Healthcare resource utilization and costs associated with anogenital warts in Morocco.

BACKGROUND: Human papillomavirus (HPV), primarily genotypes 6 and 11, cause the majority of cases of anogenital warts (AGW). Although benign, AGW are associated with a substantial economic and psychosocial burden. Several vaccines have been developed to prevent HPV. The objective of this study was to describe the epidemiology and healthcare resource utilization of AGW in Morocco, as well as the associated costs of treatment from the public healthcare perspective. METHODS: This was a descriptive analysis of questionnaire data obtained via a Delphi panel. The panel consisted of 9 physicians practicing in public hospitals in Morocco (4 dermatologists and 5 obstetricians/gynecologists). The questionnaire collected data on physician and practice characteristics, diagnostic tests and procedures, treatments, and follow-up (including recurrence) of patients with AGW. Questionnaire items on which ≥ 70% of respondents agreed were considered as having consensus. Costs associated with diagnosis, treatment, and follow-up were calculated in Moroccan dirham (MAD) and converted to euros (€) based on official national price lists for public hospitals and the HCRU estimates from the questionnaire. RESULTS: The physician-estimated prevalence of AGW in Morocco was 1.6%-2.6% in women and 2.0%-5.3% in men. A mean (median) of 6.4 (4) patients per month per physician sought medical attention for AGW. Simple observation was the most common diagnostic method for AGW in both men and women, and excision was the most prescribed therapy (75%), requiring a mean of 2 visits. Recurrence occurred in approximately 27% of patients. The cost per case of managing AGW, including recurrence, was estimated at 2182-2872 MAD (€207-272) for women and 2170-2450 MAD (€206-233) for men. The total annual cost of medical consultations for AGW in Morocco ranged from 3,271,877 MAD to 4,253,703 MAD (€310,828-404,102). CONCLUSIONS: Expert consensus indicates that AGW represent a significant burden to the Moroccan public healthcare system. These data can inform policy makers regarding this vaccine-preventable disease.

[Uterine rupture in patients with healthy uterus: misoprostol complication (case study and literature review)]. / Rupture utérine sur utérus sain: complication du misoprostol (à propos d'un cas et revue de la littérature).

Uterine rupture in patients with healthy uterus during the 2nd and 3rd trimester of pregnancy is a rare and severe obstetric complication involving maternal and fetal vital prognosis as well as obstetrical outcome of patients in the absence of diagnosis and early treatment. It mainly occurs in women who have had scarred uterus and it is anecdotal in those with healthy uterus. We report the case of a primiparous patient with unscarred uterus who had had uterine rupture during labour induction with misoprostol for fetal death in utero (FDIU) due to intrauterine growth retardation (IGR) and severe oligohydramnios at 31 weeks of amenorrhea (WA). This study and the literature review highlights the importance of administrating misoprostol for labour induction with extreme caution as well as the clinical features, the risk factors, the diagnostic method and the therapeutic treatment of this rare but potentially serious condition.

[Cesarean-scar pregnancy: about a case and literature review]. / Grossesse sur cicatrice de césarienne: à propos d'un cas et revue de la littérature.

Cesarean-scar pregnancy is a rare form of the ectopic pregnancy which can be life-threatening or threaten patient's functional prognosis due to hemorrhage or early uterine rupture. We report the case of a 23-year old patient with ectopic pregnancy, gravida 3, para 2, with bi-scarred uterus who was diagnosed with cesarean-scar pregnancy due to metrorrhagias at 7 weeks of amenorrhea. Transvaginal ultrasound allowed early diagnosis and treatment was based on conservative therapy. This study and literature review aim to highlight the diagnostic and therapeutic features of this rare disorder whose knowledge can improve prognosis.

Adenoid cystic carcinoma of cervix: two cases report and review of the literature.

Adenoid cystic carcinoma of the cervix is a rare and aggressive tumor with fatal outcome. In this paper we report two cases of primary adenoid cystic carcinoma and a review of literature. A 80 years old woman, admitted to our hospital with postmenopausal bleeding and hydrorrhea. Gynealogical examination showed a cervical stenotic with the presence of a tumor processus. Biopsy of cervical growth was done. 80-year-old woman presented with vaginal bleeding with pelvic pain. Physical examination revealed a friable mass in the cervix. Incisional biopsy was performed. In the both cases the diagnosis of adenoid cystic carcinoma of the cercix was confirmed. Adenoid cystic carcinoma of the cervix is clinically and radiologically similar to other tumors of the cervix but the diagnosis can only be made by histological examination.

Vaginal metastasis of pancreatic cancer.

Vaginal metastasis from pancreatic cancer is an extreme case and often indicates a poor prognosis. We present a case of pancreatic carcinoma with metastasis to the vagina that was discovered by vaginal bleeding. To our knowledge, this is the third case in the world of a primary pancreatic adenocarcinoma discovered of symptoms from a vaginal metastasis.