Faut-il continuer à infiltrer le scalp par un anesthésique local pour une craniotomie?

Introduction: Le maintien de la stabilité hémodynamique est un objectif primordial de l'anesthésie pour craniotomie. Peu d'études ont prouvé l'efficacité de l'infiltration du scalp par un anesthésique local pour le maintien de la stabilité hémodynamique après l'incision. L'objectif de notre travail est d'évaluer l'influence de l'infiltration de la ligne d'incision du scalp par la lidocaïne à 0,5% adrénalinée sur les paramètres hémodynamiques après incision pour craniotomie supratentorielle. Méthodes: Étude prospective en double aveugle réalisée au bloc opératoire de l'hôpital des spécialités de Rabat sur une période d'une année incluant 80 malades programmés pour craniotomie supratentorielle.  Les malades étaient randomisés par tirage au sort en 2 groupes: Le groupe 1 était infiltré par 40 ml du  sérum salé adrénaliné (1/200 000) et le groupe 2 était infiltré par 40 ml de la lidocaïne 0,5% adrénalinée (1/200 000). Le critère de jugement principal était la pression artérielle moyenne (PAM) après l'incision. L'étude statistique a fait appel aux tests t de student et l'U- mann-whitney. Une valeur de p <0.05 était considérée significative.Résultats: L'étude a inclus 80 patients (40 hommes et 40 femmes). L'âge moyen était 42 ,33±14,76  ans. Le poids moyen était 71,58 ±10 kg. Le 3/4 des patients était ASA 1, seulement 25% étaient ASA2. La durée moyenne de la chirurgie était de 252,06±38,62 mn. Les deux groupes étaient comparables  concernant l'âge, le sexe, le poids, la durée d'intervention, le type d'abord chirurgical, la dose totale du fentanyl reçue jusqu'a l'incision, ainsi que les paramètres hémodynamiques avant l'incision. Après l'incision la FC moyenne a augmenté dans les deux groupes: 80,53±7,72 bpm dans le groupe contrôle et 76,85±8,52 bpm dans le groupe lidocaïne. La différence d'augmentation de la FC entre les deux groupes était statistiquement significative (p=0,047). L'augmentation de la PAM était également  significativement plus élevée dans le groupe placebo (96,45± 3,53mmHg vs 94,75± 3,76mmHg)  (p=0,041). Nous n'avons pas noté de troubles de rythme ou d'hypertension artérielle par les solutions adrénalinées à 1/200000. Par contre, six cas d'hypotension artérielle ont été notés (3cas dans chaque groupe) après 2 minutes de l'infiltration et ayant répandu au remplissage par 500 ml de sérum salé 0,9 %. Conclusion: L'infiltration par la lidocaïne procure une stabilité hémodynamique (PAM et FC)  statistiquement significative. Les autres études rapportées dans la littérature et avec un échantillon  réduit ont permis de retrouver une différence significative concernant uniquement la PAM et non la  fréquence cardiaque.Key words: Scalp, infiltration, lidocaïne, anesthesie local, craniotomie

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Serum levels of Selenium and C-reactive protein in comatose patients with severe traumatic brain injury during the first week of hospitalization: case-control study

Introduction: Mortality and morbidity related to traumatic brain injuries still remain high in patients. Many authors reported the importance of Selenium in maintaining the integrity of brain functions. This fact is supported by clinical evidence that therapy with selenium supplementation could help patients suffering from brain disorders like neurodegenerative diseases. The aim of our study was to assess the relationship between Selenium concentration in serum and evolution of comatose patients with severe traumatic brain injury, in the first week of admission, and the correlation between selenium and C-reactive protein. Methods: This case-control study was conducted with 64 comatose patients with TBI, in the Department of Anesthesiology and Reanimation, IbnSina University Hospital and Hospital of specialties in Rabat-Morocco, and healthy volunteers recruited in Blood transfusion center of Rabat. Blood sampling was collected from TBI patients, in the first week (3h after admission and each 48h during one week), and from healthy volunteers one time. Concentration of Se in serum was determined by electrochemical atomic absorption spectrometry. Statistical analysis was performed using Statistical software (SPSS) and the cases and controls were compared using the Mann- Whitney U test. A P-value < 0.05 was considered to be statistically significant. Results: Comparison selenium concentration in the first day (D0), third day (D2) and fifth day according to the death and survival statue in patients did not show statistical significance (p > 0.05). Selenium concentration of D0 in patients and Selenium concentration in control group also did not show statistical significance (p > 0.05). Similarly, we did not report a correlation between selenium and C-reactive protein. Conclusion: According to our data selenium and CRP may not play a role in progression of coma state in patients with severe traumatic brain injury

The Influence of Heavy Metals and Trace Elements on Comatose Patients with Severe Traumatic Brain Injury in the First Week of Admission

Purpose. The aim of this study is to investigate the possible role of heavy metals (lead and cadmium) and imbalance of trace elements (chromium, iron, zinc, copper, and manganese) in death among patients with severe traumatic brain injury. Material and Methods. A case-control study was conducted with 64 comatose patients with severe TBI, in the Department of Anesthesiology and Reanimation, Ibn Sina University Hospital and Hospital of Specialties in Rabat, Morocco; 22 healthy volunteers were recruited in Blood Transfusion Center of Rabat. Blood samples were collected from TBI patients, in the first week (3h after admission and each 48h during one week) and from healthy volunteers one time. Concentration of heavy metals and trace elements in serum was determined by electrochemical atomic absorption spectrometry. Statistical analysis was performed using Statistical software (SPSS) and the cases and controls were compared using the Mann–Whitney U test and Student’s t-test for cadmium according to gender and final evolution. A P-value <0.05 was considered to be statistically significant. Results. Our data showed that the difference of heavy metals concentration (lead and cadmium) between patients and healthy subjects was not statistically significant. However, the difference of some trace elements concentration (iron, copper, chromium, and selenium) between patients and healthy subjects was statistically significant. According to the final evolution, the concentration of manganese was higher in dead patients and statistically significant (p = 0.04) for heavy metals; the concentration of lead was not statistically significant while the concentration in cadmium was statistically significant (p = 0.004). By sex, lead and cadmium were statistically significant, respectively p = 0.02, p = 0.001, and cadmium was higher in women, while lead was higher in men. Conclusion. Among all studied heavy metals (lead and cadmium) and trace elements (iron, zinc, copper, selenium, chromium, and manganese), manganese and cadmium may play a role in the death of patients from severe traumatic brain injury

Single-molecule Real Time sequencing (PacBio) of the Staphylococcus capitis NRCS-A clone reveals the basis of multidrug resistance and adaptation to the Neonatal Intensive Care Unit environment

The multi-resistant Staphylococcus capitis clone NRCS-A has recently been described as a major pathogen causing nosocomial, late-onset sepsis (LOS) in preterm neonates worldwide. NRCS-A representatives exhibit an atypical antibiotic resistance profile. Here, the complete closed genome (chromosomal and plasmid sequences) of NRCS-A prototype strain CR01 and the draft genomes of three other clinical NRCS-A strains from Australia, Belgium and the United Kingdom are annotated and compared to available non-NRCS-A S. capitis genomes. Our goal was to delineate the uniqueness of the NRCS-A clone with respect to antibiotic resistance, virulence factors and mobile genetic elements.We identified 6 antimicrobial resistance genes, all carried by mobile genetic elements. Previously described virulence genes present in the NRCS-A genomes are shared with the six non-NRCS-A S. capitis genomes. Overall, 63 genes are specific to the NRCS-A lineage, including 28 genes located in the methicillin-resistance cassette SCCmec. Among the 35 remaining genes, 25 are of unknown function, and 9 correspond to an additional type I restriction modification system (n=3), a cytosine methylation operon (n=2), and a cluster of genes related to the biosynthesis of teichoic acids (n=4). Interestingly, a tenth gene corresponds to a resistance determinant for nisin (nsr gene), a bacteriocin secreted by potential NRCS-A strain niche competitors in the gut microbiota.The genomic characteristics presented here emphasize the contribution of mobile genetic elements to the emergence of multidrug resistance in the S. capitis NRCS-A clone. No NRCS-A-specific known virulence determinant was detected, which does not support a role for virulence as a driving force of NRCS-A emergence in NICUs worldwide. However, the presence of a nisin resistance determinant on the NRCS-A chromosome, but not in other S. capitis strains and most coagulase-negative representatives, might confer a competitive advantage to NRCS-A strains during the early steps of gut colonization in neonates. This suggests that the striking adaptation of NRCS-A to the NICU environment might be related to its specific antimicrobial resistance and also to a possible enhanced ability to challenge competing bacteria in its ecological niche

Building bridges through science

WOS: 000415310800007PubMed ID: 29144972Science is ideally suited to connect people from different cultures and thereby foster mutual understanding. To promote international life science collaboration, we have launched "The Science Bridge'' initiative. Our current project focuses on partnership between Western and Middle Eastern neuroscience communities.Medical Research Council [MC_UP_1202/5