Malleostapedotomy for otosclerosis,our experience of nitinol piston on twelve patients

ObjectiveMalleostapedotomy allows to completely by-pass the incus in otosclerosis surgery. Recently its use has been rivaled by hydroxyapatite cement for cases of mild and moderate necrosis of the incus. However, it remains gold standard for cases of extensive necrosis, incus dislocation, or epitympanic fixation. Modern heat-crimping pistons make surgery easier and safer. This study focuses on our experience with this technique.MethodsRetrospective analysis of patient’s files and pre- and post-operative audiograms, for cases of surgically treated otosclerosis with malleostapedotomy.ResultsTwelve patients underwent malleostapedotomy for otosclerosis between 2011 and 2019. Amongst them there were 10 revision surgeries and 2 primary cases. 75% had incus long-process necrosis, 17% had epitympanic fixation and one had a history of incus transposition. Nine patients (75%) had closure of air-bone gap (ABG) of <10 dB (p < 0.001) and 11 (92%) had a threshold of 20 dB (p < 0.001). Mean pre-operative ABG was 31 dB (15 dB–55 dB), and mean post-operative ABG was 7 dB (0 dB–21 dB; p < 0.001). There was no sensorineural hearing loss nor any other post-operative complication.ConclusionsMalleostapedotomy is a safe and reliable technique, allowing an ABG closure comparable to conventional incus to vestibule prosthesis. It remains the preferred technique whenever the incus cannot be used.     

Glycated hemoglobin in pregnancies at increased risk for gestational diabetes mellitus

Objective

The glycated hemoglobin (HbA_1c) value is increasingly used for the detection of (pre)diabetes, but HbA_1c decreases during pregnancy. We sought to identify clinical and metabolic correlates of HbA_1c in pregnancies at increased risk for gestational diabetes mellitus (GDM).

Study design

We prospectively studied 335 gravidas who received a 3-h 100 g oral glucose tolerance test (OGTT) at 24–32 weeks, in most cases after an abnormal glucose challenge test. Several indices of insulin sensitivity and secretion were computed from fasting measurements and the OGTT.

Results

HbA_1c concentrations gradually increased in diet-treated and insulin-treated GDM gravidas compared with non-GDM gravidas. HbA_1c was higher if the insulin peak was delayed until 180 min compared with 60 or 120 min. Stepwise regression identified the homeostasis modeling assessment of insulin resistance (HOMA-IR) as the first-rank correlate. Other correlates were ethnicity, a low insulin-to-glucose response at 60 min, and gestational age. The HbA_1c value corresponding to a fasting glucose of 5.1 mmol/l (diagnostic of GDM) was 2 mmol/mol (∼0.2%) higher if sampling occurred at 29–32 vs. 24–28 weeks or if ancestry was non-European vs. European.

Conclusion

HbA_1c is strongly associated with insulin resistance; in addition, HbA_1c captures the first-phase insulin response. However, HbA_1c varies with gestational age and ethnicity.     

Vaccination coverage and sociodemographic determinants of measles–mumps–rubella vaccination in three different age groups

WHO-Europe's goal is to eliminate measles and rubella by 2010 which will require a coverage rate of 95% for both MMR-vaccine doses. Belgian recommendations include a first MMR vaccine at 12 months and a second at 10-12 years of age. To survey MMR vaccination coverage, EPI two-stage random cluster samples of 1,500 toddlers (18-24 months of age), 900 primary school children (born in 1997), and 1,500 adolescents (born in 1991) living in Flanders (Belgium) were drawn. Documented MMR-vaccination was recorded and a questionnaire on sociodemographic factors was completed at home by trained interviewers in 2005. Missing data were retrieved from well-baby clinics and school health service documents. The overall response rate was 89.5%, leaving 3,490 subjects fit for analysis. MMR coverage (first dose) was 94.0% in the toddler group, 88.0% in the 7-year-olds, and 80.6% in adolescents. The 10- to 12-year dose was documented in 83.6% of the adolescents, but only 74.6% had proof of both MMR vaccines. A lower MMR coverage was noted in single or divorced parents (toddlers, adolescents), families with more than four children (toddlers, adolescents), non-Belgian parental origin (children, adolescents), lower education or unemployment of parents (toddlers, children, adolescents), low family income (children, adolescents), vaccination by the GP (toddlers, children), and education-related factors (children, adolescents). The recommended WHO coverage rate of 95% for MMR is within reach in toddlers. Documentation of vaccination is a major concern in older age groups and may explain lower coverage estimates. Children growing up in a less privileged environment deserve special attention.     

High mortality due to congenital malformations in children aged &lt; 1 year in French Guiana

Background

In French Guiana, pregnant women may be exposed to infectious, environmental, and social risks leading to congenital malformation. The objective of the study was to study mortality rates from congenital malformations among infants <?1?year and to compare them with those in mainland France.

Methods

We used the CEPI DC (INSERM) database, which compiles annual data from death certificates in all French territories using the International Classification of Diseases. Annual deaths for French Guiana and mainland France between 2005 and 2015 were compiled. The age category studied was children less than 1?year and deaths from congenital malformations, deformations and chromosomal abnormalities were compiled. Crude risk ratios and 95% confidence intervals were calculated to quantify the excess risk of disease in French Guiana.

Results

In French Guiana between 2005 and 2015 there were 666 deaths of children aged <?1?year, among which, 132 (19.8%) were due to congenital malformations and chromosomal anomalies. Overall the risk ratio of death from congenital malformations and chromosomal anomalies between French Guiana and mainland France was 2.7 (1.5–4.7), P?<?0.001 for neurological congenital malformations it was 4.8 (1.2–19.7), P?=?0.01 and for congenital malformations of the circulatory system it was 3.3 (1.5–6.9), P?=?0.001.

Conclusions

The incidence of death from congenital malformations or chromosomal anomalies in French Guiana was significantly higher than in mainland France. Explanations for this may be infections, genetic causes, nutritional causes, and toxic causes that are prevalent. There is a need to identify factors that predispose children born in French Guiana to having a higher risk of congenital malformations and chromosomal anomalies.

     

Hypoketosis as a cause of symptoms in childhood hypoglycemia

Children with symptomatic hypoglycemia and asymptomatic hypoglycemia-prone children were shown to differ in the degree of ketosis after a 20 h fast. In the latter children the close negative correlation between ketone body levels and glucose levels yielded a regression line against which the former children's data could be compared. Half of the patients were found to be hypoketotic during hypoglycemia. The significance of this hypoketosis in the symptomatology is discussed. The finding of other abnormal responses to fasting, particularly in the patients' nitrogen metabolism, suggests that all these aberrations have a common cause which may be of hepatic origin.     

Intervention with adolescents and youngsters in prevention and health promotion

BACKGROUND: Over at least the past ten years, measures aimed at health promotion and prevention among young adults and teenagers have been being implemented from different public institutions and, in a certain sense, on a sectorial basis. The overall objective is to assess how the different measures carried out by different Public Institutions with regard to Health Promotion and Prevention have an impact on the actual conduct and practices of teenagers and young adults within the 14-25 age range in the Autonomous Community of Madrid. METHODS: A study based on a structural or qualitative methodology was conducted using the discussion group method, eight groups having been formed and their comments analyzed. RESULTS: The young adults do not feel any health-related prevention "system" as such exists on not considering themselves to be the object thereof. In the opinion of the young adults, disease, confined to the physical body, is conceived as being a short-lived, temporary and readily remedied based on the technological advances current medicine has to offer. On the contrary, the diseases related to the psychological perspective (mental disease dissociated with the area of the medical and connected to the individual/personal area) arouse interest in so much as young people are highly vulnerable to these diseases. CONCLUSIONS: Any measure aimed at generating identification and, therefore, the active response of young people must entail creating a connection between young people and health, which, not based exclusively in providing information, is capable of putting a space of control of the youths with regard to their harmful practices into play whilst at the same time highlighting their taking responsibility for their own actions. Considering we believe it best to "redefine" the term "prevention" in terms nearer to those of maintaining, improving or regaining (in short-lived cases) health, to thus connote the idea of physical and mental well-being.     

3-D real-time motion correction in high-intensity focused ultrasound therapy

A method for tracking the 3-D motion of tissues in real-time is combined with a 2-D high-intensity focused ultrasound (US), or HIFU, multichannel system to correct for respiratory motion during HIFU therapy. Motion estimation is based on an accurate ultrasonic speckle-tracking method. A pulse-echo sequence is performed for a subset of the transducers of the phased array. For each of these subapertures, the displacement is estimated by computing the 1-D cross-correlation of the backscattered signals acquired at two different times. The 3-D motion vector is then computed by a triangulation algorithm. This technique is experimentally validated in phantoms moving as fast as 40 mm s(-1), and combined with HIFU sequences. A real-time feedback correction of the HIFU beam is achieved by adjusting the delays of each channel. The sonications "locked on target" are interleaved with very short motion-estimation sequences. Finally, in vitro experiments of "locked on target" HIFU therapy are performed in fresh moving tissues.     

Trends in the treatment of orthopaedic prosthetic infections

The most commonly used therapy for prosthetic joint infection is a two-stage prosthetic exchange separated by 6 weeks of intravenous antibiotic therapy. This often results in long periods of hospitalization, morbidity, severe functional impairment and sometimes increased mortality. Therefore novel and challenging therapeutic approaches have been attempted, particularly in hip prosthetic infection. This includes, whenever possible, according to the type of microorganism, antibacterial susceptibility and clinical presentation (including age and comorbidities): (i) less aggressive surgical techniques (debridement and prosthesis retention, or re-implantation with a single-stage exchange arthroplasty); and (ii) antibiotic combinations active against biofilm-associated bacteria, including rifampicin (particularly with quinolones) with excellent bio-availability which allow prolonged and efficient oral therapy.