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L'Hermitte N, Markarian T, Grau-Mercier L, Coisy F, Muller L, Saadi L, Claret PG, Krebs H, Bobbia X. Diagnostic performance of a clinical ultrasound-based algorithm for acute heart failure in patients presenting to the emergency department with dyspnea. Emergencias 2024; 36:109-115. [PMID: 38607306 DOI: 10.55633/s3me/011.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
OBJECTIVES To study the diagnostic performance of an ultrasound-based algorithm that includes the deceleration time (DT) of early mitral filling to establish a diagnosis of acute heart failure (AHF) in patients who come to an emergency department because of dyspnea. MATERIAL AND METHODS Prospective analysis in a convenience sample of patients who came to a hospital emergency department with acute dyspnea. The algorithm included ultrasound findings and 4 echocardiographic findings as follows: mitral annular plane systolic excursion, Doppler mitral flow velocity, tissue Doppler imaging measure of the lateral annulus, and the DT of early mitral filling. The definitive diagnosis was made by 2 physicians blinded to each other's diagnosis and the ultrasound findings. RESULTS A total of 166 adult patients with a mean (SD) age of 76 (13) years were included; 79 (48%) were women. AHF was the definitive diagnosis in 62 patients (37%). Diagnostic agreement was good between the 2 physicians (κ = 0.71). The algorithm classified all the patients, and there were no undetermined diagnoses. Diagnostic performance indicators for the ultrasound-based algorithm integrating early DT findings were as follows: area under the receiver operating characteristic curve, 0.91 (95% CI, 0.86-0.96); sensitivity, 87% (95% CI, 76%-94%); specificity, 95% (95% CI, 89%-98%); positive likelihood ratio, 18.1 (95% CI, 7.7-42.8); and negative likelihood ratio, 0.14 (95% CI, 0.07-0.26). CONCLUSION The ultrasound-based algorithm integrating the DT of early mitral filling performs well for diagnosing AHF in emergency patients with dyspnea. The inclusion of early DT allows all patients to be diagnosed.
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Affiliation(s)
- Nicolas L'Hermitte
- Montpellier University, UR UM 103 IMAGINE, Emergency Department, Nîmes University Hospital, Nîmes, Francia
| | - Thibaut Markarian
- Department of Emergency Medicine, Timone University Hospital, Marsella, Francia. UMR 1263 Center of Cardiovascular and Nutrition Research (C2VN), Aix-Marseille University, INSERM, INRAE, Marsella, Francia
| | - Laura Grau-Mercier
- Montpellier University, UR UM 103 IMAGINE, Emergency Department, Nîmes University Hospital, Nîmes, Francia
| | - Fabien Coisy
- Montpellier University, UR UM 103 IMAGINE, Emergency Department, Nîmes University Hospital, Nîmes, Francia
| | - Laurent Muller
- Montpellier University, EA2992 IMAGINE, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, Francia
| | - Laysa Saadi
- Montpellier University, EA2992 IMAGINE, Department of Anesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, Nîmes, Francia
| | - Pierre-Géraud Claret
- Montpellier University, UR UM 103 IMAGINE, Emergency Department, Nîmes University Hospital, Nîmes, Francia
| | - Hugo Krebs
- Montpellier University, UR UM 103 IMAGINE, Emergency Department, Nîmes University Hospital, Nîmes, Francia
| | - Xavier Bobbia
- Montpellier University, UR UM 103 IMAGINE, Emergency Department, Montpellier University Hospital, Montpellier, Francia
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Gallo E, Gaudard P, Provenchère S, Souab F, Schwab A, Bedague D, de La Barre H, de Tymowski C, Saadi L, Rozec B, Cholley B, Scherrer B, Fellahi JL, Ouattara A. Use of Aprotinin versus Tranexamic Acid in Cardiac Surgery Patients with High-Risk for Excessive Bleeding (APACHE) trial: a multicentre retrospective comparative non-randomized historical study. Eur J Cardiothorac Surg 2024; 65:ezae001. [PMID: 38180872 DOI: 10.1093/ejcts/ezae001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 11/30/2023] [Accepted: 01/03/2024] [Indexed: 01/07/2024] Open
Abstract
OBJECTIVES Following the reintroduction of aprotinin into the European market, the French Society of Cardiovascular and Thoracic Anaesthesiologists recommended its prophylactic use at half-dose for high-risk cardiac surgery patients. We examined whether the use of aprotinin instead of tranexamic acid could significantly reduce severe perioperative bleeding. METHODS This multicentre, retrospective, historical study included cardiac surgery patients treated with aprotinin or tranexamic acid between December 2017 and September 2020. The primary efficacy end point was the severe or massive perioperative bleeding (class 3-4 of the universal definition of perioperative bleeding). The safety secondary end points included the occurrence of thromboembolic events and all-cause mortality within 30 days after surgery. RESULTS Among the 693 patients included in the study, 347 received aprotinin and 346 took tranexamic acid. The percentage of patients with severe or massive bleeding was similar in the 2 groups (42.1% vs 43.6%, Adjusted odds ratio [ORadj] = 0.87, 95% confidence interval: 0.62-1.23, P = 0.44), as was the perioperative need for blood products (81.0% vs 83.2%, ORadj = 0.75, 95% confidence interval: 0.48-1.17, P = 0.20). However, the median (Interquartile range) 12 h postoperative blood loss was significantly lower in the aprotinin group (383 ml [241-625] vs 450 ml [290-730], P < 0.01). Compared to tranexamic acid, the intraoperative use of aprotinin was associated with increased risk for thromboembolic events (adjusted Hazard ratio 2.30 [95% Cl: 1.06-5.30]; P = 0.04). CONCLUSIONS Given the modest reduction in blood loss at the expense of a significant increase in thromboembolic adverse events, aprotinin use in high-risk cardiac surgery patients should be based on a carefully considered benefit-risk assessment.
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Affiliation(s)
- Eloïse Gallo
- Department of Cardiovascular Anaesthesia and Critical Care, CHU Bordeaux, France
| | - Philippe Gaudard
- Department of Anaesthesia and Critical Care, Arnaud de Villeneuve Hospital, Montpellier, France
| | - Sophie Provenchère
- Department of Anaesthesia and Critical Care, Bichat Claude Bernard Hospital, Paris, France
| | - Fouzia Souab
- Department of Anaesthesia and Critical Care, Hôpital Laennec, CHU Nantes, France
| | - Anaïs Schwab
- Department of Anaesthesia and Critical Care, Hospices Civils de Lyon, France
| | - Damien Bedague
- Department of Anaesthesia and Critical Care, Grenoble-Alpes University Hospital, France
| | - Hugues de La Barre
- Department of Anaesthesia and Critical Care, Hôpital Européen Georges Pompidou, Paris, France
| | - Christian de Tymowski
- Department of Anaesthesia and Critical Care, Bichat Claude Bernard Hospital, Paris, France
| | - Laysa Saadi
- Department of Anaesthesia and Critical Care, Arnaud de Villeneuve Hospital, Montpellier, France
| | - Bertrand Rozec
- Department of Anaesthesia and Critical Care, Hôpital Laennec, CHU Nantes, France
| | - Bernard Cholley
- Department of Anaesthesia and Critical Care, Hôpital Européen Georges Pompidou, Paris, France
| | - Bruno Scherrer
- Bruno Scherrer Conseil, Saint Arnoult en Yvelines, France
| | - Jean-Luc Fellahi
- Department of Anaesthesia and Critical Care, Hospices Civils de Lyon, France
| | - Alexandre Ouattara
- Department of Cardiovascular Anaesthesia and Critical Care, CHU Bordeaux, France
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Leclaire C, Saadi L, Scigliano S, Olivier P, Wahl D. Impact de la Tomoscintigraphie par Emission de Positons dans la prise en charge des vascularites. Rev Med Interne 2008. [DOI: 10.1016/j.revmed.2008.03.302] [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: 10/22/2022]
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Saadi L, Lebaili N, Benyoussi M. Exploration of cytotoxic effect of malathion on some rat organs structure. Commun Agric Appl Biol Sci 2008; 73:875-881. [PMID: 19226838] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Widespread use of insecticides has caused several risks to public health. This work was designed to investigate the histological changes in Liver, lung, adrenal medulla and testis of Wistar rats treated with malathion, administered intra peritoneally at a dose of 33,051 mg/kg per day. Exposure to the malathion, for 40 days, induced histological alterations: regular arrangement of hepatocytes with dilated sinusoidal spaces, thickened Lung epithelium, regression of adrenal medulla with congestion and disruption of the germ Line. These alterations represent the signs of cytotoxicity of malathion in Wistar rats.
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Affiliation(s)
- L Saadi
- Département de Biologie, Faculté des Sciences Agro-Vétérinaires Université Saad Dahleb de Blida, Algérie
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Lebaili N, Saadi L, Mosbah R, Mechri N. Exploration of the cytotoxic effects of an insecticide, lambda cyhalothrine, on sexual exocrine function in the white rat. Commun Agric Appl Biol Sci 2008; 73:883-889. [PMID: 19226839] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Many xenobiotiques (solvents, pesticides, metals heavy.....) are suspected to be responsible for the fall of the male and female fertility. The purpose of this work is to study the insecticide impact, Lambda-cyhalothrine, managed by oral way during 7 days on the rat testicles histology. Wistar rats were given distilled water (controls) or containing 15,383 mg/kg or 23,075 mg/kg of Lambda-cyhalothrine. The exposure to this insecticide induced an increase in the diameters of the seminiferous tubes. The histological of the seminiferous tubes revealed deteriorations of the germinatif epithelium: blocking of the spermatogenesis, presence of the apoptotic cells and absence of the spermatozoids in certain lumens. All these histological alterations constitute a signs of cytotoxicity of Lambda-cyhalothrine on the male fertility in the Wistar rat.
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Affiliation(s)
- N Lebaili
- Department of biology, Ecole Normale Supérieure de Kouba, Algeria.
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Karim F, Waqif M, Saadi L. A comparative study of natural and synthetic calcium sulfates. Acta Crystallogr A 2007. [DOI: 10.1107/s0108767307093373] [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: 11/10/2022] Open
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Abstract
The diagnosis of vascularitis should be proposed when a concentric and regular thickening of the wall of the aorta or one of its branches is observed or when there is late enhancement of the arterial wall, on sites which are usually free from atheromatous lesions and in a young patient. The radiologist must be aware of the associated clinical signs: oral and genital ulcerative lesions in the Behçet syndrome; finger necrosis in a young male smoker in Buerger disease; hip and shoulder arthropathy and headache in a 70 Year old female and Horton disease; pulseless upper limbs and inflammatory syndrome in a young adult for the Takayasu arteritis. The diagnosis of popliteal entrapment or adventitial cyst should be proposed in young patients without atheromatous lesions.
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Affiliation(s)
- M Sapoval
- Service de Radiologie Cardio-Vasculaire, Hôpital Européen Georges Pompidou, 20, rue Leblanc, 75015 Paris.
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Sapoval M, Long A, Saadi L, Krause D, Baqué J. [Case report: radiologic spectrum of specific vascular diseases]. J Radiol 2004; 85:927-8. [PMID: 15243369 DOI: 10.1016/s0221-0363(04)97700-1] [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: 04/30/2023]
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Saadi L, Wahl D, Guillemin F, Bollaert P, Walter F, Frédéric M, de Maistre E, Manel J, Laprévote M, Lambert H, Blum A. Comparaison des caractéristiques des patients suspects d'embolie pulmonaireinclus ou non inclus dans une étude prospective comparant angio-scanner et angio-IRM. Rev Med Interne 2002. [DOI: 10.1016/s0248-8663(02)80127-8] [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: 10/25/2022]
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Baty V, Blain H, Saadi L, Jeandel C, Canton PH. Fatal myocardial infarction in an elderly woman with severe ulcerative colitis: what is the role of steroids? Am J Gastroenterol 1998; 93:2000-1. [PMID: 9772083 DOI: 10.1111/j.1572-0241.1998.2000a.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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