Rimonabant during early pregnancy Ducarme, Guillaume; Ceccaldi, Pierre-François; Pejoan, Hélène ...
International journal of gynecology and obstetrics,
June 2010, Letnik:
109, Številka:
3
Journal Article
Acid folic and pregnancy: A mandatory supplementation Valentin, Morgane; Coste Mazeau, Perrine; Zerah, Michel ...
Annales d'endocrinologie,
April 2018, 2018-Apr, 2018-04-00, Letnik:
79, Številka:
2
Journal Article
Recenzirano
Neural tube defects (NTD) occur in 0.5 to 2 per 1000 pregnancies with various handicaps for the affected child. It is now well established that folic acid deficiency (absolute or relative) is a ...predisposing factor to this type of malformation. Several randomized controlled trials showed that high-dose folic acid (4mg) is an essential factor for prevention of neural tube defects recurrence and significantly prevents the first occurrence of neural tube defects with a lower dose (0.4mg). Other etiologies can favor the occurrence of NTD such as MTHFR polymorphism, some antiepileptic therapies, obesity and pregestational mellitus diabetes. Necessity of a preconception folic acid supplementation or at least folate nutritional status evaluation should be known for all of us including patients and public.
Les anomalies du tube neural (ATN) touchent 0,5 à 2 grossesses pour 1000 et entraînent divers handicaps chez l’enfant atteint. Il est aujourd’hui bien établi qu’une carence en acide folique (absolue ou relative) est un facteur de prédisposition à ce type de malformation. Plusieurs essais contrôlés randomisés ont montré que l’acide folique à haute dose (4mg) était un facteur essentiel pour la prévention de la récidive des anomalies du tube neural et empêchait de manière significative leur première apparition avec une dose plus faible (0,4mg). D’autres étiologies peuvent favoriser l’apparition des ATN, tels le polymorphisme de la MTHFR, certaines thérapies antiépileptiques, l’obésité et le diabète prégestationnel. La nécessité d’une supplémentation préconceptionnelle en acide folique ou, tout au moins, d’une évaluation des apports nutritionnels en folates, devrait être considérée par l’ensemble du corps médical, divulguée aux patientes et le grand public.
Paediatric anaesthesia is a very specialised domain lacking training during the traditional curriculum. The laryngospasm is a stressful and life-threatening event that requires immediate action. The ...main objective of this study was to assess the effect of knowledge of a simple algorithm on the management of laryngospasm by trainee anaesthetists and nurse anaesthetists during a high-fidelity simulation session.
Residents in paediatric anaesthesia and training nurse anaesthetists with similar curriculum were randomly allocated to undergo a simulation session of laryngospasm with the help of a simple algorithm administered to them 5 min before the simulation session (group A) or as taught in their curriculum (group C). The primary endpoint was the assessment score of laryngospasm management using 10 technical items (validated in experienced paediatric anaesthetists). Secondary endpoints were: the non-technical skills using the Anaesthetists' Non-Technical Skills (ANTS) score and timing of critical management steps. The correlation between the technical and non-technical scores was also studied. Data are expressed as median (range).
72 participants (18 teams in each group) were included in this study. There was a statistically significant difference between group A and C on the primary endpoint: 8.5 (2-10) vs 5 (2-8), respectively (p<0.0001). There was also a significant difference between the two groups for the ANTS score 12 (7-16) vs 8 (6-12), respectively (p<0.0001). No difference in timing of management was observed. Finally, there was a strong correlation between the technical skills and all the non-technical skills categories in the A group.
A simple algorithm improved the technical and non-technical skills of students during the management of a simulated laryngospasm.
Nutrition parentérale et grossesse Billiauws, Lore; Ceccaldi, Pierre-François; Joly, Francisca
Nutrition clinique et métabolisme,
November 2021, 2021-11-00, Letnik:
35, Številka:
4
Journal Article
Recenzirano
L’insuffisance intestinale chronique (IIC) est une situation clinique rare dont la principale cause est le syndrome de grêle court (SGC). La pseudo-obstruction intestinale chronique (POIC) est ...également une cause d’IIC. La nutrition parentérale à domicile (NPAD) a permis d’augmenter la survie et la qualité de vie des patients ayant une insuffisance intestinale chronique. Plusieurs grossesses sous NPAD ont été décrites. L’objectif de cette revue est de faire la synthèse sur l’état des connaissances sur les grossesses en NPAD, et de faire le point sur les adaptations nécessaires des traitements et de la nutrition. En NPAD prolongée, les grossesses sont donc possibles, mais le taux de complications maternelles liées à la maladie sous-jacente et à la NP est élevé. Un suivi rapproché et une préparation à la grossesse doivent être réalisés afin de prévenir et traiter d’éventuelles carences et leurs effets délétères.
Chronic intestinal failure is a rare disease and short bowel syndrome is its main etiology. Chronic intestinal pseudo obstruction (CIPO) is also a cause of IIC. Home parenteral nutrition (HPN) has improved survival and quality of life of patients with IIC. Some pregnancy during HPN have been reported. The aim of this review was to summarize the state of knowledge on pregnancy during HPN, and to resume the needed adaptations of treatments and PN. During long term HPN, pregnancy are possible but the complication rate, due to PN and to underlying disease, is high. A close follow-up end pregnancy preparation are necessary, in order to prevent and treat some deficiencies and their deleterious effects.
Neonatal hyperthyroidism was first described in 1912 and in 1964 was shown to be linked to transplacental passage of maternal antibodies. Few multicenter studies have described the perinatal factors ...leading to fetal and neonatal dysthyroidism.
To show how fetal dysthyroidism (FD) and neonatal dysthyroidism (ND) can be predicted from perinatal variables, in particular, the levels of anti-thyrotropin receptor antibodies (TRAbs) circulating in the mother and child.
This was a retrospective multicenter study of data from the medical records of all patients monitored for pregnancy from 2007 to 2014.
Among 280,000 births, the medical records of 2288 women with thyroid dysfunction were selected and screened, and 417 women with Graves disease and positive for TRAbs during pregnancy were included.
Using the maternal TRAb levels, the cutoff value of 2.5 IU/L best predicted for FD, with a sensitivity of 100% and specificity of 64%. Using the newborn TRAb levels, the cutoff value of 6.8 IU/L best predicted for ND, with a sensitivity of 100% and a specificity of 94%. In our study, 65% of women with a history of Graves disease did not receive antithyroid drugs during pregnancy but still had infants at risk of ND.
In pregnant women with TRAb levels ≥2.5 IU/L, fetal ultrasound monitoring is essential until delivery. All newborns with TRAb levels ≥6.8 IU/L should be examined by a pediatrician with special attention for thyroid dysfunction and treated, if necessary.
Mifepristone is a progesterone receptor antagonist widely used in obstetrics. The aim of the study was to focus on free corticotrophin-releasing hormone (CRH) and also describe modulation of adrenal ...and placental steroid hormone concentrations induced by mifepristone.
Twenty-six women were enrolled in the study. They received mifepristone for termination of pregnancy. Maternal blood samples were retrieved before administration of mifepristone (600 mg) and 48 h after, just before induction of labor. Bound and free CRH levels were determined in maternal blood concomitantly with cortisol, estriol, progesterone and SDHEA levels. Also paired fetal cord blood samples were collected.
Maternal plasmatic CRH level did not change after mifepristone absorption but free CRH increased significantly (0.500 ± 0.326 vs. 0.388 ± 0.303 ng/ml, p = 0.040). A significant decrease of progesterone was observed (83.6 ± 49.3 vs. 95.6 ± 54.9 ng/ml, p = 0.001) with a lower progesterone/estriol ratio (26.9 ± 15.7 vs. 40.7 ± 31.1, p = 0.004). There was a strong association between maternal and fetal free CRH (r² = 0.675, p = 0.001), cortisol (r² = 0.570, p = 0.019), and positive but modest correlation for progesterone (r² = 0.341, p = 0.046) and estriol (r² = 0.379, p = 0.025) levels.
Mifepristone has an effect on free CRH level and changes the estriol-progesterone balance.
La ponction lombaire (PL) est un geste médical couramment pratiqué dans un large éventail d’indications. La réalité virtuelle (VR) offre un environnement d’apprentissage stimulant, sûr et efficace.
...Décrire la conception et l’évaluation d’un tutoriel vidéo en trois dimensions (3D) pour la procédure de PL.
Nous avons enregistré une vidéo stéréoscopique en 3D à 180 degrés à partir de deux PL réalisées en soins courants à l’Hôpital Fernand Widal Lariboisière, Paris, France. La vidéo a été diffusée à 108 étudiants en médecine de troisième année ainsi qu’à 60 internes et chefs de clinique lors de sessions de formation en simulation à la PL.
La satisfaction après visionnage de la vidéo était élevée (4,7±0,6 sur 5). Aucun inconfort significatif n’a été signalé (confort : 4,5±0,8 sur 5). Les étudiants n’ayant jamais réalisé de PL ont exprimé une satisfaction et un bénéfice perçu plus élevés que les internes et CCA (p<0,05 respectivement). Les étudiants ont évalué favorablement la caractéristique 3D de la vidéo et étaient favorables au développement de supports similaires pour d’autres gestes (respectivement, 3,9±1,1 et 4,4±0,9 sur 5).
Notre vidéo a été facile à concevoir et à diffuser aux utilisateurs. La modalité stéréoscopique à 180 degrés a permis de filmer en vue opérateur, augmentant ainsi le sentiment d’immersion en VR et facilitant l’apprentissage des différentes étapes de la procédure.
L’utilisation d’un support en VR pourrait favoriser l’apprentissage et l’acquisition des compétences techniques en association avec la formation à la PL en simulation.
Fetal thyroid is essential for normal fetus development. Echography of fetuses from mothers with Graves' disease is extremely specific for detecting an intrauterine thyroid dysfunction. We report the ...first correlation of two cases between color Doppler and histologic study of fetal thyroid goiters.
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