Efficacy of Oseltamivir-Zanamivir Combination Compared to Each Monotherapy for Seasonal Influenza: A Randomized Placebo-Controlled Trial

Analysis of virological and clinical outcomes from a randomized trial that was terminated early suggest that combined treatment of seasonal influenza in adult outpatients with oseltamivir plus zanamivir is no more effective than either oseltamivir or zanamivir monotherapy

Evaluation du niveau de risque cardio-vasculaire des médecins généralistes de la région PACA (étude sur 168 questionnaires)

NICE-BU Médecine Odontologie (060882102) / SudocSudocFranceF

Echocardiography in Confirmed and Highly Suspected Symptomatic COVID-19 Patients and Its Impact on Treatment Change

Background. COVID-19 interacts at multiple levels with the cardiovascular system. The prognosis of COVID-19 infection is known to be worse for patients with underlying cardiovascular diseases. Furthermore, the virus is responsible for many cardiovascular complications. Myocardial injury may affect up to 20% of the critically ill patients. However, echocardiography’s impact on the management of patients affected by COVID-19 remains unknown. Objectives. To explore echocardiography’s impact on the management of COVID-19 patients. Methods. This study was conducted from March 24th to April 14th, 2020, in a single center at Adolphe de Rothschild Foundation Hospital, Paris, France. All consecutive inpatients with laboratory and/or CT COVID-19 diagnosis were included in this study. Patients’ characteristics (clinical, biological, and imaging) and treatment change induced by echocardiography were collected and analyzed. Patients with and without treatment change induced by echocardiography were compared. Results. A total of 56 echocardiographies in 42 patients with highly suspected or confirmed COVID-19 were included in the final analyses. The median age was 66 (IQR 60.5–74). Echocardiography induced a treatment change in 9 cases (16%). The analyzed clinical data were not associated with any treatment change induced by echocardiography. D-dimer and Troponin levels were the only biological predictors of the induced treatment change. On echocardiography, higher systolic pulmonary arterial pressure and documented cardiac thrombi were associated with treatment changes in these patients. Conclusions. Echocardiography may be useful for the management of selected COVID-19 patients, especially those with elevated D-Dimer and Troponin levels, in up to 16% of patients

Management of low blood pressure in ambulatory heart failure with reduced ejection fraction patients

International audienceLow blood pressure is common in patients with heart failure and reduced ejection fraction (HFrEF). While spontaneous hypotension predicts risk in HFrEF, there is only limited evidence regarding the relationship between hypotension observed during heart failure (HF) drug titration and outcome. Nevertheless, hypotension (especially orthostatic hypotension) is an important factor limiting the titration of HFrEF treatments in routine practice. In patients with signs of shock and/or severe congestion, hospitalization is advised. However, in the very frequent cases of non-severe and asymptomatic hypotension observed while taking drugs with a class I indication in HFrEF, European and US guidelines recommend maintaining the same drug dosage. In instances of symptomatic or severe persistent hypotension (systolic blood pressure < 90 mmHg), it is recommended to first decrease blood pressure reducing drugs not indicated in HFrEF as well as the loop diuretic dose in the absence of associated signs of congestion. Unless the management of hypotension appears urgent, a HF specialist should then be sought rather than stopping or decreasing drugs with a class I indication in HFrEF. If symptoms or severe hypotension persist, no recommendations exist. Our HF group reviewed available evidence and proposes certain steps to follow in such situations in order to improve the pharmacological management of these patients

Effect of oseltamivir, zanamivir or oseltamivir-zanamivir combination treatments on transmission of influenza in households

Background The effectiveness of neuraminidase inhibitors to reduce transmission when used as treatment in influenza-infected patients remains debated. Methods In a prespecified analysis of a blinded randomized controlled trial on the efficacy of oseltamivir– zanamivir combination therapy versus oseltamivir and zanamivir monotherapy conducted during the 2008– 2009 seasonal influenza epidemic, we compared the rate of secondary illness in household contacts of influenza-positive index patients between arms. Secondary illness was defined as occurrence in contacts of fever plus cough within 7 days from randomization of index patients. Analyses were conducted according to the delay between patients’ onset of symptoms and intervention. Results A total of 543 household contacts of 267 index patients were included, of which 466 had follow-up assessment. A secondary illness was reported in 58 (12.5%) contacts with no significant difference between arms overall ( P=0.07). When the analysis was limited to the 232 contacts of 136 index patients with first treatment intake within 24 h of onset of symptoms, a lower rate of secondary illness was reported in the combination therapy arm (2 of 56 [4%]) than in the oseltamivir arm (14 of 81 [17%]; P=0.014) and the zanamivir arm (14 of 95 [15%]; P=0.031). Multivariate analysis accounting for intra-household correlation confirmed these findings. Conclusions Our analysis suggests a greater effectiveness of the combination therapy to reduce transmissibility when given to the index patient within 24 h of onset of symptoms. As the finding was obtained from a subgroup analysis, it should be interpreted with caution. </jats:sec

Factors associated with non-persistence to oral and inhaled antiviral therapies for seasonal influenza: a secondary analysis of a double-blind, multicentre, randomised clinical trial

International audienceOBJECTIVES:We aimed to evaluate and compare non-adherence to oral and inhaled antiviral therapies prescribed of a randomised clinical trial in outpatients with influenza A infection.DESIGN:A parallel, three-arm, double-blinded trial randomly allocated antiviral therapies twice daily for 5 days: (1) oral oseltamivir plus inhaled zanamivir (arm OZ); (2) oseltamivir plus inhaled placebo (arm Opz); or (3) oral placebo plus inhaled zanamivir (arm poZ). Analysis of non-adherence was a secondary objective of the trial.SETTINGS:Outpatients were enrolled by 145 general practitioners throughout France during the 2008-2009 seasonal influenza epidemics.PARTICIPANTS:A total of 541 adults presenting with influenza-like illness for less than 36 hours.PRIMARY OUTCOMES:Non-persistence, the time between inclusion and the last dose treated as a failure time, was used as the primary endpoint.RESULTS:The proportions of patients who persisted on treatment until the end of prescription were estimated at 85.73% (±3.28%) for the oral route and 82.73% (±3.44%) for the inhaled route. Based on multivariable models, non-persistence was associated with a PCR confirmation of influenza for both the oral (HR=0.54, p=0.010) and inhaled (HR=0.59, p=0.018) drugs and antibiotic coprescriptions (HR=2.07, p=0.007; and HR=1.88, p=0.017, respectively) and active combination treatment (HR=1.71, p=0.035; and HR=1.58, p=0.035, respectively). The hazard of non-persistence of the inhaled therapy was increased compared with that of the oral therapy (HR=1.23, p=0.043).CONCLUSION:In addition to the clinical and virological profiles of influenza infection, non-persistence may have been influenced by an active combination and the route of administration

Wearable cardioverter-defibrillator in patients with a transient risk of Sudden cardiac death: the WEARIT-France cohort study

International audienceAims : We aimed to provide contemporary real-world data on wearable cardioverter-defibrillator (WCD) use, not only in terms of effectiveness and safety but also compliance and acceptability.Methods and results : Across 88 French centres, the WEARIT-France study enrolled retrospectively patients who used the WCD between May 2014 and December 2016, and prospectively all patients equipped for WCD therapy between January 2017 and March 2018. All patients received systematic education session through a standardized programme across France at the time of initiation of WCD therapy and were systematically enrolled in the LifeVest Network remote services. Overall, 1157 patients were included (mean age 60 ± 12 years, 16% women; 46% prospectively): 82.1% with ischaemic cardiomyopathy, 10.3% after implantable cardioverter-defibrillator explant, and 7.6% before heart transplantation. Median WCD usage period was 62 (37-97) days. Median daily wear time of WCD was 23.4 (22.2-23.8) h. In multivariate analysis, younger age was associated with lower compliance [adjusted odds ratio (OR) 0.97, 95% confidence interval (CI) 0.95-0.99, P < 0.01]. A total of 18 participants (1.6%) received at least one appropriate shock, giving an incidence of appropriate therapy of 7.2 per 100 patient-years. Patient-response button allowed the shock to be aborted in 35.7% of well-tolerated sustained ventricular arrhythmias and in 95.4% of inappropriate ventricular arrhythmia detection, finally resulting in an inappropriate therapy in eight patients (0.7%).Conclusion: Our real-life findings reinforce previous studies on the efficacy and safety of the WCD in the setting of transient high-risk group in selected patients. Moreover, they emphasize the fact that when prescribed appropriately, in concert with adequate patient education and dedicated follow-up using specific remote monitoring system, compliance with WCD is high and the device well-tolerated by the patient

Protection agroécologique des cultures pour une production agricole durable

International audienceCrop losses from pests threaten global food security and safety. In the last six decades, pest control using chemical pesticides has resulted in important yield gains per unit area, worldwide. However, the long-term sustainability of chemical pest control has been increasingly thrown into doubt due to the negative impact on human health, biodiversity, and the environment. Consequently, there is an urgent need to improve the science of crop protection in order to tackle the five key challenges of 21st century agriculture holistically: (i) maintaining or improving agricultural productivity, (ii) producing healthy food, (iii) reducing the negative impacts of agriculture on ecosystem and human health, (iv) ensuring the economic viability of farms, and (v) adapting agriculture to climate change. Agroecological Crop Protection (ACP) can be a powerful approach to address these challenges, as we demonstrate in this paper. ACP is the application of the principles of agroecology to crop protection in order to promote virtuous and sustainable changes in agriculture and food systems. ACP combines multiple approaches and disciplines including ecology, agroecology, and Integrated Pest Management. It promotes a crop protection system compatible with healthy agricultural and food systems, agroecological principles and the “one health” approach. We predict that ACP will meet the challenge of pesticide-free agriculture in the future. In this paper, we will first present the scientific, agricultural and social components of ACP. We will then analyze the research approaches, questions, methods and tools needed to adopt ACP. Finally, we suggest key mechanisms to facilitate the transition to ACP, which will ultimately provide sustainable food, feed, and fuel in a context of major global change