Covichem: A biochemical severity risk score of COVID-19 upon hospital admission

Clinical and laboratory predictors of COVID-19 severity are now well described and combined to propose mortality or severity scores. However, they all necessitate saturable equipment such as scanners, or procedures difficult to implement such as blood gas measures. To provide an easy and fast COVID-19 severity risk score upon hospital admission, and keeping in mind the above limits, we sought for a scoring system needing limited invasive data such as a simple blood test and co-morbidity assessment by anamnesis. A retrospective study of 303 patients (203 from Bordeaux University hospital and an external independent cohort of 100 patients from Paris Pitié-Salpêtrière hospital) collected clinical and biochemical parameters at admission. Using stepwise model selection by Akaike Information Criterion (AIC), we built the severity score Covichem. Among 26 tested variables, 7: obesity, cardiovascular conditions, plasma sodium, albumin, ferritin, LDH and CK were the independent predictors of severity used in Covichem (accuracy 0.87, AUROC 0.91). Accuracy was 0.92 in the external validation cohort (89% sensitivity and 95% specificity). Covichem score could be useful as a rapid, costless and easy to implement severity assessment tool during acute COVID-19 pandemic waves

Limbic encephalitis as a relapse of Whipple’s disease with digestive involvement and spondylodiscitis

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Time to treatment initiation and HIV viral suppression in people diagnosed with HIV-1 during COVID-19 pandemic in ex-Aquitaine, France (ANRS CO3 AQUIVIH-NA Cohort-QuAliCOV Study)

International audienceThe Covid-19 pandemic's impact on initiation and effectiveness of antiretroviral therapy (ART) in people diagnosed with HIV remains unclear. We evaluated critical delays in HIV care in people diagnosed before and during the pandemic in ex-Aquitaine, France. We considered adults diagnosed with HIV-1 in 2018-2021 and enrolled in the ANRS CO3 AQUIVIH-NA and followed them until 10/10/2022 for those diagnosed during the pandemic (1/4/2020 - 31/12/2021) and until 31/03/2020 for historical controls. We compared their characteristics at inclusion and the median time between diagnosis and ART initiation, ART initiation and viral suppression and diagnosis and virological suppression (effective management). 83 individuals were diagnosed during the pandemic versus 188 during the pre-pandemic period. Median follow-up was 549 (IQR: 329-713) days. Populations were similar in terms of sex, age, HIV transmission group, hospital type, and clinical characteristics at diagnosis, however, fewer were foreign-born during the pandemic (15.7% versus 33.5%, p=0.003). The probability of ART initiation, therapeutic success, effective management was higher in PLWH diagnosed during the pandemic in adjusted analyses (HR 2.0 95%CI. 1.5-2.7, HR 1.7 95%CI. 1.2-2.3, HR 1.8 95%CI. 1.3-2.6, respectively). Those diagnosed during the pandemic were 2.3 (95%CI: 1.2-4.1) times more likely to be virologically suppressed within 6 months of diagnosis compared to historical controls. Pandemic-related reorganizations may have resulted in newly diagnosed PLWH being prioritized, however, the lower proportion of foreign-born PLWH diagnosed during the pandemic period, likely due to reduced migration and potential delays in diagnosis, may contribute to these preliminary findings

High-resolution Free-breathing late gadolinium enhancement Cardiovascular magnetic resonance to diagnose myocardial injuries following COVID-19 infection

International audiencePURPOSE: High-resolution free-breathing late gadolinium enhancement (HR-LGE) was shown valuable for the diagnosis of acute coronary syndromes with non-obstructed coronary arteries. The method may be useful to detect COVID-related myocardial injuries but is hampered by prolonged acquisition times. We aimed to introduce an accelerated HR-LGE technique for the diagnosis of COVID-related myocardial injuries. METHOD: An undersampled navigator-gated HR-LGE (acquired resolution of 1.25 mm(3)) sequence combined with advanced patch-based low-rank reconstruction was developed and validated in a phantom and in 23 patients with structural heart disease (test cohort; 15 men; 55 ± 16 years). Twenty patients with laboratory-confirmed COVID-19 infection associated with troponin rise (COVID cohort; 15 men; 46 ± 24 years) prospectively underwent cardiovascular magnetic resonance (CMR) with the proposed sequence in our center. Image sharpness, quality, signal intensity differences and diagnostic value of free-breathing HR-LGE were compared against conventional breath-held low-resolution LGE (LR-LGE, voxel size 1.8x1.4x6mm). RESULTS: Structures sharpness in the phantom showed no differences with the fully sampled image up to an undersampling factor of x3.8 (P > 0.5). In patients (N = 43), this acceleration allowed for acquisition times of 7min21s ± 1min12s at 1.25 mm(3) resolution. Compared with LR-LGE, HR-LGE showed higher image quality (P = 0.03) and comparable signal intensity differences (P > 0.5). In patients with structural heart disease, all LGE-positive segments on LR-LGE were also detected on HR-LGE (80/391) with 21 additional enhanced segments visible only on HR-LGE (101/391, P < 0.001). In 4 patients with COVID-19 history, HR-LGE was definitely positive while LR-LGE was either definitely negative (1 microinfarction and 1 myocarditis) or inconclusive (2 myocarditis). CONCLUSIONS: Undersampled free-breathing isotropic HR-LGE can detect additional areas of late enhancement as compared to conventional breath-held LR-LGE. In patients with history of COVID-19 infection associated with troponin rise, the method allows for detailed characterization of myocardial injuries in acceptable scan times and without the need for repeated breath holds

Interglaciaires pléistocènes en domaine karstique méditerranéen. Interprétation de la sédimentation et de la biodiversité fossile à la Caune de l’Arago (Tautavel, Pyrénées-Orientales)

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Interglaciaires pléistocènes en domaine karstique méditerranéen. Interprétation de la sédimentation et de la biodiversité fossile à la Caune de l’Arago (Tautavel, Pyrénées-Orientales)

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Engagement entrepreneurial et territoires

Les nouvelles technologies de l’information et de la communication ont transformé et rendu caduque la notion même de territoire : dans la réalité, celui-ci n’est plus le résultat d’un découpage administratif, mais coïncide avec l’usage qui lui est prêté. À la notion d’une géographie du territoire spatialement délimitée se substitue celle d’un territoire réticulaire dont les limites deviennent indéfinissables. Penser l’ancrage territorial des entreprises (qui ne doit pas, cependant, apparaître comme antagoniste au concept du nomadisme), permet d’interroger le développement des territoires. Par ailleurs, cet ancrage facilite l’inscription durable de ce type d’organisations dans une réalité locale, en leur octroyant une légitimité dans les questions relevant du social et de l’environnement. L’engagement entrepreneurial en matière d’emploi, de formation, de sensibilisation à la culture, de responsabilité écologique, etc., contribue au développement territorial car les initiatives des entreprises en accompagnant la croissance des acteurs économiques et des partenaires locaux, participent également de la vie citoyenne. Se pose alors la question des moyens financiers, technologiques, humains, etc. Comment repenser la relation entreprise-territoire comme une source de compétitivité et cela à des échelles différentes (locale, régionale, nationale) ? Comment matérialiser l’engagement ? Comment entraîner les « parties prenantes » dans une spirale vertueuse d’aménagement des territoires ? C’est à l’ensemble de ces questions que répondent les contributions publiées dans ce dossier

Epidemiological and clinical characteristics of patients with monkeypox in the GeoSentinel Network: a cross-sectional study

© 2022 Elsevier Ltd. All rights reserved.Background: The early epidemiology of the 2022 monkeypox epidemic in non-endemic countries differs substantially from the epidemiology previously reported from endemic countries. We aimed to describe the epidemiological and clinical characteristics among individuals with confirmed cases of monkeypox infection. Methods: We descriptively analysed data for patients with confirmed monkeypox who were included in the GeoSentinel global clinical-care-based surveillance system between May 1 and July 1 2022, across 71 clinical sites in 29 countries. Data collected included demographics, travel history including mass gathering attendance, smallpox vaccination history, social history, sexual history, monkeypox exposure history, medical history, clinical presentation, physical examination, testing results, treatment, and outcomes. We did descriptive analyses of epidemiology and subanalyses of patients with and without HIV, patients with CD4 counts of less than 500 cells per mm3 or 500 cells per mm3 and higher, patients with one sexual partner or ten or more sexual partners, and patients with or without a previous smallpox vaccination. Findings: 226 cases were reported at 18 sites in 15 countries. Of 211 men for whom data were available, 208 (99%) were gay, bisexual, or men who have sex with men (MSM) with a median age of 37 years (range 18-68; IQR 32-43). Of 209 patients for whom HIV status was known, 92 (44%) men had HIV infection with a median CD4 count of 713 cells per mm3 (range 36-1659; IQR 500-885). Of 219 patients for whom data were available, 216 (99%) reported sexual or close intimate contact in the 21 days before symptom onset; MSM reported a median of three partners (IQR 1-8). Of 195 patients for whom data were available, 78 (40%) reported close contact with someone who had confirmed monkeypox. Overall, 30 (13%) of 226 patients were admitted to hospital; 16 (53%) of whom had severe illness, defined as hospital admission for clinical care rather than infection control. No deaths were reported. Compared with patients without HIV, patients with HIV were more likely to have diarrhoea (p=0·002), perianal rash or lesions (p=0·03), and a higher rash burden (median rash burden score 9 [IQR 6-21] for patients with HIV vs median rash burden score 6 [IQR 3-14] for patients without HIV; p<0·0001), but no differences were identified in the proportion of men who had severe illness by HIV status. Interpretation: Clinical manifestations of monkeypox infection differed by HIV status. Recommendations should be expanded to include pre-exposure monkeypox vaccination of groups at high risk of infection who plan to engage in sexual or close intimate contact.US Centers for Disease Control and Prevention, International Society of Travel Medicineinfo:eu-repo/semantics/publishedVersio

Cartographier les ressources pour gérer les priorités

International audienceComment, depuis plusieurs décennies, la recherche scientifique contribue-t-elle au développement des pays du Sud ? À travers plus de 100 succès emblématiques de la recherche en partenariat, cet ouvrage nous plonge au coeur des grandes questions de développement : oeuvrer pour des sociétés plus justes, lutter contre les maladies, faire face aux risques naturels, mettre en place une agriculture durable garantissant la sécurité alimentaire, préserver la biodiversité, partager les savoirs... Il montre ainsi comment la recherche contribue à l'amélioration des conditions de vie et à la préservation de l'environnement dans les pays en développement, en soulignant le rôle de la science pour répondre aux défis du monde actuel et à venir. Composé de textes courts, didactiques et richement illustrés, il s'adresse à tous les publics