Symptoms of depression and post-traumatic stress in a group of lightning strike victims.

INTRODUCTION: Lightning strike victims often suffer repercussions. Although a lightning strike constitutes a severe traumatic event, there is a lack of data about potential psychological sequelae. This is precisely the context in which we assessed the prevalence of Post-Traumatic Stress Disorder (PTSD) and Major Depressive Episode (MDE) in a group of lightning strike victims. METHODS: The symptoms of peritraumatic dissociation were evaluated on the basis of the Peritraumatic Dissociative Experiences Questionnaire (PDEQ) whilst the Peritraumatic Distress Inventory (PDI) was used to assess symptoms of distress. PTSD and MDE diagnoses were evaluated using the MINI (Mini International Neuropsychiatric Interview). Symptom intensity was assessed using the self-report PTSD Checklist-Specific (PCLS) and the Beck Depression Inventory II (BDI II), respectively. RESULTS: Forty-nine patients were enrolled in the study. As regards symptoms of depression, 28 patients (57.1%) reported a major depressive episode (MINI) including 10 (20.4%) of moderate intensity and 5 (10.2%) of severe intensity (BDI). In terms of PTSD symptoms, 13 patients (26.5%) reported probable PTSD (MINI) with a PCL-S score ≥ 45. A significant correlation was established between PDEQ and BDI II (Spearman correlation coefficient = 0.36, p = .012). A significant correlation was also found between PDI and PCLS (Spearman correlation coefficient = 0.43, p = .002). A further significant correlation was noted between PDEQ and PCLS (Spearman correlation coefficient = 0.31, p = .028). DISCUSSION: This study highlights the need for a multidisciplinary evaluation of lightning strike victims. Indeed, the prevalence of psychiatric disorders such as PTSD and MDE appears to be significant.

[Treating patients with serious burns, emergency care before reconstructive surgery]. / La prise en charge des brûlés graves, l'urgence avant la chirurgie réparatrice.

Every year, 200 000 burn victims require medical treatment. Burn patient treatment centres provide specialist care. Faced with a patient with serious burns, initial treatment focuses on ensuring the patient's survival. Reconstructive surgery is envisaged after a year of intensive treatment.

Medicolegal evaluation of aesthetic impairment: particularities of post-burn scars.

Burns are serious injuries with incidence decreasing with the increasing efficacy of prevention campaigns. Their cause may be non-intentional or criminal. Thanks to advances in burn management, mortality has declined; however, the sequelae are more severe. The medical expert must be familiar with this field in order to carry out precise clinical evaluation so that individual compensation may be determined by the judge. Aesthetic damage, which is purely a non-economic loss, is difficult to assess, as it is dependent on the subjective opinion of the medical expert. The principle of financial compensation for aesthetic impairment is an imperfect one, but it gives victims a satisfactory compensation to which they attach importance. Without detailing the various national compensation systems, we review the burn patient's examination by the medical expert with particular attention to the specific characteristics of burn scars, their course and aesthetic impact.

A population pharmacokinetic approach to ceftazidime use in burn patients: influence of glomerular filtration, gender and mechanical ventilation.

AIMS: The aim of this study was to evaluate the disposition of ceftazidime in burn patients using a population pharmacokinetic approach, and to identify the clinical and biological parameters influencing its pharmacokinetics. METHODS: The development of the pharmacokinetic model was based on 237 serum ceftazidime concentrations from 50 burn patients. The determination of the pharmacokinetic parameters and the selection of covariates were performed using a nonlinear mixed-effect modelling method. RESULTS: A two-compartment model with first order elimination incorporating a proportional error model best fitted the data. Ceftazidime clearance (CL, l h(-1)) was significantly correlated with creatinine clearance (CL(CR)), and the distribution volume of the peripheral compartment (V2, l) was correlated with gender, mechanical ventilation and the CL(CR). The final model was defined by the following equations: Ceftazidime clearance was 6.1 and 5.7 l h(-1) for mechanically ventilated males and females, respectively, and 7.2 and 6.6 l h(-1) for nonventilated patients. The total volume of distribution was 31.6 and 49.4 l for mechanically ventilated males and females, respectively, and 22.8 and 28.1 l h (-1)for nonventilated patients. CONCLUSIONS: We have shown that gender, mechanical ventilation and CL(CR) significantly influence the disposition of ceftazidime in burn patients. Interindividual variability in the pharmacokinetics of ceftazidime was significant and emphasizes the need for therapeutic monitoring.

Retrospective analysis of multidrug-resistant Acinetobacter baumannii strains isolated during a 4-year period in a university hospital.

OBJECTIVE: To describe the epidemiology of Acinetobacter baumannii infection during 2000-2003 and to determine whether the multidrug-resistant strains were already present in our Toulouse hospital before the 2003 French national outbreak. DESIGN: Descriptive molecular and clinical epidemiologic study of A. baumannii isolates using a combination of antibiotyping and pulsed-field gel electrophoresis (PFGE). SETTING: A 1,000-bed university hospital in Toulouse, France. METHODS: All clinical samples that had tested positive for A. baumannii between January 1, 2000, and December 31, 2003, were collected. Multidrug-resistant isolates of A. baumannii were then submitted to PFGE, and clinical characteristics of the source patients were noted. RESULTS: A total of 1,277 A. baumannii samples were identified, 791 of which had not been previously identified; 148 were positive for multidrug-resistant strains. These strains were more likely to have been isolated in the intensive care unit (ICU) than were susceptible strains (P<.001; relative hazard, 3.77). The positive clinical samples were of various types (eg, nonprotected respiratory samples [43%] and blood [5%]), but no difference in type of source was seen between resistant and susceptible strains. A simultaneous analysis of pulsotypes and antibiotypes proved that the outbreak in the ICU in 2003 could be linked to an initially endemic clone that had been isolated in 2001. Furthermore, a second clone responsible for an extended-spectrum beta -lactamase phenotype was sporadically present in our institution. Although the strains isolated in the burn unit were also genetically related one to another, the specific responsible clone only appeared in 2003. CONCLUSION: Several multidrug-resistant clones can coexist endemically for several years and can be detected during an outbreak by close survey of epidemic sources.