What Factors Increase the Risk of Complications in SARS-CoV-2-Infected Patients? A Cohort Study in a Nationwide Israeli Health Organization.
Identifieur interne : 000072 ( Main/Exploration ); précédent : 000071; suivant : 000073What Factors Increase the Risk of Complications in SARS-CoV-2-Infected Patients? A Cohort Study in a Nationwide Israeli Health Organization.
Auteurs : Chen Yanover [Israël] ; Barak Mizrahi [Israël] ; Nir Kalkstein [Israël] ; Karni Marcus [Israël] ; Pinchas Akiva [Israël] ; Yael Barer [Israël] ; Varda Shalev [Israël] ; Gabriel Chodick [Israël]Source :
- JMIR public health and surveillance [ 2369-2960 ] ; 2020.
Descripteurs français
- KwdFr :
- Adolescent (MeSH), Adulte (MeSH), Adulte d'âge moyen (MeSH), Facteurs de risque (MeSH), Femelle (MeSH), Humains (MeSH), Infections à coronavirus (complications), Infections à coronavirus (épidémiologie), Israël (épidémiologie), Jeune adulte (MeSH), Mâle (MeSH), Pandémies (MeSH), Pneumopathie virale (complications), Pneumopathie virale (épidémiologie), Sujet âgé (MeSH), Études de cohortes (MeSH).
- MESH :
- épidémiologie : Infections à coronavirus, Israël, Pneumopathie virale.
- Adolescent, Adulte, Adulte d'âge moyen, Facteurs de risque, Femelle, Humains, Jeune adulte, Mâle, Pandémies, Sujet âgé, Études de cohortes.
- Wicri :
- geographic : Israël.
English descriptors
- KwdEn :
- Adolescent (MeSH), Adult (MeSH), Aged (MeSH), Cohort Studies (MeSH), Coronavirus Infections (complications), Coronavirus Infections (epidemiology), Female (MeSH), Humans (MeSH), Israel (epidemiology), Male (MeSH), Middle Aged (MeSH), Pandemics (MeSH), Pneumonia, Viral (complications), Pneumonia, Viral (epidemiology), Risk Factors (MeSH), Young Adult (MeSH).
- MESH :
- geographic , epidemiology : Israel.
- complications : Coronavirus Infections, Pneumonia, Viral.
- epidemiology : Coronavirus Infections, Pneumonia, Viral.
- Adolescent, Adult, Aged, Cohort Studies, Female, Humans, Male, Middle Aged, Pandemics, Risk Factors, Young Adult.
Abstract
BACKGROUND
Reliably identifying patients at increased risk for coronavirus disease (COVID-19) complications could guide clinical decisions, public health policies, and preparedness efforts. Multiple studies have attempted to characterize at-risk patients, using various data sources and methodologies. Most of these studies, however, explored condition-specific patient cohorts (eg, hospitalized patients) or had limited access to patients' medical history, thus, investigating related questions and, potentially, obtaining biased results.
OBJECTIVE
This study aimed to identify factors associated with COVID-19 complications from the complete medical records of a nationally representative cohort of patients, with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
METHODS
We studied a cohort of all SARS-CoV-2-positive individuals, confirmed by polymerase chain reaction testing of either nasopharyngeal or saliva samples, in a nationwide health organization (covering 2.3 million individuals) and identified those who suffered from serious complications (ie, experienced moderate or severe symptoms of COVID-19, admitted to the intensive care unit, or died). We then compared the prevalence of pre-existing conditions, extracted from electronic health records, between complicated and noncomplicated COVID-19 patient cohorts to identify the conditions that significantly increase the risk of disease complications, in various age and sex strata.
RESULTS
Of the 4353 SARS-CoV-2-positive individuals, 173 (4%) patients suffered from COVID-19 complications (all age ≥18 years). Our analysis suggests that cardiovascular and kidney diseases, obesity, and hypertension are significant risk factors for COVID-19 complications. It also indicates that depression (eg, males ≥65 years: odds ratio [OR] 2.94, 95% CI 1.55-5.58; P=.01) as well as cognitive and neurological disorders (eg, individuals ≥65 years old: OR 2.65, 95% CI 1.69-4.17; P<.001) are significant risk factors. Smoking and presence of respiratory diseases do not significantly increase the risk of complications.
CONCLUSIONS
Our analysis agrees with previous studies on multiple risk factors, including hypertension and obesity. It also finds depression as well as cognitive and neurological disorders, but not smoking and respiratory diseases, to be significantly associated with COVID-19 complications. Adjusting existing risk definitions following these observations may improve their accuracy and impact the global pandemic containment and recovery efforts.
DOI: 10.2196/20872
PubMed: 32750009
PubMed Central: PMC7451109
Affiliations:
Links toward previous steps (curation, corpus...)
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A Cohort Study in a Nationwide Israeli Health Organization.</title><author><name sortKey="Yanover, Chen" sort="Yanover, Chen" uniqKey="Yanover C" first="Chen" last="Yanover">Chen Yanover</name><affiliation wicri:level="1"><nlm:affiliation>KI Research Institute, Kfar Malal, Israel.</nlm:affiliation><country xml:lang="fr">Israël</country><wicri:regionArea>KI Research Institute, Kfar Malal</wicri:regionArea><wicri:noRegion>Kfar Malal</wicri:noRegion></affiliation></author><author><name sortKey="Mizrahi, Barak" sort="Mizrahi, Barak" uniqKey="Mizrahi B" first="Barak" last="Mizrahi">Barak Mizrahi</name><affiliation wicri:level="1"><nlm:affiliation>KI Research Institute, Kfar Malal, Israel.</nlm:affiliation><country xml:lang="fr">Israël</country><wicri:regionArea>KI Research Institute, Kfar Malal</wicri:regionArea><wicri:noRegion>Kfar Malal</wicri:noRegion></affiliation></author><author><name sortKey="Kalkstein, Nir" sort="Kalkstein, Nir" uniqKey="Kalkstein N" first="Nir" last="Kalkstein">Nir Kalkstein</name><affiliation wicri:level="1"><nlm:affiliation>KI Research Institute, Kfar Malal, Israel.</nlm:affiliation><country xml:lang="fr">Israël</country><wicri:regionArea>KI Research Institute, Kfar Malal</wicri:regionArea><wicri:noRegion>Kfar Malal</wicri:noRegion></affiliation></author><author><name sortKey="Marcus, Karni" sort="Marcus, Karni" uniqKey="Marcus K" first="Karni" last="Marcus">Karni Marcus</name><affiliation wicri:level="1"><nlm:affiliation>KI Research Institute, Kfar Malal, Israel.</nlm:affiliation><country xml:lang="fr">Israël</country><wicri:regionArea>KI Research Institute, Kfar Malal</wicri:regionArea><wicri:noRegion>Kfar Malal</wicri:noRegion></affiliation></author><author><name sortKey="Akiva, Pinchas" sort="Akiva, Pinchas" uniqKey="Akiva P" first="Pinchas" last="Akiva">Pinchas Akiva</name><affiliation wicri:level="1"><nlm:affiliation>KI Research Institute, Kfar Malal, Israel.</nlm:affiliation><country xml:lang="fr">Israël</country><wicri:regionArea>KI Research Institute, Kfar Malal</wicri:regionArea><wicri:noRegion>Kfar Malal</wicri:noRegion></affiliation></author><author><name sortKey="Barer, Yael" sort="Barer, Yael" uniqKey="Barer Y" first="Yael" last="Barer">Yael Barer</name><affiliation wicri:level="1"><nlm:affiliation>Maccabi Institute for Research and Innovation, Tel Aviv, Israel.</nlm:affiliation><country xml:lang="fr">Israël</country><wicri:regionArea>Maccabi Institute for Research and Innovation, Tel Aviv</wicri:regionArea><wicri:noRegion>Tel Aviv</wicri:noRegion></affiliation></author><author><name sortKey="Shalev, Varda" sort="Shalev, Varda" uniqKey="Shalev V" first="Varda" last="Shalev">Varda Shalev</name><affiliation wicri:level="1"><nlm:affiliation>Maccabi Institute for Research and Innovation, Tel Aviv, Israel.</nlm:affiliation><country xml:lang="fr">Israël</country><wicri:regionArea>Maccabi Institute for Research and Innovation, Tel Aviv</wicri:regionArea><wicri:noRegion>Tel Aviv</wicri:noRegion></affiliation></author><author><name sortKey="Chodick, Gabriel" sort="Chodick, Gabriel" uniqKey="Chodick G" first="Gabriel" last="Chodick">Gabriel Chodick</name><affiliation wicri:level="1"><nlm:affiliation>Maccabi Institute for Research and Innovation, Tel Aviv, Israel.</nlm:affiliation><country xml:lang="fr">Israël</country><wicri:regionArea>Maccabi Institute for Research and Innovation, Tel Aviv</wicri:regionArea><wicri:noRegion>Tel Aviv</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:affiliation>Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.</nlm:affiliation><country xml:lang="fr">Israël</country><wicri:regionArea>Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv</wicri:regionArea><wicri:noRegion>Tel Aviv</wicri:noRegion></affiliation></author></analytic><series><title level="j">JMIR public health and surveillance</title><idno type="eISSN">2369-2960</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adolescent (MeSH)</term><term>Adult (MeSH)</term><term>Aged (MeSH)</term><term>Cohort Studies (MeSH)</term><term>Coronavirus Infections (complications)</term><term>Coronavirus Infections (epidemiology)</term><term>Female (MeSH)</term><term>Humans (MeSH)</term><term>Israel (epidemiology)</term><term>Male (MeSH)</term><term>Middle Aged (MeSH)</term><term>Pandemics (MeSH)</term><term>Pneumonia, Viral (complications)</term><term>Pneumonia, Viral (epidemiology)</term><term>Risk Factors (MeSH)</term><term>Young Adult (MeSH)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adolescent (MeSH)</term><term>Adulte (MeSH)</term><term>Adulte d'âge moyen (MeSH)</term><term>Facteurs de risque (MeSH)</term><term>Femelle (MeSH)</term><term>Humains (MeSH)</term><term>Infections à coronavirus (complications)</term><term>Infections à coronavirus (épidémiologie)</term><term>Israël (épidémiologie)</term><term>Jeune adulte (MeSH)</term><term>Mâle (MeSH)</term><term>Pandémies (MeSH)</term><term>Pneumopathie virale (complications)</term><term>Pneumopathie virale (épidémiologie)</term><term>Sujet âgé (MeSH)</term><term>Études de cohortes (MeSH)</term></keywords><keywords scheme="MESH" type="geographic" qualifier="epidemiology" xml:lang="en"><term>Israel</term></keywords><keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>Coronavirus Infections</term><term>Pneumonia, Viral</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Coronavirus Infections</term><term>Pneumonia, Viral</term></keywords><keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Infections à coronavirus</term><term>Israël</term><term>Pneumopathie virale</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adolescent</term><term>Adult</term><term>Aged</term><term>Cohort Studies</term><term>Female</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Pandemics</term><term>Risk Factors</term><term>Young Adult</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adolescent</term><term>Adulte</term><term>Adulte d'âge moyen</term><term>Facteurs de risque</term><term>Femelle</term><term>Humains</term><term>Jeune adulte</term><term>Mâle</term><term>Pandémies</term><term>Sujet âgé</term><term>Études de cohortes</term></keywords><keywords scheme="Wicri" type="geographic" xml:lang="fr"><term>Israël</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>Reliably identifying patients at increased risk for coronavirus disease (COVID-19) complications could guide clinical decisions, public health policies, and preparedness efforts. Multiple studies have attempted to characterize at-risk patients, using various data sources and methodologies. Most of these studies, however, explored condition-specific patient cohorts (eg, hospitalized patients) or had limited access to patients' medical history, thus, investigating related questions and, potentially, obtaining biased results.</p></div><div type="abstract" xml:lang="en"><p><b>OBJECTIVE</b></p><p>This study aimed to identify factors associated with COVID-19 complications from the complete medical records of a nationally representative cohort of patients, with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>We studied a cohort of all SARS-CoV-2-positive individuals, confirmed by polymerase chain reaction testing of either nasopharyngeal or saliva samples, in a nationwide health organization (covering 2.3 million individuals) and identified those who suffered from serious complications (ie, experienced moderate or severe symptoms of COVID-19, admitted to the intensive care unit, or died). We then compared the prevalence of pre-existing conditions, extracted from electronic health records, between complicated and noncomplicated COVID-19 patient cohorts to identify the conditions that significantly increase the risk of disease complications, in various age and sex strata.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>Of the 4353 SARS-CoV-2-positive individuals, 173 (4%) patients suffered from COVID-19 complications (all age ≥18 years). Our analysis suggests that cardiovascular and kidney diseases, obesity, and hypertension are significant risk factors for COVID-19 complications. It also indicates that depression (eg, males ≥65 years: odds ratio [OR] 2.94, 95% CI 1.55-5.58; P=.01) as well as cognitive and neurological disorders (eg, individuals ≥65 years old: OR 2.65, 95% CI 1.69-4.17; P<.001) are significant risk factors. Smoking and presence of respiratory diseases do not significantly increase the risk of complications.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>Our analysis agrees with previous studies on multiple risk factors, including hypertension and obesity. It also finds depression as well as cognitive and neurological disorders, but not smoking and respiratory diseases, to be significantly associated with COVID-19 complications. Adjusting existing risk definitions following these observations may improve their accuracy and impact the global pandemic containment and recovery efforts.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">32750009</PMID><DateCompleted><Year>2020</Year><Month>09</Month><Day>04</Day></DateCompleted><DateRevised><Year>2020</Year><Month>09</Month><Day>04</Day></DateRevised><Article PubModel="Electronic"><Journal><ISSN IssnType="Electronic">2369-2960</ISSN><JournalIssue CitedMedium="Internet"><Volume>6</Volume><Issue>3</Issue><PubDate><Year>2020</Year><Month>08</Month><Day>25</Day></PubDate></JournalIssue><Title>JMIR public health and surveillance</Title><ISOAbbreviation>JMIR Public Health Surveill</ISOAbbreviation></Journal><ArticleTitle>What Factors Increase the Risk of Complications in SARS-CoV-2-Infected Patients? A Cohort Study in a Nationwide Israeli Health Organization.</ArticleTitle><Pagination><MedlinePgn>e20872</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.2196/20872</ELocationID><Abstract><AbstractText Label="BACKGROUND">Reliably identifying patients at increased risk for coronavirus disease (COVID-19) complications could guide clinical decisions, public health policies, and preparedness efforts. Multiple studies have attempted to characterize at-risk patients, using various data sources and methodologies. Most of these studies, however, explored condition-specific patient cohorts (eg, hospitalized patients) or had limited access to patients' medical history, thus, investigating related questions and, potentially, obtaining biased results.</AbstractText><AbstractText Label="OBJECTIVE">This study aimed to identify factors associated with COVID-19 complications from the complete medical records of a nationally representative cohort of patients, with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.</AbstractText><AbstractText Label="METHODS">We studied a cohort of all SARS-CoV-2-positive individuals, confirmed by polymerase chain reaction testing of either nasopharyngeal or saliva samples, in a nationwide health organization (covering 2.3 million individuals) and identified those who suffered from serious complications (ie, experienced moderate or severe symptoms of COVID-19, admitted to the intensive care unit, or died). We then compared the prevalence of pre-existing conditions, extracted from electronic health records, between complicated and noncomplicated COVID-19 patient cohorts to identify the conditions that significantly increase the risk of disease complications, in various age and sex strata.</AbstractText><AbstractText Label="RESULTS">Of the 4353 SARS-CoV-2-positive individuals, 173 (4%) patients suffered from COVID-19 complications (all age ≥18 years). Our analysis suggests that cardiovascular and kidney diseases, obesity, and hypertension are significant risk factors for COVID-19 complications. It also indicates that depression (eg, males ≥65 years: odds ratio [OR] 2.94, 95% CI 1.55-5.58; P=.01) as well as cognitive and neurological disorders (eg, individuals ≥65 years old: OR 2.65, 95% CI 1.69-4.17; P<.001) are significant risk factors. Smoking and presence of respiratory diseases do not significantly increase the risk of complications.</AbstractText><AbstractText Label="CONCLUSIONS">Our analysis agrees with previous studies on multiple risk factors, including hypertension and obesity. It also finds depression as well as cognitive and neurological disorders, but not smoking and respiratory diseases, to be significantly associated with COVID-19 complications. Adjusting existing risk definitions following these observations may improve their accuracy and impact the global pandemic containment and recovery efforts.</AbstractText><CopyrightInformation>©Chen Yanover, Barak Mizrahi, Nir Kalkstein, Karni Marcus, Pinchas Akiva, Yael Barer, Varda Shalev, Gabriel Chodick. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 25.08.2020.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y" EqualContrib="Y"><LastName>Yanover</LastName><ForeName>Chen</ForeName><Initials>C</Initials><Identifier Source="ORCID">0000-0003-3663-4286</Identifier><AffiliationInfo><Affiliation>KI Research Institute, Kfar Malal, Israel.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y" EqualContrib="Y"><LastName>Mizrahi</LastName><ForeName>Barak</ForeName><Initials>B</Initials><Identifier Source="ORCID">0000-0002-1053-4773</Identifier><AffiliationInfo><Affiliation>KI Research Institute, Kfar Malal, Israel.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kalkstein</LastName><ForeName>Nir</ForeName><Initials>N</Initials><Identifier Source="ORCID">0000-0002-1641-6532</Identifier><AffiliationInfo><Affiliation>KI Research Institute, Kfar Malal, Israel.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Marcus</LastName><ForeName>Karni</ForeName><Initials>K</Initials><Identifier Source="ORCID">0000-0003-4979-8394</Identifier><AffiliationInfo><Affiliation>KI Research Institute, Kfar Malal, Israel.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Akiva</LastName><ForeName>Pinchas</ForeName><Initials>P</Initials><Identifier Source="ORCID">0000-0003-1535-5536</Identifier><AffiliationInfo><Affiliation>KI Research Institute, Kfar Malal, Israel.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Barer</LastName><ForeName>Yael</ForeName><Initials>Y</Initials><Identifier Source="ORCID">0000-0002-3264-3380</Identifier><AffiliationInfo><Affiliation>Maccabi Institute for Research and Innovation, Tel Aviv, Israel.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Shalev</LastName><ForeName>Varda</ForeName><Initials>V</Initials><Identifier Source="ORCID">0000-0002-6010-6232</Identifier><AffiliationInfo><Affiliation>Maccabi Institute for Research and Innovation, Tel Aviv, Israel.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Chodick</LastName><ForeName>Gabriel</ForeName><Initials>G</Initials><Identifier Source="ORCID">0000-0002-5189-8995</Identifier><AffiliationInfo><Affiliation>Maccabi Institute for Research and Innovation, Tel Aviv, Israel.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2020</Year><Month>08</Month><Day>25</Day></ArticleDate></Article><MedlineJournalInfo><Country>Canada</Country><MedlineTA>JMIR Public Health Surveill</MedlineTA><NlmUniqueID>101669345</NlmUniqueID><ISSNLinking>2369-2960</ISSNLinking></MedlineJournalInfo><SupplMeshList><SupplMeshName Type="Disease" UI="C000657245">COVID-19</SupplMeshName></SupplMeshList><CitationSubset>H</CitationSubset><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000293" MajorTopicYN="N">Adolescent</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D015331" MajorTopicYN="N">Cohort Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D018352" MajorTopicYN="N">Coronavirus Infections</DescriptorName><QualifierName UI="Q000150" MajorTopicYN="Y">complications</QualifierName><QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D005260" 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IdType="pubmed">32320003</ArticleId></ArticleIdList></Reference><Reference><Citation>BMC Med Res Methodol. 2019 Jun 6;19(1):115</Citation><ArticleIdList><ArticleId IdType="pubmed">31170931</ArticleId></ArticleIdList></Reference></ReferenceList></PubmedData></pubmed><affiliations><list><country><li>Israël</li></country></list><tree><country name="Israël"><noRegion><name sortKey="Yanover, Chen" sort="Yanover, Chen" uniqKey="Yanover C" first="Chen" last="Yanover">Chen Yanover</name></noRegion><name sortKey="Akiva, Pinchas" sort="Akiva, Pinchas" uniqKey="Akiva P" first="Pinchas" last="Akiva">Pinchas Akiva</name><name sortKey="Barer, Yael" sort="Barer, Yael" uniqKey="Barer Y" first="Yael" last="Barer">Yael Barer</name><name sortKey="Chodick, Gabriel" sort="Chodick, Gabriel" uniqKey="Chodick G" first="Gabriel" last="Chodick">Gabriel Chodick</name><name sortKey="Chodick, Gabriel" sort="Chodick, Gabriel" uniqKey="Chodick G" first="Gabriel" last="Chodick">Gabriel Chodick</name><name sortKey="Kalkstein, Nir" sort="Kalkstein, Nir" uniqKey="Kalkstein N" first="Nir" last="Kalkstein">Nir Kalkstein</name><name sortKey="Marcus, Karni" sort="Marcus, Karni" uniqKey="Marcus K" first="Karni" last="Marcus">Karni Marcus</name><name sortKey="Mizrahi, Barak" sort="Mizrahi, Barak" uniqKey="Mizrahi B" first="Barak" last="Mizrahi">Barak Mizrahi</name><name sortKey="Shalev, Varda" sort="Shalev, Varda" uniqKey="Shalev V" first="Varda" last="Shalev">Varda Shalev</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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