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Objectives: During the pandemic of covid-19, Safe and effective vaccines have been urgently needed. Our study aims to investigate the adverse effects of vaccines and their severity factors in people who have been vaccinated in the Rabat region. Methods: This is a multicentric cross-sectional study conducted in the Rabat region of Morocco from February to December 2021. Consenting subjects aged 12 years and older who presented symptoms after a first, second or third dose of covid 19 vaccine and who received one of the following vaccines were included in the study: AstraZeneca-Oxford, Sinopharm, Pfizer-BioNTech. An evaluation form was drawn up. Univariate analysis was performed using the chi-square, Fisher's exact and Mann Whitney tests. Multivariate analysis was performed using logistic regression, and data analysis was performed using Jamovi 2.3.19 and R 4.3.1. Results: We recruited 489 patients with a median age of 52 years [32.3–66.0], 67.2 % were women,52.6%were vaccinated by AstraZeneca,4.8 % by Pfizer, and 42.6 % by Sinopharm, 84 of cases were severe 17.2 %, the majority of side effects were represented by influenza-like illness, fever, dizziness, vagal shock, skin rash, Covid, cardiac, digestive and neurological manifestations.In univariate analysis, age and the presence of a previous history were risk factors, and in multivariate analysis only age remained a risk factor for the severity of adverse events. Conclusion: The study identifies common adverse events and underlines the importance of ongoing surveillance and suggests the need for large samples in order to comprehensively assess the effects of vaccines.

Objectives: Assessing the level of health literacy among nursing and healthcare technician students at the Higher Institute of Nursing and Technical Health in Agadir, Morocco, regarding cervical cancer, and identifying associated factors. Materials and methods: This is an observational, cross-sectional, and analytical study conducted among nursing and health technician students in the 2nd and 3rd years. A self-administered health literacy assessment test was employed. Univariate and multivariate logistic regression analyses were performed to determine the factors associated with health literacy level. Results: Three hundred students were surveyed in the study. The average health literacy score was 17.1 ± 6.32, with a median score of 18 (IQR 13.50–22). Approximately one-third (30%) had a low level of health literacy. Multivariate logistic regression analysis revealed that the non-healthcare profile (OR 4.458; CI95%: 2.327–8.545; p

Abstract Background Self-medication during pregnancy is of great interest. The use of drugs during pregnancy requires a careful reflection on the benefits to the mother and the risks to the fetus. Selecting a drug or drugs for treating pregnant women can be difficult for clinicians owing to the various pharmacokinetic and physiological changes encountered during pregnancy. This systematic review and meta-analysis aimed to estimate the pooled prevalence of self-medication and associated factors among women during pregnancy. Methods Searches were carried out at PubMed, Science Direct, Web of Science, and Google Scholar. The quality of the studies and the risk of bias were analyzed using the Joanna Briggs Critical Appraisal Checklist for Analytical Cross-Sectional Studies instrument. The extracted data were tabulated and analyzed qualitatively and quantitatively through meta-analysis. Results The overall prevalence of self-medication among pregnant women was 44.50% (95% CI: 38.92–50.23). Subgroup analyses showed differences in self-medication prevalence influenced by region, county income, and study design. The Heterogeneity, assessed by the statistical test I2 varied from 96 to 99% and was statistically significant. The result of this funnel plot showed that the funnel plot was symmetry with p-value = 0.36, and there is no publication bias. Conclusion The results obtained from this study showed that the prevalence of self-medication among pregnant women is relatively high. This requires effective measures and interventions to reduce self-medication. Trial registration ID = CRD42022312333 .

Background. Preventing overweight and obesity in early childhood is a priority for healthcare systems worldwide due to the harmful effects on health and economy over the medium and long term. Objective. The aim of this study is therefore the identification of the determinants predictive of overweight and obesity during the first 24 months of a child’s life. Material and Methods. From May 2021 to January 2022, 1012 mother-child pairs were included in this study and were interviewed at urban and rural health centers in the Skhirat-Temara in Morocco prefecture using a questionnaire. The anthropometric measurements of the children were also taken according to World Health Organization standards. Results. The prevalence of overweight and obesity in children aged 0-24 months was 16.5%. This prevalence increased with age (12.5% for the 0-6 months group, and 15.5% and 21.5% respectively for the 7-12 months and 13-24 months groups). Cesarean delivery (aOR=1.78; 95%CI: 1.26-2.51; p=0.001), more than two living siblings in the household (aOR=1.48; 95%CI: 1.03-2.12; p=0.03), male gender (aOR=1.56; 95%CI: 1.10-2.20; p=0.01), and child age (aOR=0.94; 95%: 0.92-0.97; p

Healthcare-associated infections (HAI), also referred to as nosocomial infections, is defined as an infection acquired in a hospital setting. This infection is considered a HAI if it was not present or incubating at the time of admission. This includes infections acquired in the hospital but appearing after discharge, and also occupational infections among staff of the facility. HAI are a major patient safety measure to be considered in hospitals.

Abstract Background The Kingdom of Morocco approved BBIBP-CorV (Sinopharm) COVID-19 vaccine for emergency use on 22 January 2021 in a two-dose, three-to-four-week interval schedule. We conducted a retrospective cohort study to determine real-world BBIBP-CorV vaccine effectiveness (VE) against serious or critical hospitalization of individuals RT-PCR-positive for SARS-CoV-2 during the first five months of BBIBP-CorV use in Morocco. Methods The study was conducted among adults 18–99 years old who were tested by RT-PCR for SARS-CoV-2 infection between 1 February and 30 June 2021. RT-PCR results were individually linked with outcomes from the COVID-19 severe or critical hospitalization dataset and with vaccination histories from the national vaccination registration system. Individuals with partial vaccination (

Introduction: In Morocco, the traditional media allows messages of non-scientific prescriptions for the treatment of diseases and statements criticizing doctors to pass, which are considered by doctors as defamation and attacks on the honor of the medical profession. The aim of this study was to analyze physicians’ perception in Morocco regarding health topics in the traditional media (TM). Methods: This is a descriptive transversal study of physicians practicing in Morocco. The data were collected through the use of a questionnaire that included questions on reliability, speed, up-to-dateness and influence of TM, also trust and interest in TM, and quantity, quality of health messages in TM. Results: A total of 417 physicians responded, among them 234 (56.1%) had little or no interest in health topics in TM; 248 (59.5%) considered the quantity of transmitted messages to be low; 234 (56.1%) considered that health messages in TM are of low quality; 248 (59.5%) had little or no trust in health topics in TM. Also, three quarters [314(75.3%)] of the physicians recognized a moderate to strong influence of TM on health behaviors. Conclusions: Our results show that physicians have a perception that seems negative towards TM. This may partially explain the chronic tension situation between physicians and journalists/media in Morocco. To better understand this situation and improve this relationship in favor of health promotion, it is necessary to conduct a research addressing the opinion of journalists and the propositions of solutions of both parties.

Background: The aim of this study was to evaluate the prevalence of active tuberculosis (TB) infection in Moroccan patients with rheumatic diseases under biologic therapy, and to describe the demographic characteristics of these patients as well as to explore potential risk factors. Methods: This 14-year nationally representative multicenter study enrolled Moroccan patients with rheumatic diseases who had been treated with biologic therapy. Patient medical records were reviewed retrospectively for demographic characteristics, underlying rheumatic diseases, associated comorbidities, and TB-related data. Results: In total, 1407 eligible patients were studied, detailed records were obtained for only 130 patients; 33 cases with active TB were identified at an estimated prevalence rate of 2.3%. The mean age was 42.9 ± 12 years and 75.8% were males. Ankylosing spondylitis accounted for 84.8% of active TB cases, and the majority of the cases (31/33) occurred among antitumor necrosis factor-alpha (TNF-α) users. A total of 8 out of 33 patients were positive at initial latent TB infection (LTBI) screening by tuberculin skin test and/or interferon-gamma release assay. Consumption of unpasteurized dairy products (odds ratio [OR], 34.841; 95% confidence interval [CI], 3.1–389.7; P = 0.04), diabetes (OR, 38.468; 95% CI, 1.6–878.3; P = 0,022), smoking (OR, 3.941; 95% CI, 1–159.9; P = 0.047), and long biologic therapy duration (OR, 1.991; 95% CI, 1.4–16.3; P = 0.001) were identified as risk factors for developing active TB. Conclusion: Moroccan patients with rheumatic diseases under anti-TNF-α agents are at an increased TB risk, especially when risk factors are present. Strict initial screening and regular monitoring of LTBI is recommended for patients living in high TB prevalence areas.

Background and aim: Vaccination against COVID-19 was one of the most important resolute to stop the spread of the pandemic; however, its acceptance was controversial especially by pregnant and lactating women. This study aims to assess the prevalence of vaccination among participants as well as to explore the determinants of reluctance or adherence to vaccination among this population, and to investigate the intention towards vaccination among the unvaccinated. Method: This is a cross-sectional study conducted among mothers (n = 458) residing in the prefecture of Skhirat-Temara in Morocco, and who have children aged between one month to 2 years, the survey was conducted on the basis of a semi-structured questionnaire. Result: The prevalence of vaccination among the participants was 61.8%, although they were all vaccinated after their delivery. Among the unvaccinated, 64% wanted to be vaccinated either because they believed the vaccines were useful or because they wanted to get the vaccine pass, while 36% absolutely refused to be vaccinated due to lack of sufficient information on the efficacy and safety of new vaccines against COVID-19. The age of the last child (p

Abstract Background Moroccan incidence of cancer is increasing with the lengthening of life expectancy. Data regarding elderly Moroccan cancer patients are lacking. In the context of our project aiming to develop an adapted version of the Comprehensive Geriatric Assessment CGA to the Moroccan population, we launched the first Moroccan multicenter transverse study to explore the characteristics of elderly Moroccan cancer patients. Methods The study was conducted in nine Moroccan medical oncology departments. Patients were enrolled over 4 months. Inclusion criteria were patients aged 65 years or over with verified solid cancer. The questionnaire included four sections: socio-demographic and economic data, clinical data, vulnerability and EORTC-QLQ C30. We explored the entire included population. Then, we compared the results according to age (65–70 years old and ≥ 71 years old) and sex. We also explored the correlation between G8 scores and the ability to practice religion as an indicator of fitness level. Results In total, 164 patients were enrolled. The mean age was 73.18 ± 6.01 years. The majority of patients were married, lived with their children and received their financial income from them. Fifteen percent of families asked to hide the diagnosis from the patient. Breast (23%), colorectal (15.9%) and lung (14%) cancers were the most frequent, and 83.5% had an abnormal G8. The majority of the patients were independent for basic daily activities. Female patients had poorer social and economic conditions. Abnormal G8 was correlated with religious practice and quality of life scores. Conclusion This is the first multicenter prospective study designed to collect data on the lifestyle and clinical profiles of elderly Moroccan cancer patients as an Arab and Muslim population. Our study shows that it is a well-cared-for population with strong social ties. However, there is deep economic vulnerability, especially among women, requiring urgent care. Religious practice is an important daily activity for our elderly patients and should be included in the Moroccan CGA.

Aim: The objective of this study was to analyse the effect of the introduction in 2010 of the pneumococcal conjugate vaccine (PCV) on the reduction in mortality from respiratory causes in children under 5 years in Morocco. Methods: Child mortality rates from respiratory cause were analysed using an interrupted time series analysis. Mortality rates from congenital and chromosomal causes were also analysed for comparative purposes. Results: In the post-vaccination period, child mortality rates from respiratory causes decreased by 28% (Mortality rate ratio (MRR) = 0.72, 95% CI: 0.58–0.83) and by 30% in children under 1 year (MRR = 0.70, 95% CI: 0.50–0.98). In children aged between 1 and 5 years, the decrease in the child mortality rate was not statistically significant (MRR = 0.99, 95% CI: 0.91–1.08). Mortality rates from congenital and chromosomal causes in the post-vaccination period were stable in children under 5 years (MRR = 1.19, 95% CI: 0.97–1.48), in children under 1 year (MRR = 1.15, 95% CI: 0.94–1.40) and in children aged between 1 and 5 years (MRR = 1.19, 95% CI: 0.97–1.48). Conclusion: The decrease in child mortality from respiratory causes in the post-vaccination period provides strong evidence of the effectiveness of PCV. Keywords: Child mortality, Pneumococcal conjugate vaccine, Interrupted time series analysis, Morocco

BackgroundWe provide national estimates of the real-world Vaccine effectiveness (VE) based on nationally available surveillance data. The study aimed to estimate the effectiveness of the inactivated Covid-19 vaccine BBIBP-CorV (Vero Cells) Sinopharm vaccine currently deployed in Morocco against SARS- CoV-2 severe disease/ hospitalization" within 9 months after vaccination.MethodsWe conducted a test-negative, case-control study among a population aged 18 years or older who were tested by rt-PCR for SARS-CoV-2 infection from February to October 2021 in Morocco. From the national laboratory COVID-19 database; we identified cases who were rt-PCR positive amongst severe and critical COVID-19 cases and controls who had a negative rt-PCR test for SARS-CoV-2. From the national vaccination register (NVR); individuals vaccinated with COVID-19 Vaccine (Vero Cell) and those unvaccinated were identified and included in the study. The linkage between databases was conducted for the study of Vaccination status based on the timing of the vaccine receipt relative to the SARS-CoV-2 rt-PCR test date. For each person, who tested positive for SARS-CoV-2, we identified a propensity score-matched control participant who was tested negative. We estimated vaccine effectiveness against SARS- CoV-2 severe disease/ hospitalization using conditional logistic regression.ResultsAmong 12884 persons who tested positive and 12885 propensity score-matched control participants, the median age was 62 years, 47.2% of whom were female. As a function of time after vaccination of second dose vaccination, vaccine effectiveness during the first month was 88% (95% CI, 84-91), 87% (95% CI: 83-90) during the second and third month, 75% (95% CI: 67-80) during the fourth month, 61% (95% CI: 54-67) during the fifth month, and 64% (95% CI: 59-69) beyond the sixth month. VE remained high and stable during the first three months in the two-age subgroup. In the fourth month, the VE in the older population aged 60 years and above (64%) was reduced by 20 points compared to VE in the younger population (84%).ConclusionA Sinopharm vaccine is highly protective against serious SARS-CoV-2 infection under real-world conditions. Protection remained high and stable during the first three months following the second dose and decreases slightly beyond the fourth month especially beyond 60 years.

Abstract Background The aim of this systematic review is to determine the epidemiological and etiological profiles, the influential factors of the prehospital delay, thrombolysis management, the acute and 3-month mortality rate and the genetic aspect of ischemic stroke in Morocco. Methods The present work is a systematic review that was conducted according to the recommendations of the “Preferred reporting items for systematic reviews and meta-analysis”. We used Pubmed, Sciencedirect, Scopus, Clinicalkey, and Google scholar databases for the raking of the gray literature during the time frame 2009 and 2018. The protocol of the review was registered in the PROSPERO register (CRD42018115206). These studies were analyzed based on: Age, sex ratio, risk factors, etiological profile according to Trial of ORG classification 10,172 in Acute Stroke Treatment, prehospital delay average and its influential factors, thrombolyzed patients’ proportion, acute and 3-month mortality and the genetic factors of ischemic stroke in Morocco. Results Twenty-nine (n = 29) studies were selected. The average age ranged from 49 ± 15.2 to 67.3 ± 9.9 years old. Moreover, we reported male predominance within all ages in 13 studies. High blood pressure, diabetes, smoking and heart disease were the four identified main risk factors by the prementioned studies. Atherosclerosis and cardioembolic were the main described etiologies of cerebral ischemia, and the average prehospital time ranged from 26 to 61.9 h. The proportion of thrombolysed patients ranged from 1.8% to 2.9%, the mortality rate varied in the acute phase from 3 to 13%, and the 3-month mortality ranged from 4.3 to 32.5%. It is also important to highlight that most of these studies, which were conducted in hospital environment, have a reduced sample size and no confidence interval. Conclusions Ischemic stroke is affecting more likely the young population with male predominance. Moreover, the long prehospital delay and the low proportion of thrombolysed patients are alarming. This indicates the need to investigate in depth the key factors influencing the access to care for Moroccan patients in order to improve the management of this neurologic deficit in Morocco.

Background:Pandemic confinement of COVID-19 may influence dietary behaviors and physical activity, and increases the risk of stress, especially among adolescents. This increases the subsequent risk of degenerative diseases such as obesity, diabetes, cardiovascular disease, etc., which can lead to a higher risk of death. This study aims to evaluate the effect of confinement on the weight load, physical activity and dietary behavior of higher education students during the period of confinement. Methods:Data was collected by an anonymous online questionnaire with 406 students. Physical activity was evaluated with the International Physical Activity Questionnaire. A reference score of the National Nutrition and Health Program (PNNS-GS) was used to determine the dietary habits. Stress appreciation was assessed by using a psychological instrument known as the “Perceived Stress Scale” provided by Mind Garden. Results:More than a quarter of the students were overweight or obese. During the confinement of COVID-19, most of the students suffered from nutritional disorders, only one-third were moderately physically active, and the majority of students were at risk of stress. Multivariate analysis showed that the concept of threat of Stress increases the risk of weight gain at a risk level of 2.4 [95% CI 1.09–5.43], low physical activity increases the risk level to 1.9 [95% CI 1.18–3.04]. However, a balanced diet is protective against the occurrence of weight gain (ORa = 0.30, [95% CI 0.15–0.61]). Conclusion:The study showed that confinement appeared to contribute to weight gain and those students were more sedentary than active with unhealthy eating behaviors. Understanding these behaviors during COVID-19 confinement will help public health authorities implement future policies on recommendations when new pandemics arrive and confinement policies are implemented.

Background: Stroke is increasingly becoming a major cause of disability and mortality. However, it can be prevented by raising awareness about risk factors and early health care management of patients. Objective: The aim of this study is to assess the level of knowledge on stroke, its risk factors, and warning signs in the population attending urban primary health care centers in the city of Agadir, Morocco. Methods: This is a multicentric cross-sectional study with a descriptive and analytical purpose. The study was conducted at five urban primary health care centers in Agadir in centralwest Morocco. All persons over the age of 18 years who consulted the health centers and who agreed to fill in the questionnaire were recruited, except for the foreign population and health workers. An interview questionnaire was used to assess the level of knowledge on stroke. Findings: A total of 469 participants were involved in the study. The median knowledge score was 8 (Interquartile range 4–13). High blood pressure (55.7%), depression and stress (48.8%) were the most well-known risk factors. Sudden weakness of the face, arms or legs (37.3%) was the main warning sign cited by the participants. Multivariate analysis revealed that illiteracy (OR 1.92; CI95%: 1.08–3.44) primary education (OR 3.43; CI95%: 1.63–7.21), rural residential (OR 1.67; CI95%: 1.07–2.59), no history of stroke among respondents (OR 16.41; CI95%: 4.37–61.59) and no history of stroke among relatives, acquaintances, or neighbors (OR 4.42; CI95%: 2.81–6.96), were independently associated with a lower level of knowledge of stroke (Table 4). Conclusions: The low level of knowledge on stroke among this Moroccan population indicates the importance of implementing stroke education initiatives in the community. More specifically, proximity education and awareness programs ought to be considered to anchor lifestyle preventive behaviors along with appropriate and urgent actions regarding the warning signs of stroke.

INTRODUCTION: In otolaryngologic surgery, ankle is frequently used for monitoring anesthesia in place of brachial when the patient doesn´t need invasive arterial cannulation. If there is a clinically useful and Predictable link between the two readings in hemodynamic normal patient, this difference during otolaryngologic surgery, was not evaluated. We aimed to investigate the reliability and the acceptability of non invasive blood pressure measurements at the ankle compared to those obtained concurrently at the arm during otolaryngologic surgery. METHODS: eighty ASA grade I and II patients who had to be operated under general anesthesia were taken as subjects for our study. Blood pressures were measured simultaneously in the 2 limbs before induction and then every 10 minutes until the end of the surgical procedure. Readings were initiated concurrently. Statistical analysis was performed with PASW Statistics 13. RESULTS: there were 41 males (51.2 %) and 39 females (48.8 %). Bland-Altman analysis of mean difference between the ankle and arm (95 % limits of agreement) was -11.47 (- 23.77 to 0.82)mmHg for systolic blood pressure (SBP), -7.89 (-19.16 to 3.36)mmHg for diastolic blood pressure (DBP) and - 9.09 (18.19 to 0.00)mmHg for mean arterial pressure (MAP). Non-parametric analysis showed that 67.5 % of SBP, 46.2 % of DBP and 56.2 % of MAP measurements differed by = 10mmHg. CONCLUSION: ankle BP cannot be used routinely in otolaryngological surgery. Although, the ankle can be used as an alternative where the arm cannot be used taking into account a difference.

Congenital malformations are one of the leading causes of neonates and infants’ mortality and morbidity. The frequency of these congenital malformations varies in different populations. The objective of this study was to find out the prevalence and pattern of congenital malformations in a tertiary teaching hospital in Rabat, Morocco. This four-year retrospective descriptive study was conducted from January 2011 to December 2014. All newborns with congenital malformations diagnosed at birth were included. Mothers and newborn characteristics were analyzed using SPSS 13.0. A total of 706 newborns were noted to have congenital malformation. The prevalence rate was 1.02%. The mean maternal age was 28.8±7.2 years. The mean maternal body mass index was 28.1±6.9 kg/m2. 13.3% of the mothers had a history of abortion. The nervous system was the most affected system (19.4%) followed by the musculoskeletal system (14.2%), the chromosomal abnormalities (12.3%) and the genito-urinary system (10.8%). Males newborns (57.9%) had more congenital malformations than females (40.5%). The rates for live-births, fetal asphyxia and stillbirths were 75.2%, 7.2% and 17.3%, respectively. This retrospective study provides recent and detailed data about congenital malformations in a Moroccan region. The result from this study will contribute to the knowledge of congenital malformations in this particular area and hence the supportive preventive policy.

Introduction: Triple-negative breast cancer (TNBC) is a group of breast carcinoma characterized by the lack of expression of estrogen and progesterone hormone receptors (ER, PgR) and HER2. This form is also characterized by its aggressiveness, a low survival rate, and the absence of targeted therapies. This study was planned to evaluate the clinical features, treatment, and prognosis characteristics of TNBC in a population of Moroccan patients. Methods: In this retrospective study, a total of 905 patients diagnosed with breast cancer at the National Institute of Oncology in Rabat, Morocco, have been included. Based on molecular subtype, patients were divided into 2 categories: TNBC and non-TNBC patients. Data were recorded from patients’ medical files and analyzed using SPSS 13.0 software (IBM). Results: Overall, 17% of the patients had TNBC. At diagnosis, the median age of TNBC cases was 47 years, with extreme ages of 40 and 55 years. The median follow-up time was 30 months (10-53 months) and the 3-year survival rate was 76%. No significant difference was observed among the patients in terms of age at diagnosis, age at menarche, age at the time of first birth, nulliparity, oral contraception, and family history of breast cancer. Menopausal status and the number of pregnancy were significantly higher in the non-TNBC group. The percentage of grade 3 (G3) tumors was higher in the TNBC group ( P

Parkinson’s disease (PD) is the second most common neurodegenerative disorder after Alzheimer disease. Five to ten percent of patients have monogenic form of the disease, while most of sporadic PD cases are caused by the combination of genetic and environmental factors. Microtubule-associated protein tau (MAPT) has been appointed as one of the most important risk factors for several neurodegenerative diseases including PD. MAPT is characterized by an inversion in chromosome 17 resulting in two distinct haplotypes H1 and H2. Studies described a significant association of MAPT H1j subhaplotype with PD risk, while H2 haplotype was associated with Parkinsonism, particularly to its bradykinetic component. We report here an isolated case displaying an akinetic-rigid form of PD, with age of onset of 41 years and a good response to levodopa, who developed dementia gradually during the seven years of disease progression. The patient does not carry the LRRK2 G2019S mutation, copy number variations, nor pathogenic and rare variants in known genes associated with PD. MAPT subhaplotype genotyping revealed that the patient has the H1j/H2 diplotype, his mother H1j/H1j, his two healthy brothers H1j/H1v and his deceased father was by deduction H1v/H2. The H1j/H2 diplotype was shown in a total of 3 PD patients among 80, who also did not have known PD-causing mutation and in 1 out of 92 healthy individual controls. The three patients with this diplotype all have a similar clinical phenotype. Our results suggest that haplotypes H1j and H2 are strong risk factor alleles, and their combination could be responsible for early onset of PD with dementia.

Introduction: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is known as a therapy of choice of advanced Parkinson's disease. The present study aimed to assess the beneficial and side effects of STN DBS in Moroccan Parkinsonian patients.Material and Methods: Thirty five patients underwent bilateral STN DBS from 2008 to 2016 in the Rabat University Hospital. Patients were assessed preoperatively and followed up for 6 to 12 months using the Unified Parkinson's Disease Rating Scale in four conditions (stimulation OFF and ON and medication OFF and ON), the levodopa-equivalent daily dose (LEDD), dyskinesia and fluctuation scores and PDQ39 scale for quality of life (QOL). Postoperative side effects were also recorded.Results: The mean age at disease onset was 42.31 ± 7.29 years [28–58] and the mean age at surgery was 54.66 ± 8.51 years [34–70]. The median disease duration was 11.95 ± 4.28 years [5–22]. Sixty-three percentage of patients were male. 11.4% of patients were tremor dominant while 45.71 showed akinetic-rigid form and 42.90 were classified as mixed phenotype. The LEDD before surgery was 1200 mg/day [800-1500]. All patients had motor fluctuations whereas non-motor fluctuations were present in 61.80% of cases. STN DBS decreased the LEDD by 51.72%, as the mean LEDD post-surgery was 450 [188-800]. The UPDRS-III was improved by 52.27%, dyskinesia score by 66.70% and motor fluctuations by 50%, whereas QOL improved by 27.12%. Post-operative side effects were hypophonia (2 cases), infection (3 cases), and pneumocephalus (2 cases).Conclusion: Our results showed that STN DBS is an effective treatment in Moroccan Parkinsonian patients leading to a major improvement of the most disabling symptoms (dyskinesia, motor fluctuation) and a better QOL.

Background. The LRRK2 G2019S mutation is the most common genetic determinant of Parkinson’s disease (PD) identified to date. This mutation, reported in both familial and sporadic PD, occurs at elevated frequencies in Maghreb population. In the present study, we examined the prevalence of the G2019S mutation in the Moroccan population and we compared the motor and nonmotor phenotype of G2019S carriers to patients with idiopathic Parkinson’s disease. Methods. 100 PD patients were assessed for motor and nonmotor symptoms, current medication, and motor complication including motor fluctuations and dyskinesia. The LRRK2 G2019S mutation was investigated by direct sequencing in patients and ethnically matched controls, all of Moroccan origin. Results. Among the 100 PD Moroccan patients, 41 (41%) were carriers of the G2019S mutation. The mutation frequency was higher among probands with autosomal dominant inheritance (76%) than among sporadic ones (28%). Interestingly, G2019S mutation was also found in 5% of control individuals. Clinically, patients carrying the G2019S mutation have more dystonia (OR = 4.6, p = 0.042) and more sleep disorders (OR = 2.4, p = 0.045) than noncarriers. Conclusions. The LRRK2 G2019S prevalence in Morocco is the highest in the world reported to date. Some clinical features in G2019S carriers such as dystonia and sleep disturbances are worth noting.

INTRODUCTION: le cancer du sein représente un problème de santé publique au Maroc. L'objectif de ce travail était d'estimer le taux de survie au cancer du sein chez les patientes habitant la ville de Rabat. METHODES: étude pronostique réalisée chez les patientes diagnostiquées pour cancer du sein de 2005 à 2008, habitant la ville de Rabat et enregistrées au registre des cancers de Rabat. La date d'inclusion dans l'étude correspondait à la date de confirmation histologique du cancer. L'estimation de la survie a été réalisée par la méthode de Kaplan Meier, et la comparaison entre les différentes classes d'une variable a été réalisée par le test de log rank. L'étude des facteurs associés à la survie a été effectuée par le modèle de Cox. RESULTATS: durant la période d'étude 628 cas de cancer du sein ont été collectés. Le pourcentage de décès était de 19,9%. La survie globale à un an était de 97,1%, elle était de 89,2% à 3 ans et de 80,6 % à 5 ans. En analyse multivariée la survie au cancer du sein était statistiquement moins bonne chez les patientes âgées de plus de 70 ans (p=0,001), ayantune grande taille de tumeur (p=0,001), un stade avancé d'adénopathies (p=0,007), présentant des métastases (p=0,001) et non traitées par hormonothérapie (p=0,002). CONCLUSION: une grande taille de la tumeur et la présence de métastases sont des facteurs de mauvais pronostic du cancer du sein d'où la nécessité de renforcer les programmes de dépistage.

BACKGROUND:Breast cancer in young women is quite uncommon and shows more aggressive characteristics with major disparities between worldwide populations. Prognosis and outcome of breast cancer in young patients are widely studied, but still no consensus is available. METHODS:We retrospectively included 716 cases of breast cancer women diagnosed in 2009 at the National Institute of Oncology of Rabat. Patients were divided into two groups according to their age: women aged ≤40 years (Group 1) and women aged >40 years (Group 2). Data were recorded from patients' medical files and analyzed using SPSS 13.0 software (IBM). RESULTS:Young patients represent 24.9% of all patients with breast cancer. The comparison between the two groups displayed significant differences regarding nulliparity (p = 0.001) and progesterone receptor negativity (p = 0.01). Moreover, more progression (Metastases/Relapse) was registered in young women as compared to older women with breast cancer (p = 0.03). The estimated median follow-up period was 31 months. The 5-years Event-Free Survival (EFS) of patients with local disease was 64.6% in young women and 71.5% in older women with breast cancer (p = 0.04). Multivariate analysis in young women showed that nulliparity (HR: 7.2; 95%CI: 1.16-44.54; p = 0.03), T3 tumors (HR: 17.39; 95%CI: 1.74-173.34; p = 0.01) and negative PgR status (HR: 19.85; 95%CI: 1.07-366.54; p = 0.04) can be considered as risk factors for poorer event free survival while hormone therapy was associated with better EFS (HR: 0.11; 95%CI: 0.00-0.75; p = 0.03). In Group 2, multivariate analysis showed that patients with inflammatory breast cancer, N+ status, absence of radiotherapy, absence of chemotherapy, and absence of hormone therapy are at increased risk of recurrence. CONCLUSIONS:In Morocco, breast cancer is more frequent in young women as compared to western countries. Breast cancer in young women is more aggressive and is diagnosed late, leading to an intensive treatment. Moreover, the main factors associated with breast cancer development in young women would be hormonal and reproductive status. Analysis of other genetic biomarkers is needed to explain the high prevalence of breast cancer in young women to improve breast cancer management in Morocco.

This study aimed to assess students’ perceptions of their educational environment in the Faculty of Medicine and Pharmacy of Rabat, Morocco, using the Dundee Ready Educational Environment Measure (DREEM). A cross-sectional survey was conducted in the Faculty of Medicine and Pharmacy of Rabat, Morocco, in which medical students’ perceptions of their educational environment were assessed using the DREEM criteria during the 2013-2014 academic years. The DREEM inventory encompasses 50 items divided into five subdomains: perceptions of learning, perceptions of teaching, academic self-perceptions, perceptions of atmosphere, and social self-perceptions. The DREEM has a maximum score of 200, which would correspond to a perfect educational environment. The mean scores (±standard deviation) of students’ responses were compared according to their year of study and gender. The responses of 189 postgraduate medical students were included. The mean total DREEM score was 90.8 (45.4%). The mean total scores for five subdomains were 21.2/48 (44.2%), 21.8/44 (49.6%), 13.1/32 (40.9%), 19.0/48 (39.6%), and 15.6/28 (55.7%) respectively. Female students reported higher perceptions of teaching scores than males (P=0.002), and students in their fifth year of study reported significantly higher social self-perceptions scores than those in their fourth year (P=0.03). In this study of the oldest faculty of medicine in Morocco, students perceived the educational environment as having many problems.

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.

INTRODUCTION: le maintien de la stabilité hémodynamique est un objectif primordial de l'anesthésie pour craniotomie. Peu d'études ont prouvé l'efficacité de l'infiltration du scalp par un anesthésique local pour le maintien de la stabilité hémodynamique après l'incision. L'objectif de notre travail est d'évaluer l'influence de l'infiltration de la ligne d'incision du scalp par la lidocaïne à 0,5% adrénalinée sur les paramètres hémodynamiques après incision pour craniotomie supratentorielle. METHODES: étude prospective en double aveugle réalisée au bloc opératoire de l'hôpital des spécialités de Rabat sur une période d'une année incluant 80 malades programmés pour craniotomie supratentorielle. Les malades étaient randomisés par tirage au sort en 2 groupes: Le groupe 1 était infiltré par 40 ml du sérum salé adrénaliné (1/200 000) et le groupe 2 était infiltré par 40 ml de la lidocaïne 0,5% adrénalinée (1/200 000). Le critère de jugement principal était la pression artérielle moyenne (PAM) après l'incision. L'étude statistique a fait appel aux tests t de student et l'U- mann-whitney. Une valeur de p =0.05 était considérée significative. RESULTATS: l'étude a inclus 80 patients (40 hommes et 40 femmes). L'âge moyen était 42 ,33,14,76 ans. Le poids moyen était 71,58 ,10 kg. Le 3/4 des patients était ASA 1, seulement 25% étaient ASA2. La durée moyenne de la chirurgie était de 252,06.,38,62 mn. Les deux groupes étaient comparables concernant l'âge, le sexe, le poids, la durée d'intervention, le type d'abord chirurgical, la dose totale du fentanyl reçue jusqu'a l'incision, ainsi que les paramètres hémodynamiques avant l'incision. Après l'incision la FC moyenne a augmenté dans les deux groupes: 80,53,7,72 bpm dans le groupe contrôle et 76,85,8,52 bpm dans le groupe lidocaïne. La différence d'augmentation de la FC entre les deux groupes était statistiquement significative (p=0,047). L'augmentation de la PAM était également significativement plus élevée dans le groupe placebo (96,45, 3,53mmHg vs 94,75 3,76mmHg) (p=0,041). Nous n'avons pas noté de troubles de rythme ou d'hypertension artérielle par les solutions adrénalinées à 1/200000. Par contre, six cas d'hypotension artérielle ont été notés (3cas dans chaque groupe) après 2 minutes de l'infiltration et ayant répandu au remplissage par 500 ml de sérum salé 0,9 %. CONCLUSION: l'infiltration par la lidocaïne procure une stabilité hémodynamique (PAM et FC) statistiquement significative. Les autres études rapportées dans la littérature et avec un échantillon réduit ont permis de retrouver une différence significative concernant uniquement la PAM et non la fréquence cardiaque.

Le ballon de contre pulsion intra-aortique (BCPIA) est fréquemment utilisé en chirurgie cardiaque, comme moyen d'assistance circulatoire en cas de bas débit cardiaque. Il est d'intérêt clinique de déterminer les facteurs pronostiques chez les patients porteurs d'un BCPIA en chirurgie cardiaque, et qui restent un sujet rarement élucidé dans la littérature. L'objectif de notre travail est de déterminer les facteurs prédictifs de morbi-mortalité chez les patients sous ballon de contre pulsion intraortique en périopératoire d'une chirurgie cardiaque. Il s'agit d'une étude rétrospective portant sur l'ensemble des patients opérés en chirurgie cardiaque sous circulation extracorporelle, et ayant bénéficiés de la mise en place d'un ballon de contre pulsion intra-aortique en périopératoire, au service de chirurgie cardiovasculaire de l'Hôpital Militaire Mohamed V de Rabat, entre le mois de janvier 2005 et le mois d'aout 20014. Soixante dix patients ont été inclus dans notre étude. En analyse univariée l'âge, la dyspnée de stade III et IV, l'insuffisance cardiaque, la présence d'un infarctus du myocarde, d'une coronaropathie mono et bitronculaire, les anomalies du doppler de trons supra-aortique et du membre inférieur, le caractère urgent de la chirurgie, la durée de la circulation extracorporelle, l'instabilité hémodynamique postopératoire, le saignement et l'insuffisance rénale postopératoire étaient statistiquement associés à une mortalité postopératoire élevée. La dyskinésie préopératoire et la sortie de circulation extracorporelle sous drogues étaient associées à une morbidité globale élevée. En analyse multi variée, seule l'âge, constituait un facteur de risque indépendant de mortalité dans notre série avec un Odds Ratio (OR): 1,89; un Intervalle de Confiance (IC) 95% de (1,52-4,97) et un p=0,045. Au terme de notre étude, le taux de mortalité était de 48,57% et de morbidité globale était de 87,1%. Il nous parait donc nécessaire pour diminuer l'incidence de cette morbimortalité dans notre population, d'agir sur les facteurs que nous jugeons modifiables tels l'amélioration de la fonction cardiaque préopératoire, l'optimisation de la fonction rénale, la réduction de la durée de CEC et le contrôle du saignement.

INTRODUCTION: Le but de ce travail était d'étudier la mortalité et les facteurs pronostiques de la Coagulopathie Traumatique (CoT) aigue précoce. METHODES: Il s'agissait d'une étude prospective sur 21 mois, incluant tous les traumatisés crâniens graves 16 ans. Les données clinico-démographiques biologiques et radiologiques ont été collectées à l'admission. La CoT a été définie par une thrombopénie 120 000 /mm3 et/ou un Taux de Prothrombine (TP) 70 % et/ou un International Normalized Ratio (INR) 1,3 et/ou un Temps de Céphaline Activé (TCA) 40 sec. RESULTATS: Nous avons colligé 69 patients ayant une CoT avec une médiane d'âge à 29 avec un intervalle interquartile à (23-41), et une prédominance masculine dans 87% des cas (60 patients). L'ISS médian à 56 avec un intervalle interquartile à (42-75). La mortalité était de 52,2 % des cas (36 patients) suite à une souffrance cérébrale dans 74,3 % des cas (26 patients). La durée médiane de séjour de 10 jours avec un intervalle interquartile à (5-19). Les facteurs associés à la mortalité en analyse univariée étaient : le passager de véhicule, le délai de prise en charge, l'hématome sous dural aigu, l'AAIS tête et l'ISS à l'admission; alors qu'en analyse multivariée c'étaient le délai de prise en charge (OR: 1,01; IC à 95%: 1,001-1,02) et l'ISS à l'admission (OR: 1,1; IC à 95%: 1,04-1,15) sont des facteurs pronostiques indépendants. CONCLUSION: L'amélioration du pronostic de ces patients repose essentiellement sur un développement de la médecine pré-hospitalière.

Objectives. To evaluate the impact of the body mass index (BMI) before pregnancy and the weight gain during pregnancy, on the occurrence of maternal and neonatal morbidity in the Moroccan population, as well as to analyze the quality of the weight gain depending on the BMI. Methods. A study was carried out over a period of one year from October 1, 2010 to October 1, 2011, using data collected from a descriptive-transversal study. We recruited nondiabetic women without several HTAs, delivering singletons from 37 completed weeks up to 42 weeks gestation. Results. Total of 1408 were analyzed. The risks of moderate hypertension, macrosomia, dystocia, and resort to cesarean section were higher among overweight or obese women, as well as among women whose weight gain was >16 kg. The differences were significant