Facteurs predictifs de gravite des cellulites cervico-faciales diffuses d’origine dentaire : a propos de 78 cas

Introduction : La cellulite cervico-faciale est une dermohypodermite qui prend origine au niveau de la graisse hypodermique a partir d’effraction d'un foyer dentaire. Sa gravité réside d'une part dans sa forme diffuse avec risque d'obstruction des voies aériennes et de médiastinite et d'autre part dans sa forme nécrosante avec risque de fasciite nécrosante et de gangrène gazeuse. en l'absence de prise en charge multidisciplinaire et urgente, l'évolution de ces formes grave se fera vers le sepsis, le choc septique et le Syndrome de défaillance multi viscérales. L’objectif est de retrouver des facteurs prédictifs d'extension allant de l'atteinte des voies aériennes supérieures à l'infiltration médiastinale, ainsi que des facteurs prédictifs du type de cellulite (phlegmoneuse ou nécrotique).Patients et méthode : étude rétrospective faite sur une période de 7ans qui a permis d’exploiter 78 dossiers de cellulites cervico-faciales diffuses (CCFD) colligées au service d’OrL et chirurgie maxillo-faciale du CHU de rabat, l’atteinte des voies aériennes(VaS) l’atteinte médiastinale et le type de cellulite ont été retenu sur la tomodensitométrie. afin de dégager les éléments prédictifs de gravité statistiquement significatifs, l’évaluation a porté sur l’analyse des éléments épidémiologiques, cliniques, par acliniques et évolutifs en comparant respectivement les groupes de CCFD avec et sans atteinte des voies aériennes(VaS), avec et sans atteinte médiastinales, et en cas de formes nécrosantes versus cellulites phlegmoneuses. L’analyse statistique a été faite par le logiciel spss version 13.01 et les comparaisons ont été réalisées en utilisant les tests khi 2 et le test exact de Fisher pour les variables qualitatives, le test student et anOVa pour les variables quantitatives.Résultats : Cette série comporte 44 hommes et 34 femmes, L’âge moyen est 32 ans. Les facteurs favorisants significatifs sont, Le mauvais état buccodentaire et l’éthylotabagisme, alors que les aInS et Le diabète ne sont pas significatifs. Le diagnostic est clinique, et la tomodensitométrie permet l’étude de l’extension, le type, et de suivre l’évolution sous traitement. Les signes cliniques significatifs sont, l’altération de l’état général, le sepsis, la dyspnée, et les crépitations sous cutanées. Tous les malades ont été hospitalisés, dont 15 en réanimation, avec signification statistique pour le sepsis, l’atteinte médiastinale, et la cellulite nécrosante ou gangreneuse. Le drainage chirurgical (44,9%) avec signification pour médiastinites. L’évolution était favorable chez 75 patients ,3 décès par choc septiqueConclusion : Cette étude a montrée comme décrit dans la littérature que la CCFD prédomine chez le sujet jeune de sexe masculin, que la mauvaise hygiène bucco-dentaire intervient dans la genèse de la cellulite phlegmoneuse avec infiltration des VaS et que l’éthylotabagisme a un effet dans les formes graves cervico-médiastinales et nécrosantes .la clinique a permit le diagnostic mais elle a sous estimée l’atteinte des VaS et médiastinale et c’est la tomodensitométrie qui permit de préciser l’extension et le type de cellulite. L’antibiothérapie était comparable à la littérature, le drainage chirurgical des CCFD a été réalisé sous anesthésie générale avec intubation classique ou sous fibroscope, La trachéotomie n’est pas recommandée en première intention que lorsqu’elle était inévitable. Le recours à la chirurgie en urgence était pour les mêmes impératifs que la littérature dans les formes nécrotiques, dans l’atteinte médiastinale, et en cas de sepsis.Mots clés : Cellulite cervico-faciale - médiastinite –fasciite nécrosanteObjective : Cervicofacial cellulitis is a dermohypodermitis which originates at the hypodermic fat from a burglary of a focus dental, Its gravity lies partly in its diffuse form with a risk of airway obstruction and mediastinitis and secondly in its venture with necrotizing fasciitis and necrotizing gangrene. In the absence of multidisciplinary care and urgent, the evolution of these forms will be serious to sepsis, septic shock and multi-visceral dysfunction syndrome. The aim is to find predictors of extension from reaching the upper airways to mediastinal infiltration, as well as predictors of type of cellulitis (phlegmon or necrotic).Patients et méthods : retrospective study done over a period of 7 years who has exploited 78 cases of diffuse cervicofacial cellulitis (CCFD) collected in the service of Otolaryngology and maxillofacial Surgery University Hospital of rabat, achieving the airways (VaS), the mediastinal involvement and type of cellulite have been selected on the CT scan. To identify predictors of severity statistically significant, the evaluation focused on the analysis of the epidemiological, clinical, paraclinical and evolutionary elements by comparing respectively CCFD groups with and without airway involvement (VaS), with and without mediastinal involvement, and in case of necrotizing forms phlegmonous against cellulite. Statistical analysis was done by SPSS version 13.01 and comparisons were made using the chi 2 test and Fisher's exact test for qualitative variables, the Student test and anOVa for quantitative variables.Results: This series includes 44 men and 34 women; the average age is 32 years. Significant Contributing factors are the poor oral dental state, smoking and alcoholism . non-steroidal anti-inflammatory and diabetes were not significant. The diagnosis is clinical with discordance between the clinical and CT scan specifying the extension, type, and changes in treatment. The significant clinical signs are impairment of general condition, sepsis, dyspnea, and subcutaneous crepitus. all patients were hospitalized, including 15 in intensive care with statistical significance for sepsis, mediastinal involvement, and necrotizing or gangrene cellulitis. Surgical drainage (44.9%) with statistical significance for mediastinitis. The outcome was favorable in 75 patients, 3 deaths from septic shock.Conclusion: This study has shown as described in the literature that CCFD predominates in the young male, that poor oral hygiene is involved in the genesis of cellulite phlegmonous with airway infiltration and that smoking and alcoholism has effect in severe neck and mediastinal necrotizing. The clinical diagnosis allowed but she underestimated airway and mediastinal damage and computed tomography which enabled it to clarify the extent and type of cellulite. antibiotic therapy was comparable to the literature, surgical drainage of CCFD was performed under general anesthesia with classical intubation or under fiberscope, tracheostomy is not recommended as first-line until it was inevitable. The surgery was urgent for the same imperatives that literature in necrotic forms, in the mediastinal involvement, and sepsis.Keywords : cervico-facial cellulitis - mediastinitis - necrotizing fasciiti

In Vitro Activities of Ertapenem and Imipenem against Clinical Extended Spectrum Beta-Lactamase-Producing Enterobacteriaceae Collected in Military Teaching Hospital Mohammed V of Rabat

Objective. To study the sensitivity level of extended spectrum beta-lactamase-producing Enterobacteriaceae to Carbapenems (Imipenem, Ertapenem) marketed in Morocco and discusses the place of Ertapenem in the treatment of extended spectrum-beta-lactamase-producing. Materials and Methods. A retrospective study of 110 extended spectrum beta-lactamase-producing Enterobacteriaceae. Isolates obtained from blood cultures, superficial and deep pus, and catheters were conducted. The minimum inhibitory concentrations of Imipenem and Ertapenem were done by the E-test. The modified Hodge test was conducted for resistant or intermediate strains. Results. 99.1% of isolates were susceptible to Imipenem. For Ertapenem, 4 were resistant and 4 intermediate. The modified Hodge test was positive for all 08 isolates. A minimum inhibitory concentration comparison of K. pneumoniae, E. cloacae, and E. coli for Imipenem has noted a significant difference between E. cloacae on one hand and E. coli, K. pneumoniae on the other hand (<0.01). No significant difference was noted for minimum inhibitory concentration of Ertapenem. Conclusion. Our results confirm in vitro effectiveness of Ertapenem against extended spectrum beta-lactamase-producing Enterobacteriaceae as reported elsewhere. However, the emergence of resistance to Carbapenems revealed by production of carbapenemases in this study confirmed a necessary bacteriological documented infection before using Ertapenem

Musculoskeletal Disorders in Patients with Diabetes Mellitus: A Cross-Sectional Study

Introduction. A variety of musculoskeletal disorders (MS) have been associated with diabetes mellitus (DM). This study aimed at assessing the prevalence and associated factors of MS disorders in Moroccan diabetic patients. Methods. A cross-sectional study enrolled consecutive patients with DM. We recorded demographic features of patients and characteristics of DM. MS disorders and vascular complications were assessed by clinical examinations and investigations. Associated factors of MS disorders were assessed by univariate and multivariate analyses. Result. 376 subjects were included; 84.6% had type 2 DM. The participants’ median age was 54 years [45–62]; 41% had one or more vascular complications. 34.4% had one or more MS disorders. Osteoarthritis was present in 19.4% of patients. Hand disorders were seen in 14.4%. Shoulder capsulitis was present in 12.5%. Long duration of diabetes and dyslipidemia were associated with increased prevalence of hand abnormalities (P=0.017; P=0.019, respectively). Age and dyslipidemia were associated with shoulder capsulitis (P=0.019; P=0.047, respectively). Female gender, overweight, and nephropathy were associated with increased odds of osteoarthritis (P=0.009, P=0.004, and P=0.032, respectively). Conclusion. MS disorders are frequent in this population and associated with various factors. HbA1c level does not appear to be associated with development of MS disorders