sCXCL16 as a prognostic biomarker for COVID-19 outcome

As elevated levels of the soluble CXCL16 (sCXCL16) chemokine have been reported in severe coronavirus disease 2019 (COVID-19) patients, this study examined whether sCXCL16 concentration on the first day of hospitalization predicted death in COVID-19 patients. A total of 76 patients with COVID-19 were admitted to the Military Hospital of Tunis, Tunisia, between October 2020 and April 2021, and later classified as survivors or nonsurvivors based on their outcomes. At admission, the groups were matched by age, gender, comorbidities, and the percentage of patients with moderate conditions. On the first day of admission, serum's sCXCL16 concentrations were measured using a magnetic-bead assay. There was an eightfold increase in serum sCXCL16 levels in the nonsurvivors' group (3661.51 ± 2464.87 pg/mL vs. 454.3 ± 338.07 pg/mL, p < 0.0001). For the optimal cutoff value of sCXCL16 at 2095 pg/mL, we found a 94.6% sensitivity and a 97.4% specificity, with an area under curve of 0.981 (p = 5.03E-08; 95% confidence interval [95% CI]: 0.951-1.0114). Considering the risk of death at a concentration above the threshold, the unadjusted odds ratio was 36 (p < 0.0001). The adjusted odd ratio was estimated at 1.003 (p < 0.0001; 95% CI: 1.002-1.004). Finally, there was a significant difference between survival and nonsurvival groups in leukocyte numbers (p = 0.006), lymphocytes (p = 0.001), polymorphonuclear neutrophils (p = 0.001), and C-reactive protein levels (p = 0.007), except for monocytes (p = 0.881). Based on these results, sCXCL16 level could be used for detecting nonsurvival COVID-19 patients. Therefore, we recommend assessing this marker in hospitalized COVID-19 patients.

Deciphering the balance of IL-6/IL-10 cytokines in severe to critical COVID-19 patients

The severity of COVID-19 is largely determined by the inflammatory response, a “Cytokine storm,” that involves both pro- and anti-inflammatory cytokines. In the current study we investigated the balance of pro- and anti-inflammatory status as represented by the levels of IL-6/IL-10 in severe to critical COVID-19 patients. 66 confirmed COVID-19 patients admitted to the ICU were categorized into groups according to the mortality and respiratory failure. Data were collected retrospectively in ICU, including a peripheral immune cells and infection-related biomarker CRP. The measurements of cytokine levels were performed by Immulite analyzer for IL-6 and ELISA sandwich for IL-10. In addition, longitudinal measurement of IL-6 was performed during 5 days post admission. Longitudinal assays showed that IL-6 was sustained at a medium level within 5 days post admission in severe cases who survived or not requiring mechanical ventilation, whereas it was sustained at high levels throughout the disease course in either deceased cases or who developed respiratory failure. The ratio of IL-6/lymphocytes was positively correlated with the risk of mortality, while IL-10/lymphocytes ratio could predict respiratory failure in ICU. IL-6/IL-10 profiling revealed that deceased patients have different magnitudes of both IL-6 and IL-10 cytokine release. Notably, excessive levels of IL-6 concomitant with high levels of IL-10 were more common in diseased COVID-19 patients. Taking into account the IL-6/IL-10 profiling may help clinicians to identify the right time of anti-inflammation treatment and select patients who will respond to anti-cytokine therapies and maintain an adequate inflammatory response for SARS-CoV-2 clearance.

Outcomes of treatment of severe COVID-19 pneumonia with tocilizumab: a report of two cases from Tunisia

The SARS CoV-2 pandemic is a global health threat with high morbidity and mortality (1 to 4%) rates. COVID-19 is correlated with important immune disorders, including a “cytokine storm”. A new therapeutic approach using the immunomodulatory drug, Anti-IL6 (tocilizimub), has been proposed to regulate it. We report here the first Tunisian experience using tocilizimub in two severe cases of COVID-19 pneumonia. The diagnosis was confirmed by chest scan tomography. Biological parameters showed a high level of Interleukin-6 (IL-6) that increased significantly during hospitalization. The patients developed hypoxia, so they received intravenously 8 mg/kg body weight tocilizumab. There was a resultant decrease in the level of IL6, with clinically good evolution. Blocking the cytokine IL-6 axis is a promising therapy for patients developing COVID-19 pathology.

Acceptability of COVID-19 vaccine: a cross-sectional study in a Tunisian general hospital

Introduction

the year 2020 was marked by the COVID-19 pandemic that killed more than one million people. Several vaccines have been developed and vaccination campaigns started in December 2020. The objective of our study was to assess the acceptability of the COVID-19 vaccine by hospital staff.

Methods

cross-sectional study conducted on a representative sample drawn at random from the staff of the Military General Hospital of Tunis. Data was collected between August and September 2020 by a clinical psychologist. We studied the associations between the different characteristics of our population and the decision to accept or refuse vaccination against COVID-19.

Results

a total of 398 hospital staff agreed to answer our questionnaire. Our sample was composed of 9% (n=36) physicians, 0.9% (n=3) pharmacists, 41.3% (n=164) paramedics, 16.1% (n=64) cleaning staff and 32.7% (n=131) administrative staff. The rapid discovery of the vaccine was hoped by 97% (n=386). Vaccination was considered a means of collective protection by 84.7% (n=337). However, only 58% (n=231) agreed to be vaccinated by the COVID-19 vaccine. The main factors significantly associated with acceptance of the COVID-19 vaccine was previous influenza vaccination (aOR: 2.58, 95% CI 1.69-3.94; p=0.000).

Conclusion

apprehension about vaccination does not appear to be sparing the future COVID-19 vaccine. Fear of vaccine side effects outweighs fear of the disease, even among hospital staff. To achieve vaccination coverage, several awareness and communication activities must be carried out.

Inflammatory cytokines dysfunction in autism spectrum disorder

Introduction

Autism spectrum disorder (ASD) is a common neurodevelopmental disorder. Its underlying causes and pathophysiologies remain unclear. Recent data support the potential involvement of neuroinflammation in the onset of this disorder.

Objectives

The aim of our study was to investigate the potential link between ASD and inflammatory mediators.

Methods

This descriptive study was conducted among ASD outpatients followed-up at the child and adolescent psychiatry department in the Military Hospital of Instruction of Tunis. Blood samples were collected for inflammatory cytokines dosage, notably the interleukin 1β (IL-1β), interleukin 6 (IL-6) and the Tumor Necrosis Factor α (TNF-α) immunodosage.

Results

Twenty-four patients were included in this study, aged between four and ten years old (mean age= 6,55 years; minimum=4; maximum=10 years). Our sample was mainly represented by male patients (95,6%). TNF-α plasmatic levels were high (>5pg/mL) among all of our sample with a mean of 11,6 pg/mL (minimum= 6,87; maximum=17,7 pg/mL; standard deviation= 3,52 pg/mL), suggesting abnormal peripheral blood mononuclear cells response. However, IL-1β and IL-6 plasmatic levels were relatively normal.

Conclusions

An immune response dysregulation was detected in our sample. Multiple clinical and experimental studies investigated the implication of inflammatory cytokines in neurodevelopmental disruption. Their results, however, remain controversial and limited by small samples. Further studies need to be done in order to investigate the neuroimmunological factors linked with ASD.

Impact of synthesis route on structural, magnetic, magnetocaloric and critical behavior of Nd0.6Sr0.4MnO3 manganite

Nd0.6Sr0.4MnO3 polycrystalline manganite was synthesized by two different methods: the auto-combustion reaction (NSMO-AC) and the sol-gel method (NSMO-SG). The structural, magnetic, magnetocaloric and critical behavior of the samples were examined. Rietveld refinements of the XRD patterns revealed that both compounds are pure single phase indexed to the orthorhombic system adopting the Pnma space group. The nanometric size estimated using the Williamson-Hall method was confirmed by TEM micrographs. Magnetic measurements as a function of temperature indicated that both samples underwent a second order ferromagnetic (FM)-paramagnetic (PM) phase transition at Curie temperature (T C). The relative cooling power was observed to be around 95.271 J kg-1 for NSMO-AC and 202.054 J kg-1 for NSMO-SG at μ 0 H = 5 T, indicating that these materials are potential candidates for magnetic refrigeration application close to room temperature. The critical behavior was estimated using diverse techniques based on the isothermal magnetization data recorded around the critical temperature T C. The calculated values are fully satisfactory to the requirements of the scaling theory, implying their reliability. The estimated critical exponents matched well with the values anticipated for the mean-field model and the 3D Ising model for NSMO-AC and NSMO-SG, respectively, showing that the magnetic interactions depended on the process of elaboration.

Immediate Psychological Responses, Stress Factors, and Coping Behaviors in Military Health-Care Professionals During the COVID-19 Pandemic in Tunisia

Objective: The COVID-19 epidemic began in Tunisia in March 2020; health-care workers (HCWs) were suddenly confronted with a particularly stressful situation. The aim of this study was to assess the psychological responses of HCWs during the epidemic, determine the stressors and identify ways to cope. Methods: This cross-sectional study used an online questionnaire that included 62 questions. ANOVAs and t-tests were used to compare the responses between professional groups, age groups, and genders. Results: Questionnaires were completed by 368 HCWs. HCWs believed they had a social and professional obligation to continue working long hours (95.3%). They were anxious regarding their safety (93.7%) and the safety of their families (97.8%). Youthful age (p = 0.044) and female gender (ps <0.046) were identified as stressors. The availability of personal protective equipment (PPE; 99.7%) and good communication between colleagues (98.1%) and managers (91.6%) were important protective factors. Family and friend support (95.9%), following strict protective measures (99.4%), knowing more about COVID-19 (94.8%), adopting a positive attitude (89.6%), and engaging in leisure activities (96.1%) helped in dealing with this epidemic. Conclusion: This study highlights the importance of providing HCWs with infection control guidelines and adequate PPE. Communication and support within the team and maintaining family support help in coping with this stressful situation.

Successful treatment of rhino-facial mucormycosis in a diabetic patient

Mucormycosis is a rapidly progressing and lethal infection caused by fungi of the order mucorales. The disease occurs mostly in patients with uncontrolled diabetes or other predisposing systemic conditions. We report a case of rhinofacial mucormycosis in a 39-year-old diabetic patient. The diagnosis was established by clinical examination, imaging, and confirmed by mycological examination. Rhizopus arrhizus was isolated. He was successfully treated with amphotericin B, surgical resection, diabetes control and hyperbaric oxygen therapy.

Screening of biological activities of fungi associated with pistachio bark beetle, Chaetoptelius vestitus (Coleoptera, Curculionidae), infesting pistachio cultivations in Tunisia

AIMS

In this study, we aimed to explore the enzymatic diversity, the entomopathogenic and the antimicrobial potentialities of fungi associated with the pistachio bark beetle, Chaetoptelius vestitus.

METHODS AND RESULTS

A total of 40 isolates were screened for enzymatic diversity. Most of them, 92·5%, were able to produce at least two of the screened enzymes. Pathogenic assays performed on C. vestitus showed a high entomopathogenic activity of the isolates Ata_io_1 (A. tamarii), Fve_io_1 (F. verticillioides), Tpi_io_1 (T. pinophilus), Pal_io_1 (P. album), Pbi_io_2 (Penicillium bilaiae) and Pch_io_1 (P. chrysogenum), as based on mean mortality of C. vestitus. A screening of antimicrobial activity using well diffusion method showed that the isolates Tro_io_1 (T. pinophilus), Tat_io_1 (T. atroroseus) and Pch_io_1 (P. chrysogenum) presented the highest antibacterial activity. Furthermore, Mgu_io_1 (M. guilliermondii), Asc_io_1 (A. sclerotiorum), Ata_io_1 (A. tamarii), G. lavendula (Gla_io_1), Pva_io_1 (P. variotii), Pul_io_1 (P. ulaiense), Tat_io_1 (T. atroroseus) and Tro_io_1 (T. roseum) were active against at least two of the three tested fungal phytopathogens.

CONCLUSIONS

Fungal isolates representing entomopathogenic activity and a broad spectrum of antimicrobial activities can be considered as promising resources for biological pistachio trees protection.

SIGNIFICANCE AND IMPACT OF THE STUDY

Fungi associated with C. vestitus were investigated for detecting their potential biotechnological applications.

The effects of hyperbaric oxygen therapy on diabetic retinopathy: A preliminary study

PURPOSE

The objective of this study was to prospectively assess the effect of hyperbaric oxygen therapy (HBOT) on diabetic retinopathy lesions and macular edema in patients undergoing the treatment for diabetic foot ulcers.

METHODS

We compared two groups: a first group including 25 patients with non-proliferative diabetic retinopathy treated by HBOT for foot ulcers, and a second group (control group) composed of 25 patients with diabetic retinopathy who did not receive HBOT. The HBOT protocol performed for the patients in the first group was: 30 sessions of 90 minutes each at 2.5 ATA with a mean frequency of five sessions per week. All patients had an ophthalmological exam at baseline (visual acuity, intraocular pressure, fundus exam), fundus photography and an OCT exam. A follow-up exam was performed at the conclusion of the HBOT.

RESULTS

Compared to the control group, patients treated with HBOT showed a regression or stabilization of diabetic retinopathy lesions and a decrease in central macular thickness (CMT).

CONCLUSION

Hyperbaric oxygen therapy may improve diabetic retinopathy and diabetic macular edema. This therapy may serve as an adjunctive treatment in the management of retinal ischemia and capillary hyperpermeability in diabetic retinopathy.

Screening of bacterial isolates related to olive orchard pests in Tunisia using 16S ribosomal RNA and evaluation of their biotechnological potential

AIM

This study investigated the bacterial diversity of dead insects collected from olive tree orchards widely cultivated in Tunisia. We aimed to explore metabolic diversity, screen enzymatic activities for biotechnological applications and carry out preliminary bioassays for bio-insecticide development.

METHODS AND RESULTS

A total of 50 bacteria strains were randomly isolated from four different biotopes situated in Sfax (Tunisia). 16S rRNA gene sequencing was used to identify 24 species, and isolates were evaluated for enzymatic activity and antimicrobial potential. Nineteen of the total number of Bacillus strains have enzymatic activity compared to strains from the other genera (14/50). Our bacterial collection was evaluated for antimicrobial potential against bacterial and fungal isolates. Isolates B8-2 (Bacillus subtilis) showed strong antibacterial activities and isolates B2-3 (Bacillus licheniformis) and B10-1 (Serratia marcescens) showed the highest antifungal activity. Seventeen of the total number of isolates caused greater than 50% mortality rate of second and fourth instar larvae of Ephestia kuehniella.

CONCLUSION

The selected species from olive orchards represent a broad spectrum of antimicrobial and insecticidal activities and can be considered promising resources in biological control.

SIGNIFICANCE AND IMPACT OF THE STUDY

Bacteria isolated from olive pests in olive orchards were investigated for detecting their potential biotechnological applications.

Structural, magnetic and magnetocaloric properties of 0.75La0.6Ca0.4MnO3/0.25La0.6Sr0.4MnO3 nanocomposite manganite

The present study involves an investigation of structural, magnetic and magnetocaloric effect (MCE) properties of 0.75La_0.6Ca_0.4MnO₃/0.25La_0.6Sr_0.4MnO₃ composite material. Crystal structure analysis is performed by using Rietveld refinement of the X-ray diffraction patterns. The studied composite exhibits two structural phases; the rhombohedral and the orthorhombic structures corresponding to the mother compounds; La_0.6Ca_0.4MnO₃ and La_0.6Sr_0.4MnO₃, respectively. The scanning electron microscopy micrographs support our findings. Magnetic measurements as a function of temperature of the composite display two successive second order magnetic phase transitions at 255 and 365 K associated to both mother compounds. Therefore, a broadening of the magnetic entropy change peak is noted. A better relative cooling power (RCP) value of 360 J kg⁻¹ compared to those observed in mother compounds is obtained at μ₀H = 5 T, making of this material considered as a suitable candidate for magnetic refrigeration applications near room temperature. A consistent agreement between experimental results and numerical calculations based on the rule of mixtures has been shown. The theoretical modeling of the MCE using Landau theory reveals an acceptable concordance with experimental data indicating the importance of magnetoelastic coupling and electron interaction in the MCE properties of manganite systems. The field dependence of the magnetic entropy change is applied to study the critical behavior. Our results go in tandem with the values corresponding to the mean field model. The spontaneous magnetization values determined using the magnetic entropy change (ΔS_Mvs. M²) are in good agreement with those found from the classical extrapolation of Arrott curves (μ₀H/M vs. M²).

The present study involves an investigation of structural, magnetic and magnetocaloric effect (MCE) properties of a 0.75La_0.6Ca_0.4MnO₃/0.25La_0.6Sr_0.4MnO₃ composite material.

Magnetocaloric study, critical behavior and spontaneous magnetization estimation in La0.6Ca0.3Sr0.1MnO3 perovskite

A detailed study of structural, magnetic and magnetocaloric properties of the polycrystalline manganite La_0.6Ca_0.3Sr_0.1MnO₃ is presented. The Rietveld refinement of X-ray diffraction pattern reveals that our sample is indexed in the orthorhombic structure with Pbnm space group. Magnetic measurements display a second order paramagnetic (PM)/ferromagnetic (FM) phase transition at Curie temperature T_c = 304 K. The magnetic entropy change (ΔS_M) is calculated using two different methods: Maxwell relations and Landau theory. An acceptable agreement between both data is noted, indicating the importance of magnetoelastic coupling and electron interaction in magnetocaloric effect (MCE) properties of La_0.6Ca_0.3Sr_0.1MnO₃. The maximum magnetic entropy change (−ΔS^max_M) and the relative cooling power (RCP) are found to be respectively 5.26 J kg⁻¹ K⁻¹ and 262.53 J kg⁻¹ for μ₀H = 5 T, making of this material a promising candidate for magnetic refrigeration application. The magnetic entropy curves are found to follow the universal law, confirming the existence of a second order PM/FM phase transition at T_c which is in excellent agreement with that already deduced from Banerjee criterion. The critical exponents are extracted from the field dependence of the magnetic entropy change. Their values are close to the 3D-Ising class. Scaling laws are obeyed, implying their reliability. The spontaneous magnetization values determined using the magnetic entropy change (ΔS_Mvs. M²) are in good agreement with those obtained from the classical extrapolation of Arrott curves (μ₀H/M vs. M²). The magnetic entropy change can be effectively used in studying the critical behavior and the spontaneous magnetization in manganites system.

A detailed investigation was conducted on the magnetocaloric properties of La_0.6Ca_0.3Sr_0.1MnO₃ and its potential application in cooling fields.

Successful treatment of a Carbapenem-resistant Klebsiella pneumoniae carrying bla OXA-48 , bla VIM-2 , bla CMY-2 and bla SHV- with high dose combination of imipenem and amikacin

We describe a case of 58-year-old man with septic shock due to Carbapenem-resistant Klebsiella pneumoniae (CR-Kp) bloodstream infections (BSI) who was successfully treated with a high dose association of amikacin and imipenem combined with continuous venovenous hemodiafiltration (CVVHDF).

A Klebsiella pneumoniae (Kp) was isolated from the catheter culture and from two blood samples, drawn from the catheter before removal and from a peripheral vein. The Kp was intermediate to Amikacin (MIC = 16 μg/ml) and was resistant to all other antibiotics including Imipenem (MIC = 4 μg/ml), Colistin (MIC = 16 μg/ml) and Tigecycline (MIC = 4 μg/ml) according to the Clinical and Laboratory Standards Institute (CLSI) published in 2011. PCR amplification and sequencing verified the presence of blaOXA-48, blaVIM-2, blaCMY-2 and blaSHV-1 genes.

Amikacin was given at a dose of 30 mg/kg (2.5 g) in a 30 min infusion and the dose of imipenem was increased to 1 g every 6 h despite patient's altered renal function (Creatinine Clearance = 25 ml/min). To avoid amikacin nephrotoxicity and to allow the use of high doses of imipenem, continuous venovenous hemodiafiltration (CVVHDF) (blood flow, 200 ml/h; dialysate, 1000 ml/h; ultrafiltrate, 2000 ml/h) was initiated 1 h after the start of the amikacin infusion and continued thereafter.

The patient improved hemodynamically and norepinephrine was stopped five days after antibiotherapy adaptation.

Risk of mishaps during intrahospital transport of critically ill patients

BACKGROUND

Mishaps are common during transport and may have major impacts on patients.

AIMS

The main objectives of our study are: first to determine the incidence of complications during intra hospital transports (IHT) of critically ill patients, and second, to determine their risk factors.

METHODS

All intra hospital transports for diagnostic and therapeutic purposes of patients consecutively admitted in an 18-bed medical surgical intensive care unit in an university hospital, have been studied prospectively during a period of six months (September 1st 2012 to February 28th 2013).

RESULTS

Of 184 transports observed (164 patients), 85 (46.2%) were associated with mishaps. Eighty two mishaps were patient-related (44.5%).Oxygen desaturation (30 cases), agitation (24 cases) and hemodynamic instability (15 cases) were predominantly. One case of cardiac arrest and 3 cases of accidental extubation were occurred during IHT. Seventy three systems-based mishaps were noted (39.6%). Emergency transports, mechanical ventilation and positive end-expiratory pressure (PEEP) ≥ 6 cmH2O were independent risk factors for a higher rate of mishaps. In our study, complications did not statistically increase ventilator-associated pneumonia.

CONCLUSION

This study confirms that IHT of critically-ill patients still involves considerable risks and mishaps incidence remains high.

Lower incidence of hypotension following spinal anesthesia with 6% hydroxyethyl starch preload compared to 9 ‰ saline solution in caesarean delivery

BACKGROUND

Hypotension is a common complication following spinal anesthesia for cesarean delivery. Techniques to prevent hypotension include preloading intravenous fluid.

AIM

To compare the effect of two preloading regimens: 6% hydroxyethyl starch (HES) and 9‰ saline solution, to prevent hypotension after spinal anesthesia in cesarean delivery.

METHODS

105 patients undergoing intrathecal anesthesia for elective cesarean delivery were randomized and allocated to receive a preload of 500 ml HES 130/0.4 (HES Group) or a preload of 1500 ml 9‰ saline solution (CR group). Blood pressure and heart rate were recorded at baseline and after spinal anesthesia (every minute for the first 10 min, every 3 min for the next 10 min, and then every 5 min for the last 20 min). The primary outcome was to compare the incidence of hypotension (defined as a 20% reduction in systolic arterial pressure from baseline) between the two preloading regimens. Vasopressor requirements (i.v. bolus of 6 mg ephedrine) were also compared.

RESULTS

The incidence of hypotension was 87% in the CR group and 69% in the HES group (p= 0.028). Ephedrine requirement, incidence of nausea, and/or vomiting and neonatal outcome did not significantly differ between the two groups.

CONCLUSION

The incidence of hypotension was lower after preloading of 500 mL of HES 130/0.4 than preloading with 1500 mL of 9‰ saline solution.

Development and application of an in-house reverse hybridization method for Chlamydia trachomatis genotyping

AIM

To develop and evaluate an in-house reverse hybridization technique for Chlamydia trachomatis genotype identification.

METHODS AND RESULTS

The evaluation of the developed and optimized reverse hybridization method on reference strains showed the specific detection of all genotypes. This technique showed its ability to type one inclusion-forming unit of C. trachomatis genotype E and equivalent sensitivity to the Cobas TaqMan assay. It was also able to detect mixed infections in vitro. Application of the reverse hybridization method on 38 isolated C. trachomatis strains and their respective swabs allowed the detection of six urogenital genotypes D, E, F, G, H and K and one trachoma genotype B. Genotype E was the most prevalent, detected in 73% of the swab samples. Mixed infections were detected in 26% of swab cases.

CONCLUSION

The reverse hybridization technique is simple and does not require specialized instruments. It is powerful in the diagnosis of mixed infections and is suitable for use in epidemiological studies.

SIGNIFICANCE AND IMPACT OF THE STUDY

This technique allowed rapid C. trachomatis genotype identification.

[Effects of 15 mcg intrathecal clonidine added to bupivacaine and sufentanil for labor analgesia]

BACKGROUND

For the combined spinal epidural analgesia for labour, 30 mcg of subarachnoid clonidine has proved its effectiveness to extend the analgesia, but increased severe hemodynamic effects.

AIM

To assess the effectiveness and the safety of 15 mcg intra thecal clonidine for labour analgesia.

METHODS

Four months, prospective, randomised, simple blind Study, including ASA I or II women, with mono foetal pregnancy. Patients were randomised in 2 groups: SB Group received intra thecal isobaric bupivacaine 2.5 mg and sufentanil 5 mcg and SBC Group received 15 mcg clonidine added to the same doses of bupivacaïne and sufentanil. Epidural analgesia was used when VAS is more than 30. Studied parameters were: delay of installation, duration of analgesia, VAS score, hemodynamic parameters and the incidence of maternal and neonatal side effects.

RESULTS

Sixty pregnant women were included (27 in SBC Group and 33 in SB group). The duration of initial analgesia was significantly longer in the SBC group (145 ± 43 min) compared with the SB group (98 ± 28 min). The delay of analgesia, sensory level and motor block level were similar. There was neither significant increase of the low incidence of blood pressure nor of the ephedrine consumption. The abnormalities of fetal heart rate, the mode of delivery and the incidence of side effects were also similar.

CONCLUSION

The addition of 15 mcg intra thecal clonidine to the bupivacaine and the sufentanil during combined spinal epidural analgesia for obstetrical labour results in extended significantly duration of analgesia without increasing side effects.

Cardiac surgery in patients on hemodialysis: eight years experience of the Tunisian military hospital

End-stage renal disease (ESRD) is known to be an important risk factor for cardiac operations performed with cardiopulmonary bypass. We investigated the influence of preoperative status on perioperative mortality and morbidity. We retrospectively analyzed data from 26 patients with ESRD, who were on maintenance dialysis and underwent a cardiac surgical procedure bet-ween 2000 and 2007. Of them, 61.5% of the patients had isolated coronary artery bypass grafting (CABG) and 38.5% had replacement or reconstruction of one or two valves. The perioperative mortality rate was 26% with five deaths occurring in patients undergoing CABG procedure. We found CABG procedure, being female and left ventricular (LV) function < 30% to be associated with a higher relative risk for perioperative death. In conclusion, our data suggest that both indi-cations and referral for surgical intervention for coronary artery disease may be delayed in pa-tients who have ESRD, contributing to the relatively high perioperative mortality.

Spinal anesthesia for endoscopic urological surgery--low dose vs. varying doses of hyperbaric bupivacaine

BACKGROUND AND OBJECTIVE

The aim of this study is to compare the efficiency of low dose vs. varying doses of hyperbaric bupivacaine in spinal anesthesia for endoscopic urological procedures.

METHODS

Sixty consecutive patients were studied in a randomized prospective manner. They received either of 5 (Gr I), 7.5 (Gr II) or 10 mg (Gr III) of hyperbaric bupivacaine 0.5% combined with 25 microg of fentanyl, through a 25-gauge W hitacre spinal needle placed in the L3-L4 interspace. Characteristics of sensory and motor block, dose of ephedrine required, secondary effects, the patients, and the surgeons satisfaction, were noted.

RESULTS

The maximum number of blocked segments was 14 +/- 1 (Gr I), 15 +/- 2 (Gr II) and 16 +/- 2 (Gr III). Time to T12 regression was significantly shorter for Gr I (53 +/- 13 min) than for Gr II (69 +/- 20 min) or Gr III (94 +/- 14 min). Bromage 3 block was not found in Gr I compared to 4 patients in Gr II and 15 patients in Gr III. The duration of motor block was shorter in Gr 1(51 +/- 18 min) than in Gr II (86 +/- 19 min) and in Gr III (138 +/- 21 min). Ephedrine was used for 16 patients in Gr III (9.8 +/- 12.2 mg), 5 patients in Gr II (3.7 +/- 7.8 mg) and 2 patients in Gr I (0.5 +/- 1.5 mg). The difference is statistically significant between Gr III and the other groups.

CONCLUSIONS

These results suggest that the use of a low dose of bupivacaine (5 mg) added to fentanyl (25 microg) for endoscopic urological surgery, resulted in short-acting sensory block, without motor block and a lower incidence of cardiovascular side effects, as compared to either of 7.5 or 10 mg bupivacaine with 25 microg fentanyl.