Post-traumatic cerebral venous sinus thrombosis in an intensive care unit: A case series of ten patients.

Post-traumatic cerebral venous sinus thrombosis is one of the several causes of cerebral venous thrombosis, but its early diagnosis and management are still difficult in this traumatic context. Our objective is to describe clinical and radiological presentations and to report specific management and outcomes of this rare post-traumatic complication. We reported in this manuscript a case series of 10 patients hospitalized in the intensive care department with post-traumatic cerebral venous thrombosis. Demographic, clinical, and radiological data and their medical management are reported. The incidence of post-traumatic cerebral venous sinus thrombosis in our institution was 4.2%. Cerebral thrombophlebitis was diagnosed incidentally on the initial body scan, on ICU admission in five patients. The left or right lateral sinus was affected in four patients; the sigmoid sinus was affected in 6 patients. Five patients had a thrombosis in the jugular vein. Seven patients had 2 or 3 sites of occlusion. All patients had medical treatment. No hemorrhagic complications were reported. The total duration of anticoagulation was available in 5 cases. A follow-up of MRI or CT scan at 3 months revealed complete sinus recanalization in three patients. Post-traumatic cerebral venous sinus thrombosis in the intensive care department remains underdiagnosed because of the common clinical presentation of traumatic brain injury. Its incidence is increasing because of the increase in high-velocity accidents. And, it seems necessary to conduct prospective studies with a large cohort of patients in the intensive care department.

Sexual violence against women in southern Tunisia: Epidemiology and risk factors.

INTRODUCTION: Sexual violence (SV) against women represents a public health problem. Despite, the promulgation of the new Act of 2017-58, SV remains frequent in Tunisia. In this paper, we propose to determine the socio-demographic characteristics of women victims of SV and to identify risk factors related to serious SV. MATERIAL AND METHODS: This is a retrospective, descriptive and analytical study including all women victims of SV, examined at the Forensic Department of Sfax Hospital, between 1st March 2018 and February 29th, 2020. We defined serious SV as any sexual violence associated with genital or anal lesions. RESULTS: We collected 269 cases of women victims of SV. This sexual violence was associated with extra-genital physical violence in 18.86 % of the cases. The average age of the victims was 21.23 years (+/-10.67 years). The consultation delay was relatively long. Only 11.52 % of victims consulted within 24 h. It was mainly an extra-family abuse. Vaginal examination revealed recent defloration in 9.29 % of the cases. The proctological examination was normal in most cases (61.63 %).Seven victims were pregnant. In the analytical study, we studied the risk factors of serious SV against women. A total of 150 cases were considered serious (55.8 %). Serious SV was statistically related to the age (over 18),the profession (housewives),the origin (urban),and the relationship with the aggressor (friend, neighbor, or family member).The risk of serious SV was greater when the victim didn't have any traumatic extra-genital injury. CONCLUSION: Sexual violence is a serious problem worldwide and in Tunisia. The Tunisian legislation repressing SV has been strengthened by the promulgation of the 2017-58 Act. However, much effort remains to be deployed to fight against this form of violence.

The effect of dexamethasone as an adjuvant in spinal anesthesia for femur upper extremity surgery: a prospective randomized trial.

Introduction: the aim of our study was to evaluate the efficacy of dexamethasone added to bupivacaine and sufentanil in spinal anesthesia to improve postoperative analgesia after femur upper extremity surgery. Methods: we conducted a prospective controlled, randomized double-blinded clinical trial including patients proposed for surgery of the upper extremity of the femur under spinal anesthesia. The patients were randomly allocated to receive intrathecally 10 mg hyperbaric bupivacaine 0.5% with 5µg sufentanil and 2 ml normal saline (control group) or 10 mg hyperbaric bupivacaine 0.5% with 5 µg sufentanil and 8 mg dexamethasone (Dexa group). The patients were evaluated for onset time and duration of sensory block, duration of pain-free period, overage consumption of morphine in the 6 first postoperative hours, hemodynamic parameters, nausea, and vomiting, or other complications. Results: fifty-eight patients were analyzed. There were no signification differences in demographic data and onset time of the sensory block between the two groups. Sensory block duration was 121.55 ± 16.42 minutes in the control group and 183.62 ± 33.93 minutes in the Dexa group which was significantly higher in the Dexa group (P<0.001). The pain-free period was longer in the Dexa group than in the control group (P<0.001). There was a reduction in morphine consumption during the first 6 postoperative hours in the Dexa group against the control group (p=0.02). The frequency of complications was not different between the two groups. Conclusion: the addition of intrathecal dexamethasone in spinal anesthesia improved the postoperative analgesia after femur upper extremity surgery.