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Characteristics and Associated Factors of Burn-out among Moroccan Dentists
Get PDFObjective: Burnout is a real threat for healthcare professionals and is growing exponentially in our modern societies. Our study aims to determine the prevalence of burnout among dentists in Rabat, Sale, and Kenitra region and look for the associated factors.Method: This is a descriptive and analytical cross-sectional epidemiological study carried out in 2019 with a group of 120 dentists using a self-administered questionnaire; burnout was assessed by the French version of the Maslash Burnout Inventory (MBI).Results: A total of 100 dentists participated in the study (response rate of 83.33%) with a female predominance at 56% and an average age of 38 years. Severe burnout affected 25% of participants, and only 3% presented low burnout for all three dimensions (According to Maslach's Burnout Inventory). The percentages of the MBI sub-dimensions were as follows: 47% had high emotional exhaustion, 51% had high depersonalization, and 42% had low personal fulfillment. High depersonalization was associated with unmarried status (p = 0.019) and working alone (p = 0.002).Conclusion: 25% of the dentists in our study were affected by severe burnout, which presents a worrying result proving that burnout is a reality in our country. The contributing factors were working alone in the office and being unmarried, and the essential protective element seemed to work in association
The Contribution of Lumbar Puncture in Neonatal Infections - About 206 cases
Get PDFBackground: Neonatal meningitis is a serious infection, no clinico-biological score has been established to accurately identify neonates at high risk of developing neonatal meningitis.Objective: The aim of this work is to clarify the place of lumbar puncture in neonatal infections and to identify the predictive factors of meningeal localization in case of neonatal infection.Materials and methods: This is a prospective study of 861 observations of newborns hospitalized in the pediatric department of Mohammed V Hospital, CHU of Tangier, during a 14-month period from 1January 2019 to 29 February 2020. Among these patients the diagnosis of neonatal infection (NNI) was retained in 473 cases. Initial lumbar puncture was performed in 206 cases (43%). We included neonates aged 0 to 28 days, suspected of NNI, who had a lumbar puncture. Neonates treated as carriers of neonatal infection without sufficient anamnestic and clinical evidence and with an inconclusive or unperformed biological workup were excluded from the study.Results: During the study period, 861 newborns were hospitalized and the diagnosis of neonatal infection was retained in 473 cases, a rate of 55%, and the initial lumbar puncture was performed in 206 cases (43%). 61 newborns were diagnosed with neonatal meningitis, with fever in 76% of cases, 85% with convulsions, hypotonia and/or refusal to suckle in 63% of cases, and CRP >25mg/l in 67% of newborns.Conclusion: Lumbar puncture is the only diagnostic means of meningitis. Indeed, the indication of this procedure should not be systematic, but it should be dictated by the careful and simultaneous analysis of the anamnestic, clinical and biological criteria evocative of the infection and its meningeal localization in order to diagnose meningitis early and treat it correctly. The need to establish scores combining these different parameters, in order to accurately identify newborns at high risk of developing neonatal meningiti
Which Management for Gunshot Chest Wounds in a War Zone Hospital?
No full textIntroduction: Gunshot chest wounds are a life-threatening surgical emergency without immediate management. Method: The study period is two years, covering cases admitted from June 2017 to May 2019. The surgical service of the regional hospital center (CHR) of Diffa in Niger is one of the main second-level referral structures where victims of the armed conflict that started in 2014 in the Lake Chad basin are referred and treated. Through this study, we report the preliminary results of the hospital management gunshot chest. Results: Firearm-related chest wounds accounted for 9.22% of firearm injury admissions, interesting especially for young man subjects. Penetrating thoracic lesions involved 14 patients, 12 of whom had high and medium-abundant effusion treated by thoracic drainage. Two patients had a pulmonary contusion and a fatal tamponade pattern respectively. Conclusion: Emergency chest drainage is a first-line saving procedure in the treatment of thoracic wounds with firearms in armed conflict
Lung Carcinoid Tumors and Paraneoplastic Cushing's Syndrome: Diagnostic and Therapeutic Difficulties - A Case Report
No full textIntroduction. - Paraneoplastic Cushing's syndrome is a rare cause of endogenous hypercorticism. It is caused by ectopic secretion of ACTH by a non-pituitary endocrine tumor. The aetiological biological and radiological data are often inconclusive, which creates a problem of differential diagnosis with Cushing's disease. In addition, these tumors are often small and their location is extremely variable. As a result, the difficulties of localization require the use of specific imaging techniques.Observation. - We report the observation of a 44-year-old man suffering from diabetes and high blood pressure, presenting a severe and rapidly progressive Cushing syndrome, in connection with a hypercorticism caused by an ectopic ACTH secretion. The thoracic computed tomography performed within the framework of a search for a neoplastic origin objectified a 15 mm nodule isolated at the level of the middle lobe, the scintigraphy with octreotide marked with indium-111 found a significant fixation at the level of the lung nodule. The patient had a middle lobe lobectomy. The outcome was favorable with regression of Cushing's syndrome. Pathological examination was in favor of a typical carcinoid tumor, and the immunohistochemical complement showed tumor cell positivity for ACTH, CD56, chromogranin, and synaptophysin.Conclusion. - This observation illustrates the dilemma between the need to locate an ectopic ACTH secretion and the control of aggressive and threatening Cushing's syndrome. Early use of the octreotide scintigraphy should be considered if a topographic diagnosis of the causative tumor cannot be done through conventional imaging techniques
The Characteristics of Women Aged 59-64 Years Who Consult Health Care Practitioners for Back Pain from the Australian Longitudinal Study on Women's Health (ALSWH)
No full textBackground: Back pain affects a substantial proportion of the adult population, and back pain sufferers tend to explore a wide range of health care options. This study investigates the use of medical and physiotherapy services by Australian women with back pain. Method: This is a sub-study of the Australian Longitudinal Study on Women's Health (ALSWH), designed to investigate multiple factors affecting the health and well-being of women over a 20-year period. The study focuses on 1,851 women aged 59-64 years, who had indicated that they had previously sought help from a health care practitioner for back pain.Results: Half of the women (56.5%) with back pain had consulted a general practitioner (GP), 16.2% had consulted a medical specialist, and 37.3% had consulted a physiotherapist for their back pain. Women with regular or continuous back pain were more likely to consult a GP (OR=3.98), medical specialist (OR=5.66) and a physiotherapist (OR=1.63).Conclusion: Australian women with back pain were more likely to consult a GP, medical specialist or physiotherapist if they had more regular/continuous back pain. Future research needs to investigate further the consultation and referral patterns identified in this study
Review of Coveralls, Gowns, and their Use as Part of Personal Protective Equipment (PPE KIT) for Effective Protection of Healthcare Workers in India in COVID-19
No full textHealthcare Workers (HCWs) and public health professionals are playing a pivotal role in containing COVID-19. Personal Protective Equipment (PPEs) are a critical component in the hierarchy of primary infection controls to ‘break the chain of infection’ to protect patients, HCW’s, and public. As SARS-CoV-2 is highly contagious, and vaccine and prophylactics not yet available, understanding correct PPE usage is imperative. This study aims to: understand purpose, use, and quality standards of body-coveralls and gowns and how to use PPE’s for effective protection in COVID 19 in India. Types of PPE’s in healthcare, their purposes, materials used, and properties were reviewed. Gowns and Body-coveralls classification and standards in Europe, USA and India were studied. While current stipulated test standards for coveralls in India are lower, as routine use of reusable gowns made of woven fabrics is more common in India, one could hypothesize that these coveralls provide a higher level of protection. As per current understanding of mode(s) of transmission of SARS-CoV-2 a properly fitted N95 respirator; goggles and splash resistant face shield; gloves; and single-use full body-coverall/gown preferably resistant to Synthetic Blood Penetration under pressure and made of non-woven Laminated SMS (Spunbond-Meltblown-Spunbond)_or Non Laminated SSMMS fabrics are advisable depending upon anticipated level of exposure. HCW’s should educated about transmission risks, correct principles of infection control, functional purpose of PPE’s and must be conscious that PPE’s alone will not protect them. They must follow good practices of how to wear (don) and how to remove (doff) and ensure that they do not inadvertently contaminate their clothing/skin and self-inoculate
Radiotherapy and Management in Maxillofacial Prosthodontic: Part 2 - During and After Radiotherapy
Get PDFThe prevalence of head and neck cancers continues to increase throughout the world, the modality of their management mainly includes surgery, radiotherapy (RTH), and chemotherapy and antiresorptive treatment.The complications of radiotherapy imperatively require concerted management and rigorous monitoring. Indeed, collaboration with the multidisciplinary team is essential and guarantees therapeutic success.The management of patients during and after these anticancer treatments by the specialist in maxillofacial prosthesis essentially comprises the treatment of early and late complications of radiotherapy, oral care and finally prosthetic rehabilitation depending on the case.The objective of this work is to describe the protocols and recommendations for the management of patients during and after radiotherapy and to highlight the role of the specialist in maxillofacial prosthodontics in this management
Evaluation of Drug Use Practices Using WHO Core Drug Use Indicators at Pediatric Health Facilities, Kabul, Afghanistan
Get PDFBackground: Irrational medicine use is a global problem. It can lead to increased morbidity and mortality and increased costs of drug therapy, thus imposing an adverse impact on the overall quality of the pharmaceutical care system. Objective: To evaluate drug use practices based on WHO core drug use indicators at pediatric health facilities of Kabul, Afghanistan.Methods: A cross-sectional study was conducted at outpatient departments of the three pediatric health facilities at samples that were collected using a systematic random sampling method. The sample size included 600 outpatient prescriptions. Data were evaluated as per the WHO guidelines.Results: On average 2.795, 2.745, and 4.2 drugs per prescription were prescribed in 001, 002, and 003 health facilities respectively (WHO standard is 1.6-1.8). 37.03% of drugs in 001, 42.62% in 002, and 42.64% of drugs in 003 were prescribed by the generic name (WHO standard is 100%). Antibiotics were prescribed in 79% prescriptions of the 001, 88% of the 002, and 52% of the 003 health facilities (WHO standard value is 20-26.8%). Injections were prescribed in 6% of the 001, 32% of the 002, and 19.5% of the 003 prescriptions (WHO standard is 13.4-24.1%). 65.47% of drugs in 001, 67.94% of drugs in 002, and 73.1% of drugs in 003 health facilities were prescribed from the Afghanistan national essential medicines list (WHO standard is 100%).Conclusion: Most of the core drug use indicators were not met with WHO standards in these pediatric health facilities. However, in 001 and 003 health facilities the prescribing patterns may be more complex because they are tertiary health care centers
Cantilever Resin Bonded Bridges…What evolution? About case reports
Get PDFResin bonded bridge technique was first introduced in 1963 by Rochette. It was the first type of non-invasive fixed dental prosthesis because the abutment tooth didn’t undergo any prior preparation. As early as 1996, Hussey and Linden studied cantilever resin bonded bridges and showed that there was no significant difference in the survival rates of a conventional bridge and cantilever resin bonded bridges. The main indications for a resin bonded bridge in children are post-traumatic edentulousness, during the early detection of agenesis and pre-implant temporization situations. Resin bonded bridges are also recommended in adults when the implant context is unfavourable or contraindicated (periodontal diseases and / or anatomical and prosthetic obstacles). Cantilever resin bonded bridge has many advantages compared to the traditional bridge: simpler and faster to make, more economical for the patient, easier hygiene and absence of partial detachment that can lead to secondary caries lesion.The preparation criteria will be adapted to the clinical situation, which will take into account the patient's age, the extent of edentulousness, the extent of occlusal loads and dental mobility. Thus, when the joint is subject to excessive stress, retention devices will complete the preparation. With the continuous development of materials as well as new minimally invasive treatment modalities, the alternative solution of the bonded bridge in the anterior region now corresponds to the realization of an all-ceramic zirconia cantilever bridge with a single wing
Odontogenic Keratocyst Mimicking a Radicular Cyst
No full textThe odontogenic keratocyst (OKC) is a benign intraosseous cyst of the odontogenic origin, characterized by an aggressive behavior with a relatively high recurrence rate.OKC is mostly presented at the 2nd and 3rd decades and predominantly affect males. It affects mandible more than maxilla and is frequently found at the angle of mandible. OKC can clinically and radiographically mimic other benign and less aggressive lesions. It is therefore important to differentiate them from other cysts and tumors, for a proper treatment and reduction of recurrences.We report the case of a 19-year-old woman who presented with a swelling in left mandible. The clinicaland radiographicfeatures were in favor of a radicular cyst.Histological examination, however, contradicted this diagnosis, indicating a case of OKC