Chlorhexidine alcohol base mouthrinse versus Chlorhexidine formaldehyde base mouthrinse efficacy on plaque control: double blind, randomized clinical trials

Background: Chlorhexidine is well known for its antiplaque effect. However, the mouthrinse based chlorhexidine antiplaque efficiency may vary according to the formulation of the final product. The aim of the present study was to compare anti-plaque effectiveness of two commercial mouthrinses: 0.12 % Chlorhexidine alcohol base (CLX-A) versus a diluted 0.1% Chlorhexidine non-alcohol base with 0.1% of Formaldehyde (CLX-F). Material and Methods: the study was a seven day randomized, double-blind, placebo-controlled trial including 30 volunteers. At the start, all participants received a dental prophylaxis. Over 7 days experimental non-brushing period, during which subjects abstained from all forms of mechanical oral hygiene, one group test rinsed twice daily with 15ml of an alcohol base 0.12% Chlorhexidine mouthrinse. The second group test used 15ml of alcohol free 0.1% Chlorhexidine mouthrinse base 0.1% formaldehyde twice daily. The negative control group used a placebo. Plaque indexes were recorded in all volunteers prior to treatment at Day 0, 1 and 7. Results: After 7 days, the mean plaque index for the first group was 0.76±0.38 compared with a mean plaque index of 1.43±0.56 for the second group. The difference in plaque scores between the groups was statistically significant. Conclusion: the results of this study showed that rinsing with an alcohol base 0.12% Chlorhexidine mouthrinse is significantly different from rinsing with an alcohol free 0.1% Chlorhexidine mouthrinse on plaque inhibition

Violence toward physicians in emergency departments of Morocco: prevalence, predictive factors, and psychological impact

<p>Abstract</p> <p>Introduction</p> <p>Anyone working in the hospital may become a victim of violence. The effects of violence can range in intensity and include the following: minor physical injuries, serious physical injuries, temporary or permanent physical disability, psychological trauma, and death. The aim of this study was to determine the frequency of exposure, characteristics, and psychological impact of violence toward hospital-based emergency physicians in Morocco.</p> <p>Methods</p> <p>This was a survey including emergency physicians who ensured emergency service during the last fortnight. The variables studied were those related to the victim (age and gender), and those related to aggression: assaulter gender, number, time, reason (delay of consultation and/or care, acute drunkenness, neuropsychiatric disease), and type (verbal abuse, verbal threat and/or physical assault). After the questionnaire was completed, State-Trait Anxiety Inventory (STAI) of Spielberg was applied to all participants.</p> <p>Results</p> <p>A total of 60 physicians have achieved permanence in emergency department during the 15 days preceding the questionnaire response. The mean age was 24 ± 1 year and 57% were male. A total of 42 (70%) had been exposed to violence. The violence occurred at night n = 16 (27%), afternoon n = 13 (22%), evening n = 7 (12%) and morning n = 6 (10%). Reasons for violence were: the delay of consultation or care in n = 31 (52%) cases, acute drunkenness in n = 10 (17%) cases and neuropsychiatric disease in n = 3 (5%) cases. Twenty eight (47%) participants stated that they experienced verbal abuse, n = 18 (30%) verbal threat and n = 5 (8.3%) physical assault. Exposure to some form of violence was related to a higher median [interquartile range, IQR] state anxiety point (SAP); (51 [46-59] vs 39 [34-46]; <it>P </it>< 0,001), and trait anxiety point (TAP) (48 [41-55] vs 40,5 [38-53]; <it>P </it>= 0,01).</p> <p>Conclusions</p> <p>This study revealed a high prevalence (70%) of violence toward doctors in Morocco emergency departments. The exposure of physicians to some form of violence is greater among doctors with anxiety trait and was related to significant degree of anxiety state.</p

Polypharmacy-related polypathology in the elderly: A case study at Ibn Sina Hospital, Morocco

Purpose: To determine the polypathological and therapeutic profiles of a population of elderly subjects at the Ibn Sina Hospital, Rabat, Morocco. Methods: This was a prospective cross-sectional observational study on a population made up of 356 patients aged ≥ 65 years. Data were collected from different departments during the study period, regarding age, sex, educational level, socio-cultural and economic status, self-care ability, polypathologies, polymedication, effectiveness of treatments, adverse effects, and knowledge of the concept of generic medication. The results, which are presented in percentages and simple averages, were processed with Excel 2016 software. Results: Patients aged 66 - 75 years comprised 60.4 % of the studied population. The most common pathologies were diabetes, asthma, and cardiovascular disease. A total of 237 patients (66.6 %) took &lt; 6 drugs, while 119 patients (33.4 %) were on polypharmacy, i.e., &gt; 6 drugs. The elderly were more vulnerable to polypathology and polypharmacy due to age-related reduction in physiological functions and their impact on pharmacological parameters. Polypathology led to polypharmacy which increased the risk of side effects and problems with adherence to medications. Conclusion: This study provides information on the pathological profiles of a population of elderly subjects in a Moroccan hospital, and details of the therapeutic strategies used in managing these patients

Chronic neck pain and anxiety-depression: prevalence and associated risk factors

Introduction: Chronic pain in rheumatology often has a psychic impact, which may aggravate the daily life of patients. Chronic neck pain, as an example, is a frequent reason for consultation. The aim of this study is to assess the prevalence of anxiety and depression in patients with neck pain, and identify risk factors associated with their occurrence. Methods: it was a cross-sectional study that concerned 80 patients with neck pain lasting for more than 3 months, seen in rheumatology consultations. All patients with symptomatic neck pain or psychological history or receiving psychotropic medication were excluded from the study. For each patient, we determined the sociodemographic characteristics and clinical ones. The anxious and depressed mood was assessed by the Hospital Anxiety and Depression Scale (HAD). Results: Of the 80 patients, 67 (83.8%) were women. Average age of our population was 51.8± 11.8 years. Median duration of symptoms was 24 months [12, 48]. Mean VAS pain was 63.9% ± 12.5, mean VAS functional discomfort was 60.9% ± 14.2 and mean VAS disability was 59.8% ± 14.7. 32 patients (40%) were illiterate and 18 (22.5%) had university level. Anxiety was found in 54 (68.4%) and 44 (55.7%) patients were depressed. In univariate analysis, VAS disability was statistically linked to anxiety (OR:1.05; 95%CI: 1.01-1.08; p = 0.02). The cervicobrachial neuralgia (CBN) was significantly associated with depression (OR: 3.33; 95%CI: 1.20-9.23; p=0.02). Primary education level had a statistically significant relationship with anxiety (OR: 6.00; 95%CI: 1.03-34.84; p=0.04) and depression (OR: 5.00; 95%CI: 1.09-22.82; p=0.03). In multivariate analysis, VAS disability and CBN were independently associated with anxiety and depression respectively. Conclusion: This study underlines the fact that anxiety and depression are prevalent in chronic neck pain (CNP) patients. Furthermore, disability and CBN which are linked to CNP can predict which patient is at higher risk of psychological distress.The Pan African Medical Journal 2016;2

Sexual dysfunction and its determinants in Moroccan women with rheumatoid arthritis

Introduction: To assess the prevalence of sexual dysfunction in married women with rheumatoid arthritis (RA) and compare it with a control group and to determine its association with clinical and disease activity factors. Methods: We conducted a cross-sectional study including sixty married women with a confirmed diagnosis of Rheumatoid Arthritis according to the American College of Rheumatology (ACR)/ European League against Rheumatism (EULAR) 2010 Criteria, aged 18 or over and having sexual activity. Our controls were healthy volunteers women matched for age. Clinical and sociodemographic characteristics were collected. Sexual function was assessed by a self-reported questionnaire the index of female sexual function (FSFI). Sociodemographic and disease activity profiles were compared between those who had and did not have sexual dysfunction. Results: The prevalence of female sexual dysfunction in women with rheumatoid arthritis attending El Ayachi hospital was 71.9%, it was 54% in controls. There was a significant difference in the total FSFI score between patients 18.29±9.09 and controls 23.05±7.91 (p=0.016). We found a statistically significant difference between the two groups in almost all dimensions of sexual function (desire, arousal, orgasm, satisfaction), except for pain and lubrication. In multivariate analysis, pain assessed by visual analogue scale (VAS) and depression assessed by hospital anxiety and depression score (HAD) were the independent determinants of sexual dysfunction. Conclusion: Our study suggests that sexual dysfunction is more common among patients with RA compared to controls. These dysfunctions were related to desire, arousal, orgasm and satisfaction. Pain and depression appear to be the most important predictors of sexual dysfunction.Pan African Medical Journal 2016; 2

Health-care associated infections rates, length of stay, and bacterial resistance in an intensive care unit of Morocco: Findings of the International Nosocomial Infection Control Consortium (INICC)

<p>Abstract</p> <p>Background</p> <p>Most studies related to healthcare-associated infection (HAI) were conducted in the developed countries. We sought to determine healthcare-associated infection rates, microbiological profile, bacterial resistance, length of stay (LOS), and extra mortality in one ICU of a hospital member of the International Infection Control Consortium (INICC) in Morocco.</p> <p>Methods</p> <p>We conducted prospective surveillance from 11/2004 to 4/2008 of HAI and determined monthly rates of central vascular catheter-associated bloodstream infection (CVC-BSI), catheter-associated urinary tract infection (CAUTI) and ventilator-associated pneumonia (VAP). CDC-NNIS definitions were applied. device-utilization rates were calculated by dividing the total number of device-days by the total number of patient-days. Rates of VAP, CVC-BSI, and CAUTI per 1000 Device-days were calculated by dividing the total number of HAI by the total number of specific Device-days and multiplying the result by 1000.</p> <p>Results</p> <p>1,731 patients hospitalized for 11,297 days acquired 251 HAIs, an overall rate of 14.5%, and 22.22 HAIs per 1,000 ICU-days. The central venous catheter-related bloodstream infections (CVC-BSI) rate found was 15.7 per 1000 catheter-days; the ventilator-associated pneumonia (VAP) rate found was 43.2 per 1,000 ventilator-days; and the catheter-associated urinary tract infections (CAUTI) rate found was 11.7 per 1,000 catheter-days.</p> <p>Overall 25.5% of all <it>Staphylococcus aureus </it>HAIs were caused by methicillin-resistant strains, 78.3% of <it>Coagulase-negative-staphylococci </it>were methicillin resistant as well. 75.0% of <it>Klebsiella </it>were resistant to ceftriaxone and 69.5% to ceftazidime. 31.9% of <it>E. Coli </it>were resistant to ceftriaxone and 21.7% to ceftazidime. 68.4% of <it>Enterobacter sp </it>were resistant to ceftriaxone, 55.6% to ceftazidime, and 10% to imipenem; 35.6% of <it>Pseudomonas sp </it>were resistant to ceftazidime and 13.5% to imipenem.</p> <p>LOS of patients was 5.1 days for those without HAI, 9.0 days for those with CVC-BSI, 10.6 days for those with VAP, and 13.7 days for those with CAUTI.</p> <p>Extra mortality was 56.7% (RR, 3.28; P =< 0.001) for VAP, 75.1% (RR, 4.02; P = 0.0027) for CVC-BSI, and 18.7% (RR, 1.75; P = 0.0218) for CAUTI.</p> <p>Conclusion</p> <p>HAI rates, LOS, mortality, and bacterial resistance were high. Even if data may not reflect accurately the clinical setting of the country, programs including surveillance, infection control, and antibiotic policy are a priority in Morocco.</p

Normative values for the bath ankylosing spondylitis functional index in the general population compared with ankylosing spondylitis patients in Morocco

<p>Abstract</p> <p>Background</p> <p>The Bath Ankylosing Spondylitis Functional Index (BASFI) has been commonly used in rheumatology to quantify functional disability in patients with Ankylosing Spondylitis (AS). Our aim was to evaluate the discriminating power of BASFI and determine the best cutoff score of this index in the general population compared with AS patients.</p> <p>Methods</p> <p>A cross-sectional study that included 200 patients suffering from AS and 223 subjects from the general population matched for age and sex was carried-out. The discriminating power of the BASFI by strata of age was evaluated by the area under the Receiver Operating Characteristic curve and the best cutoff was determined by the Youden index.</p> <p>Results</p> <p>The mean age of the general population was 39 ± 12 years. 76.7% of them were male. The median BASFI of the healthy subjects and patients was 0.2 and 4.5 (P < 0.001) respectively. The best cutoff of BASFI was 1.5 with a sensitivity of 86% and a specificity of 90%. In the age group of 18-29 years, the best cutoff of the BASFI was 0.9 with a sensitivity of 93% and a specificity of 94%. In the age group of 30-50 years, the best cutoff of the BASFI was 1.5 with a sensitivity of 84% and a specificity of 88%. For those over 50 years of age, the best cutoff of the BASFI was 2.5 with a sensitivity of 84% and a specificity of 97%.</p> <p>Conclusions</p> <p>This study suggests that the discriminating power of BASFI is considered good at any age. The best cutoff of this index increased as age increases as functional disability is associated in part with lifestyle choices and increases with age. The cutoff values of the BASFI that we have presented could be used as a reference benchmark for both clinical practice and research.</p

Evaluation of intermittent hemodialysis conducted off-site on patients with renal insufficiency admitted in the intensive care unit of a developing country

Background: In most developing countries, the renal replacement therapy (RRT) in ICU is not performed locally. We designed this study to assess the intermittent hemodialysis (IHD) offsite intakes on survival in critically ill patients admitted with renal failure.Methods: We prospectively analyzed all patients admitted to medical ICU with Acute Renal Failure (AKF) or Chronic Renal Failure (CKF) from February 2011 to September 2013. Patients were divided into two groups: those that received IHD in Hemodialysis Unit (IHD+) and those who did not (IHD-). Every patient IHD+ was matched to a patient IHD - using propensity score.Results: 202 patients were included: 151 with ARF and 51 with CRF. 116 patients were matched (age: 48±18 years; 46F/70M; median serum creatinine: 51mg/l; IQR: 32-90 mg/l). The total number of dialysis sessions was 112 for 58 patients (1.8±1.4 session/patient). The median delay to initiate IHD was 5.5h (IQR: 2-8h) and median duration of transportation was 10 min (IQR: 10-15min) with 23.6% transportation incidents. Significant hypotension with tachycardia were reported during IHD. ICU mortality rate was the same in the both groups (58.6%). In multivariate analysis, CRF (RR=2.69; p=0.006), serum creatinine >50mg/l (RR=3.54; p=0.007) and requirement for vasopressors infusion (RR=1.8; p=0.041) were independent predictive factors for receiving IHD.Conclusions: Our study doesn’t show an improvement in survival in ICU patients who receive IHD offsite. The probability to require IHD offsite increases with CRF and the use of vasopressors

Measuring quality of life after intensive care using the Arabic version for Morocco of the EuroQol 5 Dimensions

<p>Abstract</p> <p>Background</p> <p>Health-related quality of life (HRQL) is a relevant outcome measures in intensive care unit (ICU). The aim of this study was to evaluate HRQL of ICU patients 3 months after discharge using the Arabic version for Morocco of the EuroQol-5-Dimension (EQ-5D), and to examine the psychometric properties of the questionnaire.</p> <p>Results</p> <p>The Arabic version for Morocco of the EQ-5D was approved by the EuroQol group. A prospective cohort study was conducted after medical ICU discharge. At 3-month follow up, the EQ-5D (self classifier and EQ-VAS) was administered in consultation or by telephone. EQ-VAS varies from 0 (better HRQL) to 100 (worst HRQL). An unweighted scoring for EQ5D-index was calculated. EQ5D-index ranges from -0.59 to 1. Test-retest reliability of the EQ-5D was tested using Kappa coefficient and intraclass correlation coefficient (ICC). Criterion validity was assessed by correlating EQ-VAS and EQ5D-index with the Short Form 36 (SF-36). Construct validity was tested using simple and multiple liner regression to assess factors influencing patients'HRQL. 145 survivors answered the EQ-5D. Median EQ5D-index was 0.52 [0.20-1]. Mean EQ-VAS was 62 ± 20. Test-retest reliability was conducted in 83 patients. ICCs of EQ5D-index and EQ-VAS were 0.95 and 0.92 respectively. For EQ-5D self classifier, agreement by kappa was above 0.40. Significant correlations were noted between EQ5D-index, EQ-VAS and SF-36 (<it>p </it>< 0.001). In multivariate analysis, factors associated with poorer HRQL for EQ5D-index were longer ICU length of stay (β = -0.01; <it>p </it>= 0.017) and higher educational level (β = -0.2; <it>p </it>= 0.001). For EQ-VAS men were associated with better HRQL (β = 6.5; <it>p </it>= 0.048).</p> <p>Conclusions</p> <p>The Arabic version for Morocco of the EQ-5D is reliable and valid. Women, high educational level and longer ICU length of stay were associated with poorer HRQL.</p