Délégation Nord, Pas-de-Calais et Picardie

Background The type 1 insulin-like growth factor receptor (IGF1R) is a keystone of fetal growth regulation by mediating the effects of IGF-I and IGF-II. Recently, a cohort of patients carrying an IGF1R defect was described, from which a clinical score was established for diagnosis. We assessed this score in a large cohort of patients with identified IGF1R defects, as no external validation was available. Furthermore, we aimed to develop a functional test to allow the classification of variants of unknown significance (VUS) in vitro. Methods DNA was tested for either deletions or single nucleotide variant (SNV) and the phosphorylation of downstream pathways studied after stimulation with IGF-I by western blot analysis of fibroblast of nine patients. Results We detected 21 IGF1R defects in 35 patients, including 8 deletions and 10 heterozygous, 1 homozygous and 1 compound-heterozygous SNVs. The main clinical characteristics of these patients were being born small for gestational age (90.9%), short stature (88.2%) and microcephaly (74.1%). Feeding difficulties and varying degrees of developmental delay were highly prevalent (54.5%). There were no differences in phenotypes between patients with deletions and SNVs of IGF1R . Functional studies showed that the SNVs tested were associated with decreased AKT phosphorylation. Conclusion We report eight new pathogenic variants of IGF1R and an original case with a homozygous SNV. We found the recently proposed clinical score to be accurate for the diagnosis of IGF1R defects with a sensitivity of 95.2%. We developed an efficient functional test to assess the pathogenicity of SNVs, which is useful, especially for VUS.

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, any situation of malabsorption, clinical signs consistent with vitamin D deficiency or vitamin D overload, and calcium phosphorus evaluation. We suggest that the measurement of serum 25OHD concentration should remain reimbursed as part of these extended indications.

Rationale Telemonitoring has shown benefits during the initiation of home non-invasive ventilation (NIV) but evidence is lacking regarding its use during follow-up. A French national telemonitoring programme incorporating remote support and therapeutic education is designed to improve patient pathways and reduce healthcare resource utilisation. This study investigated the impact of the telemonitoring programme versus usual follow-up on the effectiveness of home NIV. Methods The prospective, multicentre, open-label eVENT trial enrolled adults recently started on home NIV. Participants were randomised to the telemonitoring or usual follow-up group. In the telemonitoring group, a CE-marked algorithm generated alerts based on teletransmitted ventilator data. Specialised nurses managed alerts and provided therapeutic education. The primary outcome was mean nocturnal transcutaneous carbon dioxide level (PtCO 2 ) on NIV after 6 months. Results 56 patients were randomised and 53 were analysed (telemonitoring: n=27, usual follow-up: n=26). At 6 months, mean PtCO 2 did not differ significantly between the telemonitoring and usual follow-up groups (42.1±6.1 vs 43.9±6.4 mm Hg; p=0.352) but mean room air partial arterial carbon dioxide pressure (PaCO 2 ) was significantly lower in the telemonitoring versus usual follow-up group (41.7±6.8 vs 46.2±3.5 mm Hg; p=0.003). The proportion of participants without diurnal or nocturnal hypercapnia at 6 months was 82.6% with telemonitoring and 27.3% with usual follow-up (p<0.001). Compared with usual follow-up, the telemonitoring group had greater NIV use, more days with NIV usage ≥4 hour and less non-intentional leaks. Conclusions In patients on home NIV, PtCO 2 was similar with telemonitoring and usual follow-up, but PaCO 2 levels and the quality of ventilatory support were significantly better with telemonitoring. Trial registration number NCT04615078 .

INTRODUCTION: Patients with inflammatory bowel disease (IBD) are at higher risk of thromboembolic events (TE). In pediatric-onset IBD, more data on incidence and risk factors of venous (VTE) and arterial events (ATE) at the population level are needed to guide thromboprophylaxis. METHODS: All patients aged ≤ 16 years diagnosed with Crohn's disease (CD) or ulcerative colitis (UC) between 1988 and 2011 in the prospective EPIMAD population-based registry were followed until 2013. Every TE occurring during the follow-up period was included. RESULTS: A total of 1,344 patients were included: 1,007 with CD and 337 with UC, and a median diagnosis age of 14.3 years. After a median follow-up of 8.3 years, 2 (0.15 %) ATE and 15 (1.1 %) VTE occurred at median age of 20.4 years. The global incidence rate of thromboembolic events was 1.32 per 1000 person-years. Periods of active disease (HR=8.4, p = 0.0002), the 3-month-period following surgery (HR=16.4, p = 0.0002) and hospitalization (HR=21.7, p < 0.0001) were found to be associated with an increased risk of VTE. A lower rate of VTE was found in patients treated with 5-aminosalicylates (HR=0.1, p = 0.002). CONCLUSION: The risk of TE was low in this population. VTE were strongly associated with active disease, surgery and hospitalization.

The periorbital area is the third highest-ranking area for cosmetic surgery. However, surgery in this area presents a number of difficulties and safety concerns. First generation Monopolar RF treatments in this area were usually associated with considerable pain and long downtime. In the present clinical study, we used the iFine handpiece of the EndyMed PRO, multi-source phase-controlled radiofrequency (RF) for Non-invasive, pain free, skin rejuvenation of the periorbital area. The study included eleven (11) subjects, treated for periorbital signs of aging (iFine handpiece, EndyMed PRO platform, EndyMed Medical, Caesarea, Israel). The degree of clinical improvement was assessed by the global aesthetic improvement scale (GAIS) and subjects satisfaction by post treatment questionnaires. 91% of patients showed good to excellent improvement as a result of the treatment. Subjects satisfaction showed that 55% of patients reported that they were very satisfied, 45% were satisfied while none were dissatisfied. There were no incidences of infections, scarring, hypopigmentation, or any other serious complications.

BACKGROUND: Neurodevelopmental disorders (NDDs) may influence the course of Alzheimer's disease (AD) and frontotemporal dementia (FTD). However, prior studies have focused on specific pairs of NDDs and variants of AD/FTD. Adopting a dimensional approach to NDDs and considering the heterogeneity of AD/FTD, we investigated the association between a neurodevelopmental vulnerability (DV) and the clinical presentation and age at onset of AD/FTD. METHODS: We prospectively and consecutively recruited 84 AD/FTD participants and 41 matched controls. AD/FTD participants were classified into typical (amnestic AD, behavioral FTD) and atypical (primary progressive aphasia, frontal and posterior variants of AD, right temporal variant of FTD, amnestic FTD) presentations. Participants underwent a neuropsychological assessment and answered a novel questionnaire on NDDs symptoms. Using k-means clustering based on the questionnaire, participants were assigned to a DV+ (with neurodevelopmental vulnerability) or a DV- (without) cluster. This data-driven approach enabled an unbiased classification of individuals with a DV, beyond traditional diagnostic labels. RESULTS: = 0.205; p = 0.651); and between typical (21%) and atypical (11%) subgroups (Fisher's test, p = 0.184). However, in DV+ patients, symptom onset occurred 8.0 years earlier than in DV- patients (95% CI [-14, -3.0]; p = 0.005), with a median onset age of 58 years (IQR: 15). CONCLUSIONS: A DV could favor early-onset AD/FTD, but may not affect susceptibility to typical and atypical variants of AD/FTD. The underlying neurophysiological processes involved require future investigation, with implications for precision medicine and individualized treatment strategies. STUDY REGISTRATION NUMBERS: RnIPH 2023-71 and Research Ethics Committee file No. 2023_765.

Neurodevelopmental disorders are frequent in the general population and are often lifelong conditions despite sometimes being masked by conscious or unconscious compensation and avoidance mechanisms. These conditions are often unknown or underestimated in adults, even when diagnosed in childhood. Neurodevelopmental disorders share similarities with and frequently interact in a complex way with neurodegenerative disorders. Considering these aspects during memory clinic assessments can provide a new perspective on lifelong neurocognitive trajectories. Assessing both neurodevelopmental and neurodegenerative dimensions is challenging but should improve diagnostic accuracy. It is therefore necessary to understand the lifelong specific neurocognitive trajectory of each patient in order to develop personalized and focused cognitive medicine and care.

Introduction Depression is a leading cause of disability, worldwide. Recently, WHO highlighted the negative impact of recent crises (COVID-19 pandemic, war in Ukraine, economic crisis). Although most international guidelines recommend psychotherapies as first-line treatment of depression, access remains scarce in France due to limited availability of trained clinicians (notably those with CBT certification), high cost for patient in a context of non-reimbursement and fear of stigmatization (Coldefy M. HCAA, 2022/04,19). Therefore, online blended psychological treatment such as deprexis® could increase access to care for people with depression. It presents several advantages such as easy access, scalability, and a proven efficacy (Twomey et al. PLoS One. 2020;15(1):e022810). Objectives This study aims to test real-life acceptability of deprexis® for people with depression in France outside a reimbursement pathway. Primary objective of this cross-sectional study is to measure acceptability of deprexis® a new digital therapy in France. Questionnaire includes acceptability of deprexis® assessed with patient willingness to complete deprexis® course, reasons of refusal, when needed, demographics and depression characteristics. The secondary objectives are to study 1/ acceptability according to type of center (Hospital based, Community Based or private practice) and type of practitioners (psychiatrists or psychologists), 2/ differences in acceptability according to severity’s level (evaluated with PHQ 9), 3/ differences in acceptability according to administration or not of a treatment (including psychotherapy), 4/ differences in acceptability according to prescriber’s profile (age, sex, place and type of practice), 5/ identification of reasons for refusal , and 6/ analyze refusal rate over time. Methods DARE is as a cross-sectional study in which deprexis® is suggested to any patient meeting the inclusion criteria over the fixed inclusion period June-December 2022 Inclusion criteria are: 1/ depression, 2/ age between 18 and 65 years, 3/ speak French sufficiently, 4/ access to Internet with a device to connect to deprexis® platform. Exclusion criteria are diagnosis of bipolar disorder, psychotic symptoms and/or suicidal thoughts during the current episode. All investigators received a video-based training on deprexis® before inclusion to make sure they all have same level of information and understanding on the program. Results The study is currently recruiting. Data will be available for EPA congress. Conclusions It is a first time a digital therapy is completing the current therapeutic options for the treatment of depression in France. Acceptability of this innovation by both patients and Healthcare providers is a first step. DARE may allow to have a better understanding of the acceptability of a digital therapy in the treatment of depression in France and identify the different factors influencing it in a natural setting. Disclosure of Interest O. Amiot Consultant of: Ethypharm Digital Therapy, A. H. Clair Consultant of: Ethypharm Digital Therapy, P. Courtet Consultant of: Ethypharm Digital Therapy, E. Fakra Consultant of: Ethypharm Digital Therapy, V. Narboni Employee of: Ethypharm Digital Therapy, F. Gheysen Consultant of: Ethypharm Digital Therapy, E. Haffen Consultant of: Ethypharm Digital Therapy, D. Drapier Consultant of: Ethypharm Digital Therapy, L. Lecardeur Consultant of: Ethypharm Digital Therapy

Hidradenitis suppurativa (HS) is an inflammatory skin condition with a global prevalence is estimated between 0.00033% and 4.1%, but is likely around 0.7%–1.2% in Europe and the United States.1, 2 Misdiagnosis of HS is common and leads to delays in proper treatment.3, 4 ‘Diagnostic wandering’ refers to the process in which a patient undergoes multiple tests, consultations or referrals without reaching a definitive diagnosis. This term often describes situations where healthcare providers are unable to pinpoint the exact cause of a patient's symptoms, leading to a prolonged search for a diagnosis. This study aimed to assess diagnostic wandering in HS patients and identify associated factors in France. A questionnaire, developed with input from HS experts and patient groups and approved by the French Society of Dermatology's Task Force HS group, was administered to patients with a confirmed HS diagnosis at 26 centres from February to May 2024. The questionnaire covered sociodemographic factors and the duration of diagnostic wandering in weeks. Results were compared by gender. Multivariate logistic regression analysed predictors of diagnostic wandering, including age, gender, residential area (rural vs. urban), time since diagnosis (less than 3 years), education level, and income (with a reference of the French minimum wage of 1500 euros per month). 905/1255 responses (72.1%) were women. Men were significantly older than women (40.2 ± 12.6 vs. 33.3 ± 10.9 years, p = 0.005). The average age of HS onset was 27.1 years for women and 25.1 years for men. Nearly 49% (n = 613) of patients had an income below the minimum wage. Diagnostic wandering was reported by 68.8% (n = 863) of participants, with 73% (n = 661) of women and 57.8% (n = 202) of men experiencing delays (p < 0.001). The average duration of diagnostic wandering was 235.8 ± 283.3 weeks (about 4.5 years) for women and 213.3 ± 229.3 weeks (about 4.1 years) for men, with no significant difference (p < 0.05). Patients with diagnostic delays consulted an average of 5.2 ± 4 doctors compared to 2 ± 1.2 doctors for those without delays (p < 0.0001). Multivariate analysis identified factors associated with diagnostic wandering: females (OR = 2.26 [1.66; 3.06], p < 0.0001), >40 y.o (OR = 1.52 [1.12; 2.06], p = 0.01), income below the minimum wage (OR = 1.52 [1.12; 2.06], p = 0.006), low education (OR = 1.41 [1.04; 1.92], p = 0.028). Diagnoses made after 2020 were less likely to involve diagnostic wandering (OR = 0.66 [0.4; 0.93], p < 0.001), but living in urban or rural areas showed no significant association (OR = 0.96 [0.25; 1.28], p = 0.99) (Table 1). The study highlights significant gender differences in age at diagnosis and diagnostic wandering, with women more frequently experiencing delays. This contrasts with a study by Kokolakis et al.,4 finding similar delays for both genders (mean 10.0 ± 9.6 years). Most affected were individuals with low income and education. Earlier studies2, 3 showed delays averaging 7 years, with similar results between 2017 and 2020 averaging 10 years.4-6 Recent improvements in awareness among healthcare professionals might be contributing to reduced delays. Targeted education for medical professionals could address these disparities and improve timely diagnosis. Diagnostic delays not only worsen patient morbidity but also increase healthcare costs. A 2014 study7 involving over 16,000 HS patients found that inpatient care was the largest component of healthcare spending, with nearly 16% hospitalized over a 3-year period and over a quarter visiting the emergency department. Early diagnosis and appropriate maintenance therapy could likely reduce the use of these high-cost settings, shifting the focus to outpatient management. Furthermore, prolonged diagnostic wanderings have been associated with a higher likelihood of absenteeism at work, potentially leading to lost wages for patients.8 In view of the significant disparities9 that still exist, particularly affecting vulnerable populations, continued attention and targeted interventions are necessary and enhanced efforts remain crucial to mitigate these disparities and ensure timely and accurate diagnoses, thereby improving outcomes for all HS patients. The authors would like to thank the patient associations [Solidarité Verneuil & AFRH] and the members of HS France, a thematic group of the French Dermatology Society. This project was funded by La Roche Posay International & Almirall. C. Le Floc'h; D. Kerob; A. L. Demessant are Employees La Roche Posay, J. M. Joubert & G. Caillet are Employees of Almirall. C. Fite; C. Taieb; A. Nassif; M. Delage-Toriel; C. Cassius; C. Skayem; Y. Benhayoun; M. F. Bru; M. Moulin; B. Halioua; C. Zimmermann; E. Pommaret; I. Nicol; O. Cogrel; M. A. Richard have no conflicts of interest to declare. The patients have confirmed their agreement to take part. information note IDRCB 2022-A05651-42 [Committee for the Protection of Individuals South-East IV, dated 31 July 2023]. The data that support the findings of this study are available from the corresponding author upon reasonable request.

ABSTRACT To eliminate hepatitis C virus (HCV) infection in France, prescribing rights for sofosbuvir/velpatasvir (SOF/VEL) were extended to non‐specialists, and a simplified care pathway for non‐severe patients was implemented. Patients can thus be treated once diagnosis is confirmed (“Test and Treat” model). The study's objective was to describe the effectiveness and safety of SOF/VEL when prescribed in routine practice in France. This French multicenter, prospective, noninterventional study included adults with chronic HCV infection, treated with SOF/VEL for 12 weeks. Data on patient characteristics, fibrosis stage and HCV RNA were collected from medical charts. The primary endpoint was the proportion of patients with sustained virologic response 12 weeks post‐treatment (SVR12). Secondary endpoints included safety profile, time between tests and treatment initiation, and demographics of treated patients. A total of 371 eligible patients received at least one dose of SOF/VEL: 77.4% were treated by specialists, and 22.6% by non‐specialists. In the specialist group, more patients had ongoing comorbidities (29.6% vs. 7.1%), and advanced fibrosis (26.3% vs. 18.4%). In the non‐specialist group, more patients reported alcohol consumption (39.3% vs. 34.4%) and drug abuse (23.8% vs. 16.4%). Among the 303 patients eligible for SVR12 analysis, SVR12 rates were nearly identical between the groups: 98.4% (95% CI: 95.84–99.36) with the specialists and 98.3% (95% CI: 91.14–99.71) with the non‐specialists. Median time between positive PCR test and treatment initiation was 30 days in both groups. SOF/VEL was well tolerated, and adherence was high regardless of the prescriber. Non‐specialists successfully treated chronic HCV infection with a simplified care pathway.

A global call was made by the World Health Organization for governments to take action in reducing the stigmatization of patients with skin conditions.1 The Patient Unique Stigmatization Holistic tool in Dermatology (PUSH-D) is a newly validated tool that assesses stigmatization in skin conditions.2 Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that can severely impact patients' quality of life.3 The objective of our study was to assess for the first time the PUSH-D in a large population of patients with HS. A questionnaire [constructed with HS experts and patient associations, was administered to patients with a confirmed diagnosis of HS by a dermatologist in 26 centers in France between February and May 2024]. We aimed to study the factors impacting stigma in HS patients using the PUSH-D score. The questionnaire included sociodemographic factors and HS characteristics, as well as a dedicated part for the PUSH-D. The PUSH-D questionnaire explores the stigma experienced over the past 4 weeks through 17 questions.2 Multivariate linear regression was employed to evaluate the relationship between the PUSH-D score and the following variables: gender, Hurley stage, intensity of discharge, severity of painful flare-ups, BMI ≥25 kg/m2, time since diagnosis >3 years, reduced libido, partner's devaluation, and overall unsatisfactory sexual life. Data multicollinearity was tested using the Belsley–Kuh–Welsch technique. Statistical analysis was performed using EasyMedStat. A total of 1255 responses were obtained, with 419 considered evaluable [respondents had the option not to answer questions related to sexuality], resulting in a female/male ratio of 78.5% to 21.5%. In multivariate analysis, being male [β = 6.23]; Hurley III [β = 3.59], frequent discharge [β = 2.66], intense residual pain outside of a flare-up [β = 7.92], an overweight BMI [β = 2.93], reduced libido [β = 3.73], partner's devaluation[β = 12.09] and a USL [β = 2.45] were associated with a higher PUSH-D score and thus greater stigma. The duration of time since diagnosis was not associated with a higher stigma score (Figure 1). Our study is the first to assess the PUSH-D-score in HS patients. Male patients reported higher stigma, contrasting with some studies showing higher psychological burden in female patients due to societal appearance expectations. Some previous studies found that women had higher sexual health4 burden from HS. In contrast, others showed no gender difference regarding depression from HS.3 Severe disease presentation (Hurley III), frequent discharge, and intense residual pain were also significant predictors of stigma. In fact, persistent symptoms can lead to social withdrawal and shame, exacerbating stigma. Overweight BMI was associated with higher stigma, which might reflect a compounded stigma from societal biases against obesity and visible skin conditions. This dual stigma highlights the need for comprehensive management addressing both dermatological and metabolic health. Sexual health emerged as crucial, with reduced libido and unsatisfactory sexual life significantly linked to higher stigma. This aligns with other studies reporting HS severely impacts sexual health, causing psychological distress and stigma.3, 5, 6 The strong association between partner devaluation and stigma underscores the importance of interpersonal relationships in HS patients' psychological well-being.7 Interestingly, the duration of time since diagnosis did not show a significant association with stigma scores in our study. This contrasts with some previous findings8 suggesting that longer disease duration may lead to increased stigmatization due to cumulative psychological burden. However, our results suggest that factors related to disease severity and its impact on daily life9, 10 may have a more immediate effect on perceived stigma. In conclusion, our study identified critical factors associated with stigma in HS patients, providing insights for targeted interventions. Moreover, our study is the first to use a skin-specific stigmatization tool in HS, which helps to better interpret the PUSH-D-score and facilitate its use in future clinical trials. The authors would like to thank the patient associations [Solidarité Verneuil & AFRH] and the members of HS France, a thematic group of the French Dermatology Society. This project was funded by La Roche-Posay International & Almirall. C. Le Floc'h, D. Kerob, A. L. Demessant are Employees of La Roche-Posay. J. M. Joubert & G. Caillet are Employees of Almirall. C. Fite, C. Taieb, A. Nassif, M. Delage-Toriel, C. Cassius, C. Skayem, Y. Benhayoun, M. F. Bru, M. Moulin, B. Halioua, C. Zimmermann, E. Pommaret, I. Nicol, O. Cogrel, M. A. Richard had no conflicts of interest in this work. The South-East IV Committee for the Protection of Individuals gave a favourable opinion on the project on 31 July 2023 [IDRCB 2022-A05651-42]. The patients have confirmed their agreement to take part. Information note IDRCB 2022-A05651-42 [Committee for the Protection of Individuals South-East IV, dated 31 July 2023]. The data that support the findings of this study are available from the corresponding author upon reasonable request.

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La maladie de Parkinson est, tout au long de son évolution, à l’origine de multiples incapacités et déficiences (motrices, cognitives, psychiatriques, dysautonomie…) qui peuvent avoir un impact direct sur l’aptitude à la conduite automobile. Cette aptitude doit être régulièrement évaluée. Depuis l’arrêté ministériel du 28 mars 2022, les troubles neurologiques de la maladie de Parkinson sont susceptibles d’entraîner une incompatibilité à la conduite automobile et de nécessiter une validation du permis par un médecin agréé. À partir d’une revue de la littérature et d’avis d’experts, nous avons proposé une méthode simple d’évaluation pour les médecins spécialistes en neurologie ou gériatrie. Le risque à la conduite a été catégorisé selon 3 niveaux : « feu vert » (risque minime), « feu orange » (risque modéré qui nécessite une évaluation plus détaillée, idéalement avec un test de conduite en conditions réelles), et « feu rouge » (risque majeur devant faire cesser la conduite). La restriction ou l’interdiction de la conduite a souvent un impact majeur pour les malades et leurs aidants sur le plan psychologique et celui de l’autonomie. Toute restriction de la conduite automobile doit être accompagnée de conseils et d’accompagnement vers d’autres formes de mobilité. All along its progression, Parkinson's disease (PD) causes many disabilities (e.g. motor, cognitive, psychiatric or dysautonomia), which could impact driving ability. Thus, driving ability must be regularly assessed. In France, since the 28 March 2022 ministerial decree, parkinsonian symptoms must be considered as having a potential impact on driving capacity and might need the renewal of the driving license to be validated. Based on the review of published articles on the subject and on experts’ opinion, we have proposed a simple method of assessment to be used by neurologists or geriatricians. We have defined a 3-level risk gradation: “green light” (mild risk of car accident), “orange light” (moderate risk, thus requiring a more detailed evaluation – ideally with a real-world driving test), and “red light” (high risk that leads to recommend driving cessation). Restriction or cessation of driving has for patients and caregivers a major impact on autonomy and psychological well-being. Any imposed driving restriction should be accompanied by advice and support towards other forms of mobility.

La découverte d’une maladie incurable est un choc pouvant entraîner des réaménagements psychiques permettant de lutter contre un effondrement narcissique. À travers le cas de monsieur T., l’auteur s’intéressera à la métamorphose des investissements libidinaux d’un patient ayant reçu un mauvais diagnostic. La mise en place d’un clivage fonctionnel entre réalité interne et réalité externe soutient les relations d’objet du sujet au détriment de la stabilité de son Moi. L’auteur exposera le rétablissement du patient à un accès subjectif à ses éprouvés sensoriels à travers un atelier d’écriture thérapeutique. Enfin, il mettra en évidence le rôle potentiel d’un groupe thérapeutique dans l’accompagnement du travail de trépas.

L’apport le plus innovant et le plus audacieux de l’EPNP constitue l’intérêt porté au développement de l’enfant entre 4 et 14 semaines. Le professionnel formé au développement du nourrisson pourra observer l’adaptation de l’enfant à sa nouvelle niche écologique et en particulier la gestion de la sensation de pesanteur, sa motricité, les premiers schémas moteurs et les premières coordinations. Il s’agit de repérer, le plus tôt possible, les anomalies neuromotrices transitoires, signes avant-coureurs des troubles du neurodéveloppement, afin de proposer des ajustements physiques et humains appropriés.

Hidradenitis suppurativa (HS) has a major impact on women’s sexual health and desire for children. The results of our nationwide study in France reveal that more than one-third of women with HS face substantial challenges in fulfilling their desire for pregnancy, with sexual and emotional burdens often overlooked during medical consultations. Enhanced counselling and systematic evaluation are essential to address these gaps in care.

Cet article explore la complexité clinique d’états dissociatifs observés chez des sujets réfugiés en France qui interprètent leurs expériences psychiques à travers la croyance d’être victime de transe de possession par des Djinns. S’appuyant sur une approche interculturelle et une méthodologie mixte, cette recherche vise à identifier les étiologies sous-jacentes de ces phénomènes et leur articulation possible avec le traumatisme ou la psychose, en tenant compte des référentiels culturels propres aux sujets. Trois hypothèses sont explorées : une origine psychotraumatique, une structure psychotique à thème mystique et la nécessité d’une lecture contextuelle intégrant les croyances culturelles dans l’analyse clinique. Cet article met ainsi en lumière la complexité des processus de subjectivation chez ces patients, entre altération du sentiment d’agentivité, élaboration narrative du trauma et recours à une cosmologie culturelle signifiante.

Les études Epistress avaient comme objectif de caractériser les sujets vivant avec un diabète de type 1 (SvDT1) selon l’impact du stress sur leur glycémie. Epistress 1 et 2 sont des enquêtes épidémiologiques transversales ponctuelles, réalisées via un formulaire en ligne auprès respectivement de 170 svDT1 (Epistress 1, étude monocentrique) et de 1134 SvDT1 (Epistress 2, étude multicentrique, 11 centres), tous ces sujets étant traités par pompe. Dans Epistress 1 ( n = 170), 57 % des participants indiquent que le stress perturbe souvent leur glycémie, (1–2 fois/semaine à plusieurs fois/jour) et la perturbation la plus fréquente était l’hyperglycémie (62 %). Quatre profils ont été définis : P1 (57 %) ; P2 (11 %) ; P3 (25 %) ; P4 (6 %). Il n’était pas retrouvé de différence entre ces 4 groupes concernant l’âge, l’ancienneté du diabète, le sex-ratio, l’HbA1c, la fréquence/seuil de perception des hypoglycémies. Dans Epistress 2, les proportions des 4 profils glycémiques étaient similaires : P1 54 % la glycémie augmente sous l’effet du SPSC en moyenne de 1,3 g/L ; P2 10 % la glycémie diminue (−0,7 g/L), P3 25 % impact glycémique variable (−0,8 à +1,3 g/L) et P4 11 % pas d’impact glycémique notable. Parmi 94 des 170 patients de l’étude Epistress 1 ont répondu au même questionnaire (QI) lors d’Epistress 2 et ¾ d’entre eux avaient gardé strictement le même profil 3 ans plus tard. Le stress psychosocial chronique induit plus souvent des hyperglycémies que des hypoglycémies. Cet impact peut être majeur chez certains sujets. Cet effet est durable et retrouvé à 3 ans d’intervalle.

L’évolution des grossesses après chirurgie bariatrique apparaît favorable avec une diminution des risques de diabète gestationnel, d’hypertension et de macrosomie fœtale, mais une augmentation des risques de petit poids de naissance pour l’âge gestationnel et de prématurité des nouveau-nés. Sont également reportées des carences nutritionnelles plus oumoins sévères chez les mères et les nouveau-nés, ainsi que des complications chirurgicales de pronostic parfois défavorable. BARIA-MAT est un groupe de travail multidisciplinaire, proposant des recommandations de bonnes pratiques cliniques, élaborées selon la méthodologie de la Haute Autorité de santé. Les questions abordées par le groupe ont inclus : délai entre chirurgie et grossesse, choix de contraception, technique chirurgicale privilégiée pour les femmes en âge de procréer, spécificité du parcours obstétrical, modalités de dépistage des carences et supplémentations nutritionnelles, dépistage et gestion du diabète gestationnel, prise de poids optimale, ajustement de l’anneau gastrique, conduite à tenir devant une suspicion d’urgence chirurgicale, soins spécifiques pendant la période post-partum et pour les nouveau-nés.