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

Design, synthesis and evaluation of new supramolecular assemblies : quantification and diagnosis for tumoral angiogenesis

Actuellement, il n’existe pas de techniques fiables pour la détection de marqueurs du cancer ou le suivi de l’administration de médicaments tels que les anticorps monoclonaux. Cette détection est essentielle pour réaliser un diagnostic précoce et ainsi améliorer le pronostic de survie des patients, et d’autre part adapter la posologie et un traitement personnalisé à chaque patient. L’objectif majeur de ce travail a été de concevoir et de développer des systèmes dits biocapteurs répondant à ces problématiques : d’une part, la détection et la quantification de l’activité des métalloprotéinases matricielles (MMP) en tant que nouvel outil de diagnostic de la progression et du développement tumoral; et d’autre part, le dosage d’un anticorps anti-VEGF, le bevacizumab, impliqué dans les biothérapies antiangiogéniques. La quantification de l’activité métalloprotéasique a été rendue possible grâce à la conception d’un biocapteur basé sur un édifice supramoléculaire. Celui-ci est constitué de substrats peptidiques fluorogéniques des MMP et d’une surface fonctionnalisée par des cyclodextrines. Une détection par fluorescence a alors permis d’évaluer l’efficacité et la spécificité de ce système à quantifier l’activité des MMP in vitro et ex vivo en conditions de biopsie tumorale. D’autre part, nous avons conçu des biocapteurs basés sur un mime peptidique du VEGF, permettant le dosage du bevacizumab. L’utilisation de ce mime en remplacement du VEGF humain a été démontrée, et plusieurs systèmes supramoléculaires fonctionnalisés par ce peptide ont été synthétisés, en vue de la conception d’une plateforme de détection régénérable des interactions peptide/protéine par transduction acoustique.Nowadays, there are no reliable techniques for detecting biomarkers of cancer or for monitoring therapeutic drugs such as monoclonal antibodies in blood samples. This detection is essential in order to highlight the early onset of a disease prior to the appearance of clinical symptoms and therefore ensure a greater therapeutic effect, but also to provide a personalized treatment for each patient. The major goal of this thesis work was to design and develop plateforms of detection called biosensors answering these problematics: on one hand, detection and monitoring of matrix metalloproteinases (MMP) activities as a new tool for the diagnosis of tumoral progression, and on the other hand, quantification of an anti-VEGF antibody named bevacizumab, involved in antiangiogenic therapies. Monitoring of MMP activities was made possible by the design of a biosensor based on a supramolecular assembly between fluorogenic susbtrates of MMP and cyclodextrins functionalized surface. Fluorescence detection has enabled to evaluate the efficacity and specificity of this system to quantify MMP activities in vitro and ex vivo in tumoral biopsy conditions. On the other hand, we have designed biosensors based on a cyclopeptide mimicking human VEGF for the monitoring of bevacizumab. The ability of this peptide to substitute the human protein has been demonstrated and several supramolecular assemblies functionalized by this peptide have been synthesized in order to create a regenerable biosensor screening peptide/protein interactions by acoustic transduction

Conception, synthèse et évaluation de nouveaux édifices supramoléculaires : dosages et diagnostics pour l'angiogenèse tumorale

Nowadays, there are no reliable techniques for detecting biomarkers of cancer or for monitoring therapeutic drugs such as monoclonal antibodies in blood samples. This detection is essential in order to highlight the early onset of a disease prior to the appearance of clinical symptoms and therefore ensure a greater therapeutic effect, but also to provide a personalized treatment for each patient. The major goal of this thesis work was to design and develop plateforms of detection called biosensors answering these problematics: on one hand, detection and monitoring of matrix metalloproteinases (MMP) activities as a new tool for the diagnosis of tumoral progression, and on the other hand, quantification of an anti-VEGF antibody named bevacizumab, involved in antiangiogenic therapies. Monitoring of MMP activities was made possible by the design of a biosensor based on a supramolecular assembly between fluorogenic susbtrates of MMP and cyclodextrins functionalized surface. Fluorescence detection has enabled to evaluate the efficacity and specificity of this system to quantify MMP activities in vitro and ex vivo in tumoral biopsy conditions. On the other hand, we have designed biosensors based on a cyclopeptide mimicking human VEGF for the monitoring of bevacizumab. The ability of this peptide to substitute the human protein has been demonstrated and several supramolecular assemblies functionalized by this peptide have been synthesized in order to create a regenerable biosensor screening peptide/protein interactions by acoustic transduction.Actuellement, il n’existe pas de techniques fiables pour la détection de marqueurs du cancer ou le suivi de l’administration de médicaments tels que les anticorps monoclonaux. Cette détection est essentielle pour réaliser un diagnostic précoce et ainsi améliorer le pronostic de survie des patients, et d’autre part adapter la posologie et un traitement personnalisé à chaque patient. L’objectif majeur de ce travail a été de concevoir et de développer des systèmes dits biocapteurs répondant à ces problématiques : d’une part, la détection et la quantification de l’activité des métalloprotéinases matricielles (MMP) en tant que nouvel outil de diagnostic de la progression et du développement tumoral; et d’autre part, le dosage d’un anticorps anti-VEGF, le bevacizumab, impliqué dans les biothérapies antiangiogéniques. La quantification de l’activité métalloprotéasique a été rendue possible grâce à la conception d’un biocapteur basé sur un édifice supramoléculaire. Celui-ci est constitué de substrats peptidiques fluorogéniques des MMP et d’une surface fonctionnalisée par des cyclodextrines. Une détection par fluorescence a alors permis d’évaluer l’efficacité et la spécificité de ce système à quantifier l’activité des MMP in vitro et ex vivo en conditions de biopsie tumorale. D’autre part, nous avons conçu des biocapteurs basés sur un mime peptidique du VEGF, permettant le dosage du bevacizumab. L’utilisation de ce mime en remplacement du VEGF humain a été démontrée, et plusieurs systèmes supramoléculaires fonctionnalisés par ce peptide ont été synthétisés, en vue de la conception d’une plateforme de détection régénérable des interactions peptide/protéine par transduction acoustique

Design, Characterization and evaluation of reusable biosensors allowing the direct monitoring of MMP activities

International audienc

Supramolecular Peptide/Surface Assembly for Monitoring Proteinase Activity and Cancer Diagnosis

International audienceMatrix metalloproteinases (MMP) are a family of proteolytic enzymes, the expression of which in a key step of tumor progression has recently been better defined. The overexpression of one or more MMPs is thus common among malignant tumors. It may characterize tumor progression and help predict its response to chemotherapy. Consequently, the development of a device for measuring MMP activities is an important challenge for diagnosis and prognosis. In this study, we describe an innovative supramolecular peptide/surface assembly for screening MMP activities. This sensor was used to discriminate various MMP activities and to distinguish between invasive and noninvasive cancerous cell suspensions. Our results confirm the proof-of-concept of a powerful tool for the determination of the tumor aggressiveness and a technical building block for future development of MMP lab-on-chip devices

Design, synthesis and biological evaluation of novel 4-alkapolyenylpyrrolo[1,2-a]quinoxalines as antileishmanial agents – Part III

International audienc

Predictive factors for severe long-term chronic kidney disease after acute kidney injury requiring renal replacement therapy in critically ill patients: an ancillary study of the ELVIS randomized controlled trial

International audienceBackground. Acute kidney injury (AKI) requiring renal replacement therapy (RRT) is a serious complication in the ICU that results in increased mortality and risk of chronic kidney disease (CKD). Some studies suggest RRT modality may have an impact on long-term renal recovery after AKI. However, other predictive factors of severe long-term CKD in ICU patients with AKI requiring RRT are unknown. Methods. We performed an ancillary study of the multicenter ELVIS trial in the population with AKI requiring RRT. Patients alive 3 months after RRT initiation were eligible. Serum creatinine levels available at 3, 6 and 12 months and 3 and 5 years were recorded. CKD stage was determined according to the glomerular filtration rate as estimated by the CKD-EPI formula. At each timepoint, two groups of patients were compared, a no/mild CKD group with normal or mildly to moderately decreased renal function (stages 1, 2 and 3 of the international classification) and a severe CKD group (stages 4 and 5). Our objective was to identify predictive factors of severe long-term CKD. Results Of the 287 eligible patients, 183 had follow-up at 3 months, 136 (74.3%) from the no/mild CKD group and 47 (25.7%) from the severe CKD group, and 122 patients at 5 years comprising 96 (78.7%) from the no/mild CKD group and 26 (21.3%) from the severe CKD group. Multivariate analysis showed that a long RRT period was associated with severe CKD up to 12 months (OR M12 = 1.03 95% CI [1.02–1.05] per day) and that a high SOFA score at the initiation of RRT was not associated with severe CKD up to 5 years (OR M60 = 0.85 95% CI [0.77–0.93] per point). Conclusion. Severe long-term CKD was found in 21% of ICU survivors who underwent RRT for AKI. The duration of the RRT in AKI patients was identified as a new predictive factor for severe long-term CKD. This finding should be taken into consideration in future studies on the prognosis of ICU patients with AKI requiring RRT. Trial registration ELVIS trial was registered with ClinicalTrials.gov, number: NCT00875069 (June 16, 2014), and this ancillary study was registered with ClinicalTrials.gov, number: NCT03302624 (October 6, 2017)

Design, synthesis and biological evaluation of novel 4-alkapolyenylpyrrolo[1,2-a]quinoxalines as antileishmanial agents – Part III

International audienc

Pressure-Support Ventilation vs T-Piece During Spontaneous Breathing Trials Before Extubation Among Patients at High Risk of Extubation Failure

International audienceBackgroundSpontaneous breathing trial (SBT) using a T-piece remains the most frequently performed trial before extubation in ICUs.Research QuestionWe aimed at determining whether initial SBT using pressure-support ventilation (PSV) could increase successful extubation rates among patients at high risk of extubation failure.Study Design and MethodsPost hoc analysis of a multicenter trial focusing on reintubation in patients at high-risk of extubation failure. The initial SBT was performed using PSV or T-piece according to the physician/center decision. The primary outcome was the proportion of patients successfully extubated 72 hours after initial SBT, that is, extubated after initial SBT and not reintubated within the following 72 hours.ResultsAmong the 641 patients included in the original study, initial SBT was performed using PSV (7.0 cm H2O in median without positive end-expiratory pressure) in 243 patients (38%) and using a T-piece in 398 patients (62%). The proportion of patients successfully extubated 72 hours after initial SBT was 67% (162/243) using PSV and 56% (223/398) using T-piece (absolute difference 10.6%; 95% CI, 2.8 to 28.1; P = .0076). The proportion of patients extubated after initial SBT was 77% (186/283) using PSV and 63% (249/398) using T-piece (P = .0002), whereas reintubation rates within the following 72 hours did not significantly differ (13% vs 10%, respectively; P = .4259). Performing an initial SBT using PSV was independently associated with successful extubation (adjusted OR, 1.60; 95% CI, 1.30 to 2.18; P = .0061).InterpretationIn patients at high risk of extubation failure in the ICU, performing an initial SBT using PSV may hasten extubation without an increased risk of reintubation