Penile Doppler ultrasound study in priapism: A systematic review.

BACKGROUND: Penile Doppler ultrasound (PDU) is suggested to be an alternative to blood gas analysis (BGA) from the corpora cavernosa in differentiating between high- and low-flow priapisms, with limited supportive evidence. AIM: To compare penile Doppler ultrasound study and blood gas analysis in the diagnosis of priapism, through a systematic review of the literature. METHODS: Studies were identified by literature search of Medline, Scopus, Cochrane and ClinicalTrials.Gov. Studies were included if their participants had priapism evaluated by Penile Doppler ultrasound, and reported data on the blood gas analysis or pudendal artery angiography (PAA). Two authors independently extracted the articles using predetermined datasets, including indicators of quality. OUTCOMES: Correlation of penile Doppler ultrasound with blood gas analysis and pudendal artery angiography. RESULTS: Twelve studies were included. Three studies compared Penile Doppler ultrasound to blood gas analysis and pudendal artery angiography. Penile Doppler ultrasound was used as adjunctive to blood gas analysis to differentiate low flow from high flow priapism, guidance for embolization, etiological diagnosis in three studies. Compared to pudendal artery angiography, penile Doppler ultrasound had a sensitivity of 40-100% and a specificity of 73%, to localize vascular injury and anatomical abnormalities (two studies). Penile Doppler ultrasound was also used for the follow-up after the treatment of priapism (two studies). No study reported an impact on functional results or a delay of management due to penile Doppler ultrasound use. CLINICAL TRANSLATION: We reviewed evidence on penile Doppler ultrasound study in priapism. Penile Doppler ultrasound study performance was comparable to blood gas from corpus cavernosum. It is recommended to use doppler as an alternative diagnostic tool. STRENGTHS & LIMITATIONS: Our systematic review had limitations. Firstly, the number of cases in the included studies was small. Secondly, these studies were all retrospective. Lastly, few data were reported with regards to hemodynamic parameters of penile Doppler ultrasound, and the majority of studies did not describe these in detail. CONCLUSIONS: Evidence supports that penile Doppler ultrasound is a reliable way for differentiating high-flow and low-flow priapism. We recommend penile Doppler ultrasound study as an alternative of blood gas analysis from corpus cavernosum, especially when the latter is not available. LEVEL OF EVIDENCE: 3.

Follow-up of glycemic index before and after Ramadan fasting in type 2 diabetes patients under antidiabetic medications.

INTRODUCTION: Fasting has no adverse effects on healthy Muslims during Ramadan. However, it can induce serious complications for patients with type 2 diabetes (T2D). We aimed to follow the variation of some biochemical and clinical parameters in T2D patients before and after Ramadan; and to determine the incidence of fasting on hypoglycaemia and lactic acidosis associated with antidiabetic agents such as metformin. MATERIALS AND METHODS: This work is a prospective study conducted during Ramadan on 150 patients, recruited 2 to 3 weeks prior to the start. These patients were sensitized about the Ramadan lifestyle and diet as well as the medications to take. RESULTS: This study results indicated a significant decrease of glycated haemoglobin (from 8.06% to 7.42%) and a similar trend in the fasting plasma glucose (from 1.81 to 1.36g/L) before and after Ramadan respectively. The serum lipid profile showed significant variations during the study period, and antidiabetic medications was associated with low serum lactate. The plasma creatinine and uric acid were reduced but remained insignificant. DISCUSSION AND CONCLUSION: Based on data from our study, we concluded that a safe fasting with a lower risk hypoglycaemia, can be achieved in a well-controlled patients, under antidiabetic drugs. However, the diabetes medication was associated with a small increase in serum lactate levels that seemed to be dose-independent and not affected by treatment duration.

[Medicines and breastfeeding: assessing the risk of medicines to infants]. / Médicaments et allaitement maternel: evaluation du risque médicamenteux chez le nourrisson.

Milk, in addition to its undeniable nutritional and immunological benefits, is an important element for the development of the infant. Warnings, sometimes exaggerated, may prevent the mother and child from enjoying the benefits of both breastfeeding and appropriate medication. This approach is justified by the total absence of investigations on the excretion of drugs in breast milk during clinical trials. The actual risk was evaluated by several classifications; an estimate of the passage of drugs into milk and estimation of infant exposure to the drug are possible and can provide a reliable indicator to better judge the risk to the infant. Generally we are faced with two different situations: a new treatment during lactation or maintenance treatment already prescribed during pregnancy. If treatment needs to be prescribed for a long period of breastfeeding, a strategic approach is required.

Medicines and breastfeeding: assessing the risk of medicines to infants

Milk, in addition to its undeniable nutritional and immunological benefits, is an important element for the development of the infant. Warnings, sometimes exaggerated, may prevent the mother and child from enjoying the benefits of both breastfeeding and appropriate medication. This approach is justified by the total absence of investigations on the excretion of drugs in breast milk during clinical trials. The actual risk was evaluated by several classifications; an estimate of the passage of drugs into milk and estimation of infant exposure to the drug are possible and can provide a reliable indicator to better judge the risk to the infant generally we are faced with two different situations: a new treatment during lactation or maintenance treatment already prescribed during pregnancy. If treatment needs to be prescribed for a long period of breastfeeding, a strategic approach is required

[Introduction of pharmacovigilance in a new university hospital in Morocco: how and why]. / L'instauration de la pharmacovigilance dans un nouveau centre hospitalier universitaire au Maroc: comment et pourquoi?

In an effort to improve patient safety, Hassan II hospital in Fez introduced a pharmacovigilance system for notification of adverse drug reactions as a priority objective. The implementation of pharmacovigilance activities actually began in June 2007 but it was in 2009 after the inauguration of the new complex that the system became properly operational. This report outlines the activities carried out to develop and implement this system, including informing and training the health professionals, and the results obtained after its introduction. From 2007 to 2009, fewer than 100 cases of adverse drug reactions were reported. Up to June 2011, however, 520 reports of adverse drug reactions were recorded. The classes of drugs most implicated in adverse events were: cancer drugs (26%), anti-inflammatory drugs and antibiotics (each 15%), analgesics (12%), iodinated contrast agents (6%), and anticoagulants and corticosteroids (5%). The main adverse events were dermatological and 27% of reports came from the internal medicine department, followed by hepatogastroenterology (25%). Of the 520 cases reported, 46% were severe.

[Anti-inflammatory activity of aqueous and ethanolic extracts of Zygophyllum gaetulum]. / Activité anti-inflammatoire des extraits aqueux et éthanolique de Zygophyllum gaetulum.

Zygophylle or Zygophyllum gaetulum Emberger and. Maire is a Moroccan medicinal plant which has been used as an anti-inflammatory, antidiabetic, antispasmodic and antidiarrheic. The present study was carried out to study and compare the anti-inflammatory effect of ethanolic extract with aqueous extract of Z. gaetulum. Organic extract of Z. gaetulum was obtained in soxhlet apparatus. Aqueous extract was obtained by infusion. The Wistar albinos rats of either sex weighing 200-300 g aged 2-3 months were used for this experiment. The rats were housed under standard environmental conditions. The anti-inflammatory activity was estimated by measuring the oedema induced by carragenin according to the method of Winter and al. Ethanolic extract of Z. gaetulum reduced the increase of the paw volume with a percentage of inhibition of 46% (p<0.01), this percentage was 47.48% (p<0.01) with aqueous extract. The inhibition decrease in time, it arrived to 39% (p<0.01) at the sixth hour while the activity of aqueous extract decrease a lot. In conclusion, Z. gaetulum is an interesting plant which the aqueous and éthanolic extracts could be used scientifically in the treatment of inflammation.

Introduction of pharmacovigilance in a new university hospital in Morocco: how and why

In an effort to improve patient safety, Hassan II hospital in Fez introduced a pharmacovigilance system for notification of adverse drug reactions as a priority objective. The implementation of pharmacovigilance activities actually began in June 2007 but it was in 2009 after the inauguration of the new complex that the system became properly operational. This report outlines the activities carried out to develop and implement this system, including informing and training the health professionals, and the results obtained after its introduction. From 2007 to 2009, fewer than 100 cases of adverse drug reactions were reported. Up to June 2011, however, 520 reports of adverse drug reactions were recorded. The classes of drugs most implicated in adverse events were: cancer drugs [26%], anti-inflammatory drugs and antibiotics [each 15%], analgesics [12%], iodinated contrast agents [6%], and anticoagulants and corticosteroids [5%]. The main adverse events were dermatological and 27% of reports came from the internal medicine department, followed by hepatogastroenterology [25%]. Of the 520 cases reported, 46% were severe

Carbon monoxide poisoning in Morocco during 1999-2007.

INTRODUCTION: Carbon monoxide (CO) intoxication is one of the most common types of poisoning in the modern world. The aim of the present study is to describe the evolution of CO poisoning during a period between January 1999 and December 2007 based on data collected from result of toxicological analysis in the laboratory of toxicology in the National Institute of Health in Morocco. MATERIALS AND METHODS: This study was based on autopsies samples sent to the laboratory of forensic toxicology covering the time period January 1999 to December 2007. Cases were analyzed according to the following criteria: age, region, month, gender, presence or not of autopsy report and post mortem blood carbon monoxide determination. RESULT: From January 1999 to December 2007, 139 out of the 4402 analysis performed were recorded as acute CO intoxications. Cases (93.5%) were classified as accident (E859). Hundred percentage of our cases were exclusively due to gaze inhalation. Circumstances of intoxications were described in autopsy report which is found in 41% (57 cases). Males predominated in accidental poisoning with 77 cases (55%) while females represented 62 cases (44%). the most represented city was Rabat with 48 cases (34%), followed by Casablanca with 20 cases (14.4%). the highest frequency of CO deaths was found in February and March with 29 cases (20.9%) and 28 cases (20.1%), respectively. The highest poisoning frequency was recorded for the age mean 34+/- years old. The average of carbon monoxide concentration was 5.76+/-4.3 ml/100ml of blood. Males predominated in accidental poisoning with 77 cases (55%) while females represented 62 cases (44%). CONCLUSION: Acute carbon monoxide intoxication is too dangerous because of its speed in addition to the particularities of carbon monoxide which is one of many ubiquitous contaminants of our environment that requires prevention and control measures inside and outside to insure adequate protection of public health.