A. Chaari

Acinetobacter baumannii ventilator-associated pneumonia: epidemiology, clinical characteristics, and prognosis factors

OBJECTIVE The aim of this study was to describe the epidemiological characteristics of Acinetobacter baumannii ventilator-associated pneumonia (VAP) and to identify factors predictive of a poor outcome. METHODS A retrospective study was conducted over 16 months in a Tunisian intensive care unit (ICU). All adult patients with A. baumannii VAP were included. RESULTS Ninety-two patients were included in they study; 41 (44.6%) were admitted because of multiple trauma. The mean age of the patients was 44.5±19.5 years. All patients needed mechanical ventilation on admission. The mean SAPS II score was 39±15. The mean delay before VAP onset was 8.1±4.7 days. On VAP onset, 57 patients (62%) developed septic shock. Only 14.2% of isolated strains were susceptible to imipenem; none were resistant to colistin. The mean duration of mechanical ventilation was 20±11 days. The mean duration of ICU stay was 24.3±18.7 days. ICU mortality was 60.9%. In the multivariate analysis, factors predictive of a poor outcome were previously known hypertension (odds ratio 5.8, 95% confidence interval 1.4-24.9; p=0.018) and VAP-related septic shock (odds ratio 8.5, 95% confidence interval 3-23.7; p<0.001). CONCLUSION A. baumannii VAP is associated with a high mortality. Hemodynamic impairment is predictive of a poor outcome.

Gastrointestinal manifestations in severe scorpion envenomation

OBJECTIVES To evaluate the type and incidence of gastrointestinal manifestations secondary to scorpion envenomation and their prognostic significance. PATIENTS AND METHODS All patients admitted to our ICU for scorpion envenomation were included in this retrospective chart review of a 13-year period (1990 - 2002). RESULTS During the study period, 951 patients were admitted for scorpion envenomation and 72 (7.6%) died. Ages ranged from 0.5 to 90 years with a mean of 14.7 +/- 17.4 years. Gastrointestinal symptoms were present in 700 patients (73.6%): nausea in 24 (2.5%), vomiting in 687 (72.2%) and diarrhea in 41 patients (4.3%). At univariate analysis, the presence of diarrhea was associated with a fatal outcome (P < 0.05). Diarrhea was also correlated with other indicators of severe envenomation and poor prognosis: respiratory failure (P = 0.01), neurological failure (P < 0.0001), liver failure (P < 0.0001) and low blood pressure requiring catecholamine support (P = 0.02). The multivariate analysis showed that young age (age less than 5 years), fever > 38.5 degrees C, neurological failure and pulmonary edema were independent factors of severity. Digestive disorders were more frequent in children and in this subgroup diarrhea appeared to be associated with poor outcome. In a subset of patients for whom data were available, fatal cases demonstrated significantly higher liver enzymes levels on admission. CONCLUSION In Tunisia, gastrointestinal symptoms are often observed in severe scorpion envenomations, especially in young patients. In children, diarrhea and elevated liver enzymes are associated with poor prognosis.

Maladie cœliaque, thrombose veineuse cérébrale et déficit en protéine S, Une association fortuite ?

Resume Introduction La maladie cœliaque est une pathologie qui s’associe rarement a des complications thrombo-emboliques. La thrombose veineuse cerebrale n’a jamais ete decrite chez des patients ayant une maladie cœliaque. Observation Nous rapportons une observation d’une fille âgee de 21 ans ayant des antecedents de maladie cœliaque sous regime sans gluten, hospitalisee en reanimation pour etat de mal convulsif en rapport avec un ramollissement cerebral secondaire a une thrombose veineuse cerebrale. L’enquete etiologique de cette complication thrombo-embolique revele un deficit en proteine S. Commentaire Cette observation originale permet de discuter l’association fortuite de la maladie cœliaque et de la thrombose veineuse cerebrale. (J Mal Vasc 2005 ; 30 : 228-230).

A New Clustering Approach for Face Identification

We propose in this paper a search approach which aim to improve identification in biometric databases. We work with face images and we develop appearance-based Eigenfaces and Fisherfaces methods to generate holistic and discriminant features and attributes. These features, which describe faces, are often used to establish the required identity in a classical identification process. In this work we introduce a clustering process upstream the identification process which divides faces into partitions according to their features similarities. Indeed, we aim to split biometric databases into partitions in order to simplify the recognition task within these databases. This paper describes the proposed clustering approach, the Eigenfaces and Fisherfaces representation methods and preliminary clustering results on the XM2VTS data corpus.

Le syndrome d'activation macrophagique: une cause possible de défaillance multiviscérale chez le traumatisé du crâne ?

We report the case of a 26-year-old patient who was victim of severe head trauma following a trafic road accident. Two days after trauma, she had fever, pancytopenia and multi-organ failure. The haemophagocytic lymphohistiocytosis syndrome was suspected. This diagnosis was confirmed by biologic findings (elevated serum levels of ferritin and triglycerid) and histological findings (examination of bone marrow smears showing histiocytes phagocytosing blood cells). The evolution was unfavorable despite of corticotherapy and symptomatic measures.