Adsorption of antibiotics by bentonite-chitosan composite: Phenomenological modeling and physical investigation of the adsorption process.

The increased use of antibiotics worldwide turned into a serious preoccupation due to their environmental and health impacts. Since the majority of antibiotic residuals are hardly eliminated from wastewater, based on usual methods, other treatments receive considerable attention. Adsorption is known as the most effective method of the treatment of antibiotics. In this paper, the adsorption isotherms of doripenem, ampicillin, and amoxicillin on bentonite-chitosan composite are determined at three temperatures, T = 303.15, 313.15 and 323.15 K, which are used to achieve a theoretical investigation of the removal phenomenon, based on a statistical physics theory. Three analytical models are utilized to describe the AMO, AMP, and DOR adsorption phenomena at the molecular level. From the fitting results, all antibiotic adsorption on a BC adsorbent is associated with the monolayer formation with one type of site. Concerning the number of adsorbed molecules per site (n), it is concluded that multi-docking (n < 1) and multi-molecular (n > 1) phenomena are feasible for AMO, AMP, and DOR adsorption on BC. The adsorption amounts at saturation of the BC adsorbent, deduced by the monolayer model, are found to be 70.4-88.0 mg/g for doripenem, 57.8-79.2 mg/g for ampicillin and 38.6-67.5 mg/g for amoxicillin indicating that the antibiotics adsorption performance of BC was greatly depended on temperature where the adsorption capacities increased with the increment of this operating variable. All adsorption systems are demonstrated by a calculation of the energy of adsorption, considering that the extrication of these pollutants implies physical interactions. The thermodynamic interpretation confirms the spontaneous and feasible nature of the adsorption of the three antibiotics on BC adsorbent. In brief, BC sample is regarded as a promising adsorbent to extract antibiotics from water and presents important potentials to be effected in wastewater handling at industrial level.

Pulmonary embolism in intensive care units: More frequent or more Known? Prospective study of 75 cases.

PURPOSE: to evaluate the current rate of pulmonary embolism (PE) in our medico-surgical intensive care unit (ICU), to identify risk factors, and to determine the outcome of PE in ICU. METHODS: We performed a prospective cohort study of consecutive patients requiring intensive care admission during a one-year period. We included, in this prospective study, all the patients with confirmed PE admitted in ICU with more than 18 years of age, and expected to stay in ICU for more than 48 hours. Only the patients who had a clinical suspicion (unexplained hypoxemia and/or shock) for PE underwent diagnostic studies. RESULTS: During the study period, 842 patients were admitted in our ICU. One hundred and two patients were excluded. The diagnosis of PE was confirmed in 75 patients (10.1%). In our study, all patients (100%) had received some forms of pharmaceutical prophylaxis (PP) during ICU stay. The median time from ICU admission to diagnosis of PE was 6 days. The diagnosis of PE was made by spiral CT in 74 patients (98.7%), and by echocardiography in 1 case (1.3%). The mean ICU stay was 26.3 ± 26.5 days (median: 20 days). During their ICU stay, 73 patients (97.3%) developed one, or more, organ failure. Respiratory failure was the most observed (97.3%). Moreover, 38 patients (50.6%) developed nosocomial infections and 29 (38.6%) died. The multivariate analysis showed that the risk factors associated with mortality were the presence of shock the day of PE diagnosis and the presence of right ventricular dilatation on echocardiography. CONCLUSION: Our findings confirm that subjects in the ICU are at high risk of PE, due to a high number of risk-factors. PE was associated with higher ICU mortality and a significantly higher ICU LOS. Our results invite to revise the preventive strategies of deep venous thrombosis and PE in patients requiring ICU admission.

[Handling of cytostatics in oncology wards of an Algerian university hospital]. / Manipulation des cytostatiques dans les services d'oncologie d'un Centre Hospitalo-Universitaire algérien.

Introduction: A study was conducted in the oncology wards of an Algerian university hospital in order to analyse cytostatic handling conditions. Materials and methods: Working conditions were evaluated in 2014 and then re-evaluated after opening of the cancer centre in 2015, using validated tools: professional questionnaire, ward monograph support and oncology ward audit support. The results were compared to clinical practice guidelines and oncology wards were classified according to the percentage compliance: non-compliance (< 69%), partial compliance (70-79%), substantial compliance (80-94%) and high compliance (95-100%). Exposure was evaluated by calculating the Cytotoxic Contact Index (CCI). Results: Oncology wards are situated in three hospitals. Reconstitution is performed in nonspecific treatment rooms with no collective protection measures. 62% of oncology units (oncology, gynaecology and haematology wards) were classified as level 2 and 3 exposure, requiring collective prevention measures. The level of compliance was very low (28%). All wards were classified as non-compliant for all items. Compliance essentially concerned training, quality control and hygiene measures. An improvement of cytostatic handling conditions was observed in 2015, concerning personnel training, recruitment of clinical pathologists and pharmacists, floorspace and hygiene of premises, storage of cytostatic agents and individual and collective protection equipment. Conclusion: In the light of this study, it appears relevant to improve cytostatic handling conditions by setting up a medical and environmental surveillance programme with the participation of all prevention personnel.

[Acute fatty liver of pregnancy. "Incidence, pathogenesis, diagnosis, treatment and prognosis"]. / La stéatose hépatique aiguë gravidique. "Epidémiologie, physiopathologie, tableau clinique, prise en charge thérapeutique et pronostic".

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 termination and handling in special care or treating complications has lead to good maternofetal results.

[Contribution of liver biopsy in intensive care unit. (180/2004)]. / Apport de la ponction biopsie du foie en milieu de réanimation.

AIM: Our aim was to evaluate the indications and contribution of liver biopsy (LB) in intensive care (ICU) and to compare them to those of LB in gastroenterology. METHODS: We included retrospectively 37 successive LB achieved in ICU and 38 successive LB achieved in gastroenterology. All data were reviewed by three intensivists and three gastroenterologists to determine the contribution of the LB. RESULTS: The indications of LB were different in the two units. The most frequent indications were cirrhosis (36.8%), isolated biological hepatic disruptions (26.3%) and histological classification of viral hepatitis (18.4%) in gastroenterology and isolated biological hepatic disruptions (48.6%), hepatopathy during pregnancy (27%) and fever of unknown origin (10.8%) in intensive care unit. According to the six reviewers, LB was enough contributive in the two units, (78.4% in ICU and 71.1% in gastroenterology -p=0.46-). It allowed to eliminate, to confirm, or to change a diagnosis in more than 70% of cases and allowed to modify the course of therapy in 21.6% of cases in ICU and in 26.3% of cases in gastroenterology (p-0.6). CONCLUSION: The LB is a feasible technique in ICU and can be as contributive as it is in gastroenterology.

Curious fatal intentional poisoning case with organophosphate pesticide.

BACKGROUND: A case of organophosphorus intoxication with rebounding symptoms is reported. CASE REPORT: Case report of a 24-year-old man who poisoned himself with organophosphorus pesticide and was hospitalized in a 22-bed adult medical surgical intensive care unit at a tertiary care hospital. The patient had ingested organophosphorus pesticide after an argument and fight with his family and had presented typical clinical and biological manifestations of intoxication by this chemical. He was treated by mechanical ventilation, large fluid infusion, gastric lavage, as well as atropine and pralidoxime. After 48 hours of intensive care, the patient improved considerably, but shortly after this improvement, mental, hemodynamic, and respiratory status altered again. Gastric fibroscopy showed a small plastic bag containing powder in the stomach which was responsible for the rebounding symptoms of the intoxication. CONCLUSIONS: Gastric fibroscopy can be helpful in case of organophosphorus intoxication with persistent or rebounding symptoms.

Gastrointestinal manifestations in severe scorpion envenomation.

OBJECTIVES: To evaluate the type and incidence of gastrointestinal manifestations secondary to scorpion envenomation and their prognostic significance. PATIENTS AND METHODS: All patients admitted to our ICU for scorpion envenomation were included in this retrospective chart review of a 13-year period (1990 - 2002). RESULTS: During the study period, 951 patients were admitted for scorpion envenomation and 72 (7.6%) died. Ages ranged from 0.5 to 90 years with a mean of 14.7 +/- 17.4 years. Gastrointestinal symptoms were present in 700 patients (73.6%): nausea in 24 (2.5%), vomiting in 687 (72.2%) and diarrhea in 41 patients (4.3%). At univariate analysis, the presence of diarrhea was associated with a fatal outcome (P < 0.05). Diarrhea was also correlated with other indicators of severe envenomation and poor prognosis: respiratory failure (P = 0.01), neurological failure (P < 0.0001), liver failure (P < 0.0001) and low blood pressure requiring catecholamine support (P = 0.02). The multivariate analysis showed that young age (age less than 5 years), fever > 38.5 degrees C, neurological failure and pulmonary edema were independent factors of severity. Digestive disorders were more frequent in children and in this subgroup diarrhea appeared to be associated with poor outcome. In a subset of patients for whom data were available, fatal cases demonstrated significantly higher liver enzymes levels on admission. CONCLUSION: In Tunisia, gastrointestinal symptoms are often observed in severe scorpion envenomations, especially in young patients. In children, diarrhea and elevated liver enzymes are associated with poor prognosis.