MAINTENANCE. “Brain tumors are becoming more common in Algeria”

Prof. Souhil Tliba is head of the Department of Neurosurgery at the CHU Frantz-Fanon in Blida. In this interview, this eminent surgeon warns about the prevalence of brain tumors in Algeria. The specialist outlines some possible explanations for this phenomenon.

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TSA. Tell us about your work in your department of neurosurgery at the CHU de Blida?

Prof Tliba : This is a neurosurgical department headed by a team of 33 physicians (professors, lecturers, assistant professors, resident physicians, resident physicians and general practitioners) and 138 non-physician nurses (paramedics, service staff).

The department has four dedicated operating rooms and a common room for medical and surgical emergencies.

Our department tries to meet the needs of patients with a strong neurosurgical activity. As it is a hospital-university structure, our department, which is essentially dedicated to nursing, has training and research activities, among others.

Either scientific research within the framework of university development in support of doctoral theses, or sectoral research under the supervision of the Ministry of Higher Education, or cross-sectoral research projects involving the Ministry of Health.

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Educational activities are provided for the graduate training of medical students doing their internship and for neurosurgeons as part of the postgraduate residency training.

In terms of care, our service offers neurosurgical care as well as emergency care. We have a very intensive day-care center activity. The latter is structured in such a way that every day a team consisting of a specialist with two assistant doctors covers 24 hours a day in the medical and surgical emergencies of the CHU. During his shifts, the teams operate on an average of 3 to 5 patients per day.

TSA. Where do the patients you treat in your department at Blida University Hospital come from?

Prof Tliba : Since Blida is a passage on the east-west highway axis between Algiers and Oran, there are many accidents on public roads.

In the summer there are also other emergencies such as motorbike accidents, shore diving accidents, fights, suicide attempts….

There are also domestic accidents, like when children fall from the roofs of houses, a rarity under other skies…

TSA. Regarding traffic accidents, in what condition do you receive the sick?

Prof Tliba : It is very variable. There are patients who arrive in a state of apparent death, there is not much to do. It’s a minority. We mainly operate on brain bleeding (hematoma), certain fractures of the skull and spine.

The advantage is that the on-call service is structured: the block is open at all times to take care of the patient. After that, other parameters elude us: the distance, the collection and evacuation conditions, and the severity of the accident.

On the other hand, we saved many patients. We conduct more than fifty emergency consultation hours.

There are other neurosurgical emergencies such as brain tumors, which can worsen at any time, and tumorous or infectious spinal cord compression.

We have accumulated a very large waiting list over the two years of Covid which we are trying to accommodate by redoubling our efforts. We have many unoperated patients, we try to operate on as many as possible.

We also operate on one or two brain tumors every day. Sometimes we schedule two a day. It is enormous for a service, for an operating room and an intensive care unit, to operate on two tumors in one day.

Interventions lasting between 6 and 8 hours. It’s exhausting for the teams and requires a lot of resources because we overload our equipment.

The latter such as the surgical microscope, the neuroendoscopy column, the neuronavigation, the motors of the craniectomy, the ultrasonic aspiration, the ventilators…. Require very expensive specific, specialized maintenance.

We are also one of the few centers performing cerebrovascular surgeries (cerebral aneurysms, vascular malformations). On the other hand, the demand is greater than the care services, hence the orientation of many patients abroad.

I remind you that the treatment of this condition (neurovascular) is shared between neurosurgeons and interventional neuroradiologists.

Indeed, there is still an urgent need to establish neurovascular centers. This model is initiated at Blida University Hospital with the participation of four specialties: neurosurgery, interventional radiology, neurology and medical resuscitation.

Our goal is to first maintain this activity and then strengthen it with devices for care and others for training.

TSA. You say that brain tumors are widespread in Algeria, why are they?

The subject is very complicated. There are several hypotheses, some of which are confirmed, such as B. genetic predisposition, the involvement of certain viruses, a history of head injuries …

Two other factors influencing the occurrence of brain tumors also need to be considered: access to diagnostic tools (radiology) and the prolongation of cancer survival, i.e. the increase in the number of brain metastases.

Today scientific articles evoke certain hypotheses but no certainty. Some speak of electromagnetic waves as the overuse of cell phones, especially in children, because the skull is still thin and fragile and heat is more easily transmitted to the brain.

An epidemiological study was conducted on a cohort of 600 patients with brain tumors, which was compared to other studies conducted in North Africa and published by the WHO in Europe and the world in general.

There are a few features that are really annoying. The average age of patients with brain tumors in Algeria is 47 years.

While in the world this median age is 58 years. In our country, brain tumors affect the young population more than the world average. This is the first parameter of concern. This has nothing to do with the age pyramid.

The second element is mortality from brain tumors.

In the world, brain tumors rank 12th in terms of tumor mortality, while in our country this disease ranks 6th.

In terms of frequency, this type of cancer ranks 18th in the world, according to WHO figures. In Algeria, brain cancer ranks 9th. Now we have to look for hypotheses. I can give you some…

TSA. Do it…

Prof. Tliba: I would rather address the hypothesis of plant protection products like pesticides. We have produced papers published with collaborators and research colleagues from the University of Bejaia.

We have spoken of a predisposition, but the hypothesis that perhaps comes closest to reality is the use of pesticides and insecticides in agriculture, and in a somewhat anarchic way.

It’s regulated, but is there field surveillance for their use? Do the users (farmers and consumers) comply with the prevention rules? We’re talking about the DAR (the pre-harvest interval) as an example. Are we sure that this deadline will be met?

We did laboratory work on mice and found that there is a causality between pesticides and the development of a brain tumor. It’s an Algerian study.

TSA. Are children affected by this disease?

Prof Tliba : The work has been published, we have made announcements, held conferences and talked about all this. Again, this is a hypothesis that needs to be proven in a little more detail.

We cannot ban these products (pesticides) because it is a necessity; On the other hand, we know that it is regulated, but it would be necessary for its use to be well followed and controlled, especially in the laboratories.

Brain tumors are becoming more common in Algeria. We have found that many children are affected. You are born with brain tumors. It’s worrying. Once again we are in the situation.

There are brain tumors, malformations. In addition, we are working on Covid and malformations. Lately we have noticed that there are newborns with malformations of the nervous system.

These are mothers who contracted Covid during pregnancy. Is there causality? The virus is known to disrupt the fetal development mechanism. Did the virus attack the fetus and cause mutations?

In addition, there are more and more spinal problems in adolescents and children. There is more and more scoliosis, herniated discs… related to sedentary lifestyle and lifestyle, sedentary lifestyle, etc.

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