[The impact of the COVID-19 health crisis on the well-being of women giving birth]. / Face à la COVID-19. L'impact de la crise sanitaire de la COVID-19 sur le bien-être des accouchées.

The objective of this work is to investigate the impact of COVID-19 health crisis on the psychological status in the first few days after giving birth. Three hundred and sixty women who gave birth in 2020 at Vivalia Hospital in Arlon (Belgium) responded to an objective data questionnaire as well as to the Edinburgh Postnatal Depression Scale (EPDS) self-questionnaire translated into French, a tool recognized in the aids in screening for postpartum depression. According to their due date, the patients were divided into three conditions, a control group and two experimental groups. The aim of this exploratory study was to assess the impact of social restrictions associated with COVID-19 on the well-being of women giving birth. The results show that the EPDS score in the immediate postpartum period for women who gave birth during the two waves of COVID-19 in 2020, associated with a strict limitation of visits, is lower (corresponding to less depression) than that of women who gave birth outside the COVID-19 period or during the partial deconfinement phase.

Le but de ce travail est d'étudier l'impact de la crise sanitaire COVID-19 sur l'état psychologique des femmes venant d'accoucher. Trois cent soixante femmes ayant accouché en 2020 à l'hôpital Vivalia d'Arlon (Belgique) ont répondu à un questionnaire comprenant l'auto-questionnaire Edinburgh Postnatal Depression Scale (EPDS), un outil reconnu dans l'aide au dépistage de la dépression du post-partum. Selon leur date d'accouchement, les patientes étaient réparties dans trois conditions, un groupe contrôle et deux groupes expérimentaux. Le but de cette étude était d'évaluer l'impact de crise sanitaire de la COVID-19 sur le bien-être des accouchées. Les résultats de l'EPDS dépistent moins de risque de dépression du post-partum chez les femmes ayant accouché durant les deux vagues de COVID-19 en 2020, imposant une limitation stricte des visites, que chez les femmes ayant accouché hors période COVID-19 ou lors de la phase de déconfinement partiel.

Severe Thoracic and Spinal Bone Abnormalities in neurofibromatosis type 1.

Neurofibromatosis type 1 (NF1) is an autosomal dominant, multi-system, neurocutaneous disorder that predisposes to the development of benign and malignant tumors. Classical skeletal abnormalities encompass sphenoid wing dysplasia, congenital bowing of the long bones and vertebral osteopathy associated with non-dystrophic or dystrophic scoliosis found in about 10% of NF1 patients. We report a 17-year-old boy affected by NF1 with extreme severe spinal and thoracic malformations affecting bone and lung tissues, including hypoplasia of the right lung, unilateral costal agenesis and severe dystrophic scoliosis characterized by association of hemivertebra, fusion of adjacent vertebral bodies and defective pedicles. At birth, he presented an acute respiratory distress requiring invasive ventilator support. The diagnosis of NF1 was confirmed at age 5 by the identification of a de novo heterozygous mutation c.4537C > T, p.Arg1513* in NF1. Trio-based Whole Exome Sequencing (WES) was performed to exclude coexistence of a second hit but no clearly other pathogenic variant has been identified. Until now, only one similar NF1 patient suffering from the same association of severe scoliosis and chest deformity leading to respiratory insufficiency was described. The severe prenatal NF1-related scoliosis could explain the lung abnormal development by absence of mechanical constraints. Severe Thoracic and Spinal Bone Abnormalities may be part of the NF1 bone phenotype and should be taken into account to allow adequate genetic counseling.

Neurologic Disorders in Immunocompetent Patients with Autochthonous Acute Hepatitis E.

Neurologic disorders, mainly Guillain-Barré syndrome and Parsonage­Turner syndrome (PTS), have been described in patients with hepatitis E virus (HEV) infection in industrialized and developing countries. We report a wider range of neurologic disorders in nonimmunocompromised patients with acute HEV infection. Data from 15 French immunocompetent patients with acute HEV infection and neurologic disorders were retrospectively recorded from January 2006 through June 2013. The disorders could be divided into 4 main entities: mononeuritis multiplex, PTS, meningoradiculitis, and acute demyelinating neuropathy. HEV infection was treated with ribavirin in 3 patients (for PTS or mononeuritis multiplex). One patient was treated with corticosteroids (for mononeuropathy multiplex), and 5 others received intravenous immunoglobulin (for PTS, meningoradiculitis, Guillain-Barré syndrome, or Miller Fisher syndrome). We conclude that pleiotropic neurologic disorders are seen in HEV-infected immunocompetent patients. Patients with acute neurologic manifestations and aminotransferase abnormalities should be screened for HEV infection.

Long-term bone loss in kidney transplant recipients: a cross-sectional and longitudinal study.

Organ transplantation is associated with an early bone loss that subsequently increases the risk of osteopenia and bone fractures. It is not known whether bone loss continues in long-term survivors, but persistent bone demineralization could further jeopardize an already diminished bone mass. To better define long-term bone status of kidney transplant recipients (KTR), we conducted cross-sectional and longitudinal evaluations of bone mineral density (BMD) in 70 KTR with a mean posttransplantation time of 8.1 years. BMD was determined by dual-energy X-ray absorptiometry and was repeated in 55 of the patients after a mean follow-up period of 22 +/- 5 months. Lumbar and femoral osteopenia, defined as a BMD lower than 2 standard deviations from mean value of sex- and age-matched controls, was present in 28.6% and 10.5% of patients, respectively. There was a significant negative correlation between cumulative prednisone dose and adjusted lumbar as well as femoral BMD (R = 0.45, P < 0.001 and R = 0.29, P < 0.05, respectively). Five patients had a vertebral BMD below a fracture threshold of 0.777 g/cm2. Vertebral fractures (VF) were found in four men and were associated with higher prednisone dosage (P < 0.05), larger cumulative prednisone dose (P < 0.05), and significantly lower BMD values. According to World Health Organization recent criteria for women, prevalences of lumbar and femoral osteopenia and lumbar and femoral osteoporosis in female patients reach 75%, 65%, 33%, and 10%, respectively. The longitudinal part of the study showed a persistent pathological lumbar demineralization process. Over the study period, BMD, expressed as a percentage of that of controls, decreased from 89 +/- 14% to 86 +/- 14% (P < 0.001). Annual change of bone mass was -1.7 +/- 2.8% per year. Accelerated vertebral bone loss (defined as a decrease of BMD, expressed as a percentage of that of controls, of more than 1% per year) was present in 56% of patients and was associated with higher prednisone dosage (P < 0.01). In conclusion, although VF are relatively infrequent in long-term survivors of renal transplantation, osteopenia is a frequent finding, and a substantial proportion of women present lumbar osteoporosis. An ongoing demineralization process of the spine is also demonstrated and probably contributes to long-term spinal osteoporosis incidence. Prednisone dosage remains the most constantly isolated risk factor.