Protocol-Driven Intensive Outpatient Management of Pregnant Patients With Symptomatic Coronavirus Disease 2019.

BACKGROUND: Reports of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have focused on pregnant women hospitalized due to moderate to severe coronavirus disease 2019 (COVID-19) or asymptomatic women diagnosed through universal screening at the time of obstetric admission. Many pregnant women who have symptomatic SARS-CoV-2 infection may not meet criteria for hospitalization; however, whether and how these women can be managed safely in outpatient setting is not well described. METHODS: We sought to describe the time to symptom and viral clearance and to identify predictors of hospitalization to better understand the safety of monitoring pregnant patients with symptomatic COVID-19 in the outpatient setting. We performed a retrospective cohort study of pregnant patients with symptomatic, confirmed COVID-19 illness at a large, academic medical center. Patients had systematic telehealth follow up by a clinician team to assess for symptoms, provide virtual prenatal care, and arrange in-person visits when appropriate in a dedicated outpatient center. Data were collected via chart abstraction. RESULTS: Of 180 pregnant patients presenting with symptoms and undergoing reverse-transcription polymerase chain reaction (RT-PCR) testing, 67 patients with confirmed COVID-19 infection were identified during the study period. Nineteen (28%) required acute care given worsening of COVID-19 symptoms, and 95% of these were directed to this acute care setting due to symptom severity telehealth evaluation. Nine women (13%) were admitted to the hospital given worsening symptoms, 3 required intensive care unit care, 2 required ventilatory support, and 2 required delivery. Women with the presenting symptoms of fever, cough, shortness of breath, chest pain, or nausea and vomiting were more likely to require admission. The median duration from initial positive test to RT-PCR viral clearance was 26 days. Disease progression, time to viral clearance, and duration of symptoms did not vary significantly by trimester of infection. CONCLUSIONS: Management of the majority of pregnant women with symptomatic COVID-19 illness can be accomplished in the outpatient setting with intensive and protocol-driven monitoring for symptom progression.

Improving postpartum glucose monitoring in women with gestational diabetes.

OBJECTIVE: To improve 6-week postpartum visit attendance, glucose test ordering and test completion among postpartum patients with a history of gestational diabetes (GDM). METHODS: Pre- and post-intervention GDM women at Mount Sinai Hospital were studied via chart review. Interventions included advanced order sets for glucose monitoring at the 35-week pregnancy visit, educational modules, and nutritionist phone calls reminding patients to attend postpartum visits fasting. RESULTS: One hundred and seven pre-intervention and 42 post-intervention women were studied. Percentages of orders placed for postpartum testing was higher post-intervention vs. pre-intervention (57% vs. 42%, p = 0.03). There were higher test completion rates post-intervention vs. pre-intervention (36% vs. 17%, p = 0.01). Postpartum visit attendance rates did not vary between the groups (73% vs. 69% p = 0.60). Six percent of patients pre-intervention fasted for postpartum visits vs. 60% post-intervention. CONCLUSION: There was no observed increase in women attending their 6-week postpartum visits, yet rates of completed orders for postpartum testing, women attending visits fasting, and postpartum test completions were higher post-intervention. More research may identify the barriers to attendance at 6-week postpartum visits.

[Study of reports to the departmental home of disabled children placed in social assistance to children in the Bouches-du-Rhône]. / Étude des notifications à la Maison départementale des personnes handicapées chez les enfants placés à l'Aide sociale à l'enfance dans les Bouches-du-Rhône.

INTRODUCTION: By the end of 2011, 275,000 children in France were included in the Aide sociale à l'enfance (ASE, Child Welfare System). Half of these children were entrusted to public care. There is limited data on these children. The MDPH (Maison départementale des personnes handicapées) is an administrative body assisting in the care of disabled children, through material, financial, and human means. Analyzing MDPH medical records can provide medical information about these children. The aim of this study was to describe the characteristics of children left to the ASE with a record at MDPH in Bouches-du-Rhône. METHODS: We extracted administrative data from two registers, the ASE register and the MDPH register. The MDPH medical files of each patient were analyzed and their medical information was coded: gestational age, deficiencies, and pathologies. RESULTS: In Bouches-du-Rhône, 2965 children were entrusted, 506 (17%) of whom were known by the MDPH: 30.6% of the entrusted children known by MDPH were taken into foster care and 48% were in residential group homes. Half of the MDPH notifications concerned a referral to a school or medico-social institution. By analyzing the medical data, we observed an average of 2.1 deficiencies per child. The types of deficiencies were distributed as follows: 35.9% were psychological deficiencies, 26.4% were speech deficiencies, and 21.6% were intellectual cognitive deficiencies. The most common pathology was mental and behavioral disorder (71% of diagnoses). DISCUSSION: The MDPH notification rate in children entrusted to public care was seven times higher than in the general population. Overall, explaining the relation between child abuse and neglect and disability is difficult. The psychopathology of these children is complex. These results show the importance of specific medical monitoring for these children.

Folding and self-assembly do not prevent ER retention and proteasomal degradation of asialoglycoprotein receptor H2a.

The human asialoglycoprotein receptor H2a precursor, a type II membrane protein, is cleaved to a soluble form that is secreted. Uncleaved precursor molecules are completely retained in the endoplasmic reticulum (ER) and degraded by the proteasome. To find out the causes of its fate we studied folding of H2a precursor, which was very similar to that of its alternatively spliced variant H2b which can exit to the Golgi. Proteasomal inhibition led to accumulation of folded rather than unfolded molecules. Accumulation of ER-retained H2a did not cause an unfolded protein response. Although the receptor is a heterooligomer of the H1 and H2 subunits, single expression led to some self-assembly. Whereas these homooligomers accumulated for H2b they were degraded for H2a. Translocation of H2a into the ER occurred efficiently. Therefore, the retention and proteasomal degradation of uncleaved membrane-bound H2a precursor from the ER do not involve aberrant translocation or misfolding and are not prevented by self-assembly.

Differential role of mannose and glucose trimming in the ER degradation of asialoglycoprotein receptor subunits.

To gain insight into how sugar chain processing events modulate endoplasmic reticulum (ER)/proteasomal degradation we looked at human asialoglycoprotein receptor polypeptides H2a and H2b, variants which differ only by an extra pentapeptide (EGHRG) present in H2a. Membrane-bound H2a is a precursor of a soluble secreted form while H2b reaches the plasma membrane. Uncleaved precursor H2a molecules are completely retained in the ER and degraded as well as a portion of H2b. Inhibition of N-linked sugar chain mannose trimming stabilized both variants. In contrast, inhibition of glucose trimming with castanospermine greatly enhanced the degradation rate of H2a but not that of H2b. We studied a possible involvement of the ER chaperone calnexin, as inhibitors of glucose trimming are known to prevent calnexin binding. Incubation of cells with low concentrations of castanospermine (30 microg/ml) did not interfere with calnexin binding to H2a while causing the same accelerated degradation as high concentrations (>100 microg/ml) which did inhibit the association. Castanospermine treatment after calnexin binding blocked the dissociation of the chaperone but still caused accelerated degradation. The increased degradation could be blocked by a specific proteasome inhibitor, ZL(3)VS. Our results suggest that extensive mannose trimming or retention of glucose residues due to lack of glucose trimming are signals for ER/proteasomal degradation independent of interaction with calnexin.

Enfermedadf por igA lineal / Lineal igA disease

Presentamos dos pacientes con enfermedad por ig A lineal, de 2 y 3 años de edad respectivamente, ambos del sexo masculino, se llegó al diagnóstico por la clínica dermatológica, la histología y la inmunofluorescencia directa, donde se detectó ig A lineal en la zona de la membrana basal. Fueron tratados con diamino difenil sulfona (DAPS), con una rápida y efectiva respuesta y con antihistamínicos (difenhidramina) para mejorar el prurito. Los controles se realizaron periódicamente desde el comienzo de la afección hasta la actualidad. Consideramos que la enfermedad por igA lineal no es una dermatosis muy frecuente en la infancia, pero se debe tener presente. Loas diagnósticos diferenciales obligados so: la dermatitis herpetiforme y el penfigoide ampollar, sin dejar de tener en cuenta otras afecciones ampollares no geneticas como el impétigo ampollar, la epidermólisis ampollar adquirida de la infancia y el eritema poliformo ampollar

Enfermedadf por igA lineal / Lineal igA disease

Presentamos dos pacientes con enfermedad por ig A lineal, de 2 y 3 años de edad respectivamente, ambos del sexo masculino, se llegó al diagnóstico por la clínica dermatológica, la histología y la inmunofluorescencia directa, donde se detectó ig A lineal en la zona de la membrana basal. Fueron tratados con diamino difenil sulfona (DAPS), con una rápida y efectiva respuesta y con antihistamínicos (difenhidramina) para mejorar el prurito. Los controles se realizaron periódicamente desde el comienzo de la afección hasta la actualidad. Consideramos que la enfermedad por igA lineal no es una dermatosis muy frecuente en la infancia, pero se debe tener presente. Loas diagnósticos diferenciales obligados so: la dermatitis herpetiforme y el penfigoide ampollar, sin dejar de tener en cuenta otras afecciones ampollares no geneticas como el impétigo ampollar, la epidermólisis ampollar adquirida de la infancia y el eritema poliformo ampollar(AU)

Fibroma digital infantil

La perifolliculitis capitis abscedens et suffodiens es una enfermedad crónica y supurativa del cuero cabelludo. Presentamos dos casos; uno en un hombre que fue tratado con cirugía; la evolución a los 8 años de la intervención quirúrgico es satisfactoria y otro caso en una mujer de 43 años con 10 de evolución tratada con eritromicina a razón de 2 grs. por día, por vía oral con buena respuesta a la terapéutica

Fibroma digital infantil

La perifolliculitis capitis abscedens et suffodiens es una enfermedad crónica y supurativa del cuero cabelludo. Presentamos dos casos; uno en un hombre que fue tratado con cirugía; la evolución a los 8 años de la intervención quirúrgico es satisfactoria y otro caso en una mujer de 43 años con 10 de evolución tratada con eritromicina a razón de 2 grs. por día, por vía oral con buena respuesta a la terapéutica (AU)

Diagnostic efficacy of a nasotracheal protected specimen brush in patients with suspected bacterial pneumonia.

The diagnostic yield and safety of a novel nasotracheal protected specimen brush (PSB) were evaluated in 15 nonintubated adult patients with suspected bacterial pneumonia. A double-catheter PSB was passed directly through the anesthetized nose and into the trachea without bronchoscopy or fluoroscopy. Endotracheal brushing was performed in less than 10 sec, and the brush was immediately processed for Gram staining and quantitative aerobic and anaerobic cultures. According to clinical follow-up and response to therapy, 11 episodes of bacterial pneumonia and five cases of nonbacterial lung disease were established. The PSB Gram stain confirmed lower respiratory sampling in all cases. The PSB cultures indicated respiratory pathogens in 9/11 (82%) cases of pneumonia, with greater than 10(3) colony-forming units (cfu)/ml in all but two specimens. All patients with pneumonia responded to specific antibiotics. All patients with nonbacterial disorders had PSB cultures of less than 10(3) CFU/ml, and their pulmonary processes improved without antibiotic therapy. The procedure was well tolerated, although two patients had transient bronchospasm or apnea. Experience with the nasotracheal PSB is limited, but the procedure appears to be a reliable and relatively safe alternative diagnostic method in selected patients with suspected bacterial pneumonia. Quantitative cultures are necessary to improve its diagnostic accuracy.

[Treatment by external drainage of perirenal abscess in AIDS]. / Guérison par drainage externe d'un abcès périrénal au cours d'un SIDA.

Fever of undetermined origin in a young white heroin addict with a positive HIV (human immunodeficiency virus), serology was secondary to a staphylococcal perinephric abscess. Ultrasound examination and tomodensitometry allowed the diagnostic. Percutaneous drainage led to complete recovery. Interventional radiology associated with antibiotherapy appears to be an alternative to surgery in the treatment of perinephric abscesses.

[Computed tomography in the exploration of the adrenal gland]. / La place de l'examen tomodensitométrique dans l'exploration des surrénales.

After reviewing their normal procedure (protocole) in studying the suprarenals, the authors will now present their results: --normal anatomy, --normal variants and pit falls, --pathological aspects: masses and other causes. Anyway, computed scanning of the suprarenals should be associated to clinical and biological signs.

4-Methylpyrazole may be an alternative to ethanol therapy for ethylene glycol intoxication in man.

4-Methylpyrazole (4 MP) is a strong inhibitor of alcohol dehydrogenase. Its use in acute ethylene glycol (EG) or methanol intoxication has been suggested in experimental studies about its efficacy and safety. We report three cases of accidental intoxication with ethylene glycol in man treated orally with 20 mg/kg/day of 4 MP. The treatment was maintained until plasma EG concentrations became unmeasurable. The patients were admitted early during the course of the poisoning. Their neurological status was good. A slight metabolic acidosis observed in two cases was easily corrected and did not recur. Renal function remained normal in all cases. No patient underwent hemodialysis. On admission plasma EG concentrations were 24.2 mmol/l, 13 mmol/l and 9.7 mmol/l respectively. Plasma EG half-lives were 14.5, 11.5 and 14.75 hours respectively. Plasma oxalate concentrations and the rate of urine oxalate elimination, determined in two patients, were high on admission but quickly returned to normal. Concerning possible side effects of 4 MP, a skin rash was observed in one patient and a possible eosinophilia in the others. These three cases suggest that 4 MP may decrease the metabolic consequences of EG poisoning in man and may be of therapeutic value when administered early during the course of the intoxication before coma, seizures and organic renal failure have occurred.

Conservation of oxygen supply using a reservoir nasal cannula in hypoxemic patients at rest and during exercise.

A reservoir nasal cannula which stores oxygen during exhalation and delivers it as a bolus during inhalation has been reported to conserve oxygen delivery in patients with chronic obstructive pulmonary disease (COPD) at rest. We compared the effects upon arterial oxygen saturation (SaO2) of the reservoir cannula and a standard nasal cannula in hypoxemic obstructed and restricted patients at rest and during exercise. The SaO2 was monitored by ear oximeter. While at rest, 13 obstructed and four restricted patients breathed oxygen from the reservoir cannula at 0.5, 1.0, 1.5, and 2.0 L/min and from a standard cannula at 0.5, 1.0, 2.0, 3.0, and 4.0 L/min. Mean SaO2 was significantly higher with the reservoir cannula compared to the standard cannula at 1.0 and 2.0 L/min (p less than 0.0006) and tended to be higher at 0.5 L/min (p less than 0.1). Seven obstructed patients walked on a level treadmill at 0.75 mph while breathing oxygen at 0.5 and 1.5 L/min from the reservoir cannula and at 1.0 and 3.0 L/min from the standard cannula. The SaO2 during exercise with the reservoir cannula was comparable to that with the standard cannula at approximately half of the oxygen flow rate. The ratio of the oxygen flow rate of the standard to the reservoir cannula to produce 90 percent saturation was estimated and found to be 2.5 +/- 0.8 (mean +/- SD) for patients at rest and 2.9 +/- 1.8 during exercise. We conclude that in hypoxemic patients at rest and during exercise, the reservoir cannula uses less than half the oxygen of a standard cannula to produce similar improvement in SaO2 and thus has advantages of a reduced cost of ambulatory therapy with low-flow oxygen and a longer time permitted away from a stationary source of oxygen.