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 frequency of brain tumors in Algeria. The specialist outlines some possible explanations for this phenomenon.
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TSA. Tell us about your activity in your neurosurgery service at CHU de Blida?
Prof. Tliba : It is a neurosurgery service that is directed by a team of 33 doctors (professors, professors, assistants, assistants, residents and general practitioners) and 138 non-medical nursing staff (paramedics, service agents).
The service has four specific operating rooms and a common room for medical and surgical emergencies.
Our service tries to cover the needs of patients with a strong neurosurgical activity. Being a hospital-university structure, our department, which is basically healthcare, has, among others, training and research activities.
Whether it is academic research as part of university progression to support doctoral theses, or sectoral research under the supervision of the Ministry of Higher Education or intersectoral research projects involving the Ministry of Health.
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Educational activity is provided for postgraduate training of intern medical students and neurosurgery residents as part of postgraduate training to become specialists.
Regarding care, our service provides neurosurgical care, as well as emergency care. We have a very intense nursery activity. The latter is structured as every day a team, made up of a specialist with two residents, covers 24 hours in the medical and surgical emergencies of the CHU. During their shifts, the teams operate an average of 3 to 5 patients per day.
TSA. Where do the patients you see in your Blida University Hospital service come from?
Prof. Tliba : As Blida is a pass on the axis of the east-west motorway between Algiers and Oran, there are many accidents on public roads.
There are also other emergencies during the summer, such as motorcycle accidents, shore diving accidents, brawls, suicide attempts…
There are also domestic accidents such as when children fall from the roofs of houses, a rare thing under other skies…
TSA. As for traffic accidents, under what conditions 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 is a minority. We mainly operate brain hemorrhages (hematomas), certain fractures of the skull and spine.
The advantage is that the on-call activity is structured: at any time, the block is open for patient care. Then, there are other parameters that escape us: the distance, the collection and evacuation conditions and the severity of the accident.
On the other hand, we saved many patients. We carry out more than fifty emergency consultations.
There are other neurosurgical emergencies such as brain tumors that can worsen at any time and tumor or infectious spinal cord compressions.
During the two years of Covid, we have accumulated a very large waiting list that we are trying to absorb by redoubling our efforts. We have many patients who have not undergone surgery, we try to operate on as many as possible.
In addition, we operate on one or two brain tumors a day. Sometimes we schedule two a day. It is enormous for a service, for an operating room and an intensive care unit to have two tumors to operate on in one day.
Interventions that last between 6 and 8 hours. It is exhausting for teams and requires a lot of resources, because we are abusing our team.
The latter such as the surgical microscope, the neuroendoscopy column, neuronavigation, craniectomy motors, ultrasonic aspiration, respirators… They require specialized, specific and very expensive maintenance.
We are also one of the few centers that perform cerebrovascular surgery (brain aneurysms, vascular malformations). On the other hand, the demand is greater than healthcare services, hence the orientation of many patients abroad.
I remind you that the management of this condition (neurovascular) is shared between neurosurgeons and interventional neuroradiologists.
In fact, there is still an urgent need to establish neurovascular centers. This model begins at the University Hospital of Blida with the participation of four specialties: neurosurgery, interventional radiology, neurology and medical resuscitation.
Our goal is first to maintain and then strengthen this activity with teams for care and others for training.
TSA. You say that brain tumors are common in Algeria, what are they due to?
The subject is very complicated. There are several hypotheses, some of which are confirmed, such as genetic predisposition, the involvement of certain viruses, a history of head trauma…
Two other factors that influence the incidence of brain tumors should also be noted: access to diagnostic means (radiology) and the prolongation of cancer survival, hence the increase in the number of brain metastases.
Today, scientific articles evoke certain hypotheses but no force of certainty. Some speak of electromagnetic waves as the excessive use of cell phones, especially among children, because the skull is still thin and fragile and heat is more easily transmitted to the brain.
An epidemiological study was carried out on a cohort of 600 patients with brain tumors compared with other studies carried out in North Africa and those published by the WHO in Europe and the world in general.
There are some features that are genuinely disturbing. The average age in Algeria of patients with brain tumors is 47 years.
While in the world this average age is 58 years. In our country, brain tumors affect the young population more than the world average. This is the first worrying parameter. This is not related to 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, the brain tumor ranks ninth. Now we have to look for hypotheses. I can give you some…
TSA. Go for it…
Professor Tliba: I prefer to address the hypothesis of plant protection products as pesticides. We did a study that was published with collaborators and fellow researchers from the University of Bejaia.
We have talked about predisposition, but the hypothesis that is perhaps closest to reality is the use of pesticides and insecticides in agriculture, and this in a somewhat anarchic manner.
It is regulated but is there any field monitoring for its use? Do users (farmers and consumers) respect prevention regulations? We speak as an example of the DAR (the pre-harvest interval). Are we sure that this deadline is respected?
We did lab work on mice and found that there was a causality between pesticides and the development of a brain tumor. It is an Algerian studio.
TSA. Are children affected by this disease?
Prof. Tliba : The work was published, we made announcements, conferences and we talked about all that. Again, this is a hypothesis that needs to be tested in a bit more depth.
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 very frequent and, above all, to be controlled in laboratories.
Brain tumors are becoming more frequent in Algeria. What we have found is that there are many children who are affected. They are born with brain tumors. It’s disturbing. 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 were infected with Covid during pregnancy. Is there a causality? The virus is known to disrupt the developmental mechanism of the fetus. Did the virus attack the fetus and cause mutations?
In addition, there are more and more spinal problems in young people and children. There is more and more scoliosis, herniated discs… in relation to a sedentary lifestyle and lifestyle, lack of physical activity, etc.
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