Outpatient balloon catheter versus expectant management for post-term labor induction in nulliparous women: A randomized trial

BACKGROUND

Increased use of labor induction has renewed interest in outpatient cervical ripening. Post-term pregnancy (i.e., ≥41 weeks) is a specific situation of increased neonatal risk, including greater risk of perinatal death and adverse perinatal outcomes. While a high proportion of these patients will need induction, outpatient management of this specific population has never been studied. Therefore, our objective was to compare two policies of management of post term pregnancies: the use of a transcervical Foley catheter for outpatient cervical ripening compared with expectant management.

METHODS

Multicenter, randomized controlled open-label study comparing home induction with a Foley catheter versus expectant management. Inclusion criteria were nulliparous, live singleton fetus in a vertex position, post-term (at 41 + 4 days), requiring cervical ripening (Bishop score <6), intact membranes, and distance home-hospital within 40 min. The primary endpoint was change in Bishop score beetween randomization (41 + 4 days) and consultation (41 + 5 days).

RESULTS

Forty-five women were included: 21 in the home induction group and 24 in the control group. The study was stopped due to low recruitment. The difference in Bishop score increases one day after randomization approached significance (p = 0.055), with home induction showing a larger change compared with expectant management (Cohen's d = 0.60; 95 % confidence interval [CI] -0.002 to 1.21). Regarding change in Bishop score, 81 % of home induction group patients had a better score at 41 + 5 days versus 52.2 % in the control group (relative risk = 1.55; 95 %CI 0.99 to 2.15).

CONCLUSION

By specifically evaluating home induction in nulliparous women with post term pregnancies, we observed a Bishop score improvement in the home induction group. These data support further evaluation of induction methods and birth experiences in a larger cohort of this population.

TRIAL REGISTRATION

The study was registered under European policy (number EudraCT 2015-A01298-41) and on www.clinitrials.gov (number NCT02932319). Date of registration: 13/10/2016, Date of initial participant enrollment: 31/03/2017.

[Comparison of vaginal prostaglandins with oral misoprostol as a second line of cervical ripening after using a cervical balloon catheter]

OBJECTIVE

To compare vaginal prostaglandins with oral misoprostol as a second line of cervical ripening after using a cervical balloon catheter.

MATERIAL AND METHODS

This is a retrospective monocentric study (Lille, France), according to a "before"/"after" design. The inclusion criteria were a singleton pregnancy, with a fetus in cephalic presentation, a term >37 WA, with a cervix having a Bishop score lower than 6 after a first line of maturation by cervical balloon catheter. Two groups were formed: "before" corresponding to the continuation of maturation by vaginal prostaglandins, from March 2019 to November 2019, and "after": corresponding to the continuation of maturation by oral misoprostol, from June 2020 to December 2020. The primary outcome was vaginal delivery rate.

RESULTS

One hundred women were included in each group. The rate of vaginal delivery was similar between the 2 groups (76% vs 81%, p=0.39), as were the times between the start of induction and the birth and between the start of induction and the transition to birth room. There was no difference in the indication for caesarean section, with in particular an identical rate of caesarean sections for induction failure (p=0.52). Subgroup analysis in obese women showed a significantly higher rate of vaginal delivery in the "after" group (OR=4.17;95% CI [1.02;17.07]).

CONCLUSION

The vaginal delivery rate is similar when using vaginal prostaglandins or oral misoprostol as second line cervical ripening after use of a cervical balloon catheter.

Metal ion release after hip resurfacing arthroplasty and knee arthroplasty: a retrospective study of one hundred ninety-five cases

PURPOSE

Hip arthroplasty with metal-on-metal bearings like hip resurfacing results in the release of metallic ions. In parallel, like every metallic implant, knee arthroplasty implants undergo passive corrosion. We analyzed blood levels of cobalt and chromium ions in patients who have a hip resurfacing arthroplasty and compared them to patients who have undergone knee arthroplasty at a minimum follow-up of one year. The hypothesis was that there is no difference in the ion release between hip resurfacing and knee arthroplasty.

METHODS

Sixty-three patients who underwent knee arthroplasty were compared to a cohort of 132 patients who underwent hip resurfacing. The blood levels of cobalt and chromium ions were determined preoperatively and at six and 12 months postoperatively and then compared between groups. We analyzed the relationship between ion release and the change in clinical outcome scores (Harris Hip score, Oxford Hip score, Merle D'Aubigné Postel score, Oxford Knee score, International Knee Society score), the BMI, sex, physical activity, implant size and inclination of the acetabular implant (hip resurfacing patients only). Mixed linear models were used to assess the changes in ion blood levels over time.

RESULTS

The cobalt blood levels were higher in the first 6 months in the resurfacing group (0.87 ug/L vs 0.67 ug/L; p = 0.011), while it was higher in the knee arthroplasty group at 12 months (1.20 ug/L vs 1.41 ug/L; p = 0.0008). There were no significant differences in chromium levels during the follow-up period.

CONCLUSION

The increase in metal ion release after knee arthroplasty is as high as after hip resurfacing at the one year follow-up. The monitoring of this parameter probably should not be recommended in case of good clinicals outcomes.

How do French Obstetrician-Gynaecologists perceive their quality of life? A national survey

OBJECTIVE

Obstetrics is a constraining specialty due to heavy workloads and repeated stressful situations. French maternity wards are facing many difficulties to recruit, as a consequence of the conversion of a significant number of Obstetrician-Gynecologists (OB-GYNs) to exclusive daily private practice. The aim of this study was to evaluate the quality of life (QOL) of OB-GYNs in order to identify burnout risk factors, develop prevention strategies and therefore ensure patient safety.

STUDY DESIGN

A Google forms questionnaire assessing QOL and life/work balance was distributed by e-mail to 1397 members of the National College of French OB-GYNs (CNGOF). This was a declarative multicenter cross-sectional survey.

RESULTS

Four hundred sixty-one responses were collected (response rate 30%). A burnout episode was reported by 31.3% of respondents. Main burnout risk factors were limited staff on the on-call schedule (p = 0.008) and low salary (p < 0.001). On-call work was considered to have a negative personal life impact by 57.8% of the sample; 34.1% wanted to stop this practice and 81.3% believed that financial compensation would help reinforce its attractiveness. Medico-legal risks influenced the daily practices of 70% of respondents and 86.8% had been personally affected by media coverage of obstetrical violence.

CONCLUSIONS

This report confirms a high burnout rate within a stressful profession, with major impacts from on-call activity, insufficient salary relative to the arduousness of this practice, high exposure to medico-legal actions and media attention. Revising shift duration to a maximum 12 h, better control over global workload, higher salary and renewed social recognition are urgent priorities.

AB1120 PSYCHOLOGICAL ASSESSMENT IN PATIENTS WITH CHRONIC RHEUMATIC, SYSTEMIC AUTOIMMUNE, OR AUTOINFLAMMATORY DISEASES PRESENTED WITH COVID-19: THE MentCOVRMD STUDY

Background

The COVID-19 pandemic has raised concerns about its psychological effects. Sleep disturbances, anxiety and/or depressive symptoms, post-traumatic stress symptoms have been reported in general population. Patients with chronic rheumatism, systemic autoimmune disease or auto-inflammatory disease, due to immunosuppression, are at risk of severe forms of infection. Currently, there is little information on psychological impact of the pandemic on the mental health of these more vulnerable patients.

Objectives

To compare psychological assessment between patients with chronic rheumatic, autoimmune and/or autoinflammatory diseases who presented with COVID-19 infection between March and September 2020, first wave of French pandemic, and patients with same diseases who did not presented with infection to date.

Methods

The MentCOVRMD study was a multicenter descriptive study. Cases were patients with chronic rheumatic, autoimmune and/or autoinflammatory diseases from the French RMD cohort who presented COVID-19 infection between March and September 2020. Controls were patients with same diseases who did not develop infection. The study is registered in Clinical Trials under number 2020-A02058-31.

For participants, following criteria were collected: demographics (age, gender, smoking status); psychological assessment questionnaires: Insomnia Severity Index (ISI); Post-traumatic stress disorder (PTSD) checklist; Patient Health Questionnaire (PHQ9) Depression; Generalized Anxiety Disorder (GAD7) Anxiety; Patient Health Questionnaire-15 (PHQ-15) and Somatic Symptom Disorder (SSD)-12.

Results

Between February and December 2021, 60 cases (46 (76.7%) women), median age 52.0 (39.0; 63.0) were included, of which 15 (25%) had been hospitalized during infection, and 169 controls (148 (87.6%) women), median age of 52.0 (38.0; 63.0). There were more smokers in the group of cases 12 (20%) than controls 14 (9.1%) (p=0.028) as well as more cases on ARA2 treatment (8 (13.3%)) than controls (7 (4.5%)) (p=0.035) with no statistically significant difference in others comorbidities or treatments.

There was no statistically difference concerning the ISI scores between cases (11.83 ± 7.31) of which 60% had sleep disorders and controls (11.64 ± 6.82) of which 70.4% had sleep disorders. There was no statistically significant difference in PTSD scores of 15.5 (5.0 to 28.0) for cases and 18.0 (8.0 to 35.0) for controls, of which respectively 12 (20%) had values indicating possible PTSD for cases and 50 (29.6%) for controls. There was no statistically significant difference in PHQ-9 scores (5.5 (1.5 to 11.0)) of which 50% had depressive symptoms and controls (6.0 (2.0 to 11.0)) of which 54.5% had symptoms. There was no statistically significant difference in GAD-7 scores (3.5 (0.0 to 8.0)) of which 40% had anxiety symptoms and controls (4.0 (0.0 to 8.0)) of which 43.2% had symptoms. There was no statistically significant difference in PHQ-15 scores (11.4 ± 6.7), 85% of whom reported presence of symptoms, and controls (10.9 ± 6.2), 82.3% of whom reported symptoms. There was no statistically significant difference in SSD scores between cases (17.7 ± 10.9) and controls (18.4 ± 10.9).

There was a statistically significant difference in reported VAS scores of pain related to inflammatory rheumatism in cases with a median of 4.5 (3.0 to 6. 0) compared to controls with a median of 4.0 (1.0 to 6.0) (p=0.011).

There was no statistically significant difference in any of the psychological assessment scores between the inpatient and outpatient COVID cases.

Conclusion

There was no statistically significant difference between COVID cases and controls in the evaluation of these psychological parameters. Prevalence of all these variables were high in the whole study population, testifying to the need to manage these psychological aspects for patients with chronic rheumatisms, autoimmune and/or autoinflammatory diseases.

Disclosure of Interests

None declared

Is the Development of Gestational Diabetes Associated With the ABO Blood Group/Rhesus Phenotype?

AIMS

There are few published data on the putative association between the ABO blood group/rhesus (Rh) factor and the risk of developing gestational diabetes mellitus (GDM). Our aim was to explore the link between each one factor and GDM development.

METHODS

All women having given birth at Lille University Medical Center (Lille, France) between August 1^st, 2017, and February 28^th, 2018, were tested for GDM, using the method recommended in the French national guidelines. The risk of GDM was assessed for each ABO blood group, each Rh phenotype and combinations thereof, using logistic regression models.

RESULTS

1194 women had at least one GDM risk factor. The percentage of GDM varied with the ABO group (p=0.013). Relative to group O women, group AB women were more likely to develop GDM (OR = 2.50, 95% CI [1.43 to 4.36], p=0.001). Compared with the Rh-positive O group, only the Rh-positive AB group had an elevated risk of developing GDM (OR = 3.02, 95% CI [1.69 to 5.39], p < 0.001).

CONCLUSIONS

Our results showed that Rh-positive group AB women have a greater risk of GDM. With a view to preventing GDM, at-risk individuals could be identified by considering the ABO blood group phenotype either as a single risk factor or in combination with other risk factors.

Caractéristiques cliniques de la Covid-19 chez les enfants et adolescents atteints de maladies rhumatismales et inflammatoires : données de la cohorte française RMD COVID-19 de 95 patients

Introduction

Patients et méthodes

Résultats

Conclusion

How to reduce fetal scalp blood sampling? A retrospective study evaluating the diagnostic value of scalp stimulation to predict fetal wellbeing assessed by scalp blood sampling

BACKGROUND

The Fetal Blood Sample (FBS) is used as an indicator of fetal acidosis during labor. Its place is discussed through the lack of randomized trials, as well as the limitations related to the technical procedure. An alternative could be the Fetal Scalp Stimulation (FSS).

AIM

Our objective was to describe the FSS diagnostic value to predict fetal wellbeing defined from FBS.

METHODS

The FSS consisted in a digital scalp stimulation for 15 s. Test was negative when an acceleration and/or a normal variability were elicited in the 2 min following. FSS was performed before each FBS which was classified as normal when pH was > 7.25. The diagnostic value was assessed by sensibility, specificity, positive and negative predictive values.

FINDINGS

148 women were included in our center from February to December 2019. Of the 191 FBS procedures, when accelerations were elicited sensibility was 58,3 (36.8-77.1), specificity was 67,5 (59.3-75), positive predictive value was 20,9 (12.5-32.9) and negative predictive value was 91.7 % (95 %CI, 85-95.5).

DISCUSSION

FBS is considered as the gold standard in our study which could be discussed as it is abandoned in some countries because of its questioned reliability and the lack of controlled randomized trials.

CONCLUSION

This study suggests that FSS could be an interesting alternative adjunctive test to perform in the first instance as it seems to be reliable, non-invasive and easy to perform in order to limit FBS only to absence of acceleration after FSS.

OP0284 OUTCOME OF COVID-19 IN PATIENTS WITH RHEUMATIC AND INFLAMMATORY DISEASES TREATED WITH RITUXIMAB: DATA FROM DE FRENCH RMD COVID-19 COHORT

Background:

Various observations have suggested that the course of the COVID-19 infection may be less favorable in patients with inflammatory rheumatic and musculoskeletal diseases (iRMD) receiving rituximab (RTX).

Objectives:

To investigate whether treatment with RTX is associated with severe infection and death.

Methods:

We performed an observational, multicenter, French national cohort study querying the French RMD COVID-19 cohort, including highly suspected/confirmed iRMD-COVID-19 patients. The primary endpoint was to assess the severity rate of COVID-19. Severe disease was defined by hospitalization in intensive care unit or death. The secondary objectives were to analyze death rate and length of hospital stay. Two control groups were considered for comparison with RTX treated patients: a first group including all non-RTX treated iRMD patients and a second consisting on RTX untreated iRMD patients with diseases for which RTX is a recognized therapeutic option. Adjusting on potential confounding factors was performed by using inverse probability of treatment weighting (IPTW) propensity score method.

Results:

We collected a total of 1090 records. Patients were mainly females (67.3%, 734/1090) with a mean age of 55.2±16.4 years, and 51.1% (557/1090) were over the age of 55. Almost 70% of the population had at least one comorbidity (756/1090). A total of 63 patients were treated with RTX, mainly for rheumatoid arthritis (RA) (31/63, 49.2%). RTX treated patients were more likely to be males, with older age, higher prevalence of comorbidities and corticosteroid use. The control population consisted on 1027 non-RTX treated iRMD patients, and 495 RTX untreated iRMD patients with diseases for which RTX is a recognized therapeutic option.

Of the 1,090 patients, 137 developed severe disease (12.6%). After adjusting on potential confounding factors (age, sex, arterial hypertension, diabetes, smoking status, body mass index, interstitial lung disease, cardiovascular diseases, cancer, corticosteroid use, chronic renal failure and the underlying disease), severe disease was confirmed to be observed more frequently in patients receiving RTX compared to all RTX untreated iRMD patients (effect size, ES 3.26, 95% confidence interval, CI 1.66 to 6.40, p<0.001) and the subgroup of untreated RTX patients with diseases eligible for RTX therapy (ES 2.62, 95% CI 1.34 to 5.09, p=0.005). Patients who developed a severe disease had a more recent rituximab infusion compared to patients with mild or moderate disease. Indeed, the time between the last infusion of rituximab and the first symptoms of COVID-19 was significantly shorter in patients who developed a severe form of COVID-19 (Figure 1).

Figure 1.

Distribution (Tukey’s box plot) of Lag time between last infusion of Rituximab according to disease severity. P-Values for comparison between disease severity with Kruskal Wallis test are reported; P-Value<0.001 for either post-hoc comparison of severe disease group with moderate or mild disease group (calculated using Dunn’s test).

Eighty-nine patients in our cohort died, resulting in an overall death rate of 8.2%. Death rate was numerically higher in RTX treated patients (13/63, 20.6%) compared to all RTX untreated iRMDs patients (76/1027, 7.4%) and the subgroup of untreated RTX patients with diseases eligible for RTX therapy (49/495, 9.9%). After considering the previously described confounding factors, the risk of death was not significantly increased in patients treated with RTX compared to all RTX untreated iRMDs patients (ES 1.32, 95% CI 0.55 to 3.19, p=0.53) (Table 2) and the subgroup of untreated RTX patients with diseases eligible for RTX therapy (ES 1.48, 95% CI 0.68 to 3.20, p=0.32). In line with a more severe COVID-19 disease, the length of hospital stay was markedly longer in patients treated with RTX compared to both untreated RTX patient groups.

Conclusion:

RTX therapy is associated with a more severe COVID-19 infection. RTX will have to be applied with particular caution in patients with iRMDs.

Acknowledgements:

Muriel Herasse played a major role in collecting the missing data of the cohort.

We thank Julien Labreuche (biostatistician, CHU-Lille) for the help in the statistical analysis.

Disclosure of Interests:

None declared

POS1227 IMPACT OF A PRE-EXISTING INTERSTITIAL LUNG DISEASE ON SEVERITY OF COVID-19 IN PATIENTS WITH RHEUMATIC AND MUSCULOSKELETAL DISEASES

Background:

COVID19 due to SARS-CoV-2 infection implies an important anti-viral immune response leading to a major inflammatory syndrome with increased pro-inflammatory cytokine levels (i.e. the cytokine storm paradigm). The impact of a preexisting interstitial lung disease (ILD) on the morbi-mortality of COVID-19 is unclear. An increased mortality rate has been identified in studies that included a limited number of patients with ILD from various etiologies. To date, no studies have investigated the severity of COVID-19 in patients with preexisting ILD in a large population of rheumatic and musculoskeletal diseases (RMD-ILD). Since March 18th, 2020, the French RMD COVID19 dataset (NCT04353609) includes patients with an RMD and SARS-Cov-2 infection.

Objectives:

To assess the impact of a preexisting ILD on COVID-19 morbi-mortality within the French RMD COVID-19 dataset.

Methods:

Patients from the French RMD COVID-19 dataset were included in the analysis. COVID-19 diagnosis was established by a positive SARS-CoV-2 PCR test and/or typical symptoms or chest CT scans pattern during the period of the pandemic. Baseline phenotypic characteristics of the RMD including pre-existing ILD prior to the SARS-CoV-2 infection were collected. COVID-19 evolution was characterized as benign (ambulatory care), moderate (hospitalization outside intensive care unit [ICU]) and severe (hospitalization in ICU). Association between the ILD status and the severity and mortality rate of COVID-19 was assessed using multivariable logistic regression adjusted on sex, age, body mass index and diabetes.

Results:

By June 26, 2020, 897 patients were included. Pre-existing ILD was reported in 27 patients (3%): 11 patients with systemic sclerosis, 8 with rheumatoid arthritis, 2 with auto-immune myositis, 2 with mixed connective tissue disease and 4 with other RMD. Among these 27 patients (11 male, mean age 63.1 ± 16.4 y/o, 56.5% having a usual interstitial pneumonia HRCT pattern), 22 had severe infection. Death related to COVID-19, was observed in 58 patients with RMD without ILD (7.1%) and in 10 patients with RMD-ILD (37%). Having a preexisting ILD was found to be independently associated with an increased risk of severe COVID-19 (adjusted OR=7.6 [2.9 – 20.2], P<0.001) and an increased mortality rate (adjusted OR=12.3 [3.8 – 39.2], P<0.001).

Conclusion:

In RMD patients with SARS-CoV-2 infection, preexisting ILD was associated with an increased risk to severe COVID-19 and related mortality. Our findings suggest that RMD-ILD patients should be prioritized for COVID-19 vaccination according to the high morbi-mortality rate during SARS-CoV-2 infection.

Disclosure of Interests:

Pierre-Antoine Juge Consultant of: BMS, Eric Hachulla Consultant of: Actelion, Bayer, GSK and Pfizer, Grant/research support from: Actelion, Bayer, GSK and Pfizer, Christophe Richez: None declared, Elodie Drumez: None declared, Alain Duhamel: None declared, Raphael Borie: None declared, Philippe Dieudé: None declared

[Impact of a protocol based on the new national recommendations on the use of oxytocin and its maternal-fetal consequences: A single-center before/after study]

OBJECTIVE

Evaluate oxytocin use and impact on maternal and fetal morbidity before and after implementation of a protocol based on national recommendations.

MATERIALS AND METHODS

A single-center retrospective before-and-after study (Lille, France). A service protocol to harmonize the use of oxytocin was implemented in May 2017 following national recommendations. Data were collected from January to March 2016 for period 1, and from January to March 2019 for period 2. Nulliparous patients in spontaneous labor=37SA delivering a live newborn in cephalic presentation were included. The primary outcome was the use of oxytocin.

RESULTS

Five hundred eighty-seven patients were included, 302 for period 1 and 285 for period 2. The rate of oxytocin use was 48% (n=144) in 2016 versus 28% (n=79) in 2019 (P<0.001). Total labor time was significantly longer after protocol implementation (425.7min vs. 510.4min ; P<0.001). The cesarean section rate was identical between the 2 periods (7.0% vs. 6.0%; P=0.62). The rate of postpartum hemorrhage greater than 500mL was higher in period 1 (17.7% vs. 10.9%; P=0.019), as was the occurrence of a pH<7.05 (5.4% vs. 1.1%; P=0.004).

CONCLUSION

The implementation of a protocol contributed to a decrease in the use of oxytocin and thus would allow a decrease in the rate of postpartum hemorrhage and neonatal acidosis, but with an increase in the duration of labor.

Dramatic impact of morbid obesity on child lung development

OBJECTIVE

To assess the respiratory function and sleep characteristics of obese adults and children.

METHODS

All patients with non-syndromic, severe obesity (BMI ≥3 z-scores for children and ≥40.00kg/m² for adults), referred for pulmonary function tests at Lille University Hospital, were retrospectively included.

RESULTS

A total of 69 children (mean±SD BMI 36.8±6.7 and mean BMI z-score 4.7±1.0) and 70 adults were included (mean BMI 45.7±6.2). Metabolic syndrome was diagnosed in 13 children (26%) and 40 adults (80%). Reduced lung volumes were observed in 34 children (50.0%) and 16 adults (24.0%) and both the mean functional residual capacity (FRC) and the mean residual volume (RV) were lower in children than in adults (FRC: -1.7±2.1 z-score in children vs. -1.0±1.1 in adults, P=0.026; and RV: -0.8±1.2 z-score in children vs. -0.1±1.1 in adults, P=0.002). The prevalence of severe obstructive sleep apnea syndrome was greater in adults (40.7% vs. 18.8%, P=0.007). Children had a higher average oxygen saturation (median of 96.0% [91.0-98.0] vs. 93.0% [76.0-97.0] in adults, P<0.0001).

CONCLUSION

Obesity has consequences for lung volumes in children; however, a longitudinal study is needed to determine the impact on pulmonary expansion and growth.

Effects of COVID-19 pandemic lockdown on gestational diabetes mellitus: A retrospective study

OBJECTIVE

The objective of our study was to evaluate the impact of the lockdown period on the glycemic balance in patients with GDM.

METHODS

A retrospective study in one center (Lille, France) compared two periods: the COVID-19 lockdown of 18 March 2020 to 7 May 2020 versus the same period during 2019. Glucose targets were defined by a capillary fasting glucose target < 5.1mmol/L and/or a 2-hour postprandial capillary glucose < 6.6 mmol/L. GDM control was defined as: good (< 20% of the glycemic values were not within the target range), acceptable (20 to 40% of the glycemic values were not within the target range) or poor (> 40% of the glycemic values were not within the target range).

RESULTS

Two hundred twenty-nine patients were included in 2019 and 222 in 2020. The same mean number of capillary blood sugar tests was performed by the two groups. Postprandial blood sugar was significantly less well controlled in 2020, with a lower rate of good control (61.6% vs 69.4%) and higher rates of acceptable (24.7% vs 21.8%) and poor control (13.7% and 8.7%) (p < 0.05). Use of insulin therapy was significantly higher in 2020 compared with 2019 (47.7% and 36.2%, respectively; p < 0.05).

CONCLUSION

Diabetes control was lower during the COVID-19 pandemic lockdown, even if follow-up was not impacted. This may be explained by reduced physical activity, modified dietary habits and anxiety during this period.

Validation in French of the Montreal Cognitive Assessment 5-Minute, a brief cognitive screening test for phone administration

BACKGROUND

The prevalence of cognitive impairment and dementia is high and steadily increasing. Early detection of cognitive decline is crucial since some interventions can reduce the risk of progression to dementia. However, there is a lack of manageable scales for assessing cognitive functions outside specialized consultations. Recently, the MoCA-5min, a short version of the Montreal Cognitive assessment (MoCA), phone-administered, was validated for screening for vascular cognitive impairment. The aim of the present study was to validate the MoCA-5min in French in diverse clinical populations.

METHODS

The Cantonese version of the MoCA-5min was adapted for French language. Healthy volunteers and patients with possible or established cognitive impairment (Alzheimer's disease or related disorders, Parkinson's disease, Huntington's disease, type-2 diabetes) participated in the study. The original MoCA and the MoCA-5min were administered, by phone, with a 30-day interval. Alternate forms were used to reduce learning effects.

RESULTS

The scores of the original MoCA and MoCA-5min correlated significantly (Spearman rho=0.751, P<0.0001, 95% confidence interval 0.657 to 0.819). Internal consistency was good (Cronbach alpha=0.795). The area under the ROC curve was 0.870 and the optimal cut-off value for separating patients with and without cognitive impairment with the MoCA-5min was≤27 with 87.32% sensitivity and 76.09% specificity. Interrater and test-retest reliability were adequate.

CONCLUSION

This study demonstrates that the French version of the MoCA-5min is a valid and reliable scale for detecting cognitive impairment in different clinical populations. It is administrable by phone and thus suitable for remote assessment as well as for large-scale screening and epidemiological studies.

Fréquence des acrosyndromes chez les patients avec infection sévère à SARS-CoV-2 en réanimation

Introduction

De nombreuses manifestations cliniques dermatologiques ont été rapportées durant la pandémie mondiale de la COVID-19. Parmi elles, des phénomènes d’acrosyndromes ont été décrits, principalement chez des patients suspects d’infection par SARS-Cov-2 mais asymptomatiques ou pauci-symptomatiques. Peu d’études se sont intéressées à ces manifestations chez les patients admis en réanimation. Notre objectif était donc d’évaluer la fréquence instantanée des manifestations acrales cutanées chez les patients sévères atteints de la COVID19 admis en réanimation.

Matériel et méthodes

Nous avons réalisé une étude observationnelle et prospective, réalisée du 5 au 6 mai 2020. Tout patient adulte hospitalisé en réanimation au CHU de Lille dans le cadre de la COVID19 était inclus et bénéficiait d’un examen systématique du tégument par un dermatologue sénior.

Résultats

Au total, 39 patients ont été examinés (34 hommes, 5 femmes) avec un âge moyen de 60,6 ans. Aucun patient n’avait présenté de symptôme dermatologique au début de la maladie. La durée médiane d’hospitalisation en réanimation était de 35 jours [21-41] ; 35 patients (90 %) avaient reçu un support ventilatoire par intubation oro-trachéale et 21 (54 %) un support circulatoire par amines vasopressives. Nous avons observé des manifestations cutanées acrales chez 11 patients (28 %) : lésions nécrotiques (5/11, 45 %), bulles hémorragiques (3/11, 27 %), livedo (1/11, 9 %), érosions (1/11, 9 %), hémorragies sous unguéales (2/11, 18 %). Un patient présentant à la fois des lésions nécrotiques et des érosions cutanées. Aucun patient ne présentait de manifestations à type d’engelure ou pseudo-engelure. Il n’y avait pas de différence significative entre les patients avec et sans manifestation acrale concernant la durée d’hospitalisation et les complications thromboemboliques, les symptômes initiaux, et les caractéristiques de base des patients excepté l’IMC moyen plus bas chez les patients avec manifestations acrales. La durée moyenne de la maladie était significativement plus longue et davantage de médicaments vasoactifs ont été administrés aux patients présentant des manifestations cutanées acrales, suggérant une gravité plus élevée de la maladie dans ce groupe et pouvant être en lien avec les manifestations observées.

Discussion

Nous rapportons une série de manifestations cutanées acrales chez seulement 28 % des patients pris en charge en réanimation au moment de l’étude. Ces manifestations sont variées et peu spécifiques. Aucune manifestation à type d’engelure n’était observée contrairement aux patients suspects de formes pauci ou asymptomatiques et inconstamment confirmées sur le plan sérologique ou moléculaire. Sur le plan physiopathologique, plusieurs hypothèses sont avancées comme une réponse immune antivirale de type interféron. Des études sont nécessaires afin de mieux comprendre les mécanismes à l’origine de ces manifestations.

[Comparison of antepartum management of breech versus cephalic presentation]

OBJECTIVES

Delivery mode of term breech presentation is still being discussed. The aim of this study was to compare the labor management of a breech presentation to a vertex presentation during a vaginal delivery attempt.

METHODS

It was a single-center, comparative, descriptive retrospective study from 2014 to 2017. We studied fetal heart rate (FHR) during labor and expulsion, duration of the different stage of labor, mode of delivery and neonatal outcomes for breech and vertex presentations.

RESULTS

Two hundred and thirty-nine patients were included whom 106 (44%) breech presentation. The use of oxytocin was more common in breech group (63,2% versus 48,1%, P=0.020). Average dilatation rate was slower for breech presentation than for vertex presentation (1.9cm/h vs. 2.8cm/h; P=0.005). There was more FHR with high risk of acidosis in the breech presentations (37.2% vs 19.1%, P=0.001) and Melchior's FHR classification were comparable in both groups.

CONCLUSIONS

The per-partum management of a fetus in breech presentation differs from a fetus in cephalic presentation. It must be known and anticipated for an optimal management in the delivery room.