The ANTENATAL multicentre study to predict postnatal renal outcome in fetuses with posterior urethral valves: objectives and design

Abstract Background Posterior urethral valves (PUV) account for 17% of paediatric end-stage renal disease. A major issue in the management of PUV is prenatal prediction of postnatal renal function. Fetal ultrasound and fetal urine biochemistry are currently employed for this prediction, but clearly lack precision. We previously developed a fetal urine peptide signature that predicted in utero with high precision postnatal renal function in fetuses with PUV. We describe here the objectives and design of the prospective international multicentre ANTENATAL (multicentre validation of a fetal urine peptidome-based classifier to predict postnatal renal function in posterior urethral valves) study, set up to validate this fetal urine peptide signature. Methods Participants will be PUV pregnancies enrolled from 2017 to 2021 and followed up until 2023 in >30 European centres endorsed and supported by European reference networks for rare urological disorders (ERN eUROGEN) and rare kidney diseases (ERN ERKNet). The endpoint will be renal/patient survival at 2 years postnatally. Assuming α = 0.05, 1–β = 0.8 and a mean prevalence of severe renal outcome in PUV individuals of 0.35, 400 patients need to be enrolled to validate the previously reported sensitivity and specificity of the peptide signature. Results In this largest multicentre study of antenatally detected PUV, we anticipate bringing a novel tool to the clinic. Based on urinary peptides and potentially amended in the future with additional omics traits, this tool will be able to precisely quantify postnatal renal survival in PUV pregnancies. The main limitation of the employed approach is the need for specialized equipment. Conclusions Accurate risk assessment in the prenatal period should strongly improve the management of fetuses with PUV

Maternal outcomes and risk factors for COVID-19 severity among pregnant women.

Pregnant women may be at higher risk of severe complications associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which may lead to obstetrical complications. We performed a case control study comparing pregnant women with severe coronavirus disease 19 (cases) to pregnant women with a milder form (controls) enrolled in the COVI-Preg international registry cohort between March 24 and July 26, 2020. Risk factors for severity, obstetrical and immediate neonatal outcomes were assessed. A total of 926 pregnant women with a positive test for SARS-CoV-2 were included, among which 92 (9.9%) presented with severe COVID-19 disease. Risk factors for severe maternal outcomes were pulmonary comorbidities [aOR 4.3, 95% CI 1.9-9.5], hypertensive disorders [aOR 2.7, 95% CI 1.0-7.0] and diabetes [aOR2.2, 95% CI 1.1-4.5]. Pregnant women with severe maternal outcomes were at higher risk of caesarean section [70.7% (n = 53/75)], preterm delivery [62.7% (n = 32/51)] and newborns requiring admission to the neonatal intensive care unit [41.3% (n = 31/75)]. In this study, several risk factors for developing severe complications of SARS-CoV-2 infection among pregnant women were identified including pulmonary comorbidities, hypertensive disorders and diabetes. Obstetrical and neonatal outcomes appear to be influenced by the severity of maternal disease

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Quel traitement pour nos patients en situation d’obésité ?

Les médecins ont longtemps pensé que pour perdre du poids, le conseil « manger moins et bouger plus » pourrait suffire. Mathématiquement, il est juste de dire que si la personne réduit ses apports caloriques et augmente sa dépense énergétique, elle perdra du poids. Mais si cette théorie était vraie, pourquoi y aurait-il toujours autant de patients qui n’arrivent pas à perdre du poids ou, malgré une perte initiale, reprennent-ils facilement des kilos ? Pourquoi est-il si difficile de changer nos habitudes et ceci durablement

Treatment challenges for type 1 diabetes after Roux-en-Y gastric bypass: A case report and review of the Literature

L'obésité est un problème majeur de santé publique et la chirurgie bariatrique est reconnue comme le traitement à long terme le plus efficace pour une perte pondérale significative et pour un impact sur les comorbidités qui y sont associées, particulièrement le diabète de type 2. L'épidémie d'obésité n'épargne cependant pas les patients diabétiques de type 1. La résistance à l'insuline, habituellement caractéristique du diabète de type 2, s'observe également chez les patients diabétiques de type 1 obèses. Une chirurgie bariatrique est donc désormais discutée chez ces patients mais les cas rapportés dans la littérature montrent des résultats inconsistants quant à l'impact de cette chirurgie sur le diabète de type 1. Au travers de la description unique d'une patiente qui a développé un diabète auto-immun (LADA) quelques années après la réalisation d'un by-pass gastrique, nous avons souhaité exposer les difficultés rencontrées dans la gestion de ce diabète de type 1 : variations glycémiques importantes et rapides en raison des modifications de l'absorption du glucose après une telle chirurgie et risques d'hypoglycémie. L'introduction d'une pompe à insuline couplée à une mesure de la glycémie en continu avec arrêt automatique de l'infusion d'insuline pour limiter les hypoglycémies a permis un meilleur contrôle du diabète. La revue de la littérature sur le sujet permet de comprendre les raisons expliquant les résultats discordants décrits chez les patients diabétiques de type 1 bénéficiant d'une chirurgie bariatrique. Les différentes chirurgies que sont le by-pass gastrique, la gastrectomie en manchon et anneau gastrique n'entraînent pas des modifications similaires dans l'absorption du glucose. Après un by-pass gastrique, une élévation rapide et importante de la glycémie est observée lors de la consommation d'un repas test. L'élévation de la glycémie est moindre et plus tardive après une gastrectomie en manchon. Finalement, l'absorption du glucose n'est pas modifiée chez les patients porteurs d'un anneau gastrique. Certaines études reportent l'évolutionde tels patients ayant subi différents types de chirurgie bariatrique et confondent ainsi des situations notablement différentes. Finalement, pour expliquer les résultats inconsistants retrouvés dans la littérature, on relève également que la valeur du c-peptide et/ou des autoanticorps spécifiques au diabète de type 1 ne sont souvent pas rapportés et que le diagnostic formel de ce diabète peut alors être questionné. En conclusion, il n'existe donc pas de recommandations pour la prise en charge chirurgicale sur le plan bariatrique des patients avec diabète de type 1 et bien que la réduction pondérale soit satisfaisante, le contrôle glycémique reste incertain. Il peut notamment ne pas s'améliorer voire être rendu encore plus difficile, contrairement à ce qui est observé chez les patients diabétiques de type 2 après une chirurgie bariatrique et chez qui une rémission du diabète peut parfois être observée. Une documentation attentive du type de diabète doit être proposée avant une telle chirurgie et les implications d'une telle chirurgie sur la gestion du diabète de type 1 doivent être clairement exposées aux patients