COVID-19 outpatient management: Shorter time to recovery in Healthcare workers according to an electronic daily symptoms assessment.

OBJECTIVES: Our aim is to compare the course of the disease between healthcare workers (HCWs) and non-HCWs suffering from covid-19 and eligible for outpatient management. METHODS: Single-center prospective cohort of outpatients with covid-19, diagnosed between the 10th March and the 2nd April, 2020 with a daily collection of symptoms by an on-line auto-questionnaire. RESULTS: A total of 186 patients were included (median age, 41 years [interquartile range, 19-78 years]; 74.2% female), of whom 132 (71%) were HCWs. The median follow-up after symptom onset was 14 (min 4-max 24) days. HCWs were significantly younger than non-HCWs (median age 40.3 years vs. 47.2 years [P<0.005]), and 81.8% were women. Four patients (2.2%) were hospitalized including one HCW. The median time to recovery was 9 days after symptom onset (95% CI 8-11) in the global population and respectively 8 (95% CI 8-9) and 13 (95% CI 11-15) days in HCWs and in non-HCWs (P<0.005). After adjusting for age, co-morbidities, and gender, the instantaneous risk ratio for symptom absence in HCWs was 1.76 compared with non-HCWs (95% CI [1.16-2.67], P=0.037). CONCLUSION: HCWs suffering from covid-19 had favorable outcomes and had a shorter time to recovery than non HCWs.

A hidden Markov model approach to neuron firing patterns.

Analysis and characterization of neuronal discharge patterns are of interest to neurophysiologists and neuropharmacologists. In this paper we present a hidden Markov model approach to modeling single neuron electrical activity. Basically the model assumes that each interspike interval corresponds to one of several possible states of the neuron. Fitting the model to experimental series of interspike intervals by maximum likelihood allows estimation of the number of possible underlying neuron states, the probability density functions of interspike intervals corresponding to each state, and the transition probabilities between states. We present an application to the analysis of recordings of a locus coeruleus neuron under three pharmacological conditions. The model distinguishes two states during halothane anesthesia and during recovery from halothane anesthesia, and four states after administration of clonidine. The transition probabilities yield additional insights into the mechanisms of neuron firing.

Chemotherapy of advanced ovarian cancer with 4'-O-tetrahydropyranyl doxorubicin and cisplatin: a randomized phase II trial with an evaluation of circadian timing and dose-intensity.

The efficacy and toxicity of the new anthracycline, 4'-0-tetrahydropyranyl doxorubicin (THP) (50 mg/m2 intravenous [IV] bolus) in association with cisplatin (100 mg/m2 IV as a 4-hour infusion) was assessed in 31 patients with advanced ovarian carcinoma. Twenty-eight patients were assessable for toxicity among whom 25 were assessable for response (International Federation of Gynecology and Obstetrics [FIGO] stage IIIa, four patients; IIIb, 15 patients; IV, six patients). Nine patients had received prior treatment. Patients were randomized to receive schedule (sch) A (THP at 6 hours, then cisplatin from 16 to 20 hours) or sch B (THP at 18 hours, then cisplatin from 4 to 8 hours). Sch A was hypothesized as less toxic since THP was best tolerated in the late rest span and cisplatin near the middle of the activity span in experimental studies. The rate of clinical complete response (CR) was 52%, that of partial response (PR) was 12%, and the overall clinical response rate (CR plus PR) was 64% (sch A, 73%; sch B, 57%). Median progression-free survival and survival times were, respectively, 10 and 19 months. Of 12 patients in clinical CR evaluated at second-look laparotomy, four had a pathological CR (33%), and three had microscopic residual disease (MD). The overall rate of pathological CR was 16%. Sch A was associated with less neutropenia (P = .10), thrombocytopenia (P less than .01), anemia (P less than .01), and renal toxicity (P less than .05) than sch B. Of four patients withdrawn for toxicity, three were on sch B (one death). Mean dose intensities (DIs) of THP and cisplatin, respectively, decreased by 30% and 47% over the five initial courses. Such decrease was significantly more pronounced for sch B than for sch A in previously untreated patients (P from 2-way analysis of variance [ANOVA] less than .01). THP-cisplatin is active against advanced ovarian cancer, and its toxicities can be significantly decreased by dosing THP in the early morning and cisplatin in the late afternoon as compared with THP in the evening and cisplatin the next morning.

[Comparative study of heparin and a very low molecular-weight heparin in hemodialysis in chronic renal insufficiency]. / Etude comparative de l'héparine et d'une héparine de très faible masse moléculaire en hémodialyse dans l'insuffisance rénale chronique.

In the course of dialysis sessions, we have compared the antithrombotic effect of two heparinization regimens: low molecular weight heparin (CY 222, mean molecular weight: 2,500, Institute Choay, France): 90 anti-Xa units/kg bodyweight as a bolus injection followed by a continuous infusion of 1,000 anti-Xa units/hour (regimen 1); or 300 anti-Xa units/kg as a bolus injection (regimen 3), with a standard heparinization regimen (100 IU/kg regimen 2). Eight patients received the 3 regimens successively. Factor IIa and factor Xa inactivation was measured by a method that uses chromogenic substrates. The frequency of adverse effects, ultrafiltration rates, creatinine and BUN clearances of the 3 regimens were similar, whereas dialyser blood loss was higher in the first regimen. At the dose of 300 anti-Xa units of CY 222 (regimen 3), inactivation of factor Xa was similar to Xa inhibition reached through the conventional treatment (regimen 2) but IIa inhibition was less pronounced.

Waldenström macroglobulinemia and nephrotic syndrome with minimal change lesion.

A case of Waldenström macroglobulinemia with nephrotic syndrome is reported. Kidney biopsy, revealing only foot process fusion and response to steroid therapy, fits minimal change disease.

[Cannulation of the internal jugular vein with 2 silastic catheters. A new method of vascular access for hemodialysis]. / La canulation jugulaire interne avec deux cathéters silastic. Une nouvelle méthode d'accès vasculaire pour hémodialyse.

The internal jugular vein cannulation (IJV) using two silastic catheters (CT) is a new vascular access method for temporary and immediate use in hemodialysis. From November 1982 to November 1984, 138 pairs of CT were used in 129 uremic patients for a mean duration of 54 days per patient (1 to 17 months) permitting to carry out more than 3000 dialysis sessions. Five complications were observed: 3 skin exit infections with 2 septicemias cured with antibiotics and CT removal, 2 vascular thrombosis treated with urokinase and anticoagulant; 1 anaphylactoid reaction at the time of insertion. IJV CT offers a convenient alternative to conventional percutaneous vascular access method that can be safely proposed in long term hemodialysis.

[Prostacyclin versus regional heparinisation during haemodialysis (author's transl)]. / Comparaison de la prostacycline et de l'heparinisation régionale au cours de la séance d'hémodialyse.

Ten patients with terminal renal failure underwent two haemodialysis sessions: one with regional heparinisation, the other with prostacyclin (PGI2). The values compared included duration of dialysis, amount of fluid perfused, weight loss, coagulation in the dialyser, side-effects, changes in electrolyte, urea, creatinine and blood gases values and changes in blood count and differential platelet function was included in coagulation studies. The only statistically significant differences recorded concerned weight loss during dialysis (inferior with PGI2) and number of leucocytes after dialysis (superior with PGI2).