Cholecystitis-related cystic artery pseudoaneurysm: Case report.

The pseudoaneurysms of the cystic artery (CAP) are very uncommon. They usually develop as a result of an acute cholecystitis or after a cholecystectomy. Among the complications, we can find hemorrhaging, biliary blockage, and haemobilia. Limited understanding of the illness makes managing specific cases difficult. We describe a case of a cystic artery pseudoaneurysm complicating an acute cholecystitis that was successfully treated by transcatheter arterial embolization.

Midwives' experience of maternal death / Vécu de la mort maternelle par les sages-femmes

Introduction: In Morocco, maternal mortality is a crucial public health problem with a current rate of 72.6/100000 live births. This phenomenon is emotionally overwhelming, and the midwife's experience of this drama is disordering. Purpose of research: To explore how midwives experience maternal death, the resulting consequences, and the coping strategies used to overcome it. Results: 19 midwives were interviewed and reported 39 cases of maternal death. The results show that no midwife remains indifferent to maternal death. The experience is painful, and the grief of the families is transferred to the midwife. Sadness, denial, fear, feelings of guilt and failure have characterized almost all the victims. In the face of her suffering, the midwife mobilizes coping strategies. The consequences are diverse: psychological, somatic, and professional. Conclusions: The experience of maternal death associated with unfavorable working conditions and lack of recognition increases stress and leads to the intention to abandon the profession. The improvement of working conditions, the focus on teamwork, the implementation of discussion groups, professionalize the experience of maternal death.

Introduction: Au Maroc, la mortalité maternelle est un problème de santé publique crucial dont le taux actuel est de 72,6/100 000 naissances vivantes. Ce fléau est à charge émotionnelle importante, et le vécu de ce drame par la sage-femme est une expérience désorganisatrice. But de l'étude: Explorer la manière dont la sage-femme vit la mort maternelle, les conséquences qui en résultent et les stratégies d'ajustement mobilisées pour la surmonter. Résultats: 19 sages-femmes ont été interviewées rapportant 39 cas de décès maternels vécus. Les résultats montrent qu'aucune sage-femme ne reste indifférente devant la mort maternelle. Le vécu est douloureux, et le deuil des familles est transféré vers la sage-femme. La tristesse, le déni, la peur, le sentiment de culpabilité et d'échec caractérisent les vécus. Devant sa souffrance, la sage-femme mobilise des stratégies de coping. Les conséquences sont diverses : psychologiques, somatiques et professionnelles. Conclusions: Le vécu de la mort maternelle associé aux conditions de travail défavorables, au manque de reconnaissance, accentue le stress et conduit à l'intention d'abandonner la profession. L'amélioration des conditions de travail, la focalisation sur le travail d'équipe, la mise en place de groupes de discussion professionnalisent le vécu de la mort maternelle.

Genetic Diversity and Maternal Phylogenetic Relationships among Populations and Strains of Arabian Show Horses.

Genetic diversity and phylogenetic relationships within the Arabian show horse populations are of particular interest to breeders worldwide. Using the complete mitochondrial DNA D-loop sequence (916 pb), this study aimed (i) to understand the genetic relationship between three populations, the Desert-Bred (DB), a subset of the Kingdom of Saudi Arabia (KSA), United Arab Emirates (UAE) and Bahrain (BAH), the Straight Egyptian (EG) and the Polish bloodline (PL), and (ii) to assess the accuracy of the traditional strain classification system based on maternal lines, as stated by the Bedouin culture. To that end, we collected 211 hair samples from stud farms renowned for breeding Arabian show horses from Nejd KSA, Bahrain, Egypt, Qatar, Morocco, UAE, and Poland. The phylogenetic and network analyses of the whole mitochondrial DNA D-loop sequence highlighted a great genetic diversity among the Arabian horse populations, in which about 75% of variance was assigned to populations and 25% to strains. The discriminant analysis of principal components illustrated a relative distinction between those populations. A clear subdivision between traditional strains was found in PL, in contrast to the situation of DB and EG populations. However, several Polish horse individuals could not be traced back to the Bedouin tribes by historical documentation and were shown to differ genetically from other studied Bedouin strains, hence motivating extended investigations.

An unusual case of native aortic endocarditis due to Corynebacterium pseudodiphtheriticum.

Corynebacterium pseudodiphtheriticum, a Gram-positive rod belonging the oropharynx microbiota, is usually described in pulmonary infections, especially in immunocompromised patients. This paper describes a rare case of native aortic infectious endocarditis (IE) and reviews the literature on similar cases. A 62-year-old man with rheumatic fever since childhood was hospitalized for surgical treatment of a febrile IE due to C. diphtheriticum with a large vegetation (15.8 X 8.3 mm). MALDI-TOF-MS from strain isolated in positive blood cultures identified C. pseudodiphtheriticum (2.34), and 16S rRNA sequencing from the valve sample confirmed the identification. The summary of 25 cases shows that the outcome of an IE due to C. pseudodiphtheriticum is bad. The review of the literature shows that this agent found in blood cultures in a cardiovascular context deserves to be explored meticulously because an unfavorable prognosis is frequent.

In-vitro evaluation of the probiotic potential and the fermentation profile of Pediococcus and Enterococcus strains isolated from Moroccan camel milk.

The promotion of human health through natural approaches like functional foods and probiotics is in high demand. The medicinal plants are the major feed of Moroccan dromedary, which improves the functional properties of their milk. A few studies have reported the probiotic and functional aptitudes of lactic acid bacteria (LAB) of this milk. In this context, our study aimed to identify LAB isolated from Moroccan raw camel milk and investigate their probiotic features and their fermentation profile. The molecular identification of twelve isolates indicated that they belong to Pediococcus pentosaceus, Enterococcus faecium, and Enterococcus durans. All LAB strains displayed high tolerance to gastrointestinal conditions (survival rate of 31.85-96.52% in pH 2.5, 35.23-99.05% in 0.3 bile salts, and 26.9-90.96% in pepsin), strong attachment abilities (auto-aggregation and hydrophobicity ranged from 28.75 to 95.9% and from 80.47 to 96.37%, respectively), and high co-aggregation ability with pathogenic bacteria. Importantly, they did not present antibiotic resistance or hemolytic activity. Our LAB strains demonstrated antimicrobial activity against Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, Bacillus subtilis, and Salmonella enterica. Moreover, they could acidify cow milk (ΔpH of 2.55 after 24 h) and improve its antioxidant ability (inhibition of 36.77% of DPPH). Based on the multivariate analysis, Pediococcus pentosaceus Pd24, Pd29, Pd38, Enterococcus faecium Ef18, and Enterococcus durans Ed22 were selected as the most promising probiotics. Therefore, we propose that Pediococcus pentosaceus isolated from camel milk could be used as potential probiotic strains and/or starter cultures in functional milk fermentation.

Psychometric evaluation of the Arabic version of the Perceived Stress Scale in clinical practicum: Validity and reliability in the Moroccan nursing students.

BACKGROUND: During clinical practicum, nursing students are subjected to stressors that can affect their well-being, academic performance, and technical skills. The purpose of this study was to evaluate the psychometric properties of the Arabic version of the Perceived Stress Scale of Clinical Practicum (PSS-CP) in a sample of Moroccan nursing students. MATERIALS AND METHODS: In this study, a translation and back-translation method and comparisons were made with the original version. The study population consisted of 215 nursing students. The construct validity of PSS-CP was measured using exploratory (EFA) and confirmatory factor analysis (CFA). Convergent validity was demonstrated by correlation with the Arabic version of the Depression, Anxiety, and Stress Scale (DASS-21). For reliability, Cronbach's alpha and test-re-test reliability (with a 10-day interval) were used. Data were analyzed using IBM SPSS Statistics V. 23.0 (SPSS) and AMOS V.21.0 (SPSS) software. RESULTS: The results showed that the PSS-CP is a reliable and valid scale with good internal consistency and test-re-test reliability. In terms of convergent validity, the PSS-CP showed a positive and significant correlation with the DASS-21 scale items. The results of this study led to a two-factor model consisting of 29 items. CONCLUSION: The PSS-CP is a valid and reliable instrument for assessing clinical stressors among nursing students in Morocco.

Evaluation of different models for validating of photovoltaic cell temperature under semi-arid conditions.

Photovoltaic (PV) solar energy enables direct production of electricity. The photovoltaic effect produced in the solar cells converts light energy from the sun's rays into electricity. Some of the solar radiation absorbed by a PV module is not converted into electricity but takes the form of an increase in the temperature of the module, reducing its electrical efficiency. The operating temperature of PV modules generally affects the performance of the PV system; performance also depends on numerous variables such as ambient temperature, wind speed, wind direction, total irradiance, dust accumulating on the PV module face and relative humidity. In this study different models for predicting the operating temperature of PV modules have been investigated. The models' relevance to PV module technology and climatic conditions in Errachidia city (coordinates: 31° 55' 55″ north, 4° 25' 28″ west) in the Drâa Tafilalet region was examined. The models that factor in wind data predict PV cell temperature better than the standard approach which does not include wind data. The models' accuracy was estimated based on R2 and RMSE values. A model is more accurate the higher the R2 is and the lower the RMSE is. In addition, we noticed that the models investigated are more accurate for a short time period during the day.

Complete Genome Sequence of a SARS-CoV-2 Strain Sampled in Morocco in May 2020, Obtained Using Sanger Sequencing.

The complete genome sequence of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strain was obtained. The strain was isolated from a nasopharyngeal swab specimen from a female patient in Rabat, Morocco, with coronavirus disease 2019 (COVID-19). This strain belongs to clade 20A and has 12 mutations and 8 amino acid substitutions compared to the reference strain Wuhan/Hu-1/2019.

Moroccan National Immunization Technical Advisory Group: a valuable asset for the national immunization program and the immunization agenda in the EMRO region.

The main mission of a National Immunization Technical Advisory Group (NITAG) is to provide impartial, evidence-based recommendations on immunization to the Ministry of Health. We report on the findings from an evaluation of the Moroccan NITAG with emphasis on its functionality, quality of work processes and outputs, and its integration into the immunization policy process. We conducted a cross-sectional study from October to December 2019. We used the standardized, US-CDC/WHO-developed "simplified assessment tool for national immunization technical advisory groups". The evaluation included eight participants. The evaluation has shown that it fully complies with the WHO recommendations. Among its strengths, the Moroccan NITAG has a solid legal basis, diverse expertise and many years of combined experience. This composition contributed to the credibility and strength of its recommendations and facilitated their implementation. The NITAG could, however, benefit from implementing written declarations of interests and standardized operating procedures in addition to establishing a standardized methodology to guide and document the decision-making process. The Moroccan NITAG could also gain from inviting members with public health/epidemiology research experience and from exchanging with other NITAGs in the region and globally. Finally, ensuring sustainable funding for the NITAG's activities will be crucial, so that it can continue its valuable support to the national immunization program.

Evidence for zoonotic transmission of species A rotavirus from goat and cattle in nomadic herds in Morocco, 2012-2014.

Species A rotaviruses (RVAs) are a leading cause of diarrhea in children and in the young of a large variety of mammalian and avian host species. The purpose of this study was to identify RVA in nomadic goats and calves during severe diarrhea outbreaks in 2012 and 2014 in Bouaarfa, Morocco, and to characterize the complete genomic constellation of two bovine and caprine strains (S18 and S19) and their genetic relatedness with the human strain ma31 detected in 2011 in Morocco. Partial nucleotide sequencing of VP4 and VP7 genes for the twenty-two positive samples revealed three circulating genotypes: G6P[14], G10P[14], and G10P[5] with predominance of G6P[14] genotype. Full-genome sequencing for both strains S18 and S19 presented, respectively, the following genomic constellations: G6-P[14]-I2-R2-C2-M2-A3-N2-T6-E2-H3 and G10-P[14]-I2-R2-C2-M2-A11-N2-T6-E2-H3. Phylogenetic analyses and the analysis of the VP8* antigenic epitopes for S18, S19 and ma31 revealed a shared similarity with bovine, caprine, ovine and human strains from Morocco and other countries. The VP2 and NSP1 genes of the S19 strain were closely related to those of the cognate genes of the human ma31 strain, while the VP4 gene of S18 strain was closely related to the cogent gene of the ma31 strain. Our findings revealed cases of zoonotic transmission and confirmed the risk of emergence of new genotypes in some environments such as nomadic regions, where close physical proximity between human and livestock is common. The present study is novel in reporting whole-genome analyses of RVA isolates obtained from nomadic livestock in Morocco.

Structure Based Design of Potent Selective Inhibitors of Protein Kinase D1 (PKD1).

We previously disclosed a series of type I 1/2 inhibitors of NF-κB inducing kinase (NIK). Inhibition of NIK by these compounds was found to be strongly dependent on the inclusion and absolute stereochemistry of a propargyl tertiary alcohol as it forms critical hydrogen bonds (H-bonds) with NIK. We report that inhibition of protein kinase D1 (PKD1) by this class of compounds is not dependent on H-bond interactions of this tertiary alcohol. This feature was leveraged in the design of highly selective inhibitors of PKD1 that no longer inhibit NIK. A structure-based hypothesis based on the position and flexibility of the α-C-helix of PKD1 vs NIK is presented.

HIV-1 Integrase Resistance among Highly Antiretroviral Experienced Patients from Morocco.

BACKGROUND: We aimed to analyze for the first time in Morocco the integrase (IN) sequence variability among highly experienced HIV-1-infected patients with no prior IN strand transfer inhibitor (INSTI) exposure who failed on reverse transcriptase inhibitors and protease inhibitors. METHODS: The HIV-1 IN region was sequenced from plasma samples of all 78 recruited patients. The amino acid IN sequences were HIV-1 subtyped and screened for the presence of polymorphisms against the HxB2 clade B consensus sequence by the geno2pheno subtyping tool and interpreted for drug resistance according to the Stanford algorithm. RESULTS: The viral subtypes were subtype B (88.4%), CRF02_AG (8.9%), CRF01_AE (1.28%), and subtype C (1.28%). The major INSTI resistance mutations at positions 66, 92, 118, 138, 140, 143, 147, 148, 155, and 263 were absent, while two accessory mutations, L74M/I, known to have no clinical impact to INSTIs in the absence of the major resistance mutations, were detected in three samples (3.84%; two CRF02_AG and one CRF01_AE). Others specific substitutions with an uncertain role on the HIV-1 susceptibility to INSTIs at positions 72, 101, 119, 124, 156, 165, 193, 201, 203, 206, 230, 232, and 249 were found to be relatively common. CONCLUSION: This study demonstrated that INSTIs should be an excellent alternative for salvage therapy in highly experienced patients with multidrug resistant viruses in Morocco.

Full-length genome analysis of the first human G8P[14] rotavirus strain from Morocco suggests evidence of zoonotic transmission.

An unusual group A rotavirus (RVA) strain MAR/ma31/2011/G8P[14] was detected for the first time in Morocco in a stool sample from hospitalized child aged 18 months suffering from acute gastroenteritis and fever in 2011. Complete genome sequencing of the ma31 strain was done using the capillary sequencing technology. The analysis revealed the G8-P[14]-I2-R2-C2-M2-A11-N2-T6-E2-H3 constellation and the backbone genes: I2-R2-C2-M2-A11-N2-T6-E2-H3 are commonly found in RVA strains from artiodactyls such as cattle. The constellation was shared with another Italian zoonotic G8P[14] strains (BA01 and BA02), two Hungarian human strains (182-02 and BP1062) and a sheep RVA strain OVR762. Phylogenetic analysis of each genome segment of ma31 revealed a mixed gene configuration originated from animals and human. Comparison of the antigenic regions of VP7 and VP4 amino acid sequences between ma31 strain and selected animal and human strains bearing G8 and or P[14], showed a high level of conservation, while many substitutions was observed in comparison with RotaTeq™ and Rotarix™ vaccine strains. In contrast, alignment analysis of the four antigenic sites of VP6 revealed a high degree of conservation. These findings reveal a typical zoonotic origin of the strain and confirm a high potential for RVA zoonotic transmission between bovine and humans, allowing the generation of novel rotavirus genotypes.

A multi-base harmonic balance method applied to Hodgkin-Huxley model.

Our aim is to propose a new robust and manageable technique, called multi-base harmonic balance method, to detect and characterize the periodic solutions of a nonlinear dynamical system. Our case test is the Hodgkin-Huxley model, one of the most realistic neuronal models in literature. This system, depending on the value of the external stimuli current, exhibits periodic solutions, both stable and unstable.

Prevalence of resistance to integrase strand-transfer inhibitors (INSTIs) among untreated HIV-1 infected patients in Morocco.

OBJECTIVE: The integrase strand-transfer inhibitors (INSTIs) are an important class in the arsenal of antiretroviral drugs designed to block the integration of HIV-1 cDNA into the host DNA through the inhibition of DNA strand transfer. In this study for the first time in Morocco, the complete HIV-1 integrase gene was analysed from newly diagnosed patients to evaluate the prevalence of natural polymorphisms and INSTIs resistance-associated mutations in the integrase gene. RESULTS: The 864pb IN coding region was successfully sequenced from plasma sample for 77 among 80 antiretroviral naïve patients. The sequences were interpreted for drug resistance according to the Stanford algorithm. Sixty samples were HIV-1 subtype B (78%), fourteen CRF02_AG (18%), two subtype C and one subtype A. Overall 81 of 288 (28%) amino acid IN positions presented at least one polymorphism each. We found 18 (36.73%), 42 (25.76%) and 21 (27.27%) of polymorphic residues assigned to the N-Terminal Domain, Catalytic Core Domaine and the C-Terminal Domain positions respectively. Primary INSTIs resistance mutation were absent, however secondary mutations L74IM, T97A were detected in four samples (5.2%). These results demonstrate that untreated HIV-1 infected Moroccans will be susceptible to INSTIs.

Prevalence and correlates of non-optimal secondary medical prevention in patients with stable coronary artery disease.

BACKGROUND: In patients with coronary artery disease (CAD), non-optimal use of evidence-based medications is associated with an increased risk of adverse outcome. AIMS: To assess the prevalence and correlates of non-optimal secondary medical prevention in patients with stable CAD. METHODS: We included 4184 consecutive outpatients with stable CAD. Treatment at inclusion was classified as optimal/non-optimal regarding the four major classes of secondary prevention drugs: antithrombotics; statins; angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs); and beta-blockers. For each treatment, the prescription was considered non-optimal if the drug was missing despite a class IA indication according to international guidelines. To assess the information globally, non-optimal secondary prevention was defined as at least one major treatment missing. RESULTS: The proportions of patients with non-optimal treatment were 0.7%, 7.8%, 12.9% and 10.3% for antithrombotics, statins, ACE inhibitors/ARBs and beta-blockers, respectively. Non-optimal secondary medical prevention was observed in 16.8% of cases. By multivariable analysis, the correlates of non-optimal secondary medical prevention were long time interval since last coronary event (P<0.0001), older age (P<0.0001), diabetes mellitus (P<0.0001), hypertension (P<0.0001), no history of myocardial infarction (P=0.001), no history of coronary revascularization (P=0.013) and low glomerular filtration rate (P=0.042). CONCLUSIONS: Although most patients with stable CAD are receiving evidence-based medications according to guidelines, there remain subgroups at higher risk of non-optimal treatment. In particular, it might be feasible to improve prevention by focusing on patients in whom a long time has elapsed since the last coronary event.

Affinity comparison of different THCA synthase to CBGA using modeling computational approaches.

The Δ(9-)Tetrahydrocannabinol (THCA) is the primary psychoactive compound of Cannabis Sativa. It is produced by Δ(1-) Tetrahydrocannabinolic acid synthase (THCA) which catalyzes the oxidative cyclization of cannabigerolic acid (CBGA) the precursor of the THCA. In this study, we were interested by the three dimensional structure of THCA synthase protein. Generation of models were done by MODELLER v9.11 and homology modeling with Δ1-tetrahydrocannabinolic acid (THCA) synthase X ray structure (PDB code 3VTE) on the basis of sequences retrieved from GenBank. Procheck, Errat, and Verify 3D tools were used to verify the reliability of the six 3D models obtained, the overall quality factor and the Prosa Z-score were also used to check the quality of the six modeled proteins. The RMSDs for C-alpha atoms, main-chain atoms, side-chain atoms and all atoms between the modeled structures and the corresponding template ranged between 0.290 Å-1.252 Å, reflecting the good quality of the obtained models. Our study of the CBGA-THCA synthase docking demonstrated that the active site pocket was successfully recognized using computational approach. The interaction energy of CBGA computed in 'fiber types' proteins ranged between -4.1 95 kcal/mol and -5.95 kcal/mol whereas in the 'drug type' was about -7.02 kcal/mol to -7.16 kcal/mol, which maybe indicate the important role played by the interaction energy of CBGA in the determination of the THCA level in Cannabis Sativa L. varieties. Finally, we have proposed an experimental design in order to explore the binding energy source of ligand-enzyme in Cannabis Sativa and the production level of the THCA in the absence of any information regarding the correlation between the enzyme affinity and THCA level production. This report opens the doors to more studies predicting the binding site pocket with accuracy from the perspective of the protein affinity and THCA level produced in Cannabis Sativa.

G894T endothelial nitric oxide synthase polymorphism and ischemic stroke in Morocco.

Nitric oxide plays a major role in the regulation of cerebral blood flow and loss of its function leads to alteration of the vascular relaxation given its central role in the physiology of the vascular system. G894T eNOS polymorphism could have adverse effects on the expression and activity of endothelial nitric oxide synthase, which can result in functional impairment of the endothelium and contribute to the development of ischemic stroke in the different models of transmission. In this study, genotyping with PCR-RFLP and HRM (high resolution melting) methods were conducted on 165 ischemic stroke patients as well as 182 controls. The goal here was to compare genotyping with PCR-RLFP primer sequences of eNOS gene (size < 300 bp) to HRM. Our data suggests a statistically significant association between G894T eNOS polymorphism and ischemic stroke in recessive, dominant and additive models with P < 0.05 and odds ratio of 2.68 (1.08-6.70), 1.78 (1.16-2.73), and 1.71 (1.21-2.43) respectively. In sum, although the sample size is relatively small, it suggests that G894T eNOS polymorphism could be a potentially important genetic marker of ischemic stroke in the Moroccan population. Future studies should be conducted in this direction taking into consideration the functional activity of eNOS.

Extraction of high quality DNA from seized Moroccan cannabis resin (Hashish).

The extraction and purification of nucleic acids is the first step in most molecular biology analysis techniques. The objective of this work is to obtain highly purified nucleic acids derived from Cannabis sativa resin seizure in order to conduct a DNA typing method for the individualization of cannabis resin samples. To obtain highly purified nucleic acids from cannabis resin (Hashish) free from contaminants that cause inhibition of PCR reaction, we have tested two protocols: the CTAB protocol of Wagner and a CTAB protocol described by Somma (2004) adapted for difficult matrix. We obtained high quality genomic DNA from 8 cannabis resin seizures using the adapted protocol. DNA extracted by the Wagner CTAB protocol failed to give polymerase chain reaction (PCR) amplification of tetrahydrocannabinolic acid (THCA) synthase coding gene. However, the extracted DNA by the second protocol permits amplification of THCA synthase coding gene using different sets of primers as assessed by PCR. We describe here for the first time the possibility of DNA extraction from (Hashish) resin derived from Cannabis sativa. This allows the use of DNA molecular tests under special forensic circumstances.