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.
Hyperglycaemia is often observed in severe scorpion-envenomed patients. It is due to a severe autonomic storm with a massive release of catecholamines, increased glucagon levels, cortisol levels, and ...either decreased insulin levels or insulin resistance. The presence of hyperglycaemia is an indicator of severity in this specific condition. Indeed, hyperglycaemia was associated with the severity of clinical manifestations of severe scorpion envenomation requiring intensive care unit (ICU) admission. In fact, the presence of hyperglycaemia was associated with the presence of respiratory failure, pulmonary oedema, haemodynamic instability, neurological failure, multisystem organ failure, and an increased mortality and ICU length of stay. As a consequence, we think the presence of hyperglycaemia in scorpion-envenomed patients at the emergency department prompts searching for presence of systemic manifestations or cardiorespiratory manifestations. As a consequence, the presence of hyperglycaemia can help screen severe patients at the emergency department.
The current management of severe scorpion envenomation involves the admission and close surveillance in the ICU, where vital signs and continuous monitoring enable early initiation of therapy for life-threatening complications. The use of antivenom for scorpion stings remains controversial. All patients with pulmonary oedema should receive prazosin and possibly dobutamine, according the scorpion’s species. Mechanical ventilation is usually used in severe cases. Insulin should be reserved for severe cases with confirmed excessive hyperglycaemia (>10 mmol/l).
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.
Guillain–Barré syndrome (GBS) and polymyositis (PM) are two rare autoimmune diseases, one of which affects the peripheral nervous system and other the muscle. We report the case of a young woman with ...no previous medical history who was hospitalized with an ascending paralysis associated with acute respiratory failure due to a GBS. The patient was treated with plasmapheresis with unfavorable outcome and permanent proximal muscular disability. The diagnosis of an associated PM was retained based on biological myolysis and the results of electromyography and muscular biopsy. To our knowledge, this association of GBS and PM has been reported only once in the literature. The search for syndromic associations in the presence of an autoimmune helps to avoid diagnostic errors.
Muscle biopsy: paraffin section: A—Endomysial inflammation (Arrow). B—Inflammatory infiltrate with lymphocytic predominance
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.
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