Introduction: Renal lithiasis is a very common condition worldwide, linked to the presence of calculi in the urinary tract. It is multifactorial, recurrent and serious. It is the 3rd leading cause of chronic kidney di...Introduction: Renal lithiasis is a very common condition worldwide, linked to the presence of calculi in the urinary tract. It is multifactorial, recurrent and serious. It is the 3rd leading cause of chronic kidney disease (CKD) in Morocco. The aim of our study is to describe the clinical, paraclinical and management aspects of renal lithiasis in our patients, to determine the factors of recurrence of renal lithiasis and to identify the factors of progression of renal failure. Materials and Methods: This is a retrospective, descriptive and analytical study conducted in the nephrology department of CHU IBN Sina in Rabat, over a 3-year period from 2020 to 2023. We included 160 patients with renal lithiasis having a follow-up in our training. We analyzed their epidemiological, clinical, paraclinical and therapeutic profile. Results: The mean age of our patients was 56 +/− 16.6 years, with a M/F sex ratio of 1.02. Lithiasis was expressed by renal colic in 71% of cases, and by stone emission in 31% of cases, although discovery was incidental in 16% of cases. At the time of the first consultation, 59% of patients had renal failure (RF), 15% of whom were at the stage of chronic end-stage renal disease. Crystalluria and calculus spectrophotometry were performed in only 30% and 22% of patients respectively. All patients benefited from hygienic and dietary measures according to the nature of the stone, as well as additional urological management. Recurrence of renal lithiasis was reported in 36% of cases. In univariate analysis, advanced age, male gender, diabetes, hypertension and the presence of recurrent urinary tract infection were factors in the progression to CKD (OR = 0.979, p = 0.035;OR = 0.527, p = 0.48;OR = 4.127, p = 0.015;OR = 1.926;p = 0.015, OR = 2.5 p = 0.019, respectively). In multivariate analysis, only diabetes and high baseline creatinine were factors in the progression to CKD. Recurrence of renal lithiasis was reported in 36.5% of cases. Only the presence of a history of familial lithiasis and of renal cysts on imaging were significantly associated with a risk of renal lithiasis recurrence in univariate analysis. (OR = 3.06, p = 0.035;OR = 5.27, p = 0.017, respectively). Conclusion: Renal lithiasis is a disabling pathology that can be complicated by recurrence and chronic end-stage renal failure. Early diagnosis and identification of factors leading to the recurrence and progression of chronic renal failure could improve management.展开更多
Goal: Evaluate the techniques and results obtained from the mammary Oncoplastic in the conservative treatment of breast cancer. Patients and methods: This is a retrolective descriptive study conducted during the perio...Goal: Evaluate the techniques and results obtained from the mammary Oncoplastic in the conservative treatment of breast cancer. Patients and methods: This is a retrolective descriptive study conducted during the period from 3 April 2017 to 3 April 2019, the Gynecologic Breast pole of the Oncology National Institute of Rabat. Results: Out of 105 files listed, the locations of the tumours were: 35% 37/105 QSE, QSI QSE + 21/105 or 20%, QSI 19/105 or 18%, QSI 12/105 or 11%, other maps 16/105 or 16%. The techniques were Oncoplastic: Pamectomy 10/105 or 10% Round Block 58/105 or 55%, plasty inverted T 21/105 or 20%, and other technical 16/105 or 15%. The aesthetic results and the quality of resection were correct and above all stable at 82/105 patients 78% of cases. The lymphocele 13/105 or 12% 5/105 5% lymphoedema represented early complications occurred as late complications consisted of retractile unsightly scars 15/105 or 14%, breast asymmetry 13/105 soit12% and cutaneous sclerosis 3/105 or 3%. Conclusion: The oncoplastic surgery is a part of multidisciplinary management of breast cancer. It imposes oncologic resections and reassuring cosmetic results for the patient and the practitioner.展开更多
<strong>Background and Purpose:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> Paragangliomas are rare tumors of the he...<strong>Background and Purpose:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> Paragangliomas are rare tumors of the head and </span><span style="font-family:Verdana;">neck. Their management remains problematic and</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">varies considerably de</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">pending on the center. This study reported 14 years of experience in the</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> management of head and neck paraganglioma (HNPGls)</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">.</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> We aimed to assess the therapeutic results of these tumors in terms of local control and overall survival. </span><b><span style="font-family:Verdana;">Materials and Methods</span></b><span style="font-family:Verdana;">: We included 16 patients followed for HNPGls and treated by radiotherapy from January 2006 to June 2018 in the National Institute of Oncology in Rabat. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> The median age was 44.5 years (15 - 67). 13 patients were female and three male with a sex ratio of 4.3. Cervical mass was the common sign (56</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">.</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">3%). All patients received radiation therapy. This radiation was exclusive in 43.7% of cases or adjuvant to partial surgical resection in 56.3%. The median dose of radiotherapy was 54 Gy (46 - 60) and it was delivered by a three-dimensional conformal radiotherapy technique in 15 patients and volumetric modulated arc therapy in one. There were few acute complications such as grade I and II mucositis and dermatitis. After a median follow-up of 5.6 years (2 - 13.4), local control, defined by radiological stability or regression, was obtained in 14 patients, two patients progressed and one died. Progression-free survival rates at 5 and 7 years were 93.8% and 78.1% respectively, and overall survival at 5 and 7 years was 92.3%. </span><b><span style="font-family:Verdana;">Conclu</span><span style="font-family:Verdana;">sions:</span></b><span style="font-family:Verdana;"> Surgery is the first-line treatment for HNPGls. When surgery is not</span><span style="font-family:Verdana;"> possible or incomplete, radiotherapy has its place in the therapeutic strategy of this rare disease for long-term local control.</span></span></span></span>展开更多
This study is focused on two types of Moroccan rocks, among the most widely used as building stones: the calcarenite of Salé (CS) and the marble of oued Akrech (MA). The two rocks, lithologically different, show ...This study is focused on two types of Moroccan rocks, among the most widely used as building stones: the calcarenite of Salé (CS) and the marble of oued Akrech (MA). The two rocks, lithologically different, show a clear contrast of their P-wave velocities (Vp): 3.90 vs 5.10 km/s at dry state and 4.29 vs 5.64 km/s at saturation. The “Artificial fractures” created in the two rock types reveal that their Vp undergo diminutions which the rates vary depending of the number and the plane orientation of the fractures. In the CS, Vp shows an increasing of cumulative diminution (Dc) according to the number of fractures, but with a variable rate of unitary diminution (Du) from one fracture to the other. This defines a linear regression with a low coefficient of determination (Dc = 10.18NbFr + 10.96;r2 = 0.87). The mode of the Vp evolution would be related to the roughness of fractures surface, which itself depends upon the petrographic nature of the calcarenite (friable structure, high porosity and heterogenous composition). The MA manifested an increasing Dc with a fairly constant rate of Du from a fracture to another, giving a regression line with a high coefficient of determination (Dc = 12.17NbFr – 10.69;r2 = 0.99). This steady diminution of Vp would be related to the granoblastic texture and the monomineral composition of the marble, which engender smoother fracture surfaces. The rates of Vp diminution also depend on the orientation plane of the fractures relative to the direction of wave propagation. The fractures parallel (θ = 0°) amplify slightly the Vp, playing a significant role of “waveguide”. The fractures oriented at 45° lead to a diminution lower than those of fractures oriented at 25° and 90°. The same trend of diminution, but at variable rates, appears on the samples of the two types of stones at dry and saturated state. This can be explained by the compressive nature of P-waves, which obey the physic laws of the transmission of the constraints in the solid mediums.展开更多
<strong>Introduction:</strong> <span><span><span style="font-family:""><span style="font-family:Verdana;">Chordoma is a rare bone tumor, which develops main...<strong>Introduction:</strong> <span><span><span style="font-family:""><span style="font-family:Verdana;">Chordoma is a rare bone tumor, which develops mainly from the sacrum, the base of the skull, or the spine. Surgery + radiotherapy (if necessary) is the standard treatment. Data on chordoma are scarce in this re</span><span style="font-family:Verdana;">gion, and thus, here we summarized 9 patients with this tumor whom we</span><span style="font-family:Verdana;"> treated in this institute. </span><b><span style="font-family:Verdana;">Material: </span></b><span style="font-family:Verdana;">Nine chordoma patients were summarized, who were treated in National Institute of Oncology in Rabat between 2013 </span><span style="font-family:Verdana;">and 2018. We retrieved data from medical charts and analyzed the clinical</span><span style="font-family:Verdana;"> characteristics of this tumor. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">The average age was 49 years (range: 29 </span><span style="font-family:Verdana;">- 72), with male: female of 3:6. The manifestation-diagnosis time was 4</span><span style="font-family:Verdana;"> months (range: 2 - 14). Regarding the tumor location, lumbosacral spine;5, the skull;4. Mass was evident in 6. Signs of locoregional compressions (paraparesis or tetraparesis) were observed in 3. As for treatment, a partial tumor excision was performed in 8, with 3 patients undergoing a wide excision. Radiotherapy was done;3 patients with a dose of 46 Gy, 3 patients with 66 Gy, 1 patient with 50 Gy, and 1 patient with a 16 Gy gamma radio-knife in a single session. 4 patients with a dose of 46 Gy, 2 patients with 60 Gy, and 1 patient with a 16 Gy gamma radio-knife in a single session. Of 9, 4 patients had good locoregional control whereas 5 patients had local recurrence. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Chordoma is a predominantly local aggressive tumor with low metastatic potential. The surgical excision remains the main prognostic factor. Advances in radiotherapy may improve local control. These data are of use in management of this tumor in Rabat (Morocco).</span></span></span></span>展开更多
Natural materials(e.g. rocks and soils) are porous media, whose microstructures present a wide diversity.They generally consist of a heterogeneous solid phase and a porous phase which may be fully or partially saturat...Natural materials(e.g. rocks and soils) are porous media, whose microstructures present a wide diversity.They generally consist of a heterogeneous solid phase and a porous phase which may be fully or partially saturated with one or more fluids. The prediction of elastic and acoustic properties of porous materials is very important in many fields, such as physics of rocks, reservoir geophysics, civil engineering, construction field and study of the behavior of historical monuments. The aim of this work is to predict the elastic and acoustic behaviors of isotropic porous materials of a solid matrix containing dry, saturated and partially saturated spherical pores. For this, a homogenization technique based on the Morie Tanaka model is presented to connect the elastic and acoustic properties to porosity and degree of water saturation. Non-destructive ultrasonic technique is used to determine the elastic properties from measurements of P-wave velocities. The results obtained show the influence of porosity and degree of water saturation on the effective properties. The various predictions of Morie Tanaka model are then compared with experimental results for the elastic and acoustic properties of calcarenite.展开更多
Background: The practice of exclusive breastfeeding (EB) in Morocco has witnessed a worrying decline in recent decades, contrary to the recommendations of the World Health Organization (WHO) which advocates it during ...Background: The practice of exclusive breastfeeding (EB) in Morocco has witnessed a worrying decline in recent decades, contrary to the recommendations of the World Health Organization (WHO) which advocates it during the first six months as a significant public health tool. The present study aims to assess the impact of educational materials on mothers’ behaviour with regard to keeping up EB as long as six months, at least. Methods: This is a cohort study with a prospective collection of data over a period of one year, through a questionnaire-based survey of 500 women who delivered at the Souissi Maternity Hospital in Rabat. The subjects were divided into an intervention group sensitized, during the medical visit, by means of information delivered orally about breastfeeding and a booklet containing instructions on breastfeeding management and the benefits of EB, especially when extended for the first six months;and a control group attending the same operation with no awareness-rising through educational materials. To assess EB rates, the subjects had been followed for six months through telephone. Results: 372 women who delivered were followed, 194 from the intervention group and 178 from the control group. The remaining 128 women not followed were lost sight of. A higher percentage of mothers in the intervention group exclusively breastfed their babies up to the age of six months compared to the control group, 55.2% against 38.8% (p = 0.002). The main reason produced by most mothers who ceased to exclusively breastfeed their babies is milk insufficiency. Conclusion: The postnatal nutritional education strategy based on the distribution of educational materials has considerably raised the number of women who exclusively breastfed their babies until the age of six months.展开更多
Introduction: Cardio-renal syndrome (CRS) is a complex pathophysiological entity affecting the heart and kidneys in which acute or chronic dysfunction of one organ can induce acute or chronic dysfunction of the other ...Introduction: Cardio-renal syndrome (CRS) is a complex pathophysiological entity affecting the heart and kidneys in which acute or chronic dysfunction of one organ can induce acute or chronic dysfunction of the other organ. Five types of CRS have been described. Methods: The study explored the prevalence and types of Cardiorenal Syndrome (CRS) at CHU Ibn Sina in Rabat. Over a year, 120 CRS patients were assessed, excluding those with end-stage chronic renal failure. We analyzed the epidemiological, clinical, therapeutic and evolutionary profile of these patients. Results: The average age of our patients is 67.8 ± 12 years, with extremes ranging from 39 years to 92 years. The sex ratio is 1.35. The different types of CRS types (1, 2, 4 and 5) were noted respectively in 28.4%, 20.8%, 5%, 45.8%, however, we did not note patients having CRS type 3. On the renal level, we noted acute renal failure (ARF) in 51.6% of patients, of whom 61.3% had functional ARF and 38.7% presented with acute tubular necrosis. Chronic renal failure (CRF) is found in 48.4% of cases, of which 39% are at stage III and 61% are at stage IV. The etiology of CKD is dominated by hypertensive nephropathy (72.4%) followed by diabetic nephropathy (60.3%). Therapeutically diuretics are administered in 51% of our patients. We used hemodialysis in 9.1% of patients who are resistant to diuretics. Vasoactive drugs are used in 9.5% of our patients. Mortality risk factors for patients with CRS are significantly related to advanced age, long hospital stay, type 1 CRS, re-hospitalization, acute pulmonary edema (APE), use of hemodialysis, right heart failure (RHF), valvulopathy and hemodynamic instability (OR = 1.15, p = 0.01;OR = 4.5, p = 0.03;OR = 5.2, p = 0.019;p Conclusion: CRS type 5 was most common, with hypertension and diabetes being primary causes of Chronic Kidney Disease. Mortality factors were linked to acute pulmonary edema, hemodialysis, right heart failure, valvulopathy, and re-hospitalization.展开更多
Hypofractionated radiation therapy has proven effective on locoregional control and tolerance in the adjuvant treatment of breast cancer. The aim of this study is to compare the results of hypofractionated radiation t...Hypofractionated radiation therapy has proven effective on locoregional control and tolerance in the adjuvant treatment of breast cancer. The aim of this study is to compare the results of hypofractionated radiation therapy versus conventional radiation therapy in terms of local control and tolerance. It was a retrospective study of patients observations collected from January 2007 to December 2008 in Department of Radiation Therapy in Institut National d’Oncologie de Rabat. The treatment results were evaluated by the rate of locoregional recurrence, distant recurrence and research of late toxicities. Radiotherapy was delivered using the same technique in both groups, by gamma photons of cobalt 60 with an energy of 1.25 MeV. They were 2 groups: the first group treated with standard dose rate and the second group treated by hypofractionated radiation therapy. The mean age of the patients was 42.8 ± 6.9 years old in the standard group and 43.22 ± 7.2 years old in the hypofractionation group. We noted a predominance of infiltrating ductal carcinoma. The majority of patients were pT<sub>2</sub>, pN<sub>0</sub> and pN<sub>1</sub>.<sub> </sub>The majority of patients had radical surgery and chemotherapy with anthracyclines in both groups. We noted a statistically significant difference in the irradiation of chest wall between the standard (89.2%) and hypofractionated group (70.3%), with p = 0.043. The median duration of radiation therapy was statistically different in both groups: 39 days in the standard and 23 days in the hypofractionated group (p 0.001). The local recurrences were statistically identical to 12 and 24 months (p = 0.999). Concerning toxicities, the frequency of adverse event was similar in both groups. Hypofractionated radiation therapy with a total dose of 42 Gy at 2.8 Gy per fraction in 5 fractions weekly is comparable to standard radiotherapy in terms of local control and tolerance and is therefore a very good alternative to standard treatment.展开更多
Risk of infection by hepatitis B (HBV) and C (HCV) viruses remains a permanent problem, not only for health care workers but also for patients. It is often a major public health concern in low incomes countries. The a...Risk of infection by hepatitis B (HBV) and C (HCV) viruses remains a permanent problem, not only for health care workers but also for patients. It is often a major public health concern in low incomes countries. The aims of this study were to determine seroprevalence of viral hepatitis B (HBV) and C (HCV), frequency occurrence of blood exposure accidents (BEA) and identify key risk factors for infection among 601 health care workers of Ibn Sina Hospital in Rabat. In this study nineteen health personnel (3.16%) were HBsAg positive and fifteen (2.50%) were anti-HCV antibodies positive. The seropositivity to hepatitis B and C in the surgical department respectively was 4.22% and 3.45%. Nurses were the most affected by hepatitis virus infections. We noticed that HCV came first with a prevalence of 4.44%. The seropositivity reached its acme within the health staff having practiced for more than 20 years, hepatitis C coming first with a prevalence of 4.27%. Globally, 34 health care personnel are positive for HBV or HCV, 32 among them were victims at least once of blood exposure accident (BEA) while practicing. The needlestick represented 81.25% of the BEA type. Prevalence of hepatitis B and C serologic markers in health care workers in our Hospital outnumbered that of the general population. Nurses, surgery department personnel and the professional having worked for a long time were the main factors behind the high risks of infections.展开更多
Carbon monoxide （CO） intoxication is one of the most common types of poisoning in the modem world. To better tailor messages and communication needs to the public, a perception survey of CO and his risk was conducte...Carbon monoxide （CO） intoxication is one of the most common types of poisoning in the modem world. To better tailor messages and communication needs to the public, a perception survey of CO and his risk was conducted among the population of Rabat-Sale-Zemmour-Zaer. The authors included 400 people in this survey. The demographic characteristics of the respondents consisted of： 85.0% female, 92.9% adults, 29.7% had a high level of education, 49.6% unemployed, 89.5% were home owners and 53.9% lived in apartments. Water heaters were present in the homes of 91.0% of respondents and 6.5% of them used gas. Gas was used as fuel in 45.4% of cases. For water heaters, 20.8% had an exhaust duct, 9.9% were serviced regularly and 47.5% were installed in a well ventilated area. Regarding the media, television was the medium that allowed 73.4% of the CO to know, regardless of age, sex and level of education among the 94.3% of who ever heard of this deadly gas before the survey.展开更多
Background: chronic subdural hematoma is a common pathology, especially in the elderly. Although it has a good prognosis, it poses the problem of recurrence after surgical evacuation. Objective: To analyze the risk fa...Background: chronic subdural hematoma is a common pathology, especially in the elderly. Although it has a good prognosis, it poses the problem of recurrence after surgical evacuation. Objective: To analyze the risk factors of reoperation in patients surgically treated for chronic subdural hematoma (cSDH) and evaluate the outcome of patients who benefited from a reoperation. Materials and Methods: A retrospective review was conducted in a single University Hospital Center in Rabat (Morocco) on 49 patients operated on from January 2020 to June 2021 for cSDH. Possible risk factors described in the literature were analyzed and the outcome of post-operative course was evaluated. Statistical significance was defined by p-value Results: 49 patients underwent surgical evacuation of cSDH. The sex ratio of male/female was 3.08. The mean age was 70.6 years. Concerning the medical history, 8.2% were diabetics, 10.2% had heart disease, 18.4% had hypertension, 16.3% associated of comorbidities, 2% had pulmonary embolism, and 2% had neoplasm. 18.4% were on anticoagulation therapy, no patients were on new oral anticoagulants. The clinical findings upon admission were motor deficit at 57.1%, signs of intracranial hypertension at 20.4%, altered consciousness at 16.9% and impaired behavior at 6.1%. 28.6% of patients had a past history of head trauma. The pre-operative CT scan showed unilateral cSDH at 81.6%, midline shifts at 77.6%, and false membranes at 34.7%. Blood appeared chronic at 40.8%, subacute at 24.5%, and mixed densities at 34.7%. The post-operative course was uneventful in 73.5%. According to Ibanez grading 8 patients had mild complications (grade I) and 5 moderate complications (grade II) after the first surgery. We recorded 10.2% of patients who needed a second surgery because of the deterioration of neurologic status or motor deficit associated with an abnormal CT scan. According to the GOS, 85.7% of patients had a good recovery while 10.2% died. None of the factors assessed was found to be a risk factor for reoperation. Conclusion: No risk factors of reoperation after an initial burr hole evacuation for cSDH were found. However medical history and male sex was common condition among reoperated patients with their CT scan showing a chronic aspect of blood, midline shift and false membranes. Most patients who underwent revision surgery died on the postoperative course.展开更多
The iTrace Dysfunctional Lens Index (DLI) offers a quantitative approach to lens assessment, potentially facilitating the early detection of cataracts. Globally, the prevalence of cataracts has increased due to aging ...The iTrace Dysfunctional Lens Index (DLI) offers a quantitative approach to lens assessment, potentially facilitating the early detection of cataracts. Globally, the prevalence of cataracts has increased due to aging populations, and in Morocco, they remain a significant cause of reversible blindness. This study examines the specificity and sensitivity of the DLI in identifying cataracts among a large sample of patients, focusing on differentiating early-stage cataracts from other conditions that affect visual quality. The DLI, which generates a score from 0 to 10, provides an objective lens quality measure, with lower values indicating dysfunction. In a cohort of 621 patients (1242 eyes), 243 eyes displayed a DLI < 5. Of these, 56 eyes had confirmed cataracts and 187 eyes presented with various ocular conditions but clear lenses. The results demonstrate 100% sensitivity for identifying cataracts within the DLI < 5 threshold, with a specificity of 72.4%. These findings highlight the utility of DLI as a diagnostic tool for early-stage cataracts despite variability influenced by ocular characteristics such as axial length and keratoconus.展开更多
Work-related stress has become an alarming reality that continues to intensify over the past decades. The pressure exerted by the work environment demands the utilization of defensive and coping strategies to deal wit...Work-related stress has become an alarming reality that continues to intensify over the past decades. The pressure exerted by the work environment demands the utilization of defensive and coping strategies to deal with it. Our study aims to explore the relationship between professional stress factors, stress symptoms, and the consumption of psychoactive substances as a defensive and coping strategy deployed to address psychological distress at work. A qualitative and quantitative study was conducted with a sample of 405 employees from a wiring manufacturing. The main professional stress factors identified were concentration, overload, long working hours, and monotony, which showed a significant correlation with PAS consumption. Women were found to be more affected by stress and tended to consume more sedatives. Among the respondents, 21.98% reported PAS consumption, with tobacco being the most commonly used (M = 2.66), followed by alcohol (M = 1.94), cannabis (M = 1.79), and sedatives (M = 1.45). There was a significant positive correlation between PAS consumption and stress symptoms {tobacco (r = 0.232*), alcohol (r = 0.305**), cannabis (r = 0.389**)}.展开更多
BACKGROUND Kidney transplantation is increasingly more common due to the ongoing shortage of deceased donors.However,anatomical challenges,such as a short renal artery,can complicate surgical procedures and increase c...BACKGROUND Kidney transplantation is increasingly more common due to the ongoing shortage of deceased donors.However,anatomical challenges,such as a short renal artery,can complicate surgical procedures and increase complication risk,including thrombosis and anastomotic stenosis.To address these issues and optimize graft outcomes,innovative surgical techniques are essential.CASE SUMMARY We present a case of kidney transplantation complicated by a short donor renal artery.To address the discrepancy between arterial length and diameter mismatch,the recipient’s inferior epigastric artery was used as a cuff interposition for arterial reconstruction.Following standard laparoscopic donor nephrectomy,vascular reconstruction was performed on the back table.The use of the inferior epigastric artery as a cuff allowed for successful elongation and size matching of the donor renal artery,enabling a tension-free anastomosis to the recipient’s external iliac artery.Postoperative Doppler ultrasound and angiography confirmed excellent graft perfusion.The patient experienced an uneventful recovery with immediate graft function and maintained stable renal function at 6 months post-transplant.To our knowledge,this is the first reported use of the inferior epigastric artery as a cuff interposition in renal artery reconstruction,offering a novel and effective technique for managing short renal arteries in kidney transplantation.CONCLUSION Interposition of the epigastric artery offers an innovative technique for managing short donor renal arteries,reducing the risk of early thrombosis and long-term complications as size mismatch and intimal hyperplasia.展开更多
Sirenomelia is a rare and lethal condition and its etiopathogenesis is unclear. The diagnosis is based on first trimester ultrasound showing a complete fusion of soft tissue in both lower limbs and other visceral abno...Sirenomelia is a rare and lethal condition and its etiopathogenesis is unclear. The diagnosis is based on first trimester ultrasound showing a complete fusion of soft tissue in both lower limbs and other visceral abnormalities. We report in this article, the misdiagnose of sirenomelia as IUGR leading the other to continue the pregnancy until 35 weeks of gestation.展开更多
The Moroccan automotive industry is experiencing steady growth,positioning itself as the largest manufacturer of passenger cars in Africa.This expansion is leading to a significant increase in waste generation,particu...The Moroccan automotive industry is experiencing steady growth,positioning itself as the largest manufacturer of passenger cars in Africa.This expansion is leading to a significant increase in waste generation,particularly from end-of-life vehicles(ELVs),which require proper dismantling and disposal to minimize environmental harm.Millions of tonnes of automotive waste are generated annually,necessitating efficient waste management strategies to mitigate environmental and health risks.ELVs contain hazardous substances such as heavy metals,oils,and plastics,which,if not properly managed,can contaminate soil and water resources.To address this challenge,reverse logistics networks play a crucial role in optimizing the recovery of used components,enhancing recycling efficiency,and ensuring the safe disposal of hazardous and non-recyclable waste.This paper introduces a mathematical programming model designed to minimize the total costs associated with ELVs collection,treatment,and transportation while also accounting for revenues from the resale of repaired,directly reusable,or recycled components.The proposed model determines the optimal locations for processing facilities and establishes efficient material flows within the reverse logistics network.By integrating economic and environmental considerations,this model supports the development of a sustainable and cost-effective automotive waste management system,ultimately contributing to a circular economy approach in the industry.展开更多
Object detection in occluded environments remains a core challenge in computer vision(CV),especially in domains such as autonomous driving and robotics.While Convolutional Neural Network(CNN)-based twodimensional(2D)a...Object detection in occluded environments remains a core challenge in computer vision(CV),especially in domains such as autonomous driving and robotics.While Convolutional Neural Network(CNN)-based twodimensional(2D)and three-dimensional(3D)object detection methods havemade significant progress,they often fall short under severe occlusion due to depth ambiguities in 2D imagery and the high cost and deployment limitations of 3D sensors such as Light Detection and Ranging(LiDAR).This paper presents a comparative review of recent 2D and 3D detection models,focusing on their occlusion-handling capabilities and the impact of sensor modalities such as stereo vision,Time-of-Flight(ToF)cameras,and LiDAR.In this context,we introduce FuDensityNet,our multimodal occlusion-aware detection framework that combines Red-Green-Blue(RGB)images and LiDAR data to enhance detection performance.As a forward-looking direction,we propose a monocular depth-estimation extension to FuDensityNet,aimed at replacing expensive 3D sensors with a more scalable CNN-based pipeline.Although this enhancement is not experimentally evaluated in this manuscript,we describe its conceptual design and potential for future implementation.展开更多
Introduction:When conservative treatments fail,botulinum toxin A(BoNT-A)is an option for refractory idiopathic overactive bladder(OAB).This review evaluates the efficacy,safety,and predictive factors for BoNT-A in thi...Introduction:When conservative treatments fail,botulinum toxin A(BoNT-A)is an option for refractory idiopathic overactive bladder(OAB).This review evaluates the efficacy,safety,and predictive factors for BoNT-A in this situation.Material and Methods:A literature search up to January 2025 was performed using PubMed,Google Scholar,and Embase to assess efficacy,safety,and predictors of adverse events(AE)related to BoNT-A.The risk of bias was assessed using the Risk of Bias 2(RoB 2)tool for randomized studies and the Critical Appraisal Skills Programme(CASP)checklist for cohort studies.The quality of the review was evaluated based on the Oxford criteria,following the Strengthening the Assessment of Narrative Review Articles(SANRA)guidelines,and by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines for systematic reviews.Results:31 studies were included,involving 5410 patients.BoNT-A improves OAB symptoms even after reinjections.Higher doses do not enhance efficacy but increase AE.AE includes high post-void residual(PVR),clean intermittent self-catheterization(CISC),and Urinary Tract Infection(UTI).Predictors of CISC include age,male gender,hysterectomy,≥3 vaginal deliveries,mixed incontinence,prior mid-urethral sling(MUS),high PVR,low Pressure at Pdet at First Micturition(PIP1)in women,low Bladder Compliance Index(BCI)in men,and high Bladder Outlet Obstruction Index(BOOI).Diabetes and heart failure increase PVR.UTIs are more frequent in women and men with benign prostatic hyperplasia,with CISC increasing the risk fivefold.Severe complications are rare.Predictors of poor response include male gender,high BOOI,low urinary flow,and diabetes.Discussion:BoNT-A is effective for OAB,especially for incontinence.AE is dose-dependent and limits treatment adherence.Their link with poor response remains unclear.Conclusion:BoNT-A effectively treats refractory idiopathic OAB,improving symptoms and quality of life with repeated injections.展开更多
A classification of multipartite entanglement is introduced for pure and mixed states.The classification is based on the distribution of entanglement between the qubits of a given system,with a mathematical framework ...A classification of multipartite entanglement is introduced for pure and mixed states.The classification is based on the distribution of entanglement between the qubits of a given system,with a mathematical framework used to characterize fully entangled states.Then we use current machine learning and deep learning techniques to automatically classify a random state of two,three,and four qubits without the need to compute the amount of the different types of entanglement in each run;rather this is done only in the learning process.The technique shows high,near-perfect,accuracy in the case of pure states.As expected,this accuracy drops,more or less,when dealing with mixed states and when increasing the number of parties involved.展开更多
文摘Introduction: Renal lithiasis is a very common condition worldwide, linked to the presence of calculi in the urinary tract. It is multifactorial, recurrent and serious. It is the 3rd leading cause of chronic kidney disease (CKD) in Morocco. The aim of our study is to describe the clinical, paraclinical and management aspects of renal lithiasis in our patients, to determine the factors of recurrence of renal lithiasis and to identify the factors of progression of renal failure. Materials and Methods: This is a retrospective, descriptive and analytical study conducted in the nephrology department of CHU IBN Sina in Rabat, over a 3-year period from 2020 to 2023. We included 160 patients with renal lithiasis having a follow-up in our training. We analyzed their epidemiological, clinical, paraclinical and therapeutic profile. Results: The mean age of our patients was 56 +/− 16.6 years, with a M/F sex ratio of 1.02. Lithiasis was expressed by renal colic in 71% of cases, and by stone emission in 31% of cases, although discovery was incidental in 16% of cases. At the time of the first consultation, 59% of patients had renal failure (RF), 15% of whom were at the stage of chronic end-stage renal disease. Crystalluria and calculus spectrophotometry were performed in only 30% and 22% of patients respectively. All patients benefited from hygienic and dietary measures according to the nature of the stone, as well as additional urological management. Recurrence of renal lithiasis was reported in 36% of cases. In univariate analysis, advanced age, male gender, diabetes, hypertension and the presence of recurrent urinary tract infection were factors in the progression to CKD (OR = 0.979, p = 0.035;OR = 0.527, p = 0.48;OR = 4.127, p = 0.015;OR = 1.926;p = 0.015, OR = 2.5 p = 0.019, respectively). In multivariate analysis, only diabetes and high baseline creatinine were factors in the progression to CKD. Recurrence of renal lithiasis was reported in 36.5% of cases. Only the presence of a history of familial lithiasis and of renal cysts on imaging were significantly associated with a risk of renal lithiasis recurrence in univariate analysis. (OR = 3.06, p = 0.035;OR = 5.27, p = 0.017, respectively). Conclusion: Renal lithiasis is a disabling pathology that can be complicated by recurrence and chronic end-stage renal failure. Early diagnosis and identification of factors leading to the recurrence and progression of chronic renal failure could improve management.
文摘Goal: Evaluate the techniques and results obtained from the mammary Oncoplastic in the conservative treatment of breast cancer. Patients and methods: This is a retrolective descriptive study conducted during the period from 3 April 2017 to 3 April 2019, the Gynecologic Breast pole of the Oncology National Institute of Rabat. Results: Out of 105 files listed, the locations of the tumours were: 35% 37/105 QSE, QSI QSE + 21/105 or 20%, QSI 19/105 or 18%, QSI 12/105 or 11%, other maps 16/105 or 16%. The techniques were Oncoplastic: Pamectomy 10/105 or 10% Round Block 58/105 or 55%, plasty inverted T 21/105 or 20%, and other technical 16/105 or 15%. The aesthetic results and the quality of resection were correct and above all stable at 82/105 patients 78% of cases. The lymphocele 13/105 or 12% 5/105 5% lymphoedema represented early complications occurred as late complications consisted of retractile unsightly scars 15/105 or 14%, breast asymmetry 13/105 soit12% and cutaneous sclerosis 3/105 or 3%. Conclusion: The oncoplastic surgery is a part of multidisciplinary management of breast cancer. It imposes oncologic resections and reassuring cosmetic results for the patient and the practitioner.
文摘<strong>Background and Purpose:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> Paragangliomas are rare tumors of the head and </span><span style="font-family:Verdana;">neck. Their management remains problematic and</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">varies considerably de</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">pending on the center. This study reported 14 years of experience in the</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> management of head and neck paraganglioma (HNPGls)</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">.</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;"> We aimed to assess the therapeutic results of these tumors in terms of local control and overall survival. </span><b><span style="font-family:Verdana;">Materials and Methods</span></b><span style="font-family:Verdana;">: We included 16 patients followed for HNPGls and treated by radiotherapy from January 2006 to June 2018 in the National Institute of Oncology in Rabat. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> The median age was 44.5 years (15 - 67). 13 patients were female and three male with a sex ratio of 4.3. Cervical mass was the common sign (56</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">.</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">3%). All patients received radiation therapy. This radiation was exclusive in 43.7% of cases or adjuvant to partial surgical resection in 56.3%. The median dose of radiotherapy was 54 Gy (46 - 60) and it was delivered by a three-dimensional conformal radiotherapy technique in 15 patients and volumetric modulated arc therapy in one. There were few acute complications such as grade I and II mucositis and dermatitis. After a median follow-up of 5.6 years (2 - 13.4), local control, defined by radiological stability or regression, was obtained in 14 patients, two patients progressed and one died. Progression-free survival rates at 5 and 7 years were 93.8% and 78.1% respectively, and overall survival at 5 and 7 years was 92.3%. </span><b><span style="font-family:Verdana;">Conclu</span><span style="font-family:Verdana;">sions:</span></b><span style="font-family:Verdana;"> Surgery is the first-line treatment for HNPGls. When surgery is not</span><span style="font-family:Verdana;"> possible or incomplete, radiotherapy has its place in the therapeutic strategy of this rare disease for long-term local control.</span></span></span></span>
文摘This study is focused on two types of Moroccan rocks, among the most widely used as building stones: the calcarenite of Salé (CS) and the marble of oued Akrech (MA). The two rocks, lithologically different, show a clear contrast of their P-wave velocities (Vp): 3.90 vs 5.10 km/s at dry state and 4.29 vs 5.64 km/s at saturation. The “Artificial fractures” created in the two rock types reveal that their Vp undergo diminutions which the rates vary depending of the number and the plane orientation of the fractures. In the CS, Vp shows an increasing of cumulative diminution (Dc) according to the number of fractures, but with a variable rate of unitary diminution (Du) from one fracture to the other. This defines a linear regression with a low coefficient of determination (Dc = 10.18NbFr + 10.96;r2 = 0.87). The mode of the Vp evolution would be related to the roughness of fractures surface, which itself depends upon the petrographic nature of the calcarenite (friable structure, high porosity and heterogenous composition). The MA manifested an increasing Dc with a fairly constant rate of Du from a fracture to another, giving a regression line with a high coefficient of determination (Dc = 12.17NbFr – 10.69;r2 = 0.99). This steady diminution of Vp would be related to the granoblastic texture and the monomineral composition of the marble, which engender smoother fracture surfaces. The rates of Vp diminution also depend on the orientation plane of the fractures relative to the direction of wave propagation. The fractures parallel (θ = 0°) amplify slightly the Vp, playing a significant role of “waveguide”. The fractures oriented at 45° lead to a diminution lower than those of fractures oriented at 25° and 90°. The same trend of diminution, but at variable rates, appears on the samples of the two types of stones at dry and saturated state. This can be explained by the compressive nature of P-waves, which obey the physic laws of the transmission of the constraints in the solid mediums.
文摘<strong>Introduction:</strong> <span><span><span style="font-family:""><span style="font-family:Verdana;">Chordoma is a rare bone tumor, which develops mainly from the sacrum, the base of the skull, or the spine. Surgery + radiotherapy (if necessary) is the standard treatment. Data on chordoma are scarce in this re</span><span style="font-family:Verdana;">gion, and thus, here we summarized 9 patients with this tumor whom we</span><span style="font-family:Verdana;"> treated in this institute. </span><b><span style="font-family:Verdana;">Material: </span></b><span style="font-family:Verdana;">Nine chordoma patients were summarized, who were treated in National Institute of Oncology in Rabat between 2013 </span><span style="font-family:Verdana;">and 2018. We retrieved data from medical charts and analyzed the clinical</span><span style="font-family:Verdana;"> characteristics of this tumor. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">The average age was 49 years (range: 29 </span><span style="font-family:Verdana;">- 72), with male: female of 3:6. The manifestation-diagnosis time was 4</span><span style="font-family:Verdana;"> months (range: 2 - 14). Regarding the tumor location, lumbosacral spine;5, the skull;4. Mass was evident in 6. Signs of locoregional compressions (paraparesis or tetraparesis) were observed in 3. As for treatment, a partial tumor excision was performed in 8, with 3 patients undergoing a wide excision. Radiotherapy was done;3 patients with a dose of 46 Gy, 3 patients with 66 Gy, 1 patient with 50 Gy, and 1 patient with a 16 Gy gamma radio-knife in a single session. 4 patients with a dose of 46 Gy, 2 patients with 60 Gy, and 1 patient with a 16 Gy gamma radio-knife in a single session. Of 9, 4 patients had good locoregional control whereas 5 patients had local recurrence. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Chordoma is a predominantly local aggressive tumor with low metastatic potential. The surgical excision remains the main prognostic factor. Advances in radiotherapy may improve local control. These data are of use in management of this tumor in Rabat (Morocco).</span></span></span></span>
文摘Natural materials(e.g. rocks and soils) are porous media, whose microstructures present a wide diversity.They generally consist of a heterogeneous solid phase and a porous phase which may be fully or partially saturated with one or more fluids. The prediction of elastic and acoustic properties of porous materials is very important in many fields, such as physics of rocks, reservoir geophysics, civil engineering, construction field and study of the behavior of historical monuments. The aim of this work is to predict the elastic and acoustic behaviors of isotropic porous materials of a solid matrix containing dry, saturated and partially saturated spherical pores. For this, a homogenization technique based on the Morie Tanaka model is presented to connect the elastic and acoustic properties to porosity and degree of water saturation. Non-destructive ultrasonic technique is used to determine the elastic properties from measurements of P-wave velocities. The results obtained show the influence of porosity and degree of water saturation on the effective properties. The various predictions of Morie Tanaka model are then compared with experimental results for the elastic and acoustic properties of calcarenite.
文摘Background: The practice of exclusive breastfeeding (EB) in Morocco has witnessed a worrying decline in recent decades, contrary to the recommendations of the World Health Organization (WHO) which advocates it during the first six months as a significant public health tool. The present study aims to assess the impact of educational materials on mothers’ behaviour with regard to keeping up EB as long as six months, at least. Methods: This is a cohort study with a prospective collection of data over a period of one year, through a questionnaire-based survey of 500 women who delivered at the Souissi Maternity Hospital in Rabat. The subjects were divided into an intervention group sensitized, during the medical visit, by means of information delivered orally about breastfeeding and a booklet containing instructions on breastfeeding management and the benefits of EB, especially when extended for the first six months;and a control group attending the same operation with no awareness-rising through educational materials. To assess EB rates, the subjects had been followed for six months through telephone. Results: 372 women who delivered were followed, 194 from the intervention group and 178 from the control group. The remaining 128 women not followed were lost sight of. A higher percentage of mothers in the intervention group exclusively breastfed their babies up to the age of six months compared to the control group, 55.2% against 38.8% (p = 0.002). The main reason produced by most mothers who ceased to exclusively breastfeed their babies is milk insufficiency. Conclusion: The postnatal nutritional education strategy based on the distribution of educational materials has considerably raised the number of women who exclusively breastfed their babies until the age of six months.
文摘Introduction: Cardio-renal syndrome (CRS) is a complex pathophysiological entity affecting the heart and kidneys in which acute or chronic dysfunction of one organ can induce acute or chronic dysfunction of the other organ. Five types of CRS have been described. Methods: The study explored the prevalence and types of Cardiorenal Syndrome (CRS) at CHU Ibn Sina in Rabat. Over a year, 120 CRS patients were assessed, excluding those with end-stage chronic renal failure. We analyzed the epidemiological, clinical, therapeutic and evolutionary profile of these patients. Results: The average age of our patients is 67.8 ± 12 years, with extremes ranging from 39 years to 92 years. The sex ratio is 1.35. The different types of CRS types (1, 2, 4 and 5) were noted respectively in 28.4%, 20.8%, 5%, 45.8%, however, we did not note patients having CRS type 3. On the renal level, we noted acute renal failure (ARF) in 51.6% of patients, of whom 61.3% had functional ARF and 38.7% presented with acute tubular necrosis. Chronic renal failure (CRF) is found in 48.4% of cases, of which 39% are at stage III and 61% are at stage IV. The etiology of CKD is dominated by hypertensive nephropathy (72.4%) followed by diabetic nephropathy (60.3%). Therapeutically diuretics are administered in 51% of our patients. We used hemodialysis in 9.1% of patients who are resistant to diuretics. Vasoactive drugs are used in 9.5% of our patients. Mortality risk factors for patients with CRS are significantly related to advanced age, long hospital stay, type 1 CRS, re-hospitalization, acute pulmonary edema (APE), use of hemodialysis, right heart failure (RHF), valvulopathy and hemodynamic instability (OR = 1.15, p = 0.01;OR = 4.5, p = 0.03;OR = 5.2, p = 0.019;p Conclusion: CRS type 5 was most common, with hypertension and diabetes being primary causes of Chronic Kidney Disease. Mortality factors were linked to acute pulmonary edema, hemodialysis, right heart failure, valvulopathy, and re-hospitalization.
文摘Hypofractionated radiation therapy has proven effective on locoregional control and tolerance in the adjuvant treatment of breast cancer. The aim of this study is to compare the results of hypofractionated radiation therapy versus conventional radiation therapy in terms of local control and tolerance. It was a retrospective study of patients observations collected from January 2007 to December 2008 in Department of Radiation Therapy in Institut National d’Oncologie de Rabat. The treatment results were evaluated by the rate of locoregional recurrence, distant recurrence and research of late toxicities. Radiotherapy was delivered using the same technique in both groups, by gamma photons of cobalt 60 with an energy of 1.25 MeV. They were 2 groups: the first group treated with standard dose rate and the second group treated by hypofractionated radiation therapy. The mean age of the patients was 42.8 ± 6.9 years old in the standard group and 43.22 ± 7.2 years old in the hypofractionation group. We noted a predominance of infiltrating ductal carcinoma. The majority of patients were pT<sub>2</sub>, pN<sub>0</sub> and pN<sub>1</sub>.<sub> </sub>The majority of patients had radical surgery and chemotherapy with anthracyclines in both groups. We noted a statistically significant difference in the irradiation of chest wall between the standard (89.2%) and hypofractionated group (70.3%), with p = 0.043. The median duration of radiation therapy was statistically different in both groups: 39 days in the standard and 23 days in the hypofractionated group (p 0.001). The local recurrences were statistically identical to 12 and 24 months (p = 0.999). Concerning toxicities, the frequency of adverse event was similar in both groups. Hypofractionated radiation therapy with a total dose of 42 Gy at 2.8 Gy per fraction in 5 fractions weekly is comparable to standard radiotherapy in terms of local control and tolerance and is therefore a very good alternative to standard treatment.
文摘Risk of infection by hepatitis B (HBV) and C (HCV) viruses remains a permanent problem, not only for health care workers but also for patients. It is often a major public health concern in low incomes countries. The aims of this study were to determine seroprevalence of viral hepatitis B (HBV) and C (HCV), frequency occurrence of blood exposure accidents (BEA) and identify key risk factors for infection among 601 health care workers of Ibn Sina Hospital in Rabat. In this study nineteen health personnel (3.16%) were HBsAg positive and fifteen (2.50%) were anti-HCV antibodies positive. The seropositivity to hepatitis B and C in the surgical department respectively was 4.22% and 3.45%. Nurses were the most affected by hepatitis virus infections. We noticed that HCV came first with a prevalence of 4.44%. The seropositivity reached its acme within the health staff having practiced for more than 20 years, hepatitis C coming first with a prevalence of 4.27%. Globally, 34 health care personnel are positive for HBV or HCV, 32 among them were victims at least once of blood exposure accident (BEA) while practicing. The needlestick represented 81.25% of the BEA type. Prevalence of hepatitis B and C serologic markers in health care workers in our Hospital outnumbered that of the general population. Nurses, surgery department personnel and the professional having worked for a long time were the main factors behind the high risks of infections.
文摘Carbon monoxide （CO） intoxication is one of the most common types of poisoning in the modem world. To better tailor messages and communication needs to the public, a perception survey of CO and his risk was conducted among the population of Rabat-Sale-Zemmour-Zaer. The authors included 400 people in this survey. The demographic characteristics of the respondents consisted of： 85.0% female, 92.9% adults, 29.7% had a high level of education, 49.6% unemployed, 89.5% were home owners and 53.9% lived in apartments. Water heaters were present in the homes of 91.0% of respondents and 6.5% of them used gas. Gas was used as fuel in 45.4% of cases. For water heaters, 20.8% had an exhaust duct, 9.9% were serviced regularly and 47.5% were installed in a well ventilated area. Regarding the media, television was the medium that allowed 73.4% of the CO to know, regardless of age, sex and level of education among the 94.3% of who ever heard of this deadly gas before the survey.
文摘Background: chronic subdural hematoma is a common pathology, especially in the elderly. Although it has a good prognosis, it poses the problem of recurrence after surgical evacuation. Objective: To analyze the risk factors of reoperation in patients surgically treated for chronic subdural hematoma (cSDH) and evaluate the outcome of patients who benefited from a reoperation. Materials and Methods: A retrospective review was conducted in a single University Hospital Center in Rabat (Morocco) on 49 patients operated on from January 2020 to June 2021 for cSDH. Possible risk factors described in the literature were analyzed and the outcome of post-operative course was evaluated. Statistical significance was defined by p-value Results: 49 patients underwent surgical evacuation of cSDH. The sex ratio of male/female was 3.08. The mean age was 70.6 years. Concerning the medical history, 8.2% were diabetics, 10.2% had heart disease, 18.4% had hypertension, 16.3% associated of comorbidities, 2% had pulmonary embolism, and 2% had neoplasm. 18.4% were on anticoagulation therapy, no patients were on new oral anticoagulants. The clinical findings upon admission were motor deficit at 57.1%, signs of intracranial hypertension at 20.4%, altered consciousness at 16.9% and impaired behavior at 6.1%. 28.6% of patients had a past history of head trauma. The pre-operative CT scan showed unilateral cSDH at 81.6%, midline shifts at 77.6%, and false membranes at 34.7%. Blood appeared chronic at 40.8%, subacute at 24.5%, and mixed densities at 34.7%. The post-operative course was uneventful in 73.5%. According to Ibanez grading 8 patients had mild complications (grade I) and 5 moderate complications (grade II) after the first surgery. We recorded 10.2% of patients who needed a second surgery because of the deterioration of neurologic status or motor deficit associated with an abnormal CT scan. According to the GOS, 85.7% of patients had a good recovery while 10.2% died. None of the factors assessed was found to be a risk factor for reoperation. Conclusion: No risk factors of reoperation after an initial burr hole evacuation for cSDH were found. However medical history and male sex was common condition among reoperated patients with their CT scan showing a chronic aspect of blood, midline shift and false membranes. Most patients who underwent revision surgery died on the postoperative course.
文摘The iTrace Dysfunctional Lens Index (DLI) offers a quantitative approach to lens assessment, potentially facilitating the early detection of cataracts. Globally, the prevalence of cataracts has increased due to aging populations, and in Morocco, they remain a significant cause of reversible blindness. This study examines the specificity and sensitivity of the DLI in identifying cataracts among a large sample of patients, focusing on differentiating early-stage cataracts from other conditions that affect visual quality. The DLI, which generates a score from 0 to 10, provides an objective lens quality measure, with lower values indicating dysfunction. In a cohort of 621 patients (1242 eyes), 243 eyes displayed a DLI < 5. Of these, 56 eyes had confirmed cataracts and 187 eyes presented with various ocular conditions but clear lenses. The results demonstrate 100% sensitivity for identifying cataracts within the DLI < 5 threshold, with a specificity of 72.4%. These findings highlight the utility of DLI as a diagnostic tool for early-stage cataracts despite variability influenced by ocular characteristics such as axial length and keratoconus.
文摘Work-related stress has become an alarming reality that continues to intensify over the past decades. The pressure exerted by the work environment demands the utilization of defensive and coping strategies to deal with it. Our study aims to explore the relationship between professional stress factors, stress symptoms, and the consumption of psychoactive substances as a defensive and coping strategy deployed to address psychological distress at work. A qualitative and quantitative study was conducted with a sample of 405 employees from a wiring manufacturing. The main professional stress factors identified were concentration, overload, long working hours, and monotony, which showed a significant correlation with PAS consumption. Women were found to be more affected by stress and tended to consume more sedatives. Among the respondents, 21.98% reported PAS consumption, with tobacco being the most commonly used (M = 2.66), followed by alcohol (M = 1.94), cannabis (M = 1.79), and sedatives (M = 1.45). There was a significant positive correlation between PAS consumption and stress symptoms {tobacco (r = 0.232*), alcohol (r = 0.305**), cannabis (r = 0.389**)}.
文摘BACKGROUND Kidney transplantation is increasingly more common due to the ongoing shortage of deceased donors.However,anatomical challenges,such as a short renal artery,can complicate surgical procedures and increase complication risk,including thrombosis and anastomotic stenosis.To address these issues and optimize graft outcomes,innovative surgical techniques are essential.CASE SUMMARY We present a case of kidney transplantation complicated by a short donor renal artery.To address the discrepancy between arterial length and diameter mismatch,the recipient’s inferior epigastric artery was used as a cuff interposition for arterial reconstruction.Following standard laparoscopic donor nephrectomy,vascular reconstruction was performed on the back table.The use of the inferior epigastric artery as a cuff allowed for successful elongation and size matching of the donor renal artery,enabling a tension-free anastomosis to the recipient’s external iliac artery.Postoperative Doppler ultrasound and angiography confirmed excellent graft perfusion.The patient experienced an uneventful recovery with immediate graft function and maintained stable renal function at 6 months post-transplant.To our knowledge,this is the first reported use of the inferior epigastric artery as a cuff interposition in renal artery reconstruction,offering a novel and effective technique for managing short renal arteries in kidney transplantation.CONCLUSION Interposition of the epigastric artery offers an innovative technique for managing short donor renal arteries,reducing the risk of early thrombosis and long-term complications as size mismatch and intimal hyperplasia.
文摘Sirenomelia is a rare and lethal condition and its etiopathogenesis is unclear. The diagnosis is based on first trimester ultrasound showing a complete fusion of soft tissue in both lower limbs and other visceral abnormalities. We report in this article, the misdiagnose of sirenomelia as IUGR leading the other to continue the pregnancy until 35 weeks of gestation.
文摘The Moroccan automotive industry is experiencing steady growth,positioning itself as the largest manufacturer of passenger cars in Africa.This expansion is leading to a significant increase in waste generation,particularly from end-of-life vehicles(ELVs),which require proper dismantling and disposal to minimize environmental harm.Millions of tonnes of automotive waste are generated annually,necessitating efficient waste management strategies to mitigate environmental and health risks.ELVs contain hazardous substances such as heavy metals,oils,and plastics,which,if not properly managed,can contaminate soil and water resources.To address this challenge,reverse logistics networks play a crucial role in optimizing the recovery of used components,enhancing recycling efficiency,and ensuring the safe disposal of hazardous and non-recyclable waste.This paper introduces a mathematical programming model designed to minimize the total costs associated with ELVs collection,treatment,and transportation while also accounting for revenues from the resale of repaired,directly reusable,or recycled components.The proposed model determines the optimal locations for processing facilities and establishes efficient material flows within the reverse logistics network.By integrating economic and environmental considerations,this model supports the development of a sustainable and cost-effective automotive waste management system,ultimately contributing to a circular economy approach in the industry.
文摘Object detection in occluded environments remains a core challenge in computer vision(CV),especially in domains such as autonomous driving and robotics.While Convolutional Neural Network(CNN)-based twodimensional(2D)and three-dimensional(3D)object detection methods havemade significant progress,they often fall short under severe occlusion due to depth ambiguities in 2D imagery and the high cost and deployment limitations of 3D sensors such as Light Detection and Ranging(LiDAR).This paper presents a comparative review of recent 2D and 3D detection models,focusing on their occlusion-handling capabilities and the impact of sensor modalities such as stereo vision,Time-of-Flight(ToF)cameras,and LiDAR.In this context,we introduce FuDensityNet,our multimodal occlusion-aware detection framework that combines Red-Green-Blue(RGB)images and LiDAR data to enhance detection performance.As a forward-looking direction,we propose a monocular depth-estimation extension to FuDensityNet,aimed at replacing expensive 3D sensors with a more scalable CNN-based pipeline.Although this enhancement is not experimentally evaluated in this manuscript,we describe its conceptual design and potential for future implementation.
文摘Introduction:When conservative treatments fail,botulinum toxin A(BoNT-A)is an option for refractory idiopathic overactive bladder(OAB).This review evaluates the efficacy,safety,and predictive factors for BoNT-A in this situation.Material and Methods:A literature search up to January 2025 was performed using PubMed,Google Scholar,and Embase to assess efficacy,safety,and predictors of adverse events(AE)related to BoNT-A.The risk of bias was assessed using the Risk of Bias 2(RoB 2)tool for randomized studies and the Critical Appraisal Skills Programme(CASP)checklist for cohort studies.The quality of the review was evaluated based on the Oxford criteria,following the Strengthening the Assessment of Narrative Review Articles(SANRA)guidelines,and by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines for systematic reviews.Results:31 studies were included,involving 5410 patients.BoNT-A improves OAB symptoms even after reinjections.Higher doses do not enhance efficacy but increase AE.AE includes high post-void residual(PVR),clean intermittent self-catheterization(CISC),and Urinary Tract Infection(UTI).Predictors of CISC include age,male gender,hysterectomy,≥3 vaginal deliveries,mixed incontinence,prior mid-urethral sling(MUS),high PVR,low Pressure at Pdet at First Micturition(PIP1)in women,low Bladder Compliance Index(BCI)in men,and high Bladder Outlet Obstruction Index(BOOI).Diabetes and heart failure increase PVR.UTIs are more frequent in women and men with benign prostatic hyperplasia,with CISC increasing the risk fivefold.Severe complications are rare.Predictors of poor response include male gender,high BOOI,low urinary flow,and diabetes.Discussion:BoNT-A is effective for OAB,especially for incontinence.AE is dose-dependent and limits treatment adherence.Their link with poor response remains unclear.Conclusion:BoNT-A effectively treats refractory idiopathic OAB,improving symptoms and quality of life with repeated injections.
基金supported through computational resources of HPC-MARWAN(www.marwan.ma/hpc)provided by CNRST,Rabat,Morocco。
文摘A classification of multipartite entanglement is introduced for pure and mixed states.The classification is based on the distribution of entanglement between the qubits of a given system,with a mathematical framework used to characterize fully entangled states.Then we use current machine learning and deep learning techniques to automatically classify a random state of two,three,and four qubits without the need to compute the amount of the different types of entanglement in each run;rather this is done only in the learning process.The technique shows high,near-perfect,accuracy in the case of pure states.As expected,this accuracy drops,more or less,when dealing with mixed states and when increasing the number of parties involved.
