Physiology and Anatomy

Leukemia is a common malignancy in young children. Acute lymphoblastic leukemia (ALL) accounts for %75 of all leukemia which has higher incidence in boys than to girls except during the first year of life. This study is the survey of oral manifestations in children who are suffering from leukemia and lymphoma in Amir Blood and Oncology Hospital ,Shiraz ,Iran. Method &Material: In this 18 months durated study, the oral manifestations of 200 patients was analyzed including gingival bleeding &hyperplasia, pale mucosa hairy tongue, oral candidiasis, toothache and oral ulcers. The data obtained was subjected to statistical analysis using Chi-square test. Significance for all the statistical test was predetermined at a P value of 0.05 or less.

the study of the bacterial ecology in a surgical intensive care unit has a huge interest for the fight against the infections. the aim of this work is to analyze the epidemiological and the bacteriological profiles of infections, also to identify the risk factors and others influence the prognosis, finally to propose the measures of prevention. during one year at the bacteriology unit of mohammed V military teaching hospital of Rabat city in Morocco this prospective study was giving: the results of the total samples about the surgical intensive care unit patients. The characteristics of the patients “having infectious state” in intensive care unit: the middle age is 45,5 years old, the majority of cases correspond to male people, the high blood pressure (35,29%) and diabetes (23,53%) are the most frequent breeding . the severe cranial trauma corresponds to the most cases (16, 33%), secondly, we find the polytrauma 14, 28%. the infection incidence was considered as 6, 10%. the gram-negative bacilli are the most observed (69, 23%), secondly, we find the gram-positive cocci 23,10%. the klebsiella pneumoniaei is the most frequently identified species (25%), is the most frequently isolated on catheters samples, it has an important susceptibility to imipeneme. the acinetobacter baumanii is present in the second row (13,46%), having a susceptibility to colistine. the escherichia coli (9, 62%) and staphylococcus coagulase negative (9,62%) are both in the third row, this one is the most frequently isolated species in blood cultures and presents a neatly susceptibility to teicoplanine and vancomicine. in the fourth row we find enterococcus faecalis (7, 69%), corresponds to the second germ isolated from protected bronchial specimens, pratically found in the almost specimens, and presents a high susceptibility to ampicilline, vancomycine and teicoplanine. the mortality dealing with infections is 55, 56%, while the mortality happened to “sepsis states” is 20%; the male people are frequently affected (73%). a global strategy of prevention must be established for fighting infections and making better the prognosis.

Acute upper gastrointestinal bleeding (UGIB) is a common emergency and can be a serious condition that requires hospitalization, rapid evaluation and management. The usual presentation is hematemesis (vomiting of blood or coffee ground-like material) and/or melena (black, tarry stools). UGIB occurs more commonly in men and older subjects. Peptic ulcers are the most common cause of UGIB. Esophago-Gastro-Duodenoscopy (EGD) is a primary diagnostic and therapeutic modality in the setting of UGIB. This study aims to evaluate causes and outcomes of UGIB in the emergency. Material and methods: monocentric study conducted from January 2019 to January 2024. Were included all patients hospitalized by our Unit for a UGIB as : hematemesis and/or melena and/or hematochesia with severe anemia or hemodynamic instability. All patiennts had an oesophagogastroduodenoscopy (EGD) to find the cause of bleeding and for a therapeutic approach when possible. Results: A total of 737 individuals underwent UGE for UGIB during the study period. Mean age was 56,3 years and 58,7% of patients were male. Among all patients, 17.3% reported consumption of NSAIDs and 21,4% were taking anti-thrombotics. The most frequent presenting symptom was isolated melena in 37,8% followed by melena associated with hematemesis in 31,4%, isolated hematemesis in 27,4% and abundant hematochezia in 3,4%. Hemodynamic instability was seen in 24,5% of patients. Ulcers were the most common cause of bleeding seen in 36,9% : duodenal in 23% of the patients and gastric in 13,9%. 59% of those ulcers were classified Forrest III. Esophageal and fundal varices were found in 19,8% of the cases. The other causes of bleeding were : oesophagitis in 12,2% of the patients, gastritis (including gastric erosions) in 10%, gastric or duodenal neoplasm in 9,3%, vascular anomaly in 2,2% and postoperative in 1,6%. The oesogastroduodenoscopy was normal in 8% of the patients. Regarding therapeutic interventions, 41,5% had undergone therapeutic endoscopy. Conclusion: UGIB is a frequent cause of hospitalization in the emergency. EGD has a diagnostic as well as therapeutic role in UGIB .In this study endoscopy provided diagnosis in 92% of patients. We found duodenal ulcers as the most common cause of upper GI bleeding followed by gastric ulcers, and clean based ulcers were the most common type of peptic ulcers. Varices are an important cause of massive variceal bleed. NSAIDs and anti-thrombotics are important factors for UGIB.

The ventilatory failure after a programmed extubation is defined as the inability to maintain spontaneous ventilation within a period of 72 hours of surveillance. The incidence of this problem is approximately 15%, and causes related to respiratory problems include 28% of the total being the principal cause of ventilatory failure and left ventricular dysfunction is the second cause. The criteria used to determine the possibility to extubate a patient only include respiratory factors; from the cardiac point of view only contemplates the use of amines. So far there is no a reliable noninvasive marker that can predict heart failure as a cause of ventilatory failure. Considering that the increase in ventilatory mechanics defines the majority of cases of ventilatory failure after extubation, it is possible that a tissue hypoperfusion marker could discern those patients with the possibility of ventilatory failure. In situations with low tissue perfusion, the difference in carbon dioxide is seen as an increase in CO2 in the venous blood and related to a decrease in cardiac output according to Fick equation. The amount of CO2 in venous blood is dependent on blood flow. For this reason, an increase in the venous-arterial CO2 difference reflects a decrease in blood flow and tissue hypoperfusion that could be used as a predictor of failure in extubation. We propose delta CO2 as a risk marker for ventilatory failure after extubation.

Non-Hodgkin's malignant lymphomas are malignant haemopathies characterized with clinical and anatomy diversity. Mycosis associated lymphoma tissue (MALT) is part of marginal zone B-cell lymphoma. The stomach is the most common site. We report in this study, a case of a 57 year old woman with no particular history who presented a right superior eyelid and orbit tumor with the exophthalmos. Context of fever noted in the progression. The immunohistochemistry of the biopsy of this tumor concludes with a MALT lymphoma. Nowadays such a case has seldom been published. After using Rituximab, cyclophosphamide, vincristine and prednisone, all the tumefactions disappeared. This case was interesting because of the rarity localisation of this lymphoma, and shows the interest of a first biopsy before any surgical excision of tumor.

The history of cannabis in Morocco goes back several centuries. Its consumption was subject to social norms limiting its market as well as its impact on society. The advent of the protectorate (1912-1956) made cannabis an economic product of great value through a monopoly of its cultivation and marketing despite the undeniable impact on public health. This article traces the history of cannabis in Morocco from its earliest origins, passing through multiple historical events that marked the place of this product in Moroccan society and finally pausing on the great change that will experience the cultivation and consumption of cannabis under the protectorate.

A carotid web (CW), an atypical fibromuscular dysplasia, is rare and may cause ischemic stroke. It is challenging to recognize a carotid web promptly and treat it accordingly. We report a case of young man who has no history of stroke, and initially consulted for vertigo and cervical plusatility sensation.

Thiopurines (TP) are frequently used in inflammatory bowel disease, especially in remission maintenance. One of the reasons for stopping these treatments is appearance of side effects. In this study, we focus on liver damage induced by thiopurines by specifying their types, their mechanisms, and practical behavior in order to diagnose them early and avoid their aggravation This is a retrospective and descriptive study on monocentric cohort of 115 patients followed for IBD under TP recorded over a period from January 2009 to January 2019. 11 patients had disorder of liver function test, a prevalence of 9.5%, which occurred in half of patients, three months from the start of treatment. 3 (2.6%) patients had abnormal liver test and 8 (7%) had hepatotoxicity. occurrence of hepatotoxicity has resulted in stopping treatment in 4 (36.3%) patients. There was no difference in toxicity between azathioprine and 6-mercaptopurine (p=0,081). The incidence of hepatotoxicity in patients with inflammatory bowel disease receiving thiopurines is not negligible. In our clinical practice, it is advisable to start the treatment gradually, to carry out a well codified clinical and biological control, and to pay particular attention to drug interactions.

Neurological complications of infectious endocarditis (IE) occur in 20% to 40% of patients with IE and increase their risk (1). Most often, it is about embolisms, at the origin of ischemic vascular accidents, sometimes secondarily hemorrhagic. Central nervous system infections during IE are relatively rare (2,3,4): 6-7% for meningitis (2,4) and 1-4% for brain abscess (2,4). We report the case of a 34-year-old patient whose diagnosis of endocarditis complicated by massive mitral insufficiency by ruptured cordage was retained after a dramatic episode of meningoencephalitis, the origin of which was described as tuberculosis surgical treatment. The interest of this case lies in the importance to be accorded to the cardiovascular examination in the context of neurological emergencies, the scarcity of the tubercular origin of this affection and the medical and surgical challenge to raise in front of a patient carrying a massive mitral insufficiency, a candidate for cardiac surgery and subjected to an anti-bacillary treatment of difficult management

A typical presentation of miliary tuberculosis is radiologically defined by the presence of diffuse micronodules of different size and irregular contours distributed throughout the lung parenchyma. We report the case of a 24-year-old young adult, who presented a metastatic adenocarcinoma revealed by respiratory symptoms, and a balloons releasing image on the chest scanner.