Physiology and Anatomy

Cardiac involvement is the leading cause of death in patients with chronic kidney disease (CKD), including cardiac arrhythmias that increase the risk of sudden death. The purpose of our work is to study the prevalence of heart complications in this population and to propose better cardiac and nephrological management.A total of 92 patients with CKD participated in the study, in the Department of Renal Dialysis and Renal Transplantation the Mohammed V Military Training Hospital in Rabat, the mean age of the patients was 50 years ± 16.55 with extremes ranging from 34 to 76 years, sex ratio was 1.1(H / F). Causal nephropathy is indeterminate in 48% of cases, 58% of our patients are hypertensive; 64% had cardiac arrhythmias; the electrical abnormalities were respectively: left ventricular hypertrophy in 41,4% of cases, left atrial hypertrophy in 9,2 % of cases, atrial fibrillation in 5,5 % of cases and repolarization disorders respectivelyin 12 % of cases.

The lack of ample amount of literature, limited size of the study group in the available studies and relating the potential clinical applications of variation of origin of inferior phrenic artery has validated the study so that additional information could be added to the present literature. Objective: Few dedicated studies have been available demonstrating variations in the origin of inferior phrenic in the present growing era of intervention radiology. The cause has been satisfied by studying a group of 100 patients and reviewing the available literature. Methods: A group of 100 patients that were the potential liver and renal donors were studied in a 40 slice CT scanner as pre transplant evaluation in the Department of Radiology, Institute of nuclear medicine and allied sciences ,Timarpur ,New Delhi. Results: The right inferior phrenic arteries arise from abdominal aorta in 41(42%) of cases, celiac axis 50(50%) ,right renal artery 7(7%) and from left gastric in 2(2%) of cases. The left inferior phrenic arise from aorta in 38(38%) of cases, celiac axis in 55(52%) of cases, left renal artery 4(4%),left gastric artery in 3(3%) of cases. Conclusion: The importance of the IPA is not limited to the arterial supply to the diaphragm . Practically any hepatic neoplasm (including metastatic disease to the liver) may receive blood supply from the IPA. Literature have been reviewed regarding variation in origin of inferior phrenic artery and its implication in surgical intervention. KEYWORDS: Inferior phrenic artery, diaphragm

Cardiovascular diseases (CVDs), including coronary arter disease, cerebrovascular events, rheumatic heart disease and arter diseases, remain the most common cause of death in the world. Changes in the regulation of vasoactive peptides in abnormal conditions, cardiovascular diseases; Endothelial dysfunction, which is the critical processes underlying vascular damage, results in vascular repair and inflammation. Studies with specific receptor antagonists; It will be very important to understand the physiological role of urotensin II and its receptor and to reveal its therapeutic potential. The aim of this study is to know the pathophysiological role of U-II following the development of UT receptor antagonists and to give an insight into the design of new drugs and to give a current perspective. The development of urotensin receptor antagonists may provide a useful diagnosis tool as well as a new treatment for cardiovascular diseases.

Epilepsy is a chronic condition that often begins in childhood and is characterized by the occurrence of spontaneous and recurrent epileptic seizures. The aim of our study is to identify the different etiologies of epilepsy in children and to highlight the importance of imaging in the etiological diagnosis, in the extension assessment and in the therapeutic management of epilepsy. Our study was carried out over a 5-year period from January 2014 and 2019, and involved 30 cases in the pediatric radiology department of the Rabat Children's Hospital. Seizures and loss of consciousness dominated the clinical picture. The etiological diagnosis in the majority of our series was based on CT scan and brain magnetic resonance imaging. The evolution under treatment was favourable for all our patients.

Freeman-Sheldon Syndrome (FSS), also known as Distal Arthrogryposis Type 2A (DA2A), Craniocarpotarsal Dystrophy, Windmill-Vane-Hand Syndrome, or Whistler Face Syndrome, was first described by Freeman and Sheldon in 1938 [1,2]. It is a very rare syndrome of multiple congenital contractures characterized by a microstomy giving the appearance of the "whistling face", a club foot and articular contractures. FSS is the most severe form of distal arthrogryposis. We report a rare observation of a two years old child, who has a poly malformative syndrome admitted in our ENT department at the Specialty Hospital, Rabat. On examination, the child presents a facial dysmorphism with head bird facies with prominent forehead, hyperthelorism and small mouth. Otherwise, H aspect of the chin and mandibular retrognation are noted. At the endoral examination, we notice a cleft palate, dental overlap and glossoptosis. Moreover, osteo-articular examination shows hypertonicity of the limbs, especially on the fingers, and a left club foot. The geneticist's opinion is in favor of a Freeman-Sheldon syndrome. The child has benefited from a surgical closure of the cleft palate. FSS is caused by genetic abnormalities involving the "distal arthrogryposis multiplex congenita" gene, whose inheritance may be either mostly autosomal dominant or autosomal recessive. The management by health professionals of several medical disciplines must be undertaken from birth to evaluate the severity of their phenotypic presentation and minimize the risk of patient development delay.

Clinical research competencies are enhanced when there is synergy and strong internal cohesion, with the appropriate level of clinical expertise in recruitment of participants and undertaking a study from initial stages, to conclusion. When a study sponsor approaches a site to conduct a clinical trial, the site must convey accurately that it has the resources and capability to undertake a study. The clinical research site should be able to demonstrate competencies in meeting minimum clinical and research capabilities in conducting a study.  Explicit and optimal utilization of available resources and capabilities to meet clinical, regulatory, ethical, and other mandates will reflect this capability. The United States Food and Drug Administration regulatory process is demanding, exacting, time consuming and complicated.  Clinical research sites must conform to regulatory clinical research standards.  The interaction and collaboration of researchers in different roles and functions in a clinical research study may necessitate studying the factors that promote or constrain inter-professional synergy. The complex human interplay of many diverse and dedicated professionals, comprising clinical site coordinators, researchers, physicians, and research subjects, engaged in clinical research is not fully understood and merits further study. The aim of this scientific paper is to present research to map and assess human dynamics in a clinical research site, so that the results may contribute to reducing the human factors which constrain clinical research. Clinical research sites must cope with intense scrutiny and copious FDA and other regulations, which often limits clinical discovery, lowers financial success and often impedes successful research execution.  The exploratory outlook of a future and recommended research study may be deemed important, to examine the positive and negative factors that may facilitate, or impede internal team cohesion within clinical research sites, using a quantitative method and a descriptive design. A comprehensive description of a research plan and data collection methodology is detailed herewith. A study is recommended herewith, based on a research method and design founded on extensive experience in organizational management, review of pertinent literature, and the best practices in clinical research study management.   

Micropapillary carcinoma (MPC) of urinary tract is an uncommon histological variant of urothelial carcinoma. It is characterized by an aggressive clinical course, an advanced stage at first presentation and a high metastatic potential. Though MPC shows characteristic microscopic features, there exists interobserver variability and controversies concerning certain aspects of this rare tumor. The aim of our study is to present four cases of MPC treated by radical cystectomy in the Department of Urology, at the University Hospital Center of Rabat Morocco, during the period from January 2014 to December 2017. The clinical and morphological features of this rare and aggressive variant of urinary badder carcinoma, as well as a brief review of the literature are all presented.

Pleomorphic Adenoma (PA) also called as benign mixed tumour is the most common tumour of salivary glands. Intraoral presentation of tumour is comparatively rare with more chances of malignancy. Wide surgical excision with adequate margins is the most preferred mode of management. Histopathological analysis is essential for confirmatory diagnosis. A 62 year old female patient reported with chief complaint of a growth on right side of the throat since 6 years. Growth has gradually increased in size, painless but has difficulty in swallowing because of the same. Examination revealed a growth in relation to junction of hard and soft palate mostly on right side which is firm in consistency and non tender. Growth was excised with primary closure under General anesthesia. Histopathology confirmed the case to be pleomorphic adenoma.Pleomorphic adenoma should be considered in the differential diagnosis of palatal swellings. As the lesion has a tendency for malignancy, careful evaluation of history, examination, histology and follow up is advised.

Ductal carcinoma is a rare tumor, which accounts for 1 to 3% of all malignant salivary gland tumors primarily affecting middle-aged men with a high potential for metastasis. In salivary gland neoplasms, rhabdoid cells are not commonly seen. We report the case of a 58-year-old man, who presented a mass of the left cheek evolving for 3 months, who underwent an exofacial parotidectomy, the extemporaneous histopathological analysis of the specimen revealed a ductal carcinoma with rhabdoid features. We completed by a total conservative parotidectomy of the facial nerve. Salivary duct carcinoma with rhabdoid features should be distinguished from malignant lymphoma, malignant melanoma, and myogenic sarcomas. Transformation to ductal carcinoma with rhabdoid features has occurred in metastatic lesions. Treatment was based on extensive carcinological resection with postoperative radiotherapy with regular follow-up.

The term Coarctation can be defined as the stricture or narrowing of the aorta, it affects both child and adult, but is seen mostly in children. Coarctation can be either be preductal or postductal. Depending on the severity of the condition and the time of diagnosisthe treatment can be determined in an individual.Identifying this condition very early in life is also beneficial to the patient even though there would be a few complications that would be faced depending on the form of treatment one choses. The present study aimed to understand the embryological basis and its clinical significance.