Rhino-Orbito-Cerebral Mucormycosis: A Challenging Case

Mucormycosis is a rare opportunistic fungal infection caused by Mucorales and associated with high mortality rates. Rhino-orbito-cerebral localization usually occurs in individuals with uncontrolled diabetes mellitus. We report the case of a 41-year-old male, with previously undiagnosed diabetes, who presented with unilateral facial extensive black eschar and signs of diabetic ketoacidosis. Cerebral magnetic resonance imaging showed left pansinusitis, left craniofacial edematous infiltrate, and left proptosis. A left internal temporal abscess was identified at an early pre-suppurative stage. Magnetic resonance angiography revealed total occlusion of the left intracranial internal carotid artery. A histopathological study of nasal mucosa biopsy suggested mucormycosis. According to the clinical presentation and the radiological and histopathological findings, rhino-orbito-cerebral mucormycosis was presumed. Culture of nasal, ocular, and skin lesion specimens grew Rhizomucor sp. and confirmed the diagnosis. The patient was treated with systemic liposomal amphotericin B. He died of multiple organ failure before surgical debridement was possible as he was in critical condition requiring stabilization before surgical treatment.

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

BACKGROUND

Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation.

METHODS

WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109.

FINDINGS

Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0-4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2-6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital.

INTERPRETATION

In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates.

FUNDING

European Society of Intensive Care Medicine, European Respiratory Society.

Epidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patients: the EUROBACT-2 international cohort study

PURPOSE

In the critically ill, hospital-acquired bloodstream infections (HA-BSI) are associated with significant mortality. Granular data are required for optimizing management, and developing guidelines and clinical trials.

METHODS

We carried out a prospective international cohort study of adult patients (≥ 18 years of age) with HA-BSI treated in intensive care units (ICUs) between June 2019 and February 2021.

RESULTS

2600 patients from 333 ICUs in 52 countries were included. 78% HA-BSI were ICU-acquired. Median Sequential Organ Failure Assessment (SOFA) score was 8 [IQR 5; 11] at HA-BSI diagnosis. Most frequent sources of infection included pneumonia (26.7%) and intravascular catheters (26.4%). Most frequent pathogens were Gram-negative bacteria (59.0%), predominantly Klebsiella spp. (27.9%), Acinetobacter spp. (20.3%), Escherichia coli (15.8%), and Pseudomonas spp. (14.3%). Carbapenem resistance was present in 37.8%, 84.6%, 7.4%, and 33.2%, respectively. Difficult-to-treat resistance (DTR) was present in 23.5% and pan-drug resistance in 1.5%. Antimicrobial therapy was deemed adequate within 24 h for 51.5%. Antimicrobial resistance was associated with longer delays to adequate antimicrobial therapy. Source control was needed in 52.5% but not achieved in 18.2%. Mortality was 37.1%, and only 16.1% had been discharged alive from hospital by day-28.

CONCLUSIONS

HA-BSI was frequently caused by Gram-negative, carbapenem-resistant and DTR pathogens. Antimicrobial resistance led to delays in adequate antimicrobial therapy. Mortality was high, and at day-28 only a minority of the patients were discharged alive from the hospital. Prevention of antimicrobial resistance and focusing on adequate antimicrobial therapy and source control are important to optimize patient management and outcomes.

Multidrug-Resistant Bacteria Isolated from Blood Culture Samples in a Moroccan Tertiary Hospital: True Bacteremia or Contamination?

Purpose

To demonstrate the relevance of clinico-biological correlation in the interpretation of positive blood cultures (BC) for multidrug-resistant (MDR) bacteria, among adult and pediatric patients, in order to distinguish between true bacteremia (TB) and contaminations and to evaluate the impact on patient management.

Patients and Methods

This six-month study was conducted at Mohammed VI University Hospital in Marrakech. All MDR bacteria isolated from BCs carried out on hospitalized patients during this period were included. For each positive BC to MDR microorganism, demographic and clinical characteristics, laboratory findings, therapeutic and evolution data were collected.

Results

TB was considered in 157 (94.6%) of the 166 positive-culture episodes for MDR bacteria, while 9 (5.4%) were classified as false-positive. Contamination rate was 0.2% (9/3824). TB and contaminations occurred mainly in intensive care units (ICUs), with the neonatal ICU being the most concerned (p = 0.016). Clinical signs of sepsis were present in all TB patients, with a significant difference between the two groups (p = 0.000). CRP values were higher in the TB group (p = 0.000). The most isolated true pathogens were ESBL-producing Enterobacterales (50%) and carbapenem-resistant Enterobacterales (33.3%). They also predominated in contaminated BCs. Isolation of the same microorganism from other sites was significantly associated with TB (p = 0.012). In contrast to the contaminations group, the difference in the clinical course of TB patients, according to whether or not they received appropriate probabilistic antibiotics, was statistically significant (p = 0.000). These patients had longer hospital stays and longer durations of antibiotic therapy. The overall mortality rate was 39.6%.

Conclusion

Distinguishing between MDR-positive BCs representing clinically significant bacteremia or simple contamination requires a careful clinical, biological, and microbiological confrontation of each MDR positive BC in order to avoid unnecessary overuse of broad-spectrum antibiotics and thus reduce resistance selective pressure.

Coronavirus disease 2019 (COVID-19) pathogenesis: a concise narrative review

SARS-CoV-2 is the third zoonotic coronavirus. Since December 2019, it has spread through the globe and infects more than four million patients (as of May 10^th, 2020). The disease was named coronavirus disease 2019 (COVID-19) by the World Health Organization (WHO). It involves many organs and systems in the human organism. We aimed to describe the pathogenesis of the COVID-19.

Pratique de la ventilation non-invasive aux urgences et réanimations marocaines : enquête auprès des praticiens

Introduction : La ventilation non invasive (VNI) est une technique utilisée, depuis longtemps, dans les urgences et lesréanimations. L'objectif de notre travail était d'évaluer la prévalence de la pratique de la VNI, la maîtrise des paramètres,les indications et les critères d'échec dans notre contexte marocain.Matériels et méthodes : Une première partie des praticiens a été interrogée par un questionnaire auto-administré lorsdu congrès de la société marocaine d'anesthésie, d'analgésie et de soins intensifs tenu en janvier 2018. Une secondepartie a été abordée par un questionnaire électronique. Il comprenait les caractéristiques démographiques, les méthodesde mise en œuvre de la VNI, les indications et les critères de défaillance.Résultats : Parmi les 800 questionnaires distribués, nous avons recueilli 183 réponses avec un taux de participation de23 %. La majorité des participants (88 %) ont déclaré avoir pratiqué la VNI. Le mode PSV-PEP était préféré dans 70 %des cas. L'œdème pulmonaire cardiogénique et la décompensation de la maladie pulmonaire obstructive chronique ontété retenus comme premières indications de la mise en place. Un protocole n'existait que dans 5 % des structures. LaVNI est plus utilisée par les médecins anesthésistes-réanimateurs et dans les CHU et les structures privées.Conclusion : La VNI est une technique couramment utilisée en situation d'urgence. Ses indications et paramètres deréglage étaient conformes à la conférence de consensus. Cependant, l'absence de protocole peut entraver le démarrage.

Intravenous immunoglobulin vs plasma exchange in treatment of mechanically ventilated adults with Guillain-Barré syndrome

Introduction

The aim of the study is to compare efficacy of IvIg versus PE in treatment of mechanically ventilation adults with GBS in intensive care unit.

Methods

It is a prospective, non randomized study, realized in a medical ICU from 2006 to 2010. We included all patients with GBS who required mechanical ventilation (MV). We defined two groups: group 1 (group treated by IvIg: 0.4 g/kg/day for 5 days) and group 2 (group treated by PE: 4 PE during 10-14 days). We collected demographic characteristics, clinical and therapeutic aspects and outcome. Statistical analysis used: The quantitative variables are expressed on mean ± standard derivation and compared by Student test. The statistic analysis has been based on SPSS for windows. P < 0.05 is considered as significant.

Results

Forty-one patients (21 in group 1 and 20 in group 2) were enrolled. The mean age was 37.4 ± 9.2 years, with a masculine predominance (75.4%). Electromyogram in all patients found acute inflammatory demyelinating polyradiculoneuropathy in 80.5% of patients. The mean length of hospitalization was 45.3 ± 9.2 days. The length of hospitalization of the IvIg group is less long than PE group (p = 0.03). The weaning of the MV was more precocious in IvIg group than PE group (p = 0.01). Also, the beginning of motility recuperation was precocious at IvIg group than PE group (p = 0.04).

Conclusion

Our work reveals a meaningful difference for the MV weaning and precocious recovery in IvIg group compared to PE group.

[Anthrax meningoencephalitis: a case following a cutaneous lesion in Morocco]

Anthrax meningoencephalitis is very rare especially following skin location. We report a case of meningoencephalitis secondary to skin lesion. The diagnosis is based on clinical presentation and confirmed by microbiological tests. Its evolution remains fatal despite aggressive resuscitation.

Outcome of patients admitted during off hours in Moroccan intensive care unit

Background

The first few hours after intensive care unit (ICU) admission, where a patient’s condition is stabilized and treatment plans are formulated, are crucial to patient outcome. Although admission of patients who are unstable to ICU occurs 24 hours a day, not all units maintain the same level of staffing during off hours. We evaluated whether ICU admission during off hours affects mortality in a Moroccan ICU with the same level of staffing.

Methods

This prospective study was carried out at an ICU in a Moroccan hospital during 6 months. Demographic, clinic, acute physiology and chronic health evaluation score, length of stay, time of admission (day time or off hours), and ICU mortality data were collected. The mortality in the ICU was the end point of the study. Logistic regression analysis was used to identify risk factors associated with ICU mortality at various day and time of admission.

Results

A total of 195 patients were included in the study; 125 (63.6%) were admitted during the day time and 70 (36.4%) were admitted during off hours. Most of the patients admitted during the off hours were male (75% versus 58% during the day time, P=0.01). Patients admitted in off hours after traumatism were more frequent than those admitted during the day time (64% versus 24%, P=0.001). There was no significant difference in ICU mortality for time of ICU admission (P=0.05).

Conclusion

We can conclude that off hours care is not necessarily inadequate. For ICU managers, it is important to know how to maintain adequate quality of care around the clock.

Coagulopathie aigue précoce des traumatismes crâniens graves: mortalité et facteurs pronostiques

Introduction

Le but de ce travail était d'étudier la mortalité et les facteurs pronostiques de la Coagulopathie Traumatique (CoT) aigue précoce.

Méthodes

Il s'agissait d'une étude prospective sur 21 mois, incluant tous les traumatisés crâniens graves > 16 ans. Les données clinico-démographiques, biologiques et radiologiques ont été collectées à l'admission. La CoT a été définie par une thrombopénie < 120 000 /mm³ t/ou un Taux de Prothrombine (TP) < 70% et/ou un International Normalized Ratio (INR) > 1,3 et/ou un Temps de Céphaline Activé (TCA) > 40 sec.

Résultats

Nous avons colligé 69 patients ayant une CoT avec une médiane d'âge à 29 ans avec un intervalle interquartile à (23-41), et une prédominance masculine dans 87% des cas (60 patients). L'ISS médian à 56 avec un intervalle interquartile à (42-75). La mortalité était de 52,2% des cas (36 patients) suite à une souffrance cérébrale dans 74,3% des cas (26 patients). La durée médiane de séjour était de 10 jours avec un intervalle interquartile à (5-19). Les facteurs associés à la mortalité en analyse univariée étaient: le passager de véhicule, le délai de prise en charge, l'hématome sous dural aigu, l'AIS tête et l'ISS à l'admission; alors qu'en analyse multivariée c'étaient le délai de prise en charge (OR: 1,01; IC à 95%: 1,001-1,02) et l'ISS à l'admission (OR: 1,1; IC à 95%: 1,04-1,15) étaient des facteurs pronostiques indépendants.

Conclusion

L'amélioration du pronostic de ces patients repose essentiellement sur un développement de la médecine pré-hospitalière.

Paludisme grave d'importation chez l'adulte: étude rétrospective de dix cas admis en réanimation à Casablanca

INTRODUCTION

We report a retrospective study in the medical intensive care unit of the Casablanca Ibn-Rochd University hospital.

MATERIAL AND METHODS

All patients over 14 years of age with falciparum malaria, who were admitted to ICUs between 1996 and 2001, were included. The main epidemiological features, criteria of admission, treatment, and outcome were investigated.

RESULTS

Ten patients were included for severe imported malaria. The mean age was 32+/-4 years. All patients had acquired falciparum malaria in sub-Saharan Africa. Chemoprophylaxis was inadequate in all patients. The mean time from symptom onset to treatment initiation was 9+/-2 days. Criteria of admission were impaired consciousness (7), acute renal failure (4), and respiratory distress (3). The most worrying factors were the severity of consciousness disorders, the acute respiratory distress syndrome, the metabolic acidosis, and the refractory shock. All patients presented with nosocomial respiratory infection related to Gram-negative bacilli, in the evolution. All patients received quinine therapy with loading dose and symptomatic treatment. Five patients died.

CONCLUSION

The lethality of severe imported malaria is still high despite optimal management in ICUs. Improving chemoprophylaxis and an earlier diagnosis may reduce significantly the mortality rate.

Rhabdomyolyse et intoxication à la paraphénylène-diamine

OBJECTIVE

The aim of this study is to describe clinical description, biological findings, outcome and prognostic factors of paraphenylene-diamine poisoning.

PATIENTS AND METHODS

We report a cohort study spreaded over 6 years (1999-2004), realized in Medical Intensive Care Unit in Ibn-Rochd University Hospital at Casablanca (Morocco). This study included 315 patients admitted for paraphenylene-diamine (PPD) poisoning. Diagnosis was based on: poisoning reported by the patient or his family, clinical data, biological findings and qualitative determination of PPD. Epidemiological parameters was obtained at admission. Every day, clinical and biological data, therapy and gravity scores were collected and a mean was calculated.

RESULTS

315 patients were admitted over this period. The mean age was 23+/-9 years. We noticed a clear female predominance (sex-ratio=9.86). The intoxication was voluntarily aiming at autolysis in 93.3% of the cases. The patients were admitted at about 5+/-5.3 hours after the intoxication. The clinical chart was at first dominated by the respiratory and renal symptoms. The mean of CPK was 132,351.8+/-164,978 UI/l. The treatment was especially symptomatic. The mortality was 47%. The multivariate analysis concluded that acid urinary pH, hyperglycaemia, hard muscles, betamimetic drugs and MPM II>0.14 were associated with a poor prognosis.

CONCLUSION

The PPD poisoning represents the first cause of toxic rhabdomyolysis in our context and responsible of high mortality. For that, it's necessary to control PPD trade, to inform the medical persons and a rapid management.

[Biphasic sarcomatoid carcinoma of the thyroid: an exceptional localization of a rare tumor]

Thyroid sarcomatoid carcinoma is a rare and aggressive neoplasm composed of a follicular carcinoma which is contiguous or admixed with a pleomorphic spindle cell component. We report the case of a thyroid tumor reputed to have a poor outcome, in a 62-year-old woman. The radical thyroidectomy specimen was totally invaded. Results of immunoperoxidase staining for thyroglobulin and epithelial markers were positive in the areas of follicular carcinoma and negative in the sarcomatous component. The patient died a few days later due to septic shock. The epithelial and mesenchymal components of thyroid carcinosarcoma were both part of the neoplastic parenchyma and evolved from a single common stem cell, in agreement with the hypothesis that the tumors are of monoclonal origin. The definition of this tumor as its histogenesis and prognostic are discussed.

Colistin and rifampicin in the treatment of nosocomial infections from multiresistant Acinetobacter baumannii

INTRODUCTION

The increased incidence of nosocomial infections by multi-drug resistant Acinetobacter baumannii creates demand on the application of some combinations of older antimicrobials on that species. We conducted the present observational study to evaluate the efficacy of intravenous and aerosolized colistin combined with rifampicin in the treatment of critically patients with nosocomial infections caused by multiresistant A. baumannii.

PATIENTS AND METHODS

Critically ill patients with nosocomial infections caused by A. baumannii resistant to all antibiotics except colistin in a medical intensive care unit. Diagnosis of infection was based on clinical data and isolation of bacteria. The bacterial susceptibilities to colistin were tested. Clinical response to colistin+rifampicin was evaluated.

RESULTS

Twenty-six patients (43.58+/-18.29 years, Acute Physiology and Chronic Health Evaluation II Score (APACHE II): 6.35+/-2.99), of whom 16 cases of nosocomial pneumonia treated by aerosolized colistin (1x10(6) IU three times/day) associated with intravenous rifampicin (10 mg/kg every 12h), nine cases of bacteraemia treated by intravenous colistin (2x10(6)IU three times/day) associated with intravenous rifampicin (10 mg/kg every 12h) in which three cases associated with ventilator associated pneumonia and one case of nosocomial meningitis treated by intrathecal use of colistin associated with intravenous rifampicin. The clinical evolution was favourable for all ill patients. Concerning side effects, we have noticed a moderate hepatic cytolysis in three patients.

CONCLUSION

This is the first clinical report of colistin combined with rifampicin for treatment of A. baumannii infection. Despite the lack of a control group and the limited number of patients, the results seem to be encouraging.

Cryptococcose neuroméningée chez un sujet immunocompétent

The authors report a case of cryptococcal neuromeningitis (CNM) in a 27-year-old man, non HIV-infected, with a normal CD(4) T-lymphocyte count. He had a clinical history of subacute meningitis. The evolution was fatal. CNM is a rare infection the prognosis of which remains bad, even in immunocompetent patient.

Milk-arterial plasma transfer of PCDDs and PCDFs in pigs

Polychlorodibenzo-para-dioxins (PCDDs) and Polychlorodibenzofurans (PCDFs) are ubiquitous in the environment. They are mainly formed as unwanted byproducts during various chemical, industrial, and combustion processes. Thus, these pollutants can be found in the food chain. The aim of this experiment was to study the transfer of PCDD/Fs from spiked milk to arterial blood in pigs, which are considered as valid models for humans. Pigs were fed with 900 mL of milk spiked with a mixture of 17 dioxins. The levels of PCDD/Fs in the serum extracts were determined using HRGC/HRMS prior to consumption of the milk, and at 3, 5, and 7 h after milk ingestion. Concentrations of PCDD/Fs in arterial plasma increased from 3 h to 5 h and decreased at 7 h. At time point 5 h, concentrations were found between 500 and 10000 pg x g(-1) fat. The transfer ratio <<plasma fat/milk fat >> was usually found between 0.7 and 3%. Related to the different milk concentrations, results of this study indicate a similar behavior of the studied molecules.

Laser microprobe mass spectrometry: principle and applications in biology and medicine

Laser microprobe mass spectrometry (LMMS) is an interesting technique for micro- and surface analysis. It employs local ionization by a focused laser under high power density conditions and subsequent mass analysis of the generated ions. This paper surveys the main LMMS instruments and their operational principles. Sample preparation is discussed in the context of biological materials. The problem of quantification is addressed. Selected examples show the way that precise information on the molecular composition can be deduced from the detected signals. Both inorganic and organic substances can be identified, even without reference spectra, from in-situ analysis with a lateral resolution in the order of 1 to 5 micrograms.

Toxicity of iron oxides and metabolites of benzo[a]pyrene alone or in combination in cells culture and identification by laser microprobe mass spectrometry

The goal of the gas-phase studies of well-characterized transition-metal systems is to enhance our understanding of the chemistry and sometimes of the toxic, carcinogenic effects of transition metal oxide clusters and compounds. The analysis of inorganic solids by time of flight laser microprobe mass spectrometry (TOF-LMMS) shows the formation of clusters in the mass spectra which can be used for the identification of inorganic particles. First, we have applied non-resonance ionization (delta = 226 nm) or resonant ionization (delta = 293.7 nm) of iron to study the non stoichiometric Fe1-xO, Fe3O4, Fe2O3 compounds in positive mode by TOF-LMMS. The positive mass spectra are characterized by many differences between the clusters detected and their intensities. Then, we have analysed the benzo[a]pyrene (BaP), the 1-hydroxbenzo[a]pyrene (1-OH-BaP) and the 3-hydroxybenzo[a]pyrene (3-OH-BaP) of TOF-LMMS and by Fourier Transform Irons Cyclotron Resonance Mass Spectrometry (FT-ICR-MS). It is possible to distinguish these different compounds by their respective fingerprint. Later on, we have studied toxic effects of iron oxides (Hematite Fe2O3 and Magnetite Fe3O4), benzo[a]pyrene (BaP) and Pyrene, alone or in combination. The LC50 was appreciated by colony-forming cell culture method. Cells were observed by electron microscopy and the valence of particles was analysed by TOF-LMMS. With Fe2O3 we have observed a significant decrease (20%) at higher concentration (0.5 mmol/l) and smaller quantities of BaP were highly toxic. The association of BaP at the LC10 dose (0.05 mumol/l) with growing doses of Fe2O3 or Fe3O4 (0.0125; 0.025; 0.05; 0.1; 0.2 mmol/l), appeared to increase the toxic effect of BaP 3 to 4 times. These results suggest that Fe2O3 and Fe3O4 alone are not very toxic but the association of one of these compounds with BaP increases the toxicity of the latter. On the other hand, TOF-LMMS seems to show a metabolization of iron oxide into reduced form. But, it is necessary to raise the ambiguity about the iron which is always in the cells present. For that purpose, studies with iron oxides enriched by 54Fe isotope have begun.

Interaction study of alpha Ni3S2 with guinea pig alveolar macrophages by resonance ionization mass spectrometry

Studies on the mechanism of nickel toxicity and carcinogenesis in humans and animals have generated a great deal of interest in metal-induced diseases. However, little information exists on the cell structures implicated in nickel metabolism. The present study reports on the application of energy dispersive spectrometry (EDS) and resonance ionization spectrometry coupled with mass spectrometry (RIMS). This study deals with the uptake, incorporation and biological transformation of alpha Ni3S2 and their consequent binding to cell constituents. A RIMS technique was achieved instrumentally by coupling a commercial time-of-flight laser microprobe mass spectrometer with a dye laser. The most interesting result of this investigation was the loss of sulphur with emergence in the mass spectrum of a calcium signal in some metabolized particles. Secondly, spectral analysis of ionized cluster ions of type (NixSy)+ differs from those obtained from standards of alpha Ni3S2 showing that nickel is in an elemental form. EDS analysis of particles generated from alpha Ni3S2 in different compartments of a cell confirmed a decrease of concomitant sulphur with the appearance of an organic Ni-P complex, either with the phosphate groups of membrane phospholipids or with phospho-transferring proteins. This study showed that RIMS is a sensitive and specific analytical technique to understand the interaction of alpha Ni3S2 with cells.