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L’antibiorésistance croissante des bactéries responsables des infections urinaires limite le choix des antibiotiques en chirurgie urologique. Parmi ces germes sont retrouvées les entérobactéries productrices de bétalactamases à spectre élargi (EBLSE) dont la progression devient inquiétante. L’objectif de cette étude était de déterminer la prévalence des entérobactéries sécrétrices de BLSE dans les prélèvements d’urines en péri opératoire de chirurgie urologique. Il s’agissait d’une étude rétrospective réalisée au centre hospitalier universitaire Ibn Sina de Rabat sur une période de 19 mois. N’ont pas été inclus dans cette étude, les prélèvements urinaires réalisés à dans un laboratoire externe. Les données étaient traitées avec le logiciel SPSS, les comparaisons faites par test du Khi deux ou de Student avec un seuil de risque alpha fixé à 5%. Sur 830 prélèvements positifs 656 étaient des entérobactéries soit 79 % des germes isolés. E.coli représentait 53,2%, K.pneumoniae 28%, E.cloacae 7,8% et P.mirabillis 7%. Les producteurs de BLSE représentaient 17,5% de l’échantillon avec: E.coli (12,3%), K.pneumoniae (23,6%), E.cloacae (39,2%) et P.mirabillis (6,7%). On note une augmentation de la prévalence des entérobactéries BLSE entre 2008 et 2009 : respectivement de 14,4% à 22,3% des entérobactéries isolées; pour E.coli de 32,76% à 40,68% et pour K.pneumoniae de 34,48% à 42,37%. Plusieurs facteurs de risque d’acquisition des EBLSE sont rapportés dans la littérature, dont principalement l’utilisation antérieure d’antibiotiques par ces patients. Une politique de gestion rationnelle des antibiotiques en ambulatoire et au sein des établissements de santé contribuera à une réduction de l’émergence des germes résistants

Abstract Rapid‐onset hyponatremia and rhabdomyolysis are rare, but potential, complications of olanzapine treatment. Hyponatremia, secondary to atypical antipsychotic use, has been reported in many case reports and is thought to be associated with an inappropriate antidiuretic hormone secretion syndrome. We report a case of sudden‐onset hyponatremia associated with a severe rhabdomyolysis resulting in a coma‐necessitating intensive care unit admission. His evolution was favorable after correction of all his metabolic disorders and olanzapine suspension.

Chronic inflammation results from excessive pro-inflammatory signaling and the failure to resolve the inflammatory reaction. Lipid mediators orchestrate both the initiation and resolution of inflammation. Switching from pro-inflammatory to pro-resolving lipid mediator biosynthesis is considered as efficient strategy to relieve chronic inflammation, though drug candidates exhibiting such features are unknown. Starting from a library of Vietnamese medical plant extracts, we identified isomers of the biflavanoid 8-methylsocotrin-4′-ol from Dracaena cambodiana, which limit inflammation by targeting 5-lipoxygenase and switching the lipid mediator profile from leukotrienes to specialized pro-resolving mediators (SPM). Elucidation of the absolute configurations of 8-methylsocotrin-4′-ol revealed the 2S,γS-isomer being most active, and molecular docking studies suggest that the compound binds to an allosteric site between the 5-lipoxygenase subdomains. We identified additional subordinate targets within lipid mediator biosynthesis, including microsomal prostaglandin E2 synthase-1. Leukotriene production is efficiently suppressed in activated human neutrophils, macrophages, and blood, while the induction of SPM biosynthesis is restricted to M2 macrophages. The shift from leukotrienes to SPM was also evident in mouse peritonitis in vivo and accompanied by a substantial decrease in immune cell infiltration. In summary, we disclose a promising drug candidate that combines potent 5-lipoxygenase inhibition with the favorable reprogramming of lipid mediator profiles.

Few cases of postoperative hypoglycaemia complicating the removal of a phaeochromocytoma have been reported in the literature. We reported one case of hypoglycaemia secondary to the removal of right phaeochromocytoma in a 30-year-old patient. Seven hours after the excision of the tumour, the patient developed a severe hypoglycaemia at 1.67 mmol l–1 revealed by seizures completely resolving in 24 h. The hypoglycaemia in this context resulted probably from the massive secretion of insulin by the beta cells of Langerhans islands due to the suppression of alpha-adrenergic inhibition. The prevention of this complication requires the repeated measurement of the capillary glycaemia in the postoperative period. An important supply of carbohydrate may be necessary to maintain a normoglycaemia. [Copyright &y& Elsevier]

Direct oral anticoagulant use has increased significantly over the last decade. Their perioperative management is always challenging for the anesthesiologist. Interventional radiology offers an interesting alternative nowadays, especially in emergencies. We report the case of a 52-year-old woman who was admitted to our department to manage a septic shock secondary to an abscessed collection in the right iliac fossa. After a multidisciplinary consultation, given that she was taking anticoagulation medications for venous mesenteric ischemia, it was decided to proceed with computed tomography scan-guided drainage of the collection, which resulted in the evacuation of over 500 cc of pus. This case report emphasizes the importance of interventional radiology and its role in avoiding surgical interventions in risky situations, especially for patients on anticoagulants, or at least to be carried out, in a second step, under better conditions., (© 2024 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Anesthesiology is considered a complex medical specialty. Its history has been marked by radical advances and profound transformations, owing to technical and pharmacological developments and innovations in the field, enabling us over the years to improve patient outcomes and perform longer, more complex surgical procedures on more fragile patients. However, anesthesiology has never been safe and free of challenges. Despite the advances made, it still faces risks associated with the practice of anesthesia, for both patients and healthcare professionals, and with some of the specific challenges encountered in low and middle-income countries. In this context, certain actions and initiatives must be carried out collaboratively. In addition, recent technologies and innovations such as simulation, genomics, artificial intelligence, and robotics hold promise for further improving patient safety in anesthesiology and overcoming existing challenges, making it possible to offer safer, more effective, and personalized anesthesia. However, this requires rigorous monitoring of ethical aspects and the reliability of the studies to reap the full benefits of the new technology. This literature review presents the evolution of anesthesiology over time, its current challenges, and its promising future. It underlines the importance of the new technologies and the need to pursue efforts and strengthen research in anesthesiology to overcome the persistent challenges and benefit from the advantages of the latest technology to guarantee safe, high-quality anesthesia with universal access., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Harfaoui et al.)

Trichoderma atroviride is a mycoparasitic fungus with antagonistic activity against fungal pathogens and is used as a pathogen control agent alternative to synthetic fungicides. Sensing nutrient availability in the environment and adjusting metabolism for optimal growth, development and reproduction is essential for adaptability and is relevant to its mycoparasitic activity. During mycoparasitism, secondary metabolites are produced to weaken the fungal prey and support the attack. Are1-like proteins act as major GATA-type transcription factors in the activation of genes subject to nitrogen catabolite repression. Since the quality and quantity of nitrogen has been proven particularly relevant in remodeling the biosynthesis of secondary metabolites in fungi, we decided to functionally characterize Are1, the ortholog of Aspergillus nidulans AreA, in T. atroviride. We show that the growth of the T. atroviride ∆are1 mutant is impaired in comparison to the wild type on several nitrogen sources. Deletion of are1 enhanced sensitivity to oxidative and cell-wall stressors and altered the mycoparasitic activity. We were able to identify for the first time a link between Are1 and iron homeostasis via a regulatory mechanism that does not appear to be strictly linked to the nitrogen source, but rather to an independent role of the transcription factor., (Copyright © 2024 The Authors. Published by Elsevier GmbH.. All rights reserved.)

Background: Pain is a major socio-psychological problem worldwide. Chronic pain has a negative effect on areas of psychological functioning such as depression, anxiety, and perceived stress., Aim: The present study investigated the mediating role of experiential avoidance in the relationship between chronic pain and pain anxiety with pain disability., Methods: Participants were treatment-seeking patients (N = 361) at an outpatient pain clinic in Shiraz (Fars, Iran). The Multidimensional Pain Inventory (MPI), Pain Anxiety Symptom Scale (PASS-20), Pain Disability Questionnaire (PDQ), and Acceptance and Action Questionnaire-II (AAQ-II) were used to measure multidimensional pain, anxiety, pain disability, experiential avoidance, and pain severity., Results: The results of the correlation revealed that a significant relationship exists between multidimensional pain and pain anxiety, pain disability, and experiential avoidance. Experiential avoidance mediated the associations from multidimensional pain and pain disability significantly. Also, experiential avoidance moderated associations between pain anxiety and pain disability significantly. In general, Structural Equation Modeling (SEM) showed that experiential avoidance mediated the relationship between multidimensional pain and pain anxiety with pain disability., Conclusion: In general, the results revealed that experiential avoidance can mediate the relationship among pain, pain anxiety, and pain disability as a maladaptive regulation strategy. The results obtained from this study seem to introduce experiential avoidance as a vulnerability factor effectively., Competing Interests: Declaration of competing interest The authors report no declarations of interest., (Copyright © 2024. Published by Elsevier Inc.)

Introduction and Importance: Psoas abscess is a relatively uncommon condition that can present with vague clinical features. Patients with this condition often present in different ways to different specialties leading to delays in diagnosis and management., Case Presentation: The authors present a 47-year-old woman with complaint of vague abdominal pain, fever, and raised inflammatory markers who underwent CT examination. On CT, a collection was noted in the right iliac fossa that extended along the right retroperitoneum through the retrocrural space in the right lung base communicating with a cavitary pulmonary lesion with air-fluid level. The psoas abscess was drained., Clinical Discussion: Our case presents a number of rare and intriguing features. Notably, the patient, who was immunocompetent, experienced a primary Staphylococcus infection that swiftly progressed to a sizable pulmonary abscess, a phenomenon uncommon in such hosts. The rarity further extends to the source of infection, originating abdominally but culminating in thoracic complications through contiguous spread from a retroperitoneal site. Despite the potential severity, the patient's outcome was remarkably positive., Conclusion: This case underscores the potential rapidity of pulmonary involvement in psoas abscesses, emphasizing the need for heightened awareness and consideration of respiratory signs during preoperative assessments., Competing Interests: The authors declare no competing interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Introduction: Patient safety in anaesthesia has significantly improved over the past decades, largely due to pharmacological and technological advancements, as well as the widespread adoption of guidelines and standards recommended by international organisations. This study aimed to evaluate the practice of anaesthesia and its compliance with the international standards for safe anaesthesia practice recommended by the World Federation of Societies of Anaesthesiologists (WFSA) and the World Health Organization (WHO). This study also describes the operating room within Ibn Sina University Hospital Centre (CHUIS) of Rabat, Morocco, the referral centre, with the aim of identifying its potential and shortcomings., Methods: This was a prospective analytical descriptive study from March 1, 2021, to July 31, 2021. All facilities within an operating room and information regarding patients undergoing general anaesthesia, whether it be emergency or scheduled procedures, administered by an anaesthetist, were included. A survey form based on the WHO-WFSA International Standards for a Safe Practice of Anesthesia was used to collect data about the anaesthesia sites. Sources of information included direct observation of anaesthesia procedures, patient records, registers, and qualified anaesthesia personnel. Manual data analysis and encoding were performed using Microsoft Word and Excel (Microsoft Corporation, Redmond, Washington, United States).  Results: All the facilities within the operating rooms of CHUIS were surveyed. In total, 250 patients were recorded, with 43.6% at Ibn Sina Hospital, 18.4% in the Children's Hospital, 14% at the National Institute of Oncology, 12% at the Specialties, 6% at Maternity Hospital Souissi, and 6% at Orangers Maternity Hospital. The median age of patients was 50 years old with 37% of them aged 36-55 years. Overall, 67.6% of these patients were admitted for scheduled interventions. Anaesthetic risk assessment showed that 67.2% of the patients were in American Society of Anesthesiologists (ASA) class I. Pre-anaesthesia consultations were conducted in 65.6% of cases, and pre-anaesthesia visits were conducted in 89.6% of cases. Anaesthesia checklists were used in 89.6% of cases. General anaesthesia, including tracheal intubation 85.2% and facemask 7.2%, was the most common type of anaesthesia. Regarding anaesthetic agents, propofol was the most used intravenous narcotic, with fentanyl still being used in most cases 92% and rocuronium in 82% of cases. Electrocardiogram, non-invasive blood pressure, and pulse oxygen saturation (SPO2) monitoring were consistently used, while capnography was not available in 6% of cases. Crystalloid fluid resuscitation was used in 91.2% of cases, and colloid resuscitation was used in 1.2% of cases. The post-anesthesia care unit (PACU) was present in 58.8% of cases. Postoperative analgesia was administered in 80% of cases. Adverse events occurred in 58.4% of cases. Preoperative transfusion strategies were employed in 18% of cases. Patient transfers to the intensive care unit were done for 18%., Conclusion: Despite the shortcomings of the healthcare system in Morocco, our study indicates that the anaesthesia practice at CHUIS remains highly acceptable by adhering to the highest international standards., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Harfaoui et al.)

This study presents a phytochemical survey of two common intertidal red algal species, Bostrychia scorpioides and Catenella caespitosa , regarding their MAA (mycosporine-like amino acid) composition, which are known as biogenic sunscreen compounds. Six novel MAAs from Bostrychia scorpioides named bostrychines and two novel MAAs from Catenella caespitosa named catenellines were isolated using a protocol which included silica gel column chromatography, flash chromatography on reversed phase material and semipreparative HPLC (High-Performance Liquid Chromatography). The structure of the novel MAAs was elucidated using NMR (Nuclear Magnetic Resonance) and HR-MS (High-Resolution Mass Spectrometry), and their absolute configuration was confirmed by ECD (Electronic Circular Dichroism). All isolated MAAs possess a cyclohexenimine scaffold, and the metabolites from B . scorpioides are related to the known MAAs bostrychines A-F, which contain glutamine, glutamic acid and/or threonine in their side chains. The new MAAs from C . caespitosa contain taurine, an amino sulfonic acid that is also present in another MAA isolated from this species, namely, catenelline. Previous and new data confirm that intertidal red algae are chemically rich in MAAs, which explains their high tolerance against biologically harmful ultraviolet radiation.

We investigated the anticancer mechanism of a chloroform extract of marine sponge ( Haliclona fascigera ) (sample C) in human breast adenocarcinoma (MCF-7) cells. Viability analysis using MTT and neutral red uptake (NRU) assays showed that sample C exposure decreased the proliferation of cells. Flow cytometric data exhibited reactive oxygen species (ROS), nitric oxide (NO), dysfunction of mitochondrial potential, and apoptosis in sample C-treated MCF-7 cells. A qPCR array of sample C-treated MCF-7 cells showed crosstalk between different pathways of apoptosis, especially BIRC5 , BCL2L2 , and TNFRSF1A genes. Immunofluorescence analysis affirmed the localization of p53, bax, bcl2, MAPKPK2, PARP-1, and caspase-3 proteins in exposed cells. Bioassay-guided fractionation of sample C revealed Neviotin A as the most active compound triggering maximum cell death in MCF-7, indicating its pharmacological potency for the development of a drug for the treatment of human breast cancer.