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Administration of Nebulised Ketamine for Managing Pain in the Intensive Care Unit of Obstetrics and Gynaecology

Open Journal of Anesthesiology 2023年第5期13卷 108-117页

作者： Yassine Hafiani Mohammad Khalayla Mohamed Elmouhajir Anas Erragh Soufiane Saadaoui Ibtissame Nabih ihsane mousaid Smael Elyoussoufi Said Salmi Anesthesiology and Critical Care Ibn Rochd University Hospital of Casablanca Hassan II University Casablanca Morocco Faculty of Medicine and Pharmacy of Rabat UM5 CEDOC Simulation Center Rabat Morocco

Introduction: The use of inhaled ketamine to manage a variety of painful conditions has been endorsed by the American College of Emergency Physicians and the American Academy of Emergency Medicine. Nebulized analgesia has multiple benefits, including rapid, effective and titratable analgesic delivery. The aim of our study is to assess the efficacy and safety of intranasal analgesic-dose ketamine compared to multimodal analgesia in patients presenting with acute postoperative pain or headache after a spinal anaesthetic in the intensive care unit of obstetrics and gynaecology. Materials and Methods: This was a prospective descriptive study, with hospital Ethics Committee approval and written informed consent from study participants. We compared the effect of nebulized ketamine and multimodal analgesia postoperatively in 120 patients belonging to the physical status I - II of the American Society of Anesthesiologists, in the intensive care unit of obstetrics and gynaecology, at the Ibn Rochd University Hospital Center in Casablanca from June 2021 to June 2022. Results: We included 120 patients in our study divided into two groups of 60 patients: the average age was 35 years, with extremes ranging from 18 to 45 years, All patients were hospitalized for postoperative care: all women underwent locoregional anaesthesia with a standard dose according to the service protocol (10 mg of bupivacaine, 25γ of fentanyl, 100γ of morphine), where pain was the common denominator. Among these patients, 59 were admitted for management of postpartum haemorrhage, 43 for postoperative monitoring, 15 for post-spinal anaesthesia headache and 3 for pelviperitonitis. The results of the pain assessment 30 minutes after the ketamine nebulization were marked by a request for analgesia in 12 patients, which is 20% of group A, including 5 patients, whose visual analogue scale (VAS) on admission was between 5 and 7, and 7 patients whose VAS at admission was ≥8;all these patients received a second d

关键词： Ketamine Nebulized Pain Postoperative

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First Determination of Source Parameters of Moderate Earthquakes (4.1 ≤ M ≤ 5.1) in Morocco from Spectral Analysis

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Open Journal of Earthquake Research 2014年第2期3卷 55-65页

作者： ihsane Bensaid Lahcen Bahi Fida Medina Université Mohammed V-Agdal Ecole Mohammedia d’Ingénieurs Rabat Morocco Université Mohammed V-Agdal Institut Scientifique Laboratoire de Géologie et Télédétection (URAC 46) Equipe Télédétection Risques et Ressources Naturelles Rabat Morocco Université Mohammed V-Agdal Institut Scientifique Laboratoire de Physique du Globe Equipe Géophysique de Subsurface Rabat Morocco Université Mohammed V-Agdal Ecole Mohammedia d’Ingénieurs Rabat Morocco

Recent installation of an array of broad band seismological stations in Morocco allowed us to study the records of five recent (2005-2008) moderate earthquakes (4.1 ≤ M ≤ 5.1) in order to determine their source parameters (seismic moment, fault slip, rupture area and stress drop) from P-wave spectra. We also studied the older Rissani events of 1992 using teleseismic data. Values of Mo, r, Δu and Δσ are, respectively, 1.1 × 1013 - 6 × 1016 Nm;0.50 - 3.9 km;0.8 - 5.8 cm and 0.3 - 1.49 MPa. The results are in accordance with the seismotectonic and geodynamic setting of Morocco as, for instance, the amount of slip along the faults with respect to the relative displacement of Nubia to Iberia (~4 mm·yr-1) determined from GPS data, taking into account the period of stress accumulation. However, some events show very variable corner frequency and low-frequency amplitude values which lead to considerably higher stress drop and fault slip values, especially at the nearest stations, which may reflect some site effects or uncertainties on depth and take-off angles.

关键词： Morocco Seismicity Fault-Plane Solutions P-Wave Spectra Source Parameters Seismotectonics

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Acute pancreatitis revealing ulcerative colitis—A case report

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Open Journal of Gastroenterology 2014年第1期4卷 16-18页

作者： Nora Bousfiha Iliass Iliass Charif Mohamed el Abkari Adil Ibrahimi ihsane Mellouki School of Medicine and Pharmacy of Fez Sidi Mohammed Ben Abdellah University Fez Morocco

The association of acute pancreatitis with ulcerative colitis [UC] has been described in the literature. It is usually induced by drugs, but sometimes it may be idiopathic. This association remains rare. We report the case of a patient who was treated in our department. Medical observation: Mr. KA, a 60-year-old man, was admitted in our unit for management of acute epigastric. The clinical examination at the admission was normal. After eliminating a cardiac or surgical cause, the diagnosis of acute pancreatitis was made on the basis of the presence of a serum lipase up to 5 times the normal level and pain intensity. An abdominal scanner tomography was performed for the assessment of the pancreatitis. It has shown a pancreatitis stage C associated with a thick rectosigmoidien that was discovered incidentally. Symptomatology was enriched 10 days after by the occurrence of rectal bleeding. A lower endoscopy was performed after the improvement of the pancreatitis and had shown an ulcerative colitis on pancolitis which was confirmed by biopsy. In order to search other causes of this pancreatitis, other tests were made [a biliary IRM, endoscopic ultrasonography, autoimmune tests] and the results were negative. We concluded an idiopathic pancreatitis. The ulcerative colitis was classified as moderate and the patient was put on oral corticosteroids with degression. The evolution was marked by a clinical and biological improvement of pancreatitis and colitis. Conclusion: The association of idiopathic pancreatitis with ulcerative colitis is rare. The case of our patient is the first case reported in our series with 400 cases of ulcerative colitis diagnosed in our service.

关键词： Acute Pancreatitis Ulcerative Colitis

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Papillary Carcinoma Derived from Ovarian Mature Cystic Teratoma: A New Case Report and Literature Review

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Case Reports in Clinical Medicine 2014年第4期3卷 197-202页

作者： ihsane Souaf Hinde El Fatemi Amal Bennani Chbani Leila Hammas Nawale Harmouch Tawfik Afaf Amarti Department of Pathology Hassan II Teaching Hospital Fez Morocco

Introduction: Papillary carcinoma arising from thyroid tissue in mature cysticteratoma (MCT) of the ovary is extremely rare, and it is not easy to diagnose preoperatively. No clinical, no radiological, no biological signs are specific to malignant transformation. Case presentation: A 51-year-old woman had a left ovarian tumor measuring approximately 18 cm diameter with malignant transformation of a mature cysticteratoma, who was diagnosed postoperatively with follicular variant of papillary thyroid carcinoma. A laparoscopic hysterectomy and left salpingo-oophorectomy were performed. During surgery, there were no signs of invasion or metastasis. Conclusion: Consideration should be given to thyroidectomy followed by total-body scanning and serum studies for foci of thyroid carcinoma and adjuvant therapy with thyroidectomy and radio ablation if residual disease is identified.

关键词： Ovarian Teratoma Papillary Carcinoma Malignant Transformation Thyroid Ovarian Neoplasm

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Tumor Misdiagnosed As Cancer of the Sphenoid Sinus: Case Report and Literature Review

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International Journal of Otolaryngology and Head & Neck Surgery 2012年第2期1卷 48-50页

作者： El Fatemi Hinde Bennani Amal Souaf ihsane Zaki Zouhir Alami Noureddine Amarti Afaf Department of Oto-Rhino-Laryngology Hassan II Teaching Hospital Fez Morocco Department of Pathology Hassan II Teaching Hospital Fez Morocco

Respiratory epithelial adenomatoid hamartoma (REAH) is an uncommon lesion of the upper aerodigestive tract first described by Wenig and Heffner in 1995 as prominent glandular proliferations lined by ciliated respiratory epithelium originating from the surface epithelium. Case Report: We report a case of 48-year-old women with nasal polyposis history, which consults for nasal obstruction, with suspicion of malignancy on CT. Surgical resection showed a respiratory epithelial adenomatoid hamartoma (REAH) of the nasal cavity. Conclusion: REAH is a recently described pathologic entity that can present rhinorrhea, epistaxis, hyposmia, and headaches. It is a rare lesion of nasal and paranasal sinuses, but should be considered in the differential diagnosis because it is a benign lesion and complete surgical resection is curative.

关键词： Nasal Cavity REAH Nasal Polyposis Hamartoma Nasal Obstruction

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Diagnosis Error: Carcinoma or Primary Breast Lymphoma? A Case Report and Literature Review

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Advances in Breast Cancer Research 2013年第1期2卷 11-14页

作者： Hinde El Fatemi ihsane Souaf Soufia El Jayi Kaoutar Moumna My Abdelilah Melhouf Nadia Sqali Afaf Amarti Department of Gynecology Hassan II Teaching Hospital Fez Morocco Department of Pathology Hassan II Teaching Hospital Fez Morocco Department of Radiology Hassan II Teaching Hospital Fez Morocco

Introduction: Breast involvement by non-Hodgkin lymphoma is particularly rare in women. We describe the case of a patient with a rapidly growing, nodule in the right breast. On ultrasonography, the nodule was suspicious for breast carcinoma. Case presentation: A breast biopsy from a 73-year-old Moroccan women answered invasive ductal carcinoma grade 3 from Elston and Ellis. Patey was performed. Microscopic examination showed lymphoid proliferation confirmed on immunohistochemical analysis. Our patient was treated with chemotherapy. Conclusions: The rarity of breast lymphomas, and the problems related to the diagnosis and therapeutic choices with these tumors require molecular techniques in association with classical histological diagnosis.

关键词： Breast Cancer Breast Primary Lymphoma Immunohistochemistrey Diagnosis

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Signet Ring Cell Carcinoma of Ampulla of Vater: Report of a Rare Malignancy and Literature Review

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Case Reports in Clinical Medicine 2014年第3期3卷 145-148页

作者： ihsane Souaf Kawtar Znati Sanae Chahbouni Imane Hafid Hassania Ameurtesse Nawale Hammas Leila Chbani Hinde El Fatemi Tawfik Harmouch Afaf Amarti Department of Pathology Hassan II University Hospital of Fez Hassan Morocco

Introduction: Signet ring cell carcinoma is a rare tumor that generally originates in the gastrointestinal tract. Signet-ring cell carcinoma of the ampulla of Vater is extremely uncommon and a very rare clinical entity, which is infrequently reported in medical literature and only 31 cases have been mentioned. Most tumors affecting Vater’s Ampulla are adenocarcinomas and other histological variants are less frequent. It mainly occurs in elderly patients. Case Presentation: We report a case of signet ring cell carcinoma of Vater’s Ampulla. The tumour had infiltrated the duodenal, but local lymph nodes were clear (T3N0M0). Duodenopancreatectomy with pylorus preservation is the treatment of choice. Conclusions: Etiology and survival are not well-defined in the literature due to the extreme rarity of this disease.

关键词： Ampulla of Vater Carcinoma Signet Ring Cell Pancreas

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Predictors of early rebleeding and mortality after acute variceal haemorrhage in patients with cirrhosis

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Open Journal of Gastroenterology 2013年第7期3卷 317-321页

作者： Iliass Charif Kaoutar Saada ihsane Mellouki Mounia El Yousfi Dafr Allah Benajah Mohamed El Abkari Adil Ibrahimi Nourdin Aqodad Department of Hepatology and Gastroenterology Hassan II University Hospital Faculty of Medicine and Pharmacy Sidi Mohammed Ben Abdellah University of Fez Fez Morocco

The upper gastrointestinal bleeding from esophageal or gastric varices is the most dangerous complication of portal hypertension. The purpose of this study was to identify the predictors of early rebleeding and mortality after a bleeding episode. Patients and Methods: It was a retrospective study including 215 patients admitted in our department of hepatology and gastroenterology at the Hassan II University Hospital of Fez, from January 2001 to January 2010. Results: The mean age of our patients was 51 years. Thirty percent of patients had cirrhosis due to virus (B or C). The majority of patients (79%) had only esophageal varices. Fifty patients (23%) had a bleeding recurrence. Twenty-five patients (11.5%) died during the first ten days, of which 52% had presented rebleeding (p = 0.01). In 30% of cases, the rebleeding was secondary to a fall of pressure ulcers. Univariate analysis showed that early mortality of patients was significantly associated with advanced age (p = 0.018), low prothrombin time (PT) (p = 0.022), low serum sodium (p = 0.03), low platelet count (p = 0.05), and elevated transaminases (p = 0.02). Conclusion: The survival of cirrhotic patients after a bleeding episode was influenced by advanced age, a low rate of PT, of serum sodium, and of the platelet count, and elevated transaminases.

关键词： Cirrhosis Portal Hypertension Gastrointestinal Bleeding Esophageal Varices

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The Impact of Gastroesophageal Reflux on the Quality of Life: About a Series of 100 Patients at Fez University Hospital

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Open Journal of Gastroenterology 2019年第6期9卷 99-108页

作者： Houda Meyiz Mohammed El Agheb Asmae Lamine Mounia El Yousfi Nordin Aqodad Dafr Benajeh Mohammed El Abkari Adil Ibrahimi ihsane Mellouki Hepato-Gastroenterology Department Hassan II University Medical Center Fez Morocco Faculty of Medicine Sidi Mohammed Ben Abdellah University Fez Morocco

The gastroesophageal reflux disease (GERD) represents a major problem for public health because of its high prevalence. The chronic character of the symptoms can have a very important impact on the quality of life (QoL). The purpose of this study is to assess the impact of the GERD on the quality of life of our patients and to determine the main aggravating factors. Patients and Methods: This is a cross-sectional, observational study of 100 patients presenting signs of GERD in the gastroenterology department of the university medical center Hassan II-Fez, for a period of 3 months (October to December 2014). We used the Reflux-Qual short form (RQS®) to evaluate the QoL of our patients. Results: Over the study period, 100 patients were included. The average age of our patients was 47 years [20 - 75 years] with a sex-ratio F/M in 2.12. Among our patients, 20% (n = 20) were chronic cigarette smokers. The diagnosis of GERD was clinical in 75% of the cases (n = 75) and based on 24-hour pH monitoring in the remaining 25% (n = 25). Approximately 2/3 of the patients were receiving proton pump inhibitors (PPIs) treatment at the time of the questionnaire. The impairment of QoL was moderated to severe (RQS® p = 0.01), female sex (p = 0.03) and the frequency of symptoms (p = 0.001). Moreover, patients having a GERD that requiring a daily and continuous administration of PPIs had a lower index of RQS® (p = 0.001). The quality of life impairment was not associated with chronic cigarette smoking (p = 0.3). Conclusion: The impairment of the QoL was moderated to severe (RQS® < 16) for 2/3 of the patients (n = 62). This impairment was associated with elderly, female sex, frequency and in case of GERD requiring continuous administration of PPIs.

关键词： Gastroesophageal Reflux Reflux-Qual Short Form Quality of Life

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Pregnancy with Gastric Stromal Tumor

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Case Reports in Clinical Medicine 2014年第11期3卷 571-576页

作者： Iliass Charif Najat Khalil Abdelmalek Ousadden El Bachir Benjelloun Ouafae Slimani Fatima Zahra Fdili Alaoui Fatima Zahra Hijri Omar Mesbahi Adil Ibrahimi ihsane Mellouki Hepatogastroenterology Service Hassan II University Hospital. Faculty of Medicine and Pharmacy of Fez Sidi Mohammed Ben Abdellah University Fez Morocco Visceral Surgery Service Hassan II University Hospital. Faculty of Medicine and Pharmacy of Fez Sidi Mohammed Ben Abdellah University Fez Morocco Gynecology Obstetrics Service Hassan II University Hospital. Faculty of Medicine and Pharmacy of Fez Sidi Mohammed Ben Abdellah University Fez Morocco Medical Oncology Service Hassan II University Hospital. Faculty of Medicine and Pharmacy of Fez Sidi Mohammed Ben Abdellah University Fez Morocco

Background: Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. GIST are rare during pregnancy. We report here the case of a patient who was admitted in our university hospital for GIST discovered during the second trimester of pregnancy. She was 42 years old, in the fifth months of pregnancy. She was admitted for biliary colic pain with vomiting. On abdominal examination, we objectified a distended abdomen with uterine height of 18 cm and epigastric mass of 10 cm. Abdominal ultrasound and magnetic resonance imaging (MRI) showed a hepatic, tissue and cystic mass, developing at the expense of the left liver. Endoscopy objectified an aspect of extrinsic compression at the front of the stomach. A cesarean was scheduled at the 35th month of pregnancy for fetal extraction and rescue. Exploration of the peritoneal cavity during surgery has objectified a hepatic highly vascularised mass reaching up to the umbilicus. This mass was unresectable. A postoperative CT scan revealed a large bilobed epigastric mass adhering to the stomach and the left liver. Histological and immunohistochemical study of hepatic process showed a gastrointestinal stromal tumor of high risk of malignancy. Conclusion: few cases have been reported in the literature on GIST during pregnancy showing the rarity of the condition that requires multidisciplinary care.

关键词： GIST Pregnancy Imatinib

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