Infections urinaires communautaires (les recommandations de l'AFSSAPS de 2008 sont-elles toujours adaptées à l'écologie bactérienne actuelle?)

PARIS6-Bibl. St Antoine CHU (751122104) / SudocSudocFranceF

Epidémiologie des syndromes coronaires aigüs dans le service d'urgence d'un hôpital ne disposant pas de cardiologie interventionelle

PARIS6-Bibl. St Antoine CHU (751122104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Dissections aortiques thoraciques aiguës aux urgences (caractéristiques et évolution)

PARIS6-Bibl.Pitié-Salpêtrie (751132101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Précarité et alcool (motifs de consultation aux urgences de l'hôpital Saint-Antoine, et influence de la date de perception des ressources financières)

Nous avons étudié les patients sans domicile consultant entre le 1/03/2005 et le 30/06/2005, et recherché une relation entre l'alcoolisation aiguë et la date de perception de leur revenu. Méthode : Etude prospective monocentrique non randomisée aux urgences de l'hôpital Saint Antoine à Paris, à partir d'un questionnaire rempli pour toute consultation de patient sans domicile. Résultats : 794 patients SDF ont été inclus, soit 5 % des consultants totaux durant la période de l'étude. On note une nette prédominance masculine : sexe ration 12/1, et un âge moyen de 44 ans. Les diagnostics principaux sont les pathologies liées à l'intoxication alcoolique, les traumatismes (19%) et les problèmes sociaux (12%). 7% des patients ont été hospitalisés. 58 % présentaient des signes d'alcoolisation aiguë. 86 % des patients sont sans revenu fixe avoué. 6% perçoivent le RMI. 6% l'AAH. Nous n'avons pas retrouvé d'augmentation significative de consultation pour alcoolisation aiguë au décours de la perception de leurs revenus sociaux. Conclusion : le principal motif de recours du patient SDF aux urgences est en relation avec une intoxication alcoolique. L'hypothèse initiale n'est pas confirméeCONTEXT: In central cities emergency departments, homeless people are numerous. We studied homeless people who consulted between March 1st 2005 and June 30th 2005, and we have looked for a relation between alcohol abuse and income payment date. METHOD: Non-randomised monocentric forecast survey; conducted in Saint Antoine Emergency Unit in Paris, based on a form filled for every homeless adult patient arrived in the emergency department. RESULTS: 794 homeless subjects were enrolled being 5 % of patients arrived at emergency department over the 4-months period. We notice a large male predominance: sex ratio of 12/1, with an average age of 44 years old. The most common consultation reasons were alcohol related pathologies (34%), trauma (19%), social problems (12%). 7% were hospitalised. 58 % presented acute alcohol intoxication signs. 86% admitted no fix income. 6% have Revenu Minimal d'Insertion (minimal integration income) and 6% Allocation Adulte Handicapé (handicapped adult income). We haven't found any significant increase of consultations for alcohol abuse the day following their social income payment date. CONCLUSION: homeless patients in emergency department mainly arrive for alcohol abuse. The initial hypothesis is not confirmedPARIS12-CRETEIL BU Médecine (940282101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Profil des patients consultant pour crise d'asthme aux urgences

PARIS7-Xavier Bichat (751182101) / SudocSudocFranceF

Stability of an aluminum salt-adjuvanted protein D-conjugated pneumococcal vaccine after exposure to subzero temperatures

Accidental exposure of a vaccine containing an aluminum-salt adjuvant to temperatures below 0°C in the cold chain can lead to freeze damage. Our study evaluated the potential for freeze damage in a licensed aluminum-salt-containing protein-D-conjugated pneumococcal vaccine (PHiD-CV; Synflorix, GSK) in conditions that included static storage, single subzero-temperature excursions, and simulated air-freight transportation. Several parameters were assessed including freezing at subzero temperatures, aluminum-salt-particle size, antigen integrity and immunogenicity in the mouse. The suitability of the WHO's shake test for identifying freeze-damaged vaccines was also assessed. During subzero-temperature excursions, the mean temperatures at which PHiD-CV froze (−16.7°C to −18.1°C) appeared unaffected by the type of vaccine container (two-dose or four-dose vial, or single-dose syringe), vaccine batch, rotational agitation, or the rate of temperature decline (−0.5 to −10°C/hour). At constant subzero temperature and in simulated air-freight transportation, the freezing of PHiD-CV appeared to be promoted by vibration. At −5°C, no PHiD-CV sample froze in static storage (>1 month), whereas when subjected to vibration, a minority of samples froze (7/21, 33%) within 18 hours. At −8°C with vibration, nearly all (5/6, 83%) samples froze. In these vibration regimes, the shake test identified most samples that froze (10/12, 93%) except two in the −5°C regime. Nevertheless, PHiD-CV-antigen integrity appeared unaffected by freezing up to −20°C or by vibration. And although aluminum-salt-particle size was increased only by freezing at −20°C, PHiD-CV immunogenicity appeared only marginally affected by freezing at −20°C. Therefore, our study supports the use of the shake test to exclude freeze-damaged PHiD-CV in the field

Comparison of Patients Infected With Delta Versus Omicron COVID-19 Variants Presenting to Paris Emergency Departments

International audienceBackground: At the end of 2021, the B.1.1.529 SARS-CoV-2 variant (Omicron) wave superseded the B.1.617.2 variant (Delta) wave.Objective: To compare baseline characteristics and in-hospital outcomes of patients with SARS-CoV-2 infection with the Delta variant versus the Omicron variant in the emergency department (ED).Design: Retrospective chart reviews.Setting: 13 adult EDs in academic hospitals in the Paris area from 29 November 2021 to 10 January 2022.Patients: Patients with a positive reverse transcriptase polymerase chain reaction (RT-PCR) test result for SARS-CoV-2 and variant identification.Measurements: Main outcome measures were baseline clinical and biological characteristics at ED presentation, intensive care unit (ICU) admission, mechanical ventilation, and in-hospital mortality.Results: A total of 3728 patients had a positive RT-PCR test result for SARS-CoV-2 during the study period; 1716 patients who had a variant determination (818 Delta and 898 Omicron) were included. Median age was 58 years, and 49% were women. Patients infected with the Omicron variant were younger (54 vs. 62 years; difference, 8.0 years [95% CI, 4.6 to 11.4 years]), had a lower rate of obesity (8.0% vs. 12.5%; difference, 4.5 percentage points [CI, 1.5 to 7.5 percentage points]), were more vaccinated (65% vs. 39% for 1 dose and 22% vs. 11% for 3 doses), had a lower rate of dyspnea (26% vs. 50%; difference, 23.6 percentage points [CI, 19.0 to 28.2 percentage points]), and had a higher rate of discharge home from the ED (59% vs. 37%; difference, 21.9 percentage points [-26.5 to -17.1 percentage points]). Compared with Delta, Omicron infection was independently associated with a lower risk for ICU admission (adjusted difference, 11.4 percentage points [CI, 8.4 to 14.4 percentage points]), mechanical ventilation (adjusted difference, 3.6 percentage points [CI, 1.7 to 5.6 percentage points]), and in-hospital mortality (adjusted difference, 4.2 percentage points [CI, 2.0 to 6.5 percentage points]).Limitation: Patients with COVID-19 illness and no SARS-CoV-2 variant determination in the ED were excluded.Conclusion: Compared with the Delta variant, infection with the Omicron variant in patients in the ED had different clinical and biological patterns and was associated with better in-hospital outcomes, including higher survival

The emergency department arrival mode and its relations to ED management and 30-day mortality in acute heart failure: an ancillary analysis from the EURODEM study

Background Acute heart failure patients are often encountered in emergency departments (ED) from 11% to 57% using emergency medical services (EMS). Our aim was to evaluate the association of EMS use with acute heart failure patients’ ED management and short-term outcomes. Methods This was a sub-analysis of a European EURODEM study. Data on patients presenting with dyspnoea were collected prospectively from European EDs. Patients with ED diagnosis of acute heart failure were categorized into two groups: those using EMS and those self-presenting (non- EMS). The independent association between EMS use and 30-day mortality was evaluated with logistic regression. Results Of the 500 acute heart failure patients, with information about the arrival mode to the ED, 309 (61.8%) arrived by EMS. These patients were older (median age 80 vs. 75 years, p  30/min in 17.1% patients vs. 7.5%, p = 0.005). The only difference in ED management appeared in the use of ventilatory support: 78.3% of EMS patients vs. 67.5% of non- EMS patients received supplementary oxygen (p = 0.007), and non-invasive ventilation was administered to 12.5% of EMS patients vs. 4.2% non- EMS patients (p = 0.002). EMS patients were more often hospitalized (82.4% vs. 65.9%, p < 0.001), had higher in-hospital mortality (8.7% vs. 3.1%, p = 0.014) and 30-day mortality (14.3% vs. 4.9%, p < 0.001). The use of EMS was an independent predictor of 30-day mortality (OR = 2.54, 95% CI 1.11–5.81, p = 0.027). Conclusion Most acute heart failure patients arrive at ED by EMS. These patients suffer from more severe respiratory distress and receive more often ventilatory support. EMS use is an independent predictor of 30-day mortality