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Abstract Breast cancer remains a leading cause of cancer-related deaths among women globally, necessitating the development of more effective therapeutic agents with minimal side effects. This study explores novel 1,2,4-triazine-3(2H)-one derivatives as potential inhibitors of Tubulin, a pivotal protein in cancer cell division, highlighting a targeted approach in cancer therapy. Using an integrated computational approach, we combined quantitative structure–activity relationship (QSAR) modeling, ADMET profiling, molecular docking, and molecular dynamics simulations to evaluate and predict the efficacy and stability of these compounds. Our QSAR models, developed through rigorous statistical analysis, revealed that descriptors such as absolute electronegativity and water solubility significantly influence inhibitory activity, achieving a predictive accuracy (R2) of 0.849. Molecular docking studies identified compounds with high binding affinities, particularly Pred28, which exhibited the best docking score of − 9.6 kcal/mol. Molecular dynamics simulations conducted over 100 ns provided further insights into the stability of these interactions. Pred28 demonstrated notable stability, with the lowest root mean square deviation (RMSD) of 0.29 nm and root mean square fluctuation (RMSF) values indicative of a tightly bound conformation to Tubulin. The novelty of this work lies in its methodological rigor and the integration of multiple advanced computational techniques to pinpoint compounds with promising therapeutic potential. Our findings advance the current understanding of Tubulin inhibitors and open avenues for the synthesis and experimental validation of these compounds, aiming to offer new solutions for breast cancer treatment.

Background: Despite a high prevalence, menstrual issues are often normalised or trivialised and undermanaged in young people (YP). Uncontrolled dysmenorrhoea and heavy menstrual bleeding have a vastly negative impact on the quality of life of YP, especially when these issues are compounded by the social and emotional complexities of navigating adolescence. Objectives: The Longitudinal Study of Teens with Endometriosis, Period and Pelvic Pain (LongSTEPPP) project is a 5-year study aiming to understand factors that contribute to endometriosis, period and pelvic pain in YP and to examine long-term outcomes. Design: Focus groups (FGs), held as part of co-design, sought to ensure that the perspectives and concerns of YP and their parents were incorporated into the longitudinal study design. Methods: YP and their parents were invited to participate in an online FG after completing a survey about periods. The online survey was also part of the co-design of LongSTEPPP and was advertised primarily through social media channels. Results: Four FGs were held, including three with YP ( n = 12) and one with parents ( n = 3). Major themes to emerge were (1) YPs experiences, including the physical and psychological impact of pain and bleeding; (2) pain and pain management; and (3) education. Mental health burden was significant on YP, with some reporting suicidal ideations. YP and their parents reported a lack of knowledge and awareness about menstrual issues among societies, healthcare professionals, and schoolteachers. Conclusion: This study identified the substantial impact of periods on YP, and their parents’ lives, the challenge of navigating a chronic pain condition in adolescence, and the lack of awareness in society and among professionals. Through the co-design model, these findings have informed the longitudinal study to ensure that it will adequately measure the concerns of YP and their parents.

Abstract Vehicle identification systems are vital components that enable many aspects of contemporary life, such as safety, trade, transit, and law enforcement. They improve community and individual well-being by increasing vehicle management, security, and transparency. These tasks entail locating and extracting license plates from images or video frames using computer vision and machine learning techniques, followed by recognizing the letters or digits on the plates. This paper proposes a new license plate detection and recognition method based on the deep learning YOLO v8 method, image processing techniques, and the OCR technique for text recognition. For this, the first step was the dataset creation, when gathering 270 images from the internet. Afterward, CVAT (Computer Vision Annotation Tool) was used to annotate the dataset, which is an open-source software platform made to make computer vision tasks easier to annotate and label images and videos. Subsequently, the newly released Yolo version, the Yolo v8, has been employed to detect the number plate area in the input image. Subsequently, after extracting the plate the k-means clustering algorithm, the thresholding techniques, and the opening morphological operation were used to enhance the image and make the characters in the license plate clearer before using OCR. The next step in this process is using the OCR technique to extract the characters. Eventually, a text file containing only the character reflecting the vehicle's country is generated. To ameliorate the efficiency of the proposed approach, several metrics were employed, namely precision, recall, F1-Score, and CLA. In addition, a comparison of the proposed method with existing techniques in the literature has been given. The suggested method obtained convincing results in both detection as well as recognition by obtaining an accuracy of 99% in detection and 98% in character recognition.

Abstract In Proton Exchange Membrane Fuel Cells (PEMFCs), the presence of residual water within the Gas Diffusion Layer (GDL) poses challenges during cold starts and accelerates degradation. A computational model based on the Lattice Boltzmann Method (LBM) was developed to consider the capillary pressure inside the PEMFC and to analyze the exact geometries of the GDLs, which were obtained using the Computed Tomography scan. The novelty of this study is to suggest a methodology to compare the quantitative water removal performance of the GDLs without long-term experimental testing. Two different samples of GDLs were considered, pristine and aged. The results of quantitative measurements revealed the amount of water columns (breakthroughs) inside each sample. Considering the volume of 12,250,000 µm3 for each sample, the pristine and the aged samples are prone to have 774,200 µm3 (6.32%) and 1,239,700 µm3 (10.12%) as water columns in their porous domain. Micro-structural properties such as connectivity, mean diameter, effective diffusivity, etc. were also compared to observe the impacts of aging on the properties of the GDL.

Extramedullary plasmacytoma is a rare localized plasma cell neoplasm typically found in soft tissues outside the bone marrow. Predominantly occurring in the head and neck region, particularly in the sinonasal and nasopharyngeal areas, it presents a diagnostic challenge due to its uncommon nature. Herein, we report a 38-year-old female patient with Down’s syndrome with a 2-year complaint of intermittent dysphonia, hoarseness, and progressive respiratory distress, including dyspnea, fatigue, and biphasic stridor. Examination via flexible laryngoscopy revealed a white lesion, prompting direct microscopic laryngeal surgery to excise a 1x1 cm mass. Histological findings confirmed the diagnosis as solitary extramedullary plasmacytoma. Notably, this represented the first documented case of laryngeal solitary extramedullary plasmacytoma in a patient with Down’s syndrome. This case underscores the importance of considering tumor development in the larynx among individuals with Down’s syndrome, highlighting the necessity for tailored management strategies to address such occurrences effectively. Increasing awareness of this association can aid in early detection and appropriate treatment of tumors in this population.

Abstract Background Sexually polymorphic cognition (SPC) results from the interaction between biological (birth-assigned sex (BAS), sex hormones) and socio-cultural (gender identity, gender roles, sexual orientation) factors. The literature remains quite mixed regarding the magnitude of the effects of these variables. This project used a battery of classic cognitive tests designed to assess the influence of sex hormones on cognitive performance. At the same time, we aimed to assess the inter-related and respective effects that BAS, sex hormones, and gender-related factors have on SPC. Methods We recruited 222 adults who completed eight cognitive tasks that assessed a variety of cognitive domains during a 150-min session. Subgroups were separated based on gender identity and sexual orientation and recruited as follows: cisgender heterosexual men (n = 46), cisgender non-heterosexual men (n = 36), cisgender heterosexual women (n = 36), cisgender non-heterosexual women (n = 38), gender diverse (n = 66). Saliva samples were collected before, during, and after the test to assess testosterone, estradiol, progesterone, cortisol, and dehydroepiandrosterone. Psychosocial variables were derived from self-report questionnaires. Results Cognitive performance reflects sex and gender differences that are partially consistent with the literature. Interestingly, biological factors seem to better explain differences in male-typed cognitive tasks (i.e., spatial), while psychosocial factors seem to better explain differences in female-typed cognitive tasks (i.e., verbal). Conclusion Our results establish a better comprehension of SPC over and above the effects of BAS as a binary variable. We highlight the importance of treating sex as a biological factor and gender as a socio-cultural factor together since they collectively influence SPC.

Background/Objectives: This study investigates the chemical composition, antioxidant, antibacterial, and hemolytic properties of ylang-ylang (Cananga odorata) essential oil, with a focus on its potential therapeutic applications for dermatological diseases and the importance of transforming such bioactive properties into a stable, safe, and effective formulation. Methods/Rsults: Essential oils were extracted from flowers harvested in northern Grande Comore using hydro distillation at three different distillation times to examine the impact on yield and quality. Gas chromatographic analysis identified a complex mixture of compounds, including linalool, geranyl acetate, and benzyl benzoate. Antioxidant activity was assessed using DPPH, FRAP, TAC, and beta-carotene bleaching inhibition assays, revealing significant radical scavenging capabilities, with DPPH IC50 varying between 1.57 and 3.5 mg/mL. Antibacterial activity was tested against Escherichia coli, Staphylococcus aureus, Bacillus subtilis, and Pseudomonas aeruginosa, showing promising inhibition zones and minimum inhibitory concentrations. Hemolytic tests indicated varying degrees of red blood cell damage, emphasizing the need for careful concentration management in therapeutic applications. Molecular docking studies highlighted potential therapeutic targets for dermatological conditions, identifying high binding affinities for specific compounds against proteins involved in acne, eczema, and psoriasis. Conclusions: This comprehensive analysis underscores the potential of ylang-ylang essential oil (YEOs) as a natural alternative for antimicrobial treatments and dermatological applications, with its success dependent on optimized extraction methods and precise formulation to reduce cytotoxic effects. A formulation approach is crucial to ensure controlled release, improve bioavailability, and minimize skin irritation.

Objectives The perspective of general practitioners’ (GPs) on retirement and the factors influencing their attitude towards retirement have been previously investigated. However, while the number of GPs has been declining for many years in France, leading to the emergence of medical deserts, the impact on their patients remains to be explored. The aim of this study was to understand patients’ perceptions of their GP’s retirement.Design A semistructured interview-based qualitative study was conducted, using Interpretative Phenomenological Analysis.Setting Interviews were conducted in two general practices located in Essonne, Ile-de-France, France, between January and April 2014.Participants Thirteen women and five men, aged 21–94 years, were included in this study. Exclusion criteria were the non-declaration of the physician as the declared doctor and being under 18 years of age.Results The GP–patient relationship is a link that is built up over time, over the course of several consultations. Patients choose their GP based on qualities or skills they value. In this way, the physician chosen is unique for their patients; this choice reflects a certain loyalty to their physician. The interaction with the family sphere reinforces this relationship through the multiple links created during care. When a GP retires, this link is broken. Patients’ reactions can range from indifference to real grief.Conclusion This study confirms the importance of the link between the GPs and their patients and highlights the need to prepare patients for their GP’s retirement.

Glomangiopericytoma is a rare vascular neoplasm of the nasal cavity and paranasal sinuses that occurs during the sixth or seventh decade of life. It is categorized as a borderline tumor with low malignant potential and classified as a distinct entity of sinonasal tumors with perivascular myoid phenotype by the World Health Organization (WHO). We report the case of a 50-year-old woman with nasal obstruction and severe epistaxis. The nasal sinuses computed tomography (CT), and magnetic resonance imaging (MRI) demonstrated a 3.1 cm soft tissue mass occupying the upper part of the left nasal cavity invading the left paranasal sinuses and nasal septum, and the left eye medial rectus muscle. A total mass resection was performed by nasal endoscopy. The histological and immunohistochemical examination yielded the diagnosis of glomangiopericytoma. This case report aims to contribute to the knowledge of nasal neoplasms. The need for more data on this entity is the main obstacle to developing standardized treatment guidelines.

Human Immunodeficiency Virus type 1 protease (HIV-1 PR) is one of the most challenging targets of antiretroviral therapy used in the treatment of AIDS-infected people. The performance of protease inhibitors (PIs) is limited by the development of protease mutations that can promote resistance to the treatment. The current study was carried out using statistics and bioinformatics tools. A series of thirty-three compounds with known enzymatic inhibitory activities against HIV-1 protease was used in this paper to build a mathematical model relating the structure to the biological activity. These compounds were designed by software; their descriptors were computed using various tools, such as Gaussian, Chem3D, ChemSketch and MarvinSketch. Computational methods generated the best model based on its statistical parameters. The model's applicability domain (AD) was elaborated. Furthermore, one compound has been proposed as efficient against HIV-1 protease with comparable biological activity to the existing ones; this drug candidate was evaluated using ADMET properties and Lipinski's rule. Molecular Docking performed on Wild Type, and Mutant Type HIV-1 proteases allowed the investigation of the interaction types displayed between the proteases and the ligands, Darunavir (DRV) and the new drug (ND). Molecular dynamics simulation was also used in order to investigate the complexes' stability allowing a comparative study on the performance of both ligands (DRV & ND). Our study suggested that the new molecule showed comparable results to that of darunavir and maybe used for further experimental studies. Our study may also be used as pipeline to search and design new potential inhibitors of HIV-1 proteases.

Abstract Hydatid cyst (HC) of the breast is a rare entity, even in endemic areas. We report the radiologic features of an isolated breast HC in a 50‐year‐old woman. Imaging findings may mimic other common breast lesions, but specific imaging features help establish an accurate diagnosis to adapt therapeutic management.

Abstract Wall Shear Stress (WSS) has been demonstrated to be a biomarker of the development of atherosclerosis. In vivo assessment of WSS is still challenging, but 4D Flow MRI represents a promising tool to provide 3D velocity data from which WSS can be calculated. In this study, a system based on Laser Doppler Velocimetry (LDV) was developed to validate new improvements of 4D Flow MRI acquisitions and derived WSS computing. A hydraulic circuit was manufactured to allow both 4D Flow MRI and LDV velocity measurements. WSS profiles were calculated with one 2D and one 3D method. Results indicated an excellent agreement between MRI and LDV velocity data, and thus the set-up enabled the evaluation of the improved performances of 3D with respect to the 2D-WSS computation method. To provide a concrete example of the efficacy of this method, the influence of the spatial resolution of MRI data on derived 3D-WSS profiles was investigated. This investigation showed that, with acquisition times compatible with standard clinical conditions, a refined MRI resolution does not improve WSS assessment, if the impact of noise is unreduced. This study represents a reliable basis to validate with LDV WSS calculation methods based on 4D Flow MRI.

Objective: To determine the in-vitro effect of the total alkaloid extract of Peganum (P.) harmala seeds on ram epididymal sperm. Methods: Semen was divided into six groups according to the following concentrations of the P. harmala total alkaloids: 1, 5, 10, 50, and 100 μg/mL, and the control group. The samples were incubated at ambient temperature (21 °C-24 °C) for 24 h, and analyzed in terms of motility, membrane integrity, and oxidative status. Results: The sperm kinematic parameters, i.e. straight-line velocity, curvilinear velocity, average path velocity, were significantly higher when treated with P. harmala at concentrations ranging from 1 to 10 μg/mL compared to the control group (P0.05). Conclusions: Low concentrations (1-10 μg/mL) of P. harmala extracts stimulate sperm motility, preserve membrane integrity and protect ram spermatozoa from lipid peroxidation.

Background: Fear appeals are widely used in health communication, despite conflicting views on their effectiveness. Unresolved issues include possible mediation mechanisms and the effect of defensive reactions aimed at controlling a perceived danger. Methods: The present study compared the impact of three versions of an existing online course on how to prevent noncommunicable diseases. Participants, recruited in South America via a crowdsourcing platform, were divided randomly between three versions of the course – ‘threat only’/‘threat plus coping information’/‘coping information plus threat’ (reverse order). We then asked them to complete a questionnaire measuring perceived efficacy, perceived threat, defensive reactions, and intention to change unhealthy behaviors. Results: Using a serial parallel mediation model to test the course's impact on our dependent variables did not reveal any significant differences between the three versions. Perceived efficacy was positively associated with intention to change behavior, as well as with lower suppression, lower reappraisal, and greater denial. Suppression was the only defensive reaction to be associated with intention to change behavior: greater suppression was linked to less intention to change. Conclusions: Our results open interesting perspectives for research into defensive reactions.

Abstract Lateral luxation is defined as a traumatic displacement of a tooth in any direction other than axially. A laterally luxated tooth is often immobile because of its bony lock. It produces a high metallic sound during percussion. Pulp sensibility testing is likely to be negative during the initial follow‐up. However, the tooth should be monitored until a definitive pulp diagnosis is made. Treatment includes local anesthesia, suturing soft tissue injuries, manual repositioning of the luxated tooth, and stabilization with a flexible splint for 4 weeks. Given the risk of pulp necrosis following lateral luxation, particularly in teeth with radiographically closed apices and severe displacement, an immediate (prophylactic) root canal treatment is recommended. The objective of this work was to report and discuss the management of a case of lateral luxation involving a permanent tooth treated by reduction, followed by contention with 0.4 steel wire and composite resin, and endodontic treatment, and which was complicated by root resorption 3 months later. We also highlighted the possible complications following lateral luxation, especially root resorption.

Abstract Ossification of stylohyoid chain corresponds to the ossification of stylohyoid ligament that can vary from thin short to thick long ossification and can be associated with other calcifications. We report in this case a bilateral non painful complete ossification of the stylohyoid complex extended to the thyrohyoidien ligament.

Background Tobacco consumption during pregnancy has consequences for pregnant women and their fetus, as well as during the post-natal period. Many women stop their tobacco consumption during pregnancy, but statistics vary about the exact proportion, and a non-negligible number of them are still smoking at term. Moreover, tobacco relapse after birth is frequent. This study aims to provide epidemiological indicators about tobacco consumption at term and post-partum relapse in Switzer-land, and test risks factors associated with tobacco consumption at term, including Theory of Planned Behaviour variables for the motivational correlates. Losses to follow-up precluded testing risk factors associated with post-partum relapse. Participants and procedure Respondents were recruited at the pre-birth consultations at the hospital and answered the initial survey. They were con-tacted by email in the post-partum period two and six months after childbirth. Results 10.6% of our sample were still smoking at the end of their pregnancy. The low-end estimate of relapse is 21.2% at two months (the high-end estimate being 74% after six months, using the worst-case scenario). Higher education level, in-come, and multiparity were descriptively associated with less tobacco consumption at term. Perceived behavioural control was the motivational variable differing the most between smokers and non-smokers, and with the broadest variance. Scores of attitudes and subjective norms had higher levels and were more consensual. Conclusions Incidence of tobacco consumption during pregnancy and during the post-partum period is problematic in Switzerland. One promising avenue is increasing pregnant women’s perceived behavioural control toward smoking cessation during preg-nancy and long-term abstinence.

Urtica urens is one of the main medicinal plants used in the pharmaceutical industry and traditional medicine. It is necessary to know the process of drying and storage of this product. This work is a contribution to the understanding of the mass transfer mechanisms by modeling the drying process of the Urtica urens leaves. The isothermal diffusive model is based on solving the one-dimensional Fick equation. Moreover, an algorithm of minimization compiled by MATLAB is used in this study to get the optimal parameters of the model. The results showed a reasonably good agreement between the values predicted from the model and the experimental observations. This confrontation has helped to identify the diffusion coefficient and the activation energy of the Urtica urens leaves. The effective diffusivity values changed from 4.94 10-11 to 9.66 10-11 within the given temperature range, and the activation energy was found to be 29.34 . In fact, the proposed model accurately describes, on a macroscopic scale, mass transfer processes in the product.

Abstract Case presentation This case report concerns a 49‐year‐old woman who developed cholestasis (build‐up of bile in the liver) two months and a half after initiating norethisterone, progestin‐only pills, which resolved after the withdrawal of these pills.

Abstract Drug reaction with eosinophilia and systemic symptoms (DRESS) is a distinct part of severe cutaneous adverse reactions (SCARs). It is characterized by fever, rash, hematologic abnormalities, lymphadenopathy, or/and different degrees of visceral organ involvement. Its diagnosis is particularly challenging due to the variability of its clinical presentations and its long latency period (2–6 weeks). Allopurinol, an uric acid‐lowering drug, has been incriminated in several cases of allopurinol‐induced DRESS syndrome. Through this paper, we present a case of allopurinol‐induced DRESS syndrome with initial oral mucosal involvement. A 69‐year‐old female patient presented with an erosive cheilitis that started 1 week prior to his presentation. The cheilitis was associated with maculopapular rash and fever. She started taking allopurinol, as treatment of Gout, 6 weeks before hospitalization. The histologic findings obtained from skin biopsy were consistent with a toxic drug reaction. A complete blood count (CBC) showed a moderate eosinophilia. Alteration of renal function was also noted, and the diagnosis of allopurinol‐induced DRESS syndrome was made. Systemic corticosteroid therapy was therefore started. The patient completely recovered and had been healthy for 3 years before developing a recurrence after re‐challenge with allopurinol.

Brain tumor extraction is challenging task because brain image and its structure are complicated that can be analyzed only by expert physicians or radiologist. Brain tumor detection and segmentation is one of the most challenging and time consuming task in medical image processing. The image segmentation is a very difficult job in the image processing and challenging task for clinical diagnostic tools. MRI (Magnetic Resonance Imaging) is a visualization medical technique, which provides plentiful information about the human soft tissue, which helps in the diagnosis of brain tumor. Accurate segmentation of the MRI images is extremely important and essential for the exact diagnosis by computer aided clinical tools. There are different types of segmentation algorithms for MRI brain images. This paper is to check existing approaches of Brain tumor segmentation techniques in MRI image for Computer aided diagnosis.

Le syndrome congénital d'obstruction des voies aériennes supérieures est une malformation rare qui est mortelle pour le nouveau-né après la naissance. Elle est définie comme une obstruction complète ou presque complète des voies aériennes supérieures. L'incidence réelle de la CHAOS est inconnue. Nous rapportons le cas d´une patiente de 24 ans, primipare sans antécédents médicaux ou chirurgicaux dont l´échographie de premier trimestre était sans anomalies. Au cours du deuxième trimestre l´examen échographique a montré un important œdème sous-cutané, avec un poumon hyperéchogène et hypertrophié, un cœur hypoplasique et une ascite importante associée à une oligoamnios sévères. Après avoir écarté les causes les plus fréquentes: l'iso-immunisation (Coombs indirecte négatifs), les infections (sérologies négatives) sans pouvoir disposer d'un caryotype, en raison du refus de la patiente, les résultats de l'échographie nous ont fait réfléchir à la possibilité d'un hydro-foetal secondaire au syndrome CHAOS, étant l'imagerie pathognomonique de l'hypertrophie pulmonaire avec inversion ou convexité des diaphragmes. Une IRM a été demandée montrant un probable syndrome CHAOS associé à d'autres malformations: atrésie laryngée, microphtalmie avec hypertélorisme et déviation de la cloison nasale avec absence de visualisation du tissu thymique, non identification claire de la vessie, Absence de rein droit et un rein gauche hypoplasique. L´évolution de la grossesse a été marquée par la survenue À la 24 e semaine d´aménorrhée un accouchement prématuré qui a donné la naissance d´un nouveau-né avec un poids de naissance de 1475g, polymalformés présentant une ambiguïté sexuelle, avec un abdomen distendu et une polydactylie. Le nouveau-né est décédé à 3 min du post partum. Un caryotype était réalisé montrant un profil 46XX.

Background: There is a risk that people vaccinated against COVID-19 will drop or reduce their precautionary behaviours (i.e., a phenomenon of risk homeostasis). Our aim is to assess the occurrence of this effect in a cohort of UK participants who were interviewed 141 days before and 161 days after the start of the vaccination programme. Methods: Of the 765 people who could be followed up before and after the start of the programme and whose vaccination status was known, 178 had not received any injection and 583 were more or less advanced in the process (one vs. two doses since less vs. more than 14 days). The frequency of 14 precautionary behaviours was assessed at both times of measurement, as well as potential covariates (gender, age, comorbidities and history of COVID-19). Results: Controlling for covariates, we didn’t find more decrease in precautionary behaviours among vaccinated individuals, regardless of how far along they were in the process. Conclusion: The results observed in this sample show little risk for a massive change in behaviours among early vaccinated individuals. The pressure to adopt precautionary behaviours remains strong and probably prevents the emergence of a risk homeostasis effect.

Adnexal torsion is a rare pathology secondary to the total or partial rotation of the adnexa around its vascular axis. The occurrence of adnexal torsion on a healthy ovary is an even rarer situation. The diagnosis remains difficult, due to the ascension of the ovary in advanced pregnancies, which can mimic other surgical emergencies such as acute appendicitis, cholecystitis or acute pyelonephritis. The interest of this situation lies in its diagnostic difficulty, and in the choice of the therapeutic attitude to adopt. We present the case of adnexal torsion on a healthy ovary in the second trimester of pregnancy.

L´hémorragie de délivrance reste la première cause de mortalité maternel au Maroc, c´est une urgence obstétricale qui nécessite une prise en charge rapide, efficace et multidisciplinaire dans les cas d´hémorragie du post partum grave rebelle au traitement médical, les progrès de la radiologie interventionnelle et surtout des techniques chirurgicales ont fourni des alternatives sûres et efficaces à l´hystérectomie d´hémostase. On rapporte un cas de nécrose utérine suite a un traitement conservateur chirurgicale de l´hémorragie de délivrance a base d´une combinaison de technique de compression utérine type B-Lynch et triple ligature vasculaire de Tsirulnikov. La patiente a présenté un tableau de sepsis a J4 du post partum avec un état fébrile et des douleurs pelvienne et un syndrome inflammatoire biologique qui s´est aggravé 48heurs après par l´apparition de contracture abdominale. Au scanner abdomino- pelvien a montré des bulles de gaz dans le myomètre utérin évoquant une nécrose. Une laparotomie exploratoire a été réalisée, l´exploration a révélé une nécrose complète de l´utérus. Les techniques chirurgicales des sutures de compression utérine jouent un rôle majeur dans l´arsenal thérapeutique de l´hémorragie post-partum pendant la césarienne. Elle permet, en complément ou en alternative à la ligature vasculaire, la préservation de la fertilité de la patiente mais elle nécessite également une prudence et une surveillance maximales des complications dont la plus grave est la nécrose utérine.

Le syndrome miroir ou syndrome de Ballantyne est une entité pathologique rare, définit par l'association d'une anasarque fœtale et d'un œdème maternel généralisé pouvant se compliquer d'une prééclampsie. L'objectif de ce travail est de mettre en exergue les particularités diagnostic et thérapeutique de cette entité clinique grave, qui, en dépit de sa rareté, ne doit pas être méconnu. Et ceux à travers la description d'un cas clinique d'une parturiente de 35 ans qui s'est présentée aux urgences, à 26 semaines d'aménorrhée, dans un tableau de syndrome miroir idiopathique dont l'évolution fut rapidement marquée par la survenue d'un décès in utéro puis régression de la symptomatologie clinico-biologique maternelle une fois la vacuité utérine obtenue. En effet, un traitement spécifique in utéro est vivement souhaitable. Quoique dans certains cas graves idiopathiques, seule l'obtention de la vacuité utérine permet l'amélioration du pronostic maternel voire fœtale.

Parasites from the genus Plasmodium are the causative agents of malaria. The mobility, infectivity, and ultimately pathogenesis of Plasmodium falciparum rely on a macromolecular complex, called the glideosome. At the core of the glideosome is an essential and divergent Myosin A motor (PfMyoA), a first order drug target against malaria. Here, we present the full-length structure of PfMyoA in two states of its motor cycle. We report novel interactions that are essential for motor priming and the mode of recognition of its two light chains (PfELC and MTIP) by two degenerate IQ motifs. Kinetic and motility assays using PfMyoA variants, along with molecular dynamics, demonstrate how specific priming and atypical sequence adaptations tune the motor’s mechano-chemical properties. Supported by evidence for an essential role of the PfELC in malaria pathogenesis, these structures provide a blueprint for the design of future anti-malarials targeting both the glideosome motor and its regulatory elements.

L'accouchement gémellaire différé a pour but de prolonger la vie intra-utérine du ou des fœtus restants après l'expulsion prématurée du premier jumeau au deuxième trimestre de la grossesse, en vue d'atteindre un âge gestationnel compatible avec la survie néonatale pour le ou les fœtus restants. L'objectif de ce travail est de mettre en exergue le bénéfice et les indications de cette pratique obstétricales, et ce, à travers la description d'un cas clinique d'un accouchement gémellaire différé chez une patiente porteuse d'une grossesse triple, et chez qui le délai entre l'expulsion du premier jumeau et l'accouchement du troisième jumeau était de 10 semaines.

Burns constitute a major challenge in medical science, and plants can be part of the solution. Dittrichia viscosa L. (Asteraceae) and Marrubium vulgare L. (Lamiaceae) are widely used in Moroccan traditional medicine to treat several diseases and possess high potency to cure wounds. This study aimed to investigate in vivo the analgesic, anti-inflammatory, and burn-healing effects of both plants and their mixture. The hydro-ethanolic extract of both plants was analyzed using high-performance liquid chromatography with diode-array detection (HPLC-DAD). Burns were conducted on dorsal part of rats, and the wound healing process was evaluated during 21 days. Gallic acid, caffeic acid, ferulic acid, and quercetin were identified in M. vulgare extract. The analysis recorded the presence of caffeic acid, rosmarinic acid, rutin, and quercetin in D. viscosa. The group treated with the mixture showed the lowest abdominal contractions (30.4 ± 7.52) with the highest percentage of inhibition (69.12 ± 7.04%). The inhibition of paw inflammation for M. vulgare was 47.65%, followed by D. viscosa (33.86%) and the mixture (30.41%). The mixture showed the highest wound contraction at day 7 (33.16 ± 14.33%) and day 14 (87.54 ± 3.98%). D. viscosa showed the highest wound contraction on the 21st day (99.28 ± 0.44%). In conclusion, both plants and their combination showed promising results for burn healing.

Cyclic vomiting syndrome (CVS) is defined by episodes of vomiting lasting from a few hours to several days, alternating with periods of no symptoms. Various symptoms can be associated with vomiting such as nausea, migraine or abdominal pain. Common triggers of CVS include infection, psychological stress and menstruation. CVS's diagnosis requires exclusion of alternative diseases particularly neurological and gastrointestinal. CVS shares many common features with catamenial migraine including treatment. We herein report a case of CVS in a 16 years old girl characterized by stereotypical vomiting attacks occurring in every menstrual period. Recurrent vomiting episodes began 2 years before admission. Given the negativity of paraclinical exams and the absence of response to different therapeutic approaches as well as the similarity with catamenial migraine, we treated our patient with permenstrual percutaneous oestrogen for six months. The evolution was marked by the disappearance of symptoms within the first month and the absence of their recurrence after treatment cessation during a follow-up of 6 years.

L'encéphalopathie postérieure réversible (EPR) est une entité radio-clinique associant une atteinte réversible du système nerveux central à une imagerie encéphalique typique. Il existe une grande variabilité dans la présentation clinique de ce syndrome et des aspects en imagerie parfois atypiques. L'EPR est une complication neurologique inhabituelle survenant au cours de la grossesse ou en post-partum, en dehors de toute pathologie préexistante de la grossesse dont l'œdème vasogénique par rupture de la barrière hémato encéphalique paraît être l'acteur principal. Nous rapportons l'observation d'une patiente primipare présentant des crises convulsives généralisées tonico-cloniques associées à un pic hypertensif, survenant au cours du troisième trimestre de grossesse. L'imagerie par résonance magnétique (IRM) cérébrale était en faveur d'une encéphalopathie postérieure réversible. L'EPR doit être évoqué devant tout signe d'appel neurologique, vu l'évolution favorable sans séquelles sous un traitement précoce et rapide.

Placenta accreta spectrum disorders is a rare pathology but the incidence has not stopped to increase in recent years. The purpose of our work was the analysis of the epidemiological profile of our patients, the circumstances of diagnosis, the interest of paraclinical explorations in antenatal diagnosis and the evaluation of the evolutionary profile. We hereby report a case series spread over a period of one year from 01/01/2015 to 01/01/2016 at the Gynaecology-Obstetrics department of the University Hospital Center IBN SINA of Rabat where we identified six cases of placenta accreta. We selected patients whose diagnosis was confirmed clinically and histologically. The major risk factors identified were a history of placenta previa, previous caesarean section, advanced maternal age, multiparity. 2D ultrasound and magnetic resonance imaging (MRI) allowed us to strongly suspect the presence of a placenta accreta in a pregnant woman with risk factor(s) but the diagnosis of certainty was always histological. Placenta Accreta Spectrum disorders were associated with a high risk of severe postpartum hemorrhage, serious comorbidities, and maternal death. Leaving the placenta in situ was an option for women who desire to preserve their fertility and agree to continuous long-term monitoring in centers with adequate expertise but a primary elective caesarean hysterectomy was the safest and most practical option. Placenta Accreta Spectrum disorders is an uncommon pathology that must be systematically sought in a parturient with risk factors, to avoid serious complications. In light of the latest International Federation of Gynecology and Obstetrics (FIGO) recommendations of 2018, a review of the literature and finally the experience of our center, we propose a course of action according to whether the diagnosis of the placenta is antenatal or perpartum.

BACKGROUND:Personalized targeted treatment in metastatic breast cancer relies on accurate assessment of molecular aberrations, e.g. overexpression of Human Epidermal growth factor Receptor 2 (HER-2). Molecular interrogation of circulating tumor cells (CTCs) can provide an attractive alternative for real-time biomarker assessment. However, implementation of CellSearch-based HER-2 analysis has been limited. Immunofluorescent (IF) image interpretation is crucial, as different HER-2 categories have been described. Major questions in CTC research are how these IF categories reflect gene expression and amplification, and if we should consider 'medium' HER-2 expressing CTCs for patient selection. METHODS:Tumor cells from spiked cell lines (n = 8) and CTCs (n = 116 samples) of 85 metastatic breast cancer patients were enriched using CellSearch. Comparative analysis of HER-2 expression by IF imaging (ACCEPT, DEPArray, and visual scoring) with qRT-PCR and HER-2/neu FISH was performed. RESULTS:Automated IF HER-2-profiling by DEPArray and ACCEPT delivered comparable results. There was a 98% agreement between 17 trained observers (visual scoring) and ACCEPT considering HER-2neg and HER-2high expressing CTCs. However, 89% of HER-2med expressing CTCs by ACCEPT were scored negative by observers. HER-2high expressing tumor cells demonstrated HER-2/neu gene amplification, whereas HER-2neg and HER-2med expressing tumor cells and CTCs by ACCEPT were copy-number neutral. All patients with HER-2-positive archival tumors had ≥1 HER-2high expressing CTCs, while 80% of HER-2-negative patients did not. High relative gene expression of HER-2 measured on enriched CTC lysates correlated with having ≥1 HER-2high expressing CTCs. CONCLUSION:Automated images analysis has enormous potential for clinical implementation. HER-2 characterization and clinical trial design should be focused on HER-2high expressing CTCs.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Background: Migrants often undergo an incomplete vaccination program in regards to the French recommendations. The aim of this study was to evaluate the practices of French General Practitioners’ (GPs) in terms of catch-up vaccination. Methods: A cross-sectional study was carried-out in 2017–2018 in France. An online questionnaire was disseminated by email through scholarly societies to GPs involved in the care and the vaccination of migrants. Analyses included univariate and multivariate analysis with a logistic regression model. Results: A total of 216 GPs completed the survey. A majority identified themselves with an average level regarding the prevention of infectious diseases among migrant populations (56.7%) and confirmed this is part of their daily practice (83.3%). The majority of respondents do not perform more than two injections on the same day. When compared to GPs working in health centres, those with a private practice are more likely to report returning to a full primary vaccination schedule (adjusted OR = 2.90, 95% CI [1.29–6.53]). Aside from the serology for hepatitis B and to a lesser extent for measles, other pre-vaccination serologies were not frequently used by GPs. When a migrant declares to be up-to-date with his immunisations, only 56.5% of doctors consider this information reliable. Conclusions: This study clarified the vaccination practices of GPs receiving migrant patients in consultation and showed its heterogeneity. An important need for benchmarks has been identified and these results were used for the elaboration of the French guidelines on vaccines catch-up.

L’antibiorésistance croissante des bactéries responsables des infections urinaires limite le choix des antibiotiques en chirurgie urologique. Parmi ces germes sont retrouvées les entérobactéries productrices de bétalactamases à spectre élargi (EBLSE) dont la progression devient inquiétante. L’objectif de cette étude était de déterminer la prévalence des entérobactéries sécrétrices de BLSE dans les prélèvements d’urines en péri opératoire de chirurgie urologique. Il s’agissait d’une étude rétrospective réalisée au centre hospitalier universitaire Ibn Sina de Rabat sur une période de 19 mois. N’ont pas été inclus dans cette étude, les prélèvements urinaires réalisés à dans un laboratoire externe. Les données étaient traitées avec le logiciel SPSS, les comparaisons faites par test du Khi deux ou de Student avec un seuil de risque alpha fixé à 5%. Sur 830 prélèvements positifs 656 étaient des entérobactéries soit 79 % des germes isolés. E.coli représentait 53,2%, K.pneumoniae 28%, E.cloacae 7,8% et P.mirabillis 7%. Les producteurs de BLSE représentaient 17,5% de l’échantillon avec: E.coli (12,3%), K.pneumoniae (23,6%), E.cloacae (39,2%) et P.mirabillis (6,7%). On note une augmentation de la prévalence des entérobactéries BLSE entre 2008 et 2009 : respectivement de 14,4% à 22,3% des entérobactéries isolées; pour E.coli de 32,76% à 40,68% et pour K.pneumoniae de 34,48% à 42,37%. Plusieurs facteurs de risque d’acquisition des EBLSE sont rapportés dans la littérature, dont principalement l’utilisation antérieure d’antibiotiques par ces patients. Une politique de gestion rationnelle des antibiotiques en ambulatoire et au sein des établissements de santé contribuera à une réduction de l’émergence des germes résistants

A 35 years old woman presented at 8-week gestation for her first prenatal visit. She had no complaints at the time. While her past obstetrical history showed two prior cesarean sections. Transvaginal ultrasound was performed showing fortuitously a cesarean scar ectopic pregnancy with a gestational sac implanted in the myometrium between the bladder and the anterior wall of the uterus (A) and associated with a periovulatory hyper-vascularization in color doppler (B). This aspect was confirmed in 3D Ultrasound which showed a gestational sac bulging through the anterior wall of the uterus into the bladder with diminished myometrial layer between the bladder and the sac (C). The outcome was favorable after conservative surgical treatment by laparotomy associated with a triple preventive ligation because of the high risk of bleeding. Cesarean scar pregnancy is so a rare iatrogenic complication of cesarean section; however, her incidence is actually growing due to the increase in cesarean section rates. The diagnosis is usually made via ultrasound showing an empty uterine cavity and cervical canal, a gestational sac located anteriorly at the isthmus, and evidence of a functional trophoblastic/placental circulation on color Doppler. Early diagnosis is crucial to avoid severe vital and functional complications such as hemorrhage, early uterine rupture and hysterectomy, so its recognition is important to keep fertility of young woman.

Le syndrome de Ballantyne ou préeclampsie en miroir est une entité clinique rare. Son ethiopathogénie reste encore mal élucidée. Son diagnostic doit être évoqué devant un syndrome édémateux maternel associé à un état d'anasarque fétal. Le pronostic fétal réservé auquel peut s'associer une forte morbidité maternelle expliquent l'intérêt de poser un diagnostic précoce en identifiant son étiologie afin d'établir un traitement anténatal pouvant améliorer ainsi le pronostic materno-fétal. Nous rapportons et discuterons à la lumière d'une revue de la littérature, le cas d'un probable syndrome de Ballantyne secondaire à un syndrome malformatif fétal compliqué d'éclampsie chez la mère.

Rickets are abnormalities of mineralization that can lead to bone fractures and deformities. Vitamin-resistant rickets is defined as any rickets not prevented by regular, early and prolonged administration of vitamin D and not cured by a sufficient total dose. The aim of our work is to describe the clinical, paraclinical and therapeutic aspects of X-linked hypophosphatemic rickets (XLHR), which is the most common cause of hereditary rickets and on the other hand to highlight the interest not only of the early care but also the regular long-term monitoring of these children.

La cardiomyopathie du péri-partum (CMP-PP) ou syndrome de Meadows, est une cardiomyopathie dilatée survenue pendant ou au décours d'une grossesse, définie par une insuffisance cardiaque avec une fraction d'éjection systolique du ventricule gauche inférieure à 45%. Il s'agit d'une entité pathologique rare dont le mécanisme physiopathologique en cause reste mal élucidé. Sur le plan clinique il s'agit d'une insuffisance cardiaque inopinée d'installation rapide, d'évolution imprévisible avec risque de choc cardiogénique réfractaire justifiant une prise en charge en réanimation cardiovasculaire. La CMP-PP ne nécessite aucun traitement spécifique par rapport aux autres causes d'insuffisance cardiaque. Nous rapportons le cas d'une primigeste de 29 ans qui a consulté à 32 semaines d'aménorrhée dans un tableau d'insuffisance cardiaque congestive en rapport avec une cardiomyopathie du péri-partum. L'objectif de ce travail est de préciser les caractéristiques de cette cardiopathie, qui malgré son caractère exceptionnel ne doit pas être méconnu par l'obstétricien.