Fistula recurrence, pregnancy, and childbirth following successful closure of female genital fistula in Guinea : a longitudinal study

Background: Female genital fistula is a devastating maternal complication of delivery in developing countries. We sought to analyse the incidence and proportion of fistula recurrence, residual urinary incontinence, and pregnancy after successful fistula closure in Guinea, and describe the delivery-associated maternal and child health outcomes. Methods: We did a longitudinal study in women discharged with a closed fistula from three repair hospitals supported by Engender Health in Guinea. We recruited women retrospectively (via medical record review) and prospectively at hospital discharge. We used Kaplan-Meier methods to analyse the cumulative incidence, incidence proportion, and incidence ratio of fistula recurrence, associated outcomes, and pregnancy after successful fistula closure. The primary outcome was recurrence of fistula following discharge from repair hospital in all eligible women who consented to inclusion and could provide follow-up data. Findings: 481 women eligible for analysis were identified retrospectively (from Jan 1, 2012, to Dec 31, 2014; 348 women) or prospectively (Jan 1 to June 20, 2015; 133 women), and followed up until June 30, 2016. Median follow-up was 28.0 months (IQR 14.6-36.6). 73 recurrent fistulas occurred, corresponding to a cumulative incidence of 71 per 1000 person-years (95% CI 56.5-89.3) and an incidence proportion of 18.4% (14.8-22.8). In 447 women who were continent at hospital discharge, we recorded 24 cases of post-repair residual urinary incontinence, equivalent to a cumulative incidence of 23.1 per 1000 person-years (14.0-36.2), and corresponding to 10.3% (5.2-19.6). In 305 women at risk of pregnancy, the cumulative incidence of pregnancy was 106.0 per 1000 person-years, corresponding to 28.4% (22.8-35.0) of these women. Of 50 women who had delivered by the time of follow-up, only nine delivered by elective caesarean section. There were 12 stillbirths, seven delivery-related fistula recurrences, and one maternal death. Interpretation: Recurrence of female genital fistula and adverse pregnancy-related maternal and child health outcomes were frequent in women after fistula repair in Guinea. Interventions are needed to safeguard the health of women after fistula repair

Évaluation de la détection d'une résistance isolée à la céfalotine chez Escherichia coli par l'automate Vitek2® bioMérieux (artéfact technique ou émergence d'un phénotype ?)

Au cours d'une étude phénotypique, 5,7 % de souches de E. coli, parmi les 3593 souches isolées au cours de l'année 2000 au laboratoire de Bactériologie A du CHU de Nantes, étaient détectées, par l'automate Vitek2® (bioMérieux), sensibles à l'ensemble des b-lactames, sauf vis-à-vis de la céfalotine. La première étape a été d'étudier l'antibiogramme de 80 de ces souches par des méthodes manuelles. Dix-neuf d'entre elles ont été confirmées de sensibilité intermédiaire à l'égard de la céfalotine. L'hypothèse la plus probable était une hyperproduction modérée de la céphalosporinase AmpC. L'étude spectrophotométrique des b-lactamases produites n'ayant pas confirmée cette hypothèse, nous avons alors réalisé une étude génétique du promoteur du gène ampC. Aucune mutation majeure impliquée dans l'hyperproduction de la b-lactamase AmpC n'ayant été retrouvée, il semblerait que le mécanisme de résistance ne soit pas lié à une hyperproduction de cette enzyme.NANTES-BU Médecine pharmacie (441092101) / SudocSudocFranceF

La prise en charge de l'allaitement maternel (de la grossesse au sevrage)

[Résumé en français]Le lait de femme est l'aliment le mieux adapté au nouveau-né. Pourtant, en France, seules 6 femmes sur 10 allaitent leur enfant à la naissance et les durées d'allaitement sont courtes. Nous avons donc réalisé une étude prospective auprès de 107 femmes à la Polyclinique Majorelle du 27/11/06 au 27/12/06, afin d'évaluer si les recommandations de prise en charge de l'allaitement maternel étaient mises en pratique, et si le respect de celles-ci pouvait avoir un impact sur le déroulement de l'allaitement maternel. Les résultats mettent en évidence un taux d'initiation de l'allaitement maternel à la naissance de 67,1 % et une durée médiane d'allaitement de 112 jours. Mais seules 6 % des mères allaitent exclusivement jusqu'à 6 mois, comme recommandé. On constate qu'une le mise au sein tardive, le non respect de la cohabitation mère-enfant, le don de compléments et les manœuvres visant à estimer le volume de lait produit par la mère augmentent significativement le ressenti d'un manque de lait lors du séjour à la maternité. L'utilisation de sucettes augmente le pourcentage de mères présentant des crevasses à domicile. Une durée d'allaitement plus courte est mise en évidence chez les primipares, chez les mères ayant bénéficié d'une séance d'information sur l'allaitement lors de la préparation à la naissance, lorsque la le mise au sein a été tardive et pour les femmes ayant ressenti un manque de lait durant leur séjour à la maternité et à la sortie de celui-ci. Un engorgement et des crevasses entre la sortie de la maternité et la fin du 1er mois du post-partum augmentent significativement les taux de sevrage à 1 mois.[Résumé en anglais] The human milk is the food that is best suited to the infant. But in France, only 6 women out of 10 are feeding their child at birth and breastfeeding periods are short. We are therefore conducted a prospective study among 107 women in the Polyclinic Majorelle of 27/11/06 to 27/12/06, to assess whether the recommendations care of breastfeeding were being put into practice, and if observance of them could have an impact on the course of breastfeeding. The results highlight a rate of initiation of breastfeeding at birth of 67,1% and a median duration of breastfeeding in 112 days. But only 6% of mothers are exclusively breastfeeding until 6 months, as recommended. We see that first sucking in late, the non-compliance of cohabitation child and mother, the gift of supplementary feedings and maneuvers to estimate the volume of milk produced by the mother significantly increase the feeling of a lack of milk at the stay in the maternity hospital. The use of dummys increases the percentage of mothers showing cracks at home. A duration of breastfeeding shorter is highlighted among primiparous, among mothers who received a briefing on breastfeeding at birth preparedness, when the first sucking was late and women who have feeling a lack of milk during their stay in the maternity hospital and out of it. A breast engorgement and cracks between the exit of motherhood and the end of the first month of postpartum significantly increase the rate of weaning to 1 month.NANCY1-SCD Medecine (545472101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Heart health or cardiovascular disease?

LetterSCOPUS: le.jinfo:eu-repo/semantics/publishe

Referral conditions for severe road traffic injuries and their influence on the occurrence of hospital deaths in Benin

Road traffic accidents are the leading cause of death by trauma. Delays in in first aid due, inter alia, to the long time to transfer traffic accident victims to hospital and the lack of pre-hospital emergency care, contribute to the increase in hospital mortality. This study aims to analyse the referral conditions for severe road traffic injuries and to assess their effect on the occurrence of hospital deaths in Benin. This is an analytical prospective cohort study conducted in road accident victims with a severe injury. Four groups of factors were studied: referral conditions, sociodemographic and victim-specific characteristics, factors related to the accident environment, and factors related to health services. A top-down binary stepwise logistic regression was the basis for the analyses. Nine point eight percent of severe trauma patients died after hospital admission (7.0-13.5). Associated factors were referral time greater than 1 hour (RR=5.7 [1.5-20.9]), transport to hospital by ambulance (RR=4.8 [1.3-17.3]) and by the police or fire department (RR=7.4 [1.8- 29.7]), not wearing protective equipment (RR=4.5 [1.4-15.0]), head injuries (RR=34.8 [8.7-139.6]), and no upper extremity injuries (RR=20.1 [2.3-177.1]). To reduce the risk of hospital death in severe road traffic injuries, it is important to ensure rapid and medicalized referral of severe trauma patients in Benin.info:eu-repo/semantics/publishe

Heat transfer intensification by low or high frequency ultrasound: Thermal and hydrodynamic phenomenological analysis

International audienceThe aim of this work is to quantitatively demonstrate the intensification of heat transfer in forced convection by mean of ultrasonic irradiation at low (25 kHz) or high (2 MHz) frequency. High frequency ultrasound induces convective acoustic streaming while low frequency ultrasonic waves produce mainly cavitation effects. These hydrodynamic phenomena are at the origin of strongly different observations in terms of flow pattern modification and thereby in Nusselt number values. A link is tentatively established between hydrodynamic behaviors at both ultrasonic frequencies and corresponding thermal results. Hydrodynamic approach was performed with a 2D-2C PIV device while thermal one was carried out under uniform heat flux conditions. It seems that thermal enhancement effect of acoustic streaming (2 MHz) decreases as flow rate increases. This behavior is consistent with the decrease of turbulent kinetic energy produced by acoustic streaming in the same conditions. In the contrary, thermal enhancement effect produced by acoustic cavitation (25 kHz), increases as flow rate increases. This result could be due to the increase of relative size of acoustic bubbles with respect to laminar boundary layer thickness as flow rate increases. In conclusion, the two different ultrasound frequencies, which lead to two different hydrodynamic effects, also lead to two different thermal and turbulence trend with respect to flow rate modifications

Botulinum Neurotoxin Type B Uses a Distinct Entry Pathway Mediated By Cdc42 Into Intestinal Cells Versus Neuronal Cells.

International audienceBotulinum neurotoxins (BoNTs) are responsible for severe flaccid paralysis by inhibiting the release of acetylcholine at the neuromuscular junctions. BoNT/B most often induces mild forms of botulism with predominant dysautonomic symptoms. In food borne botulism and botulism by intestinal colonization such as infant botulism, which are the most frequent naturally acquired forms of botulism, the digestive tract is the main entry route of BoNTs into the organism. We previously showed that BoNT/B translocates through mouse intestinal barrier by an endocytosis-dependent mechanism and subsequently targets neuronal cells, mainly cholinergic neurons, in the intestinal mucosa and musculosa. Here we investigated the entry pathway of BoNT/B using fluorescent C-terminal domain of the heavy chain (HcB) which is involved in the binding to specific receptor(s) and entry process into target cells. While the combination of gangliosides GD1a /GD1b /GT1b and synaptotagmin I and to a greater extent synaptotagmin II constitutes the functional HcB receptor on NG108-15 neuronal cells, HcB only uses the gangliosides GD1a /GD1b /GT1b to efficiently bind to m-ICcl2 intestinal cells. HcB enters both cell types by a dynamin-dependent endocytosis which is efficiently prevented by Dynasore, a dynamin inhibitor, and reaches a common early endosomal compartment labeled by EEA1. In contrast to neuronal cells, HcB uses a Cdc42-dependent pathway to enter intestinal cells. Then, HcB is transported to late endosomes in neuronal cells, whereas it exploits a non-acidified pathway from apical to basal lateral side of m-ICcl2 cells supporting a transcytotic route in epithelial intestinal cells

A mixed-bridging ligand nonanuclear Ru(II) dendrimer containing a tris- chelating core. Synthesis and redox properties.

The first ligand-cored dendrimer based on branching Ru(II) centers and containing mixed polypyridine bridging ligands has been prepared; redox experiments suggest that the redox-active core is not reduced at the expected potential, probably as a consequence of shielding induced by the rigid dendritic array.Journal Articleinfo:eu-repo/semantics/publishe

Approche taphonomique des loci à restes humains de la grotte de Cussac

International audienc