Reversible Wernicke encephalopathy caused by hyperemesis gravidarum in the second trimester of pregnancy: a case report

Wernicke encephalopathy is a potentially life-threatening neurologic syndrome caused by acute thiamine (vitamin B1) deficiency. It is usually associated with excessive alcohol consumption. Less frequently, this syndrome can be caused by persistent vomiting. This is a case report of a 33-year-old woman diagnosed with Wernicke encephalopathy (WE) during the second trimester of pregnancy. The presence of neurological and ophthalmological symptoms in the context of hyperemesis gravidarum led us to evoke the diagnosis of WE, and it was confirmed when specific lesions were found in the brain magnetic resonance imaging (MRI). Luckily for our patient, WE was diagnosed promptly and the signs were reversible after thiamine supplementation. In conclusion, any first line care taker or midwife must know the symptoms of Wernicke encephalopathy because prompt diagnosis and treatment can lead to recovery

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

SummaryObjectiveThe 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.MethodsA retrospective study was conducted over 16 months in a Tunisian intensive care unit (ICU). All adult patients with A. baumannii VAP were included.ResultsNinety-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).ConclusionA. baumannii VAP is associated with a high mortality. Hemodynamic impairment is predictive of a poor outcome

Gravity-induced ischemia in the brain and prone positioning for COVID-19 patients breathing spontaneously: still far from the truth!

International audienceGlobal mindset is usually considered as a positive skill or resource that helps individuals and companies succeed internationally. We argue that it is also a collective scheme of thought that brings some actors together and sets others apart. We investigate this perspective through a qualitative study of French MNC managers, internationalisation support providers, and SME owners and managers attempting to create or grow their business in China. We reveal that global mindset is a double‐edged concept: it is not solely an instrument for integration, but also a doxa, a particular viewpoint imposed to identify and reject outsiders through symbolic struggles. This alternative conceptualisation is necessary to rethink the social forces at work in the field of international business. It is also necessary to encourage educators and practitioners to acknowledge the struggles that result from the imposition of certain views and behaviours and to adapt education, support and training programs accordingly.L’objectif de cet article est de comprendre la dynamique des compétences interculturelles individuelles et collectives des prestataires dans l’expérience de service du client. Les résultats de l’étude de cas d’une business unit française prestataire de services linguistiques qui excelle en la matière montrent qu’une articulation eff icace des deux niveaux de compétence assure la satisfaction des clients et contribue à la compétitivité de l’entreprise

Clinical characteristics and outcomes of critically ill COVID-19 patients in Sfax, Tunisia

Background Africa, like the rest of the world, has been impacted by the coronavirus disease 2019 (COVID-19) pandemic. However, only a few studies covering this subject in Africa have been published. Methods We conducted a retrospective study of critically ill adult COVID-19 patients—all of whom had a confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection—admitted to the intensive care unit (ICU) of Habib Bourguiba University Hospital (Sfax, Tunisia). Results A total of 96 patients were admitted into our ICU for respiratory distress due to COVID-19 infection. Mean age was 62.4±12.8 years and median age was 64 years. Mean arterial oxygen tension (PaO2)/fractional inspired oxygen (FiO2) ratio was 105±60 and ≤300 in all cases but one. Oxygen support was required for all patients (100%) and invasive mechanical ventilation for 38 (40%). Prone positioning was applied in 67 patients (70%). Within the study period, 47 of the 96 patients died (49%). Multivariate analysis showed that the factors associated with poor outcome were the development of acute renal failure (odds ratio [OR], 6.7; 95% confidence interval [CI], 1.75–25.9), the use of mechanical ventilation (OR, 5.8; 95% CI, 1.54–22.0), and serum cholinesterase (SChE) activity lower than 5,000 UI/L (OR, 5.0; 95% CI, 1.34–19). Conclusions In this retrospective cohort study of critically ill patients admitted to the ICU in Sfax, Tunisia, for acute respiratory failure following COVID-19 infection, the mortality rate was high. The development of acute renal failure, the use of mechanical ventilation, and SChE activity lower than 5,000 UI/L were associated with a poor outcome

Pulmonary embolism in intensive care unit: Predictive factors, clinical manifestations and outcome

<b>Objective</b> :<b> </b> To determine predictive factors, clinical and demographics characteristics of patients with pulmonary embolism (PE) in ICU, and to identify factors associated with poor outcome in the hospital and in the ICU. <b> Methods</b> :<b> </b> During a four-year prospective study, a medical committee of six ICU physicians prospectively examined all available data for each patient in order to classify patients according to the level of clinical suspicion of pulmonary thromboembolism. During the study periods, all patients admitted to our ICU were classified into four groups. The first group includes all patients with confirmed PE; the second group includes some patients without clinical manifestations of PE; the third group includes patients with suspected and not confirmed PE and the fourth group includes all patients with only deep vein thromboses (DVTs) without suspicion 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 in its branches. The diagnosis was also confirmed by echocardiography when a thrombus in the pulmonary artery was observed. <b> Results</b> :<b> </b> During the study periods, 4408 patients were admitted in our ICU. The diagnosis of PE was confirmed in 87 patients (1.9&#x0025;). The mean delay of development of PE was 7.8 &#177; 9.5 days.<b> </b> On the day of PE diagnosis, clinical examination showed that 50 patients (57.5&#x0025;) were hypotensive, 63 (72.4&#x0025;) have SIRS, 15 (17.2&#x0025;) have clinical manifestations of DVT and 71 (81.6&#x0025;) have respiratory distress requiring mechanical ventilation. In our study, intravenous unfractionated heparin was used in 81 cases (93.1&#x0025;) and low molecular weight heparins were used in 4 cases (4.6&#x0025;).<b> </b> The mean ICU stay was 20.2 &#177; 25.3 days and the mean hospital stay was 25.5 &#177; 25 days. The mortality rate in ICU was 47.1&#x0025; and the in-hospital mortality rate was 52.9&#x0025;.<b> </b> Multivariate analysis showed that factors associated with a poor prognosis in ICU are the use of norepinephrine and epinephrine<b> . </b> Furthermore, factors associated with in-hospital poor outcome in multivariate analysis were a number of organ failure associated with PE &#8805; 3. Moreover, comparison between patients with and without pe showed that predictive factors of pe are: acute medical illness, the presence of meningeal hemorrhage, the presence of spine fracture, hypoxemia with PaO₂ /FiO₂ ratio &#60; 300 and the absence of pharmacological prevention of venous thromboembolism. <b>Conclusion</b> :<b> </b> Despite the high frequency of DVT in critically ill patients, symptomatic PE remains not frequently observed, because systematic screening is not performed. Pulmonary embolism is associated with a high ICU and in-hospital mortality rate. Predictive factors of PE are acute medical illness, the presence of meningeal hemorrhage, the presence of spine fracture, hypoxemia with PaO₂ /FiO₂ &lt; 300 and the absence of pharmacological prevention of venous thromboembolism

Post-traumatic pulmonary embolism in the intensive care unit

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 /FiO 2 < 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 /FiO 2 < 200, the presence of a spine fracture, and the presence of meningeal hemorrhage. Prevention is highly warranted

Isolated traumatic head injury in children: Analysis of 276 observations

<b>Background</b> : To determine predictive factors of mortality among children after isolated traumatic brain injury. <b>Materials and Methods</b> : In this retrospective study, we included all consecutive children with isolated traumatic brain injury admitted to the 22-bed intensive care unit (ICU) of Habib Bourguiba University Hospital (Sfax, Tunisia). Basic demographic, clinical, biochemical, and radiological data were recorded on admission and during ICU stay. <b>Results</b> : There were 276 patients with 196 boys (71&#x0025;) and 80 girls, with a mean age of 6.7 &#177; 3.8 years. The main cause of trauma was road traffic accident (58.3&#x0025;). Mean Glasgow Coma Scale score was 8 &#177; 2, Mean Injury Severity Score (ISS) was 23.3 &#177; 5.9, Mean Pediatric Trauma Score (PTS) was 4.8 &#177; 2.3, and Mean Pediatric Risk of Mortality (PRISM) was 10.8 &#177; 8. A total of 259 children required mechanical ventilation. Forty-eight children (17.4&#x0025;) died. Multivariate analysis showed that factors associated with a poor prognosis were PRISM &gt; 24 (OR: 10.98), neurovegetative disorder (OR: 7.1), meningeal hemorrhage (OR: 2.74), and lesion type VI according to Marshall tomographic grading (OR: 13.26). <b>Conclusion</b> : In Tunisia, head injury is a frequent cause of hospital admission and is most often due to road traffic injuries. Short-term prognosis is influenced by demographic, clinical, radiological, and biochemical factors. The need to put preventive measures in place is underscored

Isolated traumatic head injury in children: Analysis of 276 observations

BACKGROUND: To determine predictive factors of mortality among children after isolated traumatic brain injury. MATERIALS AND METHODS: In this retrospective study, we included all consecutive children with isolated traumatic brain injury admitted to the 22-bed intensive care unit (ICU) of Habib Bourguiba University Hospital (Sfax, Tunisia). Basic demographic, clinical, biochemical, and radiological data were recorded on admission and during ICU stay. RESULTS: There were 276 patients with 196 boys (71%) and 80 girls, with a mean age of 6.7 ± 3.8 years. The main cause of trauma was road traffic accident (58.3%). Mean Glasgow Coma Scale score was 8 ± 2, Mean Injury Severity Score (ISS) was 23.3 ± 5.9, Mean Pediatric Trauma Score (PTS) was 4.8 ± 2.3, and Mean Pediatric Risk of Mortality (PRISM) was 10.8 ± 8. A total of 259 children required mechanical ventilation. Forty-eight children (17.4%) died. Multivariate analysis showed that factors associated with a poor prognosis were PRISM > 24 (OR: 10.98), neurovegetative disorder (OR: 7.1), meningeal hemorrhage (OR: 2.74), and lesion type VI according to Marshall tomographic grading (OR: 13.26). CONCLUSION: In Tunisia, head injury is a frequent cause of hospital admission and is most often due to road traffic injuries. Short-term prognosis is influenced by demographic, clinical, radiological, and biochemical factors. The need to put preventive measures in place is underscored