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Tsoumbou-Bakana G, El Fahr K, Tamir M, Traore B, Charra B. Neutrophil-Lymphocyte Ratio as a Prognostic Factor for 15-Day Mortality of Patients infected in ICU. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
The determination of the groups at risk of death at admission in patients with bacterial infection in the ICU is important. Several prognostic factors have already been identified, however the neutrophil/lymphocyte ratio (NLR) has the advantage of being common and inexpensive.
Objective
To determine the threshold value of NLR to determine the group at risk of 15-day mortality and the overall survival of patients according to this threshold.
Methods
This was a retrospective cohort conducted in the intensive care unit of the Ibn Rochd University Hospital in Casablanca over a period of 2 years (January 2019 - January 2021), among hospitalized patients with bacterial infection, acquired or nosocomial. The sample size was calculated a priori and multivariate statistical analyses (multiple logistic regression, Youden index and Kaplan Meier survival estimation and Log Rank) were performed using Rstudio software. The significance level was less than 5%.
Results
A total of 200 patients were included in the study, 136 patients were alive at 15 days, there were no differences in age between the two groups. Factors associated with patient mortality at 15 days were: gender, use of vasoactive drugs, use of mechanical ventilation, type of sepsis, site of infection, SOFA score (p < 0.000), Apache score (p = 0.009) and NLR at admission (p = 0.001). The cut-off value for NLR was 15.07 with a mean discriminant value of 64.1%. The difference in median overall survival of patients in the two groups according to the threshold value was statistically significant 22 +/- 1.9 days and 11 +/-1.12 days (p = 0.042).
Conclusions
The NLR appears to be a prognostic factor for 15-day mortality. The knowledge of prognostic factors and threshold values of these indicators allow the prediction of at-risk groups in order to best adapt their management.
Key messages
The use of common and inexpensive biological prognostic markers are a reliable alternative to identify at-risk patients to optimize their management in developing countries. The RNL is a good biological prognostic markers of mortality of patients infected in ICU.
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Affiliation(s)
| | - K El Fahr
- Intensive Care Unit, UHC Ibn Rochd, Casablanca, Morocco
| | - M Tamir
- Intensive Care Unit, UHC Ibn Rochd, Casablanca, Morocco
| | - B Traore
- Epidemiolgy Laboratory, Hassan II University, Casablanca, Morocco
| | - B Charra
- Intensive Care Unit, UHC Ibn Rochd, Casablanca, Morocco
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Affiliation(s)
- B Charra
- Centre de Rein Artificiel de Tassin, Tassin, France.
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Affiliation(s)
- B Charra
- Centre de Rein Artificiel de Tassin, France
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Charra B, Laurent G, Calemard E, Terrat JC, Vanel T, Ruffet M, Chazot C. Survival in dialysis and blood pressure control. Contrib Nephrol 2015; 106:179-85. [PMID: 8174368 DOI: 10.1159/000422948] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- B Charra
- Centre de Rein Artificiel, Tassin, France
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Bassono YJ, Charra B, Ezzouine H, Benslama A, Motaouakkil S. [Leg ischaemia due to thrombosis of femoral arterial catheter]. Ann Fr Anesth Reanim 2010; 29:316-317. [PMID: 20363095 DOI: 10.1016/j.annfar.2010.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Ezzouine H, Charra B, Benslama A, Motaouakkil S. Sepsis sévère révélant une leishmaniose viscérale chez un adulte immunocompétent. ACTA ACUST UNITED AC 2010; 29:255-6. [DOI: 10.1016/j.annfar.2010.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Charra B, Benslama A, Ezzouine H, Motaouakkil S. Colistin monotherapy versus therapy combination. Crit Care 2010. [PMCID: PMC2934327 DOI: 10.1186/cc8287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Hachimi A, Charra B, Benslama A, Motaouakkil S. Scoring systems (APACHE II and Simplified Acute Physiology Score II) for predicting outcome in status asthmaticus. Crit Care 2009. [PMCID: PMC4084391 DOI: 10.1186/cc7669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Charra B, Hachimi A, Benslama A, Motaouakkil S. Intravenous immunoglobulins versus plasma exchange in the treatment of Guillain-Barré syndrome. Crit Care 2009. [PMCID: PMC4083994 DOI: 10.1186/cc7272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Charra B, Hachimi A, Benslama A, Motaouakkil S. Contribution of noninvasive ventilation in the precocious extubation in the medical ICU. Crit Care 2009. [PMCID: PMC4083898 DOI: 10.1186/cc7176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Barrou L, Charra B, Hachimi A, Idali B, Benslama A, Motaouakkil S. Intrathecal use of amikacin: a case report. Braz J Infect Dis 2008; 12:546. [DOI: 10.1590/s1413-86702008000600022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Accepted: 11/27/2008] [Indexed: 11/22/2022] Open
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Becerra AT, López DEG, Charra B, Calemard E, Terrat J, Chazot C, Laurent G, Mujais SK, Ivanovich P. Letters to the Editor. Artif Organs 2008. [DOI: 10.1111/j.1525-1594.1993.tb00410.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Charra B, Hachimi A, Benslama A, Motaouakkil S. Expansion volémique prévient-elle l’insuffisance rénale aiguë due à une rhabdomyolyse toxique ? ACTA ACUST UNITED AC 2008; 27:456-7. [DOI: 10.1016/j.annfar.2008.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ezzouine H, Charra B, Benslama A, Motaouakkil S, Sodqi M. [A case of tuberculous meningitis in pregnancy]. Med Mal Infect 2008; 38:36-7. [PMID: 18178048 DOI: 10.1016/j.medmal.2007.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2006] [Accepted: 11/11/2007] [Indexed: 11/28/2022]
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Charra B, Hachimi A, Benslama A, Motaouakkil S. Precocious tracheotomy versus prolonged intubation in a medical ICU. Crit Care 2008. [PMCID: PMC4088703 DOI: 10.1186/cc6553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Charra B, Hachimi A, Benslama A, Motaouakkil S. Immunological manifestations in paraphenylenediamine poisoning. Crit Care 2008. [PMCID: PMC4088733 DOI: 10.1186/cc6583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Charra B, Hachimi A, Arsalane H, Benslama A, Motaouakkil S. [Colchicum autumnale L. poisoning]. Ann Fr Anesth Reanim 2007; 26:1081-1082. [PMID: 17959341 DOI: 10.1016/j.annfar.2007.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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Abstract
Hypertension is very common in standard haemodialysis patients in spite of a wide use of antihypertensive medications. Up to the last decade it was reported in dialysis nts, as in the general population, as a powerful mortality risk factor. More recently several reports have challenged this view, and hypotension rather than hypertension has been claimed as the real culprit. That a risk factor has an opposite effect on mortality in conditions such as dialysis than in the general population has been termed - reverse epidemiology ,,, and suggests that our therapeutic approach toward blood pressure control in dialysis should be reconsidered. In fact, this counter intuitive concept is explained by the effect of time. Hypertension is a long-term mortality risk factor, that in a population crippled by short-acting risk factors (e.g. diabetes, congestive heart failure, malnutrition...) has not the opportunity to express itself. The clear cut noxious effect of hypertension on mortality in the years when dialysis patients were young and fit has disappeared in the present aged and highly co-morbid population. This does not mean that hypertension becomes beneficial once dialysis has been started. Hypotension is a marker of a high risk of early mortality, hypertension is a cause of late mortality. There is no evidence that hypertension might be protective in dialysis patients. Avoiding hypertension remains a capital goal of maintenance dialysis.
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Affiliation(s)
- B Charra
- Centre de rein artificiel, 42 Avenue du 8-mai- 1945, 69160 Tassin, France.
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Motaouakkil S, Charra B, Hachimi A, Benhsaien I, Benslama A. [Maajoun poisoning]. Ann Fr Anesth Reanim 2007; 26:891. [PMID: 17689044 DOI: 10.1016/j.annfar.2007.07.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
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Jean G, Chazot C, Charra B. 12 months cinacalcet therapy in hemodialysis patients with secondary hyperparathyroidism: effect on bone markers. Clin Nephrol 2007; 68:63-4. [PMID: 17703841 DOI: 10.5414/cnp68063] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Hachimi A, Charra B, Benslama A, Motaouakkil S. [Cardiac troponin I and paraphenylenediamine poisoning]. Ann Fr Anesth Reanim 2007; 26:711-2. [PMID: 17572042 DOI: 10.1016/j.annfar.2007.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
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Rafai MA, Boulaajaj FZ, Charra B, Benslama A, Motaouakkil S, Slassi I. Aspects électrophysiologiques du syndrome intermédiaire au cours des intoxications aux organophosphorés. Rev Neurol (Paris) 2007; 163:480-2. [PMID: 17452951 DOI: 10.1016/s0035-3787(07)90425-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Acute organophosphate poisoning, whether accidental or suicidal, is frequent in developing countries and produces significant morbidity and mortality. Organophosphates inhibit cholinesterase activity at the neuromuscular junction and cause extensive muscle paralysis, particularly for respiratory function. Poisonings evolve in three stages: cholinesterase crisis, intermediate syndrome and delayed neuropathy. Electrophysiological aspects have been poorly studied. We report the case of a 25-year-old woman admitted to intensive care unit with muscarinic signs and respiratory failure after attempted suicidal organophosphate poisoning. Cholinesterase activity was low and the electrophysiological study disclosed the characteristic aspect of intermediate syndrome. The patient died due to septic complications. This syndrome is exceptional with a poorly understood pathophysiology. The electrophysiological study is essential for diagnosis.
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Affiliation(s)
- M A Rafai
- Service de Neurologie, Explorations Fonctionnelles, Maroc.
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Charra B, Sodqi M, Sandali O, Nejmi H, Hachimi A, Ezzouine H, Benslama A, Himmich H, Motaouakkil S. Paludisme grave d'importation chez l'adulte: étude rétrospective de dix cas admis en réanimation à Casablanca. Med Mal Infect 2007; 37:162-5. [PMID: 17197142 DOI: 10.1016/j.medmal.2006.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2006] [Accepted: 09/06/2006] [Indexed: 10/23/2022]
Abstract
INTRODUCTION We report a retrospective study in the medical intensive care unit of the Casablanca Ibn-Rochd University hospital. MATERIAL AND METHODS All patients over 14 years of age with falciparum malaria, who were admitted to ICUs between 1996 and 2001, were included. The main epidemiological features, criteria of admission, treatment, and outcome were investigated. RESULTS Ten patients were included for severe imported malaria. The mean age was 32+/-4 years. All patients had acquired falciparum malaria in sub-Saharan Africa. Chemoprophylaxis was inadequate in all patients. The mean time from symptom onset to treatment initiation was 9+/-2 days. Criteria of admission were impaired consciousness (7), acute renal failure (4), and respiratory distress (3). The most worrying factors were the severity of consciousness disorders, the acute respiratory distress syndrome, the metabolic acidosis, and the refractory shock. All patients presented with nosocomial respiratory infection related to Gram-negative bacilli, in the evolution. All patients received quinine therapy with loading dose and symptomatic treatment. Five patients died. CONCLUSION The lethality of severe imported malaria is still high despite optimal management in ICUs. Improving chemoprophylaxis and an earlier diagnosis may reduce significantly the mortality rate.
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Affiliation(s)
- B Charra
- Service de Réanimation Médicale, CHU Ibn-Rochd Casablanca, Maroc
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Ezzouine H, Charra B, Benslama A, Motaouakkil S. [Acute cupric sulfate intoxication]. Ann Fr Anesth Reanim 2007; 26:94. [PMID: 17158022 DOI: 10.1016/j.annfar.2006.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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Rafai MA, Boulaajaj FZ, Bourezgui M, Charra B, Otmani HE, Benslama A, Motaouakkil S, Slassi I. Aspects cliniques et électrophysiologiques de l’intoxication aiguë aux organophosphorés. Neurophysiol Clin 2007; 37:35-9. [PMID: 17418356 DOI: 10.1016/j.neucli.2007.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Acute organophosphate (OP) intoxications, accidental or voluntary, are responsible for a high mortality. They cause extensive muscular paralysis by acetyl cholinesterase activity inhibition at the neuromuscular junction level. AIM To underline the rarity and the characteristic electrophysiological pattern during cholinergic crisis. OBSERVATION A 28-year-old woman was admitted to the medical intensive care unit for Malathion acute intoxication with signs of glandular hypersecretion, complicated tetraparesis, and respiratory distress. The cholinesterase activity was 17%. The electroneuromyography showed multiple motor responses to the same stimulation, which is characteristic of the cholinergic crisis. Other electrophysiological parameters, in particular low-frequency repetitive stimulations, were normal. The evolution was favourable after symptomatic treatment and respiratory assistance. DISCUSSION AND CONCLUSIONS Organophosphate intoxications evolve in three phases: acute cholinergic crisis, intermediate syndrome, and delayed neuropathy. While the electrophysiological aspects of delayed neuropathy are best characterized, those of crisis and intermediate syndrome remain very little studied. The persistence of acetylcholine in the synaptic slit would explain the multiple motor responses to single stimulation during the crisis.
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Affiliation(s)
- M A Rafai
- Service de neurologie-explorations fonctionnelles, CHU d'Ibn Rochd, quartier des hôpitaux, Casablanca, Maroc.
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Charra B, Hares N, Hachimi A, Ezzouine H, Benslama A, Motaouakkil S. [Haemodynamic profile in paraphenylene-diamine poisoning]. Ann Fr Anesth Reanim 2006; 25:1167-8. [PMID: 17010560 DOI: 10.1016/j.annfar.2006.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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Motaouakkil S, Charra B, Hachimi A, Ezzouine H, Guedari H, Nejmi H, Benslama A. Rhabdomyolyse et intoxication à la paraphénylène-diamine. ACTA ACUST UNITED AC 2006; 25:708-13. [PMID: 16698226 DOI: 10.1016/j.annfar.2006.03.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2005] [Accepted: 03/29/2006] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of this study is to describe clinical description, biological findings, outcome and prognostic factors of paraphenylene-diamine poisoning. PATIENTS AND METHODS We report a cohort study spreaded over 6 years (1999-2004), realized in Medical Intensive Care Unit in Ibn-Rochd University Hospital at Casablanca (Morocco). This study included 315 patients admitted for paraphenylene-diamine (PPD) poisoning. Diagnosis was based on: poisoning reported by the patient or his family, clinical data, biological findings and qualitative determination of PPD. Epidemiological parameters was obtained at admission. Every day, clinical and biological data, therapy and gravity scores were collected and a mean was calculated. RESULTS 315 patients were admitted over this period. The mean age was 23+/-9 years. We noticed a clear female predominance (sex-ratio=9.86). The intoxication was voluntarily aiming at autolysis in 93.3% of the cases. The patients were admitted at about 5+/-5.3 hours after the intoxication. The clinical chart was at first dominated by the respiratory and renal symptoms. The mean of CPK was 132,351.8+/-164,978 UI/l. The treatment was especially symptomatic. The mortality was 47%. The multivariate analysis concluded that acid urinary pH, hyperglycaemia, hard muscles, betamimetic drugs and MPM II>0.14 were associated with a poor prognosis. CONCLUSION The PPD poisoning represents the first cause of toxic rhabdomyolysis in our context and responsible of high mortality. For that, it's necessary to control PPD trade, to inform the medical persons and a rapid management.
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Affiliation(s)
- S Motaouakkil
- Service de réanimation médicale, CHU Ibn-Rochd, Casablanca, Maroc.
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Benslama A, Charra B, Hachimi A, Youklif A, Motaouakkil S. [Hepatic infarction and protein C deficiency]. Ann Fr Anesth Reanim 2006; 25:666-7. [PMID: 16600565 DOI: 10.1016/j.annfar.2006.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
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Motaouakkil S, Charra B, Hachimi A, Benslama A. Pneumonies nosocomiales à Acinetobacter baumaniimultirésistant traitées par colistine et rifampicine. ACTA ACUST UNITED AC 2006; 25:543-4. [PMID: 16488103 DOI: 10.1016/j.annfar.2006.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Charra B, Guedari H, Bassir S, Maski G, Rayed L, Benslama A, Motaouakkil S. [Flash pulmonary oedema]. Ann Fr Anesth Reanim 2006; 25:539-40. [PMID: 16469476 DOI: 10.1016/j.annfar.2005.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
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Rabbai O, Hachimi A, Charra B, Benslama A, Motaouakkil S. [Vertex extradural haematoma by superior sagittal sinus rupture]. Ann Fr Anesth Reanim 2006; 25:469-70. [PMID: 16524689 DOI: 10.1016/j.annfar.2005.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
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Charra B, Berrada J, Hachimi A, Judate I, Nejmi H, Motaouakkil S. [A fatal case of Mediterranean spotted fever]. Med Mal Infect 2005; 35:374-5. [PMID: 15975750 DOI: 10.1016/j.medmal.2005.03.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2004] [Accepted: 03/02/2005] [Indexed: 11/20/2022]
Affiliation(s)
- B Charra
- Service de réanimation médicale, CHU Ibn-Rochd, Casablanca, Morocco
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Chrifi-Alaoui M, Benslama A, Charra B, Hachimi A, Motaouakkil S. [Postpartum ovarian vein thrombophlebitis revealed by pulmonary signs]. ACTA ACUST UNITED AC 2005; 25:313-4. [PMID: 16311008 DOI: 10.1016/j.annfar.2005.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Charra B, Hachimi A, Nejmi H, Sodqi M, Benslama A, Motaouakkil S. Cryptococcose neuroméningée chez un sujet immunocompétent. Med Mal Infect 2005; 35:549-51. [PMID: 16253455 DOI: 10.1016/j.medmal.2005.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2005] [Accepted: 08/31/2005] [Indexed: 11/19/2022]
Abstract
The authors report a case of cryptococcal neuromeningitis (CNM) in a 27-year-old man, non HIV-infected, with a normal CD(4) T-lymphocyte count. He had a clinical history of subacute meningitis. The evolution was fatal. CNM is a rare infection the prognosis of which remains bad, even in immunocompetent patient.
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Affiliation(s)
- B Charra
- Service de réanimation médicale, CHU Ibn-Rochd, Casablanca, Maroc
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Charra B. From adequate to optimal dialysis long 3 x 8 hr dialysis: a reasonable compromise. Nefrologia 2005; 25 Suppl 2:19-24. [PMID: 16050397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
Long dialysis (3 x 8 hours/week) has been used in Tassin for three decades now, without method modifications. Results have been excellent considering both morbidity and mortality. Best survival compared to short dialysis is mainly due to low cardiovascular mortality. It is probably due to a good control of arterial hypertension, without antihypertensive medication, and the low rate of intradialytic hypotension. Slow ultrafiltration, allowed by the extended dialysis session, associated with a low-salt diet and a moderate interdialysis weight gain, tend to normalize extracellular volume and ensure normotension. Long hemodialysis assure a good dialysis dose in terms of small and even middle molecules, with good nutrition, anemia correction, phosphate and potassium control with few drugs. Optimal dialysis needs several conditions, each of them necessary. Time seems a central factor, providing a high treatment safety margin. While it is quite difficult to achieve excellent dialysis results with short sessions, long-dialysis is easy to perform with high reliability.
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Affiliation(s)
- B Charra
- Centre de Rein Artificiel deTassin, France
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Charra B, Chazot C, Jean G, Hurot JM, Terrat JC, Vanel T, Lorriaux C, Vovan C. Role of sodium in dialysis. MINERVA UROL NEFROL 2004; 56:205-13. [PMID: 15467499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
The total amount of sodium present in the body conditions the extracellular compartment volume. In advanced renal failure and in dialysis the sodium balance becomes positive and the extracellular volume inflates. This leads to hypertension and to direct cardiac and vascular changes that explain for a large part the excessive cardiovascular morbidity and mortality in dialysis patients. Controlling body sodium content and extracellular volume allows to reduce hypertension, cardiovascular changes and to improve dialysis patients survival. This can be achieved by reducing the sodium input (low sodium diet and reasonably low sodium dialysate) and/or by increasing sodium output (ultrafiltration by convection in hemodialysis or hemofiltration and osmotic drive in peritoneal dialysis). The intermittent nature of hemodialysis (and hemofiltration) conditions the saw-tooth volume fluctuations that drove to conceiving and implementing the concept of a dry weight, corresponding to normal extracellular volume and blood pressure.
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Affiliation(s)
- B Charra
- Center of Artificial Kidney, France
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Charra B. The Effect of Salt on Hypertension Control in ESRD. Int J Artif Organs 2004. [DOI: 10.1177/039139880402700914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- B. Charra
- Centre de Rein Artificiel de Tassin, Tassin - France
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Benslama A, Moutaouakkil S, Charra B, Menebhi L. [The intermediate syndrome during organophosphorus pesticide poisoning]. ACTA ACUST UNITED AC 2004; 23:353-6. [PMID: 15120779 DOI: 10.1016/j.annfar.2003.11.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2001] [Accepted: 11/28/2003] [Indexed: 11/28/2022]
Abstract
Acute intoxication by organophosphate pesticides is frequent in Morocco. We report two cases of malathion poisoning complicated by intermediate syndrome. The purpose of this work is to describe distinctive features of this syndrome, it arises 48-96 h after the cholinergic crisis and it is characterized by respiratory paresis with difficulties of weaning from the assisted respiratory, deficit of proximal limbs, neck flexors, and cranial nerves. This syndrome coincides with the prolonged inhibition of the acetylcholinesterase, and is not due to the necrosis of muscular fiber's necrosis. Both clinical and electromyographic features are explained by a combined pre- and postsynaptic dysfunction of the neuromuscular transmission. The difficulty of this syndrome lies in its rarity and also its severity, because of the respiratory failure, which justifies medical supervision in intensive care unit, for at least 96 h, in expectation for the respiratory distress, all the more cholinergic syndrome is intense.
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Affiliation(s)
- A Benslama
- Service de réanimation médicale, CHU Ibn-Rochd, rue des Hôpitaux, Casablanca, Maroc.
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Charra B, Chazot C. [The peritoneal dialysis and hemodialysis studies--will they revolutionize our ways of prescribing and evaluating dialysis?]. Nephrologie 2004; 25:77-81. [PMID: 15185554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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Abstract
AIMS Carnitine is involved in fatty acid metabolism and it is cleared by dialysis. As it plays a role in energy utilization and because malnutrition is a frequent complication of HD treatment, we studied the effects of carnitine supplementation on several nutritional parameters in HD patients. MATERIAL AND METHODS The main selection criterion was a body mass index (BMI; body weight/(height)2) < 22 kg/m2. Fifty-three patients were enrolled to participate in this open and randomized study. For 6 months, 28 patients received 15 mg/kg of intravenous L-carnitine at the end of each hemodialysis (HD) treatment (Group A), the remaining 25 patients were controls (Group B). The measured parameters were the post-dialysis body weight, serum albumin concentration (nephelemetry), food intake assessed by a 3-day food questionnaire, nPNA (normalized protein equivalent of nitrogen appearance), creatinine generation, and anthropometry. RESULTS Forty-five patients completed the study (Group A: 14 F/9 M, 66.7 years old; Group B: 11 F/11 M, 65.2 years old). At the beginning of the study, there were no differences between the groups for age, gender, HD duration, BMI, diabetes prevalence, plasma carnitine levels and measured nutritional parameters. 65.2% and 77.3% in each group were carnitine-deficient (plasma total carnitine level < 35 micromol/l). After 6 months of L-carnitine supplementation, none of the nutritional parameters had changed in either group, except that serum albumin concentration decreased in both groups. Dividing each group according to their respective median serum albumin concentrations, daily energy and protein intakes, creatinine generation or triceps skinfold thickness did not show any difference in the various nutritional parameters with or without carnitine supplementation. CONCLUSION Carnitine supplementation, despite normalization of plasma carnitine levels, has no effect on the nutritional status of HD patients.
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Affiliation(s)
- C Chazot
- Centre de Rein Artificiel, Tassin, France.
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Jean G, Charra B, Chazot C, Vanel T, Terrat JC, Hurot JM, Laurent G. Risk factor analysis for long-term tunneled dialysis catheter-related bacteremias. Nephron Clin Pract 2002; 91:399-405. [PMID: 12119469 DOI: 10.1159/000064279] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Infection, mainly related to vascular access, is one of the main causes of morbidity and a preventable cause of death in hemodialysis patients. From January 1994 to April 1998 we conducted a prospective study to assess the incidence and risk factors of catheter-related bacteremia. One hundred and twenty-nine tunneled dual-lumen hemodialysis catheters were inserted percutaneously into the internal jugular vein in 89 patients. Bacteremia (n = 56) occurred at least once with 37 (29%) of the catheters (an incidence of 1.1/1,000 catheter-days); local infection (n = 45, 1/1,000 catheter-days) was associated with bacteremia in 18 cases. Death in 1 case was directly related to Staphylococcus aureus (SA) septic shock, and septicemia contributed to deaths in 2 additional cases. Catheters were removed in 48% of the bacteremic episodes. Treatment comprised intravenous double antimicrobial therapy for 15-20 days. Bacteriological data of bacteremia showed 55% involvement of SA. Nasal carriage of SA was observed in 35% of the patients with catheters. Bacteremic catheters were more frequently observed in patients with diabetes mellitus (p = 0.03), peripheral atherosclerosis (p = 0.001), a previous history of bacteremia (p = 0.05), nasal carriage of SA (p = 0.0001), longer catheter survival time (p = 0.001), higher total intravenous iron dose (p = 0.001), more frequent urokinase catheter infusion (p < 0.01), and local infection (p < 0.001) compared with non-bacteremic catheters. Monovariate survival analysis showed that significant initial risk factors for bacteremia were nasal carriage of SA (p = 0.00001), previous bacteremia (p = 0.0001), peripheral atherosclerosis (p = 0.005), and diabetes (p = 0.04). This study confirms the relatively high incidence of bacteremia with tunneled double-lumen silicone catheters and its potential complications. Possible preventive actions are discussed according to the risk factors.
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Affiliation(s)
- G Jean
- Centre du Rein Artificiel de Tassin, 41 Avenue du 8 Mai 1945, F-69160 Tassin la Demi-Lune, France.
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Abstract
AIMS Hemodialysis tunneled catheters are widely used nowadays. However, their complications, infection and dysfunction, remain much too frequent. Different types of tunneled silicone hemodialysis catheters are available. We prospectively compared the long-term outcome of the two most popular devices, Permcath cuffed double catheter and TwinCath uncuffed twin catheter, both inserted percutaneously. METHODS From January 1994 to April 1998, 125 tunneled catheters were inserted in the internal jugular vein of 86 chronic hemodialysis patients, 63 TwinCath MedComp (TC) and 62 Permcath Quinton (PC). They were prospectively followed looking for technical patency, infection and dysfunction rate. RESULTS TC were used more often for iterative access (52 vs. 25%, p = 0.01) and were inserted more frequently in the left internal jugular vein (59 vs. 16% p < 0.001). Their median technical survival rate was longer (869 vs. 433 days for PC, p < 0.01) with a 1-year patency rate of 80 vs. 53% (p = 0.002). Total catheter extrusion was also slightly less frequent with TC (4.7 vs. 9.6%), but partial extrusion happened more frequently (43 vs. 16%, p = 0.02). No significant difference in infection rate was observed, 0.77 for TC vs. 1.3 local infection/1,000 catheter days; 1.08 vs. 1.30 bacteremia/1,000 catheter days. A persistent catheter thrombosis was observed in 7.9 vs. 20.9% in PC (p = 0.04), the number of dysfunction was 10.5 vs. 24/1,000 days in use (p = 0.0001) and the number of urokinase infusion was 4.4 vs. 12/1,000 days (p = 0.001). PC needed more radiological interventions for dysfunction with endolumenal brushes (4 vs. 0) or fibrin sleeve removal (4 vs. 0). The vena cava thrombosis incidence was not different (2 vs. 3). CONCLUSION Although the study was not randomized, TC appears more efficient allowing for a longer patency with a lower dysfunction rate than PC. This was reinforced by less favorable conditions of TC including more left jugular side and more iterative catheters. The cuff does not offer a better bacteriological barrier or protection against extrusion, and the TC seems at a less risk of fibrin sleeves. However, a large randomized study is needed to definitively conclude.
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Affiliation(s)
- G Jean
- Centre de Rein Artificiel, Tassin la Demi-lune, France.
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