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Gendron N.,Hopitaux Universitaires Paris Center Cochin Broca Hotel Dieu | Joubrel C.,Hopitaux Universitaires Paris Center Cochin Broca Hotel Dieu | Joubrel C.,University of Paris Descartes | Nedellec S.,Assistance Publique Hopitaux de Paris | And 10 more authors.
Journal of Clinical Microbiology | Year: 2014

Medical abortion is not recognized as a high-risk factor for invasive pelvic infection. Here, we report two cases of group A Streptococcus (GAS; Streptococcus pyogenes) endometritis following medical abortions with a protocol of oral mifepristone and misoprostol.Copyright © 2014, American Society for Microbiology. All Rights Reserved.

Vinot C.,University of Paris Descartes | Vinot C.,Groupe Hospitalier Cochin Broca Hotel Dieu | Gavard L.,Service de Gynecologie et Obstetrique | Treluyer J.M.,University of Paris Descartes | And 13 more authors.
Antimicrobial Agents and Chemotherapy | Year: 2013

Nowadays, antiretroviral therapy is recommended during pregnancy to prevent mother-to-child transmission of HIV. However, for many antiretroviral drugs, including maraviroc, a CCR5 antagonist, very little data exist regarding placental transfer. Besides, various factors may modulate this transfer, including efflux transporters belonging to the ATP-binding cassette (ABC) transporter superfamily. We investigated maraviroc placental transfer and the influence of ABC transporter expression on this transfer using the human cotyledon perfusion model. Term placentas were perfused ex vivo for 90 min with maraviroc (600 ng/ ml) either in the maternal-to-fetal (n=10 placentas) or fetal-to-maternal (n=6 placentas) direction. Plasma concentrations were determined by ultra performance liquid chromatography coupled with tandem mass spectrometry (UPLC-MS/MS). Fetal transfer rates (FTR) and clearance indexes (CLI) were calculated as ratios of fetal to maternal concentrations at steady state (mean values between 30 and 90 min) and ratios of FTR of maraviroc to that of antipyrine, respectively. ABC transporter gene expression levels were determined by quantitative reverse transcription (RT)-PCR and ABCB1 protein expression by Western blotting. For the maternal-to-fetal direction, the mean FTR and CLI were 8.0%±3.0 and 0.26±0.07, respectively, whereas the mean CLI was 0.52±0.23 for the fetal-to-maternal direction. We showed a significant inverse correlation between maraviroc CLI and ABCC2, ABCC10, and ABCC11 placental gene expression levels (P<0.05). To conclude, we report a low maraviroc placental transfer probably involving ABC efflux transporters and thus in all likelihood associated with a limited fetal exposition. Nevertheless, these results would need to be supported by in vivo data obtained from paired maternal and cord blood samples. Copyright © 2013, American Society for Microbiology.

PubMed | Hopitaux universitaires Paris Center Cochin Broca Hotel Dieu and University of Paris Descartes
Type: Journal Article | Journal: Annales de biologie clinique | Year: 2016

The proposals of the Working group on perioperative hemostasis (Groupe dintrt en hmostase pri-opratoire (GIHP)) concerning the perioperative management of patients receiving the direct oral anticoagulants (DOACs) are based on the measure of their anticoagulant activities (anti-Xa for rivaroxaban and anti-IIa for dabigatran) with a safety threshold 30 ng/mL. If the dosage of the drug is not available, proposals are based on the combination of a PT 80% and an aPTT 1.20. The aim of our study was to evaluate the performance of PT, aPTT and thrombin time to predict values above or below the safety threshold. The measurement of DOACs concentration was carried out in 64 samples from patients treated with rivaroxaban and 48 samples from patients treated with dabigatran. The PT and aPTT were measured for all samples, while the TT was measured only for patients receiving dabigatran. The absence of agreement between the global hemostasis tests and the DOACs concentrations was observed for 10% of patients receiving dabigatran and 27% of patients with rivaroxaban treatment. Apart from dabigatran for which the predictive negative value of PT and aPTT or TT allows to exclude a concentration >30 ng/mL in 100% of cases, our results highlight the risk of misinterpretation when using global coagulation tests (PT and aPPT) for determination of the safety threshold for patients receiving the DOACs.

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