Background: Acute mesenteric ischemia (AMI) is a rare vascular and digestive emergency associated with high mortality. Its clinical presentation is often nonspecific, which contributes to delayed diagnosis and progression to intestinal necrosis. Methods: We conducted a retrospective, longitudinal, descriptive and analytical study in the polyvalent intensive care unit A4 of Hassan II University Hospital in Fez over a seven- year period, from January 2013 to December 2019. All adult patients hospitalized for AMI were included when the diagnosis was established preoperatively on clinical, biological and radiological grounds, or intraoperatively. Incomplete records and patients managed only in the resuscitation room were excluded. Statistical analysis was performed using SPSS 20. Quantitative variables were expressed as means and qualitative variables as percentages. Univariate analysis was performed, with statistical significance set at p<0.05. Results: Sixteen patients were included, representing approximately 0.3% of ICU admissions during the study period. The mean age was 64.8 ± 12.68 years and 62.5% of patients were women. Atrial fibrillation was the most frequent comorbidity (43.75%). The mean delay before consultation was four days. All patients presented with abdominal pain, 62.5% with vomiting and 31.25% with an occlusive syndrome. CT/CT angiography established the preoperative diagnosis in 10 patients. Fifteen patients underwent surgery; intestinal necrosis was found in all operated patients. Invasive mechanical ventilation was required in 81% of patients, vasoactive drugs in 62%, and therapeutic anticoagulation in all patients. Overall mortality was 62.5%. Factors significantly associated with mortality were central venous catheterization, invasive mechanical ventilation and septic shock. Conclusion: AMI in the ICU remains associated with high mortality. Prognosis depends on early clinical suspicion, rapid CT angiography and multidisciplinary management involving intensive care, digestive surgery and vascular surgery.

Carotid endarterectomy is a well-established procedure for the secondary prevention of stroke. While general anaesthesia (GA) has traditionally been the standard approach, ultrasound-guided locoregional anaesthesia (LRA) has gained popularity due to advantages such as improved haemodynamic stability and real-time neurological monitoring. In our series, ultrasound-guided cervical plexus block was systematically employed, providing satisfactory anaesthetic comfort without the need for conversion to GA. These findings are consistent with existing literature, including the GALA trial, which highlighted the importance of individualised anaesthetic choice. Ultrasound guidance enhances the safety and precision of cervical blocks by enabling direct visualisation of anatomical structures and optimising anaesthetic diffusion. In our experience, the block was performed in an average of 10 minutes, with high surgeon satisfaction. Complications were rare and minor .Postoperative analgesia was generally effective with minimal opioid use. Despite the study’s limitations, our results support ultrasound-guided LRA as a safe and effective alternative to GA in carotid endarterectomy.

Background: Difficult tracheal intubation (DTI) may be a major cause of morbidity and mortality if not anticipated. Pre-anesthesia airway risk assessment is a must for safety reasons. The aim of this study is to analyze the clinical predictive criteria for DTI with particular focus on the Mallampati score in the supine and sitting positions. Methods: This is a 6-month prospective observational study including all surgical adult patients requiring oro-tracheal intubation and not relevant to an indication for fibroscopic intubation nor urgent surgery (N = 500). DTI predictive criteria, composite scores, mask ventilation, laryngoscopy, and glottic catheterization were collected. Primary outcome was the ability of the collected criteria to predict DTI. Secondary outcome was the comparison of the Mallampatti score in the sitting vs. supine position to predict DTI using Cohen's kappa non-parametric test. Results: Mean age was 46.5 years. 10 % had diabetes. The incidence of DTI was 26 %. Six predictive factors for DTI were identified in multivariate analysis (p < 0.05): body mass index greater than 30 kg/m(2), mouth opening <3.5 cm, thyromental distance <6.5 cm, grades III and IV of Mallampati sitting and supine scores and Cormack and Lehane score IV. Mallampati supine score outperformed Mallampati sitting score in predicting the risk of difficult intubation, with respective ROCs at 0.898 (IC95 % 0.857-0.938) vs 0.751 (IC95 % 0.678-0.824). Conclusions: Incidence of DTI was higher in our population, probably related to our specific context of care. Predictive factors of DTI are consistent with previous studies while composite scores are not conclusive. The supine Mallampati performed better than sitting Mallampati in predicting DTI and may be reliable pre-operatively to assess the airway in patients unable to sit.

Methanol poisoning is an uncommon poisoning in France. Absorption for suicidal or accidental purposes (adulterated alcohols) can occur through the digestive or transcutaneous route. The product is toxic through its metabolites: formaldehyde and formic acid, responsible for an inhibition of the enzymes of the respiratory chain and a metabolic acidosis whose part is linked to formates and lactates remains to be specified. After a variable period, corresponding to the metabolism time of the product, the prodromes appear in the form of digestive and visual disorders. The period of state associates in severe forms a coma of variable appearance, sometimes convulsive, a state of cardiogenic and/or hypovolemic shock and optic neuritis: severe metabolic acidosis is accompanied by an increase in anionic indoses and the osmolar gap. Brain CT scan reveals non-specific hypodensities of the central gray nuclei that can guide the etiological diagnosis of a coma. Only the methanol dosage will provide diagnostic certainty. Treatment, a toxicological emergency, must be started before the results. It requires massive alkalinization associated with the usual treatments for shock and coma. Etiological treatment is based on the purification of toxic substances by hemodialysis rather than peritoneal dialysis, which is less effective, and on blocking the metabolism of methanol with methyl alcohol or 4-methylpyrazole.

Background: Wernicke encephalopathy (WE) is an acute neuropsychiatric syndrome caused by thiamine deficiency. Though often linked to alcoholism, it can result from prolonged vomiting during pregnancy (hyperemesis gravidarum).Case Presentation: We describe the case of a 21-year-old primigravida at 16 weeks’ gestation, presenting with incoercible vomiting. Initial investigations revealed hepatic cytolysis and biliary sludge. Post-surgical deterioration led to neuropsychiatric symptoms. Brain MRI revealed periaqueductal hyperintensities suggestive of WE. High-dose intravenous thiamine resulted in marked clinical improvement.Conclusion: WE is a medical emergency that should be considered in pregnant women with persistent vomiting. Early recognition and treatment are crucial to prevent irreversible complications.

BACKGROUND:Cardiopulmonary resuscitation (CPR) training is crucial for nursing students as future nurses are the first responders in the ambulatory and hospital care chain. Simulation-based learning has been shown to be more effective in acquiring the knowledge and technical and non-technical skills required for CPR. The present study aims to evaluate the impact of high-fidelity simulation-based adult CPR training on the acquisition and retention of knowledge and the development of technical and non-technical skills of nursing students at the Higher Institute of Nursing Professions and Health Techniques in Fez, Morocco. METHODS:We conducted an interventional study with 49 nursing students. Twenty-five students (51.02%) in the simulation group received both traditional CPR training (theoretical lecture and demonstration of procedures) and simulation CPR training, while 24 students (48.97%) in the control group received only traditional training. Data were obtained using a questionnaire on theoretical knowledge of CPR, a technical skills assessment grid, and the Team Emergency Assessment Measure (TEAM) for non-technical skills. RESULTS:The post-test scores for theoretical knowledge immediately after simulation were significantly higher for the simulation group (16.41±1.73 out of 20) than for the control group (13.15±1.96 out of 20). Mean CPR knowledge retention scores 30 days after training were significantly higher in the simulation group (15.60±1.71) compared with the control group (11.38±1.93). Assessment of technical skills on a high-fidelity mannequin showed a considerable advantage for the simulation group (30.88±1.64 out of 34) over the control group (18.00±0.78 out of 34). In addition, the results demonstrated a significant difference between the TEAM score of the simulation group (37.84±2.67 out of 44) and the control group (22.33±0.96 out of 44) and a significant difference between the Global Team Performance of the simulation group (8.16±0.68) out of 10 and the control group (4.83±0.38). CONCLUSION:The findings demonstrated that adult CPR training using high-fidelity simulation was superior to the traditional method with regard to knowledge acquisition and retention and the development of technical and non-technical skills in undergraduate nursing students.

Introduction: Cardiac arrest is one of the most serious circumstances needing quick response. Nurses are the first to arrive at the patient's bedside in the event of cardiac arrest, starting cardiopulmonary resuscitation (CPR).As a method of teaching CPR, high-fidelity simulation has been demonstrated to have a substantial impact.Thus, the present study aims to evaluate the impact of adult CPR training based on high-fidelity simulation on anxiety and evolution in self-efficacy, satisfaction and self-confidence of undergraduate nursing students at the Higher Institute of Nursing Professions and Health Techniques in Fez, Morocco. Methods: An intervention study with a simulation group and a control group was carried out with 49 student nurses. The simulation group (n=25) received traditional training (theoretical lecture and procedural demonstration) and simulation-based CPR training, while the control group (n=24) received only traditional training. Data were obtained using the State-Trait Anxiety Inventory (STAI-Y1 and STAI-Y2), the Self-Efficacy Scale and the Student Learning Satisfaction and Confidence Scale. Results: Post-test results of the STAI-Y1 scale revealed a significant reduction in situational anxiety in the simulation group, with a mean score of 30.84 +/- 1.84 out of 80, compared with the control group score (43.04 +/- 1.36). Assessment of post-simulation self-efficacy showed a significant advantage for the simulation group (35.28 +/- 2.47) out of 40 over the control group (20.96 +/- 1.36). Mean CPR self-efficacy retention scores 30 days after training were significantly higher for the simulation group (34.80 +/- 2.19) than for the control group (20.88 +/- 1.36). Nevertheless, a significant decrease in mean self-efficacy scores was recorded for the simulation group between the post-test immediately after simulation training (35.28 +/- 2.47) and the post-test 30 days after training (34.80 +/- 2.19). Thus, the results revealed that mean satisfaction (23.16 +/- 0.68 out of 25) and self-confidence (36.08 +/- 0.99 out of 40) scale scores were high immediately after the simulation experience in the simulation group. Nevertheless, a significant increase in satisfaction (24.08 +/- 0.99) and a significant decrease (33.72 +/- 1.59) in self-confidence were recorded 30 days after simulation training. Conclusion: The outcomes demonstrated that adult CPR training using high-fidelity simulation was superior to the conventional approach in terms of decreasing anxiety and enhancing and maintaining undergraduate nursing students' self-efficacy, satisfaction, and confidence.

As the population ages, the number of elderly patients admitted to the ICU continues to rise. The physiological changes associated with ageing represent a challenge for the management of this often-fragile population at high cognitive risk. An epidemiologic and evolution profile in our Moroccan context is necessary to improve survival and its quality in post-intensive care in our elders. This is a retrospective analytic study including all patients over 65 years of age admitted to the A4 polyvalent intensive care unit of the Hassan II University Hospital in Fez, from January 2017 to December 2021, excluding patients initially admitted for COVID-19 infection. The epidemiology, stay, management and outcome data were collected and analyzed.

Introduction: Myasthenia crisis (MC) occurs in 15 % to 20 % of myasthenia gravis (MG) patients. How to prevent post-operative myasthenic crisis (POMC) is of great importance to the treatment of post-surgery MG patients. Methods: Retrospective study including myasthenia patients who underwent thymectomy and were admitted to our unit from January 2013 to December 2019. Variables analyzed were age, gender, history of MC, duration of disease, diagnostic parameters, preoperative functional muscle and Leventhal scores, Ossermann classification, patient comorbidities, treatment, and outcomes. Results: Thirty patients were included in this study. The mean age was 36.86 years. The sex ratio M/F was 0.30. Twenty percent of the patients had a history of MC. Bulbar symptoms were present in 50 % of cases. Anti-acetylcholine receptor antibodies were positive in 93 % of cases. The functional muscle score varied between 60 and 100 points with a mean of 83.63 points. The mean vital capacity was 3.302 liters. The Leventhal score was greater than 10 in five patients. Curarization was necessary in 25 patients and monitored in four cases. Surgical approach was median sternotomy in 86.67 % of cases and mean surgery duration was 159.83 minutes. The univariate analysis identified 5 variables significantly (p < 0.05) associated with the occurrence of POMC: Leventhal score > 10, weak functional muscle score, low vital capacity, prolonged duration of surgery, and prolonged length of ICU stay. Conclusion: Leventhal score > 10, weak functional muscle score, low vital capacity and prolonged surgery duration were independent risk factors for POMC.

BackgroundCoronavirus disease of 2019 (COVID-19) infection is known as a complex systematic disease with a highly variable clinical spectrum, ranging from mild symptoms to serious complications requiring intensive care, including respirator y distress, coagulopathy disorders presenting as strokes, LI or embolism, and cardiovascular and neurological complications, leading to multiple organ dysfunction and even death.Moreover, awareness of uncommon presentations and complications increase.A review of the current literature reveals several complications related to coagulopathy in the COVID-19 context.In this report, we discuss a case of an ischemic stroke complicating upper ALI and revealing COVID-19 infection in a 60-year-old diabetic male patient to raise awareness of this complication as a manifestation of COVID-19. case descriptionA 60-year-old male patient with a history of 6-year type 2 diabetes presented to the emergency room (ER) with heaviness in the left half of the body, facial asymmetry, and language disorder.Onset-to-door time was 8 hours.The patient reported the notion of fever, dry cough, and anosmia for 8 days before the neurological symptoms, as well as a confirmed COVID-19 contact case within the family.His vitals upon admission were; heart rate, 92 beats/minute; respiratory rate, 17 cycles/minute; oxygen saturation, 89% on room air; blood pressure, 125/55 mm Hg; temperature, 37.8ºC.His blood glucose was 3.9 gm/dL, and urinary stripes were positive for acetone.Clinical assessment showed a National Institutes of Health Stroke Scale score of 15, leading to a suspect of a cerebral stroke.Cerebral computed tomography (CT) scan showed a subacute right Sylvian ischemic stroke (Fig. 1).A chest CT scan was performed, showing parenchymal involvement linked to COVID-19 infection evaluated at 40% (Fig. 2).COVID-19 reverse transcription polymerase chain reaction (RT-PCR) through nasal swabbing was positive, and abnormal laboratory results as shown in Table 1.Management of stroke was carried out by emergency thrombolysis combined with anti-ischemic medical treatment.Neurological recovery was progressive within the first 24 hours, but clinical reassessment

Introduction: This study aims to determine the incidence of healthcare-related infections in our structure, identify the different types of healthcare-related infections in order of frequency, and understand the bacterial ecology. Materials and methods: We conducted a prospective observational, descriptive study, which included all patients over 16 years of age who were hospitalized in the Intensive Care Unit (ICU) A4 of the Hassan II University Hospital of Fez. The study was performed over a period of 12 months, from May 2021 to May 2022. Patients hospitalized in the ward during this period were all monitored throughout their stay. The study included those who developed a healthcare-related infection, regardless of the site of the infection. We excluded all patients who did not present with a healthcare-related infection and those who were discharged from intensive care or died within the first 48 hours. Results: Seven hundred and sixty-four patients were admitted to ICU A4 during the study period from May 2021 to May 2022. Out of these, 53 patients developed healthcare-related infections, resulting in an incidence rate of 6.9%. The average age of our patients was 47.42 years, with a significant male predominance. A total of 120 healthcare-related infections were documented during this study period. Bacteremia accounted for the highest percentage at 64.2%, followed by infections related to catheters and pneumopathies acquired under mechanical ventilation, both at 60.4%. Additionally, surgical site infections comprised 22.6%, while urinary tract infections accounted for 18.9%. The average time of infection onset associated with care, compared to hospitalization, was 5.85 days. The evolution was favorable in 13 (24.5%) cases, and unfortunately, there was a significant mortality rate of 40 (75.5%) patients. The isolated germs were mainly Acinetobacter baumannii, with a rate of 88 (61.11%) cases, followed by enterobacteria, which made up 44 (30.55%) cases. In third place comes Pseudomonas aeruginosa with a rate of 13 (9.02%), followed by enterococci with a rate of 10 (6.94%), and Staphylococcus with a rate of eight (5.55%). four (2.77%). Conclusion: Healthcare-related infections are frequent in ICUs and can be serious. The severity of these infections is due to both the infection itself and the compromised immune defense mechanisms of the patient, which reflect their overall health condition. Moreover, prevention is still the best weapon.

Subcutaneous emphysema (SE) refers to trapped air beneath the dermis. It can affect any body site and may spread from one area to another by travelling along fascial planes under the effect of pressure gradient. In some cases, air effusion in different body cavities can secondary occur leading to pneumomediastinum or pneumothorax. SE is not dangerous in it and may regress spontaneously. However, extensive SE complications such as respiratory failure and cardiovascular collapse may engage the vital prognosis requiring urgent care. In this article, we present a case of a 30-year-old male with extensive subcutaneous emphysema associated to a pneumomediastinum, secondary to a deep perianal wound. We report this case for its rarity.

La gravité de l’angiocholite aiguë est liée à la dissémination de l’infection avec risque de choc et de défaillances d’organes. À l’instar de la « Surviving Sepsis Campaign », des recommandations régulièrement mises à jour émanent du « Tokyo Guidelines Working Group ». Une approche interventionnelle précoce et multidisciplinaire est absolument essentielle à la survie. Les éléments clés sont une identification rapide des formes potentiellement graves, une thérapie antimicrobienne et une réanimation adéquates pour anticiper et/ou gérer les complications septiques, couplées à une décompression urgente pour rétablir le drainage biliaire. Cette mise au point physiopathologique et thérapeutique a pour objectifs d’améliorer le raisonnement clinique et de réduire la marge d’incertitude du praticien en proposant un protocole actualisé, contextualisé et personnalisable.

Descending necrotizing mediastinitis remains a serious condition with a high mortality rate due to its often fulminant clinical presentation. An early diagnosis and a well conducted multidisciplinary therapeutic management are essential to reduce morbi-mortality. Delayed diagnosis, inappropriate antibiotic therapy, non-optimal surgical drainage or lack of surveillance may increase morbidity and mortality. We report the case of a descending necrotizing mediastinitis complicating a dental cervical cellulitis in a 27 year old female patient with a successful outcome.

We conducted a study of 46 patients admitted to the Intensive Care Unit with postoperative peritonitis. The incidence of postoperative peritonitis in this setting was 2.7%. The average age of patients was 53.3 years, with a sex ratio of 1.2. Submesocolic surgery was the most common cause of postoperative peritonitis (65.2%), mainly occurring in the colorectal region (48%). Clinical signs were dominated by fever (78%), abdominal pain (57%) and extra-abdominal signs. The mean time between symptom onset and diagnosis was 7.3 days. Reoperation was performed on the basis of clinical and biological criteria in 56.5% of cases. Therapeutic management was based on perioperative reanimation, treatment of organ dysfunctions, probabilistic antibiotic therapy and middle laparotomy. The bacteriological profile was dominated by BGN (79%). The loosening of the anastomotic sutures was the direct cause of PPO in 57% of patients. Mortality rate was 60%. The main prognostic factors were: renal failure, the number of patients with organ failure, PT<50%, the need for ventilation and the use of catecholamines.

Introduction:There is an increasing demand for Totally Implantable Intravenous Access Ports (TIVAP), mainly to facilitate the initiation of intravenous chemotherapy.Ultrasound guidance during venipunctures for the placement of these TIVAP catheters is a good technique that is highly recommendable for Practicians.We present a prospective study for the placement of TIVAP using Ultrasound-guided percutaneous approach in 288 patients.The objective of this study is to demonstrate the contribution of Ultrasound guidance in making the procedure for the placement of these devices a safe one and also to study the complications that may arise from the placement of these intravenous devices.Patients and Methods: This is a prospective study over a period of 7 years from January 2015 until July 2021 carried out in the A4 multipurpose anesthesia-intensive care unit of the CHU Hassan II in Fez.All the TIVAP were inserted under Ultrasound guidance.The parameters studied were: the sex of the patient, age, the cancer to be treated, the puncture site, the side of the puncture, the ultrasound technique, the per-and post-operative complications that occurred during or after the placement of the intravenous device. Results:The study includes 288 Totally Implantable Venous Access Ports (TIVAP) placed in 288 patients of which 52.7% male and 47.2% female.The reasons for chemotherapy were diverse.Ultrasound exploration of the veins was systematic in all patients before starting the implantation procedure.Two cases of venous thrombosis were incidentally diagnosed during these preoperative explorations.Venipuncture was performed at the axillary area in 67.70% of cases, against 31.5% of cases at the internal jugular area, and in the end 1.05% of cases of these punctures were at the femoral area.The ultrasound technique for venipuncture was in the ultrasound plane in 71.18% of cases, compared with 28.81% of venipunctures performed outside the ultrasound plane.Venipuncture was obtained during the first trial in 100% of cases.We did not observe any case of pneumothorax, arterial puncture or hematoma.The duration of the TIVAP procedure varied between 45 and 90 minutes depending on the case.Four cases of aberrant path of the TIVAP catheter were observed on the chest X-rays;which was systematically taken at the end of the insertion procedures.These aberrant paths were subsequently corrected via endovascular route by interventional radiology.In the long term, we noted one case of extravasation of the chemotherapy product, two cases of surgical site infection and one case of catheter exposure. Discussion and Conclusion:The use of ultrasound decreases the risk of pleural damage and the formation of pneumothorax.Ultrasound guidance also decreases the risk of hematoma by reducing the number of punctures and avoiding arterial punctures.Ultrasound exploration also helps to verify the anatomical location of the vein, its permeability and the presence or absence of deep vein thrombosis.Thus, the use of ultrasound makes the procedure for inserting TIVAP a safe and secured one.

Introduction: The Term "Burnout" is characterized by a feeling of intensive and chronic fatigue which does not disappear even after rest. Closely related to workload, the Burnout Syndrome has greatly degraded the dispensation of health care in nurses. This study aimed to evaluate the prevalence of burnout and the existence of specific risk factors in Nurses population at the Hassan IId University Hospital of Fez in Morocco. Material & Methods: A descriptive and analytic study was conducted between January and May 2020 with the objective of describing all sides of the burnout syndrome: prevalence, causes and risk factors. Social, demographic, professional and medical data were collected using an anonymous quantitative questionnaire containing 35 simple multiple choice and 14 redaction questions. The questionnaires were distributed to general nurses, theater nurses, anesthetist nurses, nurse physiotherapists and runners (circulating nurses) working in Operating Theaters, Intensive care Units and Emergency Rooms. Burnout levels were assessed using the Maslach Burnout Inventory (MBI). Results: The targeted population comprised of 1039 nurses of which a study sample of 110 nurses was selected. A response rate of 67.3% was obtained (87/110). The average age was 32.5 years old [22- 56]. The female gender represented 70.3%. The experience period in nursing profession ranged from a minimum of 1 year and a maximum of 30 years Twenty seven percent of nurses were working in the intensive care unit. Fifty eight percent of professionals had a high level of BOS. The analysis also revealed several aspects associated with burnout. Conclusion: According to our findings, BOS is a reality in the Moroccan context and does exist among nurses in Hassan IId University hospital. A large number of nurses who have still not reached an elevated level of burnout are showing signs of moderate level symptoms and should be considered for a preventive approach.

Introduction: Coronavirus disease (COVID-19) is known as a highly infectious disease with several systemic complications and may lead to a severe acute lung injury. Pneumothorax is a potential though uncommon complication and the association of the two conditions may be a prognosis indicator. Case Report: We report the case of a pneumothorax complicating severe COVID-19 pneumonia in a 68-year-old patient who died 33 days after admission despite supportive measures. Conclusion: Our case highlights the increased inflammatory response as a potential underlying mechanism of pneumothorax in COVID-19 patients, which may be associated with acute decompensation and poor outcome.

In the field of intensive care, anesthesia and emergency medicine, performing invasive acts using Ultrasound guidance such as vascular puncture or performing locoregional anesthesia techniques is not devoid of iatrogenicity and adverse events which can sometimes be serious and fatal.Learning by simulation is an essential step aimed at reducing the risk of these serious undesirable events occurring when performing these techniques.The learning models offered by manufacturers remain demanding.We offer a simple and less demanding model on how to visualize the needle and to follow its progression during the realization of the invasive techniques under Ultrasound guidance.In our context, our resident anesthetists undergoing training benefit from the contribution of this model during their first training courses by simulating these invasive techniques.This allows these trainees to learn the concepts of in-plane and out-of-plane puncture of ultrasound as well as to master the techniques for tracking puncture needle progression.These simulation models would make the learning process of these invasive acts quick and easy while reducing the risk of iatrogenic incidents occurring.