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1.
Pan Afr Med J ; 33: 289, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692808

RESUMO

Introduction: This study explores why resuscitation is withheld when mobile emergency medical team arrive at the scene of a cardiac arrest. Methods: We conducted a prospective, observational study in pre hospital emergency services. We included adults' patients, with a suspicion of non-traumatic cardiac arrest (CA) in an out of hospital environment, who received or not cardiopulmonary resuscitation (CPR) by our mobile emergency medical service teams. An analytic study was conducted in order to identify independent factors that could influence the decision to resuscitate OHCA. Results: During study, 228 patients were enrolled, the mean age was 64 +/- 14 years and 59% were men. Eighteen patients (8%) received bystander CPR by witnesses. The median time elapsed to arrive at the scene was 13 [8-25] min. The median "noflow" was 22 [10-34] min. The resuscitation decision was taken by the mobile EMS staff for 106 patients (46.5%). For other patients, the decision not to resuscitate was motivated solely by the finding of a confirmed state of death in an elderly patient (p = 0.045). The predictive decision factor for resuscitation was the no flow time less than 18.5 min, Odds Ratio adjusted with 95% confidence interval to: 1.38 (1.24 - 3.55) (p <0.001). Overall out of hospital survival rate was 17% of resuscitated patients. Conclusion: The decision to resuscitate a cardiac arrest outside of the hospital depends more on the "no flow" time than on the presumed etiologies.


Assuntos
Reanimação Cardiopulmonar/métodos , Tomada de Decisões , Serviços Médicos de Emergência/estatística & dados numéricos , Parada Cardíaca Extra-Hospitalar/terapia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Taxa de Sobrevida , Fatores de Tempo
2.
Pan Afr Med J ; 33: 275, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692844

RESUMO

The diagnosis of pulmonary thromboembolism (PTE) with changes shown by electrocardiography (ECG) is a challenge in the clinical practice due to rare pathognomonic findings. We report the case of a 37-year old woman managed in out of hospital sitting for a chest pain. Electrocardiogram was suggestive of antero-septal acute myocardial infarction (AMI). Catheterization revealed non occlusive coronary disease. Transthoracic echocardiography showed an elevated pulmonary and right heart pressures. Computed tomography pulmonary angiography confirmed the diagnosis of bilateral pulmonary embolism. PTE with ECG changes should be considered in the differential diagnosis of AMI, particularly in young patients with chest pain and ST segment elevation suggestive of acute coronary syndrome.


Assuntos
Dor no Peito/diagnóstico , Infarto do Miocárdio/diagnóstico , Embolia Pulmonar/diagnóstico , Adulto , Dor no Peito/etiologia , Angiografia por Tomografia Computadorizada , Diagnóstico Diferencial , Ecocardiografia , Feminino , Humanos
3.
Soins ; (777): 32-3, 2013.
Artigo em Francês | MEDLINE | ID: mdl-23951622

RESUMO

The Libyan revolution which began in February 2011 caused a massive influx of refugees of different nationalities into Tunisia. A refugee camp was gradually set up by the Tunisian authorities in collaboration with civil society and international humanitarian organisations. The refugees' health care and emergency treatment became a necessity.


Assuntos
Distúrbios Civis , Serviços Médicos de Emergência , Socorro em Desastres , Guerra , Humanos , Refugiados
4.
Tunis Med ; 89(6): 529-33, 2011 Jun.
Artigo em Francês | MEDLINE | ID: mdl-21681714

RESUMO

BACKGROUND: The management of the older constituted a problematic that will be more attractive in the future because of the population's advanced age. AIM: To evaluate the management of the older more than 75 years that presented an arrest chest. METHODS: Retrospective study during 12 months (from the first January 2004 to 31 December 2004) and interested 15 regulation's documents; we studied demographic parameters, the cause and the time of called the evolution after cardio-respiratory resuscitation. RESULTS: We had 9276 called cases: 320 concerned patients more than 75 years (3, 45%) among 15 (4, 68%) had a chest arrest, the ratio sex was 0, 5 and the middle age: 78, 4 years. In the most cases; the called arrived by night (40%). The principal symptomatology was respiratory troubles (33, 33%); the outcome was fatal in all cases. CONCLUSION: The older over than 75 years had many pathologies that is why the prognostic of the chest arrest was very bad (mortality 100%), the gravity of the chest arrest was seen on this study so we must take seriously all the pathology presented by the older, multiplied the medical consultations to detect the complications earlier and to improve the life's quality.


Assuntos
Parada Cardíaca Extra-Hospitalar/terapia , Idoso , Feminino , Humanos , Estudos Longitudinais , Masculino , Estudos Retrospectivos
5.
Tunis Med ; 86(11): 954-6, 2008 Nov.
Artigo em Francês | MEDLINE | ID: mdl-19213483

RESUMO

BACKGROUND: The concept of risk has not clear neither in the media nor in the medical field. It appears important to us to bring details relating some definitions in the field of anaesthesia safety. AIM: This work aims to clarify the concepts of safety, of risk in a medical activity like the Anaesthesia. METHODS: A search was carried out on Medline with the following key words: Risk anaesthetic, anaesthetic Safety, anaesthetic mortality. RESULTS: The definitions of risk, of acceptable risk taking account of social and economic considerations are brought in this text. The ways to evaluate safety and the methods to achieve it was developed. DISCUSSION: The indicator of quality more used to evaluate safety is anaesthetic mortality. Many difficulties exist with the interpretation of data on mortality. The standards of care are normally established according to the degree of necessary safety. Concurrently to these standards exist certainly the human error which is a phenomenon towards which must direct all the efforts of improvement of safety but more especially the errors of system which are found regularly in the analysis of accidents and incident. CONCLUSION: The identification of the failures is the mandatory step to achieve safety.


Assuntos
Anestesia/efeitos adversos , Erros Médicos/prevenção & controle , Monitorização Intraoperatória , Garantia da Qualidade dos Cuidados de Saúde , Bases de Dados como Assunto , Humanos , Gestão de Riscos
6.
Tunis Med ; 82(8): 730-4, 2004 Aug.
Artigo em Francês | MEDLINE | ID: mdl-15532767

RESUMO

UNLABELLED: The aim of the study was to determine prognostic factors of post operative morbidity and mortality for patients aged 80 years and older. We compared two groups of patients aged 80 and over operated to determine predictive factors of morbidity and mortality: group of patients who presented post operative complication within 30 days after surgery and group of patients without any complication. Comparison of the two groups for global morbidity using univariate analysis showed only one prognostic factor: surgery of diabetic foot (p = 0.034). Predictive factors of mortality according to univariate analysis were: pre-operative shock (p = 0.001), abdominal wall pathology (p = 0.027), gastric or duodenal ulcer diseases (p = 0.011) and global morbidity (p = 0.006). After logistic regression, only pre-operative shock was an independent predictive factor of mortality (p = 0.0023). CONCLUSION: Risk for morbidity after surgery in the elderly 80 years and over is linked with type of surgery and not with soil. Likewise, risk for mortality is linked with advanced stage of disease that is presence of pre-operative shock and not with soil.


Assuntos
Procedimentos Cirúrgicos Operatórios/efeitos adversos , Procedimentos Cirúrgicos Operatórios/mortalidade , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/epidemiologia , Prognóstico , Estudos Retrospectivos
7.
Tunis Med ; 81(7): 505-9, 2003 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-14534963

RESUMO

Neuroendocrine tumors (NET) of the digestive system are rare. They comprise only 1% of all the tumors of the gastrointestinal tract. The aim of this study is to report two cases of exceptional localization of non secretary neuroendocrine tumors. Their difficulty in diagnosis, treatment and controversy in chemotherapy merit their study in depth. These are two patients that were treated in the department of general surgery (Beau Séjour) in Charles Nicolle Hospital for non secretary (NET) of the pancreas and stomach. The first was presented as a painless epigastria mass with frequent diarrhea. The second was presented as a painful mass in the left hypochondriac area without any other symptoms. Biochemical evaluation confirmed their non secretary properties. Surgery remains the first line of treatment. It was possible for the gastric, but not for the pancreatic tumor. Both were very advanced and had metastasis. Histopathological evaluation and immunohistochemical study using the method of peroxydase antiperoxydase (PAP) complexes for some special monoclonal antibodies confirmed the diagnosis. Chemotherapy of both cases was mal tolerated and was discussed in details.


Assuntos
Tumores Neuroendócrinos , Neoplasias Pancreáticas , Neoplasias Gástricas , Adulto , Feminino , Seguimentos , Gastrectomia , Humanos , Imuno-Histoquímica , Excisão de Linfonodo , Pessoa de Meia-Idade , Metástase Neoplásica , Tumores Neuroendócrinos/diagnóstico , Tumores Neuroendócrinos/cirurgia , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/terapia , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/cirurgia , Fatores de Tempo
8.
Tunis Med ; 81(4): 235-8, 2003 Apr.
Artigo em Francês | MEDLINE | ID: mdl-12848005

RESUMO

The objective of this work is to study factors of prognostic of mortality of abscesses of the liver. We have treated between 1990 and 2000 in our service, 38 patient for abscess of the liver. The symptoms are dominated by the pain of the right hypochondria (37 cases) and the fever (34 cases). An unique abscess has been recovered in 25 cases. Some multiple localizations have been observed in 12 cases. 21 patients have been operated. The bacteriological study at all patients revealed the presence of germ in 27 cases. In 6 cases, there were two germs. It was a bacillus negative gram in 26 cases and a cocci positive gram in 7 cases. Six complications have been observed at the operated patients. In 5 cases, it was a septic shock having leads to the death. After survey univariate and multivariate the only factor of bad prognostic recovered is the septic shock. The aetiology was identified in only 9 cases; it was abscess cholangiotis.


Assuntos
Abscesso Hepático/diagnóstico , Abscesso Hepático/mortalidade , Dor Abdominal/etiologia , Infecções Bacterianas/complicações , Feminino , Febre/etiologia , Humanos , Abscesso Hepático/microbiologia , Abscesso Hepático/cirurgia , Masculino , Pessoa de Meia-Idade , Prognóstico , Choque Séptico/mortalidade , Taxa de Sobrevida
9.
Tunis Med ; 80(8): 485-8, 2002 Aug.
Artigo em Francês | MEDLINE | ID: mdl-12703129

RESUMO

The aim of this study was to identify the prognostic factors of intraoperative haemorrhage, perioperative blood transfusions and morbidity. We collected 120 splenectomies in Beau Séjour department of surgery, Charles' Nicolle Hospital, Tunis, Tunisia between 1979 and 1999. The descriptive analysis showed sex-ratio 0.82 with mean age (+/- standard deviation) 30.6 +/- 15 year. Idiopathic thrombopenic purpura was the principal disease indicating splenectomy. Morbidity was defined as occurrence of post operative peritoneal sepsis or bleeding. The mortality and morbidity rates were respectively 0.8% and 6.6%. The prognostic analysis didn't identify predictive factors of intraoperative haemorrhage, however it identified two independent predictive actors of specific morbidity: intraoperative haemorrhage (p = 0.03) and preoperative rate of haemoglobin (p = 0.0049).


Assuntos
Doenças Hematológicas/terapia , Complicações Pós-Operatórias , Esplenectomia , Adolescente , Adulto , Feminino , Hemorragia , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade , Planejamento de Assistência ao Paciente , Prognóstico , Estudos Retrospectivos , Sepse
10.
Tunis Med ; 80(10): 645-9, 2002 Oct.
Artigo em Francês | MEDLINE | ID: mdl-12632759

RESUMO

The actinomycosis is a chronic suppurative granulomatosis disease. It is owed to a bacillus gram positive; actinomycès israelli. The cervical and thoracic localizations are most frequent. The digestive localization represents 20% of cases. It interest very rarely the pelvis and the genital tracts. We bring back the observation of a patient old of 30 years admitted for mass abdominal. To the exam, the patient had a sensibility of the left hypochondriac area and we found a mass of 6 cm of diameter. To the rectal touch, we found a mass in the bag of Douglas. The echography and the computed tomography revealed a collection under the spleen and a pelvic collection. A rectotomy is performed. The bacteriological study isolates actinomycès israelli. The collection under the spleen is drained under radiological control. Actinomycès israelli is also recovered in the pus brought back by the puncture. The patient is treated by Penicillin. The patient had a favourable evolution. No etiology is found at this patient. For this observation, the collection was accessible to a drainage permitting the diagnosis and the treatment of the actinomycosis while avoiding a mutilated surgery.


Assuntos
Actinomicose , Escavação Retouterina/microbiologia , Abscesso Subfrênico/microbiologia , Actinomyces/isolamento & purificação , Actinomicose/diagnóstico , Actinomicose/diagnóstico por imagem , Actinomicose/tratamento farmacológico , Adulto , Escavação Retouterina/diagnóstico por imagem , Drenagem , Feminino , Seguimentos , Humanos , Penicilina G/uso terapêutico , Penicilinas/uso terapêutico , Doenças Peritoneais/diagnóstico , Doenças Peritoneais/diagnóstico por imagem , Doenças Peritoneais/tratamento farmacológico , Doenças Peritoneais/microbiologia , Abscesso Subfrênico/diagnóstico por imagem , Abscesso Subfrênico/tratamento farmacológico , Abscesso Subfrênico/cirurgia , Fatores de Tempo , Tomografia Computadorizada por Raios X
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