Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome associated with COVID-19: An Emulated Target Trial Analysis.

RATIONALE: Whether COVID patients may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. OBJECTIVES: To estimate the effect of ECMO on 90-Day mortality vs IMV only Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO vs. no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 <80 or PaCO2 ≥60 mmHg). We controlled for confounding using a multivariable Cox model based on predefined variables. MAIN RESULTS: 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability at Day-7 from the onset of eligibility criteria (87% vs 83%, risk difference: 4%, 95% CI 0;9%) which decreased during follow-up (survival at Day-90: 63% vs 65%, risk difference: -2%, 95% CI -10;5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand, and when initiated within the first 4 days of MV and in profoundly hypoxemic patients. CONCLUSIONS: In an emulated trial based on a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and in regions with ECMO capacities specifically organized to handle high demand. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/)

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 &lt; 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

Communities and sports in Lebanon : stakes in the sports groupings and in the intercommunity meetings

Selon une opinion commune couramment répandue dans les pays occidentaux, le sport institué serait une école d’apprentissage, du sens du collectif, de la solidarité, du partage et des règles de vie : en bref, il socialiserait naturellement les jeunes en les intégrant dans la société. Cette recherche nous a amené à nous intéresser aux formes de socialisation que la société libanaise offre aux « sportifs ». Si le fait de penser le sport d’une part comme apolitique et, d’autre part, comme une passion partagée par l’ensemble de la jeunesse ne date pas d’aujourd’hui, cette question se lit différemment au Liban, pays qui a subi des conflits internes et régionaux depuis plus de 500 ans. Organisé politiquement et socialement en « communautés », le Liban propose ainsi un modèle politique à base religieuse qui imprègne la vie quotidienne des libanais, y compris au sein du monde sportif. Chaque communauté est gouvernée par une autorité spécifique, régie par ses institutions et soumise à une juridiction autonome formée de membres appartenant à la hiérarchie religieuse, à laquelle l’Etat a reconnu la compétence d’appliquer ses lois et coutumes. Mis à l’épreuve du terrain, ce constat est pourtant à relativiser. L’enquête révèle que les clivages communautaires affectent profondément les instances de gestion des fédérations sportives et provoquent une répartition confessionnelle dans les comités de direction. Cependant, dans le sport comme dans d’autres domaines de la vie sociale, la communauté n’est jamais « pure » et l’on observe aussi des coalitions intercommunautaires dans le but de conquérir le pouvoir sportif. Partant d’une approche macrosociologique, la thèse propose d’étudier le regroupement communautaire dans le sport associatif à travers deux monographies de club réalisées à Beyrouth afin d’analyser ces dynamiques confessionnelles: le Ryadi, à dominante confessionnelle musulmane, et son pendant chrétien, le club de la Sagesse. L’analyse sociologique montre à voir deux micro sociétés qui pratiquent « l’entre soi » sportif mais qui, dans le même temps, présentent une ouverture à la rencontre intercommunautaire.According to a common opinion held in Western countries, the Instituted Sport would be a school of learning, sense of community, solidarity, sharing and rules of life; in short, it will socialize young people by integrating them into society. This research draws our attention to the forms of socialization that Lebanese society offers to “athletes”. If the act of thinking about sport first, as a non-political and, secondly, as a passion shared by all of the youth did not start today, this question reads differently in Lebanon, a country that has suffered from internal and regional conflicts for over 500 years. Politically and socially organized in ‘’community’’, Lebanon offer thereby a faith-based political model that permeates daily life, including the sports world. Each community is governed by a specific authority, ruled by its institutions and submitted to a court composed of independent members from the religious hierarchy, in which the state has recognized the jurisdiction to enforce its laws and customs. Tested in the field, the finding is yet to put into perspective. The survey reveals that the communal cleavages deeply affect the management bodies of sports federations and cause a religious breakdown in the management of committees. However, in sport as in other area of social life, the community is never “pure” and there are also inter-community coalitions in order to gain the sport’s power. Starting from a macro-sociological approach, the thesis propose to study the communal consolidation in the associative sport through two monographs club conducted in Beirut in order to analyze the sectarian dynamic: le Riyadi (Sporting club), a Muslim religious ruling, and for Christians, La Sagesse club. Sociological analysis shows two micro societies that practice sport in “between the self” format, but at the same time, have an opening at the inter-communal stage

Communities and sports in Lebanon : stakes in the sports groupings and in the intercommunity meetings

Selon une opinion commune couramment répandue dans les pays occidentaux, le sport institué serait une école d’apprentissage, du sens du collectif, de la solidarité, du partage et des règles de vie : en bref, il socialiserait naturellement les jeunes en les intégrant dans la société. Cette recherche nous a amené à nous intéresser aux formes de socialisation que la société libanaise offre aux « sportifs ». Si le fait de penser le sport d’une part comme apolitique et, d’autre part, comme une passion partagée par l’ensemble de la jeunesse ne date pas d’aujourd’hui, cette question se lit différemment au Liban, pays qui a subi des conflits internes et régionaux depuis plus de 500 ans. Organisé politiquement et socialement en « communautés », le Liban propose ainsi un modèle politique à base religieuse qui imprègne la vie quotidienne des libanais, y compris au sein du monde sportif. Chaque communauté est gouvernée par une autorité spécifique, régie par ses institutions et soumise à une juridiction autonome formée de membres appartenant à la hiérarchie religieuse, à laquelle l’Etat a reconnu la compétence d’appliquer ses lois et coutumes. Mis à l’épreuve du terrain, ce constat est pourtant à relativiser. L’enquête révèle que les clivages communautaires affectent profondément les instances de gestion des fédérations sportives et provoquent une répartition confessionnelle dans les comités de direction. Cependant, dans le sport comme dans d’autres domaines de la vie sociale, la communauté n’est jamais « pure » et l’on observe aussi des coalitions intercommunautaires dans le but de conquérir le pouvoir sportif. Partant d’une approche macrosociologique, la thèse propose d’étudier le regroupement communautaire dans le sport associatif à travers deux monographies de club réalisées à Beyrouth afin d’analyser ces dynamiques confessionnelles: le Ryadi, à dominante confessionnelle musulmane, et son pendant chrétien, le club de la Sagesse. L’analyse sociologique montre à voir deux micro sociétés qui pratiquent « l’entre soi » sportif mais qui, dans le même temps, présentent une ouverture à la rencontre intercommunautaire.According to a common opinion held in Western countries, the Instituted Sport would be a school of learning, sense of community, solidarity, sharing and rules of life; in short, it will socialize young people by integrating them into society. This research draws our attention to the forms of socialization that Lebanese society offers to “athletes”. If the act of thinking about sport first, as a non-political and, secondly, as a passion shared by all of the youth did not start today, this question reads differently in Lebanon, a country that has suffered from internal and regional conflicts for over 500 years. Politically and socially organized in ‘’community’’, Lebanon offer thereby a faith-based political model that permeates daily life, including the sports world. Each community is governed by a specific authority, ruled by its institutions and submitted to a court composed of independent members from the religious hierarchy, in which the state has recognized the jurisdiction to enforce its laws and customs. Tested in the field, the finding is yet to put into perspective. The survey reveals that the communal cleavages deeply affect the management bodies of sports federations and cause a religious breakdown in the management of committees. However, in sport as in other area of social life, the community is never “pure” and there are also inter-community coalitions in order to gain the sport’s power. Starting from a macro-sociological approach, the thesis propose to study the communal consolidation in the associative sport through two monographs club conducted in Beirut in order to analyze the sectarian dynamic: le Riyadi (Sporting club), a Muslim religious ruling, and for Christians, La Sagesse club. Sociological analysis shows two micro societies that practice sport in “between the self” format, but at the same time, have an opening at the inter-communal stage

Antibiotic Prescriptions in Critically Ill Patients with Bloodstream Infection Due to ESBL-Producing Enterobacteriaceae: Compliance with the French Guidelines for the Treatment of Infections with Third-Generation Cephalosporin-Resistant Enterobacteriaceae—A Multicentric Retrospective Cohort Study

National and international guidelines were recently published regarding the treatment of Enterobacteriaceae resistant to third-generation cephalosporins infections. We aimed to assess the implementation of the French guidelines in critically ill patients suffering from extended-spectrum β-lactamase-producing Enterobacteriaceae bloodstream infection (ESBL-E BSI). We conducted a retrospective observational cohort study in the ICU of three French hospitals. Patients treated between 2018 and 2022 for ESBL-E BSI were included. The primary assessment criterion was the proportion of adequate empirical carbapenem prescriptions, defined as prescriptions consistent with the French guidelines. Among the 185 included patients, 175 received an empirical anti-biotherapy within 24 h of ESBL-E BSI onset, with a carbapenem for 100 of them. The proportion of carbapenem prescriptions consistent with the guidelines was 81%. Inconsistent prescriptions were due to a lack of prescriptions of a carbapenem, while it was recommended in 25% of cases. The only factor independently associated with adequate empirical carbapenem prescription was ESBL-E colonization (OR: 107.921 [9.303–1251.910], p = 0.0002). The initial empirical anti-biotherapy was found to be appropriate in 83/98 patients (85%) receiving anti-biotherapy in line with the guidelines and in 56/77 (73%) patients receiving inadequate anti-biotherapy (p = 0.06). Our results illustrate the willingness of intensivists to spare carbapenems. Promoting implementation of the guidelines could improve the proportion of initial appropriate anti-biotherapy in critically ill patients with ESBL-E BSI