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.

Knowledge, attitudes, and practices of the ethics in medical research among Moroccan interns and resident physicians.

BACKGROUND: In Morocco, medical research ethics training was integrated into the medical curriculum during the 2015 reform. In the same year, a law on medical research ethics was enacted to protect individuals participating in medical research. These improvements, whether in the reform or in the enactment of the law, could positively impact the knowledge of these researchers and, consequently, their attitudes and practices regarding medical research ethics. The main objective of this work is to assess Moroccan physicians' knowledge, attitudes, and practices at the beginning of their careers (interns and residents) in medical research ethics. PATIENTS AND METHODS: This is a multicenter cross-sectional study conducted in 2021 among Moroccan physicians. Three scores were created and validated to assess physicians' level of knowledge, attitudes, and practices regarding research ethics. A descriptive analysis was carried out, followed by a univariate analysis and a multivariate analysis using multivariate binary logistic regression to study the factors associated with the different calculated scores. RESULTS: A total of 924 physicians were included in the study, with an average age of 27.8 ± 2.2 years. 40.7% had a high medical research ethics knowledge score, and 68.8% had good attitudes. These two scores were positively associated with age and were statistically higher in residents and in physicians who had received training in medical research ethics during their medical curriculum. Only 29,9% of physicians who had participated in research studies had adequate practices with medical research ethics. This score was statistically higher in residents and in physicians who had heard about research ethics. CONCLUSION: A genuine introduction to ethics in the medical curriculum is essential to enhance researchers' knowledge, attitudes, and practices. This, in turn, can lead to an increase in both the quantity and quality of research conducted in Morocco.

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.

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.

Prognostic Impact of Tumor Budding on Moroccan Gastric Cancer Patients.

Background: Tumor budding (TB) has been defined as an independent prognostic factor in many carcinomas like colon adenocarcinoma, but its prognostic impact on gastric cancer patients remains not well established. In the present study, we aimed to highlight the correlation of tumor budding with clinicopathological features and predict its survival outcomes in gastric cancer patients for the first time in the Moroccan population. Methods: This study was conducted on 83 patients who underwent surgery for gastric adenocarcinoma from 2014 to 2020. The patient's clinico-pathological characteristics were obtained from the pathological and clinical records of each patient. Tumor budding was assessed on HES slides, according to the 2016 International Tumor Budding Consensus Conference criteria. The association of tumor budding grades with categorical and continuous variables were respectively assessed by the χ2-test and the unpaired t-test. Survival analysis was performed by the Kaplan-Meier method, the log-rank test. Results: Patients consisted of 65.1% of men and 34.9% of women with a median age of 61.2 years. Histologically, the majority of the tumors were adenocarcinoma (65.1%). Among all cases, 18.1% were classified as Bud1 (15/83), (27/83) 32.5% as Bud 2, and 49.4% (41/83) as Bud 3 grades. High-grade tumor budding (BUD 3) was found to be significantly associated with special clinicopathological features including older age (P = .02), unradical resection (R1/R2) (P = .03), and the presence of vascular invasion (P = .05), and perineural invasion (P = .04). Furthermore, tumors with high-grade tumor budding were significantly associated with a low rate of resected lymph nodes (P = .04) and advanced TNM stage (P = .02). Among all stages, high-grade tumor budding was correlated with shorter overall survival in univariate and multivariate analysis (P = .04). Patients with high-tumor budding had worse relapse-free survival compared with patients with low-tumor budding grade (P = .01). Conclusion: According to our study, the high-tumor budding grade was correlated with unfavorable clinicopathological features and poorer survival. The present study findings suggest that tumor budding should be considered in the treatment and prognosis of gastric cancer patients.

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.

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.

The Double Burden of Obesity and Underweight in Yemeni Adults.

INTRODUCTION:  Yemen has a unique low-income population with several sociopolitical challenges and the association between weight disorders and sociodemographic and lifestyle factors is not clearly understood. AIM:  The aim of this study is to estimate the prevalence of obesity, overweight and underweight among Yemeni adults, and to identify their associated factors. METHODS: A cross-sectional study was conducted from 11 January to 25 March 2020, including 561 subjects of Yemen's adult population aged 18 and above, from four Yemeni governorates, who answered a questionnaire including demographic, socio-economic, and physical activity items after getting their signed consent. Height and weight were measured, and body mass index (BMI) was computed. The association between obesity or overweight (BMI ≥ 25.0kg/m2) or underweight (BMI < 18.5 kg/m2) and the other variables was analyzed using multinomial logistic regression. RESULTS: A total of 561 subjects aged ≥ 18 years have participated in this survey. The overall prevalence of obesity and overweight was 10.3%, 95% CI [7.7%; 12.8%] and 20.3%, 95% CI [17%; 23.5%] respectively, while the one for underweight was 21.2%, 95% CI [17.8%; 24.5%]. The risk of overweight-obesity increased with age (OR=1.02, 95% CI (1.01-1.03)), living in urban areas (OR= 1.680, 95% CI (1.105-2.552)) and average-high socioeconomic status (SES) (OR= 1.729, 95% CI (1.156-2.587)) while the risk of underweight decreased with the age (OR= 0.981, 95% CI (0.964-0.998)). CONCLUSION: These findings provide a special case of high prevalence of obesity, overweight, and underweight in Yemen. Therefore, implementing awareness and prevention programs is highly recommended there.

Burnout among physicians and caregivers in oncology: the Moroccan experience.

Purpose: Caregivers in radiation oncology are exposed to a high risk of burnout which sometimes causes serious consequences for their health, which can in turn affect patient care. In this study, we investigated the prevalence of burnout and its psychological impact on health professionals and determined the factors that predispose to the risk of burnout. Methods and materials: A cross-sectional survey was conducted with descriptive and analytical purposes among the different teams within the oncology and radiotherapy departments in different hospitals (CHU and regional hospitals) in Morocco, through an online self-questionnaire composed of sociodemographic data, professional data, working conditions, an assessment of interfering factors, the Maslach Burnout Inventory (MBI), the Generalised Anxiety Disorder-7 (GAD-7) scale and the Patient Health Questionnaire-9 (PHQ-9) scale. Results: One hundred and eighteen caregivers participated in this evaluation. 62.7% were physicians, 75.4% worked in university hospitals and 53.4% were in radiotherapy departments. Analysis of the three dimensions of the Maslach Burnout Inventory - Human Services Survey (MBI-HSS) score found high scores in the dimensions of emotional exhaustion (81.4%) and depersonalisation (79.7%), and low scores in decreased personal accomplishment (46.6%). The evaluation of the impacts of burnout in the latter found a mean of the Patient Health Questionnaire-9 (PHQ-9) at 12.45 + 7.84 and the mean of the GAD-7 at 9.73 + 5.98. Conclusion: Our results are in line with those found in the literature, hence the need for screening and active prevention of burnout among radiation oncology caregivers.