76 research outputs found
COVID-19 : Séquelles cliniques post-aigues d’infection au SARS-CoV-2 dans la population générale
No full textLe 11 mars 2020, l’Organisation Mondiale de la Santé (OMS) a déclaré la pandémie COVID-19, et à ce jour, plus de 256 millions de cas et 5.1 millions de décès ont été attribués au COVID-19. Le SARS-CoV-2 entraîne des symptômes persistants sur plusieurs semaines voire plusieurs mois après l’infection. Ces symptômes persistants présents chez les personnes traitées en ambulatoire et en post-hospitalisation, sont associés à un impact sur la vie personnelle, professionnelle et sociale et nécessitent une prise en charge adéquate par les médecins de premier recours, ainsi que les professionnels de santé en général.
Le dispositif CoviCare mis en place aux Hôpitaux Universitaires de Genève depuis mars 2020 pour le suivi ambulatoire des personnes infectées ou suspectées d’avoir une infection au SARS-CoV-2, suit une cohorte de patient.e.s depuis son instauration. Ce dispositif illustrant la coordination interprofessionnelle dans la prise en charge des personnes infectées ou suspectées d’avoir une infection au SARS-CoV-2, a reçu le prix « Inteprofessionnalité » de l’Académie Suisse des Sciences Médicale en Novembre 2021.
Des résultats du suivi longitudinal des personnes infectées au SARS-CoV-2 ont été publiés sur la prévalence et distribution des symptômes persistants à six semaines puis à sept à neuf mois après l’infection au SARS-CoV-2. L’article faisant l’objet de cette thèse a été publié dans Annals of Internal Medicine et met en évidence la prévalence des symptômes persistants 7 à 9 mois après l’infection. En résumé, 39.0% des personnes participant à l’étude avaient gardé des symptômes persistants. La fatigue, symptôme principal et le plus fréquent, était rapportée dans 20.7% des cas, suivie par la perte de goût ou de l’odorat (16.8%), la dyspnée (11.7%), les maux de tête (10.0%), les myalgies (6.3%), la difficulté à se concentrer ou sensation de brouillard (5.9%), les troubles du sommeil (5.7%), la toux (3.7%), les palpitations (3.4%), les douleurs thoraciques (3.1%), et les paresthésies (2.2%). L’intensité des symptômes était le plus souvent légère à modérée soulignant l’importance de stratifier les symptômes ainsi que leur impact sur le quotidien.
Cette thèse élabore, en présentant le dispositif CoviCare, les facteurs de risque et la pathophysiologie associés à la persistance des symptômes suite à une infection au SARS-CoV-2. Nous discutons de la prise en charge des personnes atteintes de symptômes persistants, via la création d’une consultation et équipe multidisciplinaires aux Hôpitaux Universitaires de Genève, ainsi que de l’impact de ces symptômes.</p
Toxocara infection in the differential diagnosis of multiple sclerosis in the Middle East
No full textA critical step in the diagnosis of multiple sclerosis is to rule out a heterogeneous variety of multiple sclerosis mimickers, which is crucial in the era of powerful immune-modulator treatments. In this review, we discuss the background of toxocariasis in general, present central nervous system Toxocara infection as one of the multiple sclerosis mimickers in the Middle East, and share our experience about the diagnosis and management of this condition. This entity seems very relevant in a region such as the Middle East, where displacement of populations and conflict can result in non-hygienic food and water management bundles. The diagnosis should be entertained, especially when assessing patients with myelopathy. The presence of a single lesion in the spinal cord with inflammatory features should prompt serological testing for Toxocara IgG and IgM in serum and the cerebrospinal fluid. This infection is treatable, with the regimen of high-dose albendazole being one of the most accepted treatments. Although most cases exhibit a good prognosis, some have residual deficits localized to the affected spinal cord level. © The Author(s) 2020
Acceptability of COVID-19 Certificates: A Qualitative Study in Geneva, Switzerland, in 2020
No full textImmunity certificates related to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) have been under discussion since the beginning of the pandemic with conflicting opinions. In order to identify arguments in favor of and against the possible implementation of documents certifying immunity of an individual based on serological testing, we developed a qualitative study in Geneva, Switzerland. The study took place between two lockdowns with a sense of semi-normalcy during summer 2020 in Switzerland but at a time when no vaccine was available and seroprevalence was below 21%. Eleven focus groups with members of the public and 14 semi-structured interviews with stakeholders were conducted between July and November 2020, with a total of 68 participants with an age range between 24 and 77 years. Interviews and focus groups transcripts were coded with the ATLAS.ti CAQDAS. Few participants considered immunity certificates based on serological testing as an acceptable public health measure. Major concerns included the reliability of scientific data related to COVID-19 immunity and serological testing potential re-infection as well as the possibility that the use of certificates could result in deleterious outcomes. Discrimination, counterfeiting, incitement for self-infection, invasion of the private sphere, violation of personal integrity, and violation of medical secrecy were perceived as the major risks. Benefits of immunity certificates were more perceived when in relation to vaccination, and included gains in medical knowledge and protection in certain contexts involving leisure or work-related activities. The consequences of implementing immunity certificates are numerous, and the acceptability by the general population has to be considered when engaging in such policy. Even if the results provide a snapshot of arguments discussed around immunity certificates based on serological testing before the implementation of the COVID-19 vaccine, most of the issues discussed are central in the current debates about vaccination certificates
Perceptions of immunity and vaccination certificates among the general population: a nested study within a serosurvey of anti-SARS-CoV-2 antibodies (SEROCoV-POP)
No full textAt a time when COVID-19 immunity certificates are debated and vaccination certificates might potentially be made available if an effective vaccine is established, we conducted a study to elucidate public opinion on this issue. Our objective was to determine social and individual perceptions of COVID-19 immunity certificates through a population-based study.
A nested survey within the SEROCoV-POP study, a population-based serosurvey of anti-SARS-CoV-2 IgG antibodies in Geneva, Switzerland, was conducted with a self-administered questionnaire. The questionnaire was proposed to 1520 SEROCoV-POP participants. Measures included percentage of participants agreeing or disagreeing with statements on immunity and vaccination certificates. Stratification by age, gender, education and work status was used to examine socio-demographic variations.
Of the 1520 SEROCoV-POP participants, 1425 completed the questionnaire (response rate 93%; mean age ± standard deviation 52 ± 15.1 years; 51.9% women). About 80% of participants agreed that knowing one’s serology status would lead to a change in one’s behaviour. In the event that the presence of antibodies correlated with immunity, 60% of participants reported that certificates should be offered to the general population. The results showed variations in perceptions of certificates depending on the context (73% agreed on certificates’ utility for travel, 72% for entering a country, and 32% for the right to work). Provided an effective vaccine was available, 55% of participants agreed that vaccination should be mandatory and 49% agreed that a vaccination certificate should be mandatory. About 68% reported a potential risk of discrimination and 28% a risk of deliberate infection. Differences were seen with age, gender and education level.
This study shows that the general adult population in Geneva, Switzerland can envisage scenarios where COVID-19 immunity, and eventually vaccination, certificates would be useful. Seroprevalence estimates of anti-SARS-CoV-2 antibodies remain low to date, and the interpretability of serological testing and immunity remains undefined. However, the information from this study is important, especially the differences based on context and the socio-demographic variations, and should be taken into account if COVID-19-related certificates are to be implemented
Re-Expansion Pulmonary Edema
No full textRe-expansion pulmonary edema (RPE) is a rare complication of therapeutic thoracentesis. Unfortunately, there is no definitive treatment modality for RPE. The high mortality rate, reported up to 21%, presses the issue for finding adequate prevention and treatment. Here we report a new management modality that is very useful for a patient with RPE.
Case Report: An 80-year-old man with a history of hypertension, atrial fibrillation, congestive heart failure with preserved ejection fraction, and sacral decubitus ulcer, who was admitted for surgical debridement of his ulcer. He developed hospital-acquired pneumonia and was resolved with antibiotics and aggressive hydration. He became hypoxic, and his chest imaging revealed bilateral pleural effusions refractory to diuresis. He underwent right-sided thoracentesis with removal of 2.5 liters of transudative fluid. He immediately improved, and his chest x-ray post-thoracentesis showed a significant reduction in the right pleural effusion. Later that night, the patient developed dyspnea and hypoxia. Lung auscultation revealed new crackles on the right side extending to the apex. Repeated chest x-ray showed diffuse right-sided infiltrates, consistent with re-expansion pulmonary edema. We started him on BiPAP ventilation as well as diuresis. Repeated imaging within five hours demonstrated a significant reduction in the pulmonary edema, and his clinical condition improved markedly. He was transitioned to supplemental oxygen via nasal cannula at 2L/min within 24 hours.
Discussion: RPE occurs due to increase permeability of pulmonary capillary vessels secondary to rapid reduction in the pleural cavity pressure and sudden lung expansion. The severity of the intra-pleural negative pressure is thought to contribute to the risk of developing RPE. A recent study has proved a correlation between the amount of volume removed from the pleural cavity and the chance of developing RPE. Treatment for RPE is supportive, with oxygen supplementation and diuresis. However, we found dramatic clinical and radiological changes after applying BiPAP and thereby increasing the intra-pleural pressure.
Conclusion: Clinicians should be encouraged to place patients who develop RPE on BiPAP for six to twelve hours to prevent worsening of pulmonary edema. As presented in our case, this management modality had desirable outcomes in as little as five hours. Further studies require to assess the effectiveness of BiPAP to decrease the progression and mortality of RPE
Acceptabilité des certificats immunitaires COVID-19 ?
No full textDepuis le début de la pandémie COVID-19, la pertinence de développer des certificats immunitaires a été débattue autour de leurs enjeux éthiques. En 2020, ils se référaient aux résultats de tests sérologiques d'anticorps indiquant le statut immunitaire d'un individu. Afin d'identifier les arguments pour et contre la mise en place de ces certificats, avant même l'accès aux vaccins, une étude qualitative a été conduite en 2020. Les craintes évoquées étaient liées à la validité des données scientifiques, les usages et les potentiels privilèges du certificat, son articulation avec les autres mesures sanitaires et la garantie du respect des données privées. Les bénéfices discutés portaient sur le caractère non sensible du statut immunitaire, sur l'utilité de connaître son statut pour nourrir les connaissances médicales, protéger certaines catégories de la population et faciliter certaines transactions ou activités sociales. Les modalités de son implémentation ont été discutées autour de l'importance d'un cadre légal, de critères d'utilisation allant au-delà des frontières nationales et d'une mise en place par des autorités publiques reconnues
“No evidence of disease activity”: Is it an aspirational therapeutic goal in multiple sclerosis?
No full text‘No evidence of disease activity’ (NEDA) that has been identified as a potential outcome measure for the evaluation of DMTs effects. The concept has been adopted from other diseases such as cancer where treatment is intended to free the patient from the disease. Disease-free status has been substituted by NEDA in MS, since we are limited when it comes to fully evaluating the underlying disease. In general, NEDA, otherwise termed as NEDA-3, is defined by the lack of disease activity based on the absence of clinical relapses, disability progression with the expanded disability status score (EDSS), and radiological activity. Recently, brain atrophy, a highly predictive marker of disability progression, has been added as a fourth component (NEDA-4). The use of this composite allowed a more comprehensive assessment of the disease activity. Indeed, it has an important role in clinical trials as a secondary outcome in addition to primary endpoints. However, the evidence is insufficient regarding the ability of NEDA to predict future disability and treatment response. Moreover, combining different composites does not eliminate the limitation of each, therefore the use of NEDA in clinical routine is still not implemented. The aim of this review is first to report from the literature the available definitions of NEDA and its different variants, and second, evaluate the importance of its use as a surrogate marker to assess the efficacy of different DMTs. © 2020 Elsevier B.V
The chronification of post-COVID condition associated with neurocognitive symptoms, functional impairment and increased healthcare utilization
No full textPost-COVID condition is prevalent in 10–35% of cases in outpatient settings, however a stratification of the duration and severity of symptoms is still lacking, adding to the complexity and heterogeneity of the definition of post-COVID condition and its oucomes. In addition, the potential impacts of a longer duration of disease are not yet clear, along with which risk factors are associated with a chronification of symptoms beyond the initial 12 weeks. In this study, follow-up was conducted at 7 and 15 months after testing at the outpatient SARS-CoV-2 testing center of the Geneva University Hospitals. The chronification of symptoms was defined as the continuous presence of symptoms at each evaluation timepoint (7 and 15 months). Adjusted estimates of healthcare utilization, treatment, functional impairment and quality of life were calculated. Logistic regression models were used to evaluate the associations between the chronification of symptoms and predictors. Overall 1383 participants were included, with a mean age of 44.3 years, standard deviation (SD) 13.4 years, 61.4% were women and 54.5% did not have any comorbidities. Out of SARS-CoV-2 positive participants (n = 767), 37.0% still had symptoms 7 months after their test of which 47.9% had a resolution of symptoms at the second follow-up (15 months after the infection), and 52.1% had persistent symptoms and were considered to have a chronification of their post-COVID condition. Individuals with a chronification of symptoms had an increased utilization of healthcare resources, more recourse to treatment, more functional impairment, and a poorer quality of life. Having several symptoms at testing and difficulty concentrating at 7 months were associated with a chronification of symptoms. COVID-19 patients develop post-COVID condition to varying degrees and duration. Individuals with a chronification of symptoms experience a long-term impact on their health status, functional capacity and quality of life, requiring a special attention, more involved care and early on identification considering the associated predictors
Characteristics of long COVID among older adults: a cross-sectional study
No full textTo describe long-COVID symptoms among older adults, and to assess risk factors for two common long-COVID symptoms: fatigue and dyspnea
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