Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

La fraction vasculaire stromale autologue d'origine adipeuse dans le traitement des lésions cicatricielles des cordes vocales

Thèse présentée sous la forme d'une "Thèse article"Background: Patients with scarred vocal folds, whether congenitally or following phonosurgery, often exhibit a dysphonia that negatively impacts daily life and is difficult to treat. Autologous adipose tissue-derived stromal vascular fraction (ADSVF) is increasingly recognized as an easily accessible source of cells with angiogenic, anti-inflammatory, immunomodulatory, and regenerative properties. We aimed to evaluate the feasibility, safety, tolerability and potential efficacy of autologous ADSVF local injections in patients with scarred vocal folds.Methods: This first-in-man phase I clinical trial was a prospective, open-label, single arm, single-center study with 12-month follow-up that enrolled 8 patients (7 female, 1 male), with severe dysphonia due to vocal folds scarring (Voice Handicap Index [VHI] > 60/120). ADSVF was prepared and injected into one or two vocal folds. The primary outcome was the feasibility and the number and severity of adverse events related to ADSVF-based therapy. Secondary endpoints were changes in vocal assessment, videolaryngostroboscopy and self-evaluation of dysphonia and quality of life from baseline to 1, 6 and 12 months after cell therapy. Findings: Safety and feasibility were evident with the only adverse events related to liposuction and ADSVF injection anticipated and resolved spontaneously. One patient received massage by a physiotherapist to drain local brusing and another complained of a minor contour defect at the liposuction site. At 12 months, VHI was improved in all patients with a mean improvement from baseline of 40.1 ± 21.5 (p = 0.012). Seven patients were considered as responders defined as an improvement ≥ 18 points corresponding to the minimum clinical important difference for the VHI. A trend towards improvement of roughness of voice in perceptual analysis was also observed. The main limitations were those of a pilot study design (limited number of patients, different etiologies of scarred vocal folds involved, unblinded trial without control group).Conclusion: This study outlines the safety of the autologous ADSVF injection in scarred vocal folds and suggests potential efficacy that encourages further confirmation in a future randomised placebo-controlled trial on a larger population.Introduction : les patients présentant des cordes vocales cicatricielles, qu'elles soient d’origine congénitale ou après phonochirurgie, présentent souvent une dysphonie ayant un impact négatif majeur sur leur vie quotidienne et dont le traitement est difficile. La fraction vasculaire stromale (FVS) autologue d’origine adipeuse est de plus en plus reconnue comme une source facilement accessible de cellules aux propriétés angiogéniques, anti-inflammatoires, immunomodulatrices et régénératrices. Notre objectif était d’évaluer la faisabilité, la sécurité, la tolérance et l'efficacité potentielle des injections locales de FVS autologue d’origine adipeuse chez des patients présentant des cordes vocales cicatricielles.Méthodes : cet essai pilote de phase I était une étude prospective, ouverte, non contrôlée et monocentrique, avec un suivi de 12 mois auprès de 8 patients (7 femmes et 1 homme) présentant une dysphonie sévère due à des cordes vocales cicatricielles (Voice Handicap Index [VHI] > 60/120). La FVS était préparée et injectée dans une ou deux cordes vocales. Le critère de jugement principal était la faisabilité, le nombre et la gravité des effets indésirables liés au traitement à base de FVS. Les critères d'évaluation secondaires étaient les modifications du bilan vocal, de la vidéolaryngostroboscopie et de l'auto-évaluation de la dysphonie et de la qualité de vie, à 1, 6 et 12 mois après injection.Résultats : la sécurité et la faisabilité étaient évidentes puisque ne sont survenus que des événements indésirables liés à la liposuccion et à l’injection de FVS qui étaient prévus et se sont résolus spontanément pour la plupart. Un patient a nécessité des massages par un kinésithérapeute pour drainer un hématome au niveau des zones de liposuccion et un autre s'est plaint d’une gêne esthétique liée à un défect adipeux au niveau du site de liposuccion. À 12 mois, le VHI était amélioré chez tous les patients, avec une amélioration moyenne par rapport aux valeurs initiales de 40,1 ± 21,5 points (p = 0,012). Sept patients ont été considérés comme répondeurs soit une amélioration ≥ 18 points correspondant à la différence minimale cliniquement pertinente pour le VHI. Une tendance à l'amélioration de la raucité de la voix dans l'analyse perceptive a également été observée.Les principales limites étaient celles d'une étude pilote (nombre limité de patients, différentes étiologies de cordes vocales cicatricielles impliquées, essai ouvert sans groupe témoin).Conclusion : cette étude valide la sécurité de l'injection autologue de FVS d’origine adipeuse dans les cordes vocales cicatricielles et suggère une efficacité potentielle qui devra être confirmée par la réalisation d'un essai clinique randomisé, versus placebo, sur une population plus importante

Local anesthesia with blue-dyed lidocaine for a better patient’s tolerance during office-based laryngology procedures: how I do it

Background: In-office laryngological procedures became common alternatives to general anesthesia for biopsies, injection laryngoplasties, and laser procedures. The limiting step remains the laryngeal anesthesia whose quality can influence patients' and operators' comfort.Methods: We propose to dye the lidocaine with methylene blue and do an instillation through a catheter introduced in the video-endoscope's operating channel, which permits a progressive anesthesia focused on the larynx, avoiding an unwanted pharyngeal anesthesia and any tracheal irritation.Conclusion: Using blue-dyed lidocaine can help reduce the volume of anesthesia required for an office-based laryngology intervention, improving patients' and surgeon's comfort and reducing anesthesia's side effects

Les professionnels de la voix : physiopathologie d'une voix endurante et bilan vocal adapté – L'exemple des enseignants

International audienc

Bilan clinique de la phonation

International audienceLe bilan de la voix a un double objectif : établir un état des lieux du trouble vocal à un moment donné en vue de comparaison ultérieure et d'évaluer l'efficacité du traitement quel qu'il soit ; rechercher des éléments pertinents pouvant intervenir dans le choix thérapeutique lui-même. En dehors de l'examen des cordes vocales qui est un acte strictement médical, ce bilan peut être réalisé par un médecin, ou par un orthophoniste mais doit comporter au minimum quatre éléments : un enregistrement de la voix sur un système de qualité conservé pour comparaisons ultérieures ; l'autoévaluation par le patient de sa voix et de sa gêne à l'aide d'une des échelles disponibles. Les problèmes de voix sont en effet des problèmes fonctionnels et la demande du patient doit être analysée ; une évaluation quantitative instrumentale du problème vocal du patient peut être proposée. En fonction du matériel disponible, différents paramètres peuvent être proposés : temps maximum de phonation, mesures acoustiques plus ou moins complexes. En réalité, aucune mesure ne suffit à elle seule pour caractériser la voix pathologique ; l'évaluation des tensions musculaires, posturales et respiratoires du patient aide à fixer des repères pour la rééducation vocale.Analyse de la voix, Dysphonies, Écoute, Aérodynamique de la voix, Respiration, Postur

Les professionnels de la voix : physiopathologie d'une voix endurante et bilan vocal adapté – L'exemple des enseignants

International audienc

International Consensus et lésions bénignes des cordes vocales

National audienc

International Consensus et lésions bénignes des cordes vocales

National audienc

Commentary about mesenchymal stem cells and scarred vocal folds

International audienceA commentary to "Hertegård, S., Nagubothu, S.R., Malmström, E. et al. Treatment of vocal fold scarring with autologous bone marrow-derived human mesenchymal stromal cells-first phase I/II human clinical study. Stem Cell Res Ther 11, 128 (2020)" concerning the surgical intervention including a scar resection, the use of the Voice Handicap Index, the surgical and regulatory points of view regarding the inclusion of patients with laryngeal carcinomas history, and the side effects of bone marrow harvesting

Transmission of droplet-conveyed infectious agents such as SARS-CoV-2 by speech and vocal exercises during speech therapy: preliminary experiment concerning airflow velocity

International audiencePurpose Infectious agents, such as SARS-CoV-2, can be carried by droplets expelled during breathing. The spatial disseminationof droplets varies according to their initial velocity. After a short literature review, our goal was to determine thevelocity of the exhaled air during vocal exercises.Methods A propylene glycol cloud produced by 2 e-cigarettes’ users allowed visualization of the exhaled air emitted duringvocal exercises. Airflow velocities were measured during the first 200 ms of a long exhalation, a sustained vowel /a/ andvaried vocal exercises. For the long exhalation and the sustained vowel /a/, the decrease of airflow velocity was measureduntil 3 s. Results were compared with a Computational Fluid Dynamics (CFD) study using boundary conditions consistentwith our experimental study.Results Regarding the production of vowels, higher velocities were found in loud and whispered voices than in normal voice.Voiced consonants like /ʒ/ or /v/ generated higher velocities than vowels. Some voiceless consonants, e.g., /t/ generatedhigh velocities, but long exhalation had the highest velocities. Semi-occluded vocal tract exercises generated faster airflowvelocities than loud speech, with a decreased velocity during voicing. The initial velocity quickly decreased as was shownduring a long exhalation or a sustained vowel /a/. Velocities were consistent with the CFD data.Conclusion Initial velocity of the exhaled air is a key factor influencing droplets trajectory. Our study revealed that vocalexercises produce a slower airflow than long exhalation. Speech therapy should, therefore, not be associated with an increasedrisk of contamination when implementing standard recommendations