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To determine the impact of a systematic endotracheal aspiration (ETA) sampling program for mechanically ventilated patients on initial antibiotic therapy for ventilator-acquired pneumonia (VAP).Retrospective cohort study; before-after study design.Pediatric intensive care unit (PICU) with 16 medical and surgical beds in a tertiary teaching hospital.Patients16 years of age hospitalized in the PICU who fulfilled VAP criteria.Biweekly systematic ETA sampling was conducted in mechanically ventilated patients.We retrospectively studied patients who received antibiotic therapy for suspected VAP 12 months before and after the initiation of systematic ETA (periods 1 and 2, respectively), evaluating the initial antibiotic therapy spectrum in both periods.During period 1, 56 patients developed VAP and 47 developed VAP during period 2. The incidence was 17 cases of VAP/1000 days of mechanical ventilation in both periods. Ideal antibiotic therapy was prescribed in 19.6% of cases for period 1 and 55.2% for period 2 (P = 0.001). Initial antibiotic therapy for VAP during period 2 had a significantly lower proportion of broad-spectrum antibiotics than therapy during period 1 (P = 0.01).In our PICU, knowledge of bronchial colonization reduced initial broad-spectrum antibiotic use for VAP.

BackgroundMore than half of infants with complex congenital heart disease (CHD) will have a neurodevelopmental disorder of multifactorial causes. The preoperative period represents a time-window during which neonates with complex CHD are in a state of hypoxia and hemodynamic instability, which fosters the emergence of brain injuries and, thus, affects early brain networks and neurodevelopmental outcomes. Currently, there is no consensus regarding the optimal age for cardiac surgery in terms of neurodevelopmental outcomes, and its definition is a real challenge. Our aim is to determine the relationship between cardiac surgical timing and long-term neurodevelopmental outcomes for various types of complex CHD.MethodsWe hypothesize that earlier surgical timing could represent a neuroprotective strategy that reduces perioperative white matter injuries (WMIs) and postoperative morbidity, leading to improved neurodevelopmental outcomes in infants with complex CHD. Firstly, our prospective study will allow us to determine the correlation between age at the time of surgery (days of life) and neurodevelopmental outcomes at 24 months. We will then analyze the correlation between age at surgery and (i) the incidence of WMIs (through pre- and postoperative MRIs), (ii) postoperative morbidity, and (iii) the duration of the hospital stay.Implications and DisseminationThis research protocol was registered in the Clinical Trial Registry (National Clinical Trial: NCT04733378). This project aims to help launch the first Neurocardiac Investigation Clinic in Marseille — AP-HM — to propose an overall personalized monitoring and treatment program for patients operated on for complex CHD.

International audience; With the density increase of today’s printed circuit board assemblies (PCBA), electronic test methods such as in-circuit test (ICT) reached their limits. In the same time the requirements of high reliability and robustness are greater. Original equipment manufacturers are obliged to reduce the number of physical test points and to find better-adapted test methods to keep adequate test coverage. Current test methods must be rethought to include a large panel of physical phenomena that can be used to detect- electrical defects, absence, wrong value of components, absence and shorts without using test points on the board under test (BUT). In this paper, a test set-up based on the measurement of electromagnetic signature to diagnose faulty components contactlessly is presented. The technique consists in using magnetic field probes, which detect the field distribution over powered sensitive components. To evaluate the relevance of the method, reference EM signatures are extracted from fault-free circuits, which are compared to those extracted from a sample PCBA in which we introduced a component level defect by removing or changing the value of critical components. For more robust detection of multiple defect scenarios, the principal component analysis (PCA) method is used as an outlier detection algorithm.

In many low-and middle-income countries, health systems decision-makers are facing a host of new challenges and competing priorities. They must not only plan and implement as they used to do but also deal with discontented citizens and health staff, be responsive and accountable. This contributes to create new political hazards susceptible to disrupt the whole execution of health plans. The starting point of this article is the observation by the first author of the limitations of the building-blocks framework to structure decision-making as for strengthening of the Moroccan health system. The management of a health system is affected by different temporalities, the recognition of which allows a more realistic analysis of the obstacles and successes of health system strengthening approaches. Inspired by practice and enriched thanks a consultation of the literature, our analytical framework revolves around five dynamics: the services dynamic, the programming dynamic, the political dynamic, the reform dynamic and the capacity-building dynamic. These five dynamics are differentiated by their temporalities, their profile, the role of their actors and the nature of their activities. The Moroccan experience suggests that it is possible to strengthen health systems by opening up the analysis of temporalities, which affects both decision-making processes and the dynamics of functioning of health systems.

The prevalence of hypertension, diabetes, obesity, and chronic kidney disease (CKD) in an adult Arabic-Berber population was investigated according to 2012 KDIGO guidelines. A stratified, randomized, representative sample of 10,524 participants was obtained. Weight, height, blood pressure, proteinuria (dipstick), plasma creatinine, estimated glomerular filtration rate, and fasting glycemia were measured. Abnormal results were controlled within 2 weeks; eGFR was retested at 3, 6, and 12 months. The population adjusted prevalences were 16.7% hypertension, 23.2% obesity, 13.8% glycemia, 1.6% for eGFR under 60 ml/min/1.73 m(2) and confirmed proteinuria 1.9% and hematuria 3.4%. Adjusted prevalence of CKD was 5.1%; distribution over KDIGO stages: CKD1: 17.8%; CKD2: 17.2%; CKD3: 52.5% (3A: 40.2%; 3B: 12.3%); CKD4: 4.4%; CKD5: 7.2%. An eGFR distribution within the sex and age categories was constructed using the third percentile as threshold for decreased eGFR. A single threshold (under 60 ml/min/1.73 m(2)) eGFR classifying CKD3-5 leads to "overdiagnosis" of CKD3A in the elderly, overt "underdiagnosis" in younger individuals with eGFR over 60 ml/min/1.73 m(2), below the third percentile, and no proteinuria. By using the KDIGO guidelines in a correct way, "kidney damage" (confirmed proteinuria, hematuria) and the demonstration of chronicity of decreased eGFR

Objective In 2009, the Ministry of Health of Morocco launched a national confidential enquiry around maternal deaths based on the newly implemented routine maternal death surveillance system (MDSS). The objective of this paper is to show the importance of substandard care among the factors associated with maternal deaths. Methods The Moroccan National Expert Committee (NEC) organised an audit of maternal deaths identified by the MDSS to determine the medical cause, the preventability of the deaths and the type of substandard care involved. Results Three hundred and three cases of maternal deaths were analysed for the year 2009. Direct causes accounted for 80.8%. 75.9% were considered avoidable by the NEC. The three main factors were insufficient follow-up of care in 45.6% of cases, inadequate treatment in 43.9% and delay in seeking care in 41.3%. The auditors found that 54.3% of all maternal deaths could have been avoided if appropriate action had been taken at the health facilities. Conclusion The audit of maternal deaths in Morocco enabled a better understanding of the circumstances contributing to maternal deaths and pinpointed that more than half of maternal deaths were associated with substandard care in hospitals. Objectif En 2009, le ministere de la Sante du Maroc a lance une enquete nationale confidentielle sur les deces maternels, sur la base du nouveau systeme mis en œuvre pour la surveillance systematique de la mortalite maternelle (SSMM). L'objectif de cet article est de montrer l'importance des soins de qualite inferieure aux normes, parmi les facteurs associes a la mortalite maternelle. Methodes Le Comite National d'Experts (CNE) Marocain a organise un audit des deces maternels identifies par la SSMM pour determiner la cause medicale, le caractere evitable du deces et le type de soins impliques, inferieurs aux normes. Resultats Of 303 cas de deces maternels ont ete analyses pour l'annee 2009. Les causes directes representaient 80.8%. Of 75.9% ont ete consideres comme evitables par le CNE. Les trois principaux facteurs etaient: un suivi insuffisant des soins dans 45.6% des cas, un traitement inadequat dans 43.9% et le retard dans le recours aux soins dans 41.3%. Les experts ont constate que 54.3% de tous les deces maternels auraient pu etre evites si des mesures appropriees avaient ete prises au niveau des etablissements de sante. Conclusion L'audit des deces maternels au Maroc a permis de mieux comprendre les circonstances qui contribuent a la mortalite maternelle et a revele que plus de la moitie des deces maternels etaient associes a des soins de qualite inferieure aux normes dans les hopitaux. Objetivo En el 2009 el Ministerio de Salud de Marruecos lanzo una encuesta confidencial a nivel nacional basada en el recientemente establecido programa de vigilancia de muertes maternas (PVMM). El objetivo de esta publicacion es mostrar la importancia de cuidados subestandar entre los factores asociados con las muertes maternas. Metodos El Comite Nacional de Expertos de Marruecos (CNEM) organizo una auditoria de las muertes maternas identificadas mediante el PVMM con el fin de determinar las causas medicas, la posibilidad de prevenir las muertes y el tipo de cuidados subestandar involucrados. Resultados Se analizaron 303 casos de muertes maternas para el ano 2009. Las causas directas eran responsables del 80.8% de las muertes. Un 75.9% fueron consideradas como prevenibles por el CNEM. Los tres factores principales eran un seguimiento insuficiente en un 45.6% de los casos, tratamiento inadecuado en un 43.9%, y un retraso en la busqueda de cuidados en un 41.3%. Los auditores encontraron que un 54.3% de todas las muertes maternas podrian haberse evitado si en los centros sanitarios se hubiesen realizado las acciones apropiadas. Conclusion La auditoria de muertes maternas en Marruecos nos permite entender mejor las circunstancias que contribuyen a las muertes maternas y senalan que mas de la mitad de estas muertes estaban asociadas a unos cuidados hospitalarios subestandar.

OBJECTIVE: To describe the development of the maternal death surveillance system (MDSS) in Morocco and discuss the initial results. METHOD: The nationwide MDSS was implemented in 2009 with the involvement of health professionals and local authorities. It comprises (i) notification of all deaths of women of reproductive age (from 15 to 49 years); (ii) a preliminary survey to identify pregnancy-related deaths; (iii) a confidential enquiry into all pregnancy-related deaths. The information thus obtained describes socio-demographic characteristics of the women their obstetric and medical history the mode of delivery its follow-up and the medical cause of death. RESULTS: From 1st of January 2009 to 31st of December 2009 3814 deaths of women of reproductive age were recorded and a total of 436 pregnancy-related deaths were identified with 73.4% of those occurring in health facilities. Among the 313 reviewed records 80.8% were direct obstetric deaths and 13.5% were classified as indirect. Haemorrhage was the first direct obstetric cause of death (33%). Heart disease was the main indirect obstetric cause of death (39% of indirect causes). CONCLUSION: The Moroccan MDSS is a powerful tool for understanding the causes and circumstances of maternal deaths. However challenges remain regarding the full coverage of the system the decentralisation of the data entry and analysis and the completeness of medical records. (c) 2013 Blackwell Publishing Ltd.

Introduction La retinopathie pigmentaire dont la prevalence est de 1/4000, designe un ensemble de dystrophies retiniennes hereditaires caracterisees par des depots pigmentaires au fond d’œil, une hemeralopie et un retrecissement du champ visuel. Le but de notre travail est d’etudier le profil epidemiologique, genetique, ainsi que les traitements disponibles. Materiels et Methodes Etude retrospective a propos de 5 cas de retinopathie pigmentaire colliges dans notre service entre le 1er janvier 2003 et le 31 decembre 2006. Resultats - Âge moyen de debut : 21.5 ans avec une predominance masculine. - Enquete familiale : 65 % de cas consanguins. - ERG et PEV eteints dans 40 % des cas. - Evolution de l’acuite visuelle marquee par une aggravation progressive. Discussion - Environ 80 a 90 % des retinopathies pigmentaires ont une recessivite autosomique, les premiers troubles apparaissent le plus souvent pendant l’âge scolaire sous forme d’une hemeralopie progressive. - En perimetrie, on met en evidence un scotome annulaire, le tableau clinique est caracterise par des depots pigmentaires retiniens pseudo-osteoblastiques, retrecissements arteriels et une pâleur papillaire. - Le gene RPGR est implique dans environ 13 % de toutes les RP. - Aucun traitement ne permet pour le moment de guerir ces maladies, mais les progres therapeutiques continuent : effet benefique de la vitamine A dans la conservation du champ visuel, therapie genique, approche de neuroprotection, approche pharmacologique (inhibiteurs calciques), greffe de bâtonnets. Conclusion Affection grave d’evolution progressive dont le pronostic est sombre. Interet du conseil genetique : deconseiller les mariages consanguins.

Introduction La cataracte senile est encore aujourd’hui au Maroc la principale cause de cecite. La technique la plus ancienne, connue depuis l’antiquite et pratiquee encore jusqu’au XIX e siecle en Europe, consistait a luxer le cristallin dans le vitre grâce a un stylet introduit dans l’œil au niveau de la sclere. Cette technique d’abaissement du cristallin, appelee « dadsie » au Maroc, peu fiable, persiste encore dans certains pays causant des dommages irreversibles. Materiels et Methodes Une quarantaine de cas (46) a ete colligee au service d’ophtalmologie durant les 5 dernieres annees. L’âge moyen des patients est de 70 ans, tous sont analphabetes ; la « dadsie » etait bilaterale dans 20 % des cas ; l’acuite visuelle apres correction etait inferieure a 1/10 dans 75 % des cas ; les patients devenaient monophtalmes dans 25 % des cas. Les complications sont majoritairement representees par la panophtalmie qui a conduit a l’evisceration dans 25 % des cas, mais aussi la dystrophie de cornee, presente dans plus de la moitie des cas, l’hypertonie oculaire, l’organisation vitreenne et le decollement de retine. Discussion Le traitement medical visait a lutter contre l’hypertonie (il etait parfois debute par le guerisseur qui prescrivait de l’acetazolamide ainsi qu’une pommade cortisonee…) mais aussi contre l’infection. Le traitement chirurgical a consiste en l’extraction du cristallin a l’anse et crochet, une vitrectomie avec l’utilisation de dekaline, voire l’evisceration. Plusieurs facteurs ont contribue au choix de cette methode dangereuse par le patient, notamment la difficulte d’acces aux structures hospitalieres et le prix de la « dadsie » aux alentours de 80 euros. Conclusion Les conclusions de ce travail soulignent le danger encouru par les patients victimes de cette pratique archaique existant encore dans plusieurs pays en voie de developpement.