Physiology and Anatomy

Ocular complications are common manifestations in HIV/AIDS patients. Cytomegalovirus retinitis (CMV-R) and Herpes zoster opthalmicus are the two most common ocular complications. With the advent of highly active anti-retroviral therapy (HAART), CMV-R has declined considerably in the western world, but it is still possesses a major challenge in developing countries with significant ocular morbidity. CMV-R usually involves anterior segment and retina, manifesting as confluent retinal necrosis with haemorrhage, granular lesion, and frosted branch angiitis. The clinical picture of HIV-associated eye disease has changed dramatically since the introduction of HAART. It can lead to severe complications at times like rhegmatogenous retinal detachment and vision loss. Management of CMV Retinitis is more challenging and continuously evolving with time. Currently available effective anti-CMV pharmacological agents include injectable ganciclovir, its prodrug valganciclovir, and foscarnet. Surgical management of the complications include various approaches like pars plana vitrectomy (PPV) with gas or high viscosity silicone oil tamponad, scleral buckling and laser photocoagulation. Because of the varied clinical presentation and difficult course, CMV-R has established itself as the major determinant of visual morbidity in HIV/AIDS patients. Therefore with the introduction of newer screening methods and routine ocular examination in high risk groups, we can significantly reduce the burden of disease, severe ocular complications and ocular morbidity.

The skin biopsy is an important diagnostic tool in dermatology because it establishes a definite diagnosis and also monitors the therapy in many systemic diseases. The microscopic features involving superficial inflammatory dermatitis are very similar, but treatment varies, hence the diagnosis of the skin biopsy requires meticulous, clinical and histopathological work up. One hundred and fifty one consecutive skin biopsy specimens where a superficial inflammatory dermatosis has been queried by Dermatologists are reviewed. The lesions of superficial inflammatory dermatosis are classified based on the integration of different morphological features into three types of tissue reactions ie. Spongiotic dermatitis, lichenoid dermatitis and psoriasiform dermatitis. Histopathological diagnosis is concluded after coorelating with clinical features, which either confirms, contributes or noncontributory to the clinical diagnosis. The study revealed that the Psoriasiform Dermatitis is the most frequently encountered about 46.0%, followed by the lichenoid Dermatitis 27.2% and Spongiotic Dermatitis 16.6%. The clinico-histopathological discrepancy between few cases like Dermatitis Herpetiformis & Prurigo Simplex, Polymorphous light eruption & Leprosy, Hypertrophied Lichen Planus & Prurigo nodularis, Mycosis Fungoides & Exfoliative Dermatosis is discussed in detail. Correlation of the histopathological diagnosis with clinical diagnosis is seen in 95.6% cases of Psoriasiform Dermatitis, 92.87% cases of Lichenoid Dermatitis and in 92.3% of cases of Spongiotic Dermatitis. The present study also contributed that the histopathological diagnosis is confirmatory, diagnostic or non-contributory in 90.6%, 4.6% and 4.8% cases respectively to the clinical diagnosis. This article thus emphasizes the importance and utility of classification of superficial inflammatory dermatosis. The data showed the distribution of the lesions in three categories was helpful in reducing the number of inconclusive biopsies.

In this work, the Authors reported the medical case of a 24 years old patient who is originally from Cameron. He was diagnosed onchocerciasis disease and treated at the age of 15 years in homeland. Currently, he is followed in the service of Ophthalmology B-Hospital of Specialist, bilateral chorioretinitis for onchocerciasis, asymmetric. The patient is equally treated from a complete eye examination including measurement of visual acuity, examination of interior segment and the bottom eye. Beside this, we have perfpormed fluorescein angiography, optical coherence tomométrie of the electroretinogram were performed. The laboratory test that we performed was negative. The patient was given a treatment of doxycycline and Ivermétine. Our medical case is rare in its nature which has given the development of ocular manifestations of onchocerciasis outside the endemic areas of Morocco.

Anemic delivery is a public health problem in Morocco that can lead to complications in mothers and children. The aim is to describe the socio-demographic characteristics and risk factors of anemic delivery attendants in the maternity ward of the IBN TOFAIL Marrakech Hospital. The results revealed that anemic (AD) mothers have low socioeconomic status and education; and the risk factors associated with non-pregnancy monitoring. According to midwives, anemia affects the health of mothers and newborns. A need for clinical screening for anemia during the first pregnancy consultation and at each prenatal consultation reduces the risks associated with this pathology.

Peak expiratory flow rate is a simple, reliable and promising test of respiratory function. It can be easily measured and correlates well with other lung function measurements and useful guide for monitoring the ventilatory function of healthy and asthmatic children. Aim of the present study was to find out the correlation of PEFR with height, weight and BMI in school children and the objective was to find out if PEFR varies with gender. Study design was observational cross sectional study with convenient sampling. Total 340 samples, both boys and girls between age 8-14 years were selected from a school, in Vadgaon, Pune. Children having acute respiratory infection, asthma, recurrent cough or chest infection A family history were excluded. Pearson’s correlation coefficient was used to find out the correlation of PEFR with Height, Weight and BMI. Highest correlation was found between height and PEFR. Moderate correlation was found between weight and PEFR. Minimum correlation was found between BMI and PEFR.PEFR also shows gender variation; boys showing a Higher mean PEFR value.

The pyonephrosis is a suppurative process of the urinary tract kidney leading to a rapid and complete loss of kidney function The surgery is difficult with an early mortality and morbidity The emergency surgery is persistent sepsis or the presence of complication. We report 19 cases of pyonephrosis treated in our service

The primary objective was to evaluate if batch staining of malaria blood films results in false positive smears. False positive smears (>1%) may cause a serious underestimate of a drug’s or vaccine’s protective efficacy, as well as affect evaluation of diagnostics, estimates of malaria prevalence, and clinical management. Thick blood films may float from a glass slide during staining and adhere to other films if batch staining is used resulting in false positive readings. Venous blood in EDTA anticoagulant from malaria positive samples of ? 20 parasites per high power field and a true negative sample was utilized to make thick and thin smears. Two true negative smears were stained with Giemsa stain with eight positive smears in batch in Coplin jars for 10 minutes or overnight. Two control negatives were stained alone with the same batch of stain. Blinded microscopists read these slides using a rereading paradigm. Thick film loss was graded by gross appearance ranging from 0 (none) to 4+ (> ¾ loss). A total of 602 slides were evaluated in this study, of which 392 were true positives (65%) and 210 (35%) were true negatives. Of the true negatives, 110 were batch stained with true positives, and 100 were true negative controls stained alone. Of the initial readings, 11-20% were reported falsely positive. “Fishing” or cross-contamination was infrequently noted by one of the microscopists, but was uniformly present in these smears on reexamination. Of the true positive smears (high density), 1-3% were read falsely negative. On reexamination of these slides, the cause was found to be reporting of results from very poor quality smears. Thick film loss was clearly more severe for the positive slides with 10 minute versus overnight drying (means score 0.97 vs 1.97, p <0.001).

At maternity, the systematic approach is undoubtedly one of the main pillars of quality of care. Without it the caregiver can not claim to achieve the maximization of the quality of care. The aim of this quantitative study, is to describe the nursing care provided to women who have given birth in the immediate postpartum period at maternity level in Morocco. Results from the self-administered nurse questionnaire and observations of postpartum care, revealed deficiencies in nurses knowledge of the care approach, a lack of use of a supportive care plan Postpartum and a practice of care without planning or evaluation. 

The objective of our study was to search for the ultrasonographic afflictions of the metacarpophalangeal and metatarsophalangeal joints notably ultrasonographic synovitis , intra articular liquid accumulations , cartilaginous vascularisation as well as bone erosion and to compare them with the clinical aspects ( pain , swelling , limitations of mobility ) . MATERIALS AND METHODS : It was a transverse study ,comprising exclusively the cases of JIA corresponding to the criteria of ILAR 2001 . All the patients were clinically examined to look for pain , synovitis or articular limitations. Linear sound echography ( 14 MHz ) with doppler power , was used . The OMERACT criteria were utilised for evaluating the ultrasonograhic synovitis ; The software SPSS21 was employed as test statistic. RESULTS : 34 patients were included , with 612 joints . The mean age was 10,80 ± 3,29 . Total number of painful articulations of 31 ( 94% ) ; synovitic articulations was 4 ( 12 % ) ; total number of ultrasonography synovitis was 110 ( 18 %). In patients with normal clinical examination, ultrasound showed abnormalities in 159 (27 %) joints , the most frequent localization was at the MTP joints in 86 ( 54% ) p < 0,001.Presence subclinical synovitis for 73 ( 66 %) p< 0,001 . CONCLUSION : Our study detected subclinical synovitis ;this study suggests that ultrasound is an important supplement to clinical examination and should be performed in a systematic way to evaluate the activity of the disease. 

The objectives were to determine the DAS28 Us and DAS28 DP , to compare it with DAS28 standard and establish its influence in the assessment of the activity of the rheumatoid arthritis . Materiels and methods : The DAS28 US and DAS28DP were calculated from the four parameters (articular index, mode B or Doppler power synovial index detected in relation to the 28 joints intended for the DAS28 standard , Patient Global Visual Analogue Scale , ESR ). The examination evaluated the ultrasound synovitis and the Power Doppler activity according to the criteria OMERACT. Results: 37 patients of the average age of 50 years ±11 were enrolled. The duration of the evolution was 7,40±0,72 . There was an average correlation between DAS28 standard and the number of the synovitis modeB (r=0,43; p=0,01 )(table 3) . Conclusion: Our study revealed the subclinical synovitis in 41% of the cases. This study showed a strong correlation between the standard DAS28 and the US and DP ultrasounds DAS28. 35% of patients who were reported in clinical remission were reconsidered ill after ultrasound tests. Thus, this study suggests that the ultrasound scores as DAS28US and DAS28DP could be used in clinical practice to evaluate the rheumatoid arthritis activity.