Increased in-hospital mortality from COVID-19 in patients with schizophrenia.

BACKGROUND: There is limited information describing the presenting characteristics and outcomes of patients with schizophrenia (SCZ) requiring hospitalization for coronavirus disease 2019 (COVID-19). AIMS: We aimed to compare the clinical characteristics and outcomes of COVID-19 SCZ patients with those of non-SCZ patients. METHOD: This was a case-control study of COVID-19 patients admitted to 4 AP-HM/AMU acute care hospitals in Marseille, southern France. COVID-19 infection was confirmed by a positive result on polymerase chain reaction testing of a nasopharyngeal sample and/or on chest computed scan among patients requiring hospital admission. The primary outcome was in-hospital mortality. The secondary outcome was intensive care unit (ICU) admission. RESULTS: A total of 1092 patients were included. The overall in-hospital mortality rate was 9.0%. The SCZ patients had an increased mortality compared to the non-SCZ patients (26.7% vs. 8.7%, P=0.039), which was confirmed by the multivariable analysis after adjustment for age, sex, smoking status, obesity and comorbidity (adjusted odds ratio 4.36 [95% CI: 1.09-17.44]; P=0.038). In contrast, the SCZ patients were not more frequently admitted to the ICU than the non-SCZ patients. Importantly, the SCZ patients were mostly institutionalized (63.6%, 100% of those who died), and they were more likely to have cancers and respiratory comorbidities. CONCLUSIONS: This study suggests that SCZ is not overrepresented among COVID-19 hospitalized patients, but SCZ is associated with excess COVID-19 mortality, confirming the existence of health disparities described in other somatic diseases.

Peripherally inserted central catheters: a hidden emerging cause of infection outbreaks.

In our institution, between January 2010 and December 2017, 15 140 peripherally inserted central catheters (PICCs) were inserted in 12 314 patients. Using time-series analysis to evaluate the annual historical trend (AHT), we observed a significant increase in bloodstream infections (BSIs; AHT = 24; p < 0.001) and associated deaths (AHT = 3; p 0.02) in patient with PICCs. The risk of experiencing a BSI was significantly higher in patients with PICCs (odds ratio = 9.6; 95% confidence interval, 9.08-10.18; p < 0.001). To reduce PICC-related BSIs and their related mortality, it is important to limit the overuse of PICCs and to implement a 'no PICC' policy by limiting the insertion of PICCs to situations without other available options.

Do we need new antibiotics?

For several years, alarmist articles both in mass media and in the scientific community have reported an increase in antibiotic resistance, even citing an inability to treat patients infected with multidrug-resistant bacteria (MDR) responsible for high mortality worldwide. In this review we summarize and discuss the key points associated with the reality of (i) the existence of pandrug-resistant bacteria, (ii) the increase of resistance worldwide, (iii) the link between resistance and death, and (iv) the need to develop new antibiotics. Data on antibiotic resistance in Europe for the main bacteria associated with invasive infections apparently demonstrate that apart from Klebsiella pneumoniae, which is resistant to carbapenems in three countries (Romania, Italy and Greece), the level of resistance to three or more classes of antibiotics (defined as MDR phenotype) has remained low and stable over the last 5 years and that therapeutic options exist both for reference antibiotics and for old antibiotics. The clinical outcome of patients infected by MDR bacteria remains controversial and death rates attributable to MDR bacteria versus non-MDR bacteria are still debated. The arsenal of antibiotics currently available (including 'old antibiotics') suffices for facing the waves of emergence of new bacterial resistance and should be considered as a World Heritage. This heritage should be managed in a non-profit model with international regulatory approval.

[The incidence of the child psychic handicap in the department of Var in 2001 from CDES files]. / L'incidence du handicap psychique chez l'enfant dans le Var en 2001 à partir des dossiers de la CDES.

BACKGROUND: Thanks to an automated treatment of the medical information of the Departmental Commission of the Special Education in the Var, set up since 1999, under the responsibility of an epidemiologist doctor, it is possible to measure the incidence rates of the children recognized as been handicapped. METHODS: This study is the first one performed on the basis of good-quality and reliable medical and administrative informations. Moreover, this study has yielded thinking on the criteria of handicap definition and nomenclature to be used to define psychic deficiency. RESULTS: The occurrence rate of children recognized as handicapped by the Departmental Commission of the Var is 2.04%. The rate of children with a psychic deficiency recognized by the Commission is 1.25%. These rates are 2.5 times higher among boys than girls. Psychic deficiencies occurs mainly between five and nine years of age, at the entry to the primary school. The western part of the department displays rates of nevrotic, reactional, instrumental functions, and training disorders that are higher than those of the other geographical areas. For the eastern part of the department, the rates of psychoses, pathologies of the personality and evolutionary disorders are the highest. The distribution of declared pathologies probably reflects equipment of the medical sector of childpsychiatry and distribution of the liberal assumptions of responsibility. The geographical area of Draguignan is significantly under-equipped with medico-social structures but is characterized by a high rate of children with a psychic handicap. CONCLUSION: The Law of February 11 2005 for chance and equal right, stipulates a counting of the people affected by handicap and the underlying pathologies, to define the ethiology of the handicap, to improve the accompaniment of those people and to develop actions aimed at reducing the incapacities and at the prevention of risks. It is within the Departmental houses of the handicapped person that the information systems will have to collect a minimum common set of standardized data to meet requirements of the Law of February 2005 and to take part in the planification of the means of medico-social establishment.

Retrovirus-mediated gene transfer of the cytokine genes interleukin-1beta and tumor necrosis factor-alpha into human neuroblastoma cells: consequences for cell line behavior and immunomodulatory properties.

We have investigated the value of a gene therapy approach for neuroblastoma (NB), based on retroviral transduction of the IL-1beta or TNF-alpha cytokine genes into human NB lines. Secretion of the corresponding cytokine, was demonstrated in all lines, although with considerable quantitative variations. Cytokine gene expression significantly reduced the proliferation index (p = 0.0001); this effect was associated with either terminal neuronal (one TNF-alpha line) or fibroblast-like differentiation (two IL-1beta lines), leading to growth arrest after a few weeks. Cell surface levels of CD54 and HLA class II remained unaffected, but HLA class I (p < 0.001) and CD58 expression (p = 0.01) increased on SKNSH after TNF-alpha gene transfer. Mononuclear cells from normal allogeneic donors cocultured with both IL-1beta (p < 0.001) and TNF-alpha lines (p < 0.01), showed a significant increase in the proportion of activated T cells (CD3+DR+); however, their cytotoxicity and proliferation rate remained unchanged. Immunotherapy of neuroblastoma will require identification of transduced lines in which cytokine secretion induces phenotypic changes in such a way as to augment their likely immunomodulatory properties without impeding cell growth. Because of the limited efficacy of IL-1beta or TNF-alpha gene transfer alone, further studies should focus on combination with other immunomodulatory agents, to improve their potential efficacy in neuroblastoma.

[Lower limb morphotypes. A clinical study in 1401 children]. / Morphotypes des membres inférieurs. Etude clinique chez 1401 enfants.

PURPOSE OF THE STUDY: The purpose of this study was to analyse the repartition between femoral anteversion and tibial torsion from birth to ten years of age in children. MATERIAL: One thousand four hundred and one children ranging from 2 to 13 years age were examined in public schools by the same clinician. METHODS: Qualitative data (foot progression angle, hindfoot aspect, knee position during gait) and quantitative data (femoral anteversion, tibial torsion) were clinically quantified. RESULTS: Repartition of femoral and tibial torsion showed four lower limb morphotypes in normal children. CONCLUSION: Four femoral anteversion and tibial torsion associations are encountered in normal children. Age variation of the lower limb orientation leed to have repetitive examinations in children with in or out-toeing gait in order to make distinction between normal and pathologic gait pattern.

Epiphyseal distraction and centrally located bone bar: an experimental study in the rabbit.

The purpose of this study was to analyze the force required for an epiphysiolysis in vitro in the distal femoral growth plate of rabbits with different sized central physeal bone bars. The bars were operatively induced by drilling through the physis. An epiphyseal distraction was then performed, and the response was evaluated. Forty rabbits (67 femurs) divided into five groups were used for experimentation. Group A had not been operated on and manifested no physeal bone bridge. Groups B, C, D, and E manifested some bone bridges obtained surgically by drills 2, 2.5, 3.5, and 4.5 mm in diameter, respectively. The average force required to obtain an epiphysiolysis is not statistically significant in the different groups. However, we noted that the epiphysiolysis differed depending on the diameter of the surgically performed bridge. Group E was Salter-Harris type II fractures, whereas groups A, B, and C were type I fractures. Group D comprised both types.

Utilization of neural network in the elaboration of an evaluation scale for pain in cerebral palsy.

An interesting aspect of neural networks is shown in the elaboration of an evaluation scale for pain in cerebral palsy with severe mental retardation. Because of the diversity of cases, the number of items had to be limited in the final step of statistical validation. Classical analysis on prior data did not allow to decide whether the variability in results is more likely due to the type of disability (i.e., the possibility of pain expression) than to the actual presence of pain. A neural network was used to find implicit relations between the data, with the advantage of having total control on the variables' status by applying variations in the network architecture. This allowed for the rapid identification more significant item combinations as a function of degree of relationship to pain in cerebral palsy.

Experimental basis for autograft growth and viability.

An experimental model has been designed to evaluate the potential of growth of aortic vascular autografts and homografts. In 25 young rabbits a graft interposition was performed at the level of the infrarenal aorta, with micro-surgical techniques. Different groups included fresh autografts, fresh and cryopreserved homografts and controls. Animals were allowed to grow normally and were sacrificed when adult, at the mean weight of 2.99 kg. We studied for each case the growth of the native aorta and that of the graft, and calculated the growth-ratio (growth of the graft/growth of native vessel). Grafts and adjacent aorta were histologically studied. The growth in terms of increase in diameter of the native aorta was identical between the four groups (from 1.97 +/- 0.14 mm to 2.86 +/- 0.23 mm). Growth of the graft was normal (mean growth ratio 1.08 +/- 0.21) for autografts. Growth was absent (mean ratio 0.12 +/- 0.15) for fresh and cryopreserved homografts (p = 0.001). Histologic study showed normal optical microscopic aspects (endothelial layer, intima and media thickness and cellularity) when growth had been normal and, when growth had been absent, aspects compatible with rejection including mainly intima hyperplasia and media attenuation. In conclusion, normal growth of the arterial autografts was confirmed, the histologic features of these grafts were normal, but homologous aortic grafts, fresh or cryopreserved, never showed any growth potential.

[Mediterranean boutonneuse fever as a cause of arthritis and false-positive serology for Borrelia burgdorferi]. / Fiebre botonosa mediterránea como causa de artritis y serología falsamente positiva para Borrelia burgdorferi.

Arthritis is a rare clinical manifestation of Mediterranean boutonneuse [correction of Botonous] Fever (MBF). We present the case of a female patient with MBF who was admitted with an acute monoarthritis with inflammatory fluid and, besides, had a false-positive serology to Borrelia burgdorferi, which we have not found published before. In the scientific literature reviewed we only found 12 cases of MBF and arthritis. We discuss its probable pathogenic mechanism and underline the scarce importance which has been given to this manifestation in the large MBF series.

[Procedures in critical ischemia of the legs in non-emergency situations]. / Conduite à tenir dans les ischémies critiques des membres inférieurs en dehors de l'urgence.

Our experience with 91 operated cases in 84 patients (47 men, 37 women) relates essentially to arterial diseases resulting from overloading and diabetic arteriopathy. Diagnosis of critical ischemia is easy in clinical conditions, but it is advisable to rely on universally recognized hemodynamic standards to define this condition. Ankle pressure should be less than 400 mmHg and the Doppler trace flat or barely perceptible. Patients in our series had a mean ankle pressure of 32.4 mmHg. Local examination can determine the extent of gangrene, whereas general examination detects numerous, often associated defects diabetes, coronary artery disease, rhythm disorders, arterial hypertension, etc. As far as possible, these defects are to be corrected before surgery. X-ray examination (M. Kasbarian) is frequently done in conjunction with conventional aorto-arteriography and digital angiography. The later technique allows arteries to be visualized which are not seen with the conventional technique. The x-ray examination will indicate whether revascularization is feasible, although it cannot show whether it will be efficient. In our series, opacification of the plantar arches was predictive neither of success nor failure. But do tests exist which can predict the success of a revascularization attempt? It would be necessary to be able to estimate ankle pressure after the operation, and several methods have tried to do this. TcPO2 would seem to be a good examination. The possibilities of nuclear magnetic resonance are being studied, and the results thus far are promising. Preoperative explorations are carried out in a different situation. Arteriography performed in the operating room is a simple act which can reveal a usable downstream bed not indicated in preoperative X-rays, although it provides no hemodynamic data. Measurement of peripheral resistances would appear to be a very good predictive examination. Flow measurements by infusion or electronic flowmeter also seem to be predictive for bypass results. Unfortunately, these measurements are at present not widely performed and the critical threshold is assessed differently. Given the difficulty of correctly estimating the value of these numerous methods, many surgeons, ourselves included, have chosen to revascularize patients whenever the upstream bed as evaluated by X-ray indicates the presence of at least one viable artery.