Étude échographique de la vascularisation placentaire au 1er trimestre de la grossesse pour la prédiction de la pré-éclampsie

Tableau d'honneur de la Faculté des études supérieures et postdorales, 2015-2016La pré-éclampsie (PE) est une complication de la grossesse entrainant de graves conséquences chez la femme et l’enfant. Il n’existe à ce jour aucun traitement afin de soigner la maladie lorsque celle-ci se déclare. Certaines thérapies existent toutefois afin de prévenir la maladie mais celles-ci doivent être débutées tôt en grossesse. Il devient alors impératif d’identifier les femmes à risque de développer une PE dès le 1er trimestre de la grossesse. Notre objectif est d’évaluer la vascularisation placentaire au 1er trimestre comme marqueur échographique dans la prédiction de la PE. Les résultats de notre étude cas témoins rapportent des indices de vascularisation placentaire diminués chez les femmes qui développeront une PE en grossesse. Ce marqueur pourrait donc être utilisé, seul ou en combinaison avec d’autres marqueurs (ex. biochimiques, biophysiques) dans la prédiction de la maladie tôt en grossesse.Pre-eclampsia (PE) is a complication of pregnancy leading to severe consequences for both women and children. At present there is no treatment to cure the condition when it occurs. However, there are therapies that can prevent the disease when they are administered early in pregnancy. It is therefore critical to identify women at risk of developing PE early, within the first trimester of pregnancy. Our objective was to evaluate the use of placental vasculature in the first trimester as an ultrasound marker to predict PE. Our case-control study suggested that placental vascularization indices decreased in women who develop PE in pregnancy. This indicator could therefore be used alone or in combination with other markers (e.g. biochemical, biophysical) in the prediction of the disease early in pregnancy

Managing disease outbreaks: The importance of vector mobility and spatially heterogeneous control

This work is licensed under a Creative Commons Attribution 4.0 International License.Management strategies for control of vector-borne diseases, for example Zika or dengue, include using larvicide and/or adulticide, either through large-scale application by truck or plane or through door-to-door efforts that require obtaining permission to access private property and spray yards. The efficacy of the latter strategy is highly dependent on the compliance of local residents. Here we develop a model for vector-borne disease transmission between mosquitoes and humans in a neighborhood setting, considering a network of houses connected via nearest-neighbor mosquito movement. We incorporate large-scale application of adulticide via aerial spraying through a uniform increase in vector death rates in all sites, and door-to-door application of larval source reduction and adulticide through a decrease in vector emergence rates and an increase in vector death rates in compliant sites only, where control efficacies are directly connected to real-world experimentally measurable control parameters, application frequencies, and control costs. To develop mechanistic insight into the influence of vector motion and compliance clustering on disease controllability, we determine the basic reproduction number R0 for the system, provide analytic results for the extreme cases of no mosquito movement, infinite hopping rates, and utilize degenerate perturbation theory for the case of slow but non-zero hopping rates. We then determine the application frequencies required for each strategy (alone and combined) in order to reduce R0 to unity, along with the associated costs. Cost-optimal strategies are found to depend strongly on mosquito hopping rates, levels of door-to-door compliance, and spatial clustering of compliant houses, and can include aerial spray alone, door-to-door treatment alone, or a combination of both. The optimization scheme developed here provides a flexible tool for disease management planners which translates modeling results into actionable control advice adaptable to system-specific details.Simons Foundation (426126)University of Kansas General Research Grant (2301-2105075)Department of Defense SERDP contract (W912HQ-16-C-0054

Promoting healthy eating in early pregnancy in individuals at risk of gestational diabetes mellitus: does it improve glucose homeostasis? A study protocol for a randomized control trial

BackgroundHealthy eating during pregnancy has favorable effects on glycemic control and is associated with a lower risk of gestational diabetes mellitus (GDM). According to Diabetes Canada, there is a need for an effective and acceptable intervention that could improve glucose homeostasis and support pregnant individuals at risk for GDM.AimsThis unicentric randomized controlled trial (RCT) aims to evaluate the effects of a nutritional intervention initiated early in pregnancy, on glucose homeostasis in 150 pregnant individuals at risk for GDM, compared to usual care.MethodsPopulation: 150 pregnant individuals ≥18 years old, at ≤14 weeks of pregnancy, and presenting ≥1 risk factor for GDM according to Diabetes Canada guidelines. Intervention: The nutritional intervention initiated in the first trimester is based on the health behavior change theory during pregnancy and on Canada’s Food Guide recommendations. It includes (1) four individual counseling sessions with a registered dietitian using motivational interviewing (12, 18, 24, and 30 weeks), with post-interview phone call follow-ups, aiming to develop and achieve S.M.A.R.T. nutritional objectives (specific, measurable, attainable, relevant, and time-bound); (2) 10 informative video clips on healthy eating during pregnancy developed by our team and based on national guidelines, and (3) a virtual support community via a Facebook group. Control: Usual prenatal care. Protocol: This RCT includes three on-site visits (10–14, 24–26, and 34–36 weeks) during which a 2-h oral glucose tolerance test is done and blood samples are taken. At each trimester and 3 months postpartum, participants complete web-based questionnaires, including three validated 24-h dietary recalls to assess their diet quality using the Healthy Eating Food Index 2019. Primary outcome: Difference in the change in fasting blood glucose (from the first to the third trimester) between groups. This study has been approved by the Ethics Committee of the Centre de recherche du CHU de Québec-Université Laval.DiscussionThis RCT will determine whether a nutritional intervention initiated early in pregnancy can improve glucose homeostasis in individuals at risk for GDM and inform Canadian stakeholders on improving care trajectories and policies for pregnant individuals at risk for GDM.Clinical trial registrationhttps://clinicaltrials.gov/study/NCT05299502, NCT0529950

High yield of culture-based diagnosis in a TB-endemic setting

BACKGROUND: In most of the world, microbiologic diagnosis of tuberculosis (TB) is limited to microscopy. Recent guidelines recommend culture-based diagnosis where feasible. METHODS: In order to evaluate the relative and absolute incremental diagnostic yield of culture-based diagnosis in a high-incidence community in Cape Town, South Africa, subjects evaluated for suspected TB had their samples processed for microscopy and culture over a 21 month period. RESULTS: For 2537 suspect episodes with 2 smears and 2 cultures done, 20.0% (508) had at least one positive smear and 29.9% (760) had at least one positive culture. One culture yielded 1.8 times more cases as 1 smear (relative yield), or an increase of 12.0% (absolute yield). Based on the latter value, the number of cultures needed to diagnose (NND) one extra case of TB was 8, compared to 19 if second specimens were submitted for microscopy. CONCLUSION: In a high-burden setting, the introduction of culture can markedly increase TB diagnosis over microscopy. The concept of number needed to diagnose can help in comparing incremental yield of diagnosis methods. Although new promising diagnostic molecular methods are being implemented, TB culture is still the gold standard

Precision Journalism: a practical guide

136hal.; 21c

Screening for small for gestational age using third-trimester ultrasound markers: protocol for a systematic review and meta-analysis of screening test accuracy

Background: Fetal growth restriction (FGR) is a complication of pregnancy associated with major neonatal morbidity and commonly diagnosed at birth based on birth weight below the 5th or the 10th centile. There is no consensus on the use of routine third-trimester ultrasound for the detection of FGR in a general population. This systematic review aims to estimate the performance of third-trimester ultrasound markers in the screening for babies who are small for gestational age in low-risk or general population. Methods: A systematic review of screening test accuracy will be conducted. The databases MEDLINE, Embase, Cochrane Library, and Web of Science will be searched from their inception until December 2017, as well as reference lists of included studies and previous related review articles. Studies screening for FGR in a low-risk or general population using third-trimester ultrasound markers and reporting low birth weight for gestational age (small for gestational age at birth) as a reference will be eligible. Two reviewers will independently screen references for inclusion, assess the risk of bias, and extract data. The Quality Assessment of Diagnostic Accuracy Study 2 (QUADAS-2) tool will be used to assess the methodological quality and validity of individual studies. The hierarchal summary receiver operating characteristic and random effects hierarchal bivariate models (Bivariate) will be used to estimate the pooled sensitivity and specificity of each ultrasound marker and to compare the discriminative ability of the different ultrasound markers. Subgroup and sensitivity analyses will be performed to explore the heterogeneity between studies and to assess the effect of screening tests’ characteristics (e.g., timing) on their discriminative ability. Discussion: This systematic review will determine the relevance of routine third-trimester ultrasound markers in the screening for FGR in low-risk or general population and their usefulness in standard pregnancy care. Additionally, this knowledge synthesis represents a step in the optimization of the discriminative ability of third-trimester ultrasound and predictive tools, allowing for targeted interventions aiming at the reduction of FGR complications and ultimately improving infants’ health. Systematic review registration: This protocol has been registered at PROSPERO: international prospective register of systematic reviews. The register number is CRD42018085564 .Medicine, Faculty ofNon UBCObstetrics and Gynaecology, Department ofReviewedFacult

Ultrasonographic Evaluation of Uterine Scar Niche before and after Laparoscopic Surgical Repair: A Case Report

Abstract Context Uterine scar defects or scar niche are relatively common after cesarean delivery. An association has been observed between the severity of scar defect, also known as isthmocele, some gynecologic symptoms, and the risk of uterine scar dehiscence at the next delivery. It has been suggested that surgical repair of scar defect could improve the gynecological symptoms, but it remains unclear whether such surgery mends the uterine scar itself. Case Report We report the case of a woman with uterine scar defect in whom laparoscopic repair significantly improved the gynecological symptoms without affecting the uterine scar, evaluated by hysterosonography. Conclusion This case highlights the significant dearth of knowledge surrounding the diagnosis, consequences, and benefits of surgical repair of uterine scar defect after cesarean