REPERCOV : repérage des plaintes fonctionnelles et psychosociales après une hospitalisation pour infection sévère à SARS-CoV-2

Introduction

Dans le contexte d’une des pandémies les plus meurtrières du 21^e siècle, la France, au 15 juin 2020, comptait plus de 73 000 personnes sorties d’hospitalisation après infection par le nouveau Coronavirus (SARS-CoV-2).

Les symptômes et signes cliniques de la COVID-19 sont variés, comme la fièvre, les troubles respiratoires, signes ORL ou encore digestifs. Il semblerait que certains patients se plaignent de la persistance de ces symptômes longtemps après l’infection.

Nous avons souhaité évaluer, à distance d’une hospitalisation, la prévalence des signes fonctionnels, des plaintes psychologiques et sociales justifiant d’une prise en charge spécifique chez les patients hospitalisés pour infection sévère à SARS-CoV-2. L’objectif final était de recenser les besoins pour offrir un suivi adapté à cette pathologie émergente.

Matériels et méthodes

Nous avons réalisé une enquête auprès des 200 à 300 patients survivants hospitalisés entre le 1^er mars et le 30 juin 2020 pour infection sévère à SARS-COV-2, au sein de notre établissement.

Un questionnaire papier ou une enquête téléphonique étaient proposés deux à trois mois après la sortie d’hospitalisation afin de recueillir les plaintes existant avant et après l’infection.

Il s’agissait d’une étude purement descriptive, portant sur un ensemble de signes fonctionnels présents avant ou après l’infection, qu’ils soient cardiorespiratoires, digestifs, ORL, locomoteurs, neurologiques, mais aussi sur les traitements concomitants. Des questionnaires validés abordaient les dimensions de la qualité de vie, de la fragilité, notamment en population gériatrique.

Résultats

Outre la prévalence des plaintes présentes 2–3 mois après la sortie d’hospitalisation, nous nous sommes intéressés à :

– décrire les plaintes fonctionnelles, neuropsychologiques et sociales à distance d’une infection sévère à SARS-CoV-2, et l’évolution de celles-ci avant, pendant et après l’hospitalisation ;

– repérer les facteurs favorisants de ces plaintes, en particulier les facteurs de risques usuels (mode de vie, habitus, comorbidités, traitements, modalités de prise en charge, etc.) ;

– décrire les besoins en consultations spécialisées et en accompagnement neuropsychologique, en suivi diététique ou suivi social ;

– décrire l’impact de la COVID-19 sur la prise en charge de la maladie chronique de certains patients, notamment la prise en charge thérapeutique ;

– décrire les facteurs d’inégalités d’accès au soin et étudier leur impact sur la gravité de l’infection et la présence d’une plainte fonctionnelle ou psychosociale.

Conclusion

Cette nouvelle maladie soulève de nombreuses questions, notamment sur les éventuelles séquelles sanitaires qu’elle engendre. La parole des survivants est donc capitale pour décrire les signes fonctionnels et les plaintes psychosociales, nécessitant une prise en charge spécifique, coordonnée, afin de pouvoir améliorer le pronostic à long terme des patients infectés par le SARS-CoV-2 et créer un parcours de soins optimal.

Vaccination coverage among school children aged 14-15 years in the French department of Sarthe

OBJECTIVES

Vaccinations are the main pillar of primary prevention for infectious diseases. To guide and prioritize public health interventions, the Regional Health Agency has asked the Prevention, Vaccination, and Screening Center of the Sarthe department to assess vaccination coverage (VC) at the sub-departmental level. The main objective was to measure the VC among school children aged 14-15 years in Sarthe at the sub-departmental level.

PATIENTS AND METHODS

We conducted a VC evaluation survey at the administrative district level among school children aged 14-15 years in the Sarthe department during the first quarter of the 2015-2016 school year.

RESULTS

Among 2384 randomly selected school children, 1171 were included in the study. At the departmental level, 85% of children were up to date for DTP, 72% for pertussis, 45% for hepatitis B, 31% for meningococcus C, 93% for measles, and 18% of girls had received at least one dose of the HPV vaccine. Vaccination coverage varied by administrative districts.

CONCLUSION

At the departmental level, all VC were below national goals. Territorial disparities could be explained by sociodemographic differences or differences in medical practices. This survey allowed us to identify areas and population groups where the CV rate justified public health actions.

Association between coffee or tea drinking and Barrett's esophagus or esophagitis: an Italian study

BACKGROUND/OBJECTIVES

Only a few papers have treated of the relationship between Barrett's esophagus (BE) or erosive esophagitis (E) and coffee or tea intake. We evaluated the role of these beverages in BE and E occurrence.

SUBJECTS/METHODS

Patients with BE (339), E (462) and controls (619) were recruited. Data on coffee and tea and other individual characteristics were collected using a structured questionnaire.

RESULTS

BE risk was higher in former coffee drinkers, irrespective of levels of exposure (cup per day; ⩽1: OR=3.76, 95% CI 1.33-10.6; >1: OR=3.79, 95% CI 1.31-11.0; test for linear trend (TLT) P=0.006) and was higher with duration (>30 years: OR=4.18, 95% CI 1.43-12.3; TLT P=0.004) and for late quitters, respectively (⩽3 years from cessation: OR=5.95, 95% CI 2.19-16.2; TLT P<0.001). The risk of BE was also higher in subjects who started drinking coffee later (age >18 years: OR=6.10, 95% CI 2.15-17.3). No association was found in current drinkers, but for an increased risk of E in light drinkers (<1 cup per day OR =1.85, 95% CI 1.00-3.43).A discernible risk reduction of E (about 20%, not significant) and BE (about 30%, P<0.05) was observed in tea drinkers.

CONCLUSIONS

Our data were suggestive of a reduced risk of BE and E with tea intake. An adverse effect of coffee was found among BE patients who had stopped drinking coffee. Coffee or tea intakes could be indicative of other lifestyle habits with protective or adverse impact on esophageal mucosa.

Barrett's esophagus, esophageal and esophagogastric junction adenocarcinomas: the role of diet

Identification of modifiable risk factors is an attractive approach to primary prevention of esophageal adenocarcinoma (EAC) and esophagogastric junction adenocarcinoma (EGJAC). We conducted a review of the literature to investigate the association between specific dietary components and the risk of Barrett’s esophagus (BE), EAC and EGJAC, supposing diet might be a risk factor for these tumors. Consumption of meat and high-fat meals has been found positively associated with EAC and EGJAC. An inverse association with increased intake of fruit, vegetables and antioxidants has been reported but this association was not consistent across all studies reviewed. Few studies have examined the association between diet and BE. Additional research is needed to confirm the aforementioned association and clarify the mechanisms by which dietary components affect the risk of developing EAC and EGJAC. Future studies could advance our knowledge by emphasizing prospective designs to reduce recall bias, by using validated dietary intake questionnaires and biological measures and by considering important confounders such as gastro-esophageal reflux disease (GERD) symptoms, tobacco and alcohol use, biometrics, physical activity, and socioeconomic factors.

Self-expanding plastic stent to palliate symptomatic tissue in/overgrowth after self-expanding metal stent placement for esophageal cancer

Self-expanding metal stents (SEMS) are used to treat obstructive malignancies of the esophagus or esophagogastric junction; however, a potential complication is recurrent dysphagia because of tissue in/overgrowth. The placement of a second SEMS is one strategy to re-establish patency of the esophageal lumen. We evaluated the safety and efficacy of an alternative and likely less costly approach: placing a self-expanding plastic stent (SEPS) to manage relapsing dysphagia in patients previously treated with a partially covered SEMS. From December 2007 to January 2009, 13 patients previously treated with a SEMS for malignant dysphagia underwent treatment by inserting a SEPS to palliate relapsing dysphagia, as a result of tissue in/overgrowth. Stenosis was located in the upper esophagus in one patient, in the middle in four patients, and in the lower esophagus in eight patients. Clinical evaluation was performed at the time of stent placement, after 1 week, and then, monthly until death. The SEPS was successfully placed in a single treatment session for all patients. No preliminary dilation was required, and no further treatment was necessary for any patient. Before stenting, the median dysphagia score was 4 (range 3-4), and 1 week later the score was 0 for all patients. The resolution of dysphagia persisted until patient death (from tumor progression). The mean survival after the SEPS insertion was 4 months (range 3-8). This case series supports the use of a SEPS to palliate dysphagia from tissue in/overgrowth of a SEMS. Future clinical trials with larger patient samples are warranted.

Cap-assisted endoscopic mucosal resection of large polyps involving the ileocecal valve

Standard endoscopic mucosal resection (EMR) is limited with regard to lesions below or involving the ileocecal valve. We describe the treatment and outcomes when using cap-assisted EMR (EMR-C) to remove large laterally spreading tumors (LSTs) with ileal infiltration in seven patients (median age 74 years). Each LST (median size 40 mm) was successfully resected in one session (median procedure time 50 minutes). Intraprocedural and early bleeding occurred in two patients, and delayed hemorrhage in one. Circumferential resection of the ileum caused asymptomatic strictures in six patients, with regression during follow-up for five. We conclude that the novel EMR-C method is a potentially effective treatment for cecal LST involving the distal ileum. Serious complications such as perforation or symptomatic strictures of the ileocecal valve were not observed and any procedure-related bleeding was easily controlled.

Pegylated interferon and ribavirin in re-treatment of responder-relapser HCV patients

BACKGROUND

The re-treatment of patients who relapse after a course of standard interferon and ribavirin with pegylated interferon alfa-2b plus ribavirin is an open issue.

AIMS

To evaluate efficacy and safety of treatment with pegylated interferon alfa-2b plus ribavirin and the role of early HCV-RNA assessment as a predictor of sustained response.

PATIENTS

Between May 2001 and December 2002, 242 consecutive patients with chronic hepatitis C were enrolled in an open, regional, multicentre study. Seventy-eight of them were responder-relapsers to a previous course of combination therapy.

METHODS

Patients were treated with pegylated interferon alfa-2b (1 microg/kg/week) plus ribavirin (800-1200 mg daily). Qualitative HCV-RNA was performed at week 2. Genotypes 1-4 were treated for 48 weeks, while genotypes 2 and 3 were treated for 24 weeks.

RESULTS

We obtained an overall sustained virological response rate of 41.0% (78.6% for patients with genotypes 2-3).

CONCLUSION

This treatment schedule prove to be safe and effective in relapsers with genotype non-1 while genotype 1-4 patients had a low rate of sustained virological response. Qualitative virological assessment after 2 weeks may identify patients who are more likely to reach sustained virological response, but it is not a valid tool for a stopping rule approach.

Human tibia bone marrow blood perfusion by non-invasive near infrared spectroscopy: a new tool for studies on microgravity

Human tibia bone marrow (BM) and tibialis anterior muscle (TA) perfusion index (PI) was assessed non-invasively by near infrared spectroscopy. A decrease in the postis-chaemic reperfusion capability of the human tibia BM and TA muscle was observed for increasing age i.e., PI increases linearly as a function of age, starting from 30 years, both for BM (0.062 %/year, from -4.185 to -0.967 %/s) and TA muscle (0.046 %/year, from -5.760 to -3.883 %/s). The results define a "normal" baseline and demonstrate the sensitivity of the method to PI changes. The present technique should allow one to investigate physio-pathological effects induced by microgravity on tibia BM blood perfusion.

Carditis, intestinal metaplasia and adenocarcinoma of oesophagogastric junction

Barrett's oesophagus is a precancerous condition in which the normal squamous epithelium is replaced by intestinal metaplasia (IM). IM can then progress through increasingly severe dysplasia to oesophageal adenocarcinoma (EAC). In the gastric cardia the normal gastric mucosa, when inflamed (carditis), can be replaced by IM and can then progress to gastric adenocarcinoma (GAC). The same histopathological sequence can take place on either side of the oesophagogastric junction. Since the location of that junction can be uncertain this can result in confused diagnosis between EAC and GAC. In this review, the diagnostic criteria, incidence and risk factors for Barrett's oesophagus and carditis are discussed, together with the factors determining the risk of progression to adenocarcinoma of the oesophagus or cardia. The risk factors include familial/genetic, environmental and dietary characteristics. Finally, these risk factors are discussed within the context of cancer prevention.