COMPLICATIONS PULMONAIRES DES PANCREATITES AIGUES

AMIENS-BU Santé (800212102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Utilisation du Versatis® dans les douleurs cicatricielles (revue de 100 cas chez l'adulte)

La douleur cicatricielle, dont l origine se situe au niveau des lésions tissulaires séquellaires secondaires à une lésion traumatique ou à un acte chirurgical, requiert une prise en charge spécifique. L arrivée des emplâtres de lidocaïne en a modifié le schéma thérapeutique. Ce travail rétrospectif comprend deux parties : un rappel des connaissances concernant la douleur et l étude d une série de 100 observations de patients adultes ayant reçus du Versatis® sur une durée minimum d au moins 2 mois et traités dans le service de chirurgie orthopédique et traumatologique du Centre Hospitalier Universitaire d Amiens de mai 2008 à janvier 2011. La série comporte 36 hommes et 64 femmes. Les étiologies sont les suivantes : 30 cas de lésions traumatiques opérées, 68 cas de pathologies orthopédiques opérées, 1 cas de phlegmon opéré et 1 cas de lésions traumatiques non opérées. La topographie des zones douloureuses, par ordre de fréquence décroissante, est la suivante : 40 genoux, 22 poignets et mains, 12 pieds, 10 épaules, 8 chevilles et 8 autres localisations diverses. Le délai moyen lors de la mise en route du traitement est de 243 jours et la durée moyenne du traitement est de 4,6 mois. Dans les 100 cas, la diminution des douleurs a été systématique et aucune complication n est apparue. En conclusion, dans cette série, l application de l emplâtre de lidocaïne traitement d administration aisée a contribué à traiter la douleur cicatricielle.Pain scar whose origin is at the level of tissue damage sequelae secondary to traumatic injury or surgery, requires a specific treatment. The arrival of lidocaine patches has changed the treatment regimen. This retrospective includes two parts : a reminder of knowledge about pain and the study of a series of 100 observations of adult patients who received the Versatis® on a minimum of at least 2 months and treated in the surgical department orthopedic and Traumatology, University Hospital of Amiens from May 2008 to January 2011. The series includes 36 men and 64 women. The causes are as follows: 30 cases of traumatic lesions operated, 68 cases of orthopedic pathologies made, one case of phlegmon surgery and a traumatic event of non-operated. The topography of the painful areas, in order of decreasing frequency, is as follows: 40 knees, 22 wrists and hands, 12 feet, 10 shoulders, 8 ankles and 8 different locations. The average delay at the start of treatment was 243 days and the average duration of treatment was 4.6 months. In 100 cases, pain reduction was consistent and no complications appeared. In conclusion, in this series, the application of the lidocaine patch treatment administration has helped ease the pain scar treatment.AMIENS-BU Santé (800212102) / SudocSudocFranceF

Microvascular flow alterations in critically ill COVID-19 patients: A prospective study.

BackgroundData on microcirculatory pattern of COVID-19 critically ill patients are scarce. The objective was to compare sublingual microcirculation parameters of critically ill patients according to the severity of the disease.MethodsThe study is a single-center prospective study with critically ill COVID-19 patients admitted in ICU. Sublingual microcirculation was assessed by IDF microscopy within 48 hours of ICU admission. Microcirculatory flow index (MFI), proportion of perfused vessel (PPV), total vessel density (TVD), De Backer score (DBS), perfused vessel density (PVD) and heterogeneity index (HI) were assessed. Patients were divided in 2 groups (severe and critical) according to the World health organization definition.FindingsFrom 19th of March to 7th of April 2020, 43 patients were included. Fourteen patients (33%) were in the severe group and twenty-nine patients (67%) in the critical group. Patients in the critical group were all mechanically ventilated. The critical group had significantly higher values of MFI, DBS and PVD in comparison to severe group (respectively, PaCO2: 49 [44-45] vs 36 [33-37] mmHg; pConclusionCritical COVID-19 patients under mechanical ventilation seem to have higher red blood cell velocity than severe non-ventilated patients

Les traditions économiques françaises

Les années 1848-1939 correspondent à une époque que l’on a pu caractériser par «l’essor des sciences sociales ». Les économistes français d’alors, et plus généralement les économistes francophones, tiennent dans ce mouvement une place importante. On observe un foisonnement d’idées, d’observations, de théories, tout un riche tissu intellectuel sur des thèmes tels que les crises, la monnaie, les marchés, l’équilibre, l’économie sociale, les questions de méthode, le socialisme ou le libéralisme. Un des intérêts de l’ouvrage est de mieux faire connaître ces travaux, y compris ceux d’auteurs considérés, à tort, comme mineurs. Les économistes français sont imprégnés par les traditions économiques nationales. Traditions en ce qui concerne les théories de la valeur axée sur l’utilité, le rôle donné aux mathématiques sociales, l’importance des sciences de l’ingénieur, l’intérêt pour une économie qui ne soit pas déshumanisée, le débat entre un libéralisme et un socialisme chacun eux-mêmes originaux. L’ouvrage permet de montrer l’importance des relations de l’économie avec d’autres disciplines comme le droit, la psychologie, la sociologie, l’histoire. Il met également l’accent sur les relations entre l’histoire de la pensée et celle des faits, entre les économistes français et ceux du reste du monde

Increased risk of severe COVID-19 in hospitalized patients with SARS-CoV-2 Alpha variant infection: a multicentre matched cohort study

International audienceBackground: The impact of the variant of concern (VOC) Alpha on the severity of COVID-19 has been debated. We report our analysis in France.Methods: We conducted an exposed/unexposed cohort study with retrospective data collection, comparing patients infected by VOC Alpha to contemporaneous patients infected by historical lineages. Participants were matched on age (± 2.5 years), sex and region of hospitalization. The primary endpoint was the proportion of hospitalized participants with severe COVID-19, defined as a WHO-scale > 5 or by the need of a non-rebreather mask, occurring up to day 29 after admission. We used a logistic regression model stratified on each matched pair and accounting for factors known to be associated with the severity of the disease.Results: We included 650 pairs of patients hospitalized between Jan 1, 2021, and Feb 28, 2021, in 47 hospitals. Median age was 70 years and 61.3% of participants were male. The proportion of participants with comorbidities was high in both groups (85.0% vs 90%, p = 0.004). Infection by VOC Alpha was associated with a higher odds of severe COVID-19 (41.7% vs 38.5%-aOR = 1.33 95% CI [1.03-1.72]).Conclusion: Infection by the VOC Alpha was associated with a higher odds of severe COVID-19

Type 1 Diabetes in People Hospitalized for COVID-19: New Insights From the CORONADO Study

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The association between macrovascular complications and intensive care admission, invasive mechanical ventilation, and mortality in people with diabetes hospitalized for coronavirus disease-2019 (COVID-19)

International audienceAbstract Background It is not clear whether pre-existing macrovascular complications (ischemic heart disease, stroke or peripheral artery disease) are associated with health outcomes in people with diabetes mellitus hospitalized for COVID-19. Methods We conducted cohort studies of adults with pre-existing diabetes hospitalized for COVID-19 infection in the UK, France, and Spain during the early phase of the pandemic (between March 2020—October 2020). Logistic regression models adjusted for demographic factors and other comorbidities were used to determine associations between previous macrovascular disease and relevant clinical outcomes: mortality, intensive care unit (ICU) admission and use of invasive mechanical ventilation (IMV) during the hospitalization. Output from individual logistic regression models for each cohort was combined in a meta-analysis. Results Complete data were available for 4,106 (60.4%) individuals. Of these, 1,652 (40.2%) had any prior macrovascular disease of whom 28.5% of patients died. Mortality was higher for people with compared to those without previous macrovascular disease (37.7% vs 22.4%). The combined crude odds ratio (OR) for previous macrovascular disease and mortality for all four cohorts was 2.12 (95% CI 1.83–2.45 with an I 2 of 60%, reduced after adjustments for age, sex, type of diabetes, hypertension, microvascular disease, ethnicity, and BMI to adjusted OR 1.53 [95% CI 1.29–1.81]) for the three cohorts. Further analysis revealed that ischemic heart disease and cerebrovascular disease were the main contributors of adverse outcomes. However, proportions of people admitted to ICU (adjOR 0.48 [95% CI 0.31–0.75], I 2 60%) and the use of IMV during hospitalization (adjOR 0.52 [95% CI 0.40–0.68], I 2 37%) were significantly lower for people with previous macrovascular disease. Conclusions This large multinational study of people with diabetes mellitus hospitalized for COVID-19 demonstrates that previous macrovascular disease is associated with higher mortality and lower proportions admitted to ICU and treated with IMV during hospitalization suggesting selective admission criteria. Our findings highlight the importance correctly assess the prognosis and intensive monitoring in this high-risk group of patients and emphasize the need to design specific public health programs aimed to prevent SARS-CoV-2 infection in this subgroup