Ahmed Belkouch

Tuberculosis faríngea: 5 casos clínicos

Tuberculosis is a public health problem for many countries, whether rich or poor. Extranodal ENT locations are rare, and it prevails in the cavum in the pharyngeal region. Based on a 3-year retrospective study of 5 clinical cases, the authors aim to highlight the epidemiological, clinical, radiological, therapeutic and prognostic aspects of this disease. Clinical aspects are not specific and there is often confusion in the differential diagnosis with tumoral lesions. Positive diagnosis is guided by the clinical and the radiological findings, and confirmed by histology.

Evaluation des prescriptions antibiotiques au service des urgences de l’Hôpital Militaire d’Instruction Mohammed V (HMIMV)

The objectives of this study are to describe prescribing practices, to evaluate their appropriateness and their compliance with guidelines and to examine their influencing factors. We conducted a cross-sectional study of antibiotic prescriptions data of 105 patients in the medical and surgical Emergency Department of the Military Hospital of Instruction Mohammed V in Rabat over a period of one month. Data were collected by means of a questionnaire including demographic and anamnestic data, patients history, allergies, specific clinical examination data, paraclinical data, detailed antibiotic prescription. Collected data were then evaluated by a referring physician, who was responsible for detecting any treatment error. Among infections requiring the prescription of antibiotics, respiratory and urinary system diseases were at the forefront, the most commonly used antibiotic families were penicillins, quinolones and cephalosporins. 74 prescriptions (70.5%) were both pertinent and compliant versus 9 prescriptions (8.6%) justified but nonpertinent and 6 prescriptions (5.7%) which were considered unjustified by the referring physician due to absence of infection. The evaluation of the existing medical practice is rarely conducted in health facilities; with this in mind, our case study aims to improve appropriate antibiotic prescribing and to optimize its compliance with guidelines.

Does intranasal fentanyl provide efficient analgesia for renal colic in adults

Introduction Intranasal fentanyl provides rapid and powerful analgesia which is particularly interesting in patients without intravenous access. We propose to use it for analgesia in adults presenting renal colics. Methods A prospective study was conducted from the 2nd January to February 2013 in our emergency department. Patients aged up to 18 years old who presented with renal colic were included in this audit. Patients were excluded if they had loss of consciousness, cognitive impairment, acute or chronic nasal problems. A formal written consent was obtained from patients. The research team was alerted by medical and nursing staff. A member of the research team would check with medical or nursing staff whether administration of Intra nasal (IN) fentanyl was required. It was administered at a pre-calculated dose of 1.5 mg/kg and 50 mg/ml concentration was used. Data was prospectively collected by one of the researchers at various intervals during the patients presentation and recorded on a pre-formatted data sheet. Pain scores were collected at 5, 15, 30, 45 and 60 minutes following IN fentanyl using a visual analogue scale pain. Observations routinely collected for patients receiving IV opiates and any adverse events were also recorded. Results 23 eligible patientswere enrolled; median age was 51,3years. 47,8% were women and the mean weight was 73 kg. Median dose of IN fentanyl was 106 μg. Two patients have required morphinic analgesia despite having received adapted dose of IN fentanyl. The initial pain scores before IN fentanyl were high with a median of 82,2 mm (59-100). Five minutes after IN fentanyl administration the median pain score dropped to 48mm(36-63) and achieved the lowest score of 8mm(0-22) at 30 min. Pain scores were significantly lower at 5 min (P < 0.001) and at all subsequent time points (P < 0.001). No side effects were recorded. Conclusion Intranasal fentanyl seems to be efficient for analgesia in adult patients with renal colic.

Renal vein thrombosis in the post-partum period: a case report

IntroductionPhysiological hypercoagulability is a known condition in pregnancy designed to limit the risk of bleeding; it may exceptionally be complicated by thrombosis of the renal vein. To the best of our knowledge, this is the third case of renal venous infarction reported in the literature.Case presentationWe report the case of a 43-year-old Caucasian woman, a mother of three sons who presented with left flank pain and hematuria. The clinical investigations did not find any other cause for her thrombophilia.ConclusionsClinical onset is not specific, so it is important to evoke the diagnosis in the context of pregnancy; computed tomography angiography is the investigation of choice to set the diagnosis. It is important to know that anticoagulation therapy must be initiated as soon as possible.

Dyspnoea caused by a Chilaiditi syndrome: contribution of the non-invasive ventilation

A 49-year-old man presented to the emergency department with respiratory distress and extreme abdominal distension, with a history of chronic constipation. His chest auscultation was normal and the patient experienced drowsiness and showed signs of respiratory fatigue. He experienced severe disturbances in blood gas tensions (pH 7.28, PaO2 65 mm Hg, PaCO2 76 mm Hg); …

Complication rare et grave de la rachianesthésie: la méningite bactérienne (à propos d’un cas et revue de la littérature)

Spinal anesthesia (SA) is the first locoregional anesthesia. It can cause side effects and carry risks that need to be avoided, prevented or treated early. We here report the case of a female patient operated under spinal anesthesia who had intense headache associated with nausea and vomiting evolving in the context of fever within a few days after surgeryLumbar puncture showed cloudy liquid revealing Gram + cocci on direct examination. This allowed the diagnosis of bacterial meningitis. Patients evolution was favorable after antibiotic therapy.

Le syndrome de Mirizzi: une cause rare de l’obstruction des voies biliaires: à propos d’un cas et revue de littérature

Le syndrome de Mirizzi est une complication rare de la lithiase vésiculaire chronique, avec une incidence de 0,7% à 1,4% chez les malades cholécystéctomisés. Il est caractérisé par un ictère cholestatique en rapport avec une compression de la voie biliaire principale par un calcul enclavé dans le collet vésiculaire ou le canal cystique. La maladie peut évoluer vers l’érosion de la paroi du canal hépatique commun et par conséquent, provoquer la formation d’une fistule cholécysto-bilaire. Nous présentons ici un syndrome de Mirizzi type I en soulignant l’importance du diagnostic préopératoire, celui-ci étant rendu plus aisé par la cholangiographie rétrograde endoscopique ou par la cholangio-IRM, qui permet d’éviter des lésions iatrogènes de la voie biliaire principale. Le présent article passe en revue la littérature disponible sur les divers aspects de ce syndrome, y compris sa pathogenèse, son diagnostic et sa prise en charge.Mirizzis syndrome is a rare complication of chronic vesicular lithiasis with prevalence ranging from 0.7% to 1.4% among patients who have undergone cholecystectomy. It is characterized by cholestatic icterus associated with compression of the common bile duct due to lodged calculus in the vesicular neck or in the cystic duct. The disease can evolve toward the erosion through the common hepatic duct wall and, therefore, it can cause the formation of a gallbladder-biliary fistula. We here report a case of Mirizzis syndrome type I in order to highlight the role of preoperative diagnosis which is made easier by endoscopic retrograde cholangiography or by cholangio-MRI, allowing to avoid iatrogenic bile duct injuries. We conducted a review of the available literature on various aspects of this syndrome, including its pathogenesis, diagnosis and management.

Tumeurs digestives rares: tumeur gastro-intestinale stromale (GIST): à propos d’un cas de localisation grêlique et revue de littérature

Gastrointestinal stromal tumors (GISTs) are a rare group of mesenchymal tumors mainly occurring in the gastrointestinal tract. Previously, GISTs were classified as smooth muscle tumors also known as leiomyomas, leiomyosarcomas or leiomyoblastomas. However, since the advent of immunohistochemistry, GISTs have been diagnosed on the basis of the identification of c-kit-positive cells. We here report a case of stromal tumor of the small intestine in order to analyze it in the light of literature data and imaging results, which may suggest prebiopsy diagnosis as well as its therapeutic and prognostic peculiarities.

Akinetic mutism revealing an ischemic stroke

ABSTRACT We describe a 44‐year‐old man who developed akinetic mutism following a cerebrovascular accident involving his left middle cerebral artery. We discuss this rare condition and its unusual clinical picture.

Spontaneous splenic rupture from Plasmodium ovalae malaria

A patient of 42 years old, with no specialmedical history, repatriated in the last 2 months from Central Africa, consulted at the emergency service for a fever up to 39.2°C with chills, diffuse abdominal pain and vomiting. Clinical examination found a sensitive abdomen, with hepatosplenomegaly. Laboratory tests with blood smear came back positive for Plasmodium ovalae (0.01% of parasitemia). The blood count formula was found a leukopenia at 3800/mL, anemia at 11 g/dL and thrombocytopenia at 77 000/mL. The C-reactive protein was at 86.4 mg/L. The diagnosis of malaria was retained, and treatment with the combination of Artemether and Lumefantrine was undertaken. We note that, the malaria chemoprophylaxis was based on Mefloquine during the stay and continued until a month of returning from the endemic country. An abdominal scanner has been done and has objectified hepatosplenomegaly with presence of a peri-splenic and peri-hepatic hematoma and abundant effusion inter-hepatorenal, inter intestines, in the para-colic gutter and the Douglas (Figs. 1-3). The patient was admitted to the operating room for an exploratory coelioscopy, which revealed a presence of an intra-peritoneal hematic effusion due to a splenic rupture. Splenectomy aftermedian laparotomy conversion was carried out for the patient to facing the installation of the shockwith low blood pressure at 95/45mmHg requiring vasoactive drugs for its stabilization (Noradrenaline). The patients evolution after the operation was simple.