Uncertainty Quantification for Epidemic Risk Management: Case of SARS-CoV-2 in Morocco.

In this paper, we propose a new method for epidemic risk modelling and prediction, based on uncertainty quantification (UQ) approaches. In UQ, we consider the state variables as members of a convenient separable Hilbert space, and we look for their representation in finite dimensional subspaces generated by truncations of a suitable Hilbert basis. The coefficients of the finite expansion can be determined by approaches established in the literature, adapted to the determination of the probability distribution of epidemic risk variables. Here, we consider two approaches: collocation (COL) and moment matching (MM). Both are applied to the case of SARS-CoV-2 in Morocco, as an epidemic risk example. For all the epidemic risk indicators computed in this study (number of detections, number of deaths, number of new cases, predictions and human impact probabilities), the proposed models were able to estimate the values of the state variables with precision, i.e., with very low root mean square errors (RMSE) between predicted values and observed ones. Finally, the proposed approaches are used to generate a decision-making tool for future epidemic risk management, or, more generally, a quantitative disaster management approach in the humanitarian supply chain.

SARS-CoV-2, recurrent ischemic strokes and carotid macrothrombosis: the other face of the cytokine storm (a case report).

Since December 2019, the world has experienced the emergence in China of a new infection called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This infection quickly has progressed to a global pandemic since March 2020, with very high human-to-human transmission rate. Besides lung injury, COVID-19 is also associated with cardio and neurovascular complications. Herein, we report the case of a 77-year-old female who presented with non-severe COVID-19 and multiple ischemic strokes secondary to an extensive carotid thrombosis. The ischemic stroke was supposed to have been caused by the cytokine storm related to COVID-19. The possibility of hemorrhagic transformation, based on the assessment of bleeding score, limited the use of anticoagulation, and probably explained the stroke recurrence and poor outcome in our patient. The pathogenic mechanism and the management of this complex situation are still lacking and further studies are needed.

[Crossed renal ectopia discovered incidentally: about one case report]. / Ectopie rénale croisée de découverte fortuite chez l'adulte: à propos d'un cas.

Crossed renal ectopia is a rare congenital abnormality, in which the two kidneys are located in the same side. One of the ureters, whose length is adapted to the kidney seat, crosses the median line to implant in the bladder on the opposite side. Renal fusion of the two parenchymas is common and this abnormality is most often asymptomatic and fortuitously discovered. We report the case of a 36-year old patient with no previous pathological history, presenting with crossed renal ectopia incidentally discovered after acute cholecystitis complicated by perivescicular abscess. On the basis of this observation and of the data from the literature, we here discuss the etiopathogenic, clinical, radiological and therapeutic features of this malformation.

[Rare digestive tumors: gastrointestinal stromal tumors (GISTs): about a case of small bowel location and literature review]. / Tumeurs digestives rares: tumeur gastro-intestinale stromale (GIST): à propos d'un cas de localisation grêlique et revue de littérature.

Gastrointestinal stromal tumors (GISTs) are a rare group of mesenchymal tumors mainly occurring in the gastrointestinal tract. Previously, GISTs were classified as smooth muscle tumors also known as leiomyomas, leiomyosarcomas or leiomyoblastomas. However, since the advent of immunohistochemistry, GISTs have been diagnosed on the basis of the identification of c-kit-positive cells. We here report a case of stromal tumor of the small intestine in order to analyze it in the light of literature data and imaging results, which may suggest prebiopsy diagnosis as well as its therapeutic and prognostic peculiarities.

[Rare and severe complication of spinal anesthesia: bacterial meningitis (about a case and literature review)]. / Complication rare et grave de la rachianesthésie: la méningite bactérienne (à propos d'un cas et revue de la littérature).

Spinal anesthesia (SA) is the first locoregional anesthesia. It can cause side effects and carry risks that need to be avoided, prevented or treated early. We here report the case of a female patient operated under spinal anesthesia who had intense headache associated with nausea and vomiting evolving in the context of fever within a few days after surgeryLumbar puncture showed cloudy liquid revealing Gram + cocci on direct examination. This allowed the diagnosis of bacterial meningitis. Patient's evolution was favorable after antibiotic therapy.

[Mirizzi's syndrome: a rare cause of biliary tract obstruction: about a case and review of the literature]. / Le syndrome de Mirizzi: une cause rare de l'obstruction des voies biliaires: à propos d'un cas et revue de littérature.

Mirizzi's syndrome is a rare complication of chronic vesicular lithiasis with prevalence ranging from 0.7% to 1.4% among patients who have undergone cholecystectomy. It is characterized by cholestatic icterus associated with compression of the common bile duct due to lodged calculus in the vesicular neck or in the cystic duct. The disease can evolve toward the erosion through the common hepatic duct wall and, therefore, it can cause the formation of a gallbladder-biliary fistula. We here report a case of Mirizzi's syndrome type I in order to highlight the role of preoperative diagnosis which is made easier by endoscopic retrograde cholangiography or by cholangio-MRI, allowing to avoid iatrogenic bile duct injuries. We conducted a review of the available literature on various aspects of this syndrome, including its pathogenesis, diagnosis and management.

[Interventricular defect after myocardial infarction: about a case and literature review]. / Communication interventriculaire post infarctus du myocarde: à propos d'un cas et revue de la litterature.

Ventricular septal rupture (VSR) after myocardial infarction is a fearsome acute complication whose mortality is not negligible in the early phase. We report the case of a 70-year old patient with apical septal rupture admitted to the Emergency Department with ventricular septal rupture after anteroseptal myocardial infarction. This disease is of the utmost urgency, so its management should be multidisciplinary. This study aims to focus on the risk factors and the treatment of this complication.

Akinetic mutism revealing an ischemic stroke.

We describe a 44-year-old man who developed akinetic mutism following a cerebrovascular accident involving his left middle cerebral artery. We discuss this rare condition and its unusual clinical picture.

[Evaluation of antibiotic prescriptions in the Emergency Department of the Military Hospital of Instruction Mohammed V (HMIMV)]. / Evaluation des prescriptions antibiotiques au service des urgences de l'Hôpital Militaire d'Instruction Mohammed V (HMIMV).

The objectives of this study are to describe prescribing practices, to evaluate their appropriateness and their compliance with guidelines and to examine their influencing factors. We conducted a cross-sectional study of antibiotic prescriptions data of 105 patients in the medical and surgical Emergency Department of the Military Hospital of Instruction Mohammed V in Rabat over a period of one month. Data were collected by means of a questionnaire including demographic and anamnestic data, patient's history, allergies, specific clinical examination data, paraclinical data, detailed antibiotic prescription. Collected data were then evaluated by a referring physician, who was responsible for detecting any treatment error. Among infections requiring the prescription of antibiotics, respiratory and urinary system diseases were at the forefront, the most commonly used antibiotic families were penicillins, quinolones and cephalosporins. 74 prescriptions (70.5%) were both pertinent and compliant versus 9 prescriptions (8.6%) justified but nonpertinent and 6 prescriptions (5.7%) which were considered unjustified by the referring physician due to absence of infection. The evaluation of the existing medical practice is rarely conducted in health facilities; with this in mind, our case study aims to improve appropriate antibiotic prescribing and to optimize its compliance with guidelines.

Thrombolysis for acute ischemic stroke by tenecteplase in the emergency department of a Moroccan hospital.

INTRODUCTION: Thrombolysis has radically changed the prognosis of acute ischemic stroke. Tenecteplase is a modified form of rt-PA with greater specificity for fibrin and a longer half-life. We report the experience of a Moroccan tertiary hospital in thrombolysis using Tenecteplase. METHODS: We conducted an open prospective study of all patients who were treated with Tenecteplase for an acute ischemic stroke admitted to our emergency department. Tenecteplase was administered intravenously at a dose of 0.4 mg/kg single bolus. The primary outcome measure was the proportion of patients achieving significant early neurological recovery defined as an improvement of 4 or more points on the NIHSS score at 24h. RESULTS: 13 patients had been treated by intravenous thrombolysis. 31% were women. Mean age was 63 years old. The mean NIHSS score at admission was 14.3 and 24h after was at 9.1. The right middle cerebral artery was involved in 69% of cases. The carotid atherosclerosis was predominant 63.3% and the cardio embolic etiology 27%. The mean time to the first medical contact after the onset of symptoms was 3h 30 min. One patient presented a capsulo-lenticular hematoma of 5 mm(3) in the same side of the ischemic stroke. CONCLUSION: Tenecteplase is a more interesting thrombolytic than alteplase, it seems to be more suitable for thrombolysis in our center.

A rare case of urinary tract infection due to Trichosporon asahii in a diabetic patient.

Trichosporon asahii is a basidiomycete yeast responsible for white piedra and onychomycosis in the immunocompetent host. In the immunocompromised patients, invasive infections are reported; their diagnosis is difficult and they are associated with high mortality rate. Urinary infection due to Trichosporon Asahi is rare but its incidence increasing. We report the case of a 58 year old diabetic patient. The yeast was isolated from urine samples of three consecutive crops in pure form. The patient improved after antifungal therapy.