Internal and emergency medicine
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Algeria, like all emerging countries, has been going through a health transition over the past 30 years or so, characterized by a drop in mortality rates, an increase in life expectancy and a change in the causes of death in favor of chronic non-communicable diseases. In the past, the country mainly faced infectious diseases such as typhoid, cholera and malaria. The prevalence of the latter has been significantly reduced thanks to the many social health and vaccination programs undertaken by the health authorities. ⋯ According to the results of the latest national survey on the measurement of risk factors for non-communicable diseases (the Who StepWise approach), the prevalence of diabetes is close to 14.4% while the rate of obesity and overweight exceeds 50% of the population. High blood pressure has reached a prevalence rate of 23.6%. These diseases represent a real threat to our country's health, social and economic situation; they will lead to greater demands on health facilities and require more resources for intervention.
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Cardiometabolic risk factors in Tunisia are growing fast. The main risk factor is metabolic syndrome which is a global health issue in both developing and developed countries. ⋯ Hypertension and diabetes are also additional risk factors predicting alarming mortality rates. We propose here a review of the determinants of metabolic syndrome in Tunisia and the overall cardiometabolic risk factors.
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Anaemia is a highly prevalent condition, which negatively impacts on patients' cardiovascular performance and quality of life. Anaemia is mainly caused by disturbances of iron homeostasis. ⋯ Various mechanistic links between iron homeostasis, anaemia, and pulmonary hypertension have been described and current treatment guidelines suggest regular iron status assessment and the implementation of iron supplementation strategies in these patients. The pathophysiology, diagnostic assessment as well as current and future treatment options concerning iron deficiency with or without anaemia in individuals suffering from pulmonary hypertension are discussed within this review.
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In the last 2-3 decades internists have confronted dramatic changes in the pattern of patients acutely admitted to hospital wards. Internists observed a shift from younger subjects affected by a single organ disease to more complex patients, usually older, with multiple chronic conditions, attended by different specialists, with poor integration and treated with multiple drugs. In this regard, the concept of complex patients is addressed daily in clinical practice even if there is no agreed definition of patient complexity. ⋯ CIRS-SI was also the best predictor of all-cause of post-discharge mortality corrected for age and sex [OR: 2.12 (1.53-2.95)]. CIRS-SI (coefficient ± standard error: 1.23 ± 0.59; p < 0.0381) and CIRS-CI (coefficient ± standard error: 0.27 ± 0.10; p < 0.011) were strong predictors of LOS in comparison with NoC that did not result statistically significant (coefficient ± standard error: 0.04 ± 0.06 p < 0.0561). In conclusion, CIRS assessment of comorbidity burden is a better clinical tool in comparison with the simple count of comorbidities especially considering the length of hospital stay and all-cause mortality in hospitalized elderly patients.
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Observational Study
Infections in out-of-hospital and in-hospital post-cardiac arrest patients.
This study aims to describe infectious complications in both out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) patients with sustained return of spontaneous circulation (ROSC) and to compare differences in antimicrobial treatment and outcomes between the two groups. This was a retrospective, single-center, observational study. Adult patients (≥ 18 years) with OHCA or IHCA who had sustained ROSC between December 2007 to March 2015 were included. ⋯ We found significantly more infections in IHCA compared to OHCA patients. The most common infection category was respiratory and the most common organism isolated from sputum cultures was Staphylococcus aureus coagulase-positive. The incidence of culture-positive bacteremia was similar in both OHCA and IHCA cohorts but overall lower than previously reported.