Étude de la qualité physicochimique et bactériologique des eaux de la station thermale de Sidi Harazem (Maroc)

En présence d’un risque de contamination des eaux au cours de la distribution de l’eau minérale de la station thermale Sidi Harazem, ainsi qu’en absence d’une stratégie adéquate pour le traitement des eaux usées de cette station et qui sont déversées directement dans l’oued, nous avons suivi l’évolution de la qualité bactériologique et physico-chimique des eaux de cette station durant la saison printanière et la saison estivale de l’année 2009. Les résultats obtenus renseignent sur une contamination de l’eau minérale par Pseudomonas aeruginosa, ainsi qu’une pollution importante de l’oued de Sidi Harazem et de la piscine par les fortes charges en germes, tels que les coliformes totaux (CT) (10,5  × 105 à 1,3  × 103 UFC/100 mL), les coliformes fécaux (CF) (2,5  × 104 à 4,45  × 102 UFC/100 mL), les streptocoques fécaux (SF) (6,12  × 103 à 60 UFC/100 mL) et la flore mésophile aérobie totale (FMAT). Les germes pathogènes de la typhoïde et du choléra n’ont pas été détectés dans les eaux usées. Les résultats physico-chimiques montrent que les eaux de la station sont de bonne qualité physicochimique et répondent aux normes marocaines d’eau potable

Prise en charge de première intention du couple infertile : mise à jour des RPC 2010 du CNGOF

Objective: To update the 2010 CNGOF clinical practice guidelines for the first-line management of infertile couples.Materials and methods: Five major themes (first-line assessment of the infertile woman, first-line assessment of the infertile man, prevention of exposure to environmental factors, initial management using ovulation induction regimens, first-line reproductive surgery) were identified, enabling 28 questions to be formulated using the Patients, Intervention, Comparison, Outcome (PICO) format. Each question was addressed by a working group that had carried out a systematic review of the literature since 2010, and followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) methodology to assess the quality of the scientific data on which the recommendations were based. These recommendations were then validated during a national review by 40 national experts.Results: The fertility work-up is recommended to be prescribed according to the woman's age: after one year of infertility before the age of 35 and after 6months after the age of 35. A couple's initial infertility work-up includes a single 3D ultrasound scan with antral follicle count, assessment of tubal permeability by hysterography or HyFOSy, anti-Mullerian hormone assay prior to assisted reproduction, and vaginal swabbing for vaginosis. If the 3D ultrasound is normal, hysterosonography and diagnostic hysteroscopy are not recommended as first-line procedures. Chlamydia trachomatis serology does not have the necessary performance to predict tubal patency. Post-coital testing is no longer recommended. In men, spermogram, spermocytogram and spermoculture are recommended as first-line tests. If the spermogram is normal, it is not recommended to check the spermogram. If the spermogram is abnormal, an examination by an andrologist, an ultrasound scan of the testicles and hormonal test are recommended. Based on the data in the literature, we are unable to recommend a BMI threshold for women that would contraindicate medical management of infertility. A well-balanced Mediterranean-style diet, physical activity and the cessation of smoking and cannabis are recommended for infertile couples. For fertility concern, it is recommended to limit alcohol consumption to less than 5 glasses a week. If the infertility work-up reveals no abnormalities, ovulation induction is not recommended for normo-ovulatory women. If intrauterine insemination is indicated based on an abnormal infertility work-up, gonadotropin stimulation and ovulation monitoring are recommended to avoid multiple pregnancies. If the infertility work-up reveals no abnormality, laparoscopy is probably recommended before the age of 30 to increase natural pregnancy rates. In the case of hydrosalpinx, surgical management is recommended prior to ART, with either salpingotomy or salpingectomy depending on the tubal score. It is recommended to operate on polyps>10mm, myomas 0, 1, 2 and synechiae prior to ART. The data in the literature do not allow us to systematically recommend asymptomatic uterine septa and isthmoceles as first-line surgery.Conclusion: Based on strong agreement between experts, we have been able to formulate updated recommendations in 28 areas concerning the initial management of infertile couples