Infection in diabetic patient in emergency

This retrospective study was conducted to evaluate the place of infection in diabetic ketoacidosis in an emergency unit. It included 214 patients who were admitted for ketoacidosis and in whom an infection was identified. The infection was present in almost all patients and it seemed to be the direct cause of decompensation in 41%. The diagnosis was made on the clinical signs and the biological evaluation. On the 112 urinalysis performed, 45 were positive and on the 43 hemocultures, 9 were positive. An empirical antibiotherapy was started on admission in 88 cases. Thirty four patients had a severe sepsis of whom 21 developed a septic shock and 13 [6%] were transferred to the Intensive Care Unit; 4 patients died [1.9%]. We found a strong correlation between the initial presence of infection and the occurrence of at least one organ dysfunction [p=0.0001]

Occlusive arteriopathy of lower limbs and diabetes mellitus

Trophic disorders of the diabetic foot represent a major problem in public health since they are responsible of a high morbi-mortality rate. After a pathophysiological review of the question, we discuss the recent classification of diabetic arteriopathy, the interest of the different methods of exploration and we discuss their management

[Incidence and risk factors of nosocomial infections in gravelly traumatised patients]

To evaluate the incidence and the risk factors of the nosocomial infections [NT] in gravelly traumatized patients. It is a retrospective study of 6 months concerning a cohort of patients admitted in resuscitation department for a grave traumatism [ISS >/= 15]. The risk factors of NI were studied in univariate and multivariate analyses. The study included 55 patients [54 men and 1 woman], the average age was 36 +/- 13 years, the ISS of 19.3 +/- 3. The incidence of NI was 49%, the pulmonary localization was most frequent [81%]. The variables related to occurrence of NI in the gravelly traumatized patients were a low GCS [p<0.001], an associated cranial traumatism [p = 0.004], high scores of gravity: IGS II [p = 0.04], APACHE 11[0.01] and ISS [p = 0.006], the recourse [p = 0.001] and the duration of artificial ventilation [p<0.0001]. The logistic regression retained two independent variables: the low GCS [OR: 3.9; IC95% = 1.6 - 88; p = 0.011. In this work the incidence of NI in of a gravelly traumatized patients was high [49%], it was dominated by the pulmonary localization. The low GCS and the duration of artificial ventilation were independent risk factors

[Cerebral toxoplasmosis revealing a neuro-Aids]

Cerebral infection to toxoplasmosis is an opportunist infection. Its radiological aspect is not specific. It concernes male patient of 38 years old, treated from Crohn disease since three months, who was presented by infectious intracranial hypertension syndrome, symptomatic treatment was prescribed. In front his clinical aggravation, a multiple intracranial MRI was done, which showed a miliary encephalitis. Tubercolous origin was thought of and the patient received an anti-tubercolous treatment. Secondary, stereotaxic biopsy and biological study showed an advanced stage of toxoplasmosis infection reveals to a neuro-Aids. Through this observation, the authors paid an attention to think always in the eventuality of neuro-Aids in front of cases of miliary encephalitis

L'hematome epidural cervical spontane [considerations etiologiques]

A 36 years old man developed an incomplete tetraparesis. The myelogram showed a complete epidural stop at C6 C7 level after cervical laminectomy, a spontaneous epidural hematoma was discovered, and removed; pathophysiology of this disorder is discussed, the emergency of diagnosis and laminectomy is underlined