Application of GIS for assessing the vulnerability of aquifers to pollution in the coastal zone of Essaouira, Morocco.

Groundwater remains the main water resource for consumption of potable water, irrigation in the agricultural field, and for the use in industrial and touristic domains by inhabitants of cities and villages in the coastal areas with arid and semi-arid climate. In order to protect the groundwater table of the coastal zone of Essaouira, located in the west central part of Morocco, a study of the intrinsic vulnerability to pollution was tackled by the use of the Geographic Information Systems (GIS) from the DRASTIC method. This tool serve to highlight the overexploitation problems and water quality degradation and help decision makers to take good decisions to solve them. Vulnerability cards are fundamental documents for spatial planning. They represent excellent support for the establishment of all kinds of human activities taking into account the pollution of underground waters. The analysis of the vulnerability map for the pollution of the Plio-Pleistocene aquifer of the coastal zone of Essaouira, shows a heterogeneous variation in vulnerability across the area. With values of the DRASTIC index (ID) range from 45 to 149 spatially distributed in the study area, the vulnerability map established shows four (04) vulnerability classes: low (45-77), medium (78-92), high (93-112), and very high (113-149). Analysis of this map shows a dominance of low and medium vulnerability zones in most of the water table, with the percentage of each class is as follows: low (18%), medium (53%), high (22%), and very high (7%); this vulnerability to pollution calculated by the standard DRASTIC method is essentially dependent on the depth of the groundwater table and the unsaturated zone. These two parameters have a very important influence compared to other parameters that make up this method. The most dominant class is the low and middle class (71%), which represents almost the entire plain and corresponds to uncertain hydrogeological protection of groundwater by considering the hydrogeological vulnerability scale as certainly well protected.

Fatal scorpion envenomation in a 3-month-old infant.

Scorpion envenomation is a public health problem in several countries in the tropics and subtropics, with high mortality in the severe forms involving multiple organ failure. The correlation between young age and clinical manifestations of severe scorpion envenomation is well established. We report the case of a 3-month-old infant admitted for severe scorpion envenomation who rapidly developed fatal multiple organ failure, and we discuss the different physiopathological aspects of severe scorpion envenomation.

The antivenom efficacy against a viper bite without medical treatment for 3 days: a case report.

Snakebites can be deadly, depending on the course of extremely serious hemorrhagic complications in the absence of antivenom, which remains the only specific and effective treatment, if it is introduced in time. We report the case of a young patient of 18 years, bitten by a snake and receiving only tradition care until admission to intensive care 3 days later, with advanced bleeding and inflammation; four vials of FAV-Africa antivenom were administered and resulted in dramatic improvement in his condition. This result confirms the empirical concept that delay in management should under no circumstances exclude the administration of antivenom.

Refeeding syndrome: a forgotten and potentially lethal entity.

Refeeding syndrome (RS) is defined as the fluid, electrolyte, metabolic, and clinical disturbances that occur after nutrition of patients who have been undernourished or fasting for a prolonged period. This syndrome has been recognized for several decades but is most often overlooked and underdiagnosed by health professionals. The authors report a RS in a patient subjected to prolonged fasting after being kidnapped by a criminal gang. Refeeding resulted in severe hypophosphatemia, neurological impairments, and hematologic disorders. The patient died due to septic shock with multiple organ failure secondary to aspiration pneumonia. In this case, the failure to recognize RS was decisive in the fatal outcome. Professionals must be aware of this disease to prevent and treat it properly.

[Pneumomediastinum: an aspect of pulmonary barotrauma during mechanical ventilation of acute respiratory distress syndrome]. / Le pneumomédiastin : un aspect du barotraumatisme pulmonaire au cours de la ventilation mécanique du syndrome de détresse respiratoire aiguë

Mechanical ventilation is a fundamental treatment of acute respiratory distress syndrome (ARDS). Despite compliance with the recommendations of protective mechanical ventilation, it can results in serious complications including the pulmonary barotrauma. This is often manifested by a pneumothorax. This observation describes an unusual aspect of barotrauma which is pneumomediastinum. The authors also point out the role of chest imaging in the management of mechanical ventilation during ARDS.

[Association of ischemic and hemorrhagic cerebral stroke due to severe envenomation by the Sahara horned viper (Cerastes cerastes)]. / Association de lésions cérébrales thrombotiques et hémorragiques lors d'une envenimation grave par la vipère à cornes du Sahara (Cerastes cerastes).

Viper envenomation can cause complex disorders of hemostasis. These disorders usually lead to hemorrhagic syndrome. The occurrence of thrombosis is exceptional. This case report describes a severe envenomation by the Saharan horned viper (Cerastes cerastes), complicated by unusual brain injuries: hemorrhagic and ischemic stroke. The physiopathologic link between this serious toxic coagulopathy and the multitude of toxins in the venom of Cerastes cerastes is highlighted.

[Paraspecificity of antivenins: example of severe envenomation by the Sahara horned viper (Cerastes cerastes) treated with non-specific antivenin]. / La paraspécificité des antivenins: exemple d'une envenimation grave par la vipère à cornes du Sahara (Cerastes cerastes) traitée par un antivenin polyvalent non spécifique.

Snake bites are a major public health problem in Morocco. Both morbidity and mortality of ophidian envenomation remain very high in this country. Antivenin immunotherapy, the only etiological treatment of this envenomation, is often unavailable in local hospitals. Moreover, when available, antivenins are not necessarily suitable for local ophidian species. This case report describes severe poisoning caused by a Sahara horned viper (Cerastes cerastes) in southern Morocco. In the absence of specific immunotherapy, FAV-Afrique®, a polyvalent antivenom serum, was administered. The favorable outcome suggests that this serum is paraspecific against the Sahara horned viper. The paraspecificity of antivenin immunotherapy could be a solution to ophidian envenomation in the absence of an antivenin adapted to local snake species.

[Effect of a single intramuscular dose of dexamethasone on pain after circumcision. A randomized controlled study]. / Effet d'une dose unique intramusculaire de déxaméthasone sur la douleur après circoncision. Étude randomisée contrôlée.

OBJECTIVE: To assess the effect of a preoperative single dose of dexamethasone associated with penile block on pain after circumcision. STUDY DESIGN: Prospective randomized controlled study. PATIENTS AND METHODS: Forty male children aged 2 to 5 years, scheduled for circumcision under general anaesthesia, combined with penile block, were randomized into two groups. The dexamethasone group received dexamethasone 0.4 mg/kg preoperatively. The control group received the same volume of normal saline. Data compared between two groups were: postoperative pain assessed by the Objective Pain Scale collected in the recovery room, at 8 and 24 hours postoperatively (h0, h8 and h24), time to first analgesic request and the quality of sleep on the first postoperative night. RESULTS: Pain scores at h0 were similar between the two groups. The dexamethasone group showed significantly lower pain scores at h8 [0 (0-1) vs. 2 (0-3); P=0.04] and h24 [0 (0-0) vs. 0 (0-1); P=0.02]. The time to first analgesic administration was also significantly delayed in the dexamethasone group compared to the control group (240 vs 180 min; P=0.035). The quality of sleep was also better in children in the dexamethasone group (P=0.018). CONCLUSION: This study showed that the combination of a preoperative single dose of dexamethasone 0.4 mg/kg with penile block significantly improves the quality of analgesia after circumcision.

[Tension pneumocephalus after surgical treatment of a bilateral chronic subdural hematoma: a banal and serious complication]. / Pneumocéphalie compressive après traitement chirurgical d'un hématome sous-dural chronique bilatéral: une complication banale et sérieuse.

The occurrence of postoperative pneumocephalus is a common event and is often trivial. When the intracranial air volume is significant, it creates intracranial hypertension causing tension pneumocephalus. This case report describes the occurrence of tension pneumocephalus after surgical drainage of bilateral chronic subdural hematoma. The pneumocephalus was responsible for severe postoperative neurological deterioration. The attending physicians should be aware of the possibility of occurrence of such complication. Treatment and prevention of pneumocephalus should also be well known by the medical staff.

[Acute negative pressure pulmonary edema: illustration from a unusual clinical case following a postoperative recurrent laryngeal nerve palsy]. / L'œdème aigu du poumon à pression négative : illustration à partir d'un cas clinique inhabituel compliquant une paralysie récurrentielle postopératoire.

Acute postoperative negative pressure pulmonary edema (NPPE) is a respiratory complication due to upper airway obstruction occurring most commonly in the postoperative period. Pathophysiologically, NPPE is explained by the abrupt generation of highly negative intrathoracic pressure that lead to fluid transudation from the pulmonary capillaries. This observation reports an unusual case of a young patient who has undergone total thyroidectomy for multinodular goiter. The postoperative period was marked by the occurrence of bilateral recurrent laryngeal nerve palsy that was complicated by a NPPE. The outcome was favorable after mechanical ventilation with reversal of NPPE and recovery of the recurrent laryngeal nerve function. This article stresses the importance of prevention of recurrent nerve palsy during thyroid surgery. It also highlights a little known respiratory complication: the NPPE. Understanding the pathophysiology of NPPE, rapid diagnosis and appropriate therapeutic measures could prevent its potential lethal consequences.

[Chickenpox: a cause of acute respiratory distress syndrome to bear in mind]. / La varicelle: une étiologie de syndrome de détresse respiratoire aiguë à ne pas méconnaître.

The authors report a case of chickenpox (varicella) in an adult, complicated by acute respiratory distress syndrome and resulting in death.

[Tracheotomy complications in resuscitation patients]. / Complications de la tracheotomie chez les malades de reanimation.

Many statistics on what concerned the tracheotomy complications are old, dating from 1960-1970, and discouraging to practise this kind of gesture. Moreover, it is unfeasible to objectively evaluate this technique from these huge sets where it is often difficult to separate the dramatic complications (massive haemorrhage, suffocating pneumothorax,...) and those more benign. The authors analyze through a retrospective study of 32 tracheotomised patients, the index of these complications in distinguishing those of the early stage and the late stage can occur even after decannulation. In the acute phase, haemorrhages 9.3 p 100) per inadequate haematosis, the pneumothorax (3.1 p 100) and the infection of the stoma (12.5 p 100) are the most frequent. The opening tracheotomy infection can support pulmonary infections (28.1 p 100) which cause serious problems at tracheotomised. After decannulation, the principal complication is the tracheobronchial stenosis (3.1 p 100). Its diagnosis is difficult and should be done by systematic endoscopic control of the trachea and radiological explorations at the time of the decannulation. The authors insist on the use of proper equipments, protocols of rigorous care and strict post-operative monitoring.

[Severe imported malaria. The experience of the military hospital of Marrakech]. / Le paludisme grave d'importation à propos de neuf cas: expérience de l'hôpital militaire Avicenne de Marrakech.

Incidence of severe imported malaria increases with the multiplication of humanitarian and military missions in malarial endemic areas. The purpose of this study was to describe the demographic, clinical, therapeutic and outcome aspects of 9 cases which have been hospitalized in the intensive care unit and medecine service of the military hospital of Marrakech, between january 2001 and december 2004. Out of 68 patients admitted with symptomatic malaria during this period, 9 cases were considered as severe. All of them were male soldiers (mean age: 33,3 years), 7 of them have stayed in Democratic Republic of Congo, and 2 in Ivory Coast. Chemoprophylaxis consisted in chloroquine plus proguanil in 5 cases and mefloquine in 4 cases. The mean duration of stay in endemic area was 9,3 months. The clinical presentation was dominated by troubles of consciousness, which justified initial admission in the intensive care unit. The mean duration of hospitalization was 3,3 days in intensive care unit and 5,6 days in the medical department. Thick smear always revealed high parasitemia (5-15%) with Plasmodium falciparum, associated with Plasmodium ovale in two cases. Antimalarial treatment consisted in quinine salts administration. Evolution was favourable without recurrence in 7 cases, but 2 deaths were recorded. Severe imported malaria remains associated with bad outcome and requires early diagnosis and close monitoring of such cases.

[Severe imported malaria: the experience of the Avicenna military hospital of Marrakech]. / Le paludisme grave d'importation à propos de neuf cas : expérience de l'hôpital militaire Avicenne de Marrakech.

Incidence of severe imported malaria increases with the multiplication of humanitarian and military missions in malarial endemic areas. The purpose of this study was to describe the demographic, clinical, therapeutic and outcome aspects of 9 cases which have been hospitalized in the intensive care unit and medecine service of the military hospital of Marrakech, between january 2001 and december 2004. Out of 68 patients admitted with symptomatic malaria during this period, 9 cases were considered as severe. All of them were male soldiers (mean age: 33,3 years), 7 of them have stayed in Democratic Republic of Congo, and 2 in Ivory Coast. Chemoprophylaxis consisted in chloroquine plus proguanil in 5 cases and mefloquine in 4 cases. The mean duration of stay in endemic area was 9,3 months. The clinical presentation was dominated by troubles of consciousness, which justified initial admission in the intensive care unit. The mean duration of hospitalization was 3,3 days in intensive care unit and 5,6 days in the medical department. Thick smear always revealed high parasitemia (5-15%) with Plasmodium falciparum, associated with Plasmodium ovale in two cases. Antimalarial treatment consisted in quinine salts administration. Evolution was favourable without recurrence in 7 cases, but 2 deaths were recorded. Severe imported malaria remains associated with bad outcome and requires early diagnosis and close monitoring of such cases.