Mediastinal Bronchogenic Cysts Resection in Adults: Results of Vats and Thoracotomy Procedures.

BACKGROUND: The objectives of our study are to evaluate our surgical experience of mediastinal bronchogenic cyst (MBC) and to determine the results of resection by video-assisted thoracic surgery (VATS) and posterolateral thoracotomy (PLT). METHODS: The demographic characteristics, clinical and radiological features intraoperative data, outcomes and fol- low-up information were reviewed and analyzed from 38 patients who underwent resection of a MBC between 2008 and 2019. RESULTS: cystectomy was performed for thirty eight patients included in the present study. Seventeen of them, benefited from VATS cystectomy (VATS group) with 1 conversion to thoracotomy (5.9%) and 21 underwent PLT cystectomy (PLT group). In our series 27 (71.1%) were male. Their average age was 42.6 years. While 09 patients (23.7%) had no symptoms pre-operatively, 29 patients (76.3%) were symptomatic. There were no operative deaths and 3 patients (7.9%) presented postoperative complications. The average duration of hospital stay was 3.2 days for patients who had VATS, but 5.8 days for those who had thoracotomy. Long-term follow-up (range, 1 to 8 years) showed no late complications and no recurrence. CONCLUSION: VATS and PLT are main approaches for the surgical resection of MBCs VATS is a safe procedure, with less pain and time spent at the hospital. Early surgical procedures of MBCs may be recommended to prevent complications. Surgical adhesions are unfavorable conditions to thoracoscopic treatment.

Clinical features and treatment of bronchial rupture of pulmonary hydatid cyst in children: a retrospective study of 36 patients.

BACKGROUND: The aim of this study was to review the clinical symptoms, radiological data, surgical techniques, and postoperative complications associated with bronchial rupture of pulmonary hydatid cysts in children and evaluate the results of surgical treatment. MATERIALS AND METHODS: A retrospective study of 40 surgical procedures performed for pulmonary hydatid cyst ruptured in the bronchial tree in 36 children (22 boys and 14 girls), aged between 7 and 18 from January 2009 to December 2019. RESULTS: The study included 36 patients with a mean age of 14.7. Most symptoms were cough (63.9%), chest pain (38.9%), hemoptysis (33.3%), and hydatid vomiting (22.2%). Chest X-ray, chest CT scan and abdominal echography was performed in all cases. Surgical approach was posterolateral thoracotomy in all cases. Conservative treatment was possible in 35 patients (97.2%) through cystotomy in 25 cases, pericystectomy in 11 cases, and lobar resection in 1 case (2.8%). Average operative time was 103 min (range: 53 and 185 min) and mean postoperative hospital stay was 5.9 days. The postoperative complications occurred in 4 (11.1%): atelectasis (N = 2), wound site infection (N = 1), and prolonged air leak (N = 1). There was no postoperative mortality. After an average follow-up of 39 months there was no recurrence. CONCLUSION: Ruptured hydatid cyst of the lung into the bronchus. Must be surgically treated and carefully due to the risk of per-operative bronchial flooding. Conservative surgical procedures with precise closure of the bronchial fistulas and capitonnage can complete removal of the cyst with low complications.

Surgical treatment of hydatidothorax in children: A retrospective study of 19 patients.

OBJECTIVE: The objective of this study was to describe the role of surgical management of ruptured hydatid cysts into the pleural cavity in children. A review of the management of patients with intrapleural rupture of pulmonary hydatid cysts in children at our center was performed. MATERIALS AND METHODS: A retrospective chart review was performed on all children who developed intrapleural rupture of a hydatid cyst in the lung. Patients with intrapleural rupture from other locations (liver, mediastinum, diaphragm, kidney) were excluded. RESULTS: In these 19 patients, there were 11 males and 8 females with a mean age of 9.4 years (range 7-16 years). Different clinical symptoms, biological, and imaging data allowed the diagnosis. The surgical approach consisted of a posterolateral thoracotomy and decortication in all patients. In addition, different procedures were needed for the pulmonary lesion according to the degree of lung destruction. Radical resections were required in four cases, including lobectomies (n = 1) and segmentectomies (n = 3). Conservative treatment was possible in 15 patients (simple capitonnage and bronchial fistula closure). Post-operative complications occurred in 2 cases (10.5%), including one pyothorax with a prolonged air leak and one wound infection. There were no postoperative deaths. There was no recurrence of thoracic hydatid disease in postoperative follow-up ranging from 1 to 3 years (mean: 2 years). CONCLUSION: Intrapleural hydatid cyst rupture may be prevented by early treatment of simple forms to avoid increased morbidity. LEVEL OF EVIDENCE: Level IV.

Prevalence, antimicrobial resistance and serotype distribution of group B streptococcus isolated among pregnant women and newborns in Rabat, Morocco.

Purpose. Group B streptococcus (GBS) is an important cause of neonatal sepsis worldwide. Data on the prevalence of maternal GBS colonization, risk factors for carriage, antibiotic susceptibility and circulating serotypes are necessary to tailor adequate locally relevant public health policies.Methodology. A prospective study including pregnant women and their newborns was conducted between March and July 2013 in Morocco. We collected clinical data and vagino-rectal and urine samples from the recruited pregnant women, together with the clinical characteristics of, and body surface samples from, their newborns. Additionally, the first three newborns admitted every day with suspected invasive infection were recruited for a thorough screening for neonatal sepsis. Serotypes were characterized by molecular testing.Results. A total of 350 pregnant women and 139 of their newborns were recruited. The prevalence of pregnant women colonized by GBS was 24 %. In 5/160 additional sick newborns recruited with suspected sepsis, the blood cultures were positive for GBS. Gestational hypertension and vaginal pruritus were significantly associated with a vagino-rectal GBS colonization in univariate analyses. All of the strains were susceptible to penicillin, while 7 % were resistant to clindamycin and 12 % were resistant to erythromycin. The most common GBS serotypes detected included V, II and III.Conclusion. In Morocco, maternal GBS colonization is high. Penicillin can continue to be the cornerstone of intrapartum antibiotic prophylaxis. A pentavalent GBS vaccine (Ia, Ib, II, III and V) would have been effective against the majority of the colonizing cases in this setting, but a trivalent one (Ia, Ib and III) would only prevent 28 % of the cases.

Vitamin D status in Moroccan pregnant women and newborns: reports of 102 cases.

INTRODUCTION: Vitamin D insufficiency to pregnant women has been associated with a number of adverse consequences, and has been recognized as a public health concern. The aim of this study was to evaluate vitamin D status of Morrocan pregnant women and their newborns. Our study is being the first of its kind in Morocco, as it supports the program of systematic supplementation of pregnant women in the third quarter. Its results have established a new program for the fight against the deficit of various nutrients, thereby intake of vitamin D has become routine. So this work is a true example of action research. METHODS: It's an observational and a cross sectional study. The data was collected prospectively from the 1st January to 31 December 2012 in the labor room of the Souissi maternity hospital, at the Ibn Sina university center of Rabat in Morocco. Women included were consented to participate in the study. Data on epidemiological, sociodemographic and clinical characteristics was recolted by interview, physical exam and biochemistry parameters. Hypovitaminosis D is defined as serum level of vitamin D ≤ 50 nmol/l (20 ng/ml). RESULTS: Our study included 102 cases of mother-newborn pairs. The average age of mothers was 28.3 +/- 6.7 years (range 17-43 years), 90.1% of women enrolled had a hypovitaminosis D, the average weight of newborns was 3377.9 +/- 509g (2270 - 4880g). Hypovitaminosis D is not correlated with the origin, season, body mass index, birth interval and birth weight. It was positively correlated with maternal serum calcium (p=0.000). CONCLUSION: The maternal hypovitaminosis D is real public health problem. The prevention is necessary, by the systematic vitamin D supplementation for pregnant women.

Risk factors leading to preterm births in Morocco: a prospective study at the maternity Souissi in Rabat.

INTRODUCTION: Eminent morbidity and mortality of preterm infants is perceived, especially in developing countries. The aim of the study is to identify the main factors involved in the occurrence of premature births in Morocco. METHODS: This was a descriptive and analytical study conducted at the maternity Souissi in Rabat, from January 2011 to December 2011. The data were collected using interview with women in the postpartum, and via, the exploitation of obstetric and perinatal records. The data sheet was filled out for each newborn, including socio-demographic, obstetrical, maternal, childbirth and neonatal data, as well as, monitoring and surveillance of pregnancy. RESULTS: A total of 1015 births were collected. 954 were full term babies and 61 were preterms. The gestational age was between 33-34 weeks in 57.4%. Relying on Statistical analysis, many risk factors were, significantly, associated with the occurrence of prematurity, namely: low level of maternal education (p < 0.004), absence of pregnancy' monitoring (p < 0.001), multiparity (p < 0.001), maternal chronic diseases (p < 0.001), and drug taking during pregnancy (p < 0.001). CONCLUSION: To reduce the incidence of preterm births, reliable programs must be established, devoting all its interest, to educate the young woman in childbearing age about the appropriate ways of monitoring pregnancy, as well as, the qualitative and quantitative development of health care structures.

The Bedouin mutation c.155-166del of the TBCE gene in a patient with Sanjad-Sakati syndrome of Moroccan origin.

Sanjad-Sakati syndrome (SSS) or hypoparathyroidism-retardation-dysmorphism syndrome (HDR) is a rare autosomal recessive disorder. It is characterized by the association of congenital hypothyroidism, growth retardation, psychomotor retardation, epilepsy, dysmorphic features (microcephaly, facial, eye, and dental anomalies), and abnormalities of the extremities. The prevalence of SSS is unknown. Reported patients are were almost exclusively from the Arabian Peninsula. They are were all homozygous for the ancestral mutation c.155- 166del of the TBCE gene, also known as "the Bedouin mutation." We report on the first clinical and molecular description of a Moroccan patient with Sanjad-Sakati syndrome. He is was a carrier for the Bedouin mutation, not surprising, knowing that part of the Moroccan population has Arabian origin. This diagnosis allowed us to provide an appropriate management to the patient, to make a genetic counseling to his family, and to enrich genetic data on the Moroccan population.

First report of a Klebsiella pneumoniae ST466 strain causing neonatal sepsis harbouring the blaCTX-M-15 gene in Rabat, Morocco.

Klebsiella pneumoniae is one of the Gram-negative bacilli most commonly found in urine of pregnant women and causing neonatal sepsis. The aim of this study was to analyse in terms of epidemiology and antimicrobial resistance of 23 K. pneumoniae isolates collected from vaginal swabs or urine of pregnant women, from pharyngeal and ear swabs of apparently healthy newborns and from peripheral cultures and hemocultures of newborns with suspected invasive neonatal infection in Rabat, Morocco. The prevalence of K. pneumoniae was 0.6 and 0.9% among pregnant women and neonates, respectively. These strains showed lower antimicrobial resistance levels regarding the developed countries. Thus, only one strain from a neonate presented an ESBL. This is the first report of a K. pneumoniae strain causing neonatal sepsis harbouring the blaCTX-M-15 gene in an IncFII plasmid and belonging to ST466 in this area.

Askin tumor mimicking a hydatid cyst of the lung in children: case report.

Askin tumor is a malignant small round cell tumor that originates from the thoracopulmonary region, usually observed in young subjects. We report a case of askin tumor in a 11 year-old men, who had in his past history a surgery for hydatid cyst of the liver, actually hospitalised for right pulmonary upper lobe mass of the lung. After resection of the mass, the pathological exam confirmed the diagnosis of primitive neuroectodermal tumor (PNET). An adjuvant treatment (radiotherapy and chemotherapy) was done; the patient died 11 months after surgery. Askin tumor is an exclusion diagnosis not always readily made.

Analgesic effect of 30% glucose, milk and non-nutritive sucking in neonates.

BACKGROUND: The aim of this study was to evaluate nondrug management practices concerning pain induced by blood sampling in newborns in a Moroccan neonatal unit and to determine whether the results reported from a randomized clinical study of nondrug analgesia could be reproduced in a routine care setting. METHODS: Standardized prospective observation of analgesic practices used during blood sampling was performed. Pain was assessed using the Douleur Aiguë Nouveau-né (DAN, [Newborn Acute Pain]) scale that incorporates facial expression, vocal expression, and limb movements of the newborn during realization of a painful procedure. Five different nondrug analgesic practices were investigated in 125 infants. RESULTS: Median DAN scores for the five methods were 6 (1-10) for venous sampling with oral administration of 30% glucose, 5 (1-10) for venous sampling with sucking, 3 (0-6) for venous sampling with oral administration of 30% glucose combined with sucking, 4 (0-10) for venous sampling with oral administration of 30% glucose combined with sucking and administration of 2 mL of adapted infant formula, and 6 (3-8) for venous sampling with administration of 2 mL of adapted infant formula. CONCLUSION: Oral administration of 30% glucose combined with sucking provided better control of pain induced by blood sampling in newborns at our neonatal unit.

A patient with traumatic chylothorax.

Chylothorax refers to the accumulation of chyle in the pleural cavity. Although rare, it is the most frequent cause of pleural effusion in the neonatal period. Its incidence is estimated at one in 15,000 neonates. The causes of chylothorax are multiple, and there are several major types of chylothorax defined by origin, ie, traumatic (and iatrogenic) chylothorax, medical (spontaneous) chylothorax, and congenital chylothorax. A case of neonatal chylothorax following surgery for esophageal atresia and our therapeutic approach to this entity are presented. Conservative therapy with total enteral nutrition and drainage were sufficient. Treatment for chylothorax is essentially medical, ie, pleural drainage, removal of dietary fats, treatment of any medical cause, and use of drugs to reduce production of chyle. In the event of failure or reappearance of a large effusion, surgical treatment is needed.

Neonatal epididymo-orchitis caused by Pseudomonas aeruginosa: a case report.

Epididymitis and epididymo-orchitis are an uncommon causes of acute testicular pain in neonatal boys, epididymo-orchitis is infection or inflammation of epididymis and testis it's may be associated with urinary tract infections or reflux of urine predisposed by an underlying vasal anomaly. Pediatricians should examine the testicles meticulously after a baby is born.We report a 7 day-old boy with urinary malformations (ureteral duplication, ureterocel and right hydro-ureteronephrosis) who presented with acute scrotum. The ultrasonography exploration of the testis showed findings consistent with epididymo-orchitis, confirmed by the needle scrotal aspiration of the pus. Further radiological investigations of urinary tract showed the multiples malformations. Epididymo-orchitis should be suspected initially with abnormal physical signs and laboratory findings. Prompt prescription of antibiotics is mandatory, and appropriate therapeutic measures (antibiotics) should be undertaken to prevent recurrences and sequelae.