A 45-year-old immunocompetent man presented at the emergency unit of the Sainte-Anne hospital in Toulon (south of France) after 3 h of left-eye pain. He did not describe ocular discharge. He had no specific medical or travel history. He experienced sudden ocular pain with foreign-body sensation while moving out the garbage. The clinical examination showed a red and painful eye without photophobia. Ophthalmologic examination with a slit lamp revealed four foreign bodies, 1 mm long, fleeing light and moving on the lower palpebral conjunctiva to the fornix. Hyperhemia was observed on the bulbar and palpebral conjunctiva. Fluorescein examination did not indicate corneal keratitis. The anterior chamber showed no deposit or hemorrhage, and iris was normal. After local application of oxybuprovacaine, 4 foreign bodies were removed by physiological saline irrigation and sent to the microbiology laboratory for identification. The obtained elements had a pearly white aspect and were motile. Microscopic examination revealed that these elements were covered with spines (Fig. 1A) and possessed hooks and spines in the extremities (Fig. 1B and C).

73 (1 August) • 555 the severity of pneumonia was not specified in these studies (Figure 1C).We further stratified patients with monoinfection of 229E, HKU1, NL63, or OC43, and characterized their clinical symptoms and features, respectively (Figure 1D).Strikingly, pneumonia was reported in >40% patients with NL63 or OC43 infection, although the included patient number is small (Supplementary Data).In summary, this study comprehensively characterized the clinical features of endemic coronavirus infection.Despite the intrinsic limitations of retrospective meta-analysis with potential selection and publication bias, our findings suggest that endemic coronavirus can impose substantial clinical burden in a subset of patients, which deserves more attention.

We the study by Wong and colleagues [1] evaluating posterior oropharyngeal saliva (POPS) for detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which confirms POPS as an alternative to nasopharyngeal specimen (NPsp) for real-time ploymerase chain reaction (RT-PCR) detection. Despite NPsp being recommended, collection of samples is operator dependent, painful and exposes healthcare workers during sampling. For theses reasons we conducted a prospective study in April 2020. POPS and NPsp were both collected and tested from 92 outpatient adults attending the coronavirus disease-19 (COVID-19) consultation unit. All patients presented symptoms compatible with COVID-19 infection but none had a productive cough. NPsp were collected by experienced and trained physicians in viral medium transport (VMT) and POPS was collected by asking the patient to perform a coughing effort while keeping their surgical mask and then collect saliva themselves into a sterile container, without VMT. Samples were immediately transferred to the laboratory and subjected to an inactivation procedure with 10µL of proteinase K (25mg/mL) into 200µL of specimen at 65°C during 10 minutes. Total nucleic acid extraction was then achieved by MagNA pure compact (Roche, Switzerland) or GenoXtract (Biocentric, France). RT-PCR assay targeting the IP2 and IP4 regions of RdRp gene of SARS-CoV-2 was performed according to the French National Center protocol in a Light-Cycler 480 Real-Time PCR System (Roche, Switzerland).

Background: The novel coronavirus (2019-nCOV) appeared in China and precipitously extended across the globe. As always, natural disasters or infectious disease outbreaks have the potential to cause emergency department (ED) volume changes. Objective: We aimed to assess the influence of the Coronavirus Disease 2019 (COVID-19) pandemic on ED visits and the impact on the handling of patients requiring urgent revascularization. Methods: We reviewed the charts of all patients presenting to the ED of Hospital Sainte Anne (Toulon, France) from March 23 to April 5, 2020 and compared them with those of the same period in 2019. Then we analyzed complementary data on acute coronary syndrome (ST-elevation myocardial infarction [STEMI] and non-ST-elevation myocardial infarction [NSTEMI]) and neurovascular emergencies (strokes and transient ischemic attacks). Results: The total number of visits decreased by 47%. The number of people assessed as triage level 2 was 8% lower in 2020. There were five fewer cases of NSTEMI in 2020, but the same number of STEMI. The number of neurovascular emergencies increased (27 cases in 2019 compared with 30 in 2020). We observed a reduction in the delay between arrival at the ED and the beginning of coronary angiography for STEMI cases (27 min in 2019 and 22 min in 2020). In 2020, 7 more stroke patients were admitted. Conclusion: The COVID-19 pandemic probably dissuaded "non-critical'' patients from coming to the hospital, whereas the same number of patients with a critical illness attended the ED as attended prior to the pandemic. There does not seem to have been any effect of the pandemic on patients requiring reperfusion therapy (STEMI and stroke). (C) 2020 Elsevier Inc. All rights reserved.

The article concerning patient transportation in chemical, biological, radiologic, and nuclear scenes has received significant attention. 1 Yanagawa Y Ishikawa K Takeuchi I et al. Should helicopters transport patients who become sick after chemical, biological, radiological, nuclear and explosive attack?. Air Med J. 2018; 37: 124-125 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar This work is based both on historic data 2 Ohbu S Yamashina A Takasu N et al. Sarin poisoning on Tokyo subway. South Med J. 1997; 90: 587-593 Crossref PubMed Scopus (211) Google Scholar and results of training time. It allows authors to conclude that evacuation of contaminated patients in chemical, biological, radiologic, and nuclear conditions should not be performed to prevent contamination of the aircrew, especially the pilot in command

On January 12, 2010, Port-au-Prince, Haiti, was shattered by a violent earthquake that killed or injured thousands of its citizens. Local emergency services became overwhelmed and international assistance was required. French relief teams were deployed to assist local hospitals in caring for the victims. The medical care activity of the team at Diquini Hospital from January 17-26 was analyzed. Priority was given to surgery, leading to the creation of a pre- and post-operative area and a medical care unit. Special attention was required for infection prevention, pain relief, minor surgery, and pre-surgery triage. The continual influx of accompanied victims necessitated the creation of a receiving area. In spite of the assistance from several foreign surgical teams, some patients had to be evacuated to French or American facilities, particularly children, patients with spinal cord injuries, and those needing intensive care. Analysis of the actions undertaken highlights the importance of well-prepared and flexible medical teams and the ability to provide local and regional anesthesia, including the necessary medical supplies and equipment. Medical care activity, especially post-surgical care, was a predominant, ongoing need. The ability to provide medical care required organization and cooperation among local health care providers and other relief workers.

Fibrinolytic therapy (FT) during out-of-hospital cardiac arrest (OHCA) has been studied in several trials, but they have produced unsatisfactory results even in the most recent Thrombolysis in Cardiac Arrest (TROICA) study. This study aimed to assess the impact of FT provided by an out-of-hospital emergency physician on the immediate prognosis of patients with OHCA. We performed a retrospective study in which the primary endpoint was survival to hospital admission. Among 5,102 patients with OHCA in Paris and the suburban area who received medical care from the Fire Brigade of Paris, 1,261 met the following inclusion criteria: age above 18 years with non-traumatic OHCA. Among 107 patients who received FT, 51 (47.7%) survived to hospital admission whereas 272 out of 1,154 (23.6%) patients who did not receive FT survived to hospital admission. A matching process based on a propensity score used to equalise potential prognosis factors in both groups demonstrated that FT was associated with more frequent survival to hospital admission (OR adjusted: 1.7; CI 95% [1.09–2.68]). This result was observed particularly in patients who were not initially shocked by automatic electrical defibrillator (AED) (ORa = 3.61; CI 95% [1.88–6.96]). This study showed that fibrinolysis was associated with improved survival to hospital admission, after performing a propensity analysis. FT may be beneficial in out-of-hospital arrest patients. However, any conclusions drawn are limited by the retrospective nature of the study.

Immediate care of out-of-hospital cardiac arrest (CA) is standardized by the established ILCOR ACLS Guidelines. Studies concerning the impact of thrombolysis, generally for CA of cardiac etiology have not shown a benefit. We sought to evaluate the rate of hospital admission for all CA patients treated with pre-hospital thrombolytics. Methods: Non-randomized retrospective study was conducted from 09/1/2005 to 02/15/2007 of non-traumatic CA patients treated with (T+) or without (T-) thrombolysis. The protocol for administration of thrombolytics was at the discretion of the field physician, aiming for within 20 minutes of collapse in almost all cases, and prior to return of spontaneous circulation. The primary endpoint was admission alive to the hospital. We performed multivariate analysis by logistic regression to identify risk factors independently associated with outcome: age, gender, response time, defibrillation, witnessed arrest, bystander CPR. Results: We reviewed 1331 consecutive patient records, of which 116 (8.7%) received thrombolytics. Both T+ and T- groups had comparable response times, witnessed arrest, and bystander CPR. Patients in T+ were significantly younger (59±14 vs 67±19 years old), predominantly males (81% vs 61%), and received more defibrillation shocks (61% vs 26 %). Significantly more patients T+ arrived alive to hospital for admission (45% vs 24%). Risk factors independently associated with hospital admissions were thrombolysis, age, response time, witnessed arrest, and bystander CPR. The impact of thrombolysis was different whether or not the patient was defibrillated (odds ratio with shocks 1.1 [95%CI: 0.2–5.0] vs without shocks 3.6 [95%CI: 1.9 – 6.9]), despite a greater overall rate of hospital admission for shocked patients. Conclusion: Thrombolysis appears to improve the rate of admission alive to the hospital in patients that were not defibrillated with adjustment for age, gender, response time, witnessed arrest, and bystander CPR. These preliminary results should be confirmed by a prospective randomized study. This analysis can help determine appropriate inclusion criteria for a future study.