Lower-extremity arterial disease (LEAD) is a major endemic disease with an alarming increased prevalence worldwide. It is a common and severe condition with excess risk of major cardiovascular events and death. It also leads to a high rate of lower-limb adverse events and non-traumatic amputation. The American Diabetes Association recommends a widespread medical history and clinical examination to screen for LEAD. The ankle brachial index (ABI) is the first non-invasive tool recommended to diagnose LEAD although its variable performance in patients with diabetes. The performance of ABI is particularly affected by the presence of peripheral neuropathy, medial arterial calcification, and incompressible arteries. There is no strong evidence today to support an alternative test for LEAD diagnosis in these conditions. The management of LEAD requires a strict control of cardiovascular risk factors including diabetes, hypertension, and dyslipidaemia. The benefit of intensive versus standard glucose control on the risk of LEAD has not been clearly established. Antihypertensive, lipid-lowering, and antiplatelet agents are obviously worthfull to reduce major cardiovascular adverse events, but few randomised controlled trials (RCTs) have evaluated the benefits of these treatments in terms of LEAD and its related adverse events. Smoking cessation, physical activity, supervised walking rehabilitation and healthy diet are also crucial in LEAD management. Several advances have been achieved in endovascular and surgical revascularization procedures, with obvious improvement in LEAD management. The revascularization strategy should take into account several factors including anatomical localizations of lesions, medical history of each patients and operator experience. Further studies, especially RCTs, are needed to evaluate the interest of different therapeutic strategies on the occurrence and progression of LEAD and its related adverse events in patients with diabetes.

Objective To identify the differential diagnoses of severe COVID‐19 and the distinguishing characteristics of critically ill COVID‐19 patients in Reunion Island to help improve the triage and management of patients in this tropical setting. Methods This retrospective observational study was conducted from 11 March to 4 May 2020 in the only intensive care unit (ICU) authorised to manage COVID‐19 patients in Reunion Island, a French overseas department located in the Indian Ocean region. All patients with unknown COVID‐19 status were tested by polymerase chain reaction (PCR) on ICU admission; those who tested negative were transferred to the COVID‐19‐free area of the ICU. Results Over the study period, 99 patients were admitted to our ICU. A total of 33 patients were hospitalised in the COVID‐19 isolation ward, of whom 11 were positive for COVID‐19. The main differential diagnoses of severe COVID‐19 were as follows: community‐acquired pneumonia, dengue, leptospirosis causing intra‐alveolar haemorrhage and cardiogenic pulmonary oedema. The median age of COVID‐19‐positive patients was higher than that of COVID‐19‐negative patients (71 [58–74] vs. 54 [46–63.5] years, P = 0.045). No distinguishing clinical, biological or radiological characteristics were found between the two groups of patients. All COVID‐19‐positive patients had recently travelled or been in contact with a recent traveller. Conclusions In Reunion Island, dengue and leptospirosis are key differential diagnoses of severe COVID‐19, and travel is the only distinguishing characteristic of COVID‐19‐positive patients. Our findings apply only to the particular context of Reunion Island at this time of the epidemic.

Independent associations exist between high plasma TNFR1 or IMA concentrations and increased 5.6-year risk of major LEAD in people with type 2 diabetes. TNFR1 allows incremental prognostic information, suggesting its use as a biomarker for LEAD.

Background: The incidence of ventilator-associated pneumonia caused by Stenotrophomonas maltophilia (SM-VAP) is on the rise. This pathology is associated with increased morbidity and mortality in intensive care unit (ICU), notably due to intrinsic resistance and ineffective probabilistic antibiotic therapy. Our study aimed to determine the risk factors for a first episode of SM-VAP in ICU.Methods: This single center retrospective study was conducted from 2010 to 2018 in the polyvalent ICU of Félix Guyon University Hospital in Reunion Island. All patients who developed ventilator-associated pneumonia (VAP) during their ICU stay were consecutively evaluated. Patients with a first episode of SM-VAP were compared to those with a first episode of VAP caused by another microorganism. Results: A total of 89 patients developed a first episode of SM-VAP over the study period. In the group of patients with SM-VAP, infection was polymicrobial in 43.8% of cases and ICU mortality was 49.4%. After multivariate logistic regression analysis, the risk factors for a first episode of SM-VAP were: chronic respiratory failure (Odds Ratio (OR): 4.212; 95% Confidence Interval (CI): 1.776 – 9.989; p = 0.001), chronic renal failure (OR: 2.693; 95% CI: 1.356 – 5.352; p = 0.05), use of third-generation cephalosporins active against Pseudomonas aeruginosa (OR 2.862; 95% CI: 1.505 – 5.442; p = 0.001), and female sex (OR: 2.646; 95% CI: 1.458 – 4.808; p = 0.001). Conclusion: In our study, chronic respiratory failure, chronic renal failure, use of third-generation cephalosporins active against P. aeruginosa, and female sex were identified as risk factors for a first episode of SM-VAP.

No abstract

Aim: We tested whether inflammation and oxidative stress biomarkers may predict the risk of peripheral arterial disease (PAD) in the SURDIAGENE (SURvie, DIAbete de type 2 et GENEtique) type 2 diabetes cohort. Methods: plasma concentrations of angiopoietin like 2 (ANGPTL2), TNF receptor 1 (TNFR1), fluorescent advanced glycation end products (F-AGE), advanced oxidation protein products (AOPP), protein carbonyl, ischemia-modified albumin (IMA), total reductive capacity of plasma (TRCP) and oxidative hemolysis inhibition assay (OxHLIA) were measured at baseline using ELISA, spectrofluorimetry, spectrophotometry and Folin-Ciocalteu methods. Cox model was fitted to assess the risk of severe PAD, requiring aortic or lower limb revascularization, by increasing tertiles of each biomarker at baseline adjusting for confounding variables. C-statistic was used to test PAD discrimination. Results: Among 1395 participants free for PAD at baseline (men 57%, mean±SD age 65±11 years, diabetes duration 14±10 years), aortic or lower limb revascularization was performed in 66 (4.7%) patients during 5.8±3.2 years of follow-up. The rate of revascularisation was higher in the upper tertiles (T2, T3) compared to the lower one (T1): TNFR1 (HR [95% CI] T2 vs. T1, 1.15 [1.01-1.32]; T3 vs. T1, 1.59 [1.34-1.88], trend p<0.0001), F-AGE (1.43 [1.25-1.64]; 2.[1.76-2.38], trend p<0.0001), and TRCP (1.00 [0.88-1.15]; 1.25 [1.09-1.44], trend p=0.002). Similar results were observed when the 3 markers were included together in the same model. TNFR1 (change in c-statistic 0.010 [0.004-0.015], p=0.001), F-AGE (0.026 [0.014-0.039], p<0.0001) and TRCP (0.017 [0.009-0.024], p<0.0001), considered individually or together (0.052 [0.038-0.065], <0.0001), improved PAD discrimination. Conclusion: Our results suggest that TNFR1, F-AGE, and TRCP can be used to screen severe PAD in type 2 diabetes, and support the role of inflammation and oxidative stress on the pathogenesis of PAD. Disclosure M. Nativel: None. F. Schneider: None. P. Saulnier: None. O. Meilhac: None. P. Rondeau: None. M. Cournot: None. L. Potier: Consultant; Self; Sanofi, Novo Nordisk A/S, Eli Lilly and Company. Board Member; Self; Merck Sharp & Dohme Corp.. G. Velho: None. M. Marre: Board Member; Self; Abbott. Consultant; Self; AstraZeneca. Board Member; Self; Intarcia Therapeutics, Inc.. Consultant; Self; Eli Lilly and Company. Board Member; Self; Merck Sharp & Dohme Corp., Novo Nordisk A/S. Research Support; Self; Sanofi. Board Member; Self; Servier. R. Roussel: Advisory Panel; Self; AbbVie Inc., Abbott, Eli Lilly and Company, Sanofi, Novo Nordisk A/S, AstraZeneca. Speaker's Bureau; Self; Servier. Consultant; Self; Bayer AG. Advisory Panel; Self; Merck Sharp & Dohme Corp.. Research Support; Self; Amgen Inc., Sanofi, Novo Nordisk A/S, Danone Research. Stock/Shareholder; Self; Iriade. Advisory Panel; Self; Physiogenex S.A.S.. V. Rigalleau: None. K. Mohammedi: Speaker's Bureau; Self; Novo Nordisk Inc.. Other Relationship; Self; Novo Nordisk Inc.. Speaker's Bureau; Self; Sanofi. Other Relationship; Self; Sanofi, Takeda Development Centre Europe Ltd., Boehringer Ingelheim Pharmaceuticals, Inc. S. Hadjadj: Consultant; Self; Abbott, Novo Nordisk A/S, Servier, AstraZeneca, Merck Sharp & Dohme Corp.. Board Member; Self; Valbiotis. Consultant; Self; Sanofi, Eli Lilly and Company.