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Treatment Results of Diaphyseal Forearm Fractures with Dynamique Compression Plate a Retrospective Study of 156 Cases.
Get PDFThis retrospective study addresses a series of 156 cases of forearm fractures. These 156 cases were managed in the trauma-orthopedic department (B4) of Fez University Hospital, Morocco, from May 2008 till January 2013. The purpose of this study is to analyze epidemiological and clinical factors of diaphyseal forearm fractures and the results of their treatment with dynamic compression plate (DCP), as well as the complications and therapeutic errors of this surgical technique. The frequency of hospitalization in the trauma-orthopedic department was 3,96%. Ages ranged between 16 and 83, the average age was 32. 132 patients were male (85%). 90% were managed on the day of trauma. Traffic accidents were the most frequent cause in 52% of patients. The fracture was in the left forearm in 65% of patients. 53% of fracture lines were in the middle third of the forearm. 38 fractures were open, and 30 were admitted for polytrauma. Osteosynthesis was performed with a dynamic compression plate for all patients. In comparison with the literature, our series shows the predominance of young male patients, with traffic accidents being the cause. Osteosynthesis with a dynamic compression plate remains the treatment of choice that provides satisfactory results if the accuracy in this technique was respected
Fatal Cardiothyreosis Revealed Through a Status Epilepticus and Resulting in a Therapeutic Impasse - A Case Report
Get PDFCardiothyreosis is a rare and serious complication of thyroid disease. We report a case that is unique in its inaugural clinical picture (status epilepticus) due to late diagnosis and iatrogenic drug which precipitated the patient in an array of congestive heart failure where therapeutic management was limited by insufficient technical facilities leading to death
Public-Private Partnerships in Health
Get PDFExtract: The current importance of public debt requires governments to increasingly shift towards Public-Private Partnerships (PPPs). They are long-term contracts of private financing methods providing or contributing to public service. The payment is made by the public partner and/or users of the service.The World Health Organization (WHO) defines this type of partnership as ‘‘a means to bring together a set of actors for the common goal of improving the health of populations based on mutually agreed roles and principles.’’Historically, the principle of PPP was established by the Private Finance Initiative (PFI), launched by the conservative government of John Major in 1992. It was from this moment that this model quickly spread to the rest of the world. In the mid-90s and from Australia, the PPP agreement began to become part of the language of governments. In 1997, Labour with Tony Blair leading, strongly developed this management method, first and particularly in hospitals and then, in the entire public sector and spreading to the Royal Navy. Today, 10-15% of British public investments are made using the PFI method
Penile Cavernous Hemangioma
Get PDFHemangiomas are benign lesions that occur in any part of the body in newborns or in young patients, they are typically capillary or cavernous. Cavernous hemangioma of the penis is extremely rare, and its etiology is not completely understood. Treatment options (surgical excision, laser therapy, or sclerotherapy…) are controversial and are required if pain, cosmetic defect, and/or bleeding during intercourse.
We report a case of a 26 years old man presented with a five years history of a painless lesion on his penis. Physical examination showed an ovoid, solid, 1 x 2 mm in size on the dorsum of penis (Panel A) and two elevated irregular lesions on the ventral side (Panel B). The lesions were compressive, nonpulsatile, and bluish-red in color with strawberry like appearance. Biopsy and histopathological examination of the lesion revealed a gaping and communicating vessels proliferated in the superficial and medium dermis which is pathognomonic for cavernous hemangioma (Panel C and D). Given the small size, a large number of lesions, the young age, and the ulceration risk during intercourse if skin graft after excision, Neodymium: YAG laser coagulation was recommended to get a good cosmetic result and sexual function satisfaction
Risk Factors for Diabetic Foot in Tetouan, Morocco - A Case-Control Study
Get PDFIntroduction Diabetes is a globally major public health problem. Its evolution is insidious and silent before the appearance of serious complications as a consequence in terms of morbidity than mortality. Complications in the feet are among the most frequent and feared. This study helps identify factors associated with diabetic foot in diabetic patients in the province of Tetouan in the public and private sector.Methods This is a case-control study in which 136 diabetic patients monitored in the public and private sector in the province of Tetouan were chosen. 68 patients had diabetic foot and 68 were diabetic patients without this complication. Data were collected from patients’ records and supplemented by interviews. The factors compared between the two groups were sociodemographic, biological, and related to diabetes and lifestyle. These risk factors were determined by bivariate and multivariate analyses.Results Statistically significant associations were found between diabetic foot and several factors including: the irregular monitoring of patients: ORadjusted = 7.7 [1.9-23], the rate of glycated hemoglobin: ORadjusted = 1.7 [1.2-2.3], diabetes duration: ORadjusted = 1.2 [1.03-1.26], and physical activity ORadjusted = 1.1 [0.02-0.9]. However, no association was found between the diabetic foot and the level of education or occupation.Conclusion To prevent the development of the diabetic foot, more attention should be given to diabetic patients whose diabetes duration is long, patient monitoring should be regular and diabetes control should be optimal. In addition, physical activity is recommended for diabetic patients as part of promoting healthy lifestyles
Neurological Manifestations In Inflammatory Bowel Disease
Get PDFIntroduction: The purpose of this retrospective study was to report neurological manifestations noted in patients who were monitored for inflammatory bowel disease, in order to document the pathophysiological, clinical, progressive, and therapeutic characteristics of this entity.Material and methods: We conducted a retrospective study on patients monitored -in the gastroenterology service in Ibn Sina Hospital in Rabat, Morocco- for inflammatory bowel disease from 1992 till 2013 and who developed neurological manifestations during its course. Patients with iatrogenic complications were excluded, as well as patients with cerebrovascular risk factors. Results: There were 6 patients, 4 of whom have developed peripheral manifestations. Electromyography enabled the diagnosis to be made and the outcome was favorable with the disappearance of clinical manifestations and normalization of the electromyography. The other 2 patients, monitored for Crohn’s disease, developed ischemic stroke. Cerebral computed tomography angiography provided a positive and topographic diagnosis. Two patients were admitted to specialized facilities.Conclusion: Neurological manifestations in inflammatory bowel disease are rarely reported. Peripheral neuropathies and stroke remain the most common manifestations. The mechanisms of these manifestations are not clearly defined yet. Currently, we hypothesize the interaction of immune mediators
Myasthenia Revealed Following Laparotomy - A Case Report
Get PDFMyasthenia (muscle weakness) is a rare neuromuscular disease of which respiratory failure is the main complication. The accidental discovery of such disease in the perioperative period is rare and potentially serious.We report a case of a woman who underwent an emergency operation for appendiceal peritonitis and failed repeatedly at weaning from postoperative mechanical ventilation. The usual etiologies such as postoperative respiratory complications, ventilator-associated pneumonia, acute respiratory distress syndrome complicating the septic shock or having no impact on it, and neuromyopathy’s resuscitation were considered, researched, examined, or eliminated.Faced with the diagnostic impasse and the obvious weaning failure, another interview revealed signs of muscle fatigue which led to the diagnosis of myasthenia gravis decompensated perioperatively. Once the diagnosis was confirmed by means of a neostigmine test, the specific treatment began, particularly through plasma exchange sessions, and the process of weaning resumed. The result was complete weaning. A three-month follow-up showed a stable patient with no significant muscular disability
Ocular Manifestations of Behcet's Disease: An Analysis of 133 Moroccan Patients
Get PDFIntroduction: Behcet’s disease is a systemic disorder linked to occlusive vasculitis and of a relatively unknown pathogenesis. Ocular manifestations of the disease mainly comprise uveitis in 60-80% of cases, followed by retinal vasculitis and then retinal vein occlusion. The aim of this study is to analyze ocular manifestations of patients with confirmed Behcet’s disease, their complications, treatment and evolution in our tertiary care unit of Morocco. Patients and methods : It is a retrospective study of patients with confirmed Behcet along with ocular manifestations, hospitalized in the department of ophthalmology at the teaching hospital of Rabat from Juin 2002 to June 2012.Results: A total of 133 patients were included in the study, being 29,5 years-old on average. Visual acuity is very low before treatment: 56% had less than 1/10. Ocular manifestations included mainly uveitis with 89.96%, followed by retinal vasculitis 73.6% and maculopathy 22%. The percentage of the eyes of which the VA was inferior to 1/10 became 35.9% after the treatment.Conclusion: The most frequent clinical presentation in our context is a total uveitis with a posterior predominance associated with a vasculitis. Pupillary seclusion is the most frequent complication. Corticotherapy and immunosuppressive drugs are the therapeutic methods used the most in our context
Research in Medicine: Essentials for Developing Countries
Get PDFWell-being has been the highest topic for humanity throughout the adventure of mankind on the earth. Therefore, extensive efforts have been performed in the science of medicine, and glorious advances have been gained especially in the last two centuries. Research is essential for medicine to develop new therapeutic methods and to monitor the results of the current treatment given to the patient. These are possibly the simplest reasons for investigations in medicine. On the other hand, qualified human resources, research ethics, financial supports, regular data recording and analysis, and publication are important issues for improvement of the medical researches in developing countries....
Topical Negative Pressure Therapy Recent Experience of the Department of Plastic Surgery at Ibn Sina University Hospital, Rabat, Morocco
Get PDFIntroduction: Topical negative pressure therapy (TNP) is a non-invasive method to treat chronic and acute wounds locally, using continuous or intermittent negative pressure. The objective of this study is to present the first experience of this type of treatment used in clinical cases in our department. By presenting these cases, we highlight the indication and efficiency of this new technique applied in relatively complicated situations, at the same time it also allows a significant improvement in treating injuries and chronic wounds.Materials and methods: In this study, we present the recent experience of the Department of Reconstructive and Plastic Surgery of the University Hospital Center of Avicenne in Rabat. This therapy was used for the first time this year (in 2014), in three young patients who presented with chronic wounds associated with local and general factors that are unfavorable for the healing process.Results: In all three of our cases we obtained highly satisfactory clinical results. TNP allows wounds to bud in a shorter time, as well as fast healing by the second intention due to controlled wound healing or split-skin graft without using flaps. This enables to decrease the margin of error, the time and the number of dressing replacements, and to reduce the length of hospital stay.Conclusion: This is an expensive and specific equipment. However, the cost-benefit ratio analysis shows that it is an essential method that should be part of our therapeutic strategies