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In recent years, more importance has begun to be attached to emotional life, especially in the case of doctors dealing with the death of patients. The care and death of seriously ill patients has a strong emotional impact on doctors. The grief caused by the death of patients affects not only the personal life of physicians but also their professional life and, if left unaddressed, can lead to burnout and impact both patient care and the doctor-patient relationship. Aim: The aim of the study was to identify the emotional experiences of physicians coping with the death of patients and to understand how it affects them. The overall objective of the study was to reduce the emotional impact of patients' death on physicians by normalizing the loss and using coping methods. Material and Methods: A retrospective study was conducted between March and June 2023, which consisted of a 21-question questionnaire distributed online and addressed to physicians who had experienced at least once in their lifetime the death of a patient. The research questions focused mainly on the impact of patient death on the personal and professional lives of doctors. A total of 124 physician respondents were included in the study. Results: The frequency with which physicians experience patient death differs by specialty and professional experience. The medical specialties where physicians face the most patients who die are oncology, internal medicine, cardiology, anesthesiology and intensive care. The most common emotions that physicians encounter after the death of a patient are: acceptance, anxiety, depression, disappointment, exhaustion, frustration, anger, helplessness, stress, sadness, guilt. Conclusions: The death of a patient can have a significant emotional impact on physicians and varies from physician to physician. The emotions generated by the death of a patient can influence physicians' personal and professional lives to varying degrees. In order to prevent burnout, doctors should be more aware of their own emotional experiences related to the death of a patient and seek help from colleagues or a psychologist to keep themselves in the best possible physical and emotional state. [ABSTRACT FROM AUTHOR]

Introduction. Il existe une relation complexe entre le statut résidentiel et la consommation de substances. En effet, la consommation de substances réduit les perspectives de logement et le fait d'être sans logement augmente les raisons de consommer des substances ainsi que les risques et la stigmatisation qui y sont associés. Méthodologie. Dans cette analyse descriptive des personnes sans logement qui ont perdu la vie en raison d'une intoxication aiguë accidentelle liée à une substance au Canada, nous avons utilisé les données relatives aux enquêtes sur les décès tirées d'une étude nationale d'examen des dossiers concernant les décès par intoxication aiguë due à une substance en 2016 et 2017, afin de comparer les facteurs sociodémographiques, les antécédents médicaux, les circonstances du décès et les substances ayant contribué au décès des personnes sans logement et des personnes non identifiées comme sans logement, au moyen du test du khi carré de Pearson. Nous avons comparé le profil démographique des personnes décédées d'une intoxication aiguë aux données du Dénombrement ponctuel coordonné de l'itinérance dans les collectivités canadiennes de 2016 et du Recensement de 2016. Résultats. Les personnes sans logement étaient nettement surreprésentées parmi les personnes décédées d'une intoxication aiguë en 2016 et 2017 (8,9 % contre moins de 1 % de la population générale). L'intoxication aiguë ayant entraîné le décès des personnes sans logement a eu lieu plus souvent à l'extérieur (24 %); un opioïde ou un stimulant a plus fréquemment contribué à leur décès (68 % à 82 %; les deux substances ont été responsables de 59 % des décès) et ces personnes avaient plus souvent été libérées d'un établissement correctionnel ou été autorisées à sortir d'un établissement de soins de santé au cours du mois précédant leur décès (7 %). Conclusion. Nous présentons plusieurs possibilités de réduire les décès attribuables à une intoxication aiguë chez les personnes sans logement, notamment lors de la prise de contact avec les services de santé et d'autres établissements, par des mesures de soutien à la réduction des méfaits liés à la consommation d'opioïdes et de stimulants ainsi que par la création d'environnements plus sûrs pour les personnes sans logement. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

(Pour lire l’article complet, en français ou anglais, cliquer sur le logo pdf à droite.) La Nouvelle-Calédonie est une collectivité française située dans la région du Pacifique Sud composée d’un ensemble d’îles et d’archipels. Les émeutes ont débuté en Nouvelle-Calédonie dans la soirée du 13 mai 2024 et provoqué une interruption soudaine et sans préavis de nombreux secteurs de la vie publique. Elles ont entraîné une désorganisation totale du système de santé et perturbé les soins des patients en dialyse péritonéale à domicile. Nous décrivons dans cet article l’expérience de l’équipe de dialyse péritonéale de l’Association pour le Traitement et la Prévention de l’Insuffisance Rénale en Nouvelle-Calédonie (Atir) pour la prise en charge de patients en dialyse péritonéale à domicile durant les 7 premières semaines des émeutes. Ces difficultés ont entraîné des modifications de prise en charge en dialyse (réutilisation de dispositifs à usage unique, non passage chez le patient de l’infirmier(e) libéral(e) à domicile ainsi que des baisses de volumes et/ou fréquence de dialyse). Notre étude concerne 35 patients en dialyse péritonéale, et non hospitalisés, au 12 mai 2024. Ces ajustements de prise en charge, ont sollicité toute la vigilance téléphonique de l’équipe soignante auprès des patients concernés. Elles n’ont pas entraîné de survenue d’événement grave sur les 7 semaines étudiées. Suite à cette expérience, les aspects principaux indispensables à une bonne réactivité dans ce contexte ont été : 1) Un référent médical d’équipe ayant une bonne connaissance des patients et de la géographie; 2) Une équipe de soignants en dialyse péritonéale coordonnée habituée à travailler ensemble; 3) Des outils partagés et accessibles en ligne avec la possibilité d’être déployés en télétravail pour l’ensemble des acteurs intervenant dans la prise en charge des patients de dialyse péritonéale; 4) Les formations harmonisées des patients et des infirmier(e)s libéraux dans le parcours de soin habituel.

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Copyright of Population & Sociétés is the property of Institut National d'Etudes Demographiques and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Scop. Studierea mortalității bolnavilor de tuberculoză prin boli asociate și alte cauze. Materiale și metode. A fost efectuată o analiză comparativă, retrospectivă a 222 cazuri de deces prin tuberculoză, boli asociate și alte cauze în mun. Chișinău în două perioade de timp: perioada I (2001-2003) - 157 și perioada II (2018- 2020) - 65 cazuri. Rezultate. În perioada II comparativ cu perioada I a avut loc o deplasare a vârstei spre 65+ (peste 1/3 cazuri); apro- ximativ ½ cazuri de decese au fost din cazurile de retratament; a predominat forma infiltrativă de tuberculoză; a crescut patologia oncologică; a scăzut numărul bolilor hepatice, au apărut cazuri de deces după ulcerul gastric perforant și COVID-19. În ambele perioade bolnavii au decedat și de alte cauze: În perioada I - septicemie - 2; accdente rutiere -15 , îngheț - 8 și suicide - 2 cazuri; În perioada II- peritonite -2, înec - 2, îngheț - 2, supradozarea drogurilor- 2 și suicid - 1 caz. Concluzie. Cele mai frecvente boli asociate care au contribuit la decesul bolnavilor de tuberculoză au fost: patologia oncologică, bolile sistemului cardiac, ictusul cerebral.

Polémique, la remise en question permanente des mesures de contention et de leur dangerosité permet aujourd'hui d'améliorer et d'actualiser les recommandations de bonne pratique en psychiatrie. L'étude d'un cas de décès par asphyxie d'un patient hospitalisé en soin psychiatrique sous contrainte nous permet de questionner les méthodes et manœuvres pouvant être employées pour la contention des patients souffrant du « syndrome de délire agité » tel que décrit dans la littérature. Une discussion des recommandations actuelles à propos de la contention physique et chimique, ainsi que sur les méthodes dites non violentes de désescalade, semble indispensable dans une démarche d'amélioration des pratiques, qu'elles soient intra-hospitalières ou extrahospitalières (premier contact avec les forces de l'ordre). Controversial, the constant questioning of restraint measures and the dangers associated with their use makes it possible for us to improve and update the recommendations for good practice in psychiatry. The case study of the death by asphyxiation of a patient hospitalized in psychiatric care and who had been restrained allows us to question the methods and procedures that can be used to restrain patients suffering from "agitated delirium syndrome" as described in the literature. A discussion of the current recommendations on physical and chemical restraint, as well as the so-called non-violent de-escalation methods, seems essential for developing an approach to improving practices, whether intra-hospital or extra-hospital (an initial contact with the police). [ABSTRACT FROM AUTHOR]

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Lorsqu’une personne vient à décéder, sa succession est ouverte au lieu où elle avait, lors de son décès, son domicile ou sa principale résidence . Au cas où le de cujus n’a pas laissé de testament, l’on se retrouve en face de la succession ab intestat ou légale car les modalités de gestion sont clairement définies par le Code de la famille. La succession ab intestat ou succession légale est celle dans laquelle la loi désigne, puisque le de cujus ne l’a pas fait, les personnes appelées à recueillir les biens du de cujus . L’établissement du testament revêt une importance capitale car cela réduit des risques des conflits post-mortem en ce sens que dans le testament on est libre de déterminer non seulement les modalités de gestions de ses biens après sa mort, mais aussi prendre toutes autres dispositions que l’on voudrait après son décès. Rien ne justifie que l’établissement d’un testament précipiterait sa mort. Nous recommandons l’établissement du testament pour pouvoir assurer la paix sociale au sein de sa famille après décès du testateur, lequel testament doit répondre aux exigences légales imposées en vue d’éviter tout empiétement sur la quotité disponible en dehors de ce qui revient aux héritiers réservataires car tout empiétement entraînerait la réduction de la quotité disponible.

The causes of death are of great importance in assessing the health status of the population and care'squality. Their study could guide health policies aimed at increasing life expectancy. Objectives: It was to determine the causes of death; to study the socio-demographic characteristics of deceased. Materials and methods: This was a retrospective and descriptive study of all deaths that occurred in the Medical Department of Sikasso Hospital from January 2018 to December 2020. Results: Among 265 deaths recorded, the mean age was 45.12 ± 17.5 years. The sex ratio was 1.59. They were mostly city dwellers and 51.64% lived in Sikasso city. The mean length of hospitalization was 7.09 ± 6.38 days. Kidney failure was the first reason for hospitalization. HIV infection was the leading cause of death (29.8%), followed by renal failure (24.2%). The male sex was predominant in all causes of death except HIV infection and anemia. Deaths linked to kidney failure have increased fivefold from 2018 to 2020. Conclusion: Deaths related to HIV/AIDS remain in the lead despite their strong reduction; those related to kidney failure have increased fivefold. [ABSTRACT FROM AUTHOR]

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Copyright of Population & Sociétés is the property of Institut National d'Etudes Demographiques and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Rezumat.Embolia pulmonară reprezintă o cauză majoră de mortalitate a pacienților care au suportat accident vascular cerebral și până la 50 % din decesele precoce ale pacienților spitalizați. Tabloul clinic nespecific determină erori de diagnostic și limitarea severă a inițierii tratamentului în timp util.Scopul studiului a fost analiza cazurilor ratate de embolie pulmonară la pacienții tratați cu accident vascular cerebral în cadrul cohortei instituționale prin analiza rezultatelor examinărilor morfopatologice. Materiale și metode. Studiu retrospectiv. A fost studiată Tromboembolia pulmonară ca cauză majoră de deces la pacienții cu accident vascular cerebral, internați în Institutul de Neurologie și Neurochirurgie Diomid în perioada 2017-2020. În studiu au fost incluși 13 pacienți cu diagnosticul confirmat morfopatologic. Rezultate. Studiul a cuprins 5 bărbați (38.5%) și 8 femei (61.5%) cu vârsta medie 65±5.2 ani. La toți pacienții diagnosticul de AVC a fost confirmat prin CT: accident vascular cerebral ischemic a fost stabilit la 6 pacienți (46.8%), AVC hemoragic la 4 pacienți (30.1 % ), dintre care 1 pacient a fost operat (7.7%), AVC cu transformare hemoragică la 3 pacienți (23.1%). Pentru 11 pacienți (84.6%) AVC a fost primar, iar pentru 2 pacienți (15.4%) repetat. Factorii de risc au fost hipertensiunea arterială - 12 pacienți (92.3%), la 8 pacienți (61.5%) obezitatea gradul II-IV, diabetul zaharat -5 pacienți (38.5%), fibrilația atrială la 5 pacienți (38.5%), 1 pacient (7.7%) cu tromboza în alte zone. Diagnosticul morfopatologic a stabilit ca embolia pulmonară a fost cauza de deces în toate cazurile, însă doar 2 (15.4%) pacienți au prezentat simptome specifice. Concluzie. Pacienții cu accident vascular cerebral prezintă un risc crescut de embolie pulmonară din cauza repausului la pat, paraliziei membrelor și factorilor de risc predispozanți, însă doar un mic număr de pacienți sunt diagnosticați în timp util, de aceea este important conștientizarea gravității problemei de către clinician și stabilirea protocoalelor stricte de profilaxie și tratament.

Goals We studied the socio-demographic and paraclinicalcharacteristics of tuberculosis patients to identify the factors associated with their deaths in Bamako. Materials and methods: A retrospective cohort study was carried out on tuberculosis patients registered in Bamako from October 1, 2017 to September 30, 2018. Quantitative variables were presented by their mean, qualitative ones by their proportions. Analysis was performed with R version 3.5.0. Results: Out of 2396 patients enrolled, 25 to 45-year olds represented 50.3% and children 4.51%; the average age 37.3 years; the sex ratio M/F 1.94 and co-infected TB/HIV 8.64%. 25 to 45 year olds (HR=2.58; 95% CI [1.35-4.92]; p=0,0042) and those ≥ 46 years (HR=4.64; 95% CI [2.39-9.01] ; p=5.69e-06) and positive HIV status (HR= 5.87 ; 95% CI [2.24-15.41] ; p= 0.0003) were associated with an increased risk of patient death. Conclusion: Tuberculosis affects young and old males. The risks of death identified were the patient's age and positive HIV status. We recommend specific monitoring of patients aged 25 to 45 and 46 and over and those with positive HIV status. [ABSTRACT FROM AUTHOR]

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Au fost studiate datele a 112 bolnavi, care au decedat prin tuberculoză pe parcursul a 3 ani (2018-2020) în Spitalul Municipal de Ftiziopneumologie din Chişinău. Bolnavii decedaţi au fost repartizaţi în două loturi: lotul 1 — 73(65,9%) din cazurile noi de tuberculoză pulmonară şi lotul 2 — 39(34,8%) cazuri din re-tratament. S-a constatat, că 55(75,5%) pacienţi din lotul 1 şi 22(56,4%) — din lotul 2 au decedat prin progresarea TB şi complicaţiile ei. Bolnavii au decedat prin alte boli în 18 (24,7%) din lotul 1 şi în 17(45,6%) cazuri — din lotul 2. În ambele loturi a predominat vârsta între 41 şi mai mult de 60 ani, persoanele neangajate, solitare, cu forme grave de tuberculoză (generalizată, pneumonie cazeoasă), fără loc de trai — 36(32,1%), cu co-infecţia TB/HIV — 26(23,21%), alcoolism — 58(51,8%) decedaţi. Din staţionarele somatice în stare gravă au fost transferaţi — 107(95,5%) pacienţii şi în 2/3 cazuri decesul a survenit în prima lună după internare

Les admissions hospitalières pour anaphylaxie alimentaire augmentent dans tous les pays mais la mortalité reste stable. Analyser rétrospectivement les cas d'anaphylaxie alimentaire, létale/prélétale (grade 4 selon Ring et Messmer, inefficacité cardio-circulatoire ou arrêt respiratoire), du Réseau d'Allergo-Vigilance® (2002–2020) et rechercher les facteurs associés à la survie. Parmi 2475 anaphylaxies alimentaires (1,7 %), 42 patients [âge moyen : 22,2 ans (ET : 19,3) ; âge < 18 ans : 60 %] ont présenté une anaphylaxie de grade 4 ; 19 (45 %) sont décédés. Parmi les antécédents, 21 (50 %) avaient un asthme, 33 (79 %) une allergie alimentaire connue dont 21 (50 %) pour le même allergène responsable de l'anaphylaxie grade 4. Les principaux allergènes étaient : arachide (33 %), laits (19 %), crevette (7 %), noisette et blé (5 %, respectivement). Il existait un bronchospasme dans 26 (62 %) cas et un angio-œdème laryngé dans 6 (14 %) cas. Un cofacteur était identifié dans 16 (38 %) cas, effort (21 %) et alcool (14 %). La réaction allergique survenait au domicile (n = 11, 26 %), à l'école ou au restaurant (n = 4, 10 %, chacun). Nous n'avons pas identifié de facteur associé à la survie. Les enfants avaient plus souvent un antécédent d'asthme (64 % versus 29 %, p = 0,01) et moins de cofacteurs (20 % versus 65 %, p = 0,02) que les adultes. Ces données alertent sur la fréquence des anaphylaxies sévères souvent sous-estimées. Elles confirment l'importance de facteurs de risque (asthme, allergie arachide-laits) et des cofacteurs chez l'adulte. Il faut mieux préciser le phénotype des patients à haut risque de réaction allergique grave et sélectionner ceux qui pourront bénéficier d'une prise en charge personnalisée (immunothérapie, biothérapie). Hospital admissions for food-induced anaphylaxis are increasing in most countries but mortality remains stable. Analyze retrospectively cases of letal/preletal food-induced anaphylaxis (grade 4 among Ring and Messmer classification) recorded by the Allergy-Vigilance® network (2002–2020) and assess factors associated with survival. Forty-two patients (male sex : 57%) of 2475 food anaphylaxis (1.7%) were recorded as grade 4 [mean age: 22.2 y (CI: 19.3) ; age < 18y: 60%] and 19 (45%) died. Twenty-one (50%) had a history of asthma, 33 (79%) of food allergy [21% (50%) with the same index food allergen] and 13 (31%) of previous anaphylaxis. The most frequent allergens were: peanut (33%), milks (19%), shrimp (7%), hazelnut and wheat (5%, respectively). Food allergen was uncertain in 10%. Clinical symptoms were bronchospasm in 26 (62%) of cases and laryngeal oedema in 6 (14%). A cofactor was identified in 16 (38%) cases, mostly physical exercise (21%) and alcohol (14%). Allergic reaction occurred at home (26%), at school or in a restaurant (10%, each). No factor associated with survival was identified. Children were more likely to have a history of asthma (64% versus 29%, P = 0.01) and less cofactors (20% versus 65%, P = 0.02) than adults. These data highlight on the high frequency of preletal anaphylaxis cases that are underestimated in epidemiological studies and also on the importance of risk factors (asthma, milks-peanut allergy) and cofactors in adults. It is necessary to better phenotype patients with a high risk of severe anaphylaxis and select those who will benefit a personalized approach (immunotherapy, biologicals). [ABSTRACT FROM AUTHOR]

Au fost supuse analizei comparative datele a 164 bolnavi decedați din retratament prin progresarea tuberculozei înstaționarele de profil în două perioade: I perioadă – 120 (73,2%) în anii 2001-2003 (perioada introducerii strategii DOTS)și a II-a perioadă – 44 (26,8%) bolnavi decedați în anii 2018-2020. S-a constatat că în perioada II comparativ cu perioadaI au decedat mai mulți bolnavi cu vârsta de peste 55 ani, a crescut de 6 ori numărul decedaților cu co-infecția HIV, eșeculterapeutic de 7 ori. A crescut formele infiltrativă și generalizată de tuberculoză și a scăzut forma fibro-cavitara. Peste ½din bolnavii decedați au avut tuberculoză rezistentă, inclusiv XDR (13,6%)

Copyright of Strategic Universe Journal / Univers Strategic is the property of Dimitrie Cantemir Christian University, Institute for Security Studies and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The cross-country relationship of coronavirus disease 2019 (COVID-19) case and death rates with previously measured income inequality and poverty in the pandemic's first wave is studied, controlling for other underlying factors, in a worldwide sample of countries. If the estimated associations are interpreted as causal, the Gini coefficient for income has a significant positive effect on both cases and deaths per capita in regressions using the full sample and for cases but not for deaths when Organisation for Economic Co-operation and Development (OECD) and non-OECD sub-samples are treated separately. The Gini coefficient for wealth has a significant positive effect on cases, but not on deaths, in both sub-samples and in the full sample. Poverty generally has weak positive effects in the full and non-OECD samples, but a relative poverty measure has a strong positive effect on cases in the OECD sample. Analysis of the gap between COVID-19 first-wave cases and deaths per capita in Canada and the higher rates in the United States indicates that 37 percent of the cases gap and 28 percent of the deaths gap could be attributed to the higher-income Gini in the United States according to the full-sample regressions. [ABSTRACT FROM AUTHOR]

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Bullous drug eruptions such as Toxic Epidermal Necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are rare but known adverse reactions of fluoroquinolones. Although uncommon, TEN can be life-threatening for the patient, especially in the context of delayed treatment and in fragile patients such as the pediatric population. In the present case, TEN occurred in a 13-year-old girl with no medical history following initiation of ciprofloxacin treatment for an inguinal cyst. We hope that the case report will make interrogate the practices concerning the use of antibiotics, in particular fluoroquinolones in the context of an use not prescribed by the Marketing Authorization of the drug in children. [ABSTRACT FROM AUTHOR]

Introduction: Due to the risk of overdoses increase especially with methadone, a reinforced monitoring has been set up by the French Addictovigilance Network following the first lockdown related to coronavirus disease 2019 (COVID-19). In this context, we managed a specific study to analyze overdoses related to methadone in 2020 compared to 2019., Material and Methods: We analyzed methadone-related overdoses which occurred in 2019 and 2020 from two sources: DRAMES program (deaths with toxicological analysis) and the French pharmacovigilance database (BNPV) (overdoses that did not lead to death)., Results: Data from DRAMES program in 2020 show methadone as the first drug involved in deaths as well as an increase in deaths: in number (n=230 versus n=178), in proportion (41% versus 35%) and number of deaths per 1000 exposed subjects (3.4 versus 2.8). According to BNPV, the number of overdose increased in 2020 compared to 2019 (98 versus 79; i.e., 1.2-fold increase) particularly during several target periods: first lockdown, end of lockdown/summer period and second lockdown. In 2020, a higher number of cases were observed in April (n=15) and May (n=15). Overdoses and deaths occurred in subjects enrolled in treatment programs or not (naïve subjects/occasional users who obtained methadone from street market or family/friends). Overdoses resulted from different factors: overconsumption, multiple drug use with depressants drugs or cocaine, injection, consumption for sedative, recreational purposes or voluntary drug poisoning., Discussion/conclusion: All these data show an increase of morbidity and mortality related to methadone during COVID-19 epidemic. This trend has been observed in other countries., (Copyright © 2023 Société française de pharmacologie et de thérapeutique. Published by Elsevier Masson SAS. All rights reserved.)

INTRODUCTION: Le risque de décès serait élevé dans les unités des soins intensifs (USI) des pays en développement. Nous décrivons les décès survenus à l´Unité des Soins Intensifs du Centre Mère et Enfant de Yaoundé au Cameroun. METHODES: étude rétrospective portant sur les caractéristiques cliniques, sociodémographiques, l´itinéraire thérapeutique ainsi que certains facteurs associés aux décès survenus entre 2010 et 2014 chez 200 patients âgés de 3-59 mois. RESULTATS: sur 2675 patients admis, 1807 étaient âgés de 3 à 59 mois et 303 sont décédés. Les taux de mortalité global et spécifique à cette tranche d´âge étaient de 11,3% et de 16,7% respectivement. La plupart (152/200 soit 76,0%) décédait à moins de 24 mois et le délai médian de leur admission était de 7 jours. Plus de la moitié (57,0%) avait recouru à un centre de santé et seuls 66 (33,3%) avaient bénéficié d´une référence. Le paludisme grave (24,0%), la pneumonie (18,0%) et la gastroentérite (16,0%) étaient les pathologies les plus incriminées. La malnutrition et le VIH/Sida constituaient les causes sous-jacentes de décès chez 23,0% et 20,5% de sujets respectivement. La présence de la gastroentérite multipliait le risque de décès d´environ 6 fois (OR = 5,76; P = 0,000) lorsque la malnutrition et l´infection à VIH étaient présentes. Les décès survenaient majoritairement (90,0%) dans les 72 heures d´admission. CONCLUSION: certaines pathologies auraient pu être traitées avec des moyens simples afin d´éviter les complications nécessitant une réanimation dans un contexte à ressources limitées. Il est crucial d´intensifier la lutte contre le paludisme, l´infection à VIH et la malnutrition.

Introducere. Începând cu anul 2016, România se confruntă cu o epidemie importantă de rujeolă apărută pe fondul unui procent tot mai scăzut de vaccinare. Evoluţia epidemiei a fost marcată şi de o creştere alarmantă a numărului de complicaţii şi decese. Materiale şi metode. Am evaluat retrospectiv 632 pacienţi diagnosticaţi cu rujeolă, internaţi în Spitalul Clinic de Boli Infecţioase şi Tropicale „Dr. Victor Babeş“, în perioada ianuarie 2016 – decembrie 2017. Datele epidemiologice, caracteristicile clinice şi rezultatele probelor biologice au fost obţinute din fişele medicale ale pacienţilor. Rezultate. Din cei 632 de pacienţi, 341 (53,9%) au fost de sex masculin. Grupa de vârstă cea mai afectată a fost 1-4 ani (39,2%), urmată de cea a sugarilor cu un procent de 19,6%. O treime din cazuri (31,3%) au avut contactul infectant în cadrul familiei. În ceea ce priveşte statusul vaccinal, aproape jumătate din pacienţi (47,1%) nu au fost vaccinaţi, iar 44,3% nu cunoşteau istoricul de vaccinare (probabil nevaccinaţi sau incomplet vaccinaţi). Complicaţiile virale au fost prezente la majoritatea pacienţilor (84,1%) sub forma unei pneumonii interstiţiale. Pneumonia bacteriană a fost prezentă la 15% dintre pacienţi, iar dintre aceştia 45,2% au asociat şi insuficienţă respiratorie. Şase pacienţi au necesitat transfer în secţia de terapie intensivă pediatrie pentru suport respirator, înregistrându-se 2 decese. Laringita a fost prezentă în 8,2% cazuri, otita în 12% cazuri, în timp ce 61,7% dintre pacienţi au avut afectare gastrointestinală. Paraclinic, a fost evidenţiată citoliza hepatică la 101 (15,9%) pacienţi şi diselectrolitemia a fost prezentă la 94 (14,8%) din cazuri. Concluzii. Studiul prezent arată creşterea alarmantă a incidenţei bolii şi a complicaţiilor sale în ultimii 3 ani, mai ales la vârstele mici. Considerăm imperios necesară aplicarea programului de vaccinare pentru a asigura o acoperire vaccinală optimă, utilă atât în stoparea epidemiei actuale, cât şi în prevenirea unor viitoare epidemii.

Les certificats de décès doivent mentionner la présence d'une prothèse fonctionnant avec une batterie et ses possibilités d'explantation. Cet acte ne peut être pratiqué que par un médecin ou un thanatologue. L'existence d'une infection par le SARS-CoV-2 ne modifie pas les exigences légales. In France, every death certificate must mention the presence of a prosthesis operating by means of a battery and its explantation or not. The explantation must be made regardless of the burial. Explantation can only be performed by a doctor or a thanatopractor. The health emergency related to covid-19 does not affect these principles of ordinary law. [ABSTRACT FROM AUTHOR]

Le décès est un évènement rare en pédopsychiatrie et il reste très peu étudié. Nous rapportons ici une recension de la littérature sur la mortalité en pédopsychiatrie et une série rétrospective depuis 2007 la mise en place des revues de mortalité et de morbidité réalisée dans un service hospitalo-universitaire disposant de plusieurs unités d'hospitalisation. La revue a colligé 73 études. Toutes concourent à confirmer la surmortalité des enfants et adolescents suivis en pédopsychiatrie qu'elle soit en population générale ou non spécifique (ex : patients hospitalisés) ou en population spécifique (ex : patients autistes). Les causes de surmortalité sont bien sûr le suicide mais également nombre de causes naturelles (ex : complications d'addiction ou d'anorexie mentale). Notre étude rétrospective collige 11 patients (âge moyen = 15,5 ans ; 9 filles pour 2 garçons) avec 5 décès et 14 situations engageant le pronostic vital (EPV). Là encore les suicides complétés et les tentatives de suicide graves sont très présents (n = 8 dont 2 décès), mais nous décrivons également des causes somatiques complications de conduites pathologiques (n = 5 : dénutrition dans un contexte d'anorexie, intoxication à l'eau) ou sous-tendues par une maladie somatique (n = 5, dont 2 décès liés à une maladie de Sanfilippo et un lymphome infiltrant du tronc cérébral). Tout comme en psychiatrie adulte, les enfants et adolescents atteints de troubles mentaux semblent avoir une espérance de vie diminuée par rapport à la population générale. Néanmoins, le décès en pédopsychiatrie reste un phénomène rare et ce d'autant plus lorsqu'il s'agit d'une prise en charge hospitalière. Notre étude met en évidence que les cas de décès ou d'EPV en pédopsychiatrie hospitalière sont dus à des maladies somatiques plus ou moins intriquées à des troubles psychiatriques, d'une part, et à des suicides, d'autre part. Death is a rare event in child psychiatry and still not widely studied. Here, we report a review of literature concerning mortality in child psychiatry and a retrospective study (begun in 2007) of the implementation of "mortality and morbidity reviews" carried out in a university hospital within several inpatient units. The review pulled together 73 studies, all of them confirming the excess mortality of children and adolescents in child psychiatry, whether in the general/non-specific populations (ex : hospitalized patients) or in specific populations (e.g. : autistic patients). The causes of excess mortality are undoubtedly suicide but also many natural causes (e.g. : complications due to addiction or anorexia nervosa). Our study includes 11 patients (mean average age = 15.5 years; 9 girls and 2 boys) and saw 5 deaths and 14 life-threatening situations. Again, suicides and serious suicide attempts were very common (n = 8 including 2 deaths), but the study also describes somatic causes, complications of pathological behaviour (n = 5 : undernutrition in the context of anorexia, water poisoning) or underlying somatic disease (n = 5, including 2 deaths related to Sanfilippo disease and infiltrative brain lymphoma). As with adult psychiatry, children and adolescents with mental disorders appear to have a lower life expectancy compared to the general population. Nevertheless, death in child psychiatry remains a rare phenomenon, especially when it happens in hospital care. Our study shows that cases of death or life-threatening situations in hospitalized child psychiatry are due to somatic diseases (that are more or less entangled with psychiatric disorders) or due to suicides. [ABSTRACT FROM AUTHOR]

Introduction: mortality risk is high at the Intensive Care Units (ICU) in developing countries. We here report the deaths occurred in the ICU at the Mother and Child Center in Yaounde, Cameroon. Methods: we conducted a retrospective study on the clinical, socio-demographic features, the therapeutic strategy as well as some of the factors associated with deaths occurred in 200 patients aged 3-59 months between 2010 and 2014. Results: out of 2675 patients included in the study, 1807 were aged 3-59 months and 303 died. The overall and cause-specific mortality rate in this age group was 11.3% and 16.7% respectively. Most patients (152/200; 76.0%) died within 24 months and the median admission time was 7 days. More than half of patients (57.0%) presented to a health center and only 66 (33.0%) presented to a referral hospital. Severe malaria (41.5%), pneumonia (22.7%) and gastroenteritis (27.8%) were the most common diseases. Malnutrition and HIV/AIDS were the underlying causes of death in 23.0% and 20.5% of patients respectively. Gastroenteritis multiplied the risk of death of approximately 6 times (OR = 5.76; p = 0.000) in patients affected by malnutrition and HIV infection. Deaths mainly occurred (90.0%) within 72 hours of admission. Conclusion: despite limited resources, some diseases could have been easily treated avoiding complications which require reanimation. It is essential to intensify the fight against malaria, HIV infection and malnutrition. [ABSTRACT FROM AUTHOR]

The present study aimed to know the perceptions of health professionals about the death of patients. A descriptive and exploratory qualitative study was carried out. Data collection was carried out through semi-structured interviews and observations. Seventeen doctors and nurses, who work in the emergency department at a teaching hospital in Rio Grande do Sul, were interviewed. The data obtained were submitted to triangulation based on content analysis. The results showed that defensive strategies are used to face situations considered stressful. Furthermore, the feelings raised are not elaborated by the professionals. It was concluded that defensive strategies are used when the death of patients occurs, but this does not reduce the suffering of professionals, so it is important that death is a topic of initial and continuing training among health professionals. [ABSTRACT FROM AUTHOR]

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Objectives: To analyse and present the literature describing the health consequences of falsified medicines, focusing on mortality and morbidity, as well as the scale of the issue, the geographic extent, the medicines affected, and the harm caused at both the individual and population levels.Methods: We searched for articles in PubMed, using pre-optimized keywords '(counterfeit OR fake OR bogus OR falsified OR spurious) AND (medicine OR drug)'. Searches up to February 2017 yielded 2006 hits, of which 1791 were full-length articles in English. Among them, we found 81 papers that qualitatively or quantitatively described 48 incidents in which falsified medicines caused patients to suffer serious adverse effects, injury, symptoms or death.Results: The distribution of incidents was examined according to the economic status of the countries involved, regional location in the world, therapeutic category of the medicines, number of incidents and victims by year, and characteristics of the falsified medicines. Among the 48 reported incidents, 27 (56.3%) occurred in developing countries and 21 (43.7%) in developed countries. These incidents involved a total of approximately 7200 casualties including 3604 deaths.Conclusions: Despite the poor quality of much of the reported data, the results of this study indicate that all types of medications have been targeted for falsification, and falsified medicines have had a serious impact on the health of both adults and children worldwide, with similar numbers of incidents in developing and developed countries. [ABSTRACT FROM AUTHOR]

INTRODUCTION : au Congo, les données concernant l'acidocétose diabétique (ACD) chez l'enfant sont anciennes et rares. Notre étude avait pour objectifs de décrire les caractéristiques sociodémographiques de l'ACD et d'identifier les facteurs de risque de décès.Méthodes: de Janvier 2013 à Juin 2016, nous avons réalisé une étude analytique portant sur l'ACD chez l'enfant au CHU de Brazzaville. Les variables sociodémographiques, cliniques, paracliniques et évolutives ont été étudiées. Les tests de Chi-2, de Fischer et l'odds ratios ont servi pour l'analyse univariée et le modèle de régression logistique pour l'analyse multivariée.Résultats: sur 172 enfants hospitalisés pour un diabète, 55(31%) l'étaient pour une acidocétose. Il s'agissait de 33(60%) filles, l'âge moyen: 11,1± 4,9 ans (extrêmes 1 mois et 17 ans), 61,8% des parents avaient un bas niveau socioéconomique. L'acidocétose était révélatrice dans 67,2 % de cas. Le diagnostic avant l'hospitalisation était erroné: 50%. Le facteur déclenchant était souvent infectieux (52,7%). La létalité était de 12,7%. Les facteurs de risque de décès en analyse univariée étaient : l'âge 5 ans (p=0,000006), le délai de consultation supérieur à 7 jours (p= 0,001), la déshydratation sévère (p = 0,0006), les troubles hémodynamiques (p= 0,0006), la dénutrition sévère (p= 0,02), le Glasgow 9 (p= 0,007) et la diarrhée (p= 0,001).Conclusion: l'importance et la gravité de l'acidocétose imposent des mesures de prévention axées sur la sensibilisation, l'information, l'éducation et la maîtrise des facteurs de risque de décès.

Résumé Le traitement de l'anaphylaxie en pratique courante repose, en première ligne, sur l'utilisation sans délai de l'adrénaline par voie intramusculaire. Les auto-injecteurs d'adrénaline permettent une injection dans des conditions d'efficacité et de sécurité optimales, mais dans une gamme de doses restreinte, entre 0,15 et 0,50 mg, par injection. Toutes les recommandations internationales sur le traitement de l'anaphylaxie en pratique courante valident une même posologie d'adrénaline de 0,01 mg/Kg de poids par injection intramusculaire (dose maximale de 0,5 mg par injection) malgré l'absence d'étude de qualité sur ce thème. Cette mise au point du groupe de travail « Anaphylaxie » de la Société française d'allergologie analyse les données actuelles concernant le traitement par adrénaline avec les auto-injecteurs, en insistant sur la problématique de la posologie. Abstract Intramuscular adrenaline is the first-line treatment for anaphylaxis. Adrenaline auto-injectors allow injection under conditions of optimal efficacy and safety, but commercially available formulations are restricted to a dose range of 0.15 and 0.50 mg per injection. All the international anaphylaxis guidelines recommend the administration of intramuscular adrenaline at a dose of 0.01 mg/Kg of body weight, with a maximum dose of 0.5 mg per injection, despite the lack of evidence-based data. This position statement, prepared by the Anaphylaxis working group of the French Allergology Society, attempts to analyse current data regarding the use of adrenaline auto-injectors as treatment of anaphylaxis with, in particular, emphasis on the dosage issue. [ABSTRACT FROM AUTHOR]

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Résumé La cystinurie est une maladie génétique à transmission autosomique récessive due à un défaut de transport transtubulaire de cystine et d’autres acides aminés dibasiques (ornithine, arginine et lysine). Nous rapportons le cas atypique d’un enfant hospitalisé au service de pédiatrie et d’urologie du centre hospitalier régional de Saint-Louis du Sénégal. Il s’agit d’un garçon de 6 ans. Il a été hospitalisé pour la première fois à l’âge de 4 ans pour une infection urinaire à Escherichia coli multirésistante traitée et guérie. Il a été réhospitalisé à l’âge de 5 ans pour lithiases urinaires objectivées à l’échographie dans un contexte d’infection urinaire à Alkalenses dispar. Le patient a été réadmis à l’âge de 6 ans pour des douleurs abdominales, une toux sèche quinteuse et une rétention aiguë d’urine évoluant depuis 24 heures L’analyse chimique des urines montrait une cystinurie 420 mg/24 heures et une créatinine urinaire à 135 μmol/24 heures L’examen cytobactériologique des urines (ECBU) avait isolé E. coli sécrétrice de bêta-lactamase sensible seulement à l’imipenème. La tomodensitométrie de l’arbre urinaire montrait des lithiases multiples avec une densité à 560 unités Hounsfield (UH) aux niveaux vésicale et urétérale avec une uretéro-hydronéphrose bilatérale sans anomalies malformatives visualisées. La chirurgie ouverte avait permi l’extraction de 2 calculs jaunâtres, durs, pierreux. La spectrophotométrie infrarouge avait conclu à une lithiase de type cystinique. L’évolution était marquée par la persistance du syndrome infectieux et la survenue d’un choc septique avec défaillance multiviscérale et une hémorragie de grande abondance de survenue brutale ayant évolué vers le décès. Summary Cystinuria is an inherited autosomal recessive inherited disease caused by transtubular transport defect of cystine and other dibasic amino acids (ornithine, arginine and lysine). We report the atypical case of a hospitalized child in the Pediatrics and Urology Department of the Saint-Louis Regional Hospital Center in Senegal. This is a 6-year-old boy. He was hospitalized for the first time at 4 years of age for a multiresistant Escherichia coli infection treated and cured. He was rehospitalized at the age of 5 for urolithiasis objectified on ultrasound in a context of urinary infection at Alkalenses dispar. The patient was readmitted at 6 years of age for abdominal pain, a dry, hacking cough, and acute urine retention that had been occurring for 24 hours. The chemical analysis of the urine showed 420 mg/24 h cystinuria and urinary creatinine at 135 μmol/24 h. Cytobacteriological examination of urine (ECBU) isolated Escherichia coli secreting beta-lactamase sensitive only to imipenem. Computed tomography of the urinary shaft showed multiple lithiases with a density of 560 Hounsfield (UH) units at the vesical and ureteral levels with bilateral uretero-hydronephrosis without visual malformation abnormalities. Open surgery had allowed the extraction of 2 yellowish, hard, stony calculi. Infrared spectrophotometry concluded that there was cystine lithiasis. The evolution was marked by the persistence of the infectious syndrome and the occurrence of septic shock with multi-visceral failure and a haemorrhage of great abundance of sudden occurrence that progressed to death. [ABSTRACT FROM AUTHOR]

The development of newborns' palliative care in delivery room has led professionals to develop new practices. We share the experience of the decision-making procedure and the accompaniment of 40 cases in a type 3 maternity ward: 16 extremely premature and 24 newborns with prenatal diagnosed pathology. The census of cases is uncertain and, while these practices require a lot of time and humanity, the written records they leave reveal that their legality is not obvious for all. [ABSTRACT FROM AUTHOR]

Introduction: In Congo, data on diabetic ketoacidosis (DKA) in children are old and rare. This study aims to describe the sociodemographic features of DKA and to identify risk factors for mortality. Patients and Methods: We conducted an analytical study on DKA in childred at the University Hospital in Brazzaville over the period from January 2013 to June 2016. We examined the socio-demographic, clinical, paraclinical and evolutionary variables. Chi-Square Test, Fisher's exact test and odds ratio were used in the univariate analysis process and logistic regression model in the multivariate analysis. Results: Out of 172 children hospitalized with diabetes 55 (31%) were hospitalized with ketoacidosis. They were girls (33; 60%) with an average age of 11.1± 4.9 years (ranging from 1 months to 17 years), 61.8% of parents came from low socioeconomic status. Ketoacidosis was the revealing symptom in 67.2 % of cases. The diagnosis made before hospitalization was wrong (50%). The triggering factor was often an infection (52.7%). Mortality rate was 12.7%. The risk factors for mortality in the univariate analysis were: age < 5 years (p=0,000006), average consultation time higher than 7 days (p= 0.001), severe dehydration (p = 0.0006), hemodynamic disorders (p= 0.0006), severe undernutrition (p= 0.02), Glasgow Coma Scale < 9 (p= 0.007) and diarrhea (p= 0.001). Conclusion: The importance and the seriousness of ketoacidosis impose preventive measures based on awareness, information and education campaigns as well as on the management of risk factors for mortality. [ABSTRACT FROM AUTHOR]

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Introducere. Începând cu anul 2016, România se confruntă cu o epidemie importantă de rujeolă apărută pe fondul unui procent tot mai scăzut de vaccinare. Evoluţia epidemiei a fost marcată şi de o creştere alarmantă a numărului de complicaţii şi decese. Materiale şi metode. Am evaluat retrospectiv 632 pacienţi diagnosticaţi cu rujeolă, internaţi în Spitalul Clinic de Boli Infecţioase şi Tropicale „Dr. Victor Babeş“, în perioada ianuarie 2016 - decembrie 2017. Datele epidemiologice, caracteristicile clinice şi rezultatele probelor biologice au fost obţinute din fişele medicale ale pacienţilor. Rezultate. Din cei 632 de pacienţi, 341 (53,9%) au fost de sex masculin. Grupa de vârstă cea mai afectată a fost 1-4 ani (39,2%), urmată de cea a sugarilor cu un procent de 19,6%. O treime din cazuri (31,3%) au avut contactul infectant în cadrul familiei. În ceea ce priveşte statusul vaccinal, aproape jumătate din pacienţi (47,1%) nu au fost vaccinaţi, iar 44,3% nu cunoşteau istoricul de vaccinare (probabil nevaccinaţi sau incomplet vaccinaţi). Complicaţiile virale au fost prezente la majoritatea pacienţilor (84,1%) sub forma unei pneumonii interstiţiale. Pneumonia bacteriană a fost prezentă la 15% dintre pacienţi, iar dintre aceştia 45,2% au asociat şi insuficienţă respiratorie. Şase pacienţi au necesitat transfer în secţia de terapie intensivă pediatrie pentru suport respirator, înregistrându-se 2 decese. Laringita a fost prezentă în 8,2% cazuri, otita în 12% cazuri, în timp ce 61,7% dintre pacienţi au avut afectare gastrointestinală. Paraclinic, a fost evidenţiată citoliza hepatică la 101 (15,9%) pacienţi şi diselectrolitemia a fost prezentă la 94 (14,8%) din cazuri. Concluzii. Studiul prezent arată creşterea alarmantă a incidenţei bolii şi a complicaţiilor sale în ultimii 3 ani, mai ales la vârstele mici. Considerăm imperios necesară aplicarea programului de vaccinare pentru a asigura o acoperire vaccinală optimă, utilă atât în stoparea epidemiei actuale, cât şi în prevenirea unor viitoare epidemii. [ABSTRACT FROM AUTHOR]

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Copyright of Médecine et Santé Tropicales is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Médecine et Santé Tropicales is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Résumé Le tabac, qui est un facteur de risque reconnu de développement d’une polyarthrite rhumatoïde (PR), peut également avoir un impact sur le devenir de la maladie. Les données sont assez bien documentées sur le tabagisme actif. En termes d’activité du rhumatisme, les résultats sont plutôt contradictoires. Il semble associé à une activité articulaire et systémique plus marquée au début de la maladie mais il n’apparaît pas prédictif d’une activité persistante de la maladie. S’agissant de la sévérité de la PR, le tabagisme actif n’est pas prédictif d’une progression structurale plus importante et aurait plutôt des effets « protecteurs ». En revanche, il contribue à la survenue de manifestations extra-articulaires (nodules rhumatoïdes, pneumopathie interstitielle infraclinique et symptomatique, parodontopathie, vascularite) et majore le risque d’infections sévères, d’infection périprothétique, de cancer pulmonaire et de décès. Quel que soit le statut immunologique, le tabagisme est associé à une moindre réponse au méthotrexate et aux 3 antagonistes du TNF (infliximab, etanercept et adalimumab) qui ont été évalués. Nous ne disposons pas d’informations de son impact sur les autres agents biologiques. En outre, les taux de rémission et de maintien thérapeutique sont moindres en cas d’exposition au tabac. Néanmoins, il n’a pas d’effet péjoratif en cas d’allégement ou d’arrêt du traitement. Alors que l’arrêt du tabac, qui reste un objectif difficile à atteindre en raison de plusieurs freins identifiés, ne semble pas modifier l’activité de la maladie, son intérêt demeure pour limiter l’apparition de manifestations extra-articulaires, de complications infectieuses et d’une surmortalité d’origine cardiorespiratoire ou tumorale. Tobacco, that is a well-known risk factor for rheumatoid arthritis (RA) development, can have an impact on disease outcome. Data are rather well-documented about active smoking. Concerning disease activity, there are contradictory results. While smoking is associated to a more important articular and systemic activity in early RA, it is not predictive of a persistent disease activity. In terms of disease severity, current smoking is not related to a higher radiographic progression and would have “protective effects”. But it enhances the occurrence of extra-articular manifestations (nodules, interstitial lung disease, periodontitis, vasculitis) and increases the risk of severe infections, periprosthetic joint infection, lung cancer and mortality. Whatever the immunological status, smoking is linked to a lower response to methotrexate and to the 3 TNF-blocking agents (infliximab, etanercept and adalimumab) that have been assessed until now. No informations are available about the other biologic agents. Moreover, remission and drug survival rates are lower under tobacco exposure. Nevertheless, active smoking has no deleterious effect in case of dose reduction or drug discontinuation. Although smoking cessation, which is an objective difficult to achieve because of several well-identified brakes, does not modify disease activity, its interest remains to reduce the appearance of extra-articular manifestations, severe infections and the risk of premature mortality due to cardiorespiratory comorbidities or cancer. [ABSTRACT FROM AUTHOR]