Publications by authors named "Chafik El Kettani"

21 Publications

  • Page 1 of 1

Hemorrhagic Shock Revealing Rupture of Splenic Artery Pseudoaneurysm Three Years After Post-Traumatic Pancreatitis.

Cureus 2021 Jun 16;13(6):e15678. Epub 2021 Jun 16.

Anesthesia and Critical Care, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences, Casablanca, MAR.

Splenic artery pseudoaneurysm (SAP) is an uncommon entity but extremely serious, given the high mortality rate if untreated. Only a limited literature reports association with post-traumatic pancreatitis. We report the case of a 30-year-old man, who was brought to the emergency department (ED) for acute confusion. His past medical history includes trauma of right hypochondriac and epigastric regions, three years ago. Three days before his admission to the hospital, he experienced abdominal pain with nausea and vomiting, without transit disorders or fever. When examined, the patient was disoriented, pale with profuse sweating, cold extremities, and a temperature of 36.3°C. Blood pressure was 75/51 mmHg, heart rate was 126 beats per minute, and oxygen saturation was 96% on room air. The abdominal exam detected generalized abdominal sensitivity. A CT angiography of the abdomen revealed hemoperitoneum of medium abundance, with extravasation of the contrast product from the splenic artery. The size of the spleen was normal with a lower polar hypodense area. In addition, a pancreas of normal size, steady outlinings, seat of bilobed cystic formation suggested a pancreatic pseudocyst. This led us to suspect a rupture of a pseudoaneurysm of the splenic artery. A laparotomy was performed and showed an estimated 2 L hemoperitoneum. Active bleeding was noted from an SAP in the mid-portion of the splenic artery, next to the pancreatic pseudocyst. Ligation of the splenic artery and splenectomy was carried out. The patient was discharged home on the 10th post-operative day. Our case highlights an uncommon cause of hemorrhagic shock, but critical to recognize. Indeed, ruptured SAP needs to be promptly detected and managed, to avoid fatal complications if left untreated.
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http://dx.doi.org/10.7759/cureus.15678DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8283245PMC
June 2021

Cardiovascular Risk Factors and the Severity of COVID-19 Disease.

Cureus 2021 Jun 7;13(6):e15486. Epub 2021 Jun 7.

Anesthesia and Critical Care, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR.

Background and objective Several cardiovascular risk factors have emerged as important determinants of severe illness and death among coronavirus disease 2019 (COVID-19) patients. However, the full impact of these cardiovascular risk factors is still under investigation. This study aimed to investigate the association between patients' level of cardiovascular risk and the severity of COVID-19. Materials and methods This observational study included all adult patients with COVID-19 hospitalized at Sheikh Khalifa Ibn Zaid International University Hospital from March 20 to May 10, 2020. The cardiovascular risk level was assessed by the doctor responsible for each patient based on the 2019 European Society of Cardiology (ESC), the European Atherosclerosis Society (EAS), and the European Association for the Study of Diabetes (EASD) guidelines. We examined the association between the patients' level of cardiovascular risk and their severity of COVID-19 disease by using a logistic regression model. Results Among 133 patients with confirmed COVID-19, 46.6% had a low cardiovascular risk level, 19.5% had a moderate risk level, 15.8% had a high risk level, and 18.1% was found to have a very high risk level. Patients with different cardiovascular risk levels had significantly different rates of complications including secondary infection (p-value: <0.001), acute respiratory distress syndrome (ARDS) (p-value = 0.017), intensive care unit (ICU) admission (p-value: <0.001), and death (p-value: <0.001). A patient's very high cardiovascular risk level versus low, moderate, or high cardiovascular risk level was independently associated with ICU admission [OR = 6.42, 95% CI: (1.45-28.30)]. Conclusion Based on our findings, an increased level of cardiovascular risk among patients was strongly associated with the severity of COVID-19. This study also highlights the need for assessing cardiovascular risk factors in all patients with COVID-19.
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http://dx.doi.org/10.7759/cureus.15486DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8261192PMC
June 2021

COVID-19: A Potential Cause of Non-convulsive Status Epilepticus.

Cureus 2021 May 15;13(5):e15041. Epub 2021 May 15.

Anesthesia and Critical Care, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences, Casablanca, MAR.

Coronavirus disease 2019 (COVID-19) has been described as being primarily responsible for respiratory symptoms. Although several case reports have shown the importance of neurological manifestations, only a few have reported non-convulsive status epilepticus (NCSE) as the first manifestation of COVID-19 infection. Here, we report the case of a 30-year-old male patient with no past medical history who was admitted with altered consciousness. On examination, the patient had a Glasgow Coma Scale (GCS) of 13/15. Vital signs were within normal range. Computed tomography scan of the and magnetic resonance imaging of the brain were normal. Biochemical assessments showed a mild hyponatremia (134 mEq/L) and high levels of D-dimer and lactate dehydrogenase. Urine drug screening did not find any abnormality and a lumbar puncture showed an increased cerebrospinal fluid protein. The result of the reverse transcription polymerase chain reaction test in the nasopharyngeal swab was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Electroencephalogram (EEG) showed a generalized epileptiform activity. Upon undergoing antiepileptic treatment, patient's GCS improved to 15 gradually. A repeated EEG confirmed complete resolution of epileptic abnormalities four days later. This case report shows that SARS-CoV-2 infection can directly involve the central nervous system and can be manifested with isolated NCSE without any other neurological manifestations.
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http://dx.doi.org/10.7759/cureus.15041DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8202809PMC
May 2021

Acute Bilateral Renal Infarction: An Unusual Complication After Mitral Valve Replacement Surgery.

Cureus 2021 Mar 22;13(3):e14037. Epub 2021 Mar 22.

Anesthesia and Critical Care, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences, Casablanca, MAR.

Bilateral renal infarction is an uncommon clinical condition that is frequently misdiagnosed. Its various mechanisms mainly include thrombotic and embolic. We report the case of a 51-year-old Moroccan woman, who presented with acute bilateral renal infarction three days following mitral valve replacement surgery of probable embolic origin despite curative heparin. Her renal function did not improve, and the patient developed chronic renal failure. Diagnosing bilateral renal infarction is challenging, especially in the postoperative period of mechanical mitral valve replacement surgery. Curative heparin therapy does not totally protect (100%) against this serious complication. This case study aimed to raise awareness of this rare clinical condition after cardiac surgery.
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http://dx.doi.org/10.7759/cureus.14037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8059103PMC
March 2021

Obesity and Disease Severity Among Patients With COVID-19.

Cureus 2021 Feb 5;13(2):e13165. Epub 2021 Feb 5.

Department of Anesthesia and Critical Care, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR.

Background Obesity can be associated with one or more co-morbidities that worsen the effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Studies demonstrated that severe forms of coronavirus disease (COVID-19) have occurred in elderly patients and patients with co-morbidities such as diabetes, hypertension, and cardiovascular diseases. Objective This study investigated the impact of obesity on COVID-19 severity, irrespective of other individual factors. Methods This retrospective observational study included all adult patients with confirmed COVID-19 infection, who were admitted to Sheikh Khalifa Ibn Zaid International University Hospital between March 20 and May 10, 2020. First, we compared patients with and those without obesity in terms of demographic characteristics, co-morbidities, clinical symptoms, and outcomes. Further, using logistic regression models, we analyzed the association between obesity and intensive care unit (ICU) admission. Also, we examined whether the association between obesity and ICU admission was also consistent among overweight patients. Results The study population included 107 patients with confirmed COVID-19 infection. Obese patients have been admitted in ICU more than patients without obesity (P-value = 0.035). While adjusting for other risk factors for ICU admission, we found that obesity was an independent risk factor for ICU admission (OR = 5.04, 95% CI (1.14-22.37)). When we examined the association of both obesity and overweight with ICU admission, we found that only obesity was significantly associated with ICU admission (OR = 9.11, 95% CI (1.49-55.84)). Conclusion Our study found that obesity was strongly associated with severity of COVID-19. The risk of ICU admission is greater in the presence of obesity. Physicians should be awarded to the need of specific and early management of obese patients with COVID-19 disease.
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http://dx.doi.org/10.7759/cureus.13165DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7939537PMC
February 2021

Severe SARS-CoV-2 Infection: A Multisystem Inflammatory Syndrome in Moroccan Children.

Cureus 2021 Jan 29;13(1):e12991. Epub 2021 Jan 29.

Department of Pediatrics, Mohammed V University, Faculty of Medicine and Pharmacy of Rabat, Rabat, MAR.

Until October 2020, children seem to have a mild form of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Morocco. Since April 2020, a new entity of multisystem inflammatory syndrome in children associated with SARS-CoV-2 infection was reported in England, Italy, France, and the United States. This syndrome has similarities with the most frequent vasculitis in children, Kawasaki disease. Here, we describe the features and outcome of the first five cases of Kawasaki-like multisystem inflammatory syndrome in Moroccan children triggered by the SARS-CoV-2. The median age of the children was 7.8 years; three of them were boys. Criteria for Kawasaki disease were met in all of them with a complete presentation. Three patients required admission to a critical care unit with multi-organ failure in one of them, but no mortality occurred. They all received intravenous immunoglobulin (IVIG), a high dose of aspirin, methylprednisolone, and supportive therapy. Coronavirus 2019 disease (COVID-19) infection in children may be life-threatening; rigorous monitoring for several weeks is required in any positive child or living in a family cluster.
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http://dx.doi.org/10.7759/cureus.12991DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7916987PMC
January 2021

Psychiatric side effects of chloroquine in COVID-19 patients: two case reports.

Pan Afr Med J 2020 20;35(Suppl 2):83. Epub 2020 Jun 20.

Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco.

Chloroquine and hydroxy chloroquine are widely use in Africa and all over the world as anti-malarial drugs but also in the treatment of chronic inflammatory diseases. Since the outbreak of COVID-19 pandemic, Morocco have included this medication in the COVID-19 treatment guidelines in association with azithromycine. Besides dermatologic problems, ocular impairments and gastro-intestinal effects, quinolines may also cause rarely described psychiatric adverse effects. To our knowledge, there has been no reports of psychiatric side effects of chloroquine or hydroxy chloroquine in the actual context of COVID-19 pandemic. Here, we present the description of two COVID-19 patients who showed psychiatric side effects after chloroquine treatment. One patient expressed psychotic symptoms and the other one experienced acute and intense anxiety. In both cases, and according to Naranjo score, the association between chloroquine and psychiatric side effects was probable.
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http://dx.doi.org/10.11604/pamj.supp.2020.35.24064DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7875809PMC
March 2021

The critical role of complete blood count in the management of patients with COVID-19.

Pan Afr Med J 2020 4;35(Suppl 2):63. Epub 2020 Jun 4.

Department of Anesthesiology and Reanimation, Cheikh khalifa International University Hospital, Hassan II VI University Faculty of Medicine and Pharmacy, Casablanca, Morocco.

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http://dx.doi.org/10.11604/pamj.supp.2020.35.2.23764DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7875780PMC
March 2021

The epidemiological and clinical profile of COVID-19 in children: Moroccan experience of the Cheikh Khalifa University Center.

Pan Afr Med J 2020 1;35(Suppl 2):57. Epub 2020 Jun 1.

Department of Paediatrics, Cheikh Khalifa´s Hospital, Casablanca, Morocco.

Introduction: COVID-19 is an infectious disease caused by a new coronavirus. The first cases were identified in Wuhan. It rapidly spread causing a pandemic worldwide. The incidence and severity of this disease are likely to be different in children compared with adults. Few publications of COVID-19 in children have been published. Our Moroccan paediatric series is among the first studies on this disease in Africa.

Methods: We included all children with COVID-19 who were admitted and treated at the hospital from March 25 to April 26, 2020. We have collected information, including demographic data, symptoms, imaging data, laboratory results, treatments and clinical progress from patients with COVID-19.

Results: Since the outbreak of 2019 novel coronavirus infection (2019-nCoV) in Morocco, a total of 145 COVID-19 confirmed cases have been reported in the Cheikh Khalifa's Hospital. Among this cases, 15 children were registered. The median age of patients was 13 years. There were 7 boys and 8 girls. Five children are asymptomatic, 8 have mild symptoms and 2 have a moderate respiratory difficulty. The RT-PCR test results were positive in all patients. Radiologically, we found in 2 cases, multiple nodules with ground-glass opacities on the chest scan. The treatment was based on the combination of hydroxychloroquine and azithromycin. Evolution under treatment was good for all patients.

Conclusion: This study describes the profile of COVID-19 in child in a Moroccan hospital and confirms that the severity of illness in children with COVID-19 to be far less than adults.
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http://dx.doi.org/10.11604/pamj.supp.2020.35.2.23571DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7875728PMC
March 2021

Acute Hepatitis and Pancytopenia in a Child With Chronic Abuse of Senna.

Cureus 2021 Jan 2;13(1):e12436. Epub 2021 Jan 2.

Paediatrics, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences, Casablanca, MAR.

Long-term use of Senna and its anthraquinone glycosides has been associated with the development of hepatotoxicity in both children and adults. Our case study aims to present, for the first time, acute hepatitis associated with pancytopenia in relation probably to liver and bone marrow toxicity in a three-year-old child suffering from chronic abuse of Senna. We report the case of a three-year-old girl with a history of chronic constipation regularly treated with drinkable preparations made from the Senna plant and hospitalized eight months ago with an almost similar and reversible clinical presentation, probably of toxic origin. She was admitted to a pediatric intensive care unit with severe acute hepatitis and profound pancytopenia. Her first physical examination revealed an unconscious child with a Glasgow score of 11/15, generalized hypotonia, bleeding from the gum lining, facial erythrosis with peeling cheeks, hair loss (telogen effluvium), erythematous lesions ulcers of the anal margin, and fever. The myelogram performed two days after admission revealed a rich regenerative bone marrow with signs of inflammation. Besides, she developed deep vein thrombosis three days after placing her femoral catheter. Pancytopenia in hospitalized children is a rare but alarming situation. In our case, malignancy was excluded, as well as a severe infection. The cause of pancytopenia could be related to the toxic effects of Senna. Chronic use of Senna may be associated with bone marrow and liver toxicity and lead to deep vein thrombosis.
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http://dx.doi.org/10.7759/cureus.12436DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7854320PMC
January 2021

[Case study of ruptured gastroduodenal artery aneurysm revealed by hematemesis].

Pan Afr Med J 2020 17;37:244. Epub 2020 Nov 17.

Département de Chirurgie Vasculaire, Université Mohammed V, Rabat, Maroc.

Gastroduodenal artery aneurysm is a rare vascular lesion, asymptomatic in the majority of cases. However, ruptured aneurysm is associated with poor prognosis and mortality can achieve a 40% rate. We here report the case of an 83-year-old patient with abrupt onset of non-specific abdominal pain associated with hematemesis. Endoscopy showed beating formation compressing the duodenal bulb with active bleeding. Abdominal computed tomography (CT) scan was performed which objectified gastro duodenal artery aneurysms involving the artery ostium and making endovascular treatment impossible to perform. Thus, the patient underwent open surgery based on flattening associated with aneurysm exclusion and then complemented by bulb plasty. Post-operative CT scan confirmed total exclusion of the aneurysm with preservation of hepatic circulation.
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http://dx.doi.org/10.11604/pamj.2020.37.244.22380DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7847208PMC
March 2021

Hematological and biochemical abnormalities associated with severe forms of COVID-19: A retrospective single-center study from Morocco.

PLoS One 2021 4;16(2):e0246295. Epub 2021 Feb 4.

Sheikh Khalifa International University Hospital, Faculty of Medicine, Mohammed VI University of Health Sciences, Casablanca, Morocco.

Since December 2019, the coronavirus disease (COVID-19) pandemic has catapulted the world into a marked health crisis, with over 29 million cases and >930,000 deaths. To better detect affected individuals at an early stage and stop disease progression to an advanced stage, several studies have been conducted to identify the clinical, biological, and radiological characteristics of COVID-19. This study aimed to enrich the literature by critically analyzing the clinical and biological characteristics of 134 patients from the North African Mediterranean region, including numerous genetic, epigenetic, and environmental factors that may influence disease evolution. This single-center retrospective study included all patients older than 18 years confirmed to have COVID-19 and hospitalized at the Cheikh Khalifa University Hospital affiliated with Mohammed VI University of Health Sciences, Casablanca, Morocco. Clinical, demographic, and biological data were analyzed in a cohort of severe and non-severe patients. Univariate analysis was performed to identify factors predictive of severity. There were 134 patients: the median age was 53 years, and 54.5% were male. Of these, 89 had mild to moderate disease; 45 had severe to critical disease, of which 14 died and 31 survived. Advanced age, presence of comorbidities, male sex, and infection in ethnic or family groups were risk factors for progression to severe disease. The presence of abnormalities in the following parameters were strongly associated with progression to severe disease: white blood cells (WBC), neutrophils, lymphocytes, C-reactive protein (CRP), procalcitonin, D-dimers, lactate dehydrogenase (LDH), ferritin, creatinine, aspartate aminotransferase (ASAT), and alanine aminotransferase (ALAT) during both admission and hospitalization. Based on these results and an extensive literature review, we recommend that clinicians closely monitor the biological parameters identified herein and perform immunological and genetic studies.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0246295PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7861397PMC
February 2021

Personal Protective Equipment and Headaches: Cross-Sectional Study Among Moroccan Healthcare Workers During COVID-19 Pandemic.

Cureus 2020 Dec 13;12(12):e12047. Epub 2020 Dec 13.

Department of Anesthesiology and Reanimation, Cheikh Khalifa International University Hospital, Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR.

Background Healthcare workers in frontline during the coronavirus 19 disease (COVID-19) pandemic are mandated to wear specific personal protective equipment (PPE) including high filtrating masks and/or eye protection during extended period of time. Compressive headaches secondary to PPE use including N95 masks have been reported. We aim to describe subtypes of headache related to PPE use in our hospital in Casablanca and working condition factors associated with it. Methods We conducted a cross-sectional study among healthcare workers in frontline at Cheikh khalifa International University Hospital, using an online questionnaire. We collected demographic data, comorbidities and previous headaches history. Data about working conditions during pandemic, type and duration of PPE use were described. We calculated the prevalence of De Novo or an aggravated headache among healthcare workers. We studied correlations between PPE related headaches and working conditions and trends in PPE use during the pandemic. Finally, we described the overall discomfort related to PPE use. Results A total of 155 healthcare workers responded to the questionnaire. The N95 masks were the most used type (95.5%) associated with an eye protection in 61.3%. The overall prevalence of headache related to PPE was 62%. It was experienced De Novo in 32.9%, while it was an aggravation of pre-existing headache in 29%. Working more than 8 hours per shift during the pandemic was correlated to De novo headache (p = 0.008). The profession of doctor and working more than 12 hours per shift were correlated to aggravated headache (p = 0.02, p = 0.023). Healthcare workers experienced moderate discomfort, blurred vision and reduced concentration. They judged their professional performance mildly reduced by the use of PPE. Conclusion The increased use of PPE, especially high filtrating masks during the COVID-19 outbreak is responsible for generating headaches in healthcare workers on frontline either De novo or as an aggravation of pre-existing one. Working conditions have the greater impact on generating these types of headaches more than any pre-existing comorbidity. These findings should be considered to accommodate health care professionals to increase efficacy and adherence to protective measures during pandemic.
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http://dx.doi.org/10.7759/cureus.12047DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7802399PMC
December 2020

SARS-CoV2 disease seen through the prism of acutely decompensated chronic kidney disease and ischemic stroke: What lesson we have learned from using prophylaxis therapy of vascular thromboembolism?

Clin Case Rep 2020 Oct 7. Epub 2020 Oct 7.

Anesthesiology-Reanimation Cheikh Khalifa Ibn Zayed hospital Mohammed VI University of Health Sciences Casablanca Morocco.

Our case underlines the tight management of antithrombotic therapy in the context of acutely decompensated chronic kidney disease, ischemic stroke, and SARS-CoV2 infection, the development of stroke as a SARS-CoV2 complication increase the chances of adverse outcomes that may be mitigated by a rapid recognition and institution of available treatments.
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http://dx.doi.org/10.1002/ccr3.3385DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7675693PMC
October 2020

Consultation liaison psychiatry for COVID-19 inpatients: A novel care delivery program in Morocco.

Curr Psychol 2020 Nov 16:1-3. Epub 2020 Nov 16.

Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco.

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http://dx.doi.org/10.1007/s12144-020-01200-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7669262PMC
November 2020

Continuous venous hemodialysis integrated to the ECMO circuit in critically ill patient with COVID-19, a case report in Morocco.

Pan Afr Med J 2020 10;35(Suppl 2):141. Epub 2020 Aug 10.

Department of Anesthesia and Critical Care, Ibn Rochd University Hospital Center, Casablanca, Morocco.

Novel coronavirus 2019 (COVID-19) is a severe respiratory infection leading to acute respiratory distress syndrome [ARDS] accounting for thousands of cases and deaths across the world. Several alternatives in treatment options have been assessed and used in this patient population. However, when mechanical ventilation and prone positioning are unsuccessful, venovenous extracorporeal membrane oxygenation [VV-ECMO] may be used. We present a case of a 62-year-old female, diabetic, admitted to the intensive care unit with fever, flu-like symptoms and a positive COVID-19 test. Ultimately, she worsened on mechanical ventilation and prone positioning and required VV-ECMO. The use of VV-ECMO in COVID-19 infected patients is still controversial. While some studies have shown a high mortality rate despite aggressive treatment, such as in our case, the lack of large sample size studies and treatment alternatives places healthcare providers against a wall without options in patients with severe refractory ARDS due to COVID-19.
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http://dx.doi.org/10.11604/pamj.supp.2020.35.141.25332DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7608773PMC
November 2020

Hybrid open and endovascular treatment of an aortic arch pseudoaneurysm in a patient with human immunodeficiency virus infection.

J Vasc Surg Cases Innov Tech 2020 Dec 8;6(4):516-519. Epub 2020 Sep 8.

Vascular Surgery Department, Mohammed V University, Rabat, Morocco.

We describe an hybrid approach for aortic pseudoaneurysm with open and endovascular treatment as an alternative treatment for a high-risk patient infected with human immunodeficiency virus. A 42-year-old man, serum positive for human immunodeficiency virus, presented, with a large pseudoaneurysm of the arch aorta measuring 61 × 70 mm. An aortic arch debranching was performed, completed by thoracic endovascular aneurysm repair. A control computed tomography scan performed 3 months later showed a complete thrombosis of the pseudoaneurysm. The outcome of this treatment, particularly regarding the rate of infection, is yet to be determined, Longer follow-up is needed with a greater of patients.
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http://dx.doi.org/10.1016/j.jvscit.2020.08.033DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7588800PMC
December 2020

Predictors of Severity in Covid-19 Patients in Casablanca, Morocco.

Cureus 2020 Sep 29;12(9):e10716. Epub 2020 Sep 29.

Anesthesia and Critical Care, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences, Casablanca, MAR.

Background Morocco was affected, as were other countries, by the coronavirus disease 2019 (COVID-19) pandemic. Many risk factors of COVID-19 severity have been described, but data on infected patients in North Africa are limited. We aimed to explore the predictive factors of disease severity in COVID-19 patients in a tertiary hospital in Casablanca. Methods In this single-center, retrospective, observational study, we included all adult patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, admitted to Sheikh Khalifa International University Hospital in Casablanca between March 18 and May 20, 2020. Patients were separated into two groups: Non-severe patients were those with mild or moderate forms of COVID-19, and severe patients were those admitted to the intensive care unit (ICU) who had one of the following signs-respiratory rate > 30 breaths/min; oxygen saturation < 93% on room air; acute respiratory distress syndrome (ARDS); or required mechanical ventilation. Demographic, clinical, laboratory data, and outcomes were reviewed. We used univariable and multivariable logistic regression to explore predictive factors of severity. Results We reported 134 patients with confirmed SARS-CoV-2 infection. The median age was 53 years (interquartile range [IQR], 36-64), and 73 (54.5%) were men. Eighty-nine non-severe patients (66.4%) were admitted to single bedrooms, and 45 (33.6%) were placed in the ICU. The median time from illness onset to hospital admission was seven days (IQR, 3.0-7.2). Ninety-nine patients (74%) were admitted directly to the hospital, and 35 (26%) were transferred from other structures. Also, 68 patients (65.4%) were infected in clusters. Of the 134 patients, 61 (45.5%) had comorbidities, such as hypertension (n = 36; 26.9%), diabetes (n = 19; 14.2%), and coronary heart disease (n = 16; 11.9%). The most frequent symptoms were fever (n = 61; 45.5%), dry cough (n = 59; 44%), and dyspnea (n = 39; 29%). A total of 127 patients received hydroxychloroquine and azithromycin (95%). Eleven critical cases received lopinavir/ritonavir (8.2%). Five patients received tocilizumab (3.7%). We reported 13 ARDS cases in ICU patients (29%), eight with acute kidney injury (17.8%), and four thromboembolic events (8.8%). Fourteen ICU patients (31.1%) died at 28 days. In univariable analysis, older men with one or more comorbidities, infection in a cluster, chest scan with the COVID-19 Reporting and Data System (CO-RADS) 5, lymphopenia, high rates of ferritin, C-reactive protein (CRP), D-dimer, and lactate dehydrogenase were associated with severe forms of COVID-19. Multivariable logistic regression model founded increasing odds of severity associated with older age (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.01-1.09, P = .0039), men (OR 3.19, CI 1.06-9.60, P = .016), one or more comorbidities (OR 4.36, CI 1.32-14.45, P = .016), CRP > 10 mg/L (OR 5.47, CI 1.57-19.10, P = .008), and lymphopenia lower than 0.8 x10/L (OR 6.65, CI 1.43-30.92, P = .016). Conclusions Clinicians should consider older male patients with comorbidities, lymphopenia, and a high CRP rate as factors to predict severe forms of COVID-19 earlier. The higher severity of infected patients in clusters must be confirmed by epidemiological and genetic studies.
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http://dx.doi.org/10.7759/cureus.10716DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7532862PMC
September 2020
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