How Do I Integrate Hemodynamic Variables When Managing Septic Shock?

Olfa Hamzaoui,Jean-Louis Teboul 대한중환자의학회 2016 Acute and Critical Care Vol.31 No.4

Hemodynamic management of sepsis-induced circulatory failure is complex since this pathological state includes multiple cardiovascular derangements that can vary from patient to patient according to the degree of hypovolemia, of vascular tone depression, of myocardial depression and of microvascular dysfunction. The treatment of the sepsis-induced circulatory failure is thus not univocal and should be adapted on an individual basis. As physical examination is insufficient to obtain a comprehensive picture of the hemodynamic status, numerous hemodynamic variables more or less invasively collected, have been proposed to well assess the severity of each component of the circulatory failure and to monitor the response to therapy. In this article, we first describe the hemodynamic variables, which are the most relevant to be used, emphasizing on their physiological meaning, their validation and their limitations in patients with septic shock. We then proposed a general approach for managing patients with septic shock by describing the logical steps that need to be followed in order to select and deliver the most appropriate therapies. This therapeutic approach is essentially based on knowledge of physiology, of pathophysiology of sepsis, and of published data from clinical studies that addressed the issue of hemodynamic management of septic shock.

Association of Single Nucleotide Polymorphisms in Toll-like Receptor Genes With Asthma Risk: A Systematic Review and Meta-analysis

Kalthoum Tizaoui,Wajih Kaabachi,Kamel Hamzaoui,Agnès Hamzaoui 대한천식알레르기학회 2015 Allergy, Asthma & Immunology Research Vol.7 No.2

Purpose: Asthma is a complex disease, with contributions from multiple genes, various genetic backgrounds, and environmental factors. Many humanepidemiological studies have demonstrated that single nucleotide polymorphisms (SNPs) in Toll-like receptor (TLR) genes are inconsistently associatedwith asthma risk. Some have demonstrated differences concerning the study design and effect size, and conflicting results have been reported. A meta-analysis is necessary to determine the magnitude of this association. Methods: Following the Preferred Reporting Items for SystematicReviews and Meta-analyses guidelines, a systematic search and meta-analysis of the literature was conducted to estimate the associationof SNPs in TLR genes with asthma risk. We screened the medical literature based on the following keyword searches in MEDLINE and EMBASE databases:‘TLR’, ‘polymorphism’, ‘asthma’, and their combinations. Results: Meta-analysis of eight studies on TLR4 Asp299Gly showed a marginalassociation of TLR4 with asthma risk (odds ratio [OR]=0.814 [95% confidence interval [CI], 0.652-1.016; P=0.069]) in the recessive model. TLR4Thr399Ile was not associated with asthma risk under any genetic model. Meta-analysis of four studies on TLR2 Arg753Gln indicated that TLR2might be significantly associated with asthma in the dominant and codominant models (P=0.029, P=0.030, and P=0.009, respectively). TLR9 -1237was marginally associated with asthma risk (OR=0.408 [95% CI, 0.163-1.021; P=0.065]) in the codominant model. Analysis using the allele contrastmodel showed that the major TLR9 -1237 T allele tended to be a significant protective factor with OR=0.689 (95% CI, 0.471-1.007; P=0.055). Conclusions: The results showed that TLR4 Asp299Gly, TLR2 Arg753Gln, and TLR9-1237 might contribute significantly to asthma susceptibility. Futuregenetic association studies would consolidate these findings. Purpose: Asthma is a complex disease, with contributions from multiple genes, various genetic backgrounds, and environmental factors. Many human epidemiological studies have demonstrated that single nucleotide polymorphisms (SNPs) in Toll-like receptor (TLR) genes are inconsistently associated with asthma risk. Some have demonstrated differences concerning the study design and effect size, and conflicting results have been reported. A meta-analysis is necessary to determine the magnitude of this association. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a systematic search and meta-analysis of the literature was conducted to estimate the association of SNPs in TLR genes with asthma risk. We screened the medical literature based on the following keyword searches in MEDLINE and EMBASE databases: ‘TLR’, ‘polymorphism’, ‘asthma’, and their combinations. Results: Meta-analysis of eight studies on TLR4 Asp299Gly showed a marginal association of TLR4 with asthma risk (odds ratio [OR]=0.814 [95% confidence interval [CI], 0.652-1.016; P=0.069]) in the recessive model. TLR4 Thr399Ile was not associated with asthma risk under any genetic model. Meta-analysis of four studies on TLR2 Arg753Gln indicated that TLR2 might be significantly associated with asthma in the dominant and codominant models (P=0.029, P=0.030, and P=0.009, respectively). TLR9 -1237 was marginally associated with asthma risk (OR=0.408 [95% CI, 0.163-1.021; P=0.065]) in the codominant model. Analysis using the allele contrast model showed that the major TLR9 -1237 T allele tended to be a significant protective factor with OR=0.689 (95% CI, 0.471-1.007; P=0.055). Conclusions: The results showed that TLR4 Asp299Gly, TLR2 Arg753Gln, and TLR9-1237 might contribute significantly to asthma susceptibility. Future genetic association studies would consolidate these findings.

A Systematized Overview of Published Reviews on Biological Hazards, Occupational Health, and Safety

Descatha Alexis,Hamzaoui Halim,Takala Jukka,Oppliger Anne 한국산업안전보건공단 산업안전보건연구원 2023 Safety and health at work Vol.14 No.4

Introduction: The COVID-19 pandemic turned biological hazards in the working environment into a global concern. This systematized review of published reviews aimed to provide a comprehensive overview of the specific jobs and categories of workers exposed to biological hazards with the related prevention. Methods: We extracted reviews published in English and French in PubMed, Embase, and Web of Science. Two authors, working independently, subsequently screened the potentially relevant titles and abstracts recovered (step 1) and then examined relevant full texts (step 2). Disagreements were resolved by consensus. We built tables summarizing populations of exposed workers, types of hazards, types of outcomes (types of health issues, means of prevention), and routes of transmission. Results: Of 1426 studies initially identified, 79 studies by authors from every continent were selected, mostly published after 2010 (n = 63, 79.7%). About half of the reviews dealt with infectious hazards alone (n = 38, 48.1%). The industrial sectors identified involved healthcare alone (n = 16), laboratories (n = 10), agriculture (including the animal, vegetable, and grain sectors, n = 32), waste (n = 10), in addition of 11 studies without specific sectors. The results also highlighted a range of hazards (infectious and non-infectious agents, endotoxins, bioaerosols, organic dust, and emerging agents). Conclusion: This systematized overview allowed to list the populations of workers exposed to biological hazards and underlined how prevention measures in the healthcare and laboratory sectors were usually well defined and controlled, although this was not the case in the agriculture and waste sectors. Further studies are necessary to quantify these risks and implement prevention measures that can be applied in every country.

Intestinal duplication revealed by posterior reversible encephalopathy syndrome

Kerkeni, Yosra,Louati, Hela,Hamzaoui, Mourad The Korean Pediatric Society 2018 Clinical and Experimental Pediatrics (CEP) Vol.61 No.4

We report a unique case of intestinal duplication detected on posterior reversible encephalopathy syndrome (PRES) in a 13-year-old girl. She was admitted to the pediatric Emergency Department because of generalized seizures. Radiological assessment revealed a large, well-defined, thick-walled cystic lesion in the mid abdomen, suggestive of duplication cyst associated to a PRES. Exploration confirmed the diagnosis of ileal duplication cyst, and the mass was resected. The postoperative course was uneventful. Both hypertension and neurological dysfunction resolved after the mass resection. A follow-up brain magnetic resonance imaging was performed 9 months later and showed complete resolution of the cerebellar changes. Although extrinsic compression of the retroperitoneal structures has not been reported in the literature as a complication of duplication cyst, we strongly believe that this is the most logical and plausible hypothesis that would explain the pathogenesis of PRES in our patient.

Direct and Indirect Robust Adaptive Fuzzy Controllers for a Class of Nonlinear Systems

Najib Essounbouli,Abdelaziz Hamzaoui 대한전기학회 2006 International Journal of Control, Automation, and Vol.4 No.2

In this paper, we propose direct and indirect adaptive fuzzy sliding mode control approaches for a class of nonaffine nonlinear systems. ln the direct case, we use the implicit function theory to prove the existence of an ideal implicit feedback linearization controller, and hence approximate it to attain the desired performances. In the indirect case, we exploit the linear structure of a Takagi-Sugeno fuzzy system with constant conclusion to establish an affine-in-control model, and therefore design an indirect adaptive fuzzy controller. In both cases, the adaptation laws of the adjustable parameters are deduced from the stability analysis, in the sense of Lyapunov, to get a more accurate approximation level. In addition to their robustness, the design of the proposed approaches does not require the upper bounds of both external disturbances and approximation errors. To show the efficiency of the proposed controllers, a simulation example is presented.

Unusual malignant neoplasms of ovary in children: two cases report

Ghribi, Ali,Bouden, Aicha,Gasmi, Manef,Hamzaoui, Mourad The Korean Pediatric Society 2016 Clinical and Experimental Pediatrics (CEP) Vol.59 No.no.sup1

Sex cord tumors with annular tubules are known to originate from the sex cord of embryonic gonads that synthesize Sertoli cells, Leydig cells, granulosa cells, and theca cells of the ovarian stroma, while ovarian small cell carcinoma of the hypercalcemic type is a type of neuroendocrine tumor. Both these tumors are uncommon, potentially malignant neoplasms in children. We report the case of a sex cord tumor with annular tubules in an 11-year-old girl and a case of small cell carcinoma of the hypercalcemic type in a 10-year-old girl. We also discuss the prognosis and management of these tumors.

Unusual malignant neoplasms of ovary in children: two cases report

Ali Ghribi,Aicha Bouden,Manef Gasmi,Mourad Hamzaoui 대한소아청소년과학회 2016 Clinical and Experimental Pediatrics (CEP) Vol.59 No.no.sup1

Sex cord tumors with annular tubules are known to originate from the sex cord of embryonic gonads that synthesize Sertoli cells, Leydig cells, granulosa cells, and theca cells of the ovarian stroma, while ovarian small cell carcinoma of the hypercalcemic type is a type of neuroendocrine tumor. Both these tumors are uncommon, potentially malignant neoplasms in children. We report the case of a sex cord tumor with annular tubules in an 11-year-old girl and a case of small cell carcinoma of the hypercalcemic type in a 10-year-old girl. We also discuss the prognosis and management of these tumors.

Intestinal duplication revealed by posterior reversible encephalopathy syndrome

Yosra Kerkeni,Hela Louati,Mourad Hamzaoui 대한소아청소년과학회 2018 Clinical and Experimental Pediatrics (CEP) Vol.61 No.4

We report a unique case of intestinal duplication detected on posterior reversible encephalopathy syndrome (PRES) in a 13-year-old girl. She was admitted to the pediatric Emergency Department because of generalized seizures. Radiological assessment revealed a large, well-defined, thick-walled cystic lesion in the mid abdomen, suggestive of duplication cyst associated to a PRES. Exploration confirmed the diagnosis of ileal duplication cyst, and the mass was resected. The postoperative course was uneventful. Both hypertension and neurological dysfunction resolved after the mass resection. A followup brain magnetic resonance imaging was performed 9 months later and showed complete resolution of the cerebellar changes. Although extrinsic compression of the retroperitoneal structures has not been reported in the literature as a complication of duplication cyst, we strongly believe that this is the most logical and plausible hypothesis that would explain the pathogenesis of PRES in our patient.

Laparoscopic surgery: It is no necessary to change ventilator mode to improve ventilation conditions; a controlled trial

Khalil Mounir,Tarik Lamkinsi,Hamza Hamzaoui,Smail Issa,Mustapha Bensghir,Salim Jaafar Laalaoui 한국간담췌외과학회 2019 Annals of hepato-biliary-pancreatic surgery Vol.23 No.2

Backgrounds/Aims: The main objective of this study is to compare the ventilatory effects of AFVC and PC modes with the VC mode in laparoscopic surgery of the gall bladder. Methods: Thirty-five patients programmed for laparoscopic cholecystectomy were included. Four times were defined for all patients. The parameters studied were recorded ten minutes after anesthetic induction; and this is the time T1. The time T2 fits to 10 min after induction of pneumoperitoneum. Then, the ventilator mode was changed from VC mode to AFVC mode. Ten minutes later, the variables were scored; it was the time T3. The ventilator mode was then changed to a PC mode. The set pressure was adjusted in order to obtain the same Vt as at the time T2. The time T4 was 10 minutes after switching to PC mode. Results: The Vte were increased, compared to time T2, during the AFVC and PC modes. The induction of pneumoperitoneum with CO₂ induced a rise of P<SUB>ET</SUB>CO₂ between T1 and T2. These had been accompanied by a significant rise in airway pressures. The change from VC mode to AFVC mode resulted in lower Prpeak and Prtray elevation without impacting dynamic compliance. Conclusions: AFVC mode appears safe for patients in laparoscopic surgery. Its use, compared with VC, is associated with a decrease in Prpeak without effects on the Cdyn, oxygenation, capnia and hemodynamic parameters. We conclude that is no necessary to change ventlatory modes to improve ventilation conditions in nonobese patients.

Global Estimates on Biological Risks at Work

Takala Jukka,Descatha Alexis,Oppliger Anne,Hamzaoui Halim,Bråkenhielm Catherine,Neupane Subas 한국산업안전보건공단 산업안전보건연구원 2023 Safety and health at work Vol.14 No.4

Introduction: Biological risks are a major global problem in the workplace. The recent COVID-19 pandemic has highlighted the need for a more comprehensive understanding of the biological risks at work. This study presents data on both communicable infectious biological agents and noncommunicable factors leading to death and disability for the year 2021. Methods: We followed the methodology established by the International Labour Organization (ILO) in their past global estimates on occupational accidents and work-related diseases. We used relevant ILO estimates for hazardous substances and related population attributable fractions derived from literature, which were then applied to World Health Organization mortality data. The communicable diseases included in the estimates were tuberculosis, pneumococcal diseases, malaria, diarrheal diseases, other infectious diseases, neglected tropical diseases, influenza associated respiratory diseases and COVID-19. Noncommunicable diseases and injuries considered were Chronic Obstructive Diseases (COPD) due to organic dusts, asthma, allergic reactions and risks related to animal contact. We estimated death attributable to biological risk at work and disability in terms of disability adjusted life years (DALYs). Results: We estimated that in 2022, 550,819 deaths were caused by biological risk factors, with 476,000 deaths attributed to communicable infectious diseases and 74,000 deaths caused by noncommunicable factors. Among these, there were 223,650 deaths attributed to COVID-19 at work. We calculated the rate of 584 DALYs per 100,000 workers, representing an 11% increase from the previous estimate of the global burden of work-related disabilities measured by DALYs. Conclusion: This is a first update since previous 2007 ILO estimates, which has now increased by 74% and covers most biological risks factors. However, it is important to note that there may be other diseases and deaths are missing from the data, which need to be included when new information becomes available. It is also worth mentioning that while deaths caused by major communicable diseases including COVID-19 are relatively rare within the working population, absences from work due to these diseases are likely to be very common within the active workforce.