📇 Rhumatologue · ALES · (30) · Libéral

M PASCAL MEKARCHA

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Auteur de référence en rhumatologie
25 articles scientifiques publiés — un praticien à la pointe de la recherche
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📍 ALES (30)LibéralRPPS 10003891388

✨ Génération du profil synthétique IA en cours…

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Top publications · les plus citées

A Familiar Working Environment Influences Surgeon's Stress in the Operating Room: A Multi-Specialty Prospective Cohort Study

Annals of surgery · 2026

📚 3 citations🔓 Open Access

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Objective: To determine the influence of operating room familiarity on surgeon stress. Background: Regulating surgeon stress may improve patient safety. This study evaluated how assisting surgeons and operating room familiarity influence intraoperative heart rate variability among surgeons. Methods: Attending surgeons from 7 specialties within 4 university hospitals in France were enrolled from November 1, 2020 to December 31, 2021. Vagal tone, an indicator of stress derived from heart rate variability, was assessed during the first 5 minutes after incision using the root mean square of successive differences (RMSSD). Higher RMSSD values indicate greater vagal tone. Team familiarity was quantified as the cumulative time the attending and assisting surgeons had operated together in the past, while operating rooms in which the surgeon conducted >10% of their operations were termed familiar. The effect of each on the RMSSD was assessed via a linear mixed-effect model adjusting for the random effect of the surgeon and possible confounders. Results: Overall, 643 surgeries performed by 37 surgeons were included. The median surgeon age was 49 years; 299 (78.4%) were male, and 22 (59.5%) were professors. Surgeons spent an average of 21.2 hours with the assisting surgeon before surgery and conducted 585 (91.0%) of their operations in a familiar operating room. For every 10 additional hours spent operating together, ln(RMSSD) significantly increased by 0.018 (95% CI: 0.003 to 0.033, P =0.016). Familiar operating rooms also tended to increase surgeon ln(RMSSD) [0.098 (95%CI: −0.007 to 0.203, P =0.068)]. Conclusion: Familiar with assisting surgeons and potentially operating rooms, increased surgeon vagal tone. Maintaining a stable operating room environment may improve surgeon stress and patient care.

Biomarkers of Tolerance to Baked Milk in Cow's Milk-Allergic Children at High Risk of Anaphylaxis

Journal of investigational allergology & clinical immunology · 2026

📚 3 citations🔓 Open Access📄 PDF gratuit ↗

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Background: Consuming baked milk (BM) may accelerate tolerance in cow’s milk–allergic (CMA) children. In high-risk patients, controlled BM-based oral food challenge (BM-OFC) is recommended, as the benefits can outweigh the risks of a prolonged exclusion diet. Objectives: To identify predictive biomarkers for BM-OFC outcomes in a cohort at high risk of anaphylaxis and compare the OFC thresholds for baked and pasteurized cow's milk protein (CMP). Methods: We performed a prospective study of children (≥12 months to <6 years) with a history of CMA. Testing at diagnosis involved prick testing, specific IgE (sIgE) for CM and components, sIgG4, and the basophil activation test (BAT). Patients underwent a BM-OFC aiming for a cumulative dose of 1 g of CM protein. BM-tolerant children subsequently underwent a CM-OFC to confirm CMA. Results: The study population comprised 50 patients (66% with a history of anaphylaxis). A reaction was recorded during BM-OFC in 36% of patients (39% with anaphylaxis). The median reactivity threshold was 138 mg of CMP. Risk factors for BM allergy included history of anaphylaxis, age >3 years, elevated CM-sIgE and casein-sIgE, and a positive BAT result. The cut-offs were as follows: >5 mm for skin prick testing with casein, ≥8.5 kUA/L for CM-sIgE, and ≥5.7 kUA/L for casein-sIgE. These made it possible to distinguish BM-allergic patients from CMA patients who tolerated BM. Among BM-tolerant patients, the CM-OFC threshold was 270 mg, with 43.8% reacting to <100 mg (40% with anaphylaxis). Conclusions: BM-OFC is not risk-free. Nevertheless, two-thirds of high-risk CMA children were BM-tolerant and benefited from early introduction of BM products. Patient selection can be guided by biomarkers and a prior history of anaphylaxis to baked goods. The reactivity threshold to pasteurized milk was less than half of the tolerated dose of BM (1000 mg).

High-risk genomic consensus validation for patients with newly diagnosed multiple myeloma using next-generation sequencing

Blood · 2026

📚 2 citations

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Abstract The prognostic heterogeneity of multiple myeloma is mainly driven by the genomic features of myeloma cells. The International Myeloma Society (IMS)/International Myeloma Working Group (IMWG) recently proposed a high-risk (HR) genomic model to have a consensus definition of genomic risk. We performed next-generation sequencing in the form of a panel on samples from 6528 patients with newly diagnosed multiple myeloma (NDMM) and 1583 patients at first relapse between 2019 and 2024. We observed that 22.4% of patients at diagnosis and 36.7% of patients at first relapse were classified as high risk according to the Consensus Genomic Staging. Clinical data were available for 2695 patients at diagnosis. After a median follow-up of 35 months, the median progression-free survival (PFS) was 30 months for patients with HR NDMM and 51 months for standard-risk (SR) patients (P&lt; .0001). The HR cytogenetic criteria from the Revised- International Staging System score were not able to differentiate between HR and SR patients based on the IMS/IMWG genomic subgroups. Looking at each criterion independently, we found that the presence of del(17p), TP53 mutation, biallelic del(1p32), or the combination of intermediate-risk cytogenetics (gain 1q, del(1p32), t(4;14), t(14;16), t(14;20)) significantly reduced the PFS when compared with SR patients. Moreover, patients with several cumulating criteria had an even worse prognosis. Among SR patients, classified according to the genomic definition with normal creatinine, the median PFS for those with high β2-microglobulin was not significantly different from that of patients with normal β2-microglobulin level. This study validated the IMS/IMWG genomic definition of HR myeloma in a large cohort of patients diagnosed from 2019 onwards.

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M PASCAL MEKARCHA

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Top publications · les plus citées

Publications scientifiques (25) — classées par pathologie

Transversal8

Essai clinique4

Épidémiologie & registres3

Microbiote2

Pédiatrie2

Pharmacovigilance2

Recommandations2

Anti-IL-231

Ostéoporose1

Revue / méta-analyse1

Vraie vie / RWE1

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