Prévalence des carences en calcium, 25 (OH)-D et Zinc sur un suivi de 3 ans après une chirurgie bar iatrique de sujets bénéficiant d une supplémentaire standard en vitamines et oligo-éléments

La chirurgie bariatrique est un traitement de première intention en cas d'obésité morbide. Cependant, elle se complique fréquemment de carences nutritionnelles, notamment en calcium, zinc et vitamine D, qui peuvent avoir un impact sur la santé en général et l'homéostasie osseuse. Le but de notre étude était de définir la prévalence de ces carences avant et pendant un suivi maximal de 36 mois après une chirurgie bariatrique. Méthode. Cette étude rétrospective a porté sur une cohorte de 252 français obèses (IMC moyen 46.7 kg/m ) ayant bénéficié soit d'un by-pass gastrique, d'une sleeve-gastrectomy ou d'une diversion biliopancréatique avec duodénal switch. Résultats. En pré-opératoire, 49.6% des sujets sont déficitaires en vitamine D, 39.7% en calcium, 12% en zinc. Les données post-opératoires montrent l'aggravation d'une carence en 25(OH)-D et en zinc chez respectivement 49.2 et 47.4% d'entre eux, 12 mois après la chirurgie et respectivement 56.6 et 36.8% d'entre eux 24 mois après la chirurgie, quelque soit la procédure chirurgicale et malgré la prise d' une supplémentation vitaminique. La fréquence de l'hyperparathyroidie secondaire est stable alors que la carence calcique s'aggrave touchant 56% des sujets à 3 ans. Les carences sont plus fréquentes après une chirurgie malabsorptive pure (DS), malgré une prescription spécifique adaptée (65 et 95% de carence en calcium et en zinc à 12 mois). La prescription de la supplémentation vitaminique est qualitativement inadéquate après GBP et SG, et insuffisante après DS pour corriger ces carences. Conclusion. Notre étude montre l'importance de futures études interventionnelles pour définir précisément le type et la quantité de suppléments vitaminiques nécessaires après une chirurgie bariatrique, selon la procédure chirurgicale réalisée.ANGERS-BU Médecine-Pharmacie (490072105) / SudocSudocFranceF

Protectiveness, morphology and composition of corrosion products formed on carbon steel in the presence of Cl⁻, Ca²⁺ and Mg²⁺ in high pressure CO₂ environments

This study investigates the individual effects of chloride (Cl⁻), calcium (Ca²⁺), and magnesium (Mg²⁺) ions on the CO₂ corrosion behaviour of carbon steel in simulated CO₂ geologic storage environments (60 °C and 100 bar CO₂). The influence of the aforementioned ions was assessed over immersion times from 6 to 96 h. The corrosion product growth was monitored over this period and related to the extent of both general and localised corrosion. For each test, corrosion product morphology and chemistry were analysed using a combination of scanning electron microscopy (SEM), focused ion beam (FIB) method, energy-dispersive X-ray spectroscopy (EDX) and X-ray diffraction (XRD)

Relationship between obesity and severe COVID ‐19 outcomes in patients with type 2 diabetes: Results from the CORONADO study

International audienceAim: To assess the relationship between body mass index (BMI) classes and early COVID-19 prognosis in inpatients with type 2 diabetes (T2D).Methods: From th e CORONAvirus-SARS-CoV-2 and Diabetes Outcomes(CORONADO) study, we conducted an analysis in patients with T2D categorized by four BMI subgroups according to the World Health Organization classification. Clinical characteristics and COVID-19–related outcomes (i.e. intubation for mechanical ventilation [IMV], death and discharge by day 7 [D7]) were analysed according to BMI status.Results: Among 1965 patients with T2D, 434 (22.1%) normal weight (18.5-24.9 kg/m2, reference group), 726 (36.9%) overweight (25-29.9 kg/m2) and 805 (41.0%) obese subjects were analysed, including 491 (25.0%) with class I obesity (30-34.9 kg/m2) and 314 (16.0%) with class II/III obesity (≥35 kg/m2). In a multivariable-adjusted model, the primary outcome (i.e. IMV and/or death by D7) was significantly associated with overweight (OR 1.65 [1.05-2.59]), class I (OR 1.93 [1.19-3.14]) and class II/III obesity (OR 1.98 [1.11-3.52]). After multivariable adjustment, primary outcome by D7 was significantly associated with obesity in patients aged younger than 75 years, while such an association was no longer found in those aged older than 75 years.Conclusions: Overweight and obesity are associated with poor early prognosis in patients with T2D hospitalized for COVID-19. Importantly, the deleterious impact of obesity on COVID-19 prognosis was no longer observed in the elderly, highlighting the need for specific management in this population

Use of dipeptidyl peptidase-4 inhibitors and prognosis of COVID-19 in hospitalized patients with type 2 diabetes: A propensity score analysis from the CORONADO study

International audienceAim: To investigate the association between routine use of dipeptidyl peptidase-4 (DPP-4) inhibitors and the severity of coronavirus disease 2019 (COVID-19) infection in patient with type 2 diabetes in a large multicentric study. Materials and Methods: This study was a secondary analysis of the CORONADO study on 2449 patients with type 2 diabetes (T2D) hospitalized for COVID-19 in 68 French centres. The composite primary endpoint combined tracheal intubation for mechanical ventilation and death within 7 days of admission. Stabilized weights were computed for patients based on propensity score (DPP-4 inhibitors users vs. non-users) and were used in multivariable logistic regression models to estimate the average treatment effect in the treated as inverse probability of treatment weighting (IPTW). Results: Five hundred and ninety-six participants were under DPP-4 inhibitors before admission to hospital (24.3%). The primary outcome occurred at similar rates in users and non-users of DPP-4 inhibitors (27.7% vs. 28.6%; p = .68). In propensity analysis, the IPTW-adjusted models showed no significant association between the use of DPP-4 inhibitors and the primary outcome by Day 7 (OR [95% CI]: 0.95 [0.77-1.17]) or Day 28 (OR [95% CI]: 0.96 [0.78-1.17]). Similar neutral findings were found between use of DPP-4 inhibitors and the risk of tracheal intubation and death. Conclusions: These data support the safety of DPP-4 inhibitors for diabetes management during the COVID-19 pandemic and they should not be discontinued

Type 1 Diabetes in People Hospitalized for COVID-19: New Insights From the CORONADO Study

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The association between macrovascular complications and intensive care admission, invasive mechanical ventilation, and mortality in people with diabetes hospitalized for coronavirus disease-2019 (COVID-19)

International audienceAbstract Background It is not clear whether pre-existing macrovascular complications (ischemic heart disease, stroke or peripheral artery disease) are associated with health outcomes in people with diabetes mellitus hospitalized for COVID-19. Methods We conducted cohort studies of adults with pre-existing diabetes hospitalized for COVID-19 infection in the UK, France, and Spain during the early phase of the pandemic (between March 2020—October 2020). Logistic regression models adjusted for demographic factors and other comorbidities were used to determine associations between previous macrovascular disease and relevant clinical outcomes: mortality, intensive care unit (ICU) admission and use of invasive mechanical ventilation (IMV) during the hospitalization. Output from individual logistic regression models for each cohort was combined in a meta-analysis. Results Complete data were available for 4,106 (60.4%) individuals. Of these, 1,652 (40.2%) had any prior macrovascular disease of whom 28.5% of patients died. Mortality was higher for people with compared to those without previous macrovascular disease (37.7% vs 22.4%). The combined crude odds ratio (OR) for previous macrovascular disease and mortality for all four cohorts was 2.12 (95% CI 1.83–2.45 with an I 2 of 60%, reduced after adjustments for age, sex, type of diabetes, hypertension, microvascular disease, ethnicity, and BMI to adjusted OR 1.53 [95% CI 1.29–1.81]) for the three cohorts. Further analysis revealed that ischemic heart disease and cerebrovascular disease were the main contributors of adverse outcomes. However, proportions of people admitted to ICU (adjOR 0.48 [95% CI 0.31–0.75], I 2 60%) and the use of IMV during hospitalization (adjOR 0.52 [95% CI 0.40–0.68], I 2 37%) were significantly lower for people with previous macrovascular disease. Conclusions This large multinational study of people with diabetes mellitus hospitalized for COVID-19 demonstrates that previous macrovascular disease is associated with higher mortality and lower proportions admitted to ICU and treated with IMV during hospitalization suggesting selective admission criteria. Our findings highlight the importance correctly assess the prognosis and intensive monitoring in this high-risk group of patients and emphasize the need to design specific public health programs aimed to prevent SARS-CoV-2 infection in this subgroup