Background Coronavirus disease 2019 (COVID-19) is now a global pandemic with Europe and the USA at its epicenter. Little is known about risk factors for progression to severe disease in Europe. This study aims to describe the epidemiology of COVID-19 patients in a Swiss university hospital. Methods This retrospective observational study included all adult patients hospitalized with a laboratory confirmed SARS-CoV-2 infection from March 1 to March 25, 2020. We extracted data from electronic health records. The primary outcome was the need to mechanical ventilation at day 14. We used multivariate logistic regression to identify risk factors for mechanical ventilation. Follow-up was of at least 14 days. Results 200 patients were included, of whom 37 (18.5%) needed mechanical ventilation at 14 days. The median time from symptoms onset to mechanical ventilation was 9.5 days (IQR 7.00, 12.75). Multivariable regression showed increased odds of mechanical ventilation in males (3.26, 1.21-9.8; p=0.025), in patients who presented with a qSOFA score ≥2 (6.02, 2.09-18.82; p=0.001), with bilateral infiltrate (5.75, 1.91-21.06; p=0.004) or with a CRP of 40 mg/l or greater (4.73, 1.51-18.58; p=0.013). Conclusions This study gives some insight in the epidemiology and clinical course of patients admitted in a European tertiary hospital with SARS-CoV-2 infection. Male sex, high qSOFA score, CRP of 40 mg/l or greater and a bilateral radiological infiltrate could help clinicians identify patients at high risk for mechanical ventilation.
Background Concern about intoxication by e-liquid is growing as calls to poison control centers have increased since their introduction. Only three cases of intoxication by injection have been reported worldwide. Our case is unique because of the precise follow-up of a patient who survived a lethal dose of self-injected e-liquid, without other co-intoxication. Case presentation A 51-year-old male presented to the Emergency Department after injecting himself intravenously (IV) in the forearm with 10 mL of e-liquid (1000 mg of nicotine diluted in propylene glycol). An agitation phase was followed by coma and bradypnoea requiring mechanical ventilation. The patient developed a transitory neurological impairment with the appearance of tetraparesis, gaze palsy and myoclonus due to nicotinic syndrome. The arterial blood gas (ABG) analysis confirmed uncompensated lactic acidosis with an elevated anion gap, which is an expected effect of propylene glycol. The toxicology screen indicated the presence of nicotine and cotinine in the blood and excluded the presence of concomitant intoxication. The patient recovered without sequelae. Conclusion Even a small quantity of intravenous (IV) e-liquid can lead to an acute intoxication and fatal outcomes due to the toxic effects of nicotine. This case might help emergency doctors cope with acute intoxication by injection of e-liquid and increase their comprehension of the two main substances, nicotine and propylene glycol with overview of their pharmacodynamics and kinetic effects.
Inhibiteurs de points de contrôle immunitaires et atteinte rénale : mise au point sur une pathologie émergente Récemment, la compréhension des mécanismes immuns impliqués dans la réponse antitumorale a permis de développer de nouveaux traitements oncologiques, les inhibiteurs de points de contrôle immunitaires. L'action de ceux-ci repose sur une rupture des mécanismes de tolérance immune envers la tumeur. Avec leur développement, on observe l'apparition d'effets indésirables d'un nouveau genre, s'apparentant à une autoimmunité et touchant différents systèmes. La toxicité rénale, sous la forme d'une néphrite tubulo-interstitielle, est une complication encore méconnue mais émergeante. Immune checkpoint inhibitors and renal toxicity : update about an emerging pathologyRecently, comprehension of immune mechanisms involved in antitumor responses has permitted the development of new oncologic drugs called immune checkpoint inhibitors. These drugs act by restoring anti-tumor responses. With their increasing use, we note a rise in the incidence rate of immune related adverse events, which can affect many organs. Renal toxicity, more precisely tubulointerstitial nephritis, is still not well understood but an emerging complication. * à lire ** à lire absolument L'atteinte rénale liée aux IPCI est sous-estimée Un monitoring régulier de la fonction rénale peut être le seul point d'appel pour un éventuel irAE (Immune relative adverse events) En cas d'atteinte rénale, il faut également évoquer d'autres causes « plus classiques » et les rechercher chez des patients fragiles avant d'évoquer un irAE avec toujours une confirmation par biopsie vu l'implication thérapeutique Le traitement par corticothérapie est généralement long et nécessite un suivi de ces effets secondaires IMPLICATIONS PRATIQUES
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