Introduction L'endocardite infectieuse (EI) est une pathologie grave, avec une morbi-mortalité élevée, nécessitant une antibiothérapie prolongée. Les bactéries les plus fréquemment responsables d'EI sont les cocci gram positif (CGP) comme les staphylocoques, les streptocoques et les entérocoques. La dalbavancine, un lipoglycopeptide actif sur les CGP avec une longue demi-vie de 14,4 jours, permet un traitement prolongé avec une à deux injections. Cette molécule pourrait être une alternative thérapeutique pour les patients présentant un maintien parentéral difficile et un relai per os complexe (interactions, faible compliance, soins palliatifs, etc). Cependant, les données sur son efficacité en vraie vie dans le traitement de l'EI restent limitées. L'objectif principal de notre étude était d'évaluer l'efficacité clinique de la dalbavancine à j90 dans le traitement des EI. Les objectifs secondaires étaient d'évaluer la toxicité et l'efficacité à 6 et 12 mois. Matériels et méthodes Une étude multicentrique (9 hôpitaux), rétrospective et observationnelle des patients avec une EI à CGP traités par dalbavancine curative a été menée entre 01/2019 et 06/2025. L'efficacité de la dalbavancine a été déterminée par un critère composite (mortalité, ré-hospitalisation, chirurgie non programmée, rechute microbiologique et nouvelle manifestation embolique). La toxicité était évaluée par les effets secondaires cliniques et biologiques. Résultats Quatre-vingt-quatorze patients ont été inclus, majoritairement des hommes (69 soit 73.4%) avec un âge moyen de 65 ans et un score de Charlson moyen à 5. Parmi eux, 24% (23) étaient usagers de drogues intraveineuses et 21% (20) étaient immunodéprimés. Les documentations bactériologiques étaient: Staphylococcus aureus (53 soit 56,4%), puis les Staphylocoques à coagulase négative (20 soit 21,3%), les Streptocoques (16 soit 17%), enfin les Entérocoques (10 soit 10,6%). Les principales indications étaient: de faciliter le retour au domicile (40 soit 42,6%), usage de drogue intraveineuse (22 soit 23,4%), toxicité ou allergie à la première ligne (21 soit 22.3%). L‘efficacité clinique à j90 était confirmée pour 72,3% des patients (68), avec 4 échecs de traitement. L‘efficacité clinique était confirmée pour 59,6% des cas (56) à 6 mois, et 37,2% (35) à 12 mois. Ce faible taux de succès à 12 mois s'explique par un grand nombre de perdus de vue (32 soit 34%) et de patients décédés de pathologies non infectieuses (20 soit 21,3%). Les échecs étaient rares (7 soit 7,4% à 12 mois) et majoritairement expliqués par des prises en charges chirurgicales insuffisantes. La tolérance était excellente avec seulement deux effets indésirables rapportés. Conclusion Pour des patients difficiles à traiter, la dalbavancine offre une efficacité de plus 70% à 3 mois. Ce taux baisse à 6 et 12 mois en lien avec des pertes de vue de patients. La dalbavancine semble une alternative efficace et bien tolérée dans les EI à CGP.
Recreational use of nitrous oxide is rapidly increasing in France and across Europe, accompanied by a rise in neurological, cardiovascular and psychiatric complications. In this context, portable devices, particularly those based on infrared spectroscopy (IR), are being proposed to detect N2O several hours after inhalation. However, physiological data show that N2O has very low blood solubility, diffuses rapidly, and is almost completely eliminated within approximately 30 minutes, with a half-time of about 5 minutes. The prolonged detection reported in profile and is based on controlled conditions that are difficult to extrapolate to real-world settings. Exhaled concentrations are strongly influenced by ventilation, cardiac output and breathing technique, resulting in significant interindividual variability. From an analytical perspective, headspace gas chromatography-mass spectrometry (HS/GC-MS) remains the laboratory reference method but is not suitable for rapid field screening. Infrared spectroscopy offers a promising portable alternative, yet it still faces methodological limitations, variability issues and a lack of robust validation. Based on current knowledge, a breath test could serve as a qualitative screening tool for recent exposure, but it does not yet allow reliable quantification or robust medico-legal interpretation without further scientific evidence and an appropriate regulatory framework.
Objective The Société Française d'Anesthésie et de Réanimation (SFAR) and the Collège d'Anesthésie-Réanimation en Obstétrique (CARO) have collaborated to propose a set of guidelines for the pain management in childbirth: neuraxial analgesia and drug alternatives. Design A consensus committee of 32 experts was convened. A formal conflict-of-interest policy (DPI santé) was developed at the beginning of the process and enforced throughout. The entire guideline construction process was conducted independently of any industrial funding (i.e., pharmaceutical, medical devices). The authors were required to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. These recommendations have undergone a certification process by the French National Authority for Health (HAS). Methods Five areas were defined: 1) Placement of neuraxial analgesia; 2) Initiation of neuraxial analgesia; 3) Maintenance of neuraxial analgesia; 4) Management of neuraxial analgesia insufficiency and failure; 5) Drug alternatives to neuraxial analgesia. For each field, the aim of the recommendations was to answer a number of questions formulated by the experts according to the PICO model (‘Population, Intervention, Comparison, Outcome’). Based on these questions, an extensive literature search covering the last 24 years was carried out using predefined keywords according to the PRISMA recommendations. Data quality was analyzed using the GRADE method. The recommendations were formulated using the GRADE method, then voted on by all the experts using the GRADE grid method. Results The experts' synthesis work and the application of the GRADE® method resulted in 39 recommendations. Among the formalized recommendations, 12 have high levels of evidence (GRADE 1+) and 10 have low levels of evidence (GRADE 2+). For 13 recommendations, the GRADE method could not be applied, resulting in expert opinions. Four questions did not find any evidence in the literature. After 3 rounds of scoring and amendment, strong agreement was reached for all the recommendations. Conclusions There was strong agreement among the experts to provide recommendations for improving the management of pain in childbirth using neuraxial analgesia or alternative drug.
Autoimmune pancreatitis type 2 (AIP-2) is associated with an inflammatory bowel disease (IBD) in 15-30 % of cases. Epidemiological and histological data suggest shared pathogenic pathways. Several studies have reported that IBD treatments may improve AIP-2 outcomes. We aimed to assess the impact of IBD treatments on the clinical course of AIP-2. We conducted a multicenter retrospective cohort study across 16 French and Belgian centres, including all patients with IBD who had a concomitant or subsequent diagnosis of AIP-2 according to ICDC criteria between2010 to 2025. Inclusion date corresponded to the date of AIP-2 diagnosis. Therapeutic effect of IBD therapies (conventional immunosuppressants, anti-TNF agents, and other advanced therapies) on AIP-2 was assessed through clinical response (symptoms improvement or resolution), radiological response (improvement or resolution of imaging abnormalities), and the occurrence of clinical and/or radiological relapse during follow-up. Ninety-six patients (48 women) were included. Mean age at IBD and AIP-2 diagnosis was 30 ± 13 and 34 ± 14 years, respectively; ulcerative colitis was the predominant IBD subtype (74%). At AIP-2 diagnosis, 52 patients (54%) were receiving IBD therapy. Clinical benefit was observed in 35/52 (67%) patients: 30/35 (86%) treated with corticosteroids, 2/4 (50%) with anti-TNF, and 3/4 (75%) with conventional immunosuppressants. Radiological benefit was observed in 22 (63%) patients treated with steroids, 2 (50%) with anti-TNF, and 3 (75%) with conventional immunosuppressants. During a median follow-up of 65 ± 43 months, 35 patients (36%) experienced AIP-2 relapse. Relapse rates at 1 and 5 years were 20% and 33.7%, respectively. In univariate analysis, AIP-2 relapse risk was significantly lower in patients receiving IBD therapy compared with untreated patients (p = 0.05). No relapse occurred after the initiation of anti-TNF therapy in biologic-naïve patients. Overall, 16 (42%) patients developed AIP-2 complications: 7 diabetes and 9 exocrine pancreatic insufficiency. In this large multicentre cohort, clinical improvement or resolution was observed in two-third of patients receiving IBD therapy during their first AIP-2 episode. Relapse of AIP-2 appeared less frequently in patients receiving conventional immunosuppressant or advanced therapy for IBD. These therapies may be included in the treatment algorithm for AIP-2. Conflict of interest: Imberton, Louise: No conflict of interest Cremer, Anneline: No conflict of interest Kirchgesner, Julien: Lecture fees and/or consulting fees from from Abbvie, Amgen, Astrazeneca, Celltrion, Galapagos, Janssen, Lilly, MSD, Takeda, Tillots, Pfizer. Bonnet, Joelle: No conflict of interest Vieujean, Sophie: No conflict of interest Hostaux, Lorent: No conflict of interest Guillo, Lucas: No conflict of interest Fumery, Mathurin: Grant: Pfizer Personal Fees: Abbvie, Janssen, Takeda, MSD, Biogen, Amgen, Sandoz, Fresenius, Gilead, Celgene, Galapagos, Mylan, Tillots, Ferring, Pfizer, Hospira, CTMA, Boehringer, Lilly, Arena Non-financial Support: Abbvie, Janssen, Takeda, MSD, Galapagos, Ferring, Pfizer Uzzan, Mathieu: Grant: ECCO-IOIBD, Fondation pour la Recherche Medicale (FRM), SNFGE Personal Fees: Abbvie, Takeda, Celltrion, Janssen, Amgen, Alfasigma, Pfizer Hupé, Marianne: No conflict of interest Vidon, Mathias: No conflict of interest Bergereau, Eric: No conflict of interest Duveau, Nicolas: No conflict of interest Le Gall, Guillaume: No conflict of interest Nahon, Stéphane: No conflict of interest Riviere, Pauline: Personal Fees: Abbvie, Celltrion, Janssen Non-financial Support: Celltrion Maire, Frederique: No conflict of interest Rebours, Vinciane: No conflict of interest Prof. Dr. Laharie, David: Personal Fees: Board, consulting and lecture fees from Abbvie, Alfasigma, Amgen, Biocon, Celltrion, Ferring, Fresenius-Kabi, Johnson & Johnson, Lilly, MSD, Pfizer, Sandoz and Takeda
