Hospital Of Casablanca Research Articles

Review of deaths cases due to carbon monoxide poisoning in a tertiary hospital

Background: Carbon monoxide threatens its victims with sudden anoxic death and severe neurological sequelae. Materials and Methods: This is a descriptive and analytical retrospective study on 14 cases of deaths due to Carbon monoxide poisoning collected at the Forensic Department of Ibn Rochd University Hospital in Casablanca (UHC), over a two years period from January 2018 to December 2019. Results: Among the 14 deaths, there were nine (N=09) male victims (64%) and five (N=05) female (36%), aged 25 to 44 years in 43% of cases and 45 to 64 years in 36% of cases. Vast majority of cases (86%) involved accidental household poisoning. A water heater was incriminated in 36%. The source of Carbon monoxide was related to a defective device (36%). Neurological signs such as disturbances of consciousness were the most common (92%) symptom. The peak poisoning period (50%) occurred in December. Autopsy revealed pulmonary petechial spots (14%) and congestion of most organs. Carboxyhemoglobin (COHb) was positive in 8 cases with a rate> 5%, including 3 victims with no history of smoking and > 10% among 5 smokers. The value was negative for two victims who received oxygen therapy during hospital resuscitation efforts. The COHb level was indeterminable in 4 cases of which 3 victims were in advanced decomposition and one was exsanguinated. Conclusion: Prevention is key in reducing the morbidity and mortality of Carbon monoxide poisoning that can cause sudden anoxic death and severe neurological sequelae.

Assessment of velopharyngeal insufficiency and oronasal fistula after primary surgery of cleft palate

<p class="abstract"><strong>Background:</strong> Cleft palates are the most common congenital craniofacial anomalies in children, and their treatment is challenging in terms of outcomes. The objective of the study was to determine the incidence of velopharyngeal insufficiency (VPI), and of the oronasal fistula after a veloplasty.</p><p class="abstract"><strong>Methods:</strong> By a retrospective study, over a period of 2 years, going from January 2017 to December 2018, carried out in the department of ENT and head and neck surgery of the August 20 hospital in Casablanca, Morocco. The inclusion criteria were all patients operated on for a cleft palate. The main results were the incidence of VPI, and of the oronasal fistula after a primary repair of the palate. </p><p class="abstract"><strong>Results:</strong> Out of a total of 21 cases, the average age was 4 years, and the sex ratio was 0.61, the average postoperative follow-up duration was 1 year and 9 months. VPI was found in 13 patients (62%), it was mild in 3 patients (14%), moderate in 6 patients (28%), and severe in 4 patients (19%), the frequency of VPI increased significantly with increasing age (p=0.05). The oronasal fistula was found in 5 (23.8%) patients, this fistula was more frequent when the patient benefited from the operation at an early age.</p><p class="abstract"><strong>Conclusions:</strong> Age is the most important factor in the management of cleft palates.</p>

Peculiarity of hypertension and pregnancy about 544 cases

Hypertension and pregnancy is a clinical diagnosis defined by the new onset of hypertension (systolic blood pressure ≥ 140 mm Hg and/or diastolic blood pressure ≥ 90 mm Hg. The objective of this work is to specify the epidemiological, clinical, para-clinical, therapeutic and prognostic. A total of 5946 deliveries collected at the gyneco-obstetric. All pregnant women were included in this study with the diagnosis of hypertension. This is a retrospective study of 544 cases of hypertension and pregnancy collected at the Lalla Meryem maternity hospital Ibn Rochd hospital in Casablanca for a period of 2 years. The incidence is 9.2%. The average age of onset was 30 years with an age range of 15 to 45 years. The primiparous were the most exposed 261 cases (48%). Three hundred and ten cases (57%) have an unsupported pregnancy. Two hundred and ninety cases (53.3%) had a systolic blood pressure greater than or equal to 160 mm Hg, and 160 cases (29.4%) had a diastolic blood pressure ≥ 110 mm Hg. The most used medical conduct was the combination of rest and antihypertensives. Obstetrical behavior was marked by the frequency of vaginal deliveries (63.4%). Maternal complications represent (14.7%) dominated by retro-placental hematoma (5.1%) and eclampsia (3.7%). Perinatal mortality represents 57 cases (9.9%). The factors of bad fœto-maternal prognosis are for the fetus: the low gestational age, the low parity, the non monitoring of the pregnancy, the massive proteinuria and the hyperuricemia. For the mother, young maternal age, primiparity, non-pregnancy monitoring, diastolic blood pressure ≥ 110 mm Hg, systolic blood pressure ≥ 160 mm Hg, and massive proteinuria. This study concludes that high blood pressure and pregnancy is a major cause of maternal mortality and morbidity. These complications can be reduced by a better physiopathological understanding and a better knowledge of fetal and maternal prognostic factors.

Combination aortic and mitral stenosis: what are the particularities?

Multivalvular heart disease is a frequent situation, but there is only few medical literature about its management. The combination between aortic stenosis(AS) and mitral stenosis(MS) is an illustrative example. This situation is far from being exceptional especially in developing countries. The aim of our study is to describe the clinical features, electrical and echocardiographic characteristics of patients with both MS and AS. We achieved a prospective, single-centric study from October 2017 to january 2019, concerning register of patients followed for valvulopathies, collected from the hospital of day and echocardiography vacations in the cardiology department of Ibn Rochd University Hospital in Casablanca, Morocco. We included only patients having association MS and AS. The valvular register included 320 patients, 20 of them (6%) had combined AS and MS. Mean age was 47,57 (± 16.27); sex ratio = 0.7. Clinical presentation was dyspnea in 95% (76% stage II and 16% stage III of NYHA), 5% Angina, 15% hemoptysis, and 28% palpitations. A Left and right heart failure were found in 10% and 14.3%. ACFA was noted in 42%. Left ventricular hypertrophy was found in 47.6%, left and right ventricular dysfunction in 28,6% and 23%. The mean mechanism was rheumatic in 90%. MS was very severe in 30%, severe in 70%; with a mean mitral surface at 1.1 cm 2 , and mean gradient at 9 mmHg. AS was severe in 45%, moderate in 25%, and mild in 30%, with a mean aortic surface at 0,7cm 2 /m 2 , and mean gradient at 31 mmHg. A state of low flow was found in 30% with a VES < 35 ml/m 2 responsible of a low aortic gradient in 5%. Pulmonary hypertension was noticed in 45%. The association AS and MS is not rare in our context. It is important not to underestimate the diagnosis and therapeutic challenges raised by this entity. These complex situations require a multidisciplinary approach of heart team involving cardiologist, surgeons and imaging specialists (1).

Knowledge, Attitude &amp; Perception of Hemodialysis Patients at Cheikh Khalifa Ibn Zaid University Hospital in Casablanca about Covid 19 Disease

Introduction: Coronavirus disease 2019: COVID 19, is a new communicable disease caused by the SARS-CoV-2 virus, which appeared in Wuhan, Hubei Province, China in December 2019, and declared a global pandemic on March 11, 2020, by the World Health Organization (WHO). This disease is generally manifested by damage to the airways, most often of a mild form, but can be complicated by acute respiratory distress syndrome. Patients with end-stage renal disease are at high risk of contracting the infection, due to their co-morbidities, the state of immunosuppression and the logistical aspect of the provision of care requiring physical movement of patients to the center dialysis.Objectives of this study: This study aims to assess the knowledge, attitude and perception, in terms of the 2019 coronavirus pandemic, of a sample of patients with chronic end-stage renal disease hemodialysis at the nephrology and dialysis center at the university hospital Cheikh Khalifa Ibn Zaid , in Casablanca, where positive COVID 19 patients were hospitalized and treated during the pandemic.Design: The investigation began after the decree of compulsory confinement and the state of health emergency by the Moroccan government. Awareness sessions, for patients and their family members, were led by nursing staff at the start of the period and during the COVID 19 pandemic. The measuring instrument used was a self-administered questionnaire, 1 month after the start of confinement, with 25 patients with chronic end-stage renal disease on hemodialysis at the rate of 3 sessions per week, at the nephrology and dialysis center at the university hospital. Sheikh Khalifa Ibn Zaid. This questionnaire was carried out after a review of the literature and included 4 headings: a) socio-demographic data b) general knowledge of COVID19 disease c) the attitude of hemodialysis patients outside and inside the dialysis center d) and their perception of this pandemic.Results : The majority of our patients were fairly well informed about the clinical presentation, the means of transmission and the prevention measures against coronavirus 2019. The means of protection were respected outside and in the university hospital center. There were no positive COVID 19 cases among our patients. Despite all the measures taken, the concern of contacting the virus was raised by most patients, especially in the hospital, during the dialysis session and in contact with medical personnel.Conclusion: Given the rapid spread and severe progression of COVID 19, it seems prudent that this profile of patients with end-stage chronic renal failure be included in high-risk populations with close medical and also psychological monitoring, tests screening and awareness and support sessions.

Anemia: Predictor of long stay for coronary patients

The aim of the study is to determine the influence of anemia on the duration of hospital stay in patients with acute coronary syndrome. A retrospective study was conducted in all coronary patients admitted to the cardiology service of Ibn-Rochd Hospital in Casablanca between January and April 2018. Anemia was defined as Hb < 13 g/dL in men and < 12 g/dL in women (WHO definition). Biological markers were collected at admission. The patients were followed for 1 month. Among the 215 patients included, there were 141 men and 74 women, the average age was 59.3 years. Seventy-seven patients had ST-segment elevation coronary syndrome, 44 patients had ST-segment elevation-related coronary artery disease, and 94 had myocardial infarction. A total pf 121 patients had 56.27% anemia. Anemia was more common in women. Cardiovascular risk factors, subclinical atherosclerosis, lower extremity arteritis, and inflammatory syndrome were more common in anemic patients. The latter presented more complications during their hospitalization. Mean hospital stay in anemic patients was longer (11.8 vs. 6.2 days, P = 0.03). Anemia is common in patients with ACS and is associated with a longer duration of hospitalization exposing the patient to the risk of care-related complications.

Tuberculosis of the breast: analysis of 17 cases.

Tuberculosis constitutes a major public health problem in the world. Certain extra-pulmonary locations of tuberculosis disease are very exceptional. Amongst these, tuberculosis of the breast is rare even in countries where this infection is endemic. This form of tuberculosis is characterized by clinical and radiological polymorphisms and might mimic other diseases, especially breast cancer. This retrospective study is entailing seventeen patients treated in the Onco-Gynecology Department of the Mohammed VI Cancer Treatment Center, in the Ibn Rochd University Hospital of Casablanca, for breast tuberculosis, over a period of three years. We report the epidemiological, clinical and paraclinical aspects and we specify the treatment and evolution of the patients.

EP1.15-10 Survival Impact of Non-Surgical Treatment in Thymic Epithelial Tumours: A Retrospective Study

The management of thymic epithelial tumours, although poorly defined due to their rarity, remains multidisciplinary in order to offer patients multimodal treatment with surgery as the therapeutic pillar. Our main objective is to highlight the impact of non-surgical treatments on the overall survival and the progression free survival of patients treated for these tumours at the Mohamed VI center. We carried out a monocentric, descriptive and retrospective study using databases from the oncology, the thoracic surgery and anatomopathology departments of the Ibn Rochd University Hospital in Casablanca. We identified all patients with thymoma or thymic carcinoma whose histological diagnosis was made on a biopsy or a surgical excision piece between July 2006 and February 2016 After exclusions, 42 patients were identified and we used a farm sheet to specify for each patient, epidemiological data, data related to histological type, Masaoka-Koga staging and progress under treatment (complete or partial response, stabilization or progression) For our analysis, we used Microsoft Office, Excel 2007 and Kaplan Meier Software to assess overall ans progression free survival. 42 cases of thymic epithelial tumours were reported between 2006 and 2016 with apredominance of type B1 in patients aged between 25 and 77 years. The radiological assessment carried out before treament showed that 9.5% of the diseases were metastatic from the outset, while the others had an intra – thoracic locoregional extension Half of the patients were resectable from the outset, wich made it possible to perform primary surgery leading to carcinological resection with generally simple post-operative outcomes. In our series, CAP D1 = D21 chemotherapy was the preferred regimen to be indicated as a pre operative treatment to reduce the size of the tumor and increase its resectivity rate in 11 patients (26,2% of cases). This chemotherapy was indicated as adjuvant treatment in 06 cases of incomplete resection (14,3% of cases) Two patients (4,8% of cases) received first chemotherapy followed by exclusive radiation therapy at 66 Gy while more than 25% received a post-operative radiation therapy at variable doses ranging from 50-54Gy for R0 tumours or microscopic disease to 60-70Gy for macroscopic disease. The overall and progression free survivals at 22 months were 94,6% and 68,4% respectively. The prognostic factors are, in univariate analysis, the performans status, the histological type, the Masaoka-Koga stage and the quality of surgical resection. The multivariate analysis could not be performed due to a lack of statistical power, due to the small number of patients and the retrospective nature of the study. The thymic epithelial tumours treatment is a real challenge given the absence of randomized prospective studies on this subject Surgery remains the mainstay of management but neo-adjuvant and or adjuvant treatments can be considered in case of poor prognostic factors in order to reduce the risk of recurrence or death from the disease.

Red blood cell alloimmunizations in beta-thalassemia patients in Casablanca/Morocco: Prevalence and risk factors.

We aimed to study the prevalence and risk factors of red cell alloimmunization in β-thalassemic patients. Retrospective study during 9 years (2009-2018) was conducted on 160 β-thalassemic patients transfused regularly in pediatric department of children's hospital in Casablanca, Morocco. The main clinical, demographic and transfusional characteristics of alloimmunized and non-alloimmunized patients were compared. Red blood cells units transfused were leukodeplated and phenotypically matched for RH-KELL systems and for other systems after immunization. Screening and antibody identification were performed by gel-filtration method on BIO-RAD caseds using 3 and 11 red blood cells panels. To detect autoantibodies, autocontrol and direct antiglobulin tests were carried out using polyspecific coombs (IgG/C3d) gel cards. The prevalence of alloimmunizations was 8.75% during the study period. Seventeen alloantibodies identified were directed mainly against antigens of KELL and RH systems: KEL 1 (35.29%), RH 3 (23.52%), RH1 (11.76%), Kpa (11.76%), RH2 (5.88%). Red blood cells autoantibodies had been detected in 6 of 14 (42.85%) of alloimmunized patients versus 12 of 146 (11.76%) of non-alloimmunized patients (P<0.01). Presence of autoantibodies, transfusional interval<3weeks and gender were associated with high rate of red cells alloimmunization. This study proves the data of literature. The presence of red cell autoantibodies appears to be a major risk factors for alloimmunization in thalassemic children, and could advocate specific transfusion guidelines.

Prevalence of coagulase-negative staphylococci in blood cultures at the Ibn-Rochd University Hospital in Casablanca

IntroductionLa réalisation des hémocultures est le meilleur moyen de diagnostic des bactériémies, cependant les résultats faussement positifs peuvent entraîner une confusion concernant les schémas thérapeutiques antibiotiques, mettant ainsi en danger la sécurité des patients. L'objectif principal de ce travail est d'évaluer la prévalence des Staphylocoques à coagulase négative (SCN) ainsi que Corynebacterium spp et Bacillus spp dans les ballons d'hémoculture analysés au laboratoire de microbiologie du Centre Hospitalier Universitaire (CHU) Ibn Rochd de Casablanca. Cette prévalence a été aussi évaluée en fonction de différents services hospitaliers sur l'année 2016.MéthodesIl s'agit d'une étude rétrospective descriptive basée sur une analyse de la base de données informatisée du laboratoire de bactériologie-virologie du CHU Ibn Rochd de Casablanca sur une période de 12 mois allant du 1er janvier au 31 décembre 2016, Ont été inclus dans notre étude les bactéries faisant partie de la flore commensale (staphylocoque à coagulase négative,corynébactéries spp et Bacillus spp) Les ballons d'hémoculture ont été incubés sur automate Bactec FX. L'identification des germes à partir d'une culture positive a été réalisée selon les techniques standards de bactériologie et l'antibiogramme selon EUCAST 2015. L'étude est basée sur une analyse de la base de données informatisée du système KALISIL (Netika) version (2.2.10.) du Laboratoire de Microbiologie du CHU Ibn Rochd-Casablanca Maroc.RésultatsSur 7959 demandes d'hémocultures adressées au laboratoire de bactériologie provenant de 5801 patients, 2491 étaient positifs dont 848, soit 34% des ballons positifs ou 10,6% de l'ensemble des ballons reçus durant l'année 2016, ont été représentées par staphylocoque à coagulase négative, 56 soit (2,2%) ballons des hémocultures par corrynébacteruim SP, suivi par 60 soit (2,4%) ballons par bacillus sp. La fréquence d'isolement du SCN par rapport aux autres bactéries en fonction des services cliniques a montré une fréquence plus élevée dans les services de pédiatrie avec 47,2% suivie des services de médecine avec 44,1%.ConclusionCette étude montre que, Les staphylocoques à coagulase négative sont les organismes les plus fréquemment isolés des hémocultures, ils constituent une cause non négligeable d'infections nosocomiales mais, ils sont également les contaminants les plus courants des hémocultures.

Drug intoxication in children: A retrospective study at the University Hospital of Casablanca

Background: The drug intoxication is increasingly a serious problem in pediatrics across the world due to their frequency and management difficulties. In Morocco, the number of studies concerning this subject is few which were made to this day at only some hospitals. Objective: The aim of this study is to review the prevalence, severity, the different etiologies, the clinical, and therapeutic aspects, also the possible preventive ways of these underestimated poisonings in Morocco. Materials and Methods: It is a retrospective study using 216 cases of drug intoxication who came to the pediatric ward II of the University Hospital of Casablanca. Results: All the age groups under 15 years old were hit with two frequency peaks at 3 years and 15 years. In most cases, it was an accidental poisoning, though some suicidal ingestions were also noted, especially in teenagers. In over half of cases, the causal drug was neurotropic (benzodiazepines and antipsychotics). The clinic was dominated by neurological signs: Consciousness disorder, behavioral disorders, or seizures. Treatment varies depending on the delay between the incident and the case management and was limited to symptomatic treatment or detoxification measures were required: Spillway treatment or an antidote. Poison Control Center was consulted in all cases. Conclusion: Accidental drug intoxication in children is a public health issue. Legislation and means of prevention must be determined and clarified to confront this problem. Studies on this issue would be appreciated to delimit the real epidemiological and clinical profile of these intoxications.

Profil clinique, fonctionnel et thérapeutique de l’asthme du sujet âgé

IntroductionAsthma in the elderly is a health problem of growing concern. Its prevalence will increase in the next 20 years due to the rising longevity of the world population. The purpose of our work is to trace the epidemiological and clinical characteristics as well as the therapeutic difficulties of asthma in this patient population. Patients and methodsRetrospective study of a cohort of 112 patients aged over 65 years and presenting bronchial asthma, followed at the allergy consultation at Ibn Rochd Hospital in Casablanca over a period of 13 years. ResultsMean age was 67.5 years with female predominance. Family atopy was present in 41% of cases and personal atopy in 67% of cases. Fifty-two percent of patients had comorbidities, dominated by diabetes, hypertension and gastroesophageal reflux. Asthma had been present on average for 16 years. The prick-tests, performed in 34.8% of cases, were positive in 51.2%. Spirometry, performed for all patients, revealed an obstructive ventilatory disorder in 56.2% of cases. Management was based on therapeutic education and environmental control in all cases. Background treatment was prescribed in accordance with stage and level of disease control. Asthma was classified as uncontrolled in 48.2% of cases. ConclusionAsthma in the elderly is severe, often uncontrolled, and associated with comorbidities, thus posing both diagnostic and therapeutic difficulties. Its management requires patient education and understanding of the treatment regimen.

Effects of propranolol therapy in Moroccan children with infantile hemangioma

Infantile hemangiomas are the most common childhood vascular tumors. Propranolol is a β-adrenergic blocker that has proven effective in the treatment of this tumor. Numerous studies around the world have been published, describing satisfactory responses in pediatric populations with a higher cure rate and fewer adverse effects than when using corticosteroids. The aim of this study was to evaluate the efficacy and adverse effects of propranolol in Moroccan pediatric patients diagnosed with infantile hemangioma who were treated with oral propranolol. A prospective study was conducted from May 2009 to May 2017 in the department of dermatology of a hospital in Casablanca. All the patients who had infantile hemangioma were included. The study comprised 121 patients with infantile hemangioma: 90 girls and 31 boys. The mean age was 6 months. The majority of hemangiomas were mixed (63%) and located on the face and neck. The treatment was well tolerated by all the patients. The dosage of propranolol was gradually increased from 1mg to 2mg/kg/day. We noted a decrease in coloration after 48hours. The healing period for ulcerated hemangiomas was 20 days. A decrease in size was noted after 1 month, while a decrease in palpebral obstruction occurred after 3 days. Treatment with propranolol in this group of Moroccan pediatric patients proved to be safe and effective at a dose of 2 mg/kg/day, reducing the size and coloration of the hemangioma. Treatment should be stopped at an appropriate time, which is determined primarily by the lesion regression rate after propranolol treatment.

HIV co-infection in patients followed up for tuberculosis in the Division of Infectious Diseases at the Ibn Rochd University Hospital in Casablanca

L'objectif du travail est de déterminer la prévalence de l'infection par le VIH chez les tuberculeux hospitalisés au service des maladies infectieuses du CHU Ibn Rochd-Casablanca et de chercher les facteurs associés à la co-infection Tuberculose-VIH. Nous avons mené une étude transversale rétrospective menée en Novembre 2016, en se basant sur l'exploitation de la base de données du service des maladies infectieuses, des laboratoires de microbiologie et d'immunologie du CHU Ibn Rochd. Etaient inclus les patients ayant une tuberculose confirmée par culture positive sur milieu de Lowenstein Jensen et une infection à VIH confirmée par Western Blot entre Janvier 2013 et Décembre 2015. Au cours de la période de l'étude, 117 cas de tuberculose ont été confirmés par culture. Parmi ces patients, 46 (39,3%) avaient une infection à VIH confirmée. Trente-quatre patients co-infectés (73,9%) avaient une tuberculose extra pulmonaire (cette forme était associée à la co-infection (p=0,04)). Tous les patients ont été mis sous traitement antituberculeux et antirétroviral selon l'indication. L'évolution était favorable chez 32 patients (69,6%) et 10 décès ont été enregistrés (21,7%). La mortalité était plus élevée chez les co-infectés que chez les tuberculeux non atteints par le VIH (8,4%), (p=0,04). Cette étude a objectivé une prévalence relativement élevée de l'infection par le VIH parmi les tuberculeux. La co-infection Tuberculose-VIH est associée aux formes graves de la tuberculose et à une augmentation de la mortalité chez les tuberculeux, d'où l'intérêt du renforcement des activités conjointes de lutte contre cette co-infection.

La miliaire tuberculeuse,une série rétrospective marocaine

Tuberculosis miliary is a severe and rare form of tuberculosis. It is often due to a haematogenous spread of the bacillus of Koch and represents less than 2% of tuberculosis. We conducted a retrospective study of 81cases of tuberculous miliary collected at the Department of respiratory diseases of the Ibn Rochd university hospital in Casablanca between September2003and November2016. A female predominance was noted with 58% of the cases. The average age was 36years. The history of tuberculosis was found in eight cases and tuberculous tuberculosis in eleven cases, postpartum in five cases, diabetes in three cases and trisomy21in one case. The clinical picture was dominated by altered general status in all cases, and fever in 69cases (86%). Chest x-ray showed a miliary aspect in all cases, cardiomegaly in two cases, pyopneumothorax in three cases, and opacities excavated in five other cases. The intradermal tuberculin reaction, performed in all cases, was positive in 26cases, and sputum oscillations were positive in 21cases. The dissemination report found cerebromeningeal involvement in nine cases, with cerebral tuberculomas in five cases, pericarditis in four cases, mediastinal and peripheral adenopathies in nine cases each. Bouchut tubercles were found in nine cases. Antibacillary therapy was started as a matter of urgency, according to the national TB control program with the old regimen (2SHRZ/7RH) and the new regimen (2RHZEb/7RH) in all cases. The outcome was good in 55cases (68.9%), 17patients were lost to follow-up, and 11deaths were reported. We insist on this work on the severity of the tuberculous miliary and the need for early and urgent therapeutic management.

Occupational exposure to blood among medical students in Casablanca (Morocco): Analysis of knowledge and practices

Occupational exposure to blood (OEB) is associated with a significant risk of transmission of bloodborne viruses to medical students. The objective of this study was to evaluate the knowledge and practices of Casablanca medical students concerning OEB preventive measures and their behaviour after accidental exposure. A cross-sectional study was carried out at the Ibn Rochd University Hospital in Casablanca using stratified cluster sampling ; data from this study were collected by means of an anonymous self-administered questionnaire. The mean age was 22.38 years (SD = 1.69) with a female predominance (56.0%). About 17.5% of students had experienced at least one OEB, and only 38.3% were familiar with the standard precautions to prevent these accidents. Accidental exposure was significantly associated with needle recapping (p = 0.002) and ignorance of standard precautions (p = 0.028).These results illustrate the insufficient knowledge and poor compliance with preventive measures of occupational exposure to blood, indicating the need for awareness-raising and training activities for medical students.

Epidemiology of pertussis in Casablanca (Morocco): contribution of conventional and molecular diagnosis tools

BackgroundPertussis, a vaccine preventable disease, is still responsible of significant morbidity and mortality around the world, mostly in newborns. The aim of the present study was (1) to introduce pertussis surveillance in the major pediatric hospital of Casablanca (2) to analyze the prevalence of pertussis among children under 14 years of age and their entourage in Casablanca, Morocco.MethodsThis is a prospective and non-case controlled study, including children suspected of Pertussis admitted at the Abderrahim Harouchi Pediatric Hospital in Casablanca, from January 2013 to June 2015. Nasopharyngeal samples were obtained for Bordetella spp. culture and Real time PCR detection (RT-PCR) with specific primers of Bordetella spp., B. pertussis, B. parapertussis and B. holmesii. The detection of Bordetella spp. was also performed in some household contacts of the children suspected of pertussis.ResultsDuring the 2.5-years period, a total of 282 samples were collected from hospitalized children (156) and in some of their contacts (126). Among 156 samples from the children (from whom 57% were under 2 month of age), Bordetella DNA was detected in 61% (96/156) by RT-PCR. Among these positive samples, 91.7% (88/96) corresponded to B. pertussis DNA. Furthermore, in 39.5% (38/96) of the Bordetella positive samples, B. holmesii DNA was also detected. B. parapertussis DNA was detected in only one sample (1/156). Out of the 156 samples collected from the hospitalized children, only 48 were tested by culture, and 4 B. pertussis were isolated (8.3%). Among the 126 samples from the contacts of the children, mostly mothers (115 cases), Bordetella DNA was detected in 47% (59/126), 90% (53/59) being B. pertussis DNA. Moreover, B. holmesii DNA was also detected in 18.6% (11/59) of the Bordetella positive samples, and coexistence of B. pertussis and B. holmesii DNA in 36.5% (35/96). Two B. pertussis were isolated by culture performed on 43 samples of the contacts of the children (4.6%).ConclusionsThis study highlights the circulation of B. pertussis but also of B. holmesii in Casablanca-Morocco with a high proportion of co-infections B. holmesii/B. pertussis in infants and their mothers, indicate that infection of non-vaccinated infants could be more associated with young parents. Moreover, the RT- PCR provides a sensitive and specific diagnosis of B. pertussis infections and distinguishes it from other Bordetella species, and is therefore suitable for implementation in the diagnostic laboratory.

Utilisation des applications mobiles par les internes du Centre hospitalier universitaire Ibn-Rochd Casablanca, Maroc

Introduction: Mobile applications are now increasingly used by trainee and practising physicians due to the wide range of applications available in the field of healthcare and their ease of use. The objective of this study was to estimate the frequency and describe the use of these applications by interns at Ibn-Rochd University Hospital in Casablanca. Methods: A cross-sectional survey was conducted in December 2014 on a sample of Ibn-Rochd interns. Participants from multiple disciplines and medical specialties completed an anonymous self-administered questionnaire. Results: One hundred and thirteen interns participated in the study with a 94.2% response rate: 95% of these interns had a smartphone and 85.2% had at least one healthcare mobile applications with an average of 3.57 applications per interns (SD = 3.14). Interns used these applications at least once a day and the most frequently downloaded applications were those devoted to diagnosis and patient care (61%). No statistically significant correlation was observed between the number of applications and the intern’s specialty, the type of operating system used or the intern’s gender. Conclusion: The use of healthcare mobile applications and the support they provide to Ibn-Rochd interns allowed an assessment of the importance of these new tools in medical training and practice. However, supervision and support by seniors are essential in view of the risks involved.

Meningococcal infections associated with febrile purpura among children hospitalized in a Moroccan Hospital: incidence and associated clinical factors

IntroductionLe purpura fébrile (PF) fait craindre une infection à méningocoque, et conduit presque toujours à la réalisation d’un bilan et au traitement par une antibiothérapie à large spectre. Notre objectif était de déterminer l’incidence des infections à méningocoque ainsi que les signes cliniques y associés chez les enfants hospitalisés aux urgences pour purpura fébrile.MéthodesNotre étude était descriptive, rétrospective, menée sur une période de 3 ans au service d’accueil des urgences Pédiatriques de l’Hôpital Universitaire d’Enfants de Casablanca. Les enfants inclus étaient ceux hospitalisés pour PF et qui avaient bénéficié d’une hémoculture, associée ou non à une ponction lombaire. Le logiciel SPSS v.16 a été utilisé pour l’analyse statistique.RésultatsNous avons inclus 96 enfants dont 49 garçons et 47 filles. La moyenne d’âge était de 53,3 ± 40,5 mois. La moyenne de la température corporelle était de 38,9°C. Une infection à méningocoque a été diagnostiquée chez 35/96 enfants. Une méningococcémie était retenue chez 22 enfants, associée à une méningite chez quatre. Les symptômes et signes physiques significativement associés à une infection à méningocoque étaient la léthargie (p = 0,04), les convulsions (p = 0,01) et la localisation du purpura en dehors du territoire cutané drainé par la veine cave supérieure (p = 0,01).ConclusionUn PF localisé en dehors du territoire cutané drainé par la veine cave supérieure ou associé à des convulsions est fortement associé à une infection à méningocoque dont l’incidence semble élevée chez l’enfant marocain.

La tuberculose des bases pulmonaires

Tuberculosis is a major public health problem in Morocco. Tuberculosis of the lung bases is a rare and atypical form and raises real diagnostic problems. We report a retrospective study of 21cases of basal pulmonary tuberculosis, collected at the service of respiratory diseases in Ibn Rushd hospital in Casablanca between 2004 and 2015 (11years). From a total of 21patients having basal pulmonary tuberculosis, 13 (62%) were women versus eight men (48%), the average age was 33years. The average time of diagnosis was 25days. The disease was unilateral in 20cases (95%). The right lower lobe was the most frequently affected (71%). Inhomogeneous opacities (66%) and consolidation (28%) were the main radiological findings. Associated comorbidities were dominated by diabetes in six cases (28%). Bronchoscopy had recovered thickening spurs in eight cases, endobronchial granules in seven cases and bronchial inflammation in six cases. Bronchial biopsies had found a necrotizing granulomatous inflammation tuberculoide in seven cases (33%). The smear was positive in sputum in three cases (14%), in the bronchial aspirate in four cases (19%), in induced sputum in one case (4.7%) and in post-bronchoscopic sputum in six cases (28%). The antituberculous treatment was started in all patients with good clinical and radiological evolution. The basal localization of the pulmonary tuberculosis is misleading; source of diagnostic delay, hence the need to think about it especially in patients with comorbidities.