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This study aims to determine the Leadership of the Village Head in the Implementation of Duties and Functions of the Ulobua Village Apparatus. This research consists of three focuses, namely managerial ability, effective communication and leadership assertiveness. The research method used is descriptive qualitative. The results showed that the leadership of the village head in the implementation of the duties and functions of the Ulobua Village Apparatus was not optimal. This can be seen from the managerial ability of the Ulobua Village Head who has not been able to direct and mobilize village officials to work based on the main tasks and functions, the ability to communicate effectively which is still lacking by using a one-way communication pattern, and the firmness of the leadership in this case the Ulobua Village Head who is still less and each is easily influenced by outside parties.

Funding Acknowledgements Type of funding sources: None. Out-of-hospital cardiac arrest (OHCA) is a major public health problem and ventricular fibrillation (VF) is the most common initial rhythm when cardiac disease is the cause of arrest. It can be favorably treated with defibrillation but rapidly tends to deteriorate to non-shockable rhythms over time, so that reported survival rates vary from 3% to 10%. Early defibrillation strategy has led to a considerable survival improvement; however, automated external defibrillators are still used in Here, we analyze data from a single-center emergency-medical-service (EMS) registry, involving all consecutive OHCA occurring from January 2013 to June 2022 in whom resuscitation or defibrillation has been attempted. The "Progetto Vita" initiative has been developed in our province since 1999 with the aim of improving deployment of automated external defibrillators into the public space so that the first line involved in the chain of survival (laic bystander or policemen/health care staff) and the use of automatic external defibrillators (AED) by policemen/citizens before the arrival of the EMS personnel are crucial indicators involved in the registry. Patients presenting with OHCA due to VF were considered eligible for this analysis. During the 10-year period of examination, 3,124 patients received medical care for OHCA; 323 of them presented VF and were considered for subsequent analysis. VF occurred prevalently at home (73%), in men (75%); mean age was 70. Bystander or laic citizen CPR was performed in 35 cases (11%) with a survival rate of 63%. AED used by either laic bystander or police was used in 30 cases (9%) with a success rate of 77%. Cardiac comorbidities were noted in 67 patients (21%), predominantly males, and CAD was the most common disease. Main historical, clinical, ECG, instrumental features and therapeutic management and differences in sex groups are listed in Table 1. As expected, incidence increased with age; male predominance was observed in all age subgroups although we observed a different distribution between sexes in age subgroups (Table 1). There were 237 deaths (mortality rate 73%), 41 (17%) of them occurring after arrival at Emergency Service.Among successfully admitted patients, VF was mostly related to coronary artery disease (70%) and STEMI was the most frequent manifestation of acute ischemic heart disease, both in males and females. Overall, 87 (27%) patients survived and were successfully admitted to intensive care unit (57%) or coronary care unit (43%). Multivariate logistic regression analysis showed that laic-performed CPR (OR 2.52, 95% CI 1.04, 6.1, p=0.04) and use of AED (OR 7.15; 95% CI 2.66, 19.19, p VF in the general population is still poorly predictable and mortality remains high: implementation of community involvement in early-defibrillation through publicly available AEDs appears effective in improving survival.

BackgroundGlobally nearly 20% of cardiovascular disease deaths were attributable to air pollution. Out-of-hospital cardiac arrest (OHCA) represents a major public health problem, therefore, the identification of novel OHCA triggers is of crucial relevance. The aim of the study was to evaluate the association between air pollution (short-, mid-and long-term exposure) and out-of-hospital cardiac arrest (OHCA) risk, during a 7 years-period from a highly polluted urban area with a high density of automated external defibrillators (AEDs).Methods and resultsOHCA were prospectively collected from the “Progetto Vita Database” between 01/01/2010 to 31/12/2017; day-by-day air pollution levels were extracted from the Environmental Protection Agency (ARPA) stations. Electrocardiograms of OHCA interventions were collected from the AEDs data cards. Day-by-day particulate matter (PM) 2.5 and 10, ozone (O3), carbon monoxide (CO) and nitrogen dioxide (NO2) levels were measured. A total of 880 OHCAs occurred in 748 days. A significantly increased in OHCA risk with the progressive increase in PM 2.5, PM 10, CO and NO2 levels was found. After adjustment for temperature and seasons, a 9% and 12% increase of OHCA risk for each 10 μg/m3 increase of PM 10 (p< 0.0001) and PM 2.5 (p< 0.0001) levels was found. Air pollutants levels were associated with both asystole and shockable rhythm risk while no correlation was found with pulseless electrical activity.ConclusionsShort-term and mid-term exposure to PM 2.5 and PM 10 is independently associated with the risk of OHCA due to asystole or shockable rhythm.

Background Behçet's disease is a multisystem vasculitis whose pathogenesis remains unclear. Although usually described in young adults, it may begin in childhood. The diagnosis is clinical, based on international criteria. The limitations of early diagnosis are related to the progressive onset of symptoms and the variety of differential diagnoses at this age in the absence of a pathognomonic diagnostic test. Objectives To report the epidemiological features of our series and to compare the 2015 pediatric criteria with the 2014 and 1990 international criteria. Materials and Methods This is a monocentric, retrospective study of 31 children over an 11-year period from January 2011 to December 2021. All patients suspected with Behcet's disease by a pediatric rheumatologist were included in the study, the 2014 international criteria “ISG 2014” being the gold standard classification criteria used in our center. Results 31 cases of Behcet's were collected. The mean age was 10 years (5.5–16) ± 2.87 years. A female predominance is noted with a sex ratio F/M of 1.21. A quarter of the patients were from a consanguineous marriage and 38.7% had a family history of Behcet disease. Mucocutaneous manifestations were represented by recurrent oral aphthosis 87.1%, genital aphthosis 29%, pseudofolliculitis 48.4%, erythema nodosum 6.5% and acne lesions 3.2%. The pathergy test was positive in 1 case. Ocular involvement was reported in 29% and joint involvement in 45.2%. Thromboembolic complication was seen in 9.6% and neurobehcet in one patient. The HLA B51 antigen was present in 45.2% of cases. In our series 38.7% respond the pediatric criteria, while 61.3% met the 2014 international criteria and 35.5% met the 1990 international criteria. The 2015 pediatric criteria have respectively a sensitivity and specificity of 63.2% and 100% (p = 0.002) compared with the 2014 international criteria taken as gold standard, as well as the 1990 international criteria with a respective sensitivity and specificity of 52.6% and 91.7% (p = 0.034). Conclusion Our study highlights a female predominance, a high rate of consanguinity and familial Behcet. The sensitivity and specificity of the 1990 pediatric and international criteria appear to be better than those of 2014, with a more significant trend for the 2015 pediatric criteria (p = 0.002).

Background Kawasaki disease (kDa) is a multisystemic vasculitis affecting medium and small vessels with a predilection for the coronary arteries. It appears to be very similar to the pediatric multisystemic inflammatory syndrome (PIMS), which is a post-infectious inflammatory condition occurring after SARS-COV2 infection. Although these two entities have clinical and biological similarities, marked differences are identified. The aim of this study is to compare the two conditions in order to highlight the specific criteria of each of these related entities and to describe their demographic, clinical, biological and therapeutic characteristics in our context. Method Single center prospective observational study from January 2021 to March 2022 was conducted, comparing children admitted for PIMS on the basis of persistent fever, inflammatory syndrome, and positive COVID-19 IgG serology to patients hospitalized for kDa according to American Heart Association criteria. Results 42 cases were recruited, among them 24 PIMS and 18 kDa, with a male predominance. The average age was 5 years for PIMS and 2 years and 7 months for kDa. All had a persistant fever with an average duration of 8 days as reason for consultation. Conjunctivitis was found in 88% of kDa vs 75% of PIMS and cheilitis in 94% of kDa vs 75% of PIMS. Skin rash, extremity involvement, cervical adenopathy were reported in both pathologies with respective percentages of 62.5%, 17.4% and 25% for PIMS vs 61.1%, 33.3% and 33.3% for kDa. Abdominal pain was reported in 54.2% of PIMS patients vs 5.6% of kDa. All patients had an inflammatory syndrome. The mean sedimentation rate was 67 mm at the first h in PIMS and 99 mm at the first h in kDa. The mean CRP was 147 mg/l in PIMS vs 132 mg/l in kDa. Lymphopenia was predominant in PIMS with 33% vs 11% in kDa. Cardiac enzymes were higher in PIMS with 29% of myocarditis and 15% of coronary dilatation vs 16.7% of coronary involvement in kDa. All PIMS patients received immunoglobulin infusion IV-IG, corticosteroid therapy, and an antiplatelet agent, whereas patients with kDa received IV-IG and acetyl salicylic acid in anti-inflammatory doses. Apyrexia was obtained at day 1 of treatment in the majority of patients, whereas 5.6% of kDa had persistent aneurysm. Conclusion PIMS cases predominated over kDa cases during this pandemic period. The distinction between the two entities could be difficult given the clinico-biological similarities. Abdominal pain was significantly more frequent in PIMS patients, whereas lymphopenia and myocarditis were not. The prognosis was better in PIMS.

Introduction Early Defibrillation is the most effective method for resuscitation in patients with out of hospital cardiac arrest(OHCA). The presence of shockable rhythm is an important determinant of survival, therefore, the implementation of systems that increase the likelihood of immediate CPR and rapid defibrillation are vital to improving survival. To this end, in 2017 the DAE REsponder APP (ADR) was developed to alert the trained citizens nearest to the scene and direct them to the closest DAE. Aim To evaluate the performance of this application in terms of number of interventions and number of patients saved. Methods: Since 2014, the Emilia Romagna region created a regional portal dedicated to the OHCA the AED REspondER emergency, in which each province registered the automated external defibrillators (AEDs), indicating their geolocation and accessibility. From this system was developed the ADR, which can be used by every citizen through their smartphone. ADR has several functions: alerting the DR citizens closest to the victim, possibility to choose whether to intervene or not, in case of acceptance, navigation to the place and to the AED closer. Results In Piacenza 1046 AEDs have been placed and 1212 people are registered as DR.From 2018, 525 blue codes have been activated (out of a regional total of 4457) and 80560 notifications have been sent to DRs: in 145 cases (27.62%)the intervention was accepted, in 19 cases DR arrived before 118 and in 12 cases the AED was applied (63.16%) with 7(55%) patients survived. Conclusion The ADR could be considered an effective method to deliver an immediate CPR and increase the chance of survival in case of OHCA.

Out–of–hospital cardiac arrest (OHCA) is a major public health problem, and ventricular fibrillation (VF) is the most frequently encountered initial rhythm when cardiac disease is the cause of the arrest. It can be treated with successful defibrillation, if prompt intervention, otherwise it rapidly progresses to non–shockable rhythms, with survival rates ranging from 3 to 10%. The early defibrillation strategy led to a significant improvement in outcome; although Automated External Defibrillators (AEDs) are still used in

Background: In Morocco the breast feeding (exclusive) prevalence has decreased from 51% in 1992 to 35% in 2018. This prevalence was lower in neonatal intensive care unit (NICU) with 12.4% in 2014. The aim of this study was to estimate the prevalence and identify the associated factors of breastfeeding (BF) practice in NICU of Casablanca Ibn Rochd teaching hospital.Method:A cross sectional study was performed between 04 January and 26 June 2021 in NICU. We included Moroccan couples mother/newborn who can practice the BF presents during the study period. We used face to face interview using pretested questionnaire. Logistic regression was used to test association between breastfeeding (BF) practice and potential associated factors. Factors with p ≤ 0.05 were considered as associated factors of BF practice. Data were analyzed using R 3.6.3 Findings: We included 170 couple mother/newborn. Around 74% of mothers practiced partial breastfeeding. The mother factors associated with BF practice were: education level (OR=0,10; 95%CI : 0,01-0,87 ;p=0,037781), family monthly income (OR=4,3 ; 95%CI: 1,12-16 ,56 ; p=0,033606) and marital status (OR=14,3 ; 95%CI:1,37-148,43 ; p=0,025853). The newborns’ factors associated to BF practice were: hospital stay length (OR= 1,12 95%CI: 1,00-1,25 ; p=0,047726) and hospitalization motif (OR=0,27 ; 95%CI: 0,076-0,95 ; p=0,042085). And healthcare facility factors associated to BF practice was: healthcare staff support: (OR=6,7 ; 95%CI:2,2-20,54 ; p=0,000891) .Conclusion: The newborn hospitalized for respiratory distress from single mothers with lower education level and social standard who, don’t have enough (or any) support from healthcare staff are the ones who receive less breast milk in NICU of Casablanca Ibn Rochd teaching hospital.

Contains fulltext : 249977.pdf (Publisher’s version ) (Closed access) BACKGROUND: It is important to evaluate whether a new treatment for heart failure with reduced ejection fraction (HFrEF) provides additive benefit to background foundational treatments. As such, we aimed to evaluate the efficacy and safety of empagliflozin in patients with HFrEF in addition to baseline treatment with specific doses and combinations of disease-modifying therapies. METHODS: We performed a post-hoc analysis of the EMPEROR-Reduced randomised, double-blind, parallel-group trial, which took place in 520 centres (hospitals and medical clinics) in 20 countries in Asia, Australia, Europe, North America, and South America. Patients with New York Heart Association (NYHA) classification II-IV with an ejection fraction of 40% or less were randomly assigned (1:1) to receive the addition of either oral empagliflozin 10 mg per day or placebo to background therapy. The primary composite outcome was cardiovascular death and heart failure hospitalisation; the secondary outcome was total heart failure hospital admissions. An extended composite outcome consisted of inpatient and outpatient HFrEF events was also evaluated. Outcomes were analysed according to background use of angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs) or angiotensin receptor neprilysin inhibitors (ARNIs), as well as β blockers and mineralocorticoid receptor antagonists (MRAs) at less than 50% or 50% or more of target doses and in various combinations. This study is registered with ClinicalTrials.gov, NCT03057977. FINDINGS: In this post-hoc analysis of 3730 patients (mean age 66·8 years [SD 11·0], 893 [23·9%] women; 1863 [49·9%] in the empagliflozin group, 1867 [50·1%] in the placebo group) assessed between March 6, 2017, and May 28, 2020, empagliflozin reduced the risk of the primary outcome (361 in 1863 participants in the empagliflozin group and 462 of 1867 in the placebo group; HR 0·75 [95% CI 0·65-0·86]) regardless of background therapy or its target doses for ACE inhibitors or ARBs at doses of less than 50% of the target dose (HR 0·85 [0·69-1·06]) and for doses of 50% or more of the target dose (HR 0·67 [0·52-0·88]; p(interaction)=0·18). A similar result was seen for β blockers at doses of less than 50% of the target dose (HR 0·66 [0·54-0·80]) and for doses of 50% or more of the target dose (HR 0·81 [0·66-1·00]; p(interaction)=0·15). Empagliflozin also reduced the risk of the primary outcome irrespective of background use of triple therapy with an ACE inhibitor, ARB, or ARNI plus β blocker plus MRA (given combination HR 0·73 [0·61-0·88]; not given combination HR 0·76 [0·62-0·94]; p(interaction)=0·77). Similar patterns of benefit were observed for the secondary and extended composite outcomes. Empagliflozin was well tolerated and rates of hypotension, symptomatic hypotension, and hyperkalaemia were similar across all subgroups. INTERPRETATION: Empagliflozin reduced serious heart failure outcomes across doses and combinations of disease-modifying therapies for HFrEF. Clinically, these data suggest that empagliflozin might be considered as a foundational therapy in patients with HFrEF regardless of their existing background therapy. FUNDING: Boehringer Ingelheim and Eli Lilly and Company.

Background HIV infection continues to be a major global public health issue. UNAIDS estimates that 690 000 HIV-related deaths occurred in 2019. In Morocco The number of people living with HIV was estimated at 21,000 in 2018. HIV prevalence in Morocco remains low (around 0.1%) in the general population. It is much higher among female sex workers, men who have sex with men (MSM), people who inject drugs and migrants. In Casablanca the epidemic is concentrated among MSM. The aim of this study was to describe the epidemiologic, clinical and immuno-virological characteristics of people newly diagnosed with HIV infection managed in the Ibn Rochd teaching Hospital of Casablanca. Methods A cross-sectional study was performed including patients newly diagnosed with HIV infection and managed in the infectious diseases department from January 1st, 2017 to June 30, 2018. Data were collected from patient's medical records and were analyzed using SPSS 16. Main outcomes were presented as mean and pourcentages. Results 525 patients newly diagnosed with HIV infection were managed during the 18 months period in the Infectious Diseases Department. The mean age was 36.1 years, with a sex ratio of 1.1. Among them, 43% were single and 61.7% were unemployed. Heterosexual transmission mode represented 65.5% and MSM represented 23%. The seropositivity was discovered through an evocative symptom in 47.8% of all cases. The main clinical symptoms were: weight loss (16.6%) and oral candidiasis (11.2%). The main opportunistic infection was tuberculosis (23%). 36.1% of cases were diagnosed at acquired immunodeficiency syndrome (AIDS) stage. Medians of the first CD4 count and viral load performed were respectively 248/mm3 and 88 174 copies/ml. Conclusions Despite a good antiretroviral coverage, HIV infection is still diagnosed late in our country. The emphasis must be on the promotion of voluntary testing mainly among groups at high risk of infection. Key messages More active offer of HIV testing, by general practitioners, should play a crucial role in the early identification of HIV infections. Strategies such as use of preexposure prophylaxis should be developed to prevent HIV transmission among MSM.

Background Rational drug prescribing is essential to ensure good disease management and avoid the emergence of drug resistance. However, the decision to prescribe a drug is not only based on the medical knowledge of physicians, but other factors may also influence this decision. We conducted this study to determine the factors that may influence drug prescribing in general practice in Casablanca. Methods A cross-sectional study was conducted in Casablanca (Moulay Rachid and Sidi Bernoussi prefectures) from January to April 2019 among general practitioners in the public and private sectors. The survey was based on the response to a self-administered questionnaire designed and pre-tested by epidemiology laboratory of the Faculty of Medicine and Pharmacy of Casablanca. In addition to a descriptive analysis of the results, a logistic regression analysis was performed to evaluate the factors that could be associated with drug prescription. Results Among 191 general practitioners practicing in the prefectures of Moulay Rachid and Sidi Bernoussi 140 agreed to participate in our study, among which 101 (72.1%) prescribed on average more than two drugs per consultation. In addition to patient-related characteristic: enrolment in medical coverage (OR = 0.1 [0.1; 0.9] if 25-50% of patients had medical coverage), long-term illnesses (OR = 1.73 [1.57; 1.90]); the independent factors associated with this doctor-related prescription were age (OR = 0.23 [0.1; 0.7] over 55 vs. under 40 years), sector of activity (OR = 22.8 [7.4; 70.0] private sector vs public sector), professional seniority (OR = 0.1 [0.01; 0.8] if seniority more than 5 years), and consultation duration (OR = 1.1 [1.09; 1.2]). Conclusions In addition to seniority, duration of consultations, and sector of activity, patient characteristics influence GPs' drug prescription. Key messages The decision to prescribe a drug is influenced by the length of time the GP has been in practice, the duration of consultations and the sector in which he/she works. Patient characteristics influence GPs' drug prescribing.

Introduction Schizophrenia is a psychiatric condition in which patient adherence is a key issue in its management. Objectives To estimate the prevalence and determine the factors associated with medication adherence in patients with schizophrenia. Methods This was a cross-sectional study conducted at the psychiatry department of the CHU IBN Rochd of Casablanca among schizophrenic patients followed from May 2019 to January 2020. The sample size was calculated apriori and the measurement of therapeutic compliance and Insight (patients' perception of the disorders related to their pathology) was made thanks to the Medication Adherence Rating Scale (MARS) and the Birchwood insight scale (BIS) respectively. Socio-demographic data and data on the management of schizophrenia were also collected. Statistical analyses were performed with RStudio software and the multivariate analysis method of logistic regression was used. The threshold of significance was set at 5%. Results A total of 370 were collected, the median age was 31 years and the most represented class was the over 28 years (26.25%). The female gender represented 28% and the majority was single (72%). Substance abuse was 68.8%, 46% were on dual therapy and 43.2% of patients were on regular follow-up. The prevalence of therapeutic compliance was 25.6% and 30.3% were aware of their pathology. The determinants of medication adherence in the schizophrenic patients included in the final model were: regularity of follow-up (p < 0.001), insight (p < 0.001), number of medications (p = 0.011), history of substance use (p = 0.008), place of residence (p = 0.082). Conclusions Therapeutic compliance was low, the knowledge of the factors associated with therapeutic compliance in schizophrenia allows us to put forward hypotheses in order to improve the management of patients. Key messages Patient adherence to treatment is important in the management of Schizophrenia. Therapeutic compliance is poor.

Introduction Diabetes is a chronic disease with a significant socioeconomic impact, especially in developing countries. In Morocco, the prevalence of diabetes is estimated at 12.4% and there are nearly 12,000 deaths/year related to this disease and its complications. Objectives To describe the epidemiological, therapeutic and follow-up profile of diabetic patients. Patients and Methods This was a cross-sectional epidemiological study conducted from 20 to 22 March 2018, in the Mers Sultan-Fida district of the city of Casablanca, in the context of mass consultation of diabetic patients. The collected data were obtained through data collection and the obtained results were analyzed by SPSS v.16 software. Results A total of 228 patients were included in this study, the median age was 62 years [13-88], the median age of diabetes was 10 years [0.25-36]. The most frequent circumstance of discovery was the appearance of functional signs (31.6%). Regarding family history, 43.9% had a history of diabetes and 49.1% a history of hypertension. The median blood pressure was 150/80 mmhg, the median body mass index was 33.54 [21.16-42.72]; the mean HbA1c level was 8 +/- 1.81 g/l [5-15]. In the follow-up of these patients, 14.5% admitted to regular check-ups. Regarding treatment, 52.6% were on oral antidiabetic drugs and 22.8% on insulin therapy, 37.3% declared to take their treatment regularly. Conclusions It seems important to continue to raise awareness among diabetic patients in these three districts about the importance of diabetes control and regular monitoring of this condition in order to prevent or delay the occurrence of possible complications. Key messages Diabetes is a major public health issue in Morocco. Patient education on the importance of diabetes management is systematic.

Background One out of three Moroccan doctors is out of the country, and the ratio doctor per population is 7.3 per 10000 people (recommended 15.3 doctors per 10000 people). The objectives of this study are to estimate the prevalence of migration intention of final year medical student and to describe the profile of student who wants to migrate. Methods A cross-sectional study was carried out between 01 January and 31 January 2021. We included Moroccan final year medical students who did their entire medical school curriculum in FMPC. Electronic Self administered questionnaire was used though Google form. The data were described through mean, standard deviation, median, quartiles, frequency and percentage. The khi2 test was used to test the association between migration intention and social-economic variables. The data was processed using R 3.6.3. Findings We included 251 final year students. The 70.1% of final year students had intention to leave the country, of which 63.6% were female. The students were attracted by foreign countries because better training (97.6%), better working conditions (99%) and quality of life (97.2%). The students intended to leave the country because they were not satisfied about formation (95.2%) and salary (97%) also the denigrating of doctor in media (83.6%). Germany was the favorite destination (34%). We did not find any significant association between the migration intention and socioeconomic profile of students. Conclusions The health policymakers should improve working conditions, training quality and salary of health workers to reduce medical student migration. Key messages The migration intention of final medical students is one of the keys indicators about the future of country healthcare system. Reducing the medical students migration is crucial to build and maintain a strong healthcare system.

Background Improving the quality of life of patients is a key concern in public health. In the context of improving therapeutic compliance, quality of life of patients undergoing anti-tuberculosis treatment, and prevention of antibiotic resistance, we conducted this systematic review to support risk minimization actions. Methods A literature review of risk management strategies targeting adverse drug reactions to anti-tuberculosis drugs was conducted, including published observational studies. Two independent reviewers identified studies through Medline, Scopus, and Web of Science. The methodological quality of the included studies was assessed using criteria defined by the Newcastle Ottawa Scale. Results Seven studies were included in this review, which identified four risk management strategies (psychological intervention, reduction of drug dose with or without prescription of adjunctive medications, change of medication, permanent or temporary discontinuation of medication). The strategies adopted were dependent on the nature and severity of the adverse events. All drugs responsible for serious adverse events were changed or discontinued. Three studies had a moderate risk of methodological bias. Conclusions Strategies to minimize the risk of adverse drug reactions and improve adherence to therapy have a strong potential to improve adherence to therapy, improve patient quality of life, and reduce antibiotic resistance. However, high-level evidence on the effectiveness of strategies to minimize the risk of adverse events is limited. Key messages Strategies to manage the risk of adverse drug reactions have a strong potential benefit for TB patients on treatment; and improve adherence to treatment. High-level evidence on the effectiveness of strategies to minimize the risk of adverse events is limited.

Background Globally infectious diseases remain the leading causes of child hood mortality and morbidity accounting for 65% of all deaths in under-five children which can be prevented if proper sanitation and hygiene measure undertaken. The aim of this study is to determine the factors associated to hand hygiene of newborn mothers in NICU of Ibn Rochd teaching hospital in Casablanca (Morocco). Methods A cross-sectional study was performed from 04 January to 15 April 2021. We included Moroccan couple newborn/mother presents in NICU during the study period. We used face to face interview using close ended questionnaire. The number of time per day the mothers used soap or alcohol for hand hygiene(6 times per day) was used to measure the variable “hand hygiene practice” The Khi2 and Kruskal-wallis tests were used to test association between hand hygiene and potential associated factors. Associated factors with p ≤ 0.05 were considered as significantly associated factors of hand washing practice. Data were analyzed using R 3.6.3. Findings We included 89 couple mother/newborn. Forty five percent practice adequate hand hygiene (washing with soap or hand rub sanitizer) between 3 and 6 times per day. Factors significantly associated with hand hygiene were: mothers' residence (rural 33.7%; urban 66.3%; p = 0,026); prenatal visit number (visits number mean: < 3 times =3.67; 3-6 times = 3.30; > 6times = 5.08; p = 0,011). Conclusions The mothers from urban residence accessing more prenatal visits practice hand hygiene more frequently than single mothers from rural residence with limited access of prenatal visits. So this study suggests the training programs to enhance mothers hand hygiene practice should prioritize the mothers from rural residence who attended less prenatal visits. Key messages We can protect the fragile hospitalized newborn from infections by cheapest gestures like hand hygiene. Hand hygiene must be continually promoted targeting all actors involved about newborn care specifically newborn mothers.

Background Congenital digestive malformations are a leading cause of infant mortality and morbidity. There are currently no reliable estimates of the number of children born with these malformations and the diversity of the underlying causes requires a range of preventive approaches. Thus, to estimate the prevalence and mortality of these pathologies and to determine the interest of prenatal diagnosis in Casablanca, we initiated this study. Methods This was a cross-sectional study conducted at the Ibn Rochd University Hospital in Casablanca from January 1, 2016, to December 31, 2019, among newborns with congenital digestive malformations diagnosed by a specialist in visceral and digestive surgery. Data related to pregnancy, delivery, and time of diagnosis were collected through the medical record and complemented by clinical and surgical data from the hospitalization registry. In addition to the descriptive analysis of the results, the statistical analysis included Log Rank tests and the Cox method. Results Among 33853 live births 140 cases (56 Esophageal Atresia, 12 Diaphragmatic Hernia, 29 Laporoschisis, 20 Neonatal Occlusion, and 23 Omphalocele) of neonatal digestive malformation (4,13/1000 live births) had been diagnosed, 19.3% (27/140) of which were diagnosed during the antenatal period with an estimated mortality of 2.86/1000 (96/33853) live births and a mean survival time of 9.14±0.92 days. There was no statistically significant association between the time of diagnosis (prenatal vs postnatal) of the disease and the risk of mortality (Log Rank test p = 0.781), and the differences in the association between prenatal diagnosis and infant mortality in the five neonatal digestive malformations were not statistically significant. Conclusions These results imply that survival may no longer be the most relevant outcome, or the best criterion, for assessing the impact of prenatal diagnosis on the outcome of neonatal digestive malformations. Key messages The prevalence and mortality of children with neonatal GI defects is high. Survival may be the most relevant outcome to assess the impact of prenatal diagnosis on the outcome of neonatal GI defects.

Introduction Violence against women is a major public health problem because, whatever its form, it has an impact on the physical and psychological health of victims. Objectives To describe the socio-demographic characteristics of the victims and their partners as well as the different forms of violence observed and their impact on the victims. Participants and Methods This was a descriptive cross-sectional study conducted from January to March 2019 in two associations providing assistance to women victims of domestic violence. Results Our study collected 102 women whose average age was 33 +/- 10.8 years (18-67 years), 77% resided in urban areas, 54% had left the marital home. Regarding marriage, 86% were married and 37% had been married for more than 10 years. The average number of dependent children was 1.75 +/-1.3. Regarding employment status, 65% were housewives and 61% had no income; a quarter of the victims had a history of domestic violence. Regarding their spouses, the average age was 40 years old, 9% were unemployed; 41% had consumed alcohol at the time of the violence and one third of them had taken drugs. Physical and psychological violence were present in almost all cases, respectively 99% and 97%, economic violence in 73% of cases and sexual violence in 69% of cases. These incidents occurred mainly in the context of conflict with in-laws (66.7%). Conclusions Despite the measures undertaken by the authorities, domestic violence is a scourge that is not limited to any particular profile and has complex triggering mechanisms. Key messages Domestic violence is still a scourge today. The identification of strategic axes of prevention is essential.

Background Breastfeeding (BF) is one of the most effective ways to ensure child health and survival. In Morocco the BF rate decreased from 51% to 27,8% between 1992 and 2011. The breast feeding rate in neonatal intensive care unit (NICU) is lower 12,4%. Studies showed if we improve the mothers knowledge, the BF practice rate increase in NICU. We aim to determine associated factors of mothers knowledge about BF in NICU of Ibn Rochd teaching hospital in Casablanca (Morocco). Methods A cross-sectional study was conducted between 04 January and 23 April 2021 in NICU ward of teaching hospital Ibn Roch of Casablanca (Morocco). We included Moroccan mothers who can practice the BF presents during the study period. We used face to face interview using questionnaire. A scoring system from 0 to 16 points was used to measure the knowledge. The student, ANOVA, Mann-Whitney-Wilcoxon, Kruskal Wallis, Pearson and spearman correlation tests were used to test association between BF and potential associated factors. Associated factors with p ≤ 0.05 were considered as determinants of BF. Data were analyzed using R 3.6.3. Results We included 111 mothers. The mean score of knowledge was 10.38 ± 2.31. Associated factors with BF knowledge were: healthcare staffs support (yes mean score =11.06 and no = 9.72; p = 0.002); getting prior information about BF (yes mean score =10.53 and no = 9; p = 0.012). The knowledge increase with age of mother (correlation coefficient = 0.26; p = 0.005) and parity (correlation coefficient = 0.30; P = 0.001). Conclusions Mothers and specifically younger primiparous should receive more attention from training program and healthcare staffs in NICU to improve the knowledge and practice of BF. Key messages we can enhance significantly the survival and health of newborn hospitalized in NICU by simple actions as advices, encouragement toward the newborn mothers to improve their knowledge about BF. Healthcare staffs and facilities have to be the teachers and school about breast feeding.

Background Improving breast milk feeding (BF) can avoid globally per year 800000 deaths in children under 5 years old. In Morocco the breast milk feeding rate decreased from 51% to 27,8% between 1992 and 2011, the breast feeding rate in neonatal intensive care unit (NICU) is lower (12,4%). The objective of this study is to determine the associated factors of BF practice in NICU. Methods A cross-sectional study was conducted between 04 January and 20 April 2021 in NICU ward of teaching hospital Ibn Roch of Casablanca (Morocco). We included Moroccan couples mother/newborn who can practice the BF presents during the study period. We used face to face interview using questionnaire. Student, Mann-Whitney-Wilcoxon and Khi2 tests were used to test association between BMF and potential associated factors. The potential associated factors with p ≤ 0.05 were considered as associated factors of BF practice. Data were analyzed using R 3.6.3. Results We included 107 couple mother/newborn. Around 77% of mothers practice BF. The mother factors associated with BF practice were: residence (30.5% rural; 69.5% urban; p = 0.007); marital status (2.4% single; 0% divorced; 97.6% married; p = 0.02); getting prior information about BF (6.2% no; 93.8%yes; p = 0.02), mother knowledge score about BF (median score yes = 10, no = 9;p= 0.03). The newborn associated factors were: hospitalization reasons (50.7% respiratory distress; 17.3% infections; 13.3% jaundice; 18.7% others; p = 0.03) and the gender (58.2% male; 41.8% female; p = 0,02) Conclusions The practice rate is lower for rural single mother who don't get any prior information about BF (lower knowledge). These mothers must get more attention from the healthcare staffs and training programs to improve the breast feeding in NICU. Key messages We can do better about the management of newborn hospitalized in NICU with actions like BF practice (promotion of breastfeeding). The benefits of breast feeding practice are significantly greater than his risks about the management of newborn hopitalized in NICU.

Background To evaluate the prevalence of anxiety and depressive disorders in facial trauma patients admitted to the Ibn ROCHD University Hospital of Casablanca, we initiated this study. Indeed, facial trauma is damage that can have serious repercussions on the mental health of patients. However, there is little data in Morocco. Methods This was a cross-sectional study conducted at the Ibn Rochd University Hospital in Casablanca from January to April 2019 among facial trauma patients without a history of anxiety and depressive disorders, admitted to the Maxillofacial Surgery Department within 72 hours of the trauma. The patients' socio-demographic and clinical data were collected through a questionnaire, and then the Hospital Anxiety and Depression Scale (HADS) was applied to assess depression and anxiety. In addition to a descriptive analysis of the results, a multinomial regression analysis was performed to assess factors that might be associated with depression and anxiety. Results Among 50 facial trauma patients admitted to the Ibn Rochd University Hospital in Casablanca and included in our study, 11 had symptoms of anxiety (22%) and 12 had symptoms of depression (24%) according to the HADS classification. The mean HADS anxiety and depression subscale scores of the patients were 7.32±4.17 and 6.32±5.10, respectively. Although gender (OR = 2.28 [0.35; 5.70] females), marital status (OR = 3.30 [0.70; 12.70] singles), occupation (OR = 2.66 [0.58; 12.18] not employed), and circumstances of occurrence (OR = 3.66 [0.35; 15.70] public roads) increased the risk of anxiety in patients without anxiety (HADS score≤7); none of these factors was statistically associated with either anxiety or depression. Conclusions This cross-sectional study showed that the prevalence of anxiety and depression in victims of facial trauma is very high in Casablanca. Key messages The prevalence of anxiety and depression among facial trauma victims is very high. Gender, marital status, occupation, and circumstances of occurrence non-significantly increase the risk of anxiety and depression.

Background The incidence of infant apparent life-threatening event (ALTE) was reported as 0.6-2.4 per 1000 live birth. The difficulty of the diagnosis lies in the delicate interpretation of the results of the clinical examination and the complementary examinations. The objectives of this study were to describe epidemiological, clinical and paraclinical characteristics of infants hospitalized for ALTE and to determine the most common diagnosis. Methods We conducted a case serie from January 2013 to April 2018 in the pediatric ward 2 at Abderrahim Harrouchi Children's Hospital, Casablanca of all infants aged less than 2 years hospitalized for malaise (newborn excluded). We obtained our data using a standardized form of service. We described our data by mean, frequency and percentages using SPSS 16. Results The mean age of onset of symptomatology is 4.8 months. Recurrence of discomfort was present in 30% of cases. The socio-economic conditions were unfavorable in more than half of the cases (63.3%). Clinical examination was abnormal in 6.6% of cases. Complementary examinations performed systematically in all patients were Blood cell count, blood ionogram, CRP, blood glucose and chest x-ray. Other examinations were performed according to the history and the clinic data. The most common diagnosis was gastroesophageal reflux (36.7%), cardiac problems (16.7%), lower respiratory tract infection (13.3%), and ‘'unknown'' (26.6%). Conclusions Few complementary examinations are systematically needed and their performance is increased if they are oriented by a careful history and physical examination which then allows to advance in the diagnostic procedure. Key messages Complementary examinations are largely inconclusive and only a history and complete clinical examination can make it possible to advance in the diagnostic procedure. Infants who demonstrate historical or physical examination elements suggestive of a specific etiology of their event, such as gastroesophageal reflux, should be evaluated and treated accordingly.

Introduction The electronic cigarette is an electronic device containing or not nicotine that produces vapours that are inhaled by users, thus mimicking the use of conventional cigarettes. These devices nevertheless contain components that are harmful to health. They have become particularly popular in recent years, especially among young people. Objective To estimate the frequency of e-cigarette use among medical students and to describe perceptions and practices of e-cigarette use. Methods This was a descriptive cross-sectional study conducted from August 2020 to March 2021 among medical students at the Faculty of Medicine and Pharmacy in Casablanca. The data were collected through a selfadministered, pre-tested, online questionnaire. The sample size was calculated a priori and statistical analyses were carried out using RStudio software. Results A total of 491 students were collected with a mean age of 21.03+/- 2.35 years, 66% were female, 51.9% were undergraduates and 20.6% were first year students. The frequency of e-cigarette use was 20.2%, and smoking was 20.8%. Of the 99 e-cigarette users, 75.75% had used e-cigarettes in the past 12 months. More than 21.9% of e-cigarette users used it daily, the most frequent reasons for use were curiosity (88.6%) and imitation (58.4%). Regarding perceptions, 22.1% felt more or less informed about the risks of e-cigarettes, 54.8% agreed that e-cigarettes are an effective way to quit smoking and 29.5% thought they would be more effective than nicotine replacement therapies. Conclusions The frequency of e-cigarette use is high among future doctors despite their knowledge of the health effects of its use. Preventive measures should be implemented to improve the health of students. Key messages Medical student are a subgroup particulary vulnarable to e-cigarette use. The perceptions of medical students, future health care providers, are heterogeneous.

Introduction Eating disorders (EDs) are multifactorial in origin. Medical students are a special population because they are particularly young and exposed to stress, workload and the experience of illness in the field. Objective To determine the prevalence of EDs and associated factors among medical students Methods This was a cross-sectional study conducted from November to December 2020 among medical students at the Faculty of Medicine and Pharmacy in Casablanca. Data were collected using a hetero questionnaire distributed online. The presence of EDs was measured using the SCOFF (Stick, Control, One stone, Fat, Food) scale and anxiety and depression were measured using the HAD (Hamilton Anxiety and Depression) scale. The sample size was calculated a priori and multivariate statistical analyses such as logistic regression were performed. The α threshold was set at 5%. Results A total of 315 students participated in the study, the mean age was 21.01+/- 2.5 years, the majority were female (68.7%), and undergraduates represented 61.7% of the sample. The incidence of EDs was 39.9%. Regarding BMI (Body Mass Index). In terms of BMI, 65.5% had a normal BMI, anxiety and depressive symptoms were absent in 48.4% and 72.2% of cases respectively. Factors associated with EDS were: use of weight control (OR: 7.14 [1.72- 32.519], p = 0.00), BMI (OR: 1.142 [1.06-1.22], p = 0.000) and anxiety symptoms (OR: 3.51 [51.98-6.23], p = 0.000). Conclusions The frequency of eating disorders is high among medical students. The knowledge of the potentially associated factors allows us to generate hypotheses in order to define the axes of prevention of these disorders. Key messages Eating disorders are a health problem among medical students. Eating disorders are multifactorial in origin.

Importance: Sodium glucose cotransporter 2 inhibitors reduce morbidity and mortality in patients with heart failure and reduced ejection fraction (HFrEF). Clinicians may find estimates of the projected long-term benefits of sodium glucose cotransporter 2 inhibitors a helpful addition to clinical trial results when communicating the benefits of this class of drug to patients. Objective: To estimate the projected long-term treatment effects of dapagliflozin in patients with HFrEF over the duration of a patient’s lifetime. Design, Setting, and Participants: Exploratory analysis was performed of Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure (DAPA-HF), a phase 3 randomized, placebo-controlled clinical trial conducted at 410 sites in 20 countries. Patients with an ejection fraction less than or equal to 40% in New York Heart Association functional classification II to IV and elevated plasma levels of N-terminal pro B-type natriuretic peptide were enrolled between February 15, 2017, and August 17, 2018, with final follow-up on June 6, 2019. Mean (SD) duration of follow-up was 17.6 (5.2) months. Interventions: Dapagliflozin, 10 mg, once daily vs placebo in addition to standard therapy. Main Outcomes and Measures: The primary composite outcome was time to first hospitalization for heart failure, urgent heart failure visit requiring intravenous therapy, or cardiovascular death. The trial results were extrapolated to estimate the projected long-term treatment effects of dapagliflozin over the duration of a patient’s lifetime for the primary outcome and the secondary outcome of death from any cause. Results: A total of 4744 patients (1109 women [23.4%]; 3635 men [76.6%]) were randomized in DAPA-HF, with a mean (SD) age of 66.3 (10.9) years. The extrapolated mean event-free survival for an individual aged 65 years from a primary composite end point event was 6.2 years for placebo and 8.3 years for dapagliflozin, representing an event-free survival time gain of 2.1 years (95% CI, 0.8-3.3 years; P = .002). When considering death from any cause, mean extrapolated life expectancy for an individual aged 65 years was 9.1 years for placebo and 10.8 years for dapagliflozin, with a gain in survival of 1.7 years (95% CI, 0.1-3.3; P = .03) with dapagliflozin. Similar results were seen when extrapolated across the age range studied. In analyses of subgroups of patients in DAPA-HF, consistent benefits were seen with dapagliflozin on both event-free and overall survival. Conclusions and Relevance: These findings indicate that dapagliflozin provides clinically meaningful gains in extrapolated event-free and overall survival. These findings may be helpful in communicating the benefits of this treatment to patients with HFrEF. Trial registration: ClinicalTrials.gov Identifier: NCT03036124.

Although multi-phase-field models are applied extensively to simulate various pattern formations, their asymptotic analysis is not typically performed at a level of rigor common to their scalar counterparts. Most of the time, arguments given, such as for the justification of the selection of the bulk phases or the phasal composition of the interfaces between them, are only heuristic in nature. In particular, the reduction of the multi-phase-field models to two-phase ones, so as to ascertain the dynamical laws captured by them, can only be termed as hand waving, at best. It is also common to land the starting point of the analysis directly at a point where the binary interfaces have already formed and continue therefrom with the prediction of their instantaneous evolution. However, exactly how a given initial filling transitions to a state characterized by the presence of bulk phases separated by internal layers, and with what distribution, is rarely addressed. Moreover, a detailed and systematic study, focused on the numerical realization of the asymptotics predicted laws, has never been reported before for multi-phase-field models. In the current article, endorsing against these undesirabilities of the common presentations, a full-fledged asymptotic analysis of a multi-grain-growth phase-field model is put forth and numerically verified. However, the consideration is only limited to the analysis of binary interfaces; that of junctions (triple points, quadruple points, etc.) is deferred to a later work.

Healthcare-associated infections are a major source of morbidity and mortality in neonatology. Our aim was to describe the epidemiology of Healthcare-associated infections in neonatology (frequency, associated factors and prognosis).Articles were searched in the PubMed, Scopus and Web of Science databases. We included observational studies describing prevalence, incidence or mortality among new-born babies having developed infections more than 48hours after hospitalization. The pooled prevalence, incidence and mortality estimates were analysed using the random effects model. Publication bias was analysed using the funnel plot and Egger's test statistics. Data analysis was carried out using R Studio software v1.2.Among the initially identified 137 studies, ten articles fulfilled the inclusion criteria and were included in the metanalysis. They mainly concerned Morocco, Tunisia and Algeria. Pooled incidence was 10% (95% CI [4%-18%]) and overall mortality was 49% (95% CI [33%-66%]). Heterogeneity between studies was significantly high, with rates of 98% and 90% respectively.This review underlined a need to undertake more large-scale multicentric surveys and studies on monitoring systems and the attitudes and practices of relevant caregivers, the objective being to better understand the realities of healthcare-associated infections in Greater Maghreb neonatology units.

During solid–solid precipitation, interface free energy anisotropy is known to drive faceting of precipitates. In this paper, using a recently developed phase field formulation based on higher order tensor terms, we develop and implement a family of phase field models and indicate the parameter choices which lead to faceted precipitate morphologies. We also indicate how to choose the parameters given either the known precipitate morphology or the interfacial free energy anisotropy. Specifically, we study the faceting of precipitates in systems with cubic and hexagonal anisotropies; in 2 and 3D implementation of our phase field model, the precipitates do show facets in accordance with the Wulff plot – including cases where the Wulff plot predicts facets made up of more than one family of planes. We also indicate the possible extensions of our model to study other problems of interest.