Primary Biliary Cholangitis: Predictors of Poor Response to Ursodeoxycholic Acid after 1 Year of Treatment in Moroccan Patients

Introduction: Primary biliary cholangitis (PBC), the new dominance of primary biliary cirrhosis, is a cholestatic disease of autoimmune etiology and represents the leading cause of intra-hepatic cholestasis. Treatment is mainly based on ursodeoxycholic acid. The biological response to treatment is the main predictor of survival without liver transplantation. The Globe-score has been recently validated as the main prognostic factor. Materials and methods: This is a retrospective study carried out in our department collating all cases of PBC followed in consultation. The aim of our work is to research the predictors of poor response to UDCA. Results: 46 patients were collected. The mean age of the patients was 58.82 years, with a predominance of women (n = 43, 93.5%). 34.78% of patients were in the stage of cirrhosis. Anti-M2 mitochondria antibodies were positive in 44 patients (95.65%). An overlap syndrome was found in 11 patients (23.9%). Treatment was based on UDCA combined with corticosteroid therapy and immunosuppressant for overlap syndrome. A biochemical response at 1 year of treatment according to the Paris II criteria was found in 47.8%. The average value of the globe score was 1.35. A score greater than 0.30 was objectified in 20 cases (43.47%). Nineteen cirrhotic patients (41.30%) had a globe score> 0.30. Factors associated with poor response to therapy were: stage of decompensated cirrhosis, elevated pre-therapy total bilirubin greater than 30 g / l and hypoalbunemia less than 35 g / l. The study of the correlation between Globe score and Paris II showed a strong and significant association with a correlation coefficient estimated at 67%. The Paris II score was significantly correlated with the response to treatment (p = 0.001). Conclusion: In accordance with the data in the literature, the globe-score and Paris II are two similar predictive means for evaluating the response at 1 year of treatment in Moroccan context. Keywords: Morocco, Predictors of response, Primary biliary cholangitis, Ursodeoxycholic acid

Comparison of Early Postoperative Outcomes of Patients Undergoing Robot-Assisted and Transsternal Thymectomy

Objective: Robot-assisted thoracoscopic surgery (RATS) is a minimally invasive technique that has been used in thymectomy operations in recent years. Minimally invasive surgical techniques offer less postoperative pain, a shorter length of hospital stay, and faster recovery compared to conventional surgical techniques. In our study, we aimed to compare the outcomes of robotic and transsternal thymectomies by analyzing the operative and postoperative data of these two approaches. Methods: Twelve robotic thymectomy patients and 16 transsternal thymectomy patients who were operated on in our clinic in 2018 were included in the study. Results: There was no significant difference between the two groups in terms of operative time (p=0.231). The median chest tube duration was 1.5 [range, 1-2] days in robotic thymectomy and 2.5 [range, 1-3.75] days in transsternal thymectomy. However, there was no statistically significant difference between the two groups (p=0.082). The amount of chest tube drainage was significantly lower in the robotic thymectomy group (p=0.006). The length of hospital stay was also significantly shorter in robotic thymectomy patients (p<0.001). Conclusion: The amount of chest tube drainage was lower and the length of hospital stay was shorter in the robotic surgery compared to the transsternal approach. There was no significant difference between the two techniques in terms of operative time. Within today's minimally invasive surgical techniques, robotic thymectomy can be considered a practical, comfortable, and safe technique with better early postoperative outcomes. Keywords: Robot-Assisted Thymectomy, Thymectomy, Transsternal Thymectomy

Evaluation of Treatment Methods and Clinical Characteristics of Patients Applying to the Outpatient Clinic with Complaint of Mastalgia

Objective: Mastalgia or breast pain is one of the most vital complaints among women patients. This study aims to determine the prevalence of mastalgia and the properties of pain, elucidate the associated factors, particularly modifiable ones, and establish a treatment of standard. Methods: The study evaluated 685 female patients admitted to our outpatient clinic with a complaint of mastalgia in the period between 2017 and 2019. Results: Mean age of the patients was 35.20 ±10.28 (13–86). The pain was experienced in the right breast of 123 (17.9%) patients, in the left breast of 141 (20.6%) patients, and in both breasts of 422 (61.5%) patients. The mean pain value was found to be 5.29. The study population comprised 61 (8.9%) patients in the menopause state, whereas 624 (91.1%) patients were not in menopause. The pain was noncyclic in 519 (75.8%) patients, while cyclic for 166 (24.2%) patients. For treatment, a restricted diet in terms of coffee, salt, and fat as well as wearing supportive bra were recommended for 456 (66.5%) patients, while 181 patients with pain VAS (Visual Analog Scale) score of 8 and above was initiated with vitex agnus-castus. No patient was initiated with local or systemic analgesics and LHRH (luteinizing hormone-releasing hormone) analogs. Conclusion: The prevention and management of mastalgia reflected that restricted salt intake, regulated diet, and the use of properly fitted bras could significantly improve the quality of life. Appropriate radiological imaging could eliminate patients’ concerns regarding developing cancer. Keywords: Breast cancer, Diet, Mastalgia, Risk factor

The Bedel Score: Suggesting a New Scoring System to Avoid Negative Appendectomy

Introduction: Scoring systems are still valuable and valid for differential diagnosis of acute appendicitis (AA). Bedel Score is a new diagnostic tool with 7 parameters that can be easily applied. The aim of this study is to determine the diagnostic performance of the Bedel score in AA and compare it with the Alvarado score. Methods: Our study consisted of 95 patients as a prospective cohort who were admitted to our emergency department due to abdominal pain and were hospitalized with a preliminary diagnosis of AA. Bedel and Alvarado scores were calculated. The patients were categorized into two groups (positive and negative appendectomy) according to their histopathological diagnosis. Results: The study population consisted of 65 (68.4%) male and 30 (31.6%) female patients. The mean age of the patients was 34 (18-87) years. 81 (85.3%) of the patients had histopathologically confirmed AA. Median Alvarado score was significantly higher in patients with positive AA than those with negative AA (7 (range: 3-10) vs. 5 (range 3-7), p<0.001, respectively). Median Bedel score of positive AA patients were also significantly higher than those with negative AA (9 (range: 6-10) vs. 5 (range 2-8) p<0.001, respectively) In separating acute appendicitis from negative exploration, the threshold of the Alvarado score is 63% sensitivity for ?7, 85.7% specificity; The Bedel score had 80.2% sensitivity and 92.9% specificity for the threshold value ?7. Conclusion: Bedel score is fast, simple, easy to learn and apply, as well as an effective and practical scoring system with only 7 parameters. Keywords: Acute appendicitis, Alvarado score, New score, Negative appendectomy

Acute Limb Ischemia in Critically ill COVID-19 Patients: a Case Series and Literature Review

Background: The vascular burden increased by COVID-19 infection and including acute limb ischemia (ALI) quickly emerged as a major medical challenge with devastating consequences such as limb loss, multiorgan dysfunction and death. We report a case series of COVID-19 infection associated with ALI to raise awareness and knowledge towards this life-threatening association. Methods: COVIDS-19 patients with acute limb ischemia (ALI) managed in a Moroccan 14 beds COVID-19 ICU between March 2020 and January 2021, were reviewed. Data collected included demographics, clinical presentation, treatments and outcomes. Results: Over the 10-month period, our ICU cared for 407 hospitalized patients with confirmed COVID-19. A total of 6 COVID-19 patients with ALI were identified. The mean age was 61 years (52 - 70) and 5 were men. The most common preexisting condition was diabetes (50%). The mean CRP level was 219 mg/L. Five patients had thrombus in multiple locations. No concomitant deep vein thrombosis was identified. Four patients presented with signs of acute No arterial ischemia with or without respiratory symptoms and were subsequently diagnosed with COVID-19. The remaining two patients developed ischemia during hospitalization. Mean SOFA score was 5 (2 -9). Respiratory support, corticosteroids and heparin therapies were used in all patients. Intubation and vasopressors were required in four patients. Revascularization was performed in five patients and reintervention was necessary in three cases. Four patients died in the ICU while two were successfully discharged. Conclusion: ALI in COVID-19 patients is a challenging life-threatening vascular emergency that requires appropriate multidisciplinary management (intensivists, anesthesiologists, vascular surgeons and interventionists, radiologists, haematologists…) and further studies focused on anticoagulation. Keywords: Acute Limb ischemia, Coagulopathy, COVID-19, SARS-CoV-2, Thrombosis

Psychometric Properties of Nurse Cultural Competence Scale among Filipino Nurses

Purpose: Assessment of the cultural competence of nurses is becoming an important parameter in assessing the provision of quality care to patients especially in multicultural populations such as the Philippines. The study was conducted to assess the construct validity and internal consistency reliability of the Nurse Cultural Competence Scale (NCCS) among Filipino nurses. Methods: A methodological study was utilized and a convenience sample of 124 Filipino nurses were included in the study. An exploratory factor analysis was used to assess the construct validity of the instrument while internal consistency reliability was determined using Cronbach’s α coefficient and item-total correlations. Results: The 20-item NCCS was loaded on one dimension with factor loadings ranging from 0.72 to 0.95, explaining 79.19% of the total variance. Cronbach’s α was 0.986 which demonstrated high reliability and item-total correlations were between 0.811 and 0.929. Conclusion: The NCCS is a reliable and valid instrument for the measurement of cultural competencies among Filipino nurses. Keywords: Cultural competence, Filipino nurses, Reliability, Validity

The Impact of the COVID-19 Pandemic on Gastric Cancer Surgery: A Single-Center Study.

Introduction: Coronavirus disease 2019 (COVID-19) was declared to be a global pandemic by the World Health Organization on March 11, 2020. The impact on gastric cancer (GC) surgery is unknown. Various reports have shown data indicating that cancer patients with COVID-19 have high morbidity and mortality rates. The choice of surgical procedures and perioperative management of the patients with malignancy has become even more impor¬tant in the COVID-19 pandemic. In this study, we aimed to evaluate the effects of the COVID-19 pandemic on the preopartive, intraoperative, and postoperative findings of patients operated for gastric cancer in our clinic. Materials and Methods: We defined the ‘COVID-19’ period as occurring between 12-03-2020 and 31-08-2020. All the enrolled patients were divided into two groups, pre-COVID-19 group (Pre-CG; 64 cases) and COVID-19 group (CG; 39 cases). A total of 103 patients with gastric cancer were included in this study. Patient characteristics, preoperative, intraoperative, and postoperative clinicopathological findings were compared between groups. Results: The waiting times before admission increased in CG (Pre-CG [6.73±2.85] vs CG [20.61±5.16] ; p<0.001). After admission, the waiting time before surgery was longer in CG (Pre-CG [5.06±3.06] vs CG [6.89±3.32] ; p=0.006). No significant difference was detected between the groups in terms of operation time, surgical procedure, combine organ resection, intraoperative blood transfusion requirment (p values, respectively; p=0.108; p=0.951; p=0.204; p=0.597). Postoperative complications were oesophagojejunostomy leak (3/1) , atelectasis (2/2), duodenal leak (2/2), ileus (3/0), pleural effusion (2/2), and others (1/1), and there was no statistically significant difference between the two groups (p = 0.333). There was no significant difference between the two groups in terms of hospital stay (p = 0.086) and ICU stay (p = 0.989). Conclusion: In this study, it was seen that the COVID-19 pandemic did not affect morbidity and mortality in gastric cancer surgery, but it prolonged admission waiting and operation waiting times. Since there is very little data in the literature regarding the effect of COVID-19 on gastric cancer surgery, our study will guide future studies on this subject. Keywords: COVID-19, Impact, Gastric Cancer, Pandemics, Surgery

Psychological Impact of the COVID-19 Pandemic on Health Workers in Morocco: Results of a Cross Sectional Survey .

Background : This study aims to assess the psychological impact of the COVID-19 pandemic, in particular stress, depression, and Post-traumatic disorder, among health care workers in Oujda. Methods:We conducted a survey among 85 health care workers by using a google form questionnaire, during three months (from to). We assessed the work condition, fears, negative emotions, relationships, lifestyle, and coping of medical staff. We also evaluated stress, depression, and post- traumatic stress disorder through the Perceived Stress Scale (PSS), The World Health Organization- Five Well-Being Index (WHO-5), and Primary Care-Post Traumatic Disorder. Results: 65.8% work in front-line, and did between 4 to 15 shifts per month. 71.1% are in fear of COVID-19 infection. 97.6% are afraid to transmit the virus to relatives. More than two-thirds of responders describe negative feelings and exhaustion. 49.4% had a low level of well-being and probably depressed. 67% presented high perceived stress. Anxiety and depression were associated with fears, negative feelings, previous psychiatric disorder, poor sleep, and lack of family support. Conclusion: Our current study showed the high prevalence of depression and perceived stress among medical staff, hence the need to accompany and support all health workers. Keywords: COVID -19 impact; pandemic, Depression; Health care workers; Morocco. Perceived stress; style life.

Liver Resection for Metastasis of Adenoid Cystic Carcinoma of the Lacrymal Gland : A Case Report and Literature Review

Adenoid cystic carcinoma (ACC) is a rare malignant tumor. The first description of the ACC dates back to 1856 by Billroth. The ACC of the lacrimal glands are very rare. They are known for their locally aggressive character. Liver metastases are almost exceptional. We report the case of a patient with hepatic metastasis ACC. After eye enucleation of the primitive lacrimal gland ACC, the patient received external adjuvant radiotherapy. Three years later, she presented an upper abdominal pain. CT scan and MRI showed a liver tumor and the diagnosis of intrahepatic cholangiocarcinoma was made regarding imaging features. A left hepatectomy was performed; histology concluded to a liver metastasis of ACC. The immediate post-operative course was uneventful and no adjuvant treatment was decided. Thirty four months later, the patient presented with lung metastasis. Liver metastasis of ACC are very rare. Extended liver surgery is recommended especially for isolated liver metastasis with a long free gap between primary tumor and the liver metastasis. Keywords: Adenoid cystic carcinoma, Hepatic metastasis, Lacrymal gland