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Motivation is the cornerstone in building success. If it is strong, the achievement of a greater number of objectives will be assured, and therefore a more glorious success can be met. Thus, to promote motivation, it is advisable to pay particular attention to the pedagogical approach adopted by the teacher, since it has been proven that there is a positive relationship between the choice of an active approach and an enhancing motivation. The situation generated by COVID-19, has been a profitable opportunity to experiment with hybrid “Flipped Classroom” pedagogy, with a view to inverting the class and adapting learning activities, that have been traditionally offered to students, through distance (online) and in-person learning alternately. Thus, the present study aims at evaluating the impact of this Flipped Pedagogy on the motivation of undergraduate students of the Higher Institute of Nursing Professions and Healthcare Techniques in Fez. Data have been collected from 410 students, who were questioned before and after the adoption of the Flipped Classroom, based on a motivation scale validated by Rolland Viau in 1994. The answering percentage was of 90.73%. Data analysis demonstrated the existence of a significant relationship between the Flipped Classroom and students' motivation; the motivational profile, which was 18.54%, became 89.25% after flipping the class. The Flipped Classroom can significantly bring a surplus value to pedagogy, hence the importance of broadening its spectrum and integrating it as a new approach of teaching within health sciences educational institutions.

Descending necrotizing mediastinitis remains a serious condition with a high mortality rate due to its often fulminant clinical presentation. An early diagnosis and a well conducted multidisciplinary therapeutic management are essential to reduce morbi-mortality. Delayed diagnosis, inappropriate antibiotic therapy, non-optimal surgical drainage or lack of surveillance may increase morbidity and mortality. We report the case of a descending necrotizing mediastinitis complicating a dental cervical cellulitis in a 27 year old female patient with a successful outcome.

Background. Severe acute cholangitis is a life-threatening biliary infection, leading to organ dysfunction, septic shock, and naturally death. Mortality has dropped significantly in the past years through improving resuscitation and biliary drainage techniques. The aim of our study is to analyze our daily practice and the factors associated with mortality. Methods. A retrospective study including severe acute cholangitis patients admitted to our unit from January 2009 to December 2018. Variables analyzed (univariate then multivariate analysis) were age, sex, history, origin, evolution time, bilirubin, etiology, organ dysfunction, qSOFA, SOFA, TOKYO, biliary drainage timing and technique, shock, antibiotherapy, and resuscitation. Results. 140 patients were included in this study. Average age was 61. Sex ratio M/F was 0.59. Lithiasis etiology was dominant (69%). SOFA average score upon admission was 8. Ceftriaxone + metronidazole was the empirical antibiotic used in 87%. Average time to biliary drainage was 1.58 ± 0.89 days . Endoscopic unblocking was the technique used in 76%. Mean duration of ICU stay was 6 days. Mortality rate was 28%. Statistically significant factors for mortality ( p < 0.05 ) were history of taking anticoagulant treatment, use of catecholamines and mechanical ventilation during ICU stay, and delay in consultation and administration of antibiotic therapy. Conclusions. Early recognition, antibiotics, resuscitation, and minimally invasive biliary drainage have improved patient outcomes although there is still progress to be made. Moreover, as multiple organ failure is often associated with mortality in severe acute cholangitis, predictive risk factors of organ failure should be more investigated.

Introduction Tracheal tumors are a rare pathological entity whose diagnosis is usually delayed by clinical latency. Surgery, which consists of a tracheal resection-anastomosis with or without reconstructive reconstruction, remains the treatment that ensures the best long-term survival. Methods This is a retrospective study about 8 patients admitted in the department of thoracic surgery of Hassan II's university hospital of Fes for tracheal tumors management during 7 years time (December 2010 to December 2017). Results There were 6 men and 2 women with an average age of 44.4 years ranged from 17 to 65 years, 4 were smokers. Dyspnea was the main trigger sign. Seven (7) have undergone bronchial fibroscopy diagnostic with a finding of budding process in 5 patients, the middle of the trachea is often concerned in 3 patients, obstructing the lumen of the trachea in almost all patients. The treatment in all patients was surgical with an intubation via the operative field, 4 trachea resection-anastomosis, 4 plasty (Lateral resection with V plasty, Kergin's plasty, Mattey's tracheobronchial anastomosis and widened V-resection to the carina). The most common histological type in our series was Adenoid Cystic Carcinoma in 2 of our patients. For the other patients we have found squamous cell carcinoma (1 case), adenocarcinoma (1 case), atypical carcinoid tumor (1 case), low grade mucoepidermoid carcinoma (1 case), an adenoma pleomorph (1 case) and endotracheal goiter (1 case). The operative follow-up was simple in 7 of our patients, all of whom underwent post-operative fibroscopy within an average of 9 days. Two cases of post-operative recurrent palsy had been observed, all of which had progressed well under treatment. We have noted 2 deaths, including one at day 4 post-operative, and the other died from complications of post-radiation tracheal stenosis. Back to 32 months' average follow-up, we have enregistered a case of a distant relapse by cervical lymph node metastasis in one patient, 5 years after surgery. Conclusion Primary tumors of the trachea remain of reserved prognosis with 5-year survival of 57% of all histological types combined. Computed tomodensitometry and tracheobronchial fibroscopy remain the means of reference exploration in the diagnosis and assessment of surgical resectability.

La perforation stercorale est une entite assez rare et tres peu decrite dans la litterature surtout francophone. C’est une complication a la constipation chronique et survient preferentiellement chez les personnes âgees et alitees. Le tableau clinique est non specifique et l’evolution est defavorable dans 30 a 45 % des cas vue l’association des comorbidites au sepsis intra-abdominal ou systemique. Nous rapportons le cas d’une perforation stercorale asthenique chez un sujet de 80 ans avec une evolution favorable.

Le crush syndrome correspond à l'ensemble des manifestations systémiques secondaire à une destruction des fibres musculaires striées. Il survient le plus souvent dans le cadre d'accidents graves tels que les catastrophes, accidents de travail et accidents de la voie publique. Il est responsable d'une hypovolémie, état de choc, hyperkaliémie, hypocalcémie, acidose métabolique et d'insuffisance rénale aigue. Le succès du traitement dépend largement de la rapidité de la prise en charge. Les principaux objectifs thérapeutiques sont la correction de l'hypovolémie, traitement de l'hyperkaliémie, l'alcalinisation et la prévention de l'insuffisance rénale. L'utilisation de garrots compressifs doit être réservée au seul contrôle d'hémorragies importantes. Dans cet article, nous rapportons le cas d'un jeune patient de 20 ans ayant présenté un crush syndrome à la suite d'un accident de la voie publique. L'évolution était favorable, mais une amputation du membre écrasé était nécessaire.Key words: Crush syndrome, rhabdomyolyse traumatique, insuffisance rénale aigue, dialyse, aponévrotomie

Le pheochromocytome est une tumeur rare. Il se manifeste habituellement par la triade de Menard ou par une hypertension arterielle. Des cas rares de pheochromocytome ont ete reveles par un syndrome coronaire aigu. Patiente âgee de 57 ans, ayant l'antecedent d'hypertension arterielle sous amlodipine, est admise pour syndrome coronaire aigue sans sus decalage du segment ST a troponine positive. La coronarographie est revenue en faveur d'un reseau coronaire grele sans stenose significative. Une masse tissulaire surrenalienne droite a ete retrouvee sur une echographie renale de routine et confirmee par un scanner scanner abdominal. Le dosage des cathecholamines urinaires trouve des taux tres eleves d'adrenaline et de noradrenaline. Apres une preparation par un β bloquants associe a un inhibiteur calcique, l'exerese chirurgicale de la tumeur a ete realisee par voie coelioscopique sous monitorage hemodynamique invasif. L'examen anatomopathologique de la piece operatoire confirme le diagnostic de pheochromocytome. L'evolution a court et moyen terme est favorable, notamment disparition de la triade de Menard, des douleurs thoraciques. La revelation d'un pheochromocytome par la survenue d'un syndrome coronaire aigu est rare, souvent ignorees, mais dont les consequences peuvent etre dramatiques. La tumorectomie peut conduire a la guerison complete et definitive des manifestations cardiaques. Key words : Pheochromocytome, syndrome coronaire, coronarographie

La pancreatite aigue est une complication rare durant la grossesse. Son incidence est de 1 pour 1000 a 3000 grossesses. L'origine lithiasique est de loin la plus frequente. Elle survient le plus souvent au cours du 3 eme trimestre ou precocement dans le post-partum. Son pronostic depend de la rapidite du diagnostic. Nous rapportons un cas de pancreatite aigue grave d'origine biliaire survenant deux semaines apres l'accouchement chez une patiente de 24 ans avec une bonne evolution. Key words : Pancreatite aigue, grossesse, lithiases, traitement

Le crush syndrome correspond à l'ensemble des manifestations systémiques secondaire à une destruction des fibres musculaires striées. Il survient le plus souvent dans le cadre d'accidents graves tels que les catastrophes, accidents de travail et accidents de la voie publique. Il est responsable d'une hypovolémie, état de choc, hyperkaliémie, hypocalcémie, acidose métabolique et d'insuffisance rénale aigue. Le succès du traitement dépend largement de la rapidité de la prise en charge. Les principaux objectifs thérapeutiques sont la correction de l'hypovolémie, traitement de l'hyperkaliémie, l'alcalinisation et la prévention de l'insuffisance rénale. L'utilisation de garrots compressifs doit être réservée au seul contrôle d'hémorragies importantes. Dans cet article, nous rapportons le cas d'un jeune patient de 20 ans ayant présenté un crush syndrome à la suite d'un accident de la voie publique. L’évolution était favorable, mais une amputation du membre écrasé était nécessaire.

We report a case of transurethral resection of prostate (TURP) syndrome. A 78-year-old man with prostatic hypertrophy was scheduled for transurethral resection of the prostate under spinal anesthesia. 30 minutes after the end of the surgery, the patient presented signs of TURP syndrome with bradycardia, arterial hypotension, cyanosis, hypoxemia and coma. The electrolytes analysis revealed an acute hyponatremia (sodium concentration 125 mmol/L). Medical treatment consisted of hypertonic saline solution 3%, volume expansion, intubation and ventilation. The presented case describes a typical TURP syndrome, which was diagnosed and treated early. The patient was discharged from hospital without any complications.Pan African Medical Journal 2013; 14:14

La pancréatite aigüe est une complication rare durant la grossesse. Son incidence est de 1 pour 1000 à 3000 grossesses. L'origine lithiasique est de loin la plus fréquente. Elle survient le plus souvent au cours du 3ème trimestre ou précocement dans le post-partum. Son pronostic dépend de la rapidité du diagnostic. Nous rapportons un cas de pancréatite aigüe grave d'origine biliaire survenant deux semaines après l'accouchement chez une patiente de 24 ans avec une bonne évolution.