Modeling scalability of impurity precipitation in downstream biomanufacturing.

Precipitation during the viral inactivation, neutralization and depth filtration step of a monoclonal antibody (mAb) purification process can provide quantifiable and potentially significant impurity reduction. However, robust commercial implementation of this unit operation is limited due to the lack of a representative scale-down model to characterize the removal of impurities. The objective of this work is to compare isoelectric impurity precipitation behavior for a monoclonal antibody product across scales, from benchtop to pilot manufacturing. Scaling parameters such as agitation and vessel geometry were investigated, with the precipitate amount and particle size distribution (PSD) characterized via turbidity and flow imaging microscopy. Qualitative analysis of the data shows that maintaining a consistent energy dissipation rate (EDR) could be used for approximate scaling of vessel geometry and agitator speeds in the absence of more detailed simulation. For a more rigorous approach, however, agitation was simulated via computational fluid dynamics (CFD) and these results were applied alongside a population balance model to simulate the trajectory of the size distribution of precipitate. CFD results were analyzed within a framework of a two-compartment mixing model comprising regions of high- and low-energy agitation, with material exchange between the two. Rate terms accounting for particle formation, growth and breakage within each region were defined, accounting for dependence on turbulence. This bifurcated model was successful in capturing the variability in particle sizes over time across scales. Such an approach enhances the mechanistic understanding of impurity precipitation and provides additional tools for model-assisted prediction for process scaling.

Does cannabis affect cognitive functioning in patients with schizophrenia?

Introduction: Cannabis use impairs cognitive performance in healthy subjects; several studies have shown improved cognitive outcomes in schizophrenic patients using cannabis. The aim of this study was to evaluate the effects of cannabis use on cognitive function in Moroccan patients with schizophrenia who were cannabis users. Method: Two groups were recruited in a Moroccan University Psychiatric Centre. Fifty patients diagnosed with schizophrenia according to the DSM-V who were cannabis users (SZ CANN +) and forty-nine patients diagnosed with schizophrenia according to DSM-V who do not use cannabis (SZ CANN-). Cognitive functioning was assessed using the CogState neuropsychological battery. Results: The results of the study suggest that SZ CANN- patients performed better in the test of psychomotor function, attention and verbal memory. While SZ CANN+ patients performed better in the test of working memory, visual memory and emotional recognition. We found no relationship between SZ CANN+ patients and SZ CANN- patients concerning executive function. Conclusions: Our results suggest that cannabis use may have different effects on neurocognitive functioning. It is associated with disorders of psychomotor function, attention and verbal memory. So, it is associated with an improvement in working memory, visual memory and emotion recognition.

[Factors associated with the risk of developing eating disorders among medical students in Casablanca, Morocco]. / Facteurs associés au risque de troubles du comportement alimentaire chez les étudiants en médecine de Casablanca, Maroc.

INTRODUCTION: eating disorders (EDs) are particularly common among young adults, including students. The purpose of this study is to determine eating disorder prevalence among medical students in Casablanca and to assess the risk of developing EDs on the bases of associated factors including socioeconomic factors, clinical features, anxiety and depression. METHODS: we conducted a cross-sectional, descriptive and analytical study at the Ibn Rochd University Hospital and at the Faculty of Medicine and Pharmacy of Casablanca, Morocco, during the academic year 2016-2017. The survey involved a sample of 506 students. We used the SCOFF-F (Sick, Control, One Stone, Fat, Food, French version) questionnaire, a validated tool for eating disorders and the hospital anxiety and depression scale (HAD) for anxiety and depression. RESULTS: the SCOFF questionnaire found that 127 people out of 506 (25.09%) were likely to suffer from eating disorders. Age, educational level, weight-management tools, anxiety and depression were significantly associated with the risk of developing eating disorders among medical students. CONCLUSION: our results are in agreement with data from the literature concerning eating disorder rates in the student population and, more specifically, among medical students. Further, studies of a more heterogeneous population are needed to have a more global vision of the situation in Morocco.

COVID-19: Patient care after discharge from the Intensive Care Unit.

INTRODUCTION: The Ibn Rochd CHU is a tertiary care structure that provides care for the most severe cases of COVID-19 requiring hospitalisation in intensive care. The objective of study is to describe the complementary medical and psychological care of patients with COVID-19 in the endocrinology department after a stay in intensive care. PATIENTS AND METHODS: This is a descriptive observational study of patients transferred from the intensive care unit to the endocrinology service following a COVID-19 infection during the period from 17 April 2020 to May 26, 2020. Clinical characteristics of the patients and complications related to COVID-19 infection were studied; a nutritional assessment using the MNA nutritional status assessment questionnaire; psychological assessment using quality-of-life questionnaires (Hamilton depression and anxiety, HAD, SF36, PCLS); a treatment satisfaction questionnaire (TQCMII) and an assessment of patient autonomy by the ADL score. RESULT: Our study included 41 patients with an average age of 55 years (19-85 years), a sex ratio M/F of 1.05, 43.9% were diabetic, 34.1% hypertensive, 4.9% asthmatic and 5% obese, and 51.2% were severe and critical cases. The average ICU stay is 8.42 days, requiring intubation in 12.2% of cases. All patients were treated with the Hydroxychloroquine, Azithromycin, vitamin C, zinc and corticosteroid protocol, 14.6% had undernutrition and 65.9% had a risk of undernutrition. The average BMI was 25.34 kg/m2 (17-42), 61% had experienced weight loss, which was greater than 8 kg in 26.1% of cases, 12.2% of patients were not autonomous, 12.2% had moderate depression, 2.4% severe depression, 14.6% mild to moderate anxiety, 12.2% severe anxiety and 29.3% suffered acute post-traumatic stress disorder. CONCLUSION: Patients with COVID-19 are, in addition to the complications from coronavirus infection, vulnerable to undernutrition, psychological and motor complications. Additional care before discharge is essential for better integration of patients into their families.

Real-Time Monitoring System to Manage Mental Healthcare Emergency Unit.

OBJECTIVES: Real-time relevant information helps guide the healthcare decision-making process in daily clinical practice as well as the management and optimization of healthcare processes. However, proprietary business intelligence suite solutions supporting the production of decision-making information requires investment that is out of reach of small and mediumsized healthcare facilities or those with limited resources, particularly in developing countries. This paper describes our experience in designing and implementing a real-time healthcare monitoring system solution to manage healthcare emergency units. METHODS: Through the use of free Business Intelligence tools and Python data science language we designed a real-time monitoring system, which was implemented to explore the Electronic Medical Records system of a university mental health emergency unit and render an electronic dashboard to support health professional daily practice. RESULTS: Three main dashboards were created to monitor patient waiting time, to access the clinical notes summary for the next waiting patient, and to obtain insights into activity during the last 24 hours. CONCLUSIONS: The designed system could serve as a monitoring support model using free and user-friendly data science tools, which are good alternatives to proprietary business intelligence solutions and drastically reduce cost. Still, the key to success in decision-making systems is based on investment in human resources, business intelligence skills training, the organizational aspect of the decision-making process, and data production quality insurance.

Monitoring Mental Healthcare Services Using Business Analytics.

OBJECTIVES: Monitoring healthcare activities is the first step for health stakeholders and health professionals to improve the quality and performance of healthcare services. However, monitoring remains a challenge for healthcare facilities, especially in developing countries. Fortunately, advances in business analytics address this need. This paper aims to describe the experience of a low-income healthcare facility in a developing country in using business analytics descriptive techniques and to discuss business analytics implementation challenges and opportunities in such an environment. METHODS: Business analytics descriptive techniques were applied on 3 years' electronic medical records of outpatient consultation of the University Psychiatric Centre (CPU) of Casablanca. Statistical analysis was conducted to compare results over years. RESULTS: Over the 3 monitored years, the monthly number of computerized physician order entries increased significantly (p < 0.001). Physicians improved their personal recording over years. Schizophrenia as well as depressive and bipolar disorders were noted at the top of outpatient mental disorders. Antipsychotics are the most prescribed drugs, and a significant annual decrease in outpatient care wait time was noted (p < 0.001). CONCLUSIONS: Business analytics allowed CPU to monitor mental healthcare outpatient activity and to adopt its business processes according to outcomes. However, challenges mainly in the organizational dimension of the decision-making process and the definition of strategic key metrics, data structuration, and the quality of data entry had to be considered for the optimal use of business analytics.

How service users and carers understand, perceive, rephrase, and communicate about "depressive episode" and "schizophrenia" diagnoses: an international participatory research.

BACKGROUND: For ICD-11, the WHO emphasized the clinical utility of communication and the need to involve service users and carers in the revision process. AIMS: The objective was to assess whether medical vocabulary was accessible, which kinds of feelings it activated, whether and how users and carers would like to rephrase terms, and whether they used diagnosis to talk about mental health experiences. METHOD: An innovative protocol focused on two diagnoses (depressive episode and schizophrenia) was implemented in 15 different countries. The same issues were discussed with users and carers: understanding, feelings, rephrasing, and communication. RESULTS: Most participants reported understanding the diagnoses, but associated them with negative feelings. While the negativity of "depressive episode" mostly came from the concept itself, that of "schizophrenia" was largely based on its social impact and stigmatization associated with "mental illness". When rephrasing "depressive episode", a majority kept the root "depress*", and suppressed the temporal dimension or renamed it. Almost no one suggested a reformulation based on "schizophrenia". Finally, when communicating, no one used the phrase "depressive episode". Some participants used words based on "depress", but no one mentioned "episode". Very few used "schizophrenia". CONCLUSION: Data revealed a gap between concepts and emotional and cognitive experiences. Both professional and experiential language and knowledge have to be considered as complementary. Consequently, the ICD should be co-constructed by professionals, service users, and carers. It should take the emotional component of language, and the diversity of linguistic and cultural contexts, into account.

[Risperidone and carbamazepine-induced syndrome of inappropriate antidiuretic hormone secretion: case study]. / Syndrome de sécrétion inappropriée d'hormone antidiurétique secondaire à la rispéridone et la carbamazépine: à propos d'un cas.

The inappropriate antidiuretic hormone secretion Syndrome (ADHS) accounts for approximately 50% of all diagnosed cases of hyponatremia while drug-induced ADHS accounts for a small proportion of cases. We report the case of a female patient, treated for schizoaffective disorder, who developed ADHS following the initiation of risperidone and carbamazepine. Biochemical test results suggested risperidone and carbamazepine-induced ADHS. The patient was successfully treated by stopping drug use and by fluid restriction. After correcting the serum sodium levels, the patient was treated with clozapine. She is currently on clozapine 400mg with stable serum sodium rates. Psychiatrists should be aware of the risk of severe hyponatremia associated with psychotropic drug use. It is therefore essential to monitor electrolyte levels, in particular sodium levels, in patients taking antipsychotics and anticonvulsants.

Comparison of eosin and fluorescein conjugates for the photoinitiation of cell-compatible polymer coatings.

Targeted photopolymerization is the basis for multiple diagnostic and cell encapsulation technologies. While eosin is used in conjunction with tertiary amines as a water-soluble photoinitiation system, eosin is not widely sold as a conjugate with antibodies and other targeting biomolecules. Here we evaluate the utility of fluorescein-labeled bioconjugates to photopolymerize targeted coatings on live cells. We show that although fluorescein conjugates absorb approximately 50% less light energy than eosin in matched photopolymerization experiments using a 530 nm LED lamp, appreciable polymer thicknesses can still be formed in cell compatible environments with fluorescein photosensitization. At low photoinitiator density, eosin allows more sensitive initiation of gelation. However at higher functionalization densities, the thickness of fluorescein polymer films begins to rival that of eosin. Commercial fluorescein-conjugated antibodies are also capable of generating conformal, protective coatings on mammalian cells with similar viability and encapsulation efficiency as eosin systems.

[Evaluation of burnout syndrome among doctors in training at the Ibn Rochd University Hospital, Casablanca]. / L'évaluation du syndrome du Burnout chez les médecins en formation au CHU Ibn Rochd de Casablanca.

METHODS: We conducted a descriptive cross-sectional study of a sample of 300 physicians using self-administered questionnaire over the period 2013- 2014. Burnout has been operationally defined through a French translation of the Maslach Burnout Inventory (MBI). RESULTS: A total of 191 physicians participated in the study (response rate 63.7%) with a female predominance at 79.1% and an average age of 26.7 years (N = 3). The average scores of sub-dimensions of the MBI: emotional exhaustion, depersonalization and personal fulfilment were (33.7±10.7), (12.2±6.5) and (30.6±8.3) respectively. 31.8% of participants suffered from severe burnout. It was associated with communication problems within the healthcare team (p < 0.01), insufficient accompaniment (p < 0.05), dissatisfaction among seniors (p = 0.01), fear of making medical errors (p<0.05), use of a psychotherapist (p<0.001), use of psychotropic drugs (p = 0.001), anxiety disorders (p < 0.01), depression (p < 0.01) and suicidal ideation (p < 0.05). Protective factors were: sense of equity within the healthcare team (p < 0.01) and practice of leisure (p<0.05). Changing career direction was associated with severe burnout (p<0.05). CONCLUSION: These results are consistent with those of previous studies and justify the importance of a prevention program at different levels.

[Noise Effects on Mental Health: a review of literature]. / Les effets du bruit sur la santé mentale : recension des écrits.

UNLABELLED: Any human activity generates noise. It is considered as a risk factor for people's health. The present review of literature has assessed the impact of noise on mental health; it is summarized into four points: objective, methods, results and conclusion. OBJECTIVE: The main objective of this study is to expose the actual knowledge state of noise effects on mental health after overview and critical analysis of literature to identify the acquired and shortcomings, to reflect on research direction in terms of noise pollution in the future. METHODS: The literature review was conducted based on: research of keys words in articles published, research of the number of quotations of articles in Journal Citation Reports (JCR), published in web of science, research of impact factor of journals. One hundred articles were selected, after analyzing contents, items were classified into: fundamental studies (25%), experimental studies (50%), and epidemiological studies (25%). RESULTS: The fundamental studies have verified the hypothesis according to which noise generates stress. Researchers have dosed hormones of stress in plasma, urine and saliva in individuals exposed to noise of different decibels. The results found were unanimous: The rates of stress hormones found, were significantly high in three liquids. This means that noise causes stress. For experimental studies, researchers have experienced the role of noise on memory, attention and performance. Human subjects were exposed to different decibels to assess level of disruption to their memory, attention, and performance. The results revealed that noise disturbs memory, distracts attention and decreases performance. Experimental studies are the most abundant and constitute 50% of the current literature review.The epidemiological studies have evaluated the intellectual performance of students in schools located in noisy environments and residents in areas surrounding airports, railways and highways. RESULTS have revealed that students in schools located in noisy environments have presented cognitive impairment. CONCLUSION: This review of literature on noise effects on mental health lead to the following conclusion. It seems to exist a consensus in fundamental and experimental studies on the detrimental effect of noise but results from epidemiological are not convincing and require further studies.

Prevalence of stress in Casablanca medical students: a cross-sectional study.

INTRODUCTION: Recently, an important literature data has reported that medical students experience stress more than students in other disciplines. In contrast, there is a significant shortage of the stress impact on the academic performance. The primary purpose of our study was to determine the prevalence of stress among Casablanca Medical students and to investigate if there is an association between stress and academic skills. METHODS: A total of 275 participants studying at Casablanca Medical School were included. The study was conducted using a self-administered, anonymous questionnaire, which included four subscales on academic skills perception (Academic competence, Test competence, Time management and Strategic study habits) and a Test Anxiety scale to assess the degree of stress related to exams among medical students. RESULTS: The overall findings showed that 52.7% of respondents were stressed by examinations, and the highest stress prevalence was among the fifth-year medical students. Measures of comparative stress degrees between male and female students did not show any statistical significant differences (p=0.34). Correlation analysis revealed negative association between stress and academic competence (-0.394), test competence (-0.426), time management (-0.240), strategic study (-0.183) respectively (p<0.001). CONCLUSION: Medical educators and psychologists have to increase clinical awareness of stress among medical students, by establishing strategies for stress management.

Prevalence of anxiety disorders: a population-based epidemiological study in metropolitan area of Casablanca, Morocco.

BACKGROUND: In Morocco, no epidemiological study has been conducted to show the current prevalence of mental disorders in the general population. The aim of the present study was to assess the prevalence and comorbidity of anxiety disorders in Moroccan subjects. METHODS: We used cross-sectional study, with a representative sample of Casablanca city. Direct interviews used the Mini International Neuropsychiatric Interview in its validated Moroccan Arabic version RESULTS: Among 800 subjects, 25.5% met criteria of at least one current anxiety disorder: Panic Disorder (2%), Agoraphobia (7.6%) Social phobia (3.4), Obsessive Compulsive Disorder (6.1%), Post Traumatic Stress Disorder (3.4%), Generalized Anxiety Disorder (4.3%) CONCLUSION: The results are generally similar to those of Western countries. Future studies need to replicate these results and to concentrate on their impact on the quality of life and the cost of such conditions in the community.

Assessment of suicidality in a Moroccan metropolitan area.

BACKGROUND: The aim of the study was to evaluate the prevalence of suicidal ideations and suicide attempts in a representative sample of the general population of the urban area of Casablanca, Morocco. METHODS: The survey was conducted based on face-to-face household interviews. The Mini International Neuropsychiatric Interview (M.I.N.I.) was used to assess axis I diagnoses according to DSM-IV criteria and the M.I.N.I. suicidality module to rate the severity of active suicidality. RESULTS: The 1-month prevalence of suicidal ideation was 6.3%. Seventeen subjects (2.1%) reported at least one suicide attempt during their lifetime. Some variables were positively associated to suicidal ideation: the non-married status, subjects with a history of psychiatric disorders, and subjects without children. At least one mental disorder was present among 88.2% of subjects with suicidal ideation. Major depressive disorder was the most prevalent one (23.5%). LIMITATIONS: The sample was small and the prevalence was not determined longitudinally. CONCLUSION: Suicidal ideation being relatively frequent in the general population, there is a need to develop programs of prevention of suicide.

Validity of the depressive dimension extracted from principal component analysis of the PANSS in drug-free patients with schizophrenia.

Depressive symptoms frequently occur during the course of schizophrenia. This study explored the relationships between the schizophrenia symptomatology and three measures of depression. Eighty-one drug-free inpatients with acute schizophrenia were assessed with the positive and negative syndrome scale (PANSS), the Calgary depression scale for schizophrenia (CDSS), and the Hamilton rating scale for depression (HAM-D). The depressive subscale of PANSS (PANSS-D) was also considered as a third scale for measuring depression. A principal component analysis (PCA) of PANSS items identified five clinical dimensions of schizophrenia called 'negative', 'positive', 'anxio-depressive', 'excitement', and 'disorganisation and others'. Our anxio-depressive dimension (PANSS-ad) was strictly identical with the PANSS-D. Scores on CDSS and HAM-D were highly inter-correlated and highly correlated with the PANSS-ad. Furthermore, while scores on CDSS were correlated only with this dimension, scores at HAM-D were also positively correlated with the negative dimension and negatively correlated with the excitement dimension. In conclusion, our results suggest that PANSS evaluation itself may be sufficient to give a correct approximation of the depression in patients with schizophrenia. However, depression scales are of course needed to assess specifically depressive symptoms in patients with schizophrenia; hence, the CDSS could be a more specific instrument than HAM-D.