[Social media and its impact on ophthalmology training]. / Réseaux sociaux : quel impact sur la formation en ophtalmologie ?

For the past ten years or so, the emergence of social media has disrupted modes of communication and social interaction, in both the personal and professional arenas; it also plays a major role in medical education. The goal of our work is to assess the current degree of use of social media by ophthalmology residents and its effect on the learning process. Our results show that social media were used by all the residents interviewed; the mean time spent on social media was 3.08±1.98 hours per day, of which 1.08±1.014 minutes were devoted to education; over half of the residents use social media between one and two hours per day for medical education. YouTube is the most widely used social network for medical education, followed by Instagram and Facebook. Ninety-eight percent feel that social media can improve their training; 92% feel that social media may become increasingly more important in medical education.

Incidence des cancers chez les personnes vivant avec le VIH suivies à Casablanca / Incidence of cancer among people living with HIV at Casablanca

Objectif. Décrireles aspects épidémiologiques des cancers chez les personnes vivant avec le VIH à Casablanca. Patients et méthodes. Il s'agissait d'une étude rétrospective sur 13 ans dans le service des maladies infectieuses du CHU Ibn Rochd de Casablanca. Ont été inclus tous les patients infectés par le VIH et présentant un cancer documenté histologiquement. Les données ont été colligées à partir du Nadis. L'analyse des données a été faite sur le logiciel épi info. Une valeur de p< 0,05 était considérée significative. Résultats. Nous avons inclus 139 patients qui présentaient des pathologies cancéreuses soit un taux d'incidence de 3,7patients pour 1000 patients année. L'âge moyen était de 37ans. Le sexe ratio était de 1,72 (88H/51F). Les cancers classant sida ont représenté 84% (117 cas) contre 16 % (22 cas) de cancers non classant sida. Le sarcome de Kaposi a été le plus fréquent (58,99%). Le cancer non classant sida le plus fréquent était le lymphome de Hodgkin (6,47%)(9 cas). Les Lymphomes malins non hodgkiniens et le sarcome de Kaposi étaient corrélés au sexe masculin (p=0,002, p=0,0006). Nous avons enregistré 39 décès (28%) et 34 perdus de vue (24,48%). Conclusion. Les pathologies cancéreuses restent fréquentes au cours du VIH avec une morbi-mortalité importante. Les cancers classant sida demeurent les plus fréquents dans notre contexte.

Objective. To describe the epidemiology of malignancies in people living with HIV at Casablanca. Patients and methods. It was a 13-year retrospective study in the Infectious Diseases Department of Ibn Rochd University Hospital in Casablanca. Included were all HIV-infected patients with histologically documented cancer. Data was collected from Nadis. Data analysis was done on the software epi info. A value of p <0.05 was considered significant. Results. 139 patients had cancerous diseases, an incidence rate of 3.7 patients per 1000 patients' year. The average age was 37 years old. The sex ratio was 1.72 (88H / 51F). Cancer classifying AIDS represented 84% (117 cases) against 16% (22 cases) of non-AIDS-defining cancers. Kaposi's sarcoma was the most common with 58.99%. The most common non-classifying AIDS cancer was Hodgkin's lymphoma with 6.47% (9 cases). Non-Hodgkin's malignant lymphoma and Kaposi's sarcoma were correlated with male sex (p = 0.002, p = 0.0006). We recorded 39 deaths (28%) and 34 lost to follow-up (24.48%). Conclusion. Cancerous pathologies remain frequent during HIV with significant morbidity and mortality. Cancer classifying AIDS remains the most common in our context.

Hepatitis B knowledge, attitudes and practices among Moroccan college students.

BACKGROUND: Viral Hepatitis B (HBV) prevalence in Morocco is estimated at 1.81%. University students are an exposed population due to their risky behaviors. Their knowledge about HBV is still unknown. The aim of our study was to assess the knowledge, attitudes and practices of college students in Casablanca about HBV. METHODS: A cross-sectional study was carried out in January 2015 among the students of the eight schools of Hassan II University in Casablanca using a self-administered questionnaire. A knowledge score was calculated to compare the groups with sufficient and insufficient knowledge. A logistic regression adjusted on gender was performed to explore the factors associated with a sufficient knowledge about HBV (P<0.05). RESULTS: The response rate was 90.2% (n=652). The median age was 21 years old. From our sample, 97.5% knew the existence of "hepatitis". The main means of information were media and relatives. The most known way of infection was blood transmission (50.3%) while 11.5% believed in the effectiveness of the traditional methods of treatment. Eating with an HBV infected person was thought to be a risky behavior for 38% of the students. A knowledge level that was deemed to be sufficient was scored by 31.1% of the students. The sufficient knowledge was correlated to being a health care student, being vaccinated and being married. CONCLUSION: Casablanca's student knowledge about HBV remains limited. We believe that improvements in awareness and access to immunization are needed. These measures would likely help decreasing HBV incidence in students and ensure a better social integration of patients.

[The effects of corneal cross-linking on intraocular pressure measurement in keratoconus]. / Les effets du cross-linking cornéen sur la mesure de pression intra-oculaire dans le kératocône.

Cross-linking (CXL) is a technique whose design aims to achieve a specific goal: to harden the corneal tissue of eyes with a progressive form of keratoconus. Other indications are being investigated, such as treatment of infectious keratitis and prevention of corneal ectasia post corneal ablative refractive surgery. Hardening the cornea means changing its biomechanical properties. The existence of true corneal hardening after CXL would inevitably result in an increase in measured intraocular pressure (IOP). This would have a considerable impact in the screening and follow-up of glaucoma patients who have undergone cross-linking because of the central role of IOP measurement in glaucomatous pathology.

[Central Neurological Diagnosis in Patients Infected with HIV in the Infectious Diseases Unit of University Hospital of Casablanca, Morocco]. / Manifestations neurologiques centrales chez les patients infectés par le VIH dans le service des maladies infectieuses du CHU de Casablanca, Maroc.

The aim of this work is to study the epidemiology of central neurological system (CNS) diagnosed in the population of people living with HIV in the department of infectious diseases in UHC Ibn Rochd of Casablanca from January 2005 to May 2015. The demographic and clinical profile along with the outcome of these patients were studied. The data were collected from Nadis software. Three hundred and eighty-seven patients were admitted for CNS diagnosis, out of 3496 people living with HIV admitted during this time period, i.e., a prevalence of 11%. The sex ratio (M/F) was 1.27. The average age was 39 years (± 7). Neurological involvement was indicative of HIV infection in 225 cases (68.8%). Neurological disorders were dominated by headache (70%), focal neurological syndrome (35%), and meningeal syndrome (30%). CNS diagnosis noted were CNS tuberculosis (37%), cerebral toxoplasmosis (30%), and cryptococcal meningitis (20%). The median CD4 T-lymphocyte was 184 cells/mm3. Infection with severe immunosuppression was progressive multifocal leucoencephalitis, cryptococcal meningitis, and primary cerebral lymphoma. Lethality was 39%. In the department of infectious diseases of the UHC, the main cause of death among HIV-infected patients is tuberculosis. Collaboration between the national tuberculosis and AIDS programs has been established to improve the detection and management of these patients.

L'objectif de ce travail est d'étudier l'épidémiologie des manifestations neurologiques centrales (MNC) des patients vivant avec le VIH (PvVIH) suivis dans le service des maladies infectieuses du CHU Ibn Rochd de Casablanca entre janvier 2005 et mai 2015. La source des données était le logiciel Nadis. Trois cent quatre-vingt-sept patients ont été hospitalisés pour une MNC sur 3 496 PvVIH, soit une prévalence de 11 %. Le sex-ratio (H/F) était de 1,27. L'âge moyen des patients était de 39 ans (± 7). L'atteinte neurologique était révélatrice de l'infection à VIH dans 266 cas (69 %). Les troubles neurologiques étaient dominés par les céphalées (70 %), le syndrome neurologique focal (35 %) et le syndrome méningé (35 %). Les étiologies étaient dominées par la méningoencéphalite tuberculeuse (37 %), la toxoplasmose cérébrale (30 %) et la cryptococcose neuroméningée (CNM) (20 %). La médiane des lymphocytes T CD4 était de 184 cellules/mm3. Les atteintes survenues en cas d'immunodépression sévère étaient la leucoencéphalite multifocale progressive, la CNM et le lymphome cérébral primitif. Le taux de létalité global était de 39 %. Dans le service des maladies infectieuses du CHU prenant en charge les PvVIH, la tuberculose est la première étiologie des MNC au cours de l'infection au VIH. Une collaboration conjointe du programme national de lutte contre la tuberculose et de celui de lutte contre le sida a été mise en place pour améliorer le dépistage et la prise en charge de ces patients.

[Anterior lamellar resection with lid margin split of the upper eyelid in the treatment of trachomatous entropion]. / Marginoplastie par recul de la lamelle antérieure dans le traitement de l'entropion trichiasis trachomateux de la paupière supérieure.

INTRODUCTION: The goal of this study is to assess functional and aesthetic results of anterior lamellar resection with lid margin splitting of the upper lid in the treatment of cicatricial trachomatous entropion. PATIENTS AND METHODS: Descriptive cross-sectional study of a series of 26 consecutive patients treated between January 2014 and December 2015. All patients were operated for cicatricial trachomatous entropion in our tertiary center using the technique of the anterior lamellar resection with lid margin splitting of the upper eyelid. All patients were followed for 6 to 12 months after surgery. The anatomical, functional and aesthetic results were evaluated six months after surgery. They were considered good if there was no recurrence of the entropion, no lashes in contact with the cornea and no associated eyelid complications. RESULTS: The mean age of the patients was 68.5±10 years with a male predominance (sex ratio=1.8). The average initial corrected visual acuity was 0.65±0.35 LogMAR, ranging from counting fingers at 1m to 6/10. Involvement was bilateral in 34.6% of cases. Correction of the cicatricial entropion was achieved in 24 patients (92.3% of cases) and full correction of misdirected lashes without any contact with the ocular surface was obtained in 23 patients (88.4% of cases). The lid margin was regular in 88.4% of cases. A significant improvement of the tear film and corneal surface was observed in 84.6% of patients. During the follow-up period, no cases of recurrent entropion were reported. DISCUSSION: Among the various surgical techniques, anterior lamellar resection with lid margin splitting is one that most respects the anatomy of the upper eyelid and allows precise intraoperative control of eyelid rotation and eversion of the misdirected lashes. Therefore, it reduces significantly the risk of recurrence and significantly enhances the aesthetic results of surgery. CONCLUSION: Anterior lamellar resection with lid margin splitting of the upper eyelid is a simple and effective technique that significantly improves the aesthetic result of cicatricial trachomatous entropion.

[Role of Köllner-Hughes tarsoconjunctival flap in the reconstruction of large eyelid defects]. / Intérêt du lambeau tarsoconjonctival de Köllner-Hughes dans la reconstruction des larges défects palpébraux.

PURPOSE: To evaluate the aesthetic and functional results of the Köllner-Hughes tarsoconjonctival flap technique for large defects of over three-quarter of the lower eyelid. PATIENTS AND METHODS: A retrospective descriptive study of a series of 15 patients treated between January 2013 and December 2015. We included all patients who underwent reconstructive surgery for a tumor involving more than three-quarter of the lower eyelid and sparing the canthi. Reconstruction of the lower eyelid defect was performed using Köllner-Hughes technique. RESULTS: The mean age of our patients was 65.7±8 years. The sex ratio was 1.5 with male predominance. All patients had well-differentiated basal cell carcinoma of the lower eyelid. The average size of the eyelid defect induced by the surgery was 18±4mm. Release of the tarsoconjonctival flap was performed after a period of 8 to 10 weeks after the reconstructive surgery. After a mean follow-up of 12±6 months, the aesthetic and functional results were satisfactory in 86.7% of cases especially in terms of eyelid closure and protection of the ocular surface. Complications included erythema of the newly formed free edge in 26.7% of cases, keratinization and hypertrophy of the free edge in 20% of cases, the deformation of the upper free edge with an associated entropion in 20% of cases and lower eyelid retraction in 6.67% of cases. Ocular surface disease such assuperficial punctate keratitis or dry eye was found in 13.4% of cases. DISCUSSION: Several authors have chosen the Köllner-Hughes technique to treat increasingly wide eyelid defects with very satisfactory results. Eyelid reconstruction with the Köllner and Hughes technique is a very attractive procedure because it offers several advantages. It is a quick and easy technique that covers wide defects over three-quarter of the lower eyelid well with very satisfactory cosmetic results and without significantly increasing morbidity at the donor site. In combination with additional procedures, this technique can totally reconstruct the lower eyelid. Despite all its benefits, the Köllner-Hughes tarsoconjonctival flap has some minor drawbacks, such as the need for two surgeries spaced a few weeks apart to open the palpebral fissure; therefore it is contraindicated for one-eyed patients and children because of the risk of amblyopia. CONCLUSION: The tarsoconjonctival flap as initially described by Köllner and Hughes was indicated in the reconstruction of moderate and medium-sized defects of the lower eyelid. In our practice, we can extend the indications of this technique to much larger defects than three-quarter of the lower eyelid, while ensuring satisfactory aesthetic results and minimal complications.

[Retrospective study of neuromeningeal cryptococcosis in patients infected with HIV in the infectious diseases unit of university hospital of Casablanca, Morocco]. / Étude rétrospective de la cryptococcose neuroméningée chez les patients infectés par le VIH dans le service des maladies infectieuses du CHU de Casablanca, Maroc.

OBJECTIVE: To report the cases of neuromeningeal cryptococcosis and to describe the clinical, paraclinical, therapeutic and outcomes of patients. PATIENTS AND METHODS: Retrospective study of 43 patients infected with HIV admitted from January first 2010 to June 30th 2015 in the infectious disease unit of UHC Ibn Rochd, for neuromeningeal cryptococcus. RESULTS: The mean frequency of neuromeningeal cryptococcosis in patients infected with HIV was 1.4%. The mean age was 39 years and a sex ratio of 1.38. The mean CD4 count was 70 cells/mm3. The diagnosis of HIV was revealed by neuromeningeal cryptococcus in 77% of cases. Fifteen days interval was reported between the first symptom and hospital admission. Headache (77%) was the most represented clinical sign. The cerebrospinal fluid analysis showed hypoglycorachy (67%), hyperproteinorachy (65%) and lymphocytosis (63%). Chinese ink direct examination for Cryptococcus neoformans in CSF was positive in 86% of cases and all cases were positive after culture on Sabouraud's medium. Patients were treated with monotherapy amphotericin B (42%) or fluconazole (28%) and bitherapy amphotéricine B/fluconazole (28%). Fatal evolution was observed in 60% of cases. CONCLUSION: Neuromeningeal cryptococcosis remains a severe opportunistic infection in HIV patients with a heavy mortality rate.

Fanconi syndrome induced by tenofovir: A case report.

Tenofovir disoproxil fumarate (TDF) is a nucleotide reverse transcriptase inhibitor discovered in the USA in 2001. It is currently the treatment of choice for patients co-infected with human immunodeficiency virus (HIV) and hepatitis B virus. Its antiretroviral efficacy and good tolerance are responsible for the higher frequency of prescriptions compared with other nucleoside analogs. However, it can induce acute renal toxicity causing impairment of the proximal tubular function of the kidney. This is highly dependent on factors such as associated co-prescription didanosine or a protease inhibitor "boosted" with ritonavir, preexisting renal insufficiency, low body weight, or presence of associated diabetes. In contrast, long-term renal toxicity remains highly debated. Some studies describe a decrease in estimated glomerular filtration rate during prolonged treatment with TDF. Others reported renal safety even during prolonged use. The differences between patients enrolled in the different studies, the measured parameters and their interpretation could explain these discrepancies. We describe a case of a patient infected with HIV, who presented with Fanconi syndrome with acute renal failure six months after starting antiretroviral treatment including tenofovir.

[Pneumocystosis during HIV infection]. / La pneumocystose au cours de l'infection à VIH.

Pneumocystosis is an opportunistic disease caused by invasion of unicellular fungus Pneumocystic jirovecii which is responsible for febrile pneumonia among patients with cellular immunodeficiency especially those HIV infected. Despite the decreasing of its incidence due to the introduction of antiretroviral therapy, as well as anti-Pneumocystis prophylaxis among these patients, Pneumocystis pneumonia remains the first AIDS-defining event and a leading cause of mortality among HIV-infected patients. The usual radiological presentation is that of diffuse interstitial pneumonia. The diagnosis is confirmed by the detection of trophozoides and/or cysts P. jirovecii in bronchoalveolar lavage (BAL) samples using several staining techniques. The use of polymerase chain reaction in the BAL samples in conjunction with standard immunofluorescent or colorimetric tests have allowed for more has allowed for more rapid and accurate diagnosis. The standard regimen of treatment is the association of trimethoprim-sulfamethoxazole which has been utilized as an effective treatment with a favourable recovery. Early HIV diagnosis and antiretroviral therapy should reduce the incidence of this dreaded disease.

[Long-term results of phacoemulsification in pseudoexfoliation syndrome]. / Résultats à long terme de la phacoémulsification dans le syndrome pseudoexfoliatif.

INTRODUCTION: The prevalence of pseudoexfoliation syndrome is estimated at 8 % of all cataracts operated within our institution. The goal of our study was to describe the frequency of intraoperative and postoperative complications and long-term anatomical and functional results of phacoemulsification in pseudoexfoliation syndrome. PATIENTS AND METHODS: A retrospective observational study of a series including 103 patients (107 eyes) with cataract associated with pseudoexfoliation syndrome admitted between January 2010 and September 2014. All patients underwent phacoemulsification. RESULTS: The average age of our patients was 72.5±6 years. The average initial corrected visual acuity was 0.52±0.14LogMAR. The cataract was grade C3N3 in 58 % of cases. The pseudoexfoliation syndrome was bilateral in 69 % of cases. Pupillary dilatation was≤6mm in 54 % of cases. Among intraoperative complications, zonular dialysis was found in 1.8 % of cases. Posterior capsular rupture and vitreous loss was noted at 5.4 % of patients. The incidence of secondary cataract was 31.7 % at 12 months. The mean postoperative best corrected visual acuity was 0.13±0.15 LogMAR. DISCUSSION: The small pupil associated with high grade of the cataracts in our series explains the slightly higher frequency of intraoperative zonular dialysis. Cataract surgery by phacoemulsification allows for a statistically significant improvement in visual acuity (P<0.001). The incidence of secondary cataract, the main postoperative complication, is higher in our series compared to data in the literature. CONCLUSION: Pseudoexfoliation syndrome is common in our country. Functional results of phacoemulsification are very satisfactory, and secondary cataract is the main complication. A meticulous search for pseudoexfoliation is mandatory during the initial examination in order to reduce intraoperative complications. Careful removal of the cortex and systematic polishing of the lens capsule should limit the incidence of secondary cataracts.

[Cryptococcosis during HIV infection]. / La cryptococcose au cours de l'infection à VIH.

Cryptococcosis is a cosmopolitan fungal serious condition due to an encapsulated yeast Cryptococcus neoformans. This is the systemic fungal infection the most common in HIV infection. This yeast is present in the environment and its main entrance in the body is the respiratory tract. Its gravity is linked to its tropism for the central nervous system. It generally affects subjects with severe deficit of cellular immunity and in particular, patients living with HIV. The diagnosis of neuromeningeal cryptococcosis is based on the detection of encapsulated yeasts at microscopic examination of cerebrospinal fluid, the detection of capsular polysaccharide antigen in serum or cerebrospinal fluid, but especially on the culture. A staging is always essential. The prognosis is severe. The control of intracranial hypertension is a major element of prognosis.

[Pseudophakic retinal detachment: how to manage?]. / Décollement de rétine du pseudophaque : quelle prise en charge ?

INTRODUCTION: Retinal detachment, a common complication of cataract surgery, requires urgent surgical treatment. The external approach combining retinopexy with scleral buckling remains the gold standard in the surgical management of pseudophakic retinal detachment (RD) without marked proliferative vitreoretinopathy (PVR), although intraocular surgery is currently preferred by most of the authors. The purpose of this study is to compare the anatomical and functional results obtained with both techniques. PATIENTS AND METHODS: This study compares the results of two techniques for treating pseudophakic retinal detachment: external surgery (group I), and vitrectomy with internal tamponade (group II). Ab-externo surgery was performed in 24 patients (24 eyes), while 22 patients (22 eyes) underwent primary vitrectomy. In order to make both groups comparable, we excluded recurrences of RD, vitreous hemorrhage and other media opacities, giant tears and initial grade C PVR. Minimum follow-up was 12 months. Postoperative variables analyzed and compared were the rate of initial and final anatomical success, final visual acuity, and causes of failure of the initial surgery. RESULTS: The retina was reattached with a single operation in 21 eyes in group I (87.5%) and 19 eyes in group II (86.4%) (P=0.91). The causes of anatomical failure in both groups were proliferative vitreoretinopathy (4 cases) and secondary tears or tears not seen on initial examination (2 cases). For patients in group I, secondary surgery consisted of total vitrectomy with encircling buckle. Patients in group II underwent an additional vitrectomy (peeling of vitreoretinal proliferation, and silicone oil tamponade as necessary). After a mean follow-up of 12 months, the final examination noted a reattached retina in 23 eyes in group I (95.84%) and 21 eyes in group II (95.45%) (P=0.95). The final visual results were identical at comparable follow-up periods. Indeed, the final visual acuity was similar in the two groups with nearly 40% of patients having recovered visual acuity between 1/10 and 5/10 (P=0.98). CONCLUSION: With regard to surgical treatment of pseudophakic retinal detachment, vitrectomy with internal tamponade provides anatomical and functional results comparable to those obtained with external surgery.

[Use of bevacizumab in the treatment of complicated proliferative diabetic retinopathy]. / Utilisation du bévacizumab dans le traitement de la rétinopathie diabétique proliférative compliquée.

INTRODUCTION: Diabetes is the leading cause of neovascular vitreoretinal proliferation. Several recent publications have appeared showing the efficacy and safety of intravitreal bevacizumab (IVT) in proliferative or complicated diabetic retinopathy (PDR), but with no consensus on the injected dose. We report the results of its use as adjuvant intravitreal injection (IVT) prior to posterior vitrectomy in the setting of complicated PDR. The goal of our work is to evaluate the benefits of and try to establish a protocol for proper use of intravitreal bevacizumab prior to vitrectomy for complicated PDR, so as to incorporate it in the management of this disease. PATIENTS AND METHODS: A prospective comparative study of series of patients hospitalized for severe complicated PDR requiring vitrectomy was spread over one year, from January 2011 to December 2011. Included patients were divided into two groups: group A: receiving an injection preoperatively at a dose of 1.25mg, and group B, which received an injection of bevacizumab at a dose of 0.75mg (with a time to surgery of either less than 3 days, more than 6, or 3 to 6). We analyzed the epidemiological characteristics, data from the initial eye examination and intraoperative complications and follow-up after vitrectomy. RESULTS: Thirty-five patients were included. We noted no significant difference in epidemiological characteristics between group A and B. Sixty percent of patients underwent surgery after a period of three to six days post-IVT. The reduction of neovascularization, decreased risk of bleeding and the facilitation of membrane peeling during surgery were significantly similar between group A and B. No complication related to the molecule and no recurrence, including bleeding, were noted throughout follow-up in both groups. CONCLUSION: We opt for a systematic use of anti-VEGF, particularly bevacizumab prior to all vitrectomies for complicated PDR. A 0.75mg dose at an interval of 3 to 6 days seems to be a good compromise between the desired effect and possible complications that may arise.