Introductionthe assessment of neuropsychological and behavioral disorders outcomes, functional outcomes and quality of life in traumatic brain injury victims. It was also to evaluate initial means of ...care provided to these patients. Finally, to study correlations between neuropsychological and behavioral disorders with demographic characteristics, injury severity, functional status and quality of life.Methodsit was a cross-sectional study including 50 patients with traumatic brain injury conducted in the physical medicine and rehabilitation department of Sfax. Memory disorders were tested by the mini mental state and the Glaveston orientation and amnesia tests. Executive functions were evaluated by the dysexecutive function scale. The psychological profile was evaluated using the hospital anxiety and depression scale and behavioral disorders were tested by the agitated behavior scale. Glasgow outcome scale has allowed the assessment of traumatic brain injury severity in terms of disability. Otherwise, functional capacity was measured by functional independence measure scale. Finally, health-related quality of life was measured using a generic measure (short-form-36) and the QOLIBRI scales.Resultsabnormal executive functions were noted in 41 patients (82%) with a dysexcutive function average score of 33.20 ± 22.74. About psychological profile, depressive symptoms were found in 32 patients (64%). Moreover anxiety was noted in 20 patients (40%). Behavioral disorders such as aggressiveness and agitation were noted respectively in 32 (64%) and 8 patients (16%). The global social functional evolution was considered as unfavorable in 42% of the patients and favorable in 58%. Regarding to functional independence measure scale, 92% of the victims showed impairment. Memory impairment and abnormal executive functions were statistically correlated with traumatic brain injury severity. Elementary brain injury lesions shown on computed tomography were correlated with memory disorders especially for temporal, cortical brain contusion and diffuse axonal injury. Our study showed that patients with severe memory impairment, abnormal executive functions and depressive mood had significant functional.Conclusionthe executive function disorders, depressed mood and the memory disorders seemed to be the most frequent among neuropsychological disorders in traumatic brain injury. We noted that it is so important to evaluate neuropsychological disorders in traumatic brain injury because they were underestimated. We have already started this experience despite the lack of means in our department. The evaluation of the executive function in addition to the classic neuropsychological assessment is essential to propose efficient means of rehabilitation.
Summary Objective The aim of this study was to describe the epidemiological characteristics of Acinetobacter baumannii ventilator-associated pneumonia (VAP) and to identify factors predictive of a ...poor outcome. Methods A retrospective study was conducted over 16 months in a Tunisian intensive care unit (ICU). All adult patients with A. baumannii VAP were included. Results Ninety-two patients were included in they study; 41 (44.6%) were admitted because of multiple trauma. The mean age of the patients was 44.5 ± 19.5 years. All patients needed mechanical ventilation on admission. The mean SAPS II score was 39 ± 15. The mean delay before VAP onset was 8.1 ± 4.7 days. On VAP onset, 57 patients (62%) developed septic shock. Only 14.2% of isolated strains were susceptible to imipenem; none were resistant to colistin. The mean duration of mechanical ventilation was 20 ± 11 days. The mean duration of ICU stay was 24.3 ± 18.7 days. ICU mortality was 60.9%. In the multivariate analysis, factors predictive of a poor outcome were previously known hypertension (odds ratio 5.8, 95% confidence interval 1.4–24.9; p = 0.018) and VAP-related septic shock (odds ratio 8.5, 95% confidence interval 3–23.7; p < 0.001). Conclusion A. baumannii VAP is associated with a high mortality. Hemodynamic impairment is predictive of a poor outcome.
To compare Decompressive hemicraniectomy (DHC) versus medical treatment alone for malignant middle Cerebral Artery infarction (MMCAI) and to define factors associated with mortality in the surgery ...group.
We conducted a monocenter retrospective study over 11 years including patients with MMCAI. We compared the surgery group versus the no-surgery group. Mortality was assessed at discharge. Functional outcomes were measured at discharge and after 90 days with the modified Rankin Scale.
We included 55 patients, 27 patients in the surgery group and 28 patients in the no-surgery group. Mortality at discharge was lower in the surgery group than in the no-surgery group 55.55% vs 64.28% but without statistical significance (p =0.58). Survivors have poorer outcome mRS (4-5) in the surgery group than the no-surgery group 44.44% vs 25% without significant difference (p = 0.17). At 90 days, mRS scores of 0 and 1 were not observed, and a score of 2 was observed in only 2 patients (3.6%) in the no-surgery group. mRS score of 3 was observed in 2 patients (3.6%) in the no-surgery group. We noted that patients in the surgery group had an increased number of patients with mRS 4 from 9 to 11 and decreased the number of patients with mRS 5 from 3 to 1. The independent factors associated with mortality in surgery group were age ≥60 years (p = 0.017, OR = 0.46, CI95% (0.04–0.57)) and choc (p = 0.036, OR = 0.96, CI95% (0.11–0.86)).
DHC decreased mortality risk in a patient with MMCAI but without statistically significant differences and it was associated with poor functional outcomes.
To analyze clinical, epidemiological, radiological characteristics and outcome of patients undergoing decompressive craniectomy (DC) after traumatic brain injury (TBI) and to identity predictive ...factors associated with poor prognosis.
Demographic, clinical, and radiologic data from a retrospective study on unilateral or bilateral DC following TBI, admitted to the Intensive Care Unit (ICU) of a university hospital (Sfax-Tunisia), were collected during a 9-year period.
We included 147 patients. Ninety-nine patients (67.7%) were younger than 45 years. GCS ≤ 8 was found in 100 patients (68%). Primary DC was done for 104 patients (70.74%) and secondary DC was done for 43 patients (29.25%). Surgery was done within the first 6 h for 94 patients (63.9%). A mortality rate was at 42.2%. Independent factors associated with mortality were age > 65 years (p = 0.001;OR8.9;CI95% 1.90–42.02),GCS ≤ 8 (p = 0.001;OR3.8;CI95%1.69–8.54),SOFA score > 5 (p = 0.01;OR2.2; CI95%1.13–4.32), persistence anisocoria or mydriasis after surgery (p < 0.001;OR13.16; CI95%5.00–34.6), hypercapnia > 45 mmHg (p = 0.002;OR4.2; CI95%1.62–10.9), disseminated intravascular coagulation (p = 0.003;OR4.3;CI 95% 1.57–11.96) and use of corticosteroids (p = 0.034; OR2.04;CI95%1.05–3.97). Independent factors associated with poor outcome at discharge were GCS ≤ 8 (p = 0.029; OR 2.72; CI95% 1.09–6.78), hydrocephalus (p = 0.017; OR4.13; CI95% 1.21–14.1) and hyponatremia < 135 mmol/l (p = 0.009; OR6.77; CI95% 1.38–33.1). Independent factors associated with poor outcome at 6 months were GCS ≤ 8 (p = 0.014; OR 3.93; CI 95% 1.27–12.1), systolic arterial pressure < 90 mmHg at admission (p = 0.029; OR 3.54; CI 95% 2.48–5.05) and diffuse axonal injury (p = 0.009; OR 3.89; CI 95% 1.35–11.2).
DC can be life-saving for patients with TBI with decrease of mortality. The control of secondary systemic insults may lead to good prognosis.
Global mindset is usually considered as a positive skill or resource that helps individuals and companies succeed internationally. We argue that it is also a collective scheme of thought that brings ...some actors together and sets others apart. We investigate this perspective through a qualitative study of French MNC managers, internationalisation support providers, and SME owners and managers attempting to create or grow their business in China. We reveal that global mindset is a double‐edged concept: it is not solely an instrument for integration, but also a doxa, a particular viewpoint imposed to identify and reject outsiders through symbolic struggles. This alternative conceptualisation is necessary to rethink the social forces at work in the field of international business. It is also necessary to encourage educators and practitioners to acknowledge the struggles that result from the imposition of certain views and behaviours and to adapt education, support and training programs accordingly.
L’objectif de cet article est de comprendre la dynamique des compétences interculturelles individuelles et collectives des prestataires dans l’expérience de service du client. Les résultats de l’étude de cas d’une business unit française prestataire de services linguistiques qui excelle en la matière montrent qu’une articulation eff icace des deux niveaux de compétence assure la satisfaction des clients et contribue à la compétitivité de l’entreprise.
In this study, we aim to explore the value of procalcitonin (PCT), C-reactive protein (CRP), and serum cholinesterase (SChE) activity kinetics as useful predictors of mortality in patients with ...septic shock admitted to the intensive care unit (ICU).
We conducted a prospective single-blinded study in the ICU of a university hospital during a period of 1 year. Were included all patients 18 years of age or older, with confirmed septic shock. For all included patients, blood samples of septic biomarkers (PCT, SChE activity, and CRP) were obtained. Serum was collected at the day of ICU admission (day 0), the day of septic shock (day 1), then 3 and 5 days after the septic shock development.
During the study period, 60 patients were included. The mean age (± SD) was 47.7 ± 19 years. There were 46 male (74%) and 14 female (26%) patients. Mean SAPSII on ICU admission was 40.7 ± 16 (median: 37), and mean SOFA score on ICU admission was 16 ± 4 (median: 7). During their ICU stay, out of the 60 included patients, 37 patients died (61%). The comparison between the 2 groups (deaths and survivors) showed that the factors associated with poor outcome were age, SOFA score on ICU admission, and the need for invasive mechanical ventilation. The day of septic shock, there was no difference in the mean concentrations in those of plasma SChE activity or in the PCT and CRP plasma between survivors and non-survivors. However, the comparison of mean plasma SChE activity, and PCT and CRP plasma concentrations (on day 3 and day 5) between survivors and non-survivors, showed a significant difference between the 2 groups.
Our study suggests that, in a group of critically ill patients with severe septic shock, a rise or no change in procalcitonin and/or CRP level, and/or a decrease or no change in SChE activity should warn the clinician about the insufficiency and/or inadequacy of the therapy. However, a fall in procalcitonin and/or CRP levels, and/or a rise in SChE activity were associated with a favourable prognosis. Based on our study and some other data detailed above, we recommend that an estimation of SChE acti-vity, procalcitonin, and CRP on the day of septic shock, followed by estimation within the next 72-120 h, could help the prognostic assessment of critically ill patients with septic shock. Further studies are needed to define the critical values related to mortality.
Background: In this study, we explored whether early application of the prone position (PP) can improve severe hypoxemia and respiratory failure in coronavirus disease 2019 (COVID-19) patients with ...spontaneous breathing.Methods: This is a prospective observational study of severe, critically ill adult COVID-19 patients admitted to the intensive care unit. All vital parameters were recorded in real time for all patients. Moreover, the results of chest computed tomography (CT), when available, were analyzed.Results: PP was applied in 21 patients who were breathing spontaneously. The application of PP was associated with a significant increase in oxygen saturation measured by pulse oximetry (SpO2) from 82%±12% to 96%±3% (P<0.001) 1 hour later. Moreover, PP was associated with a significant reduction in respiratory rate from 31±10 to 21±4 breaths/min (P<0.001). Furthermore, the number of patients who exhibited signs of respiratory distress after PP was reduced from 10 (47%) to 3 (14%) (P=0.04). Early PP application also led to a clear improvement on CT imaging. It was not, however, associated with a reduction in mortality rate or in the use of invasive mechanical ventilation (P>0.05 for both).Conclusions: Our study confirmed that the early application of PP can improve hypoxemia and tachypnea in COVID-19 patients with spontaneous breathing. Randomized controlled trials are needed to confirm the beneficial effects of PP in COVID-19 patients with spontaneous breathing.
Africa, like the rest of the world, has been impacted by the coronavirus disease 2019 (COVID-19) pandemic. However, only a few studies covering this subject in Africa have been published.
We ...conducted a retrospective study of critically ill adult COVID-19 patients-all of whom had a confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection- admitted to the intensive care unit (ICU) of Habib Bourguiba University Hospital (Sfax, Tunisia).
A total of 96 patients were admitted into our ICU for respiratory distress due to COVID-19 infection. Mean age was 62.4±12.8 years and median age was 64 years. Mean arterial oxygen tension (PaO2)/fractional inspired oxygen (FiO2) ratio was 105±60 and ≤300 in all cases but one. Oxygen support was required for all patients (100%) and invasive mechanical ventilation for 38 (40%). Prone positioning was applied in 67 patients (70%). Within the study period, 47 of the 96 patients died (49%). Multivariate analysis showed that the factors associated with poor outcome were the development of acute renal failure (odds ratio OR, 6.7; 95% confidence interval CI, 1.75-25.9), the use of mechanical ventilation (OR, 5.8; 95% CI, 1.54-22.0), and serum cholinesterase (SChE) activity lower than 5,000 UI/L (OR, 5.0; 95% CI, 1.34-19).
In this retrospective cohort study of critically ill patients admitted to the ICU in Sfax, Tunisia, for acute respiratory failure following COVID-19 infection, the mortality rate was high. The development of acute renal failure, the use of mechanical ventilation, and SChE activity lower than 5,000 UI/L were associated with a poor outcome.
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