Psychological impact of the end of lockdown on the Moroccan population.

This work is a descriptive cross-sectional study that aimed to assess by means of an online survey the well-being and psychological impact, mainly depression, anxiety, stress and post-traumatic stress disorder (PTSD), experienced by the general population after the end of lockdown following the COVID-19 pandemic. In this study, we used the PCL-S scales to assess PTSD and the DASS scale to assess depression, anxiety, and stress related to end of quarantine. Our study found that following the decontamination related to COVID-19, the psychological impact was not negligible with a significant prevalence of occurrence for several psychological disorders. We found depression (68.8%), anxiety (57.47%), stress (45.50%) and post-traumatic stress disorder (31.5%) in the subjects of our study. Following the decontamination related to COVID-19, the psychological impact was found to be as important or even more serious than the other situations that preceded it. The development of a database allowing us to understand the effect of the decontamination on the mental health of Moroccans could be useful in order to watch and prevent the occurrence of complications for psychological disorders such as depression, anxiety, stress or even a state of post-traumatic stress.

Silent brain infarctions in patients with acute cardioembolic stroke.

INTRODUCTION AND AIM: The advances and the wide use of brain imaging have considerably increased the prevalence of silent brain infarctions (SBI). We aim in this study to determine the prevalence of SBI in patients presenting with acute cardioembolic stroke and the predictive cardiovascular risk factors. METHODS: This retrospective study included 267 patients presenting with acute cardioembolic stroke in the emergency and/or neurology departments of the Hassan II University Hospital Center. Clinical, biological and echocardiographic characteristics were recorded. All patients were screened for SBI by brain imaging. RESULTS: The prevalence of SBI in our series was 46%. A group of 203 non-valvular patients and a group of 64 valvular patients were distinguished. In non-valvular group, the average age was 72.97±10.53years. The prevalence of SBI was 45.3%. Forty-four percent of patients with SBI had atrial fibrillation (AF). In multivariate regression analysis, the history of previous stroke, CHA2DS2-VASc Score≥4, enlarged left atrium (LA), the association of AF with enlarged LA and the lability of International Normalized Ratio in patients initially treated with anticoagulants were significantly associated with the occurrence of SBI (P=0.013, P=0.032, P=0.0001, P=0.01, P=0.03, respectively). Territorial location was significantly the most frequent (P=0.007). In valvular group, the average age was 57.19±14.38years. The prevalence of SBI was 48.4%. In multivariate regression analysis, SBI were significantly associated with moderate or severe mitral stenosis (P=0.02) and with the enlarged LA (P=0.02). In all patients, Modified Rankin Scale at 3 months of discharge from the acute stroke was significantly higher (mRS≥3) in patients with SBI (P=0.04). CONCLUSIONS: SBI requires good management of associated cardiovascular risk factors in a population presenting with initial cardioembolic stroke.

Quality of life predictors among Moroccan adults with epilepsy.

PURPOSE: This study aimed to determine the factors associated with quality of life (QOL) in adult patients living with epilepsy in Morocco. METHODS: 110 patients with epilepsy aging 18 years old were interviewed using the standard and validated Moroccan version of the Quality of Life in Epilepsy inventory with 31 items (QOLIE-31). Descriptive statistics, one-way ANOVA, and multivariate regression were used for data analysis. RESULTS: The mean age of the patients was 35.70 years old (standard deviation (SD)12.2). The mean total score of QOLIE-31 was 43.6±10.2. The highest mean±SD score was the medication effects subscale 52.3±12.1, and the lowest was the overall quality of life subscale 39.2±13.2. Patients with no seizure episode during the last month had a better mean total score of QOLIE-31 (47.6±10.5) than the study participants having a seizure in the last month (40.6±8.9, p≤0.001). These data supported that presence of seizure in the past 4 weeks (ß=4.626, CI95 % 1.123; 8.130), memory disorders (ß=10.025, IC 95 % 2.811; 17.239), seizure trigger factors such as forgetting to take antiepileptic drugs (AEDs) (ß=5.205, IC 95 % 1.769; 8.641), personal problems (ß=4.957, IC 95 % 0.604; 9.310), low monthly income (<2000MAD, 194.94$: ß= -9.937, IC 95 % -18.536; -1.338), (2000-5000MAD, 194.94$- 487.35$: ß= -24.804, IC 95 % -43.171; -6.437), and employment (ß= -4.291, IC 95 % -7.976; -0.605) were the factors associated with QOL. SIGNIFICANCE: The overall QOL of patients with epilepsy was low. This study showed that the presence of seizures, memory disorders, monthly income, trigger factors, and employment status were QOL predictors for epileptic patients.

Measurement Properties of an Arabic Version of the Jefferson Scale of Empathy (JSE) in Moroccan Medical Students.

Introduction: Empathy is an essential communication skill in the doctor-patient relationship. In fact, measuring its level in medical students is becoming increasingly important. There is a Lack of tools to measure it in Morocco. The aim of this study was to validate the Arabic version of the Jefferson Scale of Empathy (JSE) among Moroccan medical students. Methods: The questionnaire was translated from its original English version to Arabic in accordance with international guidelines for cross-cultural adaptation of self-report measures. After translation and transcultural adaptation, the final Arabic version was administered to a sample of Moroccan medical students. Descriptive statistics at the item level and at the scale level were calculated. The internal consistency, reproducibility, criterion, and construct validity were assessed. A multitrait scale analysis was used to examine construct validity. To measure criterion validity, the Arabic JSE scale was correlated to a visual analog scale (VAS), measuring the level of empathy. The mean of score was compared by gender, year of medical training, and specialty preference using the Student (t) and ANOVA tests. All statistical analyses were performed by SPSS, Version 26. Results: A total of 201 students participated in the study. The average empathy score was 105.1±13.4. It was higher in female than male students (P=0.003). The Cronbach alpha was 0.76. The instrument has moderate test-retest reliability (ICC=0.6). The results showed a positive and significant correlation between Arabic JSE and VAS ((r=0.28, p<0.0001). The multitrait scaling analysis by testing convergent and discriminant validity confirmed the original scale structure. Conclusion: The adapted Moroccan version of the Jefferson Scale of Empathy proved to be a valid instrument. It demonstrated an acceptable reliability and validity. Indeed, it can be used in national studies to measure empathy in medical students.

Cutaneous Squamous Cell Carcinoma: Clinico-Dermoscopic and Histological Correlation: About 72 Cases.

INTRODUCTION: Cutaneous squamous cell carcinoma (cSCC) is the second most common skin cancer, accounting for 20% of malignant skin tumors. Dermoscopy is a very useful tool for diagnosing cSCC, and its findings are confirmed through histopathological studies. OBJECTIVES: to describe the different dermoscopic structures of invasive cSCC and investigate their association with the clinical form and histopathological grade of differentiation. METHODS: We conducted a cross-sectional study, collecting all patients diagnosed with squamous cell carcinoma over a period of 5 years. The study population was divided into two groups based on histological differentiation (well-differentiated and non-well-differentiated) and clinical form ( nodulo-ulcerative and nodular). Various dermoscopic parameters were compared between these groups. RESULTS: Out of 72 invasive cSCC, 81.9% were well-differentiated, while 18.1% were non-well-differentiated. The clinical form of cSCC was nodulo-ulcerative in 83.3% of cases and nodular in 16.7%. Well-differentiated tumors showed dotted, glomerular and hairpin vessels, along with a predominant white pattern characterized by centrally distributed keratin as well as white circles, and whitish perivascular halo (P < 0.05). The distribution of these white structures was radial in nodulo-ulcerarive lesions, whereas in nodular lesions, their distribution, as well as that of keratin, was more diffuse (P < 0.05). Non-well-differentiated tumors showed a combined white-red pattern with the predominance of arborizing vessels (P < 0.05). CONCLUSIONS: Our results show the reliability of dermoscopy as a tool for distinguishing between well- and poorly differentiated cSCC. This distinction is characterized by an increase in predominantly arborizing vessels and a corresponding decrease in white structures as the tumor progresses from a well-differentiated to a poorly differentiated state. Additionally, the nodulo-ulcerative form exhibits a central distribution of keratin, while the nodular form displays a diffuse distribution.

The Scale Assessment of Executive Functions-Adult (SAEF-A): Construction of a valid ecological instrument.

OBJECTIVES: This study aims to validate the SAEF-A (Scale Assessment Of Executive Functions-Adult) test, a new instrument for measuring executive functions in adults. MATERIALS AND METHODS: The study participants are residents of Fez-Meknes over 18 years old. Two groups were enrolled: people with epilepsy and a healthy group. We constructed the tests in all three Moroccan languages: Darija, Tamazight, and Arabic. We validated the SAEF-A test according to Bernaud's instructions compared to the BRIEF-A test. RESULTS: The Alpha Cronbach and Split Half were 92% and 88%, respectively. Exploratory research results highlight five facets of perceived value. Significant convergent validation existed between the BRIEF-A subscales and the SAEF-A scale. The results show that the people with epilepsy sample can be discriminated from the healthy ones in all dimensions, except planning, with a minor difference. CONCLUSIONS: The results provide good reliability and validity for the SAEF-A. It will be helpful in studies of Moroccan adults and other people.

Economic burden of chronic obstructive pulmonary disease in Morocco: a cost of illness study.

Chronic obstructive pulmonary disease (COPD) carries an important economic burden worldwide. However, the cost of this disease in Morocco is not well explored. This study aimed to estimate the economic cost associated with COPD in Morocco and identify its determinants. A cost of illness, prevalence-based study using a bottom-up approach method, including COPD patients, was carried out in 2021-2022. The cost was estimated from a societal perspective, and the time horizon was 1 year. Data collection was performed using a questionnaire including socio-demographic, clinical data, and utilization of health care resources in 2019: hospitalization, medical tests, medications, and medical visits. Direct health cost (DHC) was estimated by multiplying the use of health services by the official prices (unit costs) published by the National Agency for Health Insurance. The indirect cost (IC) represented by labor productivity losses was calculated using the human capital method. Costs were compared according to different socio-demographic and clinical factors. We included 159 patients; 82.4% were men, 80.4% were current or former smokers, and 78.7% were categorized as "high-risk" groups (grades C-D). The DHC was estimated at $1816.6 per patient per year. Pharmaceutical and hospitalization costs represented the highest part of the total DHC (42.5% and 22.1%, respectively). The IC was estimated at $709.5±1081.3 per patient per year. DHC increased with increasing disease severity and with the number of severe exacerbations (p<0.001). Current and former smokers were more costly to the healthcare system than nonsmokers (p=0.029). IC also increased with the number of severe exacerbations (p=0.003). In this study, we showed that COPD in Morocco generates important costs for the health system, mainly related to smoking and the severity of the disease. It is therefore important to strengthen tobacco control measures in our country.

Anxiety and Depression in Patients With Chronic Respiratory Diseases in the Fès-Meknès Region of Morocco.

Background Chronic respiratory diseases (CRDs) are a major public health problem in Morocco. Several studies have shown that anxiety and depression are important comorbidities of CRDs and are often associated with CRDs. This study aimed to estimate the prevalence of depression and anxiety and identify their determinants in patients with CRDs. Methodology A cross-sectional study was conducted in the Pneumology Department at the Hassan II University Hospital in Fez in 2021. An anonymous questionnaire was used to collect sociodemographic, clinical, and therapeutic data. The Moroccan version of the Hospital Anxiety and Depression Scale (HADS) was used to measure depression and anxiety. A descriptive analysis was performed, followed by a bivariate analysis to investigate the association between anxiety and depression and other factors using tests appropriate to the types of variables studied. A p-value ≤0.05 was considered significant. Data entry was performed in Excel 2013 (Microsoft Corp., Redmond, WA, USA), and data analysis was done using SPSS software version 26 (IBM Corp., Armonk, NY, USA). Results The study included 209 patients, 50.7% (n = 106) of whom were female, with an average age of 57.84 ± 15.36 years. Chronic obstructive bronchopneumopathy was the most represented CRD (43.1%; n = 90), followed by asthma (32.2%; n = 67). The prevalence of depression and anxiety was 46.4% (n = 97) (95% confidence interval (CI) = 39.2-52.8) and 57.4 % (n = 120) (95% CI = 50.3-63.7), respectively. In the univariate analysis, depression was associated with the presence of dyspnea (51.3% vs. 32.7%; p = 0.018), the presence of asthenia (56.5% vs. 38.5%; p = 0.009), the use of oxygen therapy (66.7% vs. 42.7%; p = 0.015), and a higher number of hospitalizations (76.9% vs. 44.4%; p = 0.023). Moreover, 87.6% of patients with depression also had anxiety (p < 0.001). Anxiety was associated with a history of surgery (37.2% vs. 62.4%; p = 0.003) and with the presence of chronic obstructive pulmonary disease (66.7% vs. 50.4%; p = 0.019). Conclusions The results reveal the importance of screening for anxiety-depressive disorders in patients with CRDs and taking into account psychological aspects in the management of the disease to improve quality of life.

Digestive cancer surgery in low-mid income countries: analysis of postoperative mortality and complications in a single-center study.

PURPOSE: This study aimed to analyze postoperative and 90-day morbidity and mortality and their risk factors in all digestive cancer curative intent resections of a single digestive surgical department in a low-mid income country. METHODS: All consecutive patients who underwent a surgical resection for digestive cancer with a curative intent between January 1, 2021, and December 31, 2021, were included. This is a retrospective analysis of a prospective cancer surgery database managed during the period. Patterns and factors associated with increased morbidity and mortality were analyzed and presented in tabular and descriptive forms. RESULTS: Seventy-six patients were included, 38 (50%) were men with a mean age of 59 years (±13.5). Forty patients (52.63%) had tumors locally advanced, staged CT3-CT4 on preoperative imagery. Thirty-three of our population (43.42%) had laparoscopic surgery (conversion rate at 12.12%). In immediate preoperative, the morbidity rate was 36.84%; among each, 7 patients (9.21%) had serious complications (>2 Clavien-Dindo grade), and mortality rate was 5.26%. At 90 days after surgery, morbidity remained the same, and mortality increased to 7.9%. Risk factors for increased morbidity and mortality were female gender, obesity, high levels of carcinoembryonic antigen, hypoalbuminemia, laparotomy approach, hand sewn anastomosis, prolonged operating time, and wide drainage (p < 0.05). CONCLUSIONS: This study provides figures on mortality and morbidity related to digestive cancer curative surgery in a low-mid income country digestive department and discusses risk factors increasing postoperative complications and death.

Prevalence of epilepsy in Morocco: A population-based study.

OBJECTIVE: In Morocco, there was a lack of data related to the epidemiology of epilepsy. This data serves as a useful basis for the development of any national intervention or action program against epilepsy in Morocco. Through this study, we aimed to estimate the active and lifetime prevalence of epilepsy in Morocco. METHODS: We collected data from eight out of 12 Moroccan regions in two steps: In the screening step, we first used a nationwide telephone diagnosis questionnaire and in the second stage, a team of physicians under the direction of an epileptologist conducted a confirmative survey for suspected cases. We fixed the confidence interval at α = 5% and the precision at 0.02. RESULTS: Up to 3184 responded positively to our invitation to participate in this study and were able to answer the questions of the first diagnostic questionnaire. In the diagnostic phase, physicians in neurology reinterviewed all 86 suspected cases using a confirmative diagnosis questionnaire, and 63 persons were confirmed as having lifetime epilepsy and 56 with active epilepsy. The mean age (Mean ± SD) of persons with epilepsy was 35.53 years (±21.36). The prevalence of lifetime and active epilepsy were 19.8 (19.6-20.0) and 17.6 (17.5-17.8) per 1000 (95% confidence interval), respectively. SIGNIFICANCE: This is the first study to estimate the active and lifetime prevalence of epilepsy in Morocco according to the international recommendations of the ILAE. The prevalence of lifetime and active epilepsy were 19.8 (15-24.6) and 17.6 (13.3-22.8) per 1000, respectively. We included both children and elderly subjects. The rates of active and lifetime population epilepsy prevalence in Morocco ranged between Asian and sub-Saharan Africa low- and middle-income countries.

Management of Chronic Kidney Disease in Morocco: A Cost-of-Illness Study.

INTRODUCTION: Chronic kidney disease (CKD) is a global public health problem. The aim of this study is to estimate the mean annual direct medical cost per patient with CKD before the start of renal replacement therapy (RRT) in Morocco. METHODS: This is a cross-sectional cost-of-illness study, using a prevalence approach among adults with CKD before RRT in a Moroccan university hospital. Information on direct medical costs was collected from the patient's report and associated costs were estimated according to national tariff/fee catalogues. We computed annual direct medical costs using society perspective. Costs were then estimated and compared according to CKD stages, health insurance categories, and monthly income. RESULTS: Eighty-eight participants were included; 63.6% of them were female, their mean age was 61.8±14.0 years, and 76.1% were in stages 4 or 5. The estimated annual direct medical cost of CKD was estimated at $ 2008.80 (95%CI 1528.28-2489.31), Hospitalization, diagnosis, and treatment represented the main expenses of the direct medical cost (32.2%, 29.7%, and 32.2%, respectively). The direct medical cost components were not significantly different between CKD stages. CONCLUSION: The cost of CKD in Morocco in its early stages is still lower than the cost of RRT, which brings to light the necessity of secondary prevention of CKD to postpone or prevent the progression to end-stage renal disease.

The Impact of Systemic Lupus Erythematosus-Related Respiratory Manifestations on the Quality of Life and Psychological Health of Patients During the COVID-19 Pandemic.

Introduction Respiratory manifestations are common among patients with Systemic Lupus Erythematosus (SLE) and can present as chest pain, dyspnea, and cough and are often accompanied by fever. These symptoms can resemble those of COVID-19, which may cause increased anxiety in SLE patients. Therefore, the aim of this study is to investigate the impact of SLE-related respiratory manifestations on anxiety, depression, and quality of life among SLE patients during the COVID-19 pandemic. Patients and methods The study involved SLE patients and was conducted in the year 2020, after the start of the pandemic in Morocco, using a cross-sectional design. Anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale (HADS), while the quality of life was assessed using the Short Form-12 Health Survey (SF12). Statistical analysis was performed using R software (R Foundation, Vienna, Austria). Results A total of 102 SLE patients, with an average age of 41.6 ± 13.7 years, participated in the study, of whom 92.2% were female. Respiratory manifestations were reported by 20.6% of the patients, and there were no significant differences observed in the general characteristics of the study population between the two groups with and without SLE-related respiratory manifestations. The study found that the prevalence of anxiety and depression was significantly higher in patients with SLE-related respiratory manifestations (50% Vs. 76,2% and 50% Vs. 85,7% successively). These patients also reported significantly more impairment in their physical quality of life (31.8 ± 8.9 Vs. 38.5 ± 10.9). This was observed across three domains of the SF12 survey, including physical functioning (34.4 ± 11.4 Vs. 39.9 ± 11.7), bodily pain (26.9 ± 11.2 Vs. 36.1 ± 14.3), and general health (28.6 ± 10.7 Vs. 35.2 ± 12.3). Although the association between mental quality of life and respiratory manifestations did not reach statistical significance (33.5 ± 12.5 Vs. 39.1 ± 11.5), there was a trend toward poorer mental quality of life in patients with SLE-related respiratory manifestations. Moreover, two domains of mental quality of life were significantly more affected in these patients, namely "social functioning" (30.6 ± 11.3 Vs. 38.7 ± 12.4) and "role-emotional" (26.8 ± 11.6 Vs. 33.8 ± 10.8). Conclusion During the COVID-19 pandemic, the presence of SLE-related respiratory manifestations appeared to be associated with a more negative impact on the psychological health and quality of life of SLE patients.

Validation of the Moroccan Arabic Version of the Pediatric International Knee Documentation Committee Score (Pedi-IKDC) Questionnaire for Children With Knee Disorders.

Background The Pedi International Knee Documentation Committee (Pedi-IKDC) is a questionnaire for the evaluation of knee function in children and adolescents with knee disorders. It has been translated and validated into many languages. The aim of this study was to translate this questionnaire into Moroccan Arabic and evaluate its psychometric properties in a pediatric population. Methods The original English version of the questionnaire was translated into Moroccan Arabic according to international guidelines. The Arabic version was administered twice to two groups: a group of children with knee disorders and a control group, and the following properties were calculated: reliability, internal consistency, and discriminant validity. The reliability was assessed using the intraclass correlation coefficient (ICC), standard error of measurement (SEM), and smallest detectable change. Internal consistency was evaluated using Cronbach's alpha. Results A total of 88 cases and 33 controls, aged between 6 and 16 years old, completed the questionnaire. The Pedi-IKDC showed adequate test-retest reliability (interclass correlation coefficient (ICC =0.89), standard error of measurement (SEM= 5.45), smallest detectable change (SDC=15.11), and appropriate internal consistency (Cronbach alpha= 0.7). The Pedi-IKDC was also able to distinguish between patients and controls (P<0.0001). Conclusion The Moroccan-Arabic version of the Pedi-IKDC showed acceptable psychometric properties and can be used in children with knee disorders.

Psychological stress and its related factors among Moroccan nursing students: A cross-sectional study.

OBJECTIVE: This study was performed to evaluate the prevalence and related factors of perceived stress among nursing students at Fez High Institute of Nursing Professions and Health Technics in Morocco. METHOD: A cross-sectional study was used to determine the perceived stress levels and stress-related factors among nursing students enrolled at Fez High Institute of Nursing Professions and Health Technics in Morocco. The Perceived Stress Scale 10, Pittsburgh Sleep Quality Index scale, and Academic Competence, Test Competence, Time Management, and Strategic Studying scale were used to collect data from 405 students enrolled in nursing courses. Univariate and bivariate analyses were conducted using SPSS version 20. RESULTS: Of the 437 nursing students, 405 (105 men and 300 women) completed the survey. A low prevalence of perceived stress (17%; N = 69) was found, with a mean stress score of 17.174,15. The stress level of the students was significantly associated with the year of study of the students, the practice of professional extracurricular activities, the monthly income of the family, and the use of public transportation. In addition, the stress level was associated with the subjective quality of the sleep of the students, sleep latency, diurnal dysfunction, and usual sleep efficiency. In addition, a positive correlation was observed between "time management" scores and "test adaptation skills" scores. However, no significant association was observed between stress scores with the age and gender of the students. CONCLUSION: Considering these results, national universities should employ preventive interventions by disclosing and controlling the associated factors of stress. Thus, the results of this investigation could be effective to determine stress-related factors to provide adequate intervention to this subset of the population.

The prevalence and associated factors of depression, anxiety, and PTSD among Moroccan medical doctors in the COVID-19 pandemic: a national study.

COVID-19 pandemic is facing healthcare professionals with unprecedented challenges, which might alter their mental health. We targeted assessing depression, generalized anxiety, and post-traumatic stress disorder (PTSD) of Moroccan medical doctors during the COVID-19 pandemic; this would allow identifying the associated factors. A cross-sectional national study was carried out on 1267 exposed and unexposed public health medical doctors to COVID-19 patients. The study was conducted between May 15 and 15 June 2020. An anonymous self-administered questionnaire was completed online voluntarily and randomly. We used the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder (GAD-7), and the PTSD Checklist for DSM­5 (PCL-5) to assess depression, generalized anxiety, and PTSD, respectively. The respondents' rate was 63.3%. The mean age was 30.97 ± 6.65 years old, and 59.3% (N = 751) were females with a sex ratio M/F of 0.68. The sample included 43.0% (N = 545) of COVID-19 frontline doctors. Among all participants, 31.5% (N = 400) had depression, 29.2% (N = 370) had generalized anxiety, and 21.7% (N = 276) had PTSD. The average scores of the PHQ-9, the GAD-7, and the PCL-5 were 7.79 (± 5.54), 6.12 (±5.72), and 18.58 (±17.62), respectively. The multivariate logistic regression showed that working in primary and secondary hospitals, moderate and high-stress perceptions, a chronic physical illness, and a family history of psychiatric disorder were independently associated factors of depression, generalized anxiety, and PTSD. The females expressed significantly more anxiety. Doctors living in a family consisting of member with chronic disease showed a significantly higher risk of PTSD. The security sense of contamination risk and low threat perception of COVID-19 were significantly protective factors of depression, anxiety, and PTSD. Moroccan medical doctors are in psychological distress. It is essential to preserve medical doctors' mental well-being health for a better fight against the COVID-19 pandemic through effective and targeted health policies.

Intense Intestinal Carriage of Carbapenemase-Producing Klebsiella pneumoniae Co-harboring OXA-48, KPC, VIM, and NDM Among Preterm Neonates in a Moroccan Neonatal Intensive Care Unit.

INTRODUCTION: This study aimed to investigate the prevalence and the carbapenemase production ability of Klebsiella pneumoniae isolates from premature neonates' intestinal tracts in a Moroccan neonatal intensive care unit Methodology: Active rectal screening was performed among 339 preterm infants. The collected isolates were subjected to antibiotic susceptibility testing, phenotypic analysis of carbapenemase production, and molecular detection of carbapenemase genes. RESULTS: Out of 293 K. pneumoniae isolates collected, 31.05% (91) were resistant to carbapenem and produced carbapenemase, resulting in a 22.12% rate of intestinal carriage. Among the carbapenem-resistant K. pneumoniae isolates, 40.65% (37) had co-harbored carbapenemase genes. All isolates contained the blaOXA-48 gene, and the blaNDM, blaVIM, and blaKPC genes were detected in 30.76%, 9.89%, and 2.19% of the isolates, respectively. Out of 30.76% of these isolates had both the blaOXA-48 and blaNDM genes, 8.79% had both blaOXA-48 and blaVIM, and only 2.20% had both blaOXA-48 and blaKPC genes. Furthermore, 88.57% of carbapenem-resistantK. pneumoniae isolates co-harboring carbapenemase genes were genetically related strains. CONCLUSIONS: This study revealed a high prevalence of intestinal carriage of carbapenem-resistant K. pneumoniae. Therefore, implementing effective screening and diagnostic measures, and focusing on antimicrobial stewardship are essential to preventing the spread of these resistant strains and minimizing the risk they pose to premature infants.

The Moroccan Knee Osteoarthritis Outcome Score (KOOS)-Child Scale: Translation, Cultural Adaptation, and Validation.

Objective The objective of this study was to perform a cross-cultural validation and adaptation of the Moroccan Dialectal Arabic version of the Knee Osteoarthritis Outcome Score (KOOS)-Child scale. Methodology Two groups of participants were recruited: a group of children affected by knee problems and another group serving as a control, free of any knee pathology. Participants were asked to complete the KOOS-Child scale twice with a minimum interval of 15 days. Results This study included 130 patients aged 9.82 ± 3.16 years, comprising 88 (67.7%) patients with knee problems and 42 (32.3%) controls. The baseline comparison showed no statistically significant difference between the two groups. The KOOS-Child scale was translated into Moroccan Dialectal Arabic without encountering difficulties in the translation and cross-cultural adaptation process. It proved practical, reliable, and suitable for assessing problems that children and adolescents with knee disorders may encounter. The scale exhibited good content validity and test-retest reliability. The Moroccan scale also demonstrated excellent internal consistency, except for the symptoms subscale. Confirmatory factor analysis indicated that the structure of the Moroccan version of the KOOS-Child scale was acceptable. Conclusions The Moroccan KOOS-Child scale exhibited good acceptability, reliability, discriminative capacity, and overall good internal consistency, with the exception of the symptoms subscale.

Molecular classification of soft tissue sarcomas for adequate diagnosis: A study on the northeast population of Morocco.

Background: Soft tissue sarcomas (STS) are a heterogeneous group of tumors. For adequate therapeutic management, an accurate diagnosis is necessary. In Morocco, the diagnosis is essentially based on the morphological and immunohistochemical study. Compared to other techniques, fluorescence in situ hybridization (FISH) is easier to develop and less expensive. This study aims to assess the feasibility and utility of implementing FISH technique to improve diagnostic accuracy and establish a good classification. Material and methods: This is a retrospective cohort study. 211 cases of mesenchymal tumors were included. Hematoxylin Eosin Safran (HES) staining was performed in all cases followed by immunohistochemistry (IHC). FISH was performed in all cases with suspected STS. The probes used were EWSR1, MDM2 and SS18. The performance of FISH and histopathological test were evaluated by the ROC curve method (receiver operating characteristic). We evaluated the concordance between FISH and real time PCR by Cohen test. Results: The real-time PCR technique showed good agreement with the FISH test by a Kappa coefficient of 60% (p = 0.035). FISH was able to confirm that it is more accurate (Youden's Index = 91%) than histological/immunohistochemical analysis (Youden's Index = 51%), as well as the positive predictive value was higher (100%) with an ROC curve finding a larger area under the curve of 0.953 (95% CI: 0.918-0.988), p = 0.000 which supports that FISH shows high performance to present an accurate final diagnosis. Conclusion: This is the first and the largest Moroccan series for the molecular diagnosis of STS by FISH. Our study shows that paraffin FISH is a sensitive and specific ancillary tool in the diagnosis of STS when used in the appropriate clinicopathological context.

The Moroccan MoCA test: Translation, cultural adaptation, and validation.

PURPOSE: Dementia includes all the symptoms associated with declining mental and cognitive skills, resulting in an inability to perform daily activities. OBJECTIVES: We aimed to translate and adapt the Montréal Cognitive Assessment (MoCA) test into the Moroccan cultural context. We compared the sensitivity and specificity between MoCA and Mini-Mental State of Folstein (MMS) in the screening of dementia. MATERIALS AND METHODS: The participants in this study were residents in the Fez-Meknes region and over 50 years old. We performed translation and adaptation of the English MoCA 8.1 version into all Moroccan languages: Darija, Tamazight in its three variants (Tachelhit, Tarifit, Atlas Tamazight), and Arabic. We validated Moroccan MoCA according to the Beaton et al. instructions. RESULTS: The sensitivity, specificity, and alpha Cronbach of the MoCA test were 88.5, 93.8%, and 0.87, while they were 90.2, 90.8%, and 0.79 for the MMS test. CONCLUSION: The Moroccan MoCA test had high sensitivity, specificity, and internal reliability compared to the MMS test. The availability of the MoCA in the Moroccan language will be helpful in the screening of dementia and research studies in Morocco and other countries.

Paediatric osteoarticular infections caused by staphylococcus aureus producing panton-valentine leucocidin in morocco: Risk factors and clinical features.

OBJECTIVE: We aimed to estimate the prevalence of Staphylococcus aureus producing Panton-Valentine leucocidin (PVL) isolated from children diagnosed with osteoarticular infections (OAIs), and to examine risk factors and clinical features. METHODS: This prospective study was conducted from January 2017 to December 2018. All hospitalised children diagnosed with S. aureus OAI are included. Blood cultures, articular fluids, synovial tissues and/or bone fragments were collected for bacteriological culture. Antimicrobial susceptibility tests were determined by disk diffusion method. Genes encoding methicillin resistance (mecA) and PVL virulence factors (luk-S-PV and luk-F-PV) were detected by multiplex polymerase chain reaction. The demographic, clinical, laboratory, radiographic and clinical features were reviewed prospectively from medical records. RESULTS: A total of 37 children with S. aureus OAIs were included, 46% of them have PVL-positive infection and 70.6% were male. The mean age was 8.12 years (±4.57), and almost were from rural settings (76.5%). Children with Staphylococcus aureus producing Panton-Valentine leucocidin (SA-PVL) were significantly associated with type of infection (P = 0.005), location of infection (P = 0.037) and abnormal X-ray (P = 0.029). All strains SA-PVL+ are sensitive to methicillin, but one strain SA-PVL negative was methicillin-resistant S. aureus, confirmed by gene mecA positive. CONCLUSION: The prevalence of S. aureus infections producing PVL toxin was high in OAIs amongst Moroccan children, mainly due to methicillin-susceptible S. aureus. Type and location of infections and abnormal X-ray were significantly associated with SA-PVL. Routine diagnostic testing of PVL-SA, continuous epidemiological surveillance and multidisciplinary management of OAI is essential to prevent serious complications.