[Epidemiological features of stress hyperglycemia in elderly at emergency department]

Background: Stress hyperglycemia among patients having an acute pathology is frequently described in recent studies

Aims: The objectives of this work were to describe epidemiologic features of elderly patients hospitalized in the emergency department and having a hyperglycemia due to stress

Methods: A retrospective chart review identified patients older than 65 years with obtained serum glucose levels. Patients with diabetes were excluded. Two levels of serum glucose were considered [>6,9 mmol/l and

Results: We included 165. There were 94 patients with high level of serum glucose level [56,9%]. Multivariate analysis found that only cardio-vascular pathologies were more predictive of having stress hyperglycemia [p=0,014, odds-ratio=2,8, IC=1,2-6,4]. There were no correlation between serum glucose levels and mortality

Conclusion: Stress hyperglycemia is a fairly common disorder but underestimated in emergency department. Its impact on the prognosis of elderly patients remains to be studied

[Pulmonary thromboembolism: incidence, physiopthology, diagnosis and treatment]

The objective of this work was to review current data about the pathophysiology, clinical features, and treatment of pulmonary thromboembolism. Venous thromboembolism [VTE] remains a major challenge in hospitalised especially the care of critically ill patients. Pulmonary embolism [PE] is the major complication of VTE. By occluding the pulmonary arterial bed it may lead to acute life-threatening but potentially reversible right ventricular failure. The outcome of patients with PE is quite variable depending primarily on the cardio-respiratory status and the embolus size. PE is a difficult diagnosis that may be missed because of non-specific clinical presentation. Clinical signs include hypoxia, tachypnea, and tachycardia. Severe cases of untreated PE can lead to circulatory instability, and sudden death. However, in ICU, most of patients require sedation and mechanical ventilation. The clinical manifestations usually observed in this condition [PE] cannot be exhibited by these patients and clinical presentation is usually atypical. For these reasons, the diagnosis of PE is usually suspected when un-explicated hypoxemia and/or shock and arterial hypotension were observed. Positive diagnosis is based on these clinical findings in combination with laboratory tests and imaging studies. D-dimer testing is of clinical use when there is a suspicion of DVT or pulmonary embolism PE. In Emergency department, a negative D-dimer test will virtually rule out thromboembolism with a negative predictive value at 95 to 98%. In massive and submassive PE, dysfunction of the right side of the heart can be seen on echocardiography. While the gold standard for diagnosis is the finding of a clot on pulmonary angiography, CT pulmonary angiography is the most commonly used imaging modality today. When the diagnosis is confirmed, anticoagulant therapy is the mainstay of treatment. Acutely, supportive treatments a pivotal role in the management of patients with PE. Severe cases may require thrombolysis with drugs such as tissue plasminogen activator [tPA] or may require surgical intervention via pulmonary thrombectomy. Prevention is highly warranted

Microbiological characteristics of catheter-related bacteremia in a Tunisian intensive care unit

Prevalence of catheter-related bacteremia in intensive care units is increasing as central venous catheters [CVC] are used more frequently. In the most of the published literature, Gram positive cocci are the leading cause of catheter-related bacteremia and the systemic empiric treatment recommended include the administration of glycopeptides. To search for the microbiological characteristics of catheterrelated bacteremia in a Tunisian ICU. Prospective observational cohort survey conducted in the ICU of the Habib Bourguiba university hospital, Tunisia [a 22 bed medical-surgical intensive care unit]. We had included all patients admitted to the unit over the study period [from August 1[st], 2001 to March 31[st], 2002], and who submitted to a central venous catheter for more than 24 hours. Catheter-tip specimens were cultured using a semiquantitative method. During the study period 218 central venous catheters [CVC] were assessed. The mean length of time the catheter was kept in place was 8 +/- 6.7 days [range; 2 and 46 days]. The CVC insertion site was the subclavian vein in 156 cases [71.6%], the jugular vein in 35 cases [16%], and the femoral vein in 27 cases [12.4%]. Seventy four catheters [33.9%] were removed because of suspicion of catheterrelated sepsis. The catheter-related bacteremia rate was 6.1 infections/1000 days-CVC. Unlike Gram-positive cocci which caused only one case of catheter-related bacteremia, Gram-negative rods, namely Klebsiella pneumoniae and Serratia marcescens were responsible for 91.7% of cases of catheter-related bacteremia. Our findings translate a specific microbiological flora in our Tunisian intensive care unit and highlight the importance of a treatment strategy based on local epidemiology in patients with catheter related bacteremia

Acute fatty liver of pregnancy [Incidence, pathogenesis, diagnosis, treatment and prognosis]

Acute fatty liver of pregnancy [AFLP] is a rare, potentially fatal complication that occurs in the third trimester or early postpartum period. It generally appears between weeks 30 and 38. Usually the APLF symptoms start one to two weeks before hospitalization with nausea, emesis, general uneasiness, jaundice, epigastric pain and other symptoms. A careful history and physical examination, in conjunction with compatible laboratory and imaging results, are often sufficient to make the diagnosis, and liver biopsy is rarely indicated. The maternal outcome has improved enormously during the last decade. Early diagnosis, pregnancy interuption and handling in special care or treating complications has lead to good materno-fetal results