Maternal and perinatal outcomes following pre-Delta, Delta, and Omicron SARS-CoV-2 variants infection among unvaccinated pregnant women in France and Switzerland: a prospective cohort study using the COVI-PREG registry.

BACKGROUND SARS-CoV-2 positive pregnant women are at higher risk of adverse outcomes, but little evidence is available on how variants impact that risk. We aim to evaluate maternal and perinatal outcomes among unvaccinated pregnant women that tested positive for SARS-CoV-2, stratified by pre-Delta, Delta, and Omicron periods. METHODS This prospective study enrolled women from March 2020 to September 2022. Exposure to the different SARS-CoV-2 variants was defined by their periods of predominance. The primary outcome was severe maternal adverse outcome defined as either intensive care unit admission, acute respiratory distress syndrome, advanced oxygen supplementation, or maternal death. The secondary outcomes were preterm birth and other perinatal outcomes. FINDINGS Overall, 1402, 262, and 391 SARS-CoV-2 positive pregnant women were enrolled during the pre-Delta, Delta, and Omicron periods respectively. Severe maternal adverse outcome was reported in 3.4% (n = 947/1402; 95% confidence intervals (95%CI) 2.5-4.5), 6.5% (n = 7/262; 95%CI 3.8-10.2), and 1.0% (n = 4/391; 95%CI 0.3-2.6) of women during the pre-Delta, Delta, and Omicron periods. The risk of severe maternal adverse outcome was higher during the Delta vs pre-Delta period (adjusted risk ratio (aRR) = 1.8; 95%CI 1.1-3.2) and lower during the Omicron vs pre-Delta period (aRR = 0.3; 95%CI, 0.1-0.8). The risks of hospitalization for COVID-19 were 12.6% (n = 176/1402; 95%CI 10.9-14.4), 17.2% (n = 45/262; 95%CI 12.8-22.3), and 12.5% (n = 49/391; 95%CI 9.4-16.2), during the pre-Delta, Delta, and Omicron period, respectively. Pregnancy complications occurred after SARS-CoV-2 exposure in 30.0% (n = 363/1212; 95%CI 27.4-32.6), 35.2% (n = 83/236; 95%CI 29.1-41.6), and 30.3% (n = 105/347; 95%CI 25.5-35.4) of patients during the pre-Delta, Delta, and Omicron periods, respectively. Stillbirths were reported in 0.5% (n = 6/1159; 95%CI 0.2-1.1), 2.8% (n = 6/210; 95%CI 1.0-6.0), and 0.9% (n = 2/213; 95%CI 0.1-3.4) or patients during the pre-Delta, Delta, and Omicron periods respectively. INTERPRETATION The Delta period was associated with a higher risk of severe maternal adverse outcome and the Omicron period with a lower risk of severe adverse outcome compared to pre-Delta era. The reported risk of hospitalization was high during the Omicron period and should not be trivialized. FUNDING Swiss Federal Office of Public Health, Fondation CHUV

Parameter identification of the STICS crop model, using an accelerated formal MCMC approach

This study presents a Bayesian approach for the parameters’ identification of the STICS crop model based on the recently developed Differential Evolution Adaptive Metropolis (DREAM) algorithm. The posterior distributions of nine specific crop parameters of the STICS model were sampled with the aim to improve the growth simulations of a winter wheat (Triticum aestivum L.) culture. The results obtained with the DREAM algorithm were initially compared to those obtained with a Nelder-Mead Simplex algorithm embedded within the OptimiSTICS package. Then, three types of likelihood functions implemented within the DREAM algorithm were compared, namely the standard least square, the weighted least square, and a transformed likelihood function that makes explicit use of the coefficient of variation (CV). The results showed that the proposed CV likelihood function allowed taking into account both noise on measurements and heteroscedasticity which are regularly encountered in crop modellingPeer reviewe

Los jesuitas y la Monarquía Hispánica en el contexto de la guerra de los treinta años (1625-1635)

The Society of Jesus is, probably, the best studied religious order for the modern age. Access to their sources and the work of the members of the congregation have enabled us pretty clear ideas about their behavior in the seventeenth century. However, most studies that have addressed policy implications have done from a well-Jesuit Roman well, often leaving aside the own sources of the Spanish monarchy. In this paper we intend to show how government circles lived in Madrid the performance of some of the most prominent members of the order, not always inclined to the interests of Philip IV, and concoct the mechanisms that launched the Monarchy to strengthen their interests in a Europe at war.<br><br>La Compañía de Jesús es, probablemente, la orden religiosa mejor estudiada para la edad moderna. El acceso a sus fuentes y la labor de los propios miembros de la congregación nos ha permitido tener ideas bastante claras sobre su comportamiento en el siglo XVII. Sin embargo, la mayoría de los trabajos que han abordado sus implicaciones políticas lo han hecho desde una perspectiva, bien jesuítica, bien romana, dejando muchas veces de lado las fuentes propias de la Monarquía Hispánica. En el presente trabajo pretendemos mostrar cómo se vivió en los círculos gubernamentales madrileños la actuación de algunos de los más relevantes miembros de la orden –no siempre proclives a los intereses de Felipe IV– y pergeñar los mecanismos que puso en marcha la Monarquía para reforzar sus intereses en una Europa en guerra

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

At the foundation of a therapeutic relationship : humility

Au cours de la relation thérapeutique qui unit le médecin et le malade dans un processus de soin, il arrive que le médecin estime le malade guéri alors que ce dernier ne se considère pas comme tel, ou, à l'inverse, que le malade s'estime guéri alors que le médecin pense le contraire. Cette situation paradoxale constitue l'antinomie de la relation thérapeutique. Elle est la conséquence de ce que la guérison n'est pas un retour à l'état de santé d'avant la maladie, mais est au contraire la constitution d'une nouvelle norme de vie, processus que Georges Canguilhem a désigné sous le nom de normativité.Résoudre l'antinomie de la relation thérapeutique nécessite de placer la normativité au cœur de cette relation, et l'humilité rend ce processus possible.L'humilité est une vertu trop souvent tenue pour suspecte, fréquemment réduite à une variante du mysticisme ou assimilée à un dénigrement de soi. Un examen critique de l'humilité permet de réfuter ce lieu commun. L'humilité, qui semble absente du corpus hippocratique et de la philosophie médicale héritée de la Grèce antique, est une vertu morale et intellectuelle, qui se cache derrière la maïeutique socratique et l'éthique aristotélicienne. La critique kantienne de la faculté de juger démontre que l'humilité possède une fonction schématique qui lui permet d'offrir à l'homme une ouverture de son être et de lui dévoiler que la maladie est une épreuve de vie apparentée au sublime.L'étude de plusieurs situations cliniques permet de montrer que l'humilité, prise comme maxime d'action de la pratique médicale, est en mesure de résoudre l'antinomie de la relation thérapeutique.During the therapeutic relationship wich brings together the doctor and the patient, it sometimes occur that the doctor considers the patient to be cured, though the patient does not feel so, or, on the contrary, that the patient considers to be cured even though the doctor thinks the opposite. This paradoxical situation is what can be called the antinomy of the therapeutic relationship. It is the consequence of the fact that healing is not returning to the state of health prior to the illness, but is the implementation of a new norm of life, process named normativity by Georges Canguilhem.Solving the antinomy of the therapeutic relationship requires to put normativity at the center of this relationship, and humility makes this process possible.Humility is a too often held under suspicion, frequently reduced to a form of mysticism or considered as self-deprecation. A critical examination of humility refutes such a commonly-held opinion. Humility, wich seems excluded from the hippocratical corpus and the philosophy of medicine inherited from ancient Greece, is an intelectual and moral virtue, wich hides behind Socrate's maieutic and Aristotle's ethic. Immanuel Kant's Critique of judgement shows that humility is also a scheme wich allows man an opening of his being and wich reveals to him that illness is a trial of life wich is similar to the sublime.A examination of several clinical cases shows that humility, taken as maxim of action of medical practice, is able to solve the antinomy of therapeutic relationship

Au fondement de la relation thérapeutique : l'humilité

During the therapeutic relationship wich brings together the doctor and the patient, it sometimes occur that the doctor considers the patient to be cured, though the patient does not feel so, or, on the contrary, that the patient considers to be cured even though the doctor thinks the opposite. This paradoxical situation is what can be called the antinomy of the therapeutic relationship. It is the consequence of the fact that healing is not returning to the state of health prior to the illness, but is the implementation of a new norm of life, process named normativity by Georges Canguilhem.Solving the antinomy of the therapeutic relationship requires to put normativity at the center of this relationship, and humility makes this process possible.Humility is a too often held under suspicion, frequently reduced to a form of mysticism or considered as self-deprecation. A critical examination of humility refutes such a commonly-held opinion. Humility, wich seems excluded from the hippocratical corpus and the philosophy of medicine inherited from ancient Greece, is an intelectual and moral virtue, wich hides behind Socrate's maieutic and Aristotle's ethic. Immanuel Kant's Critique of judgement shows that humility is also a scheme wich allows man an opening of his being and wich reveals to him that illness is a trial of life wich is similar to the sublime.A examination of several clinical cases shows that humility, taken as maxim of action of medical practice, is able to solve the antinomy of therapeutic relationship.Au cours de la relation thérapeutique qui unit le médecin et le malade dans un processus de soin, il arrive que le médecin estime le malade guéri alors que ce dernier ne se considère pas comme tel, ou, à l'inverse, que le malade s'estime guéri alors que le médecin pense le contraire. Cette situation paradoxale constitue l'antinomie de la relation thérapeutique. Elle est la conséquence de ce que la guérison n'est pas un retour à l'état de santé d'avant la maladie, mais est au contraire la constitution d'une nouvelle norme de vie, processus que Georges Canguilhem a désigné sous le nom de normativité.Résoudre l'antinomie de la relation thérapeutique nécessite de placer la normativité au cœur de cette relation, et l'humilité rend ce processus possible.L'humilité est une vertu trop souvent tenue pour suspecte, fréquemment réduite à une variante du mysticisme ou assimilée à un dénigrement de soi. Un examen critique de l'humilité permet de réfuter ce lieu commun. L'humilité, qui semble absente du corpus hippocratique et de la philosophie médicale héritée de la Grèce antique, est une vertu morale et intellectuelle, qui se cache derrière la maïeutique socratique et l'éthique aristotélicienne. La critique kantienne de la faculté de juger démontre que l'humilité possède une fonction schématique qui lui permet d'offrir à l'homme une ouverture de son être et de lui dévoiler que la maladie est une épreuve de vie apparentée au sublime.L'étude de plusieurs situations cliniques permet de montrer que l'humilité, prise comme maxime d'action de la pratique médicale, est en mesure de résoudre l'antinomie de la relation thérapeutique

Risk of congenital malformation following first trimester mRNA COVID-19 vaccine exposure in pregnancy ::the COVI-PREG prospective cohort

OBJECTIVES: this study aimed to evaluate the risk of congenital malformation among pregnant women exposed to the mRNA COVID-19 vaccines during the first trimester of pregnancy, which is a developmental period where the fetus is at risk of teratogenicity. METHODS: Pregnant women were prospectively enrolled from March 2021 to March 2022, at the time of COVID-19 vaccination. Pregnant women exposed to at least one dose of mRNA COVID-19 vaccine from conception to 11 weeks of gestations and 6 days were compared to pregnant women exposed to the vaccine from 12 weeks to the end of pregnancy. The primary outcome was a confirmed congenital malformation at birth. RESULTS: a total of 1450 pregnant women were enrolled including 124 in the first trimester and 1326 in the second and third trimester. The overall proportion of congenital malformation was 0.81% (n=1/124;95%CI 0.02-4.41) and 0.83% (n=11/1326; 95% CI 0.41-1.48) among pregnant exposed to the COVID-19 vaccine during the first and second/third trimester, respectively. First trimester exposure was not associated with a higher risk of congenital malformation with a relative risk (RR) of 0.89 (95%CI 0.12-6.80) with no significant changes after adjustment through exploratory analysis. CONCLUSION: pregnant women exposed to mRNA COVID-19 vaccine before 12 weeks of gestation did not have an increased risk of congenital malformation compared to women exposed outside the teratogenic window. As vaccination is safe and effective, emphasis must be placed on promoting vaccination during pregnancy

Évaluation didactique et ergonomique de l'EIAH EduAnatomist pour l'éducation à l'image scientifique. In M. Bétrancourt, C. Depover, V. Luengo, B. De Lièvre & G. Tamperman (Eds.), EIAH 2011 A la recherche de convergence entre les acteurs des EIAH (pp. 329-340). Mons, Belgique.

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