Efficacy of Intra-Uterine Tamponade Balloon in Post-Partum Hemorrhage after Cesarean Delivery: An Impact Study.

Invasive therapies (surgery or radiological embolization) are used to control severe post-partum hemorrhage. The intra-uterine tamponade balloon is a potential alternative, well documented after vaginal delivery. However, available data on its use after cesarean delivery remain scarce. This study assessed the efficacy of the intra-uterine tamponade balloon during post-partum hemorrhage in a cesarean delivery setting. Using a retrospective impact design, post-partum hemorrhage-related outcomes before ("pre-balloon" period) versus after implementation of intra-uterine tamponade balloon ("post-balloon" period) were compared. All women with post-partum hemorrhage requiring potent uterotonic treatment with prostaglandins after cesarean delivery over a 9-year period were eligible. The primary outcome was the rate of invasive procedure (conservative surgery, radiological embolization and/or hysterectomy). p < 0.05 was considered statistically significant. A total of 279 patients were included (140 vs. 139). Most baseline characteristics were comparable between the two studied periods. The success rate of the intra-uterine tamponade balloon was 82%, and no related complications occurred. Rates of invasive procedures and transfusion were significantly reduced (28.6% vs. 11.5%, p < 0.001 and 44.3% vs. 28.1%, p = 0.006 respectively) during the "post-balloon" period, and length of hospital stay was shorter (p < 0.001). Implementation of intra-uterine tamponade balloon during post-partum hemorrhage after cesarean delivery appears to be safe and effective, with a decrease in both invasive procedures and transfusion rates.

Bacterial colonization of healthcare workers' mobile phones in the ICU and effectiveness of sanitization.

Extra-European studies report high rates of multi-drug resistant bacteria colonization of healthcare workers' mobile phones in intensive care units. We aimed to assess the prevalence of bacterial colonization of healthcare workers' mobile phones in an intensive care unit in France and the effectiveness of a sanitization product. We designed a prospective, monocentric study in a 15-bed intensive care unit within a 300-bed private hospital. Bacterial colonization was assessed on 56 healthcare workers' mobile phones immediately before and 5 min after sanitization of the phones with bactericidal wipes. The mobile phones of 42 administrative staff acted as controls. All mobile phones in both groups were colonized. Healthcare workers' phones had a higher number of different bacterial species per phone (2.45 ± 1.34 vs. 1.81 ± 0.74, p = 0.02). Colonization with pathogens did not differ significantly between healthcare workers' and controls' phones (39.3% vs. 28.6%, p = 0.37). Excluding coagulase negative Staphylococcus, Staphylococcus aureus was the most common pathogen found in both groups (19.6% and 11.9%, p = 0.41). Only one healthcare workers' mobile phone was colonized by methicillin-resistant Staphylococcus aureus, and no other multi-drug resistant bacteria was detected. No covariate was associated with pathogen colonization. After sanitization, 8.9% of mobile phones were sterilized, and colonization with pathogenic bacteria decreased (21.4% vs. 39.3%, p = 0.04) as did the number of CFUs/mL (367 ± 404 vs. 733 ± 356, p < 0.001). Colonization of intensive care unit healthcare workers' and administrative staff's mobile phones was similar. Colonization with pathogens was frequent but colonization with multi-drug resistant bacteria was rare. Disinfecting the phones with bactericidal wipes is not completely effective. Specific sanitization protocols and recommendations regarding the management of healthcare workers' mobile phones in intensive care units should be developed. Additionally, good hand hygiene after touching mobile phones should be kept in mind to prevent cross-infections.

3D-FISH analysis reveals chromatid cohesion defect during interphase in Roberts syndrome.

BACKGROUND: Roberts syndrome (RBS) is a rare autosomal recessive disorder mainly characterized by growth retardation, limb defects and craniofacial anomalies. Characteristic cytogenetic findings are "railroad track" appearance of chromatids and premature centromere separation in metaphase spreads. Mutations in the ESCO2 (establishment of cohesion 1 homolog 2) gene located in 8p21.1 have been found in several families. ESCO2, a member of the cohesion establishing complex, has a role in the effective cohesion between sister chromatids. In order to analyze sister chromatids topography during interphase, we performed 3D-FISH using pericentromeric heterochromatin probes of chromosomes 1, 4, 9 and 16, on preserved nuclei from a fetus with RBS carrying compound heterozygous null mutations in the ESCO2 gene. RESULTS: Along with the first observation of an abnormal separation between sister chromatids in heterochromatic regions, we observed a statistically significant change in the intranuclear localization of pericentromeric heterochromatin of chromosome 1 in cells of the fetus compared to normal cells, demonstrating for the first time a modification in the spatial arrangement of chromosome domains during interphase. CONCLUSION: We hypothesize that the disorganization of nuclear architecture may result in multiple gene deregulations, either through disruption of DNA cis interaction -such as modification of chromatin loop formation and gene insulation - mediated by cohesin complex, or by relocation of chromosome territories. These changes may modify interactions between the chromatin and the proteins associated with the inner nuclear membrane or the pore complexes. This model offers a link between the molecular defect in cohesion and the complex phenotypic anomalies observed in RBS.