Centre Hospitalier Laennec

Guidelines recommend extragenital screening for sexually transmitted infections in men having sex with men but not for women who do not report extravaginal intercourses. However, it has been suggested that among female commercial sex workers, limiting sexually transmitted infection screening to vaginal samples would miss a sizeable number of infections. No study exists for nonsex worker women. Therefore, our objective was to assess the potential benefit of systematically testing three anatomical sites (oral, anal, and vaginal) versus only vaginal testing in women attending free sexually transmitted infection screening centres in France. A prospective longitudinal study was conducted in seven hospitals in France between April 2023 and September 2024 in which women were offered to be tested at the three sites instead of vaginal only. A total of 1498 women were included in the study, and 1483, 1492, and 1278 oral, vaginal, and anal samples, respectively, were reported. With a three-site strategy, the detection rate increased from 151/1492 (10.1%) to 179/1295 (13.8%) (p < 0.001) (127 [10.0%] to 152/1268 [12.0%]; p < 0.001 for all patients with three-site samples) for both infections (p < 0.001). Similarly, rate increased from 137/1492 (9.2%) to 160/1293 (12.4%) (p < 0.001) (114 [9.0%] to 135/1268 [10.7%]; p < 0.001 for all patients with three-site samples) for Chlamydia trachomatis and from 21/1492 (1.4%) to 30/1270 (2.4%) (p 0.008) (20 [1.6%] to 28/1268 [2.2%]; p 0.01 for all patients with three-site samples) for Neisseria gonorrhoeae. Neither symptoms nor reported sex practices were reliable predictors of infection. Among the C. trachomatis or N. gonorrhoeae infections detected, 15 (10.0%) and 25 (17.0%) were exclusively anal or anal-oral infections, respectively, without vaginal involvement. Multisite testing should be considered for women to ensure accurate diagnosis and treatment of C. trachomatis and N. gonorrhoeae.

A 3-month-old girl presented with a lesion since birth located below the vaginal fourchette. Clinical examination revealed a painless, nonkeratinized wet sulcus located between the vaginal fourchette and the perianal area (Figure 1). Many topical treatments had been tried without any improvement. Diagnosis: Congenital perineal groove. A perineal groove is a congenital anomaly of the perineum that is rarely described in the literature and mainly affects girls [1]. It is most likely underdiagnosed. Clinically, it presents at birth as a linear, erosive, sometimes exudative nonkeratinized lesion located between the vaginal fourchette (or the scrotum) and the anus, associated with overhanging borders. The complete perineal groove extends from the vaginal fourchette to the anus, while the incomplete form extends either from the vaginal fourchette to the middle of the perineum, or from the anus to the middle of the perineum [2]. Although the etiology, the incidence, and the pathogenesis are not well understood, authors suggest that it could be an embryological remnant; a urorectal septum malformation; a persistent cloaca, or the incomplete fusion of the perineal raphe or median genital folds [3, 4]. The histopathologic evaluation of resected lesions shows varied results from a nonkeratinized stratified squamous epithelium to an epithelium of a rectal-type mucosa suggesting the occurrence of a defect during urorectal septum development of cloacal embryology stages [5]. Cases have been reported in monozygotic twins; in a child born after in vitro fertilization; and in four children whose mothers had not received folic acid supplementation during pregnancy [2, 3, 5]. While perineal groove is commonly reported as an isolated condition, association with anal, genital, or renal anomalies is described including: hypospadias, imperforate anus, rectoperineal fistula, and bifid scrotum in boys, and vestibular fistula and anterior anus in girls [1, 6, 7]. A recent series of 66 cases demonstrated an association with anorectal malformation in 34.8% of patients [8], suggesting the importance to screen for anomaly of the surrounding structures. However, there are no recommendations for a specific screening work-up. Characteristic clinical presentation and presence since birth can help rule out other conditions in the differential diagnosis including anal fissure, diaper dermatitis, perineal trauma, or sexual abuse [1]. Although rare, the most common complications of perineal groove are local infection and irritation, or urinary tract infection [6]. In most cases, self-resolution and complete epithelialization occur by the age of 1–2 years. Early parental counseling on hygiene and gentle care of the isolated defect could be recommended to prevent infection and irritation. Surgical correction can be performed for recurrent infection or if the lesion is not epithelized after 2 years [3-5, 8, 9].

ABSTRACTPrognostic factors for the long‐term evolution of chronic hepatitis B e antigen (HBeAg)‐negative hepatitis B virus (HBV) infection may vary depending on local epidemiology. We aimed to identify these factors in France, where the epidemiology is influenced by diverse immigration. Hepatitis B surface antigen (HBsAg)‐positive, HBeAg‐negative adults with normal transaminase levels and viral loads < 20,000 IU/mL for 1 year, without viral co‐infection or advanced liver disease, were enrolled for a 5‐year follow‐up. A total of 564 patients were recruited from 23 centres (54.4% women, mean age 42.3 ± 12 years, 47.7% from sub‐Saharan Africa). HBV DNA was detectable but < 2000 IU/mL for most (71.3%). Genotypes E (27.8%) and A (20.0%) were predominant. The mean HBsAg titre was 3.8 ± 3.4 log IU/mL, > 1000 IU/mL in 60% of cases, and higher in genotype E (p < 0.0001). During follow‐up, 18 patients received antiviral treatment, 9 for viral reactivation (0.3% per year) and 9 preemptively. HBsAg loss occurred in 39 patients (1.4% per year). These patients were older (p < 0.0001), more frequently treated for dyslipidemia, hypertension or diabetes (p < 0.05), and had lower baseline HBV DNA (p = 0.0112) and HBsAg (p < 0.0001), but similar levels of HBcrAg compared to those who did not clear HBsAg. Baseline HBsAg was the only independent predictor of HBsAg loss (p = 0.009). In this cohort, HBsAg < 153 IU/mL predicted clearance with 87% sensitivity and specificity. In conclusion, baseline HBsAg accurately predicted seroclearance at 5 years in patients with chronic HBeAg‐negative infection, regardless of genotype, sex, or geographical origin, indicating that this marker is widely applicable for reducing the frequency of patient monitoring.

Data on the management of Hepatitis B-Delta (HB-D) by hepatogastroenterologists (HGs) practicing in nonacademic hospitals or private practices are unknown in France. We aimed to evaluate the knowledge and practices of HGs practicing in nonacademic settings regarding HB-D. A Google form document was sent to those HGs from May to September 2021. A total of 130 HGs (mean age, 45 years) have participated in this survey. Among HBsAg-positive patients, Delta infection was sought in only 89% of cases. Liver fibrosis was assessed using FibroScan in 77% of the cases and by liver biopsy in 81% of the cases. A treatment was proposed for patients with >F2 liver fibrosis in 49% of the cases regardless of transaminase levels and for all the patients by 39% of HGs. Responding HGs proposed a treatment using pegylated interferon in 50% of cases, bulevirtide in 45% of cases and a combination of pegylated interferon and bulevirtide in 40.5% of cases. Among the criteria to evaluate the treatment efficacy, a decrease or a normalization of transaminases was retained by 89% of responding HGs, a reduction of liver fibrosis score for 70% of them, an undetectable delta RNA and HBsAg for 55% of them and a 2 log 10 decline in delta viremia for 62% of the cases. Hepatitis Delta screening was not systematically performed in HBsAg-positive patients despite the probable awareness and knowledge of the few responders who were able to prescribe treatments of hepatitis delta.

Cet article s’appuie sur une étude qualitative réalisée auprès de treize établissements médicosociaux implantés dans le nord de la France. Les objectifs de cette étude étaient d’observer les actions mises en oeuvre en faveur de la protection de l’environnement et de communiquer sur ces actions afin de les valoriser mais aussi de favoriser le partage d’expériences. Les résultats montrent que ces actions, outre leur impact face aux enjeux climatiques, participent à une meilleure prise en compte des aspirations individuelles tant des professionnels qui y exercent que des personnes qui y vivent, à une ouverture des établissements sur leur environnement et ainsi à une diversification des relations sociales de leurs habitants. Elles se heurtent toutefois à différentes contraintes, notamment sanitaires, révélatrices d’un regard sur le handicap teinté de misérabilisme et nourrissant une approche essentiellement protectionniste. La prise en compte du handicap, dans une perspective de citoyenneté et non exclusivement de protection, constitue pourtant un enjeu majeur : la crise climatique sera d’autant mieux combattue qu’elle mobilisera l’ensemble des membres de la société, dans le respect de leur diversité et la reconnaissance de la richesse qu’elle représente.

BackgroundThis study was conducted to assess the safety and adherence of the use of a PGT (Pressure Garment Therapy) Lycra® sleeve to treat upper limb unilateral cerebral palsy (UCP) in children.MethodsThis study was conducted as a prospective, placebo-controlled, double-blinded, randomized monocenter study. Included in the study were 58 UCP children, 49 of whom were analyzed. 25 children (mean age 6.6 ± 1.6 years; 12 girls) were allocated to the active group vs. 24 (mean age 6.7 ± 1.6 years; 10 girls) in the placebo group. The intervention consisted of an active PGT Lycra® arm sleeve manufactured to generate a homogeneous pressure ranging from 15 to 25 mmHg. The placebo PGT Lycra® sleeve was manufactured to generate a homogeneous pressure under 7 mmHg. The time of wearing period was set at 3 h/day at minimum and 6 h/day at maximum, over the course of 6 months. The main outcome measures were safety outcomes including the number and intensity of Adverse Events of Special Interest (AESIs). AESIs were defined as adverse events imputable to compressive therapy and Lycra® wearing. Level of adherence was expressed in percentage of number of days when the sleeve was worn for at least 3 h per day compared to length of duration in days (start and end date of wearing period).ResultsFrequency of AESIs were very low and no different between groups (4.12 ± 11.32% vs. 1.83 ± 3.38%; p = 0.504). There were no differences in adherence (91.86 ± 13.86% vs. 94.30 ± 9.95%; p = 0.425).ConclusionThe use of PGT Lycra® arm sleeve in children with UCP is safe and well-tolerated with a very good adherence. The low rate of AESIs is promising for further randomized clinical trials on efficacy.