[How to improve vaccination coverage in France? Qualitative study among health care workers]. / Comment améliorer la couverture vaccinale en France ? Étude qualitative auprès de professionnels de santé.

BACKGROUND: The risk benefit ratio has been clearly proven for a long time to be in favor of vaccination. However, the vaccine distrust is still increasing in the French population and vaccination coverage could be improved. There is a real need to increase confidence in vaccination. In this study, we interviewed heath care workers to collect their opinion concerning vaccination hesitancy amongst their patients. METHODS: A qualitative study, using semi structured interviews, was performed. All the Pharmacists and doctors were interviewed by the same person using an interview guide prepared by a multidisciplinary team. Interviews were recorded and transcribed verbatim, then used as a basis for analysis and synthesis of the areas where improvement seems possible for the health care workers interviewed. RESULTS: Data saturation was obtained after 10 interviews. Analysis of the verbatim allowed the classification of the leads proposed by health care workers in three main themes: improvement of transparency and restoration of the trust for vaccine policy, improved initial and further training of health care workers, and a better communication towards the population. CONCLUSION: Results provide helpful insights into practical avenues to improve the vaccination confidence. If some of them need an in-depth reflection, others could be easily implemented in order to increase the adhesion of the population to vaccination, and consequently the vaccination coverage.

Prevalence and antibiotic resistance profiles of Staphylococcus sp. isolated from food, food contact surfaces and food handlers in a Moroccan hospital kitchen.

Food poisoning risk related to the consumption of contaminated food with known foodborne pathogens or antibiotic-resistant bacteria is currently a serious threat for public health. Thus, pathogenic methicillin-resistant Staphylococcus strains are considered as one of the major cause of foodborne diseases in hospitals. The present study aims to determine the prevalence and the antibiotic resistance patterns of Staphylococcus in various types of hospital food samples, work surfaces and its carriage by food handlers. A total of 608 collected samples including 300 food samples, 238 food contact surfaces and 70 nasal and hand samples were tested. The identified Staphylococcus and their antibiotic resistance patterns were analysed using the agar disk-diffusion and PCR method was used for mecA resistance gene amplification. The prevalence of S. aureus and the coagulase-negative staphylococci were 17·33 and 23·33%, respectively. The antibiotic resistance reached 100% towards oxacillin and Penicillin G for both S. aureus and CoNs. The mecA gene was detected in 5·71% (4/70) and 7·69% (4/52) of S. aureus and CoNs strains, respectively. The outcome of this study enlightens isolation of MRSA strains and resistant CoNs from food, food contact surfaces and food handlers. The presence of this resistant species in this critical setting, where products were intended to vulnerable and immunocompromised patients, represents a serious threat to this community. It can be a source of nosocomial infection and more precautions must be taken to prevent staphylococci food contamination mainly in hospitals. SIGNIFICANCE AND IMPACT OF THE STUDY: This is the first study describing the antibiotic resistance patterns of Staphylococcus aureus and coagulase-negative Staphylococcus isolated from hospital food, food contact surfaces and food handlers samples in a Moroccan hospital kitchen. High levels of multi-resistance were reported. The alarming outcome of this study emphasizes the crucial need of implementing an approach to fight multidrug-resistant staphylococci mainly in healthcare settings, where the community have already compromised health issues.

[Complete removable denture retained by symphyseal implant]. / Prothèse amovible complète retenue par un implant symphysaire médian.

INTRODUCTION: Edentulous patients often hope for stable and retentive prostheses. In very unfavorable anatomophysiological circumstances, the implant-retained removable full denture is a simple and reliable option that considerably optimizes the prosthetic balance. We present the case of one of those patients taken in charge in our department. OBSERVATION: A full edentulous 82 years old male patient was referred for a prosthetic rehabilitation. He presented with a negative mandibular crest and a very tonic peri-prosthetic musculature in the anterior region. He refused a bone augmentation surgery; we performed a piezographic mandibular prosthesis retained by a single symphyseal implant in a lingual position. The denture was stable and retentive. Comfort and masticatory efficiency were satisfactory and the psychological integration of the prosthesis was improved. DISCUSSION: Several studies focusing on octogenarian patients concluded that a complete removable denture retained by a single symphyseal implant is a simple, efficient and cost-effective option. Studies including more patients are needed.

Résultats d'une série de 42 prothèses totales du genou à plateau mobile à 5 ans de recul

Introduction -Les prothèses totales de genou à plateau mobile ont été élaborées en alternative aux prothèses à plateau fixe pour lutter contre le descellement et l'usure du polyéthylène.L'objectif de ce travail était d'évaluer les résultats d'une série continue de prothèse totale de genou à plateau mobile type SCORE® implantée en première intention avec une instrumentation classique. L'hypothèse de départ était d'avoir une survie entre 90 à 100%.Matériel et méthode -L'étude a concerné 42 patients (42 genoux). L'âge moyen des patients au moment de l'intervention était de 64,5 ans. La prothèse était cimentée. La série était composée de 30 femmes et de 12 hommes. L'indication de la prothèse était une gonarthrose (n=34) et une arthropathie inflammatoire (n=8). Le score global IKS moyen était de 71 points, avec un score genou de 45 points et un score fonction de 26 points. Résultats -Au recul moyen 5 ans (3 et 7 ans) les patients étaient très satisfaits et satisfaits (32; 76%), et déçus (n=10; 24%). Le score IKS moyen de la douleur était de 45 points. La flexion moyenne était de 110°. Le score IKS global était excellent à 170 points, avec un score fonction de 75 points et un score genou de 95 points. L'axe mécanique était de 180°± 3° chez (32/42) patients. Une reprise avec changement en deux temps par une prothèse contrainte a été faite chez un patient pour sepsis. En considérant le changement de prothèse comme un échec, la survie à 5 ans était de 97,6%. Conclusion -La prothèse totale de genou à plateau mobile type SCORE® donne de très bons résultats cliniques, fonctionnels et radiologiques. La survie à 5 ans était de 97,6%

[Atraumatic bone expansion: Interest of piezo-surgery, conicals expanders and immediate implantation combination]. / L'expansion osseuse atraumatique : intérêts de la combinaison pièzo-chirurgie, expanseurs coniques et implantation immédiate.

The durability of dental implants depends on the presence of a 1mm coating bone sheath all around the fixture. Therefore, bone resorption represents a challenge for the practitioner. Bone expansion is a surgical technique that allows the management of horizontal bone atrophy. Cortical bone splitting allows for an enlargement of the residual crest by displacement of the vestibular bone flap. The immediate placement of implants secures the widening and allows for a 97% survival rate. However, bone expansion is hard to undertake in sites with high bone density. Furthermore, the use of traditional instruments increases patient's stress and the risk for an interruptive fracture during bone displacement. Non-traumatic bone expansion is one solution to this problem. The combination of piezo-surgery and conical expanders allows for a secured displacement of the selected bone flap as well as an immediate implant placement, avoiding the risk of slipping, overheating, or fracture, all within an undeniable operative comfort. Non-traumatic bone expansion is a reliable, reproducible, conservative, and economical in time and cost procedure. We describe our atraumatic bone expension and immediate implant placement technique in high bone density sites and illustrate it by a clinical case.

[Original conception of polymerized diagnostic wax-up in an occlusal rehabilitation of distal unilateral edentulous by combined prosthesis]. / Technique originale de conception du montage directeur polymérisé dans la réhabilitation occlusale d'un édentement unilatéral de grande étendue par prothèse composite.

Rehabilitation by combined prosthesis is a therapy that requires a methodical approach especially in the case of large unilateral edentulous when all occlusal parameters are to be restored. The recording of the maxilla-mandibular position is requested at various stages of the treatment. In this context, the use of polymerized diagnostic wax up, is an evident tool for accurately recording and transfer of all occlusal data previously validated, yet concerning the global rehabilitation of unilateral distal edentulous, its stability and exact re-positioning at various prosthetic sequences remain uncertain. The aim of this study was to develop an original conception of the polymerized diagnostic wax up that will allow us to benefit from all its advantages in complex rehabilitation of edentulous unilateral of large extent.

L'expansion osseuse atraumatique. Technique originale

Le succès biologique de tout traitement implantaire dépend de la présence d'une paroi osseuse protectrice d'au moins 1 mm autour des implants. Cela soulève la question de la résorption osseuse ; la masse osseuse atrophiée est souvent incompatible avec la mise en place conventionnelle de l'implant choisi et l'os nécessite une intervention chirurgicale avant ou pendant la mise en place de l'implant. La technique de dilatation osseuse est indiquée en cas de résorption osseuse horizontale : l'agrandissement chirurgical de la crête permet, à la fin d'une seule séance, une pose immédiate des implants avec un taux de réussite de 97%. Par rapport à d'autres techniques régénératives, l'expansion osseuse permet une réduction significative de la durée et du coût du traitement. Néanmoins, il semble compliqué de l'entreprendre en cas de densité osseuse élevée et souffrent des inconvénients de l'instrumentation traditionnelle. La technique d'expansion osseuse traumatique est une réponse simplifiée aux problèmes de la technique conventionnelle. Par l'association de la piézochirurgie et des expanseurs coniques, il permet de réduire les risques et d'optimiser le confort opératoire. Ce travail vise à illustrer, à travers un cas clinique, le protocole de la technique d'expansion osseuse atraumatique en soulignant ses indications et ses limites

[Squamous cell carcinoma of the eyelids. Review of 7 years of experience of the adult ophthalmology service of the Casablanca university medical center]. / Les carcinomes épidermoïdes des paupières. Bilan de 7ans d'expérience au service d'ophtalmologie adulte du CHU de Casablanca.

Malignant eyelid tumors generate considerable functional and aesthetic complications. Squamous cell carcinoma or squamous cell epithelioma (SCE) of the eyelids represents about 9% of all peri-ocular skin tumors. It is potentially lethal by orbital invasion or metastasis and characterized by clinical polymorphism and its ability to mimic other benign lesions of the eyelids, thus requiring early diagnosis and management. The goal of our work is to establish the epidemiological and clinical characteristics, treatment modalities and prognosis of SCE of the eyelids. This retrospective study was performed over a period of 7 years on 25 cases of SCE of the eyelids. The mean age was 62 years. The gender ratio was 1.77 with a male predominance. Twelve patients had precancerous lesions. Biopsy revealed squamous epithelioma SCE in 24 cases and a mixed carcinoma in one case. Surgical treatment was performed in 23 cases. Eyelid reconstruction was immediate in all cases. Radiation therapy (RTH) was carried out for additional 5 patients. The mean follow-up was 15 months. We noted 2 cases of recurrence; revision surgery was necessary in one case and radiotherapy in the other case. SCE is often diagnosed at advanced stages in our context because of the limited access to health care and the extreme clinic polymorphism. This explains the need for histological examination of any suspicious lesion. Prevention through photoprotection is essential.

[Prevalence and clinical characteristics of oral bony outgrowth in a Moroccan population]. / Prévalence et caractéristiques cliniques des hypertrophies osseuses buccales dans une population marocaine.

OBJECTIVES: Oral bony outgrowths (OBOs) are localized bony protuberances that arise from the cortical plate. Various types of OBOs have been described, the precise designation of which depends on anatomic location such as torus palatinus, torus mandibularis, buccal exostosis, or palatal exostosis. We had for aim to determine the prevalence and clinical characteristics of OBOs in a Moroccan population. METHODS: This cross-sectional study was conducted between March 15 and June 30, 2011 at the Rabat-Salé teaching hospital dental consultation and treatment center, in Morocco. Three hundred and fifty-three patients (160 female and 193 male patients), 11 to 82 years of age, were examined clinically and radiologically to determine the presence of OBO. RESULTS: Twenty-four patients (6.8%) presented with OBOs. The prevalence for exostosis, torus mandibularis, torus palatinus, and associated OBOs was 3.1%, 2%, 0.8%, and 0.9% respectively. There was a significant difference (P=0,01) between the average age for patients presenting with OBO (43.2±12 years of age) and the average age for patients without any OBO (36.5±16 years of age). The prevalence of OBOs in female patients (7.3%) was higher than in male patients (6.3%) but the difference was not significant (P=0.439). Patients with occlusal parafunctional activity presented with significantly more OBO (P=0.016). DISCUSSION: The reported prevalence of OBO is extremely variable, according to age, gender, and ethnic group. The occurrence of OBO could be triggered by genetic factors associated with environmental factors.

Imaging of epilepsy following electrical injury.

Electrical injury may result in brain injury with delayed symptoms and sequelae. We report a case of high-voltage cerebral electrical injury in a 42-year-old man through his right hand with delayed symptoms and with imaging abnormalities suggesting that haemorrhage had occurred on the cortical somatosensory areas of his left cerebral hemisphere. An appropriate patient's clinical history should be obtained to correlate the lesions to the event as delay between the event and the symptoms can be very long.

[Frequency and risk factors for pathological gambling in a sample of gamblers in Casablanca, Morocco]. / Fréquence et facteurs de risque du jeu pathologique chez une population de joueurs à Casablanca.

INTRODUCTION: Pathological gambling is a major psychiatric disorder and a public health problem that has gained a lot of attention in the last few years. The problems caused by gambling are increasingly serious. The prevalence of pathological or compulsive gambling varies from 0.8 to 2% in Europe, Canada and the USA. AIM OF THE STUDY: A study has been conducted in different gambling spots in Casablanca to measure the frequency of pathological gambling in Morocco and to determine the risk factors and the socio-cultural factors associated with it. DESIGN OF THE STUDY: The collection of data was conducted in the most frequented gambling spots. The first part of the questionnaire permitted the gathering of the sociodemographic characteristics and drug addictions as well as the psychiatric and legal histories. The detection and diagnosis of pathological gambling was conducted using through the South Oaks Gambling Screen (SOCS) questionnaire, which has been translated to Arabic to suit the needs of the study. PARTICIPANTS IN THE STUDY: Two hundred men were retained out of the 243 interviewed, which represent a participation rate of 82%. The frequency of pathological gambling among a population of gamblers is 53%. The mean age of the sample was 42.3 more or less 10.70 years. Thirty-six percent of those interviewed had a monthly income of less than 2000 dirhams (200 euros). Horse and greyhound racing were the most popular forms of gambling among those interviewed, with rates of 91 and 60% respectively. Individuals with an educational level of no more than primary school, a monthly income of less than 5000 dirhams (500 euros), a personal psychiatric history, and a drug addiction, are most risky to be pathological gamblers. CONCLUSION: The topic pathological gambling has been studied very little in Arab and Islamic countries, and it is necessary to conduct larger epidemiological studies on the general population to inquire about its prevalence, risk factors as well as its psychiatric characteristics.

Mental health of Moroccan women, a sexual perspective.

Sexuality is a complex process coordinated with neurological, vascular, and endocrine systems. It incorporates family, societal, and religious beliefs and interpersonal relationships. Sexuality in the Muslim world is further complexed by tradition and discrimination of women. Studies conducted in Ibn Rushd University Psychiatric Center, Casablanca, Morocco, explored various aspects of sexuality in a traditional Muslim society: sexual behaviour (representative sample of Casablanca population n=728), sexual dysfunction (n=644), prevalence of abuse during childhood, effect of breast removal on sexuality (prospective study on 100 patients), effect of menopause on sexuality (comparative study between Moroccan and Tunisian samples, n=200), pregnancy and sexuality (follow up study in primary health care, n=100), and Ramadan and sexuality among healthy fasting people.

Prevalence and psychosocial correlates of depressed mood during pregnancy and after childbirth in a Moroccan sample.

The objective of the current study was to determine the prevalence of depression among 100 women followed from the first trimester of pregnancy to 9 months after delivery. Mini International Neuropsychiatric Interview, Edinburgh Postnatal Depression Scale and Paykel Life Events Inventory were used. Seventeen per cent of the subjects experienced depression during postpartum, 19.2% started their episode during pregnancy. Psychosocial variables were positively correlated to depression during pregnancy.

[Post-traumatic stress disorder in survivors of the Agadir earthquake (Morocco) in 1960]. / Syndrome de stress post-traumatique chez les survivants du séisme d'Agadir (Maroc) de 1960.

INTRODUCTION: Agadir City is geologically located on a seismic line. This city witnessed an earthquake in February 1960 with a magnitude of 6 degrees in Richter scale. During this disaster more than 17,000 people died and 60% of the town was destroyed. OBJECTIVES: Forty years later, the objective of this study was to assess post-traumatic stress disorders at the time of the disaster and currently among this population. METHODS: Two groups, matched by gender and age were included: 1) a group (G 1) of 80 earthquake survivors with an age varying from 45 to 70 years ; 2) a control group (G2) with 80 people who experienced accidental events other than the earthquake. The instruments used were: a questionnaire concerning socio-demographic data, and the Post-traumatic Stress Diagnosis Scale-Edna Foa-1995 for the diagnosis of PTSD which was translated in Moroccan Arabic language. The epidemiological survey was conducted in two steps during 13 months. The first step consisted in the inclusion of the first group: victims of the disaster. One hundred and two survivors were contacted and 80 accepted to participate in the study. The second step, concentrated on the inclusion of the other group, according to gender and age of the survivors group. All interviews were conducted in the homes of the participants. Data analysis was performed on a PC microcomputer using Epi info 6.04 French version (Center for disease control and prevention CDC, Atlanta, USA). The statistical analysis was based on the descriptive techniques of statistics. RESULTS: The main results were: 1) after the traumatic events and retrospectively, survivors from the earthquake had statistically more PTSD than G2: 38.8% vs 20%; 2) at the time of the study, the prevalence of PTSD between the two groups was not significantly different: 10% for the survivors of the earthquake vs 7.5% for G2 (victims of accidents) while the dates of trauma differed; 3) forty years later, the socio-professional life of the survivors was still perturbed. DISCUSSION: These results are in accordance with the literature, even if the methodological differences constitute a limiting factor for the comparison. Nevertheless, the persistence of symptoms of PTSD many years later might be explained by the severity of the trauma, the existence of external stimuli, such as the frequent tremors felt in Agadir, the noise, the storms, the earthquake happening in other cities...create a persistent state of hyper-vigilance which maintains and/or worsens the symptoms of PTSD. CONCLUSION: In conclusion, 40 years later, survivors are in need of care to overcome symptoms of PTSD. Preventive measures for victims of disasters should perhaps be developed.

[Pseudocontinent perineal colostomy]. / Colostomie périnéale pseudocontinente.

AIM: This prospective study was designed to evaluate functional results of a pseudocontinent perineal colostomy (PCPC) using Schmidt's technique. METHODS: Functional results in eight patients whose rectum were resected due to cancer or anal epidermoid carcinoma and reconstructed by PCPC between January 1995 and July 2002 in our institution were evaluated. Surgical technique and post-operative care were described. Morbidity, functional results and degree of patient satisfaction were reported. Median follow-up was 40 months (18-70 months) and was completed in 100% of patients. RESULTS: There were no operative deaths. Four patients had post-operative complications, whose two patients had partial disunion of sutures, and two patients had urinary infection that was treated by adequate antibiotherapy. No conversion to a definitive abdominal colostomy was performed. On a functional level, one patient has normal continence, six had gas incontinence, and one has occasional minimal soiling. Seventy-five percent of patients were either highly satisfied with their continence. DISCUSSION: PCPC is a reliable technique, which can be proposed as an alternative to a left iliac colostomy following amputation of the rectum due to cancer, provided that certain requirements are met: careful selection of patients, informed consent, flawless surgical technique and lifetime daily colic irrigation.

[Pathological fracture of the femur in a patient with a venous malformation]. / Fracture pathologique du fémur sur malformation veineuse. A propos d'un cas.

We observed a pathological fracture of the femur in a 21-year-old woman with a venous malformation. Physical examination and plain x-rays disclosed a pathological bone. Biopsy revealed the venous malformation. The extent of the lesion that involved the entire quadriceps muscle was detailed with duplex-Doppler, computed tomography and arteriography. The patient was treated with an intramedullary nail. Intra-operative bleeding necessitated transfusion (packed cells and frozen plasma). Outcome was favorable. Bone healing was achieved at seven months.

Prevalence of erectile dysfunction and its correlates: a population-based study in Morocco.

To obtain data on the prevalence of erectile dysfunction (ED) and its correlates, along with help-seeking behaviour, 655 randomly selected men at least 25 y old, residing in Casablanca, Morocco, were recruited. They responded to a questionnaire administered by five trained sociologist interviewers. Information on demographics, concomitant diseases, drugs, and sexual activity was collected. ED was prevalent in 54%, increased noticeably with age, and was highly prevalent between both the illiterate and those employed. Risk factors were diabetes, hypertension, heart disease, and smoking. Limited sexual satisfaction, low frequency of intercourse, and a disturbed psychological state with depressed mood had negative effects on erectile function. Given its prevalence in our country, ED should be considered an important medical problem with a multifactorial aetiology, making the cooperation of a multidisciplinary management team highly recommended.

Transposition-mediated transcriptional overexpression as a mechanism of insecticide resistance.

It has been proposed that amplification of genes for esterase that provide resistance to insecticides may originate from transposition events. To test this hypothesis, we have constructed a minigene coding for a soluble acetylcholinesterase under the control of a nontissue-specific promoter (hsp70). When introduced into Drosophila, the gene is expressed in all tissues and the extra acetylcholinesterase produced confers a low level of insecticide resistance (twofold). The minigene was mobilized by crossing the initial transformant with a strain providing a source of P-element transposase. After 34 generations of exposure to the organophosphate parathion, we obtained a strain with a higher resistance (fivefold). This strain had only one extra Ace gene, which overexpressed acetylcholinesterase. Thus, following transposition, resistance resulted from the overexpression of a single copy of the gene and not from gene amplification.

Presenting features at diagnosis and complications of hemophilia in Dakar: apropos of 25 cases.

In order to describe the presenting features at diagnosis and complications of hemophilia in Dakar, we conducted a study of hospital records between October 1991 and January 1993. Twenty-five cases of hemophilia were identified. We found that only 4% of our patients were diagnosed in the first 6 months of life whereas 64% of patients were diagnosed between 6 months and 5 years of age, 32% were detected between 5 years and 14 years of age. The presenting feature at diagnosis was external bleeding in 60% of cases and internal bleeding in 40%. 92% of cases were hemophilia type A and only 8% hemophilia type B. 56% of patients had mild hemophilia, 40% moderate and only 4% severe disease. Hemophiliac arthropathy was present on radiography in 76%. Complications were dominated by repeated joint bleeding, which was present in 92% of patients, and repeated hematomas (80% of patients). A functional handicap was present in 60% of cases. 12% of transfused hemophiliacs developed an inhibitor and 4% of patients were HIV positive. Greater awareness of hemophilia amongst the medical community as well as continued efforts to improve care for hemophiliacs in Senegal are necessary.