Search

Dengue is a mosquitoborne viral disease common in regions with tropical climates. Worldwide annual dengue incidence is estimated at [approximately equal to]100 million diagnosed and [approximately equal to]300 million asymptomatic [...]

Background: Congenital unilateral absence of vas deferens has been diagnosed in fertile and normozoospermic males and is associated with the risk of unilateral renal absence or cystic fibrosis transmembrane conductance regulator mutations; but no prediction model currently exists to diagnose this condition. Objectives: The study aims to identify clinical and biological variables that may have a predictive value for the diagnosis of congenital unilateral absence of vas deferens in male partners of infertile couples Materials and methods: We designed a retrospective, cross‐sectional, case‐control study on electronic health records of a single tertiary‐care andrological centre collected between 1998 and 2018. We included all subjects diagnosed with congenital unilateral absence of vas deferens using combined scrotal and transrectal ultrasounds. Controls were confirmed free of congenital unilateral absence of vas deferens by the same way. Both groups received standardised exploration procedures. Multivariable logistic regression model was built in a backward stepwise manner. Model performance and calibration were assessed. The study is reported according to TRIPOD statement. Results: We included 69 congenital unilateral absence of vas deferens cases and 78 controls. Cases had a lower semen volume than controls. The congenital unilateral absence of vas deferens risk was associated with history of cryptorchidism and both levels of semen fructose and α‐glucosidase. These predictors were confirmed by a random forest algorithm. The area under the curve was 0.886 (95% interval: 0.81–0.92). Calibration was performed with the Hosmer‐Lemeshow test (p = 0.88). Discussion and conclusion: History of cryptorchidism, semen fructose and α‐glucosidase were identified as relevant and independent predictors for the diagnosis of congenital unilateral absence of vas deferens. The model enables to identify male patients with a high risk of congenital unilateral absence of vas deferens to whom a transrectal ultrasounds would be proposed to confirm the diagnosis, whatever their semen parameters. It will also help to address the risks of unilateral renal absence and of cystic fibrosis transmembrane conductance regulator mutations carrying during the management of infertile couples. [ABSTRACT FROM AUTHOR]

Pregnant women with Graves' disease (GD) are at risk of maternal and foetal hyperthyroidism caused by stimulating anti-thyroid-stimulating hormone (TSH) receptor antibodies with pregnancy loss, preterm birth, low birth weight of the child, pre-eclampsia and maternal heart failure.1 Central hypothyroidism (CH) is rare in pregnant women and, whatever the mechanism of thyroid-stimulating hormone deficiency, early levothyroxine substitutive therapy is essential for preventing the neurodevelopment consequences of low thyroxine concentrations.2 In this letter to the editor, we report the unusual case of a woman with recurrent episodes of Graves' hyperthyroidism who developed transient CH during pregnancy. As a result of molecular similarities with the TSH molecule, hCG binds to the TSH-receptor and is responsible for a TSH-like effect inducing thyroid hormone secretion in normal pregnancy. On the other hand, Prummel et al.9 demonstrated that the TSH receptor was also expressed in folliculo-stellate cells of the human anterior pituitary.10 Indeed, these cells secrete proinflammatory interleukins (ILs), such as IL-6, which can inhibit TSH secretion by a paracrine effect on the TSH-secreting cells. Moreover, the hCG variant secreted by the woman could also bind to the TSH receptor present in folliculo-stellate cells, hence leading to their activation and inhibition of TSH secretion, thereby participating to the CH present only during the pregnancy (Figure 1). [Extracted from the article]

Objective: In order to identify women at high risk of pre-eclampsia and offer them aspirin prophylactic treatment, the Fetal Medicine Foundation (FMF) recommends a first-trimester screening test. The commonly used threshold for aspirin administration is a risk >1/100, which implies treating an important number of patients. We aimed to assess the use of this strategy with a more restrictive threshold: risk >1/70 and evaluate the impact of this strategy on the prevalence of pre-eclampsia with premature delivery in nulliparous women., Methods: A before-and-after cohort study conducted from 01/09/2014 to 01/12/2018, including nulliparous women undergoing first-trimester ultrasound at the University Hospital of Toulouse. Between 09/2014 and 09/2016 ("before cohort"), women did not undergo pre-eclampsia screening. Between 01/2017 and 12/2018 ("after cohort"), women underwent targeted pre-eclampsia screening using the FMF algorithm, and those with a risk >1/70 received 100mg aspirin. The primary outcome was pre-eclampsia with premature delivery. A univariate and then a multivariate analysis were performed to take into account potential confounding factors., Results: Among the 1030 women of the before cohort, 17 women (1.7%) experienced pre-eclampsia with premature delivery, compared to 8 women (1.3%) among the 629 of the after cohort, with no significant difference between the two groups (Adjusted Odd Ratio (95%CI)=0.73 [0.31-1.74]). In the after cohort, 18 women (2.9%) had a risk greater than 1/70 and therefore received aspirin. According to the FMF screening test, 89 women (14.1%) had a risk>1/100, which is the usual threshold for prescribing aspirin for prophylaxis. This means that 71 women had a risk greater than 1/100 but less than 1/70 and therefore did not receive aspirin in this study, even though they would have received aspirin at the usual threshold., Conclusions: The screening and prevention strategy for pre-eclampsia using restrictive thresholds did not decrease the rate of preeclampsia with premature delivery., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)