J Clin Immunol

We report a longitudinal analysis of the immune response associated with a fatal case of COVID-19 in Europe. This patient exhibited a rapid evolution towards multiorgan failure. SARS-CoV-2 was detected in multiple nasopharyngeal, blood, and pleural samples, despite antiviral and immunomodulator treatment. Clinical evolution in the blood was marked by an increase (2–3-fold) in differentiated effector T cells expressing exhaustion (PD-1) and senescence (CD57) markers, an expansion of antibody-secreting cells, a 15-fold increase in γδ T cell and proliferating NK-cell populations, and the total disappearance of monocytes, suggesting lung trafficking. In the serum, waves of a pro-inflammatory cytokine storm, Th1 and Th2 activation, and markers of T cell exhaustion, apoptosis, cell cytotoxicity, and endothelial activation were observed until the fatal outcome. This case underscores the need for well-designed studies to investigate complementary approaches to control viral replication, the source of the hyperinflammatory status, and immunomodulation to target the pathophysiological response. The investigation was conducted as part of an overall French clinical cohort assessing patients with COVID-19 and registered in clinicaltrials.gov under the following number: NCT04262921

Treatment of peritonitis in France: Comparative cost-effectiveness of the association imipenem-cilastatin and other antibiotic therapy

National audienceImipeneme, a molecule chemically related to the carbapenems (beta-lactam), is a potent wide spectrum antibiotic reserved for hospital use. Effective as therapy for major infections, and for use in severely debilitated patients (immunodepressed, etc...) its efficacy in the treatment of peritonitis has been demonstrated in numerous studies abroad, confirmed by results of a French multicenter trial in 1989. Its cost-effectiveness ratio was assessed as excellent in a comparative case-controlled study of totally matched patients treated with other antibiotics. As expected, the cost of the treatment itself (imipeneme/cilastatine plus associated products and costs of their administration) was higher by about 1000 F per patient when compared with other antibiotic regimens, but its markedly superior efficacy allowed overall economies ofabout four and a half times this sum (4300 F). This cost reduction was related to different factors, some of which could not be individualized because of missing data (personnel) or protocol bias (laboratory examinations). Nevertheless, the global result was a shortening of hospital stay by more than two days due to a very pronounced decrease in failure rate of the first treatment. This result is even more remarkable in that the peritonitis treated by Tienam was significantly more severe than that treated by the other antibiotics

Pharmacoeconomic Considerations in Assessing and Selecting Congestive Heart Failure Therapies

International audienceOver the last two decades the incidence of congestive heart failure (CHF) has increased with aging of the population and in spite of the decline in age-adjusted mortality rates due to coronary heart disease. Its management has seen substantial progress, embodied in the introduction of ACE inhibitors, initially as part of triple therapy in which they complemented diuretics and digoxin, and latterly as first-line therapy. The current consensus on treatment of CHF has been based on the multiple clinical studies performed with ACE inhibitors in which these agents have been shown to prevent a new cardiovascular accident and/or progression to more severe CHF in an increasingly wide range of patients with symptomatic CHF or post-infarction left ventricular dysfunction (ejection fraction ≤ 40% in some trials or ≤ 35% in others). Not only have the results shown a marked decrease in all-cause (and especially cardiovascular) mortality, but also a great number of cost-effectiveness analyses have shown the advantages of ACE inhibitors in terms of resource allocation: they are either cost saving or convincingly cost effective compared with standard treatment with digoxin and diuretics. Other drugs require similar cost and clinical analyses before they can earn their place in an add-on strategy. To date, cost savings have been documented only for β-blockers; implantable devices are still undergoing assessment. Two trends are now competing: one is to downplay add-on strategies and to recommend first-line therapy with ACE inhibitors and β-blockers at effective doses, supplemented by a raft of non-pharmaceutical measures (specialist nurses, patient education, dietary advice, exercise) in a multidisciplinary approach to CHF; the second is, on the contrary, to prescribe up to five drugs for patients with advanced CHF. The evidence that this decreases hospital admission rates and patient cost is more than anecdotal, but conclusive proof of cost effectiveness is still lacking and the approach presupposes dedicated structures. This review argues that despite technical limitations, a combined approach of CHF therapy based on clinical trials and cost-effectiveness analyses is essential. However, improvements can be made. The absence of sufficient comparative data still makes it difficult to choose between drugs within the same class; institutional purchasers need to conduct such analyses to identify the drugs best suited to their patients' profiles and budgetary constraints

Pharmacoeconomic Considerations in Assessing and Selecting Congestive Heart Failure Therapies

Over the last two decades the incidence of congestive heart failure (CHF) has increased with aging of the population and in spite of the decline in age-adjusted mortality rates due to coronary heart disease. Its management has seen substantial progress, embodied in the introduction of ACE inhibitors, initially as part of triple therapy in which they complemented diuretics and digoxin, and latterly as first-line therapy. The current consensus on treatment of CHF has been based on the multiple clinical studies performed with ACE inhibitors in which these agents have been shown to prevent a new cardiovascular accident and/or progression to more severe CHF in an increasingly wide range of patients with symptomatic CHF or post-infarction left ventricular dysfunction (ejection fraction ≤ 40% in some trials or ≤ 35% in others). Not only have the results shown a marked decrease in all-cause (and especially cardiovascular) mortality, but also a great number of cost-effectiveness analyses have shown the advantages of ACE inhibitors in terms of resource allocation: they are either cost saving or convincingly cost effective compared with standard treatment with digoxin and diuretics. Other drugs require similar cost and clinical analyses before they can earn their place in an add-on strategy. To date, cost savings have been documented only for β-blockers; implantable devices are still undergoing assessment. Two trends are now competing: one is to downplay add-on strategies and to recommend first-line therapy with ACE inhibitors and β-blockers at effective doses, supplemented by a raft of non-pharmaceutical measures (specialist nurses, patient education, dietary advice, exercise) in a multidisciplinary approach to CHF; the second is, on the contrary, to prescribe up to five drugs for patients with advanced CHF. The evidence that this decreases hospital admission rates and patient cost is more than anecdotal, but conclusive proof of cost effectiveness is still lacking and the approach presupposes dedicated structures. This review argues that despite technical limitations, a combined approach of CHF therapy based on clinical trials and cost-effectiveness analyses is essential. However, improvements can be made. The absence of sufficient comparative data still makes it difficult to choose between drugs within the same class; institutional purchasers need to conduct such analyses to identify the drugs best suited to their patients' profiles and budgetary constraints.nonouirechercheInternationa

Gort (Michael) - Diversification and integration in American industry.

Lévy Emile. Gort (Michael) - Diversification and integration in American industry.. In: Revue économique, volume 15, n°4, 1964. pp. 660-662

Signification et perspectives de 'l'Economie sociale

Social economics: meaning and prospects Is Social Economics a new scientific branch, with a specifie object and specific methods ? Different criteria can be advanced in order to precise the border line between the economic and the social aspect. But none of them can be sufficient, even if all contribute to enlight this distinction. Because there is a very strong imbrication between these two aspects of collective life, and because this opposition has only an historical sense, social economics have to express this overlapping. Social economics can be defined by their analytical object (the group concerned, the objectives pursued through social welfare services the adjustment processes from means to objectives) and also by their methods and their multidisciplinary aspect. Their present orientations are : welfare concepts and measurements (social indicators, social accounting), decision~waking studies and system analysis on social problems, social long-range planning. And all that shows the increasing analytical aspect of social economics and, at the same fime, their deeply political character.Signification et perspectives de l'economie sociale Ce que l'on désigne aujourd'hui par les termes d'économie sociale permet-il de définir le champ d'investigation et les méthodes d'analyse spécifiques d'une nouvelle discipline ? Après avoir passé en revue les différents critères qui peuvent fonder la distinction entre l'économique et le social, on constate qu'aucun d'eux ne fournit le principe d'une opposition claire, mais que tous contribuent à en souligner un aspect. En fait il y a une très grande imbrication entre ces deux formes de la vie collective, leur distinction n'ayant qu'une signification relative et historique ; et l'économie sociale entend précisément traduire cette imbrication. Elle peut être définie tant par son domaine d'analyse (agents concernés, finalités de l'action collective visées, processus d'ajustement des moyens aux fins) que par ses méthodes et son caractère multidisciplinaire. Quant à ses orientations actuelles, les principales se situent sur le plan de l'analyse et des mesures du bien-être (indicateurs sociaux, comptes sociaux), celui des études décisionnelles et des analyses de système à but cognitif, celui de la prospective et de la planification sociales. Ce qui permet de définir l'économie sociale par son caractère de plus en plus analytique (au sens élargi) et tout à la fois par son orientation profon­dément politique.Lévy Emile. Signification et perspectives de 'l'Economie sociale. In: Revue économique, volume 25, n°4, 1974. pp. 547-577

Gort (Michael) - Diversification and integration in American industry.

Lévy Emile. Gort (Michael) - Diversification and integration in American industry.. In: Revue économique, volume 15, n°4, 1964. pp. 660-662

Goldsmith (Raymond W.) - The national wealth of the United States in the postwar period.

Lévy Emile. Goldsmith (Raymond W.) - The national wealth of the United States in the postwar period.. In: Revue économique, volume 16, n°1, 1965. pp. 167-168

Avertissement

Lévy Emile. Avertissement. In: Politiques et management public, vol. 3, n° 4, 1985. Numéro spécial - Innovations et régulations dans les systèmes de santé (France - USA) (Numéro préparé par Emile Lévy et Béatrice Majnoni d'Intignano) sous la direction de Emile Lévy et Béatrice Majnoni d'Intignano. p. 3