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In this article, we investigate the existence and uniqueness of the solution of a fractional boundary value problem with conformable fractional derivation of the Caputo-Fabrizio type. In order to study this problem we used a new definition of fractional integral as an inverse of the conformable fractional derivative of Caputo-Fabrizio, therefore, so we transformed the problem to a equivalent linear Volterra-Fredholm integral equations of the second kind, and taking sufficient conditions existence and uniqueness of this solution is proven based on the results obtained. The analytical study is followed by a complete numerical study.

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PURPOSE: To report clinical findings after accidental ocular instillation of Angel's trumpet (Datura suaveolens) sap. OBSERVATION: A 24-year-old man, with no particular past history, presented with sudden-onset of unilateral mydriasis. The clinical appearance, as well as the detailed history, made possible the etiologic diagnosis of ocular exposure to sap from Angel's trumpet, a plant containing natural alkaloids with parasympatholytic properties. DISCUSSION: A toxic etiology of sudden-onset anisocoria may be established by taking a detailed history and being familiar with possible causative agents. Accidental ocular instillation of sap from Angel's trumpet should be noted as a possible cause of sudden-onset mydriasis and/or systemic symptoms such as tachycardia in otherwise healthy patients.

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We report the case of a 66-year-old patient with a pilomatrix carcinoma from the right submandibular region with pulmonary and cerebral metastases. The histological confirmation of the diagnosis has been based on the biopsy of the submandibular tumefaction which was rapidly growing. We tried at first a doxorubicine and cisplatine chemotherapy because of the considerable locoregional extension and the existence of pulmonary metastases. The patient response to three cures of chemotherapy was spectacular with a partial clinical response (75%) and a partially cleaned-up chest observed in the radiological evaluation. In the 5th cycle of chemotherapy following the same protocol, the patient presented a relapse with cerebral metastases. The patient received hypofractionated radiotherapy on the brain followed by etoposide and cisplatine chemotherapy, then oral vinorelbine. The patient died of progressive disease after 32 weeks.

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INTRODUCTION: The complications of chronic otitis media have become less frequent since the advent of antibiotics. However, they continue to show a high incidence in developing countries. OBJECTIVES: The aim of this study was to determine the impact of these complications in Morocco and to study the epidemiological, clinical, paraclinical and therapeutic patterns. PATIENTS AND METHODS: This is a retrospective study conducted between January 1998 and December 2005. All patients presenting to the ENT department of the hôpital du 20 Août of Casablanca, Morocco, with complications of chronic otitis media and hospitalized during this period were included. RESULTS: We selected 47 out of 824 patients hospitalized for chronic otitis media, for a 5.7% incidence of complications, including 15 intracranial complications (1.8%) dominated by meningitis (nine cases) and cerebral abscess (five cases), and 32 extracranial complications (3.8%) dominated by mastoiditis (21 cases) and facial paralysis (eight cases). The cholesteatoma was found in 70% of the patients. The open atticomastoidectomy was the surgical technique chosen in 80% of the cases, associated with specific treatment depending on the complication. Progression was favorable in 90% of the cases. CONCLUSION: With this study, the authors review the high incidence of complications of chronic otitis media in Morocco, and therefore the need to diagnose and treat all cases of chronic otitis media early to prevent the very dangerous (for example, intracranial) complications.

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OBJECTIVE: This 1-year follow-up survey of 214 medical inpatients aged 65 and older describes the outcome of major depressive episode (MDE), determines the incidence of new episodes and identifies factors associated with outcome and with new episodes of MDE. METHOD: Follow-up information was obtained from 160 patients, 69 men and 91 women. RESULTS: Of the 48 cases of MDE who were interviewed, 44% improved. Underlying dysthymic disorder strongly influenced outcome: of 21 cases of MDE alone, 62% were improved at follow-up; of the 27 cases in which MDE was superimposed on dysthymic disorder initially, only 30% were improved. New episodes of MDE occurred in 21% of patients, and were associated with dysthymic disorder initially and with change of meaning of life. CONCLUSIONS: Among older medical inpatients, MDE, particularly when superimposed upon dysthymic disorder, is a persistent condition. Randomized trials are necessary to identify efficacious treatments.

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An efficient and reliable method for shoot regeneration from leaf disks of Fragaria vesca L. has been developed. This protocol has been successfully employed to obtain transformed plants using Agrobacterium tumefaciens as gene vector. Murashige and Skoog basal medium supplemented with benzyladenine (4 mg/l) and indole-3-butyric acid (0.25 mg/l) induced the maximum percentage of shoot regeneration (98%) and the highest number of shoot colonies per explant (4.6) after 8 weeks of culture. Isolated shoots would elongate and proliferate when the benzyladenine concentration was lowered to 0.5 mg/l. The established protocol for shoot regeneration was employed to transform leaf disks using Agrobacterium tumefaciens carrying the plasmid pBI121. A 7.7% of the inoculated explants showed kanamycin resistance after 10 weeks of selection in a medium containing 25 mg/l of this antibiotic. The transgenic shoots obtained were rooted in the presence of 25 mg/ kanamycin and successfully acclimatized. The final percentage of transformation obtained based on beta-glucuronidase expression was 6.9%.

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OBJECTIVE: To evaluate the effectiveness of geriatric psychiatry consultation in reducing the severity of confusion, anxiety, depression, abnormal behavior, and functional disability among a selected group of aged medical and surgical inpatients. DESIGN: Randomized clinical trial. Cases assessed on enrollment at 2, 4, and 8 weeks later. SETTING: Primary acute care hospital. PATIENTS: Eighty hospitalized patients aged 65 or older who were referred to a multi-disciplinary team and had not received a psychiatric consultation in the month prior to referral. Sixty-three patients completed the trial. INTERVENTIONS: Patients in the treatment group received a geriatric psychiatry consultation and, when appropriate, follow-up at least once per week for 8 weeks. Control patients received usual medical care. MAIN OUTCOME MEASURES: Short Portable Mental Status Questionnaire, Anxiety Status Inventory, Geriatric Depression Rating Scale, and Crichton Geriatric Behavioral Rating Scale. RESULTS: The effect of the consultation on psychiatric symptoms and functional status was positive but small. The differences in scores of all measures between treatment and control groups were not statistically significant, but there were consistent trends for more treatment than control cases to have improved on all measures, significantly so on the Anxiety Status Inventory (P less than 0.05). Cases with delirium or depression improved most often. More control than treatment cases were discharged after 4 and 8 weeks, but twice as many treatment cases were discharged home. CONCLUSIONS: Geriatric psychiatry consultation, while not highly effective overall, may be beneficial if targeted to those most likely to benefit and compliance by referring physicians can be improved.

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