ABSTRACT
Hydrocephalus is a serious complication of tuberculous meningoencephalitis in HIV patients. The disease can affect vital and functional prognosis of patients. A 20 years-old woman was admitted for deterioration of her consciousness. She has a history of HIV infection since 3 months. Cerebral imagery showed signs of tuberculous meningoencephalitis. The paient was treated by antituberculous therapy with a good evolution. At the third months of treatment the patient presented roughly alteration of her consciousness and intracranial hypertension. Cerebral scan showed active ventricle hydrocephalous. The patient had ventricle extern derivation and then ventricle peritoneal derivation. Antituberculous and antiretroviral therapies were maintained. The outcome was favourable [follow up of one year]. central nervous system involvement in HIV patient can be observed at any stage of the disease with a consequent mortality and morbidity. central nervous system tuberculosis is observed in 10% of patients who presented an association of HIV-tuberculosis and only in 2% to 5% of tuberculous immunocompetent patients. Hydrocephalous is observed in 32% to 51% of HIV patients associated with tuberculosis meningoencephalitis. Hydrocephalous is a common complication of tuberculous meningoencephalitis witch can worsened the neurological statue of HIV infected patient. An early surgical and medical management was associated with a good prognosis
ABSTRACT
2009 H1N1 is a new influenza virus causing illness in people. The first cases detected were in Mexico and in the United States in April 2009. This virus is a variant of influenza virus A, coming from triple human restocking, aviaire and porcine. The first cases were discerned in Mexico and in USA joined in April, 2009. In the date of February 17th 2010, 17208 cases of influenza A, H1N1 was confirmed in Africa and including 167 deceases. The virus has an interhuman transmission across the world, probably according to the same mode of transmission as the seasonal virus influenza. The state of pandemic was signaled by the worldwide organization of health on June 11th, 2009 and is spreading from person-to-person worldwide, probably in much the same way that regular seasonal influenza viruses spread. On June 11, 2009, the World Health Organization signaled that a pandemic of 2009 H1N1 flu was underway. H1N1 a virus affect particularly young patient [20-40] at the difference to the seasonal influenza virus. The principal risk factors to the development of serious complications were: the young age, pregnancy and the presence of a chronic medical illness. The main clinical demonstrations of this virus are: fever, evil of throat, tiredness, aches and/or digestive disturbances with type of diarrheas and sometimes vomiting. The treatment consists of the seriousness of this influenza and the necessity of installation of appropriate prophylactic measurements [individual hygiene, vaccination and precautionary antiviral treatment in case of exhibition] to restrict the transmission of this infection and reduce total mortality. The aim of this study is to put a full stop on the clinical aspects, therapeutic measurements and the efficient means of prevention against this influenza
ABSTRACT
Bacterial meningitis is a serious disease with a high mortality. The severe forms need an early management at the intensive care unit. We report a retrospective study over 14 years [1992- 2006] in medical intensive care unit. We studied demographic clinics, biologic, therapeutic variables, and the outcomes in patients aged > 16 years and presented with community-acquired bacterial. The variables were compared between surviving and died group. Statistic: t test, Chi2, regression logistic. 201 patients were included. [139 men/ 62 women, age: 35 +/- 16 years SAPSII: 6,4 +/- 4,5]. 51 episodes of bacterial meningitis presented with altered mental status [Glasgow coma scale [GCS] was: 12 +/- 3]. Overall mortality rate was 19, 9%. On unvaried analysis, the factors associated with mortality were: age over 60 years, presence of a clinical symptoms > 72 hours before hospitalisation, GCS of 10 or less, visceral failure, lack of neck stiffness, heart rate >100 b/min, a high respiratory frequency, mean arterial blood pressure < 90 mm Hg, APACHE II score more than 12 during the 24 hours of admission, blood glucose level > 1,8 g/l and CSF glucose levels lower than 0,4 g/l. in the multivariate model seven conditions were significantly associated with mortality: age over 40 years [Odds Ratio [OR] = 4,7 ; IC 95%: 1,6 +/- 13,6], presence of symptoms >3days before admission [OR = 2,5: IC 95%: 3,2 +/- 47,8], low score of GCS[OR = 4,1: IC 95%: 1,4 +/- 11,6], respiratory rate> 30 cycles /min [OR = 7,3: IC 95%: 1,7 CSF +/- 32,3], presence of shock chock [OR = 19,8 ; IC 95%: 4,1 +/- 96], blood glucose level > 2 g/l [OR = 5,1: IC95%: 1,5 +/- 17,2] and CSF glucose level < 0,4 gl [OR = 5,1 ; IC 95%: 1,8 +/- 17,8]. Advanced age, delay of hospitalisation, severity of the disease at admission and hypoglucorrachia are the major prognosis factors of mortality intensive care unit
ABSTRACT
Lymphoide chronic leukemia [LLC] is characterized by a heterogeneous evolution introduced classficiations around thirty years ago by RAI and Binet, having based on clinical signs and biological parameters allowed of license to differentiate three groups of patients having distinct forecasts. These classifications allowed guiding therapeutic strategy. However, they do not allow predicting the evolution of illness precisely, particularly at the patients having a weak risk. Since a dozen years, the taking care of lymphoide chronic leukemia was transformed by progress accomplished in the understanding of the physiopathology of illness, the identification of new markers with value prognosticates and the advent of new therapeutic tools. The aim of this review is to report, the actualities in the management of lymphoid chronic leukemia