Whole-Genome Sequencing of Two Moroccan Mycobacterium tuberculosis Strains.

Mycobacterium tuberculosis is known to cause pulmonary and extrapulmonary tuberculosis. In Morocco, the spread of multidrug-resistant (MDR) tuberculosis (TB) has become a major challenge. Here, we announce the draft genome sequences of two Mycobacterium tuberculosis strains, MTB1 and MTB2, isolated from patients with pulmonary tuberculosis in Morocco, to describe variants associated with drug resistance.

Brûlures électriques des extrémités: devons nous amputer en urgence?

High voltage electrical burns constitute serious injury. Their depth increases over time. They lead to major tissue damage, sometimes irreversible, with tremendous functional and aesthetic sequelae, especially when extremities are involved.1 In emergency settings, the plastic surgeon faces a dilemma: should he amputate the burnt extremity immediately in order to avoid rhabdomyolysis, or wait until necrosis is delimited to avoid multiple surgeries and limit the size of amputation?

Réévaluation clinico-biologique de l'antibiothérapie probabiliste en réanimation des brules.

Bacterial resistance is a major concern and the proper use of antibiotics is a global public health priority. Inappropriate use of antibiotic therapy can have serious ecological and pharmaco-economic consequences. The objective of our work was to study the reevaluation of probabilistic antibiotherapy in the burns intensive care unit. A prospective study concerning the clinical-biological reassessment of antibiotic therapy was set up in the burns intensive care unit at the Military Hospital Instruction Mohammed V of Rabat. The data was collected over a period of 6 months, from June 1, 2017 to November 30, 2017. During the study period, 142 patients received an antibiotic prescription. Only 68 serious hospitalized septic patients were included in our study. The population was predominantly male (75%). The average age of our patients was 36 years, ranging from 15 to 56 years old. The average length of hospitalization in intensive care was 10 days. Of the 68 antibiotic regimens implemented, the reassessment rate was 72.06%, with 75% justified treatment rates, and 25% not justified. Therapeutic de-escalation was performed in 8 cases (11.76%), when it could have been performed 25 times (36.76%). This is justified by the nosocomial context of the burns intensive care unit with a bacterial ecosystem of BMR type (Klebsiella pneumoniae, Acinetobacter baumanii, Escherichia coli and Staphylococcus coagulase negative), which restricts the choice of antibiotic therapy to some molecules. Clinico-biological re-evaluation of antibiotic therapy is essential to fight the misuse of antibiotics. This study allowed us to evaluate the re-evaluation practices of antibiotic therapy at 48-72h in burns resuscitation. Subsequently, several actions were carried out: the appointment of a pharmacist in antibiotherapy within the Pole Pharmacy of the Mohammed V Military Hospital in Rabat, the activation of an Anti-Infectious Committee and the dispensing of antibiotics via Pyxis MedStation.

Oedème pulmonaire lésionnel par inhalation de vapeurs d'acide phosphorique traité par vni.

White phosphorus injuries are considered both thermal and chemical burns. They should be well known, especially in military and terrorism contexts. This type of burn causes a life-threatening systemic toxicity from hypocalcemia, cardiac arrhythmia and respiratory complications by inhalation of phosphoric acid vapours. We report a case of a non-cardiogenic pulmonary edema complicating a white phosphorus burn in a young serviceman.

Prise en charge d'une asystolie au cours d'une greffe dermo-épidermique des deux membres supérieurs.

We report the case of a severe burn patient who presented an asystole during a dermo-epidermal graft of the two upper limbs. Perioperative bleeding, hypovolemia and hypothermia are at the origin of this incident. We review the management of cardiopulmonary arrest in the operating theatre during burns surgery.

Mécanismes et traitement de l'anémie aiguë chez le brûlé grave.

Acute anaemia requiring blood transfusion frequently occurs in severe burn patients. It has two major sources: perioperative bleeding (efforts have to be made to reduce it) and "intensive care anaemia" (therefore useless blood sampling should be avoided). In these patients with abnormal haematopoiesis, treatment is based on blood transfusion, which has its own side effects. Consequently, a restrictive strategy should be applied.

Blast pulmonaire primaire chez le brûlé. a propos d'un cas et revue de la littérature.

Blasts can cause specific lesions requiring specialized care. After an explosion, primary blast injury (due to the shock wave), secondary blast injury (due to shrapnel) or tertiary blast injury (due to the victim being displaced by the blast) can occur. Secondary and tertiary blasts are much more frequent than primary blasts and can lead to polytrauma. Burns occur in 5% of cases and are termed quaternary blast lesions, which include lesions not due to the above-mentioned mechanisms. Care of secondary and tertiary blasts does not differ to that for any polytrauma. Primary pulmonary blast worsens the prognosis of more serious patients, but seldom requires specific care. Knowledge of both pathophysiologic and injury characteristics would allow better care of seriously burned-blasted patients. We report a case of primary pulmonary blast in a burn patient.

[Not Available]. / Prévention de la maladie thromboembolique veineuse chez le brûlé.

Thromboembolic complications are relatively rare in burns patients and their incidence varies according to the studies carried out. However, the many risk factors associated with burns patients can lead to these complications. Clinical diagnosis is difficult both in the case of deep vein thrombosis and of pulmonary embolism due to their infra-clinic development and nonspecific clinical symptoms. Duplex ultrasounds and computed tomography angiograms are key resources for diagnosing these conditions in burns patients. However, they are employed no differently from cases of non-burns patients with deep vein thrombosis and pulmonary embolism. Currently, the issue of prophylaxis remains controversial among authors of this subject. Many medical practitioners and organisations recommend the use of these tools in daily routine for at-risk burns patients. This is the only way to prevent potentially fatal venous thromboembolic disease in these patients. Herein we report 6 cases of venous thromboembolic disease in burns patients.

[Not Available]. / Prise en charge d'un afflux massif de brûles lors d'une situation de catastrophe par incendie au Maroc.

Burn injuries are most commonly encountered during natural disasters or disasters related to human activity (accidental fires in public places, in time of war, or in terrorist attacks). The care and triage of a large number of burn patients is a difficult problem, which requires adequate planning and emergency preparedness in anticipation of such crises. The training and readiness of doctors and paramedics is of utmost importance. The challenges are many: burn treatment requires a large and qualified staff; evacuations should be prioritized according to the severity of the burn and associated injuries; stocks (especially in topical anti-infective and crystalloid) should be sufficient and appropriate; and hospital services in a military training hospital Mohammed V such as there is in Rabat must be able to be quickly adapted to accommodate and isolate these particular patients. The hypothesis of a fire disaster with a mass influx of burn patients at this hospital should leave no room for improvisation, or else the prompt and accurate prognosis of the patients could be severely hindered.

[Cardiocirculatory arrest caused by electric shock: importance of semi-automatic defibrillator]. / Arrêt cardiocirculatoire par accidents d'électrisations: intérêt du défibrillateur semi-automatique.

Accidental electrical burn injuries are serious because they can cause death by cardiocirculatory arrest. Cardiocirculatory arrest induced by low-voltage current is generally due to ventricular fibrillation, and the prognosis is fairly good if the survival chain is efficient. It is necessary to give priority to early defibrillation using an automated external defibrillator. Early defibrillation can immediately restore spontaneous circulation.

[Pharmaceutical analysis of antibiotic drug prescription in the burns and plastic surgery departiment of the Mohammed Military Teaching Hospital]. / Analyse Pharmaceutique de la prescription des antibiotiques au service des brules et chirurgie plastique de l'Hopital Militaire d'Instruction Mohammed V, Maroc.

Infection has long been the main cause of mortality in severely burned patients. The aim of this work is to assess the prescription of antibiotics in our Burns and Plastic Surgery Department in relation to the recommendations of the manufacturers. A summary is provided of the specific features of these products. Patients hospitalized in the Mohammed V Military Teaching Hospital, Rabat, Morocco, during the period January 2008/May 2009 and treated with antibiotics were considered. This retrospective study concerned 227 nominal medical prescriptions of antibiotics to 41 patients: 70% of the prescriptions were nondocumented. The commonest method of administration was by injection (89%). Various groups of therapeutic drugs were used: betalactamines (65%), glycopeptides (10.5%), aminosides (9%), quinolones (7%), and colistin (4.3%), plus 4.2% from other groups (metronidazole 500 mg, perfusion; fluconazol 100 mg/50 ml, injection; rifampicin 600 mg, perfusion; silver sulphadiazine, 2% fusidic acid cream). A total of 227 nominal medical prescriptions were analysed: the dosages and counter-indications were correctly respected. Three drug interactions were recorded (fluconazol-rifampicin, fluconazol-Saccharomyces boulardii, amikacin-vancomycin). This study shows the importance of the pharmaceutical analysis of prescriptions for antibiotics used in a burns unit, which are active but therefore very toxic.

[The Ogilvie syndrome in a severely burned patient]. / Le syndrome d'ogilvie chez le brule grave.

The Ogilvie syndrome is an acute colonic dilatation of the previously healthy colon, without any organic obstruction. Pathological circumstances such as burns and antipsychotic medication have been identified as predisposing elements. The incidence of this complication, in the reanimation of burn patients, varies between 0.5 to 1%. The purpose of our study is to draw attention to the Ogilvie symptom by describing a case with its clinical and paraclinical data, its physiopathological causes, and the therapeutic aspects. The clinical picture in our patient was characteristic: extensive abdominal meteorism. The abdominal scan showed massive colonic dilatation without any mechanical obstacles. The outcome was successful after colonoscopic exsufflation. The Ogilvie syndrome is a rare occurrence which without effective treatment may result in caecal perforation and a poor prognosis. It is therefore necessary to establish the diagnosis early and, in particular, to initiate close radiological follow-up after the establishment of medical treatment, in which colonoscopy plays an important part.

[Burns and pregnancy: report on two cases and review of the literature]. / Brulure et Grossesse: A Propos de Deux Cas et Revue de la Litterature.

Les brûlures thermiques au cours de la grossesse sont rares, cependant elles requièrent une attention particulière du fait qu'elles engagent le pronostic maternel et foetal. Les Auteurs rapportent deux observations qui illustrent la gravité de cette association. Le traitement des brûlures pendant la grossesse connaît des particularités en rapport avec les modifications anatomiques et physiologiques de la gestation. Certains Auteurs ont préconisé des recommandations, comme en particulier le traitement précoce de la thrombose veineuse et la surveillance obstétricale avec un accouchement dirigé à l'approche du terme. La mortalité maternelle et périnatale augmente significativement à partir de 50% de la surface corporelle brûlée. De ce fait une prise en charge multidisciplinaire est indispensable. Le pronostic de brûlure chez la femme enceinte reste très réservé, d'où l'intérêt d'une prise en charge multidisciplinaire réunissant obstétricien, réanimateur et plasticien.

[Chemical burns caused by the shrub nerium oleander]. / Les Brulures Chimiques Par Le Laurier Rose.

Nerium Oleander is a shrub that grows naturally in the Mediterranean regions. In Morocco it is found in wet places. It is famous for its risk of systemic toxicity in cases of poisoning because of the presence of two alkaloids, especially oleandrine. The literature describes cases of local use of leaves of this plant against scabies, haemorrhoids, and boils. We report two cases of chemical burns of different gravity due to Nerium Oleander. This should lead to more widely diffused information for the general population and strict regulation of its marketing.

[Not Available]. / La Prise en Charge des Brulures Electriques: a Propos de 30 Cas.

Les brûlures électriques sont rares mais graves nécessitant une prise en charge urgente et adéquate car l'évolution peut être émaillée de complications graves, notamment cardiaques, neurologiques et rénales, et les séquelles sont importantes. A travers une étude analytique et rétrospective de janvier 2000 à novembre 2007 ayant inclus 30 patients admis au Service des Brûlés de l'Hôpital Militaire d'Instruction Mohamed V de Rabat, Maroc, pour prise en charge de brûlures électriques, il a été relaté les mécanismes des brûlures électriques, comme aussi les complications, la morbidité et la mortalité, dues aux brûlures électriques, tout en insistant sur les modalités de prise en charge initiale chez ces patients. La prévention reste le point capital pour réduire l'incidence de ces accidents. Cette prévention se base sur la surveillance des enfants et l'élimination de facteurs de risque à la maison, par la maintenance des installations électriques et par l'information et l'éducation du public.

[Not Available]. / L'Infection Nosocomiale en Reanimation des Brules.

L'infection nosocomiale bactérienne étant l'une des principales causes de morbidité et de mortalité chez le brûlé, nous avons réalisé une étude rétrospective portant sur 84 patients hospitalisés au sein du service de réanimation des brûlés de l'Hôpital Militaire d'Instruction Mohammed V de Rabat, sur une période de 3 ans, du premier janvier 2001 au 31 décembre 2003. Les critères d'infection nosocomiale étaient ceux du Center for Disease Control d'Atlanta de 1988. Les taux d'incidence ont été calculés. La population infectée a été comparée à celle non infectée. L'écologie bactérienne du service a été décrite comme aussi l'antibiotype. Il ressort de cette étude la survenue de 87 infections nosocomiales chez 27 patients. L'incidence cumulative était de 103 infections pour 1000 jours de traitement. Pour ce qui est des caractéristiques des infections bactériennes, les sites infectés étaient la peau (77%), le sang (13,8%), les voies urinaires (8%) et les poumons (1,1%). Les principaux germes étaient: Staphylococcus sp. (33,3%), Pseudomonas aeruginosa (23%), Enterococcus faecalis et Acinetobacter (8%). Les staphylocoques étaient méticillo-résistants dans 22,2% des cas. Le Pseudomonas et l'Acinetobacter étaient multirésistants (60%). Dans notre étude les facteurs prédictifs de survenue des infections nosocomiales que nous avons retenus après l'étude comparative des populations infectées et non infectées ont été l'âge, le body mass index, l'abbreviated burn severity index et le remplissage initial. En isolant ces paramètres, nous avons pu établir une équation à valeur prédictive de survenue d'infection nosocomiale chez le patient brûlé.

[Not Available]. / Prise en Charge du Syndrome de Lyell ou Necrolyse Epidermique Toxique.

Le syndrome de Lyell ou nécrolyse épidermique toxique (NET) est une pathologie très grave des dermatoses bulleuses d'étiologie médicamenteuse. Il se caractérise par une nécrose aiguë de l'épiderme sur toute la hauteur du corps muqueux. L'aspect clinique de la NET est celui d'une brûlure étendue du deuxième degré profond. A ce tableau s'associent constamment des lésions muqueuses et une atteinte multiviscérale qui aggrave le pronostic. Nous rapportons deux cas de NET qui illustrent l'importance d'une prise en charge précoce et multidisciplinaire de ces patients atteints au sein d'un service de réanimation des brûlés, dont les fondements reposent sur l'asepsie rigoureuse, l'apport hydroélectrolytique et nutritionnel, la prévention de l'infection et son traitement par une antibiothérapie adaptée, et un nursing et des soins locaux. L'efficacité supposée des immunoglobulines intraveineuses ne repose que sur des cas isolés et il n'y a pas encore d'études randomisées.

[Not Available]. / Le Point sur la Pharmacologie des Agents Anesthesiques Chez le Brule Grave.

La pharmacologie des agents anesthésiques chez le brûlé est variable et imprévisible. Dans les premières 48 h, il y a une hypovolémie avec chute du débit cardiaque et des fuites plasmatiques. Après 48 h, il y a une hypervolémie avec augmentation du débit cardiaque, hypermétabolisme et la clearance des médicaments est augmentée. Parmi les facteurs de déséquilibre, on retrouve les variations des protéines plasmatiques. Deux protéines sont importantes chez le brûlé grave : l'albumine et l'alpha 1- glycoprotéine. Leur taux varie beaucoup au cours de l'évolution de la brûlure. Les agents anesthésiques dont la liaison avec ces deux protéines est prédominante verront leur pharmacocinétique modifiée. L'anesthésiste-réanimateur du service des brûlés va maîtriser ces notions pharmacologiques pour utiliser à bon escient les agents anesthésiques.

[Not Available]. / Les Hemorragies Gastroduodenales de Stress Chez le Brule Grave.

Les Auteurs rapportent trois observations d'hémorragies gastroduodénales de stress chez le brûlé grave. Ils rappellent l'importance des mesures thérapeutiques qui doivent être prises chez le brûlé grave, comme le traitement du choc, du sepsis, des plaies et de la douleur, la nutrition entérale précoce et l'oxygénothérapie. Tout cela permet de réduire les facteurs de risque de survenue d'une hémorragie gastroduodénale de stress.

[Fluoxetine and inappropriate antidiuretic hormone secretion in elderly patients: a case report]. / Fluoxétine et syndrome de sécrétion inappropriée d'hormone antidiurétique chez le sujet âgé : à propos d'un cas.

Elderly people are more likely to be affected by hyponatremia related to the use of specific inhibitors of serotonin recaptation. Doctors who treat old patients should be aware of this adverse effect which can be serious but is reversible. The observation of a new case of SIADH induced by fluoxetine in a 65 years-old patient is the opportunity to point out the main aspects of this pathological entity which must be suspected in case with hyponatraemia, blood hypoosmolality and high urinary osmolarity.