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.

[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.

[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.

Atypical presentations of malignant otitis externa.

INTRODUCTION: Malignant otitis externa is a life-threatening infection of the skull base. Its presentation is not always typical. CASE REPORTS: We report three cases of malignant otitis externa which illustrate the diversity of its clinical manifestations and the difficulties in its diagnosis. DISCUSSION: The perception of malignant otitis externa as an infection caused by Pseudomonas aeruginosa in diabetic patients is not always correct. The adoption of diagnostic criteria could be helpful in identifying atypical cases.

[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.

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.

[Otitis externa, a self-inflicted disease?]. / Otites externes: une maladie auto-infligée?

Otitis externa, an inflammation of the external auditory canal is the most frequent cause of ENT consultation all over the world. It can be caused by viral, bacterial or fungal infections. In most of the cases it is provoked by anatomical causes and, even more frequently inadvertently, by the patient himself. Typically, otitis externa is an isolated episode of short duration, easily treated with topical medication. It evolves rarely to the atypical forms of chronic otitis externa and malignant otitis externa. It is important to search for an allergy, eczema or immunodepression in cases of chronic otitis externa and for diabetes in cases of malignant otitis externa.

[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.

Obliteration of the tympanomastoid cavity: long term results of the Rambo operation.

INTRODUCTION: Radical mastoidectomy and tympanomastoid obliteration with fat tissue, also called the Rambo operation, is proposed to those patients suffering chronic middle-ear disease, with or without cholesteatoma, who have no useful hearing in an ear which cannot be kept dry despite all conservative treatment. METHODS: We analysed retrospectively a series of 46 patients operated upon in our department. Information recorded included the surgical indications, surgical observations, post-operative care and complications. All patients were invited to comment on their long term anatomical and functional results and to express their degree of satisfaction with the procedure. RESULTS: Recurrent infectious episodes were observed in seven cases. Residual cholesteatoma were observed in three cases. After treatment, these patients did not present with further complications. One case presented with multiple episodes of infection with recurrences of cholesteatoma and finally had the obliterated cavity transformed into an open cavity again. For most of the patients, in the long term (i.e. one to 23 years post-operatively (mean eight years)), the operation resulted in a dry ear, ending the need for frequent consultations to clean and disinfect diseased ears or open cavities. CONCLUSION: Obliteration of the tympanomastoid cavity, as proposed by Tom Rambo, shortens considerably the post-operative care period, in comparison with canal wall down mastoidectomy, and is therefore indicated if no serviceable hearing can be expected. In the long term, the rate of complications is low and patients are satisfied.

Short- and long-term results of stapedotomy and stapedectomy with a teflon-wire piston prosthesis.

We analyzed the results of 604 cases of primary stapes surgery performed between 1974 and 1997 with replacement of the stapes by a 0.6- or 0.8-mm Schuknecht Teflon-wire piston. At long-term follow-up (1 to 21 years; mean, 7 years), the residual air-bone gap was 10 dB or less in 79% of the cases. The hearing results and postoperative complications were comparable to those reported by authors who used the same evaluation criteria. Although the aim of the surgery was to perform a small stapedotomy with a narrow footplate perforation (0.8 mm), a large stapedotomy or a stapedectomy was performed in 134 cases (22.2%) because of surgical or anatomic conditions. Our results show that the larger footplate perforations allowed a better correction of the air-bone gap at the lower frequencies. The ears with larger perforations did not show a higher incidence of sensorineural hearing loss.

Lactobacillus plantarum amylase acting on crude starch granules. Native isoforms and activity changes after limited proteolysis.

The microheterogeneous native amylolytic complex secreted by the isolate A6 of Lactobacillus plantarum revealed a selective enzyme specificity loss when submitted to a limited proteolysis under a suboptimum pH condition. A clear electrophoretic profile change toward just one shorter, more acidic, and equally active polypeptide fragment resulted from the pronase E pretreatment. Although the whole enzyme activity remained apparently unaffected for soluble starch, the native parallel activity on intact and non-gelatinized starch granules either from cereals or tubers was dramatically reduced. This phenomenon was more clearly documented by scanning electron microscopy using the easiest accessible native substrate: wheat starch granules. The anion-exchange-purified native enzymes from L. plantarum displayed a different optimum pH curve when compared with the thermotolerant alpha-amylase from Bacillus licheniformis. The alpha-amylases from the lactic-acid-producing A6 isolate presented an electrophoretic profile easily distinguishable from those from B. liqueniformis and B. subtilis species.

[Value of positron emission tomography with 18-fluorodeoxyglucose (FDG-PET) in early detection of residual tumor in oro-pharyngeal-laryngeal carcinoma]. / Rôle de la tomographie par émission de positrons avec le 18-fluoro-deoxyglucose (PET-FDG) dans la détection précoce d'une non-stérilisation tumorale des carcinomes bucco-pharyngo-laryngés.

OBJECTIVE: To evaluate and compare the performances of FDG-PET imaging, MRI and clinical examination in the detection of residual tumour 3 months after treatment of patients with head and neck squamous cell carcinoma. PATIENTS: A consecutive sample of 50 patients with squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx or larynx, or a cervical lymph node metastasis from an unknown primary site excluding T1 lip and T1 vocal cord tumours. METHODS: Treatment outcome was assessed after 3 months by clinical examination, MRI, and FDG-PET scan. Sensitivity, specificity and accuracy were calculated relative to proven biopsy of residual tumour or a clinical follow-up of 4 months. RESULTS: Residual cancer was confirmed in 8 patients (16%), while the clinical follow-up was unsuspicious in the remaining 42 patients. PET-FDG had a sensitivity of 100% as compared to MRI (88%) and clinical examination (63%). Specificity was higher for clinical examination (90%), intermediate for MRI (83%) and lowest for PET-FDG (74%). CONCLUSIONS: This study finds very high sensitivity for PET-FDG in the detection of residual tumour. However, its lower specificity, lack of anatomical resolution, and high cost, require further studies to determine its role in routine screening.

[Adenoma of the middle ear]. / Adénome de l'oreille moyenne.

We report a case of middle ear adenoma, a rare epithelial tumour composed of adenomatous and neuroendocrine cells. These tumours have been designated by many different names, leading to controversy regarding their histogenesis and classification. The diagnosis was based on light microscopy and immunohistochemistry. A positive immunoreaction was evidenced for antibodies to keratin and chromogranin. The tumour was removed surgically. No additional therapy is recommended in the literature.

[Long-term results of canal wall down mastoidectomy]. / Résultats à long terme de l'évidement pétro-mastoïdien en technique ouverte.

INTRODUCTION: This study evaluates the anatomical and functional long-term results of canal wall down mastoidectomy. METHOD: We analyse the results of 259 primary, one stage canal wall down mastoidectomies with type III, IV or V ossiculoplasty performed between 1974 and 1998. The indication for surgery was chronic active otitis with cholesteatoma or resistant to conservative treatment. RESULTS: In the long term, 1-24 (mean 7) years after surgery, 95% of the ears showed a dry, self-cleaning cavity and were disease-free. Hearing was preserved or improved in 70% of cases. Surgical revision due to of residual cholesteatoma was necessary in 16 cases (6%). The number of postoperative outpatient visits necessary to treat multiple minor problems was up to 10 visits per patient during the first 6 months after surgery and then gradually decreased over the years. DISCUSSION: The results achieved with canal wall down mastoidectomy are satisfactory in the long term, but the cavities required a high degree of postoperative outpatient care.

Polyphasic study of the spatial distribution of microorganisms in Mexican pozol, a fermented maize dough, demonstrates the need for cultivation-independent methods to investigate traditional fermentations.

The distribution of microorganisms in pozol balls, a fermented maize dough, was investigated by a polyphasic approach in which we used both culture-dependent and culture-independent methods, including microbial enumeration, fermentation product analysis, quantification of microbial taxa with 16S rRNA-targeted oligonucleotide probes, determination of microbial fingerprints by denaturing gradient gel electrophoresis (DGGE), and 16S ribosomal DNA gene sequencing. Our results demonstrate that DGGE fingerprinting and rRNA quantification should allow workers to precisely and rapidly characterize the microbial assemblage in a spontaneous lactic acid fermented food. Lactic acid bacteria (LAB) accounted for 90 to 97% of the total active microflora; no streptococci were isolated, although members of the genus Streptococcus accounted for 25 to 50% of the microflora. Lactobacillus plantarum and Lactobacillus fermentum, together with members of the genera Leuconostoc and Weissella, were the other dominant organisms. The overall activity was more important at the periphery of a ball, where eucaryotes, enterobacteria, and bacterial exopolysacharide producers developed. Our results also showed that the metabolism of heterofermentative LAB was influenced in situ by the distribution of the LAB in the pozol ball, whereas homolactic fermentation was controlled primarily by sugar limitation. We propose that starch is first degraded by amylases from LAB and that the resulting sugars, together with the lactate produced, allow a secondary flora to develop in the presence of oxygen. Our results strongly suggest that cultivation-independent methods should be used to study traditional fermented foods.

Percutaneous versus surgical tracheostomy: a double-blind randomized trial.

OBJECTIVE: To compare surgical (SgT) and percutaneous (PcT) tracheostomies. BACKGROUND: Percutaneous tracheostomy has been said to provide numerous advantages over classical SgT. METHODS: A prospective randomized trial with a double-blind evaluation was used to compare SgT and PcT. SgT and PcT were performed according to established techniques (n = 70). The procedure was performed at the bedside in the intensive care unit in 21 cases (30%). The outcome measures were divided into procedure-related variables, perioperative complications, and postoperative complications. The procedure-related variables (location, duration, and difficulty) were evaluated by the surgeon. The perioperative and postoperative complications were divided into serious, intermediate, and minor. Perioperative and early postoperative (14 days) complications were evaluated daily by an intensive care unit nurse blinded to the technique used. Long-term postoperative complications were evaluated 3 months after decannulation by a surgeon blinded to the surgical technique. RESULTS: There were no major complications in either group. Most variables studied were not statistically different between the PcT and SgT groups. The only variables to reach statistical significance were the size of the incision (smaller with PcT, p < 0.0001), minor perioperative complications (greater with PcT, p = 0.02), and difficult cannula changes (greater with PcT; p < 0.05). Among nonsignificant differences, difficult procedures and false passages were more frequent with PcT, whereas long-term unesthetic scars were more frequent with SgT. CONCLUSIONS: Both techniques are associated with a low rate of serious or intermediate complications when performed by experienced surgeons. There were more minor perioperative complications with PcT and more minor long term complications with SgT.

Patients with CHARGE association: a model to study saccular function in the human.

The term CHARGE association refers to a combination of congenital malformations, the mnemonic CHARGE designating the most frequently occurring anomalies in the constellation. "C" indicates coloboma of the retina, "H" heart defects, "A" choanal atresia, "R" retarded growth and/or central nervous system anomalies, "G" genital hypoplasia, and "E" ear anomalies and/or deafness. The inner ear anomaly consists of a specific form of labyrinthine dysplasia that includes Mondini dysplasia of the pars inferior (cochlea and saccule) and complete absence of the pars superior (utricle and semicircular canals). We observed the development of a child with CHARGE association up to the age of 10 years. There was complete absence of nystagmic response to bithermal caloric and rotatory pendular stimuli. A nystagmic reaction was elicited by the off-vertical axis rotation test, indicating stimulation of the saccular macula, the sole remaining vestibular sense organ in this dysplasia. This reaffirms that the saccule is a vestibular organ, even though it is located in the pars inferior. In spite of the severe bilateral vestibular deficit and coloboma of the retina, the child was able to walk at the age of 2 years. The delay in the development of walking was not due to central nervous system anomalies, as suggested by the "R" of the acronym CHARGE, but rather, to the severe sensorineural visual and vestibular deficits.

Test-retest reliability of vestibular autorotation testing in healthy subjects.

Vestibulo-ocular reflex rotational chair testing in the high-frequency range is seldom performed because it requires specialized and powerful systems. But today a new method of sweep-frequency vestibulo-ocular reflex testing, the Vestibular Autorotation Test system (Western Systems Research, Inc., Pasadena, Calif.), based on active head movements increasing from 2 to 6 Hz, is available on the market. The goal of this study was to evaluate the test-retest variability of this test in healthy subjects. Twelve young adults (22 to 42 years old) without any history of auditory or vestibular dysfunction were included in the study. Subjects underwent five tests under standardized conditions with a 1-week interval. Each test consisted of three measurements of the gain and phase of the vestibulo-ocular reflex in the horizontal and vertical planes. Statistical analysis shows that the test-retest reliability of the Vestibular Autorotation Test is poor. Therefore this method cannot be used routinely to evaluate precise vestibulo-ocular reflex anomalies.

Ossiculoplasty by interposition of a minor columella between the tympanic membrane and stapes head.

This study analyzes short- and long-term results of 436 ossiculoplasties accomplished by a minor columella sculptured in the remnants of the incus and placed between the tympanic membrane and stapes head. Most cases were operated on by a transcanal approach through an ear speculum, under local anesthesia. Cases in which an associated mastoidectomy was performed to remove diseased tissue are excluded. The residual air-bone gap was < 20 dB in 86.1% of cases 2 months after surgery, in 77.0% 1 year later, and then remained stable over time, even in patients seen 5 to 15 years after the operation. Complications were rare. A total sensorineural hearing loss occurred in two cases (0.4%), the cause of which remained unexplained. Other complications included a high-frequency hearing loss in 10 (2.3%) cases, tinnitus in 12 (2.7%), and transitory vertigo in two (0.4%). We conclude that this type of ossiculoplasty is a simple but adequate procedure for primary restoration of hearing in chronic otitis media if the stapes is intact and mobile.