Comparison Between Lung Ultrasonography Score in the Emergency Department and Clinical Outcomes of Patients With or With Suspected COVID-19: An Observational Multicentric Study

OBJECTIVE

Chest CT is the reference test for assessing pulmonary injury in suspected or diagnosed COVID-19 with signs of clinical severity. This study aimed to evaluate the association of a lung ultrasonography score and unfavorable clinical evolution at 28 days.

METHODS

The eChoVid is a multicentric study based on routinely collected data that was conducted in 8 emergency units in France; patients were included between March 19, 2020 and April 28, 2020 and underwent lung ultrasonography, a short clinical assessment by 2 emergency physicians blinded to each other's assessment, and chest CT. Lung ultrasonography consisted of scoring lesions from 0 to 3 in 8 chest zones, thus defining a global score (GS) of severity from 0 to 24. The primary outcome was the association of lung damage severity as assessed by the GS at day 0 and patient status at 28 days. Secondary outcomes were comparing the performance between GS and CT scan and the performance between a new trainee physician and an ultrasonography expert in scores.

RESULTS

For the 328 patients analyzed, the GS showed good performance in predicting clinical worsening at 28 days (area under the receiver operating characteristic curve [AUC] 0.83, sensitivity 84.2%, specificity 76.4%). The GS showed good performance in predicting the CT severity assessment (AUC 0.84, sensitivity 77.2%, specificity 83.7%).

CONCLUSION

A lung ultrasonography GS is a simple tool that can be used in the emergency department to predict unfavorable assessment at 28 days in patients with COVID-19.

Metabolomic analyses of COVID-19 patients unravel stage-dependent and prognostic biomarkers

The circulating metabolome provides a snapshot of the physiological state of the organism responding to pathogenic challenges. Here we report alterations in the plasma metabolome reflecting the clinical presentation of COVID-19 patients with mild (ambulatory) diseases, moderate disease (radiologically confirmed pneumonitis, hospitalization and oxygen therapy), and critical disease (in intensive care). This analysis revealed major disease- and stage-associated shifts in the metabolome, meaning that at least 77 metabolites including amino acids, lipids, polyamines and sugars, as well as their derivatives, were altered in critical COVID-19 patient's plasma as compared to mild COVID-19 patients. Among a uniformly moderate cohort of patients who received tocilizumab, only 10 metabolites were different among individuals with a favorable evolution as compared to those who required transfer into the intensive care unit. The elevation of one single metabolite, anthranilic acid, had a poor prognostic value, correlating with the maintenance of high interleukin-10 and -18 levels. Given that products of the kynurenine pathway including anthranilic acid have immunosuppressive properties, we speculate on the therapeutic utility to inhibit the rate-limiting enzymes of this pathway including indoleamine 2,3-dioxygenase and tryptophan 2,3-dioxygenase.

Asymptomatic SARS COV-2 carriers among nursing home staff: A source of contamination for residents?

Objectives

To show that circulation of SARS-COV-2 in nursing homes in France can come from staff as well as residents’ families, whether they are known or not to have had COVID-19.

Methods

This study reports a screening campaign of asymptomatic staff working in elderly nursing homes in Paris where the virus had been circulating actively in March and April 2020.

Results

Before the screening campaign, the rate of symptomatic COVID-19 was 23.3% among the residents and 12.1% among their home employees. Within a 72 h screening period, all employees not known to have the virus were screened by RT-PCR in nasopharyngeal swabs. Among the 241 screened employees, 32 (13.3%) tested positive for SARS-CoV-2 on RT-PCR. SARS-CoV-2 carriers and non-carriers did not differ in term of gender, age or type of staff. Staff carrying SARS-CoV-2 were strictly asymptomatic in 75% of cases while during the days following or before the test, 25% presented mild symptoms of COVID-19. Considering both symptomatic and asymptomatic cases, 66 out of 281 (23.5%) of the home employees had been carriers for COVID-19.

Conclusion

Screening for viral carriage of asymptomatic staff in nursing homes can avoid contact and transmission to frequently severely vulnerable residents.

Personnel asymptomatique pour le SARS-COV-2 en EHPAD : une source de contamination des résidents ?

Introduction

Matériels et méthodes

Résultats

Conclusion

L’anosmie : critère spécifique de l’atteinte COVID-19 « Coranosmie1 »

Introduction

Depuis le mois d’avril, les publications médicales suggèrent que l’anosmie est un symptôme fréquent lors d’une infection liée au COVID-19. Notre objectif était de déterminer la valeur prédictive positive (VVP) et la spécificité (Sp) de l’anosmie et de décrire sa prévalence et ses caractéristiques chez les patients COVID-19.

Matériels et méthodes

Il s’agissait d’une étude prospective observationnelle longitudinale d’une cohorte multicentrique des patients consultants entre le 17 et le 24 mars 2020, pour anosmie depuis moins de 9 jours sans autres signes typiques d’infection à COVID-19. Les patients considérés comme COVID-19 positifs sont ceux ayant eu une RT-PCR COVID-19 positive sur les sécrétions nasopharyngées, ou ayant un contact documenté avec un patient COVID-19 positif. Sur 1824 patients, nous avons comparé la performance diagnostique de l’anosmie par rapport à celle des patients présentant une toux ou des céphalées. Comme pour l’anosmie, nous n’avons incus dans cette comparaison que les patients présentant des symptômes depuis moins de 9 jours.

Résultats

Parmi les 55 patients ayant consulté pour anosmie, 51 (IC92,7 % [82,4–97,9]) avait une RT-PCR positive. La charge virale était modérée pour les 51 patients avec un taux médian de CT à 28,83 (27,55–32,72). L’âge moyen des 55 patients était 35,7 ± 9,7 ans ; 56,4 % étaient des femmes. Dix-neuf patients (34,5 %) avaient des antécédents de rhinite allergique et 12 (21,8 %) étaient des fumeurs actifs. Aucun patient avait des antécédents de trouble de l’olfaction chronique. Une anosmie totale a été rapportée pour 47/55 patients (85,5 %) et une hyposmie pour 8 patients (14,5 %). L’anosmie était d’installation brutale dans 88,7 % des cas (n = 47/55) et associée à une dysgueusie dans 80 % des cas (n = 44/55). Une obstruction nasale était retrouvée chez seulement 2 patients. Les autres symptômes les plus fréquemment retrouvés étaient les céphalées (n = 37, 68,5 %), l’asthénie (n = 28, 57,1 %) et la toux (n = 22, 40,7 %). L’anosmie était inaugurale chez 16 patients (29,1 %). Pour les autres patients, elle a commencé 3 (2–4) jours après le début de l’infection. Aucun de nos patients a eu une évolution vers une forme grave. À j15, la majorité des patients (72,9 %) ont partiellement récupéré l’odorat. L’analyse effectuée sur 1824 avait démontré que la VVP (77,8 % [73,8–81,6]) de l’anosmie et sa Sp (90,2 %, [88,2–92,0]) étaient plus élevées que celles de la toux (VVP : 47,3 % [45,0–49,5], Sp : 34,3 % [32,2–36,4]) ou les céphalées (VVP : 47,9 % [45,7–50,1], Sp : 36,7 % [34,5–38,8]).

Conclusion

L’anosmie paraît un symptôme spécifique et a une VVP élevée par rapport aux autres symptômes classiques de l’infection COVID. Elle est dans la majorité des cas d’installation brutale, sans obstruction nasale, souvent associée à une dysgueusie, et d’évolution a priori favorable.

Elevated Calprotectin and Abnormal Myeloid Cell Subsets Discriminate Severe from Mild COVID-19

Blood myeloid cells are known to be dysregulated in coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2. It is unknown whether the innate myeloid response differs with disease severity and whether markers of innate immunity discriminate high-risk patients. Thus, we performed high-dimensional flow cytometry and single-cell RNA sequencing of COVID-19 patient peripheral blood cells and detected disappearance of non-classical CD14^LowCD16^High monocytes, accumulation of HLA-DR^Low classical monocytes (Human Leukocyte Antigen - DR isotype), and release of massive amounts of calprotectin (S100A8/S100A9) in severe cases. Immature CD10^LowCD101⁻CXCR4^+/− neutrophils with an immunosuppressive profile accumulated in the blood and lungs, suggesting emergency myelopoiesis. Finally, we show that calprotectin plasma level and a routine flow cytometry assay detecting decreased frequencies of non-classical monocytes could discriminate patients who develop a severe form of COVID-19, suggesting a predictive value that deserves prospective evaluation.

Self-reported loss of smell without nasal obstruction to identify COVID-19. The multicenter Coranosmia cohort study

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Isolated loss of smell without nasal obstruction is an early red-flag of COVID-19.

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These patients should adopt all the preventive measures and a lockdown.

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Olfactory/gustative dysfunction had high predictive value to identify COVID-19.

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Olfactory/gustative dysfunction had high specificity to identify COVID-19.

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Self-reported loss of smell, among other symptoms, could help to screen COVID-19.

Objectives

To determine the frequency of SARS-CoV-2 positive samples in a subset of patients consulting for primarily isolated acute (<7 days) loss of smell and to assess the diagnostic accuracy of olfactory/gustatory dysfunction for COVID-19 diagnosis in the overall population tested for COVID-19 in the same period.

Methods

Prospective multicentric cohort study in four olfactory ENT units and a screening center for COVID-19.

Results

i) Among a subset of 55 patients consulting for primarily recent loss of smell, we found that 51 (92.7%) had a COVID-19 positive test (median viral load of 28.8 cycle threshold). Loss of smell was mostly total (anosmia), rarely associated with nasal obstruction but associated with a taste disorder in 80%. Olfactory dysfunction occurred suddenly, either as first complaint or preceded by mild symptoms occurring a median of 3 days. The majority of patients (72.9%) partially recovered the sense of smell within 15 days. ii) In a population of 1824 patients tested for COVID-19, the positive predictive value and the specificity of loss of smell and/or taste were 78.5% and 90.3% respectively (sensitivity (40.8%), negative predictive value (63.6%)).

Conclusions

Self-reported loss of smell had a high predictive positive value to identify COVID-19. Making this sign well known publicly could help to adopt isolation measures and inform potential contacts.

Measles immunity and measles vaccine acceptance among healthcare workers in Paris, France

BACKGROUND

In Europe, including France, a measles outbreak has been ongoing since 2008. Unprotected healthcare workers (HCWs) may contract and spread the infection to patients.

AIM

The objective of this study was to evaluate HCWs' measles immunity and vaccine acceptance in our setting.

METHODS

In a survey-based study conducted in three university hospitals in Paris, 351 HCWs were included between April and June 2011. The following data were collected at enrolment: age, hospital unit, occupation, history of measles infection and vaccination, previous measles serology and acceptance of a measles vaccination in case of seronegativity. Sera were tested for the presence of specific anti-measles IgG antibodies using the CAPTIA(®) measles enzyme-linked immunosorbent assay.

FINDINGS

The mean age of the participating HCWs was 36 years (range: 18-67) and 278 (79.2%) were female. In all, 104 four persons (29.6%) declared a history of measles, and 90 (25.6%) declared never having received a measles vaccination. Among the 351 HCWs included in the study, 322 (91.7%) were immunized against measles (IgG >90 mIU/mL). The risk factors for not being protected were age [18-29 years, adjusted odds ratio: 2.7 (95% confidence interval: 1.1-6.9) compared with ≥30 years], no history of measles infection or vaccination. The global acceptance rate for a measles vaccination, before knowing their results, was 78.6%.

CONCLUSION

In this cohort of HCWs, 8.3% were susceptible to measles; the group most represented were aged <30 years. Acceptance of the measles vaccine was high. A vaccination campaign in healthcare settings should target specifically healthcare students and junior HCWs.

[Metal fume fever, an almost forgotten disease]

Metal fume fever is an ancient and almost forgotten occupational disease found among welders. Diagnosis is made difficult by the frequency and the non-specific flue-like symptomatology. We present the cases of three patients admitted for developing the symptoms after being exposed to welding fumes. Treatment was symptom based. Severe cases have been described after exposure to military fumes.

Telemedicine diagnosis for fetal alcohol syndrome - The Manitoba experience

The diagnosis of fetal alcohol syndrome has been possible, with increasing precision, since the original descriptions in the 1970s. Multidisciplinary diagnostic approaches have been recognized as most appropriate, although they are often not available. Telemedicine has been used in Canada over the same time period for a variety of diagnositc applications.Since 1999, funding by the Manitoba government has allowed the consolidation of services for children with prenatal alcohol exposure in Manitoba, and has allowed the development of a format for diagnosis using telemedicine.This paper describes the authors' experience with the above and offers observations that may be helpful to other programs that are focused on developing this format for the diagnosis of fetal alcohol syndrome.

Enhancement of modal feedback in unstable resonators using mirrors with a phase step

Numerical calculations using the Prony method have shown that the feedback coefficient in unstable laser resonators can be increased by factors of as much as 5 over the geometrical value using a mirror with a phase step at its center. A phase shift of close to pi over an area of an equivalent Fresnel number of 0.5 leads to minimum output losses. Experiments with a TEA CO(2) laser confirm the prediction. The results can be attributed to a cancellation of the output wave by destructive interference, which confines the laser beam around the resonator axis.

Nephrotoxicity of orellanine, a toxin from the mushroom Cortinarius orellanus

Pure orellanine extracted from the mushroom Cortinarius orellanus is highly toxic in mice both when given intraperitoneally (LD50 = 12.5 mg/kg) or per os (LD50 = 90 mg/kg). The kidneys of mice injected i.p. with orellanine show similar tubular necrosis to that obtained with whole mushroom given per os. This demonstrates that orellanine is the true, principal toxin of C. orellanus. The similarity of the structures of the toxin and of bipyridinium herbicides such as methylviologen (paraquat) or the nephrotoxic diquat led other authors to presume a similar mechanism for orellanine toxicity. Our study of the electrochemical behaviour of orellanine shows that its mechanism of action has to be different from that of these poisons.

Phytotoxicity of orellanine, a mushroom toxin

Orellanine, a toxic principle of Cortinarius orellanus Fr., efficiently inhibited the photosynthetic activity of duckweed, Lemna minor L., at a concentration of 0.4 mM. A lower concentration (0.06 mM) blocked the O2 production in isolated spinach class A chloroplasts. However, no effect was observed on thylakoids (class C chloroplasts), showing that orellanine does not interfere with the chloroplastic electron transfer chain and that orellanine does not act like methylviologen (paraquat) in green plants, as previously suggested. An electrochemical study of orellanine and related compounds showed that orellanine can neither be reduced by electrons derived from H2O nor from NADPH, as is methylviologen in plant and animal cells, respectively.

[Qualitative and quantitative determination of amino-2 benzimidazole in aqueous medium by polarography (author's transl)]

Amino-2 Benzimidazole, a residue of the decomposition of some fungicides (Benomyl, Carbendazine, Thiophanate, Methylthiophanate), is measured by polarography in aqueous medium, with a platinium rotating electrode, for the exploration in potentials from +0.5 v to 1.4 v. The best conditions for the quantitative determination are investigated, the study according to pH is performed and the standard curve is given for concentrations from 10(-5) to 10(-3) M/l. The interaction of elementts found in tap water and in aquarium water is also investigated.