COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Dams select individual morphology but do not modify upstream migration speed of tropical amphidromous gobies

International audienceFish locomotor performance depends on inter-individual morphological differences and influences the response of populations to anthropogenic impacts. Amphidromous gobies, Sicyopterus lagocephalus and Cotylopus acutipinnis can climb up obstacles several metres high, after their arrival in rivers from the ocean. A previous study demonstrated that juveniles of S. lagocephalus performed better than C. acutipinnis when challenged with an artificial climbing ramp, and that individual morphology explained climbing performance for both species. This present study was focused on the effects of two 10-m high dams on the individual morphological selection of these species. We hypothesized that, compared with C. acutipinnis, (a) S. lagocephalus juveniles will reach the dams faster after they arrive in freshwater and (b) their morphology will play a lesser role in their capacity to climb up the dams. Anatomical traits were measured for 186 and 201 S. lagocephalus and 179 and 221 C. acutipinnis captured downstream and upstream of the dams, respectively. The time they spent in freshwater was estimated by examining the microstructures of their otoliths. As expected, S. lagocephalus individuals reached the dams 10–20 days faster than C. acutipinnis, and their morphology upstream and downstream of the dams did not differ, in contrast to C. acutipinnis. Upstream of the dam, C. acutipinnis had a larger pelvic sucker than downstream, confirming experimental observations. It suggests that juveniles of the cosmopolitan S. lagocephalus have more efficient upstream migration capacities than the endemic C. acutipinnis. Moreover, differences in individual morphologies above and below barriers appear efficient for quantifying their impact on upstream migration of amphidromous species

Climbing Waterfalls: How Metabolism and Behavior Impact Locomotor Performance of Tropical Climbing Gobies on Reunion Island

International audienceThe life cycle of gobies of the Sicydiinae subfamily depends on climbing waterfalls. Two sympatric sicydiines species from Reunion Island, Sicyopterus lagocephalus (SIL) and Cotylopus acutipinnis (COA), employ different climbing modes. SIL uses a steady “inching” mode interrupted by short rest periods, whereas COA exhibits short “power-burst” undulatory movements punctuated by longer rest periods. Consequently, we explored the relationship between climbing performance and metabolic activity in these two species. We demonstrated that the two climbing modes are supported by different ecophysiological profiles that promote the interspecific variability of locomotor performance. More specifically, SIL performed better than COA during a climbing experiment because of its inching climbing mode, supported by a generally greater metabolic capacity and a higher potential for oxidative metabolism. Interestingly, we did not detect any difference in metabolic fuel storage and lactate production during climbing in either species, suggesting that these species can maintain fuel reserves and limit lactate accumulation through extensive rest times. Overall, this study provides new insights into the ecophysiology of these two emblematic species and suggests that the better climbing capacity of SIL is supported by its muscular metabolic capacity

Climbing Waterfalls: How Metabolism and Behavior Impact Locomotor Performance of Tropical Climbing Gobies on Reunion Island

The life cycle of gobies of the Sicydiinae subfamily depends on climbing waterfalls. Two sympatric sicydiines species from Reunion Island, Sicyopterus lagocephalus (SIL) and Cotylopus acutipinnis (COA), employ different climbing modes. SIL uses a steady “inching” mode interrupted by short rest periods, whereas COA exhibits short “power-burst” undulatory movements punctuated by longer rest periods. Consequently, we explored the relationship between climbing performance and metabolic activity in these two species. We demonstrated that the two climbing modes are supported by different ecophysiological profiles that promote the interspecific variability of locomotor performance. More specifically, SIL performed better than COA during a climbing experiment because of its inching climbing mode, supported by a generally greater metabolic capacity and a higher potential for oxidative metabolism. Interestingly, we did not detect any difference in metabolic fuel storage and lactate production during climbing in either species, suggesting that these species can maintain fuel reserves and limit lactate accumulation through extensive rest times. Overall, this study provides new insights into the ecophysiology of these two emblematic species and suggests that the better climbing capacity of SIL is supported by its muscular metabolic capacity

Facial Nerve Schwannoma

International audienceBACKGROUND:Benefits and cost-effectiveness of robotic approach for distal pancreatectomy (DP) remain debated. In this prospective study, we aim to compare the short-term results and real costs of robotic (RDP) and laparoscopic distal pancreatectomy (LDP).METHODS:From 2011 until 2016, all consecutive patients underwent minimally invasive DP were included and data were prospectively collected. Patients were assigned in two groups, RDP and LDP, according to the availability of the Da Vinci® Surgical System for our Surgical Unit.RESULTS:A minimally invasive DP was performed in 38 patients with a median age of 61 years old (44-83 years old) and a BMI of 26 kg/m2 (20-31 kg/m2). RDP group (n = 15) and LDP group (n = 23) were comparable concerning demographic data, BMI, ASA score, comorbidities, malignant lesions, lesion size, and indication of spleen preservation. Median operative time was longer in RDP (207 min) compared to LDP (187 min) (p = 0.047). Conversion rate, spleen preservation failure, and perioperative transfusion rates were nil in both groups. Pancreatic fistula was diagnosed in 40 and 43% (p = 0.832) of patients and was grade A in 83 and 80% (p = 1.000) in RDP and LDP groups, respectively. Median postoperative hospital stay was similar in both groups (RDP: 8 days vs. LDP: 9 days, p = 0.310). Major complication occurred in 7% in RDP group and 13% in LDP group (p = 1.000). Ninety-days mortality was nil in both groups. No difference was found concerning R0 resection rate and median number of retrieved lymph nodes. Total cost of RDP was higher than LDP (13611 vs. 12509 €, p < 0.001). The difference between mean hospital incomes and costs was negative in RDP group contrary to LDP group (- 1269 vs. 1395 €, p = 0.040).CONCLUSION:Short-term results of RDP seem to be similar to LDP but the high cost of RDP makes this approach not cost-effective actually

A retrospective multicenter analysis on redo-laparoscopic anti-reflux surgery: conservative or conversion fundoplication?

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