Military Teaching Hospital Research Articles

Acinetobacter infections prevalence and frequency of the antibiotics resistance: comparative study of intensive care units versus other hospital units.

IntroductionThis study aims to determine the Acinetobacter sp clinical isolates frequency and its antibiotic susceptibility pattern by comparing results obtained from the Intensive Care Units (ICUs) to that of other units at the Mohammed V Military Teaching Hospital in Rabat.MethodsThis is a retrospective study over a 2-years period where we collected all clinical isolates of Acinetobacter sp obtained from samples for infection diagnosis performed on hospitalized patients between 2012 to 2014.ResultsDuring the study period, 441 clinical and non-repetitive isolates of Acinetobacter sp were collected representing 6.94% of all bacterial clinical isolates (n = 6352) and 9.6% of Gram negative rods (n = 4569). More than a half of the isolates were from the ICUs and were obtained from 293 infected patients of which 65, 2% (191 cases) were males (sex ratio = 1.9) and the median age was 56 years (interquartile range: 42-68 years). Acinetobacter clinical isolates were obtained from respiratory samples (44.67%) followed by blood cultures (14.51%). The resistance to ciprofloxacin, ceftazidime, piperacillin / tazobactam, imipenem, amikacin, tobramycin, netilmicin, rifampicin and colistin was respectively 87%, 86%, 79%, 76%; 52%, 43%, 33% 32% and 1.7%. The difference in resistance between the ICUs and the other units was statistically significant (p <0.05) except for colistin, tetracycline and rifampicin.ConclusionThis paper shows that solving the problem of prevalence and high rate of multidrug resistant Acinetobacter infection which represents a therapeutic impasse, requires the control of the hospital environment and optimizing hands hygiene and antibiotics use in the hospital.

Results of Sentinel Lymph Node Biopsy in Patients with Breast Cancer in 10-Year Own Material of the 4th Military Teaching Hospital with Polyclinic in Wrocław.

At present, sentinel lymph node biopsy is a standard procedure to assess the advancement of breast cancer and cutaneous melanoma. The aim of the study was to assess the role of the sentinel lymph node biopsy in the treatment of patients with breast cancer in our own material. Analyzed was medical documentation of 258 patients with initially operable breast cancer, qualified for operation with sentinel lymph node biopsy in 2004-2014 in the Department of Surgery of the 4th Military Teaching Hospital. A few hours prior to the planned surgery, radioisotope (technitium-99 sulfur colloid) was applied in the area of tumor or under the areola. 1-2 hours after administering the tracer, the lymphoscintigraphy with the labelling of the sentinel lymph node on the skin was performed. On the basis of the gathered material, obtained were the following parameters: sensitivity - 100%, and specificity - 94.6%. Four cases were false negative (5.5%). 1. Marking the sentinel lymph node in breast cancer, based on the single visualisation method with the use of radioisotope, is a useful and effective technique. 2. The factor influencing the results of the sentinel lymph node biopsy (true positive and negative results and false negative result) was the number of the excised lymph nodes except for the sentinel lymph node. 3. Patients with estrogen receptor expression had often metastases to sentinel lymph node (145 cases - 56%). 4. The false negative rate, i.e. 5.5% in our material, is within the limits of acceptability given in the literature. 5. The sentinel lymph node biopsy performed by the experienced surgical team is a reliable diagnostic tool with a low complication rate.

Cross-cultural challenges for assessing medical professionalism among clerkship physicians in a Middle Eastern country (Bahrain): feasibility and psychometric properties of multisource feedback.

BackgroundWe aimed to design, implement, and evaluate the feasibility and reliability of a multisource feedback (MSF) system to assess interns in their clerkship year in the Middle Eastern culture, the Kingdom of Bahrain.MethodThe study was undertaken in the Bahrain Defense Force Hospital, a military teaching hospital in the Kingdom of Bahrain. A total of 21 interns (who represent the total population of the interns for the given year) were assessed in this study. All of the interns were rotating through our hospital during their year-long clerkship rotation. The study sample consisted of nine males and 12 females. Each participating intern was evaluated by three groups of raters, eight medical intern colleagues, eight senior medical colleagues, and eight coworkers from different departments.ResultsA total of 21 interns (nine males and 12 females) were assessed in this study. The total mean response rates were 62.3%. A factor analysis was conducted that found that the data on the questionnaire grouped into three factors that counted for 76.4% of the total variance. These three factors were labeled as professionalism, collaboration, and communication. Reliability analysis indicated that the full instrument scale had high internal consistency (Cronbach’s α 0.98). The generalizability coefficients for the surveys were estimated to be 0.78.ConclusionBased on our results and analysis, we conclude that the MSF tool we used on the interns rotating in their clerkship year within our Middle Eastern culture provides an effective method of evaluation because it offers a reliable, valid, and feasible process.

Prospective randomized double-blind controlled trial of continuous local anesthetic infusion to reduce narcotic use in laparoscopic sleeve gastrectomy

BackgroundIn an era of cost containment and outcome-based medicine, bariatric surgeons are attempting to decrease perioperative morbidity and streamline care. One way of accomplishing this is by decreasing opioid use and hospital stay. Several studies of nonbariatric open procedures have shown that continuous infusion catheters (CIC) are beneficial. Bariatric surgeons frequently utilize CIC, but the data is sparse for the clinical efficacy in laparoscopic procedures. Objective: Evaluate the efficacy of CIC in laparoscopic sleeve gastrectomy. Setting: military teaching hospital. MethodsIn this single institution prospective randomized double-blind controlled study, 82 patients undergoing laparoscopic sleeve gastrectomy (LSG) received either .2% ropivacaine or .9% normal saline (placebo) via CIC. After discharge, total narcotic usage, total antiemetic usage, pain scores, and hospital length of stay were evaluated. A one-way ANOVA was used to assess statistical significance. Power was 80% to detect 52 mg morphine equivalent difference. ResultsA total of 82 patients were enrolled, 39 received ropivacaine, and 43 received placebo. There was no statistically significant difference in narcotic usage between the ropivacaine group and placebo group, 51.9 mg versus 55.2 mg, respectively (P = .63). Ondansetron usage was 10.7 mg and 10.6 mg for ropivacaine and placebo groups. (P = .98). Average pain score was 3.0 for each group (P = .632). Total hospital length of stay was 37.5 hours for ropivacaine group and 38.1 hours for placebo group (P = .768). ConclusionsWe found no difference in narcotic usage, antiemetic usage, pain scores, or hospital length of stay between ropivacaine and placebo groups. We conclude there is no utility of CIC in LSG.

Scientific meetings within a Benin Teaching Hospital: what type of research is being done? A pilot initiative to identify needs of health services research in a resource-limited country

Material and methods All presentations made during scientific meetings from June 2011 to December 2013 were reviewed and their domains of study (research) were identified. Scientific meetings at a Military Teaching Hospital were organized, in order to promote research within Benin Armed Forces Health Services, through monthly meetings. Semester and annual planning was done for presentations as each department was asked to propose 2 research conclusions per year. Research conclusions were programmed and presented as well as their perspectives.

Report of 182 Cases of Exertional Heatstroke in the French Armed Forces

Exertional heatstroke (EHS) remains a major problem for the military. The aim of our study was to describe medical history and clinical and biological features of EHS in a large military cohort. We conducted a retrospective study among military subjects admitted to the Military Teaching Hospital Laveran for EHS from 2004 to 2006. Of the 182 subjects, EHS occurred most often at the end (80%) of a timed race of 8 km in battle clothes (84%) between the months of May and October (87%). The subjects were physically fit. Motivation was the primary intrinsic factor reported. A previous episode of EHS was reported by 15.4% of the subjects. Comas or seizures occurred more frequently in subjects whose temperatures exceeded 41°C (p = 0.03). Alanine aminotransferase was consistently increased in subjects who experienced EHS. We observed acute renal failure in 31.3% of the subjects, liver insufficiency in 12%, and disseminated intravascular coagulation in 1%. High creatine kinase levels alone did not correlate with renal failure. Detection of severe EHS in the field before the onset of multiple organ failure is challenging. The determination of the factors contributing to recurrence is urgently needed as EHS remains a life-threatening condition.

Mode of Delivery Trends by Hospital Type: An 18-Year Comparison of a Military Hospital With University and Community Hospitals

To determine the rate of mode of delivery over 18 years in a military teaching hospital as compared to university and community hospitals. From January 1992 to December 2009, we retrospectively calculated yearly rates for mode of delivery from a military hospital, two university hospitals, a community hospital in South Carolina and all community hospitals in Arkansas. Over the 18-year period, 803,249 deliveries occurred from all hospitals. Overall the cesarean delivery rates have significantly increased across all practice models (22.7% + 0.9 versus 33.0% + 0.9, p = <0.001). The rate of increase has been greatest in university hospitals (21.8-37%) followed by community hospitals (26.7-32.9%) and the military hospital (19.6-29.2%). The rate of forceps-assisted deliveries has decreased dramatically across all practice models (11.6% + 1.3 versus 1.1% + 0.1, p = <0.001). The decline in forceps use was 6.4 to 1.1% in community hospital, 12.6 to 1.4% in university hospitals, and 15.7 to 0.9% in military hospitals. The overall cesarean delivery rate has increased in all practice models but less so in the military. Forceps deliveries have dramatically decreased overall especially in the military hospital.

Unknown Case

From the Department of Neurosurgery, Mohamed V Military Teaching Hospital, Rabat, Morocco. Address correspondence and reprint requests to Brahim Eljebbouri, MD, Department of Neurosurgery, Mohamed V Military Teaching Hospital, Rabat 10000, Morocco; E-mail: [email protected] Acknowledgment date: May 14, 2013. First revision date: June 2, 2013. Second revision date: July 6, 2013. Third revision date: July 22, 2013 Acceptance date: July 30, 2013. The manuscript submitted does not contain information about medical device(s)/drug(s). No funds were received in support of this work. No relevant financial activities outside the submitted work.

Utility of hCG dosage in the management of gestational trophoblastic diseases

Measurement of hCG remains today central for diagnosis, treatment and follow-up of gestational trophoblastic diseases (GTD). In order to evaluate this contribution, we conducted a prospective cohort study in the Service of high-risk pregnancy of Rabat Maternity Les Orangers and the Laboratory of Rabat Military Teaching Hospital Mohammed V over a period of eighteen months. 35 patients were included. The hCG assay was determined by electrochemiluminescence. The general frequency of the GTD is of 0.33/100 childbirth. The average age of our patients was 30.5 years. 26 patients had hCG level abnormal and higher than 200 000 UI/mL when diagnosed with GTD; 34 patients had simple endo-uterine aspiration and 1 a chemotherapy. Among 34 patients, 25 (73.5%) had a favourable evolution characterized by normal hCG level within 3 to 13 weeks and complete remission. Serum hCG remained stable and negative in all these patients with a follow-up of 18 months. 9 patients had unfavourable evolution characterized by reaxent after negativation or stagnation of hCG levels. A rigorous monitoring of hCG levels during treatment and follow-up is essential to improve forecast of these diseases.

β-thalassemia carriers in Afghanistan: a prevalence estimate

abc.2013.0873 Auteur(s) : Herve Delacour1,2 herve.delacour@santarm.fr, Aurore Brondeix1, Romain Kedzierewicz1, Paul-Vincent Martin1, Renaud Dulou1 1 NATO Medical Treatment Facility Role 3 KaIA (Kabul International Airport) Kaboul, Afghanistan 2 Department of Biology, Begin Military Teaching Hospital, Saint Mande, France Thalassemia are the commonest genetic disorders in humans [1]. They occur at particularly high frequency in a band stretching from the Mediterranean region, through the Middle [...]

Assessment ofOPG/RANK/RANKLGene Expression Levels in Peripheral Blood Mononuclear Cells (PBMC) After Treatment With Strontium Ranelate and Ibandronate in Patients With Postmenopausal Osteoporosis

Recent research results have confirmed the high significance of the OPG/RANK/RANKL system in the development of bone diseases. The aim of the reported study was to assess gene expression levels of the OPG/RANK/RANKL system in peripheral blood mononuclear cells (PBMCs) after strontium ranelate (SR) and ibandronate administered to patients with postmenopausal osteoporosis. A total of 89 postmenopausal women, aged 51 to 85 years, patients of the Outpatient Clinic of Osteoporosis of the Military Teaching Hospital in Lodz, were enrolled into the study. The patients were randomly assigned to different medical therapies: ibandronate and SR. Patients of the control group received only calcium and vitamin D₃ supplements. Patient visits were repeated after 3 and 6 months. Measurements of serum alkaline phosphatase concentrations and of RNA expression in PBMCs as well as of total serum calcium and phosphate levels and of their 24-hour urine excretion rates were carried out in material, collected at baseline and after 3 and 6 months of the therapy. Densitometry of the left hip and of the lumbar spine was done at the baseline visit and after 6 months. The differences in gene expressions of RANKL and RANK were not significant during the study period and did not differ between the groups in a statistically significant manner. No OPG gene expression was observed in PBMCs of patients in any of the studied groups and at any time point. The tendency of correlation (P = .07) was observed between decreasing RANK gene expression and increasing bone mineral density in the patients treated with SR. Both ibandronate and SR do not seem to cause any significant changes in gene expression levels of OPG/RANK/RANKL in PBMCs during the first 6 months of treatment.

Investigation on teaching secretarial job in military teaching hospital

Teaching hospital plays a central role in training excellent doctor.Clinical teaching secretaries act as the advisor,coordinator,logistics people and supervisor in hospital clinical teaching management.Their duties include helping leader form and fulfill teaching plan,collect and arrange teaching records.To better accomplish the teaching secretarial job,a clinical teaching secretary should keep improving professional quality and personal comprehensive ability,ameliorating working methods and enhancing innovative thinking in a sound managing and evaluating system. Key words: Military teaching hospital; Teaching secretary; Teaching management

CPC-046 Epidemiology, Symptoms and Chemotherapy of Imported Malaria at Mohammed V Military Teaching Hospital in Rabat, Morocco

BackgroundIn Morocco, since the neutralisation of the last outbreak of Plasmodium vivax in 2004, only imported malaria cases have been recorded, the majority from sub-Saharan Africa. At Mohammed V Military...

CPC-080 Management of Postoperative Pain at Mohammed V Military Teaching Hospital, Rabat, Morocco

BackgroundManagement of postoperative pain is a subject of interest as we believe that pain is still inadequately relieved in this population.Purpose To describe methods of postoperative pain management in anaesthesia-resuscitation...

DSL-013 Evaluation of the Limits of Automation and Impact on Drug Management at Mohammed V Military Teaching Hospital Pharmacy, Rabat, Morocco

Background Nowadays, hospitals tend to automate medicines management to increase quality, efficiency and safety of drug dispensing. At Mohammed V Military Teaching Hospital (MVMTH), a centralised Automated Drug Dispensing System...

GRP-112 Medical Devices in Morocco: What Guarantees of Quality and Safety?

BackgroundNowadays, all over the world, many medical devices, initially considered as non-risk or low risk, have been proved to be extremely dangerous to human health, as evidenced by the latest...

Prevalence of Acinetobacter baumannii and Pseudomonas aeruginosa isolates resistant to imipenem by production of metallo-β-lactamases in Rabat military teaching hospital Mohammed V

We studied the production of metallo-β-lactamases (MBL) in Acinetobacter baumannii and Pseudomonas aeruginosa strains resistant to imipenem at the Rabat Mohammed V military teaching hospital, according to Yong et al.'s method, using a sterilized solution of EDTA 0.5 M pH 8. One hundred and five bacterial strains (48 A. baumannii and 57 P. aeruginosa) were identified. 45 (42.9%) with 34 A. baumannii and 11 P. aeruginosa were resistant to imipenem. The prevalence of MBL producing strains was 22.2% (10/45). The existence of this isolates resistant to imipenem by producing metallo-β-lactamases is an emerging public health problem. It is necessary to implemente infection control programs to avoid spreading of multidrug resistant bacteria.

Bacteriological features of infectious spondylodiscitis at Mohammed V Military Teaching Hospital of Rabat

To review the bacteriological features of infectious spondylodiscitis and provide recommendations for the initial therapy which remains empirical in our context. Retrospective study including patients diagnosed with spondylodiscitis over a period of 4 years (2006-2009) at the Rabat Military Teaching Hospital. During the study period, we analysed 30 cases: the mean age was 49.9 years and 21 cases (70%) were male. The patients were predominantly hospitalized in neurosurgery department (15/30) followed by rheumatology department (10/30). The site of infection was lumbar in 21 cases (21/30), dorsal in 7 cases (7/30). 26 cultures were positive of which 19 (19/26) were monomicrobial. Tuberculosis (TB) was implicated in 10 cases (10/30) including 4 cases in association with common organisms (Propionibacterium acnes, Staphylococcus aureus, Staphylococcus epidermidis, Corynebacterium species). Brucella melitensis was isolated in 1 case. Infections caused by pyogenic bacteria were isolated in 15 cases of which 12 (12/15) revealed simple organisms including Gram-positive cocci in 9 cases (9/12) with 3 cases of S. aureus and Gram-negative bacilli in 3 cases (3/12) with 2 cases of P. aeruginosa. Blood cultures carried out for 16 patients were positive in 7 cases. The anatomopathologic exams carried out for 20 patients found in 6 cases epithelioid granulomata and giants cells with caseous necrosis in total concordance with TB culture. TB is the most frequent cause of spondylodiscitis in Morocco. Our study found the same frequency for non-specific and specific germs. Empirical treatment must take into account S. aureus and M. tuberculosis.

Rubella seroprevalence in pregnant women at the military teaching hospital, Rabat, Morocco

Rubella seroprevalence in pregnant women at the military teaching hospital, Rabat, Morocco

Epidemiology and prognostic value of organ failure during severe malaria in the Principal Military Teaching Hospital of Dakar, Senegal

We report the results of a retrospective study in the medical intensive care unit of the Principal Military Teaching Hospital of Dakar. The objectives were to determine the epidemiological and clinical aspects of severe malaria and to evaluate the prognostic values of the failure of different organs. Eighty-seven patients were admitted for severe malaria. Their average age was 35 ± 18.53 with a sex-ratio of 1.71 for men. Mortality was 33.3% and concerned mainly young adults. Neurological failure was the most frequent (79.3%). Hemodynamic failure was the most relevant prognostic factor for mortality, followed by hypoglycemia, respiratory and renal failure. The Simplified Acute Physiology ScoreII (SAPSII) was reliable in predicting mortality. The mean SAPSII was 44.85, with an expected mortality of 32.6%.