Centre de Médecine Préventive

The COVID-19 pandemic has left many survivors with persistent respiratory symptoms such as dyspnea, chronic cough, and reduced exercise capacity. Fibrosis-like abnormalities on high-resolution CT are frequently reported in theses patient. This study aimed to describe the morphological pulmonary abnormalities identified on V/Q SPECT/CT after COVID-19 infection and to evaluate their functional consequences on regional ventilation and perfusion. We also sought to identify clinical predictors of abnormal V/Q SPECT/CT findings. This retrospective multicenter study was based on a national registry of patients referred for V/Q SPECT/CT because of persistent respiratory symptoms after COVID-19 infection. CT abnormalities were characterized using standard radiological criteria. Ventilation and perfusion were visually graded using a five-point scale. Clinical, demographic, and acute COVID-19 characteristics were analyzed to identify predictors of abnormal imaging. Among the 217 included patients (mean age 58 ± 15 years), 122 (56%) presented pulmonary abnormalities on V/Q SPECT or CT. The most frequent parenchymal abnormalities were reticulations, consolidations, atelectasis, emphysema, and ground-glass opacities. Emphysema, consolidations, and fibrosis were associated with the most severe impairments of both ventilation and perfusion. Age and pre-existing chronic lung disease were the strongest predictors of abnormal imaging, while a mild acute COVID-19 course without oxygen therapy was protective. V/Q SPECT/CT provides a comprehensive structural and functional assessment of long COVID pulmonary sequelae. It allows the differentiation between reversible inflammatory lesions and persistent structural abnormalities with lasting functional consequences.

Le Dr Ian McWhinney, un jeune praticien généraliste de Stratford-Upon-Avon, en Angleterre, est arrivé au Canada avec sa famille en 1968 pour diriger la Division de la pratique familiale du Département de la médecine communautaire à la Faculté de médecine de l’Université Western Ontario

Levosimendan may facilitate weaning from venoarterial extracorporeal membrane oxygenation (VA-ECMO) and improve survival, but supporting evidence remains limited. To assess whether early administration of levosimendan reduces the time to successful VA-ECMO weaning in patients with severe but potentially reversible cardiogenic shock. Randomized, double-blind, placebo-controlled trial conducted across 11 intensive care units (ICUs) in France. Between August 27, 2021, and September 10, 2024, 205 adult patients with acute cardiogenic shock who had started VA-ECMO in the preceding 48 hours were enrolled. Final follow-up was completed on November 10, 2024. Patients were randomized in a 1:1 ratio to receive levosimendan, 0.15 μg/kg per minute, to be increased to 0.20 μg/kg per minute after 2 hours (n = 101), or placebo (n = 104). The primary outcome was time to successful ECMO weaning within 30 days following randomization. Secondary outcomes included ECMO-, mechanical ventilation-, and organ failure-free days, ICU and hospital lengths of stay, serious adverse events, and all-cause 30- and 60-day mortality. Among the 205 randomized patients (median age, 58 [IQR, 50-67] years; 149 [72.7%] male), main cardiogenic shock etiologies were postcardiotomy (79 [38.5%]), acute myocardial infarction (56 [27.3%]), and myocarditis (28 [13.7%]). Treatment dose was increased to 0.20 ± 0.01 μg/kg per minute in 93% of patients receiving levosimendan and in 96% of those receiving placebo. Within 30 days, 69 of 101 patients (68.3%) had a successful ECMO weaning in the levosimendan group compared with 71 of 104 (68.3%) in the placebo group (risk difference, 0.0% [95% CI, -12.8% to 12.7%]; subdistribution hazard ratio, 1.02 [95% CI, 0.74-1.39]; P = .92). In the levosimendan and placebo groups, respectively, median ECMO duration (5 [IQR, 4-7] days vs 6 [IQR, 4-11] days; P = .53), mean ICU length of stay (18 [SD, 15] days vs 19 [SD, 15] days; P = .42), and 60-day mortality (27.7% vs 25.0%; risk difference, 2.7% [95% CI, -9.0% to 15.3%]; P = .78) did not differ significantly. Ventricular arrhythmias occurred more frequently with levosimendan (18 [17.8%] vs 9 [8.7%]; absolute risk difference, 9.2% [95% CI, 0.4%-18.1%]). Among patients with severe but potentially reversible cardiogenic shock supported by VA-ECMO, early levosimendan administration did not significantly reduce the time to successful weaning of ECMO compared with placebo. ClinicalTrials.gov Identifier: NCT04728932.

In addition to the treatment recommendations published by the Special Interest Group (SIG) "Mental Health" (formerly "Sleep Psychiatry") of the Swiss Society for Sleep Research, Sleep Medicine and Chronobiology (SGSSC), the following article focusses on cognitive behavioural therapy for insomnia (CBT-I), its evidence, implementation and application, including in shift work, patients on medication, older people, various formats and non-pharmacological alternatives. Chronic insomnia is a disorder characterised by hyperarousal rather than sleep deprivation. The most effective treatment is bedtime restriction. This can be accompanied by increased daytime sleepiness and concentration deficits, which can be challenging. Furthermore, it is a challenge to find activities for the time that becomes available. The number of therapy places is still insufficient. However, it has been shown that CBT-I is also effective in shortened formats, digitally or when carried out by other professional groups.

BackgroundRespiratory syncytial virus (RSV) is a common respiratory virus. In addition to infants, older adults are at higher risk of severe outcomes due to RSV, particularly advanced-age older adults and those with chronic medical conditions. The authorization of three vaccines, one for adults 50 years of age and older (Arexvy) and two for adults 60 years of age and older (Abrysvo and mRESVIA), offers the opportunity to protect older Canadians from RSV disease. This article summarizes guidance from the National Advisory Committee on Immunization (NACI) on the prevention of RSV in older adults.MethodsNACI established key policy questions and performed an evidence review and synthesis for three new vaccines. In consideration of the burden of illness to be prevented, safety and efficacy of the new immunizing products, economic evidence and ethics, equity, feasibility and acceptability considerations, NACI made evidence-based recommendations.ResultsThe three RSV vaccines may provide similar reductions in hospitalizations associated with RSV and medically attended RSV respiratory tract infection for adults 60 years of age and older. However, evidence is limited for other outcomes. These vaccines were well-tolerated in clinical studies, with an acceptable safety profile among older adults. The duration of protection of the RSV vaccine is not yet known, and it is unclear if the protection offered by vaccination can be boosted by subsequent doses of vaccine.ConclusionBased on available evidence, NACI recommends RSV immunization programs for adults 75 years of age and older, particularly for older adults with chronic health conditions who are at increased risk of severe RSV disease. NACI also recommends RSV immunization programs for adults 60 years of age and older who are residents of nursing homes and other chronic care facilities. NACI recommends that receiving an RSV vaccine may be considered as an individual decision by adults 50 to 74 years of age, in consultation with their healthcare provider.