Photo Essay: The Crisis in Darfur

This is a photo essay about the internal conflict in Darfur, one of the world\u27s poorest and most inaccessible regions, on Sudan\u27s western border with Chad

Long-term medical utilization following ventilator-associated pneumonia in acute stroke and traumatic brain injury patients: a case-control study

<p>Abstract</p> <p>Background</p> <p>The economic burden of ventilator-associated pneumonia (VAP) during the index hospitalization has been confirmed in previous studies. However, the long-term economic impact is still unclear. The aim of this study is to examine the effect of VAP on medical utilization in the long term.</p> <p>Methods</p> <p>This is a retrospective case-control study. Study subjects were patients experiencing their first traumatic brain injury, acute hemorrhagic stroke, or acute ischemic stroke during 2004. All subjects underwent endotracheal intubation in the emergency room (ER) on the day of admission or the day before admission, were transferred to the intensive care unit (ICU) and were mechanically ventilated for 48 hours or more. A total of 943 patients who developed VAP were included as the case group, and each was matched with two control patients without VAP by age ( ± 2 years), gender, diagnosis, date of admission ( ± 1 month) and hospital size, resulting in a total of 2,802 patients in the study. Using robust regression and Poisson regression models we examined the effect of VAP on medical utilization including hospitalization expenses, outpatient expenses, total medical expenses, number of ER visits, number of readmissions, number of hospitalization days and number of ICU days, during the index hospitalization and during the following 2-year period.</p> <p>Results</p> <p>Patients in the VAP group had higher hospitalization expenses, longer length of stay in hospital and in ICU, and a greater number of readmissions than the control group patients.</p> <p>Conclusions</p> <p>VAP has a significant impact on medical expenses and utilization, both during the index hospitalization during which VAP developed and in the longer term.</p

Obesity and smoking are factors associated with poor prognosis in patients with bacteraemia

BACKGROUND: Bacteraemia is still a major cause of case fatality in all age groups. Our aim was to identify the major underlying conditions constituting risk factors for case fatality in bacteraemia patients. METHODS: The study involved 149 patients (79 male and 70 female) with bacteraemia caused by Staphylococcus aureus (S. aureus) (41 patients), Streptococcus pneumoniae (Str. pneumoniae) (42 patients), β-hemolytic streptococcae (β-hml str.) (23 patients) and Eschericia coli (E. coli) (43 patients). Underlying diseases, alcohol and tobacco consumption and body mass index (BMI) were registered. Laboratory findings and clinical data were registered on admission and 6 consecutive days and on day 10–14. Case fatality was studied within 30 days after positive blood culture. Associations between underlying conditions and case fatality were studied in univariate analysis and in a multivariate model. RESULTS: Nineteen patients (12.8%) died of bacteraemia. We found obesity (p = 0.002, RR 9.8; 95% CI 2.3 to 41.3), smoking (p < 0.001, RR 16.9; 95% CI 2.1 to 133.5), alcohol abuse (p = 0.008, RR 3.9; 95% CI 1.3 to 11.28), COPD (p = 0.01, RR 8.4; 95% CI 1.9 to 37.1) and rheumatoid arthritis (p = 0.045, RR 5.9; 95% CI 1.2 to 28.8) to be significantly associated with case fatality in bacteraemia in univariate model. The median BMI was significantly higher among those who died compared to survivors (33 vs. 26, p = 0.003). Obesity and smoking also remained independent risk factors for case fatality when their effect was studied together in a multivariate model adjusted with the effect of alcohol abuse, age (continuos variable), sex and causative organism. CONCLUSION: Our results indicate that obesity and smoking are prominent risk factors for case fatality in bacteraemic patients. Identification of risk factors underlying fatal outcome in bacteraemia may allow targeting of preventive efforts to individuals likely to derive greatest potential benefit

Étude rétrospective de la réhabilitation dentaire complète d’un os maxillaire atrophique par implants zygomatiques : à propos de 17 patients et de 52 implants zygomatiques

L’édentement est une pathologie de plus en plus fréquente et ayant des répercussions importantes sur l’individu. C’est devenu depuis quelques années un problème de santé publique majeur. En plus des « techniques traditionnelles » de réhabilitation d’un os maxillaire atrophique, il existe une alternative avec le concept des implants zygomatiques et leur mise en charge immédiate. À l’heure actuelle, il n’existe que peu de publications pouvant faire référence sur le sujet. L’objectif de cette thèse est double. Tout d’abord, faire le point sur les implants zygomatiques, les techniques chirurgicales, leurs avantages et inconvénients. Puis évaluer le bien-être des patients à l’aide du questionnaire OHIP-14. Etude rétrospective monocentrique incluant 17 patients ayant bénéficié de la pose de 52 implants zygomatiques au sein de la clinique des Emailleurs-Colombier à Limoges durant la période du 02/2017 au 06/2018. Dix-sept patients inclus : 5 hommes et 12 femmes. Âge moyen de 66,2 ans. 53% des patients ont bénéficié d’un « quad zygomatique » et 47% de la technique « hybride » pour un total de 52 implants zygomatiques. L’intervention a duré en moyenne 3h30. Il a été retrouvé un taux de survie implantaire de 100%, seulement deux cas de sinusites maxillaires résolues de façon médicale. Le score OHIP-14 moyen sur l’ensemble des patients était de 4,4 sur 56. Malgré un faible effectif, notre étude retrouve des résultats similaires à la littérature. Le taux de survie oscille entre 92 et 100% dans les publications. La technique chirurgicale ayant pour particularité d’avoir un double ancrage osseux (maxillaire et zygomatique) et un passage intra-sinusien mais extra-membrane sinusienne pouvant expliquer l’absence de complications majeures. À savoir l’absence de sinusite maxillaire chronique, de péri-implantite qui sont les deux complications les plus souvent retrouvées dans la littérature. Concernant le taux de satisfaction des patients, le score OHIP-14 de 4,4/56 est équivalent au score de la population générale compris entre 4 et 5. Le concept de l’implant zygomatique est un apport majeur dans la chirurgie implantaire. C’est une technique fiable, avec un taux de survie implantaire très élevé et un confort de vie satisfaisant qui permet d’éviter les greffes mais sans les remplacer. Il ne s’agit plus d’envisager les implants zygomatiques en seconde intention mais comme une véritable alternative aux techniques « traditionnelles »

Photo Essay: The Crisis in Darfur

This is a photo essay about the internal conflict in Darfur, one of the world\u27s poorest and most inaccessible regions, on Sudan\u27s western border with Chad

Difficulties in diagnosing lymphangiomas of the tongue treated with CO

Observation: A 44-year-old patient was deferred for consultation for vesicles and whitish papules a few millimeters in diameter on the tongue. Painful inflammatory attacks and phases of mitigation alternated with each other. The clinical test results were all normal. The pathological examination indicated a lymphangiomatous component caused by inflammation. A CO2 laser treatment was successfully initiated. Regular monitoring revealed no recurrence at the 12-month follow-up. Comments: Cystic lymphangioma is an early-stage benign tumor. Their occurrence in adults is rare. The case presented was atypical by the context and appearance of the lesions. The treatment of cystic lymphangioma in the oral cavity is surgical in nature, which consists of a complete removal of the cysts to avoid recurrences. Other treatments can be proposed: laser, sclerotherapy, ablation, and radiofrequency cauterization. Conclusion: Cystic lymphangioma in adults is rare. The malformations are sometimes difficult to diagnose. There is no evidence-based treatment but laser vaporization is an option for microcystic forms