[Nosocomial pneumonia due to resistant Enterobacter aerogenes].
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Cross Infection↗
Biomedical subjects
F Baud
Publications and source records attributed to F Baud.
[Surgery to save body-packers].
Cocaine body packing may expose to the risk of intestinal obstruction or acute cocaine poisoning. During the last five years (1998-2002), 17 symptomatic body-packers were admitted to our intensive care unit, for a closed monitoring. Clinical evolution of three patients required a surgical intervention. The first patient had a laparotomy, in the presence of an occlusive syndrome, to recover the packets of cocaine. The second patient presented peritonitis, in relation to an ileal perforation, treated with an intestinal segment resection followed by a double ileostomy. The third patient presented severe ventricular dysrhythmia, due to cocaine toxicity, after a bullet disruption in the stomach. Adrenaline and labetalol-combined therapy as well as gastric incision to recover the bullets were needed to allow cardiovascular stabilization. In these three cases, the surgical treatment allowed patient survival.
Adrenergic alpha-Agonists↗
[Descriptive study of the patients admitted to an intensive care unit during the heat wave of August 2003 in France].
INTRODUCTION: Several thousands of deaths were attributed to heat stroke during August 2003 in France. To date, only a very few studies have analyzed the prognosis in the intensive care unit (ICU) of the most severely hyperthermic patients. METHOD: Descriptive observational study of the patients admitted to the intensive care unit at the Lariboisière hospital in Paris, for heat stroke defined by an elevated core body temperature above 40 degrees C with central nervous system dysfunction, in the absence of other etiologies explaining the hyperthermia. RESULTS: In the Lariboisière hospital, an elevation in the ICU (+143%) and hospital mortality rate (+191%) were registered during August 2003, in comparison with August 2002. Fifteen patients (10 men, 5 women, median age: 57 years) were admitted to the ICU for heat stroke between the 4th and 14th of August 2003. Seven of them (47%) died. On admission, the occurrence of a pre-hospital cardiac arrest, the presence of coagulation abnormalities (reduction in prothrombin time and in platelet count) or of an elevation in plasma lactate concentration were significantly associated with the risk of death in the ICU. Conversely, age, body temperature, coma depth on admission and convulsions were not predictive of death. Neurological after effects (cerebellar syndrome, polyneuropathy and residual brain damage) were noted in 50% of the survivors. DISCUSSION: Although it is possible that heat alone precipitated the death of very sick people, our study clearly showed that young and valid patients died of heat stroke and suggests the possible increase in the 2003 death rate secondary to the heat wave. Moreover, it is still difficult at the moment to really appreciate the long-term consequences for survivors who presented serious neurological after effects. CONCLUSION: The August 2003 heat wave resulted in an elevation of the hospital and ICU death rates in the Lariboisière hospital in Paris. Despite adequate cooling and supportive therapies, the mortality of patients admitted to the ICU for heat stroke remained elevated and the neurological after effects severe. These preliminary results should be confirmed by larger cohort studies.
Body Temperature↗
[Bacterial pneumopathy facilitated by diazepam in acute poisoning with chloroquine].
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Adult↗
[Acute involuntary intoxication with gamma-hydroxybutyric acid].
Dangerous misuse of anaesthetic drugs is illustrated in a case of gamma-hydroxybutyrate (gamma-OH) poisoning. A 36-year-old patient, coming from USA ingested approximately 200 mL of a liquid. He presented a non reactive coma (Glasgow coma scale at 3), abnormal movements, hypotension and bradycardia. Outcome was favorable with symptomatic treatment including tracheal intubation and ventilation. The patient was discharged 24 hours later. This case was a typical gamma OH poisoning. Its consumption is current in the United States for body-builders. Poisoning was involuntary, due to a dilution mistake. Toxicological analysis assessed this diagnostic. Such poisoning is exceptional in France.
Adult↗
Rapid diagnosis of infectious pleural effusions by use of reagent strips.
Reagent strips have not yet been tested for use in the diagnosis of infectious pleural effusions. A reagent strip was used to evaluate 82 patients with pleural effusions: 20 patients had transudative effusions, 35 had infectious exudative effusions (empyema in 14 and parapneumonic effusion in 21), and 27 had noninfectious exudative effusions. Pleural fluid protein, as evaluated by the reagent strip, proved accurate for the detection of exudative effusions (sensitivity, 93.1%; specificity, 50%; positive predictive value, 84.3%; negative predictive value, 71.5%; odds ratio [OR], 6.77; and 95% confidence interval [CI], 1.87-24). The reagent strip leukocyte esterase test effectively detected infectious exudative effusions (sensitivity, 42.8%; specificity, 91.3%; positive predictive value, 88.2%; negative predictive value, 51.2%; OR, 4.46; and 95% CI, 1.2-16.4). Pleural pH was significantly predicted by the reagent strip but was of no assistance in categorization of exudative effusions as infectious or noninfectious. Compared with physical, laboratory, and microbiological data, the reagent strip was as accurate for estimation of percentages of infectious and noninfectious exudative effusions. Thus, reagent strips may be a rapid, easy-to-use, and inexpensive technique for discriminating transudative from exudative pleural effusions and for categorizing exudative pleural effusions as infectious or noninfectious.
Adult↗
[Acute verapamil poisoning. A proposal of a strategy for therapeutic management].
Verapamil poisonings are rare, but are associated with a high proportion of deaths. The authors present a case of acute poisoning by verapamil associated with collapsus and a high degree of heart block. They propose a strategy for therapeutic management based on the study of calcium-channel blocker mechanisms of toxicity.
Acute Disease↗
[Fatal lactic acidosis in a patient infected by HIV and treated with stavudine and didanosine].
We report a case of severe lactic acidosis in an human immunodeficiency virus (HIV)-infected patient treated with combination regimen of stavudine, didanosine and nevirapine. Antiretroviral nucleoside analogs are inhibitors of mitochondrial DNA polymerase gamma, resulting in the dysfunction of the mitochondrial respiratory chain. Despite symptomatic treatments and intravenous L-carnitine supplementation, lactic acidosis persisted, leading to multiorgan failure. The patient died 7 days after admission to the intensive care unit. Retrospective analysis of published cases showed neither specific nor predictive signs of outcome that is usually fatal, with no effective therapy to date. We therefore recommend determining blood lactate in patients with onset of unexplained general fatigue or digestive signs and to stop all antiretroviral treatments in the case of lactate increase.
Acidosis, Lactic↗
[Smoke poisoning].
SYSTEMIC AND LOCAL EFFECT: Smoke inhalation causes systemic and local, mainly respiratory, toxicity due to the asphyxiant and irritant properties of toxic gases. OXYGEN DEPRIVATION AND INTOXICATION: The syndrome of oxygen deprivation and intoxication by asphyxiant gases is caused by combustion-induced oxygen deprivation and exposure to carbon monoxide (CO) and cyanide (CN), but also to other toxic gases. A loss of consciousness is a good sign of systemic toxicity; however, the respective role of CO, CN and other toxic gases cannot be determined. The presence of apnea, lactic acidosis, and severe cardiovascular disturbances is consistent with CN poisoning. A correlation exists between blood CO concentration determined on a sample obtained at the site of the fire, and the occurrence and severity of the clinical disorders. IRRITANT GASES INTOXICATION: This syndrome explains the mucosal injury affecting the eyes and the lungs. These complications are better diagnosed by clinical examination rather than by various investigations such as chest X-ray or fiberoptic bronchoscopy. Dysphonia is always a sign of severe poisoning. CLINICAL COURSE: In non-burned victims, delayed neurological and respiratory complications can be observed. Oxygen administration is the cornerstone supportive therapy. Hyperbaric oxygen should be discussed according to the severity of the syndrome of oxygen deprivation and intoxication by asphyxiant gases. In case of cyanide poisoning, a safe and effective antidote should be given; hydroxocobalamine seems to be the drug of choice. Supportive treatment is efficient to treat respiratory failure. Endotracheal intubation should be considered in patients exhibiting early dysphonia associated with dyspnea.
Asphyxia↗
Measures of residue density in protein structures.
A hierarchy of residue density assessments and packing properties in protein structures are contrasted, including a regular density, a variety of charge densities, a hydrophobic density, a polar density, and an aromatic density. These densities are investigated by alternative distance measures and also at the interface of multiunit structures. Amino acids are divided into nine structural categories according to three secondary structure states and three solvent accessibility levels. To take account of amino acid abundance differences across protein structures, we normalize the observed density by the expected density defining a density index. Solvent accessibility levels exert the predominant influence in determinations of the regular residue density. Explicitly, the regular density values vary approximately linearly with respect to solvent accessibility levels, the linearity parameters depending on the amino acid. The charge index reveals pronounced inequalities between lysine and arginine in their interactions with acidic residues. The aromatic density calculations in all structural categories parallel the regular density calculations, indicating that the aromatic residues are distributed as a random sample of all residues. Moreover, aromatic residues are found to be over-represented in the neighborhood of all amino acids. This result might be attributed to nucleation sites and protein stability being substantially associated with aromatic residues.
Amino Acids↗
Atom density in protein structures.
The residue environment in protein structures is studied with respect to the density of carbon (C), oxygen (O), and nitrogen (N) atoms within a certain distance (say 5 A) of each residue. Two types of environments are evaluated: one based on side-chain atom contacts (abbreviated S-S) and the other based on all atom (side-chain + backbone) contacts (abbreviated A-A). Different atom counts are observed about nine-residue structural categories defined by three solvent accessibility levels and three secondary structure states. Among the structural categories, the S-S atom count ratios generally vary more than the A-A atom count ratios because of the fact that the backbone (O) and (N) atoms contribute equal counts. Secondary structure affects the (C) density for the A-A contacts whereas secondary structure has little influence on the (C) density for the S-S contacts. For S-S contacts, a greater density of (O) over (N) atom neighbors stands out in the environment of most amino acid types. By contrast, for A-A contacts, independent of the solvent accessibility levels, the ratio (O)/(N) is approximately 1 in helical states, consistent with the geometry of alpha-helical residues whose side-chains tilt oppositely to the amino to carboxy alpha-helical axis. The highest ratio of neighbor (O)/(N) is achieved under solvent exposed conditions. This (O) vs. (N) prevalence is advantageous at the protein surface that generally exhibits an acid excess that helps to enhance protein solubility in the cell and to avoid nonspecific interactions with phosphate groups of DNA, RNA, and other plasma constituents.
Protein Conformation↗
[Assessment of severity and treatment of chloroquine poisoning].
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Chloroquine↗
1H NMR structure of an antifungal gamma-thionin protein SIalpha1: similarity to scorpion toxins.
The three-dimensional structure of the Sorghum bicolor seed protein gamma-thionin SIalpha1 has been determined by 2D 1H nuclear magnetic resonance (NMR) spectroscopy. The secondary structure of this 47-residue antifungal protein with four disulphide bridges consists of a three-stranded antiparallel sheet and one helix. The helix is tethered to the sheet by two disulphide bridges which link two successive turns of the helix to alternate residues i, i+2 in one strand. Possible binding sites for antifungal activity are discussed. The same fold has been observed previously in several scorpion toxins.
Amino Acid Sequence↗
Percutaneous transluminal angioplasty of radial artery grafts.
The radial artery is being used with increasing frequency to replace the saphenous vein as a coronary artery bypass graft, in the belief that it will provide improved long-term patency. Several centers have confirmed that the early results of surgery using the radial artery seem to be better than those obtained with saphenous grafts. Despite these apparent gains, early failure of the radial artery graft can occur and is frequently associated with symptomatic myocardial ischemia. Percutaneous angioplasty is an alternative to reoperation to treat lesions occurring on radial artery grafts. We report on 4 patients who underwent angioplasty of radial artery grafts.
Aged↗