Exploring scientific misconduct in Morocco based on an analysis of plagiarism perception in a cohort of 1,220 researchers and students

Plagiarism is widely regarded as an issue of low- and middle-income countries because of several factors such as the lack of ethics policy and poor research training. In Morocco, plagiarism and its perception by academics has not been investigated on a large scale. In this study, we evaluated different aspects of plagiarism among scholars based on a 23-question cross-sectional survey. Factors associated with plagiarism were explored using contingency tables and logistic regression. The survey results covered all public universities (n=12) and included 1,220 recorded responses. The academic level was significantly associated with plagiarism (p<0.001). Having publication records was statistically associated with a reduced plagiarism (p=0.002). Notably, the ability of participants to correctly define plagiarism was also significantly associated with a reduced plagiarism misconduct (p<0.001). Unintentional plagiarism (p<0.001), time constraint to write an original text (p<0.001), and inability of participants to paraphrase (p<0.001) were associated factors with plagiarism. Moreover, participants that considered plagiarism as a serious issue in academic research had significantly committed less plagiarism (p<0.001). The current study showed that various actionable factors associated with plagiarism can be targeted by educational interventions, and therefore, it provided the rationale to build training programs on research integrity in Morocco.

Is there an Association between Complementary and Alternative Medicine use and Trust in Physicians in Patients with Rheumatic Diseases?

INTRODUCTION

Generally, patients with chronic rheumatic diseases use complementary and alternative medicine (CAM) in addition to their conventional treatments to manage their health. Discussing these treatments with their physician is still rare, which might be directly related to patients' trust toward them.

AIM

The primary objective of this study was to assess the association between patients' trust in their physician and the use of complementary and alternative medicine among patients with chronic inflammatory rheumatic diseases. As secondary objectives, to estimate the prevalence of CAM use, and to identify the associated factors with their use and with trust in physicians.

METHODS

This is a cross-sectional study, which included patients with established chronic inflammatory rheumatic diseases, at the University Hospital Center in Tangier. The questionnaire included demographic and clinical information, use of conventional therapy, complementary and alternative therapy, as well as interpersonal trust in patient-physician relationships using the Trust in Physician Scale (TPS). A regression analysis was conducted to identify factors associated with CAM use and with trust in physicians.

RESULTS

The study included 189 patients. 57.14% of patients reported using complementary medicine at least once, most patients were women (77.78%), mean age was 46.67 ± 13.25 years with an average course of the disease of 11.11 ± 9.23 years. The most frequently used CAM treatments were cupping therapy, massage and the ingestion of a mixture of plants. Mean ± SD Trust in Physician Scale was 47.64 ± 7.2. There was no significant difference between CAM users vs. non-users (48.08 ± 6.9 vs 47.04 ± 7.4; p = 0.35). In uni and multivariate analysis, a low level of education was significantly associated with the use of CAM. However, no statistically significant difference was found with trust in physicians (OR = 1.020, 95% CI (0.978-1.063), p = 0.354).

CONCLUSION

CAM therapy is common in patients with chronic inflammatory rheumatic diseases. No statistically significant association was found with trust in physicians, it was rather observed with level of education.

Medical students' contribution to research; the scientific output of medical theses held in Moroccan medical schools during the last decade (2011-2021)

BACKGROUND

In order to obtain their medical degree, medical students in Morocco are required to carry out a research project and provide a thesis outlining its methodology and findings. However, little is known about the scientific output of these theses. The aim of the present study was to explore and evaluate the characteristics and publication patterns in scientific-indexed journals of medical theses written by medical students in Morocco.

METHODS

Data was extracted from registered theses between 2011 and 2021 in four medical schools that have an open-source documents archiving platform. Publication of these theses was assessed in 2022 using a search strategy in three indexed databases; Pubmed, Scopus and Web of science.

RESULTS

9807 theses were registered between 2011 and 2021, 41% of them in the faculty of medicine of Rabat. 99.1% of these theses were written in French, 61.7% were reporting a retrospective case series, and 38.9% of them covered surgical disciplines. 83 (0.8%) of the registered theses were published in a scientific-indexed journal, and half of the papers (49.4%) was written in French. The graduate student was the paper's lead author in 54.2% of the papers. The articles driven from the theses were published after a mean delay of 1.49 ± 1.34 years and the targeted journals had a mean SJR score of 0.69 ± 1.21. The total number of detected citations of the 83 published papers was 216.

CONCLUSION

The publication rate of Moroccan medical theses is very low when compared to other countries, which leads to question the real benefit of this time and resources consuming educational activity.

Use of social media as a source of health information among patients with chronic low back pain

OBJECTIVE

To evaluate the use of social media (SM) as a source of health information among patients with chronic low back pain (LBP) and to evaluate the factors associated with this use.

METHODS

This was a cross-sectional study involving patients with chronic LBP. Information on their sociodemographics, LBP characteristics, and comorbidities was collected. With the use of a questionnaire, we evaluated the use of SM as a source of information, examining the frequency of use, the type of SM used, and degree of confidence and application of information found. Catastrophising, trust in physicians, and concerns regarding medicines were assessed through the Pain Catastrophizing Scale (PCS), Trust in Physician Scale (TPS) and Beliefs about Medicines Questionnaire (BMQ Specific Concerns). A regression analysis was conducted to identify factors associated with the use of SM.

RESULTS

A total of 118 patients were included. The mean age was 53.01 ± 14.09 years. Of the sample, 68.6% sought information regarding their LBP on social networks. The main source was YouTube (30%). Eighteen point six percent of patients trusted the information found through SM, and 16.1% have already acted on some of this information. The majority of patients (82%) would prefer to have healthcare professionals in their virtual spaces to answer their questions. In a multivariate analysis, only the degree of trust in the physician was negatively associated with SM use (OR = 0.95 IC 95% [0.91-0.99]; p = 0.03).

CONCLUSION

This survey showed that a proportion of patients suffering from chronic LBP use SM, YouTube in particular, as a source of health information. The level of trust in physicians was the strongest factor that impelled people to use SM as a source of health information.

Impact of central sensitization on pain, disability and psychological distress in patients with knee osteoarthritis and chronic low back pain

BACKGROUND

Central sensitization (CS) is becoming increasingly recognized as a significant factor in many chronic pain conditions, including knee osteoarthritis (KOA) and chronic low back pain (CLBP). Yet it presently remains unclear how strong is the involvement of CS in KOA and CLBP and which factors are involved in CS in these two chronic disabling diseases.

METHODS

This is a cross-sectional study in which included a total of 178 patients with KOA and 118 patients with CLBP. Inclusion criteria for eligible participants for the KOA group were a confirmed diagnosis of KOA according to the American College of Rheumatology criteria, and for the CLBP group a chronic low back pain for more than 3 months. Subjects were excluded if they presented with a diagnosed psychiatric disorder or if they lacked the capacity to provide informed consent, understand study questionnaires or perform physical performance tests. In each group, were assessed; CS-related symptoms using the Central Sentization Inventory (CSI); demographic and clinical characteristics such as disease duration, pain intensity on a visual analog scale, self-reported function using the Lequesne index for KOA patients and the Oswestry Disability index for CLBP patients, and physical performance with the 6 minutes' walk test; as well as psychosocial risk factors using the Patient Health Questionnaire for depression (PHQ-9), the Generalized Anxiety Disorder (GAD-7) and the Pain Catastrophizing Scale (PCS).

RESULTS

CSI scores significantly correlated with pain intensity and disability in KOA and CLBP patients, and were highly correlated with self-reported symptoms of depression, anxiety and pain catastrophizing. Depression significantly predicted the CSI score in both groups.

CONCLUSION

These findings provide further evidence for the impact of CS on pain, function and physical performance in KOA and CLBP patients. Psychosocial symptoms such as pain catastrophizing, anxiety and depression should also be considered as they are also associated with CS.

Changes to physical activity behavior during the COVID-19 pandemic and their associated factors: a cross sectional survey of Mexican women

BACKGROUND

On March 24, 2020, the Mexican Government established social distancing measures to address the outbreak of the COVID-19 pandemic. The resulting home confinement affected daily lifestyle habits such as eating, sleeping, and physical activity (PA). The objectives of this study were to determine changes in PA behaviors among Mexican women due to the COVID-19 pandemic and to assess potential factors associated with these changes.

METHODS

This was a cross-sectional study based on an anonymous online questionnaire developed by the Task Force on Physical Activity for Persons with Disabilities (PAPD) within the International Society of Physical and Rehabilitation Medicine (ISPRM). Descriptive, quantitative statistics were used for data analysis. A Chi-squared (χ²) test was used to explore associations between dependent and independent variables.

RESULTS

A total of 1882 surveys were completed. Among the respondents, 53.3% declared that their PA was reduced during the pandemic, 26.6% reported similar PA behavior, and 20.1% declared that their PA had increased during the pandemic. Lower PA behavior during the pandemic was associated with lower education levels, stricter pandemic constraints, obesity, and lower self-perceived functioning levels. A statistically significant association between poorer self-perceived mental health and decreased PA behaviors was also found. Respondents who were younger, self-perceived as unimpaired, not overweight, and whose income was not impacted by COVID-19 were associated with higher levels of reported physical and mental health.

CONCLUSIONS

The study results identify disparities experienced in PA behavior during the COVID-19 pandemic among Mexican women and highlights the need for social support for PA participation.

Does gender moderate the association between socioeconomic status and health? Results from an observational study in persons with spinal cord injury living in Morocco

Background

Socioeconomic status (SES) and gender are well-known social determinants of health. However, their impact on health in populations with physical disabilities in low-resource countries is still lacking. Therefore, the objective of this study was to investigate associations of individual SES with health and the moderating effect of gender on this association in a Moroccan population with a physical disability, namely spinal cord injury.

Methods

Cross-sectional survey data from 385 participants with spinal cord injury living in Morocco were analyzed. SES was operationalized by education level, household income, financial hardship, and subjective social status. Health indicators included secondary conditions, pain, vitality, quality of life, and general health. Associations between SES and health indicators were investigated using linear and logistic regressions. To test the potential moderation of gender, interaction terms between SES and gender were introduced in regression models.

Results

Financial hardship and lower subjective social status were associated with poorer health outcomes in four out of five indicators in the total sample. In contrast, education and income were inconsistently associated with health. Overall, gender did not moderate the association between SES and health, except that educational inequalities in general health were more pronounced in women, and the observation of a trend for a stronger negative effect of subjective social status on men's than woman's health (p &gt; 0.05).

Conclusion

This study revealed that subjective indicators of SES negatively impact on health, whereas evidence for the moderating role of gender in this association was weak. These findings underline the importance to reduce social marginalization and poverty in populations with disabilities in low-resource countries to reduce their double burden of living with a disability and encountering social disadvantages through low SES.

Knowledge, attitudes, and practice of leadership skills among undergraduate medical students

BACKGROUND AND AIM

Medical knowledge alone is insufficient to provide excellent medical care. Modern healthcare challenges require that all physicians have leadership skills in order to better cooperate and collaborate with other healthcare professionals and effectively lead their teams to provide the best possible care to their patients. The objective of this study was to describe medical students' prior knowledge of leadership concepts, to assess their common practice of its main skills and to explore their general perception of its application by their seniors.

METHODS

Non-graduated medical students enrolled in the 5th year of medicine or above were invited to fill-in an anonymous online questionnaire. 267 students (66% women) from different medical faculties took part in the study.

RESULTS

44% of the participants had a vague idea about leadership and 29% were completely ignorant of the concept. 52% of them thought that leadership was not to be expected from medical students, and 65% did not know that leadership in healthcare would benefit the patient. In their responses to simulated situations, the participants presented optimal attitudes embracing leadership attributes regarding self-awareness, receiving feedback, teamwork, stress and conflict management, however they present more contrasting attitudes when it came to time management and questioning oneself. Seniors with good leadership skills were perceived as few by half the participants.

CONCLUSIONS

This survey highlighted the need of introducing specific leadership training programs within the curriculum of medical studies in Morocco.

Does developing multiple-choice Questions Improve Medical Students' Learning? A Systematic Review

Practicing Multiple-choice questions is a popular learning method among medical students. While MCQs are commonly used in exams, creating them might provide another opportunity for students to boost their learning. Yet, the effectiveness of student-generated multiple-choice questions in medical education has been questioned. This study aims to verify the effects of student-generated MCQs on medical learning either in terms of students' perceptions or their performance and behavior, as well as define the circumstances that would make this activity more useful to the students. Articles were identified by searching four databases MEDLINE, SCOPUS, Web of Science, and ERIC, as well as scanning references. The titles and abstracts were selected based on a pre-established eligibility criterion, and the methodological quality of articles included was assessed using the MERSQI scoring system. Eight hundred and eighty-four papers were identified. Eleven papers were retained after abstract and title screening, and 6 articles were recovered from cross-referencing, making it 17 articles in the end. The mean MERSQI score was 10.42. Most studies showed a positive impact of developing MCQs on medical students' learning in terms of both perception and performance. Few articles in the literature examined the influence of student-generated MCQs on medical students learning. Amid some concerns about time and needed effort, writing multiple-choice questions as a learning method appears to be a useful process for improving medical students' learning.

People with spinal cord injury in Morocco: results from the very first systematic data collection

PURPOSE

To report on the methodology, participant characteristics, and associations of four most frequent environmental barriers with health conditions, general health and quality of life (QoL) in the very first systematic data collection in people with spinal cord injury (SCI) in Morocco.

MATERIALS AND METHODS

We obtained data from 385 participants of the cross-sectional Moroccan SCI community survey (MorSCI). We used descriptive statistics to describe participant characteristics and regression models to investigate associations of the five most frequently reported environmental barriers with health conditions (secondary conditions, pain intensity, mental health), general health and QoL.

RESULTS

The most frequently reported environmental barriers were "lack of public services" (92.5%), "financial strain" (93.0%), restricted access to "public transportation" (85.5%), "public places" (83.9%) and "private places" (84.7%). People who perceived those factors as barriers also reported more secondary conditions, higher pain intensity, lower mental health, lower general health, and lower QoL.

CONCLUSIONS

This study on Moroccans with SCI found that environmental barriers detract from health and QoL. Given that environmental barriers are potentially modifiable, policy interventions present powerful tools to reduce barriers and potentially increase health and QoL in this vulnerable population.IMPLICATIONS FOR REHABILITATIONPublic policy on the construction of transportation and public places is important to make the physical environment accessible for wheelchair users to support their participation in society.The provision of adequate rehabilitation services and specialized post-acute rehabilitation units for people with SCI in Morocco is urgently needed, not only to contribute to health and QoL but also to contribute to their abilities to overcome environmental barriers.Adequate state services including universal health coverage and access to rehabilitation services and assistive devices or adapted tools must be a priority on the policy level to facilitate activities of daily living and reduce barriers.Improving the skills and knowledge of health professionals in SCI rehabilitation and guide policy makers to promote patient education and self-advocacy in the meantime, may help reduce the gap between needs of people with SCI and available support.

The Impact of the COVID-19 Pandemic on Healthy Lifestyle Behaviors and Perceived Mental and Physical Health of People Living with Non-Communicable Diseases: An International Cross-Sectional Survey

The huge burden and vulnerability imposed by non-communicable diseases (NCDs) during the COVID-19 pandemic highlighted how healthy lifestyle behaviors and the well-being of people living with NCDs need to be prioritized. The aim of our study is to better understand the impact of the COVID-19 pandemic on healthy lifestyle behaviors and perceived mental and physical health among adults living with NCDs, as compared to people without NCDs. We conducted a cross-sectional study using a global online survey through Qualtrics. Over four months, 3550 participants from 65 countries worldwide responded to the survey. The study included 3079 surveys with no missing data (complete survey responses) that were used for analysis. People with NCDs were more likely to report statistically significant worsening physical health (p = 0.001) and statistically insignificant worsening mental health (p = 0.354) when compared to pre-pandemic levels. They reported lower rates of smoking during the pandemic than those without NCDs, and a statistically significant (p < 0.001) relationship was found between weight gain and NCDs. Therefore, the perceived physical and mental health, including changes in body weight and tobacco consumption, of people with NCDs were significantly impacted during the pandemic. In conclusion, this study indicates that the pandemic had a significant impact on perceived physical and mental health, changes in body weight, and tobacco consumption among people with NCDs.

Perceived Physical and Mental Health and Healthy Eating Habits During the COVID-19 Pandemic in Korea

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has disrupted the lives of people around the world since 2020. This study aims to reveal perceived impact of the coronavirus pandemic on physical and mental health and eating behaviors among people with disabilities and without disabilities in South Korea, as compared to other countries.

METHODS

A secondary analysis of a prospective cross-sectional study which was conducted with a web-based global survey.

RESULTS

Among the 3,550 responses from 65 countries, 2,621 responses with nation information were set as full data, 189 for South Korea and 2,432 for other countries. In Korea, there was no significant difference in healthy lifestyle behaviors between people with and without disabilities before the COVID-19 pandemic. Perceived physical and mental health and changes in eating habits during the COVID-19 pandemic showed no significant difference between people with and without disabilities in Korea. There were significant differences in physical health and dietary habits, but no differences in its effect on mental health between people living in Korea and other countries in both people with and without disabilities groups. In other words, more than 60% of people in all groups (disability vs. non-disability, Korea vs. non-Korea) reported worse mental health than before the COVID-19 pandemic.

CONCLUSION

In Korea and other countries, mental health showed a tendency to deteriorate regardless of the presence or absence of disability during the COVID-19 pandemic. In terms of healthy eating habits, Koreans were relatively less affected than people from other countries.

General medicine, first-line medicine in Morocco: How is it perceived by medical students and how to enhance their interest in this career?

In Morocco, family medicine does not exist, and it is general medicine that plays the role of family medicine and is also first line medicine and primary care. The current medical school curriculum is not fully in harmony with the real health needs of the population. We questioned 6th and 7th year students about the pertinence of two rotations in general medicine, that is, in a health centre and a private practice, via an anonymous questionnaire disseminated online in June 2020. A total of 266 responses were collected. Out of these, 41.5% of responses were enrolled in 6th year, versus 58.5% in 7th year. Then, 59.1% of students were females. In addition, 84.8% of them declared their intention to pursue a career in a medical specialty, whereas only 15.2% of them were interested in a career as a general practitioner. Notably, 67.4%, 26.5% and 6.1%, respectively, thought that general medicine was very undervalued, a little undervalued and not undervalued. It should be noted that 3.8%, 44.1% and 52.1%, respectively, were interested, somewhat interested and not at all interested in family medicine as a specialty if it was implemented. To that end, various actions need to be undertaken, including the introduction of quality teaching in the 6th and 7th years of medical studies, focused on the development of the knowledge and skills required, the strengthening of pre-existing practical training periods in public health and the introduction of a rotation in private practices of general medicine.

Spinal cord injury in the Moroccan healthcare system: A country case study

In this article, the authors report an overview of the healthcare management of People with Spinal Cord Injury living in Morocco. The authors' experience in monitoring neurologic recovery and rehabilitation expectations and outcomes are also presented. In addition to the epidemiological data, the patient journey through the chain of care, living with Spinal Cord Injury, the health and rehabilitation system are discussed. This paper illustrates well the suffering of people with Spinal Cord Injury specifically and of disabled persons in general living in low and middle-income countries, especially with the lack of access to specialized and quality rehabilitation facilities and shortage of healthcare workers specialized in rehabilitation.

Medical education in Morocco: Current situation and future challenges

Morocco is a North African lower middle income country; home to the oldest University in the world, where the first identifiable medical degree was issued. Medical Education in Morocco is provided through 10 Medical Schools offering each year around 3200 new places in the first year of medical studies. It is facing many challenges in both its undergraduate and postgraduate programs that need to be addressed urgently through the currently debated national reform of medical studies.

Prevalence of disability in Morocco: Results from a large-scale national survey

OBJECTIVE

Disability is considered a global health problem, with an increasing number of persons with disabilities. Up-to-date and good-quality data on disability are essential to policymakers in order to establish tailored programmes for persons with disabilities based on the specific needs of each category. The aims of this study were to determine the prevalence of disability in the adult Moroccan population, and its distribution according to socio-demographic characteristics and geographical regions.

METHODS

A national survey was conducted in 2014, including a sample of 47,275 adult participants drawn from 16,044 households from urban and rural areas proportioned to population size. The sample's socio-demographic characteristics were collected in face-to-face interviews. The data were then screened for disability using the Washington Group Short Set of Questions on Disability.

RESULTS

Overall prevalence of disability among the Moroccan adult population was 9.5%, with important geographical disparities. Older age, lower education rates, unemployment, being single, and living in rural areas, were associated with higher prevalence rates of disability. Visual and motor deficiencies were the most common disability modalities, and the prevalence of moderate-to-extreme disability, which is associated with more significant limitations in functioning, was 2.6%.

DISCUSSION/CONCLUSION

Results from this national Survey are critical and would guide national disability policies and programmes, in order to reduce disabling barriers and improve persons with disabilities access to healthcare and participation.

Patients' Acceptance of the Use of Serious Games in Physical Rehabilitation in Morocco

OBJECTIVE

The aim of this study was to determine whether serious games especially customized for physical rehabilitation could be used in daily clinics with patients who are not familiar with informatics and/or new technologies and whether such a clinical approach would be culturally acceptable within a North African population to plan further clinical distribution if the hypothesis appears to be positive.

MATERIALS AND METHODS

Twenty-one patients participated in this study. Experiments were performed in the University Hospital Mohammed VI Oujda in Morocco. Patients were asked to perform physical rehabilitation exercises with dedicated serious games after their conventional therapy session. A questionnaire was used to evaluate patients' habits to rehabilitation exercises and satisfaction and expectation about the use of serious games for physical rehabilitation.

RESULTS

The same problem of low participation in at-home exercises was found in Morocco compared to Europe and the United States: 60 (30)% of the exercises was performed by the patients in Morocco and 48 (28)% in Europe and the United States. Results of this study show that serious games are well accepted by the patients (100%) and that it can help during rehabilitation (90%). Most of the patients prefer exercises with games than conventional rehabilitation exercises.

CONCLUSION

Even in a context of low education (participants in this study attended school until the age of 10 years old), and low access and knowledge about new technology and informatics, rehabilitation exercises within serious games seem to be an interesting option to motivate patients during rehabilitation with a physiotherapist. Such a system could be installed also at home to increase patient's participation.

Spontaneous ocular positioning during visual imagery in patients with hemianopia and/or hemineglect

Spontaneous eye movements during imagery are not random and can be used to study and reveal mental visualization processes (Fourtassi et al., 2013; Johansson et al. 2006). For example, we previously showed that during memory recall of French towns via imagery healthy individuals looks straight ahead when recalling Paris and their subsequent gaze positions are significantly correlated with the real GPS coordinates of the recalled towns. This correlation suggests that memory retrieval is done via depictive representations as it is never found when the towns are recalled using verbal fluency. In the present paper we added to this finding by showing that the mental image is spontaneously centered on the head or body midline. In order to investigate the capacities of visual imagery in patients, and by extension, the role of primary visual cortex and fronto-parietal cortex in spatial visual imagery, we recorded gaze positions during memory recall of French towns in an imagery task, a non-imagery task (verbal fluency), and a visually-guided task in five patients with left or right hemianopia and in four patients with hemineglect (two with left hemianopia and two without). The correlation between gaze position and real GPS coordinates of the recalled towns was significant in all hemianopic patients, but in patients with hemineglect this was only the case for towns located on the right half of the map of France. This suggests hemianopic patients can perform spatially consistent mental imagery despite direct or indirect unilateral lesions of the primary visual cortex. In contrast, the left-sided towns recalled by hemineglect patients, revealed that they have some spatial inconsistency or representational difficulty. Hemianopic patients positioned and maintained their gaze in their contralesional hemispace, suggesting that their mental map was not centered on their head or body midline. This contralesional gaze positioning appeared to be a general compensation strategy and was not observed in patients with neglect (with or without hemianopia). Instead, neglect patients positioned their gaze in their ipsilesional hemispace and only when performing the visual imagery task. These findings are discussed in the context of the role of occipital and fronto-parietal cortices in the neuroanatomical model of visual imagery developed by Kosslyn et al. (2006).

Using eye movements to explore mental representations of space

Visual mental imagery is a cognitive experience characterised by the activation of the mental representation of an object or scene in the absence of the corresponding stimulus. According to the analogical theory, mental representations have a pictorial nature that preserves the spatial characteristics of the environment that is mentally represented. This cognitive experience shares many similarities with the experience of visual perception, including eye movements. The mental visualisation of a scene is accompanied by eye movements that reflect the spatial content of the mental image, and which can mirror the deformations of this mental image with respect to the real image, such as asymmetries or size reduction. The present article offers a concise overview of the main theories explaining the interactions between eye movements and mental representations, with some examples of the studies supporting them. It also aims to explain how ocular-tracking could be a useful tool in exploring the dynamics of spatial mental representations, especially in pathological situations where these representations can be altered, for instance in unilateral spatial neglect.

Prevalence of disability and rehabilitation needs amongst adult hospitalized patients in a Moroccan university hospital

OBJECTIVES

To investigate the prevalence of disabilities amongst adult hospitalized patients and to estimate their specific needs for rehabilitation support.

METHODS

A cross-sectional study was conducted in a Moroccan university hospital. A total of 411 patients were included, and assessed for impairments, activity limitations and participation restrictions through medical examination and structured questionnaires. Patients' clinical and assessment data were used to estimate the specific needs for rehabilitation professionals' intervention, and the optimal mode of rehabilitation support.

RESULTS

Patients' mean age was 47.75 years (standard deviation 17.34). Prevalences of types of impairments were led by pain (41.6%), followed by sensory-motor deficits (21.9%) and limitations in joint range of motion (21.4%). Activity limitations were dominated by gait and balance disorders (25.3%). Participation restrictions in social and family life were reported by 118 patients; and in professional life by 44 patients. The most needed rehabilitation interventions were: physiotherapy (36.2%), occupational therapy (20.4%), and prosthetics (15.8%), and 24.5% patients were eligible for inpatient rehabilitation support.

CONCLUSION

Disability is very common among hospitalized Moroccan patients, and there is a great need for inpatient rehabilitation support in Moroccan hospitals.

Ankylosing spondylitis associated with Sweet's syndrome: a case report

INTRODUCTION

Sweet's syndrome is an acute neutrophilic dermatosis characterized by a diffuse dermal infiltrate of mature neutrophils. In most cases, it occurs as an isolated phenomenon (idiopathic Sweet's syndrome) but it can be drug induced or associated with a variety of underlying diseases such as infections, neoplasms, and chronic inflammatory diseases. The association between Sweet's syndrome and ankylosing spondylitis is rare. Only a few cases have been reported in the literature. We report a new case in which we describe an outbreak of acute neutrophilic dermatosis revealing ankylosing spondylitis.

CASE PRESENTATION

A 33-year-old Moroccan man presented with large-joint polyarthralgia, inflammatory pain in his buttocks and lower lumbar spine, fever and skin lesions. On examination, the patient had a low-grade fever, six tender but not swollen joints, limitation of motion of the lumbar spine, and painful erythematous maculopapules over his face, neck, and hands. Laboratory tests showed hyperleukocytosis, and elevated erythrocyte sedimentation rate and C-reactive protein. The immunological tests and infectious disease markers were negative. Investigations for an underlying neoplastic disease remained negative. Magnetic resonance imaging showed a bilateral sacroiliitis. Skin biopsy findings were consistent with Sweet's syndrome. The diagnosis of Sweet's syndrome associated with ankylosing spondylitis was established. Nonsteroid anti-inflammatory drugs were started and the patient showed rapid clinical and biological improvement.

CONCLUSION

Three observations of the association between Sweet's syndrome and spondylarthropathy have been reported in the literature. The cause of this association remains unclear. Some hypotheses have been developed, but further studies are needed to confirm or refute them.

Kinematic characteristics of tenodesis grasp in C6 quadriplegia

STUDY DESIGN

Descriptive control case study.

OBJECTIVES

To analyze the kinematics of tenodesis grasp in participants with C6 quadriplegia and healthy control participants in a pointing task and two daily life tasks involving a whole hand grip (apple) or a lateral grip (floppy disk).

SETTING

France.

METHODS

Four complete participants with C6 quadriplegia were age matched with four healthy control participants. All participants were right-handed. The measured kinematic parameters were the movement time (MT), the peak velocity (PV), the time of PV (TPV) and the wrist angle in the sagittal plane at movement onset, at the TPV and at the movement end point.

RESULTS

The participants with C6 quadriplegia had significantly longer MTs in both prehension tasks. No significant differences in TPV were found between the two groups. Unlike control participants, for both prehension tasks the wrist of participants with C6 quadriplegia was in a neutral position at movement onset, in flexion at the TPV, and in extension at the movement end point.

CONCLUSION

Two main kinematic parameters characterize tenodesis grasp movements in C6 quadriplegics: wrist flexion during reaching and wrist extension during the grasping phase, and increased MT reflecting the time required to adjust the wrist's position to achieve the tenodesis grasp. These characteristics were observed for two different grips (whole hand and lateral grip). These results suggest sequential planning of reaching and tenodesis grasp, and should be taken into account for prehension rehabilitation in patients with quadriplegia.

Acute pseudo-septic arthritis following viscosuplementation of the knee

A 70-year-old woman with a history of medial femoro-tibial compartment of knee osteoarthritis was admitted for acute arthritis six days after a second intra-articular injection of Hyaluronic acid. The joint fluid was inflammatory, with no crystals, and laboratory tests showed marked inflammation leading to antibiotic treatment for suspected septic arthritis. The persistent symptoms and negative results of joint fluid and blood cultures led to discontinuation of the antibiotic therapy after 10 days. Anti-inflammatory with rehabilitation therapy of the knee relieved the symptoms, and the patient was discharged home 3 weeks after her admission. Aseptic arthritis induced by repeated Hyaluronic acid injection is the most likely diagnosis. Physicians should be conscious of this extremely severe complication.

[Transanal irrigation for bowel and anorectal management in spinal cord-injured patients]

OBJECTIVE

Bowel dysfunction and disordered defecation are very common after spinal cord injury (SCI) and can have a major impact on patients' social life and quality of life. The aim of this study was to assess the safety and efficacy of transanal irrigations (TAI) in the management of Bowel dysfunction in SCI patients.

METHODS

Forty-five consecutive SCI patients using TAI were retrospectively included. TAI efficacy was assessed through Neurogenic Bowel Dysfunction (NBD) score recorded before and after 8 weeks of regular use. Possible side effects were assessed with a semi-structured questionnaire. Patients who started TAI use at least 6 months previously were contacted to assess long-term compliance, efficacy and safety of TAI.

RESULTS

After 8 weeks of regular use of TAI, the average NBD scores decreased by four points (P<0.0001) with a specific improvement in the items related to stool frequency (P: 0.036), occurrence of malaise, headache, or sweating during defecation (P: 0.043), use of drugs against constipation (P: 0.007) and frequency of fecal incontinence (P: 0.001). The main side effects were bleeding (10%) and abdominal pain (8%). At 6 months, 80% of the assessed patients had continued regular use of TAI with no particular problem.

CONCLUSION

This study showed good medium and long-term efficacy and safety of TAI in the management of bowel dysfunction and defecation disorders in spinal cord-injured patients.

Long term outcome following mild traumatic brain injury in Moroccan patients

PRIMARY OBJECTIVES

To describe the symptoms of chronic post-concussion syndrome (PCS) and to investigate the relationship between the persistence of these symptoms and different aspects of social life (return to work, quality of life, sport and leisure activities and family relationships) in Moroccan patients with mild traumatic brain injury (MTBI), one year after the trauma.

METHODS

Forty-two adult patients who sustained MTBI were reviewed one year after trauma. We investigated the persistence of PCS by using the "Problem Checklist" questionnaire. We also assessed their quality of life using a visual analogue scale, and noted the changes in employment status, social activities and family relationships. Then, we examined whether there were significant relationships between these different data.

RESULTS

More than half of the patients (n=23, 54.8%) were found with persistent post-concussion symptoms at one year post-injury. Chronic PCS was significantly more common in married persons (p=0.008) and significantly related to both non return to work (p≤0.01), and QoL deterioration (p≤0.001).

CONCLUSION

In this study, a large proportion of persons who sustained a MTBI experienced persistent symptoms up to one year after trauma. MTBI might have significant and lasting impact on the quality of life, which is to be verified by further studies.

Influence of MDM2 SNP309 alone or in combination with the TP53 R72P polymorphism in oligodendroglial tumors

The transcription factor p53 and its negative regulator MDM2 are pivotal in normal and cancer cells biology. Recently, a functional single-nucleotide polymorphism in the promoter region of MDM2 (MDM2 SNP309), alone or in combination with TP53 R72P, was shown to be associated with the risk, prognosis, age at onset, molecular markers, and response to chemotherapy of various cancers. This SNP has never been specifically investigated in a large series of oligodendroglial tumors. In a comparison with 232 healthy controls, we retrospectively analyzed blood samples of 293 oligodendroglial tumor patients for MDM2 SNP309. In addition, the TP53 R72P polymorphism and chromosome 1p/19q status, a major biomarker in oligodendroglial tumors, were investigated. The frequencies of T/T, T/G, and G/G genotypes in patients and controls did not suggest an increased risk of oligodendroglial tumor formation correlating with MDM2 SNP309. A borderline association was found between MDM2 SNP309 and overall survival (p=0.05), but in multivariate analysis, MDM2 SNP309 did not provide prognostic information complementary to age, tumor phenotype, grade, and 1p/19q status in oligodendroglial tumors. Finally, MDM2 SNP309, alone or in combination with TP53 R72P, was not associated with oligodendroglial tumors.