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The reason why most individuals with COVID-19 have relatively limited symptoms while other develop respiratory distress with life-threatening complications remains unknown. Increasing evidence suggests that COVID-19 associated adverse outcomes mainly rely on dysregulated immunity. Here, we compared transcriptomic profiles of blood cells from 103 patients with different severity levels of COVID-19 with that of 27 healthy and 22 influenza-infected individuals. Data provided a complete overview of SARS-CoV-2-induced immune signature, including a dramatic defect in IFN responses, a reduction of toxicity-related molecules in NK cells, an increased degranulation of neutrophils, a dysregulation of T cells, a dramatic increase in B cell function and immunoglobulin production, as well as an important over-expression of genes involved in metabolism and cell cycle in patients infected with SARS-CoV-2 compared to those infected with influenza viruses. These features also differed according to COVID-19 severity. Overall and specific gene expression patterns across groups can be visualized on an interactive website (https://bix.unil.ch/covid/). Collectively, these transcriptomic host responses to SARS-CoV-2 infection are discussed in the context of current studies, thereby improving our understanding of COVID-19 pathogenesis and shaping the severity level of COVID-19.

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a multifaceted disease potentially responsible for various clinical manifestations including gastro-intestinal symptoms. Several evidences suggest that the intestine is a critical site of immune cell development, gut microbiota could therefore play a key role in lung immune response. We designed a monocentric longitudinal observational study to describe the gut microbiota profile in COVID-19 patients and compare it to a pre-existing cohort of ventilated non-COVID-19 patients. Methods: From March to December 2020, we included patients admitted for COVID-19 in medicine (43 not ventilated) or intensive care unit (ICU) (14 ventilated) with a positive SARS-CoV-2 RT-PCR assay in a respiratory tract sample. 16S metagenomics was performed on rectal swabs from these 57 COVID-19 patients, 35 with one and 22 with multiple stool collections. Nineteen non-COVID-19 ICU controls were also enrolled, among which 14 developed ventilator-associated pneumonia (pneumonia group) and five remained without infection (control group). SARS-CoV-2 viral loads in fecal samples were measured by qPCR. Results: Although similar at inclusion, Shannon alpha diversity appeared significantly lower in COVID-19 and pneumonia groups than in the control group at day 7. Furthermore, the microbiota composition became distinct between COVID-19 and non-COVID-19 groups. The fecal microbiota of COVID-19 patients was characterized by increased Bacteroides and the pneumonia group by Prevotella. In a distance-based redundancy analysis, only COVID-19 presented significant effects on the microbiota composition. Moreover, patients in ICU harbored increased Campylobacter and decreased butyrate-producing bacteria, such as Lachnospiraceae, Roseburia and Faecalibacterium as compared to patients in medicine. Both the stay in ICU and patient were significant factors affecting the microbiota composition. SARS-CoV-2 viral loads were higher in ICU than in non-ICU patients. Conclusions: Overall, we identified distinct characteristics of the gut microbiota in COVID-19 patients compared to control groups. COVID-19 patients were primarily characterized by increased Bacteroides and decreased Prevotella. Moreover, disease severity showed a negative correlation with butyrate-producing bacteria. These features could offer valuable insights into potential targets for modulating the host response through the microbiota and contribute to a better understanding of the disease's pathophysiology. Trial registration: CER-VD 2020–00755 (05.05.2020) & 2017–01820 (08.06.2018). [ABSTRACT FROM AUTHOR]

Background. Coronavirus disease 2019 (COVID-19) can result in profound changes in blood coagulation. The aim of the study was to determine the incidence and predictors of venous thromboembolic events (VTE) among patients with COVID-19 requiring hospital admission. Subjects and Methods. We performed a retrospective study at the Lausanne University Hospital with patients admitted because of COVID-19 from February 28 to April 30, 2020. Results. Among 443 patients with COVID-19, VTE was diagnosed in 41 patients (9.3%; 27 pulmonary embolisms, 12 deep vein thrombosis, one pulmonary embolism and deep vein thrombosis, one portal vein thrombosis). VTE was diagnosed already upon admission in 14 (34.1%) patients and 27 (65.9%) during hospital stay (18 in ICU and nine in wards outside the ICU). Multivariate analysis revealed D-dimer value > 3,120 ng / ml (P < 0.001 ; OR 15.8, 95% CI 4.7-52.9) and duration of 8 days or more from COVID-19 symptoms onset to presentation (P 0.020; OR 4.8, 95% CI 1.3-18.3) to be independently associated with VTE upon admission. D-dimer value ≥ 3,000 ng / l combined with a Wells score for PE ≥ 2 was highly specific (sensitivity 57.1%, specificity 91.6%) in detecting VTE upon admission. Development of VTE during hospitalization was independently associated with D-dimer value > 5,611 ng / ml (P < 0.001 ; OR 6.3, 95% CI 2.4-16.2) and mechanical ventilation (P < 0.001 ; OR 5.9, 95% CI 2.3-15.1). Conclusions. VTE seems to be a common COVID-19 complication upon admission and during hospitalization, especially in ICU. The combination of Wells ≥ 2 score and D − dimer ≥ 3,000 ng / l is a good predictor of VTE at admission. [ABSTRACT FROM AUTHOR]

Physical activity (PA) promotion has become a central objective of Public Health Organisations, due to its long-lasting global benefits on health. The 2023 recommendations recommend at least 150 minutes of moderate physical activity or 75 minutes of intense physical activity per week for adults. New approaches focus on physical exercise as an integral part of daily life. Primary care doctors play a key role in promoting physical activity. Yet in 2010, only 30% of them advised their patients on PA. This is partly due to their own sedentary lifestyle, caused by heavy workloads, irregular working hours, lack of free time and insufficient institutional and financial support for promoting physical activity. An active doctor is an active patient, and the promotion of physical activity in the workplace should be supported by institutions., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

A 78-year-old smoker patient with COPD (GOLD 3E) is admitted for COPD exacerbation. The initial examination shows abnormal fingers and nails. The hyponychial angle is 195 degrees and there is a positive Schamroth sign. A diagnosis of nail clubbing is made. Because the association of nail clubbing and COPD is rare, the history is completed and reveals significant weight loss over the past few months. A -pulmonary CT-scan shows a peri-hilar mass, and biopsy confirms small cell lung cancer.

Asymptomatic bacteriuria is frequently encountered in clinical practice and should be treated only in pregnant women and before invasive urological procedures. Inappropriate treatment of asymptomatic bacteriuria is associated with numerous adverse effects including allergic reactions, increased antibiotics resistance and increase risk of Clostridioides difficile infection. Positive urinary culture often leads to antimicrobial treatment, irrespective of urinary symptoms. Therefore, urine analysis and culture should be performed only in symptomatic individuals or in asymptomatic individuals with a clear indication for treatment.

Rapidly progressive dementia is distinguished from other neurocognitive disorders by its rapid onset (less than two years from first symptoms to diagnosis). It comprises a wide range of etiologies, including Creutzfledt-Jakob disease and Alzheimer's disease. When faced with a recent and rapid onset of major cognitive impairment, it is essential to rule out delirium or any other cause that may lead to rapid cognitive decline (such as stroke, encephalitis, or epileptic seizure). The work-up is based on a detailed history (drugs, exposure, medical history), a thorough clinical examination, and a broad biological work-up including MRI, lumbar puncture and EEG. Management should rapidly involve a neurologist or a specialized center., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

High output heart failure (HOHF) is a particular type of heart failure with multiple etiologies but a similar underlying mechanism, namely a decrease in systemic vascular resistance, in some instances associated with increased metabolic requirements. This leads to neurohormonal activation, fluid and sodium retention and a chronic hyperdynamic state resulting in a classic congestive state associated with clinical signs of high output. While no clear definition of HOHF exists, such findings and an increase in cardiac output (cardiac index >4 L/min/m2) strongly suggest the diagnosis. This probably under-diagnosed entity should actively be sought, particularly in obese patients and/or patients labelled with heart failure with preserved ejection fraction (HFpEF). Treatment and prognosis depend on the etiology., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Iodinated contrast products have been incriminated for a long time in the development of acute renal failure after injected procedures. This trend is now being questioned and this article reviews the current state of knowledge concerning the risk of acute renal failure after intra-arterial and intravenous iodinated contrast media injection. It also proposes a review of prophylactic measures for these two modalities as well as a practical attitude to adopt with patients requiring an injected examination., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.