Factors associated with hospital admission and adverse outcome for COVID-19: Role of social factors and medical care

International audienceBackground: Beyond sex, age, and various comorbidities, geographical origin and socioeconomic deprivation are associated with Coronavirus Disease (COVID-19) morbidity and mortality in the general population. We aimed to assess factors associated with severe forms of COVID-19 after a hospital emergency department visit, focusing on socioeconomic factors. Methods: Patients with laboratory-confirmed COVID-19 attending the emergency department of Béclère Hospital (France) in March–April 2020 were included. Postal addresses were used to obtain two geographical deprivation indices at the neighborhood level. Factors associated with hospitalization and factors associated with adverse outcomes, i.e. mechanical ventilation or death, were studied using logistic and Cox analyses, respectively. Results: Among 399 included patients, 321 were hospitalized. Neither geographical origin nor socioeconomic deprivation was associated with any of the outcomes. Being male, older, overweight or obese, diabetic, or having a neuropsychiatric disorder were independent risk factors for hospitalization. Among 296 patients hospitalized at Béclère Hospital, 91 experienced an adverse outcome. Older age, being overweight or obese, desaturation and extent of chest CT scan lesions > 25% at admission (aHR: 2.2 [95% CI: 1.3–3.5]) and higher peak CRP levels and acute kidney failure (aHR: 2.0 [1.2–3.3]) during follow-up were independently associated with adverse outcomes, whereas treatment with hydrocortisone reduced the risk of mechanical ventilation or death by half (aHR: 0.5 [0.3–0.8]). Conclusion: No association between geographical origin or socioeconomic deprivation and the occurrence of a severe form of COVID-19 was observed in our population after arrival to the emergency department. Empirical corticosteroid use with hydrocortisone had a strong protective impact

On the Origins of the Franco-German EMU Controversies

EMU is, to a large extent, the result of a process of Franco-German reconciliation and understanding. However, in the postwar period, there were significant differences in ideas and economic policy-making in Germany and France. France was dominated by the "tradition républicaine", giving a central role to the state in economic life. In Germany, the federal structure of the state went together with the social market economy. In this paper an analysis is presented of these differences in thought and economic policy-making, how they evolved through time, and how they contributed to shaping the nature and form of the European Union. The focus is on the Rome Treaties, the Werner Report and the Maastricht Treaty process

Identification of driver genes for critical forms of COVID-19 in a deeply phenotyped young patient cohort

International audienceThe etiopathogenesis of critical COVID-19 remains unknown. Indeed given major confounding factors (age and comorbidities), true drivers of this condition have remained elusive. Here, we employ an unprecedented multi-omics analysis, combined with artificial intelligence, in a young patient cohort where major comorbidities have been excluded at the onset. Here, we established a three-tier cohort of individuals younger than 50 years without major comorbidities. These included 47 “critical” (in the ICU under mechanical ventilation) and 25 “non-critical” (in a non-critical care ward) COVID-19 patients as well as 22 healthy individuals. The analyses included whole-genome sequencing, whole-blood RNA sequencing, plasma and blood mononuclear cells proteomics, cytokine profiling and high-throughput immunophenotyping. An ensemble of machine learning, deep learning, quantum annealing and structural causal modeling led to key findings. Critical patients were characterized by exacerbated inflammation, perturbed lymphoid/myeloid compartments, coagulation and viral cell biology. Within a unique gene signature that differentiated critical from non-critical patients, several driver genes promoted critical COVID-19 among which the upregulated metalloprotease ADAM9 was key. This gene signature was supported in a second independent cohort of 81 critical and 73 recovered COVID-19 patients, as were ADAM9 transcripts, soluble form and proteolytic activity. Ex vivo ADAM9 inhibition affected SARS-CoV-2 uptake and replication in human lung epithelial cells. In conclusion, within a young, otherwise healthy, COVID-19 cohort, we provide the landscape of biological perturbations in vivo where a unique gene signature differentiated critical from non-critical patients. The key driver, ADAM9, interfered with SARS-CoV-2 biology. A repositioning strategy for anti-ADAM9 therapeutic is feasible

Habiter le Grand Paris ! Ou? Quand? Comment?

Face à ces questions sensibles pour l’avenir du Grand Paris, les 15 équipes pluridisciplinaires, d’architectes, d’urbanistes et de chercheurs qui composent le Conseil scientifique de l’Atelier International du Grand Paris, présentent les résultats de leur recherches, leurs analyses et leurs propositions. Ces réflexions, qui donneront lieu à la parution d’un livre, constituent autant d’éclairages pour répondre aux enjeux métropolitains et aux défis quantitatifs et qualitatifs de l’évolution du logement et des modes d’habiter dans le Grand Paris. > du 1er au 7 juillet : Une exposition organisée autour de films courts réalisés par les quinze équipes de l’AIGPainsi qu’autour de parcours de trois photographes de l’agence Magnum dans le Grand Paris : Patrick Zachmann, Marc Power et Olivia Arthur. • La restitution d’ateliers participatifs organisés par des équipes de l’AIGP sur des territoires du Grand Paris