Meynard JB, de Laval F, Texier G
… +3 more, Gorgé O, Degui H, Pommier de Santi V
Bull Acad Natl Med
· 2022 Oct · PMID 35879932
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OBJECTIVES: Faced with the COVID-19 epidemic that occurred within the naval air group and the nuclear aircraft carrier Charles de Gaulle, the French Armed Forces Epidemiology and Public Health Center (CESPA) carried out...OBJECTIVES: Faced with the COVID-19 epidemic that occurred within the naval air group and the nuclear aircraft carrier Charles de Gaulle, the French Armed Forces Epidemiology and Public Health Center (CESPA) carried out an investigation (January - April 2020) whose objectives were: to identify the possible routes of introduction of the virus ; to describe the characteristics of the epidemic and to describe and model the dynamics of the epidemic's spread. METHODS: A telephone survey was conducted. The biological diagnoses were transmitted by the medical antennas. A time/place/population analysis was carried out, as well as the description of the clinical pictures with their exposure factors. The instantaneous reproduction rate Rt of the epidemic was modeled. A spatial analysis of the epidemic on board was carried out. Forty-three viral genomes were sequenced and compared to the reference bases. RESULTS: 0f 1767 sailors, 1568 (89%) participated in the telephone survey and 1064 (67.9%) were confirmed cases. Four patient profiles have been described: asymptomatic (13.0%); non-specific symptomatic (8.1%); specific symptomatic (76.3%); severe cases (2.6%). In univariate and multivariate analysis, age, overweight and obesity were significantly associated with the risk of having a severe form. Smoking was a protective factor. The evolution kinetics of Rt was in favor of an introduction of the virus at the end of February with a reintroduction during the stopover in Brest. Analysis of viral genomes ruled out introduction and spread of a single strain. CONCLUSION: Despite the control measures taken, an epidemic occurred. The often pauci-symptomatic clinical pictures resulted in a delay in identification. CESPA was able to carry out this epidemiological investigation within a highly constrained timeframe, showing all the interest of its integrated public health model.
Bouvenot G, Le Coz P, Juillet Y
… +1 more, au nom du Groupe de travail « Perception du risque médicamenteux par le public et rôle des médias » rattaché à la commission 2 de l’ANM
Bull Acad Natl Med
· 2022 Oct · PMID 35855492
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Opinion polls regularly show that the vast majority of French people have a positive perception of the efficacy and safety of using medicines, including vaccines. Distrust or hostility towards them is only the fact of a...Opinion polls regularly show that the vast majority of French people have a positive perception of the efficacy and safety of using medicines, including vaccines. Distrust or hostility towards them is only the fact of a small minority of the population, but active and noisy on social networks and overvalued by the media and public authorities. However, the pandemic due to Covid 19 (SARS-CoV-2) has confirmed to what extent the perception of drug risk by the public is unstable, sometimes irrational, how many and complex the determinants of this perception are and what role as a public resonance, fears play out in the media. We can even implicitly see the general underlying tendency of our society, which is to grant primacy to risk to the detriment of profit in the assessment of a technological innovation. The risk tree often masking the forest of efficiency. This polarization of minds on risks, associated with an overestimation of low probabilities, testifies to the impregnation of our mores by the ideology of precaution. To which are added distorting factors such as naturalistic prejudice, cultural relativism and the planetary extension of social networks which instantly spread false information that is more viral and better remembered than the true ones, hampering communication based on science data. Promoting the correct perception of drug risk requires recalling both the benefits and the risks linked to action but also those linked to inaction; to clarify institutional messages by making them as factual as possible; to limit the number of public broadcasters to achieve greater consistency in their messages; to have the frankness to sometimes say that we do not know, medicine by nature being practiced in a context of uncertainty. The Academy calls for an ambitious educational policy for young people: training in critical thinking and the acquisition of the basics of drug risk should be introduced from middle school. The Academy also believes that the public is entitled to expect quality-controlled information from the media, away from rumors, by calling on indisputable experts and by favoring objective data over subjective testimonies based on personal experiences.
Bull Acad Natl Med
· 2021 Dec · PMID 35601672
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BACKGROUND —: Smokers are 30 to 40 percent more likely to develop type 2 diabetes than non-smokers. A type 2 diabetes gene, Tcf7L2, which had lost activity, caused rats to consume more nicotine. In the present study, we...BACKGROUND —: Smokers are 30 to 40 percent more likely to develop type 2 diabetes than non-smokers. A type 2 diabetes gene, Tcf7L2, which had lost activity, caused rats to consume more nicotine. In the present study, we used data from the UK Biobank to examine the relationship of smoking, type 2 diabetes, and Tcf7L2 in human subjects. METHODS —: The gene has two SNPs, rs7903146 and rs4506565, reported to be associated with type 2 diabetes. They have approximately equal power to estimate risk for type 2 diabetes, and the results from one correlate 92% with the other. We examined the genotypes of these SNPs and cigarette consumption. RESULTS —: Genotype TT, linked to type 2 diabetes, smoked the least. But because of the large sample size (approximately 111,000 subjects) the tiny difference in cigarettes smoked daily by each genotype group (effect size), while statistically significant, is probably clinically meaningless. The average subject smoked 19 cigarettes daily, with a difference of 0.12 cigarette between each genotype group. CONCLUSION —: The fact that Tcf7L2 is involved in nicotine addiction in rats but not in humans, as UKBB data suggest, is hardly surprising. Humans and rodents descended from a common ancestor about 80 million years ago, with rats and mice diverging between 12 and 24 million years ago. Thus, over millions of years may have developed vastly different functions in rodents and humans. Genome Wide Association Studies have revealed at least 65 different loci linked to type 2 diabetes. Genes associated with type 2 diabetes include among others. Perhaps one or more of these genes might be the intermediary between type 2 diabetes and cigarette smoking. Further studies are warranted.
Boudjema K, Simon P, Moulin T
… +3 more, Pon D, Chays A, Vouhé P
Bull Acad Natl Med
· 2022 May · PMID 35601233
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Telemedicine, or remote medicine, has become an important tool for health care providers as a result of the SARS-Cov2 pandemic. It must be considered as a tool capable of improving the practice of modern medicine. This t...Telemedicine, or remote medicine, has become an important tool for health care providers as a result of the SARS-Cov2 pandemic. It must be considered as a tool capable of improving the practice of modern medicine. This text reminds the rules of its practice and encourages the organization of teaching.
Dubois G, Denoix de Saint Marc R, Durrleman A
… +5 more, Houssin D, Caton J, Bertrand D, Tillement JP, l’ex-commission VIII (Financement des dépenses de santé, assurance maladie)
Bull Acad Natl Med
· 2022 Apr · PMID 35233107
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Gonthier R, Adolphe M, Michel JP
… +6 more, Bringer J, Dubois B, Lecomte D, Milliez J, Vellas B, commission XIII (autonomie-dépendance-vieillissement) de l’Académie nationale de médecine
Bull Acad Natl Med
· 2022 Apr · PMID 35221338
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The ageing of the population induces situations of large vulnerability and dependence. Home care usually remains the best response to comply with the person's wish, the family's desire, and the civil society's interest....The ageing of the population induces situations of large vulnerability and dependence. Home care usually remains the best response to comply with the person's wish, the family's desire, and the civil society's interest. However, there are circumstances where patient management in a nursing home (EHPAD) is the only solution. The present pandemic of coronavirus COVID-19 has highlighted the issue of EHPAD and their limitations to provide high quality care. To analyze the current position of EHPAD into the care chain and to understand difficulties to their functioning, it seems essential to seek out accelerated changes in the EHPAD since their establishment in 1999 and then in the light of the current crisis, propose possible solutions with a positive view of the role which each EHPAD will have to ensure for future.
Bull Acad Natl Med
· 2022 Apr · PMID 35194225
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The arrival of anti-Covid-19 RNA vaccines in 2020 should not obscure the fact that for several years we have already had treatments based on interfering RNA or antisense oligonucleotides in a number of rare diseases with...The arrival of anti-Covid-19 RNA vaccines in 2020 should not obscure the fact that for several years we have already had treatments based on interfering RNA or antisense oligonucleotides in a number of rare diseases with a very poor prognosis such as transthyretin amyloidosis, acute hepatic porphyria, primary hyperoxaluria, spinal muscular atrophy or familial hyperchylomicronemia. If their performance, unlike that of vaccines, is for the moment only qualified as moderate therapeutic progress (moderate clinical added value) in the therapeutic strategies against these diseases, it should be taken into account that their initial evaluation was penalized by a certain number of unfavorable factors: trials of small numbers, therapeutic modalities to be refined, the lack of hindsight on their long-term effects but especially the choice of the moment of the initiation of the treatment in the natural evolution of the sickness. This choice is not trivial because it is hard to imagine that the products used could, beyond a simple stabilization of the disease installed, allow its regression as soon as certain lesions formed are irreversible. This is why their very early implementation, possibly based on genetic screening, is an avenue to be seized in the interest of patients. But, in the competitive context of innovations in the field, interfering RNAs and antisense oligonucleotides will have to reckon with gene therapy and genome editing using the CRISPR-Cas 9 technique.
Caillard S, Registre français des patients transplantés d’organe solide Covid-19, sous l’égide de la Société Francophone de transplantation
Bull Acad Natl Med
· 2022 Apr · PMID 35185155
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The Covid-19 pandemic hit the transplant world in March 2020. Teams quickly organized themselves to optimize the management of their immunocompromised patients and to progress in the knowledge of this new disease. To do...The Covid-19 pandemic hit the transplant world in March 2020. Teams quickly organized themselves to optimize the management of their immunocompromised patients and to progress in the knowledge of this new disease. To do this, a French Registry was set up, listing all solid organ transplant patients who had developed a SARS Cov2 infection. Numerous studies carried out on the basis of these data have enabled us to describe the disease in transplant patients, to characterize its clinical and biological severity factors and to define its prognosis. The mortality of transplant patients hospitalized for Covid-19 is 23% at 60 days and renal insufficiency plays a major role in the poor prognosis in addition to the classic risk factors described in the general population. The advent of vaccination has been a great relief, but transplant patients have developed a poorer vaccine response than immunocompetent subjects, keeping them at risk of severe disease after an adapted vaccination schedule. Specific strategies had to be adopted in this particularly fragile population (increased number of vaccine doses, injection of monoclonal antibodies). The collaboration of the French transplantation centers under the impulse of the allowed us to carry out many collaborative projects, which were of great use for the care of the patients.
Bull Acad Natl Med
· 2022 Apr · PMID 35185154
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The excellent results of Transplantation over the last decades have highlighted new challenges to be solved in the next years. (1) Modify the storage of harvested organs to improve their quality. (2) Modify strategies by...The excellent results of Transplantation over the last decades have highlighted new challenges to be solved in the next years. (1) Modify the storage of harvested organs to improve their quality. (2) Modify strategies by taking into account the immunodeficiency in front of news infections like the one with Sars CoV-2. (3) Better understand the mechanisms of chronic rejection, in particular the role of innate immunity. (4) Rethink immunosuppressive strategies to prevent and to treat chronic rejections.