User-centered visual analysis using a hybrid reasoning architecture for intensive care units

One problem pertaining to Intensive Care Unit information systems is that, in some cases, a very dense display of data can result. To ensure the overview and readability of the increasing volumes of data, some special features are required (e.g., data prioritization, clustering, and selection mechanisms) with the application of analytical methods (e.g., temporal data abstraction, principal component analysis, and detection of events). This paper addresses the problem of improving the integration of the visual and analytical methods applied to medical monitoring systems. We present a knowledge- and machine learning-based approach to support the knowledge discovery process with appropriate analytical and visual methods. Its potential benefit to the development of user interfaces for intelligent monitors that can assist with the detection and explanation of new, potentially threatening medical events. The proposed hybrid reasoning architecture provides an interactive graphical user interface to adjust the parameters of the analytical methods based on the users' task at hand. The action sequences performed on the graphical user interface by the user are consolidated in a dynamic knowledge base with specific hybrid reasoning that integrates symbolic and connectionist approaches. These sequences of expert knowledge acquisition can be very efficient for making easier knowledge emergence during a similar experience and positively impact the monitoring of critical situations. The provided graphical user interface incorporating a user-centered visual analysis is exploited to facilitate the natural and effective representation of clinical information for patient care

Bothrops lanceolatus Bites: Guidelines for Severity Assessment and Emergent Management

Approximately 20-30 declared snakebite cases occurin Martinique each year. Bothrops lanceolatus, a member of the Crotalidae family, is considered to be the only involved snake. B. lanceolatus, commonly named “Fer-de-Lance”, is endemic and only found on this Caribbean island. Envenomation local features include the presence of fang marks, swelling, pain, bleeding from punctures, and ecchymosis. Severe envenomation is associated with multiple systemic thromboses appearing within 48 h of the bite and resulting in cerebral, myocardial or pulmonary infarctions. Diagnosis requires first of all identification of the snake. Coagulation tests are helpful to identify thrombocytopenia or disseminated intravascular coagulation. A clinical score based on 4 grades is helpful to assess envonimation severity. A specific monovalent equine anti-venom (Bothrofav®, Sanofi-Pasteur, France) to neutralize B. lanceolatus venom is available. Its early administration within 6h from the biting in case of progressive local injures, general signs or coagulation disturbances is effective to prevent severe thrombosis and coagulopathy. Its tolerance is considered to be good. Despite an increasing incidence of bites, no deaths have been recently attributed to B. lanceolatus in Martinique, probably due to the currently recommended strategy of early antivenom administration when required

Intérêt de la toxine botulique à la phase aiguë dans le traitement de la spasticité des membres chez le patient victime d'accident vasculaire cérébral

La prise en charge des AVC (accidents vasculaires cérébraux) dans les unités de soins intensifs neurologiques a permis d'augmenter leur taux de survie. Les séquelles dues aux accidents vasculaires cérébraux, en particulier la spasticité, sont sources de handicap et compliquent la prise en charge pratique des patients. Jusqu'ici, les traitements utilisés pour lutter contre la spasticité peuvent entraîner des effets secondaires. Depuis une dizaine d'années, la toxine butolique est un traitement en plein essor. Elle est actuellement indiquée à six mois de l'ictus, avec de bons résultats. Dans ce travail prospectif, sur cinq patients victimes d'AVC et qui ont présenté uns spasticité précoce et gênante, l'injection de la toxine butolique à moins de trois mois de l'ictus, nous a montré qu'elle est un traitement efficace. Elle a amélioré, en effet, la position des membres au repos et les amplitudes articulaires à la mobilisation passive. Elle semble posséder une propriété antalgique. Chez nos cinq patients, nous n'avons pas observé d'effet secondaire. L'injection de la toxine butolique est un geste facile à réaliser, dans un cadre de réanimation avec une sécurité optimale et une bonne gestion du confort du patient. L'utilisation de la toxine botulique pourrait donc s'intégrer aisément dans une prise en charge précoce de rééducation au sein des services de soins. L'objectif est avant tout d'éviter l'enraidissement et les limites d'amplitude des articulations, inévitables si la spasticité n'est pas prise en charge rapidement.FORT-DE-FRANCE-CHRU-BU (972332102) / SudocPARIS7-Xavier Bichat (751182101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Drépanocytose et hyperbarie

FORT-DE-FRANCE-CHRU-BU (972332102) / SudocLILLE2-BU Santé-Recherche (593502101) / SudocPARIS-BIUM (751062103) / SudocABYMES-CHRUPPA-BU (971202102) / SudocSudocFranceF

Cardiac Arrest in the Airport Revealing Cocaine Body Packing: A Case Report

Ingestion of large amounts of cocaine packages is a well-known method for cross-border transportation. Intestinal obstruction and life-threatening sympathomimetic toxidrome including seizures, ventricular dysrhythmia, and cardiac arrest resulting from the rupture of cocaine packages may occur. Here, we report a case of a 34-year-old pregnant woman who had a sudden cardiac arrest while waiting for her bags at Paris-Charles de Gaulle Airport, France. According to the flight attendants, the patient travelled from Brazil and complained of abdominal pain during the flight. After resuscitation, the patient presented sustained tachycardia and convulsions suggesting cocaine overdose caused by body packing. Once admitted to the hospital, laparotomy was performed allowing the extraction of 50 cocaine packages. Cardiac symptoms were attributed to the rupture of five of the packages. Prehospital and emergency physicians need to be aware of the possibility of cocaine overdose by body packing in patients presenting sudden cardiac arrest in airports

Near-Drowning: To Be or Not to Be … Is It the Question?

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Inflammation and Oxidative Stress in Snakebite Envenomation: A Brief Descriptive Review and Clinical Implications

Snakebite envenoming is a pathological condition which may occur in response to the injection of venom. Snake venoms contain a complex mixture of biologically active molecules which are responsible for a broad spectrum of clinical manifestations, ranging from local tissue injuries to fatal complications. Snake venom administration commonly provokes local tissue injury often associated with systemic effects, including neurotoxic and cardiotoxic manifestations, bleeding, acute kidney injury, and rhabdomyolysis. An important spectrum of pathogenesis of snake envenomation is the generation of reactive oxygen species (ROS), which can directly provoke tissue damage and also potentiate the deleterious consequences of inflammation at the bite site. Snake venom components known to induce oxidative stress include phospholipases A2, metalloproteinases, three-finger toxins, and L-amino acid oxidase. Clear evidence is mounting suggesting that inflammation and oxidative stress participate in the destructive effects of envenoming, including acute renal failure, tissue necrosis, and unusual susceptibility to bleed (hemorrhage), mostly due to hypocoagulability, neuro/cardio toxicity, and myonecrosis. Impaired regulation of oxidative stress may also set the stage for secondary/long-term complications of snakebite envenomation such as musculoskeletal disabilities. Some aspects of natural antioxidant therapeutic options are discussed in this review

Sargassum invasion in the Caribbean: the role of medical and scientific cooperation

International audienc

Snakebites in French Guiana: Conclusions of an international symposium

International audienc