Réévaluation clinico-biologique de l'antibiothérapie probabiliste en réanimation des brules.

Bacterial resistance is a major concern and the proper use of antibiotics is a global public health priority. Inappropriate use of antibiotic therapy can have serious ecological and pharmaco-economic consequences. The objective of our work was to study the reevaluation of probabilistic antibiotherapy in the burns intensive care unit. A prospective study concerning the clinical-biological reassessment of antibiotic therapy was set up in the burns intensive care unit at the Military Hospital Instruction Mohammed V of Rabat. The data was collected over a period of 6 months, from June 1, 2017 to November 30, 2017. During the study period, 142 patients received an antibiotic prescription. Only 68 serious hospitalized septic patients were included in our study. The population was predominantly male (75%). The average age of our patients was 36 years, ranging from 15 to 56 years old. The average length of hospitalization in intensive care was 10 days. Of the 68 antibiotic regimens implemented, the reassessment rate was 72.06%, with 75% justified treatment rates, and 25% not justified. Therapeutic de-escalation was performed in 8 cases (11.76%), when it could have been performed 25 times (36.76%). This is justified by the nosocomial context of the burns intensive care unit with a bacterial ecosystem of BMR type (Klebsiella pneumoniae, Acinetobacter baumanii, Escherichia coli and Staphylococcus coagulase negative), which restricts the choice of antibiotic therapy to some molecules. Clinico-biological re-evaluation of antibiotic therapy is essential to fight the misuse of antibiotics. This study allowed us to evaluate the re-evaluation practices of antibiotic therapy at 48-72h in burns resuscitation. Subsequently, several actions were carried out: the appointment of a pharmacist in antibiotherapy within the Pole Pharmacy of the Mohammed V Military Hospital in Rabat, the activation of an Anti-Infectious Committee and the dispensing of antibiotics via Pyxis MedStation.

[In vitro comparative study of plasma protein binding of 99mTc-DTPA used in renal scintigraphy]. / Étude comparative de l'estimation in vitro de la fixation plasmatique du 99mTc-DTPA utilisé en scintigraphie rénale.

The radiopharmaceutical (99m)Tc-DTPA (diethylene-triamine-pentaacetic acid) is a tracer widely used in renal scintigraphy to assess glomerular filtration rate. The estimation of protein binding is very important due to its impact on clinical parameters biodistribution since only the free fraction is filtered by the kidney. A number of laboratory techniques have been developed to study protein binding. Precipitation and ultrafiltration are the mostly used techniques in pharmacology for studies of the binding between proteins and small molecules. The aim of this work is to apply and compare those two analytical methods in (99m)Tc-DTPA protein binding determination in vitro before in vivo application. The results obtained by precipitation with trichloroacetic acid are not enough reproducible, while those obtained by ultrafiltration seem more consistent and reproducible.

[Anti-inflammatory activity of aqueous and ethanolic extracts of Zygophyllum gaetulum]. / Activité anti-inflammatoire des extraits aqueux et éthanolique de Zygophyllum gaetulum.

Zygophylle or Zygophyllum gaetulum Emberger and. Maire is a Moroccan medicinal plant which has been used as an anti-inflammatory, antidiabetic, antispasmodic and antidiarrheic. The present study was carried out to study and compare the anti-inflammatory effect of ethanolic extract with aqueous extract of Z. gaetulum. Organic extract of Z. gaetulum was obtained in soxhlet apparatus. Aqueous extract was obtained by infusion. The Wistar albinos rats of either sex weighing 200-300 g aged 2-3 months were used for this experiment. The rats were housed under standard environmental conditions. The anti-inflammatory activity was estimated by measuring the oedema induced by carragenin according to the method of Winter and al. Ethanolic extract of Z. gaetulum reduced the increase of the paw volume with a percentage of inhibition of 46% (p<0.01), this percentage was 47.48% (p<0.01) with aqueous extract. The inhibition decrease in time, it arrived to 39% (p<0.01) at the sixth hour while the activity of aqueous extract decrease a lot. In conclusion, Z. gaetulum is an interesting plant which the aqueous and éthanolic extracts could be used scientifically in the treatment of inflammation.

The effect of irrigation fluid temperature on core body temperature in arthroscopic shoulder surgery.

INTRODUCTION: The purpose of this study was to investigate the relationship between irrigation fluid temperature and core body temperature in patients undergoing arthroscopic shoulder surgery. MATERIALS AND METHODS: Twenty-four consecutive patients undergoing arthroscopic subacromial decompression were allocated to receive irrigation fluid at either room temperature (22 degrees C) or warmed to 36 degrees C. There were no statistically significant differences between the two groups in any of the preoperative parameters. Core temperature was monitored throughout surgery. The maximum drop in core temperature for each patient was calculated. RESULTS: The mean maximum drop in the room temperature group was 1.67 degrees C (95% CI 1.33-1.97) and 0.33 degrees C (95% CI 0.17-0.49) in the warmed fluid group (P < 0.001). Further to this the drop in core temperature in the room temperature group was maintained throughout surgery whereas normothermia resumed by 30 min in the warmed fluid group. CONCLUSION: We thus conclude that core temperature may be influenced by irrigation fluid temperature and recommend that fluid be warmed to 36 degrees C.