Hôpital Jean-Verdier

BackgroundDespite improvement in acute care of immune-mediated thrombotic thrombocytopenic purpura (iTTP), numerous studies showed that patients with iTTP have inferior mental health and health-related quality of life (HRQoL). Caplacizumab led to shorter hospitalization, less plasma exchange, and improved survival in iTTP and might influence long-term HRQoL.ObjectivesWe aimed to address the impact of iTTP on HRQoL, posttraumatic stress disease, depression, and anxiety, as well as the possible role of caplacizumab on improving these features.MethodsWe conducted a survey among patients with iTTP enrolled in the French thrombotic microangiopathy registry: patients completed the Short Form (SF)-36 HRQoL, the Hospital Anxiety and Depression Scale screening for anxiety and depression, and the Posttraumatic Stress Disorder Checklist for DSM-IV posttraumatic stress disease questionnaires. Results were compared to those of a sample of the French general population.ResultsA total of 101 patients with iTTP in remission (45 patients previously treated with caplacizumab and 56 patients without caplacizumab) and 76 healthy controls were included. Patients with iTTP had significantly lower scores in all domains in the SF-36 survey and higher anxiety and depression scores than healthy controls. Advanced age was associated with improved SF-36 scores, lower anxiety scores and less severe anxiety cases. Furthermore, the use of caplacizumab led to a lower risk of severe anxiety.ConclusionBased on our results, HRQoL is decreased in patients with iTTP, and depression and anxiety are more prevalent. Caplacizumab treatment might influence long-term mental and psychological outcomes in iTTP by shortening the duration of treatment with plasma exchange.

ABSTRACTMycoplasma pneumoniae (MP), primarily a respiratory pathogen, can cause extra‐pulmonary manifestations including cold agglutinin syndrome (CAS). We conducted a national, multicenter, observational, ambispective study to describe the characteristics, risk factors, and outcomes of MP‐associated CAS. Adult patients hospitalized for a MP‐infection with CAS (hemolytic anemia with hemoglobin < 10 g/dL and C3 positive direct anti‐globulin test) were included. Recovery was defined as hemoglobin > 10 g/dL off therapy. We also compared MP‐infected patients with or without CAS. Sixty patients (51.7% of females; median age of 48.5 years) were included. CAS was diagnosed a median of 10 days after MP‐infection symptoms onset. At diagnosis, the median hemoglobin level was 6.9 g/dL, and 71.7% of patients received red blood cell transfusions. Intensive care unit (ICU) admission was required in 45% of patients, and 16.7% experienced a venous thromboembolic event (VTE). Seventeen patients (28.3%) received glucocorticoids alone, while 40 (66.7%) did not receive any specific treatment for CAS. After a median follow‐up of 56 (30–83) days, 90% of patients achieved recovery, while 2 patients (3.3%) died from sepsis and pulmonary embolism. Glucocorticoid use did not significantly impact the rate or timing of recovery. Compared with MP‐infected patients from the MYCADO cohort study (n = 1267), CAS patients had significantly more VTE (p < 0.0001) and ICU admissions (p = 0.03). MP‐associated CAS typically occurs 10 days after the first symptoms of MP infection and is associated with ICU admissions and VTE. Overall, the prognosis of CAS is good, and glucocorticoids do not appear to influence outcomes.

How do hematological characteristics affect ovarian reserve, ovarian response to ovarian stimulation, and fertility outcomes? Although lymphoma characteristics impact serum AMH levels, they do not affect, per se, the response to ovarian stimulation and the number of mature oocytes recovered at the time of fertility preservation; in addition, fertility in survivors of hematologic malignancies is relatively conserved. Hematologic cancers can affect young women of reproductive age. While survival rates have improved over the years due to advances in treatment protocols, the treatments used can impact fertility. Fertility preservation methods, such as oocyte or ovarian tissue cryopreservation, are increasingly offered, but concerns remain about reduced ovarian reserve and response to ovarian stimulation in women with these cancers, which may influence the effectiveness of fertility preservation strategies. Moreover, fertility potential after hematologic cancers has been poorly studied. This is a retrospective, observational bi-centric cohort study. All patients with hematologic cancer (lymphoma, leukemia, myeloma, and myelodysplastic syndrome) who underwent fertility preservation before gonadotoxic treatment (n = 286) from January 2013 to March 2023 were included. For fertility after cancer, and use of frozen oocytes/embryos, the endpoint date was 7 July 2023. Only patients with lymphoma were included for analysis of ovarian reserve (n = 238) and ovarian response to ovarian stimulation (n = 230). Low ovarian reserve and impaired ovarian response to ovarian stimulation were defined as AMH <1.2 ng/ml and ≤9 mature oocytes retrieved after ovarian stimulation, respectively, according to POSEIDON criteria. A Cox regression model was used to determine predictive factors of impaired response to ovarian stimulation, low ovarian reserve, and pregnancy after cancer. Cumulative incidence of pregnancy and cumulative use of frozen oocytes/embryos was calculated in all patients suffering from hematological malignancies. There was an impact of lymphoma characteristics on AMH levels independent of age. After adjustment based on POSEIDON Groups 3 and 4, no specific impact of lymphoma characteristics (e.g. stage, clinical, or biologic B signs) on ovarian response to ovarian stimulation was observed. Regarding post-cancer fertility in the whole population, among the women who tried to conceive, 62% achieved at least one pregnancy, and 85% of these occurred naturally. After adjustment, positive predictive factors for pregnancy were age <35 years, being in a relationship at the first oncofertility consultation, and absence of hematopoietic stem cell transplantation. Limitations include potential biases due to the heterogeneity of hematological conditions and the retrospective design, which may lead to missing data. Additionally, the duration of follow-up may not be sufficient to evaluate long-term fertility outcomes. Lymphoma characteristics did not affect the response to ovarian stimulation in terms of mature oocyte retrieval, although AMH levels were impaired. Reassuring post-cancer fertility data support informed decision-making regarding fertility preservation techniques. Larger prospective studies are needed to tailor oncofertility counseling, ensuring optimized care and reproductive outcomes. Medical editorial support was provided by Peter Todd of Tajut Ltd (Kaiapoi, New Zealand) and was funded by AFPR (Advances in Fertility Preservation and Reproduction). The authors declare no conflicts of interest. N/A.

BackgroundFollowing non-pharmaceutical interventions (NPI) lifting in 2021, an important surge in childhood lower respiratory tract infections (LRTI) was reported in several countries, raising major concerns about the middle-term consequences of such interventions. Whether this recent upsurge overwhelms the initial benefit of NPI remains unknown.MethodsWe conducted an interrupted time-series analysis based on exhaustive national surveillance systems. All hospitalisations from January 2015 to March 2023 and all ambulatory visits for LRTI from a network of 110 paediatricians from June 2017 to March 2023 were included. The main outcome was the monthly incidence of children hospitalised for LRTI per 100,000 over time, assessed by a seasonally adjusted quasi-Poisson regression model.ResultsWe included 845,047 hospitalisations. The incidence of hospitalisation for LRTI significantly decreased during the NPI period (− 61.7%, 95% CI − 98.4 to − 24.9) and rebounded following NPI lifting, exceeding the pre-NPI baseline trend (+ 12.8%, 95% CI 6.7 to 19.0). We observed similar trends for hospitalisation due to bronchiolitis, pneumonia and pneumonia with pleural effusion, along with ambulatory LRTI. Overall, despite the recent rebound, 31,777 (95% CI, 25,375 to 38,179) hospitalisations for paediatric LRTI were averted since NPI implementation up to 2023.ConclusionsThree years after their implementation, despite an increase in LRTI incidence, the middle-term impact of NPI remains highly beneficial in preventing overall paediatric LRTI. The implementation of some societally acceptable NPI, particularly during epidemics, may be considered in the future to further reduce the burden of paediatric LRTI.

Although often overlooked sleep apnea has emerged as a significant public health concern. Obstructive sleep apnea (OSA) and diabetes commonly co-exist with a vicious cycle worsening the incidence and severity of both conditions. OSA has many implications including cardiometabolic disorders and impaired cardiovascular (CV) prognosis. OSA combined with diabetes generates a cumulative effect on CV outcomes. The association of OSA with several comorbidities including CV disease and heart failure is bi-directional meaning that some of them are likely to contribute to OSA. In patients with diabetes, OSA treatment should be integrated in a holistic strategy of prevention of CV and microvascular complications. This article provides some clues to advance the understanding of the interplay between OSA and CV disorders in diabetes and to consider the role of some CV risk markers like cardiac autonomic neuropathy and artery stiffness and of novel metrics for hypoxic-related events in CV risk stratification, and offers a discussion on the effects of medical approaches including weight loss strategies, GLP1-receptor agonists and sodium-glucose cotransporter 2 inhibitors. It provides a guidance to improve screening and diagnosis of OSA, and adherence to OSA treatment in patients with diabetes.

Access to healthcare remains a persistent challenge. Socially disadvantaged populations often encounter barriers to care and may frequently seek out emergency departments (EDs), including for nonurgent medical care. The objective of this study is to study the association between nonurgent presentations to pediatric EDs and patients' socioeconomic environment in an urban setting. A retrospective study of all visits to a pediatric ED in eight participating centers of the Paris metropolitan area (France) between 1 January 2017 and 31 December 2021 was carried out. Routinely collected data were analyzed. Socioeconomic status was evaluated using ecological variables defined at the municipality level. These variables were collected from public sources and included a social deprivation index, the accessibility to general practitioners, the proportion of single-parent families, and the proportion of immigrants. The primary endpoint was a nonurgent ED presentation, defined as being assigned one of the two lowest triage categories on a five-point scale. A multilevel logistic model assessed the association between nonurgent ED presentations and patients' characteristics, socioeconomic environment, and healthcare accessibility. Nonurgent visits accounted for 51.6% of the 1 499 108 visits during the study period. The admission rate was 2.1% for nonurgent presentations and 18.8% for urgent presentations. In the final multivariate model ( n = 1 412 895 visits), after adjustment for sex, age, time of day, day of the week, month, and year, the risk of nonurgent presentation was significantly higher for children living in less advantaged areas and in areas where the rate of single-parent families was high. It was also higher for children living close to the ED. This extensive retrospective multicenter study emphasizes the increased risk of visiting EDs for nonurgent medical care among children from disadvantaged urban areas.