Search

Le prolapsus gestationnel est une pathologie rare de la grossesse, multiples facteurs sont incriminés. Il est révélé par une gêne fonctionnelle, le diagnostic est clinique. Elle est souvent diagnostiquée en 3ème trimestre de la grossesse.Le traitement est souvent conservateur. Nous rapportons un cas de prolapsus gestationnel diagnostiqué en post partum et pris en charge à notre formation., Journal Marocain des Sciences Médicales, Vol 23, No 1

The purpose of the study was to investigate the degree to which chronic patients adhered to medication regimens during the economic crisis in Greece. It is a quantitative cross-sectional study, with a convenience sample of 1,009 residents of Western and Northern Greece, aged ≥ 18 years, with chronic health problems. The survey was conducted between February and June 2016. Data were collected via a structured questionnaire with closed-ended questions, filled out during face to face interviews with all participants. The vast majority of respondents (94.5 %) said that they were able to buy prescribed drugs but had to economise in other ways (for example, by cutting back on clothing and travel) to cope with essential household expenses, including medication. Only 71 % of participants said they remembered to take their prescribed medications every day, following all of their physicians' recommendations. Almost 70 % of participants said that using generic medications made it easier to adhere to their treatment regimens. The results of a correlation analysis showed that patients experiencing financial hardships as a result of health problems were less likely to adhere to pharmaceutical care regiments than those who were not experiencing financial difficulties (p = 0.026). Men had a higher level of adherence than women (p = 0.001).

International audience; Background: The clinical presentation of European patients with mild-to-moderate COVID-19 infection is still unknown. Objective: To study the clinical presentation of COVID-19 in Europe. Methods: Patients with positive diagnosis of COVID-19 were recruited from 18 European hospitals. Epidemiological and clinical data were obtained through a standardized questionnaire. Bayesian analysis was used for analysing the relationship between outcomes. Results: A total of 1,420 patients completed the study (962 females, 30.7% of healthcare workers). The mean age of patients was 39.17 ± 12.09 years. The most common symptoms were headache (70.3%), loss of smell (70.2%), nasal obstruction (67.8%), cough (63.2%), asthenia (63.3%), myalgia (62.5%), rhinorrhea (60.1%), gustatory dysfunction (54.2%) and sore throat (52.9%). Fever was reported by 45.4%. The mean duration of COVID-19 symptoms of mild-to-moderate cured patients was 11.5 ± 5.7 days. The prevalence of symptoms significantly varied according to age and sex. Young patients more frequently had ear, nose and throat complaints, whereas elderly individuals often presented fever, fatigue and loss of appetite. Loss of smell, headache, nasal obstruction and fatigue were more prevalent in female patients. The loss of smell was a key symptom of mild-to-moderate COVID-19 patients and was not associated with nasal obstruction and rhinorrhea. Loss of smell persisted at least 7 days after the disease in 37.5% of cured patients. Conclusion: The clinical presentation of mild-to-moderate COVID-19 substantially varies according to the age and the sex characteristics of patients. Olfactory dysfunction seems to be an important underestimated symptom of mild-to-moderate COVID-19 that needs to be recognized as such by the WHO.

International audience; Objective: To investigate the occurrence of olfactory and gustatory dysfunctions in patients with laboratory-confirmed COVID-19 infection. Methods: Patients with laboratory-confirmed COVID-19 infection were recruited from 12 European hospitals. The following epidemiological and clinical outcomes have been studied: age, sex, ethnicity, comorbidities, and general and otolaryngological symptoms. Patients completed olfactory and gustatory questionnaires based on the smell and taste component of the National Health and Nutrition Examination Survey, and the short version of the Questionnaire of Olfactory Disorders-Negative Statements (sQOD-NS). Results: A total of 417 mild-to-moderate COVID-19 patients completed the study (263 females). The most prevalent general symptoms consisted of cough, myalgia, and loss of appetite. Face pain and nasal obstruction were the most disease-related otolaryngological symptoms. 85.6% and 88.0% of patients reported olfactory and gustatory dysfunctions, respectively. There was a significant association between both disorders (p < 0.001). Olfactory dysfunction (OD) appeared before the other symptoms in 11.8% of cases. The sQO-NS scores were significantly lower in patients with anosmia compared with normosmic or hyposmic individuals (p = 0.001). Among the 18.2% of patients without nasal obstruction or rhinorrhea, 79.7% were hyposmic or anosmic. The early olfactory recovery rate was 44.0%. Females were significantly more affected by olfactory and gustatory dysfunctions than males (p = 0.001). Conclusion: Olfactory and gustatory disorders are prevalent symptoms in European COVID-19 patients, who may not have nasal symptoms. The sudden anosmia or ageusia need to be recognized by the international scientific community as important symptoms of the COVID-19 infection.

Objective To ensure the safety and quality of vaccines, especially the newest RNA-vaccines against COVID-19, is one of the World Health Organization's current highest priorities. Design Case description. Study sample We report three cases of sudden unilateral tinnitus following BNT162b2 mRNA-vaccine injection, which rapidly resolved in 2 out of 3 cases. Results The mechanism responsible for its development remains unclear. A hypersensitivity reaction with an abnormal autoimmune response or a vasculitic event may be implicated. Conclusions Large-scale and well-designed studies are needed to improve surveillance of the COVID-19 vaccine and better define possible adverse reactions involving the cochleo-vestibular system and/or immunisation anxiety-related reactions.

Introduction:Les manifestations oculaires au cours des maladies auto-immunes sont principalement le syndrome sec, la sclérite et la kératite.La kératolyse aseptique est rare et constitue une véritable urgence thérapeutique.Le but de notre travail est de rappeler le tableau clinique et la démarche diagnostique, d’insister sur la gravité de l’atteinte et mettre à jour le volet thérapeutique. Patients et méthode : Nous rapportons un cas de kératolyse aseptique bilatérale révélant un syndrome de Goujerot sjogren primitif,et ayant bien répondu au traitement médical. Cas clinique : Il s’agit d’un homme de 45ans, qui consulte pour œil rouge douloureux bilatéral et baisse brutale d’acuité visuelle (AV) à droite.L’AV était à mouvement de main au niveau des deux yeux, avec un ulcère de cor- née paracentral à gauche, périphérique et préperforatif à droite.Le bilan a confirmé un syndrome de goujerot sjogren primitif. Le patient a été mis sous sérum autologue, tarsorraphie à droite,et bolus de méthylprédniso- lone, avec bonne évolution. Conclusion : Les ulcères de cornée stérils au cours des pathologies inflammatoires auto-immunes sont des complications rares mais très redoutables. Le traitement fait appel essentiellement aux corticoïdes et néces- site une collaboration étroite avec les internistes., Journal de la Société Marocaine d’Ophtalmologie, No 29 (2020)

BACKGROUND: Surgical site infection (SSI) is defined as an infection that occurs after a surgical incision or organ manipulation during surgery. The frequency reported for clean head and neck surgical procedures without antimicrobial prophylaxis is

Objective Nose and nasopharyngeal swab is the preferred and worldwide‐accepted method to detect the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS‐CoV‐2) within the nose and nasopharynx. This method may be linked with possible difficulties, such as patient's discomfort or complications. This article shows a pilot study of SARS‐CoV‐2 detection with nasal and nasopharyngeal lavage fluids (level of evidence: 3). Methods Nasal lavage fluid was collected from patients who were submitted to SARS‐CoV‐2 screening test, due to a preceding positive rapid antigen test. A control group was enrolled among health care professionals whose nasopharyngeal swab tested negative. Nasal lavages were performed using isotonic saline solution injected through a nasal fossa. Both lavage fluid and traditional nasopharyngeal swab were analyzed by real‐time (RT) PCR and antigenic test. Results A total of 49 positive subjects were enrolled in the study. Results of the analysis on lavages and nasopharyngeal swabs were concordant for 48 cases, regardless of the antigenic and molecular test performed. RT‐PCR resulted weakly positive at swab in one case and negative at lavage fluid. Among the control group (44 subjects), nasopharyngeal swab and lavage fluid analyses returned a negative result. Sensitivity of the molecular test based on nasal lavage fluid, compared to traditional nasal swab, was 97.7%, specificity was 100%, and accuracy was 98.9%, with high agreement (Cohen's κ, 0.978). Conclusion Nasal and nasopharyngeal lavages resulted to be highly reliable and well tolerated. A larger series is needed to confirm these results. This approach may potentially represent a valid alternative to the traditional swab method in selected cases. Level of Evidence 3.

Natural orifice transluminal endoscopic surgery (NOTES) is an important innovation in the field of minimally invasive surgery. Transvaginal NOTES (vNOTES) have gained more popularity compared to other natural transluminal orifices such as the mouth, rectum and urinary tract. Since the introduction of vNOTES, many surgeons have developed this technique in various interventions in gynecological surgery. In this work, we present a case of tubal sterilization by vNOTES technique and we try to expose the current literature review concerning the application of vNOTES in gynecological surgery. Our results showed that vNOTES had been successfully performed in a series of surgical procedures, including salpingectomy, ovarian cystectomy, myomectomy, hysterectomy, lymphadenectomy and sacrocolpopexy. Advances in technology have improved the feasibility of vNOTES and when technical limitations are overcome, wide application of vNOTES is expected to increase. Other prospective and comparative studies are necessary to clarify the application of this new technique in gynecological surgery.

The Samsat "X" office is a joint service office between the police, the regional income office, and the Jasa Raharja. The services provided are annual and five years of tax payments for motorized vehicles. The current service process is having an uncertain or probabilistic service time and long waiting time, resulting in long queues. This long queue condition causes taxpayer dissatisfaction. One of the methods to solve this problem is the Monte Carlo simulation. Monte Carlo simulation is a simulation method for solving problems with a set of sampling techniques from a probabilistic process. The objective of this research is to determine the optimum number of service personnel by using the Monte Carlo simulation method. The results of this simulation are the optimum conditions (best) for the tax payment services problem at the Samsat "X" office. The result shows that the optimum conditions are obtained with an average waiting time = 22.5479 minutes, an average of service utility level = 81.23%, queue length = 3 persons, and the number of service personnel = 3 persons for annual tax payment services, while for five years tax payment services, the optimum condition for average waiting time = 42.85336 minutes, an average of service utility level = 91.38%, queue length = 5 persons, and the number of service personnel 2 persons.

International audience; Background: It has become clear that healthcare workers are at high risk, and otolaryngology has been theorized to be among the highest risk specialties for coronavirus disease 2019 (COVID-19). The purpose of this study was to detail the international impact of COVID-19 among otolaryngologists, and to identify instructional cases.Methods: Country representatives of the Young Otolaryngologists-International Federation of Otolaryngologic Societies (YO-IFOS) surveyed otolaryngologists through various channels. Nationwide surveys were distributed in 19 countries. The gray literature and social media channels were searched to identify reported deaths of otolaryngologists from COVID-19.Results: A total of 361 otolaryngologists were identified to have had COVID-19, and data for 325 surgeons was available for analysis. The age range was 25 to 84 years, with one-half under the age of 44 years. There were 24 deaths in the study period, with 83% over age 55 years. Source of infection was likely clinical activity in 175 (54%) cases. Prolonged exposure to a colleague was the source for 37 (11%) surgeons. Six instructional cases were identified where infections occurred during the performance of aerosol-generating operations (tracheostomy, mastoidectomy, epistaxis control, dacryocystorhinostomy, and translabyrinthine resection). In 3 of these cases, multiple operating room attendees were infected, and in 2, the surgeon succumbed to complications of COVID-19.Conclusion: The etiology of reported cases within the otolaryngology community appear to stem equally from clinical activity and community spread. Multiple procedures performed by otolaryngologists are aerosol-generating procedures (AGPs) and great care should be taken to protect the surgical team before, during, and after these operations.

Uterine rupture is a serious complication for both mother and child, occurring in 0.2 to 0.8% of attempts at vaginal delivery after cesarean section. A case of 29-year-old Moroccan woman, G2P2, with a previous caesarean section, was admitted to our emergency department at 38 weeks´ gestation for acute fetal distress with complete cervical dilation. The delivery was imminent and done by vaginal route. The uterine revision objectified a uterine rupture. An immediate laparotomy was performed. The surgical exploration revealed uterine rupture on the right uterine edge with vascular pedicle lesion. More, we have found a huge hematoma of the right broad ligament diffusing into the right deep retroperitoneal space. The surgical management consisted of a total hysterectomy and packing of retroperitoneal hematoma. Removal of packing was performed on the fourth day after stabilization of clinical and biological parameters. Fortunately, the evolution was favorable under antibiotic therapy and massive transfusion. The patient was discharged from the hospital on the 10th postoperative day. The baby was doing well without any neurological sequelae.

Les léiomyomes infectés ou suppuratifs, sont des complications rare mais grave des léiomyomes bénins. On rapporte un cas rare d´une femme ménopausée de 47 ans, G4P4, suivie pour une connectivite mixte avec une notion d'une corticothérapie au long cours, a été admise au service des urgences gynécologiques pour une douleur abdominale aigüe. L'examen physique et les études d'imagerie ont révélé une masse pelvienne avec péritonite. Une laparotomie d'urgence a révélé un utérus polymyomateux avec un grand myome spontanément perforé qui fuit un matériel purulent abondant directement dans la cavité péritonéale. Une hystérectomie totale et une salpingo-ovariectomie bilatérale ont été réalisées. L'histopathologie a confirmé une nécrobiose septique, avec des foyers de nécroses associés à des infiltrats inflammatoires et n'a révélé aucune malignité. Les études bactériologiques ont montré la présence d'une infection par Enterococcus faecalis. La patiente s'est rétablie après une antibiothérapie combinée et déclarée sortante après 7 jours d'hospitalisation. Les gynécologues doivent être conscients de cette rare situation d'urgence, en particulier lors de la présence des antécédents de léiomyome utérin et si des signes d'infection ou même de septicémie sont présents.