A psychological insight of Moroccan adults' immunisation behaviour towards emergency vaccines.

BACKGROUND: The psychology of vaccination behaviour explains how thoughts and feelings influence people's willingness to receive vaccines. Understanding vaccination behaviour is crucial to successfully managing vaccination campaigns. AIM: Investigating factors associated with immunisation stress among students at Mohammed First University. SETTING: This study was conducted on students at Mohammed First University institutions. METHODS: This study is a descriptive and analytical cross-sectional study. It was conducted on 305 students at Mohammed First University institutions using a 90-item questionnaire. RESULTS: Three hundred and five participants have been included in this survey. Overall, 65.5% of the students in our sample had a positive perception towards COVID-19 vaccines. Nevertheless, 34.5% had a negative opinion regarding immunisation. According to the analysis of perceived stress scale, 40% (n = 122) of students expressed moderate to high stress regarding vaccination. Students with a negative perception of vaccine showed a higher level of stress than those with a positive one. Stressed students tended to be older than others, coming from other institutions, other than the medical faculty, and were renting alone. Vaccine accessibility was the less significant reason associated with stress regarding vaccination. Moreover, participants with high levels of confidence in social media, exhibited higher stress. Nevertheless, those who believed in scientific journals were significantly less stressed. CONCLUSION: These results reflect a positive perception and acceptance of vaccines, with a considerable level of stress regarding vaccination.Contribution: This study suggests emphasising the mental health of Moroccan young adults, to better sensitise and inform them about immunisation.

Assessment of drug prescription practises in chronic hemodialysis patients: case series.

Introduction: The aim of the study was to assess the quality of drugs prescriptions in chronic haemodialysis patients. Material and methods: The authors conducted a prospective study in chronic haemodialysis patients of two haemodialysis centres in the city of Oujda eastern Morocco, during the year of 2020. The authors identified the drugs prescribed in this population with regards to the product characteristics, in terms of indications, contraindications, dosage and drug interactions. Our data were analyzed by SPSS version 27 software. Results: The mean number of drugs taken per patient was 8.15±6. Ninety-three percent of patients received treatment for anaemia. Phosphocalcic disorders and hypertension were treated in 89% and 72% of patients, respectively. In 77.6% of the cases, these drugs were taken orally. According to Vidal, the majority of prescriptions met the criteria of good prescription, in 81.54% of the cases, versus 18.46% of the patients with at least one of non-compliant prescription. On the other hand, 6.15% of the patients had at least one inadvisable combination. No contraindicated association was noted in our patients. Conclusion: Patients undergoing haemodialysis have a higher risk of developing side effects and drug interactions than patients with normal kidney function. Given the paucity of pharmacokinetic studies in this population, nephrologists refer to their own experience to treat his patients effectively.Therapeutic education and regular monitoring of chronic haemodialysis patients can improve clinical outcomes, quality of life and reduce the cost of care.

Long-term patency of bypass to the right atrium as a last resort in two hemodialysis patients: case report.

Introduction: Central venous occlusion (CVO), which is caused by central venous catheters in haemodialysis patients , remains a challenge in vascular surgery. Case presentation: The authors report data evaluating bypass graft patency and complications of two patients with CVO who have benefited from a subclavian artery to right atrium bypass using polytetrafuloroetylene. The first patient , underwent three times an angioplasty of the atrio prothetic anastomosis , finally the graft failed at 12 month. The second one, presented a steal syndrome with ischaemia of the right upper limb immediately postoperatively. Three months after the procedure , she underwent an angiographic control that showed a stenosis of the protheto atrial junction. Clinical discussion: Central venous occlusion in patients with end-stage kidney disease is most often due to central venous catheters. Although the endovascular therapy is the first-line approach to the treatment of CVO, the surgical bypass to the right atrium is often the last resort to preserve adequate vascular access in haemodialysis patients, with CVO. The autologous vein and bovine arterial bypass remains better than polytetrafuloroetylene grafts in terms of long-term patency. Only few cases have been reported un the literature , besides no long-term outcome data has been previously reported. Conclusion: Long-term secondary patency of bypass to the right atrium can be achieved, but requires strict follow-up, and multiple endovascular procedures to maintain the bypass access.

End-stage kidney disease patients with severe coronavirus disease: clinical characteristics, biological data, and mortality in nephrology unit, short communication.

Patients suffering from end-stage kidney disease (ESKD) are particularly vulnerable to SARS-CoV-2 infection, and their risk of death is higher than for the general population. The objective was to determine the epidemiologic profile at admission and mortality among patients presenting EKSD with severe coronavirus disease (COVID-19). Methods: A retrospective study was conducted in the Nephrology unit between October 2020 and February 2022. Were included all adult patients who presented ESKD on dialysis, or not on dialysis with an estimated glomerular filtration rate less than or equal to 15 ml/min/1.73 m2 and presenting a confirmed COVID-19. Patients with ESKD who were immediately admitted to the ICU were excluded. Results: Sixty-five patients' data were collected. The mean age was 58.9 ±16.7 years and 60% were males. Hypertension arterial and diabetes observed in 75% and 56.3% of cases, respectively. 52.3% were on haemodialysis, 4.6% were on peritoneal dialysis and 43.1% not were on dialysis. 94% of the patients were symptomatic of COVID-19, dominated by dyspnoea (87.5%), cough (65.6%), and fever (58.5%). More than half of patients (58.5%) showed signs of gravity and 62% required oxygen therapy. According to thoracic scan, 72.3% were classified COVID-19 Raw Data System 5 and 6. Most patients had severe anaemia (58.5%), lymphopenia (81.3%), and high levels of C-reactive protein (54%), D-Dimer (93.6%) and ferritin (91.2%). 38.5% of patients presented complications of whom 60% were transferred to ICU. Mortality was observed in 8% of cases. Conclusion: Rigorous monitoring is necessary for patients in ESKD, particularly those with comorbidities, to reduce the risk of severe form of COVID-19.

The SARS-CoV-2 responsible for phlegmasia cerulea dolens: a case report.

Coronavirus disease 2019 (COVID-19) is a worldwide pandemic systemic infection that is responsible for serious coagulopathies similar to disseminated intravascular coagulation. Case Presentation: The authors report the case of a COVID-19 patient who presented with phlegmasia cerulea dolens (PCD) of the left lower limb, so he benefited from aponeurotomies of the internal and anterolateral muscular compartments. Clinical Discussion: The severe acute respiratory syndrome coronavirus 2 involves an inflammatory process in thrombotic events in COVID-19 patients, including a cytokine storm. PCD evolves in three semiological phases: venous stasis, weakening of the pulses, and the constitution of major ischemia. In the literature, the authors find many reports that have been published regarding increased thrombus formation in COVID-19 patients; these include DVT formation, pulmonary embolism, and stroke. Nevertheless, publications concerning PCD in COVID-19 patients remain rare. Conclusion: Although the severe acute respiratory syndrome coronavirus 2 remains a thrombogenic pathology, systematic anticoagulation is the subject of hypothesis. Hence the importance of regular monitoring of markers of vascular thrombosis.

Knowledge, attitudes, and practice of leadership skills among undergraduate medical students.

BACKGROUND AND AIM: Medical knowledge alone is insufficient to provide excellent medical care. Modern healthcare challenges require that all physicians have leadership skills in order to better cooperate and collaborate with other healthcare professionals and effectively lead their teams to provide the best possible care to their patients. The objective of this study was to describe medical students' prior knowledge of leadership concepts, to assess their common practice of its main skills and to explore their general perception of its application by their seniors. METHODS: Non-graduated medical students enrolled in the 5th year of medicine or above were invited to fill-in an anonymous online questionnaire. 267 students (66% women) from different medical faculties took part in the study. RESULTS: 44% of the participants had a vague idea about leadership and 29% were completely ignorant of the concept. 52% of them thought that leadership was not to be expected from medical students, and 65% did not know that leadership in healthcare would benefit the patient. In their responses to simulated situations, the participants presented optimal attitudes embracing leadership attributes regarding self-awareness, receiving feedback, teamwork, stress and conflict management, however they present more contrasting attitudes when it came to time management and questioning oneself. Seniors with good leadership skills were perceived as few by half the participants. CONCLUSIONS: This survey highlighted the need of introducing specific leadership training programs within the curriculum of medical studies in Morocco.

Acute kidney injury in critically ill patients with COVID-19: prevalence, risk factors and mortality in eastern Morocco.

INTRODUCTION: Acute kidney injury (AKI) is commonly seen in critically ill hospitalized patients with COVID-19 and its incidence reaches 60% in this setting. The aim of this work was to determine the prevalence, characteristics, risk factors and mortality of AKI in patients admitted to the intensive care unit (ICU) for COVID-19. PATIENTS AND METHODS: This observational retrospective case series was conducted between February 1, 2020 and December 31, 2020 at the ICU of the university hospital Mohammed VI of Oujda, Morocco. all COVID-19 patients hospitalized in the ICU with acute respiratory failure were included. AKI was defined and classified into three stages using the KDIGO criteria 2012. We excluded patients with end-stage kidney disease and those who were under 18 years old. RESULTS: Six hundred adult patients were included and 65.5% of them were men. Sixty patients had minimal lung damage (< 25%), 105 patients had mild lung damage (25-50%), 186 had severe lung damage (50-75%) and 193 patients had very severe lung damage (> 75%). A total of 210 patients (35%) developed AKI, of whom 78 (37.2%) had mild AKI (stage 1) and 132 (62.8%) severe AKI (stages 2 and 3). Patients in the severe and mild AKI groups had a higher rate of comorbidities, especially hypertension (mild AKI [46.2%] vs. severe AKI [36.4%] vs. no AKI [27.4%], p = 0.002) and diabetes (mild AKI [52.6%] vs. severe AKI [33.3%] vs. no AKI [26.4%], p < 0.001). During hospitalization, 23.3% of patients with AKI received kidney replacement therapy. In-hospital mortality was observed in 51.3% for mild AKI, 55.3% for severe AKI and 21% in patients who did not have AKI (p < 0.001). CONCLUSION: Our findings revealed that not only severe AKI, but also mild AKI was correlated to in-hospital mortality. Whatever the severity of the kidney impairment, it remains a major prognostic element.

Right subclavian artery to right atrium bypass using Polytetrafluoroethylene (PTFE) graft in hemodialysis patient with central venous occlusion: Case report.

Introduction: Central venous Occlusion (CVO) is a serious complication that occurs mainly in patients with long term central venous catheters for dialysis. It remains a challenge in vascular surgery. Case presentation: We report a case of a patient with end-stage kidney disease (ESKD), who was admitted for chronic occlusion of the superior and inferior vena cava and underwent a right subclavian artery to right atrium (RA) bypass using polytetrafuloroetylene (PTFE) graft. Clinical discussion: Central venous catheters remains the main cause of CVO in ESKD. Although the endovascular therapy is the main approach in the treatment of CVO, the surgical bypass to the RA is often the last resort to preserve vascular access in hemodialysis patients. The autologous vein and bovine arterial bypass remains better than PTFE grafts in terms of long term patency. Conclusion: fistulas as a first approach for dialysis access must be privileged at the expense of central catheters. However bypass to RA by mini thoracotomy incision remains as an excellent option for dialysis access in ESKD with CVO.

HLA-identical living related kidney transplantation: Outcomes of a national multicenter study.

OBJECTIVES: The kidney prognosis of HLA-identical seems theoretically very interesting with the lowest risk of acute rejection after that of identical twins. Objectives were to determine the prevalence of acute rejection and various complications in a cohort of HLA-identical living-related kidney transplant. METHODS: A retrospective, multicenter study was conducted in seven university centers in Morocco, which included all recipients of an HLA-identical living-related kidney transplant performed between 1990 and 2019. RESULTS: Data on 68 HLA-identical living-related kidney transplants were collected. The donors were siblings in 89.7%, the parents in 7.3%, and identical twins in 3% of cases. 53.6% of all recipients were under 35 years old, and 59.4% of them were male. 39.7% of all donors were under 35 years old, and 47% of them were male. 48.5% of HLA-identical living-related kidney transplants were performed before the year 2000. 18 kidney transplant biopsies were performed on 16 kidney transplant recipients. Seven episodes of acute rejection occurred in six patients, 8.8% of the whole cohort (n = 68). Two cases of acute rejection among the seven were related to poor adherence, cessation of immunosuppressive therapy, and loss of medical follow-up by these patients. These two patients were 20 years old at the time of kidney transplantation. The global kidney transplant survival was 66.7% versus 91.9% (P = 0.04) in the two patient groups having developed acute rejection and not having developed acute rejection, respectively. CONCLUSIONS: Acute rejection is a real threat to HLA-identical kidney transplant recipients. Therefore, it seems very important to codify the immunosuppressive regimen and to adopt a minimal and effective treatment.

Distant education in Moroccan medical schools following COVID-19 outbreak at the early phase of lockdown: Were the students really engaged?

The Coronavirus pandemic outbreak has induced many urgent adaptation measures in Morocco including medical education that had to abruptly adopt an exclusive distant education approach, without former sufficient preparation. The present study aimed to assess medical students' engagement in their acutely implemented distant learning and to identify factors that could be associated to the students' studying engagement levels. Medical students from 1st to 5th years of medical studies, enrolled in all Moroccan public medical faculties were invited to fill-in an anonymous online questionnaire. 3174 medical students took part in the study, with a mean age of 20.4 +/- 1.8 years old, and 65.4% of them were women. 90% of the participants reported moderate to drastic change of their sleeping habits and 65% suffered depression symptoms. 20.7% of students didn't engage at all in their learning, 26% studied for less than one hour daily, and only 53.3% studied for one hour or more daily. Only 46.4% of the participants had access to multimedia studying resources and only 20.9% were offered online interactive sessions with their teachers. 41.8% of the participants were unsatisfied from their distant learning experience. Lower studying engagement rates were significantly associated with older age, male gender, change of sleeping patterns, depression symptoms, and also with lack of access to multimedia studying resources and poor general satisfaction from the distant learning experience. Distant Education needs to include more interactive activities and more multimedia studying resources to engage students more efficiently in their self-regulated learning.

Consumption of nephrotoxic plants among chronic hemodialysis patients in the Eastern region of Morocco: A multicentric cross-sectional study.

ETHNOPHARMACOLOGICAL RELEVANCE: The consumption of nephrotoxic plants is quite frequent in Morocco and could explain the high prevalence of indeterminate nephropathy in patients with End-Stage Kidney Disease (ESKD). AIM OF THE STUDY: to determine, in a population of chronic hemodialysis (CHD) patients and before the occurrence of ESKD, the prevalence of the use of nephrotoxic plants, in particular, Aristolochia longa L. (Bereztam) and the etiological role of plants in the rapid progression of known and unknown nephropathy toward the end stage of chronic hemodialysis. MATERIALS AND METHODS: This was a multicentric cross-sectional study spread over 12 months (May 2019-May 2020), carried out in public hemodialysis centers in the eastern region of Morocco. Clinical data were collected from medical records. Herbal and sociodemographic data were collected from a detailed and precise interview with each enrolled CHD patient. RESULTS: A total of 404 CHD patients participated in the study. 71.5%, had used medicinal plants before the occurrence of ESKD and 32.9% had indeterminate nephropathy. Among the plants consumed, we identified plants whose kidney toxicity was well demonstrated, mainly Rhamnus alaternus L. (Mlilas) in 66.7%, Artemisia herba alba Asso (Chih) in 54.32%, Aristolochia longa L.(Bereztam) in 52.6%, and Rubia tinctorum L. (Fowa) in 47.4%. 27.7% of CHD patients had presented complications following the use of the plants before the occurrence of ESKD. In multivariate analysis, the use of plants to treat digestive disorders (OR 9.57; 95%CI [4.49-20.37], P < 0.001) and asthenia associated with anemia (OR 8.59; 95%CI [3.92-18.81], P < 0.001), as well as side effects observed after taking the plants (OR 4; 95%CI [1.09, 14.7], P = 0.03), were identified as significant risk factors for the occurrence of severe indeterminate nephropathy. CONCLUSIONS: This study showed the high prevalence of consumption of nephrotoxic herbs which may be the root cause of chronic renal failure in CHD patients.

Is There Gender Discrimination in Living-Donor Kidney Transplantation?

Kidney transplantation is the ideal treatment for patients with end-stage kidney disease as it provides better survival and quality of life. The best form is living donor kidney transplantation. Numerous studies documented significant gender inequality when it comes to receiving or donating a kidney transplant among women. This article will summarize the present knowledge of gender-related kidney transplantation and discuss the potential causes for the observed disparities and their consequences.

Management of post cardiac transplantation immunosuppression and COVID-19: A case report.

BACKGROUND: There is very limited experience in management of heart transplant (HT) recipients and their immunosuppressive drug therapies while confronted with a SARS-CoV-2 infection. CASE DETAILS: We report the case of a 60-year-old male, heart transplant recipient patient, admitted in our ICU for severe COVID-19. His immunosuppressors were discontinued. He presented an ARDS, a multiple organ failure and a refractory septic shock that eventually resulted in his death. DISCUSSION: Multiple studies reported a lower incidence of SARS-Cov-2 infection in HT recipients compared to the general population, probably due to their prior knowledge and use of protective and barrier measures; but when infected they tend to have poorer outcomes and higher fatality; on account of their pre-existing comorbidities and immunodeficiency. Therefore, the management of the immunosuppressive therapy raises a challenge, in the absence of trials. Physicians rely on experts' recommendations, to maintain the immunosuppressors in case of mild COVID-19, lower to the bare minimum or even discontinue them in case of critical COVID-19 or systemic complications. CONCLUSION: COVID-19 infection is associated with poor outcomes and high mortality in HT recipients, and their immunosuppressive therapy management still raises questions and challenges in the absence of trial-validated data.

General medicine, first-line medicine in Morocco: How is it perceived by medical students and how to enhance their interest in this career?

In Morocco, family medicine does not exist, and it is general medicine that plays the role of family medicine and is also first line medicine and primary care. The current medical school curriculum is not fully in harmony with the real health needs of the population. We questioned 6th and 7th year students about the pertinence of two rotations in general medicine, that is, in a health centre and a private practice, via an anonymous questionnaire disseminated online in June 2020. A total of 266 responses were collected. Out of these, 41.5% of responses were enrolled in 6th year, versus 58.5% in 7th year. Then, 59.1% of students were females. In addition, 84.8% of them declared their intention to pursue a career in a medical specialty, whereas only 15.2% of them were interested in a career as a general practitioner. Notably, 67.4%, 26.5% and 6.1%, respectively, thought that general medicine was very undervalued, a little undervalued and not undervalued. It should be noted that 3.8%, 44.1% and 52.1%, respectively, were interested, somewhat interested and not at all interested in family medicine as a specialty if it was implemented. To that end, various actions need to be undertaken, including the introduction of quality teaching in the 6th and 7th years of medical studies, focused on the development of the knowledge and skills required, the strengthening of pre-existing practical training periods in public health and the introduction of a rotation in private practices of general medicine.

Vascular Complications of Infective Endocarditis: Diagnosis and Management.

INTRODUCTION: The complications of infective endocarditis (IE) are frequent and severe. Our aim was to study the clinical and paraclinical profiles and prognosis of vascular complications, observed in a cardiology unit in Oujda, Morocco. Among 57 patients hospitalized for IE between 2015 and 2020 at the cardiology unit, 19 patients, or 33.3% of patients, had one or more vascular complications. We present here a retrospective analysis. AIM: Prevention, early diagnosis, and treatment of vascular complications are primordial to improving prognosis, following the guidelines of the European Society of Cardiology. PATIENTS AND METHODS: We retrospectively studied 57 patients hospitalized for IE. The diagnostic criteria for IE were modified from the Duke University criteria and we present all vascular complications among this cohort. RESULTS: Nineteen patients presented with one or more vascular complications, 10 men and nine women, with a mean age of 49 years. IE had grafted on a mechanical prosthetic valve in four cases. Overall, we found 25 vascular lesions: six neurological complications, five cases of peripheral vascular involvement, nine splenic infarcts, and five recurrent septic pulmonary embolisms (SPEs). The vascular complications accrued after three to 14 days of antibiotherapy or on extension reports; blood cultures were positive in 17 (89.4%) cases; streptococcus was isolated in nine cases; Staphylococcus aureus in seven cases; and acinetobacter in one case. CONCLUSION: Vascular complications of IE are severe, the most common in our study being splenic infarct. Prevention and early diagnosis are essential to instituting optimal management. All the patients were followed up with a mean follow-up of three years. Late mortality involved one patient in connection with a hemorrhagic stroke secondary to an accident with vitamin K antagonists after its release in one month. No cases of recurrence of endocarditis were noted in this group. Data were collected from archived medical records and analyzed by Statistical Package for the Social Sciences.

Parvovirus B19 in kidney transplantation: key points and essential pitfalls to know.

Parvovirus B19 infection is s new viral threat in post-kidney transplantation. It is a viral infection often acquired from the donor, occurring in young transplant patients during the first post-kidney transplantation months, and with a non-specific clinico-biological picture. The hallmark symptom is regenerative anaemia which may be severe, requiring blood transfusion. The C3 and C4 complement fractions are reduced and constitute an early and inexpensive diagnostic marker. Diagnosis is often delayed due to the non-specific clinico-biological picture. However, severe anaemia and hypocomplementemia are early and suggestive signs of parvovirus B19 infection. Levels of parvovirus B19 DNA, as determined by real time-polymerase chain reaction (RT-PCR), are often very high and tend to decrease slowly over several months. Treatment is based on adaptive reduction of immunosuppression, adequate in the forms with few symptoms, discontinuation of antiproliferative agents, or a switch to other molecules associated with intravenous immunoglobulins in the severe and highly symptomatic forms. Screening for other concomitant viral infections, particularly for cytomegalovirus, Epstein Barr virus, and BK virus is systematic. Relapses are quite frequent during the first-year post-transplantation. Clinical-biological follow-up aims to detect any recurrence of the parvovirus B19 infection, the occurrence of parvovirus B19-related glomerulopathy, and acute rejection. Parvovirus B19 infection is a new viral threat in post-kidney transplantation and requires broader and/or randomised studies to better establish the diagnostic and therapeutic approach.

Diabetic retinopathy in the Eastern Morocco: Different stage frequencies and associated risk factors.

Diabetes is a major cause of morbidity and mortality worldwide. It can affect many organs and, over time, leads to serious complications. Diabetic retinopathy (DR), a specific ocular complication of diabetes, remains the leading cause of vision loss and vision impairment in adults. This work is the first in Eastern Morocco aimed at identifying the different stages of DR and to determine their frequencies and associated risk factors. It is a case-control study conducted from December 2018 to July 2019 at the ophthalmology department of Al-Irfane Clinic (Oujda). Data were obtained from a specific questionnaire involving 244 diabetic patients (122 cases with retinopathy vs 122 controls without retinopathy). All results were analyzed by the EPI-Info software. This study shows a predominance of proliferative diabetic retinopathy (PDR) with 57.4% of cases (uncomplicated proliferative diabetic retinopathy (UPDR): 23.8%; complicated proliferative diabetic retinopathy (CPDR): 33.6%). The non-proliferative diabetic retinopathy (NPDR) represents 42.6% (minimal NPDR: 8.2%; moderate NPDR: 26.2%; severe NPDR: 8.2%). The determinants of DR were insulin therapy, high blood pressure, poor glycemic control and duration of diabetes. Regarding the chronological evolution, retinopathy precedes nephropathy. Diabetic nephropathy (DN) was present in 10.6% of cases especially in patients with PDR. In summary, the frequency of PDR was higher than that of NPDR. DR appears before DN with a high frequency of DN in patients with PDR. Good glycemic control and blood pressure control, as well as early diagnosis are the major preventive measures against DR.

Cutaneous necrosis of the arteriovenous fistula puncture site in chronic hemodialysis: A historical complication or an ever-present threat? A series of 26 cases.

INTRODUCTION: Cutaneous necrosis (CN) at the puncture site of the arteriovenous fistula (AVF) in chronic hemodialysis (CHD) is a rare but potentially fatal complication. The objective of our work was to establish the associated complications, vascular prognosis, and patient survival of CHD patients presenting cutaneous necrosis. METHODS: This retrospective study (January 2016 to March 2020) was conducted in the Department of Vascular Surgery and the Department of Nephrology at the University Hospital Center Mohammed VI of Oujda, Morocco. Included were all CHD patients admitted for treatment of cutaneous necrosis at the puncture site of a native AVF. RESULTS: Data from 26 cases were collected. The mean age was 58.7 ± 16 years, 70.8% were female, and 25% had diabetic nephropathy; 42.3% of the AVFs were radiocephalic and 46.1% were brachiocephalic; 42.2% of patients presented active bleeding, of whom 91% required a blood transfusion; 80.8% of the AVFs were complicated by aneurysms. Fistulography showed stenosis in 42.3% of cases. Urgent surgical intervention was performed on all the patients. Fifty percent of patients required placement of a short-term hemodialysis catheter. Two patients had presented a recurrence. Death occurred in one case following a massive hemorrhagic shock. CONCLUSION: Cutaneous necrosis is a relatively common complication and requires early screening and immediate surgical intervention.