Neurological manifestations of COVID-19 in adults and children

Different neurological manifestations of coronavirus disease 2019 (COVID-19) in adults and children and their impact have not been well characterized. We aimed to determine the prevalence of neurological manifestations and in-hospital complications among hospitalized COVID-19 patients and ascertain differences between adults and children. We conducted a prospective multicentre observational study using the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) cohort across 1507 sites worldwide from 30 January 2020 to 25 May 2021. Analyses of neurological manifestations and neurological complications considered unadjusted prevalence estimates for predefined patient subgroups, and adjusted estimates as a function of patient age and time of hospitalization using generalized linear models. Overall, 161 239 patients (158 267 adults; 2972 children) hospitalized with COVID-19 and assessed for neurological manifestations and complications were included. In adults and children, the most frequent neurological manifestations at admission were fatigue (adults: 37.4%; children: 20.4%), altered consciousness (20.9%; 6.8%), myalgia (16.9%; 7.6%), dysgeusia (7.4%; 1.9%), anosmia (6.0%; 2.2%) and seizure (1.1%; 5.2%). In adults, the most frequent in-hospital neurological complications were stroke (1.5%), seizure (1%) and CNS infection (0.2%). Each occurred more frequently in intensive care unit (ICU) than in non-ICU patients. In children, seizure was the only neurological complication to occur more frequently in ICU versus non-ICU (7.1% versus 2.3%, P < 0.001). Stroke prevalence increased with increasing age, while CNS infection and seizure steadily decreased with age. There was a dramatic decrease in stroke over time during the pandemic. Hypertension, chronic neurological disease and the use of extracorporeal membrane oxygenation were associated with increased risk of stroke. Altered consciousness was associated with CNS infection, seizure and stroke. All in-hospital neurological complications were associated with increased odds of death. The likelihood of death rose with increasing age, especially after 25 years of age. In conclusion, adults and children have different neurological manifestations and in-hospital complications associated with COVID-19. Stroke risk increased with increasing age, while CNS infection and seizure risk decreased with age

Exposition prénatale aux pesticides et solvants organiques et risque de dysfonction placentaire (pré-éclampsie et retard de croissance intra utérin)

A placental defect can induce various pathologies such as preeclampsia and intrauterine growth retardation. Preeclampsia is responsible for more than 70,000 maternal deaths a year worldwide and 500,000 fetal and neonatal deaths. At the fetal level, intrauterine growth retardation is responsible for increased neonatal mortality and long-term complications (endocrine, cardiovascular, neurodevelopmental disorders, etc.). Chemical exposures during pregnancy are numerous. Two classes are particularly notable for their frequency and toxic potential: pesticides and solvents. At least some of them cross the placental barrier. This thesis aimed to explore consequences of domestic prenatal exposure to pesticides and occupational exposure to solvents on the risk of developing preeclampsia and on fetal growth. We observed an increased risk of developing preeclampsia among women living near crops associated to prochloraz application. We also observed more newborns small for gestational age when mothers were occupationally exposed to oxygenated and petroleum solvents. Finally, women who developed preeclampsia were more often exposed to oxygenated and petroleum solvents.Un défaut de placentation peut induire différentes pathologies telles que la pré-éclampsie et le retard de croissance intra-utérin. La pré-éclampsie est responsable de plus de 70 000 morts maternelles par an dans le monde et 500 000 décès fœtaux et néonataux. Sur le plan fœtal, le retard de croissance intra-utérin est responsable d’une augmentation de la morbi-mortalité néonatale et de complications à long terme (pathologies endocrines, cardiovasculaires, troubles du neurodéveloppement…). Les expositions chimiques pendant les grossesses sont nombreuses. Deux classes s’illustrent particulièrement de par leur fréquence et leur potentiel toxique : les pesticides et les solvants. Au moins une partie d’entre eux traversent la barrière placentaire. L’objectif de cette thèse était d’explorer les conséquences des expositions prénatales domestiques aux pesticides et professionnelles aux solvants sur le risque de développer une pré-éclampsie et sur la croissance fœtale. Nous avons ainsi mis en évidence un risque plus important de développer une pré-éclampsie lorsque les femmes habitaient à proximité des cultures associées à l’utilisation de prochloraz. Nous avons également observé une augmentation du risque d’être petit pour l’âge gestationnel chez les nouveau-nés dont les mères étaient professionnellement exposées aux solvants oxygénés et pétroliers. Enfin, le risque de pré-éclampsie était plus élevé chez les femmes exposées professionnellement aux solvants oxygénés et pétroliers

Exposition prénatale aux pesticides et solvants organiques et risque de dysfonction placentaire (pré-éclampsie et retard de croissance intra utérin)

A placental defect can induce various pathologies such as preeclampsia and intrauterine growth retardation. Preeclampsia is responsible for more than 70,000 maternal deaths a year worldwide and 500,000 fetal and neonatal deaths. At the fetal level, intrauterine growth retardation is responsible for increased neonatal mortality and long-term complications (endocrine, cardiovascular, neurodevelopmental disorders, etc.). Chemical exposures during pregnancy are numerous. Two classes are particularly notable for their frequency and toxic potential: pesticides and solvents. At least some of them cross the placental barrier. This thesis aimed to explore consequences of domestic prenatal exposure to pesticides and occupational exposure to solvents on the risk of developing preeclampsia and on fetal growth. We observed an increased risk of developing preeclampsia among women living near crops associated to prochloraz application. We also observed more newborns small for gestational age when mothers were occupationally exposed to oxygenated and petroleum solvents. Finally, women who developed preeclampsia were more often exposed to oxygenated and petroleum solvents.Un défaut de placentation peut induire différentes pathologies telles que la pré-éclampsie et le retard de croissance intra-utérin. La pré-éclampsie est responsable de plus de 70 000 morts maternelles par an dans le monde et 500 000 décès fœtaux et néonataux. Sur le plan fœtal, le retard de croissance intra-utérin est responsable d’une augmentation de la morbi-mortalité néonatale et de complications à long terme (pathologies endocrines, cardiovasculaires, troubles du neurodéveloppement…). Les expositions chimiques pendant les grossesses sont nombreuses. Deux classes s’illustrent particulièrement de par leur fréquence et leur potentiel toxique : les pesticides et les solvants. Au moins une partie d’entre eux traversent la barrière placentaire. L’objectif de cette thèse était d’explorer les conséquences des expositions prénatales domestiques aux pesticides et professionnelles aux solvants sur le risque de développer une pré-éclampsie et sur la croissance fœtale. Nous avons ainsi mis en évidence un risque plus important de développer une pré-éclampsie lorsque les femmes habitaient à proximité des cultures associées à l’utilisation de prochloraz. Nous avons également observé une augmentation du risque d’être petit pour l’âge gestationnel chez les nouveau-nés dont les mères étaient professionnellement exposées aux solvants oxygénés et pétroliers. Enfin, le risque de pré-éclampsie était plus élevé chez les femmes exposées professionnellement aux solvants oxygénés et pétroliers

Prenatal exposure to pesticides and organic solvents and risk of placental dysfunction (preeclampsia and intra uterine growth retardation)

Un défaut de placentation peut induire différentes pathologies telles que la pré-éclampsie et le retard de croissance intra-utérin. La pré-éclampsie est responsable de plus de 70 000 morts maternelles par an dans le monde et 500 000 décès fœtaux et néonataux. Sur le plan fœtal, le retard de croissance intra-utérin est responsable d’une augmentation de la morbi-mortalité néonatale et de complications à long terme (pathologies endocrines, cardiovasculaires, troubles du neurodéveloppement…). Les expositions chimiques pendant les grossesses sont nombreuses. Deux classes s’illustrent particulièrement de par leur fréquence et leur potentiel toxique : les pesticides et les solvants. Au moins une partie d’entre eux traversent la barrière placentaire. L’objectif de cette thèse était d’explorer les conséquences des expositions prénatales domestiques aux pesticides et professionnelles aux solvants sur le risque de développer une pré-éclampsie et sur la croissance fœtale. Nous avons ainsi mis en évidence un risque plus important de développer une pré-éclampsie lorsque les femmes habitaient à proximité des cultures associées à l’utilisation de prochloraz. Nous avons également observé une augmentation du risque d’être petit pour l’âge gestationnel chez les nouveau-nés dont les mères étaient professionnellement exposées aux solvants oxygénés et pétroliers. Enfin, le risque de pré-éclampsie était plus élevé chez les femmes exposées professionnellement aux solvants oxygénés et pétroliers.A placental defect can induce various pathologies such as preeclampsia and intrauterine growth retardation. Preeclampsia is responsible for more than 70,000 maternal deaths a year worldwide and 500,000 fetal and neonatal deaths. At the fetal level, intrauterine growth retardation is responsible for increased neonatal mortality and long-term complications (endocrine, cardiovascular, neurodevelopmental disorders, etc.). Chemical exposures during pregnancy are numerous. Two classes are particularly notable for their frequency and toxic potential: pesticides and solvents. At least some of them cross the placental barrier. This thesis aimed to explore consequences of domestic prenatal exposure to pesticides and occupational exposure to solvents on the risk of developing preeclampsia and on fetal growth. We observed an increased risk of developing preeclampsia among women living near crops associated to prochloraz application. We also observed more newborns small for gestational age when mothers were occupationally exposed to oxygenated and petroleum solvents. Finally, women who developed preeclampsia were more often exposed to oxygenated and petroleum solvents

Exposition prénatale aux pesticides et solvants organiques et risque de dysfonction placentaire (pré-éclampsie et retard de croissance intra utérin)

A placental defect can induce various pathologies such as preeclampsia and intrauterine growth retardation. Preeclampsia is responsible for more than 70,000 maternal deaths a year worldwide and 500,000 fetal and neonatal deaths. At the fetal level, intrauterine growth retardation is responsible for increased neonatal mortality and long-term complications (endocrine, cardiovascular, neurodevelopmental disorders, etc.). Chemical exposures during pregnancy are numerous. Two classes are particularly notable for their frequency and toxic potential: pesticides and solvents. At least some of them cross the placental barrier. This thesis aimed to explore consequences of domestic prenatal exposure to pesticides and occupational exposure to solvents on the risk of developing preeclampsia and on fetal growth. We observed an increased risk of developing preeclampsia among women living near crops associated to prochloraz application. We also observed more newborns small for gestational age when mothers were occupationally exposed to oxygenated and petroleum solvents. Finally, women who developed preeclampsia were more often exposed to oxygenated and petroleum solvents.Un défaut de placentation peut induire différentes pathologies telles que la pré-éclampsie et le retard de croissance intra-utérin. La pré-éclampsie est responsable de plus de 70 000 morts maternelles par an dans le monde et 500 000 décès fœtaux et néonataux. Sur le plan fœtal, le retard de croissance intra-utérin est responsable d’une augmentation de la morbi-mortalité néonatale et de complications à long terme (pathologies endocrines, cardiovasculaires, troubles du neurodéveloppement…). Les expositions chimiques pendant les grossesses sont nombreuses. Deux classes s’illustrent particulièrement de par leur fréquence et leur potentiel toxique : les pesticides et les solvants. Au moins une partie d’entre eux traversent la barrière placentaire. L’objectif de cette thèse était d’explorer les conséquences des expositions prénatales domestiques aux pesticides et professionnelles aux solvants sur le risque de développer une pré-éclampsie et sur la croissance fœtale. Nous avons ainsi mis en évidence un risque plus important de développer une pré-éclampsie lorsque les femmes habitaient à proximité des cultures associées à l’utilisation de prochloraz. Nous avons également observé une augmentation du risque d’être petit pour l’âge gestationnel chez les nouveau-nés dont les mères étaient professionnellement exposées aux solvants oxygénés et pétroliers. Enfin, le risque de pré-éclampsie était plus élevé chez les femmes exposées professionnellement aux solvants oxygénés et pétroliers

Comparison of adjustable continence therapy periurethral balloons and artificial urinary sphincter in female patients with stress urinary incontinence due to intrinsic sphincter deficiency

International audienceIntroduction and hypothesis - The objective was to compare the outcomes of the ACT® device with those of the artificial urinary sphincter (AUS) AMS 800 in the treatment of stress urinary incontinence (SUI) due to sphincter deficiency in women.Methods - All the women who underwent surgical treatment for SUI due to intrinsic sphincter deficiency from 2007 to 2017 were included in a single-center retrospective study. The primary endpoint was the functional outcome. Perioperative functional parameters of the two groups were compared.Results - Twenty-five patients underwent an ACT® implantation and 36 an AUS implantation. Patients in the AUS group were younger (62.9 vs 70.4 years; p = 0.03) with less comorbidity (ASA Score = 3 in 12.1% vs 33.3%; p = 0.005). Operative time and hospital stay were shorter in the ACT® group (45.7 vs 206.1 min; p Conclusions - In the present series, keeping in mind the significantly different baseline characteristics, AUS implantation was associated with better functional outcomes than the ACT® in female patients with SUI due to intrinsic sphincter deficiency, but with a higher intraoperative complications rate, longer operative time, and a longer stay.<br

Retrospective evaluation of labor induction with scar uterus at the university hospital of Rennes

International audienceObjective: The aim of the study was a retrospective evaluation of labor induction in women with one previous cesarean section. The primary outcome was the mode of delivery. We also studied the severe maternal and neonatal morbidity and identify some prediction factors of vaginal delivery after labor induction after one previous cesarean section.Study design: This was a retrospective observational monocentric study performed over the period from January 1st, 2016 to April 30th, 2020 at the university hospital of Rennes. Were included women with scar uterus because of one previous cesarean section with a viable singleton fetus in cephalic presentation and an induction of labor for medical reason, at term. Multivariate logistic regression analysis was used to analyze prediction of vaginal delivery after labor induction after one previous cesarean section. We also studied maternal (included uterine rupture, loss of blood, obstetrical injury of anus sphincter) and neonatal (APGAR score, arterial umbilical pH after 1 minute of life and eventual admission to neonatal unit) morbidity. We used a stepwise multivariate logistic regression model to select variables for multivariate analysis. The model with the lowest Akaike Index Criteria was chosen.Results: The study enrolled 353 women with scar uterus: 121 women were induced by balloon catheter, 57 by osmotic cervical dilatators, 91 by oxytocin alone, 84 by amniotomy. Vaginal delivery rate was 47,9%. There was 45% of vaginal delivery in the group with Bishop < 6 before induction of labor versus 62% in the group with Bishop ≥ 6. There was no statistically significative difference in neonatal and maternal severe morbidities between vaginal delivery and cesarean section: 4,5% of severe maternal morbidities (n = 16). Among their, we highlighted 7 uterine ruptures (3,8%). We observed also 3% of postpartum severe hemorrhage in vaginal delivery group (n = 5) against 1,6% in cesarian section group (n = 3) with no statistical significant difference (p = 0,632). Regarding to the obstetric perineal tears and lacerations we noticed 1,2% of OASIS 3 (n = 2) and 0,6% of OASIS 4 (n = 1). Severe neonatal morbidities were comparable by mode of delivery without significant difference: APGAR score at 5 min was similar (p = 1), as well as arterial umbilical pH after 1 min. (p = 0.719) and admissions to a neonatal unit (p = 1). Two variables were statistically associated with vaginal delivery after labor induction in women with scar uterus: Bishop score ≥ 6 (OR = 0,44; 95%CI: 0,25-0,81) and/or previous vaginal delivery after cesarean section (OR = 0,17; 95%CI: 0,08-0,35).Conclusion: With 47,9% of vaginal delivery after labor induction in women with scar uterus, only 3.8% (n = 7/353) of uterine ruptures, less than 1% APGAR < 7 at 5 min (n = 3/353), induction on scar uterus should be consider in obstetrical practice. Bishop score ≥ 6 and/or previous vaginal delivery after cesarean section are associated to vaginal delivery after labor induction

Trial of labor versus elective cesarean delivery for patients with two prior cesarean-sections: A retrospective propensity score analysis

International audienceIntroduction: Despite awareness of obstetricians to the constant increase in the number of cesarean sections in recent years, the fear of a uterine scar rupture is still present and influences the choice of the mode of delivery in patients with two previous cesarean sections. However, several clinical studies have suggested that, under certain conditions, vaginal birth after two cesarean sections is usually successful and safe. Objective: The objective of this study was to compare maternal and neonatal issues according to the planned mode of delivery in patients with two previous cesarean sections. Methods: It was a retrospective observational comparative study at Rennes University Hospital between January 1, 2013, and December 31, 2020. We performed a propensity score for the comparison of neonatal outcomes: cord pH, cord lactates, Apgar scores, transfer to neonatal unit and deaths, according to the planned delivery mode. Secondary outcomes were maternal issues: uterine rupture, post-partum hemorrhage, deaths. Results: A total of 410 patients with two previous cesarean section were eligible for our study. Prophylactic cesarean was performed in 358 cases (87.3%). Trial of labor was attempted in the 52 remaining patients (12.7%), 67.3 % of whom were successful. Neonatal weight, APGAR score at 1–5–10 min, and pH on cord blood were comparable in both groups. One case of uterine rupture occurred in the trial of labor group. Conclusion: Trial of labor seems to be a reasonable option for women with two previous cesarean sections in a selected population

Surgical management of isthmocele symptom relief and fertility

International audienceObjective: To describe symptoms and fertility and quality of life outcomes after isthmocele surgery.Study design: We conducted a retrospective study on from January 2012 to December 2017 in two tertiary referral centers in Rennes (France). All the patients diagnosed with isthmocele and operated were included. They all underwent isthmocele surgery by hysteroscopy, vaginal way or laparotomy.Results: The following data were collected: surgical procedure, symptoms and fertility before and after surgery, patient satisfaction about the surgery, and quality of life after surgery. Eighteen patients were included. The mean duration of follow-up was 15 months. Surgical procedures consisted of hysteroscopy (n = 5/18, 27.8%), vaginal surgery(n = 8/18, 44.4%) and laparotomy (n = 5/18, 27.8%). Surgical indications were: secondary infertility (n = 10/18, 55 %), pelvic pain (n = 5/18, 28%) and abnormal uterine bleeding (n = 3/18, 17%). Among patients with abnormal uterine bleeding, improvement was obtained after hysteroscopy, laparotomy and vaginal surgery for 83.3%, 75% and 50%, respectively. Among those with pelvic pain, improvement was obtained after hysteroscopy, laparotomy and vaginal surgery for 80%, 81% and 66%, respectively. One patient (1/18, 5.5%) had post-operative complication. Of the 12 patients who wished to conceive eleven pregnancies were obtained (91.7%). Of the 10 patients with secondary infertility, six became pregnant (60%). Five pregnancies (5/11, 45.4%) were carried to full term, including four in patients whose surgical indication was infertility. Among these, one patient had a vaginal delivery (after vaginal surgery) without obstetric complication. All patients operated on by hysteroscopy would recommend this surgery versus 75% of patients with vaginal surgery and 60% of patients with laparotomy (p = 0.24). Pain and quality-of-life scores were comparable between the three groups.Conclusion: Isthmocele surgery is effective for abnormal uterine bleeding, pain and infertility regardless of the surgical route