The impact of the COVID-19 epidemic on primary care in South-eastern France: implementation of a real-time monitoring system based on regional health insurance system data.

BACKGROUND: The spring 2020 COVID-19 epidemic severely impacted France's healthcare system. The associated lockdown (17 March- 11 May 2020) and the risk of exposure to SARS-CoV-2 led patients to change their use of healthcare. This article presents the development and implementation of a real-time system to monitor i) private doctors' activity in South-eastern France, and ii) changes in prescription of drugs for people with diabetes, mental health disorders and for certain vaccines from Mars 2020 to October 2020. METHODS: Data extracted from the regional healthcare insurance databases for 2019 and 2020 were used to construct indicators of healthcare use. They were calculated on a weekly basis, starting from week 2 2020 and compared for the same period between 2019 and 2020. RESULTS: Private doctors' activity decreased during the spring 2020 lockdown (by 23 % for general practitioners and 46 % for specialists), followed by an almost complete return to normal after it ended until week 41. Over the same period, a huge increase in teleconsultations was observed, accounting for 30 % of private doctors' consultations at the height of the crisis. The start of the lockdown was marked by a peak in drug prescriptions, while vaccinations declined sharply (by 39 % for the measles, mumps and rubella (MMR) vaccine in children under 5 years old, and by 54 % for human papillomavirus vaccine in girls aged 10-14 years old). CONCLUSION: The ongoing COVID-19 epidemic may lead to health consequences other than those directly attributable to the disease itself. Specifically, lockdowns and foregoing healthcare could be very harmful at the individual and population levels. The latter issue is a concern for French public authorities, which have implemented actions aimed at encouraging patients to immediately seek treatment. However, the COVID-19 crisis has also created opportunities, such as the roll-out of teleconsultation and tele-expertise. The indicators described here as part of the monitoring system can help public decision-makers to become more responsive and to implement tailored actions to better meet the general population's healthcare needs.

[Bilio-digestive fistula with an unusual etiology]. / Une fistule bilio-digestive d'étiologie inhabituelle.

On the basis of one case, the authors give the highlights on the various clinicopathological features of malignant gastric perforations. While medical imaging does not seem to contribute much in the positive diagnosis of such complications, it does remain essential to establish the local extension of the tumour process and thus to allow a better therapeutic management.

[Primary malignant fibrous histiocytoma of the lung]. / Histiocytome fibreux malin primitif du poumon.

On the basis of one personal case, the various clinicopathological features of primary malignant fibrous histiocytoma of the lung are summed up. This tumor, which has a nonspecific radiological appearance, most often appears as a large peripheral pulmonary opacity, for which the prognosis is guarded and the positive diagnosis based on surgical exeresis or biopsy.

New autosomal recessive chondrodysplasia--pseudohermaphrodism syndrome.

Two siblings with a previously undescribed syndrome are presented. They both have severe dwarfism, antenatal in origin, with generalized chondrodysplasia, severe microcephaly with cerebellar vermis hypoplasia, a hypoplastic iris and a papillous coloboma (Coloboma of the optic disc). The first sibling has a 46,XY karyotype despite normal female internal and external genitalia. She has moderate mental retardation. Gestation of the second sibling was interrupted after antenatal diagnosis. The fetus was 46,XX and very similar to the first case.

Nilutamide pneumonitis: a report on eight patients.

BACKGROUND: Nilutamide is a new, specific synthetic antiandrogen, released in several countries for the treatment of metastatic carcinoma of the prostate. Eight patients at the University Medical Centre at Dijon and affiliated referring hospitals developed reversible pulmonary opacities and respiratory symptoms while taking the drug. METHODS: Records of eight patients who developed new, otherwise unexplained chest opacities while taking nilutamide were reviewed. In each patient a careful aetiological search was made for other environmental or endogenous causes. Six patients underwent bronchoalveolar lavage, and lavage fluid was cultured. Corticosteroids were not given, unless gas exchange was compromised (two patients). RESULTS: The eight patients (all male) had had carcinoma of the prostate diagnosed on average 10.2 months earlier. All had improved with nilutamide, with a dramatic decrease of prostate specific antigen levels. Seven had received nilutamide at the recommended dosage of 150 mg/day, and one had received twice that amount. Treatment had lasted on average 113 (range 10-225) days, and the mean cumulated exposure was 21.8 (3-38) grams. The chest radiographs showed bilateral infiltrates, with no consistent topographic predilection. A restrictive lung defect was present in six patients and hypoxia in all (mean arterial oxygen tension (PaO2) 6.6 kPa). Bronchoalveolar lavage showed lymphocytosis in four patients and neutrophilia in two. The outcome was favourable in all patients after they had stopped nilutamide only (five patients), with corticosteroids (two patients) or a simple reduction of nilutamide from 300 to 150 mg/day (one patient). Recovery was associated with improvement of pulmonary function and PaO2. CONCLUSION: Nilutamide is associated with interstitial pneumonitis in about 1% of patients and appears reversible.

[Primary sarcoma of the pulmonary artery]. / Sarcome primitif de l'artère pulmonaire.

On the basis of one personal case of leiomyosarcoma, the various anatomicoclinical features of sarcomas of the pulmonary artery are summed up. They most often produce a picture of severe pulmonary embolism that is resistant to all treatments; the lesion most often is a hilar mass without any associated bronchoscopic abnormality. Angiograms are not always easily interpreted, and the modern imaging techniques (ultrasound, computed tomography, and above all MRI) can best lead to the preoperative diagnosis, although this lesion is unfrequent.

[A radiologic image to be recognized in patients with thoracic injury: the retroligamentary pneumatocele]. / Une image à connaître chez un traumatisé thoracique: la pneumatocèle rétroligamentaire.

A 17-year-old female patient had a road traffic accident. She suffered from a minor head injury, and a right pneumothorax which had to be drained. However, when admitted, an unusual picture was found on the chest film. It was a left para-mediastinal shadow with a fluid level, its greater axis being vertical. She underwent a computerised tomographic chest scan. This picture was seen to be in the left costo-vertebral gutter, and in contact with an area of pulmonary contusion in the left posterior basal segment. Another smaller similar picture was discovered on the right side. These were interpreted as being infrapleural pneumatoceles on the mediastinal surface of the lower pulmonary lobes. The patient recovered spontaneously. In fact, these effusions of air and blood can be seen in other areas in the chest (mediastinum, pleura, lung); these are discussed.

[Post-traumatic retroligamentary pneumatocele. Apropos of a case]. / La pneumatocèle rétroligamentaire post-traumatique. A propos d'une observation.

A case-report of a 17 year-old man admitted for thoracic trauma associated with a vertical air and fluid collection located behind the pulmonary ligament raises the question of the exact nature of retroligamentary pulmonary pneumatoceles. They may be intraparenchymatous pneumatoceles or simple loculated pneumothorax but whatever the actual lesion, exact recognition of this radiological image avoids drainage and operation. This lesion resolves spontaneously within several weeks.

[Renal hyperechogenicity associated with an obstructive urologic disease in the newborn infant. A case]. / Hyperéchogénicité rénale associée à une uropathie obstructive du nouveau-né. Une observation.

A newborn infant exhibited bilateral hydronephrosis induced by uretero-pelvic junction syndrome (U.J.S.), pathological renal hyperechogenicity, and renal dysplasia at histology. Renal hyperechogenicity rapidly improved after curative surgery of the U.J.S. and therefore could not relate to dysplasia which is irreversible. The diagnostic value of renal hyperechogenicity is discussed.

[Thalamic dementia after a unilateral hemorrhagic lesion of the right pulvinar]. / Démence thalamique après lésion hémorragique unilatérale du pulvinar droit.

A 68 year-old man with a history of right thalamic hemorrhage demonstrated radiologically in the pulvinar and posterior portion of the dorsomedian nucleus developed a clinical picture of severe physical sequelae associated with major affective, behavioral and psychic disorders. Affective manifestations were a permanent anxiety-depression state contrasting with indifference to his surroundings. Behavioral changes included marked apathy, inertness and hypersomnia, together with occasional clastic agitated episodes and verbal and gestural stereotypies and soliloquies. Psychic sequelae were psychotic in nature: depersonalization crises, delusions of persecution, multisensorial hallucinations and absurd acts.

Obliteration of the pelvic space with pedicled omentum after excision of the rectum for cancer.

From 1979 through 1982, removal of the rectum for cancer in 67 patients (50 of whom underwent preoperative radiotherapy) was completed by obliteration of the resulting dead space with pedicled omentum. No complication could be related to the method. After abdominoperineal resection (54 patients), primary healing of the perineal wound was achieved in 77 percent of the patients (85 percent during the last 2 years), and the mean postoperative hospital stay was 22 days. Minor perineal suppuration occurred in 10 patients with a 40 day average time of healing, and major suppuration occurred in 1 patient only with a 3 month time of healing. After the extended Hartmann operation (12 patients), no pelvic abscess was observed and the median hospitalization stay was 19 days. Pelvic filling in the management of patients undergoing rectal excision is an adjunctive procedure that is mainly intended to provide a better postoperative course. It might also facilitate postoperative radiotherapy.

[Transfontanellar echography in the early detection of traumatic subdural hematoma in the infant. Apropos of a case]. / Apport de l'échographie transfontanellaire dans le dépistage précoce des hématomes sous-duraux traumatiques du nourrisson. A propos d'un cas.

About one case of skull injury in a infant, brain ultrasonography potency is underlined. This technic allowed to diagnose a subdural hematoma which was inapparent clinically and by complementary investigations.

[Congenital generalized cutis laxa]. / Cutis laxa généralisée congénitale.

Congenital cutis laxa is a rare disorder of the elastic tissue in which lax skin gives a premature senile appearance. We report a new case of this disease associated with craniosynostosis. In the literature, the genetics of cutis laxa are not clear. Fleischmajer and Matus (18) considers an inherited autosomal recessive or an incomplete autosomal dominant trait, Mehregan (33) reports an autosomal recessive mode of transmission and Byers (10) an X-linked form. Among these cases, the most serious visceral involvement is the development of pulmonary emphysema. However, in cutis laxa with development retardation, variety of minor injury of the skeleton, the prognosis seems appears to be better.