ISARIC-COVID-19 dataset: A Prospective, Standardized, Global Dataset of Patients Hospitalized with COVID-19

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Neurological manifestations of COVID-19 in adults and children

Different neurological manifestations of coronavirus disease 2019 (COVID-19) in adults and children and their impact have not been well characterized. We aimed to determine the prevalence of neurological manifestations and in-hospital complications among hospitalized COVID-19 patients and ascertain differences between adults and children. We conducted a prospective multicentre observational study using the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) cohort across 1507 sites worldwide from 30 January 2020 to 25 May 2021. Analyses of neurological manifestations and neurological complications considered unadjusted prevalence estimates for predefined patient subgroups, and adjusted estimates as a function of patient age and time of hospitalization using generalized linear models. Overall, 161 239 patients (158 267 adults; 2972 children) hospitalized with COVID-19 and assessed for neurological manifestations and complications were included. In adults and children, the most frequent neurological manifestations at admission were fatigue (adults: 37.4%; children: 20.4%), altered consciousness (20.9%; 6.8%), myalgia (16.9%; 7.6%), dysgeusia (7.4%; 1.9%), anosmia (6.0%; 2.2%) and seizure (1.1%; 5.2%). In adults, the most frequent in-hospital neurological complications were stroke (1.5%), seizure (1%) and CNS infection (0.2%). Each occurred more frequently in intensive care unit (ICU) than in non-ICU patients. In children, seizure was the only neurological complication to occur more frequently in ICU versus non-ICU (7.1% versus 2.3%, P < 0.001). Stroke prevalence increased with increasing age, while CNS infection and seizure steadily decreased with age. There was a dramatic decrease in stroke over time during the pandemic. Hypertension, chronic neurological disease and the use of extracorporeal membrane oxygenation were associated with increased risk of stroke. Altered consciousness was associated with CNS infection, seizure and stroke. All in-hospital neurological complications were associated with increased odds of death. The likelihood of death rose with increasing age, especially after 25 years of age. In conclusion, adults and children have different neurological manifestations and in-hospital complications associated with COVID-19. Stroke risk increased with increasing age, while CNS infection and seizure risk decreased with age

L'assistance médicale à la procréation à l'aube du réexamen de la loi no 2004-800 du 6 août 2004 relative à la bioéthique

PARIS-BIUP (751062107) / SudocSudocFranceF

Accuracy of thyroid uptake calibration method: a multi-centric study with realistic phantoms.

International audienceAim/Introduction: measurement of the thyroid uptake is of interest in diagnostic and for treatment of benign thyroid disease. The sensitivity obtained from measurement in air or in a standard neck phantom does not take into account the real thyroid anatomy. The goal of this multi-centric study was to assess the accuracy of thyroid uptake measurement using a set of realistic thyroid phantoms of varying size. These measurements were carried-out according to the site-specific local procedure (Local) and according to a standardized protocol (Std). In this preliminary report sensitivities obtained with routine calibration objects were compared with those obtained with the set of phantoms, for both protocols. Material and methods: measurements were carried-out from October 2020 to June 2021 on 20 NaI gamma-cameras and 3 CZT cameras with parallel and pinhole collimators. Radionuclides were Tc-99m and I-123. Five thyroid phantoms between 3 and 30 mL were used. Images were centrally analyzed, a 3DSlicer module has been developed for automatic segmentation and calculation of the sensitivity. The mean sensitivity over five thyroid volumes was compared with the routine calibration factor (Srout) and with the sensitivity in air, obtained with a unique syringue (Sair). The three sensitivities were measured for both protocols. Results: 25 configurations have been analyzed (58% of final set). For pinhole Tc-99m measurements, the mean sensitivities Sair were 101 ±45 counts/MBq/s (Std, n=7) and 148 ±91 counts/MBq/s (Local, n=7). The difference being mainly due to different measurement distances in the protocols.For I-123 measurements with parallel collimators, the mean sensitivities Sair were 73 ±13 counts/MBq/s (Std, n=10) and 72 ±14 counts/MBq/s (Local, n=9). Sair was almost independent of radionuclides and protocol. For pinhole collimator the sensitivity decreased when the thyroid volume increased, whatever the radionuclide and protocol. For the 30 mL phantom, on mean, the sensitivity was 12% lower than . Considering the local protocol and both radionuclides the relative difference between Srout and was greater than 15% in 43% of the cases. The standard protocol did not reduce this difference. For parallel collimators the difference between Srout and was always less than 17%, almost independently of the protocol, radionuclide and parallel collimator model. Conclusion: with parallel collimators, the sensitivity was relatively independent of the thyroid volume and the routine calibration was suitable for thyroid uptake estimation. For pinhole collimators the calibration was strongly influenced by the volume and quantitative measurement were of limited accuracy

Correction to: National dose reference levels in computed tomography–guided interventional procedures—a proposal

International audienceAbstract Computed tomography imaging plays a major role in the preoperative assessment of tumor burden by providing an accurate mapping of the distribution of peritoneal metastases (PM). Spectral Photon Counting Computed Tomography (SPCCT) is an innovative imaging modality that could overcome the current limitations of conventional CT, offering not only better spatial resolution but also better contrast resolution by allowing the discrimination of multiple contrast agents. Based on this capability, we tested the feasibility of SPCCT in the detection of PM at different time of tumor growth in 16 rats inoculated with CC531 cells using dual-contrast injection protocols in two compartments (i.e. intravenous iodine and intraperitoneal gadolinium or the reverse protocol), compared to surgery. For all peritoneal regions and for both protocols, sensitivity was 69%, specificity was 100% and accuracy was 80%, and the correlation with surgical exploration was strong ( p = 0.97; p = 0.0001). No significant difference was found in terms of diagnostic performance, quality of peritoneal opacification or diagnostic quality between the 2 injection protocols. We also showed poor vascularization of peritoneal metastases by measuring low concentrations of contrast agent in the largest lesions using SPCCT, which was confirmed by immunohistochemical analyses. In conclusion, SPCCT using dual-contrast agent injection protocols in 2 compartments is a promising imaging modality to assess the extent of PM in a rat model

Corticosteroids in patients hospitalized for COVID-19 pneumonia who require oxygen: observational comparative study using routine care data

International audienceObjective: To assess the effectiveness of corticosteroids on outcomes of patients with coronavirus disease 2019 (COVID-19) pneumonia requiring oxygen without mechanical ventilation.Methods: We used routine care data from 51 hospitals in France and Luxembourg to assess the effectiveness of corticosteroids at 0.8 mg/kg/day eq. prednisone (CTC group) versus standard of care (no-CTC group) among adults 18-80 years old with confirmed COVID-19 pneumonia requiring oxygen without mechanical ventilation. The primary outcome was intubation or death by day 28. In our main analysis, characteristics of patients at baseline (i.e. time when patients met all inclusion criteria) were balanced by using propensity-score inverse probability of treatment weighting.Results: Among the 891 patients included in the analysis, 203 were assigned to the CTC group. Use of corticosteroids was not significantly associated with risk of intubation or death by day 28 (weighted hazard ratio (wHR) 0.92, 95%CI 0.61-1.39) nor cumulative death rate (wHR 1.03, 95%CI 0.54-1.98). However, use of corticosteroids was associated with reduced risk of intubation or death by day 28 in the prespecified subgroups of patients requiring oxygen >3 L/min (wHR 0.50, 95%CI 0.30-0.85) or C-reactive protein level >100 mg/L (wHR 0.44, 95%CI 0.23-0.85). The number of hyperglycaemia events was higher for patients with corticosteroids than for those without, but the number of infections was similar.Conclusions: We found no association between the use of corticosteroids and intubation or death in the broad population of patients 18-80 years old, with COVID-19, hospitalized in settings non intensive care units. However, the treatment was associated with a reduced risk of intubation or death for patients with >3 L/min oxygen or C-reactive protein level >100 mg/L at baseline. Further research is needed to confirm the right timing for corticosteroids in patients with COVID-19 requiring oxygen only

National dose reference levels in computed tomography–guided interventional procedures—a proposal

International audienc