45 research outputs found
Complications respiratoires péri-opératoires chez les patients à risque de syndrome d'apnées du sommeil en chirurgie urgente. Etude STOP SAS
No full textANGERS-BU Médecine-Pharmacie (490072105) / SudocSudocFranceF
Acomys chudeaui Kollman 1911
No full text10. Chudeau’s Spiny Mouse Acomys chudeaui French: Acomys de Chudeau / German: Chudeau-Stachelmaus / Spanish: Ratén espinoso de Chudeau Taxonomy. Acomys chudeaui Kollman, 1911, SW Biskra, Atar, Mauritania. Acomys chudeawi was considered a synonym of A. cahirinus and rehabilitated according to cytogenetic and molecular analyses. T. Benazzou in 1983 found 2n = 40 for A. chudeaui vs. 2n = 36 for A. cahirinus, a distinction later confirmed by cytogenetic studies. Some morphological differences also allowed recognition of A. chudeawi as separate from A. cahirinus and also distinct from A. sewrati and A. airensis, both found in montane regions of southern Sahara. Molecular studies found A. chudeawi to be a member of the A. cahirmus— dimidiatus species complex, and V. Nicolas and colleagues in 2009 synonymized A. airensis and A. chudeaui, the senior taxon. Recorded karyotypes are 2n = 40-46 in Mali, 2n = 40 in Mauritania, and 2n = 41-43 and 46 in Niger. Monotypic. Distribution. N & W Africa, N of the Niger River. Descriptive notes. Head—body 93-120 mm, tail 72-125 mm, ear 15-19 mm, hindfoot 15-20 mm; weight 25-64 g. Dorsum of Chudeau’s Spiny Mouseis gray, with red-orange glint; spiny hairs are more abundant on rump; and belly is pure white. Tail is ¢.90% of head-body length and naked. Skin is fragile, and tail skin can be removed easily (autotomy), as inother species of Acomys. Females have four pairs of mammae. Habitat. Rocky areas. Chudeau’s Spiny Mice have been found as a commensal in cultivated zones, grain storages, and houses. Food and Feeding. Captive Chudeau’s Spiny Mice eat meat. Breeding. In Mauritania, female Chudeau’s Spiny Mice reproduce in August-October, and they have 1-3 embryos (average 2). Activity patterns. Chudeau’s Spiny Mouse is nocturnal, resting and avoiding heat in crevices during the day, but some individuals in the Air regionwere caught during the day. Movements, Home range and Social organization. No information. Status and Conservation. Not assessed on The IUCN Red List. Chudeau’s Spiny Mouse has a wide distribution through Sahelo-Sudanian region whereit receives little human impact, and it is locally abundant in Mauritania and Mali. Bibliography. Ba et al. (2001), Baréme et al. (2000), Benazzou (1983), Denys et al. (1994), Dobigny, Moulin et al. (2001), Dobigny, Nomao & Gautun (2002), Granjon & Duplantier (2009), Monadjem et al. (2015), Musser & Carleton (1993), Nicolas et al. (2009), Tranier et al. (1999), Viegas-Péquignot et al. (1983), Volobouev, Gautun & Tranier (1996), Volobouey,Tranier & Dutrillaux (1991).Published as part of Don E. Wilson, Russell A. Mittermeier & Thomas E. Lacher, Jr, 2017, Muridae, pp. 536-884 in Handbook of the Mammals of the World – Volume 7 Rodents II, Barcelona :Lynx Edicions on page 601, DOI: 10.5281/zenodo.688726
Eulimnadia acutirostris Daday de Dees 1926
No full text<i>Eulimnadia acutirostris</i> Daday de Deés, 1926 (Fig. 1 A-D) <p> <i>Eulimnadia acutirostris</i> Daday de Deés, 1926: 513, fig. 126.</p> <p> <i>Limnadia acutirostris</i> – Brtek 1997: 56.</p> <p>TYPE LOCALITY. — A temporary pool in Simbidissi and Hogui in the middle part of Niger Basin in French West Africa during the collecting period (Daday de Deés 1926) and now in Niger or in Mali.</p> <p>MATERIAL EXAMINED. — Middle part of the Niger Basin, Hogui, temporary pool, 8. VI.1909, D. R. Chudeau, 5 eggs from the bottom of the bottles (MNHN-Bp316, 317).</p> <p>RANGE. — The present knowledge of egg morphology leads us to considerer this species as known only from type locality.</p> <p>EGG MORPHOLOGY</p> <p>Spherical egg covered by spiral ridges. The bottom of the furrows are narrow and the ridges separating them are large and round (Fig. 1D). The ridges are complexly fused where they intersect (Fig. 1A). Average egg diameter is 139.5 µm (n = 2, SD = 2.12 µm).</p> <p>REMARKS</p> <p> The eggs, described from the type specimens only, and coming from the bottle bottom, match the original description, “Ova membrana spiraliter plicata tecta” of Daday de Deés (1926). Long furrows are also present in <i>Imnadia yeyetta</i> oval eggs (Thiéry & Gasc 1991). However the fusion area of the furrows in <i>Eulimnadia acutirostris</i> is complex because there are several parallel furrows while in <i>Imnadia yeyetta</i> the furrow is unique and forms a spiral with a simple end at the apex. In the studied eggs, the surface is partially covered by micro-organisms and mud.</p>Published as part of <i>Rabet, Nicolas, 2010, Revision of the egg morphology of Eulimnadia (Crustacea, Branchiopoda, Spinicaudata), pp. 373-391 in Zoosystema 32 (3)</i> on page 376, DOI: 10.5252/z2010n3a1, <a href="http://zenodo.org/record/4521152">http://zenodo.org/record/4521152</a>
Actualités dans la prise en charge des patients admis en réanimation pour un arrêt cardiaque
No full textInternational audienceL'arrêt cardiaque (AC) représente la troisième cause de décès en Europe et est grevé d'une morbidité importante. La prise en charge du syndrome post-AC repose sur le remplissage vasculaire et l'administration de noradrénaline avec un objectif de pression artérielle moyenne > 65 mmHg. La prise en charge respiratoire repose sur des objectifs d'oxygénation incluant une saturation pulsée en oxygène entre 94 % et 98 %, une pression artérielle partielle en oxygène entre 75 et 100 mmHg et un objectif de normocapnie. La lutte active contre la fièvre est recommandée chez tous les patients. Un contrôle de la température à 33°C ou 36°C pourrait être envisagé chez certains patients plus sévères. La neuropronostication doit être la plus fiable possible pour éviter des décisions inappropriées chez les patients susceptibles de récupérer neurologiquement et éviter le maintien de traitements futiles chez ceux présentant une encéphalopathie sévère. Elle doit systématiquement débuter précocement et reposer sur une évaluation multimodale clinique et paraclinique du patient dans le coma malgré l'arrêt de la sédation. La majorité des patients sortants vivants de l'hôpital après un AC ont une évolution neurologique favorable permettant un retour à domicile même si plus d'un tiers présentent des séquelles cognitives et psychologiques légères à modérées potentiellement invalidantes
The STOP-BANG questionnaire and the risk of perioperative respiratory complications in urgent surgery patients: A prospective, observational study
No full textIntroduction
The STOP-BANG (SB) questionnaire, a tool originally proposed for identifying patients at risk of obstructive sleep apnoea, may also identify patients at increased risk of perioperative complications (when > 3). Perioperative complications, including respiratory ones, are more frequent in emergency surgery. This study aimed at evaluating whether the SB is predictive of perioperative respiratory complications in urgent surgery.
Methods
Consecutive adult patients admitted for an urgent surgery under general anaesthesia were included. The STOP-BANG questionnaire was completed before anaesthesia. Perioperative respiratory complications were prospectively recorded during surgery and in the postoperative care unit (PACU).
Results
One hundred and eighty-nine patients were included (women 46%, median age 60 [43–78] years old) of which 104 (55%) were SB+. Diabetes mellitus and arrhythmia were more frequent in the SB+ patients than in SB-. The ASA class was higher in SB+ patients compared with SB-, but type and duration of surgery were statistically similar. The incidence of respiratory complications was higher in SB+ patients both during surgery (21% versus 6%, P < 0.002) and in the PACU (57% versus 34%, P = 0.0015). Furthermore, SB+ patients had a prolonged length of hospital stay (6 [3–12] versus 4 [2–7] days, P = 0.0002). In a multivariate analysis, the STOP-BANG score was independently associated with respiratory complications (OR [CI 95%] = 1.44 [1.03–2.03], P = 0.03).
Conclusions
An elevated STOP-BANG score (≥ 3) is associated with an increased risk of perioperative respiratory complications and with prolonged length of stay in urgent surgery patients
Prevalence of iron deficiency on ICU discharge and its relation with fatigue: a multicenter prospective study
No full textInternational audienceINTRODUCTION: Prevalence of iron deficiency (ID) at intensive care (ICU) admission is around 25 to 40%. Blood losses are important during ICU stay, leading to iron losses, but prevalence of ID at ICU discharge is unknown. ID has been associated with fatigue and muscular weakness, and may thus impair post-ICU rehabilitation. This study assessed ID prevalence at ICU discharge, day 28 (D28) and six months (M6) after and its relation with fatigue. METHODS: We conducted this prospective, multicenter observational study at four University hospitals ICUs. Anemic (hemoglobin (Hb) less than 13 g/dL in male and less than 12 g/dL in female) critically ill adult patients hospitalized for at least five days had an iron profile taken at discharge, D28 and M6. ID was defined as ferritin less than 100 ng/L or less than 300 ng/L together with a transferrin saturation less than 20%. Fatigue was assessed by numerical scale and the Multidimensional Fatigue Inventory-20 questionnaire at D28 and M6 and muscular weakness by a hand grip test at ICU discharge. RESULTS: Among 107 patients (men 77%, median (IQR) age 63 (48 to 73) years) who had a complete iron profile at ICU discharge, 9 (8.4%) had ID. At ICU discharge, their hemoglobin concentration (9.5 (87.7 to 10.3) versus 10.2 (92.2 to 11.7) g/dL, P =0.09), hand grip strength (52.5 (30 to 65) versus 49.5 (15.5 to 67.7)% of normal value, P =0.61) and visual analog scale fatigue scale (57 (40 to 80) versus 60 (47.5 to 80)/100, P =0.82) were not different from non-ID patients. At D28 (n =80 patients) and M6 (n =78 patients), ID prevalence increased (to 25 and 35% respectively) while anemia prevalence decreased (from 100% to 80 and 25% respectively, P \textless0.0001). ID was associated with increased fatigue at D28, after adjustment for main confounding factors, including anemia (regression coefficient (95%CI), 3.19 (0.74 to 5.64), P =0.012). At M6, this association disappeared. CONCLUSIONS: The prevalence of ID increases from 8% at discharge to 35% six months after prolonged ICU stay (more than five days). ID was associated with increased fatigue, independently of anemia, at D2
Rib fractures after chest compressions for cardiac arrest: retrospective analysis of the AfterROSC1 and AfterROSC2 multicenter databases
No full textPurpose: External chest compressions for resuscitation after out-of-hospital cardiac arrest (OHCA) can cause rib fractures, which are best diagnosed by computed tomography (CT). We assessed the prevalence, management, and associations with outcomes of CT-documented rib fractures in patients with OHCA. Methods: We retrospectively analyzed data collected prospectively at five AfterROSC Network centers in 2020–2023. We included consecutive patients with return of spontaneous circulation and coma after non-traumatic OHCA who underwent CT within 6 h after admission. Rib fractures and other chest-wall injuries were recorded. Associations with the day-90 functional outcome were sought. Analgesic treatment was compared between patients with 0–2 vs. ≥3 rib fractures. Results: Of 2129 patients, 233 (11%) underwent chest CT, which showed at least one rib fracture in 116 (50%). The mean number of rib fractures was 2.4 ± 3.4 and the median was 0 [0–4]. One patient had clinical flail chest. In patients with ≥3 rib fractures, the mean modified Cardiac Arrest Hospital Prognosis (mCAHP) score was higher (91 ± 23 vs. 82 ± 25) and a favorable day-90 neurological outcome (modified Rankin Scale score 0–3) was significantly less common, even after adjustment on mCAHP (18% vs. 35%; adjusted odds ratio, 0.37 [0.19–0.72]; P = 0.003). Analgesic therapy was not significantly different between patients with 0–2 and ≥3 rib fractures. Conclusions: Rib fractures related to chest compressions are common in OHCA survivors. Having ≥3 rib fractures was associated with a poorer prognosis after adjustment on cardiac-arrest characteristics. The management of pain related to rib fractures may require reappraisal
Performance of the ERC/ESICM-recommendations for neuroprognostication after cardiac arrest: insights from a prospective multicenter cohort
No full textInternational audienceBrief abstract: In a multicentre network of 28 ICUs in France and Belgium, all comatose patients who fulfilled the 2021 ERC-ESICM criteria for poor outcome after cardiac arrest died or survived with severe neurological disability, even after excluding patients with active WLST to limit self-fulfilling prophecy bias. However, in almost half of the patients, these criteria were not fulfilled, resulting in an indeterminate outcome; in these patients, normal NSE levels and benign EEG predicted neurological recovery, helping reduce prognostic uncertainty.AimTo investigate the performance of the 2021 ERC/ESICM-recommended algorithm for predicting poor outcome after cardiac arrest (CA) and potential tools for predicting neurological recovery in patients with indeterminate outcome.MethodsProspective, multicenter study on out-of-hospital CA survivors from 28 ICUs of the AfterROSC network. In patients comatose with a Glasgow Coma Scale motor score ≤3 at ≥72 hours after resuscitation, we measured: 1) the accuracy of neurological examination, biomarkers (neuron-specific enolase, NSE), electrophysiology (EEG and SSEP) and neuroimaging (brain CT and MRI) for predicting poor outcome (modified Rankin scale score≥4 at 90 days), and 2) the ability of low or decreasing NSE levels and benign EEG to predict good outcome in patients whose prognosis remained indeterminate.ResultsAmong 337 included patients, the ERC-ESICM algorithm predicted poor neurological outcome in 175 patients, of whom 106 (60%) had withdrawal of life-sustaining treatment (WLST). Among the 69 patients without active WLST, the positive predictive value for an unfavourable outcome was 100% [95-100]%. The specificity of individual predictors ranged from 90% for EEG to 100% for clinical examination and SSEP. Among the remaining 162 patients with indeterminate outcome, a combination of 2 favourable signs predicted good outcome with 99[96-100]% specificity and 23[11-38%]% sensitivity.ConclusionAll comatose resuscitated patients not undergoing WLST who fulfilled the ERC-ESICM criteria for poor outcome after CA had poor outcome at three months, even if a self-fulfilling prophecy cannot be completely excluded. In patients with indeterminate outcome (half of the population), favourable signs predicted neurological recovery, reducing prognostic uncertainty
