Successful high flow nasal cannula therapy for severe COVID-19 pneumonia is associated with tocilizumab use.

INTRODUCTION: Our aim was to determine the rate of success of HFNO and its relationship with current treatments for severe COVID-19. METHOD: This was a cohort study including patients admitted for HFNO because of respiratory failure despite oxygen therapy through a facial mask. Care was standardized, with systematic use of steroids and prevention or treatment of thromboembolic complications, and tocilizumab when deemed useful. HFNO failure was defined by the requirement for mechanical ventilation and/or death. RESULTS: In August 2021, among 1397 patients with COVID-19 admitted in the emergency department, 110 (7.8%) received HFNO (mean age 55 years, sex-ratio M/F 1.4). Thirteen patients (12%) had received a steroid treatment before hospital admission. At least one comorbid condition was observed in 57% of the patients. Mean duration of the disease at admission was 8.8 days and mean respiratory rate was 34/min. A CT scan was performed for 101 patients (92%), among whom 13 had a pulmonary embolism. All patients received a steroid treatment, and tocilizumab was prescribed in 79 cases (72%). Failure of HFNO was observed in 54 cases (49%); the only risk factor was the absence of tocilizumab administration: AOR [IC95%] 3.50 [1.40-8.69]. We observed a trend toward failure with steroid use before hospital admission: AOR 3.83 [0.96-16.66]. CONCLUSION: Success of HFNO, when all therapeutic means of treatment for severe COVID-19 pneumonia were applied, was associated with tocilizumab administration. Our data suggest the interest of a randomized study to determine whether HFNO is the right signal for prescription of anti-IL6 drugs.

[Cognitive decline in geriatric oncology: Trends, evaluation and treatment]. / Cancer de la personne âgée : rechercher, évaluer et prendre en charge le déclin cognitif.

Cancer prevalence increases with aging. Prevalent or incident neurocognitive disorders are frequent in geriatric oncology. Cognitive decline associated with cancer increases the risk of under or over-cancer treatment and makes therapeutic decisions complex. In this context, we present tools to optimize cognitive impairment screening, identification of underlying mechanisms and specific treatments. Geriatric specialists intervention can help global care, social services utilization and patient's orientation when ambulatory cares become difficult.

Information fusion for diagnosis coding support.

All patient-related medical information during a hospital stay in France, has to be collected and coded in the compilation of medical units discharge documents, according to a standardized approach. The process of describing a patient disease in terms of appropriate diagnostic codes is nevertheless, a non-intuitive operation for the physician. As a consequence, coding errors, inaccuracies and missing data are frequent, leading to potentially severe economical upshots. A coding support system developed to improve medical coding results, integrates three information processing methodologies, using the outputs from various Hospital Information System applications. Each methodology generates partial heterogeneous information, with considerable semantic variety. In order to properly synthesize these outputs, information fusion is required to produce enriched contextualized information, presented to the physician as an ordered list of suggested codes. This paper explores two information fusion approaches: voting system and possibilistic. Both methods are tested on a database of 1,000 discharge summaries, to show the interest of information fusion in this context. Results show that fusion methods perform better in most of the cases than partial information extraction methods.

ANTEROCOD: actuarial survival curves applied to medical coding support for chronic diseases.

For the practitioner, choosing diagnosis codes is a non-intuitive operation. Mistakes are frequent, causing severe consequences on healthcare performance evaluation and funding. French physicians have to assign a code to all their activities and are frequently prone to these errors. Given that most of the time and particularly for chronic diseases indexed information is already available, we propose a tool named AnterOcod, in order to support the medical coding task. It suggests the list of most relevant plausible codes, predicted from the patient's earlier hospital stays, according to a set of previously utilized diagnosis codes. Our method applies the estimation of code reappearance rates, based on an equivalent approach to actuarial survival curves. Around 33% of the expected correct diagnosis codes were retrieved in this manner, after evaluating 998 discharge abstracts, significantly improving the coding task.

[Hypothyroidism as the result of drug interaction between ferrous sulfate and levothyroxine]. / Hypothyroïdie secondaire à une interaction médicamenteuse entre lévothyroxine et sels de fer.

We report a case of drug-drug interaction between ferrous sulfate and l-thyroxin. A 95-year-old woman treated successfully with l-thyroxin for many years received ferrous sulfate for anemia. This association led rapidly to recurrence of hypothyroidism with elevated serum than TSH level which completely resolved after withdrawal of iron therapy. Interaction was confirmed after both drugs were daily administrated separately without recurrence of hypothyroidism.

REFEROCOD: a probabilistic method to medical coding support.

Choosing diagnosis codes is a non-intuitive operation for the practitioner. Mistakes are frequent with severe consequences on healthcare evaluation and funding. French physicians have to assign a code for everything they do and they are not spared with these kinds of errors. We propose a tool named REFEROCOD to support the medical coding task in order to minimize errors without losing time, by suggesting a list of codes in accordance with the physician activities and of the patient medical context. The proposed method uses probabilistic knowledge and indicates the probability to have a proper diagnosis code considering the realized procedure, age, sex and other information available in the discharge abstract.

Olfactory esthesioneuroma: a report of 40 cases.

Olfactory esthesioneuroma is a rare malignant tumor arising in the olfactory epithelium. Forty cases observed at the Institut Gustave-Roussy from 1956 to 1987 are reported. This tumor usually grows slowly and is usually local, but it is important to be aware of the possibility of lymph node involvement (17%) and, particularly, of rapid development of distant metastases (25%), usually within 6 months. CT scan, and more recently, NMR have proved to be of value in choosing the surgical approach. In view of the usual point of departure, a combined neurosurgical and transfacial approach seems to be a satisfactory approach for obtaining oncological control of the lesion. The role of chemotherapy is discussed. The main prognostic factors seem to be the size of the lesion, the intracranial extension, and the lymph node involvement.

[The association of megaesophagus, Binder's syndrome and dysautonomia: a new neurocristopathy]. / Association méga-oesophage, syndrome de Binder et dysautonomie: une nouvelle neurocristopathie?

A case of esophageal achalasia is reported in a 12 year-old child. Nasal hypoplasia (Binder syndrome) and dysautonomia were associated. This may be explained by the common embryologic origin (neural crests) of nasal bud, autonomic nervous system and digestive intramural neurons. Such a neurocristopathy suggests exploration of the autonomic nervous system in cases of esophageal achalasia.

[Fibrous dysplasia and ossifying fibroma of the base of the skull. Apropos of 6 cases]. / Dysplasie fibreuse et fibrome ossifiant de la base du crane. A propos de 6 cas.

The authors report 6 cases of fibrous dysplasia (F.D.) of the base of the skull and review the literature. They confirm the impossibility of histological differentiation between ossifying fibroma and monostic dysplasia with cranio-facial sites. They stress the value of CAT scan in the assessment of spread and that of dynamic isotope scan in the differential diagnosis with plaque-shaped hyperostotic meningioma, in the diagnosis of polyostotic forms and in postoperative surveillance. They stress the risk of visual sensorial impairment: visual by stenosis of the optic canals and auditory by stenosis of the E.A.M. Operative indications are influenced by this risk, thereby explaining the need for prolonged surveillance.

[Olfactory esthesioneuroma. Clinical description and therapeutic results apropos of 45 cases observed at the Gustave Roussy Institute from 1956 to 1986]. / Esthésioneurome olfactif. Présentation clinique et résultats thérapeutiques à propos de 45 cas observés à l'Institut Gustave-Roussy de 1956 à 1986.

Olfactory esthesioneuroma is a rare malignant nerve tumour of the nasal fossa, generally developing from the olfactory epithelium, 45 cases seen at the Gustave-Roussy Institute between 1956 and 1986 are studied. From a clinical standpoint, this tumour usually progresses slowly and essentially locally, but it is important to be aware of the possibility of a rapid progression with diffuse bone metastases. The diagnosis, borne in mind of the presence of any tumor of the upper part of the nasal fossa, is based upon histo-pathological examination. It has benefitted from the use of new indicators. The role of CAT scan in the evaluation of spread is confirmed in the present series. Treatment is based above all on surgical excision followed by radiotherapy (the neurosurgical approach being of a certain value). The prognosis of these malignant tumors is similar to that of adenocarcinomas of the ethmoid and better than that of squamous carcinomas of the facial bone structure. The role of chemotherapy is discussed.

[Cervicofacial lymphangiomas in children]. / Les lymphangiomes cervico-faciaux chez l'enfant.

Of 41 children, 22 girls and 19 boys, with cervicofacial lymphangioma, 31 had congenital lymphangiomas, 30 lymphangiomas with cervical expression but only 9 were restricted to the neck region. Operation in 35 children showed that in 12 cases the lymphangioma was limited in extent and failed to extend to the neck or parotidojugular region, and excision was complete and there were no recurrences. Partial excision was performed in 23 children in whom the lymphangioma extended to various degrees into the tongue, pharynx or larynx, and tracheotomy was necessary in 10 of these cases. Several operations, and particularly endoscopic resections, are often necessary in this type of dysembryoplasia in order to obtain a sufficient airway. Esthetic results are often disappointing.

[Plunging and mediastinal goiters]. / Les goitres plongeants et médiastinaux.

Of 185 cases of substernal goitre operated upon between 1976 and 1985, four were patients with autonomous mediastinal goitre. Diagnosis was established from results of clinical examination, a scan of mediastinum and radiologie imaging with a cervical and mediastinal CT scan as the investigation of choice. Treatment is exclusively surgical because of the risk of mediastinal compression. Most cases in this series were operated upon through a purely cervical approach, but 22 patients required partial upper sternotomy combined with cervicotomy, this minimal approach route allowing very good exposure of upper mediastinum.

[Mucoceles of the maxillary sinus. Diagnostic and therapeutic problems. Apropos of 5 cases]. / Mucocèles du sinus maxillaire. Problèmes diagnostiques et thérapeutiques. A propos de 5 cas.

Five cases of the rarely observed maxillary sinus mucocele are reported, one patient with bilateral lesions presenting primary dilatation of the bronchi. A previous history of surgery or injury to sinuses was obtained in all cases, the diagnosis being confirmed by computed tomography imaging. Recovery is usually complete after the Caldwell-Luc operation. One case with exclusion of the sinus is described and the literature reviewed.