Infections bacteriennes communautaires aux urgences

The most frequent community infections caused by bacteria that are found at medical emergencies are urinary infections and meningiti. This study's aim is to determine the type and frequency of the bacteria isolated at the emergencies, and to test their sensitivity against different antibiotics. Material and methods: We have studied in a prospective way 220 bacteriological samples of 200 patients at the medical emergencies during 7 months from the begining of June 2001 till Janury 2002. Each patient was tested according to the signs he presented and to the available technical means. We did: 100 spinal punctures [US], 82 cytological bacteriological urinary examination [ECBU], 21 blood-culture, 8 pus, 6 effusion liquids, 3 plate culture of faeces. Klebsillea and Echerichia coli are responsible for most of the urinary infections. The bacteria found showed a very high level of resistance [almost 100%] against ampicillin and [60%] against amoxicillin / calvolanic acid. However they were sensitive to fluoroquinolons and to 3 rd generation cephalosporins. Pneumococus is the most frequent germ for purulent meningitis. Isolated bacteria were all sensitive to penicillin G. The progression of resistance to antibiotics of the principal community bacteria implies to rationalize the use of antibiotics, and to monitor regularly the resistance of these bacteria, and also to make new therapeutical recommendations based on the local epidemiological data

Prevalence of antitiuberculous drug-induced cytolytic hepatitis of tuberculous meningitises

The aim of this work was to specify the prevalence and the description of scondary cytolytic hepatitis of the antituberculous drugs used in treatment of tuberculous meningitis in the intensive care units. Method: We have been included retro-spectively [January 1998 - December 2002] patients having a tuberculous meningitis treated with antituberculous drugs who developed a cytolytic hepatitis defined by an increase of the alanin-aminotransferase [ALAT] level more than two times of its normal upper limit. Six cases have been included among 74 patients [prevalence of 8,1%], three women and three men aged 17 to 45 years. The delay of apparition of cytolytic hepatitis varied from four days to five weeks. ALAT rates varied from two and half to 26 times the normal level. No other potentialy hepatotoxic medication has been prescribed. Three patients normalized their ALAT after reducing the rifam picin dose to half measure, in another case a definitive stoppage of isoniazid was required. Ytolytic hepatitis regressed spotaneously in one patient whereas another died as a result of a nosocomial infection. The prevalence of secondary cytolytic hepatitis of antituberculous drugs during treatment of tuberculous meningitis in the intensive care unit raised to 8,1%, the evolution is most often favourable after adaptation of doses

Les indices de gravite en reanimation [a propos de 340 cas] etude retrospective et prospective

The objective evaluation of the medical activity of a polyvalent I.C.U. at present orients towards the utilization of a system of classification which rests on severity scores that are non specific. Five scores were selected for the study, either for physiological [A.P.S., S.A.P.S.] or for a therapeutic approach [T.I.S.S., T.IS.S. simplified]. The study includes 350 patients, which was conducted in a retrospective manner [one out of two patients] and prospective [successive admissions] by an independent observer. The statistic methodology, based on informational indexes and linear adjustment, was made easier by the adoption of the code and diagnostic catalogue of the "Societe de R‚animotion de Langue Francaise" [S.R.L.F.], notably by the level of the computerized exploitation of the data. The authors, while reaffirming, the predective value of the method used, they characterized the profile of their patients by numerical values and compared them to two other similar foreign studies. This evaluation also includes the determination of the specific severity caused by the morbid entities, the most representative of the series, and the relation of cost-effectiveness was determined by a curve having the parabolic shape which shows the limits of the intensive care. In addition the necessity for the planification of the care led the authors to propose a predictive model on the original classification of three groups of patients; - the model uses simple and reliable scores, a sequence of well defined measures, and a prognostic delay 48 hours. The purpose of this model is that it allows for a dynamic surveillance of the patients and the rational reevaluation of the care while the patients change from the one class to the other. At the conclusion of the study, the authors proposed the severity scores as indicators of the level of care, their evaluation on a large scale could leave to suggest the needs of intensive care at the national level

Les syndromes hyperosmolaires [a propos de 31 cas]

The hyperosmolar syndrome observed in the middle intensive care with a non negligible frequence, it occurs usually during serious diseases. In this from worth, the authors brought 21 observed cases during a three year activity in an intensive medical care service which doesn't arrive from a special diabetic recruitement. This series consists of eleven cases of hypero smolar hyperglycemic non ketotic syndrome and which accounts in this class four cases of diabetes and four cases due to drugs. Ten cases are hyperosmolar syndrome with a minor disorder of the glycoregulation where hypernatremic which had originally a neurogenic cause in the three cases, a hydric negative balance for diverse reasons in five of the cases, an iatrogenic cause in two of the cases. The clinical aspect at admissions is severe consisting of a shock and a coma in half of the cases, the biological aspect is stereotyped: hypernatremia, hyperglycemia [important in eleven Cases], functional renal failure. There is neither metabolic, acidosis nor major ketonuria. The prognosis remains serious with a mortality rate of 25% where there intervens such. prognostic factors as advanced, the field and the sepsis, in the series one notes besides a diagnostic delay specially de 13.6 days on the average

Anguillulose autochtone: a propos de 3 cas

For the first time in Morocco, three cases report were related by the Authors, to autochtonous anguilluliasis; including that disseminated and deadly form of an utmost gravity, that happened to a corticotreated dermatomyositis patient. The two other patients had a mild evolution. Diagnosis is made by putting evidence of Rhabditoids larva and by stool-enhancing in the third case. This helminthiasis, although rare, must be well known by physicians and called for in numerous circumstances. Usually clinical manifestations are mainly expressed by digestive and cutaneous symptoms. Anarchic and prolonged hyper-eosinophilia is a great value biologic sign; thus it's also a therapeutic overseeing criterium. Severe forms happen on debilitated backgrounds, thus anguilluliasis case finding and it's systematic, non discriminated treatment [mainly in endemic zone] must appear between preventive bounds in acceptance with immunodepressed patients or with those subject to a long term immunosuppressive therapy