Morocco is one of the countries most affected by the scarcity of water resources and the poor distribution of rainfall. Natural lagoon is the most widely used treatment process in Morocco. Indeed, Morocco is a sunny country throughout the year. The lagoon system requires minimal effort in operation and maintenance. Moreover, this system is the best process for removing bacteria indicators. For these reasons, a study of the purification performance of natural lagoons during five years, located in Chichaoua region (Morocco) was carried out. The lagoon system was monitored for five years, with measurements taken every three months at the input and output of the system. It received a hydraulic loading rate (HLR) between 1171 and 2760 m 3 with an average of 2053 m 3 /day. The obtained results show the removal of 37% of TSS, 63% of BOD 5 , 60% of COD, 61% of NH 4 + , 37% of TP, and 6.5 log units of coliforms during the mentioned monitoring period. Thus, the effluent values do not always comply with the Moroccan water quality requirement for irrigation reuse. Additionally, the statistical analyses confirm the presence of a strong linear correlation between almost all variables in the lagoon output. Therefore, the performance efficiency of the lagoon in removing organic matter and nutrients was significantly (p < 0.05) dependent on the season. However, the fecal contamination was not significantly (p > 0.05) affected by the seasons in this study. At the end of this study a complementary treatment before the reuse of treated wastewater, was proposed.

Background: Anaemia is a common problem in surgical patient, and it is an independent risk factor for blood transfusion, peri-operative infection, mortality and a longer in-patient stay. Diabetic foot wound results from the interaction of several contributory factors, the most important of which is neuropathy. With respect to the management of acute Charcot neuroarthropathy in diabetics, patients with diabetic foot wounds suffer from chronic inflammation, repeated infection, often undergo several invasive or operative treatments, and can have a protracted hospital stay. We hypothesised that, for these reasons, many patients with diabetic foot wound may suffer anaemia, require blood transfusion and suffer from poor nutrition.Aim of the work: Anaemia and nutritional status assessment as they affect the healing in patients presenting with diabetic foot wounds.Patients and methods: Two observational studies were undertaken. Initially a retrospective series of 20 patients with diabetic foot wounds. Patient demographics, clinical details, transfusion status and in-patient laboratory haemoglobin values (Hb) were recorded. In a prospective series of 33 patients, laboratory markers and nutritional status were assessed. Infection was excluded and managed appropriately by antibiotics and surgically by wound debridement or amputation. Other factors affecting wound healing were excluded as peripheral arterial diseases or debilitating diseases as renal failure.Results: In the retrospective series, 17 patients (85%) were anaemic (100% females) with average haemoglobin of 5g (SD 2.4) below the lower limit of normal for the sex of the patients. Ten patients (50%) were transfused. The average trigger haemoglobin index was 8.5 g/dl (SD 0.8). Patients who were transfused had lower haemoglobin on admission (p = 0.0016). Overall, at discharge, most of the patients were anaemic (92%). In the prospective series on admission, 27 patients (82%) were anaemic, also anaemic patients had a higher CRP and lower albumin level. 17 patients (52%) had been scored to be undernourished. Clinical follow up with appropriate dressing of the wounds and calculating the healing rate was observed. Conclusion:Usually anaemia as well as poor nutrition is the normal event and affecting the healing of diabetic wounds. Multidisciplinary review should be undertaken in all patients.

Background: Splenic artery aneurysms (SAAs) are rare but are increasingly being diagnosed as incidental findings. They account for around 60% of visceral artery aneurysms and are the third most common intra-abdominal aneurysms after aortic and iliac aneurysms.The true incidence of SAA is difficult to determine as the majority of cases are asymptomatic. It is clear, however, that SAAs are being found more frequently and identified earlier due to the availability of advanced imaging techniques.The appropriate treatment for SAAs depends on the location and size of the aneurysm, operative risks, and clinical status. The treatment of symptomatic SAAs should be performed. However, no consensus has been reached regarding intervention in asymptomatic patients.Aim of work: Was to study the appropriate and different ways of management of splenic artery aneurysms.Patients and methods: 13 patients in ten years attended the main hospital of Alexandria University with a diagnosis of splenic artery aneurysm. Assessed risk factors included age, gender, hypertension, diabetes, hyperlipidaemia, gallbladder diseases, coronary artery diseases, and tobacco use. Patients were also assessed for whether SAA was an incidental finding, symptomatic, or ruptured at presentation. The role of duplex scanning and/or computed tomography (CT) was successful in distinguishing pseudoaneurysm from true one. Calcification, thrombosis, and postoperative splenic infarction were assessed with the assistance of reconstruction of axial imaging. Surgical treatment depended on the site of the aneurysm. Aneurysms located in the proximal or middle third of the splenic artery were treated with simple excision, with proximal and distal ligation of the artery and with splenic preservation. The spleen was preserved only after observation of good back-flow in the distal portion of the splenic artery, and the colour of the spleen was not changed. For aneurysms located in the distal third, resection with splenectomy was performed.Results: The mean age at diagnosis was 66 years, and 8 of 13 patients (62%) were females. Co-morbidities were gallbladder diseases (69%) and systemic hypertension (54%), however to a less extent were cigarette smoking (54%), portal hypertension (46%) and hyperlipidaemia (46%). 77% of the patients were complaining of abdominal symptoms, varying from dyspepsia, abdominal discomfort and attacks of upper abdominal pain. One patient was haemodynamically unstable. Two patients were diagnosed incidentally. The size of the splenic artery aneurysms were between 8mm and 120mm with mean of 26mm in diameter. Most of the aneurysms (85%) were located in the middle and the distal third of the splenic artery; however the proximal third was affected in only 2 (15%) patients. Calcification of the wall of the aneurysm was present in 10 (83%) patients. Open surgery was done for all patients, and the lesser sac was opened to approach the splenic artery. Double ligation of the splenic artery and splenectomy was the strategy except in two patients where the aneu...