Does cannabis affect cognitive functioning in patients with schizophrenia?

Introduction

Cannabis use impairs cognitive performance in healthy subjects; several studies have shown improved cognitive outcomes in schizophrenic patients using cannabis. The aim of this study was to evaluate the effects of cannabis use on cognitive function in Moroccan patients with schizophrenia who were cannabis users.

Method

Two groups were recruited in a Moroccan University Psychiatric Centre. Fifty patients diagnosed with schizophrenia according to the DSM-V who were cannabis users (SZ CANN +) and forty-nine patients diagnosed with schizophrenia according to DSM-V who do not use cannabis (SZ CANN-). Cognitive functioning was assessed using the CogState neuropsychological battery.

Results

The results of the study suggest that SZ CANN- patients performed better in the test of psychomotor function, attention and verbal memory. While SZ CANN+ patients performed better in the test of working memory, visual memory and emotional recognition. We found no relationship between SZ CANN+ patients and SZ CANN- patients concerning executive function.

Conclusions

Our results suggest that cannabis use may have different effects on neurocognitive functioning. It is associated with disorders of psychomotor function, attention and verbal memory. So, it is associated with an improvement in working memory, visual memory and emotion recognition.

Current State and Prospects of Telemedicine in Morocco: Analysis of Challenges, Initiatives, and Regulatory Framework

The Moroccan healthcare system is grappling with a pronounced lack of resources, particularly in terms of human personnel. Presently, Morocco has 28,892 doctors, which equates to a ratio of around 7.8 doctors per 10,000 inhabitants, whereas the WHO recommends a minimum of 23 doctors per 10,000 inhabitants. More than half of these doctors work along the Casablanca-Rabat axis, underscoring a significant disparity between urban and rural areas. In addition, about 270 rural municipalities find themselves in a state of critical medical isolation, denoting their location more than an hour away from a hospital facility. Among these municipalities, 160 are classified as priority, encompassing roughly two million inhabitants. Hence, the Moroccan healthcare system is confronted with several challenges in ensuring equitable access to quality services and curbing the escalating costs. Telemedicine holds the potential to address these twin needs by optimizing the utilization of existing human and material resources through telecommunications. In fact, telemedicine enables a reimagining of the healthcare landscape, promoting a territorial rebalancing in favor of regions with lower medical density. In this context, Morocco has established a regulatory framework outlining the rules for telemedicine practice. Numerous initiatives have emerged, particularly within the public sector, such as the National Telemedicine Initiative launched in October 2018, with the aim of covering 80% of medical deserts in Morocco by 2025. Nevertheless, despite the concerted efforts, there remain challenges to overcome in order to make strides and achieve the objectives set forth by the Moroccan healthcare system. This literature review aims to examine and analyze the current state of telemedicine in Morocco. It seeks to highlight the challenges, initiatives, regulatory progress, and existing gaps in the landscape of telemedicine in Morocco.

Telemedicine: The Situation in Morocco

The Moroccan healthcare system is facing several challenges in ensuring equitable access to quality services and reducing or at least controlling their rising cost. Telemedicine can address these two needs by optimizing the use of existing human and material resources through telecommunications. Today, the gradual increase in the population's healthcare needs poses a major challenge to the Moroccan healthcare system, given the shortage of personnel in healthcare facilities and the persistent difficulties in accessing certain regions. In this regard, Morocco has established a regulatory framework defining the rules for the practice of telemedicine. Several initiatives have been launched, particularly in the public sector, aiming to cover 80% of medical deserts in Morocco by 2025.

Understanding and Use of Artificial Intelligence Among Doctors in a University Hospital in Morocco

INTRODUCTION

Research and development in artificial intelligence (AI) has increased dramatically over the past decade, with all areas of life being affected and particularly the medical field. It is with this in mind that this study focused on the perceptions of AI by physicians at the University Hospital of Casablanca in Morocco.

METHODS

A cross-sectional study conducted among physicians at the University Hospital of Casablanca in April 2023. A questionnaire was distributed electronically by sending it to the participants' email addresses.

RESULTS

We received 103 responses to our questionnaire from physicians. The median age of the participants was 27 years with a range of 23-44 years. Concerning the seniority in clinical practice; about 59% had an experience ranging from 1 to 5 years,58% agreed that the use of medical artificial intelligence technologies will complete clinical tasks quickly, and 51% of these respondents agreed that these applications increase clinical performance. Prevalence of physicians using AI in daily life was 48% with a CI [38-57]%. The concerns perceived by the responding physicians regarding the use of artificial intelligence in the medical field were in 63% of the cases reported about the reduction of human contact with patients.

CONCLUSION

In our study doctors have good knowledge in terms of artificial intelligence and they are open to develop their medical competences in relation with this artificial intelligence.

Mobile Applications for Family Planning

INTRODUCTION

Family planning reduces maternal and child morbidity and mortality by promoting pregnancy spacing. The postpartum period is an ideal time for patients to access family planning services. Mobile applications can aid in accessing information about family planning.

METHODS

A review was conducted on PubMed from 2012 to 2022, using keywords "mobile app," "family planning, "contraception,".

RESULTS

Numerous studies have found as randomized controlled trials evaluating the use of mobile applications such as Decide + Be Ready in contraception. Other studies focused on healthcare providers' use of mobile apps for postpartum care and monitoring contraceptive methods.

CONCLUSION

Mobile applications in family planning can assist healthcare providers in clinical care delivery is feasible and acceptable, saving time and providing accessible information.

Predictors of poor response to oral propranolol in infantile hemangiomas

BACKGROUND

Propranolol is the first-line treatment for infantile hemangiomas (IH). Cases of propranolol-resistant infantile hemangiomas are rarely reported. The purpose of our study was to investigate the predictive factors for poor response to propranolol.

METHODS

A prospective analytical study was conducted between January 2014 and January 2022 including all patients with IH who received oral propranolol therapy at a dose of 2-3 mg/kg/day maintained for at least 6 months.

RESULTS

A total of 135 patients with IH were treated with oral propranolol. Poor response was reported in 18 (13.4%) of the patients: 72% were girls and 28% were boys. Overall, 84% of the IH were mixed, and hemangiomas were multiple in three cases (16%), nasal tip hemangiomas accounted for four cases (22%), and 15 patients (83%) had segmental hemangiomas. There was no significant association between the age or sex of the children and type of response to treatment (p > 0.05). No significant association was found between the type of hemangioma and the therapeutic outcome as well as the recurrence after treatment discontinuation (p > 0.05). Multivariate logistic regression analysis revealed that nasal tip hemangiomas, multiple hemangiomas, and segmental hemangiomas were at greater risk of poor response to beta-blockers (p < 0.05).

CONCLUSION

Poor response to propranolol therapy has rarely been reported in the literature. In our series, it was approximately 13.4%. To our knowledge, no previous publications have focused on the predictive factors of poor response to beta-blockers. However, the reported risk factors for recurrence are discontinuation of treatment before 12 months of age, mixed or deep type IH, and female gender. In our study, the predictive factors for poor response were multiple type IH, segmental type IH, and location on the nasal tip.

Parental Response to Children's Chronic Pain

AIMS

The aim of this study was to describe the behavior of Moroccan parents toward their children's chronic pain.

METHODS

A cross-sectional study was conducted in different hospital wards. Parents of hospitalized children with chronic pain aged six or over participated in the study. The parents' behavior toward their children's pain was assessed using an Arabic version of the Adult Responses to Children's Symptoms (ARCS) scale. The scores for each dimension were calculated by summing the responses of the items related to that dimension, and then they were normalized to obtain scores ranging from 0 to 100. The comparison of scores was performed using Student's t-test or ANOVA. The association between quantitative variables was assessed using a correlation coefficient.

RESULTS

A total of 100 parents of children with chronic pain participated in the study. The children's average age was 10.0 ± 2.7 years. The majority of children (62%) experienced pain for more than six months. The joints were the most common location of pain (43%), followed by the abdomen (35%). The "Protect" and "Monitor" dimensions had good reliability with Cronbach's alpha coefficients of 0.80 and 0.69, respectively. The highest mean normalized scores were noted for the "Monitor" and "Protect" dimensions, with means of 82.1 and 70.8, respectively. The "Minimize" dimension had the lowest mean score of 41.4. Parental behavior was not linked to child- or pain-related characteristics. There was no difference in how mothers and fathers behaved towards their children's pain.

CONCLUSION

Parents of children with chronic pain in Morocco scored higher on all dimensions of the ARCS, with the highest scores in the "protect" and "monitor" dimensions. These behaviors can negatively affect children's somatic symptoms, functional disability, and anxiety. Our study revealed the importance of providing support to both children and parents of children with chronic pain to manage the pain and related behaviors.

Women's Knowledge and Attitudes Towards Cervical Cancer Screening in Morocco

High incidence rates of cervical cancer are still common in low- and middle-income countries (LMICs) with ineffective prevention policies. This study assessed Moroccan women's knowledge and practices regarding the cervical cancer screening program. A cross-sectional study was conducted in 2019 in four primary healthcare centers in Casablanca. Women over the age of 18 who came to these centers during the study period were invited to participate in the study. The variables collected were related to women's knowledge of cervical cancer, the screening program, and their reasons for not participating in the screening program. The main risk factors identified by the participants were multiple sexual partners (4.3%) and sexually transmitted diseases (4%). About 77% of the cases (95% confidence interval (CI): 72.1%; 80.4%) knew that a cervical cancer screening program exists in Morocco. However, a small proportion had an idea about the population targeted by the program (46%) and the recommended interval between two screening tests (20%). Only 28% (95% CI: 19.2%; 38.2%) of eligible women had ever been screened for cervical cancer. These results underline the importance of implementing a communication strategy to increase women's awareness of the cervical screening program and their involvement in it.

How Physicians in a Moroccan Tertiary Care Center Perceive Teleconsultation During COVID-19 Pandemic?

Background: Recent technological advances have paved the way for a new modality of medical practice known as teleconsultation. Positive perceptions about the benefits of teleconsultation and its acceptance by clinicians are key predictors of its uptake. The aim of this study was to assess knowledge, perceptions, and acceptability of teleconsultation among Moroccan physicians. Methods: This is a descriptive cross-sectional study conducted at the Cheikh Khalifa International University Hospital (HCK) of Casablanca, Morocco. Study participants answered an anonymous self-administered questionnaire designed based on similar studies. The questionnaire contained four sections related to demographic characteristics, knowledge about telemedicine and teleconsultation, perceptions about teleconsultation, and its acceptability by the study participants. Results: Of 486 eligible participants, a total of 212 completed the questionnaire. Approximately 96.7% had prior knowledge of teleconsultation. Most participants identified internet access (95.3%), data security (93.4%), and confidentiality (92.9%) as the main facilitators to the use of teleconsultation. The main barriers to the use of teleconsultation were internet access issues (98.6%), poor audio quality (96.2%), poor video quality (94.3%), and difficulty encountered by patients in expressing themselves and communicating with their physician (79.7%). The majority of participants (91.5%) believed that teleconsultation will be an integral part of future medical practice and about 70.8% thought that they would be able to allot time to teleconsultation in their current schedules. Conclusions: The findings of this study should be used by policy makers to remove barriers and promote enablers of teleconsultation use by physicians to bring health care closer to the Moroccan population.

[Immunization coverage and predictive factors for non-completion of immunization among migrant children under 5 years old, Casablanca - Morocco]

INTRODUCTION

Despite several initiatives by the Moroccan health ministry to protect migrants' rights to health services, the vaccination of migrant children remains a public health issue.

AIM OF THE STUDY

The objective of this study was to measure the vaccination coverage and identify the factors associated with the non-completion of vaccination of sub-Saharan migrant children under 5 years of age in the city of Casablanca.

METHODS

Based on an analytical cross-sectional study, snow-ball sampling was conducted and a questionnaire was given to sub-Saharan migrant mothers of children under 5. The results of the descriptive analyses and the Chi test led to the elaboration of a predictive model through a multivariate logistic regression. The information collected included socio-demographic characteristics, factors linked to accessibility to vaccination services, the mothers' knowledge and perception of vaccination.

RESULTS

Approximately 57% of sub-Saharan migrant children under 5 were incompletely or non-vaccinated. The factors significantly associated with vaccination status after the multivariate analysis were the mothers' educational levels (4.895 [1.907-12.562]), professional status (0.411 |0.206-0.821]), knowledge about the advantage of vaccination (0.035 [0.004-0.309]), the vaccination calendar (6.854 [3.172-14.813]), the waiting period (0.115 [0.051-0.261]), administrative barriers (7.572 |2.004-28.617]) and psychological barriers (0.086 [0.043-0.170]).

CONCLUSION

The vaccination status of migrant children under 5 years of age in the city of Casablanca remains a public health issue and requires better healthcare coverage in order to improve the vaccination situation in this vulnerable population.

Maghreb doctors need capacity building in epidemic investigation and control

OBJECTIVE

Describe the training needs of young Maghreb doctors in epidemic management.

METHODS

This is a study to quantify the need for medical training on "epidemic management". The study population was formed by residents and assistant professors of the French-speaking faculties of medicine in the Greater Maghreb, hospital-university professors, who were invited to respond to an online questionnaire. The "need" for learning a skill was defined by the perception of its importance, of its low coverage by the curricula and its poor mastery. A grid with 20 items, coded according to the Likert scale of 1 to 5 points, was specially developed for the measurement of need, retained beyond the thresholds of 45/90 points for the two dimensions "confirmation" and "investigation", 60/120 points for the "control" dimension, and 150/300 for the total sum.

RESULTS

A total of 121 young Maghreb doctors answered the questionnaire to assess the needs for learning epidemic management skills. The median overall scores for the chapters "importance", "coverage" and "performance" were 76, 40 and 48 respectively out of 100 points. The median scores for training "needs" were 54/90, 48/90 and 67/120 points, respectively, for the dimensions "confirmation", "investment" and "control", giving a global median score of 168 / 300.

CONCLUSION

Capacity building in epidemic management is a need felt by young Maghreb doctors, partially covered by current medical school programs, and consequently altering their professional performance.

[Predictors of catheter-related bladder discomfort]

INTRODUCTION

Establish a descriptive epidemiological profile of patients with Catheter Related Bladder Discomfort (CRBD) and identify its predictive factors.

MATERIAL AND METHOD

Between June 2019 and December 2019, 300 patients have been evaluated. Different parameters were taken into account including: sex, age, body mass index (BMI), historical health data, duration and indications of the urinary catheterization, type of the transurethral catheter used, lubrication of the catheter and the existence of CRBD. We grouped our patients according to the intensity of CRBD syndrome. The various factors likely to be correlated with the occurrence of CRBD were subject of a univariate then multivariate analysis.

RESULTS

300 patients were included. The average age was 49 years (133 men and 167 women). 68 patients (22.6%) had history of urinary catheterization. 19% of patients were catheterized for acute urinary retention, while 81% were catheterized before surgery. The average duration of the urinary catheterization was 2.5 days. 54% showed CRBD symptoms, including more than 92% on the first day of the urinary catheterization. The significant risk factors in multivariate analysis were: the caliber of the catheter ≥18 Fr, the absence of lubrication, laparotomy, age <50 years, Cesarean and urinary catheterization medical history.

CONCLUSION

This study identified various factors incriminated in the occurrence of CRBD. The role of the hospital practitioner is to prevent this syndrome by reducing predictive factors, particularly the technical ones.

LEVEL OF EVIDENCE

3.

Monitoring Mental Healthcare Services Using Business Analytics

Objectives

Monitoring healthcare activities is the first step for health stakeholders and health professionals to improve the quality and performance of healthcare services. However, monitoring remains a challenge for healthcare facilities, especially in developing countries. Fortunately, advances in business analytics address this need. This paper aims to describe the experience of a low-income healthcare facility in a developing country in using business analytics descriptive techniques and to discuss business analytics implementation challenges and opportunities in such an environment.

Methods

Business analytics descriptive techniques were applied on 3 years’ electronic medical records of outpatient consultation of the University Psychiatric Centre (CPU) of Casablanca. Statistical analysis was conducted to compare results over years.

Results

Over the 3 monitored years, the monthly number of computerized physician order entries increased significantly (p < 0.001). Physicians improved their personal recording over years. Schizophrenia as well as depressive and bipolar disorders were noted at the top of outpatient mental disorders. Antipsychotics are the most prescribed drugs, and a significant annual decrease in outpatient care wait time was noted (p < 0.001).

Conclusions

Business analytics allowed CPU to monitor mental healthcare outpatient activity and to adopt its business processes according to outcomes. However, challenges mainly in the organizational dimension of the decision-making process and the definition of strategic key metrics, data structuration, and the quality of data entry had to be considered for the optimal use of business analytics.

Antidiabetics and antihypertensive medications use in Morocco: A pharmacoepidemiological descriptive study

Background

In Morocco, and many other African countries, there is a paucity of antihypertensive and antidiabetics use amongst the general population.

Aim

To investigate the epidemiological profile of antihypertensive and antidiabetics use and analysis their adverse reactions.

Setting

This study was conducted in the prefecture of Figuig, Morocco.

Methods

A cross-sectional descriptive study. Data was collected using semi-structured questionnaire about their pharmacological treatment and presented using descriptive statistical analysis.

Results

Sample of 244 subjects, predominantly women 58.15% (p < 0.03) composed of diabetic patients 56.96% (n = 139) and hypertensive patients 43.03% (n = 105). After adjustments, 60.24% of all patients were under monotherapy. The diabetics were being treated using the Biguanide class (26.92%), insulin (20.0%) and sulfonylureas (10.0%) while hypertensive patients were treated by Calcium Channel Blockers (27.36%), Angiotensin Converting Enzyme Inhibitors (21.05%), Angiotensin T-Blockers (16.84%), Diuretics (7.36%) and β-adrenergic receptors blockers (3.15%). In total, 23.00% of all subjects have experienced negative side-effects, mostly, reported (90.38%) to health professionals and 23.52% of them have interrupted temporarily or try to change their treatment. Gastro-intestinal problems were the most adverse reactions reported (11.11%) followed by headache, dizziness and tinnitus (6.66%) and asthenia, feeling sick and feeling of faintness (5.33%).

Conclusion

Managing diabetes and hypertension entails a lot of public challenges and requires more focus and interest, especially amongst the illiterate population in remote areas. Some of the suggested ways to help face the problem include the introduction of new innovative measures, systems of fellow-up and adverse reactions.

Electronic health records implementation in Morocco: Challenges of silo efforts and recommendations for improvements

OBJECTIVE

Electronic Health Records (EHRs) interventions hold the promise for enabling better healthcare. However, the implementation of EHR systems has been scarce in developing countries. The objective of this study is to investigate the state of EHRs implementation in Morocco; and draw insights for potential improvements.

MATERIALS AND METHODS

University Medical Centers, known by locals in French as Centres Hospitalier Universitaires (CHU), are the largest and most advanced public healthcare centers in Morocco. A two-phase qualitative study was conducted in four out of the five CHUs. Phase One involved data collection through semi-structured interviews with 27 clinician champions, administrators, and medical directors. Phase Two included a brainstorming session during a health informatics conference held in Fes, Morocco. The data were analyzed using inductive analysis.

RESULTS

We identified five main categories of challenges due to silo strategies: (1) EHRs selection and weak bargaining power, (2) identical errors repeated across silos, (3) a lack of interoperability standards, (4) insufficient human and financial, and (5) missed cooperation and collaboration opportunities.

DISCUSSION

While identifying these silo challenges is an important milestone, proposing guidelines to address these challenges can bring Morocco and similar developing countries a step closer to improving healthcare through the use of health informatics and EHRs. Our recommendations for public healthcare organizations are threefold: (1) recognize the power of partnerships among all CHUs, (2) establish an e-health framework, and (3) seek national and international collaborations to drive and shape the eHealth agenda. Furthermore, we align our recommendations with the World Health Organization toolkit for an eHealth strategy to further benefit developing countries.

CONCLUSION

This study identifies the challenges faced by the Moroccan EHRs implementation silo-ed strategy, and it proposes practical and fundamental guidelines to address these challenges and develop an interoperable and sustainable national eHealth system in Morocco and similar developing countries.

Profile and evolution of the Global Burden of Morbidity in the Maghreb (Tunisia,Morocco, Algeria). The Triple burden of morbidity

BACKGROUND

The Global Burden of Disease (GBD) is an objective method of measurement of disease disability, allowing the quantification of a population's health status, the identification of its health needs, and the determination of its public health priorities.

OBJECTIVES

To document the epidemiological transition in Maghreb countries (Tunisia, Morocco, Algeria) over the past three decades and to identify their priority health problems, which are responsible for a considerable burden of disability.

METHODS

This is a data synthesis work of the Institute for Health Metrics and Evaluation (IHME) global burden of disease, through its project "GBD Compare Data Visualization". Data covering the period from 1990 to 2016, examined the three major categories of health problems "communicable, maternal, neonatal and nutritional diseases", "noncommunicable diseases" and "injuries", as well as the three types of risk: metabolic, environmental / professional and behavioral.

RESULTS

Since 1990, cardiovascular diseases have consistently been the leading cause of death in the three Maghreb countries. During the period 1990-2016, and at varying speeds, the positions of communicable and neonatal diseases declined, while noncommunicable diseases (particularly cardiovascular diseases, cancers, mental disorders, diabetes and neurological disorders) increased significantly, to be at the top of the list of components of the global burden of disease.In 2016, road accidents have been ranked eighth in the ranking of the main components of the overall burden of morbidity in Tunisia and Morocco and ninth in Algeria. During the same period, the environmental and behavioral risk factors registered an overall decrease in the three Maghreb countries, in contrast to the metabolic risk factors that experienced a gradual and homogeneous increase in the Greater Maghreb.

CONCLUSION

This GBD analysis confirmed the rather old and fairly advanced epidemiological transition in Maghreb countries, leading to a real "triple burden" threatening the stability and sustainability of national health systems. Hence the urgency of supporting the following five projects: the curriculum reform of the faculties of health sciences, the development of the second line of care, the participative management of health services, universal health coverage and the implementation of a comprehensive and integrated strategy for prevention and health promotion.

Comparative study of post-graduate training programs in public health in the great maghreb countries

BACKGROUND

Training in public health, an essential lever for the success of health programs, mobilizes several disciplines, from the description of health situations to the study of their determinants, and to health management.

OBJECTIVE

To compare postgraduate training programs in Public Health, provided in the countries of the Greater Maghreb.

METHODS

Through a documentary study, various components of post-graduate training in Public Health in the Maghreb have been identified: offers and methods of training, learning objectives, program content and reference skills.

RESULTS

In the Maghreb, and with the exception of Mauritania, Training offers are limited to teaching in Public Health with a medical orientation, integrated in the university system in the form of residency. Other training (masters ...) are provided in the context of continuing professional development. Areas of competence include, in addition to medical and scientific expertise, communication and interdisciplinary collaboration. The programs focus on methodological aspects in relation to related disciplines such as health promotion, anthropology, sociology and health planning.

CONCLUSION

The pooling of training experiences in Public Health, in the Maghreb countries, would be essential to launch a quality homogeneous training based on the paradigm of global health.

Prevalence of smoking in the Maghreb: a systematic review and meta-analysis

INTRODUCTION

Tobacco is the leading preventable cause of death in the world and kills up to seven million people each year. Monitoring its prevalence is important for prevention programs. The aim of this work was to summarize the literature on the prevalence of smoking in the Maghreb countries during the past two decades.

METHODS

The research was conducted on Medline via Pubmed based on the Mesh terms: «Tobacco Use», «Smoking» and «Africa, Northern». Were included articles reporting the prevalence of current smoking in the general population or a subgroup of the population in one or more Maghreb countries. The extracted data was related to current smoking, its definition, total prevalence and prevalence by sex.

RESULTS

About 50 articles were included, the data was mainly from Morocco, Algeria and Tunisia. Two studies reported prevalence among college students in Libya. The highest prevalences in the general population were noted in Tunisia with an overall prevalence, during the period studied, of 25% (95% CI [21% -29%]). This prevalence was 16% (95% CI [14% -18%]) in Morocco and 14% (95% CI [8% -22%]) in Algeria.

CONCLUSION

The prevalence reported was generally high, especially in Tunisia, although lower than in developed countries, hence the importance of setting up and strengthening prevention and control measures, mainly among young people.

Middle East and North African Health Informatics Association (MENAHIA): Building Sustainable Collaboration

There has been a growing interest in Health Informatics applications, research, and education within the Middle East and North African Region over the past twenty years. People of this region share similar cultural and religious values, primarily speak the Arabic language, and have similar health care related issues, which are in dire need of being addressed. Health Informatics efforts, organizations, and initiatives within the region have been largely under-represented within, but not ignored by, the International Medical Informatics Association (IMIA). Attempts to create bonds and collaboration between the different organizations of the region have remained scattered, and often, resulted in failure despite the fact that the need for a united health informatics collaborative within the region has never been more crucial than today. During the 2017 MEDINFO, held in Hangzhou, China, a new organization, the Middle East and North African Health Informatics Association (MENAHIA) was conceived as a regional non-governmental organization to promote and facilitate health informatics uptake within the region endorsing health informatics research and educational initiatives of the 22 countries represented within the region. This paper provides an overview of the collaboration and efforts to date in forming MENAHIA and displays the variety of initiatives that are already occurring within the MENAHIA region, which MENAHIA will help, endorse, support, share, and improve within the international forum of health informatics.

Validation of EORTC IN-PATSAT 32 in Morocco: Methods and Processes

Background:

The EORTC IN-PATSAT32 questionnaire was developed by the EORTC Quality of Life (QL) Group to assess the satisfaction of patients affected by cancer and hospitalized in oncology centers. The aim of this study is to assess the psychometric properties of the EORTC IN-PATSAT32 administered to Moroccan patients.

Methods:

A total of 133 hospitalized patients affected by cancer in different sites completed the translated EORTC IN-PATSAT32 questionnaire in oncology hospitals. The internal consistence reliability, reproducibility and construct validity were assessed.

Results:

The homogeneity was good for all scales with Cronbach’s coefficients from 0.72 to 0.95 for all scales. Reproducibility test-retest was very satisfactory and the intra-class correlations coefficients (ICCs) for the scales were all above 0.70 except for the single general satisfaction with a ICC of 0.67. All items were highly correlated with own rather than other scales.

Conclusion:

The results of this study confirm that the Moroccan Arabic version of the EORTC IN-PATSAT32 has acceptable reliability and validity, comparable to those reported for other languages.

[Use of mobile applications by interns at Ibn-Rochd University Hospital in Casablanca, Morocco]

Introduction: Mobile applications are now increasingly used by trainee and practising physicians due to the wide range of applications available in the field of healthcare and their ease of use. The objective of this study was to estimate the frequency and describe the use of these applications by interns at Ibn-Rochd University Hospital in Casablanca. Methods: A cross-sectional survey was conducted in December 2014 on a sample of Ibn-Rochd interns. Participants from multiple disciplines and medical specialties completed an anonymous self-administered questionnaire. Results: One hundred and thirteen interns participated in the study with a 94.2% response rate: 95% of these interns had a smartphone and 85.2% had at least one healthcare mobile applications with an average of 3.57 applications per interns (SD = 3.14). Interns used these applications at least once a day and the most frequently downloaded applications were those devoted to diagnosis and patient care (61%). No statistically significant correlation was observed between the number of applications and the intern’s specialty, the type of operating system used or the intern’s gender. Conclusion: The use of healthcare mobile applications and the support they provide to Ibn-Rochd interns allowed an assessment of the importance of these new tools in medical training and practice. However, supervision and support by seniors are essential in view of the risks involved.

[Tinnitus : from the general practitioner to the specialist]

Tinnitus is a common reason for ENT consultation. Patients who suffer from tinnitus are becoming more demanding and frequently ask questions about the cause, the mechanisms of onset, and the cure of their pathology. Quite often, they feel poorly managed or misunderstood, all the more so that, despite the proposed treatments, tinnitus persists and leads to adverse effects on the patients’ daily life. The general practitioner, because of his proximity, must be involved in the prevention, diagnosis and information of individuals with tinnitus and, thus, fully fulfill his acting public health role. To approach this condition, we will outline the clinical diagnosis and discuss the possible psychological repercussions; then, we will envisage the various treatment options that are currently available and evoke the future prospects in this area.

L’évaluation du syndrome du Burnout chez les médecins en formation au CHU Ibn Rochd de Casablanca

Introduction

Le Burnout est très répandu en milieu hospitalier et sa gravité est encore plus accrue chez les jeunes médecins. L'objectif est de déterminer la prévalence du burnout parmi les médecins en formation (internes et résidents) au CHU Ibn Rochd de Casablanca et chercher les facteurs associés.

Méthodes

Étude transversale descriptive menée en 2013- 2014 auprès d'un échantillon de 300 médecins à l'aide d'un questionnaire auto-administré; le burnout était évalué par la version française du Maslash Burnout Inventory (MBI).

Résultats

Un total de191 médecins a participé à l'étude (taux de réponse à 63,7%) avec une prédominance féminine à 79,1% et une moyenne d'âge de 26,7ans (ET = 3). Les scores moyens des sous-dimensions du MBI: l'épuisement émotionnel, la dépersonnalisation et l'accomplissement personnel étaient respectivement de (33,7 ± 10,7), (12,2 ± 6,5) et (30,6 ± 8,3). Le burnout sévère touchait 31,8% des participants. Il était associé aux problèmes de communication au sein de l'équipe soignante (p < 0,01), l'accompagnement insuffisant (p < 0,05), l'insatisfaction des séniors (p = 0,01), la crainte de faire des erreurs médicales (p < 0,05), le recours à un psychothérapeute (p < 0,001), la consommation de psychotropes (p = 0,001), les troubles anxieux (p < 0,01), la dépression (p < 0,01) et les idées suicidaires (p < 0,05). Les facteurs protecteurs étaient représentés par: le sentiment d'équité au sein de l'équipe soignante (p < 0,01) et la pratique de loisirs (p < 0,05). Le changement d'orientation de carrière était associé au burnout sévère (p < 0,05).

Conclusion

Ces résultats rejoignent ceux des études précédentes et justifient l'intérêt d'un programme de prévention à différents niveaux.

Introduction

Burnout is very widespread in the hospital setting and it becomes much more severe in young physicians. The objective of this study aims to evaluate the prevalence of burnout among doctors in training (internal and residents) at the Ibn Rochd University Hospital, Casablanca and to identify factors associated with it.

Psoriasis and Staphylococcus aureus skin colonization in Moroccan patients

Psoriatic lesions are rarely complicated by recurrent infections. The aim of our study is to determine skin colonisation and nasal carriage of Staphylococcus aureus in patients with psoriasis and in healthy persons. Patients and methods: a comparative study that include 33 patients with psoriasis and 33 healthy persons. Samples were taken from lesional and non lesional psoriatic skin and from healthy skin of control group. For S. aureus nasal carriage, we used sterile cotton tipped swabs. Out of165 samples (66 skin samples and 33 nasal swabs), 26 S. Aureus strains were isolated in 26 persons, 57.69% in the control group and 42.3% in the psoriasisgroup. S. aureus skin colonization was found in one case (3%) inlesional psoriatic skin vs 9 cases (27.3%) in control skin OR=0.08 IC 95% (0.01-0.70) p=0.02 and in 12,1% in non lesional soriatic skin vs 27, 3% in control skin (p =0,13). This colonization was less important in lesional psoriatic skin (3%) than in non lesional psoriatic skin (12.1%) p= 0.20. Nasal screening identified (7/33) 21, 21% S. aureus carriers in psoriasis group and in control group. Our results are in consensus withliterature findings. They have confirmed the importance of antimicrobial peptides in Innateimmunity of human skin. These peptides are normally produced bykeratinocytes in response to inflammatory stimuli such as psoriasis. Their high expression in psoriasis skin reduces the risk of skin infection and skin colonization with S. Aureus.

Adaptation and validation of the Moroccan Arabic version of the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ)

Objective

The aims of this study were to translate and culturally adapt the PIDAQ native English version into Moroccan Arabic, and to assess the psychometric characteristics of the version thereby obtained.

Materials and methods

The PIDAQ original English version was sequentially subjected to translation into Moroccan Arabic, back-translation into English, committee review, and pre-testing in 30 subjects seeking orthodontic treatment.

Results

The final Moroccan Arabic version further underwent an analysis of psychometric properties on a random sample of 99 adult subjects (84 females and 15 males, aged 20.97 ± 1.10 years). The intraclass coefficient correlation of the scores of the responses obtained after administration of the questionnaire twice at a 1-month interval to a random sample of 30 subjects ranged from 0.63 for “Self-confidence” to 0.85 for “Social Impact”. Cronbach α coefficients ranging from 0.78 for “Aesthetic Concerns” to 0.87 for “Self-confidence” were obtained; the different subscales of the Moroccan Arabic version of the PIDAQ showed good correlation with the perception of aesthetics and orthodontic treatment need.

Conclusion

The results of the present study indicate that the Moroccan Arabic version of the PIDAQ obtained following thorough adaptation of the native form is both reliable and valid. It is able to capture self-perception of orthodontic aesthetic and treatment need and is consistent with normative need for orthodontic treatment.

[Intra-articular use of sodium hyaluronate (2,2,-2,7 MDa) in the treatment of Moroccan patients with knee osteoarthritis: randomized controlled trial]

OBJECTIVE

To assess the efficacy of intra-articular sodium hyaluronate, administred once weekly for 3 weeks (3 injections) in Moroccan patients with knee osteoarthritis over 6-month period.

MATERIAL AND METHODS

We prospectively studied the outcome of 75 patients with painful knee osteoarthritis in grade 1, 2 and 3 on ACR radiological criteria in our rheumatology clinic in Morocco. Group 1: 45 patients were treated with 3-weekly injections of intra-articular sodium hyaluronate (1%; 2,2-2,7 MDa). Group 2 : 30 patients treated with symptomatic slow-acting drugs for osteoarthritis (SYSADOA). The efficacy parameters were Visual Analogue Scale (VAS) and Lequesne index.

RESULTS

In group 1: 35/45 were female, a mean age of patients was 57.2 (± 8.2) years, and a mean Body Mass Index (BMI) was 28 (± 1.4) kg/m2. In group 2: 23/30 were female, a mean age of patients was 58.6 (± 2.8) years, and a mean of BMI was 27.8 (± 1.4) kg/m2. Before treatment in group 1, the mean of VAS was 6.5 cm (± 1), and of Lequesne index 10.5 (± 2.1). At 3 and 6 months after the third injection of sodium hyaluronate, there was a significant improvement from baseline of Lequesne index and VAS (P = 0.001). In group 2 before treatment, the mean of VAS was 7 cm (± 0,7), and of Lequesne index 8 (+ 1.1), but the improvement from baseline at 3 and 6 months of treatment was lower than group 1.

CONCLUSION

The results of this prospective study, showed the efficacy of 3-weekly injections of sodium hyaluronate in the treatment of knee osteoarthritis in Moroccan patients over a 6-month period.

Waiting times before dental care under general anesthesia in children with special needs in the Children's Hospital of Casablanca

Introduction

Oral diseases may have an impact on quality of children's life. The presence of severe disability requires the use of care under general anesthesia (GA). However, because of the limited number of qualified health personnel, waiting time before intervention can be long. Aim: To evaluate the waiting time before dental care under general anesthesia for children with special needs in Morocco.

Methods

A retrospective cohort study was carried out in pediatric dentistry unit of the University Hospital of Casablanca. Data were collected from records of patients seen for the first time between 2006 and 2011. The waiting time was defined as the time between the date of the first consultation and intervention date.

Results

127 children received dental care under general anesthesia, 57.5% were male and the average age was 9.2 (SD = 3.4). Decay was the most frequent reason for consultation (48%), followed by pain (32%). The average waiting time was 7.6 months (SD = 4.2 months). The average number of acts performed per patient was 13.5.

Conclusion

Waiting times were long, it is necessary to take measures to reduce delays and improve access to oral health care for this special population.

Motivational factors influencing career choices of Moroccan dental students

This study aims to investigate the factors that motivate dental students to choose dentistry as a career. A questionnaire-based survey involving 752 dental students from the only two Moroccan dental schools was conducted between April and May 2011. The questionnaire was designed in terms of financial factors, human factors and working conditions factors. The students were asked to rank the career choices' set of questions on a five point Likert scale from 1 (strongly disagree) to 5 (strongly agree). The internal reliability of the scale was investigated using Cronbach's alpha coefficient and validity was investigated by a confirmatory principal component analysis. Results indicate that dentistry has a noble function; the "desire to help people" and "job opportunities" determines career choice among Moroccan dental students. Another result that emerged from the study is that men were motivated by working conditions factors (p=0.025) while women were motivated by human factors (p=0.001). In brief, the results of the present study can be used by health policy makers to persuade students to pursue dentistry as a career.

Hematology reference intervals in Moroccan population

BACKGROUND

Laboratory reference intervals are important for both clinical orientations and therapeutic decisions. In Morocco, no reference ranges are available for local population. The ranges commonly used in clinical laboratories and by physicians are those of Caucasian population. We have decided that it is relevant to undertake an epidemiological investigation on local adult healthy population, with the aim of establishing hematology reference intervals in Moroccan population.

METHODS

Blood samples were taken from healthy adult volunteers of the regional transfusion center and measured on a Sysmex XE-2100 analyzer. We have grouped our data samples with regard to gender and retained donors aged between 18 and 45 years old according to ICSH guidelines 1982. Leucocyte, erythrocyte, and platelet parameters were analyzed. For any sample flagged by the automate or thrombopenia with platelets < 100000/microL, a systematic smear was done and checked.

RESULTS

A significant difference between male and female was found with regard to the values for leucocyte, erythrocyte, and platelet parameters as well as for hemoglobin and hematocrit. These data were compared to normal values reported for Arabic, Caucasian, and African population.

CONCLUSIONS

As part of this study, we have given a descriptive approach of normal blood cell count and its peculiarities in North African Arabian and Berber population not explored until now. We have established similarities and differences between our population and other African, Arab, and Caucasian populations.

Immunohistochemical expression of latent membrane protein 1 (LMP1) and p53 in nasopharyngeal carcinoma: Moroccan experience

BACKGROUND

Nasopharyngeal carcinoma (NPC) is a malignant epithelial tumor intimately associated with Epstein-Barr virus (EBV). NPC is a characteristic tumor displaying epidemiological, genetic and regional distribution properties that makes it unique by its natural behavior.

OBJECTIVES

To assess the expression pattern of LMP1 and p53 proteins in the different histological types of NPC in a sample of the Moroccan population and to define any association between the expression of those proteins with the sex, the age and the histological types of NPC.

METHODS

Archival formalin-fixed, paraffin-embedded NPC biopsies were evaluated in 23 Moroccan patients for the presence of LMP1 and p53 using immunohistochemistry (IHC).

RESULTS

No LMP1 expression was observed whereas 8 of 23 cases (34. 7%) had detectable p53 protein in the nuclei of tumor cells. After statistical analysis according to the Fisher's exact probability test, no significant association between p53 expression and histological type, age and sex distributions was demonstrated (p>0.05).

CONCLUSION

This study confirms that p53 overexpression is present in a subset of Moroccan NPC patients. Our results are consistent with those reported by other studies concerning the same NPC endemic risk area and provide original data concerning Morocco.

Effect of orthodontic treatment on lip position

Does an advanced or retracted position of the upper and lower incisors lead to modifications in lip position? The aim of our study was to evaluate modifications in lip position following orthodontic treatments.

MATERIAL AND METHODS

This study concerned 100 patients who underwent treatment in the dento-facial orthopedic unit in Casablanca. Profile headfilms at the start and at the end of orthodontic treatment were compared using Frapier's analysis. The Student test was applied to evaluate the variations in the cephalometric measurements.

RESULTS

We noted a non-significant increase in the nasolabial angle (P = 0.274), a significant decrease in the sagittal position of the lower vermillion border (PsVei) (P < 0.001) and the sagittal position of the soft-tissue supramentale (PsSmc) (P < 0.001), and a significant increase in the vertical position of the soft-tissue menton (PvMec) (P = 0.035).

CONCLUSION

The results of this study demonstrate marked improvements in the situation of soft tissues. We suggest further investigation to throw light on the relationship between tooth movement and soft tissue, increasing the size of the sample and taking growth into account.

Immunohistochemical expression of CD44s in human neuroblastic tumors: Moroccan experience and highlights on current data

Background

Peripheral neuroblastic tumors (pNTs), including neuroblastoma (NB), ganglioneuroblastoma (GNB) and ganglioneuroma (GN), are extremely heterogeneous pediatric tumors responsible for 15 % of childhood cancer death. The aim of the study was to evaluate the expression of CD44s (‘s’: standard form) cell adhesion molecule by comparison with other specific prognostic markers.

Methods

An immunohistochemical profile of 32 formalin-fixed paraffin-embedded pNTs tissues, diagnosed between January 2007 and December 2010, was carried out.

Results

Our results have demonstrated the association of CD44s negative pNTs cells to lack of differentiation and tumour progression. A significant association between absence of CD44s expression and metastasis in human pNTs has been reported. We also found that expression of CD44s defines subgroups of patients without MYCN amplification as evidenced by its association with low INSS stages, absence of metastasis and favorable Shimada histology.

Discussion

These findings support the thesis of the role of CD44s glycoprotein in the invasive growth potential of neoplastic cells and suggest that its expression could be taken into consideration in the therapeutic approaches targeting metastases.

Virtual Slides

The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1034403150888863

Résumé

Introduction

les tumeurs neuroblastiques périphériques (TNPs), comprenant le neuroblastome (NB), le ganglioneuroblastome (GNB) et le ganglioneurome (GN), sont des tumeurs pédiatriques extrêmement hétérogènes responsables de 15% des décès par cancer chez les enfants. Le but de cette étude était d’évaluer l’expression de la molécule d’adhésion cellulaire CD44s (‘s’: pour standard) par rapport à d’autres facteurs pronostiques spécifiques.

Méthodes

Un profil immunohistochimique de 32 TNPs fixées au formol et incluses en paraffine, diagnostiquées entre Janvier 2007 et Décembre 2010, a été réalisé.

Résultats

Nos résultats ont mis en évidence l’association des TNPs n’exprimant pas le CD44s avec une perte de différenciation et une progression tumorale et nous avons rapporté une association significative entre l’absence d’expression du CD44s et la présence de métastases. Nous avons également constaté que l’expression du CD44s définit des sous-groupes de patients dans les tumeurs n’amplifiant pas le MYCN, comme en témoigne son association avec les stades INSS bas, l’absence de métastases et l’histologie favorable de Shimada.

Discussion

Ces résultats appuient l’hypothèse du rôle de la glycoprotéine CD44s dans le potentiel de croissance invasive des cellules néoplasiques et suggèrent que son expression pourrait être prise en considération dans des voies thérapeutiques ciblant les métastases.

[Smoking in public middle schools in Casablanca]

The transition period between elementary and middle school is a high-risk period for smoking initiation. Hence the importance of primary prevention programs in adolescent populations. The development and implementation of appropriate preventive measures requires information on tobacco use among adolescents. The objective of this study was to estimate the prevalence of smoking among middle school students in Casablanca and to describe associated drug use. A cross-sectional study was conducted in 2010 in six collèges (middle schools) in Casablanca. The average age of the students was 16.3 years (SD = 2.1). 55% of the students were female. Overall smoking prevalence was 7.5% (CI 95% = 5.5% - 10.1%) ? 11.4% among boys and 4.6% among girls. 52.5% of the smokers began smoking between the ages of 14 and 18. The reasons for smoking included smoking as a way of escaping from problems (30%), relaxation (16%) and experience (7%). Smoking behavior was associated with drug use in 23.3% of smokers, compared to 0.6% among non-smokers (p &lt; 10?3). These results suggest the need for prevention measures aimed at strengthening tobacco control policies in schools and other gathering places for young people.