9 research outputs found
Clinical, diagnostic and Cryptococcosis neuroméningées evolutionary aspects in HIV infection
Les tuberculomes cerebraux de lâadulte immunocompetent: 21 cas a Setif-Algerie
Introduction: Les donnĂ©es sur les tuberculomes cĂ©rĂ©braux sont limitĂ©es ; ceci fait que, malgrĂ© son anciennetĂ©, cette pathologie souffre dâĂ©normes problĂšmes diagnostiques et thĂ©rapeutiques. A cet effet, les auteurs rapportent leur expĂ©rience quant Ă la prise en charge des tuberculomes puis comparent leurs rĂ©sultats Ă ceux de la littĂ©rature.MatĂ©riel et mĂ©thode: Câest une Ă©tude rĂ©trospective sur dossiers de patients hospitalisĂ©s entre janvier 2005 et dĂ©cembre 2016 pour tuberculomes cĂ©rĂ©braux uniques ou multiples.RĂ©sultats: Les malades Ă©taient en majoritĂ© des femmes (18/3), ĂągĂ©s en moyenne de 36,5 ans. Le dĂ©but Ă©tait subaigu chez lâensemble des patients mais nâa dĂ©passĂ© 2 mois quâune fois. Les signes neurologiques de focalisation (12 malades) Ă©taient variĂ©s, dominĂ©s par les convulsions et les paralysies oculomotrices. Lâatteinte neurologique nâĂ©tait pas lâunique localisation chez 13 malades dont 11 avaient une atteinte pulmonaire. Lâorigine tuberculeuse Ă©tait prouvĂ©e 5 fois au niveau neuro-mĂ©ningĂ© et 3 fois au niveau dâune localisation extra-neurologique. Ă lâimagerie cĂ©rĂ©brale, tout le cerveau Ă©tait touchĂ© et le nombre des tubeculomes a variĂ© de la lĂ©sion unique Ă la forme miliaire diffuse. Lâimagerie par rĂ©sonance magnĂ©tique Ă©tait plus contributive que la tomodensitomĂ©trie dans 85% des cas. La durĂ©e du traitement antituberculeux Ă©tait entre 9 et 18 mois. Aucun dĂ©cĂšs nâa Ă©tĂ© dĂ©plorĂ© mais 6 malades ont gardĂ© des sĂ©quelles neurologiques.Conclusion: Le caractĂšre curable des tuberculomes impose dâĂ©voquer ce diagnostic devant toute masse cĂ©rĂ©brale en zone dâendĂ©mie. Leur aspect Ă lâimagerie par rĂ©sonnance magnĂ©tique et la dĂ©couverte dâune localisation extra-neurologique peuvent palier Ă la faible sensibilitĂ© du diagnostic microbiologique. Mots clĂ©s: Imagerie cĂ©rĂ©brale, Tuberculomes cĂ©rĂ©braux, TraitementEnglish Title: Cerebral tuberculomas in immunocompetent adult: 21 cases in Setif-AlgeriaEnglish AbstractIntroduction: Cerebral tuberculomas data are limited, so, despite it is very old, this makes the disease suffer from enormous diagnostic and therapeutic problems. For this purpose, in this work we report our experience in the management of cerebral tuberculomas and compare our results with those found in the literature.Material and method: We have done a retrospective study from files of patients hospitalized between January 2005 and December 2016 for single or multiple cerebral tuberculoma.Results: Our patients were predominantly female (18/3), with an average age of 36.5 years. The onset was all the time subacute but it exceeded 2 months only once. Focal neurological signs were noted in 12 patients, they were varied, dominated by convulsions and oculomotor paralysis. Neurological involvement was not the only localization in 13 patients, 11 of whom had pulmonary involvement. The tuberculous origin was confirmed 5 times at the neuro-meningeal level and 3 times in an extra-neurological localization. In cerebral imaging, whole brain was affected and the number of tuberculomas varied from the single lesion to the diffuse miliary form. In 85% of cases, magnetic resonance imaging was more contributory than computed tomography. The duration of the tuberculosis treatment was between 9 and 18 months; no deaths have been reported but 6 patients had kept neurological sequelae.Conclusion: The curability of tuberculomas imposes to discuss this diagnosis in front of any cerebral mass in endemic zone. Their appearance in magnetic resonance imaging and the discovery of an extra-neurological location can compensate the low sensitivity of microbiological diagnosis of tuberculoma.Keywords: Cerebral tuberculomas, Brain imaging, Treatmen
Hepatitis B Surface Antigen (HbsAg) Prevalence and Risk Factors in Women of Childbearing Age in Eastern Algeria
Background: Hepatitis B is the most common chronic viral infection and a significant contributor to morbidity and death globally. Based on the mother's hepatitis B e antigen (HBeAg) status, the probability of perinatal HBV infection in children delivered to mothers with HBV ranges from 10% to 85%.Aim: to determine the prevalence of hepatitis B virus infection among women of childbearing age in the eastern region of Algeria and investigate risk factors for infection to recommend ways to reduce the disease's impact on neonatal morbidity and mortality.Methods: We conducted a cross-sectional study in SĂ©tif, Algeria, from 2005 to 2007 to assess the prevalence of Hepatitis B Surface Antigen among women of childbearing age. This study is the first and only one in Algeria. Data on risk factors, obstetrics, and sociodemographic were gathered using structured questionnaire; they were subsequently tested using an enzymelinked immunosorbent assay for HBsAg. The data collected were entered and processed using Epi info 3.3.2 software. Infection prevalence, sociodemographic, clinical, obstetric and risk factors variable frequency distributions were calculated. The student's t-test and Fisher's exact test were applied, at a significance level of 5%.Results: There are834 women of childbearing age's medical records were examined for this study. 1% of HBsAg test findings were positive. Positive HBsAg didn't significantly correlate with any other variables, including age, place of residence, municipality, marital status, occupation, parity, current pregnancy, reason for current consultation, transmission risk factors (blood transfusion, recent piercing, dental care, shared personal hygiene equipment, injection with multiple use equipment, tattoo, scarification, partner characteristics). However, history of jaundice has a significant protective effect against HBsAg positive.Conclusion: Although our results classify the two municipalities studied as low prevalence areas (< 2%). Prenatal HBsAg screening is strongly advised
Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries
Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely
Epidemiology of surgery associated acute kidney injury (EPIS-AKI): a prospective international observational multi-center clinical study
Epidemiology of surgery associated acute kidney injury (EPIS-AKI): a prospective international observational multi-center clinical study
Purpose: The incidence, patient features, risk factors and outcomes of surgery-associated postoperative acute kidney injury (PO-AKI) across different countries and health care systems is unclear. Methods: We conducted an international prospective, observational, multi-center study in 30 countries in patients undergoing major surgery (>â2-h duration and postoperative intensive care unit (ICU) or high dependency unit admission). The primary endpoint was the occurrence of PO-AKI within 72 h of surgery defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Secondary endpoints included PO-AKI severity and duration, use of renal replacement therapy (RRT), mortality, and ICU and hospital length of stay. Results: We studied 10,568 patients and 1945 (18.4%) developed PO-AKI (1236 (63.5%) KDIGO stage 1500 (25.7%) KDIGO stage 2209 (10.7%) KDIGO stage 3). In 33.8% PO-AKI was persistent, and 170/1945 (8.7%) of patients with PO-AKI received RRT in the ICU. Patients with PO-AKI had greater ICU (6.3% vs. 0.7%) and hospital (8.6% vs. 1.4%) mortality, and longer ICU (median 2 (Q1-Q3, 1-3) days vs. 3 (Q1-Q3, 1-6) days) and hospital length of stay (median 14 (Q1-Q3, 9-24) days vs. 10 (Q1-Q3, 7-17) days). Risk factors for PO-AKI included older age, comorbidities (hypertension, diabetes, chronic kidney disease), type, duration and urgency of surgery as well as intraoperative vasopressors, and aminoglycosides administration. Conclusion: In a comprehensive multinational study, approximately one in five patients develop PO-AKI after major surgery. Increasing severity of PO-AKI is associated with a progressive increase in adverse outcomes. Our findings indicate that PO-AKI represents a significant burden for health care worldwide
Acute kidney disease beyond day 7 after major surgery: a secondary analysis of the EPIS-AKI trial
Purpose: Acute kidney disease (AKD) is a significant health care burden worldwide. However, little is known about this complication after major surgery. Methods: We conducted an international prospective, observational, multi-center study among patients undergoing major surgery. The primary study endpoint was the incidence of AKD (defined as new onset of estimated glomerular filtration rate (eCFR) < 60 ml/min/1.73 m2 present on day 7 or later) among survivors. Secondary endpoints included the relationship between early postoperative acute kidney injury (AKI) (within 72 h after major surgery) and subsequent AKD, the identification of risk factors for AKD, and the rate of chronic kidney disease (CKD) progression in patients with pre-existing CKD. Results: We studied 9510 patients without pre-existing CKD. Of these, 940 (9.9%) developed AKD after 7 days of whom 34.1% experiencing an episode of early postoperative-AKI. Rates of AKD after 7 days significantly increased with the severity (19.1% Kidney Disease Improving Global Outcomes [KDIGO] 1, 24.5% KDIGO2, 34.3% KDIGO3; P < 0.001) and duration (15.5% transient vs 38.3% persistent AKI; P < 0.001) of early postoperative-AKI. Independent risk factors for AKD included early postoperative-AKI, exposure to perioperative nephrotoxic agents, and postoperative pneumonia. Early postoperative-AKI carried an independent odds ratio for AKD of 2.64 (95% confidence interval [CI] 2.21-3.15). Of 663 patients with pre-existing CKD, 42 (6.3%) had worsening CKD at day 90. In patients with CKD and an episode of early AKI, CKD progression occurred in 11.6%. Conclusion: One in ten major surgery patients developed AKD beyond 7 days after surgery, in most cases without an episode of early postoperative-AKI. However, early postoperative-AKI severity and duration were associated with an increased rate of AKD and early postoperative-AKI was strongly associated with AKD independent of all other potential risk factors