Psychological impact of COVID-19 pandemic on healthcare professionals in intensive care.

Since late 2019, Covid-19 has rapidly spread worldwide, generating a pandemic, and health care professionals have mobilized massively to cope with it. In intensive care units, the usually difficult working conditions have become even more difficult, with a marked increase in workload, but also with a reorganization of care delivery, complex admission decisions, and changes in how families are welcomed;all in a climate of uncertainty and insecurity. This article focuses on the psychological impact of this crisis on intensive care professionals, and possible support systems, based on recent literature.Copyright © SRLF 2021.

Main reasons of choice of formulation and route of triptorelin treatment initiated in patients with prostate cancer (PCa): TALISMAN study

Background: Modalities of use of androgen deprivation therapy (ADT), like triptorelin, in real life, at the era of new strategies in advanced stages, lack of recent data. Our purpose here was to describe main reasons of choice of formulation and route (F&R) of triptorelin treatment (Tt) declared by the physician. Patient comorbidities, cancer aggressiveness and physician habits may influence their choices. Method(s): Initiated in 2020, a prospective, multicenter, non-interventional study is ongoing in France (TALISMAN, NCT04593420). Patients with histologically confirmed PCa, eligible for >= 12-month triptorelin Tt within its label were enrolled. Interim analysis of baseline data was planned when 50% of 786 planned patients were enrolled. Modalities of use, including F&R of triptorelin prescribed [monthly intramuscular (1mIM), every 3 months subcutaneous (3mSC) or intramuscular (3mIM), every 6 months intramuscular (6mIM)], were described. Result(s): 509 patients were included in the interim analysis. Overall population was presented at ASCO-GU22. Subgroups of F&R are presented here. Main F&R prescribed was 3mSC (70.7%). Main baseline parameters in F&R subgroups are presented (except for 1mIM, 4 patients (0.8%)). 31 patients had missing F&R data and were not included in subgroups. 62.1% of patients overall received at least one concomitant systemic Tt for comorbidity at baseline (58.2% in 3mIM, 61.7% in 3mSC and 6mIM). 18.6% and 13.0% of patients overall received, respectively, platelet aggregation inhibitor and anticoagulant;they were 20.9% and 13.8% in 3mSC, 7.3% and 5.5% in 3mIM, 18.5% and 11.1% in 6mIM. Conclusion(s): Main reason of choice of F&R of triptorelin was physician preferred F&R (47.7%);noticeable reasons included anticoagulants for the choice of 3mSC, planned total duration of Tt for 3mIM and 6mIM, and potential impact on compliance for 6mIM. As the covid pandemic may change the management of patients with prostate cancer, longer acting formulations may become more attractive.

Maladie de Vogt-Koyanagi-Harada après vaccination contre le COVID

La maladie de Vogt-Koyanagi-Harada (VKH) est une maladie auto-immune à médiation cellulaire ciblant le mélanocyte notamment uvéal, caractérisée par une atteinte ophtalmologique à type d'uvéite antérieure granulomateuse et d'uvéite postérieure avec décollements séreux rétiniens (DSR) caractéristiques ;des atteintes extra-ophtalmologiques cutanée, neurologique ou auditive sont également possibles. Le facteur déclenchant est le plus souvent non identifié, mais des formes post-vaccinales sont décrites. Nous rapportons le cas d'une patiente de 45 ans, Caucasienne, ayant développé une maladie de VKH 3 semaines après un rappel vaccinal contre le COVID par elosomeran (Spikevax®). Apres une période d'asthénie inhabituelle, sont apparues 3 semaines après l'injection, des céphalées diffuses intenses non fébriles, puis une baisse de l'acuité visuelle bilatérale et une intolérance à la lumière. L'examen ophtalmologique confirme une baisse d'acuité visuelle 3/10e OD 1/10e OG, une mydriase non réactive bilatérale, une uvéite antérieure non granulomateuse bilatérale, et au FO et en OCT des DSR multiples au pôle postérieur des 2 yeux, avec œdème papillaire ;l'angiographie à la fluorescéine confirmera des zones d'ischémie choroïdienne au pole postérieur des deux yeux, sans vascularite. La ponction lombaire met en évidence une méningite lymphocytaire aseptique. Le bilan infectieux (dont la recherche de mycobactéries et d'une syphilis), immunologique, et la recherche de sarcoïdose sont négatifs. On ne note ni vitiligo ni poliose, ni hypoacousie. L'ensemble permet de retenir le diagnostic de VKH incomplet. La patiente est hospitalisée pour bolus de méthylprednisolone 1 gramme : après le 3ème bolus, elle rapporte une amélioration de l'acuité visuelle confirmée par les ophtalmologues (4/10e P2 OGD). Une récupération complète de l'acuité visuelle est constatée après 1 mois de corticothérapie par prednisone 1 mg/kg/jour (8/10e P2 ODG, OCT maculaire normal aux 2 yeux). La patiente reste néanmoins gênée par une intolérance à la lumière, avec persistance d'une pupille tonique ou pupille d'Adie bilatérale, rarement décrite dans le VKH, pouvant être rapportée à une dégénérescence du ganglion ciliaire ou à une atteinte des petits nerfs ciliaires. Le diagnostic est confirmé a posteriori par le Centre de référence en ophtalmologie. Une déclaration au Centre Régional de Pharmacovigilance est réalisée. Une revue de la littérature nous a permis de retrouver 13 cas publiés de maladie de VKH de novo survenant dans les suites de primovaccination ou de rappel vaccinal contre le COVID, l'ensemble des vaccins actuellement disponibles (Pfizer, Moderna, Aztra-Zeneca, Sinovac) étant impliqués. Selon le Centre de Pharmacovigilance, en France, les cas rapportés impliquent essentiellement le tozinameran (Cominarty®) ;il s'agit du premier cas après injection d'elosomeran. Au niveau international, Vigibase relate 50 cas de VKH survenus dans les suites d'une vaccination contre le COVID, dont 43 cas (86 %) chez des femmes, 30 cas (60 %) après tozinameran, 16 cas (32 %) après elosomeran, 4 cas (8 %) après vaccin AZD-1222. On rappelle cependant que, historiquement, d'autres vaccins ont déjà été mis en cause dans la survenue de maladie de VKH (grippe, hépatite B, fièvre jaune). Dans l'ensemble des cas rapportés après vaccination contre le COVID, l'évolution sous corticothérapie est favorable sur le plan de l'acuité visuelle. Malheureusement, chez notre patiente comme dans d'autres cas de VKH associant uvéite et pupille tonique, l'évolution est dissociée, avec persistance d'une mydriase bilatérale non réactive avec intolérance à la lumière réellement invalidante, et une récupération à long terme incertaine. Sans remettre en cause le bénéfice de la vaccination contre le COVID, nous interpelons sur la possibilité de déclenchement de réactions auto-immunes notamment de type VKH parfois sévères. (French) [ FROM AUTHOR]

Elders, triage and the intensivist

In France, the COVID-19 pandemic revealed the frailty of a health system that was considered unsinkable. Rationed for three decades, the human and material resources of our hospitals have been exhausted in less than two weeks, while those responsible for this precariousness and their successors were swaggering in the media. Caregivers then redoubled their efforts and initiatives to never abandon patients, sometimes to the detriment of their personal lives and their own health. The capacity of the intensive care units has been increased in proportion to the space and equipment available (especially respirators). The facilities and personnel of other specialties (operating rooms, technical platforms, intermediate care units) were also mobilized, leading to the deprogramming of surgical or exploratory procedures deemed non-urgent. As a result of the massive surge of patients and the scarcity of resources, the issue of access to critical care for the elderly has emerged early in the public debate. Apart from any controversy, well before the crisis, there was a body of scientific work evaluating the benefits or risks of a stay in intensive care for our elderly, according to specific medical criteria and a multidimensional approach to old age. © 2022 Elsevier Masson SAS

Hunger in times of COVID-19 pandemic: a critical analysis of the (re)produced meanings by the media

This study aims to understand the ways in which hunger has been represented by the mainstream press in Brazil during the COVID-19 pandemic. From Discourse Analysis, a total of twenty-four news were analyzed, fifteen from the Folha de Sao Paulo and nine from the O Globo newspaper, published from february to july 2020. Discourses were found that evoke fundamentally for the neoliberal understanding of poverty, transferring the responsibility of the State on hunger to the subjects. However, despite the discourses showing hunger as a circumstance potentially increased by the pandemic period, the analysis of the results reveals that hunger occupies places in the causes and consequences of this health crisis, both in an emergency and in a structural way. From the results, the visibility of the narratives of the subjects who experience hunger is also highlighted, however, it was observed that there is a fine line between narrating the consequences of hunger and reproducing stigmas that echo in the collective imagination of society. In this perspective, the study reveals the need to deepen, review and critically read the media narratives about hunger and their contribution to the constitution of the social imaginary about the phenomenon.