Influenza generates a significant societal impact on morbidity, mortality, and associated costs. The study objective was to identify factors associated with influenza-like-illness (ILI) episodes ...during seasonal influenza epidemics among the general population.
A prospective study was conducted with the GrippeNet.fr crowdsourced cohort between 2012/13 and 2017/18. After having completed a yearly profile survey detailing socio-demographic, lifestyle and health characteristics, participants reported weekly data on symptoms. Factors associated with at least one ILI episode per influenza epidemic, using the European Centre for Disease Prevention and Control case definition, were analyzed through a conditional logistic regression model.
From 2012/13 to 2017/18, 6992 individuals participated at least once, and 61% of them were women (n = 4258). From 11% (n = 469/4140 in 2013/14) to 29% (n = 866/2943 in 2012/13) of individuals experienced at least one ILI during an influenza epidemic. Factors associated with higher risk for ILI were: gender female (OR = 1.29, 95%CI 1.20; 1.40), young age (< 5 years old: 3.12 2.05; 4.68); from 5 to 14 years old: 1.53 1.17; 2.00), respiratory allergies (1.27 1.18; 1.37), receiving a treatment for chronic disease (1.20 1.09; 1.32), being overweight (1.18 1.08; 1.29) or obese (1.28 1.14; 1.44), using public transport (1.17 1.07; 1.29) and having contact with pets (1.18 1.09; 1.27). Older age (≥ 75 years old: 0.70 0.56; 0.87) and being vaccinated against influenza (0.91 0.84; 0.99) were found to be protective factors for ILI.
This ILI risk factors analysis confirms and further completes the list of factors observed through traditional surveillance systems. It indicates that crowdsourced cohorts are effective to study ILI determinants at the population level. These findings could be used to adapt influenza prevention messages at the population level to reduce the spread of the disease.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
To assess the efficacy of the gelatin torpedoes embolization technique after lung neoplastic lesions percutaneous radiofrequency ablation (PRFA) to reduce chest tube placement rate and hospital ...length of stay, and the safety of this embolization technique.
A total of 114 PRFA of lung neoplastic lesions performed in two centers between January 2017 and December 2022 were retrospectively reviewed. Two groups were compared, with 42 PRFA with gelatin torpedoes embolization technique (gelatin group) and 72 procedures without (control group). Procedures were performed by one of seven interventional radiologists using LeVeen CoAccess™ probe. Multivariate analyses were performed to identify risk factors for chest tube placement and hospital length of stay.
There was a significantly lower chest tube placement rate in the gelatin group compared to the control group (3 7.1 % vs. 27 37.5 %, p < 0,001). Multivariate analysis showed a significant association between chest tube placement and gelatin torpedoes embolization technique (OR: 0.09; 95 % CI: 0.02–0.32; p = 0.0006). No significant difference was found in hospital length of stay between the two groups. Multivariate analysis did not show a significant relationship between hospital length of stay and gelatin torpedoes embolization technique. No embolic complication occurred in the gelatin group.
Gelatin torpedoes embolization technique after PRFA of lung neoplastic lesions resulted in significantly reduced chest tube placement rate in our patient population. No significant reduction in hospital length of stay was observed. No major complication occurred in the gelatin group.
Heart failure (HF) is a growing complication and one of the leading causes of mortality in people living with type 2 diabetes (T2D). Among the possible causes, the excess of red meat and the ...insufficiency of vegetables consumption are suspected. Such an alimentation is associated with nutritional biomarkers, including trimethylamine N-oxide (TMAO) and its precursors. Here, we aimed to study these biomarkers as potential prognostic factors for HF in patients with T2D.
We used the SURDIAGENE (SURvival DIAbetes and GENEtics) study, a large, prospective, monocentric cohort study including 1468 patients with T2D between 2001 and 2012. TMAO and its precursors (trimethylamine TMA, betaine, choline, and carnitine) as well as thio-amino-acids (cysteine, homocysteine and methionine) were measured by liquid chromatography-tandem mass spectrometry. The main outcome was HF requiring Hospitalization (HFrH) defined as the first occurrence of acute HF leading to hospitalization and/or death, established by an adjudication committee, based on hospital records until 31st December 2015. The secondary outcomes were the composite event HFrH and/or cardiovascular death and all-cause death. The association between the biomarkers and the outcomes was studied using cause-specific hazard-models, adjusted for age, sex, history of coronary artery disease, NT-proBNP, CKD-EPI-derived eGFR and the urine albumin/creatinine ratio. Hazard-ratios (HR) are expressed for one standard deviation.
The data of interest were available for 1349/1468 of SURDIAGENE participants (91.9%), including 569 (42.2%) women, with a mean age of 64.3 ± 10.7 years and a median follow-up of 7.3 years 25th-75th percentile, 4.7-10.8. HFrH was reported in 209 patients (15.5%), HFrH and/or cardiovascular death in 341 (25.3%) and all-cause death in 447 (33.1%). In unadjusted hazard-models, carnitine (HR = 1.20, 95% CI 1.05; 1.37), betaine (HR = 1.34, 1.20; 1.50), choline (HR = 1.35, 1.20; 1.52), TMAO (HR = 1.32, 1.16; 1.50), cysteine (HR = 1.38, 1.21; 1.58) and homocysteine (HR = 1.28, 1.17; 1.39) were associated with HFrH, but not TMA and methionine. In the fully adjusted models, none of these associations was significant, neither for HFrH nor for HFrH and/or CV death, when homocysteine only was positively associated with all-cause death (HR = 1.16, 1.06; 1.27).
TMAO and its precursors do not appear to be substantial prognosis factors for HFrH, beyond usual cardiac- and kidney-related risk factors, whereas homocysteine is an independent risk factor for all-cause death in patients with T2D.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Adrenal necrosis is a rare but serious cause of abdominal pain of thrombotic origin during pregnancy. There is often a delay in diagnosis and treatment. The objective was to specify the clinical and ...paraclinical signs suggestive of adrenal necrosis, making it possible to improve the delay in diagnostic. The secondary objective was to establish a multidisciplinary protocol regarding management. This is a case report of pregnant women with a radiological diagnosis of adrenal gland necrosis. In parallel, we carried out a systematic review in the same period. We studied these patients’ clinical, biological and radiological data. We included eight patients with a computed tomography scan diagnosis of adrenal necrosis and fifteen articles in the literature describing twenty-four cases. All the patients presented with the same symptoms. The treatment was based on curative anticoagulation. The diagnosis of adrenal gland necrosis is worth suggesting in view of the array of sudden morphine-resistant abdominal pain associated with a biological inflammatory syndrome. The diagnosis is based on the computed tomography scan. Three to six months of curative anticoagulation is recommended as well as a thrombophilia and endocrinological assessment to rule out adrenal insufficiency.
While nearly all computational methods operate on pseudonymized personal data, re-identification remains a risk. With personal health data, this re-identification risk may be considered a ...double-crossing of patients' trust. Herein, we present a new method to generate synthetic data of individual granularity while holding on to patients' privacy. Developed for sensitive biomedical data, the method is patient-centric as it uses a local model to generate random new synthetic data, called an "avatar data", for each initial sensitive individual. This method, compared with 2 other synthetic data generation techniques (Synthpop, CT-GAN), is applied to real health data with a clinical trial and a cancer observational study to evaluate the protection it provides while retaining the original statistical information. Compared to Synthpop and CT-GAN, the Avatar method shows a similar level of signal maintenance while allowing to compute additional privacy metrics. In the light of distance-based privacy metrics, each individual produces an avatar simulation that is on average indistinguishable from 12 other generated avatar simulations for the clinical trial and 24 for the observational study. Data transformation using the Avatar method both preserves, the evaluation of the treatment's effectiveness with similar hazard ratios for the clinical trial (original HR = 0.49 95% CI, 0.39-0.63 vs. avatar HR = 0.40 95% CI, 0.31-0.52) and the classification properties for the observational study (original AUC = 99.46 (s.e. 0.25) vs. avatar AUC = 99.84 (s.e. 0.12)). Once validated by privacy metrics, anonymous synthetic data enable the creation of value from sensitive pseudonymized data analyses by tackling the risk of a privacy breach.
Bronchoalveolar lavage (BAL) is a major diagnostic tool in interstitial lung disease (ILD). Its use remains largely quantitative, usually focused on cell differential ratio. However, cellular ...morphological features provide additional valuable information. The significance of the "immune alveolitis" cytological profile, characterized by lymphocytic alveolitis with activated lymphocytes and macrophages in epithelioid transformation or foamy macrophages desquamating in cohesive clusters with lymphocytes, remains unknown in ILD. Our objective was to describe patients' characteristics and diagnoses associated with an immune alveolitis profile in undiagnosed ILD.
We performed a monocentric retrospective observational study. Eligible patients were adults undergoing diagnostic exploration for ILD and whose BAL fluid displayed an immune alveolitis profile. For each patient, we collected clinical, radiological and biological findings as well as the final etiology of ILD.
Between January 2012 and December 2018, 249 patients were included. Mean age was 57 ± 16 years, 140 patients (56%) were men, and 65% of patients were immunocompromised. The main etiological diagnosis was Pneumocystis pneumonia (PCP) (24%), followed by drug-induced lung disease (DILD) (20%), viral pneumonia (14%) and hypersensitivity pneumonitis (HP) (10%). All PCP were diagnosed in immunocompromised patients while HP was found in only 8% of this subgroup. DILD and viral pneumonia were also commonly diagnosed in immunocompromised patients (94% and 80%, respectively).
Our study highlights the additional value of BAL qualitative description in ILD. We suggest incorporating the immune alveolitis profile for the diagnosis and management of ILD, especially in immunocompromised patients, since it guides towards specific diagnoses.
The microsurgical literature reports the vascular calibers of the vessels studied even though the method of measurement of these vessels is very rarely reported.
We performed a metrological study ...evaluating three methods to measure the external calibers of catheters corresponding to microsurgical and super-microsurgical vessels (1.2 mm, 0.8 mm, and 0.6 mm). Six evaluators measured 15 catheters of three different hidden diameters by each of the three methods applicable in clinical practice: standard graduated ruler, Shinwa® micrometric ruler, and ImageJ® software from a photograph. Accuracy and reliability of the measurements were assessed by studying the inter- and intra-rater and inter-method coefficients (variants of the intra-class coefficient (ICC)) and analysis of the IC95% of the ICCs.
Intra class correlation ICC "intra-rater" coefficient finds for the standard rule 0.81 0.65–0.93, Shinwa® rule 0.86 0.67–0.96, and for the ImageJ® software 0.97 0.94–0.99. The “Inter-rater” ICC shows respectively the coefficient 0.51 0.23 and max 0.93, 0.87 0.75–0.95, and 0.95 0.89–0.98. It appears that the graduated decimeter is the least reliable method of measurement, the Shinwa® ruler presents acceptable reliability but requires the purchase of equipment. The reliability of ImageJ® software is the best and appears to be the most reliable method.
Our original study, with no equivalent in the scientific literature, demonstrates objectively the great accuracy and reliability of a method of measurement of vascular calibers in micro and super microsurgery using intraoperative photography and the use of free computer software.
Abstract
Background and Aims
Secondary hyperparathyroidism (sHPT) is common in kidney transplant recipients. It remains unknown if Calcimimetic agents (as cinacalcet), oftenly used in this context, ...have an impact on mortality or morbidity. The objective of this work was to compare the renal and cardiovascular outcome of kidney transplanted patients with sHPT.
Method
Data from January 2008 to December 2019 were retrospectively extracted from the DIVAT database. 575 kidney transplant recipients with sHPT (PTH > 100 pg/ml) followed in Nantes University Hospital, were separated into two groups: Treated (cinacalcet) and sHPT Controls (no cinacalcet). A propensity score was used to match the patients (age, sex, first transplant, transplantation before/after 2015, time on dialysis, history of cardiovascular disease, initial condition, anti-HLA class I and II immunization, corticosteroids, serum parathormone level). Biological data (including estimated glomerular filtration rate by CKD-Epi formula), cardiovascular events (coronaropathy, obliterating arteriopathy of the lower limbs, stroke), return in dialysis or related death were extracted from one year of transplantation to the last follow-up. Time-varying exposure Cox PH model was used.
Results
292 patients were included after matching (146 Treated, 146 sHPT Controls). After one year of transplantation, serum parathormone was significantly higher in Treated patients compared to sHPT Controls (152 pg/mL vs 111 pg/mL respectively, p < 0.001), suggesting a more severe sHPT in Treated patients. 7% of Treated and 10% of sHPT Controls suffered from a cardiovascular event or related death during the follow up (HR = 1.28 0.52; 3.14, p = 0.6). Return to dialysis or related death were more frequent in the Treated patients (HR: 1.90 0.97 - 3.75, p = 0.06. At 48 months post-transplantation, estimated glomerular filtration rate was significantly decreased in Treated patients compared to sHPT controls (52.3 mL/min/1.73 m2 vs 44.1, p = 0.006).
Conclusion
Our study highlights that kidney transplant recipients with sHPT treated with cinacalcet have a worse kidney graft outcome than non-treated sHPT patients. It remains to be assessed if this reflects an underlying more severe sHPT condition or a direct effect of cinacalcet on the graft function. This study needs to be completed by the assessment of bone mineralization. Parathyroidectomy for sHPT should be discussed in kidney transplant recipients with impaired glomerular filtration rate and/or cardiovascular events.
e20122 Background: Chemotherapy plus immunotherapy (CT-IO) is now the standard first-line for ES-SCLC patients (pts). The impact of prior IO on 2L therapies remains unclear. This study aims to assess ...the real-word efficacy of 2L therapies in ES-SCLC pts, previously treated with CT-IO. Methods: All patients from 8 French hospitals initially treated with CT-IO were screened, and those who received 2L after progression were included and divided into 3 groups: platinum-based, lurbinectedin or others (topotecan, cyclophosphamide/adriamycine/vincristine or taxanes). We assessed overall survival (OS) from 2L initiation, 2L progression-free survival (2L-PFS) and objective response rate (ORR), considering treatment group and treatment free-interval (TFI) < or ≥ 90 days (platinum-resistant and platinum-sensitive, respectively). The aim was not to compare efficacy between groups, given significant inherent selection biases. Results: Of the 132 screened ES-SCLC pts, 72 received 2L. At 2L initiation, median age was 67.0, 31.9% had a Performans Status (PS) ≥ 2, 40% had brain progression at 1L, with half of them undergoing brain radiotherapy. Regarding TFI, 66.7% were platinum-sensitive and 33.3% platinum-resistant. Only 5 pts had a TFI > 180 days. Platinum-doublet was the 2L for 33/72 (45.8%), lurbinectedin for 17/72 (23.6%) and others for 22/72 (30.6%). Pts with a TFI ≥ 90 days mainly received platinum rechallenge (30/48, 62.5%), while those with a TFI < 90 days received lurbinectedin (41.7%) or others (45.8%). With a median follow-up of 17.3 months, the median OS was 4.8 months (95%CI, 1.7-7.9) and 6.1 months (95%CI, 5.0-8.2) for platinum-resistant and platinum-sensitive, respectively. Median OS was 7.9 months (95%CI, 5.7-11.8) with platinum rechallenge, 4.5 months (95%CI, 3.0-6.8) with lurbinectedin and 4.7 months (95%CI, 2.0-6.3) with other chemotherapies (log rank p = 0.02). Median 2L-PFS was 1.8 months (95%CI, 1.2-4.5) and 3.7 months (95%CI, 2.8-6.0) for platinum-resistant and platinum-sensitive, respectively. Median 2L-PFS was 4.6 months (95%CI, 3.2-7.5) with platinum rechallenge, 2.5 months (95%CI, 1.6-4.7) with lurbinectedin and 1.9 months (95%CI, 1.4-3.8) with other chemotherapies (log rank p = 0.024). The 6-months PFS in platinum-sensitive pts was 45.6%/16.7%/11.1% with platinum/lurbinectedin/other respectively. ORR was 61%/23%/18% with platinum/lurbinectedin/other respectively. Conclusions: Platinum rechallenge following first-line CT-IO showed noteworthy results within a real-word ES-SCLC population, including patients with altered PS and brain metastases. 2L lurbinectedin efficacy appeared limited, similar to other platinum-free regimens, yet I was mostly used in platinum-resistant pts. Further data is needed to explore the potential of first-line IO in enhancing sensitivity to platinum rechallenge.
Patients with type 2 diabetes mellitus (T2DM) represent a high-risk population for both cardiovascular diseases and severe coronavirus disease 2019 (COVID-19). Recent studies have reported ...interactions between statin treatment and COVID-19-related outcomes. The study reported here specifically assessed the association between routine statin use and COVID-19-related outcomes in inpatients with T2DM.
The Coronavirus–SARS-CoV-2 and Diabetes Outcomes (CORONADO) study was a nationwide observational study aiming to describe the phenotypic characteristics and prognosis of T2DM patients with COVID-19 admitted to 68 French hospitals between 10 March and 10 April 2020. The composite primary outcome comprised tracheal intubation and/or death within 7 and 28 days of admission. The association between statin use and outcomes was estimated by logistic regression analysis after applying inverse probability of treatment weighting (IPTW) using a propensity score-weighting approach.
Of the 2449 patients with T2DM (881 women, 1568 men; aged 70.9 ± 12.5 years) suitable for analysis, 1192 (49%) were using statin treatment before admission. In unadjusted analyses, patients using statins had rates of the primary outcome similar to those of non-users within both 7 (29.8% vs 27.0%, respectively; P = 0.1338) and 28 days (36.2% vs 33.8%, respectively; P = 0.2191) of admission. However, mortality rates were significantly higher in statin users within 7 (12.8% vs 9.8%, respectively; P = 0.02) and 28 days (23.9% vs 18.2%, respectively; P < 0.001). After applying IPTW, significant associations were observed with statin use and the primary outcome within 7 days (OR 95% CI: 1.38 1.04–1.83) and with death within both 7 (OR 95% CI: 1.74 1.13–2.65) and 28 days (OR 95% CI: 1.46 1.08–1.95).
Routine statin treatment is significantly associated with increased mortality in T2DM patients hospitalized for COVID-19.
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