Side Effects Reported by Moroccan Medical Students Who Received COVID-19 Vaccines.

BACKGROUND: Low confidence in the safety of COVID-19 vaccines was found to be a key promoter of vaccine reluctance especially among youth. Furthermore, young adults are an important demographic for building herd immunity through vaccination. As a result, their reactions to getting COVID-19 vaccines are crucial in our fight against SARS-CoV-2. OBJECTIVE: The overall goal of this study was to look into the shortterm side effects experienced by Moroccan medical and pharmacy students after receiving COVID-19 vaccines. METHODS: A cross-sectional survey-based study to assess the COVID-19 vaccines' short-term AEFIs among Moroccan medical and pharmacy students. The validated questionnaire was delivered in a digital form to explore the side effects (SE) they encountered after the first or the second dose of one of three vaccines namely: AstraZeneca Vaxzevria, PfizerBioNTeck, and SinoPharm vaccines. RESULTS: There were 510 students in total who took part. After the first and second doses, approximately 72 percent and 78 percent of subjects, respectively, reported no SE. The remainder had localized injection site side effects (26%). Fatigue (21%), fever (19%), headache (17%), and myalgia (16%) were the most common systemic adverse effects after the first dose. There were no serious SEs reported. CONCLUSION: The majority of the reported AEFIs in our data were mild to moderate in intensity and lasted only one or two days. COVID-19 vaccinations are highly likely safe for young adults, according to the findings of this study.

Assessment of the Safety and Efficiency of a Preperitoneal Continuous Infusion Using Bupivacaine after Abdominal Laparotomy in Digestive Carcinology.

The purpose of this paper is to evaluate the safety and efficacy of continuous preperitoneal wound infiltration using bupivacaine after abdominal laparotomy in relation to plasma bupivacaine concentration and visual analog scale. Our study was performed on 60 adult patients with digestive cancer, operated at laparotomy, and randomized into two groups: bupivacaine and saline groups. The wound infiltration was through a multiperforated catheter along the scar. For the bupivacaine group, 0.25% bupivacaine was used; however, for the saline group, only saline (0.9%) was infiltrated. The pain was assessed by using the visual analog scale (VAS) in both groups. Plasma bupivacaine concentration was measured by high-performance liquid chromatography. The bupivacaine group had significantly lower postoperative morphine consumption and lower postoperative pain than the saline group (P < 0.0001). The majority of patients in the bupivacaine group had significant relief with the VAS scores of less than 3/10 cm at rest and 6/10 cm on mobilization. However, for the saline group, the VAS scores were higher than 6/10 cm either at rest or with mobilization. There was no clinical sign of toxicity and no technical complications for the bupivacaine group. Only eleven patients required morphine in this group, but the majority of patients received morphine at different doses in the saline group. Plasma bupivacaine was at very low concentrations. Overall, the current study has confirmed that continuous preperitoneal wound infiltration as postoperative analgesia is a simple, effective, and safe technique. It allows decreasing of morphine consumption and subsequently canceling their side effects.

[Sepsis outbreak associated with use of contaminated propofol: A new case series and literature review]. / Complications infectieuses liées à l'utilisation du propofol : une nouvelle série de cas et revue de la littérature.

INTRODUCTION: Propofol is the most commonly used hypnotic agent for the induction and maintenance of general anesthesia. Due to its lipid-based composition, propofol requires a strict handling protocol to avoid an increased risk of extrinsic contamination. METHODS: On September 09, 2021, 05 patients with post-anaesthetic Enterobacter cloacae infections were identified in the pediatric exploration department of the Hassan II University Hospital of Fez in Morocco. We describe the investigation into this outbreak. All patient medical records were reviewed to determine patient characteristics and potential risk factors. For the literature review, we identified relevant articles by searching PubMed, Medline, Embase and Science Direct. RESULTS: Our study included five patients, 80% were boys. The average age was 4.6 years (1-7 years), with no medical history. All five patients underwent exploratory procedures. Immediately after the procedures, all 5 patients presented with chills, tachycardia and fever in the same order of admission. They were all admitted to hospital and blood samples were taken. Blood cultures were positive for E. cloacae. All patients had elevated levels of C-reactive protein (CRP) and an elevated white blood cell count. Bacteriological investigation revealed that the infection was caused by extrinsic contamination of the intravenous anesthetic propofol by E. cloacae. CONCLUSION: Fatal infections due to contaminated drugs, including propofol, have been reported worldwide. Propofol is a potential source of infections due to its lipophilic nature which promotes microbial growth. This probably remains an underestimated problem that deserves awareness for early recognition.

Origanum majorana L. polyphenols: in vivo antiepileptic effect, in silico evaluation of their bioavailability, and interaction with the NMDA receptor.

Introduction: Epilepsy is a chronic brain disease characterized by repeated seizures and caused by excessive glutamate receptor activation. Many plants are traditionally used in the treatment of this disease. This study aimed to evaluate the bioavailability of a polyphenolic extract obtained from Origanum majorana L. (OMP) leaves, as well as its antiepileptic activity and its potential mechanism of action. Methods: We have developed and validated a simple, rapid, and accurate stability-indicating reversed-phase liquid chromatographic method for the simultaneous determination of caffeine and quercetin in rat plasma. The OMP antiepileptic effect was evaluated with pilocarpine-induced seizures, and a docking method was used to determine the possible interaction between caffeic acid and quercetin with the N-methyl-D-aspartate (NMDA) receptor. Results and Discussion: Both compounds tested showed low bioavailability in unchanged form. However, the tested extract showed an anticonvulsant effect due to the considerably delayed onset of seizures in the pilocarpine model at a dose of 100 mg/kg. The molecular docking proved a high-affinity interaction between the caffeic acid and quercetin with the NMDA receptor. Taken together, OLP polyphenols demonstrated good antiepileptic activity, probably due to the interaction of quercetin, caffeic acid, or their metabolites with the NMDA receptor.

Ethnobotanical Study of Medicinal Plants Used against COVID-19.

During the COVID-19 pandemic, the Moroccan population, like the entire population of the world, used medicinal plants to treat or cure symptoms of SARS-CoV-2. The present work was designed to identify the medicinal plants used by the Moroccan population in the prevention or treatment of COVID-19. To achieve this goal, a survey was conducted to collect data on plants along with the sociodemographic parameters of users. The outcome of this work showed that 1,263 people were interviewed with 63.5% male, aged between 18 and 82 years. Most plant users were between 20 and 40 years, which constituted 80.1% of the study population. The level of education of participants was 70.9% university and 27.6% secondary. The most useful plants were eucalyptus, cloves, lemon, and garlic. Notably, 61.9% of interviewed people used plants for preventing or treating COVID-19: 30.6% of them declared one-time use from the beginning of the pandemic, and 47.8% declared frequent daily use until recovery, while 17.4% declared single daily use. Five out of twenty-one plants used in the treatment are known for their potential toxicity, including Artemisia herba-alba and oleander (Nerium oleander). The findings of the present work could serve society by providing potential medicinal plants to control COVID-19.

Ethnobotanical Study of Medicinal Plants Used as Therapeutic Agents to Manage Diseases of Humans.

OBJECTIVE: This work aimed to survey medicinal plants used in phytotherapy in the Fez-Boulemane region, Morocco. METHODS: A comprehensive ethnobotanical survey was conducted using a questionnaire to collect data from thirty herbalists on medicinal plants used for therapeutic purposes in the Fez-Boulemane region, Morocco. RESULTS: The mean age of herbalists interviewed was 52.13 years. Forty percent of the herbalists were illiterate, and 73% referred to the experiences of their parents as knowledge of the properties and uses of medicinal plants. One hundred and eight medicinal plants belonging to 51 botanical families were recommended by herbalists in the region of Fez-Boulemane, Morocco, for treatment. According to the respondents, Lawsonia inermis L., Rosmarinus officinalis L., and Lavandula coronopifolia L. were the most used plants with the percentage of 13%, 12%, and 11%, respectively. Most plants had been involved in the treatment of digestive disorders (25%) and osteoarticular diseases (24%). Some (7.4%) of the plants mentioned in our survey were potentially toxic. CONCLUSION: It was learned that irrational use of toxic plants and unknown compositions of recipes are recommended to consumers. As a result, particular attention should be paid to risks related to plants used in traditional treatment without scientific validation. It is envisaged that increasing awareness, by conducting educational campaigns and transferring evidence-based scientific knowledge, on traditional treatments among the local population is expected to have beneficial impacts on health and disease management.

New 2,3-Benzodiazepine Derivative: Synthesis, Activity on Central Nervous System, and Toxicity Study in Mice.

We report the design and synthesis of a new diazepine derivative, 4-(4-methoxyphenyl)-2,3,4,5-tetrahydro-2,3-benzodiazepin-1-one (VBZ102), and the evaluation of its anxiolytic-like profile, memory impairment effect, and toxicity in Swiss mice. VBZ102 was evaluated for central nervous system effects in an open field, light-dark box, and novel object recognition tests under oral administration for acute and sub-acute treatment. We tested the VBZ102 toxicity in mice through a determination of LD50 values and examination of the biochemical and histopathological parameters. The VBZ102 induced an anxiolytic effect at different doses both in the light-dark box and open field tests. Unlike other benzodiazepines (e.g., bromazepam), a sedative effect was noted only after administration of the VBZ102 at 10.0 mg/kg.

Food and lipid intake alters the pharmacokinetics of cyclosporine in kidney transplants.

Prevention of kidney graft rejection with cyclosporine leads to a large interindividual pharmacokinetic variability. However, food intake is likely to alter cyclosporine pharmacokinetics, and therefore its efficacy. The aim of our study was to evaluate the influence of food and lipid intake on cyclosporine pharmacokinetics. Twenty-four kidney grafted patients treated with Neoral® were included in this prospective monocentric study. In all patients, the pharmacokinetics of cyclosporine was evaluated in two occasions, after meal ('feed') and without meal ('fasting'). At each occasion, blood samples were collected at trough, and 0.5, 1, 2, 3, and 4 h after administration. Cyclosporine pharmacokinetics was described using a Bayesian pharmacokinetic model including two-compartments with first-order transfer and elimination rate constants, and a gamma absorption model. Influence of meal or olive oil, very common in Morocco, was tested as covariates on interoccasion variability parameters. Cyclosporine concentration-time data were satisfactorily described using the Bayesian pharmacokinetic model. Food intake significantly increased volume of distribution and decreased elimination of cyclosporine. The influence of oil intake explained a large part of this effect, suggesting that lipid intake was the main factor of pharmacokinetic variability due to food. This intake resulted in a decrease in area under the concentration curve between two administrations of 14.6%. Food, and especially lipid intake is likely to decrease the exposure to cyclosporine and may therefore lead to a decrease in treatment efficacy. Therefore, to ensure optimal immunosuppression in time, meal composition should remain as steady as possible.

Determining factors for Cannabis use among Moroccans Schizophrenic Patients: A cross sectional study.

OBJECTIVE: Cannabis use is considered a major clinical problem associated with a poorer outcome in patients with schizophrenia. The objective of the present study was to assess the prevalence of cannabis us among patients with schizophrenia. The assessment consists in comparing some factors related to substance use in a population of schizophrenic patients between cannabis users and non. MATERIALS AND METHODS: Four hundred and three participants who were examined prospectively during their hospitalization answered the PANNS scale of schizophrenia, GAF, BIS-10, CDSS, and MARS. The consumption of cannabis was investigated using urine toxicological analysis. Sociodemographic, clinical and therapeutic data were also recorded. RESULTS: The prevalence of cannabis use among schizophrenic inpatients was 49%. Patients with cannabis use were younger (31.7 vs 34.9 years old, p<0.001), more often male (52 vs 20% female, p<0.001), and they presented more often a history of imprisonment (68.8% vs 31.2%, p<0.001). Patients who were users of cannabis had a lower age at onset of the disease than non-users (23.6 vs 24.8 years, p=0.029), and more often with poor medication adherence (p=0.001). Logistic regression revealed that factors associated with cannabis use among schizophrenics were the age, gender, history of imprisonment and poor medication adherence. CONCLUSION: The study showed that a high prevalence of cannabis use among patients with schizophrenia which was associated with negative overall outcomes. Determining comorbid substance use disorders among schizophrenic patients is crucial as it may contribute to establish a better therapeutic strategy.

Prevalence of herbal medicine use among patients with kidney disease: A cross-sectional study from Morocco.

INTRODUCTION: The objectives of this study were to determine the prevalence of herbal medicine use by patients hospitalized or consultant in the nephrology department of University Hospital center Hassan II Fez, the reasons of this use, to identify socio-demographic characteristics, and the etiology of kidney disease related to herbal medicine use, also the most used plants. METHOD: Cross-sectional study on the use of herbal medicine conducted at the nephrology department of University Hospital Center Hassan II Fez, Morocco. During 6 months between August 2015 and February 2016. Patients older than 15 years (n=471) with varying degrees of kidney disease were included. The questionnaire contained questions related to socio-demographic data, the use of plants, knowledge about herbal medicine toxicity, and etiology of KD. Descriptive statistics were used to analyze socio-demographic characteristics related to herbal medicine use. RESULTS: A total of 471 patients responded; the prevalence of herbal medicine use was 50.7%. Herbal medicine users were more likely to be males (OR 0.43; 95%CI 0.25-0.74); unemployed (OR 0.51; 95%CI 0.29-0.89), with unknown etiology (OR 0.43; 95%CI 0.22-0.84). Reasons of use were: belief in its efficacy (74%), easy access to medicinal herbal medicine (70%), and lower cost (48%). The most commonly used herbal medicine were Rosmarinus officinalis L.; Origanum compactum Benth; Artemisia herba-alba Asso and Mentha pulegium L. Potentially harmful herbal medicine included Aristolochia longa. CONCLUSIONS: The prevalence of herbal medicine use is high among patients with kidney disease in nephrology department.

Paracetamol self-poisoning: when oral N-acetylcysteine saves life? a case report.

Paracetamol is the most widely drug involved in accidental paediatric exposures and deliberate self-poisoning cases because of its availability. N-acetyl cystein is the main treatment for this poisoning. We report a case of a 24-year-old Arab female who has deliberately ingested 100 tablets of 500 mg paracetamol each (50g). Her first examination was normal. She has received oral N-acetyl cystein (NAC) 6 hours after the ingestion. Serum paracetamol level done 18 hours post ingestion was 900 mg/l. On review the next days, she did not develop any symptoms of liver failure. However, due to the massive paracetamol ingestion associated with high serum paracetamol levels, oral NAC was continued for 3 days. The patient was discharged well on the fifth day of hospitalization. Our patient has ingested one of the highest paracetamol overdose (50g) with the highest paracetamol blood levels ever reported in medical literature. She was treated, six hours after ingestion, with oral NAC for 3 days without any side effects.

[Peganum harmala L. poisoning in Morocco: about 200 cases]. / L'intoxication au Peganum harmala L. au Maroc : à propos de 200 cas.

AIM OF THE STUDY: Peganum harmala L. is commonly used in traditional medicine in Morocco for its sedative and emmenagogue properties but expose to the risk of overdose and poisoning. The aim of our study was to analyze a series of 200 cases of poisoning collected in poison control and pharmacovigilance center of Morocco in order to describe the epidemiological, clinical, therapeutic features and outcome of patients and indicate the toxicity of this plant used primarily for therapeutic purposes. METHODS: This retrospective study performed over a period of twenty four years from January 1984 to December 2008. RESULTS: The mean age of patients was 24.4±16.8 years with a female predominance (167 women against 33 men). Therapeutic circumstance was found in 32.5%, followed by suicide (28.5%) and abortion (13.5%). The symptomatology was dominated by neurological, gastrointestinal and cardiovascular signs respectively 34.4%, 31.9 % and 15.8%. The evolution has been specified in 114 cases, 7 deaths have been deplored with a fatality rate of 6.2%.

[Pesticide poisoning in Moroccan children: epidemiological and prognostic aspects (1990-2008)]. / L'intoxication par les pesticides chez l'enfant au Maroc : profil épidémiologique et aspects pronostiques (1990-2008).

OBJECTIVE: The purpose of this paper is to describe the epidemiological profile of acute pesticide poisoning in children (APP) treated by the Moroccan Poison Control Center (CAPM) and to analyze death cases in order to determine factors predictive of severity. METHOD: the study is based on a retrospective study of all cases of APP collected by the CAPM over a period of eighteen years (January 1990 to December 2008). Univariate analysis was performed to identify risk factors. RESULTS: 2,672 cases of childhood poisoning by pesticide were collected. The mean age was 5.6 ± 4.57 years. The sex ratio was 1.12. The cause of poisoning was accidental in 87.1% of cases, followed by attempted suicide (12.1%). Organophosphates were the most frequent poison (50.7%), followed by alpha-chloralose (26.5%). The case fatality rate was 3.3%. Mortality was attributed to organophosphates in 30 cases, followed by inorganic derivatives (7 cases) and carbamates (6 cases). A univariate analysis comparing survivors and groups who died showed that rural origin (p = 0.04), voluntary circumstances (p = 0.001), and the type of chemical class of pesticide (p < 0.001) significantly influence fatal poisoning. CONCLUSION: Acute pesticide poisoning among children is a reality in Morocco. Preventive measures may be needed.

Classification of clinical consequences of scorpion stings: consensus development.

The objective of our consensus process was to develop a unique classification of the natural history of scorpion stings and their clinical signs and symptoms. The technique used was an adapted Delphi approach completed by a nominal group meeting. Researchers included in a study received a questionnaire in which we listed all terms used in published studies to characterize clinical consequences of scorpion stings and all signs and symptoms belonging to each class. For each term, experts had to judge the relevance for classifying clinical consequences of scorpion stings and state whether they agreed with the terminology; they could also propose new terms or classes. For each sign or symptom, they had to choose in which class it belonged and also propose if any other sign or symptom should be added. Sixteen researchers participated. Consensus was reached to include four classes: local manifestations; minor systemic manifestations; major systemic manifestations; lethal envenomation. Signs and symptoms associated with each class were defined. A second Delphi round is planned to define indicators to follow the epidemiological situation within and across countries and to develop recommendations for an optimal management of scorpion envenomations. These consensus-based tools should facilitate development of international clinical studies.

Juniper tar (cade oil) poisoning in new born after a cutaneous application.

Juniper tar (cade oil) is distilled from the branches and wood of Juniperus oxycedrus. It contains etheric oils, triterpene and phenols, used for many purposes in folk medicine. The authors report a case of a previously healthy new born treated with a topical application of Juniperus oxycedrus for atopic dermatosis The poisoning caused convulsions, collapsus, acute pulmonary oedema, renal failure and hepatotoxicity. The newborn survived after supportive and symptomatic treatment, and discharged in a good condition on the eleventh day of hospitalisation in intensive care unit.

Reversible myocardial injury associated with aluminum phosphide poisoning.

BACKGROUND: Aluminum phosphide poisoning has high mortality resulting from cardiac impairment and hemodynamic disorders. We report two cases of aluminum phosphide associated with reversible myocardial injury. CASES REPORTS: A 19-year-old woman and a 28-year-old man were admitted to hospital following ingestion of aluminum phosphide. The clinical course was characterized by the development of a shock syndrome requiring the use of vasoactive amines in the woman. However, the arterial hypotension in the man was improved by fluid filling and vasoactive drugs. The myocardial injury was objectively documented in both cases. The electrocardiogram showed ST-segment elevations and diffusely abnormal repolarization. The plasma concentrations of cardiac enzymes were elevated. In the second case, echocardiography showed similar myocardial involvement with left ventricular hypokinesis (left ventricle ejection fraction 30%). In both cases, there was progressive improvement in hemodynamic status, cardiac traces, and biochemical values. A simultaneous improvement was observed in echocardiogram of the second case (left ventricle ejection fraction increased to 50%). CONCLUSION: Reversible myocardial injury following aluminum phosphide poisoning has been described in few cases. We objectively documented progressive clinical and electrical improvement in two cases.

[Atractylis gummifera poisoning in a pregnant woman]. / Intoxication par le chardon à glu chez une femme enceinte.

BACKGROUND: Atractylis gummifera is poisonous and its ingestion causes illness, characterized principally by hepatorenal injury, often fatal. The toxicity of this plant to the fetus is not known. We report a case of poisoning during pregnancy. CASE REPORT: A 28 year-old woman was admitted to our intensive care unit for Atractylis gummifera poisoning during her 24th week of pregnancy. She showed gastrointestinal symptoms, impaired consciousness, hypoglycemia, hepatic cytolysis and decreased factor V blood levels. The mother recovered after symptomatic treatment. A healthy boy was delivered vaginally at 39 weeks and his clinical findings and laboratory results were normal at birth and a week later. DISCUSSION: Poisoning by Atractylis gummifera has not previously been reported during pregnancy. The favorable course of our patient and her infant do not rule out possible fetal damage from which he recovered, as his mother did.