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Résumé: Objectifs: Les objectifs de ce travail ont été de réaliser un état des lieux du niveau de stress, de détecter les différents facteurs stressants et de décrire les conditions de travail comme ressenties par le personnel pour mettre le doigt sur les facteurs à modifier de façon prioritaire. Patients et méthodes: Enquête réalisée pendant les mois de juillet à août 2012 dans les différents secteurs du service des urgences. Nous avons utilisé le modèle de Karasek. Les données collectées ont été d’ordre démographique et professionnel. Résultats: Nous avons inclus 107 participants, soit 61,5 % de l’ensemble de l’équipe. La médiane d’âge des participants a été de 30ans avec une prédominance masculine (66 %). Les scores trouvés placent notre échantillon dans le cadran des « tendus ». Seuls 17,8 % des participants ont été trouvés actifs selon ce modèle. Aucune corrélation significative entre genre, statut marital, ancienneté aux urgences et risque de développer un état de stress n’a été trouvée. L’âge inférieur ou égal à 30ans a été prédictif de développement d’un état d’épuisement émotionnel (p =0,04) et de sensation de faible soutien hiérarchique (p =0,02). La satisfaction du travail a été plus faible chez les paramédicaux. En analyse multivariée, ils ont été beaucoup plus sensibles aux demandes psychologiques que les médecins. Conclusion: Cette étude pourrait servir pour montrer l’importance de la prévention de cet épuisement émotionnel afin d’améliorer la qualité de santé des soignants, mais aussi celle des soins administrés dans ce service. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Drugs’ administration via feeding tubes is a potential source of iatrogenic events for the intensive care patients because of the problem of not adapted galenic forms. Objectives: We analyzed the prescriptions of patients with enteral feedings to determine if the galenic forms were compatible with administration via feeding tubes. We also observed and analyzed the methods of drugs passage by nurses. Patients and methods: We analyzed 30 prescriptions of patients with enteral feedings in the intensive care unit of Habib Bourguiba Sfax hospital, by a prospective and exhaustive way. We also, observed and evaluated the practices of preparation and administration of drugs to these patients via feeding tube by nurses. Results: Only 12% of drugs were liquids. Eighty-eight percent of the drugs were pulverised and capsule open before administration. The galenic form was not in conformity for 20% of drugs because of the prohibition to crushing tablet or opening capsule (gastroresistant form was dissolved), or because of the administration of a parenteral form (risk of irritation). Among 78 drugs administered by 10 different nurses, the time between passage of the drug and enteral nutrition were not respected for 59% of the observations. The drugs were managed in mixture for 90% of the observations. The gloves were not worn in 80% of observations. No rinsing is made between consecutive administrations and before administration. Conclusion: This study shows that it is possible to reduce risk of administration errors in the intensive care unit and to facilitate the administration of drug via feeding tube by prescribing liquid oral form or soluble solid oral form. It also shows the need for cooperation with the pharmacist in order to adapt the galenic forms and to redact protocol of administration. [Copyright &y& Elsevier]

Abstract: We report the case of a 26-year-old patient who was victim of severe head trauma following a trafic road accident. Two days after trauma, she had fever, pancytopenia and multi-organ failure. The haemophagocytic lymphohistiocytosis syndrome was suspected. This diagnosis was confirmed by biologic findings (elevated serum levels of ferritin and triglycerid) and histological findings (examination of bone marrow smears showing histiocytes phagocytosing blood cells). The evolution was unfavorable despite of corticotherapy and symptomatic measures. [Copyright &y& Elsevier]

Abstract: We report the case of a patient who was victim of a hydrogen sulphide poisoning. This poisoning took place following a fall in sewers. The initial clinical presentation was dominated by an acute respiratory failure caused by an acute pulmonary oedema. In this context, non cardiogenic pulmonary oedema is usually evoked in the literature. Our observation supports a left ventricular systolic dysfunction as a possible cause of this cardiorespiratory complication. The initial presentation was also marked by a coma which is often associated with severe poisonings by hydrogen sulphide. Evolution was favourable under symptomatic treatment. We discuss the mechanism of heart and neurological failure. [Copyright &y& Elsevier]

Abstract: Introduction: Peripartum cardiomyopathy (PPCM) is a rare and life-threatening disease of unknown aetiology. The primary objective of this review was to analysed aetiopathogeneses, clinical presentation and diagnosis, as well as pharmacological, perioperative and intensive care management and prognosis of this pathology. Methods: We undertook a systematic review of the literature using Medline, Google Scholar and PubMed searches. Results: Unlike other parts of the world in which cardiomyopathy are rare, dilated cardiomyopathy is a major cause of heart failure throughout Africa. Its aetiopathogenesis is still poorly understood, but recent evidence supports inflammation, viral infection and autoimmunity as the leading causative hypotheses. This diagnosis should be limited to previously healthy women who present with congestive heart failure (CHF) and decreased left ventricular systolic function in the last month of pregnancy or within 5 months after delivery. Recently, introduction of echocardiography has made diagnosis of PPCM easier and more accurate. Conventional treatment consists of diuretics, vasodilators, and sometimes digoxin and anticoagulants, usually in combination. Patients who fail to recover may require inotropic therapy. In resistant cases, newer therapeutic modalities such as immunomodulation, immunoglobulin and immunosuppression may be considered. Prognosis is highly related to reversal of ventricular dysfunction. Compared to historically higher mortality rates, recent reports describe better outcome, probably because of advances in medical care. Based on current information, future pregnancy is usually not recommended in patients who fail to recover normal heart function. Conclusion: PPCM is a rare but serious form of cardiac failure affecting women in the last months of pregnancy or early puerperium. Its aetiopathogenesis is still poorly understood. Introduction of echocardiography has made diagnosis of PPCM easier and more accurate. Prognosis is highly related to reversal of ventricular dysfunction. [Copyright &y& Elsevier]

Abstract: Objectives: To analyze the clinico-biological manifestations, identify the causes and evaluate the outcome of patients with severe thrombotic microangiopathies admitted in a Tunisian intensive care unit. Methods: Retrospective study over a period of 10 years (1995–2004) in an intensive care unit. Results: Were included in this study 9 cases with a mean age of 29.2±9 years (range 15–44 years). Fever was observed in 5 patients, neurological impairment in 5 and digestive manifestations in 6. Haemolytic anaemia, thrombocytopenia and acute renal failure were observed in 100% of the cases. In our study, the aetiologies of thrombotic microangiopathies were: complicated pregnancy in 6 cases, systemic lupus erythematosus in 1 case. In contrast, no aetiology was found in 2 patients. Plasma exchange was performed in 5 patients, while 4 patients received only plasma infusion. After an average stay of 18±12.5 days, evolution was marked by the death 3 patients. Conclusion: The incidence of severe thrombotic microangiopathies is rare in Tunisian ICU. The clinical manifestations are not specific. Despite the improvement in the outcome by exogenous plasma supply, thrombotic microangiopathies with severe organ dysfunctions leading to hospitalization in the intensive care unit are associated with a high mortality rate. [Copyright &y& Elsevier]

Abstract: Justification: Candiduria is increasingly frequent among patients admitted to intensive care units but its significance remains unclear. Objectives: Search for eventual correlation between quantitative candiduria and known risk factors for invasive candidiasis. Study design: Prospective. Patients and methods: A four-month study was conducted in 162 patients hospitalized in the intensive care unit for more than 72 hours. All patients underwent a weekly research of candiduria added to sampling from different body sites to determine the Pittet Candida colonization index. Results: Candiduria has been proved in 56 cases (34%). It was superior or equal to 104 UFC/ml among 28 patients (50%). Candida tropicalis, Candida glabrata and Candida albicans has been isolated in 41, 22 and 20% respectively. All patients had at least one major and two minor risk factors for Candida infection. Six patients (10%) developed invasive candidiasis. The global mortality rate was at 52%. Pittet colonization index was significantly different between patients with candiduria and those with invasive candidiasis (p =0.01). There was a statistically significant correlation between candiduria superior or equal to 104 UFC/ml and Pittet colonization index superior or equal to 0.5 (p =0.01). Conclusion: Candiduria superior or equal to 104 UFC/ml associated with risk factors may predict invasive candidiasis in critically ill patients. [Copyright &y& Elsevier]

Abstract: Objective. – To evaluate the predictive value of pericatheter skin cultures in detecting catheter-related infections in critically-ill patients. Study design. – Prospective study. Patients and methods. – Over a 5 months period (from August 1st 2001 to December 31 2001), 500 patients were hospitalised, and 108 central venous catheters were prospectively examined. For each catheter, blood cultures, pericatheter skin cultures and semiquantitative culture of the catheter tip were performed. Results. – The median duration of catheterization was 8 days (interquartile: 8 days). Catheter was removed because of suspected infection in 54 cases (50%). Systemic catheter-related infection was found in 12 cases (11%) and the responsible organism was a gram-negative rod in 11 cases (92%). The negative predictive values of pericatheter skin cultures in the diagnosis of catheter-related infections and in case of suspected catheter-related infection were 89 and 86%, respectively. Conclusion. – These results indicate that the pericatheter skin cultures are not an effective procedure for the conservative diagnosis of catheter-related infections and that the skin-insertion wound is not the major source of catheter-contamination in our unit. [Copyright &y& Elsevier]

Résumé: Le kyste hydatique du foie (KHF) est une maladie assez répandue dans les pays nord-africains. Nous rapportons l’observation d’un patient de 39ans admis au service de réanimation médicale pour état de choc anaphylactique rattaché à un KHF fissuré de découverte fortuite. Cette fissuration a été également compliquée par la survenue d’un accident vasculaire cérébral (AVC) ischémique dont les mécanismes sont discutés. [ABSTRACT FROM AUTHOR]

The acute pancreatitis is a rare complication during the pregnancy. Causes are dominated by the gallstones and hyperlipidemia. This case report describes a 35-year-old pregnant woman who developed acute pancreatitis while suffering from a severe pre-eclampsia syndrome. Since she had no gallstones or other known aetiological factors of acute pancreatitis, the possibility of an etiologic role of pancreatic ischaemic changes associated with eclampsia is discussed. Evolution was marked with multi-organ system failure and poor outcome. Our experience and the previously reported case suggest that pre-eclampsia could be added to the list of causes of the acute pancreatitis. [Copyright &y& Elsevier]