Association of Renin-Angiotensin Pathway Gene Polymorphisms with COVID-19 Susceptibility and Severity in Moroccans: A Case-Control Study.

Infection by the recent SARS-CoV-2 virus causes the COVID-19 disease with variable clinical manifestations ranging from asymptomatic or mild respiratory symptoms to severe respiratory distress and multiorgan failure. The renin-angiotensin system, responsible for maintaining homeostasis and governing several critical processes, has been considered the main system involved in the pathogenesis and progression of COVID-19. Here, we aimed to assess the possible association between variants in the RAS-related genes and COVID-19 susceptibility and severity in a sample of the Moroccan population. A total of 325 individuals were recruited in this study, with 102 outpatients, 105 hospitalized patients, and 118 healthy controls negative for SARS-CoV-2 infection, and subjected to NGS gene panel sequencing containing eleven RAS pathway genes. A total of 65 functional variants were identified, including 63 missenses, 1 splice, and 1 INDEL. Most of them were rare, with 47 (72%) found in a single individual. According to the common disease/common variant hypothesis, five common candidate variants with MAF > 10% were identified (ACE2 rs2285666, TMPRSS2 rs12329760, AGT rs699 genes, ACE rs4341, and ACE rs4343). Statistical analysis showed that the ACE rs4343 AA genotype was associated with a 2.5-fold increased risk of severe COVID-19 (p = 0.026), and the T genotype of the ACE2 rs2285666 variant showed a borderline association with susceptibility to SARS-CoV-2 in males (p = 0.097). In conclusion, our results showed that the RAS pathway genes are highly conserved among Moroccans, and most of the identified variants are rare. Among the common variants, the ACE rs4343 polymorphism would lead to a genetic predisposition for severe COVID-19.

Prevalence of the protective OAS1 rs10774671-G allele against severe COVID-19 in Moroccans: implications for a North African Neanderthal connection.

The clinical presentation of COVID-19 shows high variability among individuals, which is partly due to genetic factors. The OAS1/2/3 cluster has been found to be strongly associated with COVID-19 severity. We examined this locus in the Moroccan population for the occurrence of the critical variant rs10774671 and its respective haplotype blocks. The frequency of single-nucleotide polymorphisms (SNPs) in the cluster of OAS immunity genes in 157 unrelated individuals of Moroccan origin was determined using an in-house exome database. OAS1 exon 6 of 71 SARS-CoV-2-positive individuals with asymptomatic/mild disease and 74 with moderate/severe disease was sequenced by the Sanger method. The genotypic, allelic, and haplotype frequencies of three SNPs were compared between these two groups. Finally, males in our COVID-19 series were genotyped for the Berber-specific marker E-M81. The prevalence of the OAS1 rs10774671-G allele in present-day Moroccans was found to be 40.4%, which is similar to that found in Europeans. However, it was found equally in both the Neanderthal GGG haplotype and the African GAC haplotype, with a frequency of 20% each. These two haplotypes, and hence the rs10774671-G allele, were significantly associated with protection against severe COVID-19 (p = 0.034, p = 0.041, and p = 0.008, respectively). Surprisingly, in men with the Berber-specific uniparental markers, the African haplotype was absent, while the prevalence of the Neanderthal haplotype was similar to that in Europeans. The protective rs10774671-G allele of OAS1 was found only in the Neanderthal haplotype in Berbers, the indigenous people of North Africa, suggesting that this region may have served as a stepping-stone for the passage of hominids to other continents.

Effectiveness of Sinopharm's BBIBP-CorV Booster Vaccination against COVID-19-Related Severe and Critical Cases and Deaths in Morocco during the Omicron Wave.

OBJECTIVE: This study investigates the effectiveness of the 1st booster dose against COVID-19 severe and critical hospitalizations and deaths occurring due to the Omicron wave in Morocco. PARTICIPANTS/METHODS: This study uses nationally representative data on COVID-19 from 15 December 2021 to 31 January 2022. The aim is to investigate the effectiveness of the inactivated COVID-19 vaccine BBIBP-CorV (Sinopharm) 1st booster dose against the Omicron wave in Morocco using real-world data established from nationally representative statistics on COVID-19 cases, deaths and vaccinations. STATISTICAL ANALYSES: The screening method was used to estimate vaccine effectiveness against COVID-19 severe or critical hospitalization and COVID-19-related deaths. The data were grouped by, age subgroup, sex, week, and geographical area and were analyzed using binary logistic regression with an offset for vaccine coverage. RESULTS: The overall BBIBP-CorV VE estimate is 89% (95% CI 85 to 92) effective in curbing COVID-19 deaths, and 81% (95% CI 78 to 84 in curbing COVID-19 severe/critical hospitalizations. Death-related VE estimate was 86% (95% CI 81 to 90) for patients aged ≥65 years, 96% (95% CI 90 to 98) for those aged <65 years, 95% (95% CI 88 to 98) in no-risk factor patients, 91% (95% CI 85 to 94) with 1 risk factor, 90% (95% CI 83 to 95) with 2 risk factors, and 72% (95% CI 52 to 84) in patients with 3 risk factors and more. Severe/critical hospitalization VE estimate was 78% (95% CI 74 to 82) for patients aged ≥65 years, 87% (95% CI 82 to 90) for those aged <65 years, 86% (95% CI 80 to 90) in no-risk factor patients, 80% (95% CI 73 to 84) with 1 risk factor, 80% (95% CI 70 to 85) with 2 risk factors, and 80% (95% CI 68 to 86) in patients with 3 risk factors and more. CONCLUSIONS: BBIBP-CorV boosters are effective in increasing protection against the Omicron variant-related COVID-19 deaths and severe/critical hospitalizations. The protection is reduced with older age and higher risk factors. These findings emphasize the importance of targeted vaccination strategies for different demographic groups and underscore the protective benefits of the first booster BBIBP-CorV vaccine.

Psychological Distress Associated with Enforced Hospital Isolation Due to COVID-19 during the "Flatten the Curve" Phase in Morocco: A Single-Center Cross-Sectional Study.

(1) Background: although much research has highlighted the mental health challenges faced by patients in hospital isolation during the COVID-19 pandemic, data from low-middle-income countries, including Morocco, are lacking. The main objective of this study was to assess the psychological distress of patients undergoing enforced hospital isolation during the initial phase of the COVID-19 pandemic in Morocco. (2) Methods: we conducted a cross-sectional study between 1 April and 1 May 2020, among patients hospitalized in isolation for suspected or confirmed COVID-19 at the Ibn Sina University Hospital of Rabat, Morocco. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS). Binary logistic regression was performed to identify variables associated with anxiety and depression, with a cutoff of ≥8 used for both scales to create dichotomous variables. (3) Results: among 200 patients, 42.5% and 43% scored above the cut-off points for anxiety and depression, respectively. Multiple logistic regression identified female gender, a higher education level, a longer duration of isolation, and a poor understanding of the reasons for isolation as significant factors associated with anxiety. Conversely, female gender, chronic disease, a longer duration of isolation, and a poor understanding of the reasons for isolation were factors significantly associated with depression. (4) Conclusions: our study underscores high rates of anxiety and depression among patients forced into hospital isolation during the initial phase of COVID-19 in Morocco. We identified several factors associated with patients experiencing psychological distress that may inform future discussions on mental health and psychiatric crisis management.

Factors associated with psychological burden of breast cancer in women in Morocco: cross­sectional study.

BACKGROUND: Depression and anxiety are among the psychological diagnoses impacting individuals diagnosed with breast cancer. This study aims to estimate the prevalence, as well as the predictors, of anxiety and depression in women with breast cancer. MATERIALS AND METHODS: This was a cross-sectional, multi-center study conducted over an eight-month period among women with breast cancer in oncology centers in southern Morocco. Anxiety and depression were assessed using the validated Moroccan dialectal version of the Hospital Anxiety and Depression Scale (HADs). To identify the predictors of anxiety and depression in the study population. Multiple linear regression analyses were performed, including variables for which univariate analyses were significant with a p < 0.05 value. Statistical analyses were performed using Jamovi software version 2.2.3. RESULTS: A total of 230 participant responses were collected. The prevalence of anxiety and depression was 77.4% and 62.6%, respectively. Multiple linear regression analysis revealed the following factors increased anxiety: being younger than 50 years old, not having studied beyond elementary school, having children aged between 10 and 18 and having TNM stage III and IV. The following factors decreased anxiety in patients with breast cancer: good physical functioning (Karnofsky score), satisfaction with social support and financial support. Regarding depression, the following factors decreased depression: good physical functioning (Karnofsky score), a minimum of 2.5 h per week of physical activity, active occupational status, satisfaction with social support and financial support. In contrast, the recurrence of breast cancer was an associated factor with increased depression. CONCLUSION: The prevalence of anxiety and depression in women with breast cancer is very high in our context. Therefore, routine screening tests for depression and anxiety as well as psychosocial management care are necessary for patients with breast cancer in Morocco.

Factors associated with recognition at work among nurses and the impact of recognition at work on health-related quality of life, job satisfaction and psychological health: a single-centre, cross-sectional study in Morocco.

OBJECTIVES: To describe the sociodemographic, occupational and health factors that influence nurses' recognition at work and to examine a recognition pathway model to assess the relationship between recognition at work and health-related quality of life (HRQOL), job satisfaction, anxiety and depression. DESIGN: This is a cross-sectional observational study with prospective data collection based on a self-report questionnaire. SETTING: University hospital centre in Morocco. PARTICIPANTS: The study included 223 nurses with at least 1 year of practice at the bedside in care units. MEASURES: We included the sociodemographic, occupational and health characteristics of each participant. The Fall Amar instrument was used to measure job recognition. HRQOL was measured using the Medical Outcome Study Short Form 12. The Hospital Anxiety and Depression Scale was used to assess anxiety and depression. Job satisfaction was measured using a rating scale (ranging from 0 to 10). Path analysis was used to examine the nurse recognition pathway model to assess the relationship between nurse recognition at work and key variables. RESULTS: The participation rate in this study was 79.3%. Institutional recognition was significantly correlated with gender, midwifery specialty and normal work schedule: ß=-5.10 (-8.06, -2.14), ß=-5.13 (-8.66, -1.60) and ß=-4.28 (-6.85, -1.71), respectively. Significant correlations were found between recognition from superiors and gender, mental health specialisation and normal work schedule: ß=-5.71 (-9.39, -2.03), ß=-5.96 (-11.17, -0.75) and ß=-4.04(-7.23, -0.85), respectively. Recognition from coworkers was significantly associated with mental health specialisation: ß=-5.09 (-9.16, -1.01). The trajectory analysis model found that supervisor recognition had the best impact on anxiety, job satisfaction and HRQOL. CONCLUSIONS: Recognition from superiors is important in maintaining nurses' psychological health, HRQOL and job satisfaction. Therefore, managers in hospitals should address the issue of recognition at work as a potential personal, professional and organisational lever.

Comparison of the psychological health of students at the higher institutes of nursing and health techniques: A Moroccan multicentre study.

BACKGROUND: Mental health is essential to students' academic success as well as their ability to participate fully and meaningfully throughout all aspects of their lives and throughout their lifespan. AIMS: This study aims to determine the psychological health status of Moroccan nursing and technique health students. In doing so, it also seeks to compare differences based on sociodemographic factors. METHOD: A multicenter cross-sectional study with a convenience sample was conducted with 2,054 participants in the academic year of 2018/2019. A set of socio-demographic information were collected, and The General Health Questionnaire-12 (GHQ-12) was used. RESULTS: The mean GHQ-12 score was 4.33 ± 2.61, and 58.7% respondents scored 4 and above in the GHQ-12 scores and thus were considered to be in psychological distress. Students' psychological distress was associated with female gender (60.4% for female compared to 52.4% for men, p = .003); living in parental residence (61.6% compared to 54.7% living away parental residence; p = .02 ), the second and the third training level year respectively (64.6%; 59.2%) compared to first-year (55.2%, p = .001), and midwifery and nursing students (61.6%; 60.3%) as compared to technique health students (43.6%, p = .001). CONCLUSIONS: It appears that a substantial number of students have psychological distress and this is likely to have negative effects on students' educational attainment and wider wellbeing.

Long term effectiveness of inactivated vaccine BBIBP-CorV (Vero Cells) against COVID-19 associated severe and critical hospitalization in Morocco.

BACKGROUND: We provide national estimates of the real-world Vaccine effectiveness (VE) based on nationally available surveillance data. The study aimed to estimate the effectiveness of the inactivated Covid-19 vaccine BBIBP-CorV (Vero Cells) Sinopharm vaccine currently deployed in Morocco against SARS- CoV-2 severe disease/ hospitalization" within 9 months after vaccination. METHODS: We conducted a test-negative, case-control study among a population aged 18 years or older who were tested by rt-PCR for SARS-CoV-2 infection from February to October 2021 in Morocco. From the national laboratory COVID-19 database; we identified cases who were rt-PCR positive amongst severe and critical COVID-19 cases and controls who had a negative rt-PCR test for SARS-CoV-2. From the national vaccination register (NVR); individuals vaccinated with COVID-19 Vaccine (Vero Cell) and those unvaccinated were identified and included in the study. The linkage between databases was conducted for the study of Vaccination status based on the timing of the vaccine receipt relative to the SARS-CoV-2 rt-PCR test date. For each person, who tested positive for SARS-CoV-2, we identified a propensity score-matched control participant who was tested negative. We estimated vaccine effectiveness against SARS- CoV-2 severe disease/ hospitalization using conditional logistic regression. RESULTS: Among 12884 persons who tested positive and 12885 propensity score-matched control participants, the median age was 62 years, 47.2% of whom were female. As a function of time after vaccination of second dose vaccination, vaccine effectiveness during the first month was 88% (95% CI, 84-91), 87% (95% CI: 83-90) during the second and third month, 75% (95% CI: 67-80) during the fourth month, 61% (95% CI: 54-67) during the fifth month, and 64% (95% CI: 59-69) beyond the sixth month. VE remained high and stable during the first three months in the two-age subgroup. In the fourth month, the VE in the older population aged 60 years and above (64%) was reduced by 20 points compared to VE in the younger population (84%). CONCLUSION: A Sinopharm vaccine is highly protective against serious SARS-CoV-2 infection under real-world conditions. Protection remained high and stable during the first three months following the second dose and decreases slightly beyond the fourth month especially beyond 60 years.

Real-world study of the effectiveness of BBIBP-CorV (Sinopharm) COVID-19 vaccine in the Kingdom of Morocco.

BACKGROUND: The Kingdom of Morocco approved BBIBP-CorV (Sinopharm) COVID-19 vaccine for emergency use on 22 January 2021 in a two-dose, three-to-four-week interval schedule. We conducted a retrospective cohort study to determine real-world BBIBP-CorV vaccine effectiveness (VE) against serious or critical hospitalization of individuals RT-PCR-positive for SARS-CoV-2 during the first five months of BBIBP-CorV use in Morocco. METHODS: The study was conducted among adults 18-99 years old who were tested by RT-PCR for SARS-CoV-2 infection between 1 February and 30 June 2021. RT-PCR results were individually linked with outcomes from the COVID-19 severe or critical hospitalization dataset and with vaccination histories from the national vaccination registration system. Individuals with partial vaccination (< 2 weeks after dose two) or in receipt of any other COVID-19 vaccine were excluded. Unadjusted and adjusted VE estimates against hospitalization for serious or critical illness were made by comparing two-dose vaccinated and unvaccinated individuals in logistic regression models, calculated as (1-odds ratio) * 100%. RESULTS: There were 348,190 individuals able to be matched across the three databases. Among these, 140,892 were fully vaccinated, 206,149 were unvaccinated, and 1,149 received homologous BBIBP-CorV booster doses. Unadjusted, full-series, unboosted BBIBP-CorV VE against hospitalization for serious or critical illness was 90.2% (95%CI: 87.8-92.0%). Full-series, unboosted VE, adjusted for age, sex, and calendar day of RT-PCR test, was 88.5% (95%CI: 85.8-90.7%). Calendar day- and sex-adjusted VE was 96.4% (95%CI: 94.6-97.6%) for individuals < 60 years, and was 53.3% (95%CI: 39.6-63.9%) for individuals 60 years and older. There were no serious or critical illnesses among BBIBP-CorV-boosted individuals. CONCLUSIONS: Effectiveness of Sinopharm's BBIBP-CorV was consistent with phase III clinical trial results. Two doses of BBIBP-CorV was highly protective against COVID-19-associated serious or critical hospitalization in working-age adults under real-world conditions and moderately effective in older adults. Booster dose vaccination was associated with complete protection, regardless of age, although only a small proportion of subjects received booster doses.

Clinical learning environment, supervision and nurse teacher (CLES+T) scale: Translation and validation of the Arabic version.

AIM: This study aimed to translate the Clinical Learning Environment, Supervision and Nurse Teacher (CLES + T) scale into Arabic and to evaluate its psychometric properties in the context of Morocco. BACKGROUND: The CLES + T scale is internationally valid and reliable instrument used to evaluate the quality of the clinical learning environment for students in the health professions. DESIGN: Transcultural validation study METHODS: The present study was carried out between March and May 2019 at two public nursing education institutions in Morocco. The sample included 1550 undergraduate students enrolled in the first, second and third year of nursing, midwifery and health-techniques degree program and who have just completed a course of clinical practicum in hospital ward or primary healthcare settings. The CLES + T scale was translated into Arabic and back-translated. Internal consistency reliability and construct validity using exploratory and confirmatory factor analysis were conducted. RESULTS: The CLES+T scale showed alpha coefficients ranging from 0.71 to 0.92 and the five factors identified explained 55% of the variance, with "Role of nurse teacher" and "Supervisory relationship" as the two main factors explaining 41% of the variance. Confirmatory factor analysis approved the factor structure of the Arabic version of the instrument. CONCLUSION: The Arabic version of CLES+T displayed suitable psychometric properties for using it in evaluating the quality of clinical learning environment of nursing students in Morocco and likely in other Arabic speaking countries.

Potentially inappropriate prescribing according to STOPP-2 criteria among elderly patients in an acute medical department: An observational study of prevalence and predictive factors.

OBJECTIVE: The aim of the study was to assess the prevalence and factors associated with potentially inappropriate medication use in elderly patients hospitalized in an acute medical unit. METHODS: It is a prospective observational study carried out in the acute medical unit of Ibn Sina University Hospital located in Rabat, Morocco. The study sample consisted of all hospitalized patients aged ≥65years. Data collection was performed by a clinical pharmacist during an interview with the patient, at the multidisciplinary team meeting and from the patient's medical records. Medication use was assessed everyday from admission to discharge. The frequency of potentially inappropriate medication (PIM) was evaluated using The Screening Tool of Older Person's Prescriptions (STOPP) criteria version 2. RESULTS: The study involved 123 elderly inpatients aged 75±7 years old. In total, 55 patients (44.7%) used≥1 PIM. The highest prevalence of PIMs was in relation with concomitant use of two or more drugs with anticholinergic properties (16%). In adjusted multivariate analysis, the following parameters were independently associated with PIM use: length of stay at the acute medical unit (OR 1.12; 95% CI 1.00-1.20), and number of pre-admission drugs (OR 1.30; 95% CI 1.00-1.60). CONCLUSION: Half of the elderly population received at least one PIM identified by the STOPP criteria. Inadequacy of prescription was associated with the number of pre-admission drugs and the length of stay. Assessing medication during conciliation and enhanced drugs monitoring at discharge especially for patients with a longer stay can be an important strategy for minimizing PIM use.

Mental health and wellbeing among Moroccan medical students: a descriptive study.

Medical students are tomorrow's healthcare professionals (HCPs), and their role in the design and delivery of healthcare in the future is crucial. Following an invitation to participate in a global call on mental health and wellbeing among medical students, it was decided to include Moroccan medical students based in the Faculty of Medicine and Pharmacy of Rabat between March 2019 and May 2019. Six hundred and thirty-seven medical students from the Faculty of Medicine and Pharmacy of Rabat responded to the BMA (British Medical Association) online survey, with females representing 66% of students. Medical studies were considered the main source of stress by 90% of respondents. The CAGE test screened 5% of students to be at risk of alcohol related health problems. Thirteen per cent of respondents reported substance misuse, 20% consumed alcohol, and 13% reported Illicit drug use. Almost half of Moroccan medical students had minor psychiatric disorder according to GHQ-12. Very high rates of burnout were found among undergraduate medical students, at 93%, and 68% reported, respectively, exhaustion and disengagement. This study showed very high levels of burnout among Moroccan undergraduate medical students. These results draw attention to the poor mental wellbeing of medical students. It is important that careful steps are put in place to support medical students who need this help.

Evaluation of Post Laryngectomy Pharyngocutaneous Fistula risk Factors.

INTRODUCTION: Pharyngocutaneous fistula (PCF) is the most common complication after total laryngectomy. Its incidence is extremely variable, with values ranging from 3% and 65%. The management of this problem considerably increases the length and the cost of hospitalization. The aim of this study is to analyze the incidence, predisposing factors, and outcome of PCF in patients undergoing total laryngectomy in a Moroccan teaching hospital in Rabat, Morocco. MATERIALS AND METHODS: This study is a retrospective study including 136 patients who underwent total laryngectomy for squamous cell carcinoma of the larynx in our institution, between January 2006 and December 2013. Socio-demographical, biological, surgical, and outcome data were included. Risk factors were analyzed for association with PCF formation. RESULTS: The overall PCF rate was 27.8%. The mean age was 58 (32-82 years). Univariate analysis showed age (P= 0,028), hemoglobin (P=0,026), and previous tracheotomy (P=0,028) to be associated with the onset of PCF. However, multivariate analysis revealed that previous tracheotomy (P=0,028) and low level of preoperative hemoglobin (P=0,026) were highly associated with the occurrence of PCF. CONCLUSION: This is an original work performed in an African country with a large serie. Our findings suggest that age, previous tracheotomy, and low level of haemoglobin are risk factors for PCF onset after total laryngectomy in T4 squamous cell carcinoma.

Practices and perceived barriers regarding pain management among Emergency Department physicians: a nationwide multicenter survey in Moroccan hospitals.

Aim: To describe pain management practices in Moroccan emergency departments, and to identify perceived barriers among emergency department physicians regarding pain management. Methods: Eleven Moroccan emergency departments participated in the study. A nationwide survey was administered to physicians. The questionnaire covered physicians' characteristics, practices regarding pain management, and the perceived barriers to pain control. Results: A total of 86 questionnaires were analyzed. The participants' mean age was 41±7 years and 59.3% had more than 10 years working experience in emergency departments. The majority of participants were general physicians (87.2%) with no pain education (73.3%). Pain assessment in emergency departments was carried out by 59.3% of the physicians. Simple interrogatory assessment was the main tool (88.3%) with poor use of algometric scales (11.7%). Pain assessment results were not recorded in clinical charts in 93% of cases. Pain reassessment after treatment was carried out by 23.2% of respondents. Physicians had opiophobia in 80.2% of cases. None of the Moroccan emergency departments participating in the study have a written protocol for pain management. Barriers relating to medical staff and the health care system were the most commonly encountered hindrances that preclude emergency department physicians from proper pain management. Conclusions: Despite the availability of international guidelines, pain management practices are still sub-optimal in Moroccan emergency departments.

Moroccan medical students' perceptions of their educational environment.

This study aimed to assess students' perceptions of their educational environment in the Faculty of Medicine and Pharmacy of Rabat, Morocco, using the Dundee Ready Educational Environment Measure (DREEM). A cross-sectional survey was conducted in the Faculty of Medicine and Pharmacy of Rabat, Morocco, in which medical students' perceptions of their educational environment were assessed using the DREEM criteria during the 2013-2014 academic years. The DREEM inventory encompasses 50 items divided into five subdomains: perceptions of learning, perceptions of teaching, academic self-perceptions, perceptions of atmosphere, and social self-perceptions. The DREEM has a maximum score of 200, which would correspond to a perfect educational environment. The mean scores (±standard deviation) of students' responses were compared according to their year of study and gender. The responses of 189 postgraduate medical students were included. The mean total DREEM score was 90.8 (45.4%). The mean total scores for five subdomains were 21.2/48 (44.2%), 21.8/44 (49.6%), 13.1/32 (40.9%), 19.0/48 (39.6%), and 15.6/28 (55.7%) respectively. Female students reported higher perceptions of teaching scores than males (P=0.002), and students in their fifth year of study reported significantly higher social self-perceptions scores than those in their fourth year (P=0.03). In this study of the oldest faculty of medicine in Morocco, students perceived the educational environment as having many problems.

Factors associated to unrelieved pain in a Morrocan Emergency Department.

BACKGROUND: In the light of the impact that pain has on patients, emergency department (ED) physicians need to be well versed in its management, particularly in its acute presentation. The goal of the present study was to evaluate the prevalence of unrelieved acute pain during ED stay in a Moroccan ED, and to identify risk factors of unrelieved pain. METHODS: Prospective survey of patients admitted to the emergency department of Ibn Sina teaching university hospital in Rabat (Morocco). All patients with acute pain over a period of 10 days, 24 hours each day were included. From each patient, demographic and clinical data, pain characteristics, information concerning pain management, outcomes, and length of stay were collected. Pain intensity was evaluated both on arrival and before discharge using Numerical Rating Scale (NRS). Comparison between patient with relieved and unrelieved pain, and factors associated with unrelieved pain were analyzed using stepwise forward logistic regression. RESULTS: Among 305 patients who complained of acute pain, we found high levels of intense to severe pain at ED arrival (91.1%). Pain intensity decreased at discharge (46.9%). Unrelieved pain was assessed in 24.3% of cases. Patients with unrelieved pain were frequently accompanied (82.4% vs 67.1%, p = 0.012), and more admitted daily than night (8 am-20 pm: 78.4% vs 64.9%; 21 pm-7 am: 21.6% vs 35.1%, p = 0.031), and complained chiefly of pain less requently (56.8% vs 78.8%, p<0.001). They had progressive pain (73% vs 44.2%, p<0.001), and had a longer duration of pain before ED arrival (72-168 h: 36.5% vs 16.9%; >168 h: 25.5% vs 17.7%, p<0.001). In multivariate analysis, predictor factors of unrelieved pain were: accompanied patients (OR = 2.72, 95% CI = 1.28- 5.76, p = 0.009), pain as chief complaint (OR = 2.32, 95% CI = 1,25-4.31, p = 0.007), cephalic site of pain (OR = 6.28, 95% CI = 2.26-17.46, p<0.001), duration of pain before admission more than 72 hours (72-168 h (OR = 7.85, 95% CI = 3.13-25.30, p = 0.001), and >168 h (OR = 4.55, 95% CI = 1.77-14.90, p = 0.02). CONCLUSION: This study reported high levels of intense to severe pain at ED arrival. However, one quarter patients felt on discharge from the ED that their pain had not been relieved. The relief of pain in ED depend both sociodemographic, clinical, and pain characteristics factors.

Preventability of death in a medical intensive care unit at a university hospital in a developing country.

OBJECTIVE: To determine the incidence and characteristics of preventable in-ICU deaths. MATERIALS AND METHODS: A one-year observational study was conducted in a medical ICU of a teaching hospital. All patients who died in medical ICU beyond 24 h were analyzed and reviewed during daily medical meeting. A death was considered preventable when it would not have occurred if the patient had received ordinary standards of care appropriate for the time of study. Preventability of death was classified by using a 1-6 point preventability scale. The types of medical errors causing preventable in-ICU deaths and the contributory factors to deaths were identified. RESULTS: 120 deaths (47 ± 19 years, 57 months-63 weeks) were analyzed (mortality: 23%; 95% confidence interval (CI):15-31%). At admission, Acute Physiology and Chronic Health Evaluation (APACHE) II score was 18 ± 7.6 and Charlson comorbidity index was 1.3 ± 1.6. The main diagnosis was infectious disease (57%) and respiratory disease (23%). The median period between the ICU admission and death was 5 days. The rate of preventable in-ICU deaths was 14.1% (17/120). The most common medical errors related to occurrence of preventable in-ICU deaths were therapeutic error (52.9%) and inappropriate technical procedure (23.5%). The preventable in-ICU deaths were associated with inadequate training or supervision of clinical staff (58.8%), no protocol (47.1%), inadequate functioning of hospital departments (29.4%), unavailable equipment (23.5%), and inadequate communication (17.6%). CONCLUSION: According to our study, one to two in-ICU deaths would be preventable per month. Our results suggest that the implementation of supervision and protocols could improve outcomes for critically ill patients.