Covid-19 and epidemiological changes in pelvic fractures secondary to winter sports

The Covid-19 pandemic led to a restriction in the practice of winter sports for two years. The Grenoble-Alpes University Hospital is a level 1 trauma center, a reference center for the management of traumatology, in particular for pelvic fractures. This comparative epidemiological study, conducted before and after the pandemic, shows an increase in the number and a change in the profile of patients with pelvic trauma secondary to the practice of winter sports. A reflection on the specific management of this new population is necessary. © 2023 La pandémie de Covid-19 a entraîné une restriction de la pratique de sports d'hiver durant deux années. Le centre hospitalier universitaire Grenoble-Alpes est un trauma center de niveau 1, centre de référence pour la prise en charge de la traumatologie, en particulier pour les fractures du bassin. Une étude épidémiologique comparative, menée avant et après la pandémie, montre une augmentation du nombre et une modification du profil des patients traumatisés du bassin secondairement à la pratique des sports d'hiver. Une réflexion sur la prise en charge spécifique de cette nouvelle population s'impose. © 2023

[Influence of the COVID-19 pandemia on the ophthalmologic emergency department in the Toulouse University Hospital during the first lockdown from March the 17th to May the 10th of 2020]. / Impact de la pandémie de COVID-19 sur les urgences ophtalmologiques du CHU de Toulouse lors du premier confinement du 17 mars au 10 mai 2020.

INTRODUCTION: We conducted this study to assess the impact of the COVID-19 pandemic and the lockdown in France from March 17, 2020 to May 10, 2020, on the ophthalmic emergency department at Toulouse University Hospital, compared to the period from March 2 to March 16, 2020. MATERIALS AND METHODS: This was a retrospective observational study, conducted in the ophthalmic emergency department of Toulouse University Hospital. We included the patients presenting to the emergency department from March 2 to May 10, 2020. We recorded age, sex, day of visit, time until care was received, past ocular history, outpatient or inpatient status, final diagnosis and its severity, outpatient or inpatient disposition, and medical or surgical treatment after the emergency department visit. RESULTS: We found a substantial decrease in the number of patients per day, mostly during the first month of the lockdown: 44 patients per day before the lockdown compared to 23 patients per day during the first month, followed by 38 patients per day for the second month of lockdown; more patients visiting promptly; and elderly patients represented a higher proportion of patients. CONCLUSION: The first lockdown in France due to the COVID-19 pandemic had an impact on the Toulouse ophthalmic emergency department, especially concerning the number of patients per day; this study helps to assess individual behavior in this context of a public health crisis.

State of the art on the relationship between vitamin D and Covid-19

Vitamin D modulates the secretion of antimicrobial peptides and anti-inflammatory cytokines and the activity of the renin-angiotensin-aldosterone system. These effects may prevent the consequences of cytokine storm. Clinical studies show, taking into account potential confounding factors, that hypovitaminosis D may be an independent risk factor for severe Covid-19. Interventional data show that high-dose supplementation limits severe disease and improves, at least temporarily, the prognosis. © 2022 Elsevier Masson SAS La vitamine D module la sécrétion des peptides antimicrobiens et des cytokines anti-inflammatoires ainsi que l'activité du système rénine-angiotensine-aldostérone. Ces effets peuvent prévenir les conséquences de l'orage cytokinique. Les études cliniques montrent, en tenant compte des potentiels facteurs de confusion, que l'hypovitaminose D pourrait constituer un facteur de risque indépendant de forme grave de Covid-19. Quant aux données interventionnelles, elles rapportent que la supplémentation à forte dose limite les formes sévères de la maladie et en améliore, au moins transitoirement, le pronostic vital. © 2022 Elsevier Masson SAS

Covid-19 pandemic and public health. How to be better prepared for the next crisis?

The Covid-19 pandemic has sparked unprecedented scientific mobilization, particularly in epidemiology. Despite this, the health burden is such that one can speak of a public health failure. This article discusses the reasons for this hiatus. It emphasizes the importance of the role of occupational physicians in this context. It presents lessons for the future. © 2022 Elsevier Masson SAS La pandémie de Covid-19 a suscité une mobilisation scientifique sans précédent, notamment sur le plan épidémiologique. Malgré cela, le fardeau sanitaire est tel que l'on peut parler d'un échec de santé publique. Cet article discute les raisons d'hiatus. Il souligne l'importance du rôle des médecins du travail dans ce contexte. Il présente les leçons à tirer pour l'avenir. © 2022 Elsevier Masson SAS

Pandémie de Covid-19 et santé publique. Comment se préparer à la prochaine crise?

Résumé La pandémie de Covid-19 a suscité une mobilisation scientifique sans précédent, notamment sur le plan épidémiologique. Malgré cela, le fardeau sanitaire est tel que l’on peut parler d’un échec de santé publique. Cet article discute les raisons de hiatus. Il souligne l’importance du rôle des médecins du travail dans ce contexte. Il présente les leçons à tirer pour l’avenir. The Covid-19 pandemic has sparked unprecedented scientific mobilization, particularly in epidemiology. Despite this, the health burden is such that one can speak of a public health failure. This article discusses the reasons for this hiatus. It emphasizes the importance of the role of occupational physicians in this context. It presents lessons for the future.

Urgences psychiatriques chez les 15–25 ans durant la première année de la crise sanitaire : une étude épidémiologique descriptive dans le plus grand centre d’urgences psychiatriques français

Résumé Depuis le 16 mars 2020, date de l’annonce du premier confinement en France dans le contexte de pandémie liée à la COVID-19 et de crise sanitaire, les Français ont connu un bouleversement brutal et durable de leurs rythmes et habitudes. La crise sanitaire a eu un impact fort sur la population générale et sur les patients souffrant de troubles psychiatriques. La demande de prise en charge en santé mentale est particulièrement accrue chez les jeunes, qui semblent les plus impactés par cette crise. Dans la première partie de cet article, nous décrirons l’impact de la crise sanitaire sur la santé mentale des jeunes et sur la fréquentation des urgences psychiatriques, avec une revue exhaustive de la littérature française et internationale. La littérature traitant de la santé mentale des enfants et des jeunes durant la crise sanitaire est vaste et régulièrement actualisée. Au 31 décembre 2021, seules quelques données concernant l’état de santé mentale des jeunes sont chiffrées et publiées. Dans la seconde partie, nous présenterons une étude épidémiologique descriptive réalisée dans le plus grand centre d’urgences psychiatriques français, afin de mettre en évidence les changements des flux de consultations des patients âgés de 15 à 25 ans durant la première année de la crise sanitaire, comparativement aux trois années précédentes. En conclusion, nous évoquerons les mesures et adaptations du système de soins français mises en place pour prendre en charge les besoins accrus en santé mentale de cette population spécifique des 15–25 ans, particulièrement malmenée par la crise sanitaire, véritable enjeu national de santé publique. Introduction Since March 16, 2020, the date of the announcement of the first confinement in France in the context of the COVID-19 pandemic and health crisis, French residents have experienced a brutal and lasting disruption in their rhythms and habits. The health crisis has had a strong impact on the general population and especially on patients suffering from psychiatric disorders. The demand for mental health care has particularly heightened among young people, who seem to be the most affected by this crisis. In the first part of this article, we will describe the impact of the health crisis on the mental health of young people and on the attendance of psychiatric emergencies, with a review of French and international literature. In the second part, we will present a descriptive epidemiological study carried out in the largest French psychiatric emergency center. Methods and objective Our sample included 9,771 young patients from 15 to 25 years old. The main objective of our study is to highlight the changes in the flow of consultations of patients aged 15 to 25 years during the first year of the health crisis, compared to the three previous years. We calculated and compared the proportion of the target population consulting between the period of the first year of the health crisis (COVID period) and the period encompassing the previous three years (pre-COVID period). We also compared different variables, between the 2,179 young people consulting during the first year of COVID-19 health crisis and the 7,592 young people during the three last years: age, sex, marital status, symptoms, environmental context and CIM-10 diagnoses. Results We observed a significant increase in the proportion of patients aged 15 to 25 during the COVID period (n=29.4% vs. 27.6%;P<0,001). The patients during the COVID period were predominantly female. We have seen a significant increase in patients coming for consultations for anxiety (+4.3%;P<0.001), sleep disorders (+2.8%;P<0.001) and suicidal thoughts (+2.7%;P=0.006) during the COVID period. During the first year of the health crisis, the target population consulted less for claustration, withdrawal or odd behavior. Family conflicts, traumatic events and other life events were more frequent. Schizophrenia, schizotypal and delusional disorders were less frequently diagnosed. Conclusion The health crisis has had a considerable impact on the mental health of the youth population. The mental health of young people is a current subject of concern and a major public health issue. Data from the literature warns of the impact of the health crisis on the mental health of this population and the need for early treatment, even as the supply of psychiatric care is decreasing.

Impact of the first lockdown related to the COVID-19 pandemic on ophthalmic emergencies in a French University Hospital.

INTRODUCTION: At the beginning of the COVID-19 pandemic, the French government implemented its first national lockdown between March and May 2020 in order to limit the dissemination of the virus. This historic measure affected patients' daily lives and transportation, resulting in changes in the delivery of medical care, particularly emergency care. This study aimed to assess the impact of this restriction policy on the number and severity of ophthalmic emergencies seen in an ophthalmology emergency department. METHODS: This retrospective study conducted at the regional university Hospital of Tours included all patients presenting to the ophthalmology emergency department over four periods: lockdown (03/16/2020 to 05/10/2020), post-lockdown (05/11/2020 to 06/12/2020) and the two corresponding periods in 2019. The following data were recorded: sex, age, time of visit, reason for visit, diagnosis, severity of emergency graded on the BaSe SCOrE, time from first symptoms until visit, existence of a work-related injury, and referral source (ophthalmologist or other). RESULTS: A total of 1186 and 1905 patients were respectively included during the 2020 lockdown period and the corresponding period in 2019. The study populations for the 2019 and 2020 post-lockdown periods consisted of 1242 and 1086 patients respectively. During the lockdown, the number of consultations decreased significantly (-37.7%), affecting mild and severe emergencies similarly. During the post-lockdown period, the number of emergencies gradually increased but did not reach the level of the corresponding period in 2019 (-12.6%). CONCLUSION: The first French lockdown resulted in a significant decrease in ophthalmic emergency visits, similar for all levels of severity. All age groups were impacted similarly, without the expected exaggerated decrease for patients over 50 years of age, who are considered to be at greater risk for developing a severe form of COVID-19. The post-lockdown period showed a gradual increase in ophthalmic emergency visits, although these remained fewer than the previous year.

[Artificial Intelligence in epidemiology]. / Apports de l'Intelligence Artificielle en épidémiologie.

Artificial Intelligence can be leveraged to analyze great amounts of data. It can be used on images or textual data to define the epidemiology of diseases, such as cancer. In this review, we will present and discuss the applications of AI in this setting.

[Diabetes and COVID-19]. / Diabète et COVID-19.

According to previous reports, diabetes seems to be associated with serious clinical events due to COVID-19. But is diabetes per se a risk factor of being infected by the virus? We discuss these points. Data about the antidiabetic drugs are scarce. Dipeptidylpeptidase-4 (DPP-4) is found as both a cell surface protein ubiquitously expressed in many tissues and as a soluble molecule found in serum/plasma, fluids. DPP-4 is involved in infection of cells by some viruses. We relate data about the use of DPP-4 inhibitors in diabetic patients. We conclude relating French and international recommendations in people with diabetes.

[Evolution of electro-convulsive therapy activity in France since the beginning of the COVID-19 pandemic]. / Évolution de l'activité d'électro-convulsivo-thérapie en France depuis le début de la pandémie COVID-19.

The recent COVID-19 pandemic has led to major organisational changes in health care settings, especially in psychiatric hospitals. We conducted a national online survey to assess the evolution of electroconvulsive therapy (ECT) in the different centres practicing this treatment. 65 responses from all over France were analysed. More than 90 % of the centres practising ECT experienced a decrease in their activity. Half of the centres experienced a total cessation of activity and 25 % of the centres experienced a decrease of more than half of their usual activity. Post-pandemic COVID-19 psychiatric care is expected to be difficult. It is essential not to add to this difficulty the complications, often serious, that will be associated with delaying or stopping the practice of ECT. It will also be necessary to remain vigilant with regard to the specific neuropsychiatric consequences that will follow the pandemic.

Clinical characteristics and outcome of hospitalized patients with SARS-CoV-2 infection at Toulouse University hospital (France). Results from the Covid-clinic-Toul cohort.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has spread worldwide from epicenter of Wuhan, China since December 2019. The aim of our study was to describe the clinical characteristics and outcome of hospitalized patients with SARS-CoV-2 pneumonia at the Toulouse university hospital, France. PATIENTS AND METHODS: We selected the patients included from March 7, 2020 to April 20, 2020 in the retrolective Covid-clinic-Toul cohort that follows all hospitalized patients with SARS-CoV-2 infection at the Toulouse Hospital. Cases were confirmed by real-time reverse transcriptase polymerase chain reaction. We report demographics, clinical, biological and radiological features, as well as unfavorable outcome at Day 14 after admission (admission in an intensive care unit, mechanical ventilation, death). RESULTS: Among 263 hospitalized patients, the median age was 65 years and 155 (58.9%) were males. Two hundred and twenty-seven patients (86.3%) had at least one comorbidity. The median time from first symptom to hospital admission was 7.0 days (interquartile range: 4-10). On day 14 after admission, 111 patients (42.2%) had been transferred to intensive care unit (ICU), including 50 (19.0%) on Day 1; 61 (23.1%) needed mechanical ventilation and 19 patients (7.2%) had died. Patients admitted to ICU at Day 1 of admission (n=50) were more frequently men (66.0% vs 57.3%), smokers (25.0% vs 7.1%), with obesity (42.0% vs 24.7%) and had a higher mean level of C-reactive protein (median: 110.9mg/L vs 46.2mg/L). CONCLUSION: This cohort provides epidemiological data on SARS-CoV-2 in hospitalized patients in a University hospital in the South of France.

Hand injuries treated at a hand emergency center during the COVID-19 lockdown.

The recent coronavirus outbreak has tested the adaptability, cooperation and organizational capabilities of our healthcare systems. Restrictions were implemented in several countries to reduce virus transmission whilst emergency departments (ED) were overwhelmed and there was shortage of healthcare providers. Given this situation and the consequences of hand injuries, we studied the epidemiology of hand injuries in an accredited FESSH emergency center during the lockdown in France (March 17 to May 10, 2020) due to the coronavirus outbreak. During this period, 1947 patients consulted for a hand injury. We found high percentages of men (63%), open wounds (70%), domestic accidents (88%) and surgical treatment being required (76%). There was a significant decrease in admissions and consultations relative to the same period in 2019. This reference data can help healthcare systems prepare for future outbreaks and similar restrictions.

[COVID-19: Clinical, biological and radiological characteristics in adults, infants and pregnant women. An up-to-date review at the heart of the pandemic]. / COVID-19 : caractéristiques cliniques, biologiques et radiologiques chez l'adulte, la femme enceinte et l'enfant. Une mise au point au cœur de la pandémie.

The spread of the new coronavirus SARS-CoV-2, discovered in China in January 2020, led to a pandemic as early as March 2020, forcing every health care system in the affected countries to adapt quickly. In order to better address this major health crisis, which has given rise to numerous scientific publications, we have synthesized the main original clinical studies to facilitate the day-to-day management of patients with COVID-19. We detail the early signs and progression of the disease as well as the different clinical forms, including extra-pulmonary, as known at the beginning of this pandemic. We focus on clinical, biological and CT markers predictive of severity or mortality. Finally, we discuss the impact of SARS-CoV-2 infection in populations suspected to be at high risk of severe forms.