[Systemic candidiasis in medical intensive care unit: analysis of risk factors and the contribution of colonization index]. / Les candidoses systémiques en réanimation médicale : analyse des facteurs de risque et intérêt de l'index de colonisation.

OBJECTIVES: Description of the epidemiological and clinical characteristics of the patients introducing risk factors of invasive candidiasis. Analysis of risk factors for candidiasis invasive and evaluation of the contribution of colonization index (CI) in the diagnosis of the systematic candidiasis in medical intensive care. PATIENTS AND METHODS: Prospective observational study (October 2007 to October 2009). The selected patients present risk factors of system IC candidiasis with an infectious syndrome or clinical signs suggestive of Candida infection and hospitalized more than 48 hours in medical intensive care unit. Pittet's colonization index was calculated at admission and then once a week added to a blood culture. Patients were classified according to level of evidence of Candida infection and the degree of colonization (CI<0.5, CI ≥ 0.5). RESULTS: The study included 100 patients. Mean age of our patients was 55.8 ± 18.2 years with male prevalence. Neurological disease was the most frequent pathology in admission (48%). The most common risk factors were broad-spectrum antibiotics and foreign material. In the various mycology IC specimens, Candida albicans was the most frequent, followed by C. tropicalis, then C. glabrata. The CI was greater than or equal to 0.5 at 53% of the patients, and less than 0.5 in 47% of the cases. Among the patients, 15% developed an invasive candidiasis. In multivariate analysis, the corticosteroid therapy was associated with a high colonisation (IC ≥ 0.5) and neutropenia with a high risk of systemic candidiasis. The positive predictive value of CI was 26%. The negative predictive value was 98%, the sensitivity and specificity was 93% and 48% respectively. CONCLUSION: CI has the advantage to provide a quantified data of the patient's situation in relation to the colonization. But, it isn't helpful with patients having an invasive candidiasis in medical intensive care unit.

[Peripheral intravenous access in the operating room: characteristics and predictors of difficulty]. / Accès veineux périphériques au bloc opératoire : caractéristiques et facteurs prédictifs de difficulté

PURPOSE: To investigate of predictor's factors of difficult venous access device in the operating room in elective surgery. METHODS: In a prospective study in central operating room, were included all patients scheduled for a surgical or diagnostic intervention. Were excluded all patients admitted with functional venous access. For each, were recorded patient's demographic characteristics (age, gender, ASA class, BMI), history (chemotherapy, prolonged ICU stay, hospitalization for more than five days), data from the clinical examination (presence of skin lesions, arteriovenous fistulas, burns, neurological deficits) and the type of operator (trainee, nurse, resident, senior). The difficulty was judged on the number of attempts required for successful venous access. Puncture was considered easier for a number of attempts to one to two and difficult if the number of attempts was greater than two. Predictor's factors were identified after univariate and multivariate analysis. RESULTS: During one year (March 2008 to February 2009), form returns in 1500 were met, 1325 were usable. Venous catheterization was successful in 50.9% at the first attempt in 24.2% of patients at the second attempt and after three attempts in 18% of patients. Only 6.8% of patients required more than three attempts. A central venous catheter was required in seven patients. In multivariate analysis, chemotherapy (OR=4.54, 95% CI [2.92 to 7.03]; P<0.001), a nurse in training (OR=2.27, 95% CI [1.40 to 3.63]; P=0.001), a resident in training (OR=2.14, 95% CI [1.29 to 3.58]; P=0.003) and the presence of burns (OR=3.59, 95% CI [2.44 to 5.27]; P<0.001) were identified as independent predictors of difficulty of peripheral venous access. DISCUSSION: The optimization of venous access devices in the operating room through the search for predictors of difficulty.

[Efficiency of bupivacaine wound subfasciale infiltration in reduction of postoperative pain after inguinal hernia surgery]. / Efficacité de l'infiltration cicatricielle subfasciale par la bupivacaïne dans la réduction de la douleur postopératoire des hernies inguinales.

INTRODUCTION: The reduction of postoperative pain after surgery of inguinal hernia is an objective of lot of studies. The subfasciale infiltration of the wound may be an efficient technique. METHODS: This study was designed as a randomized, double blind, prospective study, comparing two treatment groups: a group infiltrated by bupivacaine (Gr B), and second one infiltrated by a placebo (Gr P). A part of demographic parameters and ASA class, the postoperative pain intensity at rest and at coughing, the morphine consumption and the secondary effects were compared. Patient's satisfaction and postoperative chronic pain at 3 and 6 months were also analyzed. RESULTS: Concerning demographic parameters, ASA class and secondary effects, we didn't find any meaningful difference between the two groups. However, there was a significant reduction of postoperative pain in the bupivacaine group as well at rest as coughing. Gr P patients have more morphine consumption and they were unsatisfied and accused more chronic pain. DISCUSSION: Wound infiltration is still a simple and efficient technique in postoperative pain reduction. With this technique, hernia surgery may become ambulatory.

Behavior of 1,3-dichloropropene and methyl isothiocyanate in undisturbed soil columns.

To develop alternatives to methyl bromide (MeBr) for soil disinfection under environmental Moroccan conditions, distribution and persistence of 1,3-dichloropropene (1,3-D) and methyl isothiocyanate (MITC) were tested in undisturbed soil columns (12 cm internal diameter, 1 m length). 1,3-D was injected at a 15 cm depth and directly followed by metam-sodium (a precursor of MITC), which was applied at the soil surface of the same column using a peristaltic pump. Concerning the distribution of these fumigants in the soil profiles, our results showed that 24 h after treatment, 1,3-D and MITC were concentrated at the 0-40 cm soil layers, and reached the deeper layers 48 h later. MITC and 1,3-D dissipation was studied and the half-life (DT50) measured were 6.5 and 8 days, respectively. Total volatilization losses reached 9% for MITC and 28% for 1,3-D. MITC and 1,3-D volatilization was found to be influence by soil water contents. The results show that by reducing volatilization, photodegradation and leaching of these fumigants a suitable alternative to MeBr use is offered.

Behavior of methyl isothiocyanate in soils under field conditions in Morocco.

The behavior of methyl isothiocyanate (MITC), active metabolite of metam-sodium (MS), was studied under field conditions in Morocco. MS was applied through drip irrigation in: (i) uncovered soil, (ii) soil covered with transparent polyethylene, and (iii) soil covered with virtual impermeable film. Concentrations of MITC were determined at different soil depths to determine the distribution of MITC and the concentration-time product (CTP). Six hours after MS application, in a sandy soil, MITC reaches the 20-30 cm soil layer, but remains highly concentrated in the upper 10-20 cm soil layer. In a silty clay soil, MITC was concentrated in the upper 0-10 cm soil layer. The dissipation of MITC under different conditions of application was fast and complete after seven days. However, MITC dissipation time (DT(50)) was <24 h in sandy soil treated, but 63 h in silty clay soil. Under these application conditions of MS, the plastic film reduced MITC loss to the atmosphere but the plastic film quality did not affect the behavior of MITC. The use of plastic film maintained high MITC concentrations and appropriate CTP at different soil depths.