Bacteriological aspects of bacteremia in the intensive care unit of the Mohammed V Military Hospital: 10 months prospective study.

Introduction: Bacteremia is responsible for high rates of morbidity and mortality. The increasing prevalence of multidrug-resistant (MDR) bacteria in intensive care units (ICU) is a growing concern. Hence, prior knowledge of bacterial epidemiology and resistance phenotypes is required to optimize these infections' management. The objective of this study was to determine the epidemiological profile of bacteremia in ICU settings, as well as the place occupied by MDR bacteria in these infections. Methods: It is a prospective study carried out over 10 months on episodes of bacteremia in the ICU of Mohammed V Military Teaching Hospital (Rabat, Morocco). Microorganism growth was detected using fluorescent technology, species identification was based on morphological and biochemical characteristics. Antimicrobial susceptibility testing was performed following the recommendations of the Antibiogram Committee of the French Society of Microbiology (CA-SFM) and the European Committee on Antimicrobial Susceptibility Testing (EUCAST). Results: Among 504 hospitalized patients, sixty-one (12.1%) presented at least one episode of bacteremia. Forty patients (65.6% of bacteremic patients) presented at least one episode of bacteremia due to MDR bacteria. Male gender, cardiovascular diseases, diabetes and previous hospitalization were significant risk factors for the acquisition of MDR bacteremia. Isolated bacteria were mainly Gram-negative bacilli (GNB) (n = 62; 68.9%) dominated by Acinetobacter baumannii (n = 19; 21.1%) and Klebsiella pneumoniae (n = 16; 17.8%). MDR bacteria were represented by multi-resistant Acinetobacter baumannii (n = 19; 44.2%), extended-spectrum beta-lactamases-producing Enterobacterales (n = 9; 20.9%) and carbapenem-resistant Enterobacterales (n = 7; 16.3%). Carbapenems (n = 40; 65.6%), Aminoglycosides (n = 32; 52.5%) and Polypeptides (n = 24; 39.3%) were the most used antimicrobials. Mortality rates were 66.6% (n = 40) and 85% (n = 43) in patients with non MDR bacteremia and MDR bacteremia respectively. Conclusion: Limiting the spread of MDR bacteria and improving the management of bacteremic patients require continuous monitoring of bacteremia as well as adapting the therapeutic and preventive strategy.

Spectroscopic Ellipsometry Study on Tuning the Electrical and Optical Properties of Zr-Doped ZnO Thin Films Grown by Atomic Layer Deposition.

This work reports the ellipsometry analysis of atomic layer deposition (ALD) films of ZnO doped with Zr to determine parameters like free carrier concentration and mobility. Thin films of zinc oxide (ZnO) and Zr-doped ZnO of thickness ∼100 nm were prepared by atomic layer deposition on sapphire, SiO2/Si(100), and Si(100) substrates. Variable-angle spectroscopic ellipsometry was used to study their optical properties in the 0.5-3.5 eV spectral range. The optical constants were accurately obtained using a model that combines Drude and Tauc-Lorentz oscillators with Bruggeman effective medium approximations, allowing the inclusion of a roughness layer in the optical model. The effect of Zr doping (ca. 1.9-4.4 atom %) was then investigated in both as-prepared samples and samples annealed in the temperature range of 100-300 °C. All of the films exhibited good optical transparency (ca. 70-90% in the visible region). For doping levels below 2.7 atom %, the real part of the dielectric permittivity reveals a semiconductor-to-metal transition in the near-infrared (NIR) region, as the permittivity goes from positive to negative. Besides, the plasma energy increases with increasing Zr concentration, and both resistivity and carrier concentration exhibit slightly parabolic behaviors, with a minimum of ∼1.5 × 10-3 Ω cm and a maximum of 2.4 × 1020 cm-3, respectively, at the same critical Zr concentration (2.7 atom %). In contrast, the carrier mobility decreases rapidly from 76.0 to 19.2 cm2/(V s) with increasing Zr content, while conductivities and carrier mobilities worsen when the annealing temperature increases, probably due to the segregation of ZnO crystals. Finally, the optical band gap is very stable, revealing its interesting independence of substrate composition and annealing temperature, as it collapses to a single master curve when band gap energy is plotted versus free carrier concentration, following the Burstein-Moss effect. Overall, the Zr-doped ZnO films studied here would be a highly desirable system for developing thermally stable transparent conductive oxides (TCOs).

Conduction Mechanisms in Au/0.8 nm-GaN/n-GaAs Schottky Contacts in a Wide Temperature Range.

Au/0.8 nm-GaN/n-GaAs Schottky diodes were manufactured and electrically characterized over a wide temperature range. As a result, the reverse current Iinv increments from 1 × 10-7 A at 80 K to about 1 × 10-5 A at 420 K. The ideality factor n shows low values, decreasing from 2 at 80 K to 1.01 at 420 K. The barrier height qϕb grows abnormally from 0.46 eV at 80 K to 0.83 eV at 420 K. The tunnel mechanism TFE effect is the responsible for the qϕb behavior. The series resistance Rs is very low, decreasing from 13.80 Ω at 80 K to 4.26 Ω at 420 K. These good results are due to the good quality of the interface treated by the nitridation process. However, the disadvantage of the nitridation treatment is the fact that the GaN thin layer causes an inhomogeneous barrier height.

[Combined lumbar plexus-sciatic nerve block in the emergency surgery for pertrochanteric fracture: an alternative technique in patients at high risk of anaesthetic complications]. / Bibloc lombaire et sciatique plexique pour la chirurgie urgente des fractures pertrochantériennes: une technique alternative chez les patients à haut risque anesthésique.

INTRODUCTION: emergency surgery for pertrochanteric femoral fractures (PFF) in patients at high risk of anaesthetic complications is a real challenge for surgeons due to the increased intraoperative risk. We report our experience with combined lumbar plexus-sciatic nerve block as an alternative anesthetic technique for these fractures. METHODS: we conducted a three-year descriptive, single-center, cross-sectional study including patients with a history of recent pertrochanteric femoral fractures (PFF) at high risk anaesthetic complications. Combined lumbar plexus-sciatic nerve block was performed using the common neurostimulation technique. A mixture of 20ml of lidocaine 2% and bupivacaine 0.5% (50/50) was injected into each block. The primary endpoint was the effectiveness of lumbar plexus-sciatic nerve block assessed through the rates from anesthesia-related failures defined as need for conversion into general anaesthesia (GA). The secondary endpoints were: 1) anesthetic technique, 2) intraoperative hemodynamic, respiratory and neurological impairment, and 3) outcomes and potential postoperative complications. RESULTS: the study included 30 patients. The average age of patients was 74 ± 10 years. The average admission time in the Department of Emergency Surgery was 12(5-36) hours. The average duration of the procedure was 15.20 ± 3.45 minutes. No conversion into GA was necessary. There were no statistically significant differences between the various recorded intraoperative hemodynamic and respiratory parameters (MAP, HR, SpO2) (p > 0,05). Surgical procedure duration was 46 ± 5 minutes. Surgical satisfaction was 9.7 ± 0.1. The first post-operative analgesic treatment was started after 8(1-24) hours. All patients had complete sensorimotor recovery. CONCLUSION: combined lumbar plexus-sciatic nerve block is an anesthetic alternative for urgent PFF surgery in patients at high risk of anaesthetic complications: reduced operative delays, anesthetic efficiency, hemodynamic and intraoperative respiratory stability, absence of complications due to other anesthetic techniques, rapid admission to recovery room, and good postoperative analgesia.

[Crossed renal ectopia discovered incidentally: about one case report]. / Ectopie rénale croisée de découverte fortuite chez l'adulte: à propos d'un cas.

Crossed renal ectopia is a rare congenital abnormality, in which the two kidneys are located in the same side. One of the ureters, whose length is adapted to the kidney seat, crosses the median line to implant in the bladder on the opposite side. Renal fusion of the two parenchymas is common and this abnormality is most often asymptomatic and fortuitously discovered. We report the case of a 36-year old patient with no previous pathological history, presenting with crossed renal ectopia incidentally discovered after acute cholecystitis complicated by perivescicular abscess. On the basis of this observation and of the data from the literature, we here discuss the etiopathogenic, clinical, radiological and therapeutic features of this malformation.

[Interventricular defect after myocardial infarction: about a case and literature review]. / Communication interventriculaire post infarctus du myocarde: à propos d'un cas et revue de la litterature.

Ventricular septal rupture (VSR) after myocardial infarction is a fearsome acute complication whose mortality is not negligible in the early phase. We report the case of a 70-year old patient with apical septal rupture admitted to the Emergency Department with ventricular septal rupture after anteroseptal myocardial infarction. This disease is of the utmost urgency, so its management should be multidisciplinary. This study aims to focus on the risk factors and the treatment of this complication.

Akinetic mutism revealing an ischemic stroke.

We describe a 44-year-old man who developed akinetic mutism following a cerebrovascular accident involving his left middle cerebral artery. We discuss this rare condition and its unusual clinical picture.

Universality of the electrical transport in granular metals.

The universality of the ac electrical transport in granular metals has been scarcely studied and the actual mechanisms involved in the scaling laws are not well understood. Previous works have reported on the scaling of capacitance and dielectric loss at different temperatures in Co-ZrO2 granular metals. However, the characteristic frequency used to scale the conductivity spectra has not been discussed, yet. This report provides unambiguous evidence of the universal relaxation behavior of Pd-ZrO2 granular thin films over wide frequency (11 Hz-2 MHz) and temperature ranges (40-180 K) by means of Impedance Spectroscopy. The frequency dependence of the imaginary parts of both the impedance Z″ and electrical modulus M″ exhibit respective peaks at frequencies ωmax that follow a thermal activation law, ωmax ∝ exp(T(1/2)). Moreover, the real part of electrical conductivity σ' follows the Jonscher's universal power law, while the onset of the conductivity dispersion also corresponds to ωmax. Interestingly enough, ωmax can be used as the scaling parameter for Z″, M″ and σ', such that the corresponding spectra collapse onto single master curves. All in all, these facts show that the Time-Temperature Superposition Principle holds for the ac conductance of granular metals, in which both electron tunneling and capacitive paths among particles compete, exhibiting a well-characterized universal behavior.

[Evaluation of antibiotic prescriptions in the Emergency Department of the Military Hospital of Instruction Mohammed V (HMIMV)]. / Evaluation des prescriptions antibiotiques au service des urgences de l'Hôpital Militaire d'Instruction Mohammed V (HMIMV).

The objectives of this study are to describe prescribing practices, to evaluate their appropriateness and their compliance with guidelines and to examine their influencing factors. We conducted a cross-sectional study of antibiotic prescriptions data of 105 patients in the medical and surgical Emergency Department of the Military Hospital of Instruction Mohammed V in Rabat over a period of one month. Data were collected by means of a questionnaire including demographic and anamnestic data, patient's history, allergies, specific clinical examination data, paraclinical data, detailed antibiotic prescription. Collected data were then evaluated by a referring physician, who was responsible for detecting any treatment error. Among infections requiring the prescription of antibiotics, respiratory and urinary system diseases were at the forefront, the most commonly used antibiotic families were penicillins, quinolones and cephalosporins. 74 prescriptions (70.5%) were both pertinent and compliant versus 9 prescriptions (8.6%) justified but nonpertinent and 6 prescriptions (5.7%) which were considered unjustified by the referring physician due to absence of infection. The evaluation of the existing medical practice is rarely conducted in health facilities; with this in mind, our case study aims to improve appropriate antibiotic prescribing and to optimize its compliance with guidelines.

Thrombolysis for acute ischemic stroke by tenecteplase in the emergency department of a Moroccan hospital.

INTRODUCTION: Thrombolysis has radically changed the prognosis of acute ischemic stroke. Tenecteplase is a modified form of rt-PA with greater specificity for fibrin and a longer half-life. We report the experience of a Moroccan tertiary hospital in thrombolysis using Tenecteplase. METHODS: We conducted an open prospective study of all patients who were treated with Tenecteplase for an acute ischemic stroke admitted to our emergency department. Tenecteplase was administered intravenously at a dose of 0.4 mg/kg single bolus. The primary outcome measure was the proportion of patients achieving significant early neurological recovery defined as an improvement of 4 or more points on the NIHSS score at 24h. RESULTS: 13 patients had been treated by intravenous thrombolysis. 31% were women. Mean age was 63 years old. The mean NIHSS score at admission was 14.3 and 24h after was at 9.1. The right middle cerebral artery was involved in 69% of cases. The carotid atherosclerosis was predominant 63.3% and the cardio embolic etiology 27%. The mean time to the first medical contact after the onset of symptoms was 3h 30 min. One patient presented a capsulo-lenticular hematoma of 5 mm(3) in the same side of the ischemic stroke. CONCLUSION: Tenecteplase is a more interesting thrombolytic than alteplase, it seems to be more suitable for thrombolysis in our center.

Does intranasal fentanyl provide efficient analgesia for renal colic in adults?

INTRODUCTION: Intranasal fentanyl provides rapid and powerful analgesia which is particularly interesting in patients without intravenous access. We propose to use it for analgesia in adults presenting renal colics. METHODS: A prospective study was conducted from the 2nd January to February 2013 in our emergency department. Patients aged up to 18 years old who presented with renal colic were included in this audit. Patients were excluded if they had loss of consciousness, cognitive impairment, acute or chronic nasal problems. A formal written consent was obtained from patients. The research team was alerted by medical and nursing staff. A member of the research team would check with medical or nursing staff whether administration of Intra nasal (IN) fentanyl was required. It was administered at a pre-calculated dose of 1.5 mg/kg and 50 mg/ml concentration was used. Data was prospectively collected by one of the researchers at various intervals during the patient's presentation and recorded on a pre-formatted data sheet. Pain scores were collected at 5, 15, 30, 45 and 60 minutes following IN fentanyl using a visual analogue scale pain. Observations routinely collected for patients receiving IV opiates and any adverse events were also recorded. RESULTS: 23 eligible patients were enrolled; median age was 51,3 years. 47,8% were women and the mean weight was 73 kg. Median dose of IN fentanyl was 106 µg. Two patients have required morphinic analgesia despite having received adapted dose of IN fentanyl. The initial pain scores before IN fentanyl were high with a median of 82,2 mm (59-100). Five minutes after IN fentanyl administration the median pain score dropped to 48 mm(36-63) and achieved the lowest score of 8mm(0-22) at 30 min. Pain scores were significantly lower at 5 min (P < 0.001) and at all subsequent time points (P < 0.001). No side effects were recorded. CONCLUSION: Intranasal fentanyl seems to be efficient for analgesia in adult patients with renal colic.

Cervical spine injury in children: a case report and literature review.

Traumatic injuries of the cervical spine are less common in children than in adults. But may be associated with significant disability and mortality. Pediatric victims of blunt trauma have mechanisms of injury, developmental and anatomic characteristics different than the adults. The purpose of this observation is to highlight the differences between the adult and pediatric cervical spine. We report below the case of spinal cord cut occurs to a very young girl after a motor vehicle accident.

Intraperitoneal solitary fibrous tumor.

Solitary fibrous tumors of the pelvis are rare. We report the case of a 32-years-old patient who presented with abdominopelvic mass. The imaging studies showed a right adnexal mass of more than 10 cm. Exploratory laparotomy revealed a 20 cm mass at the Douglas pouch which was adhered to the posterior wall of the uterus. Complete resection of the mass was performed. Histological analysis showed a spindle cell undifferentiated tumor whose morphological and immunohistochemical profile are consistent with solitary fibrous tumor. It is important to know that although these tumors are rare, their evolution can be pejorative. Therefore, long-term followup should be recommended.