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

Evaluation de la qualité de prise en charge des patients tuberculeux en médecine interne (une étude rétrospective de 40 cas)

Après un rappel épidémiologique sur la tuberculose et un rappel sur les recommandations actuelles concernant la surveillance du patient sous traitement antituberculeux, nous rapportons le suivi de 40 patients dans un service de médecine interne. Notre but a été l'évaluation de la qualité de prise en charge de ces patients afin de pouvoir apporter des améliorations dans le suivi. La moitié de nos patients ont une sérologie VIH positive et la majorité provient de pays à forte endémie de tuberculose. Les faiblesses du suivi concernent la sous-déclaration des cas, l'insuffisance de la surveillance bactériologique pour les tuberculoses pulmonaires bacillifères et le manque d'information des issues de traitement des patients transférés. L'amélioration de ces données devrait permettre d'atteindre l'objectif fixé par l'OMS de 85% d'issue de traitement satisfaisantTuberculosis epidemiology and current recommendations about surveillance of patients under tuberculosis treatment are first reminded. Then, we report a treatment supervision trial of 40 patients. In our trial, half our patients are positive for HIV and most of them are immigrants. The results point out a lack in notification of diagnosed cases, in bacteriology surveillance among pulmonary tuberculosis patients and in treatment outcome data of transferred patients. The improvement of these data should allow to reach the cure rate target of 85% fixed by the WHOPARIS12-CRETEIL BU Médecine (940282101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Perception par les patients séropositifs pour le VIH du rôle et de la prise en charge par leur médecin généraliste (enquête auprès de 106 patients séropositifs du Centre hospitalier intercommunal de Créteil)

PARIS7-Xavier Bichat (751182101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Suivi et analyse des parcours de santé de patients vulnérables dépistés positifs pour les infections virales chroniques

Introduction: Véritable enjeu de santé publique, le dépistage du VIH et des hépatites B et C doit être facilité et étendu à la population générale, notamment pour les personnes en situation de vulnérabilité. Dans le cadre d'un programme de recherche/action nommé PRECA VIR et mené au sein du Pôle d'Accès au Soins de Créteil, un dépistage des infections virales chroniques a été proposé à tous les primo-consultants. La première partie de cette étude a montré la bonne acceptabilité et la forte prévalence chez ces patients fragilisés. Ce travail a consisté à étudier les caractéristiques du parcours de santé des patients dépistés positifs. Matériel et méthodes: Il s'agit d'une étude analytique et descriptive incluant les 96 patients dépistés positifs sur une période de 32 mois, dans le cadre de la première partie de l'étude PRECAVIR. Cette cohorte a été prise en charge à la Permanence d'Accès aux Soins de Santé du Centre Hospitalier Intercommunal de Créteil. Nous avons recueilli les données concernant le suivi médical et le suivi socio-économique à l'inclusion puis à 6 et 12 mois. Résultats: L'étude confirme l'intérêt du dépistage systématiquement proposé à ces personnes vulnérables. Celui-ci permet l'accès aux soins pour plus de 80% des patients de la cohorte. La dynamique d'accè aux soins s'accompagne de l'amélioration de la protection sociale permettant à 63 % des patients une prise en charge médicale dans la durée, avec à terme un relai assuré par les professionnels de santé de ville, pour un suivi partagé. Conclusion: Ce travail montre qu'avec le soutien d'un réseau, le dépistage conduit le plus souvent à l'accès effectif, dans la durée, à un suivi partagé ville/hôpital. Ce programme PRECA VIR doit être poursuivi, renforcé et valorisé.PARIS13-BU Serge Lebovici (930082101) / SudocSudocFranceF

Fabrication of Acrylonitrile-Butadiene-Styrene Nanostructures with Anodic Alumina Oxide Templates, Characterization and Biofilm Development Test for Staphylococcus epidermidis.

Medical devices can be contaminated by microbial biofilm which causes nosocomial infections. One of the strategies for the prevention of such microbial adhesion is to modify the biomaterials by creating micro or nanofeatures on their surface. This study aimed (1) to nanostructure acrylonitrile-butadiene-styrene (ABS), a polymer composing connectors in perfusion devices, using Anodic Alumina Oxide templates, and to control the reproducibility of this process; (2) to characterize the physico-chemical properties of the nanostructured surfaces such as wettability using captive-bubble contact angle measurement technique; (3) to test the impact of nanostructures on Staphylococcus epidermidis biofilm development. Fabrication of Anodic Alumina Oxide molds was realized by double anodization in oxalic acid. This process was reproducible. The obtained molds present hexagonally arranged 50 nm diameter pores, with a 100 nm interpore distance and a length of 100 nm. Acrylonitrile-butadiene-styrene nanostructures were successfully prepared using a polymer solution and two melt wetting methods. For all methods, the nanopicots were obtained but inside each sample their length was different. One method was selected essentially for industrial purposes and for better reproducibility results. The flat ABS surface presents a slightly hydrophilic character, which remains roughly unchanged after nanostructuration, the increasing apparent wettability observed in that case being explained by roughness effects. Also, the nanostructuration of the polymer surface does not induce any significant effect on Staphylococcus epidermidis adhesion

Development and Stability of a New Formulation of Pentobarbital Suppositories for Paediatric Procedural Sedation

Pentobarbital is a drug of choice to limit motion in children during paediatric procedural sedations (PPSs). However, despite the rectal route being preferred for infants and children, no pentobarbital suppositories are marketed, and therefore they must be prepared by compounding pharmacies. In this study, two suppository formulations of 30, 40, 50, and 60 mg of pentobarbital sodium were developed using hard-fat Witepsol® W25 either alone (formulation F1) or with oleic acid (formulation F2). The two formulations were subjected to the following tests described in the European Pharmacopoeia: uniformity of dosage units, softening time, resistance to rupture, and disintegration time. The stability of both formulations was also investigated for 41 weeks of storage at 5 ± 3 °C using a stability-indicating liquid chromatography method to quantify pentobarbital sodium and research breakdown product (BP). Although both formulae were compliant to uniformity of dosage, the results were in favour of a faster disintegration of F2 compared to F1 (−63%). On the other hand, F1 was found to be stable after 41 weeks of storage unlike F2 for which several new peaks were detected during the chromatographic analysis, suggesting a shorter stability of only 28 weeks. Both formulae still need to be clinically investigated to confirm their safety and efficiency for PPS

SEM images of AAO mold.

<p>(A) top view with 50 nm diameters and 100 nm interpore distances (B) cross-section view with pore lengths of about 100 nm</p

Concentration of viable <i>S</i>. <i>epidermidis</i> recovered from biofilm after different incubation times on control and nanostructured with technique 3 ABS samples.

<p>Concentration of viable <i>S</i>. <i>epidermidis</i> recovered from biofilm after different incubation times on control and nanostructured with technique 3 ABS samples.</p

SEM images of AAO mold and nanostructured ABS.

<p>(A) AAO mold; (B) ABS nanostructured with polymer wetting solution (technique 1); (C) Two areas of nanostructured ABS Film (technique 2); (D) Injected ABS nanostructured with heat plate (technique 3)</p

Variation of nanopillar lengths according to duration of melting phase.

<p>Each parameter is given: mean ± SD (CV), n = 30 measurements</p><p>Variation of nanopillar lengths according to duration of melting phase.</p