The History of Tuberculosis in Morocco

Whether TB was already spread in Morocco before the French protectorate or was it brought by foreigners; is an interesting debate in the medical history of Morocco. It was common among practitioners who were first interested in the health situation of Moroccans. TB; and especially its pulmonary form; was rather rare in Morocco [3]. In the 19th century; a medical doctor (Despine) who lived in Essaouira; declared the absence of TB in this Moroccan city; which was open for trade with Europeans very early in history

Brain Plasticity Mechanims Underlying Stroke Recovery

"Spontaneous recovery represents the only hope of regaining autonomy; for the majority of stoke victims especially in developing countries like Morocco. This recovery is mainly based on the brain's reorganization capacities; referred to as ""adaptive plasticity"". Rehabilitation is one of the most powerful modulators of brain plasticity that; if well administered; can improve post-injury recovery."

[Transanal irrigation for bowel and anorectal management in spinal cord-injured patients]. / Intérêt des irrigations transanales dans la gestion des troubles intestinaux et ano-rectaux chez les blessés médullaires.

OBJECTIVE: Bowel dysfunction and disordered defecation are very common after spinal cord injury (SCI) and can have a major impact on patients' social life and quality of life. The aim of this study was to assess the safety and efficacy of transanal irrigations (TAI) in the management of Bowel dysfunction in SCI patients. METHODS: Forty-five consecutive SCI patients using TAI were retrospectively included. TAI efficacy was assessed through Neurogenic Bowel Dysfunction (NBD) score recorded before and after 8 weeks of regular use. Possible side effects were assessed with a semi-structured questionnaire. Patients who started TAI use at least 6 months previously were contacted to assess long-term compliance, efficacy and safety of TAI. RESULTS: After 8 weeks of regular use of TAI, the average NBD scores decreased by four points (P<0.0001) with a specific improvement in the items related to stool frequency (P: 0.036), occurrence of malaise, headache, or sweating during defecation (P: 0.043), use of drugs against constipation (P: 0.007) and frequency of fecal incontinence (P: 0.001). The main side effects were bleeding (10%) and abdominal pain (8%). At 6 months, 80% of the assessed patients had continued regular use of TAI with no particular problem. CONCLUSION: This study showed good medium and long-term efficacy and safety of TAI in the management of bowel dysfunction and defecation disorders in spinal cord-injured patients.

Bladder dysfunction in hereditary spastic paraplegia: a clinical and urodynamic evaluation.

OBJECTIVES: Hereditary spastic paraplegia (HSP) is a degenerative central nervous system disorder characterized by progressive spasticity and hyperreflexia of the lower limbs. Often, patients with HSP experience symptoms of voiding dysfunction. Urodynamic evaluations of these patients are rarely reported in the literature and the etiology of voiding dysfunction remains unclear. The present study characterizes lower urinary tract dysfunction in a large series of patients. METHODS: The medical records of 29 HSP patients who underwent urodynamic evaluation were retrospectively analyzed. The history of lower urinary tract symptoms was noted and the urodynamic findings analyzed. RESULTS: Urgency was the most dominant complaint (72.4%), followed by frequency (65.5%), urinary incontinence (55.2%) and hesitancy (51.7%). The urodynamic findings showed signs of central neurogenic bladder in 24 patients (82.7%), with detrusor overactivity (DO) in 15 patients (51.7%) and detrusor sphincter dyssynergia (DSD) in 19 (65.5%). Post-void residual (PVR) of >10% of the voided volume was found in 12 patients (41.4%). There were significant relationships between detrusor overactivity and PVR (P=0.005), frequency (P=0.046) and nocturia (P=0.045). Ultrasound examination revealed no upper urinary tract complications. CONCLUSION: Despite the presence of DO and DSD, HSP patients do not seem to have a high risk of developing ultrasonographically-assessed upper urinary tract complications after a mean follow-up of 22 years, contrary to spinal cord injury population. These results may guide practitioners in their decision-making about the appropriate evaluation and treatment of bladder disturbances that accompany hereditary spastic paraplegia.

Spondylolisthesis on bilateral pedicle stress fracture in the lumbar spine: a case study.

We report the clinical case of a 54-year-old woman presenting radicular low back pain on the right side of L4 associated to spondylolisthesis on L4-L5, without any notion of trauma or spine surgery. Furthermore this patient is regularly seen for benign rheumatoid polyarthritis complicated by steroid-induced osteoporosis. A preventive treatment was implanted with good results on pain improvement and functional capacities. For pedicle fractures the literature review reports several different etiologies: spontaneous fractures, hereditary fractures or stress-related fractures. There was a discussion on the various treatments available and in this case of spondylolisthesis on pedicle fracture a conservative treatment was implemented similar to the one for isthmic spondylolisthesis. It yielded satisfying results.

Neuropsychological disorders induced by cerebellar damage.

INTRODUCTION: Motor coordination disorders caused by cerebellar dysfunction are well known. However, the less known cerebellar neuropsychological disorders also merit attention, since they occur more frequently than one might imagine. CASE REPORT: We describe a 66-year-old patient with severe cerebellar damage caused by hemorrhagic stroke and associated with cognitive impairments (including impaired executive function, reasoning and judgment). A review of the literature on these neuropsychological disorders revealed a set of clinical, anatomical and functional imaging arguments that prompted us to broaden our vision of the cerebellum's role by acknowledging the presence of a cognitive component as well as the well-known motility component. In fact, there is good evidence of altered executive function (including mental flexibility, scheduling capacities and verbal working memory) in cerebellar patients. Visuospatial capacities are also affected, with disorders of visual memory and construction abilities having been reported. In terms of language, we noted reports of hypospontaneity and agrammatism with syntax problems. Memory (especially verbal memory), learning (both associative and procedural), judgment and reasoning also seem to be affected. In terms of emotion, various types of abnormal behavior and psychiatric disorders have been described and range from depression to true psychoses. Even though these data are controversial and must be confirmed, they prompt us to reconsider and deepen our understanding of the cerebellum's role and the functioning and improve our approach to (and management of) patients with cerebellar damage.

An unusual complication of intra-articular injections of corticosteroids: Tachon syndrome. Two case reports.

Local injections of corticosteroids can, in very rare cases, be complicated by Tachon syndrome-intense lumbar and/or dorsal and/or thoracic pain a few minutes after the injection, with rapid regression of the pain. Passing the drug into a vein through a nick made during the procedure could explain the pathophysiology of this disorder. We report two good cases illustrating the typical symptoms of this distressful syndrome. Diagnosis of Tachon syndrome is made by elimination of the usual medical and surgical causes, and physicians performing local injections should be aware of this phenomenon. The patient needs to be reassured of the temporal nature of the syndrome.