RESUMEN
The dynamics of active matter driven by interacting molecular motors has a nonpotential structure at the local scale. However, we show that there exists a quasipotential effectively describing the collective self-organization of the motors propelling a cell at a continuum active gel level. Such a model allows us to understand cell motility as an active phase transition problem between the static and motile steady-state configurations that minimize the quasipotential. In particular, both configurations can coexist in a metastable fashion and a small stochastic disorder in the gel is sufficient to trigger an intermittent cell dynamics where either static or motile phases are more probable, depending on which state is the global minimum of the quasipotential.
RESUMEN
HELLP syndrome is an acronym for Hemolysis, Elevated Liver enzymes and Low Platelets. It is generally considered in the literature as a particular clinical form of pre-eclampsia, a severe complication of the second half of pregnancy. However, this syndrome can occur in isolation in the absence of pre-eclampsia symptoms. Its pathophysiology remains still unclear. The clinical picture is often incomplete and fruste at first. To date, its diagnosis and management is still the subject of much controversy. Associated or not with a vascular and renal manifestations, the HELLP syndrome is a high-risk maternal disorder. The objective of this article is to review the pathophysiological and clinical data and current treatment.
Asunto(s)
Síndrome HELLP , Plaquetas , Femenino , Síndrome HELLP/sangre , Síndrome HELLP/diagnóstico , Síndrome HELLP/terapia , Hemólisis , Humanos , Hígado/enzimología , Preeclampsia/clasificación , Preeclampsia/diagnóstico , Preeclampsia/terapia , Embarazo , Atención Prenatal/métodos , Atención Prenatal/tendencias , Diagnóstico Prenatal/métodos , Diagnóstico Prenatal/tendencias , Terminología como AsuntoRESUMEN
Head injuries are described in the literature as a rare but possible etiology of cerebral venous thrombosis although no pathophysiological link has been identified. Trauma-related venous thrombi occurring in the brain produce a broad spectrum of clinical presentations. A purely psychiatric term is exceptional, leading to misinterpretation and late diagnosis. Positive diagnosis has been greatly improved by advances in magnetic resonance imaging with venous phase angiography, currently the gold standard exploration. We report the case of a patient who presented with post-trauma cerebral venous thrombosis revealed by psychiatric disorders.
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Trombosis Intracraneal/complicaciones , Trombosis Intracraneal/diagnóstico , Trastornos Mentales/etiología , Tromboflebitis/complicaciones , Tromboflebitis/diagnóstico , Adulto , Femenino , HumanosRESUMEN
We report the case of a severe acute pulmonary edema secondary to the administration of salbutamol to a patient admitted for severe asthma. The diagnosis of acute pulmonary edema was suspected on the clinical examination, chest radiography, biological (plasmatic Pro-BNP rate) and echocardiographic findings. Rapid improvement under dobutamine and mechanical ventilation argue in favour of cardiogenic pulmonary edema. The young age of our patient, the absence of history of cardiovascular disease and the chronology of this complication onset regarded to salbutamol infusion could suggest ß2 agonist involvement in this event. The improvement of cardiac function on echocardiography and the normal results obtained with myocardial perfusion scintigraphy performed 35 days later show the left ventricular reversible dysfunction.
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Agonistas de Receptores Adrenérgicos beta 2/administración & dosificación , Agonistas de Receptores Adrenérgicos beta 2/efectos adversos , Albuterol/administración & dosificación , Albuterol/efectos adversos , Asma/tratamiento farmacológico , Edema Pulmonar/inducido químicamente , Insuficiencia Respiratoria/tratamiento farmacológico , Disfunción Ventricular Izquierda/inducido químicamente , Enfermedad Aguda , Adulto , Terapia Combinada , Dobutamina/uso terapéutico , Ecocardiografía , Femenino , Humanos , Infusiones Intravenosas , Edema Pulmonar/diagnóstico , Edema Pulmonar/terapia , Respiración Artificial , Disfunción Ventricular Izquierda/diagnóstico , Disfunción Ventricular Izquierda/terapiaRESUMEN
Hydatid cyst of the liver (HCL) is a widespread disease in North African countries. We report the case of a 39-year-old patient who was admitted in our intensive care unit because of anaphylactic shock due to a cracked HCL fortuitously discovered. This accident was also complicated by an ischemic stroke witch underline mechanisms are discussed.
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Isquemia Encefálica/etiología , Equinococosis Hepática/complicaciones , Accidente Cerebrovascular/etiología , Anciano , Anafilaxia/etiología , Anafilaxia/terapia , Equinococosis Hepática/patología , Humanos , Hígado/patología , Imagen por Resonancia Magnética , Masculino , Examen NeurológicoRESUMEN
Mucormycosis is a rare and often fatal fungal infection caused by fungi of the Mucorales order. It is mostly seen in people with weakened immune systems or with uncontrolled diabetes, and can cause extensive soft tissue damage and decay. Hemophagocytic lymphohistiocytosis has been reported only rarely and never described in an intensive care or emergency department setting. The purpose of this report is to describe a fatal case of sinonasal mucormycosis complicated by hemophagocytic lymphohistiocytosis in a diabetic child.
Asunto(s)
Encefalopatías/complicaciones , Infecciones Fúngicas del Sistema Nervioso Central/complicaciones , Linfohistiocitosis Hemofagocítica/complicaciones , Mucormicosis/complicaciones , Enfermedades de los Senos Paranasales/complicaciones , Adolescente , Femenino , Humanos , TúnezRESUMEN
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.
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Traumatismos Craneocerebrales/complicaciones , Linfohistiocitosis Hemofagocítica/complicaciones , Insuficiencia Multiorgánica/etiología , Accidentes de Tránsito , Corticoesteroides/uso terapéutico , Adulto , Médula Ósea/patología , Traumatismos Craneocerebrales/cirugía , Resultado Fatal , Femenino , Ferritinas/sangre , Humanos , Recuento de Leucocitos , Linfohistiocitosis Hemofagocítica/patología , Procedimientos Neuroquirúrgicos , Pancitopenia/complicaciones , Recuento de Plaquetas , Triglicéridos/sangreRESUMEN
UNLABELLED: Invasive candidiasis has emerged as an important nosocomial infection, causing significant morbidity and mortality especially among critically ill patients. The aim of our study was to determine specie distribution and resistance profiles of Candida species isolated from blood cultures. MATERIALS AND METHODS: We conducted a retrospective study of all episodes of candidemia diagnosed in our laboratory from January 2006 to May 2009. The susceptibility to antifungal agents of all Candida isolates was tested by using a Sensititre(®) YeastOne panel. RESULTS: A total of 130 Candida isolates were recovered from blood cultures. Candida tropicalis was the most frequent specie (37.7%), followed by C. albicans (22.3%), C. glabrata (19.2%), and C. parapsilosis (12.2%). All the isolates were inhibited by ≤1 µg/ml of amphotericin B and ≤2 µg/ml of caspofungin. For fluconazole, 7.3% of clinical isolates were resistant. It was most active against C. parapsilosis (100% susceptible), C. albicans (95.8% susceptible), and C. tropicalis (94% susceptible). All of the fluconazole-susceptible isolates were susceptible to voriconazole, as were 83.3% of the fluconazole-susceptible-dose-dependent isolates. Among fluconazole-resistant isolates, 85.7% were susceptible to voriconazole. CONCLUSIONS: In our institution, C. tropicalis was the most frequent specie isolated from the bloodstream. Caspofungin had an excellent in vitro activity against Candida isolates and was the drug of choice among fluconazole-resistant isolates.
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Antifúngicos/farmacología , Candida/efectos de los fármacos , Candidemia/microbiología , Adulto , Anfotericina B/farmacología , Candidemia/sangre , Candidemia/epidemiología , Caspofungina , Farmacorresistencia Fúngica , Equinocandinas/farmacología , Femenino , Fluconazol/farmacología , Humanos , Lipopéptidos , Masculino , Pruebas de Sensibilidad Microbiana , Pirimidinas/farmacología , Estudios Retrospectivos , Triazoles/farmacología , Túnez/epidemiología , VoriconazolRESUMEN
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.
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Insuficiencia Cardíaca/inducido químicamente , Insuficiencia Cardíaca/fisiopatología , Sulfuro de Hidrógeno/envenenamiento , Enfermedades del Sistema Nervioso/inducido químicamente , Enfermedades del Sistema Nervioso/fisiopatología , Accidentes por Caídas , Adulto , Coma/inducido químicamente , Coma/fisiopatología , Angiografía Coronaria , Humanos , Masculino , Edema Pulmonar/inducido químicamente , Edema Pulmonar/fisiopatología , Insuficiencia Respiratoria/inducido químicamente , Insuficiencia Respiratoria/fisiopatología , Función Ventricular Izquierda/fisiologíaRESUMEN
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.
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Cardiomiopatías/epidemiología , Cardiomiopatías/terapia , Parto Obstétrico , Complicaciones Cardiovasculares del Embarazo/epidemiología , Complicaciones Cardiovasculares del Embarazo/terapia , Adulto , Factores de Edad , Cardiomiopatías/tratamiento farmacológico , Cardiomiopatía Dilatada/complicaciones , Cardiomiopatía Dilatada/epidemiología , Cardiomiopatía Dilatada/terapia , Cuidados Críticos , Etnicidad , Femenino , Humanos , Recién Nacido , Embarazo , Complicaciones Cardiovasculares del Embarazo/diagnóstico , Pronóstico , Recurrencia , Resultado del Tratamiento , Túnez/epidemiología , Adulto JovenRESUMEN
Candida dubliniensis, a newly described fungal pathogen associated mainly to immunocompromised host's infection, is phenotypically closely related to C. albicans. In this study, we report for the first time, isolation and identification, in Tunisia, of 14 isolates of C. dubliniensis from 12 human immunodeficiency virus-negative patients hospitalised in the intensive care unit (ICU) at Habib Bourguiba Sfax Hospital. Our study was firstly based on the failure to grow at 45 degrees C. This presumptive identification was completed by other tests: chlamydospore production, culture on Candiselect4 (Bio-Rad) and the commercial test Bichro-Dubli fumouze, which specifically identify C. dubliniensis. The confirmation of the discrimination between both species was performed by PCR, targeting the hyphal wall protein (HWP1) gene. The recovery of C. dublinensis by routine laboratory diagnosis is recommended for elucidating the epidemiology of this novel pathogen.
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Candida/clasificación , Candida/aislamiento & purificación , Candidiasis/microbiología , Seronegatividad para VIH , Adolescente , Adulto , Anciano , Candida/genética , Candida albicans/clasificación , Candida albicans/genética , Candida albicans/aislamiento & purificación , Candidiasis/epidemiología , Medios de Cultivo , ADN de Hongos/análisis , Proteínas Fúngicas/genética , Genotipo , Hospitales , Humanos , Unidades de Cuidados Intensivos , Glicoproteínas de Membrana/genética , Persona de Mediana Edad , Técnicas de Tipificación Micológica , Fenotipo , Reacción en Cadena de la Polimerasa/métodos , Túnez/epidemiologíaAsunto(s)
Seudomixoma Peritoneal , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Seudomixoma Peritoneal/diagnósticoRESUMEN
OBJECTIVE: Our study aimed to determine the efficacy and safety of colistin in the treatment of ventilator-associated pneumonia (VAP) caused by pan-drug-resistant Pseudomonas aeruginosa or Acinetobacter baumanii. DESIGN: Pairwise, retrospective exposed-unexposed study. SETTING: Combined medical and surgical intensive care unit of Habib Bourguiba University Hospital (Sfax, Tunisia). PATIENTS: Sixty patients with VAP caused by pan-drug-resistant A. baumanii or P. aeruginosa matched to 60 controls with VAP caused by A. baumanii or P. aeruginosa susceptible to imipenem. All patients had normal renal function at the onset of antibiotic therapy. INTERVENTIONS: Case patients were treated by colistin intravenously and control patients were treated by imipenem intravenously. MEASUREMENTS AND RESULTS: Baseline characteristics were similar between the colistin and imipenem groups. The mean duration of antibiotic therapy for VAP was 9.5+/-3.8 days (range 5-22 days) with colistin and 8.9+/-2.8 days (range 5-20 days) with imipenem (p=0.32). A favorable clinical response to antibiotic therapy for VAP occurred in 45 patients (75%) in the colistin group and in 43 patients (71.7%) in the imipenem group (p=0.68). The time to resolution of infectious parameters after the initiation of antibiotic therapy was not statistically different between the two groups. During the antibiotic course, none of the patients in either group developed renal failure. CONCLUSIONS: We conclude that colistin can be a safe and effective option in the treatments of VAP caused by pan-drug-resistant P. aeruginosa or A. baumanii.
Asunto(s)
Antibacterianos/uso terapéutico , Colistina/uso terapéutico , Imipenem/uso terapéutico , Neumonía Bacteriana/tratamiento farmacológico , Neumonía Asociada al Ventilador/tratamiento farmacológico , Infecciones por Acinetobacter/tratamiento farmacológico , Acinetobacter baumannii , Adulto , Antibacterianos/administración & dosificación , Estudios de Casos y Controles , Colistina/administración & dosificación , Farmacorresistencia Bacteriana Múltiple , Femenino , Humanos , Imipenem/administración & dosificación , Inyecciones Intravenosas , Unidades de Cuidados Intensivos , Masculino , Neumonía Bacteriana/etiología , Infecciones por Pseudomonas/tratamiento farmacológico , Estudios Retrospectivos , Factores de TiempoRESUMEN
INTRODUCTION: The objective of this work was to review current data about the pathophysiology, clinical features, and treatment of thrombotic microangiopathies. CURRENT KNOWLEDGE: Thrombotic microangiopathies are microvascular occlusive disorders characterized by systemic or intrarenal aggregation of platelets, thrombocytopenia, and mechanical injury to erythrocytes. In thrombotic thrombocytopenic purpura, systemic microvascular aggregation of platelets causes ischemia in the brain and other organs. In the hemolytic-uremic syndrome, platelet-fibrin thrombi occlude predominantly the renal circulation. Thrombotic microangiopathy is a rare disorder whose varied clinical manifestations result from the formation of platelet-rich thrombi within the microvasculature and consequent tissue ischemia. The clinical features are acute renal failure, microangiopathic hemolytic anemia and thrombocytopenia. This diagnosis is of considerable importance because of the possible fulminant clinical course. Some atypical forms may be unrecognized. Plasma exchange is the current reference treatment of thrombotic thrombocytopenic purpura. However, in the light of recent publications, either infusions of concentrates of purified enzyme or more intensive immunosuppressive therapy would be more specific.
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Microcirculación/fisiología , Trombosis/epidemiología , Fibrinolíticos/uso terapéutico , Heparina/uso terapéutico , Humanos , Incidencia , Pronóstico , Trombosis/diagnóstico , Trombosis/fisiopatología , Trombosis/terapiaRESUMEN
AIM: Our aim was to study the susceptibility of Streptococcus pneumoniae to antibiotics in patients with pneumococcal meningitis and to search for the prognosis factors in those patients. METHODS: We have studied retrospectively 31 cases of pneumococcal meningitis. Comparaisons were performed with univariate analysis. RESULTS: The mean age was 36.7 +/- 20.5 years (ranged: 9 and 78 years). The sex ratio was 3,4. The susceptibility of Streptococcus pneumoniae to penicillin G was affected in 10 cases (33% of isolated pneumococcus. The MIC to penicillin G was > or =2 in only one case. The hospital mortality was 26% (8/31). With univariate analysis, factors associated with death were: age > or =55 years (Ss p= 0,006, OR: 17.2 IC95%: 2.3-134), albuminorachie > or = 7 g/l (p = 0.002, OR: 22; IC95%: 1.9-2.51), shock (p = 0.031, OR: 6.7; IC95%: 1.05-42) and Glasgow Coma Score (GCS) < or =8 (p = 0.001, OR: 20; IC95%: 2.68-149). CONCLUSION: No susceptibility to penicillin G is not associated with a worse outcome in patients with pneumococcal meningitis. An age > or =55 years, albuminorachie > or =7 g/l shock and Glasgow Coma Score < or =8 at admission were determinant of the prognosis in our study.
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Meningitis Neumocócica/tratamiento farmacológico , Adolescente , Adulto , Anciano , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Streptococcus pneumoniae/efectos de los fármacosRESUMEN
BACKGROUND AND PURPOSE: The aim of our study was to search for the incidence, the responsible organisms and the favoring causes of death of post-traumatic meningitis (PTM). METHODS: This retrospective study was conducted over a seven-year period (January 1st, 1996 - December 31, 2002) in the ICU and the neurosurgery department of the Habib-Bourguiba University Hospital, Sfax, Tunisia. RESULTS: Over the study period, 38 patients presented PTM (0.96% of patients hospitalized for head injury), 92% of them had received antibiotic prophylaxis on admission. Mean time between head injury and the diagnosis of PTM was 9+/- 8 days (range: 2-34 days). The most common isolated organisms were multidrug resistant A. baumanii, and K. pneumoniae and reduced susceptibility S. pneumoniae. Factors predictive of prognosis in the 14 days following the diagnosis of meningitis were Glasgow coma score (GCS) on the day of diagnosis of PTM, absence of nuchal rigidity, CSF protein, CSF/blood glucose ratio, and S. pneumoniae as the causal agent of PTM. CONCLUSIONS: Antibioprophylaxis in patients with head trauma must be avoided to prevent the emergence of multidrug resistant bacteria when PTM occurs. GCS on the day of diagnosis of PTM, CSF protein concentration, CSF/blood glucose ratio, and S. pneumoniae as the causal agent of PTM are predictive factors of mortality of patients with PTM.
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Traumatismos Craneocerebrales/complicaciones , Traumatismos Craneocerebrales/mortalidad , Meningitis Bacterianas/etiología , Meningitis Bacterianas/mortalidad , Adolescente , Adulto , Anciano , Antibacterianos/uso terapéutico , Glucemia/metabolismo , Causas de Muerte , Proteínas del Líquido Cefalorraquídeo/sangre , Niño , Preescolar , Farmacorresistencia Bacteriana , Femenino , Escala de Coma de Glasgow , Humanos , Lactante , Masculino , Meningitis Bacterianas/microbiología , Meningitis Neumocócica/mortalidad , Persona de Mediana Edad , Rigidez Muscular/epidemiología , Valor Predictivo de las Pruebas , Pronóstico , Curva ROC , Estudios Retrospectivos , Análisis de Supervivencia , Terminología como Asunto , Resultado del Tratamiento , Túnez/epidemiologíaRESUMEN
PURPOSE: Uterine sarcomas are rare tumours characterized by clinical and histopathological diversity and poor prognosis. We analyzed diagnostic, prognostic and therapeutic difficulties encountered with these tumors by insisting on the importance of early diagnosis. PATIENTS AND METHODS: From 1997 to 2004 ten patients with uterine sarcoma who underwent surgery in the obstetrics and gynecology unit at the Tunis maternity center were included in this retrospective study. The tumors were classified at the time of diagnosis using the FIGO staging system. The histological diagnosis was based on the WHO classification. RESULTS: There were 5 cases of leiomyosarcoma, 2 cases of carcinosarcoma, 2 cases of endometrial stromal sarcoma and 1 adenosarcoma. There were four cases of stage I, two cases of stage II, two cases of stage III and two of stage IV tumors. The diagnosis of uterine sarcoma was strongly suspected and proved before the initial operation in 20% of cases and during this operation in 60% of cases. Diagnosis was only established at the histological exam in two cases. Total hysterectomy with bilateral salpingo-oophorectomy was performed in 90% of patients. Radiation therapy was performed in four. Chemotherapy was delivered in two patients. After an average of four years five patients were in remission, three had died and two were lost to follow-up. CONCLUSION: Early preoperative or intra-operative diagnosis is essential while awaiting for more effective chemotherapy protocols or therapeutic strategies.
Asunto(s)
Histerectomía , Ovariectomía , Sarcoma/cirugía , Neoplasias Uterinas/cirugía , Adolescente , Adulto , Quimioterapia Adyuvante , Femenino , Humanos , Persona de Mediana Edad , Estadificación de Neoplasias , Pronóstico , Radioterapia Adyuvante , Estudios Retrospectivos , Sarcoma/diagnóstico , Sarcoma/patología , Sarcoma/terapia , Tasa de Supervivencia , Factores de Tiempo , Resultado del Tratamiento , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/patología , Neoplasias Uterinas/terapiaRESUMEN
OBJECTIVE: To report the clinical experience, biochemical findings, complications and maternal outcome in patients with acute fatty liver of pregnancy (AFLP). PATIENTS AND METHODS: Retrospective study over a period of 11 years (1993-2003). The diagnosis of AFLP was confirmed by liver biopsy in 15 women. However, in 7 women a medical committee that took into account clinical symptoms, and laboratory findings assessed the diagnosis. RESULTS: Were included in this study, 22 women with a mean age of 30+/-5.4 years. Only 22.7% of cases were primigravid. The mean gestational age was 36+/-2.76 weeks (range 31-41 weeks). The fetus was a male infant in 75% of cases. Ten women were admitted in the hospital without jaundice. However 15 women had developed an icterus since their hospital admission or during ICU stay. The mean SAPS II on the ICU admission was of 24.86+/-11.2 points. Biological disturbances observed were mainly: liver cytolysis in 91% of cases, a trend to hypoglycaemia in 86%, a hypoprotidemia in 66.7% and CIVD in 32%. During their ICU stay, 19 women (86.4%) developed one or several organ failures associated to the hepatic failure and 18 women required blood transfusion. After an average stay of 7.5 days, evolution was marked by the death of seven patients (31.8%). Factors correlated with a poor prognosis were: the delay of medical consultation, the development of jaundice, the development of encephalopathy, respiratory or a circulatory failure. DISCUSSION AND CONCLUSION: AFLP is a rare but life-threatening complication. Furthermore AFLP shares features with other more common and less perilous illnesses. An early diagnosis and appropriate therapy of this pathology should improve the poor prognosis in our country.
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Hígado Graso/diagnóstico , Complicaciones del Embarazo/diagnóstico , Enfermedad Aguda , Adulto , Transfusión Sanguínea , Cuidados Críticos , Hígado Graso/mortalidad , Hígado Graso/terapia , Femenino , Edad Gestacional , Humanos , Fallo Hepático/complicaciones , Masculino , Insuficiencia Multiorgánica/epidemiología , Insuficiencia Multiorgánica/etiología , Embarazo , Complicaciones del Embarazo/mortalidad , Complicaciones del Embarazo/terapia , Resultado del Embarazo , Pronóstico , Estudios RetrospectivosRESUMEN
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.