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Background As Canada continues to address challenges related to the opioid crisis, individuals suffering from opioid use disorder (OUD) can be especially vulnerable to physical and psychological destabilization after surgery. Adopting a harm reduction approach postoperatively can be a success factor for safe recovery and satisfactory analgesia. Purpose We present the case of a 40-year-old patient (referred to as DC) with OUD using illicit fentanyl, heroin, and oxycodone preoperatively and admitted for an elective liver resection for steroid-induced hepatoma. Despite a preoperative anesthesia assessment and the initiation of a standard balanced multimodal analgesic regimen, suboptimal analgesia was evident in the first 24 h postoperatively. This lack of analgesic efficacy precipitated DC’s use of illicit self-injected intravenous (IV) opioid and significant emotional distress. To address this, a nurse practitioner and anesthesiologist within the Toronto General Hospital acute and transitional pain program and the surgical team quickly met and adopted a harm reduction approach to manage DC’s postoperative pain and emotional distress. The ultimate goal was to eliminate self-administration of illicit IV opioids and prevent DC from attempting to leave hospital against medical advice. Following an interprofessional team discussion that included DC, IV fentanyl was offered via a patient-controlled analgesia pump to DC’s satisfaction (exceeding standard settings), providing acceptable pain relief. To our knowledge, DC did not self-administer additional illicit drugs during the remainder of hospitalization. Outcome This harm reduction approach resulted in DC’s safe recovery, achievement of postoperative functional milestones, and continued engagement with outpatient pain treatment.

This Consensus Statement provides recommendations on the prescription of pain medication at discharge from hospital for opioid-naïve adult patients who undergo elective surgery. It encourages health care providers (surgeons, anesthesiologists, nurses/nurse practitioners, pain teams, pharmacists, allied health professionals, and trainees) to (1) use nonopioid therapies and reduce the prescription of opioids so that fewer opioid pills are available for diversion and (2) educate patients and their families/caregivers about pain management options after surgery to optimize quality of care for postoperative pain. These recommendations apply to opioid-naïve adult patients who undergo elective surgery. This consensus statement is intended for use by health care providers involved in the management and care of surgical patients. A modified Delphi process was used to reach consensus on the recommendations. First, the authors conducted a scoping review of the literature to determine current best practices and existing guidelines. From the available literature and expertise of the authors, a draft list of recommendations was created. Second, the authors asked key stakeholders to review and provide feedback on several drafts of the document and attend an in-person consensus meeting. The modified Delphi stakeholder group included surgeons, anesthesiologists, residents, fellows, nurses, pharmacists, and patients. After multiple iterations, the document was deemed complete. The recommendations are not graded because they are mostly based on consensus rather than evidence.

The purpose of this manuscript is to summarize key aspects of care for patients with advanced oral cancer, metastatic to the head and neck region. Patients with advanced oral cancer are treated with multimodal treatment. Surgical intervention leads to limitation in speech and swallowing abilities while adverse effects of chemotherapy and radiation treatment can include nausea, vomiting, diarrhea, mucositis, cystitis, dehydration, nephrotoxicity, skin dermatitis, myelosuppression, and nutritional deficiencies leading to weight loss. These toxicities could be overcome through self-care measures practiced by the patient. Oncology nurses could impart knowledge about self-care measures via patient and family counseling.

L’objectif du présent article est de résumer les aspects centraux des soins aux patients atteints d’un cancer avancé de la bouche avec métastases dans la région de la tête et du cou. Ces patients sont traités par approche multimodale. L’intervention chirurgicale limite leur capacité de parler et d’avaler, tandis que la chimiothérapie et la radiothérapie peuvent entraîner nausées et vomissements, diarrhée, mucite, cystite, déshydratation, néphrotoxicité, dermatite, dépression médullaire et carences alimentaires entraînant une perte de poids. Il est possible de contrer ces effets toxiques à l’aide de mesures d’autosoins. Dans le cadre de leurs interventions d’enseignement, les infirmières en oncologie pourraient transmettre aux patients et aux familles les connaissances nécessaires à l’application de ces mesures d’autosoins.

Cet article traite les obstacles d'accès aux soins de santé dans la province d'Al Haouz au Maroc, les défis qui en découlent et comment répondre aux exigences d'équité territoriale. L’approche utilisée est géographique, en adoptant des méthodes quantitatives et une représentation cartographique des données pour analyser la situation. Il ressort des résultats que des facteurs géographiques et socio-économiques, entravent l'accès aux soins notamment le relief difficile, la répartition inégale des services de santé, l'insuffisance des ressources et la pauvreté persistante. Ces problèmes demeurent un défi majeur dans la province d'Al Haouz malgré les efforts du gouvernement marocain pour l’amélioration d'accès aux soins de santé. Une redéfinition donc de politiques du système de santé publique est à prévoir, à travers une stratégie élaborée sur la base des spécificités locales, y compris le développement de programmes de santé mobiles, la formation du professionnel de santé, la sensibilisation à la santé et l'investissement dans de nouvelles installations de santé. Ils nécessitent également la réduction des dépenses directes des ménages pour les soins de santé et la généralisation des programmes d'assurance maladie

Le siècle des Antonins incarne plus que tout autre une dualité inhérente à la société romaine. D’une part l’esprit de conquête brillement mis en pratique par Nerva, Trajan et Hadrien et de l’autre, la piété envers les dieux et la recherche d’équilibre, incarnés par Antonin le Pieux et perpétuée par Marc-Aurèle. Il s’agit là de deux tendances chères aux romains : l’armée et la religion. Les pensées de Marc-Aurèle semblent exprimer le mieux cette lutte pour assurer un équilibre fragile à un peuple qui n’a quasiment jamais vécu en paix. Une approche analytique des pensées de Marc-Aurèle nous a amenée à nous interroger sur l’impact de cette dualité sur la vie de l’empereur et qui semble révéler un malaise intérieur que l’on ne retrouve pas chez les autres césars. - The century of the Antonines embodies more than any other a duality deeply rooted into the roman society. On the one hand the spirit of conquest brilliantly put into practice by Nerva, Trajan and Hadrian and on the other, piety towards the gods and the search for balance, incarnated by Antoninus Pius and perpetuated by Marcus Aurelius. These are two trends precious to the romans: army and religion in a context perpetually electrified by the demands and defiance of the Senate. The thoughts of Marcus Aurelius seem clearly reflect this inevitable struggle to ensure a delicate balance between on the one hand the constraints of the status of emperor and on the other, the need to ensure justice to a population which has ultimately never known peace. An analytical approach of the thoughts of Marcus Aurelius has led us to question the impact of this duality on the life of the emperor himself and to glimpse an internal discomfort that is not to be sensed with other Caesars.

Salima Siada, Approche analytique des pensées de l’empereur Marc-Aurèle

Competing Interests: CONFLICT OF INTEREST: None.

Competing Interests: CONFLIT D’INTÉRÊTS: Aucun.

In the last few years, there has been a growing interest in the study of complement, fueleld mainly by the design of complement modulators, especially the C5-blocker eculizumab. The latter has significantly improved the prognosis of some nephropathies, such as the atypical hemolytic uremic syndrome. This breakthrough is a perfect example of fundamental translational research leading to clinical applications for patients. Currently, new molecules are being developed and some of them have already demonstrated clinical efficacy, such as avacopan (C5aR blocker) in ANCA vasculitis. As for kidney transplantation, complement modulators may lead to a new perspective in the treatment of some complications, such as humoral rejection. However, complement modulators carry the side effects, especially the infectious, and high costs., Competing Interests: Fadi Fakhouri a reçu des honoraires de consultant de la part de Roche, Alexion, Novartis et Achillion. Les autres auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

The role of angiogenic factors in the onset of clinical manifestations of preeclampsia was demonstrated in 2003 by the implication of sFlt-1, PlGF and VEGF, and in 2006 by the implication of soluble endoglin. Placental ischemia and inflammation observed in preeclampsia alter both the production and progression of angiogenic factors during pregnancy. During the first trimester, the combination of PlGF with clinical, biophysical and biological factors results in a better test than the conventional one. However, the clinical value of this method remains to be confirmed. During the second and third trimesters, the sFlt-1/PlGF ratio may be used, with or without pre-existing renal disease, for short-term prediction, diagnosis, and prognosis, and to evaluate the effectiveness of preeclampsia treatment. While a sFlt-1/PlGF ratio<38 and≤33, respectively, rules out the short-term onset and diagnosis of preeclampsia, a sFlt-1/PlGF ratio≥85 between 20 and 34 weeks of pregnancy and≥110 beyond 34 weeks of pregnancy confirms a diagnosis of preeclampsia. Angiogenic and non-angiogenic preeclampsia are identified by a sFlt-1PlGF≥85 and<85, respectively, with the risk of maternal and fetal complications at two weeks differing between the two. Similarly, a sFlt-1/PlGF ratio>665 and>205, respectively, is a good short-term predictor of adverse outcomes of early and late-onset preeclampsia. These values could be incorporated into future guidelines for better clinical management of preeclampsia., (Copyright © 2019 Société francophone de néphrologie, dialyse et transplantation. Published by Elsevier Masson SAS. All rights reserved.)

Preconceived ideas about artificial intelligence. Artificial intelligence (AI) has made considerable progress in many tasks or activities that involve a large number of jobs and sectors. She is thus the subject of many fantasies and fears. People could see AI as a machine as intelligent as a human, self-aware and able to make choices with automony. However, this representation is very far from reality. Existing AI systems are not about to be endowed with a consciousness and capable of thinking for themselves. It is true that there are many AI tools available on the healthcare market and the scope of their current applications in the field of medical diagnosis seems impressive. But overall, promises remain uncertain at this stage. The scenario of a medicine without doctors, of brutal destruction of the health professions, is today more of a buzz and a media frenzy than a science. One way to understand this media excitement would be to ask why AI and health «go well together»? What is the reality of AI today and what are its strong limitations? The objective of this article is not to affirm that AI is a non-subject, quite the contrary, but to make people aware that the future of the health system will be the one we want to promote for the future., Competing Interests: S. Benhamou déclare n’avoir aucun lien d’intérêts.

The complement system is part of the innate immunity. It is a multifunctional system including more than 30 plasma and membrane proteins. These are activated by an enzymatic cascade and proteolytic reactions producing activating fragments. Complement is : 1) among the first line of defense towards a pathogen, 2) increasing efficacy of the acquired immunity, 3) responsible for the elimination of immune complexes apoptotic and or necrotic cells (waste removal function) and many other cellular and tissue functions. The aim of this article is to analyze the consequences of complement dysregulation in the development of various diseases., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Introduction: Semen analysis is a key part of male infertility investigation. The necessity of quality management implementation in the andrology laboratory has been recognized in order to ensure the reliability of its results. The aim of this study was to evaluate intra- and inter-individual variability in the assessment of semen parameters in our laboratory through a quality control programme., Methods: Four participants from the laboratory with different experience levels have participated in this study. Semen samples of varying quality were assessed for sperm motility, concentration and morphology and the results were used to evaluate inter-participant variability. In addition, replicates of each semen sample were analyzed to determine intra-individual variability for semen parameters analysis., Results: The average values of inter-participant coefficients of variation for sperm motility, concentration and morphology were 12.8%, 19.8% and 48.9% respectively. The mean intra-participant coefficients of variation were, respectively, 6.9%, 12.3% and 42.7% for sperm motility, concentration and morphology. Despite some random errors of under- or overestimation, the overall results remained within the limits of acceptability for all participants. Sperm morphology assessment was particularly influenced by the participant's level of experience., Conclusion: The present data emphasize the need for appropriate training of the laboratory staff and for regular participation in internal quality control programmes in order to improve the reliability of laboratory results., Competing Interests: Les auteurs ne déclarent aucun conflit d’intérêt.

Aim: The objective of this work was to review current data about the pathophysiology, clinical features, and treatment of pulmonary thromboembolism. Venous thromboembolism (VTE) remains a major challenge in hospitalised especially the care of critically ill patients. Pulmonary embolism (PE) is the major complication of VTE. By occluding the pulmonary arterial bed it may lead to acute life-threatening but potentially reversible right ventricular failure. The outcome of patients with PE is quite variable depending primarily on the cardio-respiratory status and the embolus size. PE is a difficult diagnosis that may be missed because of non-specific clinical presentation. Clinical signs include hypoxia, tachypnea, and tachycardia. Severe cases of untreated PE can lead to circulatory instability, and sudden death. However, in ICU, most of patients require sedation and mechanical ventilation. The clinical manifestations usually observed in this condition (PE) cannot be exhibited by these patients and clinical presentation is usually atypical. For these reasons, the diagnosis of PE is usually suspected when un-explicated hypoxemia and/or shock and arterial hypotension were observed. Positive diagnosis is based on these clinical findings in combination with laboratory tests and imaging studies. D-dimer testing is of clinical use when there is a suspicion of DVT or pulmonary embolism PE. In Emergency department, a negative D-dimer test will virtually rule out thromboembolism with a negative predictive value at 95 to 98%. In massive and submassive PE, dysfunction of the right side of the heart can be seen on echocardiography. While the gold standard for diagnosis is the finding of a clot on pulmonary angiography, CT pulmonary angiography is the most commonly used imaging modality today. When the diagnosis is confirmed, anticoagulant therapy is the mainstay of treatment. Acutely, supportive treatments a pivotal role in the management of patients with PE. Severe cases may require thrombolysis with drugs such as tissue plasminogen activator (tPA) or may require surgical intervention via pulmonary thrombectomy. Prevention is highly warranted.

Hyperhomocysteinemia and hyperactivity of the angiotensin-1 converting enzyme (ACE1) are considered two unconventional coronary risk factors. The study of the variation of these two biochemical parameters in coronary patients and metabolic investigation of the relationship between these two markers has a fundamental interest. In this context, 110 patients and 80 control subjects are recruited for our study. Homocystenemia was determined by fluorescence polarization immunoassay (FPIA). ACE1 activity was measured by kinetic method. An increased of homocysteinemia and ACE1 activity was observed in patients compared with control subjects (Hcy: 23±18 μmol/L vs 9±4 μmol /L; p<0.0001); (ACEI: 81±18 UI/L vs 55±18 UI/L; p<0.0001). These two markers varied differently according to the risk factors. Homocysteinemia, was negatively correlated with ACE1 activity (r = -0.36; p<0.001). The negative correlation between these two markers reflects metabolic and physiopathological interactions.

Since the first procedure carried out at La Pitié Hospital, on 27 April 1968, we have performed 1918 heart transplants. We analyzed outcomes in four successive periods: initial experience from 1968 to 1981 (53 patients), using early immunosuppressive regimens; an expansion phase (839 patients) from 1982 to 1992, with the introduction of cyclosporine; a stabilisation phase (522 patients) from 1993 to 2003; and the most recent phase (504 patients) from 2004 to 2010. We focused particularly on the most recent period. National super-emergency "rules were created, and grafts from older," "borderline" donors were used. Hyperimmune recipients started to be grafted, and ECMO was frequently used during the preoperative and postoperative periods. Due to limited organ availability, we have gradually placed more and more patients on mechanical cardiac support as a bridge to transplantation. Their quality of life is improved.

Background: Schwannoma is generally a benign tumour developing from Schwann cells., Aim: To study epidemiological, clinical and pathological features of scwannoma., Methods: Retrospective study about 26 cases of cutaneous schwannoma collected in our department over 24 years., Results: Our patients were 12 females and 14 males. Mean age was 30 years. Clinically, schwannoma was a subcutaneous tumour which was painful in 11 cases. Individual tumours were located on the limbs (10 cases), on the head (9 cases) and the trunk (5 cases). Multiple tumours were seen in two patients. Histopathological examination confirmed the diagnosis of schwannoma in all cases. Treatment was complete surgical excision in all cases., Conclusion: Cutaneous location of schwannoma is not rare. Usually, and contrarily to our series, there is no sex predominance. Clinically, schwannoma is located on the limbs and head. The diagnosis is confirmed by histopathological examination. Malignant epitheloid schwannoma diagnosed in one of our patients is a rare tumour. Schwannomas usually grow slowly and are poorly invasive. Malignant degeneration is exceptional. Treatment is complete surgical excision.

Type IVA mucopolysaccharidosis or Morquio A disease is a lysosomal storage disease, autosomal recessive, caused by deficiency of the N-acetylgalactosamine-6-sulfate sulfatase or GALNS. The severe phenotype is characterized by a severe skeletal dysplasia without any mental retardation. The aim of this study was to propose a strategy of molecular and prenatal diagnosis of this pathology. A molecular study was carried out on 7 patients MPS IVA issued from 5 unrelated families recruited from different Tunisian regions. All the patients were offspring of consanguineous marriages. The clinical and biologic study confirmed the diagnosis of MPS IVA within the 7 studied patients. Three GALNS mutations were identified by molecular analysis: IVS1+1G>A, G66R and A85T. The unions between Tunisian relatives are important and increase the Morquio A incidence in Tunisia. The identification of GALNS mutations in the Tunisian population permits better understanding of the Morquio A phenotype, a reliable genetic counselling and a molecular prenatal diagnosis to Tunisian at-risk relatives.

We recruited a 44-year-old woman who had a dementia with behavioral and personality troubles. A biochemical analysis which includes a qualitative study of urinary sulfatides by thin layer chromatography followed by the determination of the enzymatic activity of arylsulfatase A (ARSA) was performed. The Molecular analysis concerned the research of the most frequent mutations (459 +1 G> A, p.P426L, p.I179S). The profile that has revealed the presence of 3-O-sulfogalactosylceramide fraction was in favor of metachromatic leukodystrophy. The activity of arylsulfatase A was collapsed in the index case which confirmed the phenotype of the adult form of the diagnosed MLD. The molecular study showed the presence of the mutation p.I179S in the homozygous state in the index case.

Background: Intracranial complications of sinusitis are always a subject of actuality. They present diagnostic and therapeutic problems., Aim: To study the clinical characteristics and treatment modalities for intracranial complications of sinusitis while insisting on their severity., Methods: Retrospective study concerning 7 patients who had intracranial complications secondary to sinusitis., Results: Our study was about 3 men and 4 women. The mean age of patients was 24 years. Neurologic signs were the most common symptoms. The diagnosis was confirmed by CT scan and lumbar puncture. The different complications were empyema in 5 cases and meningitis in 2 cases. Treatment included parenteral antibiotic therapy and surgery. The neurosurgical management has been achieved in 3 cases. Control was obtained in 4 cases, the mean receding was 18 months., Conclusion: Intracranial complications of sinusitis must be evoked, especially in cases of febrile headache or facial oedema. CT scan must be realized in slightest doubt. The treatment must be started precociously allowing a cure without after-effects.

Background: Hyalinosis cutis et mucosae (HCM), is a rare autosomal recessive genodermatosis. Cutaneous features are characteristic and allow to suspect diagnosis., Aim: To report a series of HCM., Methods: A retrospective study of all cases of HCM, diagnosed in a dermatology department over a period of 25 years (1983-2007)., Results: Over the considered period, 5 new cases of HCM were diagnosed. Patients were aged between 14 and 41 years. They were 3 females and 2 males. All patients were native of Tabarka (northwestern Tunisia). The age of the onset of the disease varied from neonatal period to 5 years. Hoarseness was the first clinical manifestation in all cases. Skin lesions developed between the ages of 3 and 8 years. Vesiculobullous lesions were observed in 2 patients. Moniliform blepharosis was seen in all patients. Warty and hyperkeratotic papules were observed in 3 patients. Diffuse thickening of the skin was seen in 3 patients. Lesions were primarily distributed on the face. All patients presented diffuse scars. Linear palmoplantar keratoderma was seen in one patient. Asymptomatic endocranial calcifications were noted in 4 patients. A pituitary adenoma was noted in one patient. Histopathological examination of a skin lesion revealed a typical pattern of HCM. Two patients were treated with systemic retinoids without improvement., Conclusion: We reported five new cases of HCM. All patients were native from Tabarka. We report also one case of linear palmar keratoderma associated with HCM. This association was not reported in the literature. Finally, the association HCM-pituitary adenoma, seen in one patient, may be fortuitous.

Background: Allergic rhinitis is a daily problem to which are confronted principally general practitioner, paediatrician, ear, nose and throat specialist and allergologist. also, this subject is still always alive because allergy seems in a constant progression in our society., Aim: To clarify diagnostic and therapeutic criteria of this affection., Methods: we have realized a literature review concerning physiopathology, clinical symptoms, the position of paraclinical investigations and finally therapeutic modality of allergic rhinitis., Results: Appropriated treatment of allergic rhinitis should be général it requires a knowledge and better comprehension of the disease and optimum prevention, if it is possible, of allergic symptoms.

Scholz's disease or metachromatic leukodystrophy (MLD) is a lysosomal storage disease caused by a deficiency in arylsulfatase A (ARSA: EC 3.1.6.8). This enzyme is responsible for the degradation of sulfatides commonly called cerebroside-3-sulfate or 3-O-sulfogalactosylcéramide in galactocérébroside and sulfate. The success of hydrolysis of these sphingolipids by ARSA necessarily depends on the presence of saposine B forms a complex with the substrate. The pathological accumulation of sulfatides in the nervous system (myelin, neurons and glial cells) results most often neurological, mental retardation, nervous disorders, blindness. The metachromatic granules accumulated in the central nervous system and peripheral compounds are highly toxic. These are at high levels in the urine of patients affected by the MLD. Arylsulfatase A activity is collapsed in these patients. Unfortunately, the value of enzyme activity is not a predictor of clinical severity of the neuropathology. In contrast, the study of the gene that codes for the ARSA is seen as a way to diagnose the simplest and most reliable of the disease to avoid misdiagnosis due to the presence of pseudodeficit. The conventional therapeutic approaches are essentially symptomatic. They were made in order to restore the enzyme activity of arylsulfatase A and prevent the progression of the pathological accumulation of sulfatides and consequently reduce morbidity associated with MLD.

X-linked adrenoleukodystrophy (ALD) is a severe demyelinating disease of the brain caused by a deficiency in ALD protein, an adenosine triphosphate--binding cassette (ABC) transporter encoded by the ABCD1 gene. ALD progression can be halted by allogeneic hematopoietic cell transplantation (HCT). We have developed a gene therapy strategy based on ABCD1 gene transfer to autologous hematopoietic stem cells (CD34+) by a lentiviral vector derived from HIV-1. We initiated a clinical trial involving three ALD patients for whom no matched donor was available. Autologous CD34+ cells were transduced ex vivo with an HIV derived vector the wild-type ABCD1 gene then re-infused after myeloablative treatment. Polyclonal reconstitution was detected up to 24 to 30 months, with between 9% and 14% of granulocytes, monocytes, and T and B lymphocytes expressing the ALD protein, strongly suggesting that the patients' hematopoietic stem cells have been successfully transduced. Cerebral demyelination halted after 14 to 16 months in two first treated patients an outcome similar to that achieved by allogeneic HCT These results suggest that lentiviral vectors are suitable for transferring therapeutic genes to hematopoietic stem cells, and provide the first example of successful gene therapy for a severe neurodegenerative disease.

Background: Sarcoidosis is a systemic disease, of unknown etiology, characterized by noncaseating epithelioid granulomas. It may affect many organs mainly lungs, lymph nodes and skin., Aim: The aim of our study is to evaluate retrospectively the epidemiological, clinical features and therapeutic particularities of cutaneous sarocidosis through a hospital series conducted in the dermatology department of Habib Thameur hospital. METHODS We have included 28 patients (23 females and 5 males) with a mean age of 45.5 years., Results: The most frequent skin lesions were: papular sarcoidosis in 6 cases, nodular sarcoidosis in 8 cases and plaques in 6 cases. The other clinical types observed were: lupus pernio (2 cases), subcutaneous nodules (2 cases) and scar sarcoidosis (2 cases). Three patients presented erythema nodosum. Tuberculin skin test was negative in 77% of cases. Lymph nodes were palpable in 4 patients. Investigative exams revealed intrathoracic involvement in 8 cases and anterior uveitis sequels in 2 cases. Cutaneous manifestations were treated by chloroquin in 13 cases, allopurinol in 3 cases and intralesional betamethasone injections in 1 case. Five patients, with systemic involvement, underwent a therapy with oral corticosteroids., Conclusion: Sarcoidosis is a rare affection in Tunisia that affects mainly females. Cutaneous manifestations incite physicians to carry out complete investigations and to uphold a regular follow-up in order to detect systemic involvement.

Background: The increasing consumption of antibiotics in hospitals and the economic implications of this increase lead to survey this consumption in the various hospital units., Aim: Our study proposes to measure the annual antibiotic use and antimicrobial resistance in an intensive care Burn department in order to manage the control measures., Methods: The study was conducted during a 5 year period (1 January 2000 to 31 December 2004). The average number of admissions was 204/year and the mean number of hospitalisation was 4036/year. Antimicrobial susceptibility testing was performed by disk diffusion method. Susceptibility testing data were stored in a laboratory data base using whonet 5.3 software. The consumption of following antibiotics: imipenem, ceftazidime, ofloxacin, ciprofloxacin, piperacillin-tazobactam was measured by antimicrobial density (AD) witch takes into account the quantity of antibiotics in Grams converted to daily defined dose (DDD) and number of hospitalization days. The daily defined dose (DDD) was proposed by WHO. The calculation of the AD for each molecule was carried out according to the following formula: [AD = Quantity consumed in grams for the particular antimicrobial X 1000]/[DDD for that antimicrobial X number of days hospitalizations]., Results: There was statistically significant relationship between increasing use of ceftazidime and ceftazidime resistant Klebsiella pneumoniae (rs=0.93; p=0.02). The use of ceftazidime was not significantly associated with resistance to this molecule in P. aeruginosa (rs=0.76 ; p=0.13). Concerning the fluoroquinolones, there was statistically significant relation ship between increasing use of ciprofloxacin and rate ciprofloxacin resistant P. aeruginosa (rs=0.89,P=0.043). Furthermore, the consumption of ciprofloxacin was significantly correlated to imipenem resistance in P. aeruginosa (rs=0.87, p=0.05 ). However, the consumption of imipenem was not significantly correlated to resistance of this drug in P. aeruginosa (rs=0.45; P=0,4)., Conclusion: The monitoring of both antibiotic consumption andantibiotic resistance is necessary to set up targeted policies and to control their effectiveness. Nevertheless this monitoring must be integrated into global policy of good use and control of antibiotics.

The concept of biodiversity hotspot at the regional and global scale has contributed to the improvement of the conservation strategies. The need for precise evaluation is often hampered by lapses of knowledge in some Mediterranean regional hotspots. The objective of the present work is to analyse the diversity of endemic and rare flora in the northern part of Algeria. According to the bibliographical data that are available, the most remarkable areas for endemism are the Oran's coast, the Great Kabylia, and the Small Kabylia. As far as rare species are concerned, coastal Numidia comes first, then the Algiers surroundings. This group 'Kabylias-Numidia-Kroumiria' comprises an unrecognised regional hotspot, made of forests, mountains and coastal ecosystems and threatened by human activities. In the face of growing threats, it is urgent to reinforce national and international policies of conservation and to cooperate for a better floristic knowledge of all the areas mentioned above.

Cell therapy was born in 1968 with the first allogeneic transplantation of hematopoietic stem cells for two immune deficiency disorders: the Wiskott-Aldrich syndrome and the Severe Combined ImmunoDeficiency (SCID). From this pioneering experience, thousands of patients affected with inherited or acquired diseases of the hematopoietic system have benefited from this therapeutic approach. Unfortunately, immunologic obstacles, represented by the compatibility in the major histocompatibility HLA system, still dictate today important limitations for a larger therapeutic utilization of hematopoietic stem cells (HSC). In this review, we have summarized the difficulties and the scientific advances leading us to improve the clinical results; the therapeutic research's track for primary immunodeficiencies is also discussed.

Background: Acute mastoiditis with ostertis is secondary to bacteria involving mastoid cavities, Aim: Describe the epidemiologic aspects, Material and Methods: Between 1990 and 2003, we listed 44 files of children hospitalized for acute mastoiditis. The treatment was in any case medical associated to a surgical treatment in 30 cases., Results: The age of our patients was consisted between 2 months and 14 years with an average is 2 years. The sex ratio of patient was 1,1. 29 patients didn't have any antecedents particular O.R.L, 8 patients were followed for otitis middle chronic and 7 had an cholestéatomateuse. The auricular old-fashioned swelling was the most frequent functional sign. A scanner has been achieved in 13 cases. The treatment was médico-surgical in 30 cases is 68,8% and an only antibiothérapie in 14 cases is 31,8%.

Dyslexia is a reading problem disorder. It can be a direct result of epilepsia for some kids. The researchers have done the study on 30 school kids that suffer from epilepsia. All the children had Audiometry which was normal in all cases. The orthophonic exam has done in all cases, founding a prononciation and speaker disorder also there is disorder at the psychometric test The purpose of the study research is to define the different profiles of dyslexia on the epileptics, then to check the importance of collaboration between Otorhinolaryngologists, Neurologists and Orthophonists to take care of the epileptic kids having dyslexia.

Introduction: Hilar cholangiocarcinoma is a rare cancer revealed in this case only after its ovarian metastasis, a Krukenberg tumor., Case Report: A 60-year old woman was hospitalized for jaundice. Her medical history included a hysterectomy eight months earlier for a Krukenberg tumor. The primary tumor had never been found. Physical examination showed isolated cholestatic jaundice. Blood tests revealed cholestasis and cytolysis. Hepatobiliary ultrasound showed dilatation of the intrahepatic bile ducts. Abdominal computed tomography confirmed that dilatation stopped at the hilar plate. Transparietal cholangiography findings suggested cholangiocarcinoma. Surgery discovered an extensive unresectable tumor of the proximal principal bile duct. The surgeon took tissue samples and placed a T-drain for decompression. The histology study found adenocarcinoma of the bile duct, and concluded that the Krukenberg tumor was secondary to this cholangiocarcinoma., Discussion: Hilar cholangiocarcinoma quickly invades adjacent structures, such as the liver, gallbladder, lymph nodes, blood vessels and local nerves. Remote metastases have been reported in the lungs, spleen, adrenal gland, and peritoneum. Ovarian metastasis of hilar cholangiocarcinoma is very rare.