[Contraception for transgender men: A case report and review]

All methods of contraception used by a cisgender woman can theoretically be used by a transgender man. In practice, some contraceptives can aggravate gender dysphoria and should be discarded. On the other hand, contraceptives which make it possible to consolidate amenorrhea or to accentuate the virilization induced by taking testosterone will be better tolerated.

Synergistic effects of Lacticaseibacillus rhamnosus GG, glutamine, and curcumin on chronic unpredictable mild stress-induced depression in a mouse model

The microbiota-gut-brain axis is important in anxiety-depressive disorders. These conditions are associated with dysbiosis of the intestinal microbiota, intestinal hyperpermeability and an increase in circulating markers of inflammation and oxidative stress. They are also associated with a deregulation of the glutamine-glutamate-γ-aminobutyric acid cycle, with impairment of the excitatory/inhibitory balance in the brain. Our aim was to examine the impact of chronic treatment with the probiotic organism Lacticaseibacillus rhamnosus GG, alone or in combination with glutamine and curcumin, in a validated model of anxiety-depressive disorder in mice. Six-month-old mice (n=144) were exposed to chronic unpredictable mild stress (CUMS) stimulation for 3 weeks and emotional disturbances were assessed using two tests assessing anxiety (elevated plus maze test) and depressive-like behaviour (tail suspension test). After discontinuation of CUMS, mice were force-fed once-daily with curcumin, glutamine and probiotic alone or in combination for 21 consecutive days. Emotional reactivity was assessed in two separate behavioural tests: open field test and forced swim test. The outcomes of the interventions were compared with those induced by acute intraperitoneal administration of clomipramine, one of the major tricyclic antidepressants used in humans. Two independent sets of experiment were performed in this study, in order to evaluate the effects of two different formulations based on the utilisation of the probiotic L. rhamnosus GG in its live or inactivated form. CUMS led to an impairment of the emotional state of 6-month-old mice. However, chronic treatment with a combination of glutamine, curcumin and L. rhamnosus GG rescued the anxiety and depressive-like phenotype with an efficiency similar to clomipramine. A synergistic effect of the three compounds was observed, suggesting that simultaneous action on different targets is a relevant approach for the management of anxiety-depressive disorders.

Prévalence de la dénutrition et évaluation de l’efficacité d’une prise en charge nutritionnelle précoce chez les patients hospitalisés atteints du COVID-19

Introduction et but de l’étude

L’infection par le SARS-Cov2 (COVID-19) s’associe à un risque majeur de dénutrition. Cependant, les données nutritionnelles chez les patients atteints de COVID-19 sont limitées. Nos objectifs étaient :

– d’évaluer la prévalence de la dénutrition chez les patients hospitalisés pour COVID-19 à j0 puis à j30 post-hospitalisation ;

– d’étudier les liens entre dénutrition et gravité de la maladie à l’admission ;

– d’étudier l’impact de la dénutrition sur une évolution défavorable de la maladie (transfert vers une unité de soins intensifs (USI) ou décès) ;

– d’évaluer l’impact d’une prise en charge nutritionnelle précoce.

Matériel et méthodes

Tous les patients hospitalisés pour COVID-19 dans le service de médecine interne du CHU Pitié-Salpêtrière ont été inclus du 21 mars au 24 avril 2020 (n = 114, 60,5 % d’hommes, âge : 59,9 ± 15,9 ans). L’état nutritionnel de ces patients a été défini en utilisant les critères de la Haute Autorité de santé (HAS) 2019. Les caractéristiques cliniques, radiologiques et biologiques des patients atteints de COVID-19 ont été comparées en fonction de leur statut nutritionnel. Une régression logistique a été utilisée pour évaluer les associations entre les paramètres nutritionnels et l’évolution défavorable de la maladie. Une prise en charge nutritionnelle précoce selon la perte de poids et d’appétit des patients (consistant à une alimentation enrichie, une prévention du syndrome de renutrition inappropriée, des compléments nutritionnels oraux CNO et/ou une nutrition entérale NE), a été mise en place dès l’admission. À j30 post-hospitalisation, les données nutritionnelles cliniques, biologiques, anthropométriques, ont été collectées afin d’étudier l’évolution de l’état nutritionnel.

Résultats et analyse statistique

La prévalence globale de la dénutrition à j0 était de 44,6 % (14,2 % de dénutrition modérée, 30,4 % de dénutrition sévère). Celle-ci atteignait 66,7 % chez les patients provenant d’un service de réanimation. Une hypoalbuminémie initiale était associée à un risque plus élevé de transfert en unité de soins intensifs (pour 10 g/L d’albumine, OR [IC95 %] : 0,31 [0,1 ; 0,7] ; p < 0,01) et ce, indépendamment de l’âge et de la CRP. Après prise en charge nutritionnelle (69 % de CNO et 2,6 % de NE), la prévalence de la dénutrition à j30 post-hospitalisation était de 20,6 % (15,2 % de dénutrition modérée et 5,4 % de dénutrition sévère). À j30, on observait une masse musculaire basse selon impédancemétrie et une fonction musculaire altérée selon Handgrip chez 29,3 % des patients par rapport aux normes HAS.

Conclusion

La COVID-19 en service de médecine est associée à une forte prévalence de la dénutrition, encore plus marquée chez les patients provenant d’une USI. L’hypoalbuminémie à l’admission est associée à une évolution défavorable de la maladie, et ce indépendamment de la CRP et de l’âge. Un dépistage et une prise en charge nutritionnelle globale est possible (malgré les difficultés de recueil de données anthropométriques et de mise en place de la stratégie nutritionnelle liées aux mesures barrière), nécessaire et efficace chez ces patients, de manière précoce, ainsi que dans le suivi.

[Complications of termination of pregnancy]

The legalization of abortion in France allowed to disappear almost maternal deaths caused by induced abortions. Nevertheless, the practice of abortion in a medical framework is encumbered with a number of immediate complications. Similarly, the late consequences of the practice of surgical abortion have generated an abundant literature, which it is important to analyse, both to meet the legitimate concerns of patients as to prevent any spread of false ideas under the influence of movements opposed to abortion.

[Impact of media alerts on contraceptive pills medication]

INTRODUCTION

The end of 2012 was marked by some media alerts regarding combined hormonal contraceptives (CHC) and lawsuit against pharmaceutical companies selling these birth control pills. In this study, we analyzed whether these information had an impact on the number of abortion.

METHODS

Prospective study determining the number of women asking for abortion and who spontaneously declare that the contraception defect was due to an abandon of their oral contraception as they were scared of some information they received from media about the medication.

RESULTS

Eleven centers out of 16 did participate to the study, allowing the study of 2300 abortion during this time frame. Ninety-eight of these pregnancies (4.2%) were due to an interruption of the contraceptive treatment as a consequence of media alerts. Average age was 26 years old. Within these pregnancies, 4 (6%) started in December 2012, 3 months after the beginning of the alerts, 11 (16%) in January, 24 (36%) in February and 18 (27%) in March 2013 (4-6 months later). In 7 cases (10%) CHC stopped by fear of information reported by media were of 2nd generation, in 17 cases (25%) of 3rd generation, in 32 cases (48%) of 4th generation and microprogestative in 2 cases (3%).

CONCLUSION

Women who declared that they stopped their birth control medication by fear of information reported in media, represented 4% of the number of abortions performed between 2013 February 18th and 2013 April 30th.

[Reproductive options for people living with HIV: 2013 guidelines from the French expert working group]

The desire for children is a legitimate aspiration that should be part of multidisciplinary care for all men, women or couples living with HIV. The use of effective antiretroviral therapy has revolutionized the prevention of sexual, as well as mother-to-child HIV transmission. When the HIV plasma viral load is undetectable on long-term antiretroviral therapy, the risk of mother-to-child transmission is <1% and the risk of heterosexual HIV transmission without condom use in a stable relationship is very low (estimated at less than 1/10,000) in the absence of inflammation of the genital tract. In a man with a long-term undetectable viral load, viral shedding in semen is uncommon, but may occur persistently or intermittently. The same appears true of viral shedding in the vaginal tract of women. Reproductive options are: natural conception, self-insemination when the woman is HIV-infected, assisted reproduction. Natural conception is now considered to be an acceptable option when the conditions are met, after exploring four aspects: (1) virological (viral load undetectable sustained for at least 6 months on therapy), (2) genital (absence of genital infections or lesions), (3) fertility (after appropriate evaluation) and (4) detecting the ovulation period to limit intercourse without condoms. Assisted reproduction has two objectives in the context of HIV, to allow the couple to conceive without abandoning condom use and/or to treat infertility.

Accouchement des patientes enceintes infectées par le VIH : étude rétrospective de 358 grossesses suivies entre 2000 et 2004

OBJECTIVE

Evaluate the mode of delivery of HIV-infected women and the risk of mother-to-child transmission.

PATIENTS AND METHODS

A retrospective study conducted on HIV-infected women who delivered at the maternity ward of Bichat Hospital in Paris between 1st January 2000 and 31(st) December 2004. Pregnancy care, antiretroviral therapy, decision of the mode of delivery and neonate treatment were conformable to the French recommendations.

RESULTS

The analysis was performed on 332 cases out of 358 pregnancies followed during this period. 75% received a Highly Active Anti Retroviral Therapy (HAART), 24% an AZT monotherapy and 1% did not receive any antiretroviral treatment. Plasmatic HIV viral load was under the level of detectability (50 copies/ml) for 64,6% of women under HAART and 28,7% of women under AZT monotherapy. Only 31,7% of women under HAART delivered vaginally. 44,7% of women under HAART with undetectable viral load at the moment of delivery delivered vaginally. 59,5% of women who were allowed to deliver vaginally had finally a vaginal delivery. 332 women gave birth to 341 babies with 9 twin pregnancies and one still-birth at 22 WA. Out of these 340 babies, 3 babies whose mother received HAART were HIV infected (2 in utero and 1 per-partum).

DISCUSSION AND CONCLUSION

The reasons why only one third of HIV-infected women could deliver vaginally in this study are primarily the persistence of a detectable HIV viral load under HAART. Women's choice of the mode of delivery comes next, which depends on the quality of the counselling about the benefits and risks of the cesarean section in the context of HIV infection. The third reason is obstetrical contra indications to vaginal delivery in the context of HIV infection. In the future, it is possible to reduce the incidence of cesarean section in HIV-infected women by elevating the level of HIV plasmatic viral load which allowed vaginal delivery (1000 copies/ml), by improving the observance to antiretroviral treatment, by adaptating antiretroviral medications posology using determination of serum protease inhibitors concentration and by modifying obstetrical management with less restrictive contra indications to vaginal delivery. However the impact of prophylactic cesarean section when plasmatic HIV viral load is undetectable must still be evaluated.

[The efficacy and acceptability of mifepristone medical abortion with home administration misoprostol provided by private providers linked with the hospital: a prospective study of 433 patients]

BACKGROUND

Until July 2001 medical abortion was only authorized in France in public hospitals or private clinics. A new law effective in July 2001 allows private practitioners (gynaecologists or general practitioners) to provide medical abortion in their offices as long as they are linked to a hospital official agreement. Unfortunately mifepristone was not available outside hospitals before September 2004, so the study was conducted still providing the drugs in the hospital family planning clinic.

OBJECTIVE

To evaluate the efficacy and the acceptability of mifepristone medical abortion with home administration of misoprostol provided by private practitioners linked with the hospital.

PATIENTS AND METHODS

Four hundred thirty-three women seeking medical abortion before 7 weeks LMP were included between 2 January 2003 and 7 July 2004. All consultations before abortion and 2 weeks after abortion took place in a private provider's office. Drugs were administrated in the hospital family planning clinic: patients were given 3 tablets of mifepristone (600 mg) orally by the midwife and received 2 tablets of misoprostol (400 microg) that they would take at home 48 hours later. In case of any problems or complications, patients could phone or meet their private providers, phone the hospital midwife or go to the hospital emergency service. Private providers received training in medical abortion training and could at any time reach a medical specialist in the hospital family planning clinic for information or to refer a patient.

RESULTS

- Efficacy was evaluated for 339 women, because 94 patients were lost to follow-up (21.7%). Efficacy of medical abortion was 93.8% (318/339). There were 21 surgical aspirations (6.2%): for women's decision in 1.5% of cases, for medical decision without complications in 3.5% of cases, and for failure of the method in 1.2% of cases (2 ongoing pregnancies and 2 heavy haemorrhages with transfusion). The family planning midwife received a phone call from 21 patients after mifepristone (4.8%), Twenty-five patients had an emergency consultation (5.7%), and 22 patients went back to their private providers before their appointment for follow-up (5%). Twenty-two patients (5%) were referred by the private provider to the hospital medical specialist. Acceptability is known for 26% of patients; 96.2% thought that the abortion procedure was acceptable.

DISCUSSION AND CONCLUSIONS

The failure rate of medical abortion in this study is largely due to aspirations for incomplete abortion. To improve the efficacy of medical abortion offered by private providers linked with the hospital, all the relevant professionals (private providers, residents in the emergency service, family planning providers) must be well trained in medical abortion, especially in how to interpret and react to ultrasound images obtained in the follow up visit. The procedure is very acceptable to women. Medical abortion offered via a network should be well accepted by practitioners, since only 5% of women will need more than two consultations and only 6.2% will need surgical aspiration in the hospital. This study allows us to be optimistic about the expansion of medical abortion in France outside the hospital via a provider-hospital network based on the fact that since September 2004 private providers can get mifepristone directly in the pharmacies of the city.

La transmission materno-fœtale du virus de l’hépatite C : actualités sur l’intérêt de la césarienne

The rate of mother-to-infant transmission for hepatitis C virus is estimated to be around 5% of viraemic mothers and represents an important route of HCV infection among children. Transmission is possible in utero but the highest risk of infection is at or near the time of delivery because of an important blood transmission of hepatitis C virus. Mothers with high levels of HCV-RNA and co-infected for human immunodeficiency virus are documented to have risk factors for vertical transmission of HCV. Thus, for these, the mode of delivery must be discussed even if there are no precise recommendations. Among obstetrical risk factors, the results of literature fail to prove a benefit of elective caesarean delivery in the aim to reduce the vertical transmission of HCV. However, obstetrical situations with a high risk of blood contact between mother and foetus must be considered and if possible evicted.

[Maternity in adolescence: obstetrical analysis and review of the influence of cultural, socioeconomic and psychological factors in a retrospective study of 62 cases]

OBJECTIVE

To analyse obstetrical outcome of teenage pregnancies and conditions of discharge from the maternity ward.

PATIENTS AND METHODS

A retrospective study of 62 deliveries of women 13 to 17 years old, between 1997 and 2000.

RESULTS

A majority of patients is aged 16 or 17 (92%); 46.8% of teenagers were born in a sub-Saharan African country. The teenagers do not go to school in 45.2% of the cases. The first visit to hospital is late in the pregnancy (40.3% had their first visit after 30 weeks of amenorrhoea). There was no follow-up at all for 17.7% of the pregnancies. The obstetrical outcome is normal in 66.2% of the cases; 93.5% of the children were born after 37 SA and had a normal weight for gestational age; 93.5% were discharged from the maternity ward with their children. A specific follow-up took place for 36.2% of the women. Compared with women from other origins, teenagers born in sub-Saharan Africa more often live with their boyfriend (P = 0.03), who is likely to be over 25 (P = 0.001). Sub-Saharan African women more often return and live at the father's home (P < 0.001) and a specific follow-up proves less often necessary (P = 0.03).

DISCUSSION AND CONCLUSION

In developed countries, obstetrical outcome of teenage pregnancies is generally good if the women are more than 15 years old. In some cases, teenagers want to have a child for socio-economical, cultural or psychological reasons. There is a great variability of interpersonal situations as shown in this study, where a better prognosis was found in sub-Saharan African teenagers. It is recommended to permit an early access to the maternity hospital and to provide economical and psychological support during and after pregnancy.

[Management of pregnant women infected with HIV at Bichat Hospital between 1990 and 1998: analysis of 202 pregnancies]

OBJECTIVE

To describe medical and obstetrical prenatal care of pregnant women infected by HIV-1 emphasizing the role of cesarean section.

DESIGN

A retrospective study of 202 pregnancies followed between 1990 and 1998 in a french hospital in Paris.

RESULTS

56.9% of the women were born in subsaharian Africa; 80.2% were infected by sexual intercourse and the seropositivity was discovered during the pregnancy in 51% of the cases. Viral coinfections by hepatitis B virus, hepatitis C virus and Human papillomavirus were found respectively in 14.7%, 16.5% and 13% of the pregnancies. Prematurity occurred in 15% of the deliveries. Efficacy of antiretroviral therapy was confirmed in this study: 5.7% of the children were infected despite the antiretrovial treatment versus 19.3% without treatment (p < 0.03). Prophylactic cesarean section was proposed to the patients since 1994; the morbidity of cesarean was 8.8% (69 cesarean sections).

CONCLUSION

The policy of the association of prophylactic cesarean section and monotherapy by Zidovudine is validated by recent studies. The extension of prophylatic cesarean section to all the pregnant women infected by HIV is proposed. However the evaluation of the morbidity of the cesarean section in HIV infected women needs a prospective case-control study.

2.5 years follow-up of weight and Body Mass Index values in the Weight Control for Life! program: a descriptive analysis

This descriptive study monitored weight, Body Mass Index, and percent excess weight changes in 60 clients, (44 women, 16 men) at about 1 year and 2.5 years following participation in the Weight Control for Life! program. The program integrates the habit reversal treatment model with contingency management and operant reinforcement principles; nutrition education; physical activity; stress management; cognitive-restructuring; relapse prevention; social support; intensive, on-going maintenance; self-monitoring; and the use of a medically supervised very-low-calorie diet or low-calorie-diet. Clients' pretreatment and posttreatment weights averaged 104.28 kg (229.42 lb) and 79.89 kg (175.76 lb), respectively, representing a 68% reduction in excess body weight at the end of the weight loss phase of the program. Mean weight loss at about 1 year and 2.5 years post weight loss was 19.28 kg (42.42 lb) and 13.09 kg (28.80 lb), indicating subjects maintained 75% and 52% of their weight losses at these two time periods. Men lost more weight and maintained better losses than women. Overall, there was a 41% reduction in excess body weight at the end of 2.5 years.

Lifetime history of relapse from exercise

Most research on relapse from exercise has investigated one relapse episode following a structured program. The present study examined the patterns and determinants of the lifetime history of relapse from exercise in a community population. Subjects were 1.811 randomly selected residents of San Diego, California who completed an extensive mailed survey. Subjects reported the number of times over their lifetime that they had exercised vigorously for at least six months and then stopped exercising for at least three months. Approximately 60% of subjects reported zero relapses, 20% reported one or two relapses, and 20% reported three or more relapses. Relapse histories of current exercisers and current nonexercisers were virtually identical. The most commonly reported reason for the last relapse was injuries for both nonexecisers and exercisers. Multiple regression analyses were used to identify correlates of exercise relapse history. These data indicate that cross-sectional surveys of exercise behavior are inadequate to characterize exercise behavior in a population, and injuries are probably a major cause of relapse.

Breast Cancer Screening Project in Northeast Florida

The American Cancer Society--Duval Unit, in June, 1987, helped organize a community demonstration screening project involving all hospitals and institutions with mammography units in the area. A Northeast Florida Cooperative Breast Cancer Screening Group was formed comprised of physicians and administrators from each institution. A total of 1,200 women agreed to participate in the project and each underwent complete screening including education, instruction in self-examination, physical examination by a physician and mammography as indicated according to ACS guidelines. Of the study group, 1,032 women were eligible for mammography at a participating center, and 628 (61%) underwent a mammogram at no cost to them as instructed. Twenty four (4%) had definite abnormalities which led to biopsy and seven (1%) of them had malignant lesions. The medical community organized to provide breast cancer screening and follow-up with low-cost mammography.

Identifying correlates of walking for exercise: an epidemiologic prerequisite for physical activity promotion

This study was designed to identify correlates of walking for exercise in adults. Over 2,050 (43.4% response rate) responses to a mailed questionnaire were analyzed. Possible correlates of walking were based on learning theory and previous empirical observations. Respondents averaged less than 1 hr of walking for exercise per week. Women and older adults (greater than or equal to 50 years) reported significantly (P less than 0.05) greater walking than men or younger respondents. Multiple regression analyses were conducted for selected subgroups of respondents. Analyses were conducted on subjects who reported no regular vigorous exercise. Multiple correlation coefficients ranged from 0.32 to 0.48, and most reached significance (P less than 0.05). For the most sedentary subgroups, self-efficacy, family and friend support, and consumption of a heart-healthy diet were repeatedly associated with walking for exercise. It was concluded that an economically secure and well-educated Caucasian sample performs an inadequate amount of walking to ensure benefits such as prevention of cardiovascular disease. Longitudinal analyses are required to confirm the influence of social learning variables. Tentatively, interventions that increase family and friends' support for walking and that enhance perceived self-efficacy should be developed.

A multivariate study of determinants of vigorous exercise in a community sample

The purpose of this study was to explore the associations between several social learning theory variables and self-reported vigorous exercise and to consider the implications for exercise promotion. A random sample of adults in San Diego, California, was surveyed by mail. The 2,053 respondents (response rate, 43.4%) overrepresented Caucasian, affluent, and well-educated groups. A model of 24 variables accounted for 0.27 of the variance in exercise, and results strongly supported social learning theory. The strongest correlates were self-efficacy (i.e., confidence in the ability to exercise in specific situations), perceived barriers to exercise, modeling, dietary habits, support from friends, and age. Smoking was inversely associated with exercise in men only. We encourage researchers to conduct intervention trials to test the hypotheses generated in this study.

Long-term weight loss maintenance: assessment of a behavioral and supplemented fasting regimen

This analysis assessed 18-30-month weight loss maintenance following treatment with both behavior modification and supplemented fasting procedures for 400 patients. Fifty-five per cent of the patients who started treatment discontinued prior to completing the program. Patients who completed treatment lost a mean of 83.9 per cent of their excess weight, but regained an average of 59 per cent to 82 per cent of their initial excess weight by 30 months following start of treatment. The combination of behavior modification and supplemented fasting regimens was a successful means of effecting weight loss. However, there appeared to be limited weight loss maintenance. Behavioral epidemiological studies are needed to identify variables responsible for maintenance of weight loss.

[Epidemiology of intestinal helminthiasis (necatoriasis, taeniasis, ascariasis, trichuriasis) in the Kaya Region (Upper-Volta)]

Prevalence of intestinal helminthiasis: 1 223 stool specimens are examined in Louda and 690 in Damesma (Kaya, Upper-Volta). In this sample eggs of N. americanus are seen in 14,7% of the specimens in Louda and 9,3% in Damesma. Eggs of H. nana are seen in 10% of the specimens, for the two villages. Eggs of T. saginata are seen in 7.4% of the specimens of the two villages. And eggs of A. lumbricoides, T. trichicera are found inters then 0.5% of the specimens.

[Hepatic distomatosis caused by Clonorchis/Opisthorchis spp. in refugees from South-East Asia. Effects of treatment with praziquantel]

The prevalence of liver infection (percentage of patients voiding Clonorchis or Opistorchis spp. eggs in faeces) is 18.5% in the South East Asian refugees. Both sexes are equally affected and the older the refugees are, the more often they are found infected. Laotians, who like to eat the fishes raw, are harboring leverflukes more often than other Far-east inhabitants. Praziquantel, prescribed at a dose of 25 mg/kg body weight given 3 times on a single day, is very efficient in the treatment of the Far-east hepatic distomatosis. Tolerability to praziquantel is excellent. Side effects are few and of moderate intensity.

[Human activities, hydro-agricultural management and urinary schistosomiasis. Methodological approach and results (a preliminary study in Upper-Volta)]

In the schistosomiasis endemic sub-sahelian region, a study of the prevalence of the disease was carried out on three different areas: the highest was around a small river, the lowest in the hydro-agricultural management region, mean prevalence was noted around a natural lake. Human activities have been classified with regards to the areas of transmission. Activity is closely linked to prevalence. For the populations, symptoms of urinary schistosomiasis (Rudzenga) constitute a real disease, traditional healers are the masters of earth (Tengsoba), water has hardly any importance in transmission.