16 avril 2020 Recommandations

Source : HAS  

Continuité de la prise en charge des patients atteints d’hépatites virales chroniques

  • Réponse rapide n°1 : Les patients atteints de cirrhose au stade B ou C de la classification de Child-Pugh sont à risque de développer une forme grave de COVID-19.
  • Réponse rapide n°2 : Réaliser le suivi des patients atteints d’hépatite chronique au maximum hors des établissements de soins et privilégier la téléconsultation en veillant à l’absence de rupture de suivi.


Source : JAAC Heart Fealure

Auteur : Nianguo Dong and al.


ABSTRACT :

A novel coronavirus (2019-nCoV) was identified as the cause associated with emerging pneumonia (COVID-19) detected in Wuhan on Jan 7th. Since the number of patients rising rapidly worldwide, COVID-19 has become a throny international public health event. As of Mar 24th, China has cumulatively diagnosed 81747 cases and 147 new cases, while the number of cases in other countries is growing rapidly with a total of 291070 cases confirmed and 22027 new cases identified that day. Emerging studies suggest that COVID-19 preferentially afflicts the elderly, particularly those with chronic comorbidities1, 2. However, the clinical profiles of COVID-19 in refractory heart failure patients is unknown. Herein, we reported the clinical features in a group of end-stage heart failure patients with COVID-19, providing strong evidence of cardiac injury by the virus.


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Source : AHA Journal

Auteur : Yaling Han and al.


ABSTRACT :

In response to the outbreak of coronavirus disease 2019 (COVID-19) in Wuhan, China, the Chinese Society of Cardiology (CSC) issued this consensus statement after consulting with 125 medical experts in the fields of cardiovascular disease and infectious disease. The over-arching principles laid out here are the following: 1) Consider the prevention and control of COVID-19 transmission as the highest priority, including self-protection of medical staff; 2) Patient risk assessment of both infection and cardiovascular issues. Where appropriate, preferential use of conservative medical therapeutic approaches to minimize disease spread; 3) At all times, medical practices and interventional procedures should be conducted in accordance with the directives of the infection control department of local hospitals and local health commissions.


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Source : JAMA Network Open Auteur : Satoshi Shoji and al.

ABSTRACT

IMPORTANCE Prasugrel was approved at a lower dose in 2014 in Japan than in the West because East Asian patients are considered more susceptible to bleeding than Western patients. However, real-world outcomes with low-dose prasugrel treatment remain unclear. OBJECTIVE To investigate the association of low-dose prasugrel vs standard-dose clopidogrel administration with short-term outcomes among patients with acute coronary syndrome undergoing percutaneous coronary intervention (PCI).


Source : JAMA Cardiology

Auteur : Chirag Bavishi and al.


ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has already surpassed the combined mortality inflicted by the severe acute respiratory syndrome (SARS) epidemic of 2002 and 2003 and the Middle East respiratory syndrome (MERS) epidemic of 2013. The pandemic is spreading at an exponential rate, with millions of people across the globe at risk of contracting SARS-CoV-2. Initial reports suggest that hypertension, diabetes, and cardiovascular diseases were the most frequent comorbidities in affected patients, and case fatality rates tended to be high in these individuals.In the largest Chinese study to date,1 which included 44 672 confirmed cases, preexisting comorbidities that had high mortality rates included cardiovascular disease (10.5%), diabetes (7.3%), and hypertension (6.0%). Patients with such comorbidities are commonly treated with renin angiotensin system blockers, such as angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs). However, the use of ACEIs/ARBs in patients with COVID-19 or at risk of COVID-19 infection is currently a subject of intense debate. Below, we outline the mechanisms by which ACEIs/ARBs may be of benefit in those with COVID-19, what the current recommendations are for their use in infected patients, and suggested areas for further research.

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Source : Amsterdam UMC

Auteur : Cheng-I Wu et al.


ABSTRACT

Depuis que le premier cas a été signalé fin 2019, le virus SRAS-COV-2 et la maladie pulmonaire associée COVID-19 se sont répandus dans le monde entier et sont devenus une pandémie. En particulier, le taux de transmission élevé du virus en a fait une menace pour la santé publique mondiale.

Actuellement, il n’existe pas de traitement efficace prouvé contre le virus, et l’impact sur d’autres maladies est également incertain, en particulier le syndrome d’arythmie héréditaire. On peut s’attendre à un effet arythmogène de COVID-19, qui pourrait contribuer à l’évolution de la maladie. Cela peut être important pour les patients présentant un risque accru d’arythmie cardiaque, soit secondaire à des affections acquises ou à des comorbidités, soit consécutif à des syndromes héréditaires. La prise en charge des patients présentant des syndromes d’arythmie héréditaires tels que le syndrome du QT long, le syndrome de Brugada, le syndrome du QT court et la tachycardie ventriculaire polymorphe catécholaminergique dans le contexte de la pandémie COVID-19 pourrait s’avérer particulièrement difficile.

Selon l’anomalie héréditaire en cause, ces patients peuvent être sensibles aux effets proarythmiques des problèmes liés à la COVID-19, tels que la fièvre, le stress, les perturbations électrolytiques et l’utilisation de médicaments antiviraux. Nous décrivons ici les risques potentiels associés à la COVID-19 et les considérations thérapeutiques pour les patients présentant des syndromes d’arythmie héréditaire distincts et fournissons des recommandations, en fonction des possibilités locales, pour leur surveillance et leur prise en charge pendant cette pandémie.

 

 


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Source : Journal of Endocrinological Investigation Auteur : G. P. Fadini and al.

ANALYSE

Commentateur : Dr Laurent MEYER Date de pré-publication : 22/03/2020

Objectif :

un article court sur les liens épidémiologiques entre diabète et Covid-19.

Résultats :

  • le diabète n’est pas associé à un risque infectieux par SARS‑CoV‑2 plus grand mais à un risque plus important de formes

Point fort:

  • données récentes Chine et Italie.


Source : Société Française de Pharmacologie et de Thérapeutique


 ABSTRACT

Les patients atteints de maladies cardiovasculaires semblent présenter un risque accru de développer une forme plus sévère en cas d’infection à coronavirus 2019 (COVID-19) [1,2]. Bien que les manifestations cliniques de COVID-19 soient dominées par des symptômes respiratoires, certains patients peuvent également présenter des complications cardiovasculaires [1]. L’objectif de cette synthèse est de faire le point sur l’état actuel des connaissances entre système-rénine-angiotensine-aldostérone (SRAA), en particulier l’enzyme de conversion de l’angiotensine II (ACE2), et COVID-19 et entre médicaments bloqueurs du SRAA et COVID-19.

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Source : Journal of Clinical Medicine

Auteur : Junxiong Pang and al.


ABSTRACT

Rapid diagnostics, vaccines and therapeutics are important interventions for the management of the 2019 novel coronavirus (2019-nCoV) outbreak. It is timely to systematically review the potential of these interventions, including those for Middle East respiratory syndrome-Coronavirus (MERS-CoV) and severe acute respiratory syndrome (SARS)-CoV, to guide policymakers globally on their prioritization of resources for research and development. A systematic search was carried out in three major electronic databases (PubMed, Embase and Cochrane Library) to identify published studies in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Supplementary strategies through Google Search and personal communications were used. A total of 27 studies fulfilled the criteria for review. Several laboratory protocols for confirmation of suspected 2019-nCoV cases using real-time reverse transcription polymerase chain reaction (RT-PCR) have been published. A commercial RT-PCR kit developed by the Beijing Genomic Institute is currently widely used in China and likely in Asia. However, serological assays as well as point-of-care testing kits have not been developed but are likely in the near future. Several vaccine candidates are in the pipeline. The likely earliest Phase 1 vaccine trial is a synthetic DNA-based candidate. A number of novel compounds as well as therapeutics licensed for other conditions appear to have in vitro efficacy against the 2019-nCoV. Some are being tested in clinical trials against MERS-CoV and SARS-CoV, while others have been listed for clinical trials against 2019-nCoV. However, there are currently no effective specific antivirals or drug combinations supported by high-level evidence.

 


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