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Phnom Penh, Cambodia

Lemyze M.,Lille University Hospital | Favory R.,Lille University Hospital | Alves I.,Lille University Hospital | Perez T.,Calmette Hospital | Mathieu D.,Lille University Hospital
Journal of Critical Care | Year: 2012

Purpose: The aim of this study was to evaluate the manual compression of the abdomen (MCA) during expiration as a simple bedside method to detect expiratory flow limitation (EFL) during daily clinical practice of mechanical ventilation (MV). Methods: We studied 44 semirecumbent intubated and sedated critically ill patients. Flow-volume loops obtained during MCA were superimposed upon the preceding breaths and recorded with the ventilator. Expiratory flow limitation was expressed as percentage of expiratory tidal volume without any increase in flow during MCA (MCA [%V T]). In the first 13 patients, MCA was validated by comparison with the negative expiratory pressure (NEP) technique. Esophageal pressure changes during MCA and intrinsic positive end-expiratory pressure were also recorded in all the patients. Results: Manual compression of the abdomen and NEP agreed in all cases in detecting EFL with a bias of -0.16%. Percentage of expiratory tidal volume without any increase in flow during MCA is highly correlated with percentage of expiratory tidal volume without any increase in flow during NEP (n = 13, P < .0001, r 2 = 0.99) and intrinsic positive end-expiratory pressure (n = 44, P < .001, r 2 = 0.78), with a good repeatability (n = 44; within-subject SD, 5.7%) and reproducibility (n = 13; within-subject SD, 2.41%). Two third of the patients were flow limited, among whom one third had no previously known respiratory disease. Conclusions: Manual compression of the abdomen provides a simple, rapid, and safe bedside reliable maneuver to detect and quantify EFL during mechanical ventilation. © 2012 Elsevier Inc.

Duong V.,Institute Pasteur in Cambodia | Mai T.T.X.,Institute Pasteur in Nha Trang | Blasdell K.,Institute Pasteur in Cambodia | Lo L.V.,Institute Pasteur in Nha Trang | And 11 more authors.
Infection, Genetics and Evolution | Year: 2013

Scrub typhus is an acute infectious disease caused by an obligate intracellular bacterium Orientia tsutsugamushi following the bite of infected trombiculid mites of the genus Leptotrombidium. This zoonotic disease is a major cause of febrile illness in the Asia-Pacific region, with a large spectrum of clinical manifestations from unapparent or mild disease to fatal disease. O. tsutsugamushi is characterized by a very high genomic plasticity and a large number of antigenic variants amongst strains. The 56-kDa type specific antigen (TSA) gene, encoding the major antigenic protein, was used as reference to investigate the genetic relationships between the strains and to genotype O. tsutsugamushi isolates. The open reading frame of the 56-kDa TSA gene of 41 sequences (28 Cambodian and 13 Vietnamese strains) from patient samples were sequenced and used for genotyping. The 28 Cambodian isolates clustered into 5 major groups, including Karp (43.5%), JG-v (25%), Kato/TA716 (21.5%), TA763 (3.5%) and Gilliam (3.5%). Karp (77%), TA763 (15.5%) and JG-v (7.5%) strains were identified amongst the 13 Vietnamese isolates. This is the first countrywide genotyping description in Cambodia and in Central Vietnam. These results demonstrate the considerable diversity of genotypes in co-circulation in both countries. The genotyping result might raise awareness amongst Cambodian and Vietnamese clinicians of the high genetic diversity of circulating O. tsutsugamushi strains and provides unique and beneficial data for serological and molecular diagnosis of scrub typhus infections as well as raw materials for future studies and vaccine development. © 2011 Elsevier B.V.

Bhalla D.,French Institute of Health and Medical Research | Bhalla D.,University of Limoges | Chea K.,University of Health Sciences | Chamroeun H.,Cambodian Society of Neurology | And 15 more authors.
Epilepsia | Year: 2013

Purpose We conducted a population-based study of epilepsy in Prey Veng (Cambodia) to explore self-esteem, fear, discrimination, knowledge-attitude- practice (KAP), social-support, stigma, coping strategies, seizure-provoking factors, and patient-derived factors associated with quality of life (QOL). Methods The results are based on a cohort of 96 cases and matched controls (n = 192), randomly selected from the same source population. Various questionnaires were developed and validated for internal consistency (by split-half, Spearman-Brown prophecy, Kuder-Richardson 20), content clarity and soundness. Summary, descriptive statistics, classical tests of hypothesis were conducted. Uncorrected chi-square was used. Group comparison was done to determine statistically significant factors, for each domain, by conducting logistic regression; 95% confidence interval (CI) with 5% (two-sided) statistical significance was used. Key Findings All questionnaires had high internal consistency. Stress was relevant in 14.0% cases, concealment in 6.2%, denial in 8.3%, negative feelings in public in 3.0%. Mean self-esteem was 7.5, range 0-8, related to seizure frequency. Mean discrimination was least during social interactions. Coping strategies were positive (e.g. look for treatment). Postictal headache, anger, no nearby health facility, etc. were associated with QOL. Significance The reliability of our questionnaires was high. A positive social environment was noted with many infrequent social and personal prejudices. Not all populations should (by default) be considered as stigmatized or equipped with poor KAP. We addressed themes that have been incompletely evaluated, and our approach could therefore become a model for other projects. © 2013 International League Against Epilepsy.

Eav S.,University of Health Sciences | Schraub S.,University of Strasbourg | Dufour P.,Comprehensive Cancer Center Paul Strauss | Taisant D.,Physicien Mdical Sans Frontires | And 2 more authors.
Oncology (Switzerland) | Year: 2012

Cambodia, a country of 14 million inhabitants, was devastated during the Khmer Rouge period and thereafter. The resources of treatment are rare: only one radiotherapy department, renovated in 2003, with an old cobalt machine; few surgeons trained to operate on cancer patients; no hematology; no facilities to use intensive chemotherapy; no nuclear medicine department and no palliative care unit. Cervical cancer incidence is one of the highest in the world, while in men liver cancer ranks first (20% of all male cancers). Cancers are seen at stage 3 or 4 for 70% of patients. There is no prevention program -only a vaccination program against hepatitis B for newborns -and no screening program for cervical cancer or breast cancer. In 2010, oncology, recognized as a full specialty, was created to train the future oncologists on site at the University of Phnom Penh. A new National Cancer Center will be built in 2013 with modern facilities for radiotherapy, medical oncology, hematology and nuclear medicine. Cooperation with foreign countries, especially France, and international organizations has been established and is ongoing. Progress is occurring slowly due to the shortage of money for Cambodian institutions and the lay public. © 2012 S. Karger AG, Basel.

Leteurtre S.,Jeanne Of Flandre University Hospital | Leteurtre S.,University of Lille Nord de France | Grandbastien B.,Calmette Hospital | Grandbastien B.,University of Lille Nord de France | And 2 more authors.
Intensive Care Medicine | Year: 2012

Objectives: To test the performance of PIM2 in Frenchspeaking (FS) paediatric intensive care units (PICUs) and its relative performance when recalibrated using data from FS and Great Britain (GB) PICUs of different size. Methods: Consecutive admissions to 15 FS (n = 5,602) and 31 GB PICUs (n = 20,693) from June 2006 to October 2007 were included. The recalibrated PIM2 were applied to PICUs of different size within the FS and GB PICUs and between the two groups. PICU size was defined using number of admissions/month. Discrimination and calibration were evaluated using the area under the ROC curve (AUC) and the goodnessof-fit test, respectively. Logistic regression, funnel plots and standardized W scores were performed in the two groups and between different PICU sizes. Results: In FS PICUs, the original PIM2 had good discrimination (AUC = 0.85) and moderate calibration (p = 0.07). The recalibrated PIM2 scores had good calibration in FS (p = 0.33) and moderate calibration in GB (p = 0.06). Calibration was poor when the recalibrated FS PIM2 was applied to GB (p = 0.02) but good when the GB recalibration was applied to the FS (p = 0.36). Using the original PIM2 coefficients, calibration was poor in large units in both groups but improved following recalibration. There were no effects of PICU size on risk-adjusted mortality in GB and a significant effect in the FS PICUs with a minimum riskadjusted mortality at about 35 admissions/month. Conclusion: The PIM2 score was valid in the FS population. The recalibration based on GB data could be applied to FS PICUs. Such recalibration may facilitate comparisons between countries. © 2012 Copyright jointly held by Springer and ESICM.

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