Background
Minor head injury is one of the major diagnoses requiring management in emergency departments (ED) but its squeals are not well studied in our country.
Objective
To describe the prevalence ...of post-concussive syndrome and its impacts on life activities, up to 6 months of follow-up, among patients having a minor head injury and discharged from ED.
Methods
A prospective bi-centric study including adults having a minor head trauma and consenting to be followed up to 6 months after discharge. The Rivermead Post-Concussion Symptoms Questionnaire (RPQ) was used at baseline, after 15 days, at 1 month, at 3 months and at 6 months post-injury to assess concussive symptoms. We also used the Rivermead Head Injury Follow-up Questionnaire (RHFUQ) to describe impacts of minor head trauma on life activities.
Results
There were 130 consenting patients at baseline interview. Proportion of patients describing post-concussive symptoms at baseline was 71/130. At 6 months of follow-up, post-concussive syndrome was diagnosed among 21.4 % of participants. Sustaining symptoms at 6 months post-injury were mainly anger and irritability (12.5 %). Correlations between high RPQ sum rates since 15 days’ post-injury call and the sum total rates of RHFUQ were significant. The major significant impact of minor head trauma at 6 months of follow-up was among domestic activities.
Conclusion
The two most important findings of this study were the huge proportion of patients having minor head injury and discharged from ED without any explanation of possible symptoms after head trauma and the unknown impacts on life activities.
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.
Temperature distribution in a 42CrMo4 steel test piece during local cooling from 900°C with a water jet from an injector is studied. Heat flux distribution with action of a jet on the side surface of ...a test piece is analyzed. The hardness of a test piece side surface is measured and the microstructure of its different cross sections is studied. Numerical software is used in order to describe cooling kinetics for the side surface of a cylindrical test piece by a fine water jet. Operating parameters are optimized for cooling by analyzing the effect on them of the number of injectors and their arrangement. Conditions are revealed for improving cooling efficiency for cylindrical test pieces with injectors.
To assess the impact of tracheotomy on sedative administration, sedation level, and autonomy of mechanically-ventilated intensive care unit (ICU) patients.
In this observational study, the charts of ...all consecutive patients undergoing mechanical ventilation requiring tracheotomy over a 14-month period in our 18-bed tertiary care ICU were reviewed retrospectively. Patients' sedation levels (according to the Riker's 7-level sedation-agitation score) and intravenous (fentanyl and midazolam) and oral (clorazepate and haloperidol) sedative administration were measured daily during the 7 days before and after tracheotomy. We also recorded patients for whom chair positioning and oral alimentation became possible in the days following tracheotomy.
None.
Tracheotomy was performed on 72 (23.1%) of the 312 patients undergoing mechanical ventilation for > or = 48 hrs. After tracheotomy, median (25th, 75th percentiles) fentanyl and midazolam administration decreased from 866 (191, 1672) to 71 (3, 426) microg/(patient.day) and from 44 (16, 128) to 7 (1, 42) mg/(patient.day) (p < .001), respectively. Concomitant median time spent heavily sedated decreased from 7 (3, 17) to 1 (0, 6) hrs/day (p < .001), with no increase in agitation time. During the 7 days following tracheotomy, partial oral alimentation became possible for 35 patients (48.6%) and out-of-bed positioning became possible for 16 patients (22.2%).
On the basis of these observations, we conclude that tracheotomized mechanically ventilated ICU patients required less intravenous sedative administration, spent less time heavily sedated, and achieved more autonomy earlier.
A variety of organic substances used in pharmaceutical and agro‐alimentary industries are often required as fine powders with a controlled size. The RESS process (rapid expansion of supercritical ...solution) allows the micronization of thermally labile materials and the formation of small particles with a similar morphology and a narrow size distribution. The goal of this study is to improve the description of the jet/particle system in the RESS process. An experimental investigation shows that the particle structure of processed caffeine could be enormously altered when recrystallization chamber conditions were varied. Indeed, long needles, yarns, or fibers of the material could be obtained by changing the operating pressure and temperature. Numerical simulations were performed to describe the effects of hydrodynamic parameters upon the developed jet and the recrystallized particles. These calculations showed isovalues and profiles of velocity, density, and temperature of the carbon dioxide jet by which recrystallized particles were transported and deposited on the flat plate.
Experiments show that the particle structure of processed caffeine could be enormously altered when recrystallization chamber conditions were varied. Numerical simulations were performed to describe the effects of hydrodynamic parameters upon the developed jet and the recrystallized particles.
In order to obtain a homogenous supercritical solution, a numerical simulation based on energy and mass balances inside a column packed with small glass balls and crossed by CO2 at high pressure, ...facilitates the analysis of the influence of certain parameters of the process on the extraction rate, e.g., temperature and CO2 velocity. This contribution aims to study heat and mass transfer mechanisms in both liquid and supercritical phases.
In order to obtain a homogenous supercritical solution, a numerical simulation based on energy and mass balances inside a column packed with small glass balls and crossed by CO2 at high pressure, is presented. This facilitates the analysis of the influence of temperature and CO2 velocity on the extraction rate.
L’insuffisance rénale aiguë succédant une grève de faim est rarement décrite. Nous en rapportons un nouveau cas secondaire à une hypovolémie et une rhabdomyolyse majeure survenant chez un homme de ...47 ans, sans antécédent pathologique, détenu. L’échec de l’expansion volémique avec surcharge pulmonaire conduisait à une épuration extrarénale permettant une évolution favorable.
Acute renal failure following hunger strike has been rarely reported. We report a 47-year-old man, prisoner, who developed an acute renal failure secondary to hypovolemia and major rhabdomyolysis. Failure of hydration with persistence of oliguria and secondary pulmonary edema required hemodialysis with eventually a favorable outcome.
Acute renal failure following hunger strike has been rarely reported. We report a 47-year-old man, prisoner, who developed an acute renal failure secondary to hypovolemia and major rhabdomyolysis. ...Failure of hydration with persistence of oliguria and secondary pulmonary edema required hemodialysis with eventually a favorable outcome.
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).
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.
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.
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.
Chercher l’incidence, les germes responsables et les facteurs de risque de mortalité des méningites nosocomiales post-traumatiques (MPT).
Notre étude est rétrospective. Elle a été réalisée sur une ...période de 7 ans (du 1
er janvier 1996 au 31 décembre 2002) dans les services de Réanimation polyvalente et de Neurochirurgie de l’Hôpital Habib-Bourguiba de Sfax, Tunisie.
Pendant la période de l’étude, 38 patients ont présenté une MPT (0,96 % des patients hospitalisés pour traumatisme du crâne), 92 % d’entre eux ont reçu une antibioprophylaxie à l’admission. Le délai moyen entre le traumatisme crânien et le diagnostic de MPT était de 9 ± 8 jours (extrêmes : 2-34 jours). Les germes les plus fréquemment isolés étaient
A. baumanii, et K. pneumoniae, multirésistantes et le pneumocoque de sensibilité diminuée à la pénicilline. Les facteurs liés au décès pendant les 14 jours suivant le diagnostic de méningite étaient le Glasgow coma score (GCS) le jour du diagnostic de MPT, l’absence de raideur de la nuque, la valeur de la protéinorachie, le ratio glycorachie/glycémie et la présence de S. pneumoniae quand il était responsable de la méningite.
L’antibioprophylaxie après traumatisme du crâne doit être évitée afin de prévenir les MPT à germes résistants. Le GCS le jour du diagnostic de MPT, l’hyperprotéinorachie, l’hypoglycorachie et l’infection à S. pneumoniae sont les facteurs de risque de mortalité des patients présentant une MPT.
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).
This retrospective study was conducted over a seven-year period (January 1
st, 1996 — December 31, 2002) in the ICU and the neurosurgery department of the Habib-Bourguiba University Hospital, Sfax, Tunisia.
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 susceptibilityS. 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.
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.
