Fatal intoxication caused by the application of the multiple transdermals patchs of fentanyl

Fentanyl (N-phenyl-N-(1-2-phenylethyl-4-piperidyl)propanamide) is a potent synthetic narcotic analgesic. He has an analgesic effect 100 timesgreater than that of morphine. The use of transdermal fentanyl delivrery systems has increased over recent years especially in patients withchronic pain who are already treated with high doses of morphine or it is derivate. However, many cases of fentanyl intoxication through a varietyof transderrmal systems have been reported. This paper reports a fatality due to excessive administered Fentanyl Sandoz® Matrix 50ìg/htransdermal therapeutic systems

Choc anaphylactique au cours de la chirurgie de kyste hydatique du foie: &#192 propos d’un cas

Nous rapportons l’observation d’un choc anaphylactique survenue au cours d’une chirurgie de kystes hydatiques hépatiques multiples. Il s’agit d’un enfant de 13 ans, de sexe féminin, sans antécédents pathologiques notables, en particulier allergique, programmé pour cure chirurgicale de kystes hydatiques hépatiques multiples. L’examen préopératoire est strictement normal. La patiente est classée ASA (American Society of Anaesthesiologists) I. L’intervention est réalisée sous anesthésie générale. Au moment de la manipulation du deuxième kyste, une augmentation des pressions d’insufflation apparaît, avec des râles sibilants au niveau des deux champs pulmonaires et une désaturation, suivi d’un collapsus vasculaire avec hypotension artérielle 50/30. La prise en charge est débutée aussitôt par un remplissage vasculaire par du sérum salé 9%, suivi par des bolus d’adrénaline de 0,1mg à trois reprises, puis d’une perfusion continue à raison. L’adrénaline est arrêtée au bout de 48 heures et la patiente est adressée au service de chirurgie à j+4 de l’intervention. Le choc anaphylactique est une complication connue de la rupture intra péritonéale spontanée ou post-traumatique du kyste hydatique du foie. Sa survenue en peropératoire est devenue exceptionnelle, grâce aux mesures de prévention chirurgicale entretenues en peropératoire par l’éviction de manipulation du kyste, de le vider avant d’injecter le scolicide, et de ne pas l’administrer sous forte pression

Utilisation des SIG pour l’aménagement du bassin-versant de l’ISSER (Algerie)

Situé au nord-ouest de l’Algérie, le bassin versant de l’Isser, espace fragilisé par les épisodes de sécheresse et caractérisé par des affleurements de marnes et d’argiles très fragiles, présente une forte sensibilité à l’érosion hydrique. En plus de la détérioration de la qualité de l’eau qu’il entraîne, le phénomène érosif dans cette zone, constitue l’accusé principal de la dégradation du patrimoine sol. Il résulte de la conjonction de plusieurs facteurs : agressivité des pluies, érodibilité des sols, dissection du relief, faiblesse du couvert végétal…La reconnaissance des zones ravinées et la précision des caractéristiques climatiques et hydriques de la zone d’étude, peuvent servir de base à l’élaboration d’un plan d’aménagement antiérosif adapté aux conditions du milieu.Pour ce faire, une carte de localisation des zones à haut risque, au niveau du bassin versant, correspondant au croisement d’une série de cartes thématiques, a été établie. Cette carte permet de mettre en évidence les zones nécessitant un aménagement prioritaire. La synthèse de l'ensemble des résultats sous un système d’information géographique (SIG), nous a encouragés à proposer des travaux d’aménagement antiérosifs techniques (correction torrentielle) et biologiques (reboisement), visant à atténuer les effets négatifs des pertes en terre aussi bien à l’amont qu’à l’aval. Le choix des ouvrages et les décisions à prendre doivent être fondés sur l’action des facteurs biophysiques et anthropiques. Par ailleurs, ces travaux doivent s’intégrer dans une nouvelle stratégie visant une meilleure gestion de l’espace dans une optique de développement durable, en tenant compte des besoins et des perspectives de la population rurale.Located in Northwest Algeria, the watershed of Isser is an ecosystem weakened by drought episodes and strongly sensitive to water erosion.Erosive phenomenon, in this ecosystem, is the result of a combination of several factors : aggressiveness of the rains ; erodibility of the soils (marls) ; stiffness of the relief, weakness of the vegetal cover.Localising the gullied zones and specifying the climatic and hydric characteristics of the study zone are prerequisites to the development of any sustainable erosion control strategy.The overlaying of a series of thematic maps, fed into a Geographical Information system (GIS), has led to the design of a map localising the gullied zones in the watershed requiring restoration works, first and foremost. The antierosive operations suggested include technical measures (torrential corrections) as well as biological measures (reforestation).Such erosion control measures should however be integrated into a program whose main objectives should be a better management of water and soil resources taking into account the expectations and needs of the rural population

Epidémiologie des bactéries multi résistantes dans un service de réanimation polyvalente d’un hôpital universitaire de Marrakech entre octobre 2006 et septembre 2009

The intensive care units, “the epicenter of resistance to antibiotics”, are and will remain the place where multidrug–resistant bacteria infections are more frequent, in spite of the preventive measures in force. Material and methods: This work is a retrospective study of 3 years duration (beginning in October 2006 to end of September 2009) reporting the epidemiology of the multidrug–resistant bacteria infections isolated from different bacteriological samples for diagnosis emanating from the ICU (intensive care unit) of Avicenna Military Hospital of Marrakesh (HMA). The identification of bacterial strains as well as the relative antibiogram are achieved by automated method and the resistance phenotypes are determined by the methods of agar diffusion as recommended by the antibiogram committee of the French Society of Microbiology. Results and discussion: Over a period of 03 years, 84 clinical isolates of multidrug-resistant bacteria were isolated from 414 pathological specimens from the ICU of the hospital. The multi-resistant bacterial strains (BMR) (n = 84) are largely predominated by Acinetobacter sp (n = 40) followed by Enterobacteria producing extended spectrum betalactamases (n = 26), Enterobacteria secreting hyperproduced céphalosporinases (n= 8), Pseudomonas aeruginosa resistant to the ceftazidime (n=6), and finally Staphylococcus aureus resistant to meticilline SARM (n=4). No enterocoque resistant to the glycopeptides was insulated. The evolution of multidrug resistance to antibiotics over the past 3 years, was marked by the emergence of Acinetobacter. The monitoring of bacterial multi resistance is a necessity in ICU provider of nosocomial infections.Introduction : Les services de réanimation, « épicentre de la résistance aux antibiotiques », sont et resteront le lieu où les infections à bactéries multi résistantes sont les plus fréquentes, malgré les mesures de prévention en vigueur. Matériel et méthodes : Le présent travail est une étude rétrospective d’une durée de 3 ans (début octobre 2006 à fin Septembre 2009) relatant l'épidémiologie des infections bactériennes multi résistantes isolées à partir des différents prélèvements bactériologiques à visée diagnostique émanant de l'unité de réanimation de l’Hôpital Militaire Avicenne de Marrakech (HMA). L’identification des souches bactériennes ainsi que l’antibiogramme relatif sont réalisés par méthode automatisée et les phénotypes de résistance sont déterminés par les méthodes de diffusion en milieu gélosé selon les recommandations du Comité de l’Antibiogramme de la Société Française de Microbiologie. Résultats et discussion : Sur une période de 03 ans, 84 isolats cliniques de bactéries multi résistantes ont été isolés à partir de 414 produits pathologiques émanant du service de réanimation de l’hôpital. Les souches bactériennes multi résistantes (BMR) (n=84) sont largement prédominées par l’Acinetobacter sp (n=40) suivi des entérobactéries productrices de Bétalactamases à spectre élargi (n=26), des entérobactéries sécrétrices de céphalosporinases hyperproduites (n= 8), de Pseudomonas aeruginosa résistant à la ceftazidime (n=6), et enfin des Staphylococcus aureus résistant à la méticilline SARM (n=4). Aucun entérocoque résistant aux glycopeptides n’a été isolé. L’évolution de la multi résistance aux antibiotiques au cours des 3 années, a été marquée par l’émergence de l’Acinetobacter. La surveillance de la multi résistance bactérienne est une nécessité en milieu de réanimation pourvoyeur d’infections nosocomiales

Évaluation par analyse multicriteres de la vulnérabilité des sols a l'érosion : cas du bassin versant de l'Isser – Tlemcen – Algérie |Full article|

The drainage basin of Isser, space weakened by the periods of drought and characterized by exposures of marls and very fragile clays, prese nts a high sensitivity to erosion. In addition to the deterioration of the quality of water, the eros ion phenomenon in this zone presents risks of depletion of topsoil, loss of fertility, loosening of plants and pollution by pesticides dissolved in surface water runoff. The erosion results from the conjunction of many pe rmanent factors (as those related to the soil or to the topography), that are evolving o r presenting a random character (such as precipitations) and intervene at different levels i n erosion processes. The purpose of the work is to produce a map of soil vulnerability to the erosion by integrating field data, different thematic maps and satellite images through GIS solution. This map sho uld be a basis for the development of the anti-eros ive land use plan adapted to the specific context of th e drainage basin of Isser. We do integrate four factors which determine the erosion: precipitations , topography, lithology, and vegetation cover. For combining these different factors, we use a cut ting space in regular meshes. The resulting map of the vulnerability to the erosion should reveal homo geneous areas for priority interventions

Are immune checkpoint inhibitors a valid option for papillary renal cell carcinoma? Transcriptomic characterization of the immune infiltrate

International audienceBackground Papillary Renal Cell Carcinoma (pRCC) is the most common non-clear cell RCC (nccRCC). Pivotal studies evaluating immune checkpoint inhibitors mostly excluded nccRCC. PD-1/PD-L1 inhibitors exhibit limited activity in metastatic pRCC. The immune microenvironment in pRCC is unknown. Methods In silico, we studied the expression of cytotoxic lymphocyte infiltration (CYT), using a descriptive (by CIBERSORT) and specific quantitative approach, as well as the expression of inhibitors checkpoint immune markers (ICI), in 258 localized papillary renal cell tumors using RNA-seq data from The Cancer Genome Atlas (TCGA) as training set. Based on previous report, we selected 8 genes of interest (CD8a, CD8b, GZMA, PRF1, PD1, PDL1, PDL2 and CTLA4). An independent data set of 34 localized pRCC (gene expression) was used as a validation set. Results Using a clustering method based on the expression level of 8 predefined genes of interest, we identified 3 groups, differentiated by CYT and ICI expression. In validation cohort, we observed similar clustering. Cluster 3, characterized by a CYT and ICI high expression, was significantly associated with increased population of TCD8, TCD4 helper, M1 macrophages and dendritic cells in CIBERSORT analysis. Additionally, these immune clusters were not associated with indels neo-antigen load but were significantly correlated with the MHC class I antigen presenting machinery expression (APM) (p = 1.1.10-11) and interferon-gamma gene expression (p = 1.6.10-13). Conclusions We characterized cytotoxic immune infiltration in pRCCs. Cluster 3 could correspond to a population of immunotherapy responders. Transcriptomic immune signature validation in pRCCs patients treated with immunotherapy is warranted. Legal entity responsible for the study Manon de Vries-Brilland. Funding Has not received any funding. Disclosure M. Gross-Goupil: Honoraria (institution), Advisory / Consultancy: Ipsen; Honoraria (institution), Advisory / Consultancy, Research grant / Funding (institution): Janssen; Honoraria (institution), Advisory / Consultancy: Astellas; Advisory / Consultancy, Research grant / Funding (institution), Travel / Accommodation / Expenses: MSD; Research grant / Funding (institution): BMS; Research grant / Funding (institution): AstraZeneca; Research grant / Funding (institution), Travel / Accommodation / Expenses: Pfizer; Research grant / Funding (institution), Travel / Accommodation / Expenses: Roche; Travel / Accommodation / Expenses: Sanofi; Travel / Accommodation / Expenses: Amgen. A. Ravaud: Research grant / Funding (institution), Travel / Accommodation / Expenses, Officer / Board of Directors: Pfizer; Travel / Accommodation / Expenses, Officer / Board of Directors: BMS; Travel / Accommodation / Expenses, Officer / Board of Directors: AstraZeneca; Travel / Accommodation / Expenses, Officer / Board of Directors: Roche; Travel / Accommodation / Expenses, Officer / Board of Directors: MSD; Travel / Accommodation / Expenses, Officer / Board of Directors: Ipsen. B. Escudier: Advisory / Consultancy, Research grant / Funding (institution), Travel / Accommodation / Expenses: BMS; Advisory / Consultancy, Research grant / Funding (institution), Travel / Accommodation / Expenses: Pfizer; Advisory / Consultancy, Research grant / Funding (institution): Novartis; Advisory / Consultancy, Research grant / Funding (self): Aveo; Advisory / Consultancy: Ipsen; Advisory / Consultancy: Roche; Advisory / Consultancy: EUSA. L. Albiges: Advisory / Consultancy: Pfizer; Advisory / Consultancy: Novartis; Advisory / Consultancy: BMS; Advisory / Consultancy: Ipsen; Advisory / Consultancy: Roche; Advisory / Consultancy: MSD; Advisory / Consultancy: AstraZeneca. All other authors have declared no conflicts of interest

Urachal carcinoma: a large retrospective multicentric study from the French Genito-Urinary Tumor Group

Introduction Urachal cancer (UrC) is a rare, non-urothelial malignancy. Its natural history and management are poorly understood. Although localized to the bladder dome, the most common histological subtype of UrC is adenocarcinoma. UrC develops from an embryonic remnant, and is frequently diagnosed in advanced stage with poor prognosis. The treatment is not standardized, and based only on case reports and small series. This large retrospective multicentric study was conducted by the French Genito-Urinary Tumor Group to gain a better understanding of UrC. Material and Methods data has been collected retrospectively on 97 patients treated at 22 French Cancer Centers between 1996 and 2020. Results The median follow-up was 59 months (range 44-96). The median age at diagnosis was 53 years (range 20-86), 45% were females and 23% had tobacco exposure. For patients with localized disease (Mayo I-II, n=46) and with lymph-node invasion (Mayo III, n=13) median progression-free-survival (mPFS) was 31 months (95% CI: 20-67) and 7 months (95% CI: 6-not reached (NR)), and median overall survival (mOS) was 73 months (95% CI: 57-NR) and 22 months (95% CI: 21-NR) respectively. For 45 patients with Mayo I-III had secondary metastatic progression, and 20 patients were metastatic at diagnosis. Metastatic localization was peritoneal for 54% of patients. Most patients with localized tumor were treated with partial cystectomy, with mPFS of 20 months (95% CI: 14-49), and only 12 patients received adjuvant therapy. Metastatic patients (Mayo IV) had a mOS of 23 months (95% CI: 19-33) and 69% received a platin-fluorouracil combination treatment. Conclusion UrC is a rare tumor of the bladder where patients are younger with a higher number of females, and a lower tobacco exposure than in standard urothelial carcinoma. For localized tumor, partial cystectomy is recommended. The mOS and mPFS were low, notably for patients with lymph node invasion. For metastatic patients the prognosis is poor and standard therapy is not well-defined. Further clinical and biological knowledge are needed