Hospital In Marrakech Research Articles

Exploring Cardiac Variability in Hypereosinophilia: Clinical Insights and Echocardiographic Findings

Introduction: The cardiac manifestations of hypereosinophilia include mainly endomyocardial fibrosis, which is the most frequently observed form. However, eosinophilic cardiopathy can manifest itself in different ways, affecting the various layers of the heart and presenting a variety of clinical and echocardiographic presentations. Aim: The aim of our study is to describe the various aspects of cardiac involvement observed in hypereosinophilia, based on our case series and data from the literature. Methods: This is a retrospective, descriptive study of five observations illustrating the diversity of eosinophilic cardiopathy, from the cardiology department of the Mohammed VI University Hospital in Marrakech, over a period of 12 months. Results: Over the period of the study, five patients presented with cardiac damage in the context of hypereosinophilia. The mean age was 53.8 years, with a predominance of women (sex ratio 0.66). In the majority of cases, the discovery of cardiac involvement was incidental to a cardiovascular check-up requested during the course of their medical condition. All cases had high levels of hypereosinophilia, with an average of 5681. These observations illustrate the wide variety of aetiologies of hypereosinophilia, all of which were represented: 3 cases of Churg-Strauss syndrome, 1 case of idiopathic hypereosinophilia syndrome, and 1 case of DRESS syndrome. The cardiac disorders observed were hypokinetic cardiomyopathy at the dilated stage in 60% of cases, acute eosinophilic myocarditis in 20%, and acute pericarditis in the remaining cases. The outcome was marked by an improvement in the FE in 60% of cases, stabilisation in 20%, and a fatal outcome in the remainder. Treatment is based on symptomatic therapy of the CHF and treatment of the underlying aetiology. Discussion and Conclusion: Eosinophils are cytotoxic through the release of granular proteins that initially attack the endocardium, leading to thrombosis and embolic events. Subsequently, this aggression contributes to fibrosis and valvular complications. Cardiac damage can also manifest itself as potentially serious acute myocarditis or pericarditis, which can progress to cardiac tamponade. These cardiac disorders and the diversity of possible aetiologies serve as a reminder that vital prognosis may be at stake in the acute phase, and to emphasise that functional prognosis depends on early echocardiographic screening and rapid initiation of treatment to limit the risk of thrombo-embolic and fibrosing complications.

Study of intestinal microbiota in Parkinson’s disease

ABSTRACT Parkinson’s disease represents a significant public health issue, with alterations in the intestinal microbiota playing an important role in its aetiology. This study aimed to investigate the intestinal microbiota in Parkinson’s disease patients. Conducted with 30 Parkinson’s patients and 22 healthy controls, the participants were recruited from the neurology department of the Mohamed VI University Hospital in Marrakech. Data collection used an exploitation form and microbiological analysis of stool samples. The average age of Parkinson’s patients was 62.2 years (standard deviation 8.40). Results indicated that the total germ count in Parkinson’s patients was significantly higher than in controls (p = 0.036). Specifically, the counts of Clostridium (463.10^3 CFU/g) in Parkinson’s patients were higher compared to controls (101.10^3 CFU/g) (p < 0.001), Lactobacillus (1965.10^3 CFU/g) versus controls (933.10^3 CFU/g) (p = 0.031), and Streptococcus (510.10^4 CFU/g) versus controls (320.10^4 CFU/g) (p = 0.022). These findings suggest that the intestinal microbiota may serve as a potential biomarker for Parkinson’s disease.

Monoclonal gammapathies: Epidemiological, immunochemical and etiological analysis of a series of 50 cases

During the period from September 2022 to January 2023, 50 cases of monoclonal gammopathy (GM) were collected at the Avicenne military hospital in Marrakech. The average age of the patients was 62 years. Thirty patients were male and 20 were female. The etiological diagnosis could be established for the 50 observations: 5 were classified as GM of undetermined significance (GMSI), 42 were classified as myeloma, two case of Waldenström's disease and one case of AL amyloidosis. The clinical symptomatology was dominated by bone pain in 78% of patients with a deterioration in general condition in 43%. The most frequently found biological abnormalities were anemia in 62% of patients, renal failure in 48% of patients and 19% had hypercalcemia. A monoclonal peak was found in the electrophoreses of 45 patients (90%), of whom 6 migrated to the beta zone and 39 migrated to the gamma zone. The IgG Kappa isotype was the most frequent with a rate of 56%, followed by IgG Lambda (27%), IgA Kappa (8%), IgA Lambda (3%), IgM Lambda (3%) and lambda free light chains (3%).

Acinetobacter baumannii: Epidemiological profile and antibiotic resistance in patients from the intensive care unit of Avicenne military hospital in Marrakech

Acinetobacter baumannii: Epidemiological profile and antibiotic resistance in patients from the intensive care unit of Avicenne military hospital in Marrakech

Merkel Cell Carcinoma: A Case Report and Literature Review

Merkel cell carcinoma (MCC) is a rare but very aggressive cutaneous malignant tumor of neuroendocrine origin with an increasing incidence rate. Its pathogenesis is linked to Merkel cell polyomavirus, and advanced age, white skin exposed to UV and immunodeficiency are among these risk factors. Its treatment is based on surgery in localized disease and immunotherapy in locally advanced or metastatic disease. We report here the case of a 79-year-old patient, followed at the Oncology-Radiotherapy Department of the Mohammed VI University Hospital in Marrakech, for treatment of a MCC of the lower lip. He benefited from primary surgery followed by adjuvant radiotherapy with an encouraging response. Currently he is under surveillance. Knowledge of this rare malignant tumor will allow health professionals to improve its management by establishing the diagnosis early and indicating adequate treatment, because therapeutic advances in recent years have significantly improved survival.

Wunderlich Syndrome in a Patient with Pyelonephritis

Wunderlich syndrome (WS) is a life-threatening emergency characterized by the sudden onset of spontaneous, non-traumatic renal hemorrhage in the sub-capsular and perirenal space, with a distinct clinical and radiological presentation that enables diagnosis. Although most cases require invasive treatments such as surgery or embolization to control the bleeding, our 17-year-old patient admitted to the Mohammed VI hospital in Marrakech was successfully managed with conservative treatment.

Study of Risk Factors for Nasopharyngeal Carcinoma: About 214 Cases

Nasopharyngeal carcinoma (NPC) is a malignant tumour of the nasopharyngeal epithelium. It is very aggressive; with geographical distribution, placing Morocco in an intermediate incidence zone; and multifactorial etiology. We report here 214 cases of NPC followed within the Radiation Oncology Department of the Mohammed VI University Hospital in Marrakech, 84.58% of whom presented with at least one risk factor. The most incriminated was ENT infection (41.12%). NPC, due to its characteristics, constitutes a public health problem that requires primary prevention. Knowledge of risk factors would make it easier to raise public awareness.

Analysis of a Series of 27 Cases of Darier-Ferrand Dermatofibrosarcoma at the Mohammed VI University Hospital in Marrakech

Darier Ferrand dermatofibrosarcoma is a low-grade superficial fibroblastic tumor with a storiform architecture. It is characterized by its local aggressiveness and low metastatic potential. We report a retrospective study spread over a period from January 2019 to July 2024 and involving 27 cases collected at the Mohammed VI University Hospital in Marrakech. Our series showed a sex ratio M/F of 1.4 with an average age of our patients at the time of diagnosis was 31.7 years with extremes of age between 68 and 21 years. The buttock and thigh were the predominant location observed in 55.6% (15 patients), the thorax 18.5% (5 cases), the leg 14.8% (4 cases), the face 3 ,7% (1 case), the back (1 case) and the vulva (1 case). The aim of this work is to report the experience of the Mohammed VI University Hospital and to discuss the related literature on the epidemiological and anatomopathological characteristics.

Can plethysmographic capillary refill time predict lactate during sepsis? An observational study from Morocco

IntroductionBlood lactate is a marker of tissue hypoxia while capillary refill time (CRT) is a surrogate of tissue perfusion. Measuring these parameters is recommended for assessing circulatory status and guiding resuscitation. However, blood lactate is not widely available in African emergency departments. Additionally, CRT assessment faces challenges related to its precision and reproducibility. This study aims to evaluate the accuracy of visual CRT(V-CRT) compared to plethysmographic CRT (P-CRT) in predicting lactate levels among septic patients. MethodsThis prospective observational study enrolled consecutive patients with sepsis or septic shock over a 6-month period from a tertiary hospital in Marrakech, Morroco. V-CRT and P-CRT were evaluated upon admission, and simultaneous measurements of arterial lactate levels were obtained. The precision of V-CRT and P-CRT in predicting arterial lactate was assessed using ROC curve analysis. ResultsForty-three patients aged of 64±15 years, of whom 70 % were male, were included in the study. Of these, 23 patients (53 %) had sepsis, and 20 patients (47 %) experienced septic shock. Both V-CRT and P-CRT demonstrated statistically significant correlations with arterial lactate, with correlation coefficients of 0.529 (p < 0.0001) and 0.517 (p = 0.001), respectively. ROC curve analysis revealed that V-CRT exhibited satisfactory accuracy in predicting arterial lactate levels >2 mmol/l, with an area under the curve (AUC) of 0.8 (95 % CI=0.65 – 0.93; p < 0.0001). The prediction ability of P-CRT was lower than V-CRT with an AUC of 0.73 (95 % CI: 0.57–0.89; p = 0.043). The optimal thresholds were determined as 3.4 s for V-CRT (sensitivity = 90 %, specificity = 58 %) and 4.1 s for P-CRT (sensitivity = 85 %, specificity = 62 %). ConclusionThese findings suggest that the plethysmographic evaluation did not improve the accuracy of CRT for predicting lactate level. However, V-CRT may still serve as a viable surrogate for lactate in septic patients in low-income settings.

PRECOCIOUS PUBERTY: EPIDEMIOLOGY, CLINICAL PRESENTATION, DIAGNOSIS, AND ETIOLOGIES

Precocious puberty, defined as the onset of sexual characteristics before the age of 8 in girls and 9 in boys, can arise from various causes, including central and peripheral mechanisms. While central precocious puberty (CPP) originates from premature activation of the hypothalamic-pituitary axis, peripheral precocious puberty (PPP) results from gonadal or adrenal hormone secretion independent of hypothalamic control. We conducted a retrospective study spanning eight years, from 2015 to 2023, at the Mohamed 6 University Hospital in Marrakech, Morocco, to investigate the epidemiological, clinical findings, laboratory, and etiological aspects of precociuos puberty in 12 children. We found a predominance of CPP, particularly in girls, with breast development being the most common clinical sign. In boys, early puberty typically presented with pubic hair development and increased penile size. Diagnostic evaluation included hormonal assays and imaging studies, with elevated levels of gonadal hormones confirming the diagnosis. CPP was predominantly idiopathic in girls, while traumatic brain injury and CNS lesions were common causes in boys. Adrenal disorders, including congenital adrenal hyperplasia, accounted for PPP cases. Brain imaging was crucial for identifying central lesions, while adrenal imaging aided in diagnosing adrenal pathologies. Despite limitations such as retrospective design and incomplete data, our study emphasizes the importance of early recognition and appropriate diagnostic procedures for children showing signs of early puberty to optimize management and outcomes.

Epidemiological, clinical and biological profile of COVID-19 in patients hospitalized at the Avicenne Military Hospital in Marrakech

In late December 2019, a series of cases of viral pneumonia caused by a novel coronavirus emerged in Wuhan, China, and quickly spread to all continents. This coronavirus, identified in respiratory tract samples, was named SARS-CoV-2 for Severe Acute Respiratory Syndrome Coronavirus-2 by the ICTV (International Committee on Taxonomy of Viruses). The disease it causes was designated COVID-19 for Coronavirus Disease 2019 by the Word Health Organization. Most often, SARS-CoV-2 infection is responsible for a mild or moderate form, with the most typical clinical presentation being that of a febrile respiratory infection with dry cough, dyspnea, fatigue, and myalgia. Approximately 10-15% of cases are severe, and 5% are critical. Cases of reinfection have been described. Treatment for COVID-19 is currently symptomatic, relying on supportive care. The present study aims to investigate the demographic, clinical, and diagnostic aspects, as well as the study of risk factors associated with SARS-CoV-2 infection among 318 patients admitted to the Avicenne Military Hospital in Marrakech during the first wave of the pandemic. This is a retrospective descriptive and analytical study involving 318 cases of SARS-CoV-2 infection, diagnosed at the microbiology-virology department, and followed up in various non-intensive care units of the Avicenna Military Hospital in Marrakech, during the period of the first wave of the epidemic in Morocco, schematically between March 22, 2020, and July 19, 2020. For patients who developed pneumonia, 20% were diabetic and 13.3% were hypertensive. A quarter of patients with pneumonia experienced desaturation upon admission. In the multivariate logistic regression model, risk factors associated with the development of pneumonia and the various disease outcomes included advanced age and absence of a history of contact with a confirmed case. In the univariate analysis, hyperleukocytosis, neutrophilia, lymphopenia, eosinopenia, anaemia, hyperferritinaemia with elevated aspartate aminotransferase, hyponatraemia and fasting hyperglycaemia were significantly associated with a higher risk of an unfavourable outcome. Patients who presented with pneumonia on admission had an unfavourable outcome during their hospitalisation compared with patients who did not develop pneumonia. The statistically significant risk factors associated with an unfavourable outcome were advanced age (&gt;60 years) with p &lt;0. 001: OR=1.194; 95%IC= [1.114-1.278], absence of contact with a confirmed case (p &lt;0.001 : OR= 43.138; 95%IC= [8.893-209.263]), presence of comorbidity (P&lt;0.001 : OR=11. 503; 95%CI= [3,306-40,028]), mainly diabetes (P&lt;0.001: OR=16,971; 95%CI= [4,267-67,504]) and arterial hypertension (P&lt;0.001: OR=18,812; 95%CI= [3,977-88,954]). The study of the epidemiological, clinical and biological characteristics of COVID 19 at the Avicenne military hospital in Marrakech has enabled us to gain a better understanding of the profile of our patients with SARS-CoV-2 infection, and then to detect shortcomings in terms of prophylaxis, diagnosis and management, in order to be able to provide the necessary solutions aimed at further improving the quality of care for this population.

Adult niemann-pick disease: A case report

Adult niemann-pick disease: A case report

Bacteriological profile of community peritonitis in adults at Mohammed VI university hospital

A good analysis of intraperitoneal bacteriological results constitutes the basis of therapeutic consideration. The objective of this work is to report the main epidemiological and bacteriological characteristics of community-acquired peritonitis in adults at the Mohammed VI University Hospital of Marrakech. This is a retrospective descriptive study carried out in the microbiology laboratory of Arrazi hospital at Mohammed VI University Hospital in Marrakech over a period of seven years from January 1, 2017 to December 31, 2023 including all community peritonitis documented in our hospital. The cytobacteriological study was carried out according to conventional methods. During the study period (2017-2023), 503 documented peritonitis were collected, The profile of the incriminated germs was dominated by Escherichia coli (48.9%) followed by Streptococci (18.3%), 8% of Pseudomonas aeruginosa and 18.5% for other Enterobacteria. Our results showed that E coli becomes increasingly resistant to the combination of amoxicillin acid clavulanic which is the antibiotic commonly used in our context, this leads us to review the antibiotics prescribed probabilistically in our context for the management of peritonitis community.

Primary Mesenteric Hydatid Cyst in Pediatric Patients: Case Report and Literature Review

Mesenteric hydatid cyst in children is not common, even in endemic areas. The primary or secondary origin of this site, especially in children, remains controversial. Secondary peritoneal hydatid cyst mainly results from spontaneous or traumatic rupture of concurrent liver cysts or leakage of cystic contents during surgery. The aim of our study is to present a mesenteric hydatid cyst in children. Our study focuses on a single case of a child with peritoneal hydatid cyst, who underwent surgery in 2021 in the pediatric surgery department of the Mohammed VI hospital in Marrakech. The diagnosis is based on abdominal ultrasound, computed tomography and hydatidosis serology. The treatment is surgical by open or laparoscopic excision, which can be associated with medical treatment.

Primary Retroperitoneal Tumors: A Report of 08 Cases at the General Surgery Department of The Mohamed VI University Hospital in Marrakech

Primary retroperitoneal tumors are a rare and heterogeneous group of neoplasms arising within the retroperitoneal space, excluding the kidneys, urinary tract, adrenal glands, major blood vessels, and adjacent viscera. Treatment involves surgical resection, often requiring sacrifices of adjacent organs, with adjuvant chemotherapy considered in some cases. Histologically, mesodermal tumors were most common, with myxoid liposarcomas being predominant. Long-term outcomes vary, with some cases showing favorable evolution but others experiencing recurrence or mortality post-surgery. This study aims to provide insights into the clinical presentation, diagnostic approach, treatment modalities, and long-term outcomes of primary retroperitoneal tumors based on a retrospective analysis of cases treated at the general surgery department of the Mohamed VI University Hospital in Marrakech. By elucidating the characteristics and management of these tumors, this study seeks to contribute to the understanding of primary retroperitoneal tumors and guide future diagnostic and therapeutic strategies to improve patient outcomes.

Evaluation of Quality of Life and Visual Outcomes in Children with Uveitis

This prospective study examines the impact of uveitis on children’s quality of life, focusing on visual outcomes and overall well-being. Thirty-two patients, primarily males, aged 6 to 16, were assessed at Mohamed VI University Hospital in Marrakech. Anterior uveitis was the most common type, with various etiologies including juvenile idiopathic arthritis and idiopathic causes. Results highlighted a substantial negative impact on quality of life, evidenced by academic difficulties, psychological distress, and physical limitations. The findings emphasize the necessity of comprehensive patient care and personalized follow-up to address the multifaceted challenges posed by pediatric uveitis.

Epidemiological aspects and resistance profile of bacteremia in the region of Marrakech

Introduction: bacteremia in hospitals is a major public health problem that can lead to mortality and morbidity. The aim of our study is to establish the bacteriological profile of bacteremia and the state of antibiotic resistance in order to optimize probabilistic antibiotherapy at the Avicenna military hospital in Marrakech. Materials and methods: This is a descriptive retrospective study spanning a period of 5 years (January 2019 - December 2023), conducted in the laboratory of bacteriology-virology and molecular biology of the Avicenna Military Hospital in Marrakech, on the all bacteria isolated from blood cultures in hospitalized patients. Results: During this period, we collected 839 blood cultures, 140 of which resulted to isolate a bacterium. The predominant causative organism was Staphylococcus aureus (27%), The resistance profile of the strains was as follows: 3.57% for methicillin for Staphylococcus aureus and 50% for staphylococcus coagulase negative. Regarding Enterobacteria; 30.28% were producing ESBL, ciprofloxacin resistance was involved in 41.8% of Enterobacteria while all strains were sensitive to kanamicin. The resistance of Acinetobacter baumanii was 100% to ciprofloxacin, and 91% to ticarcillin, ceftazidime, imipenem and amikacin while remaining 100% sensitive to colistin. Conclusion: surveillance of bacteria’s epidemiological characteristics and their antibiotic susceptibility profile should be continuous for appropriate adaptation of initial empirical treatment of bacteraemia.

Moral harassment in university hospital of Marrakesh: Epidemiological investigation

Introduction: moral harassment in the workplace is a growing phenomenon worldwide. Leymann defined it as a form of psychological terrorism that manifests itself over a relatively long period of hostile words or actions expressed or manifested by one or more people towards a third person (target) at work. It causes damaging consequences on the mental and physical workers health, with negative economic impacts on the company. Objectives: our objective was to study the epidemiological characteristics, the clinical aspects, and the consequences of moral harassment among the medical and paramedical staff of the Mohammed VI university hospital in Marrakech. Methods: We carried out a descriptive transversal study over six months covering 329 caregivers working at the Mohammed VI university hospital in Marrakech. The support of the investigation was an individual, and a strictly anonymous questionnaire containing the French version validated by the questionnaire of Leymann entitled Leymann Inventory of Psychological Terror; sociodemographic, mental health, and professional data were also collected. Results: In our study, the prevalence of moral harassment was 27.5%, according to Leymann's criteria (exposure to at least one situation, at least once a week for at least six months). Moral violence targets were between 25 to 35 years old (76%) and less than five years seniority (55%). The victims were represented mainly by residents (65.5%) and interns (33%). There was no correlation between sex and exposure to psychological violence (p=0,36). The supervisor was the main harasser (80%). Anxiety, depression, and symptoms of post-traumatic stress disorder had been the most observed consequences on the mental health of victims. Conclusion: Moral harassment at work seems, by its prevalence, to invade the hospital environment, and young doctors constitute a particular target. Exposure to this phenomenon has a negative impact on an individual's mental health. Our results are alarming enough to prompt us to continue investigating and put in place recommendations to limit and prevent the consequences.

Assessment of Asthma Control in Children During the COVID-19 Pandemic: A Cross-Sectional Study at a Pediatric Hospital in Marrakech (Morroco)

Assessment of Asthma Control in Children During the COVID-19 Pandemic: A Cross-Sectional Study at a Pediatric Hospital in Marrakech (Morroco)

Pneumothorax revealing miliary tuberculosis: A case report

Pulmonary tuberculosis can take several clinical and radiological forms; spontaneous pneumothorax is a serious complication of tuberculosis, and tuberculous miliary is a severe form of secondary tuberculosis due to hematogenous dissemination of Mycobacterium tuberculosis. We report a case of tuberculous miliary revealed by pneumothorax. The patient was 57 years old and a farmer. He was been presented to the emergency department of Mohamed VI University Hospital in Marrakech with acute dyspnea associated with chest pain. Clinical examination and imaging revealed a spontaneous pneumothorax that complicated tuberculous miliary. Treatment consisted of a combination of anti-tuberculosis chemotherapy, chest drainage, and kinesrespiratory therapy. The outcome was favorable, with improvement in clinical and radiological signs. Pneumothorax complicating TM requires careful diagnosis and prompt management to improve prognosis.