Background: The vitamin D is a supplement which allows the osseous binding of calcium. The defici... more Background: The vitamin D is a supplement which allows the osseous binding of calcium. The deficiency of the latter causes the rickets in children. Worldwide, the dosages recommended by the authorities of health differ according to the various existing specialities on the market and the mode of supply (breast-feeding or artificial feeding with or without milk enriched in vitamin D). In Morocco until 2013, the vitamin D was marketed as a single patent drug in an injectable or oral of 600.000UI. And the recommendations in vitamin D in Morocco are: a birth dose and another one after 6 months. Objective: Among the objectives of this study is to study the accountability cases of adverse effects of drugs and especially to make health professionals aware of the importance of the notification of adverse drug events to avoid serious consequences on the health of the pediatric population. Methods: During an observational forward-looking study conducted at child’s hospital of Rabat (HER) betwe...
Background and objectives: Development of capacities in childhood and adulthood depends primarily... more Background and objectives: Development of capacities in childhood and adulthood depends primarily on the environnement during pregnancy. Leptin and adiponectin are adipokines involved in food intake and energy balance of the human, especially during pregnancy. The leptin/adiponectin ratio (LAR) is related to insulin resistance and diabetes in non pregnancy conditions. The aim of this study was to evaluate the relationship between LAR ratio and insulin, glucose and lipid profile during normal pregnancy. Methods: A total of 32 women, pregnant of singleton foetus with a gestational age less than 11 weeks participated in this study. Recruited women were followed at 12, 22-24 and 34-36 weeks of pregnancy. Maternal body fat (BF) was assessed using the dilution of deuterium oxide (D2O). Blood glucose, insulin, total cholesterol, HDL, LDL, triglycerides were also measured. Leptin and adiponectin concentrations were assayed using radioimmunoassay kits. Results: Mean age of the participants w...
Objectives: Development and validation of bioelectrical impedance prediction model for Moroccan a... more Objectives: Development and validation of bioelectrical impedance prediction model for Moroccan adolescents. Subjects and methods: The total sample included 143 adolescents (34 boys and 109 girls) aged 11-17 years-old who were recruited from high schools of the capital city (Rabat) of Morocco. The study population was divided into developmental and validation sample. Anthropometric measurements performed by a trained technician were body weight, standing height, body mass index and waist-to-hip ratio. Body composition was measured by deuterium oxide dilution (D2O) (0.5 g of 2H2O for one kg of body weight) and by bioelectrical impedance analysis (4000 Bodystat Quadscan). Resistance (R50) and reactance (Xc50) were measured at 50 kHz. Pubertal status was determined. Results: The model is FFM (kg) determined by D2O = 0.578×Height²/R50 (cm²/Ω) + 0.176×Body weight (kg) - 2.296×Gender (boy=0, girl=1) + 0.791×Age (years) - 3.768; with R²=0.93 and SEE = 1.89 kg. In the validation sample, the...
Anterior meningo-encephaloceles (AME) are congenital malformations characterized by herniation of... more Anterior meningo-encephaloceles (AME) are congenital malformations characterized by herniation of brain tissue and meninges through a defect in the cranium, in frontal, orbital, nasal and ethmoidal regions. The management of this complex congenital malformation is controversial according to whether use, an intracranial, extra-cranial or combined approach. This is the first largest series published in Africa, in which we present our experience in the operative management of AME; we share our recommendation in technical consideration for surgical approach with review of the literature. All patients beneficed of neuro-radiological investigations including Plan X rays, Spiral Three dimensional CT scan and MRI. Ophthalmologic and maxillo-facial evaluations were done in all the cases. MEA are surgically approached in various ways, mainly on the basis of its location and type, by cranio-facial approach in one-step, or in two stages by intracranial approach followed by facial approach, only by cranial approach or facial approach. The surgical results were evaluated in the follow up on the basis of disappearance of cranio-facial tumefaction with correction of hypertelorism. 60 children with AME were treated in our department between January 1992 and December 2012. The mean age at time of surgery was 14 months (20 days to 18 years) with slight men predominance (28 females/32 males). Cranio-facial team operated 21 patients, 16 were operated in two stages by intracranial approach followed by facial approach, 20 cases beneficed the neurosurgical approach and three only the facial approach Some post operative complications were observed: 2 cases of post operative hydrocephalus underwent shunt; CSF fistulas in three cases cured by spinal drainage, one death due to per operative hypothermia, 3 cases of recurrence how needed second surgery. After mean follow up for 80 months (1 year to 19 years) theses techniques permitted a good cosmetics results in 42 cases, average cosmetics results in 8 cases, poor results in 5 cases and worse cosmetics results in 4 cases, The AME are rare conditions we used the multiples approach first intracranial approach followed by facial approach, but after 1998 we used one-step correction by combined approach, only cranial approach when needed or facial correction.
The national data show a receding of the child percentage nursed exclusively to the breast and th... more The national data show a receding of the child percentage nursed exclusively to the breast and the length of the breastfeeding. This study is a prospective, descriptive and analytic survey of 211 couples mother–newborn child hospitalised in the Souissi maternity hospital of Rabat in order to describe factors associated with a receding of breastfeeding. We excluded from this study the
Breast cancer is a multifactorial disease. Factors most often mentioned risks are those related t... more Breast cancer is a multifactorial disease. Factors most often mentioned risks are those related to the environment, genetics, hormones and individual behaviors. Among these include alcohol, smoking, sedentary lifestyle and eating habits. Identification of eating and the role of nutritional factors may be involved in cancer risk have been studied extensively since nearly 40 years. We conducted a study of breast cancer type case-control with food frequency questionnaire to assess the causal relationship between dietary factor, obesity and breast cancer risk. female patients with breast cancer were compared to healthy controls at the National Institute of Oncology of Rabat during 2008-2010 and were interviewed for epidemiological information and for their eating habits. A total of 800 women were included in this study (400 cases and 400 controls). Result of univariate analysis showed that significant factors associated with the etiologie of breast cancer: high body mass index (BMI) [od...
Spasmus nutans is a syndrome occurring in infants comprising a symptomatic triad: torticollis, he... more Spasmus nutans is a syndrome occurring in infants comprising a symptomatic triad: torticollis, head nodding and nystagmus. Neuropediatric and ophthalmologic investigation are normal. No case of association with non-evolutive encephalopathy has been reported to date. We report on a case of spasmus nutans-associated agenesis of the median vermian cerebellum. A 3-month-old female infant was hospitalized for head nodding lasting 1 week and nystagmus of the left eye with no other signs. A lung infection had preceded the clinical signs. The ophthalmologic examination and electroencephalography (EEG) were normal. The cerebral MRI showed an objective partial agenesis of the median vermian cerebellum. The diagnosis of spasmus nutans-associated brain malformation was retained. The discovery of non-evolutive encephalopathy was associated with spasmus nutans. A genetic study is required.
Klebsiella pneumoniae is one of the Gram-negative bacilli most commonly found in urine of pregnan... more 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.
Design. Before-after prospective surveillance study to assess the efficacy of the International N... more Design. Before-after prospective surveillance study to assess the efficacy of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control program to reduce the rate of occurrence of ventilator-associated pneumonia (VAP).Setting. Neonatal intensive care units (NICUs) of INICC member hospitals from 15 cities in the following 10 developing countries: Argentina, Colombia, El Salvador, India, Mexico, Morocco, Peru, Philippines, Tunisia, and
ABSTRACT Introduction A newborn baby is said macrosomic if the birth weight is greater than the 9... more ABSTRACT Introduction A newborn baby is said macrosomic if the birth weight is greater than the 90th percentile of growth curves. The aim of our study was to assess the prevalence of this disease in our environment and determine the resulting morbidity. Patients and methods This was a prospective study in Souissi maternity hospital in Rabat, which occurred over a period from January to April of 2009. We have developed fact sheets on which investigation we identified the characteristics of maternal conditions for childbirth, maternal complications and fetal factors etiological macrosomia. Results This study involved a total of 255 macrosomic newborns according to the criterion defined above. The weight of newborns ranged between 4000 and 5656 g. The frequency of macrosomia was 7.7%. Male sex was predominant in 67% of cases. We have selected as etiological factors: diabetes in two of our patients, obesity in 50% with a BMI between 25% and 39% of deliveries and a history of macrosomia in 4% of our parturients. Fetal complications were dominated by the bump succedaneum in 22.35% of cases. Other complications were represented by respiratory distress in 5.4% cases, brachial plexus paralysis in 4.3% and the fracture of the humerus in one case. Hypoglycemia was observed in seven patients. Conclusion Macrosomia is often the cause of fetal and maternal complications. Its management must be multidisciplinary.
ABSTRACT Materials and Methods A prospective study about all infants born in maternity Souissi (R... more ABSTRACT Materials and Methods A prospective study about all infants born in maternity Souissi (Rabat) during one year: from first January to 31 December 2010. We included all newborns symptomatic or not at birth and whose mothers have at least one infectious case histories from the following: rupture of membrane ≥ 12 hours, chorioamnionitis, urinary tract infection and/or genital, fever ≥ 38°c before or in early labor. Results On a total of 14792 live births, 1602 newborns were prone to a risky infection (10.83%). Prolonged rupture of membranes showed 1341 cases including 59 newborns were premature. The duration of the rupture was between 12 and 24 hours in 44.30% of cases, between 24 and 48 hours in 44, 37% of cases and more than 48 hours in 11.33% of cases. On 133 cases of chorioamnionitis (10.67%) 129 newborns were full-term and 7 were premature. The obstetric decision was caesarean section delivery in 25.78% of cases. 4.74% of newborns had respiratory distress with a single case of death in the first hours of life. 4.50% were preterm and 8.86% were hypotrophy. Hospitalization was required from the outset in 1059 cases among which 133 were hospitalized. For other patients an inflammatory report was requested. The were followed as outpatients.
ABSTRACT Introduction The congenital malformations are one of the leading causes of morbidity and... more ABSTRACT Introduction The congenital malformations are one of the leading causes of morbidity and infant and child mortality. The etiology of these malformations is multifactorial, determined by a combination of genetic and environmental factors. The objective of this study was to analyze the main factors involved in the occurrence of congenital malformations in our context. Patients and methods This was a prospective, descriptive and analytical study carried out at the Souissi Maternity Hospital in Rabat over 1 year period from January 2010 to December 2010. This study involved the use of obstetric and perinatal records of a sample of the population. A collection sheet was completed for every newborn with the sociodemographic, obstetric, nursery, monitoring, surveillance of pregnancy, childbirth and neonatal data, the group of healthy newborns and those of malformed were compared and analyzed. The malformations considered are those that are clinically detectable. Results One thousand births were collected, 960 were healthy and 40 carriers of malformations. The malformations found were the cleft palate (10 cases), the anencephaly (4 cases), the poly malformed (12 cases), the hydrocephalus (4 cases), the imperforate anus (2 cases) and the spina-bifida (8 cases). The statistical analysis was used to determine risk factors significantly associated with the occurrence of congenital malformations namely taking medications (antiepileptic drugs) and/or plants (fenugreek) during pregnancy (P < 0.001), the presence of chronic disease in the mother mainly diabetes (P < 0.001), the family history of congenital malformation (P < 0.001) and twin pregnancy (P = 0.028). Conclusion The study of congenital malformations should be made in each country to determine their prevalence, their natures, causes and associated risk factors and allow for specific prevention measures.
Background: The vitamin D is a supplement which allows the osseous binding of calcium. The defici... more Background: The vitamin D is a supplement which allows the osseous binding of calcium. The deficiency of the latter causes the rickets in children. Worldwide, the dosages recommended by the authorities of health differ according to the various existing specialities on the market and the mode of supply (breast-feeding or artificial feeding with or without milk enriched in vitamin D). In Morocco until 2013, the vitamin D was marketed as a single patent drug in an injectable or oral of 600.000UI. And the recommendations in vitamin D in Morocco are: a birth dose and another one after 6 months. Objective: Among the objectives of this study is to study the accountability cases of adverse effects of drugs and especially to make health professionals aware of the importance of the notification of adverse drug events to avoid serious consequences on the health of the pediatric population. Methods: During an observational forward-looking study conducted at child’s hospital of Rabat (HER) betwe...
Background and objectives: Development of capacities in childhood and adulthood depends primarily... more Background and objectives: Development of capacities in childhood and adulthood depends primarily on the environnement during pregnancy. Leptin and adiponectin are adipokines involved in food intake and energy balance of the human, especially during pregnancy. The leptin/adiponectin ratio (LAR) is related to insulin resistance and diabetes in non pregnancy conditions. The aim of this study was to evaluate the relationship between LAR ratio and insulin, glucose and lipid profile during normal pregnancy. Methods: A total of 32 women, pregnant of singleton foetus with a gestational age less than 11 weeks participated in this study. Recruited women were followed at 12, 22-24 and 34-36 weeks of pregnancy. Maternal body fat (BF) was assessed using the dilution of deuterium oxide (D2O). Blood glucose, insulin, total cholesterol, HDL, LDL, triglycerides were also measured. Leptin and adiponectin concentrations were assayed using radioimmunoassay kits. Results: Mean age of the participants w...
Objectives: Development and validation of bioelectrical impedance prediction model for Moroccan a... more Objectives: Development and validation of bioelectrical impedance prediction model for Moroccan adolescents. Subjects and methods: The total sample included 143 adolescents (34 boys and 109 girls) aged 11-17 years-old who were recruited from high schools of the capital city (Rabat) of Morocco. The study population was divided into developmental and validation sample. Anthropometric measurements performed by a trained technician were body weight, standing height, body mass index and waist-to-hip ratio. Body composition was measured by deuterium oxide dilution (D2O) (0.5 g of 2H2O for one kg of body weight) and by bioelectrical impedance analysis (4000 Bodystat Quadscan). Resistance (R50) and reactance (Xc50) were measured at 50 kHz. Pubertal status was determined. Results: The model is FFM (kg) determined by D2O = 0.578×Height²/R50 (cm²/Ω) + 0.176×Body weight (kg) - 2.296×Gender (boy=0, girl=1) + 0.791×Age (years) - 3.768; with R²=0.93 and SEE = 1.89 kg. In the validation sample, the...
Anterior meningo-encephaloceles (AME) are congenital malformations characterized by herniation of... more Anterior meningo-encephaloceles (AME) are congenital malformations characterized by herniation of brain tissue and meninges through a defect in the cranium, in frontal, orbital, nasal and ethmoidal regions. The management of this complex congenital malformation is controversial according to whether use, an intracranial, extra-cranial or combined approach. This is the first largest series published in Africa, in which we present our experience in the operative management of AME; we share our recommendation in technical consideration for surgical approach with review of the literature. All patients beneficed of neuro-radiological investigations including Plan X rays, Spiral Three dimensional CT scan and MRI. Ophthalmologic and maxillo-facial evaluations were done in all the cases. MEA are surgically approached in various ways, mainly on the basis of its location and type, by cranio-facial approach in one-step, or in two stages by intracranial approach followed by facial approach, only by cranial approach or facial approach. The surgical results were evaluated in the follow up on the basis of disappearance of cranio-facial tumefaction with correction of hypertelorism. 60 children with AME were treated in our department between January 1992 and December 2012. The mean age at time of surgery was 14 months (20 days to 18 years) with slight men predominance (28 females/32 males). Cranio-facial team operated 21 patients, 16 were operated in two stages by intracranial approach followed by facial approach, 20 cases beneficed the neurosurgical approach and three only the facial approach Some post operative complications were observed: 2 cases of post operative hydrocephalus underwent shunt; CSF fistulas in three cases cured by spinal drainage, one death due to per operative hypothermia, 3 cases of recurrence how needed second surgery. After mean follow up for 80 months (1 year to 19 years) theses techniques permitted a good cosmetics results in 42 cases, average cosmetics results in 8 cases, poor results in 5 cases and worse cosmetics results in 4 cases, The AME are rare conditions we used the multiples approach first intracranial approach followed by facial approach, but after 1998 we used one-step correction by combined approach, only cranial approach when needed or facial correction.
The national data show a receding of the child percentage nursed exclusively to the breast and th... more The national data show a receding of the child percentage nursed exclusively to the breast and the length of the breastfeeding. This study is a prospective, descriptive and analytic survey of 211 couples mother–newborn child hospitalised in the Souissi maternity hospital of Rabat in order to describe factors associated with a receding of breastfeeding. We excluded from this study the
Breast cancer is a multifactorial disease. Factors most often mentioned risks are those related t... more Breast cancer is a multifactorial disease. Factors most often mentioned risks are those related to the environment, genetics, hormones and individual behaviors. Among these include alcohol, smoking, sedentary lifestyle and eating habits. Identification of eating and the role of nutritional factors may be involved in cancer risk have been studied extensively since nearly 40 years. We conducted a study of breast cancer type case-control with food frequency questionnaire to assess the causal relationship between dietary factor, obesity and breast cancer risk. female patients with breast cancer were compared to healthy controls at the National Institute of Oncology of Rabat during 2008-2010 and were interviewed for epidemiological information and for their eating habits. A total of 800 women were included in this study (400 cases and 400 controls). Result of univariate analysis showed that significant factors associated with the etiologie of breast cancer: high body mass index (BMI) [od...
Spasmus nutans is a syndrome occurring in infants comprising a symptomatic triad: torticollis, he... more Spasmus nutans is a syndrome occurring in infants comprising a symptomatic triad: torticollis, head nodding and nystagmus. Neuropediatric and ophthalmologic investigation are normal. No case of association with non-evolutive encephalopathy has been reported to date. We report on a case of spasmus nutans-associated agenesis of the median vermian cerebellum. A 3-month-old female infant was hospitalized for head nodding lasting 1 week and nystagmus of the left eye with no other signs. A lung infection had preceded the clinical signs. The ophthalmologic examination and electroencephalography (EEG) were normal. The cerebral MRI showed an objective partial agenesis of the median vermian cerebellum. The diagnosis of spasmus nutans-associated brain malformation was retained. The discovery of non-evolutive encephalopathy was associated with spasmus nutans. A genetic study is required.
Klebsiella pneumoniae is one of the Gram-negative bacilli most commonly found in urine of pregnan... more 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.
Design. Before-after prospective surveillance study to assess the efficacy of the International N... more Design. Before-after prospective surveillance study to assess the efficacy of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control program to reduce the rate of occurrence of ventilator-associated pneumonia (VAP).Setting. Neonatal intensive care units (NICUs) of INICC member hospitals from 15 cities in the following 10 developing countries: Argentina, Colombia, El Salvador, India, Mexico, Morocco, Peru, Philippines, Tunisia, and
ABSTRACT Introduction A newborn baby is said macrosomic if the birth weight is greater than the 9... more ABSTRACT Introduction A newborn baby is said macrosomic if the birth weight is greater than the 90th percentile of growth curves. The aim of our study was to assess the prevalence of this disease in our environment and determine the resulting morbidity. Patients and methods This was a prospective study in Souissi maternity hospital in Rabat, which occurred over a period from January to April of 2009. We have developed fact sheets on which investigation we identified the characteristics of maternal conditions for childbirth, maternal complications and fetal factors etiological macrosomia. Results This study involved a total of 255 macrosomic newborns according to the criterion defined above. The weight of newborns ranged between 4000 and 5656 g. The frequency of macrosomia was 7.7%. Male sex was predominant in 67% of cases. We have selected as etiological factors: diabetes in two of our patients, obesity in 50% with a BMI between 25% and 39% of deliveries and a history of macrosomia in 4% of our parturients. Fetal complications were dominated by the bump succedaneum in 22.35% of cases. Other complications were represented by respiratory distress in 5.4% cases, brachial plexus paralysis in 4.3% and the fracture of the humerus in one case. Hypoglycemia was observed in seven patients. Conclusion Macrosomia is often the cause of fetal and maternal complications. Its management must be multidisciplinary.
ABSTRACT Materials and Methods A prospective study about all infants born in maternity Souissi (R... more ABSTRACT Materials and Methods A prospective study about all infants born in maternity Souissi (Rabat) during one year: from first January to 31 December 2010. We included all newborns symptomatic or not at birth and whose mothers have at least one infectious case histories from the following: rupture of membrane ≥ 12 hours, chorioamnionitis, urinary tract infection and/or genital, fever ≥ 38°c before or in early labor. Results On a total of 14792 live births, 1602 newborns were prone to a risky infection (10.83%). Prolonged rupture of membranes showed 1341 cases including 59 newborns were premature. The duration of the rupture was between 12 and 24 hours in 44.30% of cases, between 24 and 48 hours in 44, 37% of cases and more than 48 hours in 11.33% of cases. On 133 cases of chorioamnionitis (10.67%) 129 newborns were full-term and 7 were premature. The obstetric decision was caesarean section delivery in 25.78% of cases. 4.74% of newborns had respiratory distress with a single case of death in the first hours of life. 4.50% were preterm and 8.86% were hypotrophy. Hospitalization was required from the outset in 1059 cases among which 133 were hospitalized. For other patients an inflammatory report was requested. The were followed as outpatients.
ABSTRACT Introduction The congenital malformations are one of the leading causes of morbidity and... more ABSTRACT Introduction The congenital malformations are one of the leading causes of morbidity and infant and child mortality. The etiology of these malformations is multifactorial, determined by a combination of genetic and environmental factors. The objective of this study was to analyze the main factors involved in the occurrence of congenital malformations in our context. Patients and methods This was a prospective, descriptive and analytical study carried out at the Souissi Maternity Hospital in Rabat over 1 year period from January 2010 to December 2010. This study involved the use of obstetric and perinatal records of a sample of the population. A collection sheet was completed for every newborn with the sociodemographic, obstetric, nursery, monitoring, surveillance of pregnancy, childbirth and neonatal data, the group of healthy newborns and those of malformed were compared and analyzed. The malformations considered are those that are clinically detectable. Results One thousand births were collected, 960 were healthy and 40 carriers of malformations. The malformations found were the cleft palate (10 cases), the anencephaly (4 cases), the poly malformed (12 cases), the hydrocephalus (4 cases), the imperforate anus (2 cases) and the spina-bifida (8 cases). The statistical analysis was used to determine risk factors significantly associated with the occurrence of congenital malformations namely taking medications (antiepileptic drugs) and/or plants (fenugreek) during pregnancy (P < 0.001), the presence of chronic disease in the mother mainly diabetes (P < 0.001), the family history of congenital malformation (P < 0.001) and twin pregnancy (P = 0.028). Conclusion The study of congenital malformations should be made in each country to determine their prevalence, their natures, causes and associated risk factors and allow for specific prevention measures.
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