[Assessment of frailty in the elderly and use of geriatric scores in emergencies]. / Évaluation de la fragilité de la personne âgée et utilisation des scores gériatriques aux urgences.

According to the WHO, frailty in the elderly is a geriatric syndrome resulting from a reduction in functional reserves, limiting the body's ability to respond to even minor stress, leading to increased vulnerability to the risk of falling, hospitalization and functional decline. Being sometimes reversible, it is essential to detect fragility early, in order to prevent it. Several scores are validated for the evaluation and diagnosis of the frailty of the elderly person hospitalized but not in the emergency room. From where the need for their adaptation and the creation of new scores and decision-making algorithms appropriate to the particular context of emergencies.

Selon l'OMS, la fragilité de la personne âgée est un syndrome gériatrique résultant d'une réduction des réserves fonctionnelles, limitant les capacités de l'organisme à répondre à un stress, même mineur, et entraînant une vulnérabilité accrue au risque de chute, d'hospitalisation et de déclin fonctionnel. Étant parfois réversible, il est capital de détecter précocement la fragilité, afin de la prévenir. Plusieurs scores sont validés pour l'évaluation et le diagnostic de la fragilité de la personne âgée hospitalisée, mais pas aux urgences. D'où la nécessité de leur adaptation et de la création de nouveaux scores et algorithmes décisionnels appropriés au contexte particulier des urgences.

[Intensive care unit treatment for patients suffering from COVID-19: The second wave Neuchâtel experience]. / Traitement des patients souffrant de Covid-19 aux soins intensifs†: l'expérience neuchâteloise de la deuxième vague.

Between mid-October 2020 and mid-January 2021, during the second wave of COVID-19 pandemia, 125 patients have been admitted in the intensive care units of Neuchâtel network hospitals. To manage this flow, the bed capacity of intensive care unit increased by 240%. Each patient received corticosteroids, an increased prophylactic anticoagulation and an antibiotic. Similarly to the first wave, 51% patients received mechanical ventilation, 55% of which in prone position. Concerning the drug treatments, 16 patients were treated with tocilizumab and 4 with remdesivir. Despite an unprecedented rise in the number of ventilated beds, 15 patients were transferred out of the region of Neuchâtel in order to prevent a saturation point of the system. The mortality rate in the intensive care unit reached 16% of the admitted and non-transported patients.

Entre mi-octobre 2020 et mi-janvier 2021, durant la deuxième vague de pandémie de Covid-19, 125 patients ont séjourné aux soins intensifs du Réseau hospitalier neuchâtelois. Pour pouvoir recevoir cet afflux, la capacité d'accueil a augmenté de 240 %. Tous les patients ont bénéficié d'un traitement par glucocorticoïdes ainsi que d'une anticoagulation prophylactique majorée et d'une antibiothérapie. Similairement à la première vague, 51 % des patients ont nécessité une ventilation mécanique, dont 55 % ont bénéficié d'une ventilation en décubitus ventral. Par ailleurs, 16 patients ont bénéficié du tocilizumab et 4 du remdésivir. Malgré une augmentation hors norme du nombre de lits ventilés, 15 patients ont dû être transférés hors canton afin de prévenir une saturation du système. Le taux de mortalité des patients non transférés admis aux soins intensifs s'est élevé à 16 %.

[Physical activity and cardiovascular mortality: epidemiology, screening and secondary prevention]. / Activité sportive et mortalité cardiovasculaire†: épidémiologie, screening et prévention secondaire.

Sudden cardiac death in young athletes has become a highly visible public health issue and it has been studied for the last twenty years. In this article, we analyse the most recent literature about epidemiology and aetiology of sudden cardiac death in Switzerland in comparison to international data. We cover last recommendations for pre-participation screening in athletes and we briefly describe the strategies of secondary prevention.

Le décès par mort subite d'origine cardiovasculaire chez le jeune sportif est depuis tout temps un sujet brûlant de société et a largement été étudié durant ces vingt dernières années. Dans cet article de synthèse, nous analyserons la littérature récente sur l'épidémiologie et l'étiologie de la mort subite en Suisse en comparaison à la littérature internationale. Les dernières recommandations en matière d'examen médical de préparticipation (EMPP) des athlètes seront abordées et des stratégies de prévention secondaire seront énumérées.

[Syncope or palpitations during pregnancy]. / Syncope et palpitations chez la femme enceinte.

Syncope and palpitations are common symptoms during pregnancy ; they are elicited by physiological changes. Although they are often benign, careful management is essential to eliminate a serious aetiology requiring specialized care. Syncope is often of vasovagal origin, but trauma with possible secondary lesions that compromise the life-threatening of the mother and foetus must be researched. Some palpitations are the manifestation of serious rhythm disorders whose therapeutic management depends on their severity and must consider the potential side effects on the foetus.

Les syncopes ainsi que les palpitations sont des symptômes fréquents durant la grossesse ; elles sont favorisées par les modifications physiologiques. Si elles sont souvent bénignes, une prise en charge minutieuse est indispensable pour éliminer une étiologie grave nécessitant une prise en charge spécialisée. La syncope est dans la majorité des cas d'origine vasovagale, mais un traumatisme avec d'éventuelles lésions secondaires pouvant mettre en jeu le pronostic vital de la mère et du fœtus doit obligatoirement être recherché. Certaines palpitations sont la traduction de troubles du rythme graves dont la prise en charge thérapeutique dépend de la sévérité et doit tenir compte des potentiels effets secondaires sur le fœtus.

[Initial management of febrile neutropenia]. / Prise en chargede la neutropénie fébrile.

Despite major advances in prevention and treatment, febrile neutropenia remains one of the most concerning complications of cancer chemotherapy. Its prognosis depends directly on the quality of the initial management in the emergency department (ED). An initial assessment of circulatory and respiratory function, with vigorous resuscitation where necessary, should be followed by careful examination for potential source of infection. A broad-spectrum empirical antibacterial therapy should be given in a timespan < 1 hour. Multinational Association for Supportive Care in Cancer (MASCC) criteria were developed to help physicians make decisions about the site of care and overall management of these patients.

Malgré les progrès réalisés dans sa prévention et son traitement, la neutropénie fébrile reste une complication sérieuse et fréquente de la chimiothérapie anticancéreuse. Son pronostic dépend directement de la qualité de la prise en charge initiale. Les priorités pour l'urgentiste sont l'évaluation et le soutien des fonctions vitales, la recherche méticuleuse du foyer infectieux et une antibiothérapie empirique à large spectre administrée impérativement dans la première heure. Le choix de l'antibiotique et la décision d'hospitalisation sont guidés par les critères (MASCC) de la « Multinational association for supportive care in cancer ¼.

[Anaphylaxis and anaphylactic shock]. / Anaphylaxie et etat de choc anaphylactique.

The anaphylactic shock is an acute, multisystemic and potentially fatal circulatory insufficiency, secondary to an allergic reaction. The prevalence of anaphylaxis is underestimated in the general population. Many studies have reported a prevalence of 0.05-2%. Multiple etiologies are incriminated in the pathogenesis of anaphylaxis, and these etiologies vary depending on age and geographic zones. The clinical manifestations of anaphylaxis are multiple, owing to the multisystemic character of this pathology. The gold standard in management of anaphylaxis is thought to be the rapid and early administration of epinephrine by intra-muscular route. The prevention of anaphylaxis remains the treatment of choice. Educating the patient is an important aspect of anaphylaxis follow-up along with the prescription of epinephrine autoinjectors.

Clinical features, complications and mortality in critically ill patients with 2009 influenza A(H1N1) in Sfax,Tunisia.

PURPOSE: Africa, as the rest of the world, was touched by the 2009 pandemic influenza A(H1N1). In the literature, a few publications covering this subject emerged from this continent. We prospectively describe baseline characteristics, treatment and outcomes of consecutive critically ill patients with confirmed 2009 influenza A(H1N1) in the intensive care unit (ICU) of Sfax hospital. METHODS: From 29 November 2009 through 21 January 2010, 32 patients with confirmed 2009 influenza A(H1N1) were admitted to our ICU. We prospectively analysed data and outcomes of these patients and compared survivors and dead patients to identify any predictors of death. RESULTS: Patients were young (mean, 36·1 [SD], 20·7 years) and 21 (65·6%) of whom had co-morbidities. During ICU care, 29 (90·6%) patients had respiratory failure; among these, 15 (46·9%) patients required invasive ventilation with a median duration of 9 (IQR 3-12) days. In our experience, respiratory dysfunction can remain isolated but may also be associated with other dysfunctions or complications, such as, septic shock, seizures, myasthenia gravis exacerbation, Guillan-Barre syndrome, acute renal failure, nosocomial infections and biological disturbances. The nine patients (28·1%) who died had greater initial severity of illness (SAPS II and sequential organ failure assessment (SOFA) scores) but also a higher SOFA score and increasing severity of organ dysfunction during their ICU evolution. CONCLUSION: Critical illness from the 2009 influenza A(H1N1) in Sfax occurred in young individuals and was associated with severe acute respiratory and additional organ system failure. SAPS II and SOFA scores at ICU admission, and also during evolution, constitute a good predictor of death.

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

BACKGROUND: 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. AIM: To search for the microbiological characteristics of catheter-related bacteremia in a Tunisian ICU. METHODS: 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 1st, 2001 to March 31st, 2002), and who submitted to a central venous catheter for more than 24 hours. Catheter-tip specimens were cultured using a semiquantitative method. RESULTS: 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 catheter-related 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. CONCLUSION: 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.