Publications scientifiques de l'EnvA
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Prise en charge thérapeutique des grossesses extra-utérines tubaires. Recommandations pour la pratique clinique du CNGOF et de la SCGP
No full textInternational audience• Ectopic Pregnancy is defined as the presence of a pregnancy or pregnancy residue outside the uterine cavity, with a prevalence of approximately 2%. Tubal ectopic pregnancy is defined as the presence of a pregnancy or pregnancy residue in the extra-myometrial portion of the fallopian tube (isthmus, ampulla, or fimbriae), and accounts for 96 to 99% of ectopic pregnancy locations. Management of tubal ectopic pregnancy should depend on both its activity and whether it is symptomatic or not. • Regarding emergency management of tubal ectopic pregnancy, it is recommended not to consider expectant management for patients with symptomatic tubal ectopic pregnancy, nor for patients with active tubal ectopic pregnancy (Strong recommendation, low quality of evidence). It is recommended to offer expectant management as an alternative to medical treatment with MTX (methotrexate) for patients with non-active and asymptomatic tubal ectopic pregnancy (Strong recommendation, low quality of evidence). It is recommended to offer expectant management as an alternative to surgical treatment for patients with non-active and asymptomatic tubal ectopic pregnancy (Strong recommendation, very low quality of evidence). In cases of expectant management of tubal ectopic pregnancy, it is strongly recommended to systematically re-evaluate the patient clinically and biologically at 48 hours (Strong recommendation, low quality of evidence). If hCG levels decrease by more than 15% at 48 hours, it is recommended to continue monitoring weekly until negativity, provided there are no signs of symptomatic tubal ectopic pregnancy (Strong recommendation, very low quality of evidence). If an expectant approach is chosen, and there is an increase in hCG levels of more than 15% at 48 hours or the tubal ectopic pregnancy becomes symptomatic, it is recommended to discontinue expectant management (Strong recommendation, low quality of evidence). • Regarding medical treatment of tubal ectopic pregnancy, it is recommended not to favor a multi-dose protocol over a single-dose protocol to increase the success rate of MTX treatment (Strong recommendation, moderate quality of evidence). It is recommended to prefer the single-dose MTX protocol over the multi-dose protocol to limit the risk of adverse effects (Strong recommendation, high quality of evidence). It is also recommended not to systematically combine mifepristone treatment with an MTX injection to improve the efficacy of medical treatment for tubal ectopic pregnancy (Strong recommendation, high quality of evidence). • Regarding surgical management, in a patient with tubal ectopic pregnancy, it is recommended to perform either salpingotomy or salpingectomy with regard to fertility (Strong recommendation, high quality of evidence). It is recommended not to perform tubal expression in order to reduce morbidity compared to salpingotomy (Strong recommendation, very low quality of evidence).La Grossesse Extra-Utérine (GEU) est définie par la présence d’une grossesse ou d’un résidu de grossesse en dehors de la cavité utérine sa prévalence est d’environ 2%. La GEU tubaire est définie comme la présence d’une grossesse ou d’un résidu de grossesse dans la portion extra-myométriale de la trompe (isthme, ampoule ou pavillon) et représente 96 à 99% des localisations de GEU. La prise en charge de la GEU tubaire doit dépendre à la fois de son activité et de son caractère symptomatique ou non. Concernant la prise en charge en urgence d’une GEU tubaire, Il est recommandé de ne pas envisager une attitude expectative pour des patientes présentant une GEU tubaire symptomatique, ni pour pour des patientes présentant une GEU tubaire active (Recommandation forte, qualité de la preuve basse). Il est recommandé de proposer une attitude expectative comme alternative au traitement médical par méthotrexate (MTX) aux patientes présentant une GEU tubaire non active et asymptomatique (Recommandation forte, qualité de la preuve basse). Il est recommandé de proposer une attitude expectative comme alternative au traitement chirurgical aux patientes présentant une GEU tubaire non active et asymptomatique ( Recommandation forte, qualité de la preuve très basse). Il est recommandé, en cas de prise en charge d’une GEU tubaire par expectative, de réévaluer systématiquement cliniquement et biologiquement la patiente à 48 heures (Recommandation forte, qualité de la preuve basse) et en cas de décroissance des HCG >15% à 48h, il est recommandé de poursuivre la surveillance de la décroissance une fois par semaine jusqu’à négativation en l’absence de signes de GEU tubaire symptomatique (Recommandation forte, qualité de la preuve très basse), Si une attitude d’expectative est retenue, en cas d’augmentation des HCG > 15% à 48h ou en cas de GEU tubaire devenant symptomatique, il est recommandé de ne pas poursuivre l’attitude expectative (Recommandation forte, qualité de la preuve basse). Concernant les modalités du traitement médical de la GEU tubaire, Il est recommandé de ne pas privilégier un protocole multidose par rapport à un protocole monodose afin d’augmenter le taux de succès d’un traitement par MTX. (Recommandation forte, qualité de la preuve modérée). Il est recommandé de privilégier le traitement monodose de MTX au protocole multidose afin de limiter le risque d’effets indésirables (Recommandation forte, qualité de la preuve élévée). . il est recommandé de ne pas associer systématiquement un traitement par mifépristone à une injection de MTX pour augmenter l’efficacité du traitement médical d’une GEU tubaire (Recommandation forte, qualité de la preuve élevée). Concernant la prise en charge chirurgicale, chez une patiente présentant une GEU tubaire, il est recommandé de réaliser soit une salpingotomie soit une salpingectomie pour la fertilité. (Recommandation forte, qualité de la preuve élévée). Il est recommandé de ne pas pratiquer une expression tubaire pour diminuer la morbidité par rapport à la salpingotomie (Recommandation forte, qualité de la preuve très basse)
Arboviroses en France hexagonale :une menace émergente à l’interface hommeanimal vecteur
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Real-life impact of clinical metagenomics in the intensive care unit: a multicenter retrospective study in greater paris area hospitals
No full textInternational audienceBackground: Infection are the leading cause of intensive care unit (ICU) admission, yet conventional microbiological methods frequently fail to identify the causative pathogen. Metagenomic next-generation sequencing (mNGS) is an emerging, unbiased, pan-pathogen diagnostic tool. However, its real-world microbiological and clinical impact in the ICU remains poorly characterized. This study aimed to assess the microbiological yield and clinical impact of mNGS when implemented in routine ICU practice.Methods: This retrospective multicenter study was conducted across ten tertiary-care ICUs in the Greater Paris area between January 2018 and April 2024. All patients for whom an mNGS analysis was requested by clinicians from a microbiological sample were included. Any additional pathogens identified by mNGS were independently classified as causative, possibly causative, or non-causative by two reviewers. The independent reviewers also categorised therapeutic changes attributable to mNGS as escalation, de-escalation, discontinuation, or other decision support. Discrepancies were adjudicated by a third reviewer.Results: A total of 144 mNGS analyses were performed in 132 critically ill patients (median age 55 years), 31% of whom were immunocompromised. The number of mNGS analyses requested increased each year. The most common sample types were cerebrospinal fluid (CSF) (n = 60/144, 41.7%) and pleural fluid (n = 21/144, 14.6%). Pathogens were identified by mNGS in 58 samples (40.3%), with a higher yield in pleural fluid (n = 11/21, 52.4%) than in CSF (n = 16/60, 26.6%). Of the 107 pathogens identified, 43 (40.2%) were detected exclusively by mNGS, notably anaerobic bacteria in pleural fluid and abscess samples. mNGS identified an additional pathogen in 34 cases (25.8%) of the 132 patients included, which was deemed causative in 18 cases (13.6%). mNGS findings influenced therapeutic management in seven patients (5.3%) including five cases of antibiotic de-escalation, one appropriate antibiotic escalation, and one case of clinical decision support.Conclusion: In this real-life ICU cohort, mNGS identified additional pathogens in 25.8% of patients, deemed causative in 18 cases (13.6%), and a direct therapeutic impact was observed in 5.3% of cases. However, the median turnaround time of 14 days likely limited its clinical impact. Further studies are needed to better define the role of mNGS in the diagnostic management of critically ill patients
Relations entre la fréquence du syndrome de nécrose d’oreille et des paramètres zootechniques des élevages de porcs
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Predicting cell division orientation in ascidian development
No full textInternational audienceThe ascidian embryo exhibits a highly reproducible pattern where homologous cells can be identified across different embryos, allowing consistent cell naming. This developmental stereotypy of the embryo depends strongly on the orientation of cell divisions. To better understand the embryonic organization, identifying the cues that control division orientation by attempting to predict it is of great interest. Before the 64-cell stage, when the embryo still has a spherical shape, the longest axis of a cell's apical surface during interphase (around 20 minutes before cell division) predicts its division orientation (Hertwig's rule). After the 112-cell stage, testing this rule becomes more difficult due to the local tissue deformations occurring between a cell's interphase and its division. Here, we propose a method to systematically test the Hertwig rule in 3D+t ascidian embryos between the 64-and 300-cell stages. Our results suggest that some neural plate cells division orientation may follow nongeometric cues, and some cell divisions exhibiting two distinct orientations may arise from apical surface geometry. This quantitative analysis contributes to our understanding of the factors controlling cell division orientation
Gender differences in audience participation at infectious disease and microbiology conferences: a prospective observational study
No full textInternational audienceObjectivesIn medicine, women constitute a large proportion of the workforce but remain underrepresented in senior positions. Scientific conferences, critical for career advancement, reflect these inequities, with prior studies documenting gender gaps in invited speakers. However, less attention has been given to audience engagement, such as asking questions or making comments, which also enhances professional visibility. This study investigates gender differences in audience participation at infectious disease and clinical microbiology conferences, examining their prevalence, contextual variation, and potential structural drivers.MethodsThis prospective observational study recorded audience participations during national and international infectious disease and clinical microbiology conferences (October 2023–October 2024). Consortium members documented eligible sessions with traditional presentation–discussion formats, noting gender, role, and type of participation. Statistical analyses compared observed gender proportions with attendee distributions and examined factors associated with women's participation.ResultsA total of 298 sessions from 24 conferences were analysed, comprising 1873 audience participations. Women delivered 47.8% of presentations (n = 487/1018; 95% CI, 44.8–50.9%) but accounted for only 36.4% of participations (n = 681/1873; 95% CI, 34.2–38.5%), significantly fewer than men both in absolute terms and relative to their representation among attendees (p < 0.001). Multivariable analysis showed women were more likely to intervene when at least one moderator was female (OR = 1.44; 95% CI, 1.02–2.04%; p 0.037), with a stronger effect when all moderators were women (OR = 2.12; 95% CI, 1.40–3.24%; p < 0.001), and when the first question was asked by a woman (OR = 1.35; 95% CI, 1.00–1.81%; p 0.046).ConclusionOur findings highlight actionable levers to advance equity. Addressing participation gaps and raising awareness of gender disparities are essential to foster inclusive visibility, empower women, and strengthen scientific innovation
Are hydrophilic deep eutectic solvents a potential vehicle for topical delivery of Amphotericin B against cutaneous leishmaniasis? An investigation of physicochemical properties, tolerability and antileishmanial efficacy
No full textInternational audienceDeep eutectic solvents (DES) are homogenous, low-melting mixtures that are liquid at ambient temperature. Recently, DES have attracted interest as novel alternatives to traditional solvents in cutaneous formulations. The aim of this work was to have a better understanding of whether DES could be a safe and effective vehicle for topical delivery of Amphotericin B (AmB) in Cutaneous Leishmaniasis (CL). Based on solubility data, solutions of AmB in DES were prepared and characterized in terms of rheological properties, stability, and aggregation state of AmB by circular dichroism. The tolerability of DES-AmB on the skin was investigated by combining noninvasive techniques with histological assessment; systemic toxicity was also studied. Finally, the best-tolerated formulations were selected for direct assessment of both therapeutic efficacy and toxicity in a murine model of CL. Some of the formulations, especially those based on L-carnitine, could be promising candidates for further development of effective drug formulations against CL, as they were able to show either partial antileishmanial or palliative effects in robust test conditions. However, further optimization is necessary to ensure optimal stability and efficacy of the formulations
Valeur prédictive de l’urétrographie de contraste sur l’issue postopératoire lors d’urétrostomie périnéale chez des chats dysuriques : étude rétrospective de 22 cas
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Successful Treatment of Cutaneous Lupus Erythematosus in a Horse With Tacrolimus Ointment
No full textInternational audienceABSTRACT A 9‐year‐old gelding Quarter Horse with a lesion on the right upper eyelid was diagnosed with cutaneous lupus erythematosus. Clinical resolution and control of UV‐induced flares were achieved with topical tacrolimus and a UV‐blocking mask without adverse effects over the following 3 years