Étude observationnelle d’évolution de la COVID-19 dans une population de patients hémodialysés avec étude d’impact des comorbidités

Introduction

Nos patients dialysés ont été particulièrement exposés à la pandémie de COVID-19.

Description

Nous rapportons une étude observationnelle rétrospective de notre cohorte de patients hémodialysés repliés en secteur COVID de mars 2020 à fin mars 2021 (1 an).

Méthodes

Nous avons observé dans cette population, l’âge, le sexe, l’ancienneté en dialyse, le type de variant si disponible, les comorbidités principales, la prise d’immunosuppresseurs, l’existence d’une néoplasie active, la présence d’un diabète, d’un terrain vasculaire sévère, d’une pathologie respiratoire, le lieu de vie, les symptômes au moment du diagnostic, la prise en charge et l’évolution.

Résultats

Sur cette cohorte de 122 patients, l’âge moyen est de 71 ans (médiane 72,5 ans), 11 (9 %) vivaient en EHPAD, l’ancienneté moyenne en dialyse est de 9,5 ans (médiane 6,35 ans). Quatre-vingt-douze ont contracté le virus historique (α), 15 le variant β, 3 le variant γ et 12 n’ont pas été qualifiés. Quatre patients (3 %) étaient sous immunosuppresseurs, 9 (7 %) avaient une néoplasie active dont 2 sont décédés, 58 (47,5 %) étaient diabétiques, 15 (12 %) présentaient une pathologie respiratoire dont 4 sont décédés, 86 (70,5 %) un terrain vasculaire sévère dont 18 sont décédés sur 19 décès au total. L’IMC moyen était de 26,7 (médiane 25,8). Cinq parmi les 22 patients avec troubles cognitifs sont décédés.

Soixante (49 %) ont été pris en charge à domicile.

Quarante-deux (34,4 %) patients ont été hospitalisés, 20 en réanimation dont 8 sont décédés.

Quarante-six (37,5 %) patients ont développé une forme asymptomatique, 25 (20,5 %) une forme modérée, 32 (26 %) une forme sévère et 12 (10 %) une forme grave d’emblée.

La mortalité est de 15,5 % (19 patients décédés).

Conclusion

Dans notre cohorte, la prise d’immunosuppresseurs, les troubles cognitifs, ou l’institutionnalisation ne semblent pas être des facteurs aggravants. En revanche, le terrain vasculaire sévère semble être un élément de gravité.

Impact of selection for residual feed intake on production traits and behavior of mule ducks

A divergent selection experiment of Muscovy sires based on the residual feed intake (RFI) of their male mule progeny was initiated in 2009. Using electronic feeders, the aim of this study was to establish whether 3 generations of selection for RFI had an impact on feeding behavior traits and general behavior, and to examine its effect on liver and meat quality. Eighty mule ducks, issued from 8 Muscovy drakes per line with extreme RFI, were tested in a pen equipped with 4 electronic feeders. Feeding behaviors were recorded from 3 to 7 wk after hatching under ad libitum feeding conditions. Then animals were prepared for overfeeding with a 3-week period of restricted feeding, and overfed during 12 d before slaughter. The RFI was significantly lower in the low RFI line than in the high RFI line (−5.4 g/d, P = 0.0005) and daily feed intake was reduced both over the entire test period (−5 g/d, P = 0.049) and on a weekly basis (P = 0.006). Weekly and total feed conversion ratios were also significantly lower (−0.08, P = 0.03 and −0.06, P = 0.01, respectively). Low RFI ducks had more frequent meals, spent as much time eating as high RFI ducks, and their feeding rate was lower when analyzed at the wk level only. Additionally no significant correlation between feed efficiency and feeding behavior traits was evidenced, indicating only limited relationships between RFI and feeding patterns. Some differences in behavioral responses to stressors (open field test combined with a test measuring the response to human presence) suggested that a lower RFI is associated with less fearfulness. Selection for RFI had no effect on liver weight and quality and a slightly deleterious impact on meat quality (decreased drip loss and L*). Finally, low RFI animals had higher body weights after restricted feeding from wk 10 to wk 12 and after overfeeding than high RFI ducks. This suggests that selection for reduced RFI until 7 wk of age increases the feed efficiency up to slaughter.

Detailed analysis of the individual feeding behavior of male and female mule ducks

The feeding behavior of 19 mule ducks (males and females) bred in a group was studied during their growth phase (between 3 and 8 wk of age) using the recording system for waterfowl feeding behavior developed in our lab. The basic feeding behavior data obtained allowed us to confirm on the one hand the reliability of our tool and, on the other hand, to compute food intake traits per day (ADFI, number of visits, and time spent feeding per day), per visit (feed intake per visit, visit duration, and visit feeding rate), and per meal (meal size, meal duration, and meal feeding rate). Daily feed intake increased with age (130 to 248 g/d) while the time spent feeding decreased from 14 to 5.5 min/d. Because the duration of visits remained stable (average 45 s), this reflected a decrease in the number of visits per day. At the same time the feed intake per visit and the feeding rate per visit increased sharply with age. The same trend was observed at the meal level for both the feed intake and the feeding rate. Feed intake did not differ between males and females, but the time spent feeding was significantly greater for females than for males (10.8 and 8.9 min per day and 53 and 37 s per visit for females and males, respectively), leading to significantly greater feeding rate for males (30 g/min) than for females (24 g/min). Grouping visits in meal events minimized the differences between genders as the meals tended to comprise fewer visits for females. Under the hypothesis of a genetic link between feeding behavior during growth and force-feeding ability of ducks, genetic selection of these behavioral traits could be included in breeding programs to improve the force-feeding capacity of mule ducks.

[A look into the past: improves in obstetrical and neonatal outcome in maternity since the 19th century]

OBJECTIVE

Evaluate changes in obstetrical and neonatal outcome of women who delivered in maternity hospital since the 19(th) century.

MATERIALS AND METHODS

Data from a historic cohort of 1022 women who delivered between 1871 and 1874 in the hôtel Dieu hospital of Marseille were compared to those from 1159 women who delivered from 2005 to 2006 in the level 3 maternity of Nord hospital of Marseille (contemporary cohort). Deliveries that had occured before 22 weeks and/or with a foetal birth weight of less than 500 g were excluded.

RESULTS

A total of 2131 pregnancies were included: 1011 and 1120 in historic and contemporary cohort, respectively. Despite comparable mean term of delivery, mean birth weight of neonates from historic cohort were significantly lower: 2971 g (550-4900 g) vs 3250 g (500-5375 g), respectively (p<0.001). Stillbirths were reported in 72 (7.1%) cases in historic cohort compared to nine (0.8%) in contemporary cohort (p<0.001). Neonatal mortality was 3.7% in historic cohort and 1.9% in contemporary cohort (p=0.012). A total of 99 (9.8%) maternal deaths were reported in historic cohort, while none in contemporary cohort (p<0.001). A wide majority of maternal deaths were caused by maternal infection (72.9%); 5.2% were caused by postpartum haemorrhage.

CONCLUSION

Our results illustrate the tremendous impact on maternal and neonatal outcome of advances in obstetrical management. The significant increase in the median foetal birth weight is likely to be related to wide changes in environmental conditions and behaviour.