Search

The COVID-19 pandemic has, over the last few months, forced us to modify the way we interact with each other both in the delivery of healthcare services and in medical education. Nowadays, telehealth has globally emerged as the most appropriate approach for care, teaching, healthcare professional meetings, and advocacy. This chapter outlines the value of telemedicine, information and communication technologies during such critical situations. The authors draw in this report various experiences from countries belonging to different economic categories and describe how ICT could be a convenient solution in care, monitoring of symptom, treatment management, teaching, sensitization, and continuing education during the epidemic period of COVID-19. In conclusion, with countries facing challenges in dealing with the current situation, they need to encourage the use of ICT in remote health services and to share relevant data for the prevention, mitigation, and monitoring of the pandemic.

SARS-CoV-2 infection is characterized by its high contagiousness and unusual potential lethality. Microscopically, diffuse alveolar damage is the main histologic lung injury dominated by alveolar destruction. At the early stage, the authors note non-specific lesions similar to lesions of diffuse alveolar damage. In particular, the alveoli dilated and filled with exudative fibromyxoid material, the thickening of the interalveolar partitions by edema and an essentially mononuclear inflammatory infiltrate with eosinophilic hyaline membranes covering the alveoli. Viral inclusions are not generally found, and at an advanced stage, the installation of pulmonary fibrosis is noted. The place of non-invasive and/or invasive ventilation is undetermined in hypoxemic respiratory failure secondary to SARS-Cov-2 pneumonia, whereas in the most severe cases of COVID-19, the use of oxygenation by extracorporeal membrane is immediate. The cytokine storm in the lungs prompted clinicians to administer immunomodulators, the results of which was a reduction in hospital mortality.

The liver failure induced encephalopathy is commonly referred as hepatic encephalopathy (HE). For many decades, scientists have tried to describe the symptoms of this disorder revealing a spectrum with different types of HE. Studies on the mechanisms underlying the pathogenesis of HE have implicated several factors, mainly neurotoxins, including ammonia, manganese, in addition to changes in various physiological factors, especially an imbalance between true and false neurotransmitters, as well as the involvement of various pro-inflammatory mediators. Such changes impact on the brain, which promote disorders in glia and neurons. This review focuses on the most relevant basic pathophysiologic mechanisms associated with HE.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARSCov-2) or COVID-19 is a pandemic that appeared in December 2019 in China and which is an RNA virus. It gave rise to a major health crisis at the start of 2020, with numerous hospitalizations. It was quickly important to understand the pathophysiology of this viral attack on the human body in order to be able to develop treatment. However, there is no vaccine or effective therapeutic agent against SARS-CoV-2. Most of the therapeutic strategies used to deal with this virus come from the work of previous epidemics of SARS, and other influenza viruses, such as antiviral therapies (chloroquine, hydroxychloroquine), adjuvant therapies by combining antivirals with drugs. Antibiotics or immunostimulants (vitamins C, Dm and Zinc, etc,) and several other therapies to be used depending on the region.

Coronavirus disease 2019 (COVID-19) is an emerging infectious disease caused by a dangerous virus named SARS-CoV-2. The most important symptoms are fever, cough, fatigue, and breathing problems. In the most serious forms of the disease, the appearance of an acute respiratory distress syndrome caused by the virus can be deadly, especially when people are fragile due to their age or in case of comorbidities. The exacerbated innate immune response could be another deadly complication. Different strategies of treatments are proposed for COVID-19 such as inhibition of virus entry by blocking ACE2 receptor used by COVID-19, inhibition of virus replication by using replication inhibitors, immunomodulatory agents to stimulate a strong immune response against COVID-19, and by using vaccines as an effective method for a long-term strategy for prevention of COVID-19.

In order to stay up-to-date in the nursing field, nurses must pursue continuous education. This study examined nurses’ motivations to take part in continuing education activities by conducting a survey amongst a sample of nurses employed in two hospitals in south-east Morocco. The survey was carried out using a two-part self-administered questionnaire. Out of 144 nurses who received the questionnaire, 118 (84%) replied. The results showed that the majority of nurses have never participated in a continuing education session in the last 3 years. Respondents’ motivation for continuing education was mainly intrinsic, with the emphasis on factors related to professional competence and knowledge seeking. The use of such results can therefore be of great use to both managers and practitioners in planning continuing education programmes. However, it is desirable that more studies take place to investigate further the issue of continuing education with the aim of promoting and developing professional nursing skills.

Hepatic encephalopathy (HE) is a neurophysiological syndrome secondary to acute or chronic liver failure. Studies showed that HE patients exhibit a deficit in motor coordination, which may result from cerebellar functional impairment. The aim of this study is to assess the time-dependent alteration of locomotor behavior and the glial and neuronal alteration in rat with acute HE induced chemically. The study was carried out in male Sprague-Dawley rats with thioacetamide (TAA) induced acute liver failure at different stages 12 h, 24 h and 36 h. Hepatic and renal functions were assessed via various biochemical and histopathological examinations, while the cerebellum and the midbrain were examined using histology and immunohistochemistry for tyrosine hydroxylase (TH), cyclooxygenase-2 (COX-2) and glial fibrillary acidic protein (GFAP). We used as well, the open field test and the Rotarod test for assessing the locomotor activity and coordination. Our data showed a progressive loss of liver function and a progressive alteration in locomotor behavior and motor coordination in acute HE rats. In the cerebellum, we noted an increase in the degeneration of cerebellar Purkinje neurons parallel to increased COX-2 immunoreactivity together with astrocytic morphology and density changes. Likewise, in substantia nigra pars compacta, TH levels were reduced. We showed through the current study, a progressive deterioration in locomotor behavior in acute HE rats, as a result of Purkinje neurons death and a deficient dopaminergic neurotransmission, together with the morpho-functional astroglial modifications involving the oxidative stress and neuroinflammation.

Hepatic encephalopathy (HE) is a complex neuropsychiatric syndrome resulting from acute or chronic hepatic impairments. The clinical features of HE include attention as well as a mild cognitive deficits associated with impaired attentional and executive networks in patients as well as in animal models of HE. The underlining pathomechanism of memory impairment in HE patients is still not fully understood; however, it may involve a possible gliopathy as well as neuropathy. The aim of the present investigation is to assess progression of short working memory deterioration in acute HE and to delineate the glial and the neuronal alteration which may underlie such cognitive impairment. The study was carried out in male Sprague-Dawley rats with acute liver failure induced by thioacetamide (TAA). The study was performed on different stages of acute HE; 12 h, 24 h and 36 h following administration of TAA. The liver functions were assessed via different biochemical markers (ALT, AST, bilirubin, urea and creatinine) and an histopathological examination of the liver tissue. While for the behavioral study, we used T-Maze test to assess short working memory using the percentage of alternation behavior, together with an immunohistochemical analysis of the Glial Fibrillary Acidic Protein (GFAP) as the key marker of astrocytes in the hippocampus, as well as serotonin (5-HT) for 5-HTergic neurons within the dorsal Raphe nucleus (DRN). Our data revealed a progressive loss of liver tissue integrity with inflammation and hepatocytes degeneration which was associated to obvious loss of the liver function. In parallel, we observed a gradual alteration of the alternation behavior, as a sign of altered short working memory in the acute HE rats. At the central level, the immunohistochemical study showed a time dependent region-specific changes of GFAP-immunoreactive astrocytes within the hippocampus. While within the DRN, serotonin levels declined progressively in a time-dependant manner. Our data revealed for the first time, a gradual loss of short memory function in acute HE, resulting from liver dysfunction. Such cognitive deterioration may involve a possible gliopathy as well as a 5-HTergic dysfunction which could be considered as a new key element for understanding the basis of memory and attention loss in HE patients.

Exposure to lead is a threat factor for neurodegenerative disorders progress as it could trigger dopaminergic deficiency. We aimed herein to assess the effect of acute lead exposure (25 mg/kg B.W i.p.) during three continuous days on the dopaminergic and noradrenergic systems together with locomotor performance in Meriones shawi (M. shawi), then the neuroprotective potential of curcumin-III (30 mg/kg B.W) by oral gavage. Pb-exposed M. shawi exhibited increased tyrosine hydroxylase (TH) immunoreactivity in substantia nigra compacta (SNc), ventral tegmental area (VTA), locus coeruleus (LC), and dorsal striatum (DS), unlike the controls. This was correlated with decreased locomotor performance. A noticeable protective effect by co-treatment with curcumin-III was observed; in consequence, TH-immunoreactivity and locomotor disturbance were restored in Pb-treated Meriones. Our data results proved, on the one hand, an evident neurotoxic effect of acute Pb exposure and, on the other hand, a potent therapeutic effect of curcumin-III. Thereby, this compound may be recommended as a neuroprotective molecule for neurodegenerative disorders involving catecholaminergic impairment initiated by metallic elements.

Background Studies have shown that lead (Pb) is one of hazardous heavy metals with various adverse effects on human health including mental health; Pb can induce psychiatric disorders like anxiety. In the present work, we examined the potential of bisdemethoxycurcumin (BDMC) as a neuroprotective agent against lead induced anxiety inMeriones shawi (M. shawi). Methods We asses, the potential of three consecutive day exposure to Pb (25 mg/kg body weight) in inducing anxiogenic effect, serotoninergic and vasopressinergic disruptions inM. shawi. This was done using neurobehavioral tests (open field, elevated plus maze), immunohistochemestry by anti-serotonin (5-HT), and anti-vasopressin (AVP) antibodies. We also measured the possible restorative potential of BDMC (30 mg/kg body weight), delivered by oral gavage. After that, a biochemical and histopathological studies were done. Results Our results showed that lead exposure for three consecutive days increases significantly the 5-HT-immunoreactivity in dorsal raphe nucleus (DRN) accompanied with a significant enhancement of AVP-immunoreactivity in the cell bodies and fibers in the supraoptic (SON) and paraventricular (PVN) nuclei of the hypothalamus. In the collecting tube, AVP binds to the V2 receptor of the epithelial cells and increases the water permeability. Our results showed clearly the epithelial cells degeneration after lead exposure, then we suggest that the increased AVP could be a response to the hydric balance disrupted after degenerative effect of lead exposure on epithelial cells. BDMC produced an anxiolytic effect in meriones. Moreover, it restored 5-HT and AVP immunoreactivity within studying nuclei. The biochemical and histopathological studies showed that Pb induced renal damages. In addition, BDMC restored the renal alterations. Conclusion According to the obtained results, we suggest new pharmacological effects of BDMC; while it has an anxiolytic effect against Pb-induced anxiety by working on serotoninergic and vasopressinergic systems with an obvious restoration of the renal injuries induced by lead exposure.

Manganese (Mn) is an essential metallic trace element involved in several vital biological functions. Conversely, exposure to excessive levels of Mn induces manganism, causing neurodegeneration and symptoms similar to those seen in Parkinson's disease (PD). Docosahexaenoic acid (DHA) is a long-chain polyunsaturated fatty acid exhibiting neuroprotective properties against neurodegenerative diseases and brain injuries and is known to easily incorporate into membrane phospholipids of brain cells and meditates its corrective actions. In the present study, mice were used for a sub-acute Mn intoxication model to investigate DHA neuroprotective potential against Mn neurotoxicity. We also seek to understand the mechanism by which Mn intoxication induces these motor impairments at 30 mg/kg, by pretreatment with DHA at 200 mg/kg and assessment of changes in spontaneous locomotor behavior by open field test (OF), motor coordination using the rotarod test (RR) and strength by mean of weights test (WT). To highlight these effects on brain neurotransmission, we evaluated the tyrosine hydroxylase immunoreactivity (TH-IR) within substantia nigra compacta (SNC) and striatum (St). Results showed that Mn intoxication significantly altered motor behavior parameters including, decreased of traveled distance by 46%, decreased mean speed by 36%, reduced the ability to sustain the rotarod test to 42%; Moreover, a drop score was obtained using weights test and reflecting affected strength in Mn-intoxicated animals. Pretreatment by DHA prevents mice from Mn toxicity and maintain normal spontaneous activity, motor coordination and strength. Data also showed the ability of Mn to disrupt dopamine neurotransmission by altering tyrosine hydroxylase activity in the nigrostriatal pathway while in pretreated animals, DHA prevented this disruption. Data approved the potential neurotoxic effect of Mn as a risk factor of the Parkinsonism onset, and then demonstrated for the first time the neuroprotective and nutraceutical outcomes of DHA in the sub-acute Mn-intoxication animal model.

Objective Epilepsy is an important public health problem representing 0.6% of the global burden of disease that particularly impacts people living in the lowest income countries where epilepsy incidence may be 10 fold more than in the developed world. The battery of treatments designed to counteract the clinical manifestations of this disease are various and range from a wide spectrum of antiseizure medication and specific diets, to surgical techniques for resection of the epileptogenic focus. The aim of our study was to describe the State of the art of Epilepsy Surgery (ES) in Africa and examine ways to deal with the high surgical treatment gap. Methodology In an observational study, we prospectively disseminated questionnaires via email or directly administered to main epileptologists and neurologists involved in epilepsy care, in key African countries. We also conducted a literature search using PubMed, Google scholar on ES in all the African countries. Results We received responses from the majority of African countries, which allowed us to identify 3 levels of care for ES in African countries, a first level that uses ES with invasive presurgical evaluation, a second level that uses ES but without invasive presurgical evaluation, and a third level that does not use ES, and we summarized these results on a map. Discussion This paper studied the availability of ES as a treatment modality in several African countries. We aimed to establish optimal pathways for initiating ES with noninvasive Electroencephalography and readily available investigations. This could be achieved through collaboration with epilepsy programs in developed countries directly or by using telemedicine.