Cocci gram positive infection: regain registry

The Gram positive coccus infections were always preoccupying. In Tunisia, the epidemiological, clinics, therapeutic data concerning these infections remain insufficient. The main objective of this national epidemiological investigation achieved in 13 hospital units in Tunisia is to identify the criteria of choice of antibiotherapy and the profile of patients hospitalized for an infection to Gram positive cocci. This study included 450 patients with an average of 45.35 +/- 21.23 years of which 299 [66.4%] of men and 316 [70.2%] hospitalized in care unit. Two hundred fifty eight patients [62.2%] had one or several medical antecedents, and 145 [32.2%] one or several surgical antecedents. The diabetes [18%] and the chronic renal insufficiency [13.2%] were the two most frequent comorbidities. Signs of gravity to the admission were noted at least 14% of the patients and about 20% of the patients had presented a severe sepsis or a septic shock. The staphylococci [65.4%] were the most frequently the Gram positive cocci isolated follow-up by the streptococci [24.7%]. The resistance of the Gram positive cocci to glycopeptides concerned only one stump cf negative coagulase staphylococcus. Staphylococcus aureus is more frequently responsible for infections of skin and the soft cloths, bone and joint infections and severe sepsis. The rate of success clinic is more elevated in the infectious illness services [84.2% vs 55.3% p<0.0001], whereas mortality is more elevated the services of resuscitation [19.3% vs 3% p<0.0001]. The factors of bad prognosis are age>60 years, in the septic shock, the arterial hypotension to the admission, a score of Glasgow<8 to the admission and an infection to Staphylococcus aureus

[ epidemiological data of children burns in Tunis. about 134 cases]

Burns injuries represented the most children common domestic accident which can be responsible of a dramatic consequences. To analyse the epidemiological data and preventive aspects of this victims, a retrospective study is reported between 1 January and 31 December 2006 concerning 134 children who were examined during this period in the emergency of the surgery department [B] of the children Hospital of Tunis. In 43 cases, a hospitalisation was necessary. The mean age of the patients was 36 months. The accident occurs in the house in 99 per cent of cases, especially in the kitchen in 93 per cent. The most common agents were scalding liquid in 89.5 per cent followed by flames in 8 percent. The mean total burns surface areas was 4 per cent for the non-hospitalised children and 14 per cent for those whose been hospitalised, 16 per cent of this children developed an infection of the burns injuries during their hospitalisation. In 3 cases an amputation was necessary due to a third degrees burn with carbonisation of the members. One patient died 48hrs after his admission by a respiratory distress. The children burn injuries can be considerably reduced by preventive measures and active public health programs to promote immediate cooling of burns with cool water which is at least as important as subsequent medical and surgical treatment in determining the outcome of burns in children

[Insertion of intercostal drain into the liver in a right congenital diaphragmatic hernia]

Mortality of congenital diaphragmatic hernia [CDH] remains high despite the progress in resuscitation assessment. The diagnosis can be difficult especially in the right side form. We report a liver diaphragmatic hernia which been erratically diagnosed as a right pleuropneumopathy. An intercostal drain was inserted into the hepatic parenchyma. The diagnosis was secondarily rectified after thoracic tomodensitometry. The diagnosis of CDH must be systematically evoked in new-borns or infants presenting respiratory or gastrointestinal symptoms with chest X-ray abnormalities

[Epidemiological characteristics of the traffic accidents at the child in big Tunis]

Purpose: to kick away epidemiological profile of traffic accidents at the child in the region of Tunis

Patient and methods: It is about a retrospective study of 1191 files concerning children aged between 0 to15 years, victims of public highway accident admitted to the emergency of the institution of the Paediatric Surgery [B] between 1st January and 31 December 2003

Results: The age bracket the most concerned was that of children aged between 4 and 8 years [53.5 per cent]. Twice on three, the victim was a male [63 per cent]. The accidents were more frequent in spring and graver during the weekend. Three peaks of frequency were noted during the day; at twelve o'clock, at 15 p.m and 18 p.m. The victims became especially from the most unfavourable cities of the the capital, 98.6 per cent were pedestrians. The light care was responsible for 77 per cent of accidents. In 84 percent of cases, the driver having caused accident alerted the helps. The transport was not medically in 70 per cent of cases. The cranio-cerebral region was the most concerned in this series [66 per cent], while the thoraco-abdominal region was interested in 28.7 percent and members in 21.2 percent of cases. 11.68 per cent were hospitalized. The rate of death represents 1.1 per cent of patients. Neurological after-effects represented 1/4 of observed after-effects

Conclusion: The analysis of results every year conclude at the decrease of the traffic accident generally, contrasting with an increase of grave accidents responsible for a more important number of death and this at the same time as the increase of the number of vehicles on the road in Tunisia. We conclude to the importance of the prevention and the amelioration of the quality of the coverage to be begun by, the improvement of the conditions of collection and the implementation of structures of reception multi-field

[Congenital bladder diverticula in children. Report of four cases]

Abstract: The conginital bladder diverticulum is related to a weakness in the bladder musculature especially in the para-hiatal region. It is mostly asmptomatic but in some cases it may produce urinary tract infection or urinary retention. We present our experience with the management of congenital bladder diverticula in infants

Materials and Methods: The authors report a series of 4 patients treated from 1994 to 2003, for congenital bladder diverticulum in the department of surgery B at the children's hospital of Tunis. The diagnosis was established in three cases on recurrent urinary tract infection and in the fourth case on urinary retention. A bilateral vesicoureteral reflux was found in one patient and an intradiverticular stone in another one. Surgical treatment with excision of the diverticulum was undertaken in all patients

Results: After surgical treatment none of the patients has had reccurrence of the diverticulum, and all remain asymptomatic

Conclusion: Congenital bladder diveticulum has a wide clinical spectrum. Urinary tract infection and urinary retention are the most frequent presentation forms. The surgical treatment is indicated in all symptomatic cases

[Pathogen complete ureteric duplication in children. A 20 cases report]

Duplex System is a relatively rare malformative uropathy. It represents 0.2% of general population, with 15 to 25% of pathogen forms. A retrospective study of 20 cases, reported in 12 years is presented. Patient's age at diagnosis varied between 10 days and 10 years [mean age: 47.5 months]. Feminine predominance was noted, with a sex-ratio of 0.42. Clinical features were dominated by urinary infection [65% of cases]. Antenatal diagnosis represented 25% of cases. Diagnosis was confirmed by ultrasound, intravenous urography, cystography and cystoscopy. We noted a vesico-ureteral ref lux in the lower pole in 15 cases, 9 ureteroceles and two ectopic ureteral implantation. Conservative treatment was endoscopic in 5 cases of vesico-ureteral reflux and surgical [reimplantation +/- ureterocele excision] in 10 patients. An upper pole nephrectomy was done in 8 cases and a lower pole nephrectomy in 1 case. Outcome was uneventful in all cases. Ureteric duplication is complex with prognosis depending essentially on early diagnosis and the degree of renal parenchyma damage