[Potential teratogenicity of modafinil - Conflicting evidence, need for research]. / Tératogénicité potentielle du modafinil ­ des données contradictoires, un besoin de recherche.

Central disorders of hypersomnolence include narcolepsy type 1, narcolepsy type 2, idiopathic hypersomnia and hypersomnia associated with medical or mental disorders. Treatment is both non-pharmacological and pharmacological, including wake enhancing drugs and stimulants. One of the first-line treatment (modafinil, MODIODAL®) was the subject of a health authority alert in 2019 concerning a risk of major congenital malformations when taken during organogenesis. Since this date, three epidemiological studies have presented contradictory results. Given their methodological weaknesses, it is not possible at this stage to confirm or deny such a risk for the embryo and its nature if there is one. In clinical practice, because of these uncertainties, it is preferable if possible to suspend the treatment of a pregnant woman during the first 10 weeks from last menstrual period (organogenesis). There is an unmet clinical need for research to clarify the potential teratogenic impact of modafinil.

[Should fluoroquinolones be feared during pregnancy and breastfeeding?] / Faut-il craindre les fluoroquinolones chez une femme enceinte ou qui allaite ?

Fluoroquinolones (ciprofloxacin, ofloxacin, levofloxacin and moxifloxacin) are antibiotics which pharmacological and therapeutic advantages resulted in a large use, now restricted because of resistances emergence and adverse effect risk. For pregnant or breastfeeding women they still are a cause of concern, based on the joint toxicity described in children directly treated, thus limiting their use in these populations. However, the data about exposed pregnancies published over time have not so far confirm these fears and allow, when a fluoroquinolone is clearly indicated, not to deprive pregnant patients of the therapeutic benefit of these important antibiotics and to envisage their use whatever the term of the pregnancy, within the current scope of their prescription. During breastfeeding the use of some of them can be considered.

[Amoxicillin-clavulanic acid in late pregnancy]. / Amoxicilline-acide clavulanique (Augmentin®) en fin de grossesse.

In 2001, a clinical trial on prophylactic antibiotics in preterm prelabor rupture of membranes reported an increased risk of necrotizing enterocolitis in newborns whose mothers were given amoxicillin-clavulanic acid before delivery. This study generated concern and reluctance to use this antibiotic in late pregnancy, despite its methodological limitations and the lack of confirmation in 3 studies published between 2001 and 2008. Since then, there have been no original publications on the topic. Therefore, the results available to date do not support an increased risk of necrotizing enterocolitis with the use of amoxicillin-clavulanic acid in late pregnancy. In clinical situations where amoxicillin/clavulanic acid is required, it can be prescribed at any stage of pregnancy, including just before delivery.

[Direct oral anticoagulants and pregnancy]. / Anticoagulants oraux directs et grossesse.

The use of direct oral anticoagulants, apixaban, dabigatran and rivaroxaban, is increasing because of their simpler way of use than those of low molecular weight heparins and of antivitamines K anticoagulants. During pregnancy, although there is no warning signal to date, the data on their use are far from sufficient to allow the continuation or initiation of direct oral anticoagulant treatment in a pregnant women.

Maternal consumption of quinine-containing sodas may induce G6PD crises in breastfed children.

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common human enzyme defect often presenting with neonatal jaundice and/or hemolytic anemia. G6PD hemolytic events are linked with exposure to a pro-oxidant agent. We here report three cases of initial G6PD crises in breastfed children secondary to maternal consumption of a tonic drink which contains quinine. Quinine was found in breast milk of one of the mothers after she consumed tonic water. CONCLUSION: The amount of quinine that is transmitted through breast milk appears to be sufficient to induce G6PD crises in breastfed children. We hence recommend that consumption of quinine-containing sodas during breastfeeding should be avoided in populations with a high prevalence of G6PD deficiency. What is Known: • G6PD hemolytic events are linked with exposure to a pro-oxidant agent. • Ingestion of fava beans by a mother who was breastfeeding has been reported to induce a neonatal G6PD crisis. What is New: • Maternal consumption of tonic drink which contains quinine appears to be sufficient to induce G6PD crises in breastfed children. • Maternal consumption of quinine-containing sodas during breastfeeding should be avoided in populations with a high prevalence of G6PD deficiency.

Effects of stocking density on the growth performance and digestive microbiota of broiler chickens.

Increased stocking densities are frequently reported to depress chicken growth performance, but the mechanisms behind this are not fully understood. This study was conducted to investigate the effects of stocking density on growth performance and digestive microbiota, known to be sensitive to environmental factors. Chickens were reared at 2 stocking densities, 12 or 17 birds/m(2). Growth performance was recorded between d 1 and 39, and litter was scored for quality on d 25, 31, and 37. Digestive microbiota was analyzed along the digestive tract (crop, ileum, ceca) of 3- and 6-wk-old chickens by using 2 molecular approaches: a qualitative method (fingerprinting by temporal temperature gradient gel electrophoresis) and a quantitative method (real-time PCR). An increase in stocking density was found to negatively affect the feed conversion ratio (+3.1%) and depress the daily BW gain of broilers (-5.5%) during the period from d 32 to 39 (P ≤ 0.05). Litter quality was reduced with the high stocking density as early as d 25. At 3 wk of age, stocking density strongly affected the fingerprint profiles of the bacterial community, with the highest modifications observed in the crop and ceca (R analysis of similarity = 0.77 and 0.69, respectively, P ≤ 0.05). At 6 wk of age, significant differences in the fingerprint profiles between the stocking densities appeared in the crop and ceca (R analysis of similarity = 0.52 and 0.27, respectively, P ≤ 0.05). The abundance of bacterial groups targeted by real-time PCR was affected by stocking density, but only to a limited extent. Because digestive microbiota may have consequences on the physiology of the digestive tract, its modification by an increase in stocking density may be involved in the reduced growth performance of the bird.

[Major scoliosis, over 100 degrees, in adults. 183 surgically treated cases]. / Scolioses majeures de l'adulte supérieures à 100 degre's 183 cas traités chirurgicalement

Most severe scoliosis and kyphoscoliosis are not unfrequent in European countries. The purpose of their treatment is not only cosmetic but, often, vital. Patients are hypotrophic and their vital capacities usually very poor. Since 1952, the authors have treated (partial, reduction and fusion) 183 patients: with curves above 100 degrees (101 degrees-203 degrees). Reduction was obtained by distraction cast or halo-traction. Surgical treatment (one or two stages) used Harrington rods and fusion with a large amount of iliac bone. These procedures are dangerous for the medullary function. Controls must be performed during the operative distraction. Follow up studies demonstrated the stability of the obtained reductions.