Clinical profile of schizophrenia comorbid with obsessive-compulsive symptoms: A comparative study.

OBJECTIVE: Describe and compare the clinical profile of schizophrenic patients with and without obsessive-compulsive symptoms and obsessive-compulsive disorder (OCD) patients. METHODS: A descriptive and analytical cross-sectional study was carried out at the psychiatry department of Hassan II University Hospital in Fez over 12 months to compare three groups of patients: "schizo-obsessive" (n=32), "schizophrenia" (n=34), and "OCD" (n=46). All participants (n=112) were assessed using the mini-international neuropsychiatric interview (MINI), the Yale-Brown obsessive-compulsive scale (Y-BOCS), the Brown assessment of beliefs scale (BABS), the Hamilton anxiety rating scale (HAM-A), the Beck's depression inventory (BDI-II), the positive and negative syndrome scale (PANSS), and the clinical global impressions-severity scale (CGI-S). RESULTS: The "schizo-obsessive" group differed from the "schizophrenia" group in: more severe psychotic symptoms (mean=64.16±17.049, P<0.001), higher anxiety (mean=8.87±5,655, P<0.001) and depression (mean=7.50±5.989, P<0.001) scores, more prevalent suicide attempts (46.9%), higher illness severity score (mean=5.13±1.157, P=0.02), and more professional disinsertion (78.1%). The "schizo-obsessive" group (mean= 14.47±3.388) had significantly poor insight (P<0.001) compared to the "OCD" group (mean= 8.35±4.542). There were similarities in the obsessive and compulsive themes between the "schizo-obsessive" and the "OCD" groups, with no significant difference of severity (P=0.26). CONCLUSION: A careful assessment of obsessive symptomatology is essential in schizophrenia for better patient management and prognosis.

[The consequences of the lockdown on cardiovascular diseases]. / Les conséquences du confinement sur les maladies cardiovasculaires.

BACKGROUND: The Sars COV-2 infection causing the covid-19 disease has started in December 2019 inWuhan, China, then spread quickly to more than 100 countries in less than 3 months. On March, 11th the WHO declared officially the pandemic of Covid 19. In the absence of an effective treatment of the SARS-Cov2 the measures of social distancing and lockdown remain the most effectives ways against the pandemic. However, these measures can have repercussions in particular on patients followed for chronic diseases, the goal of our study will be to evaluate the impact of the lockdown on non-Covid cardiac patients. METHODS: We have chosen a random sample of patients followed in the cardiology department of the CHU Tangier Tetouan Alhouceima, and we collected their demographic data as well as the symptoms, vital constants, lifestyle before and 60 days after the lockdown. RESULTS: A total of 100 patients were included in the study. The average age of our population is 55.34 years±15.86. The average BMI (body mass index) is 26.40 Kg/m2±5.84. The coronary artery disease was present in 27% of the patients, valvular disease in 40% and heart failure in 37%. Finally, arrhythmias appear in 22% and more than the half of our sample has high blood pressure. We noted a significant weight gain of 1.71 Kg (P<0.000) after 60 days of lockdown, with an increase of BMI of 0,58 kg/m2 (P<0,005). The percentage of patients with SBP (systolic blood pressure) ≥140mmHg has evolved from 38 to 44%, thus an increase of 6 % (P<0,0001), while the percentage of the patients with DBP (diastolic blood pressure) ≥90mmHg has passed from 21 to 15 % (thus a decrease of 6 %, P<0,0001). Twenty patients stop smoking, thus a decrease of 7% (P<0,0001). The sedentary lifestyle rate presented an elevation of 22% (P<0,0001). The daily calorie intake has increased of 35,4 % and 46,8 % of the patients increased their salt intake by more than 4 g per day. The increase of the daily calorie intake concerned more the men than the women (41,9 % of men vs 31,3 % of the women). In the population with high blood pressure, we have not observed a statistically significant difference of the SBP, the DBP and the heart rate between the beginning and two months after the lockdown. Concerning patients with heart Failure, we have noted an worsen of the symptoms of HF. Thus, 8,1% of the patients presenting a stage two dyspnea has passed to a stage three of the NYHA (32,4 vs 40,5%), while the percentage of patients with lower limbs edema has increased of 13,5% but in a non-statistically significant way (P=0,267). We have noticed a diet gap with an increase of salt intakes (more than 4g per day) in more than the half of this subpopulation (55,6 %) during the period of the lockdown. In the subpopulation of patients with valvular pathology, we have identified a worsening of the dyspnea in 7,5% of the patients; this one has passed from stage two to stage three of the NHYA with an increase of the percentage of patients with lower limbs edema from 7,5% to 25% (P=0,065). Furthermore, we have noticed an incidence of 10% of cardiovascular events (2 cases of myocardial infarction [among which one has deceased], one death because of end stage heart failure, three hospitalizations for congestive heart failure, two cases of aortic dissections and 2 cases of rapid atrial fibrillation). OUR OBSERVATION: Depending on the results of this study, the sanitary lockdown induced important repercussions on the patients followed for cardiac diseases, hence the necessity of an awareness of these patients, and mostly a restructuring of our care system strongly disturbed by the Covid 19.

Gastric Adenocarcinoma in a Moroccan Population: First Report on Survival Data.

BACKGROUND: Although its incidence has decreased over the last 20 years, gastric adenocarcinoma remains frequent (1,033,701 new cases worldwide per year, Globocan 2018). Its prognosis is still poor, with overall survival rates of 10 to 25% despite improvement in surgical and perioperative treatment. In Morocco, we do not have data on survival and predictors of mortality in our population, the present study aims to describe the epidemiological and clinicopathological features of gastric adenocarcinoma and the survival rate. MATERIALS AND METHODS: We retrospectively reviewed data files of 265 patients with histological diagnosis of gastric adenocarcinoma between January 2007 and June 2017. Survival was estimated by the Kaplan Meier method and prognostic factors in multivariate analysis (Cox model). RESULTS: The mean age of our population was 54.48 ±15.53 with a sex ratio M/F of 1.76. Clinical symptomatology dominated by epigastralgia episodes in two-thirds of the cases and deterioration of the general state in most cases (61.7%). Proximal localization accounted for 17.4%. According to histological classification, poorly differentiated adenocarcinoma was the most common histological type (51.7%). Metastatic or locally advanced tumors accounted for 92% of cases. Only 11% of patients received curative resection. The 5-year survival was 6%. Multivariate analysis revealed three prognostic factors: vascular invasion, advanced stage and differentiation. DISCUSSION: The high mortality of gastric adenocarcinoma in our Moroccan series is probably explained by the late stage at diagnosis. Symptoms are nonspecific and endoscopy is usually performed for advanced symptoms such as anemia, bleeding or weight loss. The main identified prognostic factors in gastric adenocarcinoma are tumor subtype (Linitic forms), stage at diagnosis, vascular and lymph nodes invasion and general performance status which correlates to available data in the literature. Besides, the age distribution of GC in our series showed that the proportion of affected young adult is high (30.6%) compared to data from developed countries varying between 6 and 15%. This age distribution can be explained by the Westernization of diet, the increase of obesity in our population and more exposure to alcohol and tobacco. CONCLUSION: Overall cancer survival in our population does not exceed 7%, a rate that remains low compared to studies published in the occidental literature. Recommendations have to be elaborated to make a strategy for screening and early diagnosis of gastric adenocarcinoma to improve the survival rate.

Evolution of quality of life in patients with breast cancer during the first year of follow-up in Morocco.

BACKGROUND: Quality of life has an important place in the future of patients with breast cancer. The objective of this study is to assess the evolution of the patient's quality of life with breast cancer in Morocco after a year of follow-up. METHODS: This study involved the patients with breast cancer with all types of treatment as determined by their physicians. Patient's quality of life was assessed with the Moroccan Arabic version of QLQ- EORTC QLQ C30 and EORTC-BR23 questionnaires. Data were analyzed using SPSS Version 20 software. RESULTS: Regarding EOTRC questionnaires QLQ C-30, there was a significant improvement in global health status and all scales of the functional dimension except the social functional where there was a trend towards improvement and the financial impact of the disease where the situation has deteriorated. Quality of life was improved for most symptom-sized scales dimension of EORTC QLQ- C30 with the exception of diarrhea where it was observed degradation. Most of the EORTC QLQ-scales BR23 questionnaires showed a favorable trend in the quality of life except those of sexual functioning, sexual enjoyment, hair loss and the side effects of systemic therapy. CONCLUSION: The quality of life of the patient is significantly improved after 1 year of follow up. Quality of life instruments can be useful in the early identification of patients whose score low on functional scales and symptoms.

Psychoactive substances use and associated factors among middle and high school students in the North Center of Morocco: a cross-sectional questionnaire survey.

BACKGROUND: Data on psychoactive substance (PAS) consumption among adolescents in the North Center of Morocco are not at all available. Therefore, the current study aimed at investigating the prevalence and the determinants of psychoactive substances use among middle and high school students in this region. METHODS: A cross-sectional study was conducted from April 2012 to November 2013 in public middle and high schools in the North Central Region of Morocco. An anonymous self-administered questionnaire was used to assess psychoactive substances use among a representative sample of school students from the 7th to the 12th grade, aged 11-23 years, selected by stratified cluster random sampling. Factors associated with psychoactive substance use were identified using multivariate stepwise logistic regression analyses. RESULTS: A total of 3020 school students completed the questionnaires, 53.0 % of which were males. The overall lifetime smoking prevalence was 16.1 %. The lifetime, annual and past month rates of any psychoactive substance use among the study subjects were 9.3, 7.5, and 6.3 % respectively. Cannabis recorded the highest lifetime prevalence of 8.1 %, followed by alcohol 4.3 %, inhalants 1.7 %, psychotropic substances without medical prescription 1.0, cocaine 0.7, heroine 0.3, and amphetamine with only 0.2 %. Psychoactive substance use was associated with males more than females. The risk factors identified by multivariate stepwise logistic regression analyses were being male, studying in secondary school level, smoking tobacco, living with a family member who uses tobacco, and feeling insecure within the family. CONCLUSIONS: The prevalence among all school students reported by the current study was comparable to the national prevalence. Efforts to initiate psychoactive substance prevention programs among school students should be made by designing such programs based on the significant factors associated with psychoactive substance use identified in this study.

Paediatric neurobrucellosis: case report and literature review.

Neurological complications are rare in childhood brucellosis: there are only 33 reported cases. In children, neurobrucellosis is usually of acute presentation involving the central nervous system. We report our experience with an 8-year-old boy with brucella meningitis who demonstrated a Jarisch-Herxheimer-like reaction, i.e. initial clinical deterioration following the commencement of antibrucella treatment, associated with increased pleocytosis and shift from lymphocytic to polymorphic predominance and an already increased CSF lactate. These CSF findings have not been previously described. The patient recovered completely after 3 months' therapy consisting of rifampicin, doxycycline and gentamicin. Paediatric neurobrucellosis therapy should be a combination of three antibrucella antibiotic that include an aminoglycoside; for a period of 8-12 weeks, steroids may be added to treat complications. The prognosis of neurobrucellosis in children is usually good.

Antibiotic misuse in a paediatric teaching department in Kuwait.

Of 3813 children admitted to the paediatric teaching unit in Mubarak Hospital during 1985, 716 (19%) received either therapeutic (672) or prophylactic (44) antibiotics. The indications were respiratory infections (400), urinary infections (78), septicaemia (58), meningitis (42), gastroenteritis (32), other infections (62) and prophylaxis in rheumatic fever or splenectomy (44). Penicillins were prescribed in 553 children, ampicillins being the most frequently prescribed drugs (295, 41%). Antibiotic use was assessed as unnecessary in 282 children, of whom 203 (72%) had respiratory infections. Overall mistakes were encountered in 352 cases, of which 238 (68%) were in respiratory infections and 302 (86%) involved a penicillin, single or in combination. Mistakes were also commoner with combination than with single antibiotic therapy (66% and 44%, respectively). A departmental policy for the use of antibiotics in gastro-enteritis led to their prescription in only 4% of cases. A written justification for cefotaxime reduced its use by 90%. The lack of similar policies for antibiotic use in respiratory infections leads to high rates of antibiotic use and misuse, probably world-wide.