Powerful Words: An Exploration of Linguistic Hierarchy in Moroccan Hospitals

Morocco is a country of distinct diversity, which exists as a result of the settling of multiple peoples and European colonization. As a result of this diversity, many languages are employed in different settings and spaces, and of these languages, French represents remnants of colonialism and continual elitism in the country. One of the spheres that French commands in Moroccan society is medicine, which creates a dichotomy between the educated health care providers and the underprivileged patients in public hospitals. The aim of this paper is to explore the effect of French on the doctor-patient relationship in urban, public Moroccan hospitals. Through secondary research and personal interviews, it will outline the understanding of the language situation in hospitals from the point of view of both the doctors and the patients, describe the effect of French on patients’ understanding of healthcare, and explore the impact of French on patients’ agency within the medical system. Ultimately, this paper aims to shed light on the intersections of culture, history, and medicine in order to explore avenues for process

Genetic Contributions To Thoracic Aortic Disease

AimsThoracic aortic aneurysms and dissections are significant yet under-recognized threats in cardiovascular health, often remaining undetected until catastrophic events occur. This study aims to explore the genetic landscape of thoracic aortic diseases, focusing on genetic mutations contributing to thoracic aortic aneurysm (TAA) and dissection. It also seeks to refine the size criteria for surgical intervention in TAA, aiding clinicians in decision-making and improving patient outcomes. MethodsThe study employed a comprehensive literature review, focusing on the genetic aspects of thoracic aortic diseases. In addition to a systematic MEDLINE search, the investigation used the Genomics England PanelApp to identify genes associated with TAA and dissection. This research builds on the work of Dr. John Elefteriades and the Yale Aortic Institute published in 2019 which incorporated updated size criteria for surgical interventions based on type of genetic mutation. ResultsThe investigation expands the genetic landscape understanding of TAA, identifying 68 genes with different levels of association through the Genomics England PanelApp. Among these, thirty-three genes have a strong association ( green designation), five are of moderate concern ( amber ), and thirty have a lesser-known impact ( red ). Additionally, the research proposes a shift in size criteria for surgical interventions, specifically a “left shift” in thresholds, particularly for genes related to Loeys-Dietz syndrome and others. ConclusionsThis study highlights the evolving genetic complexity in thoracic aortic diseases. Several new genetic variants with strong associations to TAA have been identified, necessitating updates in genetic screening panels. The research also emphasizes the change in size criteria for surgical intervention, advocating for a more proactive approach in managing TAAs. Future research should continue exploring genetic contributors, reevaluating genes with medium or weak associations, and refining intervention criteria based on non-size factors. This advanced genetic understanding of TAA and dissection offers a nuanced perspective, paving the way for improved patient management and outcomes in thoracic aortic diseases

Outcomes of patients with advanced liver disease undergoing cardiac surgeryCentral MessagePerspective

Objective: Liver disease (LD) is considered a risk factor for inferior outcomes in general and cardiac surgery, yet current cardiac surgery risk estimators exclude LD, and literature on the topic remains scant. We sought to evaluate whether the presence of advanced LD is associated with inferior outcomes following cardiac surgery. Methods: This single-center, retrospective, observational study included 285 patients diagnosed with LD who underwent cardiac surgery in 2010 to 2020. The cohort contained 3 groups, Child-Turcotte-Pugh (CTP) class A (n = 219), CTP early-class B (n = 34), and CTP advanced-class B (n = 32). A model for end-stage liver disease score of 12.7 points (determined using a receiver-operating characteristic curve analysis on 30-day mortality) dichotomized class B into early- and advanced-groups. Univariate and multivariate logistic regression analyses were performed to identify predictors of 30-day mortality. Results: Patients in CTP advanced-class B had the longest length of stay (14 days), highest incidence of prolonged ventilation (46.9%), renal failure (21.9%), 30-day mortality (18.8%), and in-hospital mortality (18.8%). Incidence of ≥1 postoperative complication was higher in CTP advanced-class B (59.4%), compared with CTP class A (37.9%) and CTP early-class B (38.2%). Multivariate logistic regression analysis demonstrated that female sex (odds ratio, 3.01; 95% CI, 1.07-8.77; P = .037) and peripheral vascular disease (odds ratio, 4.01; 95% CI, 1.33-12.2; P = .013) were independent predictors of 30-day mortality in patients with advanced LD. Conclusions: Severity of LD influences perioperative outcomes following cardiac surgery. Our data suggest that patients in CTP class A and selected patients in CTP class B (model for end-stage liver disease score <12.7) can undergo surgery with acceptable risk