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STUDY QUESTION Can we monitor post-oocyte retrieval infections in the French national health data system to complement the French ART vigilance system? SUMMARY ANSWER Medico-administrative databases provide a more comprehensive view of post-oocyte retrieval infections and can be used to detect abnormal increases in frequency and outlier ART centers as a complementary tool to the ART vigilance system. WHAT IS KNOWN ALREADY The various studies of ART complications are reassuring, showing relatively low overall complication rates. Nonetheless, the European Union has set up a vigilance system to monitor these complications. However, this system is not an exhaustive source of information and does not provide a complete overview of post-ART complications. STUDY DESIGN, SIZE, DURATION The study population was identified from the comprehensive French national hospital discharge database. It included women under 46 years of age undergoing an oocyte retrieval in 2019, classified into three population subgroups according to the indication of oocyte retrieval: infertility (IF) , fertility preservation (FP), and oocyte donation (OD). The study population included 52 098 women who had undergone 65 948 oocyte retrievals in 2019. PARTICIPANTS/MATERIALS, SETTING, METHODS Hospital stays and delivery of antibiotics within 31 days after oocyte retrieval were analyzed. Women and infections were characterized according to various characteristics (age, comorbidities, indication of oocyte retrieval, type of hospital stay, length of hospital stay, type of antibiotherapy, etc.). Multivariate analysis was performed to determine the relation between the occurrence of infection and women's characteristics, and results are expressed as odds ratios (ORs) and 95% CI. A funnel plot and a box plot were used to compare the infection rate per center with the national average and to detect outliers. MAIN RESULTS AND THE ROLE OF CHANCE Infections in the month following the oocyte retrieval represented 6.9% of the procedures in 2019 (n = 4522). Of these infections, 112 were hospitalized (0.2% of oocyte retrievals), and 4410 were non-hospitalized (6.7% of oocyte retrievals). The hospitalized infections were essentially gynecological infections (40.9%) and urinary tract infections (23.5%). In 87.9% of non-hospitalized infections, a single antibiotic therapy was prescribed. Mixed-effect model analysis showed that the risk of infection was significantly higher in women under 30 years of age, in the FP population, in supplementary universal health coverage (CMU-C) beneficiaries, and women with endometriosis. Funnel plot and box plot analysis showed that three ART centers have an infection rate significantly higher than the national average. In the three centers that stand out from all the others, the objective is to return to these centers to understand the possible reasons for this observed rate and to implement corrective measures. LIMITATIONS, REASONS FOR CAUTION Despite all its advantages, the French national health data system presents some limitations, such as the risk of inappropriate coding. Another limitation of this study is that we cannot confirm an attributable relation between the infection and the ART procedure, even if the delay of 31 days after oocyte retrieval is consistent with the occurrence of a post-retrieval complication. In addition, antibiotics may be prescribed as a 'precautionary' measure in certain situations (women with a susceptibility to infection, complicated procedures), or as antibiotic prophylaxis for embryo transfer. WIDER IMPLICATIONS OF THE FINDINGS Despite the limits in identifying post-ART infections in medico-administrative databases, this approach is a promising way to complement the ART vigilance reporting system. This concept developed for infections will also be generalized to other complications with regular feedback to professionals. STUDY FUNDING/COMPETING INTEREST(S) No specific funding was sought for the study. The study was supported by the Agence de la biomédecine, France. The authors declare that they have no conflict of interest. TRIAL REGISTRATION NUMBER N/A. [ABSTRACT FROM AUTHOR]

Populations of the Critically Endangered hawksbill turtle Eretmochelys imbricata in the Seychelles showed significant declines in the past. They have since recovered and nesting numbers are increasing because of increased protection and management intervention. Data on their nesting ecology on Cousine Island were collected and analysed for the breeding seasons from 2004/2005 to 2013/2014 with the aim of improving management methods. The findings indicate that the number of nesting individuals increased during the study period (from x̅ = 34.3 nesters between 2004 and 2009, to x̅ = 55.4 nesters between 2010 and 2014); however, the clutch frequency was relatively low compared with other study areas. Night-time nesting increased, most likely because of increased disturbances across the study period. Clutch sizes decreased significantly across the nesting season, and there was a significant drop in hatching success in clutch sizes exceeding 200 eggs. The predation rate and infertility rate each showed an increasing trend over time. Nests incubating in full sun showed the highest mean hatching success rate and had the shortest mean incubation duration. The present study provides insight into the species' nesting ecology on Cousine Island and will better inform management decisions aimed at increasing hatching success and minimising threats such as beach erosion and predation. [ABSTRACT FROM AUTHOR]

The usefulness of isotope Lymphography was evaluated in patients with chronic lower leg swelling. Forty patients (15 male, 25 female, age range 5 months-67 years) were assigned one of six clinical diagnoses based on clinical assessments, venography and lymphography. All the patients and seven normal controls were examined with bilateral isotope lymphography involving subcutaneous injection of 0.15 ml 99mTc-antimony sulphide colloid into the first web space of each foot. The percentage uptake of isotope-colloid in the inguinal lymph nodes at i and 2 h was equated with lymphatic function. Highly significant (P = 0.0001) differences existed between the different clinical groups and isotope lymphography discriminated well between oedema of lymphatic and non-lymphatic origin. Isotope lymphography appears to be a safe and useful test of lymphatic function. [ABSTRACT FROM AUTHOR]

OBJECTIVE--Patients with exercise induced ventricular tachycardia associated with a "clinically normal" heart may have an abnormality of the regional distribution of the cardiac sympathetic nerve supply. In this study the regional distribution of the myocardial nerve supply in patients with ventricular tachycardia (VT) and control subjects was examined by [123] meta-iodobenzylguanidine (MIBG) scanning. PATIENTS AND DESIGN--Eight patients with exercise induced VT and seven patients with VT unrelated to exercise with "clinically normal" hearts were studied and compared with a control group of six subjects with atrioventricular reentrant tachycardia not related to exercise and eight patients with angiographically normal left ventricular function and normal coronary anatomy who had thallium scans without evidence of ischaemia or fixed perfusion deficits. METHODS--Single photon emission computed tomography gamma scanning was performed in patients three hours after intravenous injection of MIBG. The left ventricular MIBG uptake data was processed into bull's-eye target plots. The inferior portion of the scan frequently showed artefact due to uptake of MIBG in the liver or spleen and was not used for statistical analysis. Asymmetry of uptake was defined as a ratio of uptake exceeding 1.25 in the upper quadrants (posterior (anterolateral free wall)/anterior (anteroseptal region)) of the MIBG scan. RESULTS--Patients with VT had a higher proportion of asymmetrical MIBG scans (47%) than subjects in the control groups (0%) and this was particularly obvious in the patients with exercise induced VT (62.5%). This suggests that patients with VT may have relative denervation in the septal portion of the left ventricle leading to an imbalance of the sympathetic supply to the myocardium and locally imbalanced sympathetic or parasympathetic interactions. Considerable evidence from animal experiments suggests that imbalance of the sympathetic supply to the myocardium is important in the genesis of ventricular arrhythmia. CONCLUSIONS--These results support the hypothesis that selective denervation of the human myocardium may be an important mechanism in the genesis of VT in "clinically normal" hearts. [ABSTRACT FROM PUBLISHER]

Introduction: Radio-labelled white cell scans (WCS) provide non-invasive and accurate quantification of inflammatory bowel disease (IBD) activity in both large and small bowel and may be useful in the objective evaluation of treatments for IBD. Clinical activity scores are partly subjective and do not accurately reflect underlying inflammation. Aims: A methodological study to assess the efficacy of repeated planar WCS in monitoring the response to treatment of active IBD and comparing to clinical activity scores. Patients: 9 subjects with active ulcerative colitis (UC) (5 mild, 3 moderate, 1 severe) and 9 subjects with active Crohn's disease (CD) (5 mild, 3 moderate, 1 severe) were recruited. Methods: 99 mTc-HMPAO WCS were carried out immediately before and 2 weeks after treatment. Prior to each scan disease activity scores for UC (PowelI-Tuck index (PTI) and Mayo clinic score (MCS)) or CD (Crohn's disease activity index (CDAI), Harvey Bradshaw Index (HBI) and van Hees activity index (VHAI)) were calculated. Scan scores for total bowel activity were calculated by using a validated visual grading system at 1 hour. Two independent observers scored each scan and the final score was agreed by consensus. Results: In IBD subjects following anti-inflammatory treatment 11/18 (61%)of WCS improved, 4/18 (22%) remained unchanged and 3/18 (17%) deteriorated. In UC subjects there was agreement for direction of change in scan score and PTI in 4/9 (44%) and MCS in 3/9 (33%). In the CD subjects there was better agreement between WCS score and clinical scores (CDAI in 7/9 (78%); HBI in 5/9 (56%); VHAI in 5/9 (56%)). Conclusion: Clinical scores in IBD agree poorly with objective measures of bowel inflammation, and while valuable in assessing the patients general well being have limited application in assessing the anti-inflammatory effect of therapeutic agents. Non-invasive white cell scanning is a more reliable method to monitor the anti-inflammatory efficacy of treatments for... [ABSTRACT FROM AUTHOR]

Background: The amount and type of information that patients require about risk in order to consent to endoscopic procedures has never been established. Aims: To evaluate the amount of information patients undergoing endoscopic procedures require regarding risk. Methods: Patients were given written and verbal information about the nature, incidence, and consequences of complications, then asked how common each complication would have to be before requiring information for informed consent. Results: 150 colonoscopy and 150 gastroscopy patients were studied. 24-32% of gastroscopy and 31-43% of colonoscopy patients wanted to be informed of one or more complications irrespective of frequency. 19% of gastroscopy and 14% of colonoscopy patients wanted to know about all possible complications. This was unrelated to the severity of the complication. Among gastroscopy patients, 17-25% did not want to be informed of one or more complications no matter how serious or frequent they were, and again, this was unrelated to severity. In the colonoscopy patients only 2-17% did not want to be informed of one or more complications. Significantly fewer [0.7%] colonoscopy patients required no information about any complications, compared to gastroscopy patients (10%, p < 0.001). In both groups many more required information about serious complications than minor complications when the complications occurred with a risk rate < 1/1000 (p < 0.001). Conclusions: Up to a fifth of patients want to be informed of all possible complications. Consenting for colonoscopy requires greater risk disclosure. Patient's threshold for information on major complications is much lower than for minor ones. Serious complications likely to occur in >1/1000 cases should be disclosed to all patients. [ABSTRACT FROM AUTHOR]

Competing Interests: Competing interests: The BMJ has judged that there are no disqualifying financial ties to commercial companies. The authors declare the following other interests: none.

A 36-year-old woman presented to hospital 9 days after receiving her first dose of the ChAdOx1 nCoV-19 vaccine with fever, myalgia and a sore throat. She was previously fit and well with no prior vaccine reactions.There was no clinical response to initial treatment with intravenous (IV) antibiotics. Microbiology tests including for COVID-19 were negative. At day 5, she developed pleuritic pain and a pericardial rub. Echocardiography and subsequent cardiac magnetic resonance imaging showed evidence of constrictive pericarditis. Computed tomography revealed gross hepatomegaly and moderate splenomegaly. Blood tests showed raised inflammatory markers, deranged clotting, low platelets and a marked hyperferritinaemia.A presumptive diagnosis of a multi-system inflammatory disorder secondary to recent COVID-19 vaccination was made and high-dose IV methylprednisolone initiated. Following a high 'H score' of 70%-80% a diagnosis of secondary haemophagocytic lymphohistiocytosis (HLH) was made. She was treated with IV immunoglobulin with subsequent clinical response.HLH is a rare syndrome of acute and rapidly progressive systemic inflammation characterised by cytopenias, excessive cytokine production and hyperferritinaemia. The adult form has multiple triggers, including recent vaccination. This case prompts awareness among clinicians of HLH as a rare complication of COVID-19 vaccination but should not discourage individuals from vaccination., (© Royal College of Physicians 2021. All rights reserved.)

Background: As part of the French Human Biomonitoring (HBM) programme, the Esteban study described, among other things, biomarkers levels of various chemicals in adults (18-74 years old) and children (6-17 years old). This paper describes the design of the study and provides, for the first time, data on the biological exposure of the general French population to a wide range of contaminants posing a threat to human health which are currently found in domestic environments., Methods: Esteban is a cross-sectional study conducted on a nationwide sample of the French general population. Exposure biomarkers of six families of contaminants deemed detrimental to adults' and children's health were measured in biological samples collected either at participants' homes by a nurse, or brought to a National Health Insurance examination centre. All participants were randomly selected (2503 adults and 1104 children). The geometric mean and percentiles of the distribution of levels were estimated for each biomarker. Most of the descriptive statistical analyses were performed taking into account the sampling design., Results: Results provided a nationwide description of biomarker levels. Bisphenols (A, S and F), and some metabolites of phthalates and perfluorinated compounds (PFCs) (specifically, PFOS and PFOA) were quantified in almost all the biological samples analysed. Higher levels were observed in children (except for PFCs). Levels were coherent with international studies, except for bisphenols S and F, brominated flame retardants (BFRs) and parabens (with higher levels reported in the USA than in France)., Conclusion and Perspectives: This study is the first to provide a representative assessment of biological exposure to domestic contaminants at the French population level. Our results show that the French general population was exposed to a wide variety of pollutants in 2014-2016, and identify the determinants of exposure. These findings will be useful to stakeholders who wish to advocate an overall reduction in the French population's exposure to harmful substances. Similar future studies in France will help to measure temporal trends, and enable public policies focused on the reduction of those chemicals in the environment to be evaluated., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Optimising attendance rates in outpatient's clinics is important to ensure good clinical care and to avoid waste of scarce medical resources. We identified a cohort of teenagers that frequently were not brought (WNB) to the paediatric diabetes multidisciplinary clinics, compromising patient care and reducing compliance with National Padiatric Diabetes Audit (NPDA) standards. As these teenagers attend five local secondary schools, we initiated a quality improvement project to test the benefit of taking clinics into schools. From January 2017, after extensive engagement with stakeholders, quarterly clinic at school with a diabetic nurse and physician were offered to all teenagers with type 1 diabetes mellitus in these five schools. A semistructured interview was administered to identify their concerns about diabetes. HbA1c was checked, and glucose meters were downloaded. Outcome data were compared with previous 9 months. 34 teenagers were targeted (17 initially identified as frequent non-attenders and 17 controls at same schools). The hospital WNB rate was reduced in the intervention group by 50%, and patients not seen at least once in 3 months reduced from 9/17 to 1/17. Teenage patients expressed an increased positive experience. Relevant knowledge gaps and emotional difficulties were additionally identified and addressed. Lifestyle issues not previously known to team were also unveiled, for example, poor school attendance, bullying or high-risk behaviours. School clinics improved contact in this difficult to reach group. It shows promise as a vehicle to enhance engagement of young people in self-care, actively preparing them for transition., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)