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151.
Damien Contou Romain Sonneville Florence Canoui-Poitrine Gwenhaël Colin Rémi Coudroy Frédéric Pène Jean-Marc Tadié Martin Cour Gaëtan Béduneau Antoine Marchalot Laurent Guérin Sébastien Jochmans Stephan Ehrmann Nicolas Terzi Sébastien Préau François Barbier Guillaume Schnell Damien Roux Olivier Leroy Claire Pichereau Elodie Gélisse Lara Zafrani Richard Layese Christian Brun-Buisson Armand Mekontso Dessap Nicolas de Prost For the Hopeful Study Group 《Intensive care medicine》2018,44(9):1502-1511
Purpose
Data on purpura fulminans (PF) in adult patients are scarce and mainly limited to meningococcal infections. Our aim has been to report the clinical features and outcomes of adult patients admitted in the intensive care unit (ICU) for an infectious PF, as well as the predictive factors for limb amputation and mortality.Methods
A 17-year national multicenter retrospective cohort study in 55 ICUs in France from 2000 to 2016, including adult patients admitted for an infectious PF defined by a sudden and extensive purpura, together with the need for vasopressor support. Primary outcome variables included hospital mortality and amputation during the follow-up period (time between ICU admission and amputation, death or end of follow-up).Results
Among the 306 included patients, 126 (41.2%; 95% CI 35.6–46.9) died and 180 (58.8%; 95% CI 53.3–64.3) survived during the follow-up period [13 (3–24) days], including 51/180 patients (28.3%, 95% CI 21.9–35.5) who eventually required limb amputations, with a median number of 3 (1–4) limbs amputated. The two predominantly identified microorganisms were Neisseria meningitidis (63.7%) and Streptococcus pneumoniae (21.9%). By multivariable Cox model, SAPS II [hazard-ratio (HR)?=?1.03 (1.02–1.04); p?<?0.001], lower leucocytes [HR 0.83 (0.69–0.99); p?=?0.034] and platelet counts [HR 0.77 (0.60–0.91); p?=?0.007], and arterial blood lactate levels [HR 2.71 (1.68–4.38); p?<?0.001] were independently associated with hospital death, while a neck stiffness [HR?0.51 (0.28–0.92); p?=?0.026] was a protective factor. Infection with Streptococcus pneumoniae [sub-hazard ratio 1.89 (1.06–3.38); p?=?0.032], together with arterial lactate levels and ICU admission temperature, was independently associated with amputation by a competing risks analysis.Conclusion
Purpura fulminans carries a high mortality and morbidity. Pneumococcal PF leads to a higher risk of amputation.Trials registration
NCT03216577.152.
M C de Aguiar Remigio C T Brandt C C L Santos T E Arantes M I R de Aguiar 《Eye (London, England)》2015,29(4):465-468
Purpose
To evaluate macular and retinal nerve fibre layer (RNFL) measurements in patients with cyanotic congenital heart disease (cCHD) using spectral domain optical coherence tomography (OCT).Patients and methods
Thirty patients with cCHD (18 females and 12 males, mean age 10.9 years) and 60 healthy controls (35 females and 25 males, mean age 11.2 years) underwent complete ophthalmologic examination and OCT measurements of macular and peripapillary RNFL thickness.Results
Patients with cCHD had significantly thinner measurements in all macular subfields compared with healthy controls (P<0.001). There was no significant difference in peripapillary RNFL thickness between the two groups, with the exception of the upper quadrant, for which thickness measurements were higher in patients with cCHD (P=0.021).Conclusions
Patients with cCHD showed a significant decrease in macular thickness and a thickened superior quadrant RNFL thickness when compared with healthy controls. This may represent the damage caused by the effect of hypoxia. 相似文献153.
154.
Mohammed Al Thani Al Anoud Al Thani Walaa Al-Chetachi Badria Al Malki Shamseldin A. H. Khalifa Ahmad Haj Bakri Nahla Hwalla Lara Nasreddine Farah Naja 《Nutrients》2015,7(9):7593-7615
Women of childbearing age are particularly vulnerable to the adverse effects of elevated blood pressure (BP), with dietary and lifestyle habits being increasingly recognized as important modifiable environmental risk factors for this condition. Using data from the National STEPwise survey conducted in Qatar in year 2012, we aimed to examine lifestyle patterns and their association with elevated BP among Qatari women of childbearing age (18–45 years). Socio-demographic, lifestyle, dietary, anthropometric and BP data were used (n = 747). Principal component factor analysis was applied to identify the patterns using the frequency of consumption of 13 foods/food groups, physical activity level, and smoking status. Multivariate logistic regression analyses were used to evaluate the association of the identified lifestyle patterns with elevated BP and to examine the socio-demographic correlates of these patterns. Three lifestyle patterns were identified: a “healthy” pattern characterized by intake of fruits, natural juices, and vegetables; a “fast food & smoking” pattern characterized by fast foods, sweetened beverages, and sweets, in addition to smoking; and a “traditional sedentary” pattern which consisted of refined grains, dairy products, and meat in addition to low physical activity. The fast food & smoking and the traditional & sedentary patterns were associated with an approximately 2-fold increase in the risk of elevated BP in the study population. The findings of this study highlight the synergistic effect that diet, smoking and physical inactivity may have on the risk of elevated BP among Qatari women. 相似文献
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