Background. Sputum smear-positive pulmonary tuberculosis patients expel infectious viable bacilli for a period following the commencement of treatment. Objective. To determine the time to sputum smear conversion and study the factors influencing it. Design. A prospective study was undertaken at our hospital in Rabat over a six-month period on a cohort of 119 sputum smear positive patients. Patients were followed up fortnightly. At each followup, specimens were collected and processed for microscopy using standard protocol. Results. 96.6% of our patients completed the study (4 deaths). Sputum conversion rate was 42% after two weeks, 73% after one month, and 95% after two months. Univariate and stepwise regression analysis showed that patients who had high smear grading, miliary, and bilateral radiologic lesions were more likely to undergo delayed sputum conversion ( < 0.05). Other factors were thought to influence sputum conversion but were not statistically proven in our study. Conclusion. Since viable bacilli continue to be expelled for up to two months, infection control measures should be maintained for such a time. Patients with high smear grading, miliary, and bilateral radiologic lesions need to be monitored more closely.
ObjectiveScarf pin inhalation is becoming a frequent accident among young Moroccan woman who wears islamic veil. The aim of the study is to highlight indications, principles and challenges of surgical removal of that particular foreign body.MethodsTwenty-eight patients were hospitalized in Thoracic Surgery department of Ibn Sina Hospital at Rabat between January 2008 and June 2013 for surgical removal of a pin scarf after unsuccessful endoscopy.ResultsMean age was 20 years. Inhalation was accidental in all cases. Average interval between inhalation and surgery was 10 days. Penetration syndrome was found in 82% of patients. Pin was located at the left tracheo-bronchial tree in 53.5% of cases and at the right one in 46.4%. All were operated by thoracotomy. Surgery was conservative in all cases, and postoperative course was uneventful.ConclusionIn case of failure endoscopic treatment, surgery remains the only alternative. It must be as conservative as possible. Short interval between inhalation accident and surgery prevents parenchymal resection.
Background: Breast tuberculosis is an uncommon disease even in countries where the incidence of tuberculosis is high. Case Report: This is a case series concerning 4 postmenopausal breast tuberculosis cases encountered in Moulay Youssef Hospital between January 2007 and December 2010. Breast tuberculosis represents 0.25% of all hospitalized tuberculosis patients in our department. The mean age of our patients was 62.5 ± 5.8 years. Clinical findings were heterogeneous; 1 case was multifocal tuberculosis, and another case was coexistent tuberculosis and malignancy of the breast. Mammography and ultrasonography findings were suspicious for malignancy in all 4 cases. Fine needle aspiration was negative in 3 cases. The diagnosis was made in all patients by histological examination of biopsy specimens, which revealed typical tuberculous lesions. Antituberculosis therapy formed the mainstay of treatment. Conclusion: The clinical and radiological features of mammary tuberculosis can be very confusing and easily mistaken for breast cancer. Symptoms suggestive of tuberculosis warrant a biopsy to exclude possible cancer.
Introduction: Peak Expiratory Flow (PEF) has never been characterised among healthy Moroccan school children.
Background: There are few studies on presentations, treatment and outcomes of pediatric tuberculosis in Morocco. This study aimed to describe clinico-epidemiological profiles, laboratory findings, treatment and outcomes of pediatric tuberculosis (TB) in a tertiary care hospital in Morocco. Materials and Methods: This is a prospective, descriptive study undertaken in children diagnosed with TB between June 2011 and May 2012. Clinico-pidemiologicalprofiles, laboratory findings, treatment and outcome of patients was recorded. Statistical significance of category variables was evaluated. Analysis was done on SPSS package. Results were expressed as rates and proportions. Chi square test was used to test for statistical significance. Results: 53 children aged 2 to 16 years (mean age of 9±3.2) with TB diagnosis were enrolled in our study. 33 (62%) of patients were female. Common symptoms were fever, cough, chest pain, dyspnea, decreased appetite and weight loss. The types of TB were: pulmonary TB (32, 60%), and extrapulmonary TB (21, 39.6%). The sites of pediatric extrapulmonary tuberculosis (EPTB) were: lymph nodes (7, 13.2%), peritoneal (6, 11.3%), meningeal (4, 7.5%) and osteoarticular (4, 7.5%). 24 (45,3%) of the patients had positive Calmette-Guérin vaccine scar, and 42(79.2%) of the patients had a positive tuberculin skin test. An adult TB contact was identified in 19 (35.8%) of the cases. On direct microscopy, acid-fast bacilli were found in 3 (5.6%) patients and positive cul¬ture for Mycobacterium tuberculosis was found in 2 (3.7%). Drug mono- or multiresistance was not detected. Conclusion: Paediatric TB in both pulmonary and extrapulmonary forms is a challenging diagnosis, and is a common occurrence in our setting. Diagnosis was based on a combination of epidemiological and clinical suspicion supported by results of various investigations.
Extract: The current importance of public debt requires governments to increasingly shift towards Public-Private Partnerships (PPPs). They are long-term contracts of private financing method providing or contributing to public service. The payment is made by the public partner and/or users of the service. The World Health Organization (WHO) defines this type of partnership as ‘‘a means to bring together a set of actors for the common goal of improving the health of populations based on mutually agreed roles and principles.’’ Historically, the principle of PPP was established by the Private Finance Initiative (PFI), launched by the conservative government of John Major in 1992. It was from this moment that this model quickly spread to the rest of the world. In the mid-90s and from Australia, PPP agreement began to become part of the language of governments. In 1997, Labour with Tony Blair leading, strongly developed this management method, first and particularly in hospitals and then, in the entire public sector and spreading to the Royal Navy. Today, 10-15% of British public investments are made using PFI method.
Introduction. PEF has never been characterized among healthy Moroccan adults. The objective of this study is to describe the values of PEF among healthy Moroccan adults, to study its relationship with anthropometric parameters (gender, age, height, and weight), to compare spirometric and flowmetric PEF, to establish the prediction equations for PEF, and to study the correlation between PEF and FEV1. Methods. Cross-sectional study conducted between May and June 2016. It involved healthy nonsmoking volunteers living in Tetouan, Morocco, gathered through a mobile stand realization of spirometry and peak flow measurements. Results. Our final sample concerned 313 adults (143 men and 170 women). For both men and women, age and height were the main determinants of PEF, and a positive correlation was found between PEF and FEV1. Conclusion. Our study has established the PEF predictive equations in the Moroccan adult population. Our results allow us to conclude that the PEF can be a reliable alternative of FEV1 in centers not equipped with spirometry.
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