Impact de la Covid-19 sur les arrêts cardiaques extrahospitaliers en phase de suractivité épidémique : données du registre RéAC

Introduction : Notre objectif était d'analyser la survie des patients victimes d'un arrêt cardiaque extrahospitalier (ACEH) durant la pandémie Covid-19 et de comparer les données en fonction du centre de traitement de l'appel choisi, le 15 ou le 18. Méthode : Nous avons extrait les données exhaustives du Registre des arrêts cardiaques (RéAC), entre le 1er mars et le 30 avril 2020. Nous avons effectué trois comparaisons de la survie à 30 jours (J30) de cohortes de patients : 1) Covid vs non-Covid ;2) appels arrivés au service d'aide médicale urgente (Samu) (15) vs aux sapeurs-pompiers (SP) (18) et 3) appels arrivés au 15 vs 18 pour les patients Covid. Résultats : Sur un total de 870 ACEH, 184 étaient atteints de la Covid. Nous avons observé 487 (56 %) appels arrivés au 15 et 383 (44 %) au 18. La survie à J30 était de 3 %. Les ACEH Covid avaient une survie à J30 plus faible que les non-Covid (0 vs 4 %, p < 0,001). Le délai d'arrivée de SP était plus long lors d'un appel au 15. En revanche, aucune différence de survie n'est observée entre les appels arrivés au 15 ou au 18. Conclusion : La survie consécutive à un ACEH durant la pandémie est extrêmement faible. Cependant, quel que soit le numéro composé (15 ou 18), la survie n'est pas différente, même si le délai d'arrivée des prompts secours est plus court lors d'un appel au 18.Alternate abstract: Introduction: Our aim was to analyze the outof-hospital cardiac arrest (OHCA) care and patients' survival during COVID-19 pandemic by comparing the emergency phone number called to initiate the alert [EMS(#15) or firefighters(#18)]. Procedures: We used data from the French OHCA Registry (RéAC), between March 1, 2020 and April 30, 2020. We performed three comparisons of patient cohorts: 1) COVID vs non-COVID;2) 15 vs 18 calls and 3) in COVID patients, 15 vs 18 calls. Results: We included 870 OHCA, among them, 184 were affected by COVID-19. There were 487 (56%) calls to 15 and 383 (44%) to 18. Patient survival at D+30 during the study was 3%. COVID+ patients had a lower survival rate at D+30 than non-COVID patients (0% vs. 4%, P < 0.001). Firefighters had a long time to arrive on the scene for calls to 15. No difference in survival was observed between 15 or 18 calls. Conclusion: The poor survival of patients during the pandemic is multi-causal but does not appear to be related to the emergency phone number called to initiate the alert [EMS (#15) or firefighters (#18)] even if the arrival time for prompt assistance is shorter on the call to 18.

Preoperative ultra-hypofractionation radiotherapy in extremity/trunk wall soft tissue sarcoma - A meta-analysis of prospective studies.

PURPOSE: The neoadjuvant radiotherapy is now standard treatment in soft tissue sarcoma. Using ultra-hypofractionation radiotherapy shorten the treatment time. In the era of COVID pandemic, using less fraction to treat patient is an urgent need. Thus, we aim to use meta-analysis to investigate the clinical efficacy of preoperative stereotactic body radiotherapy. MATERIAL AND METHODS: PRISMA guideline was used in this study. PubMed, Cochrane and Embase were used. We include only prospective study. The main endpoint was set as wound complication rate. Other endpoints include R0 resection rate, overall survival, local control, and distant metastasis free survival. RESULTS: Seven studies were included. The pooled wound complication rate is 0.30 (95% CI=0.26-0.35). The pooled R0 resection rate is 0.87(95%CI: 0.74-0.94). The pooled 2-year overall survival is 0.86 (95%CI: 0.72-0.94). The pooled 2-year local control rate is 0.96(95%CI: 0.89-0.99). The pooled 2-year distant metastasis free survival is 0.60 (95%CI=0.50-0.70). CONCLUSION: Neoadjuvant ultra-hypofractionation radiotherapy in soft tissue sarcoma is a feasible and well tolerable treatment.

Multimorbidity Treatment Burden Questionnaire (MTBQ): Translation, Cultural Adaptation, and Validation in French-Canadian.

Reliable treatment burden measures are needed given the aging population and the associated increase in multimorbidity and polypharmacy. Treatment burden is defined as the effort to care for one's health and the resulting impact on one's daily life. This study aimed to translate the Multimorbidity Treatment Burden Questionnaire (MTBQ) for French-Canadians and assess its reliability and validity. The MTBQ was translated and tested with cognitive debriefing interviews, and the French version (MTBQ-F) was then administered 2 times among 105 participants. Reliability and validity were examined using the intra-class correlation coefficient (ICC), Cronbach's alpha, and Spearman's correlations. The median global MTBQ-F scores were 32.69 (interquartile range [IQR]: 21.15-48.08) and 30.77 (IQR: 21.15-46.15) for the first and second administrations, respectively. Test-retest (ICC: 0.73; 95% CI: 0.63-0.81) and internal consistency reliability (Cronbach's alpha: 0.80) were good. There was a moderate positive correlation between the MTBQ-F score and the number of self-reported conditions (rho: 0.28). This valid instrument could identify patients experiencing a high treatment burden and assess the impact of interventions among them.

Impact of the COVID-19 Pandemic on Adults With Type 2 Diabetes Care and Clinical Parameters in a Primary Care Setting in Ontario, Canada: A Cross-sectional Study.

OBJECTIVES: Diabetes requires ongoing monitoring and care to prevent long-term adverse health outcomes. In Canada, quarantine restrictions were put into place to address the coronavirus-2019 (COVID-19) pandemic in March 2020. Primary care diabetes clinics limited their in-person services and were advised to manage type 2 diabetes (T2D) through virtual visits and reduce the frequency of routine diabetes-related lab tests and screening. METHODS: This retrospective cross-sectional study used de-identified patient records from a primary care electronic medical records database in Ontario, Canada, to identify people with T2D who had at least 1 health-care touchpoint between March 1, 2018, and February 28, 2021. Outcomes were described on a monthly or yearly basis: 1) number of people with primary care visits (in-person vs virtual); 2) number of people with referrals; 3) number of people with each of the vital/lab measures; and 4) results of the vital/lab measures. RESULTS: A total of 16,845 individuals with T2D were included. Compared with the pre-pandemic period, the COVID-19 period had a 16.8% reduction in the T2D population utilizing any primary care and an increase of 330.4% in the number of people with at least 1 virtual visit. Compared with the pre-pandemic period, fewer people had vital/lab measures in the pandemic period. However, among the people with the test results available, the average values for all tests were similar in the pre- and pandemic periods. CONCLUSION: Further research is needed to understand the impact of the reduction of in-person clinical care on the entire population with T2D.

Les risques liés à l’oxygène à usage médical, détection et prévention

Résumé La pandémie de la COVID-19 a été l’occasion de mettre en avant l’importance de l’oxygène (O2) à usage médical à l’hôpital, dans les structures temporaires et également pour le transfert des patients et leur maintien à domicile. Les recommandations de traitement et le nombre de patients mis sous oxygène dans une même pièce ont évolué. Ce qui a eu pour conséquence une augmentation du nombre d’incidents liés à l’usage de l’O2 thérapeutique au cours de ces deux dernières années. Les risques liés à l’O2 à usage médical peuvent être répartis entre ceux liés à la propriété intrinsèque de la molécule, ceux liés à son conditionnement, à sa production ou à son utilisation, mais également ceux liés à sa disponibilité. Lors d’une catastrophe ou d’une crise sanitaire, les incidents surviennent également parce que les personnes amenées à intervenir sont amenées à être exposées à des risques, souvent très éloignés de leurs activités médicales quotidiennes. Il est donc important de pouvoir rappeler à vos équipes les risques liés à l’O2, les moyens de détection et les mesures de prévention. Le but est d’être en permanence conscient des risques et de guider les équipes dans leur prise de décisions pour leur sécurité et pour le bénéfice des patients. Summary The COVID-19 pandemic has been an opportunity to highlight the importance of oxygen (O2) for medical use in hospitals, in temporary structures and also during the patient transfer. The treatment preconisations and the number of patients under O2 therapy in the same room evolved. This resulted in an increase of the number of incidents related to therapeutic O2 usage over the past two years. The risks related to O2 for medical use can be splitted between those related to the intrinsic molecular property, those related to its packaging, production or usage, but also those related to its availability. During a disaster or a health crisis, incidents also occur because users are exposed to risks, often very far from their daily medical activities. It is therefore important to be able to remind your teams of the risks related to oxygen, their detection and the mitigation measures. The aim is to be constantly aware of the risks and to guide the teams in their decision-making for their safety and for the benefit of patients.

[Home treatment of low-risk pulmonary embolism patients : Efficacy and safety of an outpatient program including the general practitioner]. / Prise en charge ambulatoire des embolies pulmonaires à risque faible ; expérience d'une filière centrée sur le lien ville-hôpital.

AIM: Outpatient treatment (OT) of patients with low-risk pulmonary embolisms (PE) is recommended. A multidisciplinary OT program including the general practitioner (GP) has been implemented at Versailles hospital in 2019. The objectives of the study were to assess the feasibility, safety and acceptability of the program. MATERIAL AND METHODS: The feasibility of, and the inclusion criteria for OT were defined from a retrospective cohort study of PE patients carried out in 2018. In the prospective study, consecutive patients consulting in the emergency department between 2019 and 2021 with confirmed PE were eligible for OT if they had sPESI and HESTIA scores equal to 0, normal troponin and NT-pro-BNP levels, and no right ventricular dilation on imaging. PEs associated with COVID were excluded. The OT program included 4 appointments within 3 months, including 2 with the GP. Events (death, recurrence of PE or venous thromboembolism, bleeding, rehospitalisation) were collected at 3-month follow-up. RESULTS: In the retrospective study, 19% of the 138 PE patients seen in the emergency department were eligible for OT. No complication occurred at Day 90. In the prospective study, 313 consecutive patients with confirmed PE in the emergency department were included, 66 (21%) were eligible for OT. Overall, 43 patients (14%) received OT (39 eligible) and 27 patients eligible for OT were hospitalised (92% because of pulmonary infarction). At 3-month follow-up, there were no death, no recurrence of thromboembolism, and one patient has been early hospitalised for COVID; 3 female patients treated with rivaroxaban had minor bleeding (heavy menstrual bleeding). The satisfaction rate of general practitioner was 95%. CONCLUSIONS: This study confirms the feasibility and safety of our OT program for low-risk EP patients, centered on the general practitioner. It reduces the time spent in the emergency department, reduces hospitalisations and strengthens the city-hospital link for care.

[SARS-CoV-2 infection: Available data on 15th April 2021]. / Infection à SARS-CoV-2 : connaissances au 15 avril 2021.

INTRODUCTION: Since January 2020, when the first cases of SARS-CoV-2 infection were diagnosed in France, pulmonologists have been at the heart of the crisis and should be responsible for the management of acute COVID-19 (and any possible sequelae) BACKGROUND: Many drugs have been evaluated or are currently under evaluation as possible specific treatment for SARS-CoV-2. Nevertheless, as of April 15, 2021, the only recommended treatment in current practice is the "standard of care", i.e. the symptomatic management of infection with SARS-CoV-2. This review presents the state of knowledge on COVID-19 in the acute phase (virological, immunological, epidemiological and therapeutic data) available on 15th April, 2021. OUTLOOK: A large number of clinical trials are currently ongoing. It is important to propose to patients the opportunity to participate in clinical trials and to structure the research in order to complete the studies. CONCLUSION: Current management is based on oxygen therapy, thromboprophylaxis and in some cases corticosteroids. No antiviral therapy is currently recommended. These data are constantly evolving.

The treatment of SARS-CoV2 with antivirals and mitigation of the cytokine storm syndrome: the role of gene expression.

In the absence of a vaccine, the treatment of SARS-CoV2 has focused on eliminating the virus with antivirals or mitigating the cytokine storm syndrome (CSS) that leads to the most common cause of death: respiratory failure. Herein we discuss the mechanisms of antiviral treatments for SARS-CoV2 and treatment strategies for the CSS. Antivirals that have shown in vitro activity against SARS-CoV2, or the closely related SARS-CoV1 and MERS-CoV, are compared on the enzymatic level and by potency in cells. For treatment of the CSS, we discuss medications that reduce the effects or expression of cytokines involved in the CSS with an emphasis on those that reduce IL-6 because of its central role in the development of the CSS. We show that some of the medications covered influence the activity or expression of enzymes involved in epigenetic processes and specifically those that add or remove modifications to histones or DNA. Where available, the latest clinical data showing the efficacy of the medications is presented. With respect to their mechanisms, we explain why some medications are successful, why others have failed, and why some untested medications may yet prove useful.

[Influence of COVID-19 on issues relating to end of life and the support of patients]. / Influence de la Covid-19 sur les questions relatives à la fin de vie et à l'accompagnement.

The covid-19 epidemic and the resulting lockdown measures have undoubtedly led people who are ill, as well as those at risk of becoming ill, to contemplate the notions of risk, uncertainty and death. What effects has this confrontation with the question of death had and what impact will it continue to have on the palliative care approach and the decisions to withhold and withdraw treatment in certain circumstances?

[COVID-19, drugs and hospital pharmacy]. / Évolution des traitements médicamenteux en cas de Covid-19.

Observation, interpretation, actions for improvement, questioning are all terms that echo the situation of caregivers since the outbreak of the COVID-19 epidemic in France at the beginning of 2020. All those involved in the healthcare chain have had to cope with the influx of patients and to show that they are capable of seeing their practices evolve on a daily basis. What was recommended a few weeks earlier could quickly become obsolete. It was necessary to be reactive and the question of drug treatments was at the heart of the concerns, requiring prescribers to keep themselves informed and pharmacists to be as mobilized as possible to respond to requests from the field as quickly as possible.

[CME/Answers: Hypertension and the COVID-19 Pandemic: What to Consider in Medical Practice]. / CME/Antworten: Hypertonie und die COVID-19-Pandemie: Was in der medizinischen Praxis zu beachten ist.

CME/Answers: Hypertension and the COVID-19 Pandemic: What to Consider in Medical Practice Abstract. The COVID-19 pandemic represents a major public health problem. A fraction of the population is at increased risk of developing complications of this disease, in particular older subjects as well as diabetic, obese and hypertensive patients. With regard to patients with high blood pressure, the existence of an increased risk remains to be confirmed in large controlled trials. So far the findings regarding this question are reassuring, whether these patients are treated or not. There seems to be no reason to worry when using blockers of the renin-angiotensin system. The observations available to date suggest that COVID-19 vaccine can be administered safely to hypertensive patients. In conclusion, there is no reason to implement changes in the care of hypertensive patients due to the pandemic.

[CME: Hypertension and the COVID-19 Pandemic: What to Consider in Medical Practice]. / CME: Hypertonie und die COVID-19-Pandemie: Was in der medizinischen Praxis zu beachten ist.

CME: Hypertension and the COVID-19 Pandemic: What to Consider in Medical Practice Abstract. The COVID-19 pandemic represents a major public health problem. A fraction of the population is at increased risk of developing complications of this disease, in particular older subjects as well as diabetic, obese and hypertensive patients. With regard to patients with high blood pressure, the existence of an increased risk remains to be confirmed in large controlled trials. So far the findings regarding this question are reassuring, whether these patients are treated or not. There seems to be no reason to worry when using blockers of the renin-angiotensin system. The observations available to date suggest that COVID-19 vaccine can be administered safely to hypertensive patients. In conclusion, there is no reason to implement changes in the care of hypertensive patients due to the pandemic.

[Real-life data and Covid-19: The third avenue of reseach]. / Données de vie réelle et Covid-19 : la troisième voie.

The analysis of real-life data from hospital information systems could make possible to decide on the efficacy and safety of Covid-19 treatments by avoiding the pitfalls of preliminary studies and randomized clinical trials. The different drugs tested in current clinical trials are already widely prescribed to patients by doctors in hospitals, and can therefore be immediately analysed according to validated methodological standards.

[CME: Hypertension and the COVID-19 Pandemic: What to Consider in Medical Practice]. / CME: L'hypertension artérielle et la pandémie COVID-19: Ce qu'il faut retenir en pratique médicale.

CME: Hypertension and the COVID-19 Pandemic: What to Consider in Medical Practice Abstract. The COVID-19 pandemic represents a major public health problem. A fraction of the population is at increased risk of developing complications of this disease, in particular older subjects as well as diabetic, obese and hypertensive patients. With regard to patients with high blood pressure, the existence of an increased risk remains to be confirmed in large controlled trials. So far the findings regarding this question are reassuring, whether these patients are treated or not. There seems to be no reason to worry when using blockers of the renin-angiotensin system. The observations available to date suggest that COVID-19 vaccine can be administered safely to hypertensive patients. In conclusion, there is no reason to implement changes in the care of hypertensive patients due to the pandemic.

Résumé. La pandémie COVID-19 représente un problème de santé publique majeur. Une partie de la population est à risque accru de développer des complications de cette maladie, en particulier les personnes âgées ainsi que les malades diabétiques, les obèses et, possiblement, les malades hypertendus. Pour ces derniers, cela reste à être confirmé dans des études contrôlées de grande envergure. Les connaissances accumulées à ce jour sont rassurantes, que les malades soient traités ou non. Il n'y a pas de crainte à avoir en ce qui concerne la prise de médicaments antihypertenseurs, y compris les bloqueurs du système rénine-angiotensine. Les premières observations indiquent que le vaccin anti-COVID-19 peut être administré chez le malade hypertendu avec la meme efficacité que le normotendu. En conclusion il n'y a pas de raison de prendre en charge le malade hypertendu autrement qu'avant l'apparition de la pandémie.

[Non-intensive care of COVID-19 patients: treatment plan and therapeutic orientations.] / Covid-19 non réanimatoire : projet de soins et orientations thérapeutiques.

Despite the recent emergence of COVID-19 and the absence of a specific cure, the hospital treatment of patients affected by this virus is well established. It is based on symptomatic treatments including oxygen therapy, physiotherapy and anticoagulation therapy. The treatment plan and potential therapeutic limitations must be well defined and adapted to the severity, predisposition and wishes of the patient.

[Recommendations of the Urolithiasis Committee of the French Urology Association for the management and the treatment of the stone formers patients during the COVID-19 pandemic crisis]. / Recommandations du Comité Lithiase de l'Association Française d'Urologie pour la prise en charge des calculs urinaires durant la crise sanitaire liée à la pandémie à COVID-19.

For the first time, faced with a crisis with an exceptional magnitude due to the COVID-19 pandemic responsible for saturation of emergency services and intensive care units, the urolithiasis committee of the French Urology Association designed the recommendations for care and treatment of stone-forming patients and their treatment during crisis.