Ibn Rochd Research Articles

Dyspnea and right ventricular dysfunction in patients with isolated mitral stenosis: A retrospective study

Patients with severe and very severe mitral stenosis (MS) are not homogenous regarding symptomatology, and some suffer more than others. The RV systolic function is an important determinant of clinical symptoms, exercise capacity, preoperative survival, and postoperative outcome in patients with mitral stenosis The objectives of this study, is to compare RV function in symptomatic and asymptomatic patients with isolated mitral stenosis. This is a descriptive and analytique study, conducted in Ibn Rochd Center of Cardiology from January 2014 to December 2018, which included all patients with pure severe and very severe MS, devided into two groups according to their functional capacity. Group I (asymptomatic group) with NYHA class I and group II (symptomatic group) with class II–III–IV. The RV systolic function was evaluated by both Doppler tissue imaging, and pulse Doppler, we consider a RV dysfunction when TAPSE 16 mm and S’ 9,5 cm/s. In our series there was a female predominance (69%) symptomatic than men (84,42%, versus 69, 23%). Younger patients < 45 years old, were slightly predominant (51%). Group I consisted of 64 patients (25%), group II had 192 patients (75%). RV was dilated in 17% in group I, versus 34% of group II RV systolic dysfunction was found in: 29% of symptomatic patients and 14% in asymptomatic patients ( P < 0.001) Patient with and impaired RV function are more symptomatic than those with better RV systolic function, without significant difference. This result is confirmed by 2studies conducted in Turkey and India.

Stroke in patients with mechanical heart valve prosthesis: Challenge of resumption of anticoagulation

Patients with mechanical valvular prostheses are at high risk of embolism and excessive risk of bleeding by Warfarin, the vast majority of whom are cerebral. A sudden neurological deficit in a patient with a prosthetic valve requires brain imaging to determine whether it is an ischemic or haemorrhagic stroke. The decision to restart anticoagulation should be multidisciplinary to counterbalance the risk of cerebral hemorrhage and thrombosis of the prosthetic valve. The objective is to study the clinical and radiological evolution of patients with mechanical heart valve prostheses complicated by a cerebrovascular accident. A retrospective study spread over one year (November 2017 to November 2018) on 21 cases in the Cardiology Department of Ibn Rochd Casablanca Teaching Hospital. We report 21 observations of patients with cardiac mechanical prostheses placed under warfarin, hospitalized for stroke. Including 14 men and 7 women with an average age of 35 years. Of which 11 patients had mitral prostheses, 3 had aortic prostheses and 7 mitro-aortic prostheses. Of these patients, 15 had ischemic stroke and 6 hemorrhagic stroke (4 cases with ventricular flood). Radiological monitoring by brain CT from J0 and unfractionated heparin by self-injecting syringe was the method of choice for resuming anticoagulation in 17 patients in agreement with neurologists. The evolution was favorable in 13 patients (61, 9%) with a good relay to warfarin (10 AVCI and 3 AVCH), a haemorrhagic transformation in 5 patients with. We had death of 3 patients who had hemorrhagic stroke. The prognosis can be put into play after the occurrence of stroke in patients with mechanical heart valves, a risk of cerebral hemorrhage in case of early resumption of anticoagulants and thrombotic risk of prostheses in case of a delayed recovery.

Tuberculosis of the breast: analysis of 17 cases.

Tuberculosis constitutes a major public health problem in the world. Certain extra-pulmonary locations of tuberculosis disease are very exceptional. Amongst these, tuberculosis of the breast is rare even in countries where this infection is endemic. This form of tuberculosis is characterized by clinical and radiological polymorphisms and might mimic other diseases, especially breast cancer. This retrospective study is entailing seventeen patients treated in the Onco-Gynecology Department of the Mohammed VI Cancer Treatment Center, in the Ibn Rochd University Hospital of Casablanca, for breast tuberculosis, over a period of three years. We report the epidemiological, clinical and paraclinical aspects and we specify the treatment and evolution of the patients.

Electrocardiogram analysis in patients with sickle cell disease and thalassemia

This study is an analysis of the electrocardiograms (ECGs) of 52 adult patients with a hemoglobinopathy (sickle cell disease and/or thalassemia). We examined the electrocardiograms (ECG) of 52 consecutive patients (> 14 years old) with ahemoglobinopathy (sickle cell disease and/or thalassemia) monitored at the Casablanca Ibn Rochd Hospital between February 2017 and July 2018. The mean age was 24.19 ± 9.55; 50.9 percent were men. Forty-six percent of all patients had abnormal ECGs. Among the 52 electrocadiograms, 17 had left ventricular hypertrophy, one patient had left bundle branch block and 5 patients had right bundle branch block. The corrected QT interval was prolonged in 3 patients. T wave abnormalities were recorded in 9 cases (inverted T wave in 8 cases and peaked T wave in 1 case). There was one case of atrial fibrillation, and no cases of atrioventricular block or ST segment abnormalities were recorded. The most observed electrical abnormalities were left ventricular hypertrophy, left and right branch block, and prolongation of the Qtc interval.

Combination aortic and mitral stenosis: what are the particularities?

Multivalvular heart disease is a frequent situation, but there is only few medical literature about its management. The combination between aortic stenosis(AS) and mitral stenosis(MS) is an illustrative example. This situation is far from being exceptional especially in developing countries. The aim of our study is to describe the clinical features, electrical and echocardiographic characteristics of patients with both MS and AS. We achieved a prospective, single-centric study from October 2017 to january 2019, concerning register of patients followed for valvulopathies, collected from the hospital of day and echocardiography vacations in the cardiology department of Ibn Rochd University Hospital in Casablanca, Morocco. We included only patients having association MS and AS. The valvular register included 320 patients, 20 of them (6%) had combined AS and MS. Mean age was 47,57 (± 16.27); sex ratio = 0.7. Clinical presentation was dyspnea in 95% (76% stage II and 16% stage III of NYHA), 5% Angina, 15% hemoptysis, and 28% palpitations. A Left and right heart failure were found in 10% and 14.3%. ACFA was noted in 42%. Left ventricular hypertrophy was found in 47.6%, left and right ventricular dysfunction in 28,6% and 23%. The mean mechanism was rheumatic in 90%. MS was very severe in 30%, severe in 70%; with a mean mitral surface at 1.1 cm 2 , and mean gradient at 9 mmHg. AS was severe in 45%, moderate in 25%, and mild in 30%, with a mean aortic surface at 0,7cm 2 /m 2 , and mean gradient at 31 mmHg. A state of low flow was found in 30% with a VES < 35 ml/m 2 responsible of a low aortic gradient in 5%. Pulmonary hypertension was noticed in 45%. The association AS and MS is not rare in our context. It is important not to underestimate the diagnosis and therapeutic challenges raised by this entity. These complex situations require a multidisciplinary approach of heart team involving cardiologist, surgeons and imaging specialists (1).

Characteristics of Persistent or Recurrent Differentiated Thyroid Cancer

Introduction: The differentiated thyroid cancer has generally an excellent prognosis after the treatment. The aim of this study is to describe the characteristics of persistent or recurrent differentiated thyroid cancers. Patients/ Methods: It is about a descriptive and retrospective study conducted from 392 patients followed for differentiated thyroid cancer. The data concerning the persistent or recurrent differentiated thyroid cancer have been collected from 1986 to 2015 in endocrinology service in Ibn Rochd CHU. Results: In total, twenty-four patients have shown the relapse or the persistency of their tumor, corresponding to the prevalence of 6.12 percent. The papillary carcinoma was dominant in 79 percent of cases and the follicular carcinoma in 21 percent of cases. The metastases were cerebral (two cases), lung (3 cases), bones (3 cases, Figure 1), and lymph nodes (9 cases). In our series, eighteen cases of persistent differentiated thyroid cancer have been found against six cases of recurrent differentiated thyroid cancer. Two cases of death at least three years of followed in our series and concerned the two cases of cerebral metastasis. Conclusion: The persistent or recurrent differentiated thyroid cancer rate is low in our series. The discovery of the relapse t is late.

A model for measuring the impact of Hospital Supply Chain on the psychological state of cancer patients using PLS method

This paper presents the development of a conceptual model to evaluate the impact of the improvement of the hospital supply chain on the cancer patient psychological state within the oncology department of the IBN ROCHD University Hospital (UH) in Casablanca. Through an empirical study using a survey submitted to a sample of 100 users of this department (patients, staff, etc.) and using latent variable structural modelling by the partial least squares (PLS) method via the XL-STAT software (version 2017), we evaluate the proposed model in terms of reliability and validity to conclude that the improvement of the hospital supply chain impacts positively the psychological state of cancer throughout their treatment trajectory in the oncology department of the IBN ROCH UH. The results obtained allow us to propose areas for improvement and action plans to be taken into account by managers at strategic and tactical levels in the studied department.

Patient management follow-up for CAV at Ibn-Rochd-Casablanca CHU: Ten years experience

The Atrioventricular Canal is a serious pathology due to the complexity of the lesions and the risk of fixed Pulmonary Arterial Hypertension. It represents 3 to 7.3% of congenital heart disease. Its prognosis depends on the precocity of its diagnosis and its management. The interest of this work therefore was to evaluate the management of CAV at IBN-ROCHD CHU. It is to make an inventory of the CAV profile, their diagnostic and therapeutic management on the one hand, the delay of management, the postoperative evolution, the reasons for intervention and the factors predicting mortality of patients follow-up for CAV at the cardiology department of CHU Ibn-Rochd-Casablanca. We conducted a 10-year retrospective study from 2008 to 2017 including all cases of CAV found in the study period. Three hundred and thirteen patients were found in the study period. Surgical management of patients with CAV was performed in the liberal sector in 59.3% of cases, followed by 37% in the public sector, and surgeries performed in foreign missions accounted for only 3.7%. CAV surgery in our study. The median age of operated patients was 10.4 months with a minimum of 4.9 months and a maximum of 35.9 years. Of the operated patients, 69.2% received curative treatment at a median age of 7 months with a minimum of 2 months and a maximum of 35.9 years,while 13.3% received palliative treatment. The surgical management of CAV must be early to improve the survival of these patients in the long term. The Atrioventricular Canal is a serious pathology due to the complexity of the lesions and the risk of fixed Pulmonary Arterial Hypertension. It represents 3 to 7.3% of congenital heart disease. Its prognosis depends on the precocity of its diagnosis and its management. Hence the interest of this work which was to evaluate the management of CAV at IBN ROCHD CHU.

Prevalence of Musculoskeletal Disorders among Dentists in Casablanca’s Dental Center

Introduction: Musculoskeletal disorders (MSDs) are the most common occupational pathologies among dentists around the world but studies are quite limited. The present study was carried out to investigate the prevalence of MSDs among dentists in Casablanca, Morocco.Methods: This was a cross-sectional descriptive study conducted among the medical staff (120 dentists) of Casablanca's Dental Center, part of the Ibn Rochd University Hospital, Morocco, over a period of 3 weeks from July 24, 2017, to August 11, 2017. The study was based on a self-administrated questionnaire which comprises two parts: the first part included physical characteristics, academic life, clinical practice, ergonomics, and work methods; and the second part consists of the “Standardized Nordic Questionnaire” (SNQ) or Nordic style questionnaire.Results: The prevalence of musculoskeletal disorders in our sample was 71.67%, predominately affecting the neck, the upper, and the lower back.Conclusion: Prevalence of MSDs was high among Moroccan dentists and the prevention of these disorders requires the adoption of a correct posture, good working habits, and ergonomic organization of the workspace, as well as the integration of regular physical activities in order for the dentist to maintain a good quality of life.

Acute Myocarditis Mimicking an Acute Coronary Syndrome: Case Report and Mini-Review of the Literature

Acute myocarditis is often a challenging diagnosis due to a lack of specific clinical or paraclinical signs. It can be presented by a severe chest pain and localized ST elevation on Electrocardiogram, in rare cases, misleading the diagnosis towards acute coronary syndrome. After routine coronary angiography, a cardiac magnetic resonance imaging is imposed to correct the diagnosis towards acute myocarditis. We report the observation of a 19 year-old Moroccan male admitted to the cardiology department of IBN ROCHD University hospital of Casablanca, for acute myocarditis misdiagnosed initially as an acute myocardial infarction ST elevation and confirmed by cardiac magnetic resonance imaging.

The correlation between hearing loss and the site of eardrum perforation: about 260 cases

Introduction: Some authors have assumed that the hearing loss depends on the site and the size of the perforations, but the results were contradictory and inconclusive. The aim of this present study is to find correlation between hearing loss and the location of tympanic membrane perforation after a chronic otitis media. Materials and Methods: A retrospective study was conducted in our ENT department, university hospital Ibn Rochd Casablanca Morocco. Two hundred sixty patients were enrolled in this study with eardrum perforation and without any neurosensory hearing loss or middle/ inner ear diseases. Data processing and analysis were carried out with computer software SPSS. Results: Two hundred sixty patients (103 males, 157 females) with age range 8–67 years (mean = 35.9) were studied. Bilateral tympanic membrane perforations were seen in 84 patients (60%), unilateral perforation in 176 patients (68%). In the 260 patients, 253 eardrum perforations were caused by chronic otitis media. Only 7 cases were due to a traumatism. The tympanic perforation was posterior in 64 cases (24.6%), subtotal in 54 cases (20.8%), central in 49 cases (18.8%), anterior in 44 cases (16.9%), antero-superior in 1 case, antero-inferior in 23 cases (8.8%), postero-superior in 5 cases (1.9%), and postero-inferior in 10 cases (3.8%). The tympanic perforation was inferior in 10 cases (3.8%). Perforation’s sites on the tympanic membrane were correlated with the groups of average hearing loss. For anterior perforations the average loss was moderate in 52.3% and severe in 13.6%. For posterior perforations the average loss was moderate in 75%. For subtotal perforation, the percentage was equal for mild and moderate hearing loss. The average loss for anterior perforations was 41.93 dB. The average loss for posterior ones was 42.66 dB. Conclusion: The current study aimed to correlate the degree of hearing loss to the different site of perforation. From the present study we can tell that Hearing loss in chronic otitis media is independent of the site of eardrum perforation. Nevertheless, further studies are needed with a representative population to confirm our results. Keywords: Site of eardrum perforation; Hearing loss; Bone conduction

Circadian variation and seasonal differences in occurrence of acute ischemic strokes

Morocco is a country with clear seasonal variations in weather conditions. Seasonal and circadian variations in the occurrence of cerebrovascular diseases have been of interest in several studies, reported to climate changes, but discrepant results made the conclusions unclear. The aim of the study is to observe the seasonal and circadian variation in ischemic stroke onset among our population. This is an observational study based on cases of stroke recruited from a prospectively collected database, conducted between January 2018 and December 2018 in the Department of Neurology, at Ibn Rochd university hospital. All patients with a diagnosis of ischemic stroke and having a definitive time and month of onset were included in the study. The categorization of the year was distributed into months and seasons. The time of onset was subdivided into one hourly interval and 4 quadrants of 6 hourly intervals. A total of 363 patients were included in the study. Mean age of patients was 66 years. Male to female ratio was 1,14. The rate of occurrence of stroke was highest in the morning 06 h–12 h hours (p < 005) compared with other times of the day. It was lowest in the nighttime period 00 h–6 h quadrant compared with other quadrants (Fig1). Annual distribution of stroke was without any variation. No difference was found by dichotomizing the groups into four 3 month periods (Fig2).These data support the presence of a circadian pattern in the onset of stroke, with a significantly higher risk in the morning, probably explained by the circadian changes in pathophysiologic causes of stroke.

EP1.15-21 Thymic Epithelial Tumors: Review of Clinical and Pathological Findings and Prognostic Factors for the Survival

Considered as a very rare malignances (0,15 cases per 100.000), thymic epithelial tumors are also the most commun tumor of the anterior mediastinum. Their treatment is based on multidisciplinary management. The basis of the treatment is a complete surgical and carcinological resection. In locally advanced tumors, neo-adjuvant chemotherapy can be performed. In the case of invasive tumors or incomplete resection, adjuvant radiotherapy is usually recommended. We conducted a monocentric, descriptive and retrospective study based on the medical record of 32 patients who underwent surgery for a thymic epithelial tumors in the department of thoracic surgery in the university hospital Ibn Rochd, Casablanca, Morocco. The aim of this study is to review the clinical and pathological findings and also to determine which factors independently predict survival after surgical resection. The average age was 48 years and the sex ratio was 0. 88. Of the 32 cases, 32,4% had symptoms consistent with myasthenia gravis. Surgical resection was performed either by sternotomy, thoracotomy or VATS. It was complete in 87,5% of cases. 3 patients (9,4%) received neoadjuvant chemotherapy to reduce tumor size before the surgery. Post-operative radiotherapy was indicated in 31. 2% of patients. We have experienced only one death due to the disease in our series and 2 patients were lost to the follow-up. After an univariate analysis, prognostic factors were: the histological type, the Masaoka-Koga stage and the extent of surgical resection. No multivariate analysis could be done due to small numbers of patients. Thymic epithelial tumors present specific problems from anatomical pathology to therapeutic strategy. Their optimal care is still poorly defined because of their rarity and of the resulting difficulty to conceive large clinical trials. Meanwhile, ITMIG, UICC and AJCC are trying to develop a consensus on easier and more universal classification, based on the TNM, to help improve the management.

EP1.15-10 Survival Impact of Non-Surgical Treatment in Thymic Epithelial Tumours: A Retrospective Study

The management of thymic epithelial tumours, although poorly defined due to their rarity, remains multidisciplinary in order to offer patients multimodal treatment with surgery as the therapeutic pillar. Our main objective is to highlight the impact of non-surgical treatments on the overall survival and the progression free survival of patients treated for these tumours at the Mohamed VI center. We carried out a monocentric, descriptive and retrospective study using databases from the oncology, the thoracic surgery and anatomopathology departments of the Ibn Rochd University Hospital in Casablanca. We identified all patients with thymoma or thymic carcinoma whose histological diagnosis was made on a biopsy or a surgical excision piece between July 2006 and February 2016 After exclusions, 42 patients were identified and we used a farm sheet to specify for each patient, epidemiological data, data related to histological type, Masaoka-Koga staging and progress under treatment (complete or partial response, stabilization or progression) For our analysis, we used Microsoft Office, Excel 2007 and Kaplan Meier Software to assess overall ans progression free survival. 42 cases of thymic epithelial tumours were reported between 2006 and 2016 with apredominance of type B1 in patients aged between 25 and 77 years. The radiological assessment carried out before treament showed that 9.5% of the diseases were metastatic from the outset, while the others had an intra – thoracic locoregional extension Half of the patients were resectable from the outset, wich made it possible to perform primary surgery leading to carcinological resection with generally simple post-operative outcomes. In our series, CAP D1 = D21 chemotherapy was the preferred regimen to be indicated as a pre operative treatment to reduce the size of the tumor and increase its resectivity rate in 11 patients (26,2% of cases). This chemotherapy was indicated as adjuvant treatment in 06 cases of incomplete resection (14,3% of cases) Two patients (4,8% of cases) received first chemotherapy followed by exclusive radiation therapy at 66 Gy while more than 25% received a post-operative radiation therapy at variable doses ranging from 50-54Gy for R0 tumours or microscopic disease to 60-70Gy for macroscopic disease. The overall and progression free survivals at 22 months were 94,6% and 68,4% respectively. The prognostic factors are, in univariate analysis, the performans status, the histological type, the Masaoka-Koga stage and the quality of surgical resection. The multivariate analysis could not be performed due to a lack of statistical power, due to the small number of patients and the retrospective nature of the study. The thymic epithelial tumours treatment is a real challenge given the absence of randomized prospective studies on this subject Surgery remains the mainstay of management but neo-adjuvant and or adjuvant treatments can be considered in case of poor prognostic factors in order to reduce the risk of recurrence or death from the disease.

Idiopathic Chylopericardium: A case Report and Breif Review of Literature

Chylopericardium is the accumulation of chylous fluid in the pericardial space. Many etiologies can be found and the treatment depends on the etiology and remains unclear. This rare entity needs some tests to determine its causes. Diagnosis is based on many tools; the pericardial biopsy puncture and lymphoscintigraphy are the most important ones. The treatment requires low fat diet, lipid lowering therapy and surgery in some cases. We here report the first case in the IBN ROCHD university hospital’s Cardiology department of Casablanca, Morocco. It deals with a 32-year-old patient who consulted for dyspnea exacerbation for 18 months, becoming at rest. Chest X-ray and echocardiography were performed discovering pericardial effusion. Pericardiocentesis was performed to confirm the nature of liquid and lymphoscintigraphy showed no abnormal communication between the thoracic duct and pericardium.

Ethnopharmacological Study of Herbal Medicines used to treat Cancer in Morocco

Since the dawn of time, humans use plants to relieve their ills and diseases; cancer is no exception to this rule. Traditional medicine is an important part of health care but often underestimated. Aim of the study: The purpose of this investigation was to determine the prevalence of Medicinal Plants use in oncology, establish the list of plants used to treat cancer and evaluate this practice risks on the health of patients. Methods: Cross-sectional study based on a questionnaire on the use of medicinal plants by patients with cancer in unit of oncology of the university teaching hospital IBN Rochd of Casablanca, Morocco. A questionnaire was distributed to 1325 patients in face to face interviews. Results: Our study involved 1325 patients. Women made up 75% of the population, compared with 25% of men, with a ratio of 0.33. The found prevalence of plants use in our population of patients was high at 38%. 63 herbal medicine species under 38 families have been identified. The most commonly used species were essentially the Marrubium vulgare L followed by the Aristolochia longa, the Berberis vulgaris. Seeds, leaves and fruits are the most commonly used plant parts of plants to treat cancer. Decoction and infusion were the most commonly used method of preparation. The most common type of cancer treated with traditional medicines was breast cancer followed by uterus, colon and leukaemia. Conclusion: This survey provides an updated list of medicinal plants used by the entire Moroccan population. To assess the efficacy and the safety of reported herbs, Clinical and randomized trials are needed hereafter.

Management of high risk pulmonary embolism in the intensive unit care of IBN Rochd University Hospital, Casablanca

High-risk acute pulmonary embolism (PE) is associated with a mortality approaching 25% and remains defined by shock or hypotension. The high early mortality in the presence of a state of shock makes it an urgent diagnosis by favoring examinations in the patient's bed. The aim of this study was to describe the clinical features of patients admitted for acute high-risk PE, the main findings and their prognosis. This is a retrospective study conducted on 112 patients hospitalized in cardiology intensive care unit at IBN ROCHD University Hospital of Casablanca, Morocco for PE between January 2016 and October 2018, including 25 with acute PE at high risk. The average age of the patients with cardiogenic shock was 64.9 years, with a standard deviation of 17.3; with a higher frequency in the elderly > 70 years ( P = 0.06). The sex ratio (M/F) was 0.37, the risk factors for venous thromboembolism were not different from the non-shock group. The clinical presentation was a respiratory distress chart with SpO2 < 95%, arterial hypotension < 90 mmHg systolic and tachycardia > 100bpm in 88% of cases ( P = 0.003). Electrically, rhythm disorders were not more frequent than in stable patients. The echocardiography made it possible to make the diagnosis and initiate the treatment by thrombolysis without waiting for the results of the thoracic angioscanner. A thrombus was found in 24% of cases, right ventricular (RV) dysfunction in 72% of patients ( P = 0.04) with dilatation of RV, paradoxical septum and Pulmonary hypertension in more than 80% of patients. Thrombolysis was used in 88% of patients ( P < 0.001), treatment with non fractionnal heparine, dobutamine was initiated in 52% of cases ( P < 0.01). Mortality was 36% compared to 7% in the non-shock group ( P = 0.026). Despite rapid management and treatment thrombolytics and vasoactive drugs, high-risk acute PE remains a poor prognosis with significant intra-hospital mortality.

Place of Drug Adherence in Patients with chronic heart failure

The treatment of heart failure is one of the main pillars of the management of patients with chronic heart failure and adherence to treatment is a real problem in managing these patients. Several personal, social and environmental factors can participate in this component, which is why it is worthwhile to look into the question. The aim of our work was to study the adherence of patients to different treatments for heart failure and to study the main influencing factors. We carried out a cross-sectional study related to a survey at the heart failure unit in the cardiology department of the IBN ROCHD CHU Casablanca, conducted on 180 patients regularly followed in the service over a period of 6 months from January to June 2018, the data were collected by a survey: CARDIA, and analyzed by SPSS software. The mean age of our patients was 60.6 years, with male predominance (62 vs 38%), the main cause of heart failure was ischemic and the ejection fraction was between 35 and 40% in 40%. Adherence to treatment was optimal in 59% of patients. Patient's knowledge of the importance of each drug was only present in 40%. In non-adherent patients, the main etiology was low socio-economic status (22%) followed by age and non-support (15%). Poor adherence to treatment is a real public health problem in Morocco hence the interest to create support units and explanation to patients with heart failure.

Preprocessing unstructured geographical data for public health analytics applications

Improperly pre-processed data represent a challenge throughout the subsequent phases of any data exploitation project. Hence the objective of this work is to structure and standardise specifically the address field of the University Psychiatric Centre CPU Ibn Rochd's EHR, in order to have computable data. For this purpose, we have created a transformation using a combination of Natural Language Processing algorithms referring to a local geographical repository in the ETL (extract transform load) tool used for the creation of the data warehouse. We were able to structure and standardise 1523 out of 1849, i.e., 82.37% of the addresses and consolidated the data creating the geographical dimension of the data warehouse which will be later queried for population health monitoring and datamining purposes. Unstructured data and text fields in EHR represent a drawback in any kind of data exploitation, hence, when clinically validated, NLP techniques can be used to extract relevant information.

Modifiable predictors of severe heart failure in Morocco: a descriptive study using routinely collected health data.

IntroductionHeart Failure (HF) is a growing public health concern in Morocco and there is a striking paucity on determinants of severe HF (SHF) in this population. The aim of this study was to identify patients admitted with HF at Ibn Rochd Hospital, Casablanca from 2011 onwards, when electronic record keeping began.MethodsA total of 105 patients underwent a series of cardiological examinations between July 2011 and January 2014. The New York Heart Association (NYHA) criteria was used to evaluate the severity of HF. Patients with NYHA classification gradings of I and II were defined as having moderate HF (MHF) and those graded as III and IV were defined as having a SHF. Univariable and multivariable risk factors associated with SHF were explored using logistic regression. The results were reported following the RECORD (Reporting of studies Conducted using Observational Routinely-collected Data) statement.ResultsA total of 24 (33%) patients were identified as having a SHF. Four predictors of SHF were identified in univariate analysis: haemoglobin <12g/dL, neutrophil-to-lymphocyte ratio (NLR) >3, mean corpuscular haemoglobin concentration (MCHC) <32 picolitre, and high density lipoprotein (HDL) <0.35 (mmol/L). Only NLR>3 and HDL <0.35 mmol/L remained independent predictors in multivariable analysis. Patients with NLR >3 were at 6-fold increased odds of SHF [adjusted odds ratio (AOR): 6.78, 95% confidence interval (CI): 1.40-32.80, p=0.017], and those with HDL<0.35 (mmol/L) were at 10-fold increased odds of SHF [AOR: 10.11, 95% CI: 2.26-45.27, p=0.002].ConclusionThe independent biomarkers of SHF identified in this study provide valuable information to ward clinicians in resource-constrained facilities to identify patients vulnerable to developing severe heart complications.