Réparation juridique en dommage corporel de l’insuffisance antéhypophysaire post-traumatique

L'insuffisance antéhypophysaire post-traumatique (IAHPT) est une pathologie exceptionnelle mais de réalité certaine résultant des lésions ischémiques lors des traumatismes crâniens (TC) sévères. L'objectif est de préciser à partir d'une étude de cas les critères d'imputabilité de l'IAHPT suite au (TC) ainsi que les spécificités relatifs à sa réparation juridique. C'est une étude médico-légale d'un cas d'IAHPT, diagnostiqué et suivi au service d'endocrinologie et de médecine légale du CHU de Sousse (Tunisie). Il s'agit d'une femme âgée de 45 ans, sans antécédents pathologiques (6 gestes, 4 parités et 2 avortements) ayant un cycle menstruel régulier, sans notion d'accouchement hémorragique, qui a été victime d'un accident de la voie publique (piétonne, heurtée puis renversée par une voiture) occasionnant un TC avec point d'impact occipital sans perte de connaissance initiale; ayant présenté trois ans après l'accident, une hypothyroïdie. L'exploration hormonale rapporte l'atteinte de tous les autres axes. L'exploration neuroradiologique retrouve une intégrité de l'hypophyse et de la tige. Le diagnostic définitif est l'IAHPT. L'expertise médicale (faite 4 ans après l'accident) a conclue à l'imputabilité de l'IAHPT à l'accident. Le taux d'incapacité partielle permanente IIP en droit commun a été évalué à 25%. L'IAHPT est un diagnostic d'élimination. L'évaluation du dommage corporel doit tenir compte des symptômes résiduels, contraintes thérapeutiques et répercussions sur l'activité quotidienne et professionnelle. L'évolution sous hormonothérapie de substitution est souvent favorable, cependant, elle peut être émaillée de complications, d'où l'obligation d'établir des réserves préservant ainsi le droit du patient à une nouvelle révision

Death in detention in Sousse, Tunisia: a 10-year autopsy study

Abstract Background Mortality rates and causes of death of the detainees are hence different from those of the general population and there also vary according to regions and countries. Aims To study the peculiarities of death among individuals detained in the region of Sousse in Tunisia and to suggest preventive measures. Material and methods This is a descriptive retrospective study of all deaths in detention collated in the Forensic Medicine department of Farhat Hached teaching hospital in Sousse, Tunisia during a 10-year period 2006 to 2015. Results 26 deaths were collected. All the victims were males. The mean age was 39.5 years. The deaths occurred inside the prison in 42.3% and 57.7% in a hospital. The deaths were of natural causes in 69.2%. The most common natural causes were cancer (6 cases, 33.3%) and infections (5 cases,27.8%). Violent death accounted for 31.8% of deaths with 08 victims. Suicide and homicide were the violent death causes most incriminated each with 11.5% (3 cases). The suicide means was hanging in all cases. The death was accidental in 2 cases (7.7%). Conclusion This study shows that a large proportion of deaths among prisoners are preventable. Prevention is, on the one side, by improving the prison health coverage and on the other side by training the prison staff on the identification of suicidal crises and on controlling the technical devices facilitating the transition to the suicidal act, in particular the hanging cases

Case of Massive Hydatid Pulmonary Embolism Incidentally Discovered in a 56-Year-Old Woman with Posttraumatic Abdominal Pain

Hydatid pulmonary embolism rarely occurs. It arises from the rupture of a hydatid heart cyst or the opening of a visceral hydatid cyst into the venous circulation. We report a case with pulmonary hydatidosis resulting in a massive bilateral pulmonary embolism in a 56-year-old woman with history of hepatic echinococcosis. A brief overview of clinical features and radiologic findings is presented

Two-day seven-day course of levofloxacin in acute COPD exacerbation: a randomized controlled trial

Introduction: Duration of antibiotic treatment in acute exacerbation of COPD (AECOPD) is most commonly based on expert opinion. Typical administration periods range from 5 to 7 days. A 2-day course with levofloxacin was not previously assessed. We performed a randomized clinical trial to evaluate the efficacy of 2-day versus 7-day treatment with levofloxacin in patients with AECOPD. Methods and analysis: Patients with AECOPD were randomized to receive levofloxacin for 2 days and 5 days placebo ( n  = 155) or levofloxacin for 7 days ( n  = 155). All patients received a common dose of intravenous prednisone daily for 5 days. The primary outcome measure was cure rate, and secondary outcomes included need for additional antibiotics, ICU admission rate, re-exacerbation rate, death rate, and exacerbation-free interval (EFI) within 1-year follow-up. The study protocol has been prepared in accordance with the revised Helsinki Declaration for Biomedical Research Involving Human Subjects and Guidelines for Good Clinical Practice. The study was approved by ethics committees of all participating centers prior to implementation (Monastir and Sousse Universities). Results: 310 patients were randomized to receive 2-day course of levofloxacin ( n  = 155) or 7-day course ( n  = 155). Cure rate was 79.3% ( n  = 123) and 74.2% ( n  = 115), respectively, in 2-day and 7-day groups [OR 1.3; 95% CI 0.78–2.2 ( p  = 0.28)]. Need for additional antibiotics rate was 3.2% and 1.9% in the 2-day group and 7-day group, respectively; ( p  = 0.43). ICU admission rate was not significantly different between both groups. One-year re-exacerbation rate was 34.8% ( n  = 54) in 2-day group versus 29% ( n  = 45) in 7-day group ( p  = 0.19); the EFI was 121 days (interquartile range, 99–149) versus 110 days (interquartile range, 89–132) in 2-day and 7-day treatment groups, respectively; ( p  = 0.73). One-year death rate was not significantly different between the 2 groups, 5.2% versus 7.1% in the 2-day group and 7-day group, respectively; ( p  = 0.26). No difference in adverse effects was detected. Conclusion: Levofloxacin once daily for 2 days is not inferior to 7 days with respect to cure rate, need for additional antibiotics and hospital readmission in AECOPD. Our findings would improve patient compliance and reduce the incidence of bacterial resistance and adverse effects

Value of inferior vena cava collapsibility index as marker of heart failure in chronic obstructive pulmonary disease exacerbation

Abstract Introduction Inferior vena cava (IVC) diameter variability with respiration measured by ultrasound was found to be useful for the diagnosis of heart failure (HF) in ED patients with acute dyspnea. Its value in identifying HF in acute exacerbation of chronic obstructive pulmonary disease exacerbation (AECOPD) was not specifically demonstrated. Objective To determine the value of ΔIVC in the diagnosis of HF patients with AECOPD. Methods This is a prospective study conducted in the ED of three Tunisian university hospitals including patients with AECOPD. During this period, 401 patients met the inclusion criteria. The final diagnosis of HF is based on the opinion of two emergency experts after consulting the data from clinical examination, cardiac echocardiography, and BNP level. The ΔIVC was calculated by two experienced emergency physicians who were blinded from the patient’s clinical and laboratory data. A cut off of 15% was used to define the presence (< 15%) or absence of HF (≥ 15%). Left ventricular ejection fraction (LVEF) was also measured. The area under the ROC curve, sensitivity, specificity, and positive and negative predictive values were calculated to determine the diagnostic and predictive accuracy of the ΔIVC in predicting HF. Results The study population included 401 patients with AECOPD, mean age 67.2 years with male (68.9%) predominance. HF was diagnosed in 165 (41.1%) patients (HF group) and in 236 patients (58.9%) HF was excluded (non HF group). The assessment of the performance of the ΔIVC in the diagnosis of HF showed a sensitivity of 37.4% and a specificity of 89.7% using the threshold of 15%. The positive predictive value was 70.9% and the negative predictive value was 66.7%. The area under the ROC curve was 0.71(95%, CI 0.65–0.76). ΔIVC values were not different between HF patients with reduced LVEF and those with preserved LVEF. Conclusion Our results showed that ΔIVC has a good value for ruling out HF in ED patients consulting for AECOPD