COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Diabète de type I : place du pharmacien d’officine

Le diabète de type 1 appelé aussi diabète insulino-dépendant est une pathologie métabolique chronique qui touche de plus en plus de personne. Le diabète de type 1 est une pathologie juvénile touchant essentiellement les enfants et les jeunes adultes.C’est une affection métabolique, caractérisée par une hyperglycémie chronique liée à une carence absolue ou quasi absolue de l’insulinosécrétion. La définition des états diabétiques se base actuellement sur un paramètre unique : la glycémie.Une prise en charge pluridisciplinaire de l’ensemble des professionnels de santé est primordiale. De part son rôle, le pharmacien est le professionnel de santé le plus visité par le patient (au moins une fois par mois), ce qui le place dans une position privilégiée pour le suivi et l’orientation du patient dans son parcours de soin.L’éducation thérapeutique ne se résume pas à une simple information du patient sur sa pathologie mais doit faire partie intégrante de sa prise en charge au quotidien. Cette discipline place le patient et non pas la maladie au centre de la réflexion.Ainsi, il doit être conscient et informé sur sa pathologie, sur les soins qu’elle implique, sur les comportements à avoir face à celle-ci. L’éducation thérapeutique a donc pour objectif de rendre le patient diabétique acteur de son traitement afin de lui permettre d’acquérir, de maintenir et d’améliorer sa qualité de vie tout en préservant son autonomie.Nous aborderons dans cette thèse la définition, la physiopathologie du diabète de type I, les méthodes de diagnostics et les complications que celui-ci peut engendrer. Nous verrons ensuite les mesures hygiéno-diététiques et les stratégies thérapeutiques mises en œuvre. Puis nous nous concentrerons sur le rôle du pharmacien d’officine dans la prise en charge du patient diabétique

Synthesis of TiO(OH)2 precursor for low temperature sintering: A chemical and microstructural study

In this study, Titanium oxyhydroxyide powder was synthetized using a modified sol-gel route. This powder is widely studied as a catalyst for CO2 desorption but is here synthesized for the Cool-SPS sintering of titania based ceramics, as a reactive precursor. It is then important to maximize its reactivity at low temperature. The influence of different synthesis parameters (base used, temperature) on the final properties of the TiO(OH)2 powder is thus investigated. The final products were characterized by XRD, FTIR, SEM, granulometry and TGA. The microstructural parameters are crucial in order to obtain a satisfying reactivity for low temperature sintering and will determine the best parameters for the synthesis of TiO(OH)2. Preliminary results concerning the sintering of TiO2 from this precursor are also reported

Synthesis and binding affinities for sst receptors of cyclic peptoid SRIF-mimetics.

International audienceMimicking the tetradecapeptide somatostatin through the design of novel non-peptide small molecules is needed for developing analogues with selective or universal affinity for human somatostatin receptors (hsst1-5) and improved pharmacological properties. We report the synthesis and evaluation of the binding potential of the first all-peptoid SRIF (somatotropin release-inhibiting factor) analogues. Cyclic β and mixed α/β tetra- or pentapeptoids were efficiently obtained by macrocyclisation of the corresponding linear peptoids. In vitro competition binding experiments using [125I]-somatostatin were performed on this first generation of peptoids mimicking the SRIF pharmacophore (Phe7-(D)Trp8-Lys9-Thr10). The selectivity profiles of cyclic compounds 1 to 4 were similar with higher affinity for the sst3, sst5 and sst4 receptors and lower potency on sst1 and sst2 subtypes

A diffuse lung emphysema, severe pulmonary hypertension and lack of airflow limitation

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Awakening efficacy of a vibrotactile device in patients on home nocturnal ventilatory assistance and healthy subjects as family caregiver proxies

International audienceThe objective of this study was to test the capacity of vibrotactile stimulation transmitted to the wrist bones by a vibrating wristband to awaken healthy individuals and patients requiring home mechanical ventilation during sleep. Healthy subjects (n = 20) and patients with central hypoventilation (CH) (Congenital Central Hypoventilation syndrome n = 7; non-genetic form of CH n = 1) or chronic obstructive pulmonary disease (COPD) (n = 9), underwent a full-night polysomnography while wearing the wristband. Vibrotactile alarms were triggered five times during the night at random intervals. Electroencephalographic (EEG), clinical (trunk lift) and cognitive (record the time on a sheet of paper) arousals were recorded. Cognitive arousals were observed for 94% of the alarms in the healthy group and for 66% and 63% of subjects in the CH and COPD groups, respectively (p < 0.01). The percentage of participants experiencing cognitive arousals for all alarms, was 72% for healthy subjects, 37.5% for CH patients and 33% for COPD patients (ns) (94%, 50% and 44% for clinical arousals (p < 0.01) and 100%, 63% and 44% for EEG arousals (p < 0.01)). Device acceptance was good in the majority of cases, with the exception of one CH patient and eight healthy participants. In summary this study shows that a vibrotactile stimulus is effective to induce awakenings in healthy subjects, but is less effective in patients, supporting the notion that a vibrotactile stimulus could be an effective backup to a home mechanical ventilator audio alarm for healthy family caregivers

Long-term effects of chronic nicotine exposure on brain nicotinic receptors.

International audienceChronic nicotine exposure results in long-term homeostatic regulation of nicotinic acetylcholine receptors (nAChRs) that play a key role in the adaptative cellular processes leading to addiction. However, the relative contribution of the different nAChR subunits in this process is unclear. Using genetically modified mice and pharmacological manipulations, we provide behavioral, electrophysiological, and pharmacological evidence for a long-term mechanism by which chronic nicotine triggers opposing processes differentially mediated by beta2*- vs. alpha7*nAChRs. These data offer previously undescribed insights into the understanding of nicotine addiction and the treatment of several human pathologies by nicotine-like agents chronically acting on beta2*- or alpha7*nAChRs

A diffuse lung emphysema, severe pulmonary hypertension and lack of airflow limitation

Pulmonary veno-occlusive disease is characterized by remodeling of pulmonary arteries, capillaries and venules. We report a case of diffuse lung emphysema and pulmonary veno-occlusive disease with the characteristic of having no airflow limitation. A very low diffusing capacity for carbon monoxide and results of high-resolution computed tomography of the chest suggested pulmonary veno-occlusive disease. The diagnosis was confirmed on histological analysis after lung transplantation. The combination of results of the computed tomography of the chest and the histological analysis suggested a relationship between diffuse lung emphysema and remodeling of pulmonary vessels. A distinctive pattern of mild-to-moderate airflow limitation in patients with chronic obstructive pulmonary disease and severe pulmonary hypertension has been described. This observation of the combination of diffuse emphysema, pulmonary veno-occlusive disease and no airflow limitation supports further pathophysiological studies on severe pulmonary hypertension in chronic obstructive pulmonary disease