Transfer Of Patients Research Articles

Particularités de l'hypercalcémie des patients du CHU de Cocody- Côte d’Ivoire

describe the epidemiological, clinical, etiological and therapeutic aspects of hypercalcemia seen in the rheumatology department of Cocody University Hospital. Descriptive cross-sectional study carried out in the rheumatology department of Cocody University Hospital from January 2013 to July 2022 and covering the files of patients with hypercalcemia. The hospital frequency of hypercalcemia was 0.88%, or 60 cases out of 6771 hospitalizations during the study period. The workforce included 35 men and 25 women (M/F ratio=0.14), aged on average 56±11.52 years (range 25 and 80 years). The main reason for consultation related to the underlying disease was osteoarticular pain syndrome. The signs related to symptomatic hypercalcemia were digestive (23.33%), neurological (8.33%) and cardiovascular (5%). The main extra-articular signs were asthenia (90%) and weight loss (78.33%). On the biological level, there was a clear predominance of mild hypercalcemia (76.67%), followed by moderate hypercalcemia (10%) and severe hypercalcemia (13.33%). The etiologies were dominated by multiple myeloma (45%), followed by bone metastases (40%), granulomatosis (13.33%) and secondary hyperparathyroidism (1.67%). The molecules used for the treatment of hypercalcemia were corticosteroids and biophosphonates. The outcome was favorable in 18.33% of patients, and unspecified in 66.67% of cases due to the patient's transfer to another department. There were 9 deaths, or 15% of cases. Hypercalcemia is rare and most often asymptomatic in rheumatological hospitalizations in Abidjan. Multiple myeloma is the main etiology.

Detection and isolation of brain tumors in cancer patients using neural network techniques in MRI images

MRI imaging primarily focuses on the soft tissues of the human body, typically performed prior to a patient's transfer to the surgical suite for a medical procedure. However, utilizing MRI images for tumor diagnosis is a time-consuming process. To address these challenges, a new method for automatic brain tumor diagnosis was developed, employing a combination of image segmentation, feature extraction, and classification techniques to isolate the specific region of interest in an MRI image corresponding to a brain tumor. The proposed method in this study comprises five distinct steps. Firstly, image pre-processing is conducted, utilizing various filters to enhance image quality. Subsequently, image thresholding is applied to facilitate segmentation. Following segmentation, feature extraction is performed, analyzing morphological and structural properties of the images. Then, feature selection is carried out using principal component analysis (PCA). Finally, classification is performed using an artificial neural network (ANN). In total, 74 unique features were extracted from each image, resulting in a dataset of 144 observations. Principal component analysis was employed to select the top 8 most effective features. Artificial Neural Networks (ANNs) leverage comprehensive data and selective knowledge. Consequently, the proposed approach was evaluated and compared with alternative methods, resulting in significant improvements in precision, accuracy, and F1 score. The proposed method demonstrated notable increases in accuracy, with improvements of 99.3%, 97.3%, and 98.5% in accuracy, Sensitivity and F1 score. These findings highlight the efficiency of this approach in accurately segmenting and classifying MRI images.

Inkblots, Psychotherapy and the Tavistock Clinic

AbstractThe purpose of this article is to recount the early history of the Rorschach's inkblots test in Europe and the USA; its subsequent application in highlighting the ill effects on children of bombing during the Second World War; its wartime use in selecting military personnel; its post‐war use in selecting patients for psychotherapy at the Tavistock Clinic in London and subsequent decline in this use of Rorschach's inkblots in favour of focus on the psychotherapy patient's transference experience of the psychotherapist treating them. The article ends with evidence of interest, beyond psychotherapy, in Rorschach's inkblots and with the implications of this for the author's principal conclusion regarding the value of these inkblots in evoking the free association and conversation crucial to psychotherapy.

Successful Treatment of Pulmonary Embolism Causing Cardiac Arrests with Reteplase during Neurosurgery: A Case Report

Pulmonary embolism can cause cardiac arrest. Fibrinolytic therapy and surgical embolectomy can be used to manage it. This case report presents the clinical course of a patient who experienced intraoperative cardiac arrest resulting from massive pulmonary embolism. The patient encountered three instances of cardiac arrest requiring 35 minutes of cardiopulmonary resuscitation. Subsequent treatment involved the administration of reteplase, a thrombolytic agent. Following resuscitation, the patient developed multiple organ dysfunction in the intensive care unit, necessitating the use of diverse medications. Successful resolution of organ dysfunction led to the patient's transfer to the neurosurgery department. This case highlights the complexities involved in managing pulmonary embolism-induced cardiac arrest and subsequent multiorgan dysfunction, emphasizing the significance of a multidisciplinary approach in the comprehensive care and treatment of these patients.

Avoiding ICU Admission in a Case of Septic Encephalopathy Through Enhanced Connected Care Monitoring: A Case Study

Aim: To report a case of an elderly patient with septic encephalopathy admitted in the wards. With the help of enhanced connected care monitoring, ICU admission was avoided. Materials and Methods: An 81-year-old gentleman who is a known diabetic & hypertensive presented to the Emergency room with complaints of generalized weakness of bilateral upper & lower limbs and a recent history of acute gastroenteritis. The patient was evaluated and admitted to wards for further management. On examination, the patient is drowsy and arousable on call and hemodynamically stable. Stool biofire was sent, which was positive for Ecoli Shiga-toxin. A provisional diagnosis of septic encephalopathy was made. Because of background conditions and multiple issues, the patient was connected to Enhanced Care Monitoring (ECC). The patient was constantly monitored by a nurse and doctor from the command center. Three days after admission, the patient had an alert for desaturation with a low saturation of 74%, and immediately nursing staff was informed by the command center team. Shortly 2 hours later, one more critical alert was generated for Tachycardia HR 178/min. The nursing staff was informed by the command center team. Immediately bedside vitals were rechecked, and the doctor was informed, and the patient improved symptomatically with the management of sepsis and was discharged home. Discussion: Remote patient monitoring can track vital signs, identify deteriorating patterns at an early stage, and alert healthcare staff, reducing ICU admissions. This is illustrated in an elderly patient with septic encephalopathy, where continuous wireless monitoring enabled avoiding ICU admission. Enhanced care monitoring was done through wearable biosensors. Vital data obtained helped identify potential emergencies. Appropriate real-time responses avoided an ICU admission. Conclusion: Wearable and implanted sensors efficiently monitor elderly patients in wards without hindering mobility. The term "immediately" might be misleading, but it's crucial to emphasize that within two hours of observing consecutive signs of deterioration in the patient, swift action was taken. Addressing these concerning signs promptly prevented the need for the patient's transfer to the ICU, showcasing successful management within the ward setting.

Characteristics and correlates of seclusion and mechanical restraint measures in a Parisian psychiatric hospital group.

Seclusion or restraint (S/R) are last-resort measures used in psychiatry to ensure the safety of the patient and the staff. However, they have harmful physical and psychological effects on patients, and efforts to limit their use are needed. We describe the characteristics and correlates of S/R events in four Parisian psychiatric centers. Within a 3-month period, November 5, 2018 to February 3, 2019, we recorded data for patients experiencing an S/R measure as well as characteristics of the measures. We studied the mean duration of a S/R event, the time between hospital admission and the occurrence of the event, as well as correlates of these durations. We also examined factors associated with use of a restraint versus a seclusion measure. For the 233 patients included, we recorded 217 seclusion measures and 64 mechanical restraints. Seclusion measures mostly occurred after the patient's transfer from the emergency department. The duration of a seclusion measure was about 10 days. Patients considered resistant to psychotropic treatments more frequently had a longer seclusion duration than others. The mean duration of a mechanical restraint measure was 4 days. Male sex and younger age were associated with experiencing mechanical restraint. S/R measures mostly occur among patients perceived as resistant to psychotropic drugs who are arriving from the emergency department. Developing specific emergency department protocols might be useful in limiting the use of coercive measures.

Comparing outcomes following direct admission and early transfer to specialized trauma centers in open tibial fracture treatment: a systematic review and meta-analysis.

Guidelines on the management of open tibia fractures recommend timely treatment in a limb reconstruction center which offer joint orthopedic-trauma and plastic surgery services. However, patient's transfer between centers remains inevitable. This review aims to evaluate the clinical outcomes and hospital factors for patients directly admitted and transferred patients to a limb-reconstruction center. A research protocol adhering to PRISMA standards was established. The search included databases like MEDLINE, EMBASE, and the Cochrane library up until March 2023. Nine articles met the inclusion criteria, focusing on open tibia fractures. Exclusion criteria were experimental studies, animal studies, and case reports. Outcomes of interest were operation and infection rates, nonunion, limb salvage, and the Enneking limb score. The analysis involved data from 520 patients across nine studies published between 1990 and 2023, with the majority (83.8%) having Gustilo Anderson type III open tibia fractures. Directly admitted patients showed lower overall infection rates (RR 0.30; 95% CI 0.10-0.90; P = 0.03) and fewer deep infections (RR 0.39; 95% CI 0.22-0.68; P = 0.001) compared to transferred patients. Transferred patients experienced an average five-day delay in soft tissue closure and extended hospital stays by eight days. Patients transferred without initial surgical management underwent fewer total surgical procedures. The direct admission group displayed more favorable functional outcomes. Low- to moderate-quality evidence indicates worse clinical outcomes for transferred patients compared to directly admitted patients. Early treatment in specialized limb reconstruction units is essential for improved results in the management of open tibia fractures. Therapeutic level IIa.

Family carers' experiences regarding patient transfers between care settings in palliative care: an interview study.

To understand how family carers experienced the illness trajectory of their next of kin related to transfers taken place between care settings in palliative care, their experiences and attitude regarding the transfer decision and their experiences regarding patient transfers across settings. Semi-structured interviews were held with 21 family carers. A constant comparative approach was used to analyze data. Three themes were identified after data analysis: (I) patient transfer dynamics, (II) experiences regarding the changed care environment and (III) impact of the transfer on the family carer. The dynamics of the patient's transfer were affected by the balance between the care provision (professional and informal care) and the changes in the patient's needs. Experiences regarding patient transfers strongly varied depending on the setting and were based on the personnel's conduct and the quality of receiving information. Study results revealed shortcomings in perceived inter-professional communication and continuity of information during a patient's hospitalization. Concomitant feelings of relief, anxiety or feeling insecure could arise in situations of a patient's transfer. This study highlighted the adaptability of family carers when caring for their next of kin with palliative care needs. To support carers in coping with their role as caregivers and to share the responsibility of caregiving, involved healthcare professionals should timely evaluate family carers' preferences and needs and adapt the care organization accordingly. A pro-active attitude, which anticipates on the possibility of an impending decompensation of the family carer, is recommended. When the decision for a patient's transfer is taken, multiple factors influenced the choice of the care setting. Healthcare professionals need to take these factors into account when discussing, with patients and carers, the need for a transfer. Continuity of information can be improved. Further development and evaluation of interventions, aimed at improving informational continuity can be recommended.

The Effect of Easily Implementable Changes to the "D's of Stroke Care" in Reducing Sex Disparity in Door-to-Needle Time.

Door-to-needle (DTN) is the duration between patient's arrival at the hospital and receiving intravenous thrombolysis in ischemic stroke settings, for which studies have reported delays in women. The "D's of stroke care" describes 8 steps (D1 to D8) in patients' time tracker. We implemented simple modifications to the "D's of stroke care" by splitting D4 and D6 steps into these substeps: patients' arrival to the emergency room (D4-A), early assessment by a neurologist (D4-B), neurologist decision on patient's eligibility to receive recombinant tissue plasminogen activator (D6-A), and patient's transfer to the stroke unit (D6-B). We evaluated the effect of these changes on reducing DTN time disparity between men and women. This study was conducted from September 2019 to August 2021, at a comprehensive stroke center. Patients were analyzed in 2 groups: group 1, before, and group 2, after using the modifications. Sex as the main variable of interest along with other covariates was regressed toward the DTN time. In groups 1 and 2, 47 and 56 patients received intravenous thrombolysis, respectively. Although there was a significant difference in DTN≤1 hour between women and men in group 1 (36% vs. 52%, P=0.019), it was not significantly different in group 2 (P=0.97). Regression analysis showed being female was a significant predictor of DTN>1 hour in group 1 (adjusted odds ratio=6.65, P=0.02), whereas after using the modifications, sex was not a significant predictor for delayed DTN. Implementing these substeps reduced sex disparity in DTN time in our center.

An unmanned emergency blood dispatch system based on an early prediction and fast delivery strategy: Design and development study

Background and objectiveFor severe trauma patients, hemorrhage is the most common cause of medically preventable deaths. Early transfusion is beneficial to major hemorrhagic patients. However, the early supply of emergency blood products for major hemorrhagic patients is still a major problem in many areas. The aim of this study was to design and develop an unmanned emergency blood dispatch system for the fast delivery of blood resources and rapid emergency response to trauma events, especially those with mass hemorrhagic trauma patients and those occurred in remote areas. MethodsBased on the process of emergency medical services for trauma patients, we introduced unmanned aerial vehicle (UAV) and designed the main flowchart of the dispatch system, which combines an emergency transfusion prediction model and UAV-related dispatch algorithms to improve first aid efficiency and quality. The system identifies patients in need of emergency transfusion through a multidimensional prediction model. Then, by analyzing the blood center, hospitals and UAV stations nearby, the system recommends the patient's transfer destination for emergency transfusion and dispatch schemes of UAVs and trucks for a fast supply of blood products. Simulation experiments of urban and rural scenarios were conducted to evaluate the proposed system. ResultsThe developed emergency transfusion prediction model of the proposed system achieves a higher AUROC value of 0.8453 than a classical transfusion prediction score. In the urban experiment, by adopting the proposed system, the average wait time per patient decreased from 32 to 18 min, and the total time decreased from 42 to 29 min. Owing to the combination of the prediction and the fast delivery function, the proposed system took 4 and 11 min less wait time than the strategy with only the prediction function and the strategy with only the fast delivery function, respectively. In the rural experiment, for trauma patients requiring an emergency transfusion at 4 locations, the wait time for transfusion under the proposed system was 16.54, 17.08, 38.70 and 46.00 min less than that under the conventional strategy. The health status-related score increased by 6.9%, 0.9%, 19.1% and 36.7%, respectively. ConclusionsExperimental results demonstrate that the proposed system works well with a faster blood supply speed for severe hemorrhagic patients and better health status. With the assistance of the system, emergency doctors at the scene of an injury are able to comprehensively analyze patients’ status and the surrounding rescue conditions and then make decisions, especially when encountering mass casualties or casualties in remote areas.

Myeloproliferative Syndrome - A Diagnosis on the Border Between Medical Specialties

Abstract Background. Myeloproliferative disorders define a vast and heteregenous group of neoplastic entities, characterized by malignant proliferation of blood cells. These may affect multiple tissues, some of these malignancies involving organs in which there is lymphoid tissue. Case report. A 81-year-old female patient was admitted to the Department of Internal Medicine with moderate-to-intense spontaneous pain in the left hypochondrial and in the left abdominal flank, associated with generalized fatigue and loss of appetite. According to the personal medical history, the patient is known with type II diabetes mellitus, being under treatment with oral antidiabetics (metformin 1000 mg), and arterial hypertension under treatment with candesartan. Upon admission, the physical examination revealed cutaneous and mucosal pallor and marked physical weakness. Abdominal palpation revealed pain in the left hypochondrial and in the left abdominal flank, associated with firm and massive splenomegaly, descending towards the umbilicus. Abdominal ultrasound confirmed massive splenomegaly, associated with moderate hepatomegaly. Blood analysis revealed several modifications, indicative of hypochromic normocytic anemia, associated with lymphocytosis, thrombocytopenia and neutropenia. C-reactive protein (CRP) serum levels were in normal range upon admission. All of these modifications suggested a possible leukemogenous or lymphoid malignancy, which resulted in the patient's transfer towards the Department of Hematology, for further investigations. Conclusions. Massive splenomegaly, associated with anemia and thrombocytopenia in elderly patients, should always indicate a leukemogenous or lymphoid malignancy and a thorough differential diagnosis and collaboration between internists and hematologists is required.

Complexity of Transferred Geriatric Adults Requiring Emergency General Surgery: A Rural Tertiary Center Experience

IntroductionAs the American population ages, the number of geriatric adults requiring emergency general surgery (EGS) care is increasing. EGS regionalization could significantly affect the pattern of care for rural older adults. The aim of this study was to determine the current pattern of care for geriatric EGS patients at our rural academic center, with a focus on transfer status. Materials and methodsWe performed a retrospective chart review of patients aged ≥65 undergoing EGS procedures within 48 h of admission from 2014 to 2019 at our rural academic medical center. We collected demographic, admission, operative, and outcomes data. The primary outcomes of interest were mortality and nonhome discharge. Univariate and multivariate analyses were performed. ResultsOver the 5-y study period, 674 patients underwent EGS procedures, with 407 (60%) transferred to our facility. Transfer patients (TPs) had higher American Society of Anesthesiology (ASA) scores (P < 0.001), higher rates of open abdomen (13% versus 5.6%, P = 0.001), and multiple operations (24 versus 11%, P < 0.001) than direct admit patients. However, after adjustment there was no difference in mortality (OR 1.64; 95% CI, 0.82-3.38) or nonhome discharge (OR 1.49; 95% CI, 0.95-2.36). ConclusionsAt our institution, the majority of rural geriatric EGS patients were transferred from another hospital for care. These patients had higher medical and operative complexity than patients presenting directly to our facility for care. After adjustment, transfer status was not independently associated with in-hospital mortality or nonhome discharge. These patients were appropriately transferred given their level of complexity.

High-flow continuous hemodiafiltration successfully decreased blood pregabalin levels in a patient with severe pregabalin intoxication: a case report

BackgroundSevere pregabalin intoxication may cause serious symptoms, such as coma. Since pregabalin is a small molecule with no protein binding sites and has low volume of distribution, hemodialysis can be effective in eliminating pregabalin from the blood. However, in cases of emergency, it is not always possible to perform hemodialysis because of limited availability and time delay associated with using the plumbing equipment. Continuous hemodiafiltration (CHDF) can be performed without plumbing equipment; however, the knowledge on the effectiveness of CHDF in pregabalin elimination is insufficient.Case presentationA septuagenarian woman with normal renal function was found in a collapsed state with symptoms of coma and miosis. Empty medical bags of pregabalin (2350 mg), bepotastine besilate (600 mg), celecoxib (4600 mg), quetiapine fumarate (87.5 mg), clotiazepam (180 mg), and teprenone (50 mg) were found around her. During the patient's transfer to our hospital, her cognition worsened and she developed glossoptosis necessitating her emergent intubation upon arrival. We considered that the coma was mainly caused by pregabalin intoxication and were concerned about the consequent critical comorbidities. Thus, we performed CHDF in a high-flow setting in our intensive care unit for pregabalin elimination. After 8 h of CHDF, the patient regained consciousness, and after 6.5 h we extubated her. At a later date, we measured her serum pregabalin levels during the clinical course and estimated the blood pregabalin clearance levels depending on her metabolism as 76.8 mL/min and depending on CHDF itself as 65.1 mL/min. Based on these findings, we concluded that CHDF contributed to reducing blood pregabalin levels in this patient.ConclusionsOur case revealed that pregabalin clearance using CHDF is similar to metabolic clearance in patients with normal renal function, indicating that CHDF decreases blood pregabalin levels and can be a potential treatment for severe pregabalin intoxication.

Managing Transference and Countertransference in Cognitive Behavioral Supervision: Theoretical Framework and Clinical Application.

Dysfunctional patterns, beliefs, and assumptions that affect a patient’s perception of other people often affect their perceptions and behaviours towards the therapist. This tendency has been traditionally called transference for its psychoanalytical roots and presents an important factor to monitor and process. In supervision, it is important to put the patient’s transference in the context of the conceptualization of the case. Countertransference occurs when the therapist responds complementary to the patient’s transference based on their own dysfunctional beliefs or assumptions. Transference and countertransference provide useful insights into the inner world of the patient, therapist, and supervisor. Guided discovery is one of the most common approaches used by a supervisor and a supervisee to map all types and directions of transference and countertransference. Other options to map transference and countertransference are imagery and role-playing techniques.

Prediction of Postoperative Mortality in Patients With Organ Failure Following Pancreaticoduodenectomy.

Failure to rescue (FTR) patients with postoperative complications contribute to a significant proportion of postoperative mortality. Our main objective was to determine the risk factors for FTR among patients undergoing pancreaticoduodenectomy who suffered a life-threatening complication requiring intensive care unit (ICU) management. Consecutive patients undergoing pancreaticoduodenectomy from 2011 to 2020 were reviewed retrospectively. Causes of organ failure were described as the one that most commonly contributed to patient's transfer to ICU or death. Two groups were created based on whether patients had FTR and risk factors for FTR were compared. The impact of baseline characteristics, operative characteristics, and risk scoring on FTR was analyzed using multiple logistic regression. There were 19/58 (33%) FTR patients. Baseline, operative characteristics, postoperative complications, and length of hospital and ICU stay were similar between groups. However, a higher proportion of FTR patients experienced a postoperative pancreatic fistula (POPF) (16% vs 2.6%, P = .062). Among patients who experienced a POPF, the FTR group had a trend in delayed time from diagnosis to treatment (7 vs 23 hours, P=.131). Renal complications (OR 6.12, 95% CI, 1.23 to 38.43, P = .035) and time from POPF diagnosis to treatment (OR 1.05, 95% CI, 1.00 to 1.11, P = .036) were independent predictors of FTR by multivariable analysis. The occurrence of certain postoperative complications such as renal complications as well as delayed timing of the management of POPF is predictive of FTR following pancreaticoduodenectomy, especially as delayed timing to treatment is a risk factor for FTR.

Effect of Parameters on Lumbar Compressive Force during Patient Transfer

Patient transfer (PT) tasks are a significant cause of low back pain (LBP) in caregivers. Adopting proper motion strategies is an effective and inexpensive approach to reduce the risk of LBP. However, since the standardization of PT tasks is not specified in ISO 11228, there is an increasing need to develop a quantitative assessment method for the lumbar safety of caregivers. Therefore, we aim to determine the effect of representative factors, extracted from caregivers’ movements and of external force, on peak compressive force (CF) in patient transfer tasks using the lumbar compressive force as a criterion. The CF at the lumbar region is estimated using a biomechanical simulator, and regression analysis is performed between the estimated CF and representative factors. The results imply that peak CF occurs in the incipience of transfer and occurs after the occurrence of the peak trunk angle. The results also indicate that the peak CF can be reduced by preventing the representative factors from simultaneously reaching the maximum values. In this study, we provide a method of reducing peak CF by estimating the timing and magnitude of the peak to help caregivers assess the severity of LBP risk in actual PT, which is expected to contribute to the standardization of PT tasks.

If early warning systems are used, would it be possible to estimate early clinical deterioration risk and prevent readmission to intensive care?

Although the intensive care unit (ICU) admission criteria are specified clearly, it is difficult to make the decision of discharge from ICU. The purpose of this study is to test whether or not early warning scores will allow us to estimate early clinical deterioration within 24 hours and predict readmission to intensive care. A total of 1330 patients were included in the retrospective study. All the patients' age, gender, ICU hospitalization reasons and Acute Physiological and Chronic Health Evaluation (APACHE II) scores were recorded. National Early Warning Score (NEWS) and VitalpacTM early warning score (VIEWS) scores were calculated using the physiological and neurological examination records. Discharge NEWS and VIEWS values of the patients who were readmitted to intensive care 24 hours after discharge were compared with the patients who were not readmitted to intensive care. The statistical analysis was performed using the IBM SPSS version 21 package software. Age average of all the patients was 64.3 ± 20.8 years. The number of the patients who were readmitted to intensive care was 118 (8.87%). When examining the factors that affect early clinical deterioration, it was found that advanced age, high APACHE II scores, higher NEWS and VIEWS scores, lower DAP values and the patient's transfer from the ward were significantly predictive (P < 0.05). In this study, high NEWS and VIEWS are strong scoring systems that can be used in estimating early clinical deterioration risk and are easy-to-use and less time consuming.

The Impact of the Patient's State on the Destination Care Unit Choice Within the Health Emergency Services Regional Network (HES-RN) in Morocco

In the health sector and in order to avoid life threatening situations, it is obvious that the patient's state of severity has a very strong impact on what the patient's transfer time should not exceed. In this paper, we are interested in the dynamic evolution of these states of severity and the decision, to which Care Unit of destination (CUd) should the concerned patient be transferred as quickly as possible, may be most critical. In this sense, we present a model that allows us to conclude on the choice of the different candidate CUd to receive the patient, which takes into account both the CU qualification and the severity of the Occurrence of events of Health Emergency (OHE) in question.

Postoperative Pernicious Malarial Crisis in Patient Coming Back from an Endemic Area

The case of a young Moroccan doctor who spent Four months in Congo as part of an international humanitarian military mission; he underwent surgery under spinal anesthesia for an anal fissure a week after being returned to Morocco, In the seventh-day postoperative period, acute renal failure with anuria set in, justifying the patient's transfer to an intensive care unit. Upon admission, on the eighth postoperative day, one day after readmission to the emergency room and was put on triple antibiotic therapy ,and liquid resuscitation was carried out immediately by infusion of saline isotonic solution and due to the non-improvement of the hemodynamic state after volume repletion, a vasoactive support was rapidly introduced at the initial dose of 0.2 ug / kg / min, the intravenous quinine was not immediately introduced in the emergency room because the initial thick, thin film and malaria blood smear carried out on admission were negative and the postoperative clinical context argued in favor of bacterial septic shock. A sepsis context not ruled out (blood cultures performed); a surgical revision the morning of his admission to the intensive care by under umbilical laparotomy, didn’t showed an intra-abdominal collection. Parallelly a thick film (30% of parasitized red blood cells) revealing P. falciparum, and blood smear were performed again and came back positive after a positive malaria antigen detection of specific IgMs in the indirect immunofluorescence, confirming the diagnosis. The mode of infection; is associated with the end of chemoprophylaxis rigorously followed up till Finally, the possibility of pernicious malaria aggravating the initial acute renal failure and hipocalcemia is also discussed.

A new telestroke network system in northern area of Okayama prefecture

AbstractBackgroundTelestroke network can provide rapid access to specialized treatment and improves on‐site management of acute stroke patients through the “hub‐and‐spoke” model. In the northern part of Okayama Prefecture, there has been a regional gap of stroke care due to the shortage of stroke specialists and facilities. In addition, due to the novel coronavirus disease 2019 (COVID‐19), it is required to reduce the unnecessary contact with stroke patients from other hospitals.AimWe organized a novel cost‐free telestroke network with an image and video sharing for neurological diseases in the northern part of Okayama Prefecture to improve the stroke management in the area.MethodWe prepared the tablet device on which Skype® application was installed for each hospital and recruited the patients who visited or hospitalized in the spoke hospitals and were suspected to have some neurological diseases from April 2019 to May 2020. The patient's clinical data were recorded and analyzed.ResultsDuring the study period, 5 patients were recruited including the cases with the initial diagnosis of stroke or brain tumor. Among them, 2 cases were transferred to the hub hospital, 2 cases were transferred to other hospitals, and 1 case was treated on site under specialist's advice.ConclusionThe new telestroke network system may be beneficial for acute stroke management and reducing the unnecessary patient's transfer in the rural area, especially under coexistence with COVID‐19.