study included 10 298 travelers, with a median age of 48 years (interquartile range: 27-58); 52% were tourists, and 22% were traveling for business purposes. The measured level of anti-yellow fever vaccination coverage was 39.3%. Vaccination coverage was influenced by the travelers' level of knowledge and their perception of the risk.

Absence of association between ex vivo susceptibility to doxycycline and pftetQ and pfmdt copy numbers in Plasmodium falciparum isolates from Dakar, Senegal.

The objective of this study was to validate the use of pftetQ and pfmdt genes as molecular markers of decreased in vitro susceptibility to doxycycline in 113 Plasmodium falciparum isolates from Dakar, Senegal. The results show that copy numbers of pftetQ and pfmdt, estimated by TaqMan real-time PCR, are not significantly associated with reduced susceptibility to doxycycline in vitro; however, the number of samples with a high doxycycline IC(50) was likely to be too low to derive statistically significant results. Thus, no definitive conclusions could be drawn. The markers should be further tested by analysing more isolates.

Risk of prostate cancer in a population-based cohort of men with coeliac disease.

BACKGROUND: Prostate cancer (PC) is a leading cause of fatal cancer in men in developed countries. Coeliac disease (CD) has previously been linked to a raised cancer risk, and changes in some exposures following a CD diagnosis might hypothetically raise PC risk. METHODS: We identified 10,995 patients with CD who had undergone a small intestinal biopsy in 1969-2007. Statistics Sweden then identified 54,233 age-matched male reference individuals from the general population. PC data were obtained from the Swedish Cancer Register. Hazard ratios (HRs) for PC were estimated using Cox regression analysis. RESULTS: During follow-up, 185 individuals with CD (expected n=200) had an incident diagnosis of PC. This corresponds to a HR of 0.92 (0.79-1.08) (with 95% confidence interval) and an absolute risk reduction of 15/100,000 person-years among those with CD. An increased risk was not observed even when identification of PC began 5 years after biopsy. CONCLUSION: Our conclusion is that a CD diagnosis does not represent an increased risk for PC.

[Adult-onset Still's disease: case report in Dakar, Senegal]. / Maladie de Still de l'adulte: une observation à Dakar (Sénégal).

Adult-onset Still's disease is a uncommon form of inflammatory rheumatism. It has rarely been reported in black Africa. The purpose of this report is to describe a case in a 49-year-old woman from Dakar, Senegal.

[Nocardiosis: 4 cases in Senegal]. / Nocardiose: 4 observations au Sénégal.

The purpose of this report is to describe four cases of nocardiosis observed over an eight-year period in medical units of Principal Hospital in Dakar, Senegal. It is a rare infection occurring mainly in people with weakened immune systems. Pulmonary forms are predominate and clinical and laboratory presentation can mimic pulmonary tuberculosis. Diagnosis should be suspected in patients presenting pulmonary infections and negative sputum bacilloscopy. Nocardia bacteria should be identified before starting antibiotic treatment. Patients require long-term antibiotic treatment with third generation cephalosporins or sulfamethoxazole-trimethoprim.

[Screening for HIV, syphilis, Chlamydia trachomatis and Neisseria gonorrhoreae during a combined survey conducted in Malicouna, a Senegalese rural area]. / Dépistage du VIH, de la syphilis, des infections dues à Chlamydia trachomatis et à Neisseria gonorrhoreae au cours d'une enquête combinée conduite à Malicounda, une zone rurale du Sénégal.

To implement a second-generation HIV surveillance, through a prevention programme of HIV and sexually transmitted infections (STIs), Senegal conducted a combined survey from 2003 September 2 to October 5 in Malicounda located in the region of Thiès in the center of Senegal. The objectives of this study were to collect data on sexual behaviours and prevalence of HIV gonorrhoea, Chlamydia infections and syphilis in the community. After obtaining their informed consent, 679 people were interviewed among whom 617 accepted blood sampling and 619 accepted urine sampling, that is to say an acceptance rate of 90% and 91% respectively. Women reported having fewer sexual risk behaviours than men. However, when having sexual risk behaviour men only reported using condoms. Overall, the prevalence of HIV as well as the prevalence of STI are low: 0.5% for HIV, 0.9% for syphilis, 0.3% for Chlamydia trachomatis and 0.2% for Neisseria gonorrhoea. In this study, the small numbers of cases of infection identified did not allow to analyse the influence of sexual behaviour at risk on the occurrence of these infections.

[Permanent deafness following typhoid fever: case report from Dakar, Senegal]. / Surdité définitive au décours d'une fièvre typhoïde une observation a Dakar (Sénégal).

Severe infections due to Salmonella typhi and Salmonella paratyphi are still common in sub-Saharan Africa where many patients are empirically treated for malaria. In addition to the usual clinical signs and complications of typhoid fever, clinicians practicing in high incidence areas must be aware of less common manifestations. The purpose of this report is to describe a case involving an 18-year-old boy who presented with quinine-resistant febrile coma. The final diagnosis was typhoid fever. After recovery the patient presented complete deafness. Discussion raises the question of whether deafness was secondary to typhoid fever or to drug therapy.

[Shoulder pain revealing tuberculosis of the humerus]. / Une épaule douloureuse révélant une tuberculose osseuse inhabituelle.

Tuberculous spondylitis is the most common form of musculoskeletal tuberculosis. However, extraspinal manifestations have been described with tuberculosis of the wrist, femur, foot or shoulder, as in the patient presented. Because of an often-indolent clinical presentation, the diagnosis is delayed and antituberculous treatment is not able to prevent serious bone destruction.

Incidence and mortality of incidental prostate cancer: a Swedish register-based study.

In a national register-based study of incidence trends and mortality of incidental prostate cancer in Sweden, we found that a significant proportion (26.6%) of affected men diagnosed died of their disease, which challenges earlier descriptions of incidental prostate cancer as a non-lethal disease.

No association between a polymorphic variant of the IRS-1 gene and prostate cancer risk.

OBJECTIVE: Insulin receptor substrate-1 (IRS-1) acts as a docking protein between the insulin-like growth factor-1 (IGF-1) receptor and intracellular signaling molecules in the IGF-1 signaling pathway. Accumulating data support a role of IGF-1 in prostate carcinogenesis. We assessed the influence of the most common IRS-1 gene polymorphism (Gly972Arg) on prostate cancer risk, alone and in combination with IGF-1 and other components in the IGF-1 signaling pathway. MATERIALS AND METHODS: In a nested case-control study within the Physicians' Health Study, the IRS-1 polymorphism was assayed from prospectively collected samples from 564 incident prostate cancer cases and 758 controls matched on age and smoking. We calculated relative risks (RR) and 95% confidence intervals (CI) using conditional logistic regression. RESULTS: Among the controls, 0.8% were homozygous (AA) and 12% were heterozygous (GA) for the polymorphic allele. There was no association between carriage of the A allele and total prostate cancer risk (RR = 1.1 95% CI = 0.8-1.5), advanced disease (stage C or D or lethal prostate cancer, RR = 1.3 95% CI = 0.8-2.3), or plasma IGF-1 levels. We explored possible interactions with body mass index and components in the IGF-1 pathway including IGFBP3, PI3k, and PTEN but none of these factors influenced the relation between IRS-1 genotype and prostate cancer risk. CONCLUSIONS: Our data do not support an association between carriage of the variant IRS-1 gene and prostate cancer risk.

Hepatitis B, C seroprevalence and delta viruses in HIV-1 Senegalese patients at HAART initiation (retrospective study).

The aim of this study was to determine hepatitis co-infection in a cohort of HIV infected patients at their inclusion in the Senegalese Initiative of ART Access. B, C, and D Hepatitis viruses serological markers were checked retrospectively on 363 stored plasma. For HBV, the Abbott laboratories equipment IMx was used to detect HBs Ag and anti Core Ab on negative HBs Ag samples. For HDV, anti Delta Ab was performed using the Abbott Murex Kit on all HBs Ag positive samples. For HCV, anti HCV Ab was detected by IMx as double screening test and confirmed by INNO-LIA(TM) HCV Core of Innogenetics laboratories. The statistical analysis was done with STATA V8. The study population was composed of 164 men and 199 women aged between 16 and 66 years. The immune and virological markers averages at their enrollment were 154 cell/mm(3) for TLCD4+ (n = 355 patients) and 4.9 log for viral load (n = 277 patients). HBs Ag was found in 61 patients or 16.8% and the prevalence of anti-HBc Ab was 83.2% (252/295). 2 patients or 3% on HBs Ag positive sample presents HBV/HDV co-infection Ab anti HCV was detects in 6 patients or 1.6% after confirmation and 2 patients had triple infection with HBV. These results showed that the prevalence of HBV and HCV in the population of persons living with HIV/AIDS in Senegal is similar to that found in the general population. Our data indicated that hepatitis pathology in the PLwHIV was essentially due to HBV. Further studies are needed to diagnose occult hepatitis in order to set up therapeutic strategies taking into account co-infections by hepatitis viruses in the ART programmes.

[Poster presentations]. / La communication affichée.

Posters have become an essential tool for dissemination of study findings at medical meetings. By presenting a quick snapshot, posters can be an effective means of communicating the main findings of the research quickly and of stimulating rewarding exchanges with the people in attendance. Success depends on catching and holding the attention of passing attendees long enough to establish contact and share knowledge and experience. The purpose of this article is to provide a few guidelines and techniques for preparing and presenting effective and clear research posters at scientific meetings.

[Empiric antituberculous therapy in patients with unexplained exsudative pleural effusion. Is it valid in Senegal?]. / Le traitement antituberculeux présomptif est-il licite dans la pleurésie lymphocytaire exsudative inexpliquée au Sénégal?

AIM: Pleural biopsy and adenosine deaminase activity are not available at our center and the treatment begins without substantiation diagnosis in patients with tuberculous pleural effusion (PE). METHODS: In order to evaluate the validity of an empiric antituberculous therapy in exsudative PE with high prevalence of lymphocytes, we conducted a retrospective study during 1 year. Patient was enrolled if no signs of tuberculous infection, pneumonia or cancer were present. RESULTS: During 1 year, 38 patients were enrolled (23 males, mean age=36 years). PE was major (> 2/3 of the lung) in 14 cases, moderate (between 1/3 and 2/3) In 18 cases and minor (<1/3) in 6 cases. Tuberculous contagion was observed in 10 patients. Tuberculinic test was positive in all patients (12-24 mm). Clinical and radiological cure was obtained in 37 cases, except 1 patient who died from acute heart failure. No recurrence of PE was observed after 1 year follow-up. CONCLUSION: In our endemic areas, empiric antituberculous treatment seems to be an effective strategy in patients with exsudative PE.