Centre Hospitalier Intercommunal André Grégoire Montreuil

Introducción: El periodo del embarazo podría brindar a los hombres la oportunidad de hacerse un chequeo médico, dada su especial receptividad ante este acontecimiento tan importante en la vida. El estudio PARTAGE, en su fase intrahospitalaria, demostró un alto nivel de participación de los padres en estas consultas y puso de relieve las necesidades en materia de salud (detección, vacunación) y acompañamiento social. A raíz de este estudio, el municipio y el hospital de Montreuil decidieron ampliar este dispositivo a escala municipal. Objetivo del estudio: El objetivo de este artículo es analizar el contexto de esta consulta y las partes interesadas tras 20 meses de la ampliación del programa. Resultados: En 20 meses, 376 futuros padres accedieron a la consulta. A pesar de la activa labor de divulgación entre los profesionales del territorio, en particular los médicos privados, la mayoría de las derivaciones procedían de la maternidad, los medios de comunicación, la pareja y los servicios de protección materno-infantil (PMI). Los padres, principales beneficiarios, expresaron una marcada sensación de utilidad de la consulta, destacando la importancia del componente de salud mental. El programa cuenta con el firme apoyo de la Agencia Regional de Salud, el municipio y el hospital de Montreuil, lo que refuerza su alcance. Además, el contexto sociopolítico actual propicia el desarrollo de intervenciones dirigidas a los futuros padres. Conclusiones: La consulta prenatal para futuros padres es una medida innovadora que implica un cambio en las normas sociales. Para garantizar la continuidad y la generalización de esta iniciativa, es esencial coordinarla con herramientas operativas y financieras, en consonancia con las recomendaciones de las autoridades sanitarias y el marco normativo vigente.

BackgroundTrial of labor after cesarean (TOLAC) is often recommended as an alternative to elective repeat cesarean section (ERCS) in women with a single prior cesarean section. This retrospective cohort study aimed to compare obstetrical outcomes between TOLAC and ERCS in a French hospital setting.MethodsWomen with a single prior cesarean delivery, cephalic presentation, and term pregnancies (≥ 37 weeks) between 2019 and 2024 were included. Women were analyzed according to their initially intended mode of delivery (TOLAC or ERCS), irrespective of the final delivery route, to reflect a real-world, decision-based clinical approach. Primary outcomes were uterine rupture, severe postpartum hemorrhage (PPH), and neonatal intensive care unit (NICU) admission. Statistical methods included chi-square tests, Student’s t-tests, and Firth’s penalized logistic regression for rare events.ResultsIn total, 2,424 women were included, with 2,146 undergoing TOLAC and 278 undergoing ERCS. Severe PPH occurred less frequently in the TOLAC group (5.6%) than in the ERCS group (10.4%, p = 0.002), with adjusted analysis confirming a significant reduction in risk (adjusted OR: 0.45, 95% CI: 0.31–0.69, p < 0.001). NICU admissions were also lower in the TOLAC group (6.5% vs. 13.3%, p < 0.001; adjusted OR: 0.45, 95% CI: 0.31–0.69, p < 0.001). Uterine rupture rates were low and showed no significant difference in unadjusted analysis (1.7% TOLAC vs. 1.1% ERCS, p = 0.622), though adjusted models indicated an increased risk with TOLAC (adjusted OR: 2.08, 95% CI: 1.24–3.58, p = 0.005).ConclusionThe findings suggest that obstetrical practice concerning TOLAC, in a French tertiary care maternity unit, is associated with lower rates of severe PPH and NICU admission compared to ERCS, with a slightly increased risk of uterine rupture. These results support offering TOLAC as a safe and beneficial option for eligible women.

BackgroundPaediatric sepsis is the leading cause of death in children under 5 years. No studies have evaluated the application of the Surviving Sepsis Campaign 2020 (SSC-2020) guidelines in paediatric emergency departments (PEDs).ObjectiveTo assess physician adherence to the SSC-2020 fluid resuscitation guidelines in children with suspected septic shock in PEDs.MethodsThis was a prospective multicentre observational study conducted in 21 French hospitals over 5 sequential weeks, between November 2021 and March 2022. Children with suspected septic shock and who received antimicrobial therapy within 72 hours were included. Primary outcome was SSC-2020 fluid resuscitation guidelines adherence (low 0–24%; moderate 25–74%; high 75–100%) according to: bolus volume of 10–20 mL/kg each, exclusive administration of balanced crystalloids at 1 and 24 hours of management, and initiation of fluid resuscitation within 1 hour of septic shock recognition.Results63 children were included. 10 (16%) children had severe sepsis and 2 (3%) met the definition of septic shock. Compared with the SSC-2020 guidelines, 43 (68%) patients received boluses of 10–20 mL/kg; fluid resuscitation was initiated within 1 hour of septic shock recognition in 42 (76%) cases; balanced crystalloids were the only fluids administrated in 35 (56%) and 34 (55%) children at 1 and 24 hours of management, respectively. Main barriers reported by physicians were difficult intravenous access (43%), lack of team training (29%), workload constraints (28%), and absence or out-of-date protocols (24%).ConclusionsThis study found high adherence for fluid resuscitation initiation but moderate adherence for bolus volume and fluid choice.Trial registration numberNCT05066464.

We evaluated Ibalizumab (IBA)-containing standardized optimized salvage regimen (with or without a 4-week foscarnet induction) in individuals harboring multidrug-resistant human immunodeficiency virus type 2 (HIV-2). Nine were included; 2 achieved virological suppression after foscarnet induction with a sustained suppression at Week 24 after IBA initiation, and an additional individual at Week 24 after Ibalizumab initiation.

Abstract BackgroundPrenatal care provides pregnant women with repeated opportunities for prevention, screening and diagnosis that have no current extension to future fathers. It also contributes to women’s general better access to health. The goal of PARTAGE study was to evaluate the level and determinants of adherence to a prenatal prevention consultation dedicated to men.MethodsBetween January 2021 and April 2022, we conducted a monocentric interventional study in Montreuil hospital. We assessed the acceptance of a prenatal prevention consultation newly offered to every future father, through their pregnant partner’s prior consent to provide their contact details.Results3,038 women provided contact information used to reach the fathers; effective contact was established with 2,516 men, of whom 1,333 (53%) came for prenatal prevention consultation. Immigrant men were more likely to come than French-born men (56% versus 49%, p &lt; 0·001), and the more they faced social hardship, the more likely they were to accept the offer. In multivariate analysis, men born in Subsaharan Africa and Asia were twice as likely to attend the consultation as those born in Europe or North America.ConclusionAcceptance of this new offer was high. Moreover, this consultation was perceived by vulnerable immigrant men as an opportunity to integrate a healthcare system they would otherwise remain deprived of.Trial Registrationhttps://classic.clinicaltrials.gov/ct2/show/NCT05085717

Nephrosclerosis is one of the histopathological consequences of severe or malignant hypertension (MH), some of the pathophysiology of which has been extrapolated from essential polygenetic arterial hypertension. Despite our recent description of unsuspected ciliopathies with MH, causes of MH in young patients with severe renal impairment are poorly understood. To refine and better describe the MH phenotype, we studied clinical and prognostic factors in young patients receiving a kidney biopsy following their first episode of MH. Patients were identified retrospectively and prospectively from eight centres over a 35-year period (1985-2020). Keywords were used to retrospectively enrol patients irrespective of lesions found on renal biopsy. A total of 114 patients were included, 77 (67%) of whom were men, average age 34years, 35% Caucasian and 34% African origin. An isolated clinical diagnosis of severe nephrosclerosis was suggested in only 52% of cases, with 24% primary glomerulopathies. Only 7% of patients had normal renal function at diagnosis, 25% required emergency dialysis and 21% were eventually transplanted. Mortality was 1% at the last follow-up. Independent prognostic factors significantly associated with renal prognosis (6-month dialysis) and predictive of end-stage renal disease were serum creatinine on admission {odds ratio [OR] 1.56 [95% confidence interval (CI) 1.34-1.96], P<.001} and renal fibrosis >30% [OR 10.70 (95% CI 1.53-112.03), P=.03]. Astonishingly, the presence of any thrombotic microangiopathy lesion on renal biopsy was an independent, protective factor [OR 0.14 (95% CI 0.02-0.60), P=.01]. The histopathological hallmark of nephrosclerosis was found alone in only 52% of study patients, regardless of ethnicity. This suggests that kidney biopsy might be beneficial in young patients with MH.

Background: Scrotoschisis is a congenital malformation characterized by testicular exstrophy through a scrotal defect. Case report: We report a full-term baby boy with exteriorization of both testes through a right parietal scrotal defect. Discussion: Bilateral testes extrusion through a lateralized scrotoschisis can occur due to a scrotal septal defect.