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Search Results: 1 - 10 of 394 matches for " Dany Goldgran-Toledano "
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Efficacy of renal replacement therapy in critically ill patients: a propensity analysis
Christophe Clec'h, Micha?l Darmon, Alexandre Lautrette, Frank Chemouni, Elie Azoulay, Carole Schwebel, Anne-Sylvie Dumenil, Ma?té Garrouste-Orgeas, Dany Goldgran-Toledano, Yves Cohen, Jean-Fran?ois Timsit
Critical Care , 2012, DOI: 10.1186/cc11905
Abstract: We performed a propensity analysis using data of the French longitudinal prospective multicenter Outcomerea database. Two propensity scores for RRT were built to match patients who received RRT to controls who did not despite having a close probability of receiving the procedure. AKI was defined according to RIFLE criteria. The association between RRT and hospital mortality was examined through multivariate conditional logistic regression analyses to control for residual confounding. Sensitivity analyses were conducted to examine the impact of RRT timing.Among the 2846 study patients, 545 (19%) received RRT. Crude mortality rates were higher in patients with than in those without RRT (38% vs 17.5%, P < 0.001). After matching and adjustment, RRT was not associated with a reduced hospital mortality. The two propensity models yielded concordant results.In our study population, RRT failed to reduce hospital mortality. This result emphasizes the need for randomized studies comparing RRT to conservative management in selected ICU patients, with special focus on RRT timing.Acute kidney injury (AKI) significantly contributes to the morbidity and the mortality of critically ill patients through metabolic derangements, fluid overload and harmful effects of these disturbances on other failing organs. Renal replacement therapy (RRT), although not achieving the same level of homeostasis as a normally functioning kidney, helps limit the consequences of AKI and allows adequate administration of fluids and nutritional support. However, its benefits (aside from life-threatening complications, such as severe hyperkalemia, pulmonary edema, and intractable acidosis) in critically ill patients with AKI remain unclear.Available data are derived from uncontrolled studies, which all showed higher mortality rates among populations treated with RRT [1-5]. Due to their design, however, confounders and biases may have limited their accuracy. Particularly, treatment selection bias [6] may have
Model for predicting short-term mortality of severe sepsis
Christophe Adrie, Adrien Francais, Antonio Alvarez-Gonzalez, Roman Mounier, Elie Azoulay, Jean-Ralph Zahar, Christophe Clec'h, Dany Goldgran-Toledano, Laure Hammer, Adrien Descorps-Declere, Samir Jamali, Jean-Francois Timsit, the Outcomerea Study Group
Critical Care , 2009, DOI: 10.1186/cc7881
Abstract: In this prospective multicentre observational study on a multicentre database (OUTCOMEREA) including data from 12 ICUs, 2268 patients with 2737 episodes of severe sepsis were randomly divided into a training cohort (n = 1458) and a validation cohort (n = 810). Up to four consecutive severe sepsis episodes per patient occurring within the first 28 ICU days were included. We developed a prognostic model for predicting death within 14 days after each episode, based on patient data available at sepsis onset.Independent predictors of death were logistic organ dysfunction (odds ratio (OR), 1.22 per point, P < 10-4), septic shock (OR, 1.40; P = 0.01), rank of severe sepsis episode (1 reference, 2: OR, 1.26; P = 0.10 ≥ 3: OR, 2.64; P < 10-3), multiple sources of infection (OR; 1.45, P = 0.03), simplified acute physiology score II (OR, 1.02 per point; P < 10-4), McCabe score ([greater than or equal to]2) (OR, 1.96; P < 10-4), and number of chronic co-morbidities (1: OR, 1.75; P < 10-3, ≥ 2: OR, 2.24, P < 10-3). Validity of the model was good in whole cohorts (AUC-ROC, 0.76; 95%CI, 0.74 to 0.79; and HL Chi-square: 15.3 (P = 0.06) for all episodes pooled).In ICU patients, a prognostic model based on a few easily obtained variables is effective in predicting death within 14 days after the first to fourth episode of severe sepsis complicating community-, hospital-, or ICU-acquired infection.Severe sepsis remains a leading cause of death in industrialised countries, and the number of deaths caused by sepsis is increasing despite improved survival rates [1,2]. Apart from measures directed to the infectious cause (antibiotics and surgery), the treatment remains chiefly supportive despite many randomised controlled trials [3,4]. Sepsis is a syndrome, not a disease; and many factors explain the variability of outcomes, such as differences in infection sites, causative pathogens, and time and location of infection onset (community, hospital or intensive care unit (ICU)) [1]. This hete
Mortality associated with timing of admission to and discharge from ICU: a retrospective cohort study
Kevin B Laupland, Benoit Misset, Bertrand Souweine, Alexis Tabah, Elie Azoulay, Dany Goldgran-Toledano, Anne-Sylvie Dumenil, Aurélien Vésin, Samir Jamali, Hatem Kallel, Christophe Clec'h, Michael Darmon, Carole Schwebel, Jean-Francois Timsit
BMC Health Services Research , 2011, DOI: 10.1186/1472-6963-11-321
Abstract: Adults (≥18 years) admitted to French ICUs participating in Outcomerea between January 2006 and November 2010 were included.Among the 7,380 patients included, 61% (4,481) were male, the median age was 62 (IQR, 49-75) years, and the median SAPS II score was 40 (IQR, 28-56). Admissions to ICU occurred during weekends (Saturday and Sunday) in 1,708 (23%) cases, during the night (18:00-07:59) in 3,855 (52%), and on nights and/or weekends in 4,659 (63%) cases. Among 5,992 survivors to ICU discharge, 903 (15%) were discharged on weekends, 659 (11%) at night, and 1,434 (24%) on nights and/or weekends. After controlling for a number of co-variates using logistic regression analysis, admission during the after hours was not associated with an increased risk for death. However, patients discharged from ICU on nights were at higher adjusted risk (odds ratio, 1.54; 95% confidence interval, 1.12-2.11) for death.In this study, ICU discharge at night but not admission was associated with a significant increased risk for death. Further studies are needed to examine whether minimizing night time discharges from ICU may improve outcome.Patients who suffer acute illness and are admitted during the "after hours" (weekends or nights) may be at higher risk for adverse outcome as compared to patients admitted during weekdays [1]. Cavallazzi et al recently conducted a meta-analysis of ten studies conducted in adult ICUs and found that while night time admission was not associated with an increased risk, a small but significant increased risk for death was associated with weekend admission [2]. Since, Kuijsten et al reported a relative risk for death associated with admission in the afterhours of 1.059 (95% confidence interval 1.031-1.088) among 149,894 admissions to Dutch ICUs [3]. More recently Kevat et al reported on 245,057 admissions to Australian ICUs and found an increased risk for hospital mortality associated with admission during evenings/nights (17% vs. 14%; p < 0.001) and during
Prognostic consequences of borderline dysnatremia: pay attention to minimal serum sodium change
Michael Darmon, Eric Diconne, Bertrand Souweine, Stéphane Ruckly, Christophe Adrie, Elie Azoulay, Christophe Clec'h, Ma?té Garrouste-Orgeas, Carole Schwebel, Dany Goldgran-Toledano, Hatem Khallel, Anne-Sylvie Dumenil, Samir Jamali, Christine Cheval, Bernard Allaouchiche, Fabrice Zeni, Jean-Fran?ois Timsit
Critical Care , 2013, DOI: 10.1186/cc11937
Abstract: Observational study on a prospective database fed by 13 intensive care units (ICUs). Unselected patients with ICU stay longer than 48 h were enrolled over a 14-year period were included in this study. Mild to severe hyponatremia were defined as serum sodium concentration < 135, < 130, and < 125 mmol/L respectively. Mild to severe hypernatremia were defined as serum sodium concentration > 145, > 150, and > 155 mmol/L respectively. Borderline hyponatremia and hypernatremia were defined as serum sodium concentration between 135 and 137 mmol/L or 143 and 145 respectively.A total of 11,125 patients were included in this study. Among these patients, 3,047 (27.4%) had mild to severe hyponatremia at ICU admission, 2,258 (20.3%) had borderline hyponatremia at ICU admission, 1,078 (9.7%) had borderline hypernatremia and 877 (7.9%) had mild to severe hypernatremia. After adjustment for confounder, both moderate and severe hyponatremia (subdistribution hazard ratio (sHR) 1.82, 95% CI 1.002 to 1.395 and 1.27, 95% CI 1.01 to 1.60 respectively) were associated with day-30 mortality. Similarly, mild, moderate and severe hypernatremia (sHR 1.34, 95% CI 1.14 to 1.57; 1.51, 95% CI 1.15 to 1.99; and 2.64, 95% CI 2.00 to 3.81 respectively) were independently associated with day-30 mortality.One-third of critically ill patients had a mild to moderate dysnatremia at ICU admission. Dysnatremia, including mild changes in serum sodium concentration, is an independent risk factor for hospital mortality and should not be neglected.Dysnatremia is a common finding at ICU admission [1-3]. Abnormal serum sodium concentrations are known to adversely affect physiologic function and an increasing body of evidence suggests that dysnatremia may be associated with adverse outcome [1-4]. Critically ill patients are particularly exposed to dysnatremia due to the nature of the disease leading to ICU admission and to lack of free access to water [2,4,5]. Up to one-third of critically ill patients have a dys
Reliability of diagnostic coding in intensive care patients
Beno?t Misset, Didier Nakache, Aurélien Vesin, Mickael Darmon, Ma?té Garrouste-Orgeas, Bruno Mourvillier, Christophe Adrie, Sébastian Pease, Marie-Aliette de Beauregard, Dany Goldgran-Toledano, Elisabeth Métais, Jean-Fran?ois Timsit, The Outcomerea Database Investigators
Critical Care , 2008, DOI: 10.1186/cc6969
Abstract: One hundred medical records selected randomly from 29,393 cases collected between 1998 and 2004 in the French multicenter Outcomerea ICU database were studied. Each record was sent to two senior physicians from independent ICUs who recoded the diagnoses using the International Statistical Classification of Diseases and Related Health Problems: Tenth Revision (ICD-10) after being trained according to guidelines developed by two French national intensive care medicine societies: the French Society of Intensive Care Medicine (SRLF) and the French Society of Anesthesiology and Intensive Care Medicine (SFAR). These codes were then compared with the original codes, which had been selected by the physician treating the patient. A specific comparison was done for the diagnoses of septicemia and shock (codes derived from A41 and R57, respectively).The ICU physicians coded an average of 4.6 ± 3.0 (range 1 to 32) diagnoses per patient, with little agreement between the three coders. The primary diagnosis was matched by both external coders in 34% (95% confidence interval (CI) 25% to 43%) of cases, by only one in 35% (95% CI 26% to 44%) of cases, and by neither in 31% (95% CI 22% to 40%) of cases. Only 18% (95% CI 16% to 20%) of all codes were selected by all three coders. Similar results were obtained for the diagnoses of septicemia and/or shock.In a multicenter database designed primarily for epidemiological and cohort studies in ICU patients, the coding of medical diagnoses varied between different observers. This could limit the interpretation and validity of research and epidemiological programs using diagnoses as inclusion criteria.Administrative coding of medical diagnoses has become mandatory in French hospitals in order to perform epidemiological studies and to calculate medical reimbursement costs. Most databases are used by hospital administrators, according to the local system for hospital funding, which is derived from the Diagnosis-Related Group (DRG) in the US [1
The Modes of Evolutionary Emergence of Primal and Late Pandemic Influenza Virus Strains from Viral Reservoir in Animals: An Interdisciplinary Analysis
Dany Shoham
Influenza Research and Treatment , 2011, DOI: 10.1155/2011/861792
Abstract: Based on a wealth of recent findings, in conjunction with earliest chronologies pertaining to evolutionary emergences of ancestral RNA viruses, ducks, Influenzavirus A (assumingly within ducks), and hominids, as well as to the initial domestication of mallard duck (Anas platyrhynchos), jungle fowl (Gallus gallus), wild turkey (Meleagris gallopavo), wild boar (Sus scrofa), and wild horse (Equus ferus), presumed genesis modes of primordial pandemic influenza strains have multidisciplinarily been configured. The virological fundamentality of domestication and farming of those various avian and mammalian species has thereby been demonstrated and broadly elucidated, within distinctive coevolutionary paradigms. The mentioned viral genesis modes were then analyzed, compatibly with common denominators and flexibility that mark the geographic profile of the last 18 pandemic strains, which reputedly emerged since 1510, the antigenic profile of the last 10 pandemic strains since 1847, and the genomic profile of the last 5 pandemic strains since 1918, until present. Related ecophylogenetic and biogeographic aspects have been enlightened, alongside with the crucial role of spatial virus gene dissemination by avian hosts. A fairly coherent picture of primary and late evolutionary and genomic courses of pandemic strains has thus been attained, tentatively. Specific patterns underlying complexes prone to generate past and future pandemic strains from viral reservoir in animals are consequentially derived. 1. Introduction The historical emergence and pandemic potency of influenza type A virus—a prominent anthropozoonotic single-stranded segmented RNA virus (family Orthomyxoviridae)—have long constituted challenging phenomena. The Greek physician Hippocrates, the “Father of Medicine,” first described influenza in 412?BC [1]. The name “influenza” was derived from the belief of Italian astrologers in the Middle Ages that the periodic appearance of the disease was in some way related to “influence of heavenly bodies” [2]. Rather earthily, the French named influenza as “the grippe,” suggesting the acute onset of illness, upon which the patient suddenly was seized or gripped by the disease [3]. Yet still recently, influenza has been seriously attributed to introduction of viruses from the space, due to meteorological processes [4]. As far as the origins of life are concerned at large, it has been proposed that cometary ice might have embodied the provenance of earliest precursors of viruses in general on Planet Earth and perhaps cosmically [5]. Influenza pandemics are
Educando en la diversidad: investigaciones y experiencias educativas interculturales y bilingües, por María Bertely, Jorge Gasché y Rosanna Podesta (coords.). Quito y México: Editorial Abya Yala y CIESAS, 2008. 494 pp.
Mahecha Dany
Mundo Amazónico , 2010, DOI: 10.5113/ma.1.11656
Abstract:
The effects of binaries on population studies
Dany Vanbeveren
Revista mexicana de astronomía y astrofísica , 2004,
Abstract:
Fast Cooling of Neutron Stars: Superfluidity vs. Heating and Accreted Envelope
Dany Page
Physics , 1996, DOI: 10.1086/310571
Abstract: It is generally considered that the neutron star cooling scenarios involving fast neutrino emission, from a kaon or pion condensate, quark matter, or the direct Urca process, require the presence of baryon pairing in the central core of the star to control the strong neutrino emission and produce surface temperatures compatible with observations. I show here that within the kaon condensate scenario pairing is not necessary if: 1) the equation of state is stiff enough for the star to have a thick crust in which sufficient friction can occur to heat the star and 2) a thin layer, of mass larger than 10^{-12} Msol, of light elements (H and He) is present at the stellar surface. The effect of the light elements is to increase the heat flow and thus produce a higher surface temperature. Both the occurrence of heating and the presence of H and/or He at the surface (deposited during the late post-supernova accretion) can possibly be confirmed or infirmed by future observations.
THERMAL RADIATION FROM MAGNETIZED NEUTRON STARS: A look at the Surface of a Neutron Star.
Dany Page
Physics , 1995, DOI: 10.1007/BF00751430
Abstract: Surface thermal emission has been detected by ROSAT from four nearby young neutron stars. Assuming black body emission, the significant pulsations of the observed light curves can be interpreted as due to large surface temperature differences produced by the effect of the crustal magnetic field on the flow of heat from the hot interior toward the cooler surface. However, the energy dependence of the modulation observed in Geminga is incompatible with blackbody emission: this effect will give us a strong constraint on models of the neutron star surface.
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