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The changing epidemiological profile of invasive Haemophilus influenzae infections (IIHi) is noted in the post-vaccination era. The aim of this study was to characterize phenotypically and genotypically invasive Haemophilus influenzae (Hi) isolates detected in Tunisian pediatric patients. A retrospective study was conducted in the microbiology laboratory of the Children's Hospital of Tunis over ten years (2013–2023). All IIHi cases were included. Molecular identification and serotyping were conducted through qPCR. Molecular typing and analysis of resistance genes were extracted from whole genome sequencing data. Fifty-three IIHi cases were collected. Children under five years old were the most affected (81%). Non-typable isolates (NTHi) were predominant (79%) followed by serotype b (17%) and serotype a (4%). Genetic diversity was observed, essentially among NTHi isolates. Resistance of Hi isolates to ampicillin, amoxicillin–clavulanic acid and cefotaxime (CTX) were 42%, 20% and 4%, respectively. Thirteen isolates (29%) produced a beta-lactamase and 14 carried the blaTEM-1 gene (kappa = 0.95). For non-enzymatic resistance, group 3 (n = 12) showed resistance to ampicillin. Groupe 4 (n = 9, NTHi) showed discordances with resistance to CTX. The emergence of resistance to CTX is concerning. Continuous surveillance through molecular tools in conjunction with phenotypic and clinical data is necessary to ensure better management of these infections. [ABSTRACT FROM AUTHOR]

Purpose Spinal anesthesia (SA) is being increasingly used in infants to avoid the potential negative neurocognitive effects of general anesthesia (GA). However, SA has been reported to provide a relatively short duration of surgical anesthesia. Methods We retrospectively reviewed SA cases for surgical procedures lasting more than 60 min in children up to 3 years old. All patients received bupivacaine 0.5% (1 mg/kg up to 7 mg) with clonidine 1 [micro]g/kg ± epinephrine. The primary outcome was success of SA without subsequent conversion to GA. Results Thirty-five patients met inclusion criteria (all males, age 7 ± 5 months, weight 8 ± 2 kg). Procedures included male genital, groin and multiple site surgeries. Average surgical duration was 71 ± 12 min (range 60-111 min). SA was successful in 31 of 35 patients (89%; 95% confidence interval 78, 99%). The cause of failure was rarely due to the duration of surgery (1 of 4 patients). Six patients with successful SA required sedation with dexmedetomidine ± fentanyl. Differences in procedure duration and patient characteristics were not statistically significant between successful and failed SA. Conclusions SA is a highly successful technique and may offer an alternative to GA in children undergoing appropriate surgery expected to last as long as 60-100 min., Author(s): Mehdi Trifa [sup.1] [sup.2] , Dmitry Tumin [sup.1] , Emmett E. Whitaker [sup.1] [sup.3] , Tarun Bhalla [sup.1] [sup.3] , Venkata R. Jayanthi [sup.4] [sup.5] , Joseph D. Tobias [...]

Sugammadex is a novel pharmacologic agent, which reverses neuromuscular blockade (NMB) via a mechanism that differs completely from acetylcholinesterase inhibitors. By encapsulating rocuronium, sugammadex can provide recovery of neuromuscular function even when there is a profound degree of NMB. We report anecdotal experience with the use of sugammadex to reverse NMB to facilitate intraoperative neurophysiological monitoring (motor evoked potentials) in an adolescent with scoliosis during posterior spinal fusion. Its potential application in this unique clinical scenario is discussed, and potential dosing schemes are reviewed. [ABSTRACT FROM AUTHOR]

Background: The prescription of preoperative complementary tests aims to decrease morbidity and mortality associated to the perioperative period., Aim: To assess the practice and the financial cost of the systematic prescription of preoperative tests., Methods: This was a retrospective study including all patients older than three years, scheduled for elective surgery from November 2018 to January 2019. Two attendings analyzed the data collected during the pre-anesthetic assessment and evaluated the usefulness of the ordered preoperative tests. The overall cost of prescribed preoperative tests and the cost generated by inappropriate prescriptions were also estimated., Results: This study included 1006 patients. The average age was 46.9 ± 22.05 years old. Five hundred and twenty three of them (51.98%) have no medical history. Among the planned procedures, 6.46% had an intermediate or major bleeding risk. Preoperative prescriptions were ordered by surgeons in 99% of cases. Prescriptions were justifiable in only 9.42% of cases. Abnormal findings were noted in 4.98% of the patients. The total cost was almost 80992 Dinars (≈ 24543 €). Complying the guidelines would save 70245 Dinars (≈ 21286 €) during the three months' study., Conclusion: The routine prescription of preoperative complementary tests results in a significant additional economic cost. Developing national guidelines would change this attitude of unnecessary prescription.

Background: Para-umbilical block was an old block that regains a new interest. No study was available using Ropivacaine in this block., Aim: To compare quality of analgesia after using Ropivacaine 0.2% to Bupivacaine 0.25% in para-umbilical blocks., Methods: In a prospective randomized double blind study we included one to six years old children, scheduled for umbilical herniorrhaphy. The children were randomized in two groups to receive in para-umbilical block by side: Ropivacaine 0.2%: 0.2 ml.kg-1 (group GR) or Bupivacaine 0.25%: 0.2 ml.kg-1 (group GB)., Results: The data of 75 children (GR= 38; GB= 37) were analyzed. The groups were comparable regarding the demographics' characters. The scores of Children's Hospital of Eastern Ontario Pain Scale in different postoperative times were comparable between the two groups. No difference was noted in the time of the first analgesic request. The two groups were comparable regarding the peroperative analgesia. No complication was recorded in this study., Conclusion: Ropivacaine 0.2% is equivalent to the Bupivacaine 0.25% concerning postoperative and peroperative analgesia in the para-umbilical block for umbilical herniorrhaphy.

Aim: To determine the demographic, clinical, biological and bacteriological profile of acute community acquired hematogenous osteomyelitis (AHO) in children., Methods: Prospective study including children admitted for AHO. We noted the demographic parameters of patients and the clinical, biological and radiological characteristics of the infection. Blood cultures and local specimen in operated children were systematically performed., Results: 70 patients were included. The mean age was 7.7 years. The mean time between onset of symptoms and admission was 3.2 days. Distal tibia was the most frequent localization (18.66%). Fever higher than 38° on admission was found in 92.8% of patients. Creactive protein (CRP) was superior to 20 mg / L in 95.8% and ESR superior to 20 mm in the first hour in 92% of cases. A deep venous thrombosis was found in 7 patients and a pleuropulmonary Staphylococcus infection in 4 patients. A micro organism was isolated in 64.7% of cases. Staphylococcus aureus methicillin susceptible (SAMS) was the predominant germ. Staphylococcus aureus methicillin resistant (SAMR) accounted for 15.7% of staphylococcus aureus infections. The importance of CRP on admission and time to resolution of fever after the start of treatment were significantly higher in SAMR infections. The existence of deep venous thrombosis and a pleuropulmonary Staphylococcus infection and the need for surgical drainage were significantly more frequent in SAMR infections., Conclusion: The existence of a severe form of AHO should lead to a high suspicion of SAMR infection and prompt the prescription of an appropriate antibiotiotherapy.

Background: The traumatic brain injury is a major cause of morbidity and mortality in the paediatric population. Adequate knowledge of their epidemiology is necessary to develop targeted preventive campaigns, and to estimate the needs for care facilities., Aim: To specify the demographic and epidemiologic characteristics of paediatric traumatic brain injury., Methods: Longitudinal retrospective study including children hospitalized for traumatic brain injury in the Hospital of Child of Tunis during the 1-year period (2007)., Results: Our study comprised 298 children with an average age of 5.9 ± 3.9 years and a sex-ratio with 2. Minor traumatic brain injury represented 92.6 % of the cases and severe traumatic brain injury represented 5.4 %. One child of 6 had another traumatism. Accidents at home were the most frequent causes (64.1 %). Traffic accidents represented 27.9 % of the mechanisms. In 90.6 % of the cases the transport was assured by clean means. The cerebral scanner, produced at 89.9 % of the patients, revealed cerebral lesions in 49.7% of the cases. Neurosurgical indications were carried in 5 children. The death rate was 2.1 %. At three months of the exit of the hospital, 97.2 % of the children had a good recovery., Conclusion: The paediatric traumatic brain injury is a frequent and serious pathology. The epidemiologic studies can contribute to the development of prevention program in order to decrease its incidence in the target population.

Background: Stress fractures of the femoral neck are uncommon. They are caused by either excessive stress or bone fragility., Aim: To report a case of bilateral stress fracture of the femoral neck in a 15-year-old girl without any risk factors, Observation: We report a case of bilateral stress fracture of the femoral neck in a 15-year-old girl in whom no risk factors were found. One of the fractures was displaced at first diagnosis and was successfully treated by closed reduction and valgus subtrochanteric osteotomy. The other fracture was initially undisplaced but displacement occurred later despite internal fixation with a dynamic hip screw., Conclusion: A high index of suspicion of stress fractures of the femoral neck must be kept in mind even without risk factors. Delays in diagnosis and displacement should therefore be avoided.

Background: Infantile hypertrophic pyloric stenosis (IHPS) associated with metabolic alkalosis, could induce late anesthesia recovery, especially when opioids are used. The aim of this study was to compare the time of extubation and the quality of perioperative analgesia in infants scheduled for pyloromyotomy, receiving either isoflurane inhalation or remifentanil infusion., Methods: Thirty full-term infants scheduled for pyloromyotomy were prospectively studied. A standardized anesthetic induction was performed. For maintenance of anesthesia, infants were randomly allocated to receive either isoflurane 0.75% of inspired concentration (GI n = 15), or remifentanil as a continuous infusion of 0.4 microg x kg(-1) x mn(-1) (GR n = 15). At the beginning of skin closure, the anesthetic was discontinued and 15 mg x kg(-1) of paracetamol administered. Non parametric tests were used in statistical analysis., Results: The time to extubation was similar in both groups. The intraoperative heart rate was significantly lower in the GR group., Conclusion: Remifentanil provided better intraoperative analgesia than isoflurane in infants undergoing pyloromyotomy without increasing time to extubation.

Objectives: The aim of the present study was to compare the analgesic effects of ripovacaine when used as high concentration/small volume, versus its use as high volume/low concentration, in ilioinguinal-iliohypogastric nerve block in children., Methods: This is a prospective single-blind randomized study consisting of 72 children ASA I & II, 3-9 years of age, scheduled for outpatient elective surgery. Children were randomly assigned into two equal groups (36 each), to receive ropivacaine 0.8 mg.kg(-1), for ilioinguinal-iliohypogastsric block, either as: 1 mg.ml(-1) (0.8 ml.kg(-1)) G1 group, or 2 mg.ml(-1) (0.4 ml.kg(-1)) G2 group. The postoperative pain was assessed using the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS), at the end of surgery (H0), at one (H1), tow (H2), four (H4) and six (H6) postoperative hours. Parents were requested to record their child's pain every 6 hours during the first 24 postoperative hours, using the postoperative pain measurement for Parent Scale., Results: CHEOPS score H0 was significantly lower in G2 as compared to G1 group (p = 0.03). Only 2 children in G2 as compared to 8 children in G1 group, required i.v. paracetamol administration after surgery (p = 0.04). In group G1, two children required paracetamol at home and three developed a postoperative transitory femoral nerve block (p = 0.23)., Conclusions: Ropivacaine when used with high concentration/small volume is more efficient than when used a high volume/low concentration, for ilioinguinal-iliohypogastric nerve block in children.