Non-operative management of a pathological malaria splenic rupture A case report.

Malaria continues to be a major health problem in many parts of the world especially in the endemic countries. Though, because of the international travelling, any physician everywhere should know this disease and its complications such as splenic rupture which is rare but life threatening. We report the case of an expatriate Tunisian man who had been working in Togo and who had consulted in Tunisia for an acute abdominal pain. Explorations concluded to a splenic rupture, a rare complication of malaria. Our attitude was conservative based on ressuscitation with monitoring and watchful waiting. The evolution was favorable marked by a significant regression of the splenic hematoma 5 months after hospital discharge. KEY WORDS: Haematoma, Malaria, Splenic rupture, Sub capsular.

Right hepatic artery pseudoaneurysm post laparoscopic cholecystectomy A case report.

Right hepatic artery pseudoaneurysm following laparoscopic cholecystectomy is rare, but its rupture is common. It carries a high mortality rate if not successfully timely managed. In laparoscopic era, surgeons and physicians in general must be aware of this entity and its therapy. Conservative management is not recommended due to the propensity to rupture. Treatment consists on reconstructive surgery or ligation, but coil embolization is the treatment of choice nowadays and should be done without delay. KEY WORDS: Cholecystectomy, Embolization, Laparoscopy, Pseudoaneurysm rupture, Right hepatic artery.

Occupational Noise Exposure and Diabetes Risk.

Introduction: Noise is one of the most common worldwide environmental pollutants, especially in occupational fields. As a stressor, it affects not only the ear but also the entire body. Its physiological and psychological impacts have been well established in many conditions such as cardiovascular diseases. However, there is a dearth of evidence regarding diabetes risk related to noises. Aim: To evaluate the relationship between occupational exposure to noise and the risk of developing diabetes. Methods: This is a cross-sectional analytical study enrolling two groups of 151 workers each. The first group (noise exposed group: EG) included the employees of a Tunisian power plant, who worked during the day shift and had a permanent position. The second group (unexposed to noise group: NEG) included workers assigned to two academic institutions, who were randomly selected in the Occupational Medicine Department of the Farhat Hached University Hospital in Sousse, during periodical fitness to work visits. Both populations (exposed and unexposed) were matched by age and gender. Data collection was based on a preestablished questionnaire, a physical examination, a biological assessment, and a sonometric study. Results: The mean equivalent continuous sound level was 89 dB for the EG and 44.6 dB for the NEG. Diabetes was diagnosed in 24 workers from EG (15.9%) and 14 workers from NEG (9.3%), with no statistically significant difference (p=0.08). After multiple binary logistic regression, including variables of interest, noise did not appear to be associated with diabetes. Conclusion: Our results did not reveal a higher risk of developing diabetes in workers exposed to noise. Further studies assessing both level and duration of noise exposure are needed before any definitive conclusion.

Effects of music therapy on occupational stress and burn-out risk of operating room staff.

The operating theatre staff is exposed to various constraints such as excessive working hours, severe medical conditions and dreadful consequences in case of malpractice. These working conditions may lead to high and chronic levels of stress, which can interfere with medical staff well-being and patients quality of care. The aim of this study is toassess the impact of music therapy on stress levels and burnout risk on the operating room staff. This is a pre-experimental study including the operating rooms staff of urology and maxillofacial surgery in the academic hospital of Sahloul Sousse (Tunisia) over a period of six weeks. The study consisted of three phases. The first was an initial assessment of stress level with a predefined survey. The second included three music therapy sessions per day over one month. The third was an immediate stress level reassessment following the intervention. Stress levels were evaluated using the Perceived Stress Scale version PSS-10 and the Maslach Burnout Inventory. The overall response rate was 73.9%.The average age of the study population was 37.8 ± 7.7 years with a female predominance (64.7%). After the music therapy program, Perceived Stress Scale average score decreased from 22 ± 8.9 to 16 ± 7.9 (p = 0.006). Concerning the burnout, only the average score of emotional exhaustion decreased significantly from 27 ± 10.8 to 19.2 ± 9.5 (p = 0.004). Music therapy is an innovative approach that seems to reduce operating theatre staff stress. It must be considered as a non pharmacological, simple, economic and non invasive preventive tool.

[Effect of frontal electrodes location on the electrocardiogram quality of obese subjects: Roots versus limb of extremities]. / Effet de l'emplacement des électrodes frontales sur la qualité de l'électrocardiogramme du sujet obèse : racines versus extrémités des membres.

INTRODUCTION: In obese patients, standard recording of electrocardiogram seems to have specific electrical modifications related to obesity. These modifications could be minimized by the use of alternative recording techniques. The aim of this study is to evaluate the effect of the recording technique (standard versus Lund) on the electrocardiogram quality in healthy obese patients. METHOD: This is an observational and descriptive study carried out in emergency medical services during a two years period. Healthy subjects with an age over 18 years and a body mass index (BMI)≥30kg/m2 were included. Each participant had an electrocardiogram according to Lund's technique immediately followed by a standard recording. Deflections amplitude and their respective axes were compared between the two techniques. The primary endpoint was the frequency of microvoltage. The secondary endpoints were the flat T wave at the inferior and the left axial deviations. RESULTS: Fifty obese patients were included. The average BMI was 36.8±6.6kg/m2. The average age was 45±13 years with a sex ratio of 0.52. The standard technique was associated with a higher incidence of microvoltage (40% versus 20%, P=0.029) and flattening of the T wave (40% versus 18%, P=0.015). Analysis of the variance of the P, QRS and T wave axes did not find any difference between the two techniques. CONCLUSION: The Lund technique reduces the incidence of electrical abnormalities in the electrocardiogram of healthy obese patients.

[Clinical and epidemiological characterization of infections due to imipenem resistant Acinetobacter baumannii at the university hospital Sahloul, Tunisia]. / Caractérisation clinico-épidémiologique des infections à Acinetobacter baumannii résistant à l'imipénème au CHU Sahloul, Tunisie.

OBJECTIVE: to characterize epidemiological and clinical features related to the multi-drug Acinetobacter baumannii infections in the university hospital Sahloul in Tunisia. MATERIAL AND METHODS: retrospective study including twenty-four imipenem resistant Acinetobacter baumannii isolated from twenty patients hospitalized in different wards of the hospital. Study of clinical features related to the infection by multi-drug Acinetobacter baumannii, bacterial identification by classical identification scheme, antibiotic susceptibilities were determined by the disk diffusion method; genotyping was performed by arbitrarily-primed PCR. RESULTS: the most incriminated ward was the intensive care unit with a high prevalence of septicaemia. All studied strains were multi-drug to all beta-lactams tested. Genotyping has shown the clonality of studied strains. Features incriminated in the acquisition of infection were essentially immunodeficiency, invasive manoeuvring and antibiotherapy. CONCLUSION: multidrug Acinetobacter baumannii is increasingly isolated in our hospital. Rational use of antibiotics and rigorous application of hygienic rules could contribute to limit dissemination of such strains.

[Anaesthesia and right ventricular failure]. / Anesthésie et insuffisance cardiaque droite.

OBJECTIVE: The purpose of this review was to present an update of the anaesthesic management in patients with right ventricular failure (RVF). DATA SOURCES: All references obtained from the medical database Medline related to the area and more specifically during the last five years were reviewed. DATA SYNTHESIS: The preanaesthesic visit leads to identify the etiology of RVF, to evaluate the functional reserve of the patient, to plan complementary exams and to inform the patients about the risks associated with the perioperative period. During the peroperative period, the monitoring depends of the severity of the illness; however the invasive monitoring of the systemic blood pressure seems always necessary. Any hemodynamic instability should be avoided during the peri-operative period. Since the risk of death is maximal in the first days after the anaesthesia, the patient is ideally managed in intensive care during this period. CONCLUSION: Right ventricular failure is often mis-estimated. However, the perioperative morbidity and mortality of patients with RVF are important. In the perioperative period, the anaesthesiologist should identify patients at risk of right ventricular failure in order to adapt their management.

Hyponatremie en reanimation

La natremie reflete l'etat d'hydratation du patient. L'hyponatremie represente l'anomalie hydro-electrolytique la plus frequente en reanimation. Ce trouble entraine souvent une diminution de la tonicite extracellulaire avec un passage d'eau en intracellulaire. La gravite de l'hyponatremie resulte de l'installation d'un oedeme cerebral avec hypertension intracranienne. Les vraies hyponatremies sont a distinguees des pseudo hyponatremies secondaires a une hyperglycemie; une hyper protidemie ou a une hypertriglyceridemie. La correction de la natremie doit etre progressive a raison de 1;5 a 2 mmol.L-1.h-1 pour eviter une myelinolyse centropontique. L'objectif de ce travail est de faire une mise au point sur les principales etiologies de l'hyponatremie en milieu de reanimation et leur prise en charge

Bloc neuromusculaire prolonge apres injection de celocurine : un cas clinique

En tant que curare a courte duree d'action du fait de son hydrolyse rapide par les pseudo cholinesterases plasmatiques; la succinylcholine (suxamethonium) ne doit pas provoquer plus de 5 a 10 minutes de bloc neuromusculaire. Pourtant; nous rapportons un cas de curarisation prolongee apres une injection intraveineuse de 1 mg.kg-1 de succinylcholine que nous avons observe au cours d'une anesthesie generale chez un patient age de 60 ans. Les etiologies; le diagnostic preoperatoire du risque; la prise en charge therapeutique et la prevention seront discutes a travers a la litterature