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Le syndrome de Lyell est une maladie rare de survenue imprévisible, grave et

Les pancréatites aigues grave peuvent se compliquer de pseudo kystes qui peuvent conduire à la formation de fistules, ces fistules peuvent être dirigées vers différentes régions avec différentes manifestations cliniques. Ces manifestations extra pancréatiques de la pancréatite aigue constituent, par leurs particularités cliniques, biologiques et radiologiques, un réel apport au diagnostic positif. Le pronostic est celui de la pancréatite et dépend du site de la fistulisation. Le traitement par laparotomie a longtemps été le ''Gold Standard'', ces dernières années ont vu le développement de moyens moins invasifs et donc offrants un minimum de morbi-mortalité (Chirurgie mini invasive, drainage percutané). Nous rapportons l'observation d'un patient ayant séjourné dans notre structure.

Objectives: Managing severe pneumonia remains a challenge. Rapid diagnostic tests, such as multiplex polymerase chain reaction (mPCR), facilitate quick microorganism identification and may enable timely and appropriate antimicrobial therapy. However, studies from low-income countries are scarce. This study aimed to evaluate the diagnostic characteristics of mPCR and its impact on antibiotic therapy and outcomes in critically ill patients with pneumonia., Design: Multicenter observational study., Setting: Twelve ICUs across Morocco., Patients: Adult patients with pneumonia requiring invasive mechanical ventilation, including community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), and ventilator-associated pneumonia (VAP)., Interventions: None., Measurements and Main Results: Respiratory samples were analyzed using both mPCR and conventional microbiological methods. The diagnostic performance of mPCR was evaluated, including its sensitivity and specificity. Additionally, the appropriateness of mPCR-induced modifications in empiric antibiotic therapy and their impact on patient outcomes were assessed. A total of 210 patients were included, with a median age of 50 years (range, 33-67 yr), of whom 66.2% were male. Pneumonia types were distributed as 30% CAP, 58% VAP, and 12% HAP. mPCR demonstrated a sensitivity of 96.9% (95% CI, 92.3-99.2%) and a specificity of 92% (95% CI, 91-93%). Following mPCR, antibiotic therapy modifications were observed in 58% of patients (n = 122), including de-escalation or cessation in 11% (n = 23), escalation in 26.5% (n = 56), adequacy adjustments in 7.5% (n = 16), and initiation of antibiotics in 13% (n = 27). The appropriateness of antibiotic therapy increased significantly from 38.7% (n = 83) to 67% (n = 141; difference, 27.5%; 95% CI, 18.3-36.7; p < 0.0001). Generalized mixed model analysis revealed that appropriate post-mPCR antibiotic therapy was associated with reduced mortality (adjusted odds ratio, 0.37; 95% CI, 0.15-0.93; p = 0.038)., Conclusions: Our findings suggest that the use of mPCR is associated with a significant improvement in the appropriateness of empiric antibiotic therapy and is also associated with a positive impact on the outcome of patients with pneumonia., Competing Interests: The authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2025 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.)

Background: Cardiopulmonary resuscitation (CPR) training is crucial for nursing students as future nurses are the first responders in the ambulatory and hospital care chain. Simulation-based learning has been shown to be more effective in acquiring the knowledge and technical and non-technical skills required for CPR. The present study aims to evaluate the impact of high-fidelity simulation-based adult CPR training on the acquisition and retention of knowledge and the development of technical and non-technical skills of nursing students at the Higher Institute of Nursing Professions and Health Techniques in Fez, Morocco., Methods: We conducted an interventional study with 49 nursing students. Twenty-five students (51.02%) in the simulation group received both traditional CPR training (theoretical lecture and demonstration of procedures) and simulation CPR training, while 24 students (48.97%) in the control group received only traditional training. Data were obtained using a questionnaire on theoretical knowledge of CPR, a technical skills assessment grid, and the Team Emergency Assessment Measure (TEAM) for non-technical skills., Results: The post-test scores for theoretical knowledge immediately after simulation were significantly higher for the simulation group (16.41±1.73 out of 20) than for the control group (13.15±1.96 out of 20). Mean CPR knowledge retention scores 30 days after training were significantly higher in the simulation group (15.60±1.71) compared with the control group (11.38±1.93). Assessment of technical skills on a high-fidelity mannequin showed a considerable advantage for the simulation group (30.88±1.64 out of 34) over the control group (18.00±0.78 out of 34). In addition, the results demonstrated a significant difference between the TEAM score of the simulation group (37.84±2.67 out of 44) and the control group (22.33±0.96 out of 44) and a significant difference between the Global Team Performance of the simulation group (8.16±0.68) out of 10 and the control group (4.83±0.38)., Conclusion: The findings demonstrated that adult CPR training using high-fidelity simulation was superior to the traditional method with regard to knowledge acquisition and retention and the development of technical and non-technical skills in undergraduate nursing students., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. The Hospital-University Ethics Committee of Fez, Laboratory of Anatomy, Surgery and Anesthesiology, Faculty of Medicine, Pharmacy and Dental Medicine of Fez, Sidi Mohamed Ben Abdellah University, and the Regional Directorate of Health and Social Protection of Fez Meknes issued approval N°32/22 and N°5997. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, El Ougli et al.)

We conducted a study of 46 patients admitted to the Intensive Care Unit with postoperative peritonitis. The incidence of postoperative peritonitis in this setting was 2.7%. The average age of patients was 53.3 years, with a sex ratio of 1.2. Submesocolic surgery was the most common cause of postoperative peritonitis (65.2%), mainly occurring in the colorectal region (48%). Clinical signs were dominated by fever (78%), abdominal pain (57%) and extra-abdominal signs. The mean time between symptom onset and diagnosis was 7.3 days. Reoperation was performed on the basis of clinical and biological criteria in 56.5% of cases. Therapeutic management was based on perioperative reanimation, treatment of organ dysfunctions, probabilistic antibiotic therapy and middle laparotomy. The bacteriological profile was dominated by BGN (79%). The loosening of the anastomotic sutures was the direct cause of PPO in 57% of patients. Mortality rate was 60%. The main prognostic factors were: renal failure, the number of patients with organ failure, PT<50%, the need for ventilation and the use of catecholamines., Competing Interests: Les auteurs ne déclarent aucun conflit d'intérêts., (Copyright: Said Benlamkaddem et al.)

Background: Severe acute cholangitis is a life-threatening biliary infection, leading to organ dysfunction, septic shock, and naturally death. Mortality has dropped significantly in the past years through improving resuscitation and biliary drainage techniques. The aim of our study is to analyze our daily practice and the factors associated with mortality., Methods: A retrospective study including severe acute cholangitis patients admitted to our unit from January 2009 to December 2018. Variables analyzed (univariate then multivariate analysis) were age, sex, history, origin, evolution time, bilirubin, etiology, organ dysfunction, qSOFA, SOFA, TOKYO, biliary drainage timing and technique, shock, antibiotherapy, and resuscitation., Results: 140 patients were included in this study. Average age was 61. Sex ratio M/F was 0.59. Lithiasis etiology was dominant (69%). SOFA average score upon admission was 8. Ceftriaxone + metronidazole was the empirical antibiotic used in 87%. Average time to biliary drainage was 1.58 ± 0.89 days. Endoscopic unblocking was the technique used in 76%. Mean duration of ICU stay was 6 days. Mortality rate was 28%. Statistically significant factors for mortality ( p < 0.05) were history of taking anticoagulant treatment, use of catecholamines and mechanical ventilation during ICU stay, and delay in consultation and administration of antibiotic therapy., Conclusions: Early recognition, antibiotics, resuscitation, and minimally invasive biliary drainage have improved patient outcomes although there is still progress to be made. Moreover, as multiple organ failure is often associated with mortality in severe acute cholangitis, predictive risk factors of organ failure should be more investigated., Competing Interests: The authors declare that they have no conflicts of interest with the contents of this article., (Copyright © 2021 Soumaya Touzani et al.)

Carbon monoxide (CO) poisoning is a very common reason for emergency ward admission, with symptoms varying from a simple headache and dizziness to severe neurological and cardiac impairment. We report here a rare clinical presentation of CO intoxication manifested by a severe cardiac impairment with intracardiac thrombus formation, acute limb ischemia, renal infarction, and carotid artery thrombosis. There have been initial reports of thromboembolic events in acute CO poisoning with intracardiac thrombosis being sparsely reported. Contrary to venous thromboembolism, arterial thromboembolism in CO poisoning seems to be extremely rare. To the best of our knowledge, this is the first report in recent literature of a combined intracardiac thrombosis and multiple arterial thromboembolism induced by CO poisoning.

Paracetamol is the most widely drug involved in accidental paediatric exposures and deliberate self-poisoning cases because of its availability. N-acetyl cystein is the main treatment for this poisoning. We report a case of a 24-year-old Arab female who has deliberately ingested 100 tablets of 500 mg paracetamol each (50g). Her first examination was normal. She has received oral N-acetyl cystein (NAC) 6 hours after the ingestion. Serum paracetamol level done 18 hours post ingestion was 900 mg/l. On review the next days, she did not develop any symptoms of liver failure. However, due to the massive paracetamol ingestion associated with high serum paracetamol levels, oral NAC was continued for 3 days. The patient was discharged well on the fifth day of hospitalization. Our patient has ingested one of the highest paracetamol overdose (50g) with the highest paracetamol blood levels ever reported in medical literature. She was treated, six hours after ingestion, with oral NAC for 3 days without any side effects.

We report the case of a 78-year old patient, with no particular past medical history, who underwent transurethral resection of the prostate (50 g) under spinal anesthesia for benign hypertrophy. 90 minutes after the beginning of the procedure, the patient had nausea, vomiting, visual fog and bradycardia, suggesting TURP syndrome. Ionogramme objectified a serum sodium level of 118meq/L, hence the patient was treated with 3% hypertonic saline solution, with good evolution. This study describes a common but moderate occurrence of TURP syndrome whose management was facilitated by patient's alertness during spinal anesthesia.

Mucormycosis is an opportunistic fungal infection occurring in immunocompromised patients. It is a serious life threatening condition. Even though diagnosed early, mucormycosis has a mortality rate reaching 50%. We report the case of mucormycosis in a diabetic patient hospitalized in Intensive Care Unit for severe angiocholitis. Evolution was lethal., Competing Interests: Les auteurs ne déclarent aucun conflit d'intérêt.

Introduction: Simulation is an innovative educational tool based on learning experience in a secure environment without fear of repercussions especially in critical situations such as in emergencies. It offers great prospects in the development of dialysis training., Methods: We report the results of an observational study comparing medical simulation to conventional training methods in the management of hemodialysis in emergency situations. We discuss afterwards the possibilities currently allowed by medical simulation in dialysis training., Results: The training was beneficial (significant difference between initial and final level of knowledge) for all participants. There was no significant difference between the conventional approach, simulation training and the two combined tools. However, satisfaction rate was higher in simulation training. We observed a tendency to have better results in "active players" of the simulation compared to observers., Conclusion: We emphasize the importance of integrating medical simulation training in our dialysis training strategies as a complementary tool to classical teaching/learning methods., (Copyright © 2016 Association Société de néphrologie. Published by Elsevier SAS. All rights reserved.)

Leptospirosis is the most widespread zoonosis in the world. It is caused by pathogenic leptospira infection. This infection is also an uncommon cause of hepatorenal failure. Indeed, hemolysis, elevated liver enzyme levels and low platelet count syndrome, and acute fatty liver of pregnancy are specific to the pregnant state. Leptospirosis is rarely described in pregnancy; it might mimic puerperal sepsis or hepatorenal failure associated with pregnancy induced hypertension. We report a case of leptospirosis presenting as multiple organ failure during third trimester of pregnancy with a good outcome.

We report a case of transurethral resection of prostate (TURP) syndrome. A 78-year-old man with prostatic hypertrophy was scheduled for transurethral resection of the prostate under spinal anesthesia. 30 minutes after the end of the surgery, the patient presented signs of TURP syndrome with bradycardia, arterial hypotension, cyanosis, hypoxemia and coma. The electrolytes analysis revealed an acute hyponatremia (sodium concentration 125 mmol/L). Medical treatment consisted of hypertonic saline solution 3%, volume expansion, intubation and ventilation. The presented case describes a typical TURP syndrome, which was diagnosed and treated early. The patient was discharged from hospital without any complications.