Search

Background We report the results of INICC surveillance study from 2013 to 2018, in 664 intensive care units (ICUs) in 133 cities, of 45 countries, from Latin-America, Europe, Africa, Eastern-Mediterranean, Southeast-Asia, and Western-Pacific. Methods Prospective data from patients hospitalized in ICUs were collected through INICC Surveillance Online System. CDC-NHSN definitions for device-associated healthcare-associated infection (DA-HAI) were applied. Results We collected data from 428,847 patients, for an aggregate of 2,815,402 bed-days, 1,468,216 central line (CL)-days, 1,053,330 mechanical ventilator (MV)-days, 1,740,776 urinary catheter (UC)-days. We found 7,785 CL-associated bloodstream infections (CLAB), 12,085 ventilator-associated events (VAE), and 5,509 UC-associated urinary tract infections (CAUTI). Pooled DA-HAI rates were 5.91% and 9.01 DA-HAIs/1,000 bed-days. Pooled CLAB rate was 5.30/1,000 CL-days; VAE rate was 11.47/1,000 MV-days, and CAUTI rate was 3.16/1,000 UC-days. P aeruginosa was non-susceptible (NS) to imipenem in 52.72% of cases; to colistin in 10.38%; to ceftazidime in 50%; to ciprofloxacin in 40.28%; and to amikacin in 34.05%. Klebsiella spp was NS to imipenem in 49.16%; to ceftazidime in 78.01%; to ciprofloxacin in 66.26%; and to amikacin in 42.45%. coagulase-negative Staphylococci and S aureus were NS to oxacillin in 91.44% and 56.03%, respectively. Enterococcus spp was NS to vancomycin in 42.31% of the cases. Conclusions DA-HAI rates and bacterial resistance are high and continuous efforts are needed to reduce them.

The emergence of new promising technologies used in electric transportation offers opportunities to achieve sustainable urban freight deliveries. In particular fleets of electric vehicles are seen as an efficient ecologic and economic transportation alternative for operating last-mile goods distribution in cities. This paper deals with the use of electric modules which can be added or removed from a freight vehicle to help gain capacity or respect delays when delivering customers. Since the electric vehicles have a limited battery capacity, they have to stop and recharge them at dedicated stations during the delivery tours. However, with the modular feature, this problem of disturbing the whole distribution process for recharging the batteries can be reduced and sometimes overlooked. This paper objective is to design and find the optimal routing strategy for a fleet of electric modular vehicles operating the last-mile delivery, with the minimal cost including the acquisition, the travel and the recharging ones. The research problem arising from the structure of the fleet can be associated with both a truck and trailer problem and a fleet size and mix vehicle routing problem with time windows using electric vehicles. This problem is presented in the first part of the article with the proposed solving procedure. More precisely, for big instances of the problem which is NP-Hard, a Variable Neighborhood Search (VNS) is designed and adapted. Experimental studies carried out on some benchmark instances show that the VNS performs impressively well in comparison with the best solving approaches of the literature.

The minimum sum coloring of graphs is a variant of the classical graph coloring problem which is known to be NP-hard. The problem consists on minimizing the sum colorings of different graph vertices. In this paper, we propose a new bi-objective model for the underlying problem. We also propose for the resolution a hybrid schema which combines a bi-objective genetic algorithm with an Iterated Variable Neighborhood Search. The proposed approach relies on the use of different dedicated evolutionary operators mainly crossover and mutation. We also note two important features of the Variable Neighborhood Search: the use of destroy/repair method for shaking step and a multi-neighborhood search. Combined methods led us to preliminary promising results.

In most hazardous materials (Hazmat for short) transportation systems, the purpose is to reduce the risk-cost from origins to destinations. This makes the hazmat system more complicated when compared to many other transportation systems. There are different models for considering risk in a hazmat transportation, the most broadly used is the so-called “traditional risk model”, through which the risk is defined as the product of two parameters: (a) the probability of an accident; and (b) the consequences of the accident. The consequences depend on other factors such the threat zone, which indicates the geographical area in which an atmospheric release of a substance would affect a given area during a specified time period. Moreover, the dispersion of pollutants within the accident area is a function of weather parameters such as wind direction, wind speed, atmospheric stability, which changes instantly in the real world. Thus, the weather system changes the risk parameters by changing the area impacted by a hazmat accident. Hence, it is difficult to identify and to tell the dispersion of a substance. The aim of this work is to develop the microservice that focuses on the computation of dispersion model and to identify the coverage of the affected area through the simulation software Areal location of Hazardous Atmosphere (ALOHA). The proposed microservice uses emission source, accident location and real-time meteorological data near to the sources, to provide necessary and accurate results rapidly. It can be used to more accurately simulate the atmospheric evolution of the released material in both time and space, for decision making and real-time response to save lives and to evacuate peoples to safety during a disaster release.

Introduction Sickle cell disease is the most frequent genetic hemoglobinopathy worldwide and early childhood mortality has dramatically decreased in high-income countries. However, in the aging sickle cell disease population, the morbidity related to chronic organ damage, especially kidney and heart, has become a major concern. The disease is well characterized in homozygous SS patients, but the complications associated with Haemoglobin SC disease (HbSC) are mostly unknown. Dyspnea is frequent in SS patients and associated with poor quality of life, this symptom was not investigated in HbSC patients. Our objective is to investigate the prevalence and the factors associated with dyspnea in HbSC patients. Method A total of 221 HbSC patients (mean age 35 years, 47% men) were prospectively investigated. Clinical and biological data were collected, and 109 (49%) patients underwent an echocardiography. Results A dyspnea was observed in 28 (13%) patients. Compared to the rest of the cohort, these patients were older and had a lower hemoglobin level (P Fig. 1 ). Conclusion Dyspnea is relatively uncommon in adult HbSC patients and related to age and hemoglobin level. Cardiac involvement seems not to be a major factor associated to dyspnea in HbSC patients.

Biclustering is an unsupervised classification technique that plays an increasingly important role in the study of modern biology. This data mining technique has provided answers to several challenges raised by the analysis of biological data and more particularly the analysis of gene expression data. It aims to cluster simultaneously genes and conditions. These unsupervised techniques are based essentially on the assumption that the extraction of the co-expressed genes allows to have co-regulated genes. In addition, the integration of biological information in the search process may induce to the extraction of relevant and non-trivial biclusters. Therefore, this work proposes an evolutionary algorithm based on local search method that relies on biological knowledge. An experimental study is achieved on real microarray datasets to evaluate the performance of the proposed algorithm. The assessment and the comparison are based on statistical and biological criteria. A cross-validation experiment is also used to estimate its accuracy. Promising results are obtained. They demonstrate the importance of the integration of the biological knowledge in the biclustering process to foster the efficiency and to promote the discovery of non-trivial and biologically relevant biclusters.

Introduction Surgical treatment is required in approximately half of the patients with infective endocarditis (IE) because of severe complications. To date there is no recommendation favoring a specific valve substitute for IE treatment and accordingly there is a wide variation in routine surgical management of these patients. The purpose of this study is to describe surgical practices in our center and to investigate the impact on clinical outcomes. Method All patients with native valve left-sided IE, who underwent valve replacement surgery with a mechanical or biological prosthesis in our institution between 1 January 2006 and 31 December 2018 were enrolled in this retrospective study. Results A total of 303 patients were included (mean age = 58 years, 80% men). Patients in whom a biological valve was chosen (64%, n = 194) were older and had more comorbid conditions compared to patients who received a mechanical valve (36%, n = 109). In hospital mortality was respectively 19% (n = 36) in the bioprosthesis group avec 3% (n = 3) in the mechanical valve group (P Conclusion For surgical management of IE, a biological valve is the most used valve substitute in our institution. Mechanical valves seem to be implanted in a very selected and low-risk patient subgroup. The valve substitute does not appear to be related to in hospital nor to midterm mortality rates.

The dangerous goods are important to businesses and the life of a city. Thousands of tons of oil, toxic, chemical, corrosive, flammable and radioactive materials are transported each day. However, an accident involving hazardous materials could entail serious consequences for road users, infrastructure, and the environment. In order to build a planning aid system to reduce the risks of transporting hazardous, we adopt a microservices-based architecture on a cloud environment. This type of architecture consists of a set of loosely coupled and independently deployable services for more scalable applications. Due to distributed nature of microservices, the system will be developed as a suite of small services aligned with risk management process; each service will be running in its own logical machine or container technology such as Docker.

The transportation of dangerous goods represents one of the most critical risks particularly in urban areas. For example, every day large quantities of hazardous substances are transported by roads or railways inside areas with high density of population. Thus, to ensure urban and public safety the first challenge that we tackle is to find an environmental information system, which is able to provide risk management and monitoring. Moreover, it can capture urban transportation dynamics and offer specific services, visualization, analyses and evaluation of the hazmat risk in various high-risk zones. In addition, due to wireless technologies and real time intelligent sensors, the risk of dangerous goods can be carried out in real time. In this work, we adopt a microservices based architecture to have a real-time environmental sensors system that have highly scalable applications on cloud environment. By definition, this architecture consists of a set of loosely coupled and independently deployable services. In addition, the proposed system is conducted with a smart data collector, visualization abilities and a variety of distributed sensors in order to enhance the hazmat transportation network monitoring. Finally, we show how to integrate efficiently into the system prototype the hazmat routing container embedded microservice, and illustrate the orchestration with other microservices to improve this system with hazmat routing capabilities using various routing algorithms particularly bi-directional A* algorithm. This work constitutes the first step to build the Hazmat planning aid system that provides valuable data and knowledge to urban planner and decision makers

Hasan, M. Shahnaz/0000-0002-7493-7416; Abouqal, Redouane/0000-0002-6117-4341; Altindis, Mustafa/0000-0003-0411-9669; Masjedi, Mansoor/0000-0001-6175-9289; Popescu, Roxana/0000-0002-9387-1141; Mikaszewska-Sokolewicz, Malgorzata A/0000-0002-1148-7817; Meco, Basak Ceyda/0000-0003-2951-9634; Kumar, Perikala Vijayananda/0000-0001-8315-7000; Zand, Farid/0000-0003-3489-3372; Maghsoudi, Behzad/0000-0002-1279-8799; KAMARUL ZAMAN, MAZUIN/0000-0002-7920-6399; Gan, Chin Seng/0000-0002-6758-4798; Horoz, Ozden Ozgur/0000-0001-7590-650X; Medeiros, Eduardo A/0000-0002-6205-259X; Sabetian, Golnar/0000-0001-8764-2150; UNAL, SERHAT/0000-0003-1184-4711; Gan, Chin Seng/0000-0002-6758-4798; Delia, Muntean/0000-0001-9100-4530; Yalcin, Ata Nevzat/0000-0002-7243-7354; Leblebicioglu, Hakan/0000-0002-6033-8543; Horhat, Florin George/0000-0001-6133-0204; Yousef, Reham H. A./0000-0003-4004-3008; Delgado Aguirre, Hector Alberto/0000-0001-5448-7975; El Kholy, Amani/0000-0002-0645-7664; Rodriguez Ferrer, Marena Luz/0000-0002-8053-8454; Sanaei Dashti, Anahita/0000-0002-2827-3575; KARABAY, OGUZ/0000-0003-1514-1685; Barahona G., Nayide/0000-0003-3559-6900; Stagnaro, Juan Pablo/0000-0003-3836-9957; Alexandru Florin, Rogobete/0000-0003-1286-4431; KAYA, ZEYNEP/0000-0002-8468-2103; Dragan, Barbara/0000-0003-3108-4211; alvarez Moreno, carlos Arturo/0000-0001-5419-4494; Gonzalez Martinez, Marisela del Rocio/0000-0003-1474-736X; Jayatilleke, Kushlani/0000-0002-3931-6630; Unal, Necmettin/0000-0002-9440-7893; Duszynska, Wieslawa/0000-0002-5880-4904; Ngo, Quy Chau/0000-0002-6787-2757; Elmanakhly, Arwa/0000-0001-8557-0536; yildizdas, dincer/0000-0003-0739-5108; Kanj, Souha/0000-0001-6413-3396; Gupta, Umesh/0000-0001-7717-1404 WOS: 000392626300014 PubMed: 27742143 Background: We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2010-December 2015 in 703 intensive care units (ICUs) in Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific. Methods: During the 6-year study period, using Centers for Disease Control and Prevention National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DAHAI), we collected prospective data from861,284 patients hospitalized in INICC hospital ICUs for an aggregate of 3,506,562 days. Results: Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the INICC medical-surgical ICUs, the pooled rate of central lineassociated bloodstream infection, 4.1 per 1,000 central line-days, was nearly 5-fold higher than the 0.8 per 1,000 central line-days reported from comparable US ICUs, the overall rate of ventilator-associated pneumonia was also higher, 13.1 versus 0.9 per 1,000 ventilator-days, as was the rate of catheterassociated urinary tract infection, 5.07 versus 1.7 per 1,000 catheter-days. From blood cultures samples, frequencies of resistance of Pseudomonas isolates to amikacin (29.87% vs 10%) and to imipenem (44.3% vs 26.1%), and of Klebsiella pneumoniae isolates to ceftazidime (73.2% vs 28.8%) and to imipenem (43.27% vs 12.8%) were also higher in the INICC ICUs compared with CDC-NHSN ICUs. Conclusions: Although DA-HAIs in INICC ICU patients continue to be higher than the rates reported in CDC-NSHN ICUs representing the developed world, we have observed a significant trend toward the reduction of DA-HAI rates in INICC ICUs as shown in each international report. It is INICC's main goal to continue facilitating education, training, and basic and cost-effective tools and resources, such as standardized forms and an online platform, to tackle this problem effectively and systematically. (C) 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. VDR; Foundation to Fight against Nosocomial Infections The funding for design, development, maintenance, technical support, data validation, and report generation of the Surveillance Online System, and the activities carried out at International Nosocomial Infection Control Consortium headquarters, were provided by VDR and the Foundation to Fight against Nosocomial Infections.

Background Percutaneous left atrial appendage (LAA) closure is increasingly used to prevent strokes in patients with atrial fibrillation (AF). The alteration of left atrial (LA) compliance by LAA occlusion may represent a clinical issue in AF patients, which are also at high risk of heart failure (HF). Aims To describe the impact of LAA occlusion on LA hemodynamics. Materiel and methods This study included patients who underwent LAA occlusion procedure in whom LA pressure curves were recorded, before and immediately after device implantation. Mean LA pressure was defined as abnormal when > 15 mmHg. We recorded all cause death and hospitalizations for congestive HF at longest follow-up. Results We enrolled 86 patients (78 ± 8 years, 46 men). The mean LA pressure increased significatively after LAA closure from 12.6 ± 3.9 mmHg to 15.6 ± 5.2 mmHg (P Fig. 1 ). The prevalence of abnormal mean LA pressure was 20% at baseline and 45% after LAA closure (P = 0.006). Post procedural LA pressure elevation was not related to procedure duration nor to fluid expansion volume. After an average follow-up of 363 [120–731] days, 9 (10%) patients died and 6 (7%) were hospitalized for HF. There were more events (N = 11 of 39, 28%) in patients with abnormal post procedural LA pressure as compared to the rest of the population (N = 4 of 47, 9%; P = 0.02). All HF hospitalizations occurred in patients with abnormal post procedural LA pressure (P = 0.0007). Conclusion Catheter-based LAA occlusion induces an acute alteration of LA hemodynamics that seems to be linked to HF episodes. Further studies are warranted to investigate HF as a potential late complication of LAA closure.

This study identifies and proposes simple methods to assess solar radiation, daylighting availability and Sky-View Factor (SVF) modification, in complex urban environment. Numerical methods and 3D simulation software are combined with photo processing methods using digital cameras with special mirrors to project the hemispherical environment onto a circular image. This methodology has been applied to a real case study in Switzerland that is undergoing a very fast urban densification process, where urban planning strategies will determine significantly the possibility to relish solar irradiation in buildings. This paper analyzed the particularities of different urban scenarios considering the effects of urban densification planning strategies on existing buildings, in particular historical protected buildings.

BIPV technologies applied to façades are strongly affected by complex and dynamic shadings especially when located in dense urban environments. In this case, the shading effects need to be evaluated in detail in order to properly estimate the energy yield and optimise the energy harvest of such PV systems.The S.M.O (String Matching Optimisation) solution represents a new approach, entirely based on open-source software, which allows a very accurate study of the shading effects on façades and the investigation of electrical behaviour of BIPV strings under complex irradiation patterns. This solution has been validated with a real pilot BIPV façade located in southern Switzerland and the model was simulated on other theoretical PV façades with different levels of complexity. The presented method allows an accurate evaluation and optimisation of the energy yield of BIPV facades in complex urban environments.

Background The optimal management of left ventricular thrombus (LVT) is unknown, particularly with the emergence of the non-vitamin K antagonist anticoagulants (NOACs). Purpose To identify the independent correlates of LVT regression and clinical outcomes. Methods A computerized case sensitive search on 90 065 consecutive echocardiograms performed between January 2011 and December 2017 identified patients with a LVT. Repeated echocardiographic data, treatment and major adverse cardiac events (MACE), including death, stroke, myocardial infarction or acute peripheral artery emboli were analyzed as well as major bleeding events (BARC ≥ 3) and all-cause mortality. Results We included 159 patients with an LVT confirmed by two independent experts. Patients were treated by vitamin K antagonists (48.4%), parenteral heparins (27.7%) and NOACs (22.6%) with additional antiplatelet therapy in 67.9% of the population. Total LVT regression was reached in 62.3% of the patients in a median time of 103 [32–392] days. The independent correlates associated with LVT regression were a non-ischemic cardiomyopathy (HR 0.36; 95%CI [0.19–0.69], P = 0.002) and a smaller baseline thrombus area (HR 0.66; 95%CI [0.45–0.96], P = 0.031). Cardiovascular events were frequent with 37.1% of MACE, 18.9% of major bleeding and 13.2% of all-cause mortality during a median follow-up of 632 [187–1126] days. A left ventricular ejection fraction >35% (HR 0.46; 95%CI [0.23–0.93], P = 0.029) and an anticoagulation therapy > 3 months (HR 0.42; 95%CI [0.20–0.88], P = 0.021) were independently associated with less MACE. A reduced risk of mortality was observed among patients that obtained a total LVT regression (HR 0.48; 95%CI [0.23–0.98]; P = 0.039) ( Fig. 1 ). Conclusions The presence of LVT was associated with a very high risk of MACE and mortality. Total thrombus regression, obtained with either vitamin K antagonists or NOACs, led to a better prognosis.

Introduction Left ventricular outflow track obstruction (LVOTO) is a key feature of hypertrophic cardiomyopathy (HCM). Exercise echocardiography is necessary to unmask latent obstruction in patients with HCM. However, little is known about the role and impact of obstruction according to the precise time of occurrence during exercise or immediate recovery. We hypothesized that LVOT pressure gradients could be enhanced during immediate recovery after exercise compared to peak exercise in patients with HCM. Method We conducted an observational, single center and retrospective study and included all the patients with HCM referred to our department between 2010 and 2018 for an exercise echocardiography. All exercises were performed on a bicycle in a semi-supine position and LVOT pressure gradient were recorded continuously during and immediately after exercise in the same position. Results In total, 121 patients with HCM were included (age 49 ± 16 y, 64% male, 59% NYHA 2 and 3, LV ejection fraction 66 ± 7%, max LV wall thickness 19 ± 5 mm, 69% receiving betablockers). Overall, the maximal LVOT gradients increased from rest, to peak exercise and recovery (respectively 17 ± 18, 39 ± 43 and 55 ± 60 mmHg, P Conclusion The time course of significant LVOTO during exercise in HCM should be evaluated carefully. LVOTO is more severe and more prevalent during immediate recovery. Some patients exhibit only significant post-exercise LVOT pressure gradients, which therefore cannot explain limitation during exercise.

The present study describes an innovative methodology to rank suitable sites for irrigation with TWW using fuzzy-AHP based on GIS where the Nabeul-Hammamet aquifer catchment (Tunisia) is selected as the target area. The model is relatively simple and is extendable worldwide. Several influential parameters are identified considering simultaneously technical, social, economical and environmental aspects. They are grouped in five main criteria, namely land suitability for irrigation, resources conflicts, cost effectiveness, social acceptance and environmental impact. Each criterion is subdivided into several sub-criteria. A pair-wise matrix is used to compare these criteria and sub-criteria and to rank them according to their relative importance for site evaluation. Using GIS, geographical layers are obtained for the sub-criteria, leading to mapping and ranking the suitable sites for TWW irrigation. The results show that the total suitable area covers 11,426 ha which represents 31% of the total Nabeul-Hammamet aquifer watershed. This constitutes quite a large zone that can absorb the entire volume of available treated wastewater, thereby increasing the region's agricultural production. The best sites to receive the surplus amount of TWW, produced by the treatment plants of the region, are located near these plants and inside agricultural lands. In addition, all these sites are located around the districts already irrigated by TWW, which underlines the role these districts may play in encouraging neighbouring farmers to change their attitude towards TWW and to accept it as an alternative resource for irrigation.

The sum coloring problem has many applications in scheduling. It is a variant of the vertex coloring problem where the objective is to minimize the sum of colors used in coloring the vertices. In this paper, we use tabu search to solve the sum coloring problem. Experiments are performed on instances extracted from the second DIMACS challenge. Results show significative improvements on some chromatic sum bounds.

Resume Objectif Determiner le taux de mortalite et les facteurs qui l’influencent chez 70 enfants avec choc septique secondaire a une infection communautaire. Patients et methodes Analyse retrospective de toutes les observations des enfants admis, (janvier 1998 a aout 2005), dans un service de reanimation pediatrique, avec le diagnostic de choc septique, secondaire a une infection communautaire. Ont ete exclus de l’etude les nouveau-nes âges de moins de sept jours et les chocs secondaires a une infection nosocomiale. Resultats Soixante-dix observations ont ete colligees, dont 32 (45,7 %) sont decedes. L’âge moyen etait 3,8 ± 4,2 ans et le Prism durant les 24 premieres heures etait de 19,2 ± 8,4. Une defaillance multiviscerale etait presente au moment du diagnostic de choc chez 69 patients (98,6 %), dont 60 (85,7 %) avaient plus de deux organes defaillants. Le delai moyen de transfert en reanimation par rapport a la constatation des premiers troubles hemodynamiques etait de 9,4 ± 11,3 heures. Trois facteurs de risque independants de mortalite ont ete identifies : une defaillance de plus de deux organes a l’admission (OR = 4,4 ; IC a 95 % [2,1–9,4]), le recours a un volume de remplissage superieur a 20 ml/kg a j2 de reanimation (OR = 3,4 ; IC a 95 % [1,1–10,3]) et le recours a plus de deux substances vasoactives (OR = 3,3 ; IC a 95 % [1,2–9]).

Resume Objectif Determiner l'epidemiologie des infections bacteriennes nosocomiales dans l'unite de reanimation neonatale et pediatrique de l'hopital d'enfants de Tunis. Materiel et methodes Etude prospective d'incidence portant sur la cohorte des patients admis en 2004 et sejournant plus de 48 heures en reanimation. Les criteres d'infection utilises ont ete ceux du Centers for Disease Control. Resultats Sur un total de 340 patients, dont 249 (73 %) nouveau-nes, 22 episodes infectieux bacteriens ont ete enregistres chez 22 patients. L'incidence des infections bacteriennes nosocomiales etait de 6,5 % et la densite d'incidence de 7,8 pour 1000 jours d'hospitalisation. Deux sites infectieux ont ete identifies : les bacteriemies (68,2 %) et les pneumopathies (31,8 %). Les bacteriemies avaient une incidence de 4,4 % et une densite d'incidence de 15,3 pour 1000 jours de catheterisme veineux central. Les pneumopathies avaient une incidence de 2 % et une densite d'incidence de 4,4 pour 1000 jours de ventilation mecanique. Les bacilles a Gram negatif etaient les bacteries les plus frequemment isolees (68 %) et etaient domines par Klebsiella pneumoniae (22,7 %). Le germe predominant des bacteriemies etait K. pneumoniae (26,7 %), multiresistante dans 85 % des cas, suivi par Staphylococcus aureus (20 %). Pseudomonas aeruginosa etait le germe predominant des pneumopathies (28,6 %). Les procedures invasives et la colonisation par un bacille a Gram negatif multiresistant etaient les principaux facteurs associes a l'infection nosocomiale. Conclusions Les infections bacteriennes nosocomiales, dans notre unite, sont dominees par les bacteriemies et sont principalement dues aux bacilles a Gram negatif. Les facteurs associes a ces infections ont ete identifies.

Group milleri streptococci that colonize the mouth and the upper airways are generally considered to be commensal. In combination with anaerobics, they are rarely responsible for brain abscesses in patients with certain predisposing factors. Mortality in such cases is high and complications are frequent. We present a case of fatal subdural empyema caused by Streptococcus constellatus and Actinomyces viscosus in a previously healthy 7-year-old girl.

Intestinal involvement in toxic epidermal necrolysis (TEN) has been identified only rarely. We report a case of TEN complicated by small bowel intussusception. The patient was a previously healthy 8-year-old boy who presented with TEN and extensive lesions, including up to 40% of the body surface area as well as conjunctival, oropharyngeal, respiratory, and genital mucosa. Rapidly after the onset of a constant rate of enteral feeding, he developed bilious vomiting, diarrhea, and significant abdominal distension. Abdominal sonography showed a small bowel intussusception. At abdominal exploration, an ileoileal intussusception was observed with a viable but inflamed bowel wall. Manual reduction was performed. During the postoperative clinical course, the patient was managed with total parenteral nutrition and local care of the skin and mucous membranes. Enteral feeding was introduced on the sixth postoperative day, and the child left the hospital 15 days after his admission. The association of TEN and small bowel intussusception has not been previously reported in the literature.