Development, implementation and evaluation of a multinational FLS mentorship programme in Latin America.

Realising the benefits of systematic secondary fracture prevention requires supporting local sites to get started and becoming effective. We here describe the development, implementation and impact of a regional fracture liaison service (FLS) mentorship programme in Latin America that led to 64 FLS getting started and coverage of 17,205 patients. INTRODUCTION: Despite treatments and service models to deliver effective secondary fracture prevention, most patients are left untreated after a fragility fracture. To improve the capability to get FLS started and more effective, we describe the development, implementation and evaluation of an international programme to develop national communities of FLS mentors as part of the Capture the Fracture Partnership in Latin America. METHODS: The IOF regional team and the University of Oxford developed the curriculum and associated resources for training mentors in setting up FLS, service improvement and mentorship. Mentors were selected during a preparatory meeting, trained using live online sessions followed by regular mentor-led post-training meetings. The programme was evaluated using a pre-training needs assessment and post-training evaluation based on Moore's outcomes. RESULTS: The mentorship programme was initiated in Mexico, Brazil, Colombia and Argentina. The mentors were multidisciplinary, including orthopaedic surgery, rehabilitation, rheumatology, endocrinology, geriatrics, gynaecology and internal medicine. There was 100% participation in training sessions and reported satisfaction with the training. Since the initiation of the training programme, 22 FLS have been set up in Mexico, 30 in Brazil, 3 in Colombia and 9 in Argentina, in comparison with two in Chile and none in any other LATAM countries that were not involved in the mentorship programme. This equates to approximately 17,025 additional patients identified from 2019 to 2021 after initiation of mentorship. The mentors have engaged with 58 FLS for service development. Post-training activities include two published national best practice guidelines and other country-specific resources for FLS in the local language. CONCLUSION: Despite the COVID pandemic, the mentorship pillar of the Capture the Fracture Partnership has developed a community of FLS mentors with measurable improvement in national FLS provision. The programme is a potentially scalable platform to develop communities of mentors in other countries.

[Vestibular function: the 6th sense... ignored]. / La fonction vestibutaire: le sixième sens... ignoré.

Dizzy patients are often misunderstood by doctors. Those with a complete vestibular deficit and whose function is restored by a vestibular implant use all kinds of words to describe what they feel when the neuroprosthesis is turned on. Their feeling varied from a strong emotion to a feeling of heat. The notion of dizziness or motion was rare. How to describe the sensations provided by an ignored and unconscious sense? With the eyes, one sees; with the ears one hears; no term exists that describes what we do with the vestibular system! Should we say we vestibulise? The notion traditionally taught that patients suffering from a vestibular disorder should describe an imbalance or a rotatory vertigo, be able specify the direction of rotation, etc. is inadequate, unrealistic.

[Aspirin ototoxicity: a rare situation today]. / Ototoxicité à l'Aspirine: une situation rare de nos jours.

Aspirin is commonly used most often at low daily doses. We report a case of acute aspirin intoxication resulting in a transitory hearing loss, tinnitus, and vertigo. Such intoxications occur at doses of several grams. The disorders caused by aspirin are fortunately reversible. The mechanisms of ototoxicity appear to involve, in part, electro-mobility of the outer hair cells of the inner ear by inhibiting the movement of prestin.

[The benefit of systematic hearing screening of school-age children]. / Bénéfice d'un dépistage systématique de la surdité chez l'enfant en âge scolaire.

The hearing is routinely tested in all newborns in most European countries. Thereafter, no hearing test is performed in a systematic way, despite the many conditions that can cause hearing loss in the first years of life. If language acquisition is possible with only one ear, even a unilateral hearing loss can be the cause of learning difficulties at school. In Geneva, a screening program for hearing deficit was introduced in 1955 in all primary schools of the canton. This paper shows the efficiency of the program, which can detect unnoticed deafness, sometimes in children whose neonatal screening had proved normal. Such a program should be applied to all private schools and to schools for disabled children.

[Odd stories of patients suffering from Menière's disease]. / Les étranges histoires des patients... et de leurs docteurs (!) dans le tourbillon du Menière!

The cause of Meniere's disease is unknown. The postmortem examination of the temporal bone reveals an "endolymphatic hydrops" of the inner ear. Classically, patients describe episodes of vertigo, fluctuations of hearing and tinnitus. But some report "strange stories" that deserve doctor's attention. This article explains why their history (as those suffering from any other vestibular disorder) is often particular, to recall the few knowledge of the disease, how the endolymphatic hydrops was considered as the cause of the disorder, while it is rather an epiphenomenon, and to show how one can believe, wrongly, that a therapy is efficient after a study that seems however at first correctly performed.

[Causal relationship: and if "yes", and if "not"... on basis of which criterias?]. / Relation de cause à effet: et si "oui", et si "non", ... sur la base de quels critères?

A woman was referred to us 4 days after the sudden onset of continuous rotatory vertigo. The diagnosis of a left vestibular neuronitis was made. During the investigations, a meningioma of the contralateral posterior fossa was discovered. Is there any relationship between the two disorders? The etiology of peripheral vestibular disorders remains poorly understood in most cases. Anomalies of cells surrounding the sensory organs have been demonstrated in post-mortem examination of the inner ear of patients with a vestibular deficit that could be caused by a "biological stress". Therefore there may be a link between left vestibular deficit and the mass of the right posterior fossa, considered as a fortuitous discovery, at first.

[Have we made progress in the development of a vestibular implant?]. / Queues avancées cette année dans le développement d'un implant vestibulaire?

The concept of a vestibular implant to restore balance in patients suffering from bilateral loss of function is similar to that of a cochlear implant. Motion sensors will capture head movements and this information will be transmitted to the central nervous system via electrodes implanted in the vestibular system. However, several key questions must be answered before such prosthesis could be used in humans. One is to restore a baseline neural activity in the system that can be then adequately modulated by the prosthesis, without causing unbearable symptoms. We showed that this is possible in human. This is an important prerequisite for the feasibility of a vestibular implant.

Immuno-detection of Staphylococcus aureus biofilm on a cochlear implant.

CASE PRESENTATION: A 46-year-old man suffering from progressive deafness since childhood received a Clarion 90 K cochlear implant with the HiRes preformed electrode in his left ear in October 2006. A persistent Staphylococcus aureus infection failed to be treated with corticoids, amoxicillin/ clavulanate, ciprofloxaxin, and rifampin. The processor was removed on July 2007. INTERVENTIONS: The removed cochlear implant processor was treated with different reagents, with the aim of detecting a S. aureus and S. aureus biofilm: (1) fluorescein-coupled Fc of anti-human serum, (2) polyclonal anti-polysaccharide intercellular adhesion antibodies coupled to Alexa Fluor 568 goat anti-rabbit immunoglobulin (Ig)G, (3) crystal violet, (4) methylene blue, (5) acridine orange, (6) Gram stain, and (7) live/dead fluorescent stain. RESULTS: S. aureus and the major constituent of the S. aureus biofilm, the polysaccharide intercellular adhesion, were detected on the surface of the implant. S. aureus was isolated after a simple contact between the implant and a solid growth medium. The ability of the isolated S. aureus strain to produce biofilm in vitro was confirmed. INTERPRETATION: S. aureus biofilm was documented on the implant. Initial bacterial colonization could be related to the pocket of the removable magnet. Colonies of S. aureus without biofilm were found attached to the electrode wire. CONCLUSION: We report one case of a S. aureus biofilm infection documented on a cochlear implant, as assessed by immuno-microscopy. The biofilm was likely responsible for the persistent infection which manifested for many months after the implant surgery and could explain the unusual bacterial phenotypic resistance against administered antimicrobial agents.

[Cervical vertigo: myth or reality?]. / Vertiges d'origine cervicale: mythe ou réalité?

Patients displaying vertigo associated with cervical symptoms: what is the origin? Diagnosis of cervical vertigo is sometimes retained. It remains very controversial. Indeed there is neither a convincing pathological mechanism nor a diagnostic test. Despite lack of strong benefit evidence, manual therapy can be offered to selected patients.

[A series of tumors of the posterior fossa]. / Processus expansifs de la fosse postérieure.

This article presents a series of tumors of the posterior fossa. Imbalance or dizziness motivate patients to consult while they often neglect a hearing loss. However, any unilateral hearing impairment of any kind, even transitory, requires testings to rule out a retrocochlear lesion. In this series, 23% of vestibular schwannomas manifested by a sudden deafness, with a recovery of hearing in half of them.

[Dental implants and radiotherapy]. / Implants dentaires et radiothérapie.

Dental implants on irradiated and often grafted bone, in patients previously treated for head and neck cancer is a controversial issue. For some specialists, particularly in North-America they constitute a formal contra indication. However, a review of 21 studies reported mainly by European specialists argues that these implants can be done with an acceptable rate of complications, confirming our clinical observation. Patients have reported significant improvements in their quality of life after dental implantation.

[Development of a vestibular implant for the rehabilitation of bilateral deafness]. / Développement d'un implant vestibulaire pour la réhabilitation des déficits vestibulaires bilatéraux.

The development of a vestibular implant for the rehabilitation of bilateral vestibular loss is funded on a concept comparable to that of the cochlear implant used in the rehabilitation of bilateral deafness. This paper carries an overview of the main aspects of such a development and describes the first experiments done in human subjects in Geneva.

[Neonatal hearing screening program and school education for deaf children in Switzerland]. / Dépistage systématique néonatal de la surdité et mode de scolarisation des enfants malentendants en Suisse.

A national hearing screening in newborns was introduced in Switzerland in the early 2000s. Since then, the number of maternities which applies has considerably increased. Test results are collected in a national database, giving a good overview of the quality of screening and incidence of deafness in Switzerland. The diagnosis and rehabilitation of deafness is earlier than before. This, combined to modem technologies allows mainstream integration of almost every deaf child.

Enzyme activities of lactic acid bacteria from a pearl millet fermented gruel (ben-saalga) of functional interest in nutrition.

Lactic acid bacteria responsible for the fermentation of a pearl-millet based fermented gruel, ben-saalga, were investigated for enzyme activity in relation with the nutritional characteristics of gruels used as complementary foods for young children. Thirty pre-selected LAB from a set of 155 isolates were characterized principally for their ability to produce amylase, phytase and alpha-galactosidase. Two Lactobacillus plantarum strains (4.4 and 6.1) and three Lactobacillus fermentum strains (11.11.2, 3.7, 7.4) able to produce one or more of these enzymes were selected. Only weak amylase activity was found in the two Lactobacillus plantarum strains. alpha-amylase activity was associated with cells and was lower than 0.05 Ceralpha Units/ml. Phytase activity was detected in all five strains and was linked to the cell. The highest phytase activity was found in Lb. plantarum 4.4 and 6.1 (348.7 +/- 17.4U/ml and 276.3 +/- 51.4U/ml, respectively) and Lb. fermentum 7.4. (276.3 +/- 13.2U/ml). All strains displayed a cell-linked alpha-galactosidase activity. In a medium containing 2% glucose, the highest cellular activity was found in Lb. fermentum 3.7 (1441.1 +/- 133.7U/ml) and Lb. plantarum 4.4 (1223.1 +/- 148.3U/ml) after 6h of fermentation in the presence of stachyose, and in Lb. plantarum 4.4 (763.3 +/- 23.5U/ml) and Lb. fermentum 7.4 (346.7 +/- 14.8U/ml) after 24h of fermentation with raffinose. These results are consistent with previous observations showing that phytates and alpha-galactooligosaccharides decreased during the natural lactic acid fermentation of pearl millet slurries, and that partial starch hydrolysis can be performed by endogenous microflora provided a pre-gelatinisation step is included in the process.

[Spontaneous temporomandibular joint herniation into the external auditory canal]. / Hernie spontanée de l'articulation temporomandibulaire dans le conduit auditif externe.

OBJECTIVES: We report a rare case of spontaneous temporomandibular joint herniation into the external auditory canal. MATERIAL AND METHODS: A 42-year-old woman consulted for recurrent right otalgia. RESULTS: The clinical examination revealed a white mass of the anterior wall of the bony external auditory canal, very close to the tympanic annulus, which was replaced by an invagination of the skin of the canal when the patient opened her mouth, consistent with temporomandibular joint herniation into the external auditory canal. CONCLUSION: Inflammatory, malignant, and traumatic lesions are known as potential causes of temporomandibular joint herniation into the external auditory canal. Spontaneous herniations are much rare, and to the best of our knowledge this is the 15th case reported in the literature. This anomaly results from a patent foramen of Huschke. Main symptoms consist in otalgia and tinnitus. In half of the cases, they are minor and no treatment is necessary.

[Late and sudden recovery of sudden deafness or vestibular neuronitis].

INTRODUCTION: Vestibular neuronitis (VN) and sudden deafness (SD) are well-defined entities. The abrupt appearance of symptoms in both disorders represents an important element for the diagnosis. In cases of VN, symptoms regress gradually over time as the peripheral function recovers, or the central nervous system compensates for the balance deficit. In cases of SD, the recovery occurs in about half the cases and is generally progressive. The chances to recover normal levels of hearing are better if the recovery occurs early after the onset of the deficit. The goal of the paper is to present new insights of these disorders based on four unusual cases and on an evaluation of the delay for the function's recovery. MATERIAL AND METHODS: 1) We report two cases of VN and two of SD whose the recovery was late and sudden; 2) The recovery time after a SD was retrospectively analysed using the chart of 36 patients seen