Endovascular treatment of acute aortic isthmian ruptures: case study

Traumatic rupture of the aortic isthmus is a rare lesion occurring in patients subjected to violent deceleration. Because of the forces involved, it is frequently associated with concomitant life-threatening injuries. The endovascular intervention has been described to be a feasible and efficient technique which may be proposed as a therapeutic option for patients with multiple traumas instead of delayed classical surgical repair after stabilization. We report the case of an adult who has had an accident with a traumatic rupture of the aortic isthmus associated with other lesions, our patient received endovascular treatment. The aortic prosthesis was imported from France and the surgery was done 3 days after the patient's admission. This procedure was performed for the first time in Morocco in our hospital with a multidisciplinary team. The prosthesis was implemented successfully and the result was very satisfactory on the heart level.Keywords: Endovascular treatment, aortic isthmian ruptures, endovascular prosthesi

Evaluation of the cost of cervical cancer at the National Institute of Oncology, Rabat

Introduction: The Cervical Cancer (CC) is one of the heavy and costly diseases for the population and the health system. We want to know through this study, the first in Morocco, the annual cost of the treatment of this disease at the National Institute of Oncology (NIO) in Rabat, we also want to explore the possibility of flat-rate management of this disease in order to standardize medical practices and improve reimbursement by health insurance funds. Methods: 550 patients were treated for their cervical cancer in the Rabat's NIO. Data of all of medical and surgical services offered to patients were collected from the NIO registry. The cost of care was assessed using the method of micro-costing. We will focus to the total direct cost of all the services lavished to patients in NIO. Results: The global cost was about US$1,429,673 with an average estimated at US$ 2,599 ± US$ 839. Radiotherapy accounts for 55% of total costs, followed by brachytherapy (27%) and surgery (7%). This three services plus chemotherapy influence the overall cost of care (p <0.001). Other services (radiology, laboratory tests and consultations) represent only 10%. The overall cost is influenced by the stage of the disease, this cost decreased significantly evolving in the stage of CC (p <0.001). Conclusion: The standardization of medical practices is essential to the equity and efficiency in access to care. The flat-rate or lump sum by stage of disease is possible and interesting for standardizing medical practices and improving the services of the health insurance plan.Pan African Medical Journal 2016; 2

Bacteriological Quality of Seawater Bathing Areas along the Oran Coast (West northern Algeria)

Marine water of Ora

Glomérulonéphrite extra-membraneuse et syndrome myélodysplasique: une association rare

Les syndromes myélodysplasiques peuvent s’accompagner de maladies auto-immunes. L’atteinte rénale au cours de ces syndromes est rare. Dans ce cas, les glomérulopathies prédominent cette atteinte. La glomérulonéphrite extra-membraneuse est exceptionnellement reportée en association avec un syndrome myélodysplasique. Nous rapportons dans ce papier le cas d’une patiente présentant une glomérulonéphrite associée à une anémie révélant un syndrome myélodysplasique de faible risque. Dans la lumière de ce cas, nous faisons une courte revue de la littérature des cas précédemment publiés et nous discutons le lien pathogénique entre ces deux entités

Complete remission of nephrotic syndrome secondary to amyloid a amyloidosis in patient with inactive Crohn's disease after treatment by infliximab

Secondary amyloidosis Amyloid A (AA) is an infrequent but a severe complication of Crohn's disease (CD). This complication results from the activity of the underlying inflammation disease to form amyloid fibril deposits in tissues. We present a case of a 34-year-old female patient with CD treated by azathioprine with inactive disease for three years and who developed a nephrotic syndrome secondary to AA amyloidosis. The treatment by infliximab for one year leads to a complete remission of the nephrotic syndrome. In this case, this complication occurred while the patient was clinically well, with biological and endoscopic markers showing an inactive or only mildly active disease. Infliximab could be a useful tool for a successful treatment of amyloidosis secondary to CD

Late-onset choreoathetotic syndrome following heart surgery in adults with end-stage renal disease

Choreoathetotic syndrome is a rare complication of open cardiac surgery that is seen usually in children after surgery for congenital cardiac anomalies. Here, we report two cases of adult patients with end-stage renal disease (ESRD) on regular hemodialysis who developed acute choreoathetotic syndrome few days after cardiac surgeries under cardiopulmonary bypass (CPB). Improvement was seen after an interval with complete resolution in one case. Investigations of the cause have been noncontributory. Long CPB time seems to be the main identified risk factor in these cases. One of the unusual features of our adult cases was the existence of ESRD. To the best of our knowledge, this is the first time this complication is described in association with ESRD although the role of this comorbidity in these cases is uncertain

Enterobacteriaceae producing extended-spectrum β-lactamases (ESBLs) colonization as a risk factor for developing ESBL infections in pediatric cardiac surgery patients: “retrospective cohort study”

Abstract Background Children with cardiac defects need many hospitalizations and repetitive antibiotic therapies, with an increasing risk of colonization with multidrug-resistant bacteria (MDRB) such as extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) Post-operative infections with these bacteria in paediatric cardiac surgery are life threatening. This article aims to study the prevalence of ESBL colonization among paediatric cardiac surgery patients, and to compare occurrence of post-operative infections with and without ESBL colonization. We also aim to study the correlation between the onset of postoperative infection and other parameters such as age, length of stay and preoperative antibiotic therapy. Methods A retrospective cohort study included paediatric cardiac surgery patients in Cheikh Zaid hospital in Rabat, Morocco, between the 1st of January 2011 and 31 December 2014. A screening for ESBL colonization was requested for children who had a risk factor (previous hospitalization and/or taking antibiotics) at admission. Swabs were collected from three sites (throat, nose and anus). Two groups were compared – patients colonized and not colonized with ESBLs. Statistical analysis was performed using R software. Results ESBL colonization screening was performed in 111 patients. Positive colonization was detected in 17 cases (15%). Klebsiella pneumoniae (KP): 9 (53%) was the most frequently isolated species. Among the 17 patients, 23.5% (4/17) developed a postoperative infection due to ESBLs versus only one patient without colonization (1%). There was a statically significant difference in terms of occurrence of postoperative infection between the two groups (p = 0.001). Relative risk of developing a postoperative infection with positive colonization was 22 (95% CI, 8.37–58.5). Conclusions The analysis of colonization with multidrug-resistant bacteria and the prevention of nosocomial infections appear to be important challenges for paediatric cardiac surgery. Systematic screening of ESBL colonization for cardiac surgery could have a significant contribution, on one hand to guide prophylactic antibiotic therapy of patients, and on the other, to prevent spread of those infections

Knowledge, attitudes and practices of the liberal doctors in relation to the national convention signed in the framework of Mandatory Health Insurance in Morocco: a cross-sectional study

Introduction: under the Mandatory Health Insurance (MHI) scheme, liberal doctors signed their first national convention in the year of 2006. The delay in renewing this agreement could negatively affect the accessibility of the insured persons to medical care. The objective of this study was to explore the knowledge, attitude and practice of the liberal doctors towards their adherence to the national convention signed under MHI scheme and to propose some improvements. Methods: our study is cross-sectional based on a descriptive survey targeting the population of liberal doctors adhering to the signed convention under the MHI in Morocco. The material used was a questionnaire that was administered to doctors selected. The processing and analyzing of results were performed with SPSS 13.0. Results: the study, conducted in 2016, examines included 40 liberal doctors. 97.5% of them reported dissatisfaction with the National Reference Pricing. 60% of the them were demotivated to the application of the national convention because of the lack in educational materials. There was no significant difference in the attitudes between general practitioners and specialists, all of whom considered that remuneration was unfair under MHI (p = 0.689), they also considered that working conditions have deteriorated (p = 0.256). Conclusion: the behavior of liberal doctors towards the national convention signed within the framework of the MHI hides a general dissatisfaction whatever the place of practice. This dissatisfaction was felt by physicians regardless of their seniority or specialty. Several efforts should be made to find a compromise between doctors and the health insurance system to improve patient access to care