Characteristics of neonatal near-miss in hospitals in Benin, Burkina Faso and Morocco in 2012-2013.

: The objective of this study is to explore the usefulness of neonatal near miss in low- and middle-income countries by examining the incidence of neonatal near miss and pre-discharge neonatal deaths across various obstetric risk categories in 17 hospitals in Benin, Burkina Faso and Morocco. : Data were collected on all maternal deaths, maternal near miss, neonatal near miss (based on organ-dysfunction markers), Caesarean sections, stillbirths, neonatal deaths before discharge and non-cephalic presentations, and on a sample of births not falling in any of the above categories. : The burden of stillbirth, pre-discharge neonatal death or neonatal near miss ranged from 23 to 129 per 1000 births in Moroccan and Beninese hospitals, respectively. Perinatal deaths (range 17-89 per 1000 births) were more common than neonatal near miss (range 6-43 per 1000 live births), and between a fifth and a third of women who had suffered a maternal near miss lost their baby. Pre-discharge neonatal deaths and neonatal near miss had a similar distribution of markers of organ dysfunction, but unlike pre-discharge neonatal deaths most neonatal near miss (63%, 81% and 71% in Benin, Burkina Faso and Morocco, respectively) occurred among babies who were not considered premature, low birthweight or with a low 5-min Apgar score as defined by WHO's pragmatic markers of severe neonatal morbidity. : Whether the measurement of neonatal near miss adds useful insights into the quality of perinatal or newborn care in settings where facility-based intrapartum and early newborn mortality is very high is uncertain. Perhaps the greatest advantage of adding near miss is the shift in focus from failure to success so that lessons can be learned on how to save lives even when clinical conditions are life-threatening.<br/

Multisystem inflammatory syndrome in children (MIS-C) and “Near MIS-C”: A continuum?

IntroductionReports of multisystem inflammatory syndrome in children (MIS-C), following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, have been increasing worldwide, with an incidence varying significantly across studies based on the definition used for the diagnosis. At our tertiary medical center in Lebanon, we encountered several cases that presented a diagnostic challenge because they mimicked MIS-C but did not meet the US Centers for Disease Control and Prevention (CDC) definition. We decided to review these cases and describe their features in comparison with cases that met the CDC criteria of MIS-C and those that had an alternative diagnosis.MethodsThis is a retrospective chart review of subjects aged &lt;19 years old admitted to the American University of Beirut Medical Center (AUBMC) between March 1, 2020, and May 31, 2021, with suspected or confirmed MIS-C, following documented COVID-19 infection, with sufficient or insufficient criteria for diagnosis. Subjects were classified into 3 groups: “MIS-C”, “Near MIS-C” and “Alternative Diagnosis”.ResultsA total number of 29 subjects were included in our cohort. Fever was present in all subjects. In the MIS-C group, evidence for cardiovascular system involvement was the most common feature followed by the mucocutaneous and gastrointestinal systems. In the “Near MIS-C” and “Alternative Diagnosis” group, gastrointestinal symptoms were the most common with only one patient with cardiac abnormalities and none with coagulopathy. Subjects with typical MIS-C presentation had higher inflammatory markers when compared to subjects in the other groups. Almost all the subjects had positive IgG for SARS-CoV-2. Of the 29 subjects, the Royal College of Paediatrics and Child Health (RCPCH) case definition would have identified all suspected cases without an alternative diagnosis as MIS-C, whereas the World Health Organization (WHO) and the CDC definitions would have excluded 6 and 10 subjects, respectively.ConclusionMIS-C presents a diagnostic challenge due to the nonspecific symptoms, lack of pathognomonic findings, and potentially fatal complications. More research is needed to fully understand its pathogenesis, clinical presentation spectrum, and diagnostic criteria. Based on our experience, we favor the hypothesis that MIS-C has a continuum of severity that necessitates revisiting and unifying the current definitions

Removal of lead Ions by hydroxyapatite prepared from the egg shell

Carbonate hydroxyapatite (CHAP) was synthesized from domestic hen egg shells. The obtained CHAP was characterized by X-ray diffraction (XRD) and Fourier transform infrared spectroscopy and investigated as metal adsorption for Pb2+ from aqueous solutions. The effect of various parameters on the adsorption process such as contact time, solution pH, and temperature was studied to optimize the conditions for maximum adsorption. The results showed that the removal efficiency of Pb2+ by carbonate hydroxyapatite calcined at 600 °C (CHAPF) reached 99.78 %, with an initial Pb2+ concentration of 200 mg·L−1, pH = 3, and a solid/liquid ratio of 1 g·L−1. The equilibrium removal process of lead ions by CHAPF foam at pH = 3 was well described by the Langmuir isotherm model, with a maximum adsorption capacity of 500 mg·g−1 at (25 and 35) °C. The removal mechanism of Pb2+ by the CHAPF varies, depending on the initial concentration of lead in the aqueous solution: the dissolution of CHAPF and precipitation of hydropyromorphite (Pb10(PO4)6(OH)2) is dominant at low concentration [(20 to 200) mg·L−1], and the adsorption mechanism of Pb2+ on the CHAPF surface and ion exchange reaction between Ca2+ of hydroxyapatite and Pb2+ in aqueous solution is dominant at high concentration [(500 to 700) mg·L−1]. The thermodynamics of the immobilization process indicates an exothermic sorption process of Pb2

Comparative study on the removal of zinc(II) by bovine bone, billy goat bone and synthetic hydroxyapatite

The objective of this work is to investigate the possibility of using a low cost and naturally avail-able apatite rich adsorbents from animal bones such as bovine bone (BV) and billy goat (BG)bones for the removal of zinc(II) from aqueous solutions. The adsorption studies were compared with synthetic hydroxyapatite (HAPs). The samples were characterized by thermogravimetry(TG), Fourier transform infrared spectroscopy (IR) and X-ray diffraction (XRD). The equilib-rium isotherm data were fitted to the Langmuir, Freundlich, Temkin, Elovich and Dubinin-Redushkevich isotherm equations to obtain the characteristic parameters of each model. The adsorption of Zn(II) on BV and BG fi tted well with the Langmuir isotherm where as HAPs fi tted well with Dubinin Raduskevich isotherm model. The kinetic studies showed that the sorption rates could be described well by a pseudo-second-order kinetic model. Also it was shown that the adsorption of Zn(II) could be fitted to the intraparticle mass-transfer model. The studiesshowed that BG, BV and HAPs can be used as an efficient adsorbent material for the treatment of Zn(II) from water and wastewater. The order of the removal capacity for these adsorbents was determined as HAPs (93%)>BG (90%)>BV (82%

Implementing a maternal mortality surveillance system in Morocco challenges and opportunities

Objective To describe the development of the maternal death surveillance system (MDSS) in Morocco and discuss the initial results. Method The nationwide MDSS was implemented in 2009 with the involvement of health professionals and local authorities. It comprises (i) notification of all deaths of women of reproductive age (from 15 to 49years); (ii) a preliminary survey to identify pregnancy-related deaths; (iii) a confidential enquiry into all pregnancy-related deaths. The information thus obtained describes socio-demographic characteristics of the women, their obstetric and medical history, the mode of delivery, its follow-up and the medical cause of death. Results From 1st of January 2009 to 31st of December 2009, 3814 deaths of women of reproductive age were recorded, and a total of 436 pregnancy-related deaths were identified, with 73.4% of those occurring in health facilities. Among the 313 reviewed records, 80.8% were direct obstetric deaths, and 13.5% were classified as indirect. Haemorrhage was the first direct obstetric cause of death (33%). Heart disease was the main indirect obstetric cause of death (39% of indirect causes). Conclusion The Moroccan MDSS is a powerful tool for understanding the causes and circumstances of maternal deaths. However, challenges remain regarding the full coverage of the system, the decentralisation of the data entry and analysis and the completeness of medical records

Adherence to International Guidelines for the Treatment of Uncomplicated Urinary Tract Infections in Lebanon

Objective. The purpose of this study is to evaluate antibiotic-prescribing practices and adherence to IDSA guidelines for the treatment of uncomplicated urinary tract infections in Lebanon. Methods. This observational prospective study was conducted in 15 community pharmacies in Lebanon over 1 year in adult females. A regimen of nitrofurantoin 100 mg bid for 5 days or fosfomycin 3 grams single dose were considered appropriate. For the bivariate analysis, the chi-square test was used. Results. A total of 376 patients were included in this study. The prescribed antibiotic was appropriate in 35 percent of the patients. Age (more than 50 years) did not significantly affect the appropriateness of the prescribed antibiotic (p=0.508). The frequency of attacks per year (more than 3) negatively affected the choice of antibiotic (p=0.025). The dose and duration of the prescribed antibiotic was appropriate in 73 and 58 percent of the patients, respectively, with a significant inappropriate dose and duration with fluoroquinolones as compared to nitrofurantoin and fosfomycin (p<0.001 for the dose and p=0.014 for the duration of therapy). Conclusions. In an era of increasing bacterial resistance, interventions that improve physicians’ prescribing practices for uncomplicated urinary tract infections are needed

WEBRSIM: A Web-Based Reaction Systems Simulator

International audienceWe introduce WEBRSIM, the first web-based simulator for reaction systems. The simulator has an easy-to-use interface where the input is a reaction system and four functionalities: the computation of the interactive process driven by a given context sequence, the behaviour graph of the reaction system, its conservation dependency graph, and all its conserved sets. WEBRSIM comes with a browser-based friendly interface and offers a fast software to support computational modeling with reaction systems