Cardiac screening before returning to elite sport after SARS-CoV-2 infection

International audienceBackground: SARS-CoV-2 infection can induce cardiac damage. Therefore, in the absence of clear data, a cardiac evaluation was recommended for athletes before returning to play after recent SARS-CoV-2 infection.Aim: To assess the proportion of anomalies detected by this cardiac screening.Methods: We reviewed the medical files of elite athletes referred for cardiac evaluation before returning to play after a non-hospitalized SARS-CoV-2 infection (based on a positive polymerase chain reaction or antigen test) from March 2020 to July 2021 in 12 French centres.Results: A total of 554 elite athletes (professional or national level) were included (median age 22 years, 72.0% male). An electrocardiogram (ECG), echocardiogram and exercise test were performed in 551 (99.5%), 497 (89.7%) and 293 (52.9%) athletes, respectively. We found anomalies with a potential link with SARS-CoV-2 infection in four ECGs (0.7%), three echocardiograms (0.6%) and three exercise tests (1.0%). Cardiac magnetic resonance imaging was performed in 34 athletes (6.1%), mostly due to abnormal first-line examinations, and was abnormal in one (2.9%). The rates of those abnormalities were not higher among athletes with cardiac symptoms or more severe forms of non-hospitalized SARS-CoV-2 infection. Only one athlete had a possible SARS-CoV-2 myocarditis and sport was temporally contraindicated. None had a major cardiac event declared during the follow-up.Conclusion: The proportion of cardiac involvement after non-hospitalized forms of SARS-CoV-2 infection in athletes are very low. Systematic cardiac screening before returning to play seems to be unnecessary

Impact of COVID-19 lockdown on lifestyle adherence in stay-at-home patients with chronic coronary syndromes: Towards a time bomb

International audienceBackground: We aimed to evaluate the impact of coronavirus disease 2019 (COVID-19)-related lockdown on adherence to lifestyle and drug regimens in stay-at-home chronic coronary syndromes patients living in urban and rural areas.Methods: A cross-sectional population-based study was perfomed in patients with chronic coronary syndromes. A sample of 205 patients was randomly drawn from the RICO (Observatoire des infarctus de Côte d'Or) cohort. Eight trained interviewers collected data by phone interview during week 16 (April 13 to April 19), i.e. 4 weeks after implementation of the French lockdown (start March 17, 2020).Results: Among the 195 patients interviewed (of the 205, 3 had died, 1 declined, 6 lost), mean age was 65.5 ± 11.1 years. Only six patients (3%) reported drug discontinuation, mainly driven by media influence or family members. All 166 (85%) patients taking aspirin continued their prescribed daily intake. Lifestyle rules were less respected since almost half (45%) declared >25% reduction in physical activity, 26% of smokers increased their tobacco consumption by >25%, and 24% of patients increased their body weight > 2 kg. The decrease in physical activity and the increase in smoking were significantly greater in urban patients (P < .05).Conclusions: The COVID-19-related lockdown had a negative impact on lifestyle in a representative sample of stay-at-home CCS patients

Chants d'oiseaux: Document filmique d'un concert du 19 août 2013. <br>: Dix-huitièmes Rencontres d'Aubrac : Imaginaires de l'Eden.

Fonds audiovisuel du programme "ESCoM-AAR" (Equipe Sémiotique Cognitive et nouveaux Médias - Archives Audiovisuelles de la Recherche. Paris, France, 2000 - 2016).Les Rencontres d’Aubrac sont une manifestation internationale originale dans une région du sud de la France – le plateau d’Aubrac – où il est proposé de développer ses connaissances autour d’une thématique traitée par différentes approches sur un mode transversal. Elles sont nées en 1993, à l’initiative de Francis Cransac, alors instituteur en Aveyron, porté par le désir d’échanger des enthousiasmes de lectures d’œuvres dont il pensait qu’on pouvait trouver de singuliers échos au cœur du plateau d’Aubrac, espace géo-poétique fort et révélateur. Avec le thème des "Imaginaires de l'Eden", troisième volet de ce cycle des Rencontres d'Aubrac porté par "l'esprit des lieux", qui nous a fait "revenir" à Jérusalem, puis chercher l'Eldorado, nous tenterons de comprendre ce qui peut bien pousser les mortels que nous sommes à se voir, un jour futur ou déjà ici-bas, en de plus verts pâturages. Au cours de ces journées, nous cheminerons du mythe du bonheur originel, lieu de délices et de perfection, de l'âge d'or perdu, aux représentations des passage vers l'au-delà. Nous irons également vers les lieux d'utopie que l'on pourrait qualifier de quêtes d'Edens "ici et maintenant". De Saint-Urcize à Saint-Chély d'Aubrac en passant par l'église de la Dômerie du XIIe siècle, la Maison de l'Aubrac, le jardin botanique et les jardins privés au coeur du village d'Aubrac, lecteurs, conteurs, musiciens chanteurs, plasticiens, cinéastes, créateurs de goûts créeront des dialogues entre la littérature, la poésie, l'histoire, les religions, la philosophie, l'invitation au voyage, la création artistique, la musique et les saveurs. <br

Low-Flow, Low-Gradient Severe Aortic Stenosis Despite Normal Ejection Fraction Is Associated With Severe Left Ventricular Dysfunction as Assessed by Speckle-Tracking Echocardiography: A Multicenter Study.

Background- Low-flow low-gradient (LFLG) is sometimes observed in severe aortic stenosis (AS) despite normal ejection fraction, but its frequency and mechanisms are still debated. We aimed to describe the characteristics of patients with LFLG AS and assess the presence of longitudinal left ventricular dysfunction in these patients. Methods and Results- In a multicenter prospective study, 340 consecutive patients with severe AS and normal ejection fraction were studied. Longitudinal left ventricular function was assessed by 2D-strain and global afterload by valvulo-arterial impedance. Patients were classified according to flow and gradient: low flow was defined as a stroke volume index ≤35 mL/m(2), low gradient as a mean gradient ≤40 mm Hg. Most patients (n=258, 75.9%) presented with high-gradient AS, and 82 patients (24.1%) with low-gradient AS. Among the latter, 52 (15.3%) presented with normal flow and low gradient and 30 (8.8%) with LFLG. As compared with normal flow and low gradient, patients with LFLG had more severe AS (aortic valve area=0.7±0.12 cm(2) versus 0.86±0.14 cm(2)), higher valvulo-arterial impedance (5.5±1.1 versus 4±0.8 mm Hg/mL/m(2)), and worse longitudinal left ventricular function (basal longitudinal strain=-11.6±3.4 versus -14.8±3%; P<0.001 for all). Conclusions- LFLG AS is observed in 9% of patients with severe AS and normal ejection fraction and is associated with high global afterload and reduced longitudinal systolic function. Patients with normal-flow low-gradient AS are more frequent and present with less severe AS, normal afterload, and less severe longitudinal dysfunction. Severe left ventricular longitudinal dysfunction is a new explanation to the concept of LFLG AS

Activités pharmaceutiques relatives aux essais cliniques de médicaments et dispositifs médicaux réalisées au sein des établissements de santé – guide professionnel

Background and objectivesThe hospital pharmacist, in charge of the pharmaceutical aspects of clinical trials plays a central role in the management and the proper use of investigational health products (IHP), in accordance with the Good Clinical Practices and Public Health Code. The working group “Clinical trials” of the CPCHU (French University Hospitals Pharmacists’ Commission) aimed to prepare national guidelines to describe the activities and involvement of the pharmacists, whatever the type of health care institution.MethodologyAfter an analysis of the existing literature, form and content requirements were set and the structure was established. The chapters were written in subgroups, with systematic revision and validation in plenary.ResultsThe professional guidelines are composed of 109 pages and are available as an interactive pdf file on the SFPC and CNCR websites. Topics covered in the guidelines are divided into 4 chapters, and include inserts of specific recommendations and/or some illustrations. There are 374 references, including 329 regulatory texts, and 5 appendices.Discussion–conclusionThese guidelines are a part of process of dissemination, standardization and securing practices, in order to help hospital pharmacists in the management of IHP and in the development or improvement of their own performance systems in terms of quality. Its pedagogical format also makes it a training tool for students, compounders and senior pharmacists. Its regular updating is necessary

Myocardial expression of a dominant-negative form of Daxx decreases infarct size and attenuates apoptosis in an in vivo mouse model of ischemia/reperfusion injury.

BACKGROUND: Apoptosis has been described extensively in acute myocardial infarction and chronic heart failure. Because Daxx (death-associated protein) appears to be essential for stress-induced cell death and acts as an antisurvival molecule, we tested the hypothesis that Daxx is involved in myocardial ischemia/reperfusion-induced cell death in vivo. METHODS AND RESULTS: Transgenic mice overexpressing a dominant-negative form of Daxx (Daxx-DN) under the control of the beta-actin promoter and control wild-type mice underwent an ischemia/reperfusion protocol: 40 minutes of left coronary artery occlusion and 60 minutes of reperfusion. Area at risk and infarct size were measured after dual staining by triphenyltetrazolium chloride and phthalocyanine blue dye. Apoptosis was measured in the ischemic versus the nonischemic part of the left ventricle by terminal deoxynucleotidyl transferase-mediated dUTP biotin nick end labeling staining, enzyme-linked immunosorbent assay, and Western blotting of caspase-3, caspase-8, and poly(ADP-ribose) polymerase. The mitogen-activated protein kinase status was investigated by Western blot analysis. Comparison between groups was assessed by ANOVA or Student t test (statistical significance: P<0.05). Left ventricle tissues from transgenic mice expressed Daxx-DN at the protein level. Area at risk/left ventricle values were comparable among groups. Infarct size/area at risk was 45% reduced in Daxx-DN versus wild-type mice (P<0.001). This cardioprotection was maintained for a 4-hour reperfusion. Ischemia/reperfusion-induced apoptosis was significantly decreased and ERK1/2 prosurvival pathway was activated in ischemic Daxx-DN hearts. CONCLUSIONS: Our study clearly indicates that Daxx participates in myocardial ischemia/reperfusion proapoptotic signaling in vivo

COVID-19 Lockdown in Patients with Chronic Diseases: A Cross-Sectional Study

International audienceBackground: We aimed to investigate the impact of the first COVID-19 lockdown on medication adherence, physician access, lifestyle behaviours, and mental health in patients with chronic conditions. Methods: A cross-sectional phone survey was conducted in 1274 housebound adults recruited from 8 regional chronic disease cohorts (CLEO CD study: NCT04390126). Results: Medication adherence was 97%; 305 (41%) patients declared that at least one scheduled visit with a physician was missed during the first lockdown. The main changes in lifestyle behaviours were deterioration in sleep time (duration and/or quality; 71%), increase in screen time (46%), and decrease in physical activity (46%). Nineteen percent experienced psychological distress (Kessler-6 score ≥ 5). An urban living place (OR, 1.76 vs. rural; 95% CI, 1.32–2.33; p = 10−4), worse self-reported mental health (OR, 1.62 vs. about the same or better; 95% CI, 1.17–2.25; p = 0.003), and a K6 score ≥ 5 (OR, 1.52 vs. <5; 95% CI, 1.05–2.21; p = 0.03) were independent factors associated with at least one unhealthy behaviour. Conclusions: Encouraging results were observed in terms of medication adherence. Caution is needed in chronic disease patients living in urban places as well as those presenting psychological distress and worse self-reported mental health to reduce unhealthy behaviours

COLIN : intérêt d’un traitement par colchicine dans l’infarctus du myocarde avec réponse inflammatoire

International audienceBackground: Inflammation is involved during acute myocardial infarction, and could be an interesting target to prevent ischaemia-reperfusion injuries. Colchicine, known for its pleiotropic anti-inflammatory effects, could decrease systemic inflammation in this context.Aims: To evaluate the impact of colchicine on inflammation in patients admitted for ST-segment elevation myocardial infarction (STEMI).Methods: All patients admitted for STEMI with one of the main coronary arteries occluded, and successfully treated with percutaneous coronary intervention, were included consecutively. Patients were randomized to receive either 1 mg colchicine once daily for 1 month plus optimal medical treatment or optimal medical treatment only. C-reactive protein (CRP) was assessed at admission and daily until hospital discharge. The primary endpoint was CRP peak value during the index hospitalization.Results: Forty-four patients were included: 23 were treated with colchicine; 21 received conventional treatment only. At baseline, both groups were well balanced regarding age, sex, risk factors, thrombolysis in myocardial infarction flow and reperfusion delay. The culprit artery was more often the left anterior descending artery in the colchicine group (P = 0.07), reflecting a more severe group. There was no significant difference in mean CRP peak value between the colchicine and control groups (29.03 mg/L vs 21.86 mg/L, respectively; P = 0.36), even after adjustment for type of culprit artery (26.99 vs 24.99 mg/L, respectively; P = 0.79).Conclusion: In our study, the effect of colchicine on inflammation in the context of STEMI could not be demonstrated. Further larger studies may clarify the impact of colchicine in acute myocardial infarction.Contexte: L’inflammation, impliquée au cours de l’infarctus du myocarde, pourrait représenter une cible thérapeutique intéressante et limiter les lésions d’ischémie-reperfusion. La colchicine, aux effets anti-inflammatoires pléiotropes, pourrait diminuer l’inflammation systémique au cours de l’infarctus du myocarde.Objectif: Évaluer l’impact de la colchicine sur l’inflammation systémique, dans l’infarctus du myocarde avec sus-décalage du segment ST.Méthodes: Tous les patients admis pour infarctus du myocarde avec occlusion de l’une des trois artères principales traités avec succès par angioplastie primaire étaient inclus de manière consécutive. Ils étaient randomisés pour recevoir 1 mg de colchicine par jour pendant 1 mois, en sus du traitement médical optimal, ou le traitement médical optimal seul. La C-réactive protéine était dosée à l’admission et quotidiennement jusqu’à la sortie. Le critère de jugement principal était le pic de CRP au cours de l’hospitalisation.Résultats: Quarante-quatre patients ont été inclus, 23 ont reçu la colchicine et 21 le traitement conventionnel seul. Les caractéristiques de base étaient comparables entre les 2 groupes concernant l’âge, le sexe, les facteurs de risque cardiovasculaires, le flux TIMI et le délai de reperfusion. L’artère interventriculaire antérieure était le plus souvent l’artère coupable dans le groupe colchicine (p = 0,07) reflétant un groupe plus sévère. Il n’y avait aucune différence significative entre les 2 groupes concernant la valeur du pic de CRP (29,03 mg/L dans le groupe colchicine vs 21,86 mg/L dans le groupe témoin ; p = 0,36), même après ajustement sur le type d’artère coupable (26,99 vs 24,99 mg/L ; p = 0,79).Conclusion: Aucun effet de la colchicine sur l’inflammation systémique dans l’infarctus du myocarde n’a pu être démontré. Des études complémentaires de plus grande envergure apparaissent nécessaires pour clarifier l’impact de la colchicine dans l’infarctus du myocarde

Remdesivir for Patients Hospitalized with COVID-19 Severe Pneumonia: A National Cohort Study (Remdeco-19)

International audienceBackground. Given the rapidly evolving pandemic of COVID-19 in 2020, authorities focused on the repurposing of available drugs to develop timely and cost-effective therapeutic strategies. Evidence suggested the potential utility of remdesivir in the framework of an early access program. REMDECO-19 is a multicenter national cohort study assessing the ability of remdesivir to improve the outcome of patients hospitalized with COVID-19. Methods. We conducted a retrospective real-life study that included all patients from the early access program of remdesivir in France. The primary endpoint was the clinical course evolution of critically ill and hospitalized COVID-19 patients treated with remdesivir. Secondary endpoints were the SOFA score evolution within 29 days following the admission and mortality at 29 and 90 days. Results. Eighty-five patients were enrolled in 22 sites from January to April 2020. The median WHO and SOFA scores were respectively reduced by two and six points between days 1 and 29. Improvement in the WHO-CPS and the SOFA score were observed in 83.5% and 79.3% of patients, respectively, from day 10. However, there was no effect of remdesivir on the 90-day survival based on the control cohort for hospitalized COVID-19 patients with invasive ventilation. Conclusions. SOFA score appeared to be an attractive approach to assess remdesivir efficacy and stratify its utilization or not in critically ill patients with COVID-19. This study brings a new clinical benchmark for therapeutic decision making and supports the use of remdesivir for some hospitalized COVID-19 patients