Incidence, identification and antibiotic resistance of Salmonella spp. in the well waters of Tadla Plain, Morocco.

Concerns about challenges with water availability in the Tadla Plain region of Morocco have grown as a result of groundwater contamination brought on by human activity, climate change, and insufficient groundwater management. The objective of the study is to measure the number of resistant bacteria in the groundwater of Beni Moussa and Beni Aamir, as well as to evaluate the level of water pollution in this area. 200 samples were therefore gathered from 43 wells over the course of four seasonal campaigns in 2017 and 2018. Additionally, the samples were examined to determine whether Salmonella species were present and if they were resistant to the 16 antibiotics that were tested. Salmonella spp. have been identified in 31 isolated strains in total, accounting for 18.02% of all isolated strains. Data on antibiotic resistance show that 58.1% of Salmonella spp. strains are multidrug-resistant (MDR); 38.7% of Salmonella strains are tolerant to at least six antibiotics, 19.4% to at least nine antibiotics, 9.7% to four to seven antibiotics, 6.5% to at least eleven antibiotics, and the remaining 3.2% to up to twelve antibiotics. A considerable level of resistance to cefepime (61.29%), imipenem (54.84%), ceftazidime (45.16%), ofloxacin (70.97%), and ertapenem (74.19%) was found in the data. Consequently, it is important to monitor and regulate the growth of MDR in order to prevent the groundwater's quality from declining.

Analysis of Morphological Traits in Herbarium of Historical Cannabis Specimens from Maghreb: Morphological Characteristics of Landrace Kif.

Background: Exploring the morphological traits of historical Cannabis populations from the Maghreb can provide invaluable information about the characteristics of the Maghreb Landrace Kif and contribute to the preservation of this vulnerable Cannabis resource. Aim: The purpose of the present study was to analyze the morphological characteristics of Cannabis specimens collected before worldwide introgressive hybridization and summarize the morphological traits of the Maghreb Landrace Kif. Discussion: Despite the limited number of specimens collected in the Maghreb, this study identified distinct types of Cannabis in the herbaria, including the Maghreb Landrace Kif, European hemp, and potentially East Asian hemp. By examining the morphological traits of kif specimens and reviewing the relevant literature, the study identifies the morphological traits that tend to characterize Maghreb Landrace Kif. Morphologically, Kif is different from drug-type Cannabis indica ("Sativa" and "Indica"). It resembles European hemp Cannabis sativa, but has female inflorescence characteristics that allow it to be distinguished from the latter, even when the growing conditions are optimal. These are the density of pistillate inflorescences (perigonal bract-to-leaf index), and the capitate stalked glandular trichomes cover density on the perigonal bracts. Conclusion: The characteristics of pistillate inflorescences identified in this study can be used to distinguish and select plants before phytochemical and genetic analysis, thus facilitating the identification of the Maghreb Landrace Kif.

Entomological Exploration of Sand Flies in Human Communities Affected by Cutaneous and Visceral Leishmaniasis in El Hajeb Province, Morocco.

Sand flies are the exclusive vectors of leishmaniasis. This group of parasitic diseases is a serious public health problem in Morocco. The aim of this study was to investigate the sand fly fauna, mainly the species composition, biodiversity, and seasonal activity of sand flies in El Hajeb in central Morocco. A total of six stations (Aït Naaman, Aït Rbaa, Aït Brahim, Ain Taoujdate, Sidi Mbarek, and Aït Oufella) were studied, five of which had recently recorded cases of leishmaniasis. Sand fly bimonthly captures were carried out using a sticky paper trap in different biotopes from March to December 2019. A total of 14590 adult sand flies were collected. The activity of the sand fly started in April and declined in November. The periods of high abundance were July, September, and November. Morphological identification of sand flies shows the presence of twelve species: Phlebotomus papatasi, P. longicuspis, P. perniciosus, P. sergenti, P. bergeroti, P. alexandri, P. dreyfussi, P. ariasi, Sergentomyia fallax, S. minuta, S. schwetzi, and S. antennata. The analysis showed that species belonging to the genus Phlebotomus were the most dominant (93.3%) and the risk periods were spread during the summer and autumn seasons. The present study provides for the first time information on the species of sand flies in El Hajeb. It, therefore, provides decision makers with an important tool to conduct vector control actions during peak periods in order to limit the transmission of leishmaniasis. A preprint was made available by the research square in the following link: "https://assets.researchsquare.com/files/rs-1409330/v1/dfef7013-0327-4a54-897f-214924a2d950.pdf?c=1646838874."

Prevalence and risk factors of canine leishmaniasis in Morocco: a systematic review and meta-analysis.

Human visceral leishmaniasis has long been associated with canine leishmaniasis (CL). However, to date, there is no clear information on the status of the disease in dogs in Morocco that could be used by policymakers for the prevention of human cases. This study aims to assess the status of CL in Morocco and its risk factors through an exhaustive literature search. The meta-analysis was performed using RevMan 5.4. The main results showed that the overall prevalence of CL in Morocco is 17% (95% CI: 0.12-0.22), caused by two strains of Leishmania parasite: Leishmania tropica and L. infantum. According to the region, the maximum prevalence was reported in the coastal provinces and in the central part of the country; while, the CL risk was higher in rural area (18% [95% CI: 0.14-0.23]) and at altitude above 1000 m (23% [95% CI: - 0.08-0.53]). Regarding the intrinsic factors, the prevalence of the disease increased with the age of the dog, (30% [95% CI - 0.09-0.68) and the risk was very high in clinically asymptomatic dogs (RR = 2.08 [95% CI: 1.15-3.76]). This study is the first in Morocco indicating the CL prevalence, its geographical distribution and detailing its risk factors. These results are needed to improve management strategies for the canine reservoir of leishmaniasis in Morocco and interrupt the local transmission cycle to humans. Supplementary Information: The online version contains supplementary material available at 10.1007/s12639-022-01521-2.

Lead poisoning with encephalic and neuropathic involvement in a child: case report.

Lead is a toxic substance in our environment that affects adults and children of all socioeconomic backgrounds, lead poisoning is one of the most common exposures that can cause inter alia significant neurological and functional damage in humans. Children are particularly vulnerable because of the effects of the toxicity on their developing nervous systems with potentially irreversible consequences. We report a case of severe lead poisoning encephalo-neuropathy in a 3-year-old girl, admitted for progressive paraplegia, swallowing disorders, and aphasia. A multitude of investigations undertaken could not explain her atypic symptoms, so anamnesis was redone in the sense of a toxic origin, we found a notion of pica, and a traditional herbalist father, so probably consumption of medications based on traditional medicine products. A venous blood lead level (BLL) was extremely elevated at 176.4 µg/l. The child was treated with an oral chelator succimer (SUCCICAPTAL). During the two following months in the intensive care unit, the child showed progressive respiratory distress and worsening signs of the nervous system. Despite treatment and the use of lead chelators, the patient died due to septic shock. Lead is highly toxic even at very low exposure levels, at high levels of exposure, it can damage the reproductive organs, immune system, liver and kidneys. in children, it can affect neurocognitive and behavioral development that could be irreversible. Peripheral and central nervous system damage should be considered as a possible manifestation of lead poisoning.

Origin, Early History, Cultivation, and Characteristics of the Traditional Varieties of Moroccan Cannabis sativa L.

Background: Cannabis has been cultivated and used for centuries in the north Moroccan Rif (local name is kif). However, its history is poorly known and the date of its first introduction and dispersal in Morocco is still difficult to be precise. Aim: The purpose of the present work is to review the literature on the origin, history, and cultivation of Cannabis in Morocco, as well as data on the morphological, genetic, and phytochemical characteristics of local cultivated varieties. Discussion: Considering the importance of preserving the fragile environment of the Rif and the future development of the Moroccan medical Cannabis market, which will require authentication of the raw material, the use of local strains which are well adapted to the particular environment of the Rif is highly recommended. However, there is no document that summarizes and clarifies the nomenclature and the characteristics of local Moroccan Cannabis. In addition, the recent adoption by Rif growers of improved hybrid cultivars is obliterating the traits and peculiarities of Moroccan Cannabis through genetic introgression. Conclusion: Summarizing and discussing the data from the literature on the characteristics of local Moroccan Cannabis varieties may be useful for their identification and the localization of the areas of the Rif region where their cultivation is still practiced.

Assessment of medical and pharmaceutical waste flows during the coronavirus pandemic in the Rabat-Sale-Kenitra region, Morocco.

The COVID-19 pandemic has created unprecedented difficulties for health care institutions, which are required to manage not only the flow of patients with COVID-19, but also the management of medical and pharmaceutical waste (MPW). At the level of Morocco, the waste produced by hospitals has risen sharply in the regions most affected by the virus, such as the Rabat-Sale-Kenitra region (15.05% of recorded cases). The objective of this study is to perform a descriptive statistical analysis and to evaluate the generation rates of MPW generated during the treatment of the coronavirus pandemic, with reference to a large health care hospital in the region, in order to enable decision-makers to adopt responses in terms of regular and continuous management of MPW. The Moulay Abdellah hospital in Sale has a bedding capacity allocated to the COVID-19 patient of 110 beds with a Average Occupation Rate (AOR) of 100% and an average production of 13tons per month. The study showed that the average rate of MPW generated is 4 kg per bed per day, which is twice as high as the average generation rate during normal operation in 2019. As well, frequency analysis of the data revealed that MPW generation follows a log normal distribution with a correlation coefficient of 0.9. The distribution is skewed to the right and flatter than the normal distribution curve as judged by the skewness coefficient which is 0.87 and kurtosis coefficient which has a value of 1.286, indicating a deviation from normality.

Synthesis and characterization of arginine-doped heliotrope leaves with high clean-up capacity for crystal violet dye from aqueous media.

A novel arginine-modified Heliotrope leaf (Arg@HL) was used as adsorbent for the crystal violet (CV) dye adsorption in a batch process. The physicochemical and morphological composition of Arg@HL were characterized by field-emission scanning electron microscopy (FE-SEM), Fourier transform infrared (FTIR) spectroscopy, thermogravimetric analysis (TGA), and differential scanning calorimetry (DSC). The experiments were carried out to investigate the factors that influence the dye uptake by the adsorbent, such as the contact time under agitation, adsorbent amount, initial dye concentration, temperature and pH of dye solution. The optimum conditions of adsorption were found on the batch scale as followed: CV concentration of 20 mg·L-1, an amount of 0.75 g·L-1 of the adsorbent, 90 min contact time, 6 pH and 25 °C temperature for Arg@HL. The results confirmed a second-order model explaining the dye crystal violet's adsorption's kinetics by Arg-Heliotrope leaves. The Langmuir model effectively defines the adsorption isotherms. The results revealed that the Arg@HL has the potential to be used as a low-cost adsorbent for the removal of CV dye from aqueous solutions.

Knowledge and behaviour of individuals towards sandflies' vectors of leishmaniasis in Morocco.

BACKGROUND: Sandflies are active vectors of several diseases, including leishmaniasis, which Morocco hopes to eliminate by 2030. Despite efforts to limit their spread, they still remain a public health problem in the country, as the behaviour of individuals in relation to sandflies plays an important role in the sustainability of the epidemiological cycle. AIMS: To explore and determine the knowledge and behaviours related to sandfly diseases. METHODS: A quantitative method was adopted using a questionnaire assisted by a personal interview. Based on the epidemiological situation of leishmaniasis cases reported in recent years in Al-Hajeb province, we conducted a field survey among 281 persons in April and May 2019 residing in the communities where the cases of the disease are registered. RESULTS: 61.6% of Moroccans know sandflies by the name "Chniwla"; 44.1% thought that sandflies do not transmit diseases; 41.3% thought they multiplied in contaminated water; 52.7% thought sandfly bites could not be avoided; and 6.4% recognized the role of individuals in the fight against vectors. CONCLUSIONS: The need to raise public awareness of the risks of sandflies, using the popular concepts obtained to simplify scientific terms and formulate targeted health education strategies that make the individual an active player in vector control.

Modified Masquelet Technique Using Allogeneic Graft for a Gustilo-Anderson Type III-A Open Fracture of the Femur with an 8 cm Bone Defect.

The induced membrane technique was initially described by Masquelet et al. in 1986 as a treatment for tibia nonunion; then, it became one of the established methods in the management of bone defects. Several changes have been made to this technique and have been used in different contexts and different methodologies. We present the case of a 16-year-old girl admitted to our department for a polytrauma after a motorcycle accident. She presented a Gustilo III-A open fracture of the right femoral shaft with a large bone defect of 8 centimeters that we treated with a modified Masquelet technique. In the first stage, an Open Reduction and Internal Fixation of the fracture was made using a 4,5 mm Dynamic Compression Plate and a PMMA cement was inserted at the bone defect area. The second stage was done after 11 weeks, and the defect area was filled exclusively with bone allograft from a bone bank. Complete bony union was seen at 60 weeks of follow-up. After the removal of the implants by another surgeon, the patient presented an atraumatic fracture of the neoformed bone that we treated with intramedullary femoral nailing associated with a local autograft using reaming debris. A complete bony union was achieved after 12 weeks with a complete range of motion of the hip and knee. The stability given to the fracture is essential because it influences the quality of the induced membrane and Masquelet has recommended high initial fixation rigidity to promote incorporation of the graft. It is recommended to delay the second stage of this technique after 8 weeks, especially in femoral reconstruction, to optimize the quality of the induced membrane. Several studies used a modified induced membrane technique to recreate a traumatic large bone defect, and all of them used an autologous bone graft alone or an enriched bone graft. In this case, the use of allograft exclusively seems to be as successful as an autologous or enriched bone graft. Now, with the advent of bone banks, it is possible to get an unlimited amount of allograft, so additional research and large studies are necessary before giving recommendations.

The Cutaneous Leishmaniasis and the Sand Fly: Knowledge and Beliefs of the Population in Central Morocco (El Hajeb).

BACKGROUND: Cutaneous leishmaniasis is a neglected parasitic dermal disease transmitted to humans through the bite of an infected female sand fly. Morocco hopes to eliminate all forms of leishmaniasis by 2030. These dermatoses pose a real public health problem in the country. Although the information is available on the disease, individual knowledge of cutaneous leishmaniasis and sand fly is not yet developed. Exploring people's beliefs and popular behaviours about cutaneous leishmaniasis and its vector allows health officials to know the sociocultural aspects of the disease and to improve prevention and control actions. OBJECTIVES: To identify the knowledge of cutaneous leishmaniasis and its vector in the population in central Morocco. METHODS: Based on the epidemiological data of leishmaniases in the province of El Hajeb, we conducted a field survey and personal interviews in April and May 2019, among 281 persons belonging to the localities where leishmaniases were registered. RESULTS: Our results show that the participants use the concept of "Chniwla" (61.6%) for sand fly and the concept of "Hboub Chniwla" (50.8%) for cutaneous leishmaniasis; 24.6% of the respondents do not know how the disease is transmitted to humans and 43.7% use traditional treatments and home remedies to cure themselves. 44% of participants believe that sand fly does not transmit the disease to humans and only 6.4% were aware of their responsibility in vector control. CONCLUSIONS: The study concluded that there is a need to simplify the scientific terminology in the health education of citizens regarding these dermatoses and their vector by integrating the popular concepts obtained in this study to raise public awareness and facilitate their involvement as active actors in the prevention of cutaneous leishmaniasis.

Sand Flies Control: A Review of the Knowledge of Health Professionals and the Local Community, Province of El Hajeb, Morocco.

Sand flies are insect vectors of several diseases including leishmaniases. These vector-borne diseases represent a public health problem in several countries around the world, including Morocco. The objective of this study was to assess simultaneously the knowledge of health professionals and inhabitants on sand flies; a cross-sectional survey was conducted between April and June 2019 among 424 people, 34% of whom were health professionals and 66% of whom were inhabitants of the province of El Hajeb in central Morocco; 46.3% of doctors, 50.7% of nurses, 66.7% of midwives and 69.4% of inhabitants showed a low knowledge of sand flies. Most participants believed that sand flies breed in stagnant and polluted waters. Negative attitudes were found among 72.2% of the inhabitants. Factors associated with a high level of knowledge included continuing education among health professionals and information on vector-borne diseases among residents. The conceptual and cognitive gaps in the knowledge of sand flies reflect the lack of information and training on sand flies. The results of the sand fly knowledge review can be integrated into the national leishmaniases control program and the integrated vector management strategy to raise public awareness on the health risks of sand flies.

Outcomes of a Reimplanted Talus After a Total Open Extrusion.

Total traumatic extrusion of the talus is a severe and disabling ankle injury that requires a high energy trauma. Many treatment options exist and none of them guarantee a successful result. Here, we present the case of a 67-year-old woman who experienced an open total traumatic extrusion of the talus. Based on the principles of open fracture management, we have realized an early administration of antibiotics and tetanus toxoid booster followed by an urgent debridement of the wound. Next, the talus was reimplanted and fixed with a K-wire. This allowed us to avoid the common complication and achieving good clinical outcomes. In our opinion, this is an encouraging and reasonable treatment option unless the talus is grossly contaminated or missing.

Negative Pressure Wound Therapy With Instillation and Dwell Time Used to Treat a Complex Open (Terrible Triad) Injury of the Elbow: A Case Report.

INTRODUCTION: Treating a complex elbow injury known as the terrible triad, combined with a severe soft tissue trauma, is challenging for most orthopedic surgeons and can lead to permanent disabilities and poor functional outcomes if reconstruction is inadequate. CASE REPORT: A 75-year-old male with a history of high blood pressure was injured in an accident involving agricultural equipment and presented with a triad injury of the left elbow: a posterolateral dislocation combined with fractures of the radial head (Mason-Johnson Type II) and ulnar coronoid process (Morrey Type 1). Fractures to the radial head and ulnar coronoid process and injuries to the lateral collateral ligament and triceps tendon were repaired, and a local skin flap was preserved to provide adequate soft tissue coverage. A hinged external fixator was applied to maintain elbow alignment and allow early mobilization. Traditional negative pressure wound therapy (NPWT) was applied on the remaining skin defects; when local necrosis and septic arthritis of the elbow were noted, NPWT with instillation and dwell time (NPWTi-d) was initiated. Once a viable wound bed was obtained, a split-thickness skin graft was used to provide total coverage. All wounds and fractures were healed within 8 weeks, the external fixator was removed, and free elbow joint mobilization was allowed. At 3 months, the authors obtained 100°/30°/0° of elbow range of motion with a DASH 3 at 30. At 6 months, the elbow range of motion reached 120°/20°/0° with a clear improvement of DASH score (DASH 6 at 14.2). CONCLUSIONS: Management of this complex elbow injury that featured NPWTi-d contributed to a good result and facilitated coverage of an extensive loss of skin and soft tissue; more importantly, the patient experienced limited discomfort. A larger prospective study is required to support general recommendations for this approach to similar injury.

Management of a Severe Degloving Injury With a Type 2 Open Tibia Fracture Using Negative Pressure Wound Therapy With Instillation and Dwell Time.

INTRODUCTION: Severe lower extremity trauma cases are challenging for most orthopedic surgeons if a degloving injury with open fracture is associated, especially in the elderly population. The management of the soft tissue is essential for bone union and reduction of infection. CASE REPORT: The authors present the case of an 87-year-old female admitted to their department after a road accident in which she sustained an open fracture of the distal tibia classified as Gustilo-Anderson Type II, a closed fracture of the lateral malleoli, and a degloving of the posterior and lateral aspect of the left leg. After antibiotic delivery, she underwent surgical debridement and wound irrigation, 5 hours after the accident. The avulsed skin flap was conserved, the fracture of the lateral malleoli was fixed using the minimally invasive plate osteosynthesis technique, and an external fixation was applied for the distal tibia fracture. After 1 week, the necrotic skin flap and muscle were excised, and negative pressure wound therapy with instillation and dwell time (NPWTi-d) was applied for 9 days. Once granulation tissue with healthy wound edges was obtained, a split-thickness skin graft was used to provide total coverage. After 8 weeks, external fixation was replaced by a plaster cast. Eight weeks later, all wounds and fractures were healed, and the patient was able to return to their daily activities. CONCLUSIONS: The authors' main goal was achieved: preserving the architecture of the leg, achieving bone union, and avoiding infection. A large part of this good result comes back to NPWTi-d, a promising treatment that grants clinical benefit for the patient and surgeon. Additional research and larger prospective studies are required before giving a strict recommendation.

Management of a High-Energy Soft Tissue Injury of the Lower Extremity Using Negative Pressure Wound Therapy With Instillation and Dwell Time and a Reticulated Open Cell Foam Dressing.

INTRODUCTION: Soft tissue injuries of the lower extremity are the result of high-energy trauma, such as road accidents, and remain challenging for most orthopedic surgeons. Proper selection of the treatment is important considering the risk of delayed necrosis and wound sepsis. Negative pressure wound therapy (NPWT) has improved complex wound treatment since 1997, but all treatments present advantages and limits. CASE REPORT: A 21-year-old male presented with a high-energy soft tissue injury of the lower extremity. Three days after surgical debridement, complete skin necrosis developed. Successive surgical debridement was done in combination with traditional NPWT for 2 weeks; yet the wound did not progress toward healing, and the bone remained exposed. Negative pressure wound therapy with instillation and dwell time (NPWTi-d) was used with a novel reticulated open cell foam dressing (ROCF-CC) because further surgical debridement was not possible, and the use of NPWT was not recommended by the French high authority for health. Growth of granulation tissue was fast (9 days), even over the bone, without any surgical debridement and despite the presence of nonviable and fibrinous tissue. After that, traditional NPWT was discontinued and a split-thickness skin graft then was used to cover the defects. Four weeks following the accident, all wounds were completely healed. CONCLUSIONS: Surgical debridement remains irreplaceable; however, when debridement is not feasible, NPWTi-d with ROCF-CC might be the treatment of choice. This strategy allowed the authors to ensure coverage of an extensive loss of soft tissue when the traditional NPWT limit was reached.

Bilateral posterior hip dislocation associated with right Pipkin II fracture: A case report.

BACKGROUND: Bilateral posterior hip dislocations are very rare injury, requiring a very hight trauma energy. PRESENTATION OF THE CASE: We present a case of 40-year-old male who sustained bilateral posterior hip dislocation with associated right femoral head fracture Pipkin type II following a hight energy trauma without neurovascular deficit. A prompt closed reduction was made, it was successful in lift hip but incomplete in right one, therefore, an open reduction was indicated, performed through a modified Hardinge approach permitting internal osteosynthesis with two Herbert screws. DISCUSSION: Posterior hip dislocations are an orthopaedic emergency that must be reduced within 6 h to avoid sciatic nerve compression and avascular necrosis (AVN). They are most often associated with femoral head fractures commonly known as Pipkin's fractures, that need anatomic reduction and osteosynthesis through posterior approaches, rarely external or anterior approaches. RESULTS: Anatomic and functional results were good at two years follow up excepting a right hip non-bridging heterotopic ossification; the patient returned to his work normally without any functional sequelae.

[Metal contamination of the ground water in Mohammedia (Morocco)]. / Contamination métallique des eaux souterraines de la ville de Mohammedia (Maroc).

This aim of this study was to assess the heavy metal contamination of the ground water in the Moroccan city of Mohammedia and its relation to the highly developed industrial and domestic activities in the region. Six heavy metals, Cu, Zn, Cd, Hg, Fe and Pb, were assayed in the waters of 19 wells throughout the city, in industrial areas, public landfills, and residential zones. Four sampling campaigns were conducted between January and May 1999. Analysis of the heavy metal levels revealed a causal relation between the human activities at the sites studied and the degree of contamination recorded. The sites in the industrial areas had elevated concentrations of Fe, Zn, Cu or Pb and most often a combination of at least two of these at a single site. Moreover, the spatial distribution of this pollution showed water in S7 areas to be high in iron and that in S5 and S7 (industrial) areas high in mercury. The concentrations measured are respectively 2.5 and 3-5 times greater than the Maximum Acceptable Concentration (MAC) recommended by WHO for potable water. This work has conclusively proven the presence of dangerous heavy metal contamination of the ground water supply in the area of Mohammedia; it demonstrates the need for conservation and antipollution measures aimed against heavy metal contamination of the overall water supply and in particular the ground water.