Evaluation de la tenue du partogramme dans une maternité universitaire

Introduction: La mortalité maternelle est un problème majeur de santé mondiale. Une grande proportion de ces décès serait évitable par des soins adéquats, une aide à l'accouchement, la disponibilité des soins d'urgence et l'utilisation des outils d'aide à la décision tels que le partogramme. L'objectif était d'évaluer l'écart entre ce qui est censé être fait et ce qui est fait réellement pour les différents paramètres situés dans le partogramme au sein d'une maternité de 3ème niveau et élaborer des recommandations pour la mise en place d'un plan d'action. Méthodes: Il s'agit d'une étude descriptive rétrospective par audit clinique, effectuée sur un échantillon de 400 dossiers obstétricaux des parturientes ayant accouchées dans la maternité du CHU Farhat Hached durant l'année 2011. Le référentiel utilisé est celui réalisé par l'Agence Nationale d'Accréditation et d'Evaluation en Santé en l'an 2000, concernant la qualité de la tenue du partogramme. Résultats: La majorité des critères d'évaluation portant sur la présentation du partogramme était conforme. Deux critères concernant la variété de la présentation et le rythme cardiaque foetal étaient non conformes parmi ceux portant sur la surveillance du foetus. Plusieurs critères en rapport avec la surveillance de la mère étaient non conformes. Aucun des critères portant sur les traitements administrés et les marqueurs d'évènements n'est conforme. Les critères portant sur la naissance et la surveillance immédiate qui étaient non conformes sont : le début des efforts expulsifs, le mode d'accouchement, l'état du périnée, la délivrance et la révision utérine. Conclusion: La véritable démarche de l'audit clinique se doit d'aller au-delà du recueil et de l'analyse des données, le but final étant l'amélioration des pratiques

Prise en charge de l’atresie choanale

Introduction: L’atrésie choanale est une malformation congénitale rare mais non exceptionnelle. Le but de notre travail est d’étudier les caractéristiques épidémiologiques, cliniques et radiologiques de cette pathologie, et de discuter les différentes modalités thérapeutiques et leurs résultats respectifs.Matériel et méthodes: Notre étude rétrospective porte sur une série de 12 cas d’atrésie choanale opérés dans notre service entre 2002 et 2010. Tous les patients ont bénéficié d’un examen ORL et d’une tomodensitométrie du massif facial. Tous les patients ont été opérés sous anesthésie générale.Résultats: L’âge moyen était de 10,7 ans (3 jours - 31 ans) et le sex-ratio était de 2. L’atteinte était unilatérale dans 66,6% et bilatérale dans 33,3% des cas. Dans 16% des cas, l’atrésie rentrait dans le cadre d’un syndrome polymalformatif. La technique opératoire utilisée était la voie  endoscopique dans 10 cas et la voie transpalatine dans 2 cas. Le taux de succès global était de 75%. Trois cas de récidive ont été notés. Ils ont été réopérés par voie endonasale.Conclusion: L’endoscopie nasale et la TDM permettent le diagnostic positif de l’atrésie choanale. Le traitement de référence actuellement est la chirurgie par voie endonasale.Mots-clés: atrésie choanale, malformation, obstruction nasale, endoscopie, tomodensitométrie, chirurgie endonasal

Women’s pelvic floor muscle strength and urinary and anal incontinence after childbirth: a cross-sectional study

Abstract OBJECTIVE To analyse pelvic floor muscle strength (PFMS) and urinary and anal incontinence (UI and AI) in the postpartum period. METHOD Cross-sectional study carried out with women in their first seven months after child birth. Data were collected through interviews, perineometry (Peritron™), and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). RESULTS 128 women participated in the study. The PFMS mean was 33.1 (SD=16.0) cmH2O and the prevalence of UI and AI was 7.8% and 5.5%, respectively. In the multiple analyses, the variables associated with PFMS were type of birth and cohabitation with a partner. Newborn’s weight, previous pregnancy, UI during pregnancy, and sexual activity showed an association with UI after child birth. Only AI prior to pregnancy was associated with AI after childbirth. CONCLUSION Vaginal birth predisposes to the reduction of PFMS, and caesarean section had a protective effect to its reduction. The occurrence of UI during pregnancy is a predictor of UI after childbirth, and women with previous pregnancies and newborns with higher weights are more likely to have UI after childbirth.AI prior to pregnancy is the only risk factor for its occurrence after childbirth. Associations between PFMS and cohabitation with a partner, and between UI and sexual activity do not make possible to conclude that these variables are directly associated

Inhibition of Fungi and Gram-Negative Bacteria by Bacteriocin BacTN635 Produced by Lactobacillus plantarum sp. TN635

The aim of this study was to evaluate 54 lactic acid bacteria (LAB) strains isolated from meat, fermented vegetables and dairy products for their capacity to produce antimicrobial activities against several bacteria and fungi. The strain designed TN635 has been selected for advanced studies. The supernatant culture of this strain inhibits the growth of all tested pathogenic including the four Gram-negative bacteria (Salmonella enterica ATCC43972, Pseudomonas aeruginosa ATCC 49189, Hafnia sp. and Serratia sp.) and the pathogenic fungus Candida tropicalis R2 CIP203. Based on the nucleotide sequence of the 16S rRNA gene of the strain TN635 (1,540 pb accession no FN252881) and the phylogenetic analysis, we propose the assignment of our new isolate bacterium as Lactobacillus plantarum sp. TN635 strain. Its antimicrobial compound was determined as a proteinaceous substance, stable to heat and to treatment with surfactants and organic solvents. Highest antimicrobial activity was found between pH 3 and 11 with an optimum at pH = 7. The BacTN635 was purified to homogeneity by a four-step protocol involving ammonium sulfate precipitation, centrifugal microconcentrators with a 10-kDa membrane cutoff, gel filtration Sephadex G-25, and C18 reverse-phase HPLC. SDS-PAGE analysis of the purified BacTN635, revealed a single band with an estimated molecular mass of approximately 4 kDa. The maximum bacteriocin production (5,000 AU/ml) was recorded after a 16-h incubation in Man, Rogosa, and Sharpe (MRS) medium at 30 °C. The mode of action of the partial purified BacTN635 was identified as bactericidal against Listeria ivanovii BUG 496 and as fungistatic against C. tropicalis R2 CIP203

Bioactive Secondary Metabolites from a New Terrestrial Streptomyces sp. TN262

During our search for Streptomyces spp. as new producers of bioactive secondary metabolites, the ethyl acetate extract of the new terrestrial Streptomyces isolate TN262 delivered eight antimicrobially active compounds. They were identified as 1-acetyl-β-carboline (1), tryptophol (2), cineromycin B (3), 2,3-dihydrocineromycin B (4), cyclo-(tyrosylprolyl) (5), 3-(hydroxyacetyl)-indole (6), brevianamide F (7), and cis-cyclo-(l-prolyl-l-leucyl) (8). Three further metabolites were detected in the unpolar fractions using GC–MS and tentatively assigned as benzophenone (9), N-butyl-benzenesulfonamide (10), and hexanedioic acid-bis-(2-ethylhexyl) ester (11). This last compound is known as plasticizer derivatives, but it has never been described from natural sources. In this article, we describe the identification of the new Streptomyces sp. isolate TN262 using its cultural characteristics, the nucleotide sequence of the corresponding 16S rRNA gene and the phylogenetic analysis, followed by optimization, large-scale fermentation, isolation of the bioactive constituents, and determination of their structures. The biological activity of compounds (2), (3), (4), and those of the unpolar fractions was addressed as well

Oral HPV infection and MHC class II deficiency (A study of two cases with atypical outcome)

<p>Abstract</p> <p>Background</p> <p>Major histocompatibility complex class II deficiency, also referred to as bare lymphocyte syndrome is a rare primary Immunodeficiency disorder characterized by a profondly deficient human leukocyte antigen class II expression and a lack of cellular and humoral immune responses to foreign antigens. Clinical manifestations include extreme susceptibility to viral, bacterial, and fungal infections. The infections begin in the first year of life and involve usually the respiratory system and the gastrointestinal tract. Severe malabsorption with failure to thrive ensues, often leading to death in early childhood. Bone marrow transplantation is the curative treatment.</p> <p>Case reports</p> <p>Here we report two cases with a late outcome MHC class II deficiency. They had a long term history of recurrent bronchopulmonary and gastrointestinal infections. Bone marrow transplantation could not be performed because no compatible donor had been identified. At the age of 12 years, they developed oral papillomatous lesions related to HPV (human papillomavirus). The diagnosis of HPV infection was done by histological examination. HPV typing performed on the tissue obtained at biopsy showed HPV type 6. The lesions were partially removed after two months of laser treatment.</p> <p>Conclusions</p> <p>Viral infections are common in patients with MHC class II and remain the main cause of death. Besides warts caused by HPV infection do not exhibit a propensity for malignant transformation; they can cause great psychosocial morbidity.</p

Environmental risk assessments for transgenic crops producing output trait enzymes

The environmental risks from cultivating crops producing output trait enzymes can be rigorously assessed by testing conservative risk hypotheses of no harm to endpoints such as the abundance of wildlife, crop yield and the rate of degradation of crop residues in soil. These hypotheses can be tested with data from many sources, including evaluations of the agronomic performance and nutritional quality of the crop made during product development, and information from the scientific literature on the mode-of-action, taxonomic distribution and environmental fate of the enzyme. Few, if any, specific ecotoxicology or environmental fate studies are needed. The effective use of existing data means that regulatory decision-making, to which an environmental risk assessment provides essential information, is not unnecessarily complicated by evaluation of large amounts of new data that provide negligible improvement in the characterization of risk, and that may delay environmental benefits offered by transgenic crops containing output trait enzymes