Knowledge of surgeons and practical stances of healthcare institutions in the Ile-de-France region toward sustainable development: A cross-sectional study.

PURPOSE OF THE STUDY: Climate change represents one of the gravest threats to health. Surgical activities mobilize a large number of resources which contribute to increased emission of CO2 and anesthetic gases in the environment. The objective of this study was to assess the level of knowledge of surgeons and the practical stances of healthcare establishments toward sustainable development. METHODS: This was a descriptive cross-sectional study, lasting 2 months. From 1 May 2021 to 30 June 2021, surgeons were asked via an online questionnaire to participate. RESULTS: A total of 131 out of the 457 contacted surgeons responded. A majority practiced in the private sector, 48.9% knew little about the rules of sustainable development in operating theaters, and 43.5% had an average level. The sustainable development charter was available in only 23% of establishments, while 19% had a sustainable development committee, and specific sustainable development actions were carried out in 27%. CONCLUSION: The level of knowledge of surgeons in Île-de-France on sustainable development was low. In general, surgical units were not complying with the rules of good practice on CO2 reduction. It is necessary to find strategies to reduce the impact of operating theaters on the environment.

A systematic review of surgical site infections following day surgery: a frequentist and a Bayesian meta-analysis of prevalence.

BACKGROUND: Since 1990, several studies have focused on safety and patient satisfaction in connection with day surgery. However, to date, no meta-analysis has investigated the overall prevalence of surgical site infections (SSI). AIM: To estimate the overall prevalence of SSI following day surgery, regardless of the type of surgery. METHOD: A systematic review and a meta-analysis of the prevalence of SSI following day surgery, regardless of the type of surgery, was conducted, seeking all studies before June 2016. A pooled random effects model using the DerSimonian and Laird approach was used to estimate overall prevalence. A double arcsine transformation was used to stabilize the variance of proportions. After performing a sensitivity analysis to validate the robustness of the method, univariate and multi-variate meta-regressions were used to test the effect of date of publication, country of study, study population, type of specialty, contamination class, time of postoperative patient visit after day surgery, and duration of hospital care. FINDINGS: Ninety articles, both observational and randomized, were analysed. The estimated overall prevalence of SSI among patients who underwent day surgery was 1.36% (95% confidence interval 1.1-1.6), with a Bayesian probability between 1 and 2% of 96.5%. The date of publication was associated with the prevalence of SSI (coefficient -0.001, P = 0.04), and the specialty (digestive vs non-digestive surgery) tended to be associated with the prevalence of SSI (coefficient 0.03, P = 0.064). CONCLUSION: The meta-analysis showed a low prevalence of SSI following day surgery, regardless of the surgical procedure.

Fat grafting of hairy areas of head and neck - comparison between lipofilling and nanofat grafting procedures in a cadaveric study.

AIM: Fat grafting has well-recognized effects in terms of volume gain, skin trophicity, relieving of post-wound nevralgia. Recent publications suggest a regenerative action on hair follicles. The objective of our study was to compare lipofilling and nanofat grafting in hairy areas of head and neck so as to determine a convenient fat injection technique for those areas in the prospect of treating alopecia. MATERIAL AND METHODS: Our study compared lipofilling and nanofat grafting, in a cadaveric study involving one body. RESULTS: Lipofilling was found easy to perform in the face, avoiding classical pitfalls, but was more difficult in the scalp areas. Nanofat grafting seemed particularly convenient to inject into the scalp, especially in Merkel's space, and hairy areas that required high precision injections. CONCLUSION: After having compared lipofilling and nanofat grafting in hairy areas of the head and neck, we propose a combination of lipofilling (in hairy areas where a durable gain of volume is acceptable, in case of burn or scar) and nanofat grafting (in all hairy areas and in Merkel's space in scalp areas). This technique may be used either as a complement of hair follicle grafting or as a regenerative treatment of alopecia.

[Cervical cancer screening in rural Madagascar: Feasibility, coverage and incidence]. / Dépistage du cancer du col utérin en milieu rural à Madagascar : faisabilité, couverture et incidence.

OBJECTIVES: To assess the implementation of a cervical cancer screening strategy in rural Madagascar. MATERIALS AND METHODS: A mobile unit, equipped with a cold-coagulator, visited every six months the main health care centers in the Atsinanana area between 2013 and 2015. Cervical cancer screening was based on visual inspection with acetic acid (VIA). The lesions suggestive of intraepithelial neoplasia and limited to the cervix were coagulated on the same day. Non-eligible patients for immediate treatment were referred for appropriate investigations. We assessed the feasibility and the coverage of the screening strategy and estimated the incidence of cervical cancer in the targeted population. RESULTS: One thousand five hundred and sixty-nine (18%) of 8959 women aged between 25 and 65 years old were screened. Three hundred and fifty-seven (23%) were VIA positive and 322 (21%) were eligible for immediate treatment. No serious adverse effects were observed among patients treated on the same day. Among the 35 patients not eligible for immediate treatment and referred to the hospital, 16 (46%) were lost to follow up. CONCLUSION: When a cervical cancer screening by HPV or cytology is not possible, VIA remains a feasible and acceptable option in a disadvantaged environment. The effectiveness of this approach is still limited by the problems of access to care for patients who are not eligible for immediate treatment.

[Unusual antenatal gestational choriocarcinoma]. / Présentation anténatale atypique d'un choriocarcinome gestationnel.

Choriocarcinoma is a rare and aggressive tumor that occurs mainly after a molar pregnancy, and exceptionally during a diploid viable pregnancy. We report a case of a 30 years old primipare that revealed a choriocarcinoma at 37 weeks by a generalized seizure. This unusual event did not, however, delay the early introduction of chemotherapy even in the absence of histological diagnosis. This diagnosis must be evoked in woman with genital activity presenting an unknown tumor. Treatment can be started without waiting for the histological evidence, due to the important feature of the hCG assay, significantly improving the prognosis.

Efficacy of the nicotine vaccine 3'-AmNic-rEPA (NicVAX) co-administered with varenicline and counselling for smoking cessation: a randomized placebo-controlled trial.

BACKGROUND AND AIMS: Nicotine vaccination has been proposed as a possible treatment to aid smoking cessation. First efficacy results of the nicotine vaccine 3'-AmNic-rEPA (NicVAX) showed that only a subgroup of the top 30% antibody responders achieved higher abstinence rates than placebo. The present study examined the efficacy of adding NicVAX versus placebo to varenicline and behavioural support as an aid in smoking cessation and relapse prevention. DESIGN: Randomized placebo-controlled trial. SETTING: Two research centres (Maastricht University Medical Centre and Slotervaart Hospital) in the Netherlands. PARTICIPANTS: A total of 558 smokers were assigned randomly to six injections with NicVAX (n = 278) or placebo (n = 280) both co-administered with open label varenicline and behavioural support. MEASURES: Outcomes were prolonged carbon monoxide-validated abstinence from weeks 9 to 52 (primary) and weeks 37 to 52 (secondary). We also performed a pre-planned subgroup analysis in the top 30% antibody responders. FINDINGS: There was no difference in abstinence rates between NicVAX and placebo from weeks 9 to 52 [27.7 versus 30.0%, odds ratio (OR) = 0.89, 95% confidence interval (CI) = 0.62-1.29] or weeks 37 to 52 (33.8 versus 33.2%, OR = 1.03, 95% CI = 0.73-1.46). The top 30% antibody responders, compared to the placebo group, showed a non-significant tendency towards higher abstinence rates from weeks 37 to 52 (42.2 versus 33.2%, OR = 1.47, 95% CI = 0.89-2.42). CONCLUSION: The nicotine vaccine, NicVAX, does not appear to improve the chances of stopping smoking when given in addition to varenicline and behavioural support.

[Rare case of bilateral pulmonary agenesis and prenatal diagnosis]. / Diagnostic anténatal d'une agénésie pulmonaire bilatérale : une observation exceptionnelle.

Bilateral pulmonary agenesis (BPA) is a rare congenital lung malformation. The prognosis is severe as it is incompatible with extra-uterine life. Although multiple prenatal imaging modalities are developed, the prenatal diagnosis of BPA remains problematic. We report a case of BPA observed in our unity and for which the diagnosis was not clearly identified during the evaluation. This report illustrates the need to consider all the imaging aspects and particularly during US examination suspecting BPA.

[When should evoke prenatal paternal uniparental disomy 14?]. / Quand faut-il évoquer en anténatal une disomie uniparentale paternelle 14 ?

The paternal uniparental disomy 14 is a rare malformation syndrome whose postnatal pathognomonic sign is the deformation of the rib as coat hanger. In prenatal, ultrasonographic signs are major recurrent polyhydramnios, a narrow thorax and deformed long bones short and sometimes other anomalies including ends. The authors report one rare case of prenatal paternal uniparental disomy 14 with the deformation of the rib as coat hanger. Prenatally, the narrow deformed thorax can be searched by ultrasound three-dimensional (3D) and/or helical CT and thus represent an aid to prenatal diagnosis.

[Epidermolysis bullosa simplex congenital antenatal discovery and contribution of 3D ultrasound]. / Épidermolyse bulleuse simplex congénitale de découverte anténatale et apport de l'échographie 3D.

Epidermolysis bullosa (EB) comprises a heterogeneous group of genodermatoses whose prognosis is variable. The diagnosis is suggested by prenatal ultrasound at signs, especially for junctional EB with pyloric atresia. The authors report a case of antenatal image limited skin undermining highlighted by the ultrasound three-dimensional (3D) in connection with a diagnosis of a congenital epidermolysis simplex confirmed postnatal period.

[The postnatal contraception: upon 600 patients of whom 129 were postnatal controlled]. / La contraception du post-partum : à propos de 600 patientes dont 129 revues à la consultation post-natale.

OBJECTIVE: To draw a parallel between the contraceptive methods prescribed in the post-natal ward and the contraceptive methods taken by patients during their postnatal visit. PATIENTS AND METHODS: This piece of work draws information from a prospective 10 weeks study at a University Teaching Hospital post-natal ward on the contraception that is prescribed upon leaving the maternity ward and also at the time of the post-natal visit. RESULTS: From the 600 cases studied, the analysis is about 129 patients reviewed in the post-natal visit. The percentage of loss was 78.5%. A hormonal contraceptive pill was prescribed to 73.5% of women (441 patients) after birth in which 63.5% had microprogestative pills. At the earliest, the IUD was given at about 5.4 weeks postpartum. At the time of the postnatal visit, compliance was bad for one third of women with either estrogen plus progestin methods, microprogestative or natural methods. Women who chose a barrier method were only 45.5% to follow this choice, the others left without contraception. DISCUSSION AND CONCLUSION: The prescription of postpartum contraception was followed by only 66.6% of women. In order to prescribe a more effective contraceptive method, we must improve the prescriber's timing in sharing contraceptive information and completeness of the contraceptive methods offered.

[Oral infections and pregnancy: knowledge of health professionals]. / Infections buccodentaires et complications de la grossesse: connaissances et attitudes des professionnels de santé.

OBJECTIVE: The abundance of recent studies on the relationship between oral diseases and complications of pregnancy leads to questions on knowledge of health professionals. This study aims to establish an inventory of knowledge and practice of health professionals in France on this issue. PATIENTS AND METHODS: A questionnaire on knowledge of the relationship between oral diseases and complications of pregnancy was referred to gynaecologists and obstetricians, midwives and dentists. This study was conducted at the University Hospital of Nantes and Le Mans General Hospital. RESULTS: Eighty-seven professionals of pregnancy and 259 dentists responded to the survey. Bleeding gums and pregnancy gingivitis are the oral manifestations most cited by all practitioners. There is however a difference concerning the epulis and caries risk. The most cited Pregnancy complications are risk of premature delivery and chorioamniotitis. Only dentists had received initial training on pregnancy complications. Finally, all health professionals point to the lack of continued education on this topic. DISCUSSION AND CONCLUSION: There is a good knowledge of the pregnancy complications associated with oral disease despite the lack of training of pregnancy, but the attitudes of care are not still in adequacy. It appears necessary to strengthen the training of all practitioners in this field. The design and implementation of a specific questionnaire on oral health status could allow better identification of the patients at risk by the professionals of pregnancy, and optimize so the care of pregnant women.

[Interest of periodontitis screening and treatment in pregnancy: systematic review]. / Intérêt du dépistage et du traitement des maladies parodontales chez la femme enceinte: revue de la littérature.

For 15 years, the investigation of a relationship between periodontal diseases and complications of pregnancy is explored, and allowed the publication of conflicting results. This work is a literature review of articles of high level of evidence, which aims to clarify the impact of treatment of periodontal disease on pregnancy. Among the 15 selected randomized controlled trials (RCT), nine concluded a significant reduction in pregnancy complications between the "experimental" group treated and "control" group. However, six other RCT concluded that the lack of a significant difference between the two groups has higher levels and a more robust methodology. In 2006, a RCT, published in an influent medical journal, announced that there would be no significant benefit to treat pregnant women to reduce the complications of pregnancy. The contradictions found in the different studies have led some authors of meta-analysis to allocate the RCT per groups of power, based on their methodology. Meta-analysis using this methodology concluded that there is no benefit for periodontal treatment to reduce complications of pregnancy. In conclusion, the next RCT conducted should standardize their methodological criteria, and preferably multicenter, including a large number of participants. In addition, a more precise definition of periodontal diseases for the purpose of research is necessary. Finally, the notion of success or failure of periodontal treatment must be considered.

The efficacy and safety of a nicotine conjugate vaccine (NicVAX®) or placebo co-administered with varenicline (Champix®) for smoking cessation: study protocol of a phase IIb, double blind, randomized, placebo controlled trial.

BACKGROUND: A potential new treatment in smoking cessation and relapse prevention is nicotine vaccination which is based on active immunization against the nicotine molecule. This immunization will elicit the immune system to produce nicotine-specific antibodies that sequester nicotine in the blood stream, after inhaling tobacco products. The resulting antibody-antigen is too large to cross the blood-brain barrier and is therefore postulated to attenuate the rewarding effect of nicotine by preventing the latter from reaching its receptors in the brain and causing the release of dopamine. The aim of this paper is to describe the design of a phase IIb, multi-center, double blind, randomized, placebo controlled trial to assess the efficacy of the nicotine vaccine NicVAX® co-administered with varenicline (Champix®) and intensive counseling as an aid in smoking cessation and relapse prevention. METHODS/DESIGN: Two centers will include a total of 600 smokers who are motivated to quit smoking. At week -2 these smokers will be randomized, in a 1:1 ratio, to either 6 injections of NicVAX® or placebo, both co-administered with 12-weeks of varenicline treatment, starting at week 0. The target quit day will be set after 7 days of varenicline treatment at week 1. Smokers will be followed up for 54 weeks. The primary outcome is defined as biochemically validated prolonged smoking abstinence from week 9 to 52. Secondary outcomes include safety, immunogenicity, smoking abstinence from week 37 to 52, abstinence from week 9 to 24, abstinence in the subset of subjects with the highest antibody response, and lapse/relapse rate. DISCUSSION: This is the first study to assess the efficacy of a nicotine conjugate vaccine in combination with an evidence-based smoking cessation pharmacotherapy (varenicline) to quit smoking. Although NicVAX® is primarily designed as an aid to smoking cessation, our study is designed to explore its potential to maintain abstinence and prevent relapse. The results of this trial will give a unique insight in the potential of nicotine vaccination for relapse prevention. TRIAL REGISTRATION: ClinicalTrials.gov: (NCT00995033).

Nicotine vaccines to assist with smoking cessation: current status of research.

Tobacco smoking causes cardiovascular, respiratory and malignant disease, and stopping smoking is among the key medical interventions to lower the worldwide burden of these disorders. However, the addictive properties of cigarette smoking, including nicotine inhalation, render most quit attempts unsuccessful. Recommended therapies, including combinations of counselling and medication, produce long-term continuous abstinence rates of no more than 30%. Thus, more effective treatment options are needed. An intriguing novel therapeutic concept is vaccination against nicotine. The basic principle of this approach is that, after entering the systemic circulation, a substantial proportion of nicotine can be bound by antibodies. Once bound to antibodies, nicotine is no longer able to cross the blood-brain barrier. As a consequence, the rewarding effects of nicotine are diminished, and relapse to smoking is less likely to occur. Animal studies indicate that antibodies profoundly change the pharmacokinetics of the drug and can interfere with nicotine self-administration and impact on the severity of withdrawal symptoms. To date, five phase I/II clinical trials using vaccines against nicotine have been published. Results have been disappointing in that an increase in quit rates was only observed in small groups of smokers displaying particularly high antibody titres. The failure of encouraging preclinical data to completely translate to clinical studies may be partially explained by shortcomings of animal models of addiction and an incomplete understanding of the complex physiological and behavioural processes contributing to tobacco addiction. This review summarizes the current status of research and suggests some directions for the future development of vaccines against nicotine. Ideally, these vaccines could one day become part of a multifaceted approach to treating tobacco addiction that includes counselling and pharmacotherapy.

Electrocardiographic findings in women with a recent history of pre-eclampsia.

OBJECTIVE: To assess the prevalence of electrocardiographic (ECG) abnormalities after a pregnancy complicated by pre-eclampsia and/or syndrome of hemolysis, elevated liver enzymes and low platelets (PE) and to compare the ECG characteristics, at least six months after pregnancy, between primiparous early-onset PE women with and without recurrent PE. DESIGN: Longitudinal observational study. SETTING: Tertiary referral centre in The Netherlands from 1996 to 2008. SAMPLE: Six hundred and fifty-eight formerly pre-eclamptic women. For our second objective, we used a subgroup of 79 primiparae with a history of early-onset PE. METHODS: Data were obtained during a postpartum screening program for women with hypertensive disorders during pregnancy. MAIN OUTCOME MEASURES: Electrocardiographic abnormalities in PE women and characteristics of the ECG in women with recurrent PE after a first pregnancy complicated by early-onset PE. RESULTS: The ECG of 13 (2.0%), two (0.3%) and two (0.3%) former patients suggested ischemia, left ventricular hypertrophy and left atrial enlargement, respectively. Primiparae with recurrent PE in their second pregnancy differed from their counterparts with an uneventful second pregnancy by a leftward deviation of both the P- and the R-axes of 11° (p= 0.022) and 12° (p= 0.021), respectively, with a prolonged QT interval (p= 0.025). CONCLUSIONS: The prevalence of ECG abnormalities in women with a recent history of PE was low and did not differ appreciably from that in a large population of healthy women of comparable age. The ECGs in primiparae with a history of early-onset PE who developed recurrent PE in their second pregnancy differed slightly from women with an uneventful second pregnancy, probably related to potential confounders.

Contribution of three-dimensional ultrasonography in depicting perineal features in cloacal malformation.

Cloacal anomaly is a rare malformation with an incidence of 1 in 50,000 births. The definitive prenatal diagnosis of cloacal dysgenesis sequence is difficult. The use of three-dimensional (3-D) ultrasonography helps to describe the perineum and change diagnosis. In our case report, a large median genital structure was visualized, which was initially considered a penis-like structure, but the 3-D technique showed an enlarged bud. The urethral meatus was at the tip of this smooth structure. The lack of anal structure was clearly demonstrated.

[Lessons and impact of two audits on postpartum hemorrhages in 24 maternity hospitals of the network "Sécurité Naissance - Naître Ensemble" in "Pays-de-la-Loire" area]. / Leçons et impact de deux audits sur les hémorragies du postpartum dans les 24 maternités du réseau « Sécurité Naissance - Naître Ensemble ¼ des Pays-de-la-Loire.

OBJECTIVES: The aim of the study is to assess the compliance rate of treatment of postpartum hemorrhage (PPH) according to guidelines developed by the CNGOF within our network by a first audit, and evaluate the impact of this first audit by conducting a second audit. METHODS: An initial audit of resources and management of postpartum hemorrhage (PPH) was conducted in 2006-2008 in 24 maternity hospitals of the Pays-de-la-Loire. The audit had identified six areas for improvement. A second audit was implemented in 2009-2010 to evaluate the actions of prevention and measure changes in the management of PPH. Two interns have distributed the 24 maternity homes and moved in each hospital to see 10 cases of vaginal delivery (VD) (section "Prevention"), and the last cases of PPH following a VD. The results are in compliance rate compared to the repository of the HAS in 2004. RESULTS: The first audit was conducted on 101 PPH in total. It has allowed us to propose corrective actions to the 24 maternity hospitals: leaf specific monitoring, reporting amounts of blood loss, transfusion on these clinical criteria without waiting for the blood cell counts, indicating more frequent and rapid sulprostone, set for maternity hospitals without surgical skill an agreement with a visceral surgery department, and avoid maternal transfers for PPH. For the second audit, the compliance rate of the preventive aspect was 73% (95: 71-75%) of 239 cases of BA with variations according to maternity from 48 to 93%. Compliance rates according to the criteria were: 99% obstetric consultations, 98% for anesthesia, 92% for hemoglobin, 77% for the group card available in the record, 89% agglutinins, 35% for the notification of the installation of bag, 36% for the notification of the amount of blood lost, 69% for the supervisor within two hours, and 64% for the directed delivery. For component "Support", the overall compliance rate was 81% (95: 79-83%) of 118 PPH AVB, and 85% in the 71 uterine atonies in 21 pregnancies (3 had no HPP during the period) with variations according to maternity from 51 to 93%. Conformities compared with the first audit were: improvement of time noted PPH (66 and 85%), initiation of a leaf-specific monitoring (0% and 87%), equivalence of appeals responders (86 and 88%), improving the amount of blood noted (51 and 67%), equivalent to the practice of evacuation of retained placenta (88 and 91%), decreased prescription of antibiotics (83 and 71%). For only uterine atony (n=71), there was a slight improvement in the prescription of sulprostone within 30 minutes (53 and 58%), and improved decision within 2 hours (47 and 69%). Finally, there was no connection rates in the two components (r=0.32, p=0.15). Criteria associated with good compliance were calculated. CONCLUSION: There is a general improvement in prevention and care, with critical points and persistent disparities between pregnancies. In the aftermath of the completion of the audit, the overall results were sent to officials with the rank of each maternity, inviting each responsible to analyze weaknesses and implement corrective actions. Further action is planned within the network.

[Periodontal diseases and preterm birth: a pilot study]. / Maladies parodontales et accouchements prématurés: étude clinique pilote.

The aim of this work is to determine periodontal disease's prevalence in preterm delivery (before 37 weeks of gestation) and find a significant association between preterm birth and periodontal diseases. Periodontal status was determined. Status and severity were noted and correlated to term of delivery. Fifty-two patients were included in the study. Periodontal disease's prevalence was 33% for gingivitis and 44% for periodontitis. No significant correlation was found (P=0.41). Periodontal disease's prevalence is agreed with literature review. The different opinion are largely discussed. Methodological harmonization of periodontal definitions is needed to increase study's power.