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Chaari A, Munir A, Sharaf A, Khairy A, Kauts V, Erdem H. Predictive factors and prognostic value of candiduria in critically-ill patients with solid and hematological malignancies. J Mycol Med 2023; 33:101353. [PMID: 36442396 DOI: 10.1016/j.mycmed.2022.101353] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/09/2022] [Accepted: 11/22/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To investigate the epidemiology of candiduria in critically-ill patients with solid/hematological malignancies and to assess its predictive factors and prognostic value. METHODS All adult patients with confirmed solid/hematological malignancy admitted in the intensive care units (ICUs) for more than 48 h were retrospectively included. Urine cultures were sampled on admission and then whenever signs of sepsis were identified. Two groups were compared: (candiduria (+)) and (candiduria (-)). RESULTS One-hundred-seventy-three patients were included. Solid cancer was the underlying oncological disease for 147 patients (85%) while 26 patients (15%) had hematological malignancies. Twenty-nine patients (16.8%) were diagnosed with candiduria, and 31 urinary samples grew Candida spp. Candida spp represented 55.8% of the total urinary isolates. Fourteen isolates (45.2%) of Candida albicans were identified. Among the 17 non-albicans isolates, Candida tropicalis was the most predominant (41.9%). Six patients (3.5%) had candidemia with no significant difference between candiduria(+) and candiduria(-) groups (respectively, 6.9% and 2.8%; p = 0.264). In multivariate analysis, previous exposure to quinolones (OR = 3.8, CI95% [1.4-8.3]; p = 0.008), mechanical ventilation (OR = 4.1, CI95% [1.1-14.7]; p = 0.034) and renal replacement therapy (OR = 3.5, 95%CI [1.2-9.7]; p = 0.017) were identified as independent factors predicting candiduria. Candiduria was associated with significantly higher ICU-mortality after adjusting for SAPSII score on admission (OR = 2.9 CI95% [1.3-6.8]; p = 0.009). CONCLUSION Candiduria is common in cancer critically-ill patients. We reported an increased rate of non-albicans species, over albicans species. Patients with candiduria had higher ICU mortality, probably related to higher frailty and clinical severity.
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Affiliation(s)
- Anis Chaari
- Critical Care Department, Bahrain Oncology Centre, King Hamad University Hospital, Building 2435, Road 2835, Block 228 - P.O. Box 24343, Bussaiteen, Bahrain.
| | - Ahmed Munir
- Critical Care Department, Bahrain Oncology Centre, King Hamad University Hospital, Building 2435, Road 2835, Block 228 - P.O. Box 24343, Bussaiteen, Bahrain
| | - Amr Sharaf
- Critical Care Department, Bahrain Oncology Centre, King Hamad University Hospital, Building 2435, Road 2835, Block 228 - P.O. Box 24343, Bussaiteen, Bahrain
| | - Amira Khairy
- Microbiology Department, King Hamad University Hospital, Bahrain
| | - Vipin Kauts
- Critical Care Department, Bahrain Oncology Centre, King Hamad University Hospital, Building 2435, Road 2835, Block 228 - P.O. Box 24343, Bussaiteen, Bahrain
| | - Hakan Erdem
- Infectious Disease Department, Bahrain Oncology Centre, King Hamad University Hospital, Bahrain
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Jellouli M, Boussetta A, Chaari A, Charfi R, Ben Abdallah T, Trabelsi S, Gargah T. Traitement par le mycophénolate mofétil dans le syndrome nephrotique corticodépendant de l’enfant. Nephrol Ther 2021. [DOI: 10.1016/j.nephro.2021.07.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Omar I, Shirazy M, Omar M, Chaari A. Controlling nosocomial infection in adult intensive treatment unit: A quality improvement project. Int J Risk Saf Med 2020; 31:267-273. [PMID: 32538871 DOI: 10.3233/jrs-190028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Nosocomial infection is a significant burden on healthcare facilities. Its multifactorial nature renders it challenging to control. However, quality healthcare necessitates a safer service that poses no harm to the patient. OBJECTIVE The aim of this project was to reduce the infection rates in the adult ITU to the benchmark levels. METHOD We conducted an internal audit as a result of the high infection rates in the adult ITU. The audit started with root cause analysis using the fishbone quality tool. FOCUS-PDCA quality tool was used to design the framework. We introduced a change in the staff uniform laundry and organized a campaign to improve hand hygiene compliance using a multimodality approach. Moreover, we conducted training on aseptic techniques in ventilation, urinary catheter, and central lines insertion. Finally, we changed the ventilator filter to a higher quality brand which meets the standard specifications. Infection rates were monitored before and after the proposed changes. RESULTS There was a marked reduction in ventilator-associated pneumonia; however, it did not reach the benchmark rates. Catheter line-associated bloodstream infection declined from above to below the benchmark. Catheter-associated urinary tract infection rates were below the benchmark; however, they showed a noticeable reduction. Hand hygiene adherence showed an improvement from 80% to 84%. However, this was below the predetermined target level of 90%. CONCLUSIONS In-hospital laundry of staff uniforms is safer to control nosocomial infections. A multimodal approach is necessary to improve hand hygiene adherence and adoption of aseptic techniques. Quality improvement is a continuous process.
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Affiliation(s)
- Islam Omar
- Upper GI Surgery, Bariatric Unit, South Tyneside and Sunderland NHS Trust, Sunderland, UK E-mail: .,Sunderland, United Kingdom of Great Britain and Northern Ireland E-mail:
| | - Mohamed Shirazy
- University Hospitals of Morecambe Bay NHS Foundation Trust (UHMBT), UK E-mail: .,Barrow-in-Furness, United Kingdom of Great Britain and Northern Ireland E-mail:
| | - Mayar Omar
- Head of Healthcare Quality and Medical Procurement, General Authority of Health Insurance, Alexandria, Egypt E-mail: .,Head of Healthcare Quality and Medical Procurement , General Authority of Health Insurance, Alexandria, Egypt E-mail:
| | - Anis Chaari
- Head of ITU Department, Consultant Intensivist, King Hamad University Hospital, Bahrain E-mail: .,Bahrain E-mail: .,Head of ITU Department - Consultant Intensivist, King Hamad University Hospital, Bahrain
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Boudaya M, Chaari A, Marrakchi R, Turki M, Jamoussi K, Makhlouf R, Ayedi F. The testosterone/cortisol ratio can it indicates the time of choice for strength training? Clin Chim Acta 2019. [DOI: 10.1016/j.cca.2019.03.1039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Chaari A, Bousselmi K, Assar W, Kumar V, Khalil E, Kauts V, Abdelhakim K. Usefulness of ultrasound in the management of acute respiratory distress syndrome. Int J Crit Illn Inj Sci 2019; 9:11-15. [PMID: 30989062 PMCID: PMC6423925 DOI: 10.4103/ijciis.ijciis_30_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Acute respiratory distress syndrome (ARDS) is a life-threatening disease. Different imaging techniques have been used to diagnose and guide the ventilatory management of patients with ARDS. Chest ultrasound is a reliable tool to identify interstitial syndrome, lung consolidation, lung collapse, and pleural effusion. In addition, echocardiography is essential in the diagnosis of diastolic left ventricle dysfunction and the estimation of elevated ventricle filling pressures, which is necessary before diagnosing ARDS. Therefore, combining chest and heart ultrasound assessment is useful to diagnose ARDS and guide the ventilatory management of the disease. Available data in the literature suggest that protocol-based approaches should be implemented for the purposes of diagnosis and management.
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Affiliation(s)
- Anis Chaari
- Department of Critical Care, King Hamad University Hospital, Al Muharaq, Kingdom of Bahrain
| | - Kamel Bousselmi
- Department of Critical Care, King Hamad University Hospital, Al Muharaq, Kingdom of Bahrain
| | - Walid Assar
- Department of Critical Care, King Hamad University Hospital, Al Muharaq, Kingdom of Bahrain
| | - Vaguish Kumar
- Department of Critical Care, King Hamad University Hospital, Al Muharaq, Kingdom of Bahrain
| | - Elsayed Khalil
- Department of Critical Care, King Hamad University Hospital, Al Muharaq, Kingdom of Bahrain
| | - Vipin Kauts
- Department of Critical Care, King Hamad University Hospital, Al Muharaq, Kingdom of Bahrain
| | - Karim Abdelhakim
- Department of Critical Care, King Hamad University Hospital, Al Muharaq, Kingdom of Bahrain
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Bahloul M, Turki O, Chaari A, Bouaziz M. Incidence, mechanisms and impact outcome of hyperglycaemia in severe scorpion-envenomed patients. Ther Adv Endocrinol Metab 2018; 9:199-208. [PMID: 29977498 PMCID: PMC6022972 DOI: 10.1177/2042018818772779] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 04/03/2018] [Indexed: 12/15/2022] Open
Abstract
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).
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Affiliation(s)
| | - Olfa Turki
- Service de Réanimation médicale, Hôpital Habib Bourguiba, Sfax, Tunisie
| | - Anis Chaari
- Service de Réanimation médicale, Hôpital Habib Bourguiba, Sfax, Tunisie
| | - Mounir Bouaziz
- Service de Réanimation médicale, Hôpital Habib Bourguiba, Sfax, Tunisie
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Chaari A, Mahmoud ESK, El Khaja M. Lemierre Syndrome : An Unusual Complication of Tongue Cancer. BMB 2018. [DOI: 10.12816/0047475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Chelly H, Bahloul M, Ammar R, Dhouib A, Mahfoudh KB, Boudawara MZ, Chakroun O, Chabchoub I, Chaari A, Bouaziz M. Clinical characteristics and prognosis of traumatic head injury following road traffic accidents admitted in ICU "analysis of 694 cases". Eur J Trauma Emerg Surg 2017; 45:245-253. [PMID: 29234838 DOI: 10.1007/s00068-017-0885-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 12/01/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND The aim of the present study is to analyze the clinical and epidemiological characteristics of Traumatic Brain Injury (TBI) following Road Traffic Accidents (RTAs). Moreover, we aim to evaluate the outcome of the TBI victims referred to our medico-surgical Intensive Care Unit (ICU), and to define predictive factors associated with poor prognosis. METHODS A retrospective study over a 4-year period (2009 to 2012) of 694 patients with head injuries, incurred during road traffic accidents, admitted to the Intensive Care Unit (ICU) of a university hospital (Sfax-Tunisia). Basic demographic, clinical, biological, and radiological data were recorded on admission and during the ICU stay. RESULTS There were 592 males (85.3%), and 102 female patients. The mean age was at 31.8 ± 17.8 years (range 1-91). The mechanism of the accident was detailed in 666 patients (96%). The majority of the victims were motorcycle riders and/or passengers (40.5%), followed by pedestrians (29.1%). Extra-cranial pathology was present in 452 patients (65%). A total of 677 patients (97.6%) required intubation, mechanical ventilation, and sedation. Mean ICU stay was 16 ± 17.4 days. A total of 187 patients (26.9%) died during their hospital stay. The GOS performed within a mean delay of 6 months after hospital discharge was as follows: 198 deaths (28.5%), 13 vegetative state (1.9%), and 349 (50.3%) good recovery and/or moderate disability. A multivariate analysis showed that the factors which correlated with a poor prognosis (mortality and severe disability) were: age > 38 years, Glasgow coma scale score < 8, subdural hematoma, and development of secondary systemic insults (respiratory, circulatory, and metabolic). CONCLUSION In Tunisia, traumatic brain injury due to RTAs is a frequent cause of ICU admission, especially among young adults, and is associated with high mortality and morbidity rates. The majority of the victims were motorcycle riders and/or passengers and pedestrians. The factors associated with a poor outcome were: age > 38 years, Glasgow Coma Scale score < 8, subdural hematoma, and development of secondary systemic insults (respiratory, circulatory, and metabolic). As a consequence, prevention is highly warranted.
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Affiliation(s)
- Hedi Chelly
- Department of Intensive Care, Habib Bourguiba University Hospital, 3029, Sfax, Tunisia
| | - Mabrouk Bahloul
- Department of Intensive Care, Habib Bourguiba University Hospital, 3029, Sfax, Tunisia.
| | - Rania Ammar
- Department of Intensive Care, Habib Bourguiba University Hospital, 3029, Sfax, Tunisia
| | - Ahmed Dhouib
- Department of Intensive Care, Habib Bourguiba University Hospital, 3029, Sfax, Tunisia
| | | | | | - Olfa Chakroun
- Departement of Emergency Medicine, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Imen Chabchoub
- Department of Pediatrics, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Anis Chaari
- Department of Intensive Care, Habib Bourguiba University Hospital, 3029, Sfax, Tunisia
| | - Mounir Bouaziz
- Department of Intensive Care, Habib Bourguiba University Hospital, 3029, Sfax, Tunisia
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Bahloul M, Ammar R, Bouattour A, Bellil S, Chelly H, Chaari A, Bouaziz M. Effects of early administration of acetazolamide on the duration of mechanical ventilation in patients with chronic obstructive pulmonary disease: still far from the truth? J Thorac Dis 2017; 9:1393-1395. [PMID: 28740640 DOI: 10.21037/jtd.2017.05.41] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Mabrouk Bahloul
- Department of Intensive Care, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Rania Ammar
- Department of Intensive Care, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Abir Bouattour
- Department of Intensive Care, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Samar Bellil
- Department of Intensive Care, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Hedi Chelly
- Department of Intensive Care, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Anis Chaari
- Department of Intensive Care, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Mounir Bouaziz
- Department of Intensive Care, Habib Bourguiba University Hospital, Sfax, Tunisia
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Chaari A, Hakim KA, Rashed N, Bousselmi K, Kauts V, Etman M, Casey WF. Factors associated with increased pancreatic enzymes in septic patients: a prospective study. J Intensive Care 2017; 5:44. [PMID: 28725436 PMCID: PMC5513027 DOI: 10.1186/s40560-017-0243-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 07/09/2017] [Indexed: 12/29/2022] Open
Abstract
Background The perfusion of splanchnic organs is deeply altered in patients with septic shock. The aim of the study is to identify the predictive factors of septic shock-induced increase of serum lipase and amylase and to assess and evaluate its prognostic impact. Methods We conducted a prospective observational study. All adult patients admitted with septic shock were eligible for our study. Serum lipase and amylase were measured on admission. Patients with and those without increased pancreatic enzymes were compared. Predictive factors of pancreatic insult identified by the univariate analysis were integrated in a stepwise multivariate analysis. Odds ratios (OR) with the 95% confidence interval (CI) were calculated accordingly. Second, the sensitivity and the specificity of amylase and lipase to predict intensive care unit (ICU) mortality were identified through the Receiver Operator Curve. Results Fifty patients were included. Median [quartiles] age was 68.5 [58–81] years. The APACHE II score was 26 [20–31]. Twenty-three patients (46%) had increased serum amylase and/or serum lipase. Diabetes mellitus (OR = 16; 95% CI [1.7–153.5]; p = 0.016), increased blood urea nitrogen (OR = 1.12; 95% CI [1.02–1.20], p = 0.016), and decreased C-reactive protein (OR = 0.97; 95% CI [0.96–0.99]; p = 0.027) were identified as independent factors predicting increased pancreatic enzymes. Twenty patients (40%) died in the ICU. Neither serum amylase level nor serum lipase level was significantly different between survivors and non-survivors (respectively 49 [27.7–106] versus 85.1 [20.1–165] UI/L; p = 0.7 and 165 [88–316] versus 120 [65.5–592] UI/L; p = 0.952). Conclusion Increase of pancreatic enzymes is common in patients with septic shock. Diabetes and impaired renal function are predictive of increased pancreatic enzymes. Such finding does not carry any negative prognostic value.
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Affiliation(s)
- Anis Chaari
- Critical Care Department, King Hamad University Hospital, Al Muharaq, Bahrain
| | - Karim Abdel Hakim
- Critical Care Department, King Hamad University Hospital, Al Muharaq, Bahrain
| | - Nevine Rashed
- Gastroenterology Department, King Hamad University Hospital, Al Muharaq, Bahrain
| | - Kamel Bousselmi
- Critical Care Department, King Hamad University Hospital, Al Muharaq, Bahrain
| | - Vipin Kauts
- Critical Care Department, King Hamad University Hospital, Al Muharaq, Bahrain
| | - Mahmoud Etman
- Critical Care Department, King Hamad University Hospital, Al Muharaq, Bahrain
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Bahloul M, Baccouch N, Chtara K, Turki M, Turki O, Hamida CB, Chelly H, Ayedi F, Chaari A, Bouaziz M. Value of Serum Cholinesterase Activity in the Diagnosis of Septic Shock Due to Bacterial Infections. J Intensive Care Med 2017; 32:346-352. [DOI: 10.1177/0885066616636549] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Background: We aimed to investigate whether serum cholinesterase (SChE) activity can be helpful for the diagnosis of septic shock and to evaluate its usefulness in comparison with procalcitonin (PCT) and C-reactive protein (CRP). Methods: A prospective single-blinded study conducted in an intensive care unit of university hospital. Patients were classified as having cardiogenic shock, septic shock, or hemorrhagic shock. We also included a control group without neither hemodynamic instability nor sepsis. For all included patients, SChE, PCT, and CRP were simultaneously sampled. Results: The comparison of sepsis markers between all groups showed that the mean values of PCT and CRP were significantly higher in patients with septic shock. However, SChE activity was significantly lower in this group. The SChE activity was found to be more accurate than PCT and CRP for the diagnosis of septic shock. In fact, an SChE activity ≤ 4000 UI/L predicted the diagnosis of septic shock with a sensitivity of 78%, a specificity of 89%, a predictive negative value of 97%, and a predictive positive value of 65%. However, the prognostic value of SChE activity was poor in multivariate analysis. Conclusion: The SChE activity level was significantly decreased in patients with septic shock. However, its prognostic value is poor. Our results suggest that SChE activity is useful for the diagnosis of septic shock. Further studies are warranted to confirm our findings.
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Affiliation(s)
- Mabrouk Bahloul
- Service de Réanimation Médicale, CHU Habib Bourguiba, Sfax, Tunisie
| | - Najeh Baccouch
- Service de Réanimation Médicale, CHU Habib Bourguiba, Sfax, Tunisie
| | - Kamilia Chtara
- Service de Réanimation Médicale, CHU Habib Bourguiba, Sfax, Tunisie
| | - Mouna Turki
- Laboratoire de Biochimie, CHU Habib Bourguiba, Sfax, Tunisie
| | - Olfa Turki
- Service de Réanimation Médicale, CHU Habib Bourguiba, Sfax, Tunisie
| | | | - Hedi Chelly
- Service de Réanimation Médicale, CHU Habib Bourguiba, Sfax, Tunisie
| | - Fatma Ayedi
- Laboratoire de Biochimie, CHU Habib Bourguiba, Sfax, Tunisie
| | - Anis Chaari
- Service de Réanimation Médicale, CHU Habib Bourguiba, Sfax, Tunisie
| | - Mounir Bouaziz
- Service de Réanimation Médicale, CHU Habib Bourguiba, Sfax, Tunisie
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Bahloul M, Regaieg K, Chtara K, Turki O, Baccouch N, Chaari A, Bouaziz M. [Posttraumatic thromboembolic complications: Incidence, risk factors, pathophysiology and prevention]. Ann Cardiol Angeiol (Paris) 2017; 66:92-101. [PMID: 28110934 DOI: 10.1016/j.ancard.2016.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 12/08/2016] [Indexed: 06/06/2023]
Abstract
Venous thromboembolism (VTE) remains a major challenge in critically ill patients. Subjects admitted in intensive care unit (ICU), in particular trauma patients, are at high-risk for both deep vein thrombosis (DVT) and pulmonary embolism (PE). The rate of symptomatic PE in injured patients has been reported previously ranging from 1 to 6%. The high incidence of posttraumatic venous thromboembolic events is well known. In fact, major trauma is a hypercoagulable state. Several factors placing the individual patient at a higher risk for the development of DVT and PE have been suggested: high ISS score, meningeal hemorrhage and spinal cord injuries have frequently been reported as a significant risk factor for VTEs after trauma. Posttraumatic pulmonary embolism traditionally occurs after a period of at least 5 days from trauma. The prevention can reduce the incidence and mortality associated with the pulmonary embolism if it is effective. There is no consensus is now available about the prevention of venous thromboembolism in trauma patients.
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Affiliation(s)
- M Bahloul
- Service de réanimation médicale, hôpital Habib Bourguiba, route el Ain Km 1, 3029 Sfax, Tunisie.
| | - K Regaieg
- Service de réanimation médicale, hôpital Habib Bourguiba, route el Ain Km 1, 3029 Sfax, Tunisie
| | - K Chtara
- Service de réanimation médicale, hôpital Habib Bourguiba, route el Ain Km 1, 3029 Sfax, Tunisie
| | - O Turki
- Service de réanimation médicale, hôpital Habib Bourguiba, route el Ain Km 1, 3029 Sfax, Tunisie
| | - N Baccouch
- Service de réanimation médicale, hôpital Habib Bourguiba, route el Ain Km 1, 3029 Sfax, Tunisie
| | - A Chaari
- Service de réanimation médicale, hôpital Habib Bourguiba, route el Ain Km 1, 3029 Sfax, Tunisie
| | - M Bouaziz
- Service de réanimation médicale, hôpital Habib Bourguiba, route el Ain Km 1, 3029 Sfax, Tunisie
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Kamilia C, Regaieg K, Baccouch N, Chelly H, Bahloul M, Bouaziz M, Jendoubi A, Abbes A, Belhaouane H, Nasri O, Jenzri L, Ghedira S, Houissa M, Belkadi K, Harti Y, Nsiri A, Khaleq K, Hamoudi D, Harrar R, Thieffry C, Wallet F, Parmentier-Decrucq E, Favory R, Mathieu D, Poissy J, Lafon T, Vignon P, Begot E, Appert A, Hadj M, Claverie P, Matt M, Barraud O, François B, Jamoussi A, Jazia AB, Marhbène T, Lakhdhar D, Khelil JB, Besbes M, Goutay J, Blazejewski C, Joly-Durand I, Pirlet I, Weillaert MP, Beague S, Aziz S, Hafiane R, Hattabi K, Bouhouri MA, Hammoudi D, Fadil A, Harrar RA, Zerouali K, Medhioub FK, Allela R, Algia NB, Cherif S, Slaoui MT, Boubia S, Hafiani Y, Khaoudi A, Cherkab R, Elallam W, Elkettani C, Barrou L, Ridaii M, Mehdi RE, Schimpf C, Mizrahi A, Pilmis B, Le Monnier A, Tiercelet K, Cherin M, Bruel C, Philippart F, Bailly S, Lucet J, Lepape A, L’hériteau F, Aupée M, Bervas C, Boussat S, Berger-Carbonne A, Machut A, Savey A, Timsit JF, Razazi K, Rosman J, de Prost N, Carteaux G, Jansen C, Decousser JW, Brun-Buisson C, Dessap AM, M’rad A, Ouali Z, Barghouth M, Kouatchet A, Boudon M, Ichai P, Younes A, Nakad L, Coilly A, Antonini T, Sobesky R, De Martin E, Samuel D, Hubert N, Mahieu R, Nay MA, Auchabie J, Giraudeau B, Jean R, Darmon M, Ruckly S, Garrouste-Orgeas M, Gratia E, Goldgran-Toledano D, Jamali S, Weiss E, Dumenil AS, Schwebel C, Brisard L, Bizouarn P, Lepoivre T, Nicolet J, Rigal JC, Roussel JC, Cheurfa C, Abily J, Schnell D, Lescot T, Page I, Warnier S, Nys M, Rousseau AF, Damas P, Uhel F, Lesouhaitier M, Grégoire M, Gaudriot B, Zahar JR, Gacouin A, Le Tulzo Y, Flecher E, Tarte K, Tadié JM, Georges Q, Soares M, Jeon K, Oeyen S, Rhee CK, Artiguenave M, Gruber P, Ostermann M, Hill Q, Depuydt P, Ferra C, Muller A, Aurelie B, Niles C, Herbert F, Pied S, Sophie PP, Loridant S, François N, Bignon A, Sendid B, Lemaitre C, Dupre C, Zayene A, Portier L, De Freitas Caires N, Lassalle P, Espinasse F, Le Neindre A, Selot P, Ferreiro D, Bonarek M, Henriot S, 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Gharsallah L, Tlaili S, Gasri B, Hammouda R, Messadi AA, Allain PA, Gault N, Paugam-Burtz C, Foucrier A, Chatbri B, Bourbiaa Y, Thabet L, Neuschwander A, Vincent L, Beck J, Vibol C, Amelie Y, Resche-Rigon M, Pirracchio JM, Bureau C, Decavèle M, Campion S, Ainsouya R, Niérat MC, Prodanovic H, Raux M, Similowski T, Dubé BP, Demiri S, Dres M, May F, Quintard H, Kounis I, Saliba F, André S. Proceedings of Réanimation 2017, the French Intensive Care Society International Congress. Ann Intensive Care 2017. [PMCID: PMC5225389 DOI: 10.1186/s13613-016-0224-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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ESICM LIVES 2016: part two. Intensive Care Med Exp 2016. [PMCID: PMC5042923 DOI: 10.1186/s40635-016-0099-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Chaari A, El Bahr M, Khashaba SA, Ismail M, Mahmoud T, Casey WF. Acute Gastric Volvulus in the Elderly: A Case Report and Review of the Literature. INT J GERONTOL 2016. [DOI: 10.1016/j.ijge.2015.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Straaten HM, Mejeni N, Nsiala J, Kilembe A, Akilimali P, Thomas G, Egerod I, Andersson AE, Fagerdahl AM, Knudsen V, Meddeb K, Cheikh AB, Hamdaoui Y, Ayachi J, Guiga A, Fraj N, Romdhani S, Sma N, Bouneb R, Chouchene I, Khedher A, Bouafia N, Boussarsar M, Amirian A, Ziaian B, Masjedi M, Fleischmann C, Thomas-Rueddel DO, Schettler A, Schwarzkopf D, Stacke A, Reinhart K, Filipe E, Escoval A, Martins A, Sousa P, Velez N, Viegas E, Tomas E, Snell G, Matsa R, Paary TTS, Kalaiselvan MS, Cavalheiro AM, Rocha LL, Vallone CS, Tonilo A, Lobato MDS, Malheiro DT, Sussumo G, Lucino NM, Zand F, Rosenthal VD, Masjedi M, Sabetian G, Maghsudi B, Ghorbani M, Dashti AS, Yousefipour A, Goodall JR, Williamson M, Tant E, Thomas N, Balci C, Gonen C, Haftacı E, Gurarda H, Karaca E, Paldusová B, Zýková I, Šímová D, Houston S, D’Antona L, Lloyd J, Garnelo-Rey V, Sosic M, Sotosek-Tokmazic V, Kuharic J, Antoncic I, Dunatov S, Sustic A, Chong CT, Sim M, Lyovarin T, Díaz FMA, Galdó SN, Garach MM, Romero OM, Bailón AMP, Pinel AC, Colmenero M, Gritsan A, Gazenkampf A, Korchagin E, Dovbish N, Lee RM, Lim MPP, Chong CT, Lim BCL, See JJ, Assis R, Filipe F, Lopes N, Pessoa L, Pereira T, Catorze N, Aydogan MS, Aldasoro C, Marchio P, Jorda A, Mauricio MD, Guerra-Ojeda S, Gimeno-Raga M, Colque-Cano M, Bertomeu-Artecero A, Aldasoro M, Valles SL, Tonon D, Triglia T, Martin JC, Alessi MC, Bruder N, Garrigue P, Velly L, Spina S, Scaravilli V, Marzorati C, Colombo E, Savo D, Vargiolu A, Cavenaghi G, Citerio G, Andrade AHV, Bulgarelli P, Araujo JAP, Gonzalez V, Souza VA, Costa A, Massant C, Filho CACA, Morbeck RA, Burgo LE, van Groenendael R, van Eijk LT, Leijte GP, Koeneman B, Kox M, Pickkers P, García-de la Torre A, de la Torre-Prados M, Fernández-Porcel A, Rueda-Molina C, Nuevo-Ortega P, Tsvetanova-Spasova T, Cámara-Sola E, García-Alcántara A, Salido-Díaz L, Liao X, Feng T, Zhang J, Cao X, Wu Q, Xie Z, Li H, Kang Y, Winkler MS, Nierhaus A, Mudersbach E, Bauer A, Robbe L, Zahrte C, Schwedhelm E, Kluge S, Zöllner C, Morton B, Mitsi E, Pennington SH, Reine J, Wright AD, Parker R, Welters ID, Blakey JD, Rajam G, Ades EW, Ferreira DM, Wang D, Kadioglu A, Gordon SB, Koch R, Kox M, Rahamat-Langedoen J, Schloesser J, de Jonge M, Pickkers P, Bringue J, Guillamat-Prats R, Torrents E, Martinez ML, Camprubí-Rimblas M, Artigas A, Blanch L, Park SY, Park YB, Song DK, Shrestha S, Park SH, Koh Y, Park MJ, Hong CW, Lesur O, Coquerel D, Sainsily X, Cote J, Söllradl T, Murza A, Dumont L, Dumaine R, Grandbois M, Sarret P, Marsault E, Salvail D, Auger-Messier M, Chagnon F, Lauretta MP, Greco E, Dyson A, Singer M, Preau S, Ambler M, Sigurta A, Saeed S, Singer M, Sarıca LT, Zibandeh N, Genc D, Gul F, Akkoc T, Kombak E, Cinel L, Akkoc T, Cinel I, Pollen SJ, Arulkumaran N, Singer M, Torrance HD, Longbottom ER, Warnes G, Hinds CJ, Pennington DJ, Brohi K, O’Dwyer MJ, Kim HY, Na S, Kim J, Chang YF, Chao A, Shih PY, Lee CT, Yeh YC, Chen LW, Adriaanse M, Trogrlic Z, Ista E, Lingsma H, Rietdijk W, Ponssen HH, Schoonderbeek JF, Schreiner F, Verbrugge SJ, Duran S, Gommers DAMPJ, van der Jagt M, Funcke S, Sauerlaender S, Saugel B, Pinnschmidt H, Reuter DA, Nitzschke R, Perbet S, Biboulet C, Lenoire A, Bourdeaux D, Pereira B, Plaud B, Bazin JE, Sautou V, Mebazaa A, Constantin JM, Legrand M, Boyko Y, Jennum P, Nikolic M. ESICM LIVES 2016: part one. Intensive Care Med Exp 2016. [PMCID: PMC5042924 DOI: 10.1186/s40635-016-0098-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Chaari A, Abdel Hakim K, Bousselmi K, Etman M, El Bahr M, El Saka A, Hamza E, Ismail M, Khalil EM, Kauts V, Casey WF. Pancreatic injury in patients with septic shock: A literature review. World J Gastrointest Oncol 2016; 8:526-531. [PMID: 27559431 PMCID: PMC4942740 DOI: 10.4251/wjgo.v8.i7.526] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 04/26/2016] [Accepted: 05/27/2016] [Indexed: 02/05/2023] Open
Abstract
Sepsis and septic shock are life threatening condition associated with high mortality rate in critically-ill patients. This high mortality is mainly related to the inadequacy between oxygen delivery and cellular demand leading to the onset of multiorgan dysfunction. Whether this multiorgan failure affect the pancreas is not fully investigated. In fact, pancreatic injury may occur because of ischemia, overwhelming inflammatory response, oxidative stress, cellular apoptosis and/or metabolic derangement. Increased serum amylase and/or lipase levels are common in patients with septic shock. However, imaging test rarely reveal significant pancreatic damage. Whether pancreatic dysfunction does affect the prognosis of patients with septic shock or not is still a matter of debate. In fact, only few studies with limited sample size assessed the clinical relevance of the pancreatic injury in this group of patients. In this review, we aimed to describe the epidemiology and the physiopathology of pancreatic injury in septic shock patients, to clarify whether it requires specific management and to assess its prognostic value. Our main finding is that pancreatic injury does not significantly affect the outcome in septic shock patients. Hence, increased serum pancreatic enzymes without clinical features of acute pancreatitis do not require further imaging investigations and specific therapeutic intervention.
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Abdel Hakim K, Mohamed AI, Chaari A, Abulfateh FN, Alshaikh KA, Casey WF. Successful management of H1N1 related severe acute respiratory distress syndrome with noninvasive positive pressure ventilation. Ann Transl Med 2016; 4:175. [PMID: 27275488 DOI: 10.21037/atm.2016.03.52] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Acute respiratory distress syndrome (ARDS) is a life threatening complication of H1N1 pneumonia. According to the Berlin conference guidelines, severe ARDS requires management with early invasive mechanical ventilation. Whether noninvasive positive pressure ventilation (NIPPV) should be attempted in patients with H1N1 pneumonia is still a matter of debate. We report the case of one patient with severe ARDS without other organ failure. The patient was managed successfully using NIPPV. Endotracheal intubation was avoided and the patient was discharged from the intensive care unit (ICU) after 10 days with a successful outcome. NIPPV can be useful in patients with isolated severe H1N1 ARDS provided early improvement of the oxygenation parameters is achieved. Patients with multiple organ failure or with persistent severe hypoxemia under noninvasive ventilation should be electively intubated and started on invasive mechanical ventilation.
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Affiliation(s)
- Karim Abdel Hakim
- Department of Intensive Care, King Hamed University Hospital, Al Muharaq, Kingdom of Bahrain
| | - Abdulla Ismaeel Mohamed
- Department of Intensive Care, King Hamed University Hospital, Al Muharaq, Kingdom of Bahrain
| | - Anis Chaari
- Department of Intensive Care, King Hamed University Hospital, Al Muharaq, Kingdom of Bahrain
| | - Fatima N Abulfateh
- Department of Intensive Care, King Hamed University Hospital, Al Muharaq, Kingdom of Bahrain
| | - Khalid A Alshaikh
- Department of Intensive Care, King Hamed University Hospital, Al Muharaq, Kingdom of Bahrain
| | - William Francis Casey
- Department of Intensive Care, King Hamed University Hospital, Al Muharaq, Kingdom of Bahrain
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Bahloul M, Chtara K, Gargouri R, Majdoub A, Chaari A, Bouaziz M. Failure of noninvasive ventilation in adult patients with acute asthma exacerbation. J Thorac Dis 2016; 8:744-7. [PMID: 27162642 DOI: 10.21037/jtd.2016.03.07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Mabrouk Bahloul
- 1 Service de Réanimation médicale, CHU Habib Bourguiba, 3029 Sfax, Tunisie ; 2 Hospital Tahar Sfar de Mahdia, Service Anesthésie Réanimation Chirurgicale, Mahdia, Tunisie
| | - Kamilia Chtara
- 1 Service de Réanimation médicale, CHU Habib Bourguiba, 3029 Sfax, Tunisie ; 2 Hospital Tahar Sfar de Mahdia, Service Anesthésie Réanimation Chirurgicale, Mahdia, Tunisie
| | - Rahma Gargouri
- 1 Service de Réanimation médicale, CHU Habib Bourguiba, 3029 Sfax, Tunisie ; 2 Hospital Tahar Sfar de Mahdia, Service Anesthésie Réanimation Chirurgicale, Mahdia, Tunisie
| | - Ali Majdoub
- 1 Service de Réanimation médicale, CHU Habib Bourguiba, 3029 Sfax, Tunisie ; 2 Hospital Tahar Sfar de Mahdia, Service Anesthésie Réanimation Chirurgicale, Mahdia, Tunisie
| | - Anis Chaari
- 1 Service de Réanimation médicale, CHU Habib Bourguiba, 3029 Sfax, Tunisie ; 2 Hospital Tahar Sfar de Mahdia, Service Anesthésie Réanimation Chirurgicale, Mahdia, Tunisie
| | - Mounir Bouaziz
- 1 Service de Réanimation médicale, CHU Habib Bourguiba, 3029 Sfax, Tunisie ; 2 Hospital Tahar Sfar de Mahdia, Service Anesthésie Réanimation Chirurgicale, Mahdia, Tunisie
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Bahloul M, Chtara K, Chelly H, Regaieg K, Chaari A, Bouaziz M. Acetazolamide use in severe COPD exacerbations requiring invasive mechanical ventilation: impact on duration of mechanical ventilation. J Thorac Dis 2016; 8:762-764. [PMID: 27162647 PMCID: PMC4842826 DOI: 10.21037/jtd.2016.03.65] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 03/11/2016] [Indexed: 08/30/2023]
Affiliation(s)
- Mabrouk Bahloul
- Service de Réanimation Médicale, CHU Habib Bourguiba, Sfax, Tunisia
| | - Kamilia Chtara
- Service de Réanimation Médicale, CHU Habib Bourguiba, Sfax, Tunisia
| | - Hedi Chelly
- Service de Réanimation Médicale, CHU Habib Bourguiba, Sfax, Tunisia
| | - Kais Regaieg
- Service de Réanimation Médicale, CHU Habib Bourguiba, Sfax, Tunisia
| | - Anis Chaari
- Service de Réanimation Médicale, CHU Habib Bourguiba, Sfax, Tunisia
| | - Mounir Bouaziz
- Service de Réanimation Médicale, CHU Habib Bourguiba, Sfax, Tunisia
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Chakroun-Walha O, Rejeb I, Boujelben M, Chaari A, Ksibi H, Kammoun L, Chaari A, Bouaziz M, Rekik N. Epidemiological features of stress hyperglycemia in elderly at emergency department. Tunis Med 2016; 94:140-144. [PMID: 27532531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
UNLABELLED Background : Stress hyperglycemia among patients having an acute pathology is frequently described in recent studies. AIMS The objectives of this work were to describe epidemiologic features of elderly patients hospitalized in the emergency department and having a hyperglycemia due to stress. METHODS A retrospective chart review identified patients older than 65 years with obtained serum glucose levels. Patients with diabetes were excluded. Two levels of serum glucose were considered (>6,9 mmol/l and ≤ 6,9 mmol/l). RESULTS We included 165. There were 94 patients with high level of serum glucose level (56,9%). Multivariate analysis found that only cardio-vascular pathologies were more predictive of having stress hyperglycemia (p=0,014, odds-ratio=2,8, IC=1,2-6,4). There were no correlation between serum glucose levels and mortality. CONCLUSION Stress hyperglycemia is a fairly common disorder but underestimated in emergency department. Its impact on the prognosis of elderly patients remains to be studied.
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Said T, Chaari A, Hakim KA, Hamama D, Casey WF. Usefulness of full outline of unresponsiveness score to predict extubation failure in intubated critically-ill patients: A pilot study. Int J Crit Illn Inj Sci 2016; 6:172-177. [PMID: 28149821 PMCID: PMC5225759 DOI: 10.4103/2229-5151.195401] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: To assess the usefulness of the full outline of unresponsiveness (FOUR) score in predicting extubation failure in critically ill intubated patients admitted with disturbed level of conscious in comparison with the Glasgow coma scale (GCS). Patients and Methods: All intubated critically ill patients with a disturbed level of consciousness were assessed using both the FOUR score and the GCS. The FOUR score and the GCS were compared regarding their predictive value for successful extubation at 14 days after intubation as a primary outcome measure. The 28-day mortality and the neurological outcome at 3 months were used as secondary outcome measures. Results: Eighty-six patients were included in the study. Median age was 63 (50–77) years. Sex–ratio (M/F) was 1.46. On admission, median GCS was 7 (3–10) while median FOUR score was 8.5 (2.3–11). A GCS ≤ 7 predicted the extubation failure at 14 days after intubation with a sensitivity of 88.5% and specificity of 68.3%, whereas a FOUR score <10 predicted the same outcome with a sensitivity of 80.8% and a specificity of 81.7%. The areas under the curves was significantly higher with the FOUR score than with GCS (respectively 0.867 confidence interval [CI]: 95% [0790–0.944] and 0.832 CI: 95% [0.741–0.923]; P = 0.014). When calculated before extubation, FOUR score <12 predicted extubation failure with a sensitivity of 92.3% and a specificity of 85%, whereas a GCS <12 predicted the same outcome with a sensitivity of 73% and a specificity of 61.7%. Both scores had similar accuracy for predicting 28-day mortality and neurological outcome at 3 months. Conclusion: The FOUR score is superior to the GCS for the prediction of successful extubation of intubated critically ill patients.
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Affiliation(s)
- Tarek Said
- Department of Intensive Care Unit, King Hamad University Hospital, Busaiteen, Kingdom of Bahrain
| | - Anis Chaari
- Department of Intensive Care Unit, King Hamad University Hospital, Busaiteen, Kingdom of Bahrain
| | - Karim Abdel Hakim
- Department of Intensive Care Unit, King Hamad University Hospital, Busaiteen, Kingdom of Bahrain
| | - Dalia Hamama
- Department of Intensive Care Unit, King Hamad University Hospital, Busaiteen, Kingdom of Bahrain
| | - William Francis Casey
- Department of Intensive Care Unit, King Hamad University Hospital, Busaiteen, Kingdom of Bahrain
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Medhioub Kaaniche F, Chaari A, Bacouch N, Bahloul M, Bouaziz M. Syndrome hémolytique et urémique de l’adulte jeune par trouble du métabolisme de la cobalamine : à propos d’un cas. Presse Med 2016; 45:148-50. [DOI: 10.1016/j.lpm.2015.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 08/29/2015] [Accepted: 10/14/2015] [Indexed: 10/22/2022] Open
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Chaari A, Pham T, Mnif B, Chtara K, Medhioub F, Baccouche N, Bahloul M, Hammami A, Bouaziz M. Colistin–tigecycline versus colistin–imipenem–cilastatin combinations for the treatment of Acinetobacter baumannii ventilator-acquired pneumonia: a prognosis study. Intensive Care Med 2015; 41:2018-9. [DOI: 10.1007/s00134-015-4010-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2015] [Indexed: 10/23/2022]
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Chtara K, Bahloul M, Turki O, Baccouche N, Regaieg K, Ben Hamida C, Chelly H, Chabchoub I, Chaari A, Bouaziz M. Incidence and impact outcome of hyperglycaemia in severe scorpion envenomed children requiring intensive care admission. Intensive Care Med 2015. [PMID: 26208749 DOI: 10.1007/s00134-015-3991-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Kamilia Chtara
- Service de Réanimation Médicale, CHU Hôpital Habib Bourguiba, Route el Ain Km 1, 3029, Sfax, Tunisia
| | - Mabrouk Bahloul
- Service de Réanimation Médicale, CHU Hôpital Habib Bourguiba, Route el Ain Km 1, 3029, Sfax, Tunisia.
| | - Olfa Turki
- Service de Réanimation Médicale, CHU Hôpital Habib Bourguiba, Route el Ain Km 1, 3029, Sfax, Tunisia
| | - Najeh Baccouche
- Service de Réanimation Médicale, CHU Hôpital Habib Bourguiba, Route el Ain Km 1, 3029, Sfax, Tunisia
| | - Kais Regaieg
- Service de Réanimation Médicale, CHU Hôpital Habib Bourguiba, Route el Ain Km 1, 3029, Sfax, Tunisia
| | - Chokri Ben Hamida
- Service de Réanimation Médicale, CHU Hôpital Habib Bourguiba, Route el Ain Km 1, 3029, Sfax, Tunisia
| | - Hedi Chelly
- Service de Réanimation Médicale, CHU Hôpital Habib Bourguiba, Route el Ain Km 1, 3029, Sfax, Tunisia
| | - Imen Chabchoub
- Service de Pédiatrie Générale, CHU Hedi Chaker, Sfax, Tunisia
| | - Anis Chaari
- Service de Réanimation Médicale, CHU Hôpital Habib Bourguiba, Route el Ain Km 1, 3029, Sfax, Tunisia
| | - Mounir Bouaziz
- Service de Réanimation Médicale, CHU Hôpital Habib Bourguiba, Route el Ain Km 1, 3029, Sfax, Tunisia
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Pejchang D, Coëtmellec S, Gréhan G, Brunel M, Lebrun D, Chaari A, Grosges T, Barchiesi D. Recovering the size of nanoparticles by digital in-line holography. Opt Express 2015; 23:18351-18360. [PMID: 26191893 DOI: 10.1364/oe.23.018351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The development of methods to measure the size of nanoparticles is a challenging topic of research. The proposed method is based on the metrology of the stable vapor bubble created by thermal coupling between a laser pulse and the nanoparticle in a droplet. The measurement is realized by digital in-line holography. The size of the nanoparticle is deduced from numerical simulations computed with a photo-thermal finite element method.
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Bahloul M, Chaari A, Tounsi A, Turki O, Chtara K, Hamida CB, Ghadhoune H, Dammak H, Chelly H, Bouaziz M. Impact of acetazolamide use in severe exacerbation of chronic obstructive pulmonary disease requiring invasive mechanical ventilation. Int J Crit Illn Inj Sci 2015; 5:3-8. [PMID: 25810957 PMCID: PMC4366825 DOI: 10.4103/2229-5151.152296] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To analyse the impact of acetazolamide (ACET) use in severe acute decompensation of chronic obstructive pulmonary disease requiring mechanical ventilation and intensive care unit (ICU) admission. PATIENTS AND METHODS Retrospective pair-wise, case-control study with 1:1 matching. Patients were defined as cases when they had received acetazolamide (500 mg per day) and as controls when they did not received it. Patients were matched according to age, severity on admission (pH, PaO2/FiO2 ratio) and SAPSII score. Our primary endpoint was the effect of ACET (500 mg per day) on the duration of mechanical ventilation. Our secondary endpoints were the effect of ACET on arterial blood gas parameters, ICU length of stay (LOS) and ICU mortality. RESULTS Seventy-two patients were included and equally distributed between the two studied groups. There were 66 males (92%). The mean age (± SD) was 69.7 ± 7.4 years ranging from 53 to 81 years. There were no differences between baseline characteristics of the two groups. Concomitant drugs used were also not significantly different between two groups. Mean duration of mechanical ventilation was not significantly different between ACET(+) and ACET(-) patients (10.6±7.8 days and 9.6±7.6 days, respectively; P = 0.61). Cases had a significantly decreased serum bicarbonate, arterial blood pH, and PaCO2 levels. We did not found any significant difference between the two studied groups in terms of ICU LOS. ICU mortality was also comparable between ACET(+) and ACET(-) groups (38% and 52%, respectively; P = 0.23). CONCLUSION Although our study some limitations, it suggests that the use of insufficient acetazolamide dosage (500 mg/d) ACET (500 mg per day) has no significant effect on the duration of mechanical ventilation in critically ill COPD patients requiring invasive mechanical ventilation. Our results should be confirmed or infirmed by further studies.
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Affiliation(s)
- Mabrouk Bahloul
- Intensive Care Unit, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Anis Chaari
- Intensive Care Unit, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Ahmed Tounsi
- Intensive Care Unit, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Olfa Turki
- Intensive Care Unit, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Kamilia Chtara
- Intensive Care Unit, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Chokri Ben Hamida
- Intensive Care Unit, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Hatem Ghadhoune
- Intensive Care Unit, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Hassen Dammak
- Intensive Care Unit, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Hedi Chelly
- Intensive Care Unit, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Mounir Bouaziz
- Intensive Care Unit, Habib Bourguiba University Hospital, Sfax, Tunisia
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Gargouri S, Fki-Berrajah L, Messedi E, Chaari A, Bouaziz M, Hammami A, Triki H, Karray-Hakim H. Survenue d'une épidémie de rubéole à Sfax en Tunisie en 2011- 2012 caractérisée par un nombre élevé de formes sévères. Virologie (Montrouge) 2014; 18:337-339. [PMID: 33065926 DOI: 10.1684/vir.2014.0581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Saba Gargouri
- Laboratoire de microbiologie, Faculté de médecine, Avenue Majida Bouleila, 3003, Sfax, Tunisie / CHU Habib Bourguiba de Sfax, rue El Ferdaous, 3029 Sfax, Tunisie
| | - Lamia Fki-Berrajah
- Laboratoire de microbiologie, Faculté de médecine, Avenue Majida Bouleila, 3003, Sfax, Tunisie / CHU Habib Bourguiba de Sfax, rue El Ferdaous, 3029 Sfax, Tunisie
| | - Emna Messedi
- Laboratoire de microbiologie, Faculté de médecine, Avenue Majida Bouleila, 3003, Sfax, Tunisie / CHU Habib Bourguiba de Sfax, rue El Ferdaous, 3029 Sfax, Tunisie
| | - Anis Chaari
- Service de Réanimation médicale, Faculté de médecine, Avenue Majida Bouleila, 3003, Sfax, Tunisie / CHU Habib Bourguiba de Sfax, rue El Ferdaous, 3029 Sfax, Tunisie
| | - Mounir Bouaziz
- Service de Réanimation médicale, Faculté de médecine, Avenue Majida Bouleila, 3003, Sfax, Tunisie / CHU Habib Bourguiba de Sfax, rue El Ferdaous, 3029 Sfax, Tunisie
| | - Adnene Hammami
- Laboratoire de microbiologie, Faculté de médecine, Avenue Majida Bouleila, 3003, Sfax, Tunisie / CHU Habib Bourguiba de Sfax, rue El Ferdaous, 3029 Sfax, Tunisie
| | - Henda Triki
- Laboratoire de Virologie, Faculté de médecine / Institut Pasteur de Tunis, 13 place Pasteur, BP 74 Tunis Belvedère, 1002 Tunis, Tunisie
| | - Héla Karray-Hakim
- Laboratoire de microbiologie, Faculté de médecine, Avenue Majida Bouleila, 3003, Sfax, Tunisie / CHU Habib Bourguiba de Sfax, rue El Ferdaous, 3029 Sfax, Tunisie
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Bahloul M, Chaari A, Dammak H, Ammar R, Medhioub F, Hamida CB, Chelly H, Bouaziz M. Efficacy of corticosteroid therapy in severe decompensation of chronic obstructive pulmonary disease requiring mechanical ventilation. Am J Ther 2014; 20:630-7. [PMID: 23344101 DOI: 10.1097/mjt.0b013e318269123e] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to analyze the efficacy of corticosteroids in severe acute decompensation of chronic obstructive pulmonary disease requiring mechanical ventilation and intensive care unit (ICU) admission. Pairwise retrospective case-control study with 1:1 matching. Patients were defined as cases when they received corticosteroids and as controls when they did not received any steroids. Patients were matched according to age, severity factors at admission represented by the PaO2/FiO2 ratio, and simplified acute physiology score. Thirty-four patients were included. There were 17 patients in the case group and 17 patients in the control group. There were 27 men (80%) and 7 women (20%). The mean age (±SD) was 70 ± 9 years with a range of 40-85 years. Thirty-two patients (94 %) were older than 60 years. The comparison between the 2 groups showed that they had the same epidemiological, clinical, and biological findings on ICU admission. Homodynamic parameters were also not significantly different between the 2 groups. Moreover, there is the same proportion of invasive mechanical ventilation use in 2 groups. Concomitant drugs used were also not significantly different between the 2 groups. Finally, the comparison of outcome between the steroid and steroid-free groups showed that mortality rate was not significantly different (64% vs. 58%, P = 0.72). However, systemic corticosteroid therapy was associated with a significant increase in a reduction in the duration of mechanical ventilation (P = 0.004) and a trend toward a shorter length of ICU stay (P = 0.053). Although the authors detected no significant difference in mortality rate at the time of discharge between steroid and streroid-free patients, this study confirms that systemic corticosteroid therapy in patients with chronic obstructive pulmonary disease exacerbations requiring mechanical ventilation is associated with a significant reduction in the duration of mechanical ventilation. Other studies are needed on this subject.
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Affiliation(s)
- Mabrouk Bahloul
- Service de Réanimation médicale, CHU Habib Bourguiba, Sfax, Tunisie
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Messedi E, Fki-Berrajah L, Gargouri S, Chouikha A, Chaari A, Bouaziz M, Jallouli H, Yahia AB, Hammami A, Triki H, Karray-Hakim H. Clinical epidemiological and molecular aspects of rubella outbreak with high number of neurological cases, Tunisia 2011-2012. J Clin Virol 2014; 61:248-54. [PMID: 25088766 DOI: 10.1016/j.jcv.2014.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 06/30/2014] [Accepted: 07/06/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND A large and unusually prolonged rubella outbreak occurred in Tunisia from April 2011 to July 2012 and was characterized by a high number of neurological cases. OBJECTIVES To describe the outbreak and to perform virus genotyping of isolated virus strains. STUDY DESIGN From January 2011 to December 2012, 5000 sera for serological diagnosis of acute rubella and 31 cerebrospinal fluid from patients with neurological symptoms were tested for the presence of rubella immunoglobulins G and M. Real-time PCR was performed on 49 throat swabs, 21 cerebrospinal fluid and 27 serum samples. Positive samples were assessed for virus genotyping by sequencing and the obtained sequences were compared to those previously isolated in the country. RESULTS Acute rubella was confirmed in 280 patients including 15 neonates, 217 children and adults with mild rash and 48 patients with severe rubella (mainly encephalitis, n = 39). Most of acquired rubella cases (60.7%) were aged over 12 years with a male predominance observed in the age group 12-25 years (79%). Females belonged essentially to the unvaccinated age groups under 12 and over 25 years. Among the 23 samples tested positive by real-time PCR, six could be genotyped and clustered with either the 1E genotype, previously detected in Tunisia, or the 2B genotype which has never been isolated in Tunisia before. CONCLUSIONS Gender and age distributions of the patients reflect the impact of the selective rubella vaccination program adopted in Tunisia since 2005. Genotype 1E continues to circulate and genotype 2B was probably recently introduced in Tunisia.
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Affiliation(s)
- Emna Messedi
- Microbiology Department, Habib Bourguiba Hospital/Faculty of Medicine, South University, Sfax, Tunisia
| | - Lamia Fki-Berrajah
- Microbiology Department, Habib Bourguiba Hospital/Faculty of Medicine, South University, Sfax, Tunisia
| | - Saba Gargouri
- Microbiology Department, Habib Bourguiba Hospital/Faculty of Medicine, South University, Sfax, Tunisia
| | - Anissa Chouikha
- Laboratory of Clinical Virology, WHO Regional Reference Laboratory for Measles & Rubella, Institut Pasteur, Tunis, Tunisia
| | - Anis Chaari
- Department of Intensive Care, Habib Bourguiba Hospital, Sfax, Tunisia
| | - Mounir Bouaziz
- Department of Intensive Care, Habib Bourguiba Hospital, Sfax, Tunisia
| | | | - Ahlem Ben Yahia
- Laboratory of Clinical Virology, WHO Regional Reference Laboratory for Measles & Rubella, Institut Pasteur, Tunis, Tunisia
| | - Adnene Hammami
- Microbiology Department, Habib Bourguiba Hospital/Faculty of Medicine, South University, Sfax, Tunisia
| | - Henda Triki
- Laboratory of Clinical Virology, WHO Regional Reference Laboratory for Measles & Rubella, Institut Pasteur, Tunis, Tunisia
| | - Héla Karray-Hakim
- Microbiology Department, Habib Bourguiba Hospital/Faculty of Medicine, South University, Sfax, Tunisia.
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Ksibi H, Chakroun - Walha O, Rejeb I, Mejdoub I, Abdelkefi M, Abid H, Chabchoub R, Chaari A, Mahfoudh A, Rekik N. SFP P-178 - Traumatisme thoracique de l’enfant : aspect épidémiologique et pronostique. Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)72148-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ksibi H, Chakroun - Walha O, Kammoun L, Mejdoub I, Rejeb I, Abdelkefi M, Abid H, Chabchoub R, Chaari A, Mahfoudh A, Rekik N. SFP P-179 - Pronostic des enfants traumatisés crâniens admis aux urgences : Analyse multivariée de 410 cas. Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)72149-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bahloul M, Chaari A, Tounsi A, Baccouche N, Abid H, Chtara K, Ben Hamida C, Ghadhoune H, Dammak H, Chelly H, Bouaziz M. Incidence and impact outcome of pulmonary embolism in critically ill patients with severe exacerbation of chronic obstructive pulmonary diseases. The Clinical Respiratory Journal 2014; 9:270-7. [DOI: 10.1111/crj.12131] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 02/19/2014] [Accepted: 03/02/2014] [Indexed: 01/11/2023]
Affiliation(s)
- Mabrouk Bahloul
- Service de Réanimation Médicale; CHU Habib Bourguiba; Sfax Tunisie
| | - Anis Chaari
- Service de Réanimation Médicale; CHU Habib Bourguiba; Sfax Tunisie
| | - Ahmed Tounsi
- Service de Réanimation Médicale; CHU Habib Bourguiba; Sfax Tunisie
| | - Najeh Baccouche
- Service de Réanimation Médicale; CHU Habib Bourguiba; Sfax Tunisie
| | - Hanen Abid
- Department of Radiology; CHU Habib Bourguiba; Sfax Tunisie
| | - Kamilia Chtara
- Service de Réanimation Médicale; CHU Habib Bourguiba; Sfax Tunisie
| | | | - Hatem Ghadhoune
- Service de Réanimation Médicale; CHU Habib Bourguiba; Sfax Tunisie
| | - Hassen Dammak
- Service de Réanimation Médicale; CHU Habib Bourguiba; Sfax Tunisie
| | - Hedi Chelly
- Service de Réanimation Médicale; CHU Habib Bourguiba; Sfax Tunisie
| | - Mounir Bouaziz
- Service de Réanimation Médicale; CHU Habib Bourguiba; Sfax Tunisie
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Rejeb I, Regaieg K, Chakroun O, Hammami Z, Chaari L, Ghnainia T, Nasri A, Ksibi H, Chaari A, Maatoug S, Rekik N. Intoxication aiguë collective au phosphure d’aluminium. Réanimation 2014. [DOI: 10.1007/s13546-013-0813-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
We to report clinical biological and radiologic features of rubella encephalitis in childhood and assess its prognostic impact. Our retrospective study was conducted in an intensive care unit of a university hospital in Sfax, Tunisia. Twenty-one children (age range, 1-15 years) were included. Median age was 9 years (lower and upper quartiles, 7-11 years). On admission, generalized maculopapular eruption was found in 17 cases (81%). Median Glasgow Coma Scale score was 7 (lower and upper quartiles, 7-8). Twenty patients (95.2%) experienced at least 1 episode of seizures. Sixteen patients (76.2%) developed a status epilepticus. The result for enzyme-linked immunosorbent assay detecting anti-rubella immunoglobulin (M) was positive in the serum and in the cerebrospinal fluid samples for all our patients. Magnetic resonance imaging (MRI) of the brain was performed on admission for 3 patients (14.3%) and within a median of 4 days (lower and upper quartiles, 2-6 days) for 8 patients. The test was normal in 6 cases. Two deaths were recorded (9.5%). Survivors had no neurological sequelae 6 months after intensive care unit discharge.
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Affiliation(s)
- Anis Chaari
- 1Department of Intensive Care, Habib Bourguiba University Hospital, Sfax, Tunisia
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Chaari A, Kssibi H, Zribi W, Medhioub F, Chelly H, Algia NB, Hamida CB, Bahloul M, Bouaziz M. Ventilator-associated pneumonia in trauma patients with open tracheotomy: Predictive factors and prognosis impact. J Emerg Trauma Shock 2013; 6:246-51. [PMID: 24339656 PMCID: PMC3841530 DOI: 10.4103/0974-2700.120364] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 09/16/2012] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE To assess the predictive factors of ventilator associated pneumonia (VAP) occurrence following open tracheotomy in trauma patients. MATERIALS AND METHODS We conducted an observational, prospective study over 15 months, between 01/08/2010 and 30/11/2011. All trauma patients (except those with cervical spine trauma), older than 15 years, undergoing open tracheotomy during their ICU stay were included. All episode of VAP following tracheotomy were recorded. Predictive factor of VAP onset were studied. RESULTS We included 106 patients. Mean age was 37.9 ± 15.5 years. Mean Glasgow coma Scale (GCS) was 8.5 ± 3.7 and mean Injury Severity Score (ISS) was 53.1 ± 23.8. Tracheotomy was performed for 53 patients (50%) because of prolonged ventilation whereas 83 patients (78.3%) had tracheotomy because of projected long mechanical ventilation. Tracheotomy was performed within 8.6 ± 5.3 days. Immediate complications were bleeding events (22.6%) and barotrauma (0.9%). Late complications were stomal infection (28.3%) and VAP (52.8%). In multivariate analysis, independent factors predicting VAP onset were delayed tracheotomy (OR = 0.041; CI95% [1.02-7.87]; P = 0.041) and stomal infection (OR = 3.04; CI95% [1.02-9.93]; P = 0.045). Thirty three patients died in ICU (31.1%) without significant impact of VAP on mortality. CONCLUSION Late tracheotomy and stomal infection are independent factors predicting VAP onset after open tracheotomy in trauma patients. The occurrence of VAP prolongers mechanical ventilation duration and intensive care unit (ICU) length of stay (LOS) but doesn't increase mortality.
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Affiliation(s)
- Anis Chaari
- Department of Intensive Care, Habib Bourguiba University Hospital, Sfax, Tunisia
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Chaari A, Mnif B, Bahloul M, Mahjoubi F, Chtara K, Turki O, Gharbi N, Chelly H, Hammami A, Bouaziz M. Acinetobacter baumannii ventilator-associated pneumonia: epidemiology, clinical characteristics, and prognosis factors. Int J Infect Dis 2013; 17:e1225-8. [DOI: 10.1016/j.ijid.2013.07.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 06/27/2013] [Accepted: 07/19/2013] [Indexed: 01/31/2023] Open
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Abstract
The evolution of the shape and size of a bubble around a nanowire immersed in a liquid can be studied as a light absorption problem and consequently can directly be related to the distribution of the temperature around the nanowire. Such a physical phenomenon can be seen as the photo-thermal coupled problem of nanowire illuminated by an electromagnetic wave. The resolution of the multiphysic model allows to compute the variation of the temperature and consequently the evolution of the created bubble. An advanced adaptive remeshing process is developed to solve the numerical model using Finite Element Method. An optimization process is applied to solve the coupled problem and is used to detect the size of the produced bubble around nanowire under illumination. The adaptive remeshing process permits to control the convergence of the numerical solution relatively to the evolution of the temperature field. The process allows to study the evolution of the shape and size of the bubble. We show the influence of the laser parameters on the evolution of the bubble. The informations about the geometry of the nanowire can be deduced from the size and shape of the bubble.
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Chakroun W, Rejeb I, Kammoun L, Nasri A, Ghnainia T, Chaari A, Ksibi H, Chaari A, Bouaziz M, Rekik N. Évaluation du stress chez le personnel des urgences : enquête dans un service d’urgences tunisien. ACTA ACUST UNITED AC 2013; 32:565-71. [DOI: 10.1016/j.annfar.2013.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 06/18/2013] [Indexed: 12/18/2022]
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Bouaziz M, Chaari A, Turki O, Dammak H, Chelly H, Ammar R, Nasri A, Ben Algia N, Bahloul M, Ben Hamida C. Acute renal failure and pregnancy: a seventeen-year experience of a Tunisian intensive care unit. Ren Fail 2013; 35:1210-5. [PMID: 24021030 DOI: 10.3109/0886022x.2013.819767] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To describe the epidemiologic features of acute renal failure related to pregnancy (PRARF) and to evaluate its prognostic impact. METHODS Retrospective study conducted in a Tunisian intensive care unit over a period of 17 years (1995-2011). Women were included if they were more than 20 weeks pregnant and were admitted to the ICU during pregnancy or immediately (<7 d) post partum. PRARF was defined by a serum creatinine level >0.8 mg/dL and was classified as mild (0.9 to 1.4 mg/dL), moderate (1.5 to 2.9 mg/dL) or severe (>3 mg/dL). RESULTS Five hundred and fifty patients were included. Mean age was 31 ± 6 years. Mean SOFA score was 4 ± 3. PRARF was diagnosed in 313 patients (56.9%). ARF was mild in 215 cases (39.1%), moderate in 65 cases (11.8%) and severe in 33 cases (6%). Main causes leading to this complication were preeclampsia (66.5%) and acute hemorrhage (27.8%). Only two patients (0.4%) developed chronic renal failure and needed long-term dialysis. Patients who developed this complication had higher SOFA score (4.7 ± 3.5 vs. 3.2 ± 2.1; p < 0.001). Thirty-three patients (6%) died in the ICU. The rate of ICU mortality was significantly higher in patients with PRARF (9.3 vs. 1.7%; p < 0.001). CONCLUSIONS PRARF is associated with higher mortality. Thus, appropriate monitoring of pregnancies is needed in order to prevent its onset by an early and prompt management of the underlying risk factors.
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Affiliation(s)
- Mounir Bouaziz
- Intensive Care Unit, Habib Bourguiba University Hospital , Tunisia
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Chaari A, Ghadoun H, Ben Algia N, Bahloul M, Bouaziz M. La mucormycose : une cause rare d’exophtalmie unilatérale. J Mycol Med 2013; 23:140-3. [DOI: 10.1016/j.mycmed.2013.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 03/13/2013] [Accepted: 04/09/2013] [Indexed: 11/26/2022]
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Bahloul M, Chaari A, Dammak H, Samet M, Chtara K, Chelly H, Ben Hamida C, Kallel H, Bouaziz M. Pulmonary edema following scorpion envenomation: Mechanisms, clinical manifestations, diagnosis and treatment. Int J Cardiol 2013; 162:86-91. [DOI: 10.1016/j.ijcard.2011.10.013] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Revised: 08/03/2011] [Accepted: 10/15/2011] [Indexed: 10/15/2022]
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Mnif B, Ktari S, Chaari A, Medhioub F, Rhimi F, Bouaziz M, Hammami A. Nosocomial dissemination of Providencia stuartii isolates carrying bla OXA-48, bla PER-1, bla CMY-4 and qnrA6 in a Tunisian hospital. J Antimicrob Chemother 2012; 68:329-32. [PMID: 23014719 DOI: 10.1093/jac/dks386] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES To report an outbreak due to Providencia stuartii isolates carrying bla(OXA-48), bla(PER-1), bla(CMY-4) and qnrA6 in a Tunisian hospital in 2011. METHODS Eight intensive care unit (ICU) patients infected/colonized by extended-spectrum β-lactamase (ESBL)-producing P. stuartii between March and May 2011 were included. Molecular epidemiology was studied by PFGE. Antibiotic resistance genes were analysed by PCR and sequencing and the plasmid incompatibility group by a PCR-based replicon typing scheme. RESULTS Eight patients were colonized with ESBL-producing P. stuartii isolates. All these isolates were clonally related and found to carry bla(OXA-48), bla(PER-1), bla(CMY-4), qnrA6 and aac-6'-Ib genes on the same self-conjugative IncA/C plasmid. The same strain was also cultured from environmental samples in the ICU. All these isolates were susceptible to carbapenems. Only one colonized patient developed P. stuartii pleurisy and was effectively treated with imipenem alone. CONCLUSIONS This is the first report of an outbreak due to P. stuartii isolates carrying bla(OXA-48) in Tunisia. The simultaneous expression of various resistance genes (bla(OXA-48), bla(CMY-4), bla(PER-1), qnrA and aac-6'-Ib) by P. stuartii isolates is alarming.
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Affiliation(s)
- Basma Mnif
- Laboratory of Microbiology, University Hospital Center of Habib Bourguiba, Sfax, Tunisia.
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Bahloul M, Chaari A, Dammak H, Medhioub F, Abid L, Ksibi H, Haddar S, Kallel H, Chelly H, Hamida CB, Bouaziz M. Post-traumatic pulmonary embolism in the intensive care unit. Ann Thorac Med 2012; 6:199-206. [PMID: 21977064 PMCID: PMC3183636 DOI: 10.4103/1817-1737.84773] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Accepted: 05/12/2011] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE: To determine the predictive factors, clinical manifestations, and the outcome of patients with post-traumatic pulmonary embolism (PE) admitted in the intensive care unit (ICU). METHODS: During a four-year prospective study, a medical committee of six ICU physicians prospectively examined all available data for each trauma patient in order to classify patients according to the level of clinical suspicion of pulmonary thromboembolism. During the study period, all trauma patients admitted to our ICU were classified into two groups. The first group included all patients with confirmed PE; the second group included patients without clinical manifestations of PE. The diagnosis of PE was confirmed either by a high-probability ventilation/perfusion (V/Q) scan or by a spiral computed tomography (CT) scan showing one or more filling defects in the pulmonary artery or its branches. RESULTS: During the study period, 1067 trauma patients were admitted in our ICU. The diagnosis of PE was confirmed in 34 patients (3.2%). The mean delay of development of PE was 11.3 ± 9.3 days. Eight patients (24%) developed this complication within five days of ICU admission. On the day of PE diagnosis, the clinical examination showed that 13 patients (38.2%) were hypotensive, 23 (67.7%) had systemic inflammatory response syndrome (SIRS), three (8.8%) had clinical manifestations of deep venous thrombosis (DVT), and 32 (94%) had respiratory distress requiring mechanical ventilation. In our study, intravenous unfractionated heparin was used in 32 cases (94%) and low molecular weight heparin was used in two cases (4%). The mean ICU stay was 31.6 ± 35.7 days and the mean hospital stay was 32.7 ± 35.3 days. The mortality rate in the ICU was 38.2% and the in-hospital mortality rate was 41%. The multivariate analysis showed that factors associated with poor prognosis in the ICU were the presence of circulatory failure (Shock) (Odds ratio (OR) = 9.96) and thrombocytopenia (OR = 32.5).Moreover, comparison between patients with and without PE showed that the predictive factors of PE were: Age > 40 years, a SAPS II score > 25, hypoxemia with PaO2/FiO2 < 200 mmHg, the presence of spine fracture, and the presence of meningeal hemorrhage. CONCLUSION: Despite the high frequency of DVT in post-traumatic critically ill patients, symptomatic PE remains, although not frequently observed, because systematic screening is not performed. Factors associated with poor prognosis in the ICU are the presence of circulatory failure (shock) and thrombocytopenia. Predictive factors of PE are: Age > 40 years, a SAPS II score > 25, hypoxemia with PaO2/FiO2 < 200, the presence of a spine fracture, and the presence of meningeal hemorrhage. Prevention is highly warranted.
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Affiliation(s)
- Mabrouk Bahloul
- Department of Intensive Care, Hedi Chaker, University Hospital Sfax, Tunisia
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Bahloul M, Chaari A, Dammak H, Bouaziz M. "Pulmonary edema induced by scorpion venom: evidence of cardiogenic nature". Int J Cardiol 2012; 158:292-3. [PMID: 22609008 DOI: 10.1016/j.ijcard.2012.04.083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 04/14/2012] [Indexed: 10/28/2022]
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Bahloul M, Samet M, Chaari A, Ben Aljia N, Ben Mbarek MN, Chelly H, Dammak H, Ben Hamida C, Rekik N, Kallel H, Bouaziz M. [Use of catecholamines for shock. A continuous debate!]. Tunis Med 2012; 90:291-299. [PMID: 22535343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Hypotension and shocks are frequently observed in patients requiring admission in ICU. However, the optimal adrenergic support in shock is controversial. AIM To perform a descriptive approach of the current use of catecholamine in a medico-surgical ICU in patients with schoks. METHODS Our study is prospective over 3 month period. Were included all patients admitted in our ICU during the study period's. We compared the populations with and without catecholamine, we analysed the catecholamine selected in various clinical settings and we studied the impact of the use of catecholamine on the patient outcomes. RESULTS During the study's period, 226 patients were hospitalized in our service and were the subject of this study. The median age (± SD) was of 47± 24 years. During their hospitalization in the ICU, 132 patients (58.4%) presented a shock. The cardiogenic shock and the hypovolemic shock were the most observed (37.8% and 35.6% respectively). Hundred thirty patients (57.5%) received catecholamines during their stay in ICU. Eighty four patients (64.6% of the patients having received catecholamines) had received dopamine. Sixty two patients (47.7% of the patients having received catecholamines) had received dobutamine, 63 patients (48.5%) had received epinephrine and 22 patients (16.9%) had received norepinephrine. The mean's period of catecholamines use was 5 ± 4 days. Among drugs proposed in order to manage patients with cardiogenic shock, dobutamine was chosen as the first choice agent in 62% of the cases. Among drugs proposed in order to manage patients with septic shock, Dopamine was chosen as the first choice agent in 85.7 % of the cases. In our study the patients of the class C or D in the Knauss classification are significantly predisposed to receive catecholamines during their ICU stay (OR: 5.3 ; IC 95% : 1.7 - 5.7).Moreover, the needing of catecholamine use is strongly associated with high mortality (OR: 16,8; IC 95% : 16.4 - 49.2). CONCLUSION The choice of catecholamines is a matter of debate for critically ill patients. The use of catecholamines is a clinical marker of severity and provider of mortality.
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Affiliation(s)
- Mabrouk Bahloul
- Department of Intensive Care, Habib Bourguiba University, Sfax, Tunisia
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Bahloul M, Chaari A, Dammak H, Medhioub F, Abid L, Chtourou K, Rekik N, Chelly H, Kallel H, Bouaziz M. [Cardiogenic pulmonary edema following β2 agonist infusion for acute, severe asthma]. Ann Cardiol Angeiol (Paris) 2012; 64:305-8. [PMID: 22436636 DOI: 10.1016/j.ancard.2012.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 01/26/2012] [Indexed: 11/17/2022]
Abstract
We report the case of a severe acute pulmonary edema secondary to the administration of salbutamol to a patient admitted for severe asthma. The diagnosis of acute pulmonary edema was suspected on the clinical examination, chest radiography, biological (plasmatic Pro-BNP rate) and echocardiographic findings. Rapid improvement under dobutamine and mechanical ventilation argue in favour of cardiogenic pulmonary edema. The young age of our patient, the absence of history of cardiovascular disease and the chronology of this complication onset regarded to salbutamol infusion could suggest β2 agonist involvement in this event. The improvement of cardiac function on echocardiography and the normal results obtained with myocardial perfusion scintigraphy performed 35 days later show the left ventricular reversible dysfunction.
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Affiliation(s)
- M Bahloul
- Service de réanimation médicale, CHU Habib Bourguiba, route el Ain Km 1, 3029 Sfax, Tunisie.
| | - A Chaari
- Service de réanimation médicale, CHU Habib Bourguiba, route el Ain Km 1, 3029 Sfax, Tunisie
| | - H Dammak
- Service de réanimation médicale, CHU Habib Bourguiba, route el Ain Km 1, 3029 Sfax, Tunisie
| | - F Medhioub
- Service de réanimation médicale, CHU Habib Bourguiba, route el Ain Km 1, 3029 Sfax, Tunisie
| | - L Abid
- Service de cardiologie, CHU Hédi Chaker, Sfax, Tunisie
| | - K Chtourou
- Service de médecine nucléaire, CHU Habib Bourguiba, Sfax, Tunisie
| | - N Rekik
- Service de réanimation médicale, CHU Habib Bourguiba, route el Ain Km 1, 3029 Sfax, Tunisie
| | - H Chelly
- Service de réanimation médicale, CHU Habib Bourguiba, route el Ain Km 1, 3029 Sfax, Tunisie
| | - H Kallel
- Service de réanimation médicale, CHU Habib Bourguiba, route el Ain Km 1, 3029 Sfax, Tunisie
| | - M Bouaziz
- Service de réanimation médicale, CHU Habib Bourguiba, route el Ain Km 1, 3029 Sfax, Tunisie
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Bahloul M, Chaari A, Ben Algia N, Bouaziz M. Pulmonary embolism in intensive care unit “literature review”. Trends in Anaesthesia and Critical Care 2012. [DOI: 10.1016/j.tacc.2011.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Abstract
PURPOSE To identify factors correlated with poor outcome and factors correlated with acute kidney injury (AKI) onset in critically A(H1N1) infected patients. METHODS All patients admitted for respiratory distress due to a confirmed infection by A(H1N1) virus were included retrospectively. RESULTS Thirty-four patients were included. Mean age was 37.3 ± 20.8 years. Independent factors correlated to mortality in multivariate analysis were shock [OR = 32.52, CI95% (1.29-816.3); p = 0.034], AKI [OR = 31.12, CI95% (1.3-746.5); p = 0.034] and hyperglycaemia over than 5.7 mmol/l on admission [OR = 74, CI95% (1.01-5495); p = 0.049]. Only age over 30 years was identified as an independent factor correlated with the onset of AKI [OR = 18, CI95% (1.04-312.41); p = 0.047] in multivariate analysis. CONCLUSION AKI, as well as hypotension, is an independent factor correlated with mortality. Its onset is usually linked to multi-organ failure. Advanced age is an important risk factor for renal dysfunction in this group of patients.
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Affiliation(s)
- Anis Chaari
- Department of Intensive Care, Habib Bourguiba University Hospital, Sfax, Tunisia.
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Bahloul M, Chaari A, Chabchoub I, Medhyoub F, Dammak H, Kallel H, Ksibi H, Haddar S, Rekik N, Chelly H, Bouaziz M. Outcome analysis and outcome predictors of traumatic head injury in childhood: Analysis of 454 observations. J Emerg Trauma Shock 2011; 4:198-206. [PMID: 21769206 PMCID: PMC3132359 DOI: 10.4103/0974-2700.82206] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Accepted: 11/29/2010] [Indexed: 12/02/2022] Open
Abstract
Aim: To determine factors associated with poor outcome in children suffering traumatic head injury (HI). Materials and Methods: A retrospective study over an 8-year period including 454 children with traumatic HI admitted in the Intensive Care Unit of a university hospital (Sfax-Tunisia). Basic demographic, clinical, biological and radiological data were recorded on admission and during the ICU stay. Prognosis was defined according Glasgow outcome scale (GOS) performed after hospital discharge by ICU and pediatric physicians. Results: There were 313 male (68.9%) and 141 female patients. Mean age (±SD) was 7.2±3.8 years, the main cause of trauma was traffic accidents (69.4%). Mean Glasgow coma scale (GCS) score was 8±3, mean injury severity score (ISS) was 26.4±8.6, mean pediatric trauma score (PTS) was 4±2 and mean pediatric risk of mortality (PRISM) was 11.1±8. The GOS performed within a mean delay of 7 months after hospital discharge was as follow: 82 deaths (18.3%), 5 vegetative states (1.1%), 15 severe disabilities (3.3%), 71 moderate disabilities (15.6%) and 281 good recoveries (61.9%). Multivariate analysis showed that factors associated with poor outcome (death, vegetative state or severe disability) were: PRISM ≥24 (P=0.03; OR: 5.75); GCS ≤8 (P=0.04; OR:2.42); Cerebral edema (P=0.03; OR:2.23); lesion type VI according to Traumatic Coma Data Bank Classification (P=0.002; OR:55.95); Hypoxemia (P=0.02; OR:2.97) and sodium level >145 mmol/l (P=0.04; OR: 4.41). Conclusions: A significant proportion of children admitted with HI were found to have moderate disability at follow-up. We think that improving prehospital care, establishing trauma centers and making efforts to prevent motor vehicle crashes should improve the prognosis of HI in children.
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Affiliation(s)
- Mabrouk Bahloul
- Department of Intensive Care, Habib Bourguiba University hospital Sfax, Tunisia
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