A good death: another break in the wall.
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Aged↗
Biomedical subjects
M Bouaziz
Publications and source records attributed to M Bouaziz.
[Thrombotic microangiopathies in the intensive care unit].
OBJECTIVES: To analyze the clinico-biological manifestations, identify the causes and evaluate the outcome of patients with severe thrombotic microangiopathies admitted in a Tunisian intensive care unit. METHODS: Retrospective study over a period of 10 years (1995-2004) in an intensive care unit. RESULTS: Were included in this study 9 cases with a mean age of 29.2+/-9 years (range 15-44 years). Fever was observed in 5 patients, neurological impairment in 5 and digestive manifestations in 6. Haemolytic anaemia, thrombocytopenia and acute renal failure were observed in 100% of the cases. In our study, the aetiologies of thrombotic microangiopathies were: complicated pregnancy in 6 cases, systemic lupus erythematosus in 1 case. In contrast, no aetiology was found in 2 patients. Plasma exchange was performed in 5 patients, while 4 patients received only plasma infusion. After an average stay of 18+/-12.5 days, evolution was marked by the death 3 patients. CONCLUSION: The incidence of severe thrombotic microangiopathies is rare in Tunisian ICU. The clinical manifestations are not specific. Despite the improvement in the outcome by exogenous plasma supply, thrombotic microangiopathies with severe organ dysfunctions leading to hospitalization in the intensive care unit are associated with a high mortality rate.
Acute Kidney Injury↗
[Acute fatty liver of pregnancy. About 22 cases].
OBJECTIVE: To report the clinical experience, biochemical findings, complications and maternal outcome in patients with acute fatty liver of pregnancy (AFLP). PATIENTS AND METHODS: Retrospective study over a period of 11 years (1993-2003). The diagnosis of AFLP was confirmed by liver biopsy in 15 women. However, in 7 women a medical committee that took into account clinical symptoms, and laboratory findings assessed the diagnosis. RESULTS: Were included in this study, 22 women with a mean age of 30+/-5.4 years. Only 22.7% of cases were primigravid. The mean gestational age was 36+/-2.76 weeks (range 31-41 weeks). The fetus was a male infant in 75% of cases. Ten women were admitted in the hospital without jaundice. However 15 women had developed an icterus since their hospital admission or during ICU stay. The mean SAPS II on the ICU admission was of 24.86+/-11.2 points. Biological disturbances observed were mainly: liver cytolysis in 91% of cases, a trend to hypoglycaemia in 86%, a hypoprotidemia in 66.7% and CIVD in 32%. During their ICU stay, 19 women (86.4%) developed one or several organ failures associated to the hepatic failure and 18 women required blood transfusion. After an average stay of 7.5 days, evolution was marked by the death of seven patients (31.8%). Factors correlated with a poor prognosis were: the delay of medical consultation, the development of jaundice, the development of encephalopathy, respiratory or a circulatory failure. DISCUSSION AND CONCLUSION: AFLP is a rare but life-threatening complication. Furthermore AFLP shares features with other more common and less perilous illnesses. An early diagnosis and appropriate therapy of this pathology should improve the poor prognosis in our country.
Acute Disease↗
[Candiduria in intensive care unit: significance and value of yeast numeration in urine].
JUSTIFICATION: Candiduria is increasingly frequent among patients admitted to intensive care units but its significance remains unclear. OBJECTIVES: Search for eventual correlation between quantitative candiduria and known risk factors for invasive candidiasis. STUDY DESIGN: Prospective. PATIENTS AND METHODS: A four-month study was conducted in 162 patients hospitalized in the intensive care unit for more than 72 hours. All patients underwent a weekly research of candiduria added to sampling from different body sites to determine the Pittet Candida colonization index. RESULTS: Candiduria has been proved in 56 cases (34%). It was superior or equal to 10(4) UFC/ml among 28 patients (50%). Candida tropicalis, Candida glabrata and Candida albicans has been isolated in 41, 22 and 20% respectively. All patients had at least one major and two minor risk factors for Candida infection. Six patients (10%) developed invasive candidiasis. The global mortality rate was at 52%. Pittet colonization index was significantly different between patients with candiduria and those with invasive candidiasis (p=0.01). There was a statistically significant correlation between candiduria superior or equal to 10(4) UFC/ml and Pittet colonization index superior or equal to 0.5 (p=0.01). CONCLUSION: Candiduria superior or equal to 10(4) UFC/ml associated with risk factors may predict invasive candidiasis in critically ill patients.
Adolescent↗
[Contamination of blood cultures drawn from central vein catheter and peripheral venipuncture. Prospective study of 75 pairs].
OBJECTIVE: To determine the frequency of contamination, the sensitivity, specificity, and predictive values of cultures done with blood drawn through a central venous catheter or peripheral venipuncture. DESIGN: Prospective cohort study of critical ill medical surgical intensive care patients in whom samples for paired culture were drawn through a central venous catheter or peripheral venipuncture during a period of 8 months (from August 1st 2001 to Mars 31st 2002). RESULTS: During the study period, 75-paired cultures were studied. Fifteen peripheral blood cultures (20%) and 27 central blood cultures (36%) were positive and 6 peripheral blood cultures (8%) and 15 central blood cultures (20%) were contaminated (P=0.034). The organism most commonly responsible for contamination was Coagulase Negative Staphylococcus (16% of central blood cultures and 6.7% of peripheral blood cultures). The frequency of contamination was of 42.9% for blood cultures drawn through a femoral central venous catheter, of 10% for jugular, and of 19% for subclavian central venous catheter (P=0.22). For catheter draws compared with peripheral venipuncture, sensitivity was 100 and 75%, specificity was 76.2 and 90.5%, positive predictive value was 44.4 and 60% and negative predictive value was 100 and 95%. CONCLUSION: Cultures of blood drawn through a catheter are more sensible and less specific than those obtained from a peripheral venipuncture and the organism most commonly responsible for contamination of blood cultures is Coagulase Negative Staphylococcus.
Bacteria↗
[Posttraumatic meningitis: incidence, bacteriology, and outcomes].
BACKGROUND AND PURPOSE: The aim of our study was to search for the incidence, the responsible organisms and the favoring causes of death of post-traumatic meningitis (PTM). METHODS: This retrospective study was conducted over a seven-year period (January 1st, 1996 - December 31, 2002) in the ICU and the neurosurgery department of the Habib-Bourguiba University Hospital, Sfax, Tunisia. RESULTS: Over the study period, 38 patients presented PTM (0.96% of patients hospitalized for head injury), 92% of them had received antibiotic prophylaxis on admission. Mean time between head injury and the diagnosis of PTM was 9+/- 8 days (range: 2-34 days). The most common isolated organisms were multidrug resistant A. baumanii, and K. pneumoniae and reduced susceptibility S. pneumoniae. Factors predictive of prognosis in the 14 days following the diagnosis of meningitis were Glasgow coma score (GCS) on the day of diagnosis of PTM, absence of nuchal rigidity, CSF protein, CSF/blood glucose ratio, and S. pneumoniae as the causal agent of PTM. CONCLUSIONS: Antibioprophylaxis in patients with head trauma must be avoided to prevent the emergence of multidrug resistant bacteria when PTM occurs. GCS on the day of diagnosis of PTM, CSF protein concentration, CSF/blood glucose ratio, and S. pneumoniae as the causal agent of PTM are predictive factors of mortality of patients with PTM.
Adolescent↗
[Traumatic unilateral renal artery thrombosis and protein C deficiency. A case report].
Post traumatic renal artery thrombosis is rarely described in the literature. This pathology can result from stretch injury to inelastic intima of the renal artery, or by the direct flow to the abdomen causing compression injury to the renal artery against the vertebral column. However, the association of this pathology with hematologic diseases (in particular protein C deficit) was never described. We report an observation of a 28-year-old man with an uneventful history who was admitted to the intensive care unit for traumatic head injury associated with post traumatic renal artery thrombosis requiring nephrectomy. The etiologic investigation of this thrombo-embolic complication reveals a protein C deficit. Our patient was improved under treatment. This original observation confirms that post traumatic renal artery thrombosis can be associated with hematologic diseases (in particular protein C deficit).
Accidents, Traffic↗
Information-processing under incremental levels of physical loads: comparing racquet to combat sports.
AIM: Skillful performance in combat and racquet sports consists of proficient technique accompanied with efficient information-processing while engaged in moderate to high physical effort. This study examined information processing and decision-making using simple reaction time (SRT) and choice reaction time (CRT) paradigms in athletes of combat sports and racquet ball games while undergoing incrementally increasing physical effort ranging from low to high intensities. METHODS: Forty national level experienced athletics in the sports of tennis, table tennis, fencing, and boxing were selected for this study. Each subject performed both simple (SRT) and four-choice reaction time (4-CRT) tasks at rest, and while pedaling on a cycle ergometer at 20%, 40%, 60%, and 80% of their own maximal aerobic power (Pmax). RESULTS: RM MANCOVA revealed significant sport-type by physical load interaction effect mainly on CRT. Least significant difference (LSD) posthoc contrasts indicated that fencers and tennis players process information faster with incrementally increasing workload, while different patterns were obtained for boxers and table-tennis players. The error rate remained stable for each sport type over all conditions. Between-sport differences in SRT and CRT among the athletes were also noted. CONCLUSIONS: Findings provide evidence that the 4-CRT is a task that more closely corresponds to the original task athletes are familiar with and utilize in their practices and competitions. However, additional tests that mimic the real world experiences of each sport must be developed and used to capture the nature of information processing and response-selection in specific sports.
Adolescent↗
Simple and choice reaction times under varying levels of physical load in high skilled fencers.
AIM: Fencing requires rapid and accurate decision-making while competing and experiencing gradual perceived effort. This study examined the linkage between physical effort, simple reaction time and choice reaction time in fencers and non-fencer subjects. METHODS: Two age-matched groups participated in this experiment: 12 professional fencers and 12 sedentary subjects. Each subject performed both simple (SRT) and choice reaction time (CRT) tasks at rest, and while pedaling on a cycle ergometer at 20%, 40%, 60%, and 80% of their own maximal aerobic power (Pmax). RESULTS: At rest, no significant differences were found between experts and sedentary subjects neither in SRT nor CRT. The fencers showed shorter CRTs at 40%, 60% and 80% of Pmax compared to those measured at rest. In contrast, SRTs did not vary as a function of effort level. In sedentary subjects, workload did not affect SRTs and CRT. Moreover, the error rate remained stable for each group over all conditions. CONCLUSIONS: Current results showed that physical load results in enhancing information processing as measured by CRT without affecting SRT. The data provides evidence that aerobic exercise enhances attentional capability in fencers who are used to process information under similar physical conditions, but not in sedentary subjects unfamiliar to this environment. Exercise induces arousal that supports alertness to external environmental stimuli in highly trained athletes.
Adult↗
[Predictive value of pericatheter skin cultures in detecting catheter-related infections in a medical-surgical intensive care unit].
OBJECTIVE: To evaluate the predictive value of pericatheter skin cultures in detecting catheter-related infections in critically-ill patients. STUDY DESIGN: Prospective study. PATIENTS AND METHODS: Over a 5 months period (from August 1(st) 2001 to December 31 2001), 500 patients were hospitalised, and 108 central venous catheters were prospectively examined. For each catheter, blood cultures, pericatheter skin cultures and semiquantitative culture of the catheter tip were performed. RESULTS: The median duration of catheterization was 8 days (interquartile: 8 days). Catheter was removed because of suspected infection in 54 cases (50%). Systemic catheter-related infection was found in 12 cases (11%) and the responsible organism was a gram-negative rod in 11 cases (92%). The negative predictive values of pericatheter skin cultures in the diagnosis of catheter-related infections and in case of suspected catheter-related infection were 89 and 86%, respectively. CONCLUSION: These results indicate that the pericatheter skin cultures are not an effective procedure for the conservative diagnosis of catheter-related infections and that the skin-insertion wound is not the major source of catheter-contamination in our unit.
Adolescent↗
Prevalence of hospital-acquired infection in a Tunisian hospital.
In order to estimate the prevalence of hospital-acquired infection (HAI) and research factors associated with its occurrence, a one-day prevalence survey was conducted at the Habib Bourguiba University Hospital, Tunisia. We studied 280 patients who had been present in the same ward for at least 48 h, and who had occupied a hospital bed between 17 April 2002 (midnight) and 18 April 2002 (midnight). The overall prevalence of HAI was 17.9%. The most frequently infected sites were the lungs (32%), surgical wounds (28%) and the urinary tract (20%). Microbiological documentation was available in only 28% of HAIs, and the most frequently isolated organisms were Gram-negative rods (80.8%). Results of multiple logistic regression analysis indicated that HAI is linked to the medical category, the use of intravascular devices and antibiotic prophylaxis. This survey provided information on the prevalence of HAI in Tunisian hospitals, the breakdown of infections, and HAI predisposing factors.
Cross Infection↗
[Celiac disease, cerebral venous thrombosis and protein S deficiency, a fortuitous association?].
INTRODUCTION: Celiac disease is a pathology which is rarely associated with thrombosis complications. Cerebral vascular thrombosis has never been described in patients with a celiac disease. OBSERVATION: We report an observation of a 21-year-old girl with a history of celiac disease who was hospitalized in the intensive care unit for convulsive status epilepticus secondary to a cerebral venous thrombosis. The etiologic investigation of this thrombo-embolic complication revealed protein S deficit. Our patient improved under symptomatic treatment. COMMENT: This original observation confirms that celiac disease can be associated with cerebral venous thrombosis.
Adult↗
[Evaluation of the antibiotics consumption in a Tunisian university hospital].
PURPOSE: To estimate the consumption of antibiotics in our hospital and to determine the points at which will be targeted the recommendations of good practice of antibiotherapy. PATIENTS AND METHODS: Our study is a one day prevalence study where antibiotic's prescriptions are analyzed by a group of 6 doctors referents in antibiotherapy. RESULTS: During the study day, 443 patients were studied. Means age was 44.2 +/- 23.3 years (range: 1 and 102 years). 101 infections were diagnosed in 48 patients (10.8%). 192 patients (43.3%) received antibiotics. Antibiotherapy was curative in 44% of cases. The most prescribed antibiotics were gentamicin (85.2 DDD/1000 patients), metronidazole (79 DDD/1000 patients), and cefotaxime (73.9 DDD/1000 patients). According to the evaluation group, 30.7% of the antibiotic's prescription was considered unjustified. The antibioprophylaxis represents the category most often unjustified (49%). The molecules in which prescription was frequently considered unjustified are the ciprofloxacin (67%), the amoxicilline-clavulanate (40%) and the cefotaxime (40%). CONCLUSION: Our results suggest that an action of good practice should be targeted at the antibioprophylaxis and should concern especially molecules in which prescription was frequently unjustified.
Adolescent↗
[Pregnancy-induced hypertension complicated by acute pancreatitis].
The acute pancreatitis is a rare complication during the pregnancy. Causes are dominated by the gallstones and hyperlipidemia. This case report describes a 35-year-old pregnant woman who developed acute pancreatitis while suffering from a severe pre-eclampsia syndrome. Since she had no gallstones or other known aetiological factors of acute pancreatitis, the possibility of an etiologic role of pancreatic ischaemic changes associated with eclampsia is discussed. Evolution was marked with multi-organ system failure and poor outcome. Our experience and the previously reported case suggest that pre-eclampsia could be added to the list of causes of the acute pancreatitis.
Acute Disease↗
[Hemolytic-uremic syndrome secondary to scorpion envenomation (apropos of 2 cases)].
HUS was recently described following scorpion sting. We report 2 cases of HUS in the intensive care unit of a university hospital. Two children aged respectively 10 months and 1 year were admitted in the ICU after severe scorpion envenomation (with coma and pulmonary oedema) having required dobutamine and mechanical ventilation. Evolution was marked with acute anaemia without bleeding requiring blood transfusion, acute renal failure, low platelets and signs of haemolysis. Our experience and the previously reported case suggest that scorpion sting could be added to the list of causes of the HUS.
Animals↗
Nasopharyngeal carcinoma in childhood and adolescence: analysis of a series of 32 patients treated with combined chemotherapy and radiotherapy.
Standard therapy for nasopharyngeal carcinoma (NPC) in children has generally followed the guidelines established for adults. We report here, the treatment outcomes in 32 children and adolescents with NPC and we discuss treatment approaches. Between 1993 and 1997, 32 NPC patients aged </=20 years (mean age 15 years) were treated in our institution; they represented 18% of all NPC cases seen during the same time period. 27 patients had no metastases at diagnosis; 26 of these were treated with primary chemotherapy combining epirubicin and cisplatin. Radiotherapy was then delivered to 22 patients at a mean dose of 70 Gy, either conventionally (6 patients) or bifractionated (16 patients). 5 patients had metastases at diagnosis and were treated with chemotherapy combining epirubicin, bleomycin and cisplatin before definitive radiotherapy. The objective response rate (OR) after chemotherapy was 90.9% at the primary site, with a 13.6% complete response (CR) rate. At nodal sites, the OR was 95.5% and the CR was 31.8%. Local control was obtained in all patients after definitive radiotherapy with a medium follow-up of 43.7 months. Late toxicity affecting quality of life was found in 26% of the children who were irradiated, especially among those under 15 years of age (skin fibrosis, 27%; trismus, 27%; hypothyroidism, 14%). No locoregional relapses were observed. Distant metastases occurred in 33% of cases, with a median delay of 4.7 months from the end of treatment. The 2- and 5-year overall survival (OS) rates were 76 and 56%, respectively. Disease-free survival (DFS) was 65% at 2 and 5 years. Therapeutic outcomes for childhood NPC were similar to those in adults, but with more radiotherapy-induced toxicity. New chemotherapeutic combinations and new radiotherapeutic techniques should be sought to improve both survival and quality of life.
Adolescent↗
[Colonic granulocytic sarcoma: a case report].
Granulocytic sarcoma is a rare tumor composed of immature cells of the granulocytic series which usually occurs as a secondary manifestation of acute leukaemia. We report the case of a 60 years old woman without particular previous pathologies who was hospitalised for chronic diarrhea developed in a context of health impairment state. The blood cell count revealed severe leucopenia and thrombopenia; an emergency right colectomy was accomplished. The histologic examination showed granulocytic sarcoma of the ascending colon. The death occurred rapidly as a consequence of a toxic shock. This observation seems to be the sixth case report of the granulocytic large bowel sarcoma in the literature which likely complicated a pre-existant and unknown myeloid leukaemia.
Biopsy↗
[Post-traumatic hypopituitarism].
BACKGROUND: Post-trauma hypopituitarism is a rare disease, accounting for only 3% of all cases of hypopituitarism reported in the literature. CASE REPORT: A 56-year old woman developed central diabetes insipidus immediately after severe cranio-facial trauma. Four years later, she suffered severe asthenia and hypoglycemia faintness. The diagnosis of isolated corticotrope insufficiency was retained. Magnetic resonance imaging evidenced an intrasellar arachnoidoceae with extinction of the posterior pituitary gland's spontaneous hypersignal. DISCUSSION: Most cases of post-trauma hypopituitarism occur after high-energy head trauma. Hypopituitarism exceptionally involves only one hormone, particularly growth hormone. The pathogenesis involves hypothalamic failure more often than pituitary gland failure.
Asthenia↗