Impact de la crise de COVID-19 sur les consultations pour troubles psychiques en medecine generale en France, en regard de consultations pour maladies chroniques - Analyse de series temporelles

[Formula presented] Fig. 1. Evolution du nombre de consultations pour troubles psychiques et pour les pathologies chroniques temoins en 2020 et 2021 Copyright © 2022

Réactions cutanées retardées après vaccination contre le SARS-CoV-2 : étude CoVacskin

Introduction: Depuis 2020, environ 12 milliards de doses de vaccins contre le SARS-CoV-2 ont été administrées. Des réactions cutanées retardées localisées ou généralisées ont été rapportées avec une fréquence de près de 2 % après la 1re dose et un risque de récidive de 20 %. Le but de cette étude était de colliger l'expérience française. Matériel et méthodes: De mai à septembre 2021, la SFD a lancé un appel à cas afin de recueillir les réactions cutanées localisées retardées (> 4 jours (j) après l'injection) et généralisées (> 4 h après l'injection) (étude CoVacskin, No APP-2021-17). Un questionnaire standardisé permettait de recueillir antécédents, type de vaccin, numéro de l'injection, type de réaction (liste de diagnostics prédéfinis), traitement et délai de rémission de la réaction. Les photographies et comptes-rendus histologiques étaient analysés par le comité scientifique. Les biopsies étaient relues par 3 dermatopathologistes. Résultats: Au total, 194 cas ont été recueillis pour 192 patients dont 121 femmes, âge médian 54 ans. Ces réactions survenaient dans 88 % après un vaccin de type ARN. Pour 135 cas la réaction cutanée survenait après la 1re dose. Le délai médian injection-réaction était de 2,6 j. Quarante-huit réactions localisées retardées (24,7 %) étaient rapportées et 146 réactions généralisées sans réaction localisée (75,3 %), incluant urticaires ou angioedèmes, eczémas, exanthèmes maculopapuleux, purpura, réactions au produit de comblement, livedos, pseudo-engelures et 66 cas classés « autres » La relecture des photographies confirmait le diagnostic proposé par le clinicien pour 49/66 « autres ». Parmi les 17 cas restants, 2 tableaux anatomocliniques spécifiques ont été identifiés (13 avec biopsies cutanées disponibles): chez 5 patients, le tableau « Syndrome de Sweet-like » associait des lésions cliniques évocatrices de syndrome de Sweet (SS), un bilan étiologique négatif et histologiquement un SS « classique » ou histiocytoïde. Le deuxième tableau, chez 7 patients, jamais décrit antérieurement, nommé « Covid-arm multiples » était caractérisé par de multiples plaques inflammatoires et une histologie identique aux lésions cutanées localisées type « Covid-arm » (infiltrat péri-vasculaire et interstitiel de lymphocytes et éosinophiles, spongiose). Le délai de guérison moyen était de 21,4 j, spontanément dans 24,2 %. Une nouvelle injection de vaccin était administrée dans 117 cas, le plus souvent sans récidive (67,5 %). Discussion: Cette étude confirme les données de la littérature avec des réactions cutanées retardées prédominant chez les femmes, surtout après la 1ère dose, en majorité généralisées, hétérogènes, mais le plus souvent bénignes, incluant deux tableaux anatomocliniques originaux. Ces réactions étaient résolutives souvent en moins d'un mois, récidivaient peu, et ne contre-indiquaient donc pas la poursuite du schéma vaccinal.

Impact de la crise de COVID-19 sur les consultations pour troubles psychiques en médecine générale en France, en regard de consultations pour maladies chroniques – Analyse de séries temporelles

Introduction La crise sanitaire liée à la COVID-19 et les mesures appliquées pour la contenir (confinements successifs, cours/travail en distanciel et autres restrictions) ont créé un climat anxiogène inédit pour l'ensemble de la population. Dans ce contexte, nous avons étudié l'impact de cette crise au long cours sur les consultations pour troubles psychiques en médecine générale en France métropolitaine, en regard des consultations pour des maladies chroniques. Matériel et méthodes Toutes les consultations ou téléconsultations pour motif psychique (dépression, anxiété, troubles du sommeil) ont été comptabilisées de janv-15 à mai-21 en médecine générale à partir des données issues des EMR (« Electronic Medical Records » : recueil longitudinal via le logiciel de 1200 MG représentatifs) de la société IQVIA. Durant la même période, les consultations hebdomadaires pour des maladies chroniques nécessitant un suivi régulier (hypertension, diabète, insuffisance cardiaque, dyslipidémie) ont été mesurées. Des séries temporelles ont été modélisées à partir des données de la période pré-pandémie (2015-2019) à l'aide d'une régression de Poisson avec termes de Fourier, afin de simuler le nombre de consultations attendues pour les années 2020-2021 en l'absence de crise sanitaire. Ces estimations ont ensuite été comparées aux valeurs observées au cours de la crise sanitaire. Les différences obtenues entre valeurs attendues et observées pour troubles psychiques ont été mises en regard de celles constatées pour les maladies chroniques témoins. Résultats Pendant le premier confinement, du 17/03 au 11/05 2020, le nombre de consultations observées était plus bas que le nombre de consultations attendues en absence de crise sanitaire (cf. Fig. 1). En moyenne, la différence hebdomadaire était de -17 % pour les troubles psychiques et de -32 % pour les maladies chroniques témoins. Au sortir du premier confinement, du 11/05 au 29/06, le nombre de consultations observées était supérieur en moyenne de 10 % à l'attendu pour l'ensemble des pathologies. A partir de 09/2020, y compris pendant le second confinement, le volume de consultations pour troubles psychiques était presque toujours supérieur au volume des années précédentes, les consultations pour troubles du sommeil étant celles avec la plus forte hausse. Cette différence entre attendu et observé s'est poursuivi sur 2021 avec un delta moyen de +7 % de janvier à avril au profit de l'observé alors qu'il était de seulement de +2 % pour les maladies chroniques témoins. Conclusion La crise du COVID-19 semble avoir augmenté progressivement les recours aux soins primaires des patients pour des questions liées à leur santé mentale. Pendant le 1er confinement, même si un renoncement aux soins général a été observé en médecine générale, la diminution paraît moins marquée pour les troubles psychiques que pour les maladies chroniques prises en témoins. Un effet de rattrapage post-confinement est observé pour toutes les pathologies. La différence entre l'observé et l'attendu se creuse au fil du temps et davantage pour les troubles psychiques, avec un décrochage net en 2021. Ces résultats nécessitent d'être confirmés par l'analyse des séries temporelles au-delà de mai 2021 ainsi que par le profil et le nombre des patients venus consulter pour troubles psychiques. Déclaration de liens d'intérêt Etude réalisée en nom propre par IQVIA France et l'Inserm, Institut Pierre Louis d'épidémiologie et de santé publique.

Special Collection: Highlights of Medical, Urban and Veterinary Entomology. Highlights in Medical Entomology, 2021.

Life remained far from normal as we completed the first year of the Covid-19 pandemic and entered a second year. Despite the challenges faced worldwide, together we continue to move the field of Medical Entomology forward. Here, I reflect on parallels between control of Covid-19 and vector-borne disease control, discuss the advantages and caveats of using new genotyping technologies for the study of invasive species, and proceed to highlight papers that were published between 2020 and 2021 with a focus on those related to mosquito surveillance and population genetics of mosquito vectors.

Retour d'expérience sur la vaccination anti-Covid-19 des patients étiquetés « à risque allergique »

Déclaration de liens d’intérêts: Les auteurs n’ont pas précisé leurs éventuels liens d’intérêts.

From Polarization to Hate: Portrait of the Spanish Political Meme

Political polarization in Spain has been aggravated by a left-wing coalition government and the rise of the extreme right in the context of health and economic crisis created by COVID-19. This article delves into the collective story that memes offer of this context and aims to establish a categorization that can be used for comparison with other countries. We carried out a content analysis of 636 Spanish political memes published on Twitter throughout 2020. Current affairs were taken into account, as well as the frame, and rhetorical elements, references to popular culture, and symbols. We also took into consideration the objectives of the message and the presence of offensive content. We demonstrate that these memes do not play a subversive role, but rather contribute to the polarization and fragmentation of the digital public, echoing the existing ideological confrontation. They do not deliver new ideas, but only reproduce expressions and disqualifications already existing in the society, although the disinhibition of anonymity magnifies the intensity. Current affairs are an excuse to convey ideological position, and political communication becomes more emotional. There are no significant differences in terms of political polarization between left and right, and criticism toward politicians is mainly of personal and moral nature. Hate speech on other social media appears in these cultural creations, highlighting the misogyny toward women politicians regardless of their political party. The rhetorical and expressive resources are adapted to this confrontation, and there is little innovation because it is subject to the understanding of the message.

1061P Safety of cemiplimab for advanced cutaneous squamous cell carcinoma: The Spanish named patient programme

Background: Cemiplimab is a programmed cell death receptor-1 inhibitor with antitumour activity for cutaneous squamous cell carcinoma (CSCC) and acceptable safety proved in its pivotal trial. We provide the first data on cemiplimab safety in daily practice from the named patient programme (NPP) for advanced CSCC in Spain. Methods: This cemiplimab NPP was performed from March 2019 to March 2020. It included patients aged ≥18 years with advanced CSCC and ineligible for surgery, radiation therapy or clinical trials. The cemiplimab safety was assessed according to treatment-emergent adverse events (TEAEs) reported until March 2021. Results: 140 patients were included (median age [interquartile range, IQR] 77.0 [65.0-84.0] years;age ≥80 38%;men 71.7%;≥1 comorbidity 83%;ECOG 0-1 86.3%;locally advanced CSCC 60.7%;cemiplimab as first-line therapy 67.7%). Cemiplimab was received for a median (IQR) of 8.0 (3.0-14.0) cycles. Fifty-eight (41.4%) patients showed ≥1 of the 163 TEAEs reported, which most frequently included diarrhoea n=7, asthenia n=6, constipation n=4 and abdominal pain n=4. Fourteen (8.6%) were immune-mediated, mainly bronchitis n=2, pneumonitis n=2 and hepatitis n=2. Seventy-eight (47.9%) TEAEs were grade ≥3, most frequently pneumonia n=3, COVID-19 n=3, general physical health deterioration n=2, pyrexia n=2, renal transplant failure n=2, sepsis n=2, acute kidney injury n=2 and respiratory failure n=2. Twenty-one (12.9%) were treatment-related (TREAEs): 11 (6.7%) were grade 1-2 (diarrhoea n=3 and asthenia, hepatotoxicity, malnutrition, odynophagia, polymyalgia rheumatica, pneumonitis, pruritus, and skin toxicity), 9 (5.5%) grade 3 (acute kidney injury, adrenal insufficiency, abdominal pain, blood creatinine increased, dysphagia, haematuria, immune-mediated enterocolitis, panniculitis, surgical wound infection) and 1 (0.6%) unknown grade. Cemiplimab was withdrawn due to TREAEs in only 5 (3.6%) patients. The TEAE outcome was fatal in 29 (17.8%);none related to cemiplimab. Conclusions: This NPP supports the real-life safety of cemiplimab for CSCC, showing an acceptable safety profile consistent with previous reports. Editorial acknowledgement: Editorial assistance was provided by Esther Álvarez-García at Dynamic Science S.L., funded by Sanofi. Legal entity responsible for the study: Sanofi. Funding: Sanofi. Disclosure: E. Muñoz Couselo: Financial Interests, Personal, Advisory Board: Amgen;Financial Interests, Personal, Advisory Board: Bristol-Myers Squibb;Financial Interests, Personal, Advisory Board: Merck Sharp & Dohme;Financial Interests, Personal, Advisory Board: Novartis;Financial Interests, Personal, Advisory Board: Pierre Fabre;Financial Interests, Personal, Advisory Board: Roche;Financial Interests, Personal, Advisory Board: Sanofi;Financial Interests, Personal, Other, Honoraria: Amgen;Financial Interests, Personal, Other, Honoraria: Bristol-Myers Squibb;Financial Interests, Personal, Other, Honoraria: Merck Sharp & Dohme;Financial Interests, Personal, Other, Honoraria: Novartis;Financial Interests, Personal, Other, Honoraria: Pierre Fabre;Financial Interests, Personal, Other, Honoraria: Roche;Financial Interests, Personal, Principal Investigator: Amgen;Financial Interests, Personal, Principal Investigator: Bristol-Myers Squibb;Financial Interests, Personal, Principal Investigator: GlaxoSmithKline;Financial Interests, Personal, Principal Investigator: Merck Sharp & Dohme;Financial Interests, Personal, Principal Investigator: Novartis;Financial Interests, Personal, Principal Investigator: Pierre Fabre;Financial Interests, Personal, Principal Investigator: Roche;Financial Interests, Personal, Principal Investigator: Sanofi. A. Soria: Financial Interests, Personal, Invited Speaker: Novartis;Financial Interests, Personal, Invited Speaker: Sanofi Aventis;Financial Interests, Personal, Invited Speaker: Roche Pharma;Financial Interests, Personal, Invited Speaker: Merck Serono;Financial Interests, Personal, Invited Speaker: Merck Sharp & Dohme;Financial Interests, Perso al, Invited Speaker: Bristol-Myers Squibb;Financial Interests, Personal, Invited Speaker: Pierre Fabre;Financial Interests, Personal, Advisory Board: Novartis;Financial Interests, Personal, Advisory Board: Sanofi Aventis;Financial Interests, Personal, Advisory Board: Roche Pharma;Financial Interests, Personal, Advisory Board: Merck Serono;Financial Interests, Personal, Advisory Board: Merck Sharp & Dohme;Financial Interests, Personal, Advisory Board: Bristol-Myers Squibb;Financial Interests, Personal, Advisory Board: Pierre Fabre;Financial Interests, Personal, Principal Investigator: Novartis;Financial Interests, Personal, Principal Investigator: Sanofi Aventis;Financial Interests, Personal, Principal Investigator: Roche Pharma;Financial Interests, Personal, Principal Investigator: Merck Serono;Financial Interests, Personal, Principal Investigator: Merck Sharp & Dohme;Financial Interests, Personal, Principal Investigator: Bristol-Myers Squibb;Financial Interests, Personal, Principal Investigator: Pierre Fabre. O. Sanmartin: Financial Interests, Personal, Invited Speaker: Sanofi Genzyme;Financial Interests, Personal, Advisory Board: Sanofi Genzyme;Financial Interests, Personal, Officer: Sanofi Genzyme;Financial Interests, Personal, Principal Investigator: Sanofi Genzyme;Financial Interests, Personal, Invited Speaker: Roche Pharma;Financial Interests, Personal, Advisory Board: Roche Pharma;Financial Interests, Personal, Officer: Roche Pharma;Financial Interests, Personal, Principal Investigator: Roche Pharma. J. Cañueto: Financial Interests, Personal, Invited Speaker: Hoffman-La Roche;Financial Interests, Personal, Invited Speaker: Sanofi-Genzyme;Financial Interests, Personal, Invited Speaker: AbbVie;Financial Interests, Personal, Invited Speaker: LeoPharma;Financial Interests, Personal, Other, Consultancy: Sanofi-Genzyme;Financial Interests, Personal, Other, Consultancy: InflaRx;Financial Interests, Personal, Other, Consultancy: Almirall. S. Beá Ardébol: Financial Interests, Personal, Invited Speaker: Meda;Financial Interests, Personal, Advisory Board: Sanofi;Financial Interests, Personal, Advisory Board: SunPharma;Financial Interests, Personal, Other, Trial subinvestigator: Sanofi Aventis;Financial Interests, Personal, Other, Trial subinvestigator: SunPharma;Financial Interests, Personal, Other, Trial subinvestigator: PellePharma. R. Fernández-de-Misa Cabrera: Financial Interests, Personal, Advisory Board: Sanofi. A.J. Cunquero-Tomás: Financial Interests, Personal, Invited Speaker: BMS;Financial Interests, Personal, Invited Speaker: Pierre-Fabre;Financial Interests, Personal, Writing Engagements: Sanofi;Financial Interests, Personal, Other, 2021 EADO/WMC Congress inscription fee: Sanofi. L. Fernández Franco: Non-Financial Interests, Personal, Invited Speaker: Merck;Non-Financial Interests, Personal, Invited Speaker: Sanofi;Non-Financial Interests, Personal, Invited Speaker: Servier. I. Romero: Financial Interests, Personal, Invited Speaker: Pharmamar;Financial Interests, Personal, Invited Speaker: Roche;Financial Interests, Personal, Invited Speaker: GSK;Financial Interests, Personal, Invited Speaker: Clovis;Financial Interests, Personal, Invited Speaker: AstraZeneca;Financial Interests, Personal, Advisory Board: Pharmamar;Financial Interests, Personal, Advisory Board: Roche;Financial Interests, Personal, Advisory Board: GSK;Financial Interests, Personal, Advisory Board: Clovis;Financial Interests, Personal, Advisory Board: AstraZeneca. J. Medina Martínez: Non-Financial Interests, Personal, Invited Speaker: Roche;Non-Financial Interests, Personal, Speaker’s Bureau: Roche;Non-Financial Interests, Personal, Advisory Board: Roche;Non-Financial Interests, Personal, Invited Speaker: Novartis;Non-Financial Interests, Personal, Speaker’s Bureau: Novartis;Non-Financial Interests, Personal, Advisory Board: Novartis;Non-Financial Interests, Personal, Invited Speaker: BMS;Non-Financial Interests, Personal, Speaker’s Bureau: BMS;Non-Financial Interests, Personal, Ad isory Board: BMS;Non-Financial Interests, Personal, Invited Speaker: MSD;Non-Financial Interests, Personal, Speaker’s Bureau: MSD;Non-Financial Interests, Personal, Invited Speaker: Pierre Fabre;Non-Financial Interests, Personal, Speaker’s Bureau: Pierre Fabre;Non-Financial Interests, Personal, Advisory Board: Pierre Fabre;Non-Financial Interests, Personal, Invited Speaker: Merk;Non-Financial Interests, Personal, Speaker’s Bureau: Merk;Non-Financial Interests, Personal, Invited Speaker: Sanofi;Non-Financial Interests, Personal, Speaker’s Bureau: Sanofi;Non-Financial Interests, Personal, Advisory Board: Sanofi;Non-Financial Interests, Personal, Invited Speaker: Servier. All other authors have declared no conflicts of interest.

Brain atrophy asymmetry in dementia is worsened by social isolation: A translational neuroscience approach in times of coronavirus pandemic (COVID-19)

The coronavirus pandemic (COVID-19) that has ravaged the entire world presents the most dramatic scenarios in the most vulnerable populations, with exacerbated focus on the elderly people, especially the most frail needing home-care or living in nursing homes. The urgency and severity of the outbreaks forces the use of segregation in restricted areas and confinement in individual rooms as desperate strategies to avoid the spreading of disease and the worse scenario of becoming a deadly trap. Residents are becoming socially isolated, lacking the social and environmental enrichment that are key rehabilitation factors against their progressive physical and/or mental deterioration. Recently, a study on gender perspective in COVID-19 found that men have more severe disease and are over twice as likely to die. It is well known that dementia is associated with increased mortality and males show worse survival than females. On the other hand, the asymmetric neurodegeneration of subcortical structures in Alzheimer's disease (AD) has been recently demonstrated and proposed as a powerful imaging biomarker. In the present work, we studied the impact of long-term isolation in old male 3xTg-AD mice modeling advanced-stages of AD and as compared to age-matched counterparts with normal aging. A battery of behavioral tests resembling several areas in nursery homes was used. Atrophy of left and right hippocampus, cortex and cerebellum was measured. Our results are the first evidences of brain atrophy asymmetry being demonstrated in an animal model of AD, thus modeling that found in human patients. The main findings aware of a consistent impact of isolation increasing the hippocampal and cortical atrophy asymmetries. Isolated animals showed a prominent hyperactive pattern in both gross and fine-motor functions, re-structured negative valence system with the emergence of bizarre behaviors and flight copying-with-stress strategies. Overall, these results from translational neuroscience aware of the impact of isolation enhancing the neurodegenerative asymmetry and BPSDlike behaviors. They also highlight the relevance of personalized-based interventions tailored to the heterogeneous and complex clinical profile of the individuals with dementia, and to pay special attention to BPSD behaviors that may worse their caregivers' burden in these times of coronavirus and post-COVID-19 pandemic scenario.

COVID-19 in melanoma patients:Spanish register

Background: The COVID-19 pandemic has produced devastating effects on the health care system, also affectingcancer patient care. When the pandemic reached Spain by the end of February 2020, the scarce data aboutCOVID-19 infection in cancer patients pointed out a higher risk of complications due to cancer diagnosis and also tocancer therapies. These conjectures led to concerns about hospital follow-up and cancer therapies of cancerpatients. More recent studies have included a higher number of patients, but heterogeneous according to cancertype and tumor stage, with few melanoma patients recorded. Given that different tumor types are associated withspecific comorbidities that have a known impact on COVID-19 evolution, analysis of COVID-19 by cancer types ismandatory. Similarly, analysis by tumor stage is relevant, as advanced cases could have different responses to viralinfection due to tumor-related immunosuppression and general condition deterioration. Methods: In Spain we have completed a national registry of melanoma patients infected by SARS-Cov-2 since April1st, 2020 to June 8th, 2020. Patients with a previous diagnosis of melanoma, presenting with Sars-Cov-2 infectionto our network of hospitals, were eligible for enrollment. A prospective observational study with a case registryfollowed by a retrospective analysis of patient data has been performed. Results: 64 patients have been included. Median age is 68 years (range 6 to 95 years), 22 (34%) patients arefemales, and 35 (55%) patients have stage IV melanoma. Twenty-one (33%) patients were on active anticancertreatment with anti PD-1 antibodies, 19 (30%) patients with BRAF plus MEK inhibitors, and 24 (37%) patients werenot on active treatment. Asymptomatic/paucisymptomatic evolution was recorded in 19 (30%) patients and mildseverity in 13 (20%) patients, not requiring hospital admission by COVID-19. Serious and life-threateningcomplications were recorded in 18 (28%) and 14 (22%) patients, respectively, including 28 (44%) patients whorequired oxygen therapy and 3 (5%) patients who had ICU admission. COVID-19 episode is resolved in 55 cases, including 34 (53%) patients cured, eight (12%) patients who have died due to melanoma progression, and 13 (20%)patients due to COVID-19. The median age of patients who died from COVID-19 was 74 years (range 49 to 91), while for those cured it was 64 years (range 6 to 95);85% of patients who died were males, while this ratedecreased to 62% for those cured. The mortality rate from COVID-19 was 20% for both stage IV and localizedmelanoma, while according to melanoma treatment it was 21%, 16%, and 21% for immunotherapy, BRAF plus MEKinhibitors, and for those who were not undergoing active cancer treatment, respectively. Conclusion: Our results show that the risk of death in melanoma patients is higher in males and older patients, andit is similar according to tumor stage and melanoma therapy. The impact of cancer diagnosis and treatments onCOVID-19 evolution is lower than previously expected.