La télémédecine et les réseaux sociaux dans la gestion des ECMO à l’ère de COVID-19 : l’expérience Tunisienne

IntroductionIn Tunisia, as elsewhere in the world, severe forms of acute respiratory distress syndrome (ARDS) related to SARS-Covid19 have been observed. When the usual means of resuscitation were no longer sufficient, the implementation of the Extracorporeal membrane oxygenation or ECMO was needed.AimThe whole problem of the management of these patients in this pandemic period has been to manage the operation of the ECMO machine, usually reserved for expert and specialized centers in the field.MethodsThe cardio-vascular surgery department of La Rabta teaching hospital of Tunis has tried the experience of management of ECMO implanted in the different reanimations of Tunis, remotely, using telemedicine and social networks. Thus, a Facebook-Messenger discussion group was created and enabled the management of patients under ECMO via video conferencing in real time involving all stakeholders.ResultsA call was made whenever the physician needed it. The video provided an opportunity to discuss with surgeons and perfusionists in real time the complications or problems of these patients. Their clinical status was continuously shared on the focus group. Following the instructions of the expert surgeons and the exchanges made on the group, the reanimator could then intervene on this or that parameter.ConclusionSocial media have invaded everyone's daily lives and health professionals are not exception to this trend. The Covid-19 pandemic has only strengthened this digital alternative with the goal of efficiency and patient interest. While their use in a professional setting offers many advantages, it must nevertheless be done in compliance with the rules of ethics and bring real added value.     

Hemolytic-uremic syndrome secondary to scorpion envenomation (apropos of 2 cases)

HUS was recently described following scorpion sting. We report 2 cases of HUS in the intensive care unit of a university hospital. Two children aged respectively 10 months and 1 year were admitted in the ICU after severe scorpion envenomation (with coma and pulmonary oedema) having required dobutamine and mechanical ventilation. Evolution was marked with acute anaemia without bleeding requiring blood transfusion, acute renal failure, low platelets and signs of haemolysis. Our experience and the previously reported case suggest that scorpion sting could be added to the list of causes of the HUS.     

Selected components of physical fitness in rhythmic and artistic youth gymnast

Purpose

Rhythmic (RG) and artistic gymnastics (AG) are very popular female sports. These two disciplines share some common points but, at the same time, they display some relevant differences in terms of physical and technical characteristics. The aim of this study was as follows: (1) to clarify how gymnastic training background over the years could lead to the development and motor learning of the motor skills and (2) to highlight differences of conditional skills achieved by RG and AG athletes.

Methods

For these aims, 45 athletes were selected, belonging to three balanced groups: promotional (PG, n?=?15), RG (n?=?15), and AG (n?=?15). Participants were tested for joints mobility, balance, explosive strength, speed, and endurance tests.

Results

Statistical analysis showed a good test–retest reliability of the measurements (ICC?>?0.870) and some significant differences between PG, RG, and AG. RG showed higher values in joint mobility tests (coxo-femoral mobility, 166.7?±?6.3°; sit and reach, 20.5?±?1.9 cm; and scapulo-humeral mobility, 45.5?±?4.4 cm) with respect to AG, while AG showed higher values in endurance (1626.7?±?7.4 m), balance (4.33?±?1.35 n/60 s), and explosive strength (164.1?±?11.6 cm) compared to RG (p?<?0.05).

Conclusion

RG and AG seem to be effective in enhancing different and sport-specific physical fitness and conditioning. RG enables, indeed, to develop more joints mobility whereas AG improves more strength, balance, and endurance. However, given the small sample size employed, these results should be replicated by further studies utilizing larger samples.

     

Système RH : dépistage de D partiels avec RHD/RHCE gène hybride

Aim of the studyThe determination of the RhD phenotype is important in transfusion medicine. However, the complexity of the expression of the D antigen is the cause of the discrepancies observed between two serological determinations and the omission by serology of some variants that can be cause alloimmunization. Therefore, it is important to known in a population the RHD alleles responsible for partial D and weak D phenotype. The aim of the study was the screening of partial D with RHD/RHCE gene hybrid by PCR-multiplex.Materials and methodsOur study involved 308 blood donors from Tunisian Sahel (269 D positive and 39 D negative). We used the multiplex PCR assay to amplify specific exons of the RHD gene 3, 4, 5, 6, 7, 9 and 10. Further molecular investigations were carried to characterize the RHD variants that were detected by the multiplex.ResultsIn the 269 D positive samples, one case showed the absence of amplification of exons 4 and 5 of RHD gene. This variant was identified by PCR-SSP on weak D type 4. None of the RHD exons were amplified from DNA of 39 D negative samples in favor of a total deletion of the RHD gene.ConclusionWe have no found any partial D variant with RHD/RHCE gene hybrid. Results in D negative samples showed that RHD gene deletion is the most frequent mechanism of D negative phenotype in the Tunisian population.     

Lésions kystiques cérébrales : Pensez au kyste hydatique

Background. Hydatidosis is an endemic parasitosis in Tunisia that affect mostly the liver and the lung. Brain involvment is rare. Aim. To focus on diagnostic, therapeutic and evolutive characteristics of cerebral hydatidosis. Methods. We report all cases of cerebral hydatidosis seen in the infectious diseases and neurosurgery departments between January 2013 and June 2020. Results. Six cases of intracranial hydatid cyst were reported. The male to female ratio was 3:3. Age ranged from 3 to 60 years with a median age of 20,5 years. All patients lived in rural areas. The clinical symptomatology was progressive in 4 cases. It was dominated by headache (all cases). Brain imaging confirmed the diagnosis in all cases. The hydatid cyst was solitary and supratentorial in 3 cases. All the patients were operated. Albendazole was prescribed immediately after surgery, for 6 months in 5 cases and for 3 years in the case of disseminated hydatidosis. The outcome was favorable without recurrence in all patients with an average follow-up of 3,5 ± 0,5 years. Conclusion. Hydatid cyst of the brain is characterized by the severity of the neurological signs, the mandatory use of surgery because of life threatening and the excellent outcomes.     

Sudden cardiac death of rhythmic origin in athletes: literature review

The sudden death in athletes is, in the vast majority of cases, related to ventricular fibrillation, often in a subject with unknown cardiovascular abnormality; this dramatic event has a significant impact on society and the medical profession. We conducted through a literature review an analysis of data on sudden cardiac death of rhythmic origin in athletes; sudden death may be cardiovascular in 95.3% of cases and related to ventricular arrhythmia in 88% cases. The main causes are: hypertrophic cardiomyopathy, congenital anomalies of coronary arteries, and arhythmogenic right ventricular dysplasia for athletes under 35 years, and atherosclerosis beyond 35 years. Prevention is based on three main areas: the medical assessment and screening for cardiovascular disease; the chain of survival; the education of the athlete and the public. All these measures should improve significantly the survival prognosis of patients suffering from these accidents.