Common infections acquired in intensive care: Microbiological aspects and risk factors

Nosocomial infections are a serious health problem resulting in an enormous burden of morbidity and mortality rates, and high health care costs. The various microorganisms implicated in nosocomial infections were not known for causing recalcitrant nosocomial infections, they are opportunistic pathogens and hence pose a challenge to patients especially those with immunocompromised conditions. Patients at the intensive care unit are the most at risk of these hospital-acquired infections The infections usually encountered in intensive care unit (ICU) include urinary tract infection, pneumonia, tuberculosis, gastroenteritis. The main risk factors for these infections can be divided into three key groups: those related to patient characteristics and underlying diseases, those related to the acute disease process, and those related to the use of invasive diagnostic or therapeutic procedures. Incidence of ICU-acquired infections vary between hospitals and according to the type of population studied, being highest in burn units and surgical and trauma ICUs and lowest in coronary care units.The major preventive effort to reducing the risk of nosocomial infections should be focused on hospitals and other health care facilities. The responsible health authority should develop a national (or regional) programme to support hospitals. Such programmes must assess and promote good health care, appropriate isolation, sterilization, and other practices, staff training, and epidemiological surveillance should be developed

Clinical experience with insulin detemir, biphasic insulin aspart and insulin aspart in people with type 2 diabetes: Results from the Casablanca cohort of the A 1 chieve study

Background: The A 1 chieve, a multicentric (28 countries), 24-week, non-interventional study evaluated the safety and effectiveness of insulin detemir, biphasic insulin aspart and insulin aspart in people with T2DM (n = 66,726) in routine clinical care across four continents. Materials and Methods: Data was collected at baseline, at 12 weeks and at 24 weeks. This short communication presents the results for patients enrolled from Casablanca, Morocco. Results: A total of 495 patients were enrolled in the study. Four different insulin analogue regimens were used in the study. Study patients had started on or were switched to biphasic insulin aspart (n = 231), insulin detemir (n = 151), insulin aspart (n = 19), basal insulin plus insulin aspart (n = 53) and other insulin combinations (n = 41). At baseline glycaemic control was poor for both insulin naïve (mean HbA 1 c: 10.2%) and insulin user (mean HbA 1 c: 9.4%) groups. After 24 weeks of treatment, both groups showed improvement in HbA 1 c (insulin naïve: −2.3%, insulin users: −1.8%). Major hypoglycaemia was observed in the insulin naïve group after 24 weeks. SADRs were reported in 1.2% of insulin naïve and 2.1% of insulin user groups. Conclusion: Starting or switching to insulin analogues was associated with improvement in glycaemic control with a low rate of hypoglycaemia

Thyroid Ectopia Revealed in the Adulthood: About One Case

Thyroid ectopia is defined as the presence of thyroid tissue outside its normal pre-tracheal location. It’s may be discovered at any age. It’s clinical impacts are highly variable, precocious or late, depending on whether the thyroid is functional or not. We describe from this case an ectopic thyroid revealed in the adulthood. It is about a 44 years old woman with a medical history of goiter under supervision in her sister also followed for a chronic nasolacrimal duct obstruction. She benefitted from orbital and sinus computer tomography that showed a tongue’s base lesion process of with a strong contrast. Tongue MRI objectified a tongue base process measuring 43x37 mm with heterogeneous enhancement after gadolinium injection with total thyroid atrophy. Thyroid scintigraphy 131 confirmed the diagnosis of an ectopic thyroid: There was a rounded hyperfixation, a retro-mandibular median projecting as sub-lingual, without visualing uptake tracer on the thyroid lodge level. Physical examination and hormonal exploration were without abnormalities. In front of the uncomplicated asymptomatic sub-lingual thyroid, regular supervision was recommended based on thyroid hormones dosage and a scintigraphy or MRI

Management of diabetes in Morocco: results of the International Diabetes Management Practices Study (IDMPS) – wave 5

Objectives: The International Diabetes Mellitus Practice Study (IDMPS) is a 5-year survey documenting changes in diabetes treatment practices in developing countries. The primary objective of this survey was to assess the therapeutic management of type 2 diabetes mellitus (T2DM) in real-life medical practice. The secondary objectives were to evaluate the clinical management of type 1 diabetes mellitus (T1DM) and to assess the proportion of all diabetic patients failing to reach the glycated haemoglobin (HbA1c) <7% target. Methods: Data were analysed for 738 patients (240 with T1DM and 498 with T2DM) included in wave 5 of the IDMPS in Morocco in 2011. Results: Nearly two-thirds (61%) of T2DM patients were treated with oral glucose-lowering drugs (OGLDs) alone, 13.1% were treated with insulin alone and 23.3% were treated with OGLDs plus insulin. Insulin use was less frequent, was initiated later and involved a greater use of premixes versus basal/prandial schedules compared to other populations evaluated in the IDMPS. The majority (92.5%) of T1DM patients were treated with insulin alone and the remainder received insulin plus an OGLD. Insulin protocols included basal + prandial dosing (37.5%) and premix preparations (41.3%). The recommended target of HbA1c <7% was achieved by only 22.2% of T1DM patients and 26.8% of T2DM patients. More macrovascular but fewer microvascular complications were reported in T2DM compared to T1DM patients. Late complications increased with disease duration so that 20 years after diagnosis, 75.7% of T2DM patients were found to have at least one late complication. Conclusions: The clinical burden of diabetes is high in Morocco and the majority of patients do not achieve the recommended glycaemia target, suggesting that there is a huge gap between evidence-based diabetic management and real-life practice. Better education of patients and improved compliance with international recommendations are necessary to deliver a better quality of diabetic care