[Treatment of postoperative peritonitis in the Intensive Care Unit: a retrospective study of 46 cases]. / Les péritonites postopératoires en réanimation: étude rétrospective, à propos de 46 cas.

We conducted a study of 46 patients admitted to the Intensive Care Unit with postoperative peritonitis. The incidence of postoperative peritonitis in this setting was 2.7%. The average age of patients was 53.3 years, with a sex ratio of 1.2. Submesocolic surgery was the most common cause of postoperative peritonitis (65.2%), mainly occurring in the colorectal region (48%). Clinical signs were dominated by fever (78%), abdominal pain (57%) and extra-abdominal signs. The mean time between symptom onset and diagnosis was 7.3 days. Reoperation was performed on the basis of clinical and biological criteria in 56.5% of cases. Therapeutic management was based on perioperative reanimation, treatment of organ dysfunctions, probabilistic antibiotic therapy and middle laparotomy. The bacteriological profile was dominated by BGN (79%). The loosening of the anastomotic sutures was the direct cause of PPO in 57% of patients. Mortality rate was 60%. The main prognostic factors were: renal failure, the number of patients with organ failure, PT<50%, the need for ventilation and the use of catecholamines.

Factors Associated with Mortality in Severe Acute Cholangitis in a Moroccan Intensive Care Unit: A Retrospective Analysis of 140 Cases.

BACKGROUND: Severe acute cholangitis is a life-threatening biliary infection, leading to organ dysfunction, septic shock, and naturally death. Mortality has dropped significantly in the past years through improving resuscitation and biliary drainage techniques. The aim of our study is to analyze our daily practice and the factors associated with mortality. METHODS: A retrospective study including severe acute cholangitis patients admitted to our unit from January 2009 to December 2018. Variables analyzed (univariate then multivariate analysis) were age, sex, history, origin, evolution time, bilirubin, etiology, organ dysfunction, qSOFA, SOFA, TOKYO, biliary drainage timing and technique, shock, antibiotherapy, and resuscitation. RESULTS: 140 patients were included in this study. Average age was 61. Sex ratio M/F was 0.59. Lithiasis etiology was dominant (69%). SOFA average score upon admission was 8. Ceftriaxone + metronidazole was the empirical antibiotic used in 87%. Average time to biliary drainage was 1.58 ± 0.89 days. Endoscopic unblocking was the technique used in 76%. Mean duration of ICU stay was 6 days. Mortality rate was 28%. Statistically significant factors for mortality (p < 0.05) were history of taking anticoagulant treatment, use of catecholamines and mechanical ventilation during ICU stay, and delay in consultation and administration of antibiotic therapy. CONCLUSIONS: Early recognition, antibiotics, resuscitation, and minimally invasive biliary drainage have improved patient outcomes although there is still progress to be made. Moreover, as multiple organ failure is often associated with mortality in severe acute cholangitis, predictive risk factors of organ failure should be more investigated.

Spontaneous pneumomediastinum occurring in the SARS-COV-2 infection.

We report the case of a 23 year old female admitted for management of infection by the SARS-COV-2. The chest CT found a spontaneous pneumomediastinum that resorbed over 7 days with a good clinical outcome. We will discuss the mechanism underlying the occurrence of spontaneous pneumomediastinum during a COVID-19 pneumonia.

Paracetamol self-poisoning: when oral N-acetylcysteine saves life? a case report.

Paracetamol is the most widely drug involved in accidental paediatric exposures and deliberate self-poisoning cases because of its availability. N-acetyl cystein is the main treatment for this poisoning. We report a case of a 24-year-old Arab female who has deliberately ingested 100 tablets of 500 mg paracetamol each (50g). Her first examination was normal. She has received oral N-acetyl cystein (NAC) 6 hours after the ingestion. Serum paracetamol level done 18 hours post ingestion was 900 mg/l. On review the next days, she did not develop any symptoms of liver failure. However, due to the massive paracetamol ingestion associated with high serum paracetamol levels, oral NAC was continued for 3 days. The patient was discharged well on the fifth day of hospitalization. Our patient has ingested one of the highest paracetamol overdose (50g) with the highest paracetamol blood levels ever reported in medical literature. She was treated, six hours after ingestion, with oral NAC for 3 days without any side effects.

[TURP syndrome: about a case]. / TURP syndrome: à propos d'un cas.

We report the case of a 78-year old patient, with no particular past medical history, who underwent transurethral resection of the prostate (50 g) under spinal anesthesia for benign hypertrophy. 90 minutes after the beginning of the procedure, the patient had nausea, vomiting, visual fog and bradycardia, suggesting TURP syndrome. Ionogramme objectified a serum sodium level of 118meq/L, hence the patient was treated with 3% hypertonic saline solution, with good evolution. This study describes a common but moderate occurrence of TURP syndrome whose management was facilitated by patient's alertness during spinal anesthesia.

[Medical simulation in hemodialysis]. / Simulation médicale en hémodialyse.

INTRODUCTION: Simulation is an innovative educational tool based on learning experience in a secure environment without fear of repercussions especially in critical situations such as in emergencies. It offers great prospects in the development of dialysis training. METHODS: We report the results of an observational study comparing medical simulation to conventional training methods in the management of hemodialysis in emergency situations. We discuss afterwards the possibilities currently allowed by medical simulation in dialysis training. RESULTS: The training was beneficial (significant difference between initial and final level of knowledge) for all participants. There was no significant difference between the conventional approach, simulation training and the two combined tools. However, satisfaction rate was higher in simulation training. We observed a tendency to have better results in "active players" of the simulation compared to observers. CONCLUSION: We emphasize the importance of integrating medical simulation training in our dialysis training strategies as a complementary tool to classical teaching/learning methods.