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There is an urgent need to measure the impacts of COVID-19 among gay men and other men who have sex with men (MSM). We conducted a cross-sectional survey with a global sample of gay men and other MSM (n = 2732) from April 16, 2020 to May 4, 2020, through a social networking app. We characterized the economic, mental health, HIV prevention and HIV treatment impacts of COVID-19 and the COVID-19 response, and examined whether sub-groups of our study population are disproportionately impacted by COVID-19. Many gay men and other MSM not only reported economic and mental health consequences, but also interruptions to HIV prevention and testing, and HIV care and treatment services. These consequences were significantly greater among people living with HIV, racial/ethnic minorities, immigrants, sex workers, and socio-economically disadvantaged groups. These findings highlight the urgent need to mitigate the negative impacts of COVID-19 among gay men and other MSM.

BACKGROUND: Determining which patients with ARDS are most likely to benefit from lung recruitment maneuvers is challenging for physicians. The aim of this study was to assess whether the single-breath simplified decremental PEEP maneuver, which evaluates potential lung recruitment, may predict a subject's response to lung recruitment maneuvers, followed by PEEP titration. METHODS: We conducted a pilot prospective single-center cohort study with a 3-step protocol that defined sequential measurements. First, potential lung recruitment was assessed by the single-breath maneuver in the volume controlled mode. Second, the lung recruitment maneuver was performed in the pressure controlled mode, with a fixed driving pressure of 15 cm H2O and a maximum PEEP of 30 cm H2O. Third, the lung recruitment maneuver was followed by decremental PEEP titration to determine the optimal PEEP, defined as the lowest driving pressure. Responders to the lung recruitment maneuver were defined by an improvement in PaO2/FIO2 > 20% between the baseline state and the end of the PEEP titration phase. RESULTS: Forty-two subjects with moderate-to-severe ARDS were included. The mean ± SD lung recruitment was 149 ± 104 mL. A threshold lung recruitment of 195 mL (area under the receiver operator characteristic curve 0.62, 95% CI 0.43-0.80) predicted a positive response to the maximal lung recruitment maneuver. The lung recruitment maneuver, followed by PEEP titration, resulted in a modification of PEEP in 74% of the subjects. PEEP was increased in more than two thirds of the responders and decreased in almost half of the non-responders to the lung recruitment maneuver. In addition, a decrease in driving pressure and an increase in respiratory system compliance were reported in 62% and 67% of the subjects, respectively. CONCLUSIONS: The single-breath maneuver for evaluating lung recruitability predicted, with poor accuracy, the subjects who responded to the lung recruitment maneuver based on PaO2/FIO2 improvement. Nevertheless, the lung recruitment maneuver, followed by PEEP titration, improved ventilator settings and respiratory mechanics in a majority of subjects. [ABSTRACT FROM AUTHOR]

Background: All chronic kidney diseases in diabetic patients are not diabetic kidney diseases. The objective was to compare the clinical characteristics, survival and access to transplantation in diabetic patients starting dialysis and classified either as diabetic kidney disease (DKD) or non‐diabetic kidney disease in diabetic patients (NDKD). Methods: We used the nationwide French REIN registry to analyse baseline clinical characteristics at dialysis inception and outcomes defined as kidney transplantation, deaths and their causes. The probability of death or transplantation was analysed using a multivariate Cox model and the Fine and Gray competing for risk model (sdHT). Results: We included 65,136 patients from January 2009 to December 2015 with a median follow‐up of 31 months. The cumulative incidence of kidney transplantation over eight years was 46.9% (44.8–48.9) in non‐diabetic patients (ND), higher than the 19.3% (17.5–21.2) in the DKD group and 22.2% (18.4–26.7) in the NDKD group. The risk of death was significantly higher in the NDKD group than in the DKD group, even after accounting for the competing risk of transplantation (NDKD/sdHR 1.22; 95%CI 1.18–1.27; p < 0.005 vs. DKD/sdHR 1.12; 95%CI 1.08–1.16; p < 0.005 with adjustment for age, sex, major adverse cardiovascular events, cancer and chronic respiratory failure, compared to ND). Conclusions: In diabetic patients starting dialysis, patients in the DKD group had reduced access to kidney transplantation. NDKD patients had a higher risk of mortality than DKD. The distinction between DKD and NDKD should be accounted for in the plan of care of diabetic patients starting dialysis. [ABSTRACT FROM AUTHOR]

Objectives: Chest pain is a common symptom in pediatric emergency department. The causes are mostly benign without any sign on chest x-ray (CXR). However, CXR is one of the most ordered tests in this situation. Our main objective was to assess the current management of CXR by physicians in this context, according to the algorithm proposed by the French Society of Pediatrics (FSP)., Materials and Methods: We conducted a retrospective study in two French pediatric emergency departments. We reviewed the medical records of children who presented with chest pain between 2018, July 1rst to 2021, July 31th. We collected data from history and clinical examination. The prescription of CXR and its interpretation were collected., Results: Overall, 599 children were enrolled. The algorithm was followed in 57,1 % of cases, and 8,2 % of abnormal CXR were noted. On univariate analysis, medical history with a significant OR greater than 2 included cardiological history (as defined by FSP), neoplasia, pneumonia and sickle cell disease. Right lateralized pain, pain that worsens with respiration, fever and cough were also symptoms significantly associated with an abnormal CXR result. On physical finding, tachycardia, tachypnea, abnormal cardiac and pulmonary clinical examination (as defined by the FSP) were significantly associated with pathological CXR. However, the multivariate logistic regression model could not be carried out due to too many significant variables in univariate analysis, and too few number of abnormal CXR reported., Conclusion: CXR remains the cornerstone of chest pain management in pediatric emergencies, even though the rate of abnormal CXR appears low. The appropriateness of CXR prescribing can be improved by guidelines focusing on the clinical etiologies of chest pain visible on CXR. A similar prospective study may identify risk factors for pathological CXR and clarify the decision tree for the indication of CXR in chest pain., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2024. Published by Elsevier Masson SAS.)

Background: Pain management is an essential and complex issue for non-communicative patients undergoing sedation in the intensive care unit (ICU). The Behavioral Pain Scale (BPS), although not perfect for assessing behavioral pain, is the gold standard based partly on clinical facial expression. NEVVA © , an automatic pain assessment tool based on facial expressions in critically ill patients, is a much-needed innovative medical device., Methods: In this prospective pilot study, we recorded the facial expressions of critically ill patients in the medical ICU of Caen University Hospital using the iPhone and Smart Motion Tracking System (SMTS) software with the Facial Action Coding System (FACS) to measure human facial expressions metrically during sedation weaning. Analyses were recorded continuously, and BPS scores were collected hourly over two 8 h periods per day for 3 consecutive days. For this first stage, calibration of the innovative NEVVA © medical device algorithm was obtained by comparison with the reference pain scale (BPS)., Results: Thirty participants were enrolled between March and July 2022. To assess the acute severity of illness, the Sequential Organ Failure Assessment (SOFA) and the Simplified Acute Physiology Score (SAPS II) were recorded on ICU admission and were 9 and 47, respectively. All participants had deep sedation, assessed by a Richmond Agitation and Sedation scale (RASS) score of less than or equal to -4 at the time of inclusion. One thousand and six BPS recordings were obtained, and 130 recordings were retained for final calibration: 108 BPS recordings corresponding to the absence of pain and 22 BPS recordings corresponding to the presence of pain. Due to the small size of the dataset, a leave-one-subject-out cross-validation (LOSO-CV) strategy was performed, and the training results obtained the receiver operating characteristic (ROC) curve with an area under the curve (AUC) of 0.792. This model has a sensitivity of 81.8% and a specificity of 72.2%., Conclusion: This pilot study calibrated the NEVVA © medical device and showed the feasibility of continuous facial expression analysis for pain monitoring in ICU patients. The next step will be to correlate this device with the BPS scale., Competing Interests: MB and DCh participated in scientific board of SAMDOC Medical Technologies who develops NEVVA©; medical device. JL, TC, AH and TG were employed by Samdoc Medical Technologies Company. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Bellal, Lelandais, Chabin, Heudron, Gourmelon, Bauduin, Cuchet, Daubin, De Carvalho Ribeiro, Delcampe, Goursaud, Joret, Mombrun, Valette, Cerasuolo, Morello, Mordel, Chaillot, Dutheil, Vivien and Du Cheyron.)

The presence of missing data, a constant problem in medical research, has several consequences: systematic loss of power, associated or not with a reduction in the representativeness of the sample analyzed. There are three types of missing data: 1) missing completely at random (MCAR); 2) missing at random (MAR); 3) missing not at random (MNAR). Multiple imputation by chained equations allows for the correct handling of missing data under the MCAR and MAR assumptions. It allows to simulate for each missing data j, a number m of simulated values which seem plausible with regard to the other variables. A random effect is included in this simulation to express the uncertainty. Several data sets are thus created and analyzed individually, in an identical way. Then the estimators of each data set are combined to obtain a global estimator. Multiple imputation increases power, corrects for some biases and has the advantage of being applicable to many types of variables. Complete case analysis should no longer be the norm. The objective of this guide is to help the reader in conducting an analysis with multiple imputed data. We cover the following points: the different types of missing data, the different historical approaches to handling them, and then we detail the multiple imputation method using chained equations. We provide a code example for the mice package of R®.

Objective: A retrospective case-control study was conducted to evaluate whether frequent binge drinking between the age of 18 and 25 years was a risk factor for alcohol dependence in adulthood., Setting: The Department of Addictive Medicine and the Clinical Investigation Center of a university hospital in France., Participants: Cases were alcohol-dependent patients between 25 and 45 years and diagnosed by a psychiatrist. Consecutive patients referred to the Department of Addictive Medicine of a university hospital between 1 January 2017 and 31 December 2017 for alcohol dependence were included in the study. Controls were non-alcohol-dependent adults, defined according to an Alcohol Use Disorders Identification Test score of less than 8, and were matched on age and sex with cases. Data on sociodemographics, behaviour and alcohol consumption were retrospectively collected for three life periods: before the age of 18 years; between the age of 18 and 25 years; and between the age of 25 and 45 years. Frequency of binge drinking between 18 and 25 years was categorised as frequent if more than twice a month, occasional if once a month and never if no binge drinking., Results: 166 adults between 25 and 45 years were included: 83 were alcohol-dependent and 83 were non-alcohol-dependent. The mean age was 34.6 years (SD: 5.1). Frequent binge drinking between 18 and 25 years occurred in 75.9% of cases and 41.0% of controls (p<0.0001). After multivariate analysis, frequent binge drinking between 18 and 25 years was a risk factor for alcohol dependence between 25 and 45 years: adjusted OR=2.83, 95% CI 1.10 to 7.25., Conclusions: Frequent binge drinking between 18 and 25 years appears to be a risk factor for alcohol dependence in adulthood. Prevention measures for binge drinking during preadulthood, especially frequent binge drinking, should be implemented to prevent acute consequences as injury and death and long-term consequences as alcohol dependence., Trial Registration Number: NCT03204214; Results., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)