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Introduction: in dentistry, many treatments are invasive and can lead to infections. The purpose of this study was to evaluate the prevention of healthcare-associated infections in the dental practice in Rabat. Methods: a survey on the prevention of healthcare-associated infections in Rabat dental practices was conducted among 324 practitioners. A self-administered questionnaire was used to assess their training, hygiene, protection, organization of premises, asepsis, antisepsis and use of medical devices. Data were collected using JAMOVI version 1.8.4, the Χ² and Fisher tests were used to compare the variables, the significance level was set at P<0.05. Results: only 80 subjects took part in the study. All the dentists had protective equipment, but 68 (85%) did not have instructions on what to do in case of accidental exposure to blood; 41 (62.1%) operators had qualified assistants, 36.4% had a team vaccinated against hepatitis B and 61.3% of operators and assistants had been trained to handle reusable medical devices. Seventy-six studies had isolated examination rooms, 41 had a steam steriliser and a sorting area with sharps collector. However, 35.1% had a contract for the collection of waste generated by health-care activities, posing a significant risk of infection. Conclusion: the results of this study show that most practitioners in Rabat comply with the majority of the aseptic and hygienic standards in dentistry. However, more needs to be done to ensure that staff are vaccinated. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Implant placement Essure™, sterilization procedure for women, were performed under hypnosedation (HYP) and compared to the operative anxiety and analgesia of 12 patients operated-on under general anesthesia (GA). Study design: Prospective and comparative group study. Patients and methods: Two groups of twelve patients were matched and compared based on the choice of anesthetic technique: hypnotics (HYP) with possible additional sedation by propofol and remifentanil or GA involving propofol, sevoflurane and remifentanil. The assessment of anxiety and pain based on a visual analogy scale (0–10) and use of analgesics were studied in the recovery room and at discharge of hospital. The statistical analysis relies on nonparametric tests for paired data (Wilcoxon test). Results: All patients were operated. The two groups are statistically comparable. The preoperative anxiety before premedication is lower in the HYP group (p <0.05). No conversion to general anaesthesia is necessary in the HYP group, but five patients were using sedatives drugs but doses are very low compared to general anaesthesia. The analgesic consumption was equivalent in both groups. Conclusion: We conclude that hypnosedation is a valuable alternative to traditional anesthetic techniques for ambulatory Essure™ implant. The use of hypnotic tool is an interesting alternative for the management of patients during invasive medical procedures or surgical, providing psychological benefits to the patient. [Copyright &y& Elsevier]

Abstract: CSF sterilization should be obtained very rapidly to reduce both mortality and morbidity due to bacterial meningitis. Thus, antibiotic treatment should be adapted to the suspected bacterium and administered as early as possible at high dosage with – if necessary – a loading dose and continuous perfusion. The rates of abnormal susceptibility to penicillin of Streptococcus pneumoniae, Neisseria meningitis and Haemophilus influenzae are 37%, 30% and 12% respectively. Thus, ceftriaxone or cefotaxim must be used as empirical treatment. Listeria monocytogenes remains fully susceptible to aminopenicillin, so, the combination aminopenicillin and aminoglycoside is the first-line treatment. Antibiotic resistance, allergy or contra-indications, are in fact rare but in these cases, antibiotic combinations are often needed. The latter are more or less complex and clinically validated; they include molecules such as vancomycine, fosfomycin, fluoroquinolone or linezolid. [Copyright &y& Elsevier]

The evaluation of an implant, in terms of quality control, can be done ultimately only by the clinical investigation. This step should not touch only the new implants but also should be applied to any modification even if it is light of an already existing implant. The prospective clinical investigation remains however a heavy, constraining and long approach. It is undertaken currently only for new implants or when a modification truly innovating is made to an already existing implant [1]. Within the framework of the development of a new articular implant and in particular when in a new designing geometry or during the modification of this one, it could be interesting to have a tool for pre test clinical making it possible to envisage the behaviour and the performances of this prosthesis before investing heavy means of a clinical study which remains however in the long term, essential. The tribological tests on simulators can offer this possibility [2]. In this study, we show the importance of the effects of the sterilization process, as can exploit the role of the biological environment and the materials couple (prosthesis head and cup). The higher hip prostheses diameter (∅28 ram) and the choice of the CoCrMo/polyethylene couple seem to give a lower wear rate and consequently a better longevity of the arthroplasty [3]. [ABSTRACT FROM AUTHOR]

Objective: To assess the satisfaction and recovery of women undergoing sterilization with a permanent birth control device (Essure® micro-insert). Patients and methods: French multicenter survey carried out in 12 public and private hospitals. One thousand and thirty-two patients undergoing permanent hysteroscopic sterilization (Essure® micro-insert) between 2002 and 2006 were enrolled. An anonymous satisfaction questionnaire was sent to all patients. Demographic data as well as the level of tolerance and acceptability of the procedure were analyzed. Seven hundred and two (68%) patients responded to the questionnaire. Results: Forty-five percent of all procedures were done without anaesthesia, and 55% under local or general anaesthesia or neuroleptanalgesia. Mean age was 42 years. Sterilization was a personal decision in 62% of cases. Only one out of three women (33%) was informed of the law of sterilization's legalization. Patients came to know about this procedure by their gynecologist (74%), or by media (14%). Eighty-four percent of patients considered the level of tolerance during the procedure from no pain to moderate pain. The method without anesthaesia is described painless in 24% of cases when the surgeon has done more than 50 procedures versus 11% when he has done less than 50 (P =0.012). Seventy-seven percent of patients were appreciative of following the procedure on the monitor screen. Patients returned to everyday life within 24h in 90% of cases, whereas 24h return to work was attained in 75%. The procedure without general anesthesia offered a quicker return to work (80% within 24h) than the procedure carried out with general anesthesia (59%, P <0.05). The memory of the procedure was described as “very good” to “acceptable” in 96% of cases. Most of the patients (98%) would recommend this procedure to their friends. Discussion and conclusion: The results of this national survey confirm that hysteroscopic sterilization is associated with good overall satisfaction, because it is a fast, easy and safe method of permanent sterilization with good levels of tolerance and immediate recovery. The technique without anaesthesia is now recommended. Its tolerance is improved with surgeon's experience. [Copyright &y& Elsevier]

Abstract: The vacuum extractor Kiwi OmniCup™ (Clinical Innovations, Muray, Utah, USA) has been developed to provide several advantages. This is a complete system with an integral hand-held vacuum operated by the obstetrician. This is also a single use instrument, which may reduce the risk of potential transmission of infections and the logistic of sterilization process. Further potential benefits of this system include the smaller overall equipment size and the ability to measure traction force. However, the data about its efficiency remain conflicting. The first works demonstrated very high successful rate of vaginal delivery, whereas two recent randomized studies showed that the Kiwi Omnicup™ was less efficient than currently used vacuum extractor. It appears to be as safe as conventional a device for both mother and newborn. However, further additional data remain necessary needed to complete its evaluation. [Copyright &y& Elsevier]

Abstract: Meticillin resistant Staphylococcus aureus (MRSA) is among the most important causes of nosocomial infections. It possesses a particular ability to spread in hospitals worldwide. Objective: To analyze the proportion of MRSA among S. aureus isolated from specimen taken for diagnosis purposes. To make the medical staff aware of the problem of MRSA infections and to take a better care of patients. Patients and methods: During 3 months, a prospective study was carried out in the neonatal unit of centre hospitalier départemental du Zou et Collines in Benin. We identified newborn carriers of SA, particularly MRSA and factors associated with the carriage. Two hundred and ninety patients were admitted in the 3 divisions of the neonatal unit. From 195 specimens examined for diagnosis purposes 48 h after hospitalization, 112 patients were detected by nose swabbing. Concurrently, swabbing of environment was achieved. Results: Among patients''specimens, 141 isolations of S. aureus were observed. The proportion of MRSA was 36% amongst diagnostic specimens. MRSA represented 39% of the environment specimens. None of the isolated MRSA produces Panton Valentine leukocidin. Conclusion: Our survey revealed a high level of MRSA among S. aureus isolated from diagnostic specimens. Consecutive to such findings and for decreasing nosocomial infection, an appropriate prevention program was installed, including intensive promotion of hands hygiene, correct sterilization and disinfection of materials and patients. [Copyright &y& Elsevier]

Abstract: Objectives – Hysteroscopic flexible micro-insert (Essure®) is an ambulatory improvement of fallopian tube sterilization, which is a deliberated suppression of fertility. The aim of this study was an evaluation of feasibility (learning curve) and the first year outcome of this method. Patients and methods. – This prospective study, carried out between February 2002 and March 2003, included patients who were matching with manufacturer recommendations. One surgeon only realized all the device placements. Results. – Fifty patients were included (one year follow-up). Mean age was 41 (±3.3), mean parity was 2.7 (±0.8). Mean time needed for device placement was 26 minutes (±6.5) and was reduced with increased experience. Six failures of placement (12%) were related, because of submucus leiomyomas, proximal tubal stenotic disease or too retroverted uterus. Only 5 patients (11,4%) described intensive pelvic pain during the placement. The only case of device expulsion benefited from a successful second placement. The one-year follow-up showed no significant difference of body weight increasing, duration or quantity of menstruation, neither significant pelvic pain nor vaginal bleeding. Tolerance was rated at least at “somewhat satisfied”. There have been no pregnancies reported in 670 woman-months of effectiveness. Discussion and conclusion. – Our results agree in any point with those of larger studies. We think that hysteroscopy micro-insert placement is not only reserved to specialized centers but also to any gynecologist who is used to performing hysteroscopy because of its feasibility. [Copyright &y& Elsevier]

Abstract: Objectives. – The Laryngeal Tube (LT™) is a supra-laryngeal device indicated to manage upper airway during anaesthesia. Leak pressures were lately reported higher for the LT™ as compared to the LMA™. A recent study found a small amount of proteinaceous material on LMA™ after classical sterilization suggesting a risk of contamination by unconventional transmissible agents (prions). The aim of this study was to evaluate the effectiveness of the single use Laryngeal Tube: the LTD™. Study design. – Prospective study realized after ethical committee agreement and patient consent for participation. Patients et methods. – Adults, ASA score≤3, 18 to 75-year-old, without upper airway abnormality or difficult intubation criteria, anaesthesia≤2 h, free access to patient''s head and LTD™. The following criteria were evaluated: easiness of insertion, assisted (AV), controlled (CV) and spontaneous ventilation (SV); leak pressure (LP) 5 and 15 min after insertion; complications during anaesthesia conducted with propofol and remifentanil under bispectral index monitoring. Results. – 55 patients were included; only one failure was reported at insertion. AV and CV were easy, SV difficult in 4 patients with chin lift necessary for adequate ventilation. LP was 28.92±8.4 and 30.87±8.68 cmH2O 5 and 15 min after insertion respectively. No major incident was noticed throughout the study. Conclusion. – the use of the LTD™ was easy and successful. Moreover the LTD™ totally excluded the risk of contamination by unconventional transmissible agents. [Copyright &y& Elsevier]

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Summary: Objective: Delayed cerebrospinal fluid sterilization is defined by a positive second lumbar puncture, recommanded according to the guidelines from the French Consensus Conference of 1996 between the 36th and 48th hours after the beginning of antibiotics prescribed for pneumococcal meningitis. The aim of this study was to analyze specifically delayed cerebrospinal fluid sterilization, identified during the first 5 years of the French observatory of children bacterial meningitis. Patients and methods: The Groupe de Pathologie Infectieuse Pédiatrique (GPIP) and Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV) has set up since the first of January 2001 a descriptive national multicenter network, to determine incidence, main characteristics, and prognosis of bacterial meningitis in children. A questionnaire, available in all pædiatric unit taking care of bacterial meningitis, was completed by a referral doctor. It contained reasons for inclusion in the study, anamnesis, clinical examination, treatment, pneumococcal characteristics, and short term prognosis. Delayed cerebrospinal fluid sterilization were identified, and the analysis of their medical records completed the questionnaire. Results: From 1st January 2001 to 31 December 2005, 616 pneumococcal meningitis were identified. Among them, 442 had a second lumbar puncture, and 8 had delayed cerebrospinal fluid sterilization. The analyis of their medical records were reviewed to describe their characteristics. Two had an osteomeningeal breach, one a ventriculoperitoneal valve. All received previously an antibiotic, and were treated with a curative antibiotic by cephalosporins. Vancomycin was given in 6 cases. The antibiotic was inadapted to the French guidelines for 1 patient. There are 4 vaccine type pneumococci and only 1 strain was resistant to penicillin, and intermediate to cephalosporins. The controlled lumbar puncture was made between 36.5 and 179.4hours after beginning antibiotics. One patient has received a double dose of steroids. Three were in a coma, had convulsions, and were ventilated, none died. One patient has a sequellar paired deafness, two a severe disability, four a normal psychomotor development. Conclusion: The delay of sterilization is a rare situation and represented only 1.8 % of pneumococcal meningitis during the first five years of the observatory. These results suggest that a second lumbar puncture to assess sterilization could be proposed only in cases of unfavourable clinical course, MIC greater than or equal 0.5mg/l to 3GC, risk factors for delayed cerebrospinal fluid sterilization and high bacterial inoculum. [Copyright &y& Elsevier]