La Revue du praticien
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Falciparum malaria remains a major killer in developing countries, particularly for African children. The sequestration of parasitized erythrocytes in the deep microvasculature is mostly mediated by their cytoadherence to activated endothelium. Proinflammatory cytokines and particularly tumor necrosis factor contribute to severe disease but the pathophysiology of coma remains poorly understood. ⋯ In non immune adults, pictures of severe sepsis with shock, acute renal failure and respiratory distress syndrome are common and often associated with bacterial coinfection. Although chemotherapy of malaria is challenged by the continuing evolution of antimalarial resistance, quinine remains the first-line drug for severe disease. The optimization of symptomatic management of severe malaria remains a major concern in developing countries.
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Brain death is defined as an irreversible damage to the brain stem associated with lesions of the hemispheres. It determines the irremediable destruction of the whole body which occurs within a short delay. Brain death diagnosis is identified from a series of neurological criteria, i.e.: the loss of consciousness, the disappearance of brainstem reflexes, the lack of spontaneous breathing movements. ⋯ Organ harvesting is organized according to guidelines for local practice and regional and national allocation. In consideration of transplantation requirements there is a persisting organ shortage for several years. Efforts must be directed toward an improvement in brain dead patients identification and management.