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.
Acute pancreatitis (AP) is a real clinical challenge. Acute pancreatitis remains a common cause of emergency department consultations and a major cause for hospitalization. Gallstones and drinking a ...lot of alcohol are the most frequent causes of AP. Moreover, AP can be induced by diabetic ketoacidosis (DKA) complicated by hypertriglyceridemia. We report 4 cases of DKA with hypertriglyceridemia complicated by AP in previously undiagnosed diabetes patients. All of our patients presented to the emergency ward with abdominal pain. Their physical exam showed epigastric tenderness. An abdominal CT scan was performed for each patient, showing an AP grade E. Laboratory samples showed high serum glucose levels. They had metabolic acidosis with elevated anion gap. They had high lipasemia and amylasemia. Their lipid panel was disturbed with a high level of cholesterol (from 12.8 mmol/l to 33 mmol/l) and triglyceridemia (from 53 to 133 mmol/l). Our patients were admitted into our ICU where they received fluid resuscitation and intravenous insulin, and their triglycerides rates decreased gradually. Two patients recovered to a good health state, and the two others developed septic shock, requiring the use of large-spectrum antibiotics, and acute kidney injury (AKI) with refractory metabolic acidosis, requiring hemodialysis. Despite the intensive treatment, they developed an unrecoverable multiorgan failure. Through our case series, we aim to highlight the importance of making an early diagnosis, which can be difficult in some situations due to overlapping signs; however, it is crucial for a good recovery. A good understanding of the pathway of hypoinsulinemic states causing hypertriglyceridemia then AP is important because it is the key to best management.
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.
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.
Neurogenic pulmonary edema (NPE) is a possible complication of severe central nervous system insult. Its physiopathology is still debated. We report a fatal case of a 55-year-old man who was admitted ...because of severe head injury. The diagnosis of NPE was considered according to clinical and radiologic findings. Transpulmonary thermodilution study showed decreased stroke volume index and cardiac function index. Indexed extravascular lung water was increased as well as pulmonary vascular permeability index. The impairment of the left ventricular function was confirmed by the echocardiographic study. Our case suggests that NPE imply both cardiac dysfunction and lung injury. Thus, transpulmonary thermodilution can be helpful in managing fluid balance and the choice of vasopressors in patients with life-threatening NPE.
Le kyste hydatique du foie (KHF) est une maladie assez répandue dans les pays nord-africains. La rupture post-traumatique ou spontanée du kyste compliquée d'un choc anaphylactique et d'un AVC ...ischémique a été exceptionnellement rapportée. Nous rapportons un cas d'un kyste hydatique du foie (KHF) fissuré et compliqué d'un choc anaphylactique et d'un AVC ischémique.
A 61-year-old male was found to have a bilateral Bochdalek hernia on routine CT during admission for acute respiratory failure. The chest X-ray showed a left paracardiac mass having a diameter of ...6 cm. This mass was initially considered as a mediastinal tumor. However, CT scan showed a bilateral large defect of the posteromedial portion of the diaphragm and mesenteric fat. 3D imaging was also useful for the stereographic perception of Bochdalek hernia. Although Bochdalek hernia is not rare, to our knowledge, this is the first case of Bochdalek hernia continued transverse colon observed by spiral CT 3D imaging.
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