Military Teaching Hospital Research Articles

Bacteriological aspects of bacteremia in the intensive care unit of the Mohammed V Military Hospital: 10 months prospective study.

Bacteremia is responsible for high rates of morbidity and mortality. The increasing prevalence of multidrug-resistant (MDR) bacteria in intensive care units (ICU) is a growing concern. Hence, prior knowledge of bacterial epidemiology and resistance phenotypes is required to optimize these infections' management. The objective of this study was to determine the epidemiological profile of bacteremia in ICU settings, as well as the place occupied by MDR bacteria in these infections. It is a prospective study carried out over 10 months on episodes of bacteremia in the ICU of Mohammed V Military Teaching Hospital (Rabat, Morocco). Microorganism growth was detected using fluorescent technology, species identification was based on morphological and biochemical characteristics. Antimicrobial susceptibility testing was performed following the recommendations of the Antibiogram Committee of the French Society of Microbiology (CA-SFM) and the European Committee on Antimicrobial Susceptibility Testing (EUCAST). Among 504 hospitalized patients, sixty-one (12.1%) presented at least one episode of bacteremia. Forty patients (65.6% of bacteremic patients) presented at least one episode of bacteremia due to MDR bacteria. Male gender, cardiovascular diseases, diabetes and previous hospitalization were significant risk factors for the acquisition of MDR bacteremia. Isolated bacteria were mainly Gram-negative bacilli (GNB) (n = 62; 68.9%) dominated by Acinetobacter baumannii (n = 19; 21.1%) and Klebsiella pneumoniae (n = 16; 17.8%). MDR bacteria were represented by multi-resistant Acinetobacter baumannii (n = 19; 44.2%), extended-spectrum beta-lactamases-producing Enterobacterales (n = 9; 20.9%) and carbapenem-resistant Enterobacterales (n = 7; 16.3%). Carbapenems (n = 40; 65.6%), Aminoglycosides (n = 32; 52.5%) and Polypeptides (n = 24; 39.3%) were the most used antimicrobials. Mortality rates were 66.6% (n = 40) and 85% (n = 43) in patients with non MDR bacteremia and MDR bacteremia respectively. Limiting the spread of MDR bacteria and improving the management of bacteremic patients require continuous monitoring of bacteremia as well as adapting the therapeutic and preventive strategy.

Post-Myocardial Ventricular Septal Defect, Risk Factors and Epidemiological Aspects

Introduction and aims: Post-myocardial infarction ventricular septal defect is a rare dreadful complication of myocardial infarction. It usually occurs between the 3rd and 7th day of the infarction. Several risk factors for its occurrence have been identified. The aim of our work is to discuss these different risk factors through clinical cases with a literature review. Material and methods: This is a retrospective study conducted from 2015 to 2021 including 18 consecutive patients with post-myocardial ventricular septal defect presented in either cardiac intensive care unit or cardiac surgery department of Mohammed V Military Teaching Hospital Rabat. All patients had at least a clinical examination, an electrocardiogram, and an echocardiogram showing ventricular septal defect. Surgery was performed at cardiac surgery department. Results: Mean age was 65.2± 26.4 years. There were more men than women in our study (17 males/1 female). Diabetes (55.6%) and smoking (55.6%) were the two predominant cardiovascular risk factors. The average body mass index was 23.7 ± 2.98 kg/m². Anteroseptal was the most observed infarct location (38.9%.) 16 patients presented after 12 hours of pain onset. 2 of them underwent percutaneous intervention and 1 underwent coronary artery bypass graft intervention whereas 15 didn't undergo any revascularisation strategy. The culprit artery was left anterior descending artery in 13 patients. The death rate was 55.6%, 50% before surgery and 50% after surgery. Conclusion: Delayed or absence of coronary reperfusion remains the main risk factor for post-myocardial infarction ventricular septal defect occurrence which explains its frequency decline since reperfusion strategies development.

IS MY STETHOSCOPE HARMLESS? : OPERATING ROOM STETHOSCOPES UNDER MICROSCOPES

Medical equipment especially stethoscopes, are increasingly responsible for healthcare-associated infections. The objective of our work is to establish the prevalence of bacteria carried by stethoscopes among anesthesia doctors in the operating roomof the Mohammed V Military Teaching Hospital. This was a prospective prevalence study carried out over a period of 2 months on 10 stethoscopes showing that 90% of the stethoscopes collected were infected. The average number of CFU / membrane was estimated at 3.1x104. This number has clearly been reduced 172 times after disinfection. This study suggests that awareness and the use of hydro alcoholic solutions to disinfect stethoscopes can significantly reducebacterial carriage and infections.

Non-Valvular Atrial Fibrillation Cardioversion: Experience of the Cardiology department of Mohammed V Military Teaching Hospital

anticoagulation therapy would be the removal of this arrhythmia and any future recurrence, a goal often difficult to achieve.The aim of this work is to evaluate the efficacy of atrial fibrillation cardioversion as well as the success predictive factors of sinus rhythm maintenance at one year following a successful cardioversion. Materials and methods: 50 patients with non-valvular atrial fibrillation underwent cardioversion: 70% by electrical shock and 30% by pharmacological means, the clinical characteristics of the patients the results of cardioversion and follow-up were collected and analyzed. Results: The average age of our patients was 53 years with a sex ratio of 2. 30% of patients had hypertensive heart disease, 8% ischemic heart disease, 8% dilated cardiomyopathy and the rest had no underlying heart disease. The average diameter of the left atrium was 41 mm and the average surface area was 20 cm². Primary success rate of cardioversion was 82% with better efficacy of electric shock compared to pharmacological cardioversion. The maintenance rate of sinus rhythm at 1 year was 70%. Predictive factors of failure and / or recurrence at 1 year were old atrial fibrillation and significant dilation of the left atrium. Conclusion: This study confirms the interest of atrial fibrillation cardioversion and underlines the importance of preliminary selection of the patients, such a selection must be made on the basis of the predictive factors of success usually recognized in the literature.

AUTOMATION OF DRUG DISPENSING: FEEDBACK FROM A HOSPITAL PHARMACY

Background: Ensuring drug circuit security is the ultimate goal for hospital pharmacists. Alarmed by the excessive drug consumption at its on-duty pharmacy, Mohammed V Military Teaching Hospital of Rabat (Morocco) installed a centralized automation for drugs dispensation. This experience is expected to be decentralized to all care units. Our study purpose is to evaluate automations impact on pharmaceutical drug management, and then to determine limits to be improved. Resources and procedures: We analyzed, over a period of 10 months, data from the database of the automated distribution system deposited at our on-duty pharmacyin order to determine its usage profile. We also evaluated through a questionnaire the point of view of our 13 pharmacy technicians toward drug dispensing automation. Results: Over the study period, we got the following results: - 5446 transactions were accomplished and 8864 drugs unit were dispensed - Parenteral route drugs are the most delivered (67%) - Anti-inflammatories and analgesics are the most required (26%), followed by the anti-infective drugs (25%) - Young technicians did more transactions (63%) than the elders did (37%) - According to pharmacy technicians, main automations advantages are saving time in locating medications (8/13) and limiting drugs errors (5/13). Otherwise, main constraints are the irregular machine replenishment (10/13) and the reduced capacity for storing all medications (6/13), specially refrigerated and oversized ones. Conclusion: Automation of drug delivery offers many advantages. However, there are still limits to be improved before its decentralization to all care units.

Analysis of laryngeal brush biopsy-based cytology results in patients of the 4th Military Teaching Hospital and Polyclinic in Wrocław in years 2019-2020.

<b>Introduction:</b> Cytological examination of exfoliated epithelial cells of the uterine cervix, oral cavity, or rectum has been successfully used in the diagnostics of pathological conditions of these organs for many years. In these cases, the test material is collected from the available regions. </br></br> <b>Aim:</b> The aim of the study consisted in the analysis of cytological smears of laryngeal epithelial cells from patients hospitalized at the Department of Otolaryngology, Head and Neck Surgery of the 4th Military Teaching Hospital and Polyclinic in Wrocław in years 2019-2020. The analysis was aimed at demonstrating whether representative laryngeal epithelial material could be obtained from brush biopsies. </br></br> <b>Material and methods:</b> The study was carried out in 92 subjects aged between 26 and 85 years, including 34 women (37.0%), from whom material for cytological examination had been collected from the larynx in the course of microsurgical procedures carried out using the Kleinsasser laryngeal instrument set in 2019-2020. </br></br> <b>Results: </b>Analysis was performed on 90 out of 92 cell smears (97.8%). Two smears were not qualified for analysis due to ille-gibility. The smears were assessed using a proprietary scale consisting in a modification of the Bethesda system. Abnormal results of cytological examinations were obtained in a majority of cases. HSILs with invasive features were the most common abnormal results of cytological examinations. </br></br> <b>Conclusions:</b> Laryngeal epithelial cells can be successfully evaluated by means of cytological examination. Abnormal presen-tation of cytological smear is frequently hypercellular, with inflammatory cells being observed less frequently. No statistically significant relationship was observed between the results of the cytological examination and the overall quality of the smear, number of cells, number of erythrocytes, or the severity of inflammation.

Severe Trauma Patients Requiring Undelayable Combined Cranial and Extra-Cranial Surgery: A Proof-of-Concept Monocentric Study.

To date, there is no evidence concerning the emergency surgical management of severe trauma patients (STP) with severe traumatic brain injury (STBI) presenting a life-threatening intracranial hematoma and a concomitant extra-cranial noncompressible active bleeding. Current guidelines recommend stopping the extra-cranial bleeding first. Nevertheless, the long-term outcome of STP with STBI mainly depends from intracranial lesions. Thus, we propose a combined damage-control surgical strategy aiming to reduce the time spent with intracranial hypertension and to hasten the admission in the intensive care unit. The main objective of the study is to evaluate the benefits of combined cranial and extra-cranial surgery of STP on the long-term outcome. We retrospectively searched through the database of STBI of a level 1 trauma center facility (Sainte-Anne Military Teaching Hospital, Toulon, France) from 2007 until 2021 looking for patients who benefited from combined cranial and extra-cranial surgery in an acute setting. The research yielded 8 patients. The mean age was 35 years old (±14) and the male to female sex ratio was 1.7/1. The trauma mechanism was a fall in 50% of the cases and a traffic accident in 50% of the cases. The median Glasgow coma scale score was 8 (IQR 4) before intubation. The median Injury Severity Score was 41 (IQR 16). Seven patients (88%) presented hypovolemic shock upon admission. Six patients (75%) benefited from damage-control laparotomy among, whom 4 (67%) underwent hemostatic splenectomy. One patient benefited from drainage of tension pneumothorax, and one patient benefited from external fixator of multiple limb fractures. Seven patients (88%) benefited from decompressive craniectomy for acute subdural hematoma (5 patients) or major brain contusion (2 patients). One patient (12%) benefited from craniotomy for epidural hematoma. Three patients presented intraoperative profound hypovolemic shock. Six patients (75%) presented a favorable neurologic outcome with minor complications from extra-cranial surgeries and 2 patients died (25%). Performing combined life-saving cranial and extra-cranial surgery is feasible and safe as long as the trauma teams are trained according to the principles of damage control. It may be beneficial for the neurologic prognostic of STP with STBI requiring cranial and extra-cranial surgery.

Diagnostic, Therapeutic and Evolutionary Characteristics of High Risk Prostate Cancer Managed In Department of Radiotherapy, Mohamed V Military Teaching Hospital - Rabat In Morocco

Purpose: the aim of this study was to rapport the experience of Military Teaching Hospital Mohammed V and specifically the radiotherapy department in the management of high risk prostate cancer. Materials and Methods: This is a retrospective descriptive and analytical study, involving 149 patients followed for high risk prostate cancer proven histologically, in the radiotherapy department of HMIMV in Rabat between April 2009 and December 2018. All patients with low or intermediate risk prostate cancer were excluded. Results: The mean age is 68.1 years ± 6.4; screening is performed in 29.5% of cases. Urinary signs were the most frequent symptoms (obstructive syndrome 16.7%, irritative 37.5%), the initial median PSA 22ng / ml [11.1- 40]; histological evidence was obtained by prostate biopsy in 87.24% of cases. Evaluation of locoregional extension by pelvic MRI was performed in 99.3% of patients. Treatment: 132 patients (88.59%) benefited from a combination of external beam radiotherapy and androgen deprivation therapy (LH-RH analogues) for long duration (2 to 3 years), 17 patients (11.41%) underwent radical prostatectomy coupled with ilio-obturator dissection (in 14 patients); all these patients received postoperative radiotherapy (adjuvant or salvage) ± hormone therapy. Evolution: With a follow-up of 117 months, 14 of our patients (9.39%) presented a recurrence: 2 biochemical relapses (1.34%), 5 locoregional relapses (3.35%) and 7 systemic relapses (4.69%); The univariate and multivariate analyzes made it possible to retain the level of PSA Nadir (P = 0.022) and lymph node invasion (P = 0.049) as predictors of relapse. Conclusion: High risk prostate cancer is a group at high risk of specific mortality linked to progression after treatment. Hence the interest of a multidisciplinary consultation meeting management to define the optimal therapeutic strategy for these patients.

Multidrug-resistant community-acquired urinary tract infections in a northern region of Morocco: epidemiology and risk factors.

Urinary tract infection is very common and is the second most frequent reason for consultation in office-based practice. The incidence varies from one country to another. The diffusion of MDR in the community complicates therapeutic management. The objective of this study was to describe the bacterial epidemiology and to determine the risk factors for the acquisition of MDR in community urinary tract infections in our region. This was a retrospective case-control study conducted in the bacteriology laboratory of the Mohammed V Military Teaching Hospital over an 8-month period from 01 October 2015 to 31 May 2016. Cases were defined as patients with community-acquired urinary tract infection with MDR and controls were defined as patients with a urinary tract infection without MDR. Out of 373 isolates, enterobacteria represented 80%. E. coli represented 59.2%, followed by K. pneumoniae at 15%. The rate of MDR represented 13.4% of which ESBL enterobacteria represented 12.1%. Univariate analysis showed a statistically significant association between male sex (p=0.001), age >65 years (p=0.007), urban origin (p=0.003), previous hospitalization within 3 months (p=0.001) and antibiotic therapy within 6 months (p=0.001) with MDR community-acquired urinary tract infection. On the other hand, multivariate analysis by logistic regression showed that age >65 years (OR=8.4, CI: 2.1-42), previous hospitalization within 3 months (OR=13.4, CI: 3.3-140.2) and antibiotic therapy within 6 months (OR=9.2, CI: 4.1-60.1) were significantly associated to MDR community-acquired urinary tract infection. The increase in resistance to enterobacteria in the community prompts a review of the list of antibiotics prescribed for probabilistic management of these infections in our region.

Seroprevalence of Viral Markers at the Blood Transfusion Center of Mohammed V Military Teaching Hospital of Rabat, Morocco

Introduction: Blood transfusion therapy has a huge role in management of various hematological and other diseases. The prevention of transfusion-transmitted infections remains a key component of blood safety. The main objective of this study is to study the seroprevalence of viral markers on donated blood at the Blood Transfusion Center, Mohammed V Military Hospital in Rabat. Material and methods: This is a retrospective study conducted with military donors aged 19 to 50 at the Blood Transfusion Center (CTS) of the Mohammed V Military Hospital of Instruction (HMIMV), Rabat (Morocco), carried out over a period of four years from January 1, 2017 to December 31, 2020. Biological screening was carried out by a technique…. based on the principle of Results: Out of 49,703 samples tested, 48,175 were valid for transfusion and 1,528 were not valid for transfusion, among these invalid bags, 101 donations were confirmed positive for HBV (2 ‰), with an HCV seroprevalence of 1.2 ‰ (58 donations) and a seroprevalence of 0.5 ‰ (25 cases) of HIV 1 + 2 with a seroprevalence of 0.5 ‰ (25 cases). Discussion: The low rates of seroprevalence of viral markers in our study show improved preventive measures with regard to donor selection and screening tests. Conclusion: This perceived prevalence encourages the maintenance of the use of the combined reagent, which is the only alternative to molecular biology for developing countries.

The Chemical Compositon of Urinary Stones at the Military Teaching Hospital of Cotonou

The Chemical composition of urinary stones at the Military Teaching Hospital of Cotonou. Objective: To determine the chemical composition of urinary stones in our patients. Patients and method: We collect surgically removed urinary stones from our patients and send them abroad for infrared spectroscopic analysis. Results: The infrared spectroscopic analysis was performed on urinary stones from 26 patients, i.e. 21 males (80.8%) and 5 females (19.2%). Their mean age was 48 years (range: 21-71). The mean proportions of chemical components in the stones were: 40.8% whewellite (0-97), 29.4% weddellite (0-95), 12.7% uric acid (0-90), 5.4% struvite (0-70), 5.2% carbonate apatite (0-20), 1.9% ammonium urate (0-20), 1.7% silicate (0-45), 1.3% protein (0-10), 1.2% whitlockite (0-10) and 0.1% hydroxyapatite (0-2). All stones were a mixture of 2 or 3 of the identified chemical components. Based on the main component, there were 3 groups of stones: the calcium oxalate stones (77%), the uric acid stones (15.4%) and struvite stones (7.7%). One calcium oxalate stone from a female comprised 45% silicate and 5% protein. There was no stone chemical composition difference between males and females. Conclusion: The stones from the 26 patients were mainly non pure calcium oxalate stones (73%), uric acid stones 8%) and struvite stones (4%).

Genomic characterisation of extended-spectrum β-lactamase-producing multidrug-resistant Escherichia coli in Rabat, Morocco

Extended-spectrum β-lactamase (ESBL)-producing Escherichia coli are an increasingly significant cause of hospital- and community-acquired infections worldwide. Whereas several reports have highlighted their increased prevalence also in North African countries, genomic data on isolates associated with these infections are still scarce. This study aimed to provide data on ESBL-producing E. coli isolates from patients with extraintestinal infections at the Military Teaching Hospital Mohamed V of Rabat, Morocco. Whole-genome sequencing was carried out on 18 ESBL-producing extraintestinal pathogenic E. coli (ExPEC) isolates for analysis of phylogenomic evolution, virulence factors and antimicrobial resistance genes. Data were compared with ExPEC lineages from several surrounding countries using multilocus sequence typing (MLST) and single nucleotide polymorphism-based phylogenetic approaches. The majority of E. coli isolates were ST131 (n=15), followed by ST617 (n=2) and a novel sequence type (ST10703) that is closely related to the pandemic ST405 clone. All ST131 isolates belonged to the O25b-ST131 pandemic clone. They harboured more virulence genes than their non-ST131 counterparts. IncF plasmid replicons and the blaCTX-M-15 β-lactamase gene were identified in all isolates. No ESBL-producing E. coli isolates carried any known carbapenemase gene. Our findings underscore the pre-eminence of ST131 as the major factor driving the expansion of ExPEC in the Rabat region while highlighting the potential links with isolates circulating in other neighbouring countries.

The central role of the hospital director in the application of the white plan

If the Bégin military teaching hospital, a level 1 health facility, managed to maintain its position during the covid-19 crisis, it is thanks to the total commitment of its staff. To face the crisis, the hospital director ensured a very good level of preparedness and mobilisation of the teams.

Cardiac Safety of Hydroxychloroquine-Azithromycine for COVID-19 Patients: Pandemic Experience of Military Teaching Hospital of Rabat

Introduction: While recent studies are still arguing the efficacy of Hydroxychloroquine and Azithromycin to heal patients with SARS-CoV-2 infection, Moroccan’s ministry of health has decided to maintain the protocol using these drugs. The main objective of this study is to characterize the degree and risk of QT prolongation in patients with COVID-19 in association with their use. Methods: This study is a cohort performed at Mohammed V Military Hospital of Rabat, of patients hospitalized with at least 1 positive COVID-19 nasopharyngeal reverse transcriptase polymerase chain reaction (RT-PCR) test result, and who received 10 day of hydroxychloroquine with 7 days of azithromycin from May9 through May26, 2020. Hydroxychloroquine was given orally at 200 mg TID. Azithromycin was given at a dose of 500 mg the first day followed by 250 mg daily for 6 days. Electrocardiogram was performed before the prescription, 2 days after and at the end of treatment. Results: During this period, 327 ECGs were studied, representing 109 unique patients. Their median age was 30 [25.5-44] years and 100% were male. All patients developed a paucisymptomatic form of the virus. Tisdale score varied between 6 and 8 points (89.9%-10.1%). The difference ΔQTc was significant (p<0.01) from day 0 to 10 with a ΔQTc of 16.15 ms. However, the maximal QTc hadn’t exceed 500 milliseconds. None of the patients developed torsades de pointes or any other ventricular arrhythmias. Conclusion: Moroccan experience can reassure the prescribers on the safety of use of this drug combination in the threatening epidemic context.

Role of Cancer Surgery in the Improvement of the Operative Skills of Military Surgeons During Deployment: A Single-Center Study.

The maintenance of military surgeons' operative skills is challenging. Different and specific training strategies have been implemented in this context; however, little has been evaluated with regard to their effectiveness. Cancer surgery is a part of military surgeons' activities in their home hospitals. This study aimed to assess the role of oncological surgery in the improvement of military surgeons' operative skills. Between January and June 2019, the surgical activities of the departments of visceral, ear, nose, and throat, urological, and thoracic surgery were retrospectively reviewed and assessed in terms of the operative time (OT). All surgeons working at the Sainte Anne Military Teaching Hospital were sent a survey to rate on a 5-point scale the current surgical practices on their usefulness in improving surgical skills required for treating war injuries during deployment (primary endpoint) and to compare on a 10-point visual analog scale the influence of cancer surgery and specific training on surgical fluency (secondary endpoint). Over the study period, 2,571 hours of OT was analyzed. Oncological surgery represented 52.5% of the surgical activity and almost 1,350 hours of cumulative OT. Considering the primary endpoint, the mean rating allocated to cancer surgery was 4.53 ± 0.84, which was not statistically different than that allocated to trauma surgery (4.42 ± 1.02, P = 0.98) but higher than other surgery (2.47 ± 1.00, P < 0.001). Considering the secondary endpoint, cancer surgery was rated higher than specific training by all surgeons, without statistically significant difference (positive mean score of + 2.00; 95% IC: 0.85-3.14). This study demonstrates the usefulness of cancer surgery in improving the operative skills of military surgeons.

Allergic contact dermatitis from oleoyl tyrosine in a sunscreen.

Contact DermatitisVolume 85, Issue 2 p. 255-256 CONTACT POINT Allergic contact dermatitis from oleoyl tyrosine in a sunscreen Antoine Badaoui, Corresponding Author Antoine Badaoui dr.antoine.badaoui@gmail.com orcid.org/0000-0001-5725-128X Dermatology Department, Military Teaching Hospital, St Mandé, France Correspondence Dr Antoine Badaoui, 14 rue de Chateaudun 75009 Paris, France. Email: dr.antoine.badaoui@gmail.comSearch for more papers by this authorMylène Vergez, Mylène Vergez Allergy Department, Hôpital Trousseau, Paris, France Contribution: Data curationSearch for more papers by this authorAngèle Soria, Angèle Soria Dermatology and Allergy Department, Sorbonne University, Hôpital Tenon, Paris, France Contribution: Validation, Writing - review & editingSearch for more papers by this author Antoine Badaoui, Corresponding Author Antoine Badaoui dr.antoine.badaoui@gmail.com orcid.org/0000-0001-5725-128X Dermatology Department, Military Teaching Hospital, St Mandé, France Correspondence Dr Antoine Badaoui, 14 rue de Chateaudun 75009 Paris, France. Email: dr.antoine.badaoui@gmail.comSearch for more papers by this authorMylène Vergez, Mylène Vergez Allergy Department, Hôpital Trousseau, Paris, France Contribution: Data curationSearch for more papers by this authorAngèle Soria, Angèle Soria Dermatology and Allergy Department, Sorbonne University, Hôpital Tenon, Paris, France Contribution: Validation, Writing - review & editingSearch for more papers by this author First published: 19 March 2021 https://doi.org/10.1111/cod.13835Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume85, Issue2August 2021Pages 255-256 RelatedInformation

The Management of Wilms Tumor in West Africa: A Case Series Report from the Military Teaching Hospital of Cotonou

The Management of Wilms Tumor in West Africa: A Case Series Report from the Military Teaching Hospital of Cotonou

From benchmarking to best practices: Lessons from the laboratory quality improvement programme at the military teaching hospital in Cotonou, Benin.

BackgroundIn 2015, the Army Teaching Hospital–University Teaching Hospital (HIA-CHU [Hôpital D’instruction des Armées de Cotonou Centre Hospitalier et Universitaire]) laboratory in Benin launched a quality improvement programme in alignment with the World Health Organization Regional Office for Africa’s Stepwise Laboratory Improvement Process Towards Accreditation (SLIPTA). Among the sub-Saharan African laboratories that have used SLIPTA, few have been francophone countries, and fewer have belonged to a military health system. The purpose of this article was to outline the strategy, implementation, outcomes and military-specific challenges of the HIA-CHU laboratory quality improvement programme from 2015 to 2018.InterventionThe strategy for the quality improvement programme included: external baseline SLIPTA evaluation, creation of work plan based on SLIPTA results, execution of improvement projects guided by work plan, assurance of accountability via regular meetings, training of personnel to improve personnel competencies, development of external stakeholder relationships for sustainability and external follow-up post-SLIPTA evaluation.Lessons learntOver a period of 3 years, the HIA-CHU laboratory improved its SLIPTA score by 29% through a quality improvement process guided by work plan implementation, quality management system documentation, introduction of new proficiency testing and internal quality control programmes, and enhancement of personnel competencies in technical and quality management through training.RecommendationsThe programme has yielded achievements, but consistent improvement efforts are necessary to address programme challenges and ensure continual increases in SLIPTA scores. Despite successes, military-specific challenges such as the high mobility of personnel have hindered programme progress. The authors recommend that further implementation research data be shared from programmes using SLIPTA in under-represented settings such as military health systems.

Mediastinal ectopic parathyroid adenomas: diagnostic and therapeutic challenge.

IntroductionMediastinal parathyroid adenomas are a rare condition.AimAnalysis of epidemiological data, clinical manifestation of mediastinal parathyroid adenoma (MPA), including imaging modalities, and therapeutic approach to this condition.Material and methodsA retrospective study of documented cases of mediastinal parathyroid adenoma that were managed at our Department of Thoracic Surgery of the Military Teaching Hospital Mohammed V, between January 2010 and December 2019.ResultsDuring a 9-year period in our department, 21 documented cases of MPA were treated surgically. Patients ranged in age from 20 to 69 years, with a mean age of 45 years, and there was no gender predominance. The most frequently reported manifestations were osteoarticular, with bone pain in 66.6% (14/21), pathological fractures in 28.5% (6/21), and osteoporosis in 23.8% (5/21). Cervical ultrasound, MIBI scintigraphy and cervico-thoracic computed tomography scan were performed respectively in 28.5% (n = 06/21), in 47.6% (n = 10/21) and 100% (n = 21), and allowed positive diagnosis of MPA. All patients benefited from resection surgery, through a classical transverse cervicotomy which was extended in some cases to the manubrium, and in only one case treated with thoracotomy.ConclusionsManagement of mediastinal parathyroid adenoma is based on the diagnosis imaging assessment step, usually by MIBI scintigraphy. Surgical ablation is a radical treatment. Peroperative hormonal evaluation is mainly recommended.

Antimicrobial activity of leaves extracts against bacteria isolated from wound infections

Background: Lawsonia inermis (L. inermis) is perennial plant commonly called henna. It is frequently cultivated in Sudan. Beside its uses cosmetics for staining hands and as hairs dyes‚ it was reported to be useful in jaundice, enlargement of spleen, calculus affliction and skin disease. Method: This descriptive study was done during the period from December 2014 to April 2015 in order to determine the invitro antimicrobial activity of L. inermis (henna) leaves extract against standard and clinical isolates from wound swabs, including Staphylococcus aureus, Escherichia coli, Proteus species, Klebsiella pneumonia, and Pseudomonas aeruginosa. These organisms were collected from different hospitals in Khartoum State including: Soba University Hospital, Military Teaching Hospital, and Laboratory Management Center. The in vitro antimicrobial susceptibly testing was performed using cup plate diffusion method. The activity of L. inermis Linn leaves extract was controlled with four reference antibiotics including gentamicin, oxacillin, ciprofloxacin, and impinim. Results: When aqueous extract of L. inermis Linn examined against standard bacteria and clinical isolates result showed that all standard bacteria were inhibited at 100%, 50%, and 25% concentration. All clinical isolates were successfully inhibited at 100%, 50%, 25%, and 12.5%. In contrary, the activity of methanolic extract of L. inermis Linn against standard bacteria showed that all standard bacteria were inhibited at 100%, 50% concentration, However, the clinical isolates showed an inhibition rate various depending on the concentration of methanolic extract of L. inermis Linn with S. aureus being most sensitive isolate. Conclusion: We conclude that aqueous and methanolic extract of henna exhibited antimicrobial activity against all types of tested organisms both clinical and standard isolates. But the aqueous extract shows superior inhibition ability than the methanolic.