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Mounier R, Diop S, Kallel H, Constantin JM, Roujansky A. Tidal volume in mechanically ventilated patients: Searching for Cinderella's shoe rather than 6 mL/kg for all. Anaesth Crit Care Pain Med 2024; 43:101356. [PMID: 38365168 DOI: 10.1016/j.accpm.2024.101356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/25/2024] [Accepted: 01/30/2024] [Indexed: 02/18/2024]
Affiliation(s)
- R Mounier
- Department of Anaesthesiology and Critical Care, Georges Pompidou European Hospital, Paris, France; Université Paris, Paris, France; INSERM U955, Équipe 15, Institut Mondor de la Recherche Biomédicale, Université Paris-Est-Créteil, France.
| | - S Diop
- Department of Anesthesiology, Marie Lannelongue Hospital, Paris Saint Joseph Hospital, 133 Avenue de la Résistance, 92350 Le Plessis Robinson, France; Cardiothoracic Intensive Care Unit. Marie Lannelongue Hospital, Paris Saint Joseph Hospital, 133 Avenue de la Résistance, 92350 Le Plessis Robinson, France
| | - H Kallel
- Réanimation Polyvalente, Centre Hospitalier de Cayenne, Cayenne, French Guiana; Tropical Biome et Immunopathologie CNRS UMR-9017, Inserm U 1019, Université de Guyane, French Guiana
| | - J M Constantin
- Department of Anaesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France; Sorbonne University, GRC 29, AP-HP, DMU DREAM, Paris, France
| | - A Roujansky
- Réanimation Polyvalente, Centre Hospitalier de Cayenne, Cayenne, French Guiana; Tropical Biome et Immunopathologie CNRS UMR-9017, Inserm U 1019, Université de Guyane, French Guiana
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Yacoub A, Ayadi A, Ayed W, Ayari S, Chebbi S, Magroun I, Ben Afia L, Mersni M, Mechergui N, Brahim D, Ben Said H, Bahri G, Youssef I, Ladhari N, Mziou N, Grassa A, M'rad M, Khessairi N, Krir A, Chihaoui M, Mahjoub S, Bahlous A, Jridi M, Cherif Y, Derbal S, Chebbi D, Hentati O, Ben Dahmen F, Abdallah M, Hamdi I, Sahli F, Ouerdani Y, Mnekbi Y, Abaza H, Ajmi M, Guedria A, Randaline A, Ben Abid H, Gaddour N, Maatouk A, Zemni I, Gara A, Kacem M, Maatouk I, Ben Fredj M, Abroug H, Ben Nasrallah C, Dhouib W, Bouanene I, Sriha A, Mahmoudi M, Gharbi G, Khsiba A, Azouz M, Ben Mohamed A, Yakoubi M, Medhioub M, Hamzaoui L, Azouz M, Ben Attig Y, Hamdi S, Essid R, Ben Jemia E, Rezgui B, Boudaya MS, Hassine H, Dabbabi H, Fradi Y, Cherif D, Lassoued I, Yacoub H, Kchir H, Maamouri N, Khairi W, Ben Ammar H, Abaza H, Chelbi E, Merhaben S, Neffati W, Ajmi M, Tarchalla S, Boughzala S, Gazzeh M, Gara S, Labidi A, Touati H, Nefzi AM, Ben Mustpha N, Fekih M, Serghini M, Boubaker J, Zouiten L, Driss A, Meddeb N, Driss I, Walha S, Ben Said H, Bel Hadj Mabrouk E, Zaimi Y, Mensi A, Trad N, Ayadi S, Said Y, Mouelhi L, Dabbèche R, Belfkih H, Bani M, Moussa A, Souissi S, Trabelsi Werchfeni B, Chelly S, Ezzi O, Ammar A, Besbes M, Njah M, Mahjoub M, Ghali H, Neffati A, Bhiri S, Bannour R, Ayadi S, Khouya FE, Kamel A, Hariz E, Aidani S, Kefacha S, Ben Cheikh A, Said H, Dogui S, Atig A, Gara A, Ezzar S, Ben Fradj M, Bouanène I, M'kadmi H, Farhati M, Dakhli N, Nalouti K, Chanoufi MB, Abouda SH, Louati C, Zaaimi Y, Dabbeche R, Hermi A, Saadi A, Mokaddem S, Boussaffa H, Bellali M, Zaghbib S, Ayed H, Bouzouita A, Derouiche A, Allouche M, Chakroun M, Ben Slama R, Gannoun N, Kacem I, Tlili G, Kahloul M, Belhadj Chabbah N, Douma F, Bouhoula M, Chouchene A, Aloui A, Maoua M, Brahem A, Kalboussi H, El Maalel O, Chatti S, Jaidane M, Naija W, Mrizek N, Sellami I, Feki A, Hrairi A, Kotti N, Baklouti S, Jmal Hammami K, Masmoudi ML, Hajjaji M, Naaroura A, Ben Amar J, Ouertani H, Ben Moussa O, Zaibi H, Aouina H, Ben Jemaa S, Gassara Z, Ezzeddine M, Kallel MH, Fourati H, Akrout R, Kallel H, Ayari M, Chehaider A, Souli F, Abdelaali I, Ziedi H, Boughzala C, Haouari W, Chelli M, Soltani M, Trabelsi H, Sahli H, Hamdaoui R, Masmoudi Y, Halouani A, Triki A, Ben Amor A, Makni C, Eloillaf M, Riahi S, Tlili R, Jmal L, Belhaj Ammar L, Nsibi S, Jmal A, Boukhzar R, Somai M, Daoud F, Rachdi I, Ben Dhaou B, Aydi Z, Boussema F, Frikha H, Hammami R, Ben Cheikh S, Chourabi S, Bokri E, Elloumi D, Hasni N, Hamza S, Berriche O, Dalhoum M, Jamoussi H, Kallel L, Mtira A, Sghaier Z, Ghezal MA, Fitouri S, Rhimi S, Omri N, Rouiss S, Soua A, Ben Slimene D, Mjendel I, Ferchichi I, Zmerli R, Belhadj Mabrouk E, Debbeche R, Makhloufi M, Chouchane A, Sridi C, Chelly F, Gaddour A, Kacem I, Chatti S, Mrizak N, Elloumi H, Debbabi H, Ben Azouz S, Marouani R, Cheikh I, Ben Said M, Kallel M, Amdouni A, Rejaibi N, Aouadi L, Zaouche K, Khouya FE, Aidani S, Khefacha S, Jelleli N, Sakly A, Zakhama W, Binous MY, Ben Said H, Bouallegue E, Jemmali S, Abcha S, Wahab H, Hmida A, Mabrouk I, Mabrouk M, Elleuch M, Mrad M, Ben Safta N, Medhioub A, Ghanem M, Boughoula K, Ben Slimane B, Ben Abdallah H, Bouali R, Bizid S, Abdelli MN, Ben Nejma Y, Bellakhal S, Antit S, Bourguiba R, Zakhama L, Douggui MH, Bahloul E, Dhouib F, Turki H, Sabbah M, Baghdadi S, Trad D, Bellil N, Bibani N, Elloumi H, Gargouri D, Ben Said M, Hamdaoui R, Chokri R, Kacem M, Ben Rejeb M, Miladi A, Kooli J, Touati S, Trabelsi S, Klila M, Rejeb H, Kammoun H, Akrout I, Greb D, Ben Abdelghaffar H, Hassene H, Fekih L, Smadhi H, Megdiche MA, Ksouri J, Kasdalli H, Hayder A, Gattoussi M, Chérif L, Ben Saida F, Gueldich M, Ben Jemaa H, Dammak A, Frikha I, Saidani A, Ben Amar J, Aissi W, Chatti AB, Naceur I, Ben Achour T, Said F, Khanfir M, Lamloum M, Ben Ghorbel I, Houman M, Cherif T, Ben Mansour A, Daghfous H, Slim A, Ben Saad S, Tritar F, Naffeti W, Abdellatif J, Ben Fredj M, Selmi M, Kbir GH, Maatouk M, Jedidi L, Taamallah F, Ben Moussa M, Halouani L, Rejeb S, Khalffalah N, Ben Ammar J, Hedhli S, Azouz MM, Chatti S, Athimni Z, Bouhoula M, Elmaalel O, Mrizak N, Maalej M, Kammoun R, Gargouri F, Sallemi S, Haddar A, Masmoudi K, Oussaifi A, Sahli A, Bhouri M, Hmaissi R, Friha M, Cherif H, Baya C, Triki M, Yangui F, Charfi MR, Ben Hamida HY, Karoui S, Aouini F, Hajlaoui A, Jlassi H, Sabbah M, Fendri MN, Kammoun N, Fehri S, Nouagui H, Harzalli A, Snène H, Belakhal S, Ben Hassine L, Labbene I, Jouini M, Kalboussi S, Ayedi Y, Harizi C, Skhiri A, Fakhfakh R, Jelleli B, Belkahla A, Fejjeri M, Zeddini M, Mahjoub S, Nouira M, Frih N, Debiche S, Blibech H, Belhaj S, Mehiri N, Ben Salah N, Louzir B, Kooli J, Bahri R, Chaka A, Abdenneji S, Majdoub Fehri S, Hammadi J, Dorgham D, Hriz N, Kwas H, Issaoui N, Jaafoura S, Bellali H, Shimi M, Belhaj Mabrouk E, Sellami R, Ketata I, Medi W, Mahjoub M, Ben Yacoub S, Ben Chaabene A, Touil E, Ben Ayed H, Ben Miled S, El Zine E, Khouni H, Ben Kadhi S, Maatoug J, Boulma R, Rezgui R, Boudokhane M, Jomni T, Chamekh S, Aissa S, Touhiri E, Jlaiel N, Oueslati B, Maaroufi N, Aouadi S, Belkhir S, Daghfous H, Merhaben S, Dhaouadi N, Ounaes Y, Chaker K, Yaich S, Marrak M, Bibi M, Mrad Dali K, Sellami A, Nouira Y, Sellami S, Anane I, Trabelsi H, Ennaifer R, Benzarti Z, Bouchabou B, Hemdani N, Nakhli A, Cherif Y, Abdelkef M, Derbel K, Barkous B, Yahiaoui A, Sayhi A, Guezguez F, Rouatbi S, Racil H, Ksouri C, Znegui T, Maazaoui S, Touil A, Habibech S, Chaouech N, Ben Hmid O, Ismail S, Chouaieb H, Chatti M, Guediri N, Belhadj Mohamed M, Bennasrallah C, Bouzid Y, Zaouali F, Toumia M, El Khemiri N, El Khemiri A, Sfar H, Farhati S, Ben Chehida F, Yamoun R, Braham N, Hamdi Y, Ben Mansour A, Mtir M, Ayari M, Toumia M, Rouis S, Sakly H, Nakhli R, Ben Garouia H, Chebil D, Hannachi H, Merzougui L, Samet S, Hrairi A, Mnif I, Hentati O, Bouzgarrou L, Souissi D, Boujdaria R, Kadoussi R, Rejeb H, Ben Limem I, Ben Salah I, Greb D, Ben Abdelghaffar H, Smadhi H, Laatiri H, Manoubi SA, Gharbaoui M, Hmandi O, Zhioua M, Taboubi F, Hamza Y, Hannach W, Jaziri H, Gharbi R, Hammami A, Dahmani W, Ben Ameur W, Ksiaa M, Ben Slama A, Brahem A, Elleuch N, Jmaa A, Kort I, Jlass S, Benabderrahim S, Turki E, Belhaj A, Kebsi D, Ben Khelil M, Rmadi N, Gamaoun H, Alaya Youzbechi F, Brahim T, Boujnah S, Abid N, Gader N, Kalboussi S, Ben Sassi S, Loukil M, Ghrairi H, Ben Said N, Mrad O, Ferjaoui M, Hedhli L, Ben Kaab B, Berriche A, Charfi R, Mourali O, Smichi I, Bel Haj Kacem L, Ksentini M, Aloui R, Ferchichi L, Nasraoui H, Maoua M, Chérif F, Belil Y, Ayed MA, Alloulou Y, Belhadj S, Daghfous J, Mehiri N, Louzir B, Abbes A, Ghrab A, Chermiti A, Akacha A, Mejri O, Debbiche A, Yahiaoui C, Binous M, Tissaoui A, Mekni K, El Fekih C, Said MA, Chtioui S, Mestiri S, Smaoui H, Ben Hamida S, Haddar A, Mrizek N, Gares N, Zaibi A, Bouazizi N, Gallas S, Lachhab A, Belhadj M, Hadj Salem N, Garrouch A, Mezgar Z, Khrouf M, Abbassi H, Souissi D, Hamra I, Ben Mustapha N, Abessi I, Boubaker F, Bouchareb S, ElOmma Mrabet H, Touil I, Boussoffara L, Knani J, Boudawara N, Alaya W, Sfar MH, Fekih S, Snène H, Boudawara N, Gargouri I, Benzarti W, Knaz A, Abdelghani A, Aissa S, Hayouni A, Mejri I, Kacem M, Mhamdi S, Daboussi S, Aichaouia C, Moatemri Z, Chaachou A, Fsili R, Ben Ghezala H, Ben Jazia A, Brahmi N. 2022 TUNISIAN NATIONAL CONGRESS OF MEDICINE ABSTRACTS. Tunis Med 2023; 101:62-64. [PMID: 37682263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Indexed: 09/09/2023]
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Fremery A, Piednoir P, Debuire É, Pujo JM, Kallel H, Rollé A, Portecop P, Carlès M. Étude épidémiologique des accidents de la voie publique dans une île des Antilles, Marie-Galante. Ann Fr Med Urgence 2023. [DOI: 10.3166/afmu-2022-0466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Objectifs : La traumatologie routière représente 13,1 décès pour 105 habitants en Guadeloupe. Marie-Galante (MG), île de l’archipel guadeloupéen, située dans les Antilles françaises, est fortement impactée par l’accidentologie routière. La prise en charge de ces victimes implique des spécificités organisationnelles liées à la géographie et au système de soins. Les objectifs de ce travail sont la description épidémiologique des victimes d’accident de la voie publique (AVP) et l’évaluation de la prise en charge (PEC) médicale initiale des victimes les plus graves.
Méthodes : Étude observationnelle rétrospective de 2016 à 2018 incluant les victimes prises en charge par le service médical d’urgence et de réanimation (Smur) et/ou par le centre hospitalier de Sainte-Marie (CHSM) à Marie-Galante. Les patients ont été répartis par critère de gravité : instables, critiques, potentiellement graves ou stables.
Résultats : Sur la période, 499 victimes ont nécessité une PEC : 164 (33 %) impliquant des véhicules légers, 217 (43 %) des deux-roues motorisés et 60 (12 %) des vélos. La population est jeune (29 [21–49] ans), et masculine (sex-ratio H/F : 3,3). Le CHSM a pris en charge 467 (95 %) victimes, 6 (1 %) étaient instables, 11 (2 %) critiques, 142 (28 %) potentiellement graves et 264 (53 %) stables ; 7 (1 %) ont bénéficié d’un transfert héliporté (TH) direct vers le centre hospitalier universitaire de Guadeloupe (CHUG), 52 (10 %) d’un TH secondaire après une PEC au CHSM. Tous les patients instables et 10 (91 %) des 11 critiques ont été admis au CHUG.
Conclusion : Cette étude souligne la forte incidence de la traumatologie routière à Marie-Galante. Ce travail doit permettre d’élaborer des axes d’amélioration de PEC, notamment par la filiarisation du patient traumatisé.
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Fremery A, Blanc R, Mutricy R, Kallel H, Pujo JM. Ressenti des médecins lors de la prise en charge des urgences vitales dans les centres de santé en Guyane. Ann Fr Med Urgence 2022. [DOI: 10.3166/afmu-2022-0421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction : Les urgences vitales sont fréquentes dans les centres de santé isolés guyanais. La population médicale est composée de médecins généralistes avec peu de formation en médecine d’urgence.
Méthodes : Nous avons réalisé une étude descriptive au moyen d’un questionnaire diffusé à l’aide d’une mailing liste de 310 contacts de médecins ayant travaillé dans les centres délocalisés de prévention et de soins (CDPS) depuis les années 2010 à 2019.
Résultats : Nous avons obtenu 90 réponses sur 310 (29 %) et analysé 87 (28 %). La majorité des médecins était des généralistes (72 %) de moins de 40 ans (69 %) sans formation de médecine d’urgence (76 %). Les urgences majoritairement rencontrées étaient les comas et les polytraumatisés ainsi que les urgences gynéco-obstétricales. La majorité des médecins ont rapporté avoir été inconfortables durant ces prises en charge (67 %). La relation avec le service d’aide médicale urgente (Samu) a été jugée majoritairement adaptée (93 %). L’aide apportée par l’équipe paramédicale des CDPS était jugée correcte dans 49 % et excellente dans 48 % des cas. Plus d’un médecin sur cinq (21 %) a déclaré ne pas vouloir renouveler son contrat en CDPS du fait du vécu des urgences vitales. Afin d’améliorer la prise en charge des patients graves, les médecins sont favorables à la présence de fiches réflexes (87 %), à la formation en préaffectation sur mannequin (75 %), à de courtes formations aux déchoquages par des médecins urgentistes (67 %), à des alternatives à l’intubation orotrachéale telles que des dispositifs supraglottiques (68 %) et à l’aide guidée par la télémédecine (30 %).
Conclusion : Ce travail révèle une importante souffrance des médecins face aux difficultés vécues dans la prise en charge des urgences vitales. Afin de répondre aux problématiques soulevées par cette étude, la majorité des mesures d’amélioration évoquées dans ce travail sont en cours de mise en place depuis la fin de l’année 2019.
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Pignata A, Blanchet D, Demar M, Kallel H, Sendid B, Adenis A, Nacher M, Couppié P, Djossou F, Epelboin L. Intérêt du dosage des β-D-glucane dans le diagnostic de l’histoplasmose disséminée chez le sujet vivant avec le VIH. Infect Dis Now 2021. [DOI: 10.1016/j.idnow.2021.06.043] [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: 11/26/2022]
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Pujo JM, Houcke S, Fremery A, Lontsi-Ngoula G, Burin A, Mutricy R, Hommel D, Resiere D, Kallel H. Les envenimations vipérines en Guyane française. Ann Fr Med Urgence 2021. [DOI: 10.3166/afmu-2021-0306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
L’OMS classe l’envenimation vipérine comme pathologie négligée. Elle représente un problème de santé publique associé à des taux de mortalité et de morbidité importants. Notre objectif est de faire une mise au point sur les données récentes de la littérature sur l’épidémiologie et la prise en charge de l’envenimation vipérine en Guyane française. La Guyane est un département français presque entièrement recouvert par une forêt tropicale. Elle abrite une herpétofaune très riche comportant notamment les espèces du genre Bothrops (famille des Viperidae) qui provoquent le plus grand nombre de morsures et d’envenimations. La gestion des envenimations vipérines représente un défi de santé publique. En effet, la plupart des envenimations se produisent dans des zones rurales éloignées où l’accès aux soins est le plus compliqué, avec la présence d’un personnel médical peu formé à la prise en charge et l’indisponibilité de l’antivenin, ce qui constitue une véritable perte de chance pour les patients. En conclusion, dans un contexte d’efforts mondiaux visant à réduire l’impact des envenimations vipérines, la coopération internationale et l’engagement des autorités locales de santé et de la société civile sont nécessaires. En Guyane, la mise en place d’une véritable filière de soins et la mise à disposition de l’antivenin dans les structures sanitaires les plus isolées constitueraient un réel progrès sanitaire.
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Ben Jemaa A, Bahloul M, Kallel H, Turki O, Dlela M, Bouaziz M. [Inverted Takotsubo Syndrome due to Severe Scorpion Envenomation: Report of one Case]. Med Trop Sante Int 2021; 1:PWX0-M245. [PMID: 35586636 PMCID: PMC9022762 DOI: 10.48327/pwx0-m245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 12/01/2020] [Indexed: 11/17/2022]
Abstract
Scorpion envenomation (SE) is common in tropical and subtropical regions. Cardio-respiratory manifestations, mainly cardiogenic shock and pulmonary oedema are the leading causes of death after scorpion envenomation. Cardiac failure can be due to massive release of catecholamines, myocardial damage induced by the venom or myocardial ischemia. Although it has been exceptionally reported, Takotsubo syndrome during SE can help to better elucidate the pathophysiology of this cardiomyopathy. We report a case of inverted Takotsubo following a SE in a 26-year-old patient admitted to the Intensive care unit department for severe scorpion envenomation. His evolution was favorable. We concluded that cardiac involvement in this case fulfills all clinical and paraclinical criteria of Takotsubo syndrome emphasizing the importance of catecholaminergic discharge during scorpion envenomation. We discuss again the management of this syndrome in this specific condition.
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Affiliation(s)
- A. Ben Jemaa
- Département de soins intensifs, Hôpital universitaire Habib Bourguiba, 3029, Sfax, Tunisie
| | - M. Bahloul
- Faculté de Médecine de Sfax. Université de Sfax, Boulevard Majida Boulila, Sfax 3029, Tunisie,*
| | - H. Kallel
- Département de soins intensifs, Hôpital universitaire Habib Bourguiba, 3029, Sfax, Tunisie
| | - O. Turki
- Département de soins intensifs, Hôpital universitaire Habib Bourguiba, 3029, Sfax, Tunisie
| | - M. Dlela
- Département de soins intensifs, Hôpital universitaire Habib Bourguiba, 3029, Sfax, Tunisie
| | - M. Bouaziz
- Département de soins intensifs, Hôpital universitaire Habib Bourguiba, 3029, Sfax, Tunisie
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Devos M, Sainte-Rose V, Kallel H, Djossou F, Demar M, Blaizot R. Infections cutanées à Aeromonas : étude rétrospective sur 11 ans. Med Mal Infect 2020. [DOI: 10.1016/j.medmal.2020.06.253] [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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Devos M, Sainte-Rose V, Kallel H, Mayence C, Ouedraogo H, Djossou F, Demar M, Couppié P, Blaizot R. Skin and soft-tissue infections associated with Aeromonas species in French Guiana: an 11-year retrospective study. J Eur Acad Dermatol Venereol 2020; 34:e414-e416. [PMID: 32176375 PMCID: PMC7496744 DOI: 10.1111/jdv.16365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 02/11/2020] [Accepted: 03/10/2020] [Indexed: 11/29/2022]
Affiliation(s)
- M Devos
- Dermatology Department, Hôpital Andrée Rosemon, Cayenne, French Guiana
| | - V Sainte-Rose
- Laboratory of Bacteriology, Hôpital Andrée Rosemon, Cayenne, French Guiana
| | - H Kallel
- Intensive Care Unit, Hôpital Andrée Rosemon, Cayenne, French Guiana
| | - C Mayence
- Intensive Care Unit, Hôpital Andrée Rosemon, Cayenne, French Guiana
| | - H Ouedraogo
- Orthopaedics Department, Hôpital Andrée Rosemon, Cayenne, French Guiana
| | - F Djossou
- Infectious Diseases Department, Hôpital Andrée Rosemon, Cayenne, French Guiana.,EA 3593, Ecosystèmes Amazoniens et Pathologies Tropicales, University of French Guiana, Cayenne, French Guiana
| | - M Demar
- Laboratory of Bacteriology, Hôpital Andrée Rosemon, Cayenne, French Guiana.,EA 3593, Ecosystèmes Amazoniens et Pathologies Tropicales, University of French Guiana, Cayenne, French Guiana
| | - P Couppié
- Dermatology Department, Hôpital Andrée Rosemon, Cayenne, French Guiana.,EA 3593, Ecosystèmes Amazoniens et Pathologies Tropicales, University of French Guiana, Cayenne, French Guiana
| | - R Blaizot
- Dermatology Department, Hôpital Andrée Rosemon, Cayenne, French Guiana.,EA 3593, Ecosystèmes Amazoniens et Pathologies Tropicales, University of French Guiana, Cayenne, French Guiana
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Boukari M, Kallel H, Kaouel H, Errais K, Ammous I, Zhioua R. [Pellucid marginal degeneration: Role of corneo-scleral contact lens fitting]. J Fr Ophtalmol 2019; 43:e85-e87. [PMID: 31879041 DOI: 10.1016/j.jfo.2019.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 09/27/2019] [Accepted: 10/09/2019] [Indexed: 10/25/2022]
Affiliation(s)
- M Boukari
- Department of Ophthalmology, Faculty of Medicine of Tunis, Tunis El Manar University, Charles Nicolle University Hospital of Tunis, boulevard du 9-Avril-1938, 1006 Tunis Tunisie.
| | - H Kallel
- Department of Ophthalmology, Faculty of Medicine of Tunis, Tunis El Manar University, Charles Nicolle University Hospital of Tunis, boulevard du 9-Avril-1938, 1006 Tunis Tunisie
| | - H Kaouel
- Department of Ophthalmology, Faculty of Medicine of Tunis, Tunis El Manar University, Charles Nicolle University Hospital of Tunis, boulevard du 9-Avril-1938, 1006 Tunis Tunisie
| | - K Errais
- Department of Ophthalmology, Faculty of Medicine of Tunis, Tunis El Manar University, Charles Nicolle University Hospital of Tunis, boulevard du 9-Avril-1938, 1006 Tunis Tunisie
| | - I Ammous
- Department of Ophthalmology, Faculty of Medicine of Tunis, Tunis El Manar University, Charles Nicolle University Hospital of Tunis, boulevard du 9-Avril-1938, 1006 Tunis Tunisie
| | - R Zhioua
- Department of Ophthalmology, Faculty of Medicine of Tunis, Tunis El Manar University, Charles Nicolle University Hospital of Tunis, boulevard du 9-Avril-1938, 1006 Tunis Tunisie
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Kallel H, Rozé B, Pons B, Mayence C, Mathien C, Resiere D, Melot B, Hommel D, Mehdaoui H, Carles M. Infections tropicales graves dans les départements français d’Amérique, Antilles françaises et Guyane. Méd Intensive Réa 2019. [DOI: 10.3166/rea-2019-0103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Les Antilles-Guyane (AG) sont les départements français du continent américain, situés en zone intertropicale. La diversité des écosystèmes ainsi que le climat tropical à très forte pluviosité exposent à un vaste panel de pathologies infectieuses. Ces territoires sont de plus l’objet de mouvements importants de populations, voyageurs ou migrants, ce qui joue un rôle significatif dans le développement d’épidémies et/ou de pathologies émergentes. Ces pathologies infectieuses dites « tropicales » peuvent nécessiter une prise en charge en réanimation. Nous rapportons ici les principales données récentes concernant ces pathologies (hors infection liée au VIH) ainsi que les stratégies diagnostiques et thérapeutiques, à l’usage des réanimateurs amenés à exercer en zone tropicale AG ou recevant en métropole des patients issus de cette région.
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Kallel H, Kossai IE, Chaouech N, Kacem I, Romdhane NB, Manaa JE. Impact des reconstructions vasculaires sur la greffe rénale. Nephrol Ther 2018. [DOI: 10.1016/j.nephro.2018.07.389] [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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Kallel H, El Kossai I, Kacem I, Manaa JE. Leishmaniose viscérale chez un transplanté rénal. Nephrol Ther 2018. [DOI: 10.1016/j.nephro.2018.07.383] [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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Mayence C, Mathien C, Sanna A, Houcke S, Tabard P, Roux A, Valentin C, Resiere D, Lemonnier D, Nkont Cho F, Hommel D, Fan HW, Kallel H. Lonomia caterpillar envenoming in French Guiana reversed by the Brazilian antivenom: A successful case of international cooperation for a rare but deadly tropical hazard. Toxicon 2018; 151:74-78. [PMID: 29890231 DOI: 10.1016/j.toxicon.2018.06.068] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 02/17/2018] [Revised: 05/31/2018] [Accepted: 06/08/2018] [Indexed: 11/28/2022]
Abstract
In the American continent, larval forms (caterpillars) of the Lonomia genus can cause systemic reactions in human beings. In this Paper, we report the third case of Lonomia envenoming recorded in French Guiana in 25 years, and the first in which specific antivenom was administered. Severe symptoms of the envenoming were observed in our patient including pain; coagulopathy and systemic hemorrhage. They are caused by skin contact with caterpillars. Recovery, however, was quite satisfactory thanks to the international cooperation of the health authorities in both France and Brazil.
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Affiliation(s)
- C Mayence
- Intensive Care Unit, Cayenne General Hospital, French Guiana
| | - C Mathien
- Intensive Care Unit, Cayenne General Hospital, French Guiana
| | - A Sanna
- Regional Authority of Health, French Guiana
| | - S Houcke
- Intensive Care Unit, Cayenne General Hospital, French Guiana
| | - P Tabard
- Regional Authority of Health, French Guiana
| | - A Roux
- Intensive Care Unit, Cayenne General Hospital, French Guiana
| | - C Valentin
- Emergency Department, Kourou Hospital, French Guiana
| | - D Resiere
- Intensive Care Unit, Fort de France University Hospital, Martinique
| | - D Lemonnier
- Pharmacy Department, Cayenne General Hospital, French Guiana
| | | | - D Hommel
- Intensive Care Unit, Cayenne General Hospital, French Guiana
| | - H W Fan
- Butantan Institute, Sao Paulo, Brazil
| | - H Kallel
- Intensive Care Unit, Cayenne General Hospital, French Guiana.
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Kallel H, Abboud P, Nkouka S, Mahamat A, Moreau B, Nkont Cho F, Saint-Lorant G, Djossou F. Effectiveness of postprescription antibiotic stewardship to reduce carbapenem consumption: a quantitative study. J Hosp Infect 2017; 97:294-295. [PMID: 28803948 DOI: 10.1016/j.jhin.2017.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 08/05/2017] [Indexed: 11/18/2022]
Affiliation(s)
- H Kallel
- Service de Réanimation Polyvalente, Centre Hospitalier de Cayenne, Cayenne, French Guiana.
| | - P Abboud
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - S Nkouka
- Service de Pharmacie, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - A Mahamat
- Service d'hygiène Hospitalière, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - B Moreau
- Laboratoire de Microbiologie, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - F Nkont Cho
- Service de Pharmacie, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - G Saint-Lorant
- Service de Pharmacie, Centre Hospitalier Universitaire de Caen, Caen, France
| | - F Djossou
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne, Cayenne, French Guiana
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Kallel H, Kossai I, Kacem I, Mondher H, Romdhane B, Jamelleddine M. Syndrome de Conn découvert après transplantation rénale. Nephrol Ther 2016. [DOI: 10.1016/j.nephro.2016.07.293] [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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17
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Kallel H, Jerbi M, Gaied H, Trabelsi R, Goucha R, Bacha M, Ounissi M, Abderrahim E, Younsi F, Ben A. La microangiopathie thrombotique chez les transplantés rénaux. Nephrol Ther 2016. [DOI: 10.1016/j.nephro.2016.07.294] [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]
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Epelboin L, Le Turnier P, Mosnier E, Kallel H, Jolivet A, Bourhy P, Demar M, Djossou F. TROP-10 - Facteurs pronostiques de la leptospirose en Guyane. Med Mal Infect 2016. [DOI: 10.1016/s0399-077x(16)30518-2] [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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Jebali H, Laifi M, Roukaya K, Kallel H, Kheder R, Beji S, Rais L, Ben Fatma L, Krid M, Smaoui W, Zouaghi K, Ben Moussa F. Atteinte rénale au cours de la cirrhose biliaire primitive : à propos de quatre observations. Nephrol Ther 2015. [DOI: 10.1016/j.nephro.2015.07.314] [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: 11/30/2022]
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21
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Jebali H, Kallel H, Kadouri R, Raïs L, Beji S, Ben Fatma L, Kheder R, Krid M, Smaoui W, Zouaghi K, Ben Moussa F. Cardiotoxicité au cyclophosphamide chez une patiente lupique. Nephrol Ther 2015. [DOI: 10.1016/j.nephro.2015.07.276] [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: 10/23/2022]
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Herchi W, Bahashwan S, Sebei K, Ben Saleh H, Kallel H, Boukhchina S. Effects of germination on chemical composition and antioxidant activity of flaxseed ( Linum usitatissimum L) oil. Grasas y Aceites 2015. [DOI: 10.3989/gya.0463141] [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] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Herchi W, Bahashwan S, Trabelsi H, Boukhchina S, Kallel H, Rochut S, Pepe C. Changes in proximate composition and oil characteristics during flaxseed development. Grasas y Aceites 2014. [DOI: 10.3989/gya.097713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ellouze R, Kallel H, ben Said M, Oueslati M, Guermazi S. C0596: Effect of EDTA on Specialized Hemostasis Tests; Erroneous Results and Misdiagnosis of Combined Deficiencies in Factor V and Factor VIII. Thromb Res 2014. [DOI: 10.1016/s0049-3848(14)50251-4] [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: 10/25/2022]
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Kallel H, Ellouze R, Ben Said M, Guermazi S. C0449: Thrombophilia Markers in Patients with Ischemic Stroke. Thromb Res 2014. [DOI: 10.1016/s0049-3848(14)50368-4] [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: 10/25/2022]
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Ben Hassine Z, Ben Said M, Ellouze R, Kallel H, Aissaoui R, Guermazi S. C0201: D-Dimer Concentration in Tunisian Women with Recurrent Pregnancy Losses. Thromb Res 2014. [DOI: 10.1016/s0049-3848(14)50340-4] [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: 11/26/2022]
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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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Benelhoul W, Basset T, Salhi MS, Kallel H, Hommel D. [Emphysematous pyelonephritis: a rare complication of upper urinary tract infections]. ACTA ACUST UNITED AC 2012; 31:262-3. [PMID: 22305396 DOI: 10.1016/j.annfar.2011.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Accepted: 11/22/2011] [Indexed: 11/29/2022]
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Gasmi N, Fudalej F, Kallel H, Nicaud J. A genetic approach to improve heterologous protein expression in Yarrowia lipolytica: case of hIFN-α 2b. N Biotechnol 2009. [DOI: 10.1016/j.nbt.2009.06.199] [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: 10/20/2022]
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Bahloul M, Ben Ahmed MN, Laaroussi L, Chtara K, Kallel H, Dammak H, Ksibi H, Samet M, Chelly H, Ben Hamida C, Chaari A, Amouri H, Rekik N, Bouaziz M. [Peripartum cardiomyopathy: incidence, pathogenesis, diagnosis, treatment and prognosis]. ACTA ACUST UNITED AC 2008; 28:44-60. [PMID: 19111432 DOI: 10.1016/j.annfar.2008.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Accepted: 11/04/2008] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Peripartum cardiomyopathy (PPCM) is a rare and life-threatening disease of unknown aetiology. The primary objective of this review was to analysed aetiopathogeneses, clinical presentation and diagnosis, as well as pharmacological, perioperative and intensive care management and prognosis of this pathology. METHODS We undertook a systematic review of the literature using Medline, Google Scholar and PubMed searches. RESULTS Unlike other parts of the world in which cardiomyopathy are rare, dilated cardiomyopathy is a major cause of heart failure throughout Africa. Its aetiopathogenesis is still poorly understood, but recent evidence supports inflammation, viral infection and autoimmunity as the leading causative hypotheses. This diagnosis should be limited to previously healthy women who present with congestive heart failure (CHF) and decreased left ventricular systolic function in the last month of pregnancy or within 5 months after delivery. Recently, introduction of echocardiography has made diagnosis of PPCM easier and more accurate. Conventional treatment consists of diuretics, vasodilators, and sometimes digoxin and anticoagulants, usually in combination. Patients who fail to recover may require inotropic therapy. In resistant cases, newer therapeutic modalities such as immunomodulation, immunoglobulin and immunosuppression may be considered. Prognosis is highly related to reversal of ventricular dysfunction. Compared to historically higher mortality rates, recent reports describe better outcome, probably because of advances in medical care. Based on current information, future pregnancy is usually not recommended in patients who fail to recover normal heart function. CONCLUSION PPCM is a rare but serious form of cardiac failure affecting women in the last months of pregnancy or early puerperium. Its aetiopathogenesis is still poorly understood. Introduction of echocardiography has made diagnosis of PPCM easier and more accurate. Prognosis is highly related to reversal of ventricular dysfunction.
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Affiliation(s)
- M Bahloul
- Service de réanimation médicale, CHU Habib Bourguiba, route El Ain Km 1, 3029 Sfax, Tunisie.
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Belghith A, Mahjoub S, Manai Z, Chouk R, Kallel H, Zouch O, Ayadi I, Fekih M, Ben Romdhan N. Hyperhomocystéinémie dans les carences en vitamine B12. Rev Med Interne 2008. [DOI: 10.1016/j.revmed.2008.03.243] [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: 11/30/2022]
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32
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Kallel H, Kharrat I, Zouch O, Mahjoub S, Chouk R, Manai Z, Romdhan NB. Facteurs de risques constitutionnels de thrombophilie au cours de la thrombose porte. Rev Med Interne 2008. [DOI: 10.1016/j.revmed.2008.03.040] [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: 11/26/2022]
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Kallel H, Mâaloul I, Mahjoubi F, Dammak H, Ghorbel H, Chelly H, Ksibi H, Ben Hamida C, Rekik N, Ben Jemaa M, Hammami A, Bouaziz M. [Prognostic factors of pneumococcal meningitis. Retrospective study of 31 cases]. Tunis Med 2007; 85:692-696. [PMID: 18254294] [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: 05/25/2023]
Abstract
AIM Our aim was to study the susceptibility of Streptococcus pneumoniae to antibiotics in patients with pneumococcal meningitis and to search for the prognosis factors in those patients. METHODS We have studied retrospectively 31 cases of pneumococcal meningitis. Comparaisons were performed with univariate analysis. RESULTS The mean age was 36.7 +/- 20.5 years (ranged: 9 and 78 years). The sex ratio was 3,4. The susceptibility of Streptococcus pneumoniae to penicillin G was affected in 10 cases (33% of isolated pneumococcus. The MIC to penicillin G was > or =2 in only one case. The hospital mortality was 26% (8/31). With univariate analysis, factors associated with death were: age > or =55 years (Ss p= 0,006, OR: 17.2 IC95%: 2.3-134), albuminorachie > or = 7 g/l (p = 0.002, OR: 22; IC95%: 1.9-2.51), shock (p = 0.031, OR: 6.7; IC95%: 1.05-42) and Glasgow Coma Score (GCS) < or =8 (p = 0.001, OR: 20; IC95%: 2.68-149). CONCLUSION No susceptibility to penicillin G is not associated with a worse outcome in patients with pneumococcal meningitis. An age > or =55 years, albuminorachie > or =7 g/l shock and Glasgow Coma Score < or =8 at admission were determinant of the prognosis in our study.
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Affiliation(s)
- H Kallel
- Service de Réanimation Médicale, CHU Habib Bourguiba, Sfax, Tunisie
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Kallel H, Hergafi L, Bahloul M, Hakim A, Dammak H, Chelly H, Hamida CB, Chaari A, Rekik N, Bouaziz M. Safety and efficacy of colistin compared with imipenem in the treatmentof ventilator-associated pneumonia: a matched case–control study. Intensive Care Med 2007; 33:1162-1167. [PMID: 17530220 DOI: 10.1007/s00134-007-0675-2] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2006] [Accepted: 04/23/2007] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Our study aimed to determine the efficacy and safety of colistin in the treatment of ventilator-associated pneumonia (VAP) caused by pan-drug-resistant Pseudomonas aeruginosa or Acinetobacter baumanii. DESIGN Pairwise, retrospective exposed-unexposed study. SETTING Combined medical and surgical intensive care unit of Habib Bourguiba University Hospital (Sfax, Tunisia). PATIENTS Sixty patients with VAP caused by pan-drug-resistant A. baumanii or P. aeruginosa matched to 60 controls with VAP caused by A. baumanii or P. aeruginosa susceptible to imipenem. All patients had normal renal function at the onset of antibiotic therapy. INTERVENTIONS Case patients were treated by colistin intravenously and control patients were treated by imipenem intravenously. MEASUREMENTS AND RESULTS Baseline characteristics were similar between the colistin and imipenem groups. The mean duration of antibiotic therapy for VAP was 9.5+/-3.8 days (range 5-22 days) with colistin and 8.9+/-2.8 days (range 5-20 days) with imipenem (p=0.32). A favorable clinical response to antibiotic therapy for VAP occurred in 45 patients (75%) in the colistin group and in 43 patients (71.7%) in the imipenem group (p=0.68). The time to resolution of infectious parameters after the initiation of antibiotic therapy was not statistically different between the two groups. During the antibiotic course, none of the patients in either group developed renal failure. CONCLUSIONS We conclude that colistin can be a safe and effective option in the treatments of VAP caused by pan-drug-resistant P. aeruginosa or A. baumanii.
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Affiliation(s)
- H Kallel
- Service de Réanimation Médicale, CHU Habib Bourguiba, route el Ain Km 1, 3029, Sfax, Tunisia.
| | - L Hergafi
- Service de Réanimation Médicale, CHU Habib Bourguiba, route el Ain Km 1, 3029, Sfax, Tunisia
| | - M Bahloul
- Service de Réanimation Médicale, CHU Habib Bourguiba, route el Ain Km 1, 3029, Sfax, Tunisia
| | - A Hakim
- Laboratoire de Pharmacologie, Faculté de Médecine de Sfax, route el Ain Km 1, 3029, Sfax, Tunisia
| | - H Dammak
- Service de Réanimation Médicale, CHU Habib Bourguiba, route el Ain Km 1, 3029, Sfax, Tunisia
| | - H Chelly
- Service de Réanimation Médicale, CHU Habib Bourguiba, route el Ain Km 1, 3029, Sfax, Tunisia
| | - C Ben Hamida
- Service de Réanimation Médicale, CHU Habib Bourguiba, route el Ain Km 1, 3029, Sfax, Tunisia
| | - A Chaari
- Service de Réanimation Médicale, CHU Habib Bourguiba, route el Ain Km 1, 3029, Sfax, Tunisia
| | - N Rekik
- Service de Réanimation Médicale, CHU Habib Bourguiba, route el Ain Km 1, 3029, Sfax, Tunisia
| | - M Bouaziz
- Service de Réanimation Médicale, CHU Habib Bourguiba, route el Ain Km 1, 3029, Sfax, Tunisia
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Bahloul M, Dammak H, Kallel H, Khlaf-Bouaziz N, Ben Hamida C, Chaari A, Chelly H, Rekik N, Bouaziz M. [Thrombotic microangiopathies. Incidence, pathogenesis, diagnosis, treatment and prognosis]. J Mal Vasc 2007; 32:75-82. [PMID: 17490838 DOI: 10.1016/j.jmv.2007.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2006] [Accepted: 03/05/2007] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The objective of this work was to review current data about the pathophysiology, clinical features, and treatment of thrombotic microangiopathies. CURRENT KNOWLEDGE Thrombotic microangiopathies are microvascular occlusive disorders characterized by systemic or intrarenal aggregation of platelets, thrombocytopenia, and mechanical injury to erythrocytes. In thrombotic thrombocytopenic purpura, systemic microvascular aggregation of platelets causes ischemia in the brain and other organs. In the hemolytic-uremic syndrome, platelet-fibrin thrombi occlude predominantly the renal circulation. Thrombotic microangiopathy is a rare disorder whose varied clinical manifestations result from the formation of platelet-rich thrombi within the microvasculature and consequent tissue ischemia. The clinical features are acute renal failure, microangiopathic hemolytic anemia and thrombocytopenia. This diagnosis is of considerable importance because of the possible fulminant clinical course. Some atypical forms may be unrecognized. Plasma exchange is the current reference treatment of thrombotic thrombocytopenic purpura. However, in the light of recent publications, either infusions of concentrates of purified enzyme or more intensive immunosuppressive therapy would be more specific.
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Affiliation(s)
- M Bahloul
- Service de réanimation médicale, CHU Habib-Bourguiba, route El-Ain-Km 1, 3029 Sfax, Tunisie.
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Bahloul M, Abid D, Ketata H, Kallel H, Dammak H, Chelly H, Ben Hamida C, Mhiri MN, Bouaziz M. [Traumatic unilateral renal artery thrombosis and protein C deficiency. A case report]. ACTA ACUST UNITED AC 2007; 31:277-9. [PMID: 17202980 DOI: 10.1016/s0398-0499(06)76626-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Post traumatic renal artery thrombosis is rarely described in the literature. This pathology can result from stretch injury to inelastic intima of the renal artery, or by the direct flow to the abdomen causing compression injury to the renal artery against the vertebral column. However, the association of this pathology with hematologic diseases (in particular protein C deficit) was never described. We report an observation of a 28-year-old man with an uneventful history who was admitted to the intensive care unit for traumatic head injury associated with post traumatic renal artery thrombosis requiring nephrectomy. The etiologic investigation of this thrombo-embolic complication reveals a protein C deficit. Our patient was improved under treatment. This original observation confirms that post traumatic renal artery thrombosis can be associated with hematologic diseases (in particular protein C deficit).
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Affiliation(s)
- M Bahloul
- Service de Réanimation Médicale, CHU Habib Bourguiba, Route el Ain Km 1, 3029 Sfax, Tunisie.
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Kallel H, Chelly H, Ghorbel M, Bahloul M, Ksibi H, Rekik N, Ben Mansour H, Bouaziz M. La méningite post-traumatique : incidence, microbiologie et pronostic. Neurochirurgie 2006; 52:397-406. [PMID: 17185945 DOI: 10.1016/s0028-3770(06)71238-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The aim of our study was to search for the incidence, the responsible organisms and the favoring causes of death of post-traumatic meningitis (PTM). METHODS This retrospective study was conducted over a seven-year period (January 1st, 1996 - December 31, 2002) in the ICU and the neurosurgery department of the Habib-Bourguiba University Hospital, Sfax, Tunisia. RESULTS Over the study period, 38 patients presented PTM (0.96% of patients hospitalized for head injury), 92% of them had received antibiotic prophylaxis on admission. Mean time between head injury and the diagnosis of PTM was 9+/- 8 days (range: 2-34 days). The most common isolated organisms were multidrug resistant A. baumanii, and K. pneumoniae and reduced susceptibility S. pneumoniae. Factors predictive of prognosis in the 14 days following the diagnosis of meningitis were Glasgow coma score (GCS) on the day of diagnosis of PTM, absence of nuchal rigidity, CSF protein, CSF/blood glucose ratio, and S. pneumoniae as the causal agent of PTM. CONCLUSIONS Antibioprophylaxis in patients with head trauma must be avoided to prevent the emergence of multidrug resistant bacteria when PTM occurs. GCS on the day of diagnosis of PTM, CSF protein concentration, CSF/blood glucose ratio, and S. pneumoniae as the causal agent of PTM are predictive factors of mortality of patients with PTM.
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Affiliation(s)
- H Kallel
- Service de Réanimation Médicale, CHU Habib-Bourguiba, route El-Aïn, km 1, 3029 Sfax, Tunisie.
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Kallel H, Dammak H, Bahloul M, Ben Hamida C, Chelly H, Rekik N, Bouaziz M. A good death: another break in the wall. Intensive Care Med 2006; 32:1915-6. [PMID: 17019551 DOI: 10.1007/s00134-006-0369-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2006] [Indexed: 11/26/2022]
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Bahloul M, Ben Hamida C, Dammak H, Chaari L, Kallel H, Chelly H, Rekik N, Bouaziz M. Les microangiopathies thrombotiques en réanimation. ACTA ACUST UNITED AC 2006; 25:820-7. [PMID: 16859885 DOI: 10.1016/j.annfar.2006.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2005] [Accepted: 04/12/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To analyze the clinico-biological manifestations, identify the causes and evaluate the outcome of patients with severe thrombotic microangiopathies admitted in a Tunisian intensive care unit. METHODS Retrospective study over a period of 10 years (1995-2004) in an intensive care unit. RESULTS Were included in this study 9 cases with a mean age of 29.2+/-9 years (range 15-44 years). Fever was observed in 5 patients, neurological impairment in 5 and digestive manifestations in 6. Haemolytic anaemia, thrombocytopenia and acute renal failure were observed in 100% of the cases. In our study, the aetiologies of thrombotic microangiopathies were: complicated pregnancy in 6 cases, systemic lupus erythematosus in 1 case. In contrast, no aetiology was found in 2 patients. Plasma exchange was performed in 5 patients, while 4 patients received only plasma infusion. After an average stay of 18+/-12.5 days, evolution was marked by the death 3 patients. CONCLUSION The incidence of severe thrombotic microangiopathies is rare in Tunisian ICU. The clinical manifestations are not specific. Despite the improvement in the outcome by exogenous plasma supply, thrombotic microangiopathies with severe organ dysfunctions leading to hospitalization in the intensive care unit are associated with a high mortality rate.
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MESH Headings
- Acute Kidney Injury/complications
- Adolescent
- Adult
- Algeria/epidemiology
- Anemia, Hemolytic/complications
- Anemia, Hemolytic/diagnosis
- Cardiopulmonary Resuscitation
- Female
- Fever/etiology
- Humans
- Intensive Care Units
- Lupus Erythematosus, Systemic/complications
- Male
- Nervous System Diseases/etiology
- Nervous System Diseases/physiopathology
- Peripheral Vascular Diseases/epidemiology
- Peripheral Vascular Diseases/etiology
- Peripheral Vascular Diseases/therapy
- Plasma Exchange
- Pregnancy
- Pregnancy Complications, Cardiovascular/physiopathology
- Purpura, Thrombocytopenic, Idiopathic/complications
- Purpura, Thrombocytopenic, Idiopathic/epidemiology
- Purpura, Thrombocytopenic, Idiopathic/therapy
- Retrospective Studies
- Treatment Outcome
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Affiliation(s)
- M Bahloul
- ICU, Centre Hospitalier H.-Bourguiba, route El-Ain, Km 0,5, 3029 Sfax, Tunisie.
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Bahloul M, Dammak H, Khlaf-Bouaziz N, Trabelsi K, Khabir A, Ben Hamida C, Kallel H, Ksibi H, Chelly H, Chaari A, Rekik N, Bouaziz M. Stéatose hépatique aiguë gravidique. À propos de 22 cas. ACTA ACUST UNITED AC 2006; 34:597-606. [PMID: 16822693 DOI: 10.1016/j.gyobfe.2006.05.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2005] [Accepted: 05/24/2006] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To report the clinical experience, biochemical findings, complications and maternal outcome in patients with acute fatty liver of pregnancy (AFLP). PATIENTS AND METHODS Retrospective study over a period of 11 years (1993-2003). The diagnosis of AFLP was confirmed by liver biopsy in 15 women. However, in 7 women a medical committee that took into account clinical symptoms, and laboratory findings assessed the diagnosis. RESULTS Were included in this study, 22 women with a mean age of 30+/-5.4 years. Only 22.7% of cases were primigravid. The mean gestational age was 36+/-2.76 weeks (range 31-41 weeks). The fetus was a male infant in 75% of cases. Ten women were admitted in the hospital without jaundice. However 15 women had developed an icterus since their hospital admission or during ICU stay. The mean SAPS II on the ICU admission was of 24.86+/-11.2 points. Biological disturbances observed were mainly: liver cytolysis in 91% of cases, a trend to hypoglycaemia in 86%, a hypoprotidemia in 66.7% and CIVD in 32%. During their ICU stay, 19 women (86.4%) developed one or several organ failures associated to the hepatic failure and 18 women required blood transfusion. After an average stay of 7.5 days, evolution was marked by the death of seven patients (31.8%). Factors correlated with a poor prognosis were: the delay of medical consultation, the development of jaundice, the development of encephalopathy, respiratory or a circulatory failure. DISCUSSION AND CONCLUSION AFLP is a rare but life-threatening complication. Furthermore AFLP shares features with other more common and less perilous illnesses. An early diagnosis and appropriate therapy of this pathology should improve the poor prognosis in our country.
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Affiliation(s)
- M Bahloul
- Service de réanimation médicale, CHU Habib-Bourguiba, route El Ain, 3029 Sfax, Tunisie.
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Kallel H, Dammak H, Mahjoubi F, Bahloul M, Turki E, Chelly H, Rekik N, Hammami A, Bouaziz M. [Contamination of blood cultures drawn from central vein catheter and peripheral venipuncture. Prospective study of 75 pairs]. ACTA ACUST UNITED AC 2006; 54:44-8. [PMID: 16376178 DOI: 10.1016/j.patbio.2005.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2004] [Accepted: 02/09/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To determine the frequency of contamination, the sensitivity, specificity, and predictive values of cultures done with blood drawn through a central venous catheter or peripheral venipuncture. DESIGN Prospective cohort study of critical ill medical surgical intensive care patients in whom samples for paired culture were drawn through a central venous catheter or peripheral venipuncture during a period of 8 months (from August 1st 2001 to Mars 31st 2002). RESULTS During the study period, 75-paired cultures were studied. Fifteen peripheral blood cultures (20%) and 27 central blood cultures (36%) were positive and 6 peripheral blood cultures (8%) and 15 central blood cultures (20%) were contaminated (P=0.034). The organism most commonly responsible for contamination was Coagulase Negative Staphylococcus (16% of central blood cultures and 6.7% of peripheral blood cultures). The frequency of contamination was of 42.9% for blood cultures drawn through a femoral central venous catheter, of 10% for jugular, and of 19% for subclavian central venous catheter (P=0.22). For catheter draws compared with peripheral venipuncture, sensitivity was 100 and 75%, specificity was 76.2 and 90.5%, positive predictive value was 44.4 and 60% and negative predictive value was 100 and 95%. CONCLUSION Cultures of blood drawn through a catheter are more sensible and less specific than those obtained from a peripheral venipuncture and the organism most commonly responsible for contamination of blood cultures is Coagulase Negative Staphylococcus.
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Affiliation(s)
- H Kallel
- Service de réanimation médicale, CHU Habib Bourguiba, route El-Ain, km 1, 3029 Sfax, Tunisie.
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Ismail I, Baccar M, Azzabi S, Ben Salah N, Kallel H, Mefteh R, El Gharbi L, Aouina H, Bouacha H. Profil clinique et polysomnographique de 77 patients Tunisiens porteur de syndrome d’apnées de sommeil (SAOS). Rev Mal Respir 2006. [DOI: 10.1016/s0761-8425(06)72374-9] [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: 10/22/2022]
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Khouaja I, Zakhama H, Kallel H, Kahloul O, Daghfous H, Merai S, Benmrad S, Tritar F. Thrombopénie induite par la rifadine : à propos de deux cas. Rev Mal Respir 2006. [DOI: 10.1016/s0761-8425(06)72204-5] [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: 11/24/2022]
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Kallel H, Ben Mrad S, Zakhama H, Khouaja I, Daghfous H, Kahloul O, Merai S, Tritar F. La désensiblisation orale accélerée aux anti-tuberculeux. Rev Mal Respir 2006. [DOI: 10.1016/s0761-8425(06)72203-3] [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: 10/22/2022]
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Bahloul M, Chaari A, Khlaf-Bouaziz N, Kallel H, Chaari L, Ben Hamida C, Chelly H, Rekik N, Bouaziz M. Maladie cœliaque, thrombose veineuse cérébrale et déficit en protéine S, Une association fortuite ? ACTA ACUST UNITED AC 2005; 30:228-30. [PMID: 16292200 DOI: 10.1016/s0398-0499(05)88207-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Celiac disease is a pathology which is rarely associated with thrombosis complications. Cerebral vascular thrombosis has never been described in patients with a celiac disease. OBSERVATION We report an observation of a 21-year-old girl with a history of celiac disease who was hospitalized in the intensive care unit for convulsive status epilepticus secondary to a cerebral venous thrombosis. The etiologic investigation of this thrombo-embolic complication revealed protein S deficit. Our patient improved under symptomatic treatment. COMMENT This original observation confirms that celiac disease can be associated with cerebral venous thrombosis.
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Affiliation(s)
- M Bahloul
- Service de réanimation médicale, CHU Habib Bourguiba, Route el Ain Km 1, 3029 Sfax, Tunisie.
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Kallel H, Dammak H, Mahjoubi F, Bahloul M, Chelly H, Chaari A, Rekik N, Hammami A, Bouaziz M. [Predictive value of pericatheter skin cultures in detecting catheter-related infections in a medical-surgical intensive care unit]. ACTA ACUST UNITED AC 2005; 24:1343-8. [PMID: 16099126 DOI: 10.1016/j.annfar.2005.06.009] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2004] [Accepted: 06/20/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate the predictive value of pericatheter skin cultures in detecting catheter-related infections in critically-ill patients. STUDY DESIGN Prospective study. PATIENTS AND METHODS Over a 5 months period (from August 1(st) 2001 to December 31 2001), 500 patients were hospitalised, and 108 central venous catheters were prospectively examined. For each catheter, blood cultures, pericatheter skin cultures and semiquantitative culture of the catheter tip were performed. RESULTS The median duration of catheterization was 8 days (interquartile: 8 days). Catheter was removed because of suspected infection in 54 cases (50%). Systemic catheter-related infection was found in 12 cases (11%) and the responsible organism was a gram-negative rod in 11 cases (92%). The negative predictive values of pericatheter skin cultures in the diagnosis of catheter-related infections and in case of suspected catheter-related infection were 89 and 86%, respectively. CONCLUSION These results indicate that the pericatheter skin cultures are not an effective procedure for the conservative diagnosis of catheter-related infections and that the skin-insertion wound is not the major source of catheter-contamination in our unit.
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Affiliation(s)
- H Kallel
- Service de réanimation médicale, CHU Habib-Bourguiba, Sfax, Tunisie.
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Kallel H, Bahoul M, Ksibi H, Dammak H, Chelly H, Hamida CB, Chaari A, Rekik N, Bouaziz M. Prevalence of hospital-acquired infection in a Tunisian hospital. J Hosp Infect 2005; 59:343-7. [PMID: 15749323 DOI: 10.1016/j.jhin.2004.09.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2004] [Accepted: 09/10/2004] [Indexed: 11/15/2022]
Abstract
In order to estimate the prevalence of hospital-acquired infection (HAI) and research factors associated with its occurrence, a one-day prevalence survey was conducted at the Habib Bourguiba University Hospital, Tunisia. We studied 280 patients who had been present in the same ward for at least 48 h, and who had occupied a hospital bed between 17 April 2002 (midnight) and 18 April 2002 (midnight). The overall prevalence of HAI was 17.9%. The most frequently infected sites were the lungs (32%), surgical wounds (28%) and the urinary tract (20%). Microbiological documentation was available in only 28% of HAIs, and the most frequently isolated organisms were Gram-negative rods (80.8%). Results of multiple logistic regression analysis indicated that HAI is linked to the medical category, the use of intravascular devices and antibiotic prophylaxis. This survey provided information on the prevalence of HAI in Tunisian hospitals, the breakdown of infections, and HAI predisposing factors.
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Affiliation(s)
- H Kallel
- Service de Réanimation Médicale, CHU Habib Bourguiba, Route el Ain Km 1, Sfax 3029, Tunisia.
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Kallel H, Hedi C, Maaloul I, Bahloul M, Ksibi H, Khémakhem B, Ben Hamida C, Rekik N, Jarraya A, Hammami A, Ben Jemâa M, Bouaziz M. [Evaluation of the antibiotics consumption in a Tunisian university hospital]. Tunis Med 2005; 83:110-3. [PMID: 15969234] [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: 05/03/2023]
Abstract
PURPOSE To estimate the consumption of antibiotics in our hospital and to determine the points at which will be targeted the recommendations of good practice of antibiotherapy. PATIENTS AND METHODS Our study is a one day prevalence study where antibiotic's prescriptions are analyzed by a group of 6 doctors referents in antibiotherapy. RESULTS During the study day, 443 patients were studied. Means age was 44.2 +/- 23.3 years (range: 1 and 102 years). 101 infections were diagnosed in 48 patients (10.8%). 192 patients (43.3%) received antibiotics. Antibiotherapy was curative in 44% of cases. The most prescribed antibiotics were gentamicin (85.2 DDD/1000 patients), metronidazole (79 DDD/1000 patients), and cefotaxime (73.9 DDD/1000 patients). According to the evaluation group, 30.7% of the antibiotic's prescription was considered unjustified. The antibioprophylaxis represents the category most often unjustified (49%). The molecules in which prescription was frequently considered unjustified are the ciprofloxacin (67%), the amoxicilline-clavulanate (40%) and the cefotaxime (40%). CONCLUSION Our results suggest that an action of good practice should be targeted at the antibioprophylaxis and should concern especially molecules in which prescription was frequently unjustified.
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Affiliation(s)
- H Kallel
- Service de Réanimation Médicale, CHU Habib Bourguiba, Sfax, Tunisie
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Bahloul M, Ben Hmida M, Belhoul W, Ksibi H, Kallel H, Ben Hamida C, Chaari A, Chelly H, Rekik N, Bouaziz M. [Hemolytic-uremic syndrome secondary to scorpion envenomation (apropos of 2 cases)]. Nephrologie 2004; 25:49-51. [PMID: 15119220] [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: 04/29/2023]
Abstract
HUS was recently described following scorpion sting. We report 2 cases of HUS in the intensive care unit of a university hospital. Two children aged respectively 10 months and 1 year were admitted in the ICU after severe scorpion envenomation (with coma and pulmonary oedema) having required dobutamine and mechanical ventilation. Evolution was marked with acute anaemia without bleeding requiring blood transfusion, acute renal failure, low platelets and signs of haemolysis. Our experience and the previously reported case suggest that scorpion sting could be added to the list of causes of the HUS.
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Affiliation(s)
- M Bahloul
- Service de réanimation médicale CHU Habib Bourguiba, Sfax.
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Kallel H, Rourou S, Majoul S, Loukil H. A novel process for the production of a veterinary rabies vaccine in BHK-21 cells grown on microcarriers in a 20-l bioreactor. Appl Microbiol Biotechnol 2003; 61:441-6. [PMID: 12764557 DOI: 10.1007/s00253-003-1245-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2002] [Revised: 12/30/2002] [Accepted: 01/03/2003] [Indexed: 01/13/2023]
Abstract
We studied BHK-21 cells growth in a 2-l bioreactor and investigated the effects of microcarrier concentration, type of growth medium, culture mode and serum concentration. The highest cell density reached was equal to 4x10(6) cells/ml and was achieved in minimum essential medium supplemented with Hanks' salts, non-essential amino acids and 5% fetal calf serum, using a perfusion culture mode and a microcarrier concentration of 4 g Cytodex 3/l. We studied rabies virus production (PV/BHK-21 strain) by BHK-21 cells grown at the optimal conditions determined previously. We analyzed the effects of multiplicity of infection (MOI) and type of medium used for virus multiplication in spinner-flasks and showed that the highest virus titer reached (when the cells were infected at a MOI of 0.3) in M199 medium supplemented with 0.2% of bovine serum albumin was equal to 8.2x10(7) Fluorescent Focus Units (FFU)/ml. When we grew the cells in a 2-l perfused bioreactor, we obtained a maximal virus titer of 3x10(8) FFU/ml. In addition, we scaled-up to a 20-l bioreactor and obtained similar results for cell density and virus titer. The experimental vaccine we developed meets WHO requirements for vaccine potency. Each run yielded about 40,000 doses of potent vaccine.
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Affiliation(s)
- H Kallel
- Viral Vaccines Research and Development Unit, Institute Pasteur, 13 Place Pasteur, BP 74, 1002 Belvédère, Tunis, Tunisia.
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