Predictors of hospital discharge and mortality in patients with diabetes and COVID-19: updated results from the nationwide CORONADO study

AIMS/HYPOTHESIS: This is an update of the results from the previous report of the CORONADO (Coronavirus SARS-CoV-2 and Diabetes Outcomes) study, which aims to describe the outcomes and prognostic factors in patients with diabetes hospitalised for coronavirus disease-2019 (COVID-19). METHODS: The CORONADO initiative is a French nationwide multicentre study of patients with diabetes hospitalised for COVID-19 with a 28-day follow-up. The patients were screened after hospital admission from 10 March to 10 April 2020. We mainly focused on hospital discharge and death within 28 days. RESULTS: We included 2796 participants: 63.7% men, mean age 69.7 ± 13.2 years, median BMI (25th-75th percentile) 28.4 (25.0-32.4) kg/m(2). Microvascular and macrovascular diabetic complications were found in 44.2% and 38.6% of participants, respectively. Within 28 days, 1404 (50.2%; 95% CI 48.3%, 52.1%) were discharged from hospital with a median duration of hospital stay of 9 (5-14) days, while 577 participants died (20.6%; 95% CI 19.2%, 22.2%). In multivariable models, younger age, routine metformin therapy and longer symptom duration on admission were positively associated with discharge. History of microvascular complications, anticoagulant routine therapy, dyspnoea on admission, and higher aspartate aminotransferase, white cell count and C-reactive protein levels were associated with a reduced chance of discharge. Factors associated with death within 28 days mirrored those associated with discharge, and also included routine treatment by insulin and statin as deleterious factors. CONCLUSIONS/INTERPRETATION: In patients with diabetes hospitalised for COVID-19, we established prognostic factors for hospital discharge and death that could help clinicians in this pandemic period. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT04324736

Du pragmatique au pragmatisme : quels enjeux pour la formation à l’éthique ?

L’évolution contemporaine de la demande et du recours à l’éthique dans le champ de la santé interroge les modèles de formation à l’éthique. L’enjeu n’est en effet plus de former des acteurs capables d’appliquer un discours moral mais, dans un contexte déstabilisé, de les accompagner dans le développement de nouvelles pratiques en situation professionnelle. Ce qu’on peut caractériser comme un tournant pragmatique exige donc des modèles de formation plus contextuels, plus réflexifs et plus actifs, nécessitant de nouvelles articulations entre le terrain et la formation plus théorique. C’est à réfléchir aux fondements théoriques d’une telle approche de la pédagogie de l’éthique et à ses enjeux en termes de ré-institutionnalisation qu’est consacré cet article. Le courant pragmatiste et plus particulièrement l’approche de John Dewey seront ici mobilisés pour en fonder les pratiques pédagogiques (une pédagogie expérientielle, réflexive, et collective), mais aussi pour en penser les enjeux en matière de dispositif de formation. Sur ce point, si la philosophie de l’alternance intégrative s’est proposée comme une voie pour développer les compétences des futurs professionnels, la dernière partie du texte insistera sur la nécessaire gouvernance réflexive qu’elle requiert et sur la « ré-institutionnalisation de l’éthique et de sa pédagogie » que cette dernière entraîneThe contemporary evolution of the request and the recourse for ethics in the health field questions the models of ethics training. Indeed the stake is no more to train actors able of producing a moral speech on the practices but, in a destabilized context, to accompany them in the development of new practices in professional situation. This pragmatic turn in health ethics requires more active, reflective and contextual models of training, needing new links between training places and care practices. This paper is about theoretical foundations of such an ethics pedagogy, and about its stakes in terms of re-institutionalization. Pragmatism, and more particularly the approach of John Dewey, will be mobilized here to found educational practices needed by such an ethics pedagogy (an experiential, reflective and collective learning), but also to consider issues concerning training device linked to such a learning. On this point, the philosophy of integrative block-release training is investigated as a way to develop future professional competences, even if the last part of this text will insist on the reflective governance such an alternation requires and on the "re-institutionalization of the ethics pedagogy" that the latter generates

Comparative 16s RRNA sequencing analysis of the composition of the bacterial communities in contrasting freshwater ecosystems in France and Burkina Faso

International audienceWe compared the composition of the freeliving eubacterioplankton communities in the pelagic zone of three large French sub-Alpine lakes (Annecy, Bourget and Geneva) and of six small reservoirs located in Burkina Faso. More than 1,100 sequences of a 16S rRNA fragment were obtained from 25 clone libraries. In all these freshwater ecosystems, Actinobacteria was the dominant phylum (>40%), followed by Alpha- and Beta-proteobacteria. These three groups contain between 60 and 90% of the sequences retrieved. Picocyanobacteria were found in variable proportions (0-25%), and the remaining sequences were mainly affiliated to Bacteroidetes or Gammaproteobacteria. Despite contrasting trophic levels (oligotrophic to meso-eutrophic), there was no significant difference in the global composition of the bacterioplankton communities of the alpine lakes at the scale of the year. On the other hand, significant differences were found between reservoirs in Burkina Faso, suggesting the presence of local drift in the global composition of the bacterial communities in these small ecosystems. Operational Taxonomic Units (OTUs) were defined on the basis of a taxon resolution of at least 98% sequence similarity. At this taxonomic level, the diversity of the bacterial communities in small African reservoirs, estimated using the Shannon and the Chao1 estimators, was generally greater than the diversities found in Alpine lakes. Finally, a small number of OTUs belonging to the Alphabroteobacteria and to Actinobacteria phyla were found in all the ecosystems studied. It will be very interesting to go on to isolate and characterize these ubiquitous species, which probably play key functional roles in freshwater ecosystems

Genetic Diversity of Cylindrospermopsis Strains (Cyanobacteria) Isolated from Four Continents

The genetic diversity of Cylindrospermopsis strains (cyanobacteria) was examined using mainly the 16S-23S internally transcribed spacer (ITS1) sequences. Strains were grouped in three clusters: (i) America, (ii) Europe, and (iii) Africa and Australia. These results suggested a recent spread of Cylindrospermopsis across the American and European continents from restricted warm refuge areas instead of exchanges between continents. On the other hand, they also suggested a recent colonization of Australia by African strains

Philosophie et littérature

Le présent dossier s’intéresse aux rapports qu’entretiennent la philosophie et la littérature. Ces rapports méritent d’être envisagés sous deux points de vue complémentaires. Il convient d’abord de se demander de quelle manière la philosophie, le discours philosophique, se confronte à la littérature et à quels types de savoirs ces confrontations peuvent donner lieu. Mais il s’agit également d’examiner la possible dimension pratique de tels savoirs, lorsqu’ils sollicitent l’imagination morale et ouvrent ainsi la philosophie à l’ordre d’une réflexion éthique immanente aux libres expérimentations de la fiction littéraire. Philippe Sabot et Éléonore Le Jall

Intestinal dysfunctions induced by intrauterine growth retardation are associated with altered autophagy in the enteric nervous system

The intra uterine growth retardation (IUGR) is characterized by a low birth body weight (<2.5 kg) and represents 4% of births. IUGR has long term consequences on health in adulthood, with an elevated risk to develop metabolic diseases and hypertension. In this study, we examined whether IUGR alters gastrointestinal (GI) and enteric nervous system (ENS) functions during life..

Maternal protein restriction induces gastrointestinal dysfunction and enteric nervous system remodeling in rat offspring.

International audienceEarly-life adversity is a major risk factor for the development of diseases later in life. Maternal protein restriction (MPR) is associated with morbidities in offspring affecting multiple organs, but its impact on the gastrointestinal (GI) tract remains poorly studied. Using a rat model, we examined the consequences of MPR on GI function and on the enteric nervous system (ENS) in the offspring at postnatal d 35 under basal state and following a water avoidance stress (WAS). Compared with control rats, MPR rats exhibited greater colonic motility, permeability, and corticosteronemia. In contrast to controls, MPR rats presented a blunted functional and corticosteronemic response to WAS. Furthermore, MPR rats showed an increased proportion of choline acetyltransferase-immunoreactive (ChAT-IR) neurons and a reduced level of autophagy in colonic myenteric neurons. In ENS cultures, corticosterone treatment increased the proportion of ChAT-IR neurons and reduced autophagy level in enteric neurons. Inhibition of autophagy in ENS cultures resulted in a higher vulnerability of enteric neurons to a cellular stress. Altogether, this study suggests that MPR induced GI dysfunction and ENS alterations in offspring rats and that MPR-induced increased corticosteronemia might be involved in ENS remodeling and altered responsiveness of the gut to stressors later in life.-Aubert, P., Oleynikova, E., Rizvi, H., Ndjim, M., Le Berre-Scoul, C., Grohard, P. A., Chevalier, J., Segain, J.-P., Le Drean, G., Neunlist, M., Boudin, H. Maternal protein restriction induces gastrointestinal dysfunction and enteric nervous system remodeling in rat offspring