Case numbers reported in literature with neurological manifestations potentially linked to COVID-19 is constantly increasing. Most often it is sudden anosmia, headache, encephalopathy or stroke. Pathophysiology of this neurological involvement is still poorly understood. While viral genome is very rarely detected in cerebrospinal fluid, inflammatory involvement is often very significant. We report a case of SARS-CoV-2 encephalopathy without respiratory distress or cytokine storm.
Factor V congenital deficiency is a rare hereditary disease, it exposes patients to hemorrhagic risk, with high morbi-mortality. Its management is a real challenge for practitioners. Perioperative management of patients with Factor V congenital deficiency needs anesthetists, hematologists and surgeons to work in close collaboration.
Introduction: According to the World Health Organization (WHO), disability is a public health problem that can be difficult to manage medically and financially. Disability can either be innate or develop after resuscitation. Therefore, the decision regarding whether to resuscitate a patient or not raises certain ethical questions, especially in the context of a Muslim country such as Morocco.
Aim: The main aim of this study is to survey the public’s opinions regarding their willingness to be resuscitated or have their relatives be resuscitated based on their foreseeable degree of disability.
Methods: This cross-sectional study was conducted over a 10-month period and employed a self-administered questionnaire. The participants included were all adult (i.e., over 18 years of age) Moroccan nationals, and they were selected regardless of their religious identity. Moreover, the modified Rankin Scale (mRS) was used to measure the participants’ foreseeable degree of handicap. The participants were divided into two groups: healthcare workers and non-healthcare workers.
Results: In total, 1083 questionnaires were retained. The average age of the participants was 30 (± 8) years, with the male-to-female sex ratio being 0.78. Moreover, 39.6% of the participants were healthcare workers. It was found that compared to the non healthcare workers, the healthcare professionals were more willing to be resuscitated themselves and have resuscitation performed on their relatives, but only when the degree of foreseeable disability was estimated to be absent or insignificant, whereas they were less willing to be resuscitated and have resuscitation performed on their relatives when the degree of foreseeable disability was estimated to be mild or higher.
Conclusion: In conclusion, there should be a pre-established procedure, along with a legislative and multidisciplinary framework, within the hospital structures in order to help in the decision-making process regarding whether to resuscitate a patient or not.
Clavicle fixation is becoming more common but only a few comparative studies have been conducted to determine the optimal approach in regional anesthesia as the sole modality for such surgery. Combined interscalene and intermediate cervical plexus block seems to be the most effective technique [1]. However, this approach can be associated with undesirable effects and may be contraindicated in patients pulmonary function [2].The wide awake local anesthesia with no tourniquet (WALANT) technique was recently reported as an alternative landmark-based technique for clavicle fractures [3]. This technique involves injecting diluted and buffered local anesthesia with epinephrine under the clavicular periosteum. We describe the use of ultrasound guidance to perform this technique in two patients undergoing clavicle surgery. This study was approved by the local Institutional Review Board committee (approval number: 2020-09). Written informed consent was obtained from the patients.A 17-year-old patient was admitted for a displaced segmental fracture of the midshaft clavicle. The patient was placed in a semi-fowler position with the head turned away from the operative side. The anesthetic solution prepared was a mixture of 0.5% lidocaine containing 0.05% bupivacaine, epinephrine 1/200000, and 8.4% sodium bicarbonate (1 ml per 10 ml of lidocaine). We used a linear ultrasound probe (13-6 MHz, SonoSite Edge II, USA) to scan above and below the clavicle to identify relevant nearby structures particularly the pleura, brachial plexus, and subclavian vessels. After subcutaneous injection of 10 ml over the incision line, ultrasound-guided WALANT was performed by administering 40 ml of the prepared solution at four intervals along the clavicle. The probe was placed perpendicular to the long axis of the clavicle to view the bone in cross section (Fig. 1A). A conventional needle (21 gauge × 38 mm) was inserted vertically out-of-plane until the needle tip contacted the clavicle. Local anesthetic was injected, then the needle was withdrawn to the skin level and redirected cranially and caudally until bone contact to anesthetize the borders of the clavicle. Ultrasound guidance allowed visualization of adequate spread around the cortical line of the clavicle. Thickening of the hyperechoic and thin cortical line with subsequent lower echogenicity and fuzzy edges was also observed (Fig. 1B), confirming spread of the anesthetic solution under the periosteum (Supplemental Video 1). Additionally, 5 ml of anesthetic mixture was injected into the fracture site under ultrasound guidance using an in-plane technique. Surgical incision was begun after 30 min to allow maximal vasoconstriction and optimal sensory anesthesia of the clavicular area. There was no motor or sensory block of the upper limb, indicating ab-
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