Prevalence and Severity of Gastrointestinal Symptoms in COVID-19 Patients in Casablanca: A Retrospective Cohort Study.

Background The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), responsible for the coronavirus disease 2019 (COVID-19), is behind the current pandemic. At the start of the pandemic, gastrointestinal symptoms initially described as rare were reported, but their spread to other countries increased rapidly. This study aimed to determine the prevalence of digestive symptoms among COVID-19 patients and to assess the correlation between these symptoms and disease severity. Methods This retrospective observational study was conducted in the Cheikh Khalifa University Hospital of Casablanca, Morocco. Patients were divided into two groups based on the presence or absence of gastrointestinal symptoms upon initial assessment and hospital admission. Results A total of 154 patients were included in this study from March 21 to April 26, 2020. The mean age of patients was about 48.5 (± 20.0) years, and 85 (55.2%) of them were men. In our population, 8.17% of patients had toxic habits. Digestive symptoms were present at admission in 30% of our patients. The most frequent digestive symptoms were diarrhea (15%), abdominal pain (5.6%), vomiting (5%), and anorexia (3.1%). We found a significant difference in COVID-19 patients with digestive symptoms and toxic habits contrary to all other comorbidities. Neurologic symptoms were significantly associated (p=0,004) with digestive symptoms in 50%. Conclusion In this study, we found that digestive symptoms were present in 22.64% of patients diagnosed with COVID-9. The clinician must know the different digestive symptoms to evoke the diagnosis and take charge of the patient early.

Concomitant acute limb ischemia and myocardial infarction: another challenge of COVID-19’s hypercoagulability

The COVID-19, actual pandemic due to SARS COV 2 is associated with numerous thromboembolic complications. Although venous thrombosis including pulmonary embolisms have been widely described, arterial localization seems rarely reported. Acute limb ischemia and myocardial infarction are two major consequences of arterial thrombosis and their concomitant occurrence among COVID-19 patients is extremely rare. It is an evident aspect of hypercoagulability and a real challenge to physicians. We herein describe the management of a 77 years old COVID-19 patient presenting an acute lower limb ischemia with concomitant myocardial infarction. He underwent coronary angiography with subsequent stent placement then was transferred to the operating room where a thrombectomy was performed. The outcome was poor as the cardiogenic shock persisted in addition to a reperfusion syndrome with multiorgan failure.

Sex Differences in COVID-19 Outcomes.

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified as the cause of an outbreak of severe acute respiratory syndrome in Wuhan City, China in December 2019. Since then, it has caused a worldwide pandemic with over six million deaths. Many studies have been published on coronavirus disease 2019 (COVID-19), but only a few have compared the outcomes of COVID-19 between males and females, especially in African countries and the Middle East. Studies published to date on this topic report that male patients infected with SARS-CoV-2 have worse outcomes than females. This study aimed to compare sex differences in COVID-19 outcomes in a tertiary care hospital in Casablanca (Morocco). Methodology We included all adult patients hospitalized for COVID-19 infection in Cheikh Khalifa Hospital. We categorized patients according to gender and analyzed the characteristics and outcomes of each group. Results In total, 134 patients with polymerase chain reaction (PCR)-confirmed COVID-19 were admitted during the study period. These included 72 (53.7%) men and 62 (46.4%) women. The median age of the patients was 53 years (interquartile range, IQR = 36-64). Men were significantly older than women (58 vs. 44) but there was no significant difference in comorbidities on comparing men and women. Values of median C-reactive protein (35 vs. 4), ferritin (326 vs. 72), and lactate dehydrogenase (264 vs. 208) were significantly higher in men. Lymphopenia was significantly more important in men (1.2 vs. 1.7), and the ratio of neutrophil/lymphocytes was significantly higher in men (3.37 vs. 1.84). Men had greater disease severity, with significantly higher intensive care unit admission (48.6% vs. 16.1%) and higher hospital mortality (18.1% vs. 1.6%). Conclusions COVID-19 gender disparities may be due to sex differences in the inflammatory response. These can be explained by the role of sex hormones and sex chromosomes on immune cells and their regulatory genes.

Cardiovascular Risk Factors and the Severity of COVID-19 Disease.

Background and objective Several cardiovascular risk factors have emerged as important determinants of severe illness and death among coronavirus disease 2019 (COVID-19) patients. However, the full impact of these cardiovascular risk factors is still under investigation. This study aimed to investigate the association between patients' level of cardiovascular risk and the severity of COVID-19. Materials and methods This observational study included all adult patients with COVID-19 hospitalized at Sheikh Khalifa Ibn Zaid International University Hospital from March 20 to May 10, 2020. The cardiovascular risk level was assessed by the doctor responsible for each patient based on the 2019 European Society of Cardiology (ESC), the European Atherosclerosis Society (EAS), and the European Association for the Study of Diabetes (EASD) guidelines. We examined the association between the patients' level of cardiovascular risk and their severity of COVID-19 disease by using a logistic regression model. Results Among 133 patients with confirmed COVID-19, 46.6% had a low cardiovascular risk level, 19.5% had a moderate risk level, 15.8% had a high risk level, and 18.1% was found to have a very high risk level. Patients with different cardiovascular risk levels had significantly different rates of complications including secondary infection (p-value: <0.001), acute respiratory distress syndrome (ARDS) (p-value = 0.017), intensive care unit (ICU) admission (p-value: <0.001), and death (p-value: <0.001). A patient's very high cardiovascular risk level versus low, moderate, or high cardiovascular risk level was independently associated with ICU admission [OR = 6.42, 95% CI: (1.45-28.30)]. Conclusion Based on our findings, an increased level of cardiovascular risk among patients was strongly associated with the severity of COVID-19. This study also highlights the need for assessing cardiovascular risk factors in all patients with COVID-19.

COVID-19: A Potential Cause of Non-convulsive Status Epilepticus.

Coronavirus disease 2019 (COVID-19) has been described as being primarily responsible for respiratory symptoms. Although several case reports have shown the importance of neurological manifestations, only a few have reported non-convulsive status epilepticus (NCSE) as the first manifestation of COVID-19 infection. Here, we report the case of a 30-year-old male patient with no past medical history who was admitted with altered consciousness. On examination, the patient had a Glasgow Coma Scale (GCS) of 13/15. Vital signs were within normal range. Computed tomography scan of the and magnetic resonance imaging of the brain were normal. Biochemical assessments showed a mild hyponatremia (134 mEq/L) and high levels of D-dimer and lactate dehydrogenase. Urine drug screening did not find any abnormality and a lumbar puncture showed an increased cerebrospinal fluid protein. The result of the reverse transcription polymerase chain reaction test in the nasopharyngeal swab was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Electroencephalogram (EEG) showed a generalized epileptiform activity. Upon undergoing antiepileptic treatment, patient's GCS improved to 15 gradually. A repeated EEG confirmed complete resolution of epileptic abnormalities four days later. This case report shows that SARS-CoV-2 infection can directly involve the central nervous system and can be manifested with isolated NCSE without any other neurological manifestations.

Obesity and Disease Severity Among Patients With COVID-19.

Background Obesity can be associated with one or more co-morbidities that worsen the effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Studies demonstrated that severe forms of coronavirus disease (COVID-19) have occurred in elderly patients and patients with co-morbidities such as diabetes, hypertension, and cardiovascular diseases. Objective This study investigated the impact of obesity on COVID-19 severity, irrespective of other individual factors. Methods This retrospective observational study included all adult patients with confirmed COVID-19 infection, who were admitted to Sheikh Khalifa Ibn Zaid International University Hospital between March 20 and May 10, 2020. First, we compared patients with and those without obesity in terms of demographic characteristics, co-morbidities, clinical symptoms, and outcomes. Further, using logistic regression models, we analyzed the association between obesity and intensive care unit (ICU) admission. Also, we examined whether the association between obesity and ICU admission was also consistent among overweight patients. Results The study population included 107 patients with confirmed COVID-19 infection. Obese patients have been admitted in ICU more than patients without obesity (P-value = 0.035). While adjusting for other risk factors for ICU admission, we found that obesity was an independent risk factor for ICU admission (OR = 5.04, 95% CI (1.14-22.37)). When we examined the association of both obesity and overweight with ICU admission, we found that only obesity was significantly associated with ICU admission (OR = 9.11, 95% CI (1.49-55.84)). Conclusion Our study found that obesity was strongly associated with severity of COVID-19. The risk of ICU admission is greater in the presence of obesity. Physicians should be awarded to the need of specific and early management of obese patients with COVID-19 disease.

Severe SARS-CoV-2 Infection: A Multisystem Inflammatory Syndrome in Moroccan Children.

Until October 2020, children seem to have a mild form of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Morocco. Since April 2020, a new entity of multisystem inflammatory syndrome in children associated with SARS-CoV-2 infection was reported in England, Italy, France, and the United States. This syndrome has similarities with the most frequent vasculitis in children, Kawasaki disease. Here, we describe the features and outcome of the first five cases of Kawasaki-like multisystem inflammatory syndrome in Moroccan children triggered by the SARS-CoV-2. The median age of the children was 7.8 years; three of them were boys. Criteria for Kawasaki disease were met in all of them with a complete presentation. Three patients required admission to a critical care unit with multi-organ failure in one of them, but no mortality occurred. They all received intravenous immunoglobulin (IVIG), a high dose of aspirin, methylprednisolone, and supportive therapy. Coronavirus 2019 disease (COVID-19) infection in children may be life-threatening; rigorous monitoring for several weeks is required in any positive child or living in a family cluster.

Hematological and biochemical abnormalities associated with severe forms of COVID-19: A retrospective single-center study from Morocco.

Since December 2019, the coronavirus disease (COVID-19) pandemic has catapulted the world into a marked health crisis, with over 29 million cases and >930,000 deaths. To better detect affected individuals at an early stage and stop disease progression to an advanced stage, several studies have been conducted to identify the clinical, biological, and radiological characteristics of COVID-19. This study aimed to enrich the literature by critically analyzing the clinical and biological characteristics of 134 patients from the North African Mediterranean region, including numerous genetic, epigenetic, and environmental factors that may influence disease evolution. This single-center retrospective study included all patients older than 18 years confirmed to have COVID-19 and hospitalized at the Cheikh Khalifa University Hospital affiliated with Mohammed VI University of Health Sciences, Casablanca, Morocco. Clinical, demographic, and biological data were analyzed in a cohort of severe and non-severe patients. Univariate analysis was performed to identify factors predictive of severity. There were 134 patients: the median age was 53 years, and 54.5% were male. Of these, 89 had mild to moderate disease; 45 had severe to critical disease, of which 14 died and 31 survived. Advanced age, presence of comorbidities, male sex, and infection in ethnic or family groups were risk factors for progression to severe disease. The presence of abnormalities in the following parameters were strongly associated with progression to severe disease: white blood cells (WBC), neutrophils, lymphocytes, C-reactive protein (CRP), procalcitonin, D-dimers, lactate dehydrogenase (LDH), ferritin, creatinine, aspartate aminotransferase (ASAT), and alanine aminotransferase (ALAT) during both admission and hospitalization. Based on these results and an extensive literature review, we recommend that clinicians closely monitor the biological parameters identified herein and perform immunological and genetic studies.

Personal Protective Equipment and Headaches: Cross-Sectional Study Among Moroccan Healthcare Workers During COVID-19 Pandemic.

Background Healthcare workers in frontline during the coronavirus 19 disease (COVID-19) pandemic are mandated to wear specific personal protective equipment (PPE) including high filtrating masks and/or eye protection during extended period of time. Compressive headaches secondary to PPE use including N95 masks have been reported. We aim to describe subtypes of headache related to PPE use in our hospital in Casablanca and working condition factors associated with it. Methods We conducted a cross-sectional study among healthcare workers in frontline at Cheikh khalifa International University Hospital, using an online questionnaire. We collected demographic data, comorbidities and previous headaches history. Data about working conditions during pandemic, type and duration of PPE use were described. We calculated the prevalence of De Novo or an aggravated headache among healthcare workers. We studied correlations between PPE related headaches and working conditions and trends in PPE use during the pandemic. Finally, we described the overall discomfort related to PPE use. Results A total of 155 healthcare workers responded to the questionnaire. The N95 masks were the most used type (95.5%) associated with an eye protection in 61.3%. The overall prevalence of headache related to PPE was 62%. It was experienced De Novo in 32.9%, while it was an aggravation of pre-existing headache in 29%. Working more than 8 hours per shift during the pandemic was correlated to De novo headache (p = 0.008). The profession of doctor and working more than 12 hours per shift were correlated to aggravated headache (p = 0.02, p = 0.023). Healthcare workers experienced moderate discomfort, blurred vision and reduced concentration. They judged their professional performance mildly reduced by the use of PPE. Conclusion The increased use of PPE, especially high filtrating masks during the COVID-19 outbreak is responsible for generating headaches in healthcare workers on frontline either De novo or as an aggravation of pre-existing one. Working conditions have the greater impact on generating these types of headaches more than any pre-existing comorbidity. These findings should be considered to accommodate health care professionals to increase efficacy and adherence to protective measures during pandemic.

Psychiatric side effects of chloroquine in COVID-19 patients: two case reports.

Chloroquine and hydroxy chloroquine are widely use in Africa and all over the world as anti-malarial drugs but also in the treatment of chronic inflammatory diseases. Since the outbreak of COVID-19 pandemic, Morocco have included this medication in the COVID-19 treatment guidelines in association with azithromycine. Besides dermatologic problems, ocular impairments and gastro-intestinal effects, quinolines may also cause rarely described psychiatric adverse effects. To our knowledge, there has been no reports of psychiatric side effects of chloroquine or hydroxy chloroquine in the actual context of COVID-19 pandemic. Here, we present the description of two COVID-19 patients who showed psychiatric side effects after chloroquine treatment. One patient expressed psychotic symptoms and the other one experienced acute and intense anxiety. In both cases, and according to Naranjo score, the association between chloroquine and psychiatric side effects was probable.

Continuous venous hemodialysis integrated to the ECMO circuit in critically ill patient with covid 19, a case report in Morocco

Novel coronavirus 2019 (COVID-19) is a severe respiratory infection leading to acute respiratory distress syndrome [ARDS] accounting for thousands of cases and deaths across the world. Several alternatives in treatment options have been assessed and used in this patient population. However, when mechanical ventilation and prone positioning are unsuccessful, venovenous extracorporeal membrane oxygenation [VV-ECMO] may be used. We present a case of a 62-year-old female, diabetic, admitted to the intensive care unit with fever, flu-like symptoms and a positive COVID-19 test. Ultimately, she worsened on mechanical ventilation and prone positioning and required VV-ECMO. The use of VV-ECMO in COVID-19 infected patients is still controversial. While some studies have shown a high mortality rate despite aggressive treatment, such as in our case, the lack of large sample size studies and treatment alternatives places healthcare providers against a wall without options in patients with severe refractory ARDS due to COVID-19.

Predictors of Severity in Covid-19 Patients in Casablanca, Morocco.

Background Morocco was affected, as were other countries, by the coronavirus disease 2019 (COVID-19) pandemic. Many risk factors of COVID-19 severity have been described, but data on infected patients in North Africa are limited. We aimed to explore the predictive factors of disease severity in COVID-19 patients in a tertiary hospital in Casablanca. Methods In this single-center, retrospective, observational study, we included all adult patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, admitted to Sheikh Khalifa International University Hospital in Casablanca between March 18 and May 20, 2020. Patients were separated into two groups: Non-severe patients were those with mild or moderate forms of COVID-19, and severe patients were those admitted to the intensive care unit (ICU) who had one of the following signs-respiratory rate > 30 breaths/min; oxygen saturation < 93% on room air; acute respiratory distress syndrome (ARDS); or required mechanical ventilation. Demographic, clinical, laboratory data, and outcomes were reviewed. We used univariable and multivariable logistic regression to explore predictive factors of severity. Results We reported 134 patients with confirmed SARS-CoV-2 infection. The median age was 53 years (interquartile range [IQR], 36-64), and 73 (54.5%) were men. Eighty-nine non-severe patients (66.4%) were admitted to single bedrooms, and 45 (33.6%) were placed in the ICU. The median time from illness onset to hospital admission was seven days (IQR, 3.0-7.2). Ninety-nine patients (74%) were admitted directly to the hospital, and 35 (26%) were transferred from other structures. Also, 68 patients (65.4%) were infected in clusters. Of the 134 patients, 61 (45.5%) had comorbidities, such as hypertension (n = 36; 26.9%), diabetes (n = 19; 14.2%), and coronary heart disease (n = 16; 11.9%). The most frequent symptoms were fever (n = 61; 45.5%), dry cough (n = 59; 44%), and dyspnea (n = 39; 29%). A total of 127 patients received hydroxychloroquine and azithromycin (95%). Eleven critical cases received lopinavir/ritonavir (8.2%). Five patients received tocilizumab (3.7%). We reported 13 ARDS cases in ICU patients (29%), eight with acute kidney injury (17.8%), and four thromboembolic events (8.8%). Fourteen ICU patients (31.1%) died at 28 days. In univariable analysis, older men with one or more comorbidities, infection in a cluster, chest scan with the COVID-19 Reporting and Data System (CO-RADS) 5, lymphopenia, high rates of ferritin, C-reactive protein (CRP), D-dimer, and lactate dehydrogenase were associated with severe forms of COVID-19. Multivariable logistic regression model founded increasing odds of severity associated with older age (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.01-1.09, P = .0039), men (OR 3.19, CI 1.06-9.60, P = .016), one or more comorbidities (OR 4.36, CI 1.32-14.45, P = .016), CRP > 10 mg/L (OR 5.47, CI 1.57-19.10, P = .008), and lymphopenia lower than 0.8 x109/L (OR 6.65, CI 1.43-30.92, P = .016). Conclusions Clinicians should consider older male patients with comorbidities, lymphopenia, and a high CRP rate as factors to predict severe forms of COVID-19 earlier. The higher severity of infected patients in clusters must be confirmed by epidemiological and genetic studies.

SARS-CoV2 disease seen through the prism of acutely decompensated chronic kidney disease and ischemic stroke: What lesson we have learned from using prophylaxis therapy of vascular thromboembolism?

Our case underlines the tight management of antithrombotic therapy in the context of acutely decompensated chronic kidney disease, ischemic stroke, and SARS-CoV2 infection, the development of stroke as a SARS-CoV2 complication increase the chances of adverse outcomes that may be mitigated by a rapid recognition and institution of available treatments.