Transurethral resection of prostate syndrome: report of a case

We report a case of transurethral resection of prostate (TURP) syndrome. A 78-year-old man with prostatic hypertrophy was scheduled for transurethral resection of the prostate under spinal anesthesia. 30 minutes after the end of the surgery, the patient presented signs of TURP syndrome with bradycardia, arterial hypotension, cyanosis, hypoxemia and coma. The electrolytes analysis revealed an acute hyponatremia (sodium concentration 125 mmol/L). Medical treatment consisted of hypertonic saline solution 3%, volume expansion, intubation and ventilation. The presented case describes a typical TURP syndrome, which was diagnosed and treated early. The patient was discharged from hospital without any complications.Pan African Medical Journal 2013; 14:1

Dislocation of temporo-mandibular joint - an uncommon circumstance of occurrence: vaginal delivery

Dislocation of temporo-mandibular joint (TMJ) is an infrequent disease but still spectacular. This disease consists of a permanent, to some extent complete disruption of the temporo-mandibular joint. These dislocations often occur in a context of yawning, and less frequently after a burst of laughing or relatively mild facial trauma (slap, punch on the chin). We report a case of TMJ occurring in an uncommon circumstance: vaginal delivery. A woman aged 24-years with no special past medical history; primipara was admitted in the Department of Maternity of the University Hospital Hassan II of Fez for an imminent delivery of a twin pregnancy. Ten minutes after admission, the patient delivered vaginally with episiotomy. She gave birth to twins weighing 2800g and 2400g. During labour, and due to efforts of crying, the patient developed a sudden and immediate loss of function of the temporo-mandibular joint, with difficulty of speaking, the mouth permanently opened and with the chin lowered and thrown forward. The examination found an empty glenoid fossa of the temporo-mandibular joint in both sides. The diagnosis of dislocation of the TMJ was established. A CT scan of facial bones was done, objectifying a bilateral dislocation of TMJ. The reduction of this dislocation was performed in the operating room under sedation

Choc hémorragique suite à une ponction biopsie rénale (PBR): à propos d’un cas

La ponction biopsie rénale (PBR) est un examen indispensable en néphrologie mais à risque de complications graves surtout hémorragique. Nous rapportons l'observation d'un patient âgé de 27 ans ayant bénéficié d'une PBR pour un diagnostic étiologique d'une insuffisance rénale aigue, l'évolution après la biopsie a été marquée par l'installation d'un choc hémorragique d'où la prise en charge en réanimation avec une néphrectomie d'hémostase.Key words: Insuffisance rénale, ponction transcutanée, complication, choc hémorragiqu

Perforation iléale iatrogène: complication mécanique exceptionnelle de la pose du cathéter d’hémodialyse au niveau du site fémoral

Le cathétérisme veineux fémoral est d’indication fréquente et de réalisation le plus souvent aisée et rapide. Thrombose et infection sont les complications les plus couramment rapportées. La perforation iatrogène d’une anse digestive par le trocart de ponction lors de la mise en place d’un cathéter d’hémodialyse au niveau du site fémoral est une complication mécanique inhabituelle. Nous en rapportons un cas jamais décrit, à notre connaissance, dans la littérature médicale

Les evenements indesirables graves en reanimation.

OBJECTIF DE L’ETUDE : Les événements indésirables en réanimation soulèvent d’importants problèmes d’ordre médical, éthique et économique. Cette étude a pour but de relever ces événements indésirables, évaluer leurs gravité, identifier les différents facteurs de risque qui leurs sont associés, et enfin comparer nos résultats avec les donnes préexistantes. MATERIEL ET METHODE D’ETUDE : Il s’agit d’une étude prospective étalée sur une durée de 12 mois, du premier janvier au 31 décembre 2007. Ont été inclus les patients ayant présenté un événement indésirable grave, au cours de leur hospitalisation en réanimation ou ailleurs, et qui ont nécessité un séjour en réanimation. RESULTATS : L’étude a porté sur 558 patients. 100 patients ont présenté au moins un événement indésirable grave avec une incidence de 17,9%. Ils étaient dominés par ceux de types infectieux 31%, suivis des événements indésirables de type respiratoire 20,6%. Ces événements indésirables étaient considérés évitables dans 43%. Les conséquences de ces événements indésirables étaient de gravité variable, avec un taux de mortalité directement ou indirectement attribuable aux alentours de 8%. CONCLUSION : Dans notre étude, les événements indésirables sont dominés par les événements de types infectieux et respiratoires. L’impact propre de ces événements sur le pronostic est difficile à apprécier du fait qu’ils surviennent avant tout sur des terrains graves. Le but de l’étude et de l’analyse de ces événements indésirables est la mise en œuvre des programmes et politiques de gestion et de prévention afin de les prévenir et de les réduire au maximum, surtout ceux à caractère évitable

Impact of the Flipped Classroom on the Motivation of Undergraduate Students of the Higher Institute of Nursing Professions and Health Techniques of Fez-Morocco

Motivation is the cornerstone in building success. If it is strong, the achievement of a greater number of objectives will be assured, and therefore a more glorious success can be met. Thus, to promote motivation, it is advisable to pay particular attention to the pedagogical approach adopted by the teacher, since it has been proven that there is a positive relationship between the choice of an active approach and an enhancing motivation. The situation generated by COVID-19, has been a profitable opportunity to experiment with hybrid “Flipped Classroom” pedagogy, with a view to inverting the class and adapting learning activities, that have been traditionally offered to students, through distance (online) and in-person learning alternately. Thus, the present study aims at evaluating the impact of this Flipped Pedagogy on the motivation of undergraduate students of the Higher Institute of Nursing Professions and Healthcare Techniques in Fez. Data have been collected from 410 students, who were questioned before and after the adoption of the Flipped Classroom, based on a motivation scale validated by Rolland Viau in 1994. The answering percentage was of 90.73%. Data analysis demonstrated the existence of a significant relationship between the Flipped Classroom and students' motivation; the motivational profile, which was 18.54%, became 89.25% after flipping the class. The Flipped Classroom can significantly bring a surplus value to pedagogy, hence the importance of broadening its spectrum and integrating it as a new approach of teaching within health sciences educational institutions

Factors Associated with Mortality in Severe Acute Cholangitis in a Moroccan Intensive Care Unit: A Retrospective Analysis of 140 Cases

Background. Severe acute cholangitis is a life-threatening biliary infection, leading to organ dysfunction, septic shock, and naturally death. Mortality has dropped significantly in the past years through improving resuscitation and biliary drainage techniques. The aim of our study is to analyze our daily practice and the factors associated with mortality. Methods. A retrospective study including severe acute cholangitis patients admitted to our unit from January 2009 to December 2018. Variables analyzed (univariate then multivariate analysis) were age, sex, history, origin, evolution time, bilirubin, etiology, organ dysfunction, qSOFA, SOFA, TOKYO, biliary drainage timing and technique, shock, antibiotherapy, and resuscitation. Results. 140 patients were included in this study. Average age was 61. Sex ratio M/F was 0.59. Lithiasis etiology was dominant (69%). SOFA average score upon admission was 8. Ceftriaxone + metronidazole was the empirical antibiotic used in 87%. Average time to biliary drainage was 1.58±0.89 days. Endoscopic unblocking was the technique used in 76%. Mean duration of ICU stay was 6 days. Mortality rate was 28%. Statistically significant factors for mortality (p<0.05) were history of taking anticoagulant treatment, use of catecholamines and mechanical ventilation during ICU stay, and delay in consultation and administration of antibiotic therapy. Conclusions. Early recognition, antibiotics, resuscitation, and minimally invasive biliary drainage have improved patient outcomes although there is still progress to be made. Moreover, as multiple organ failure is often associated with mortality in severe acute cholangitis, predictive risk factors of organ failure should be more investigated