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Predictors of Intra-Hospital Mortality in Patients with Cirrhosis  [PDF]
Iliass Charif, Kaoutar Saada, Ihssane Mellouki, Mounia El Yousfi, Dafrallah Benajah, Mohamed El Abkari, Adil Ibrahimi, Nourdin Aqodad
Open Journal of Gastroenterology (OJGas) , 2014, DOI: 10.4236/ojgas.2014.43021
Abstract: Intra-hospital mortality in cirrhotic patients is variable depending on the studies reported in literature. Several studies have demonstrated independent predictors of mortality. The aim of this work is indeed to identify these predictors. Patients and Methods: We conducted a retrospective study of 1080 cirrhotic patients hospitalized in our department of gastroenterology and hepatology between January 2001 and August 2010. A descriptive study of the study population was performed, and a univariate analysis looking for an association between intra-hospital mortality, and clinical, biological, etiological and sociodemographic characteristics of our patients. Results: The average age of our patients was 54 years, with an equal number of men and women. 41.1% of patients had cirrhosis secondary to hepatitis C and 18.5% had cirrhosis secondary to hepatitis B. 26.1% of our patients were CHILD C. Intra-hospital mortality was 8.7% (97 deaths) with a mean of 23.4 ± 35.8 months. Univariate analysis showed that the intra-hospital mortality was significantly associated with higher age (p = 0.049) as well as the reasons for admissions like hepatic encephalopathy, and hematemesis (p < 0.0001), melena, jaundice and ascites (p = 0.001). Among the biological parameters analyzed in univariate analysis, significant associations with mortality were objectified for high white blood cell count (p = 0.035), and high serum bilirubin and creatinine (p < 0.0001); low rate of prothrombin time (PT) (p < 0.0001), of albumin (p = 0.0001) and of serum sodium (p < 0.0001). Among the complications analyzed, significant associations with mortality were objectified for jaundice, ascites (p = 0.001), hemorrhagic decompensation, hepatic encephalopathy, and spontaneous bacterial peritonitis (p < 0.001). Univariate analysis of the etiology of cirrhosis objectified significant associations for cirrhosis secondary to hepatitis B (p = 0.001) and hepatitis C (p = 0.022). Multivariate analysis objectified four independent predictors of mortality: hepatic encephalopathy, infection (hyper leukocytosis ≥ 10,000/mm3), renal failure (serum creatinine ≥ 15 mg/l) and hyponatremia. Conclusion: In our series, we identified four independent predictors of intra-hospital mortality in cirrhotic patients: hepatic encephalopathy, infection, renal failure and hyponatremia.
Evolutionary Profile of Severe Acute Ulcerative Colitis in Chronic Inflammatory Bowel Diseases  [PDF]
Hakima Abid, Fatima Babakhouya, Ihssane Mellouki, Mounia El Yousfi, Noureddine Aqodad, Dafr Allah Benajah, Adil Ibrahimi, Mohamed El Abkari
Open Journal of Gastroenterology (OJGas) , 2018, DOI: 10.4236/ojgas.2018.83012
Abstract: Background: Severe acute colitis is a common complication of inflammatory bowel disease (IBD). Their diagnosis is based on clinical, laboratory, endoscopic and radiological. The severe acute colitis is a medical and surgical emergency; its mortality is 1% to 3%. The management should be swift and coordinated, upon admission, between medical and surgical teams. Methods: This is a retrospective study in Gastroenterology Service at the University Hospital HASSAN II Fez, over a period of 10 years (2005-2015). We included all patients admitted for severe acute colitis; all the epidemiological, clinical, endoscopic, histological, and therapeutic monitoring of patients were collected. Results: We collected 123 patients. Their average age was 35 years (16 - 70). It was a female predominance (sex ratio F/M = 1.19). 54 patients were admitted for an inaugural severe acute colitis (43%), while 69 patients were known carriers of IBD (56%). All patients were admitted to an array of severe acute colitis according to the criteria of Truelove and Witts modified. 9 patients were operated urgently because there was the presence of complications (5 cases of perforation, 3 cases of massive rectal bleeding, and one patient with an abscess in the right iliac fossa). Corticosteroids intravenously was administered to 114 patients, 74 patients (64%) had remission. Patients who have not responded to corticosteroids IV (N = 40): 1) 12 patients received treatment with oral cyclosporine: the remission rate was 66%. 2) 8 patients were put under Infliximab: The response rate was 75%. 3) Patients who have not responded to a second-line treatment underwent subtotal colectomy with a dual stoma. 4) The surgery was indicated as a second-line treatment in 20 patients who all received a subtotal colectomy with double stoma; totalizing colectomy and ileoanale anastomosis ware made in 4 patients. The mortality rate is higher in our series (12%) mainly postoperatively; it is due to the delayed admission of patients, which promotes the development of complications. Conclusion: Acute Severe Ulcerative Colitis is a medical and surgical emergency that requires a multidisciplinary approach; medical treatment is the basis of initial treatment; but surgery must always be indicated at the right time avoiding increasing the death rate, this rate is important in our series.
Superior Mesenteric Arterial Embolism Associated with an Acute Limb Ischemia: A Case Report and Literature Review  [PDF]
Abdesslam Bouassria, Elbachir Benjelloun, Imane Kamaoui, Hicham Elbouhaddouti, Ouadii Mouaqit, Abdelmalek Ousadden, Khalid Mazaz, Khalid Ait Taleb, Laila Sedreddine, Mohammed El Abkari, SidiAdil Ibrahimi, Ihssane Mellouki
Open Journal of Gastroenterology (OJGas) , 2014, DOI: 10.4236/ojgas.2014.44027
Abstract: Introduction: Acute mesenteric ischemia due to an embolism of the superior mesenteric artery (SMA) is associated with a high mortality rate. Over twenty per cent of acute mesenteric embolism cases consist of multiple emboli. Case Presentation: We present a rare case of a 62-year-old man admitted with acute abdominal pain and signs of intestinal occlusion related to an acute mesenteric ischemia due to superior mesenteric arterial embolism. It was associated with a synchronous acute bilateral lower limb ischemia due to embolic arterial occlusion. He underwent an emergency explorative laparotomy with proximal jejunal resection, and the patient made an excellent recovery. As for the acute limb ischemia, it was treated by efficient anticoagulation allowing limb salvage. Conclusion: When treating a superior mesenteric arterial embolism, the possibility of recurrent or multiple arterial thromboembolic events should be considered. A prompt diagnosis, aggressive surgical treatment and intensive care could improve the prognosis.
Endoscopic Treatment of Esophageal Achalasia: Experience of the Hepato-Gastroenterology Service of Fez  [PDF]
Houda Meyiz, Asmae Lamine, Mounia El Yousfi, Nourdin Aqodad, Mohammed El Abkari, Adil Ibrahimi, Dafr Allah Benajeh, Ihssane Mellouki
Open Journal of Gastroenterology (OJGas) , 2019, DOI: 10.4236/ojgas.2019.98019
Abstract: The achalasia is a rare primary esophageal motor disorder characterized by relaxation disorders of the lower esophageal sphincter and absence of the esophageal body peristalsis. Several studies suggest that the response to the endoscopic treatment depends on several predictors. The aim of our study was to evaluate the endoscopic treatment of esophageal achalasia and identify the predictive factors of endoscopic treatment response. Patients and Methods: This is a retrospective analytical study of 78 patients with achalasia, managed in the gastroenterology department of the university medical center Hassan II-Fez, during a period of 5 years (January 2009 to December 2014). The diagnosis of achalasia was retained on a set of clinical, endoscopic, manometric and radiological arguments. A graded dilation protocol starting with a 35 mm balloon three times for 30 seconds in progressive pressure between 5 and 8 psi was performed. We used the Eckardt score to evaluate the clinical remission. Results: During the study period, 78 patients were included. The average age of our patients was 47 years old [18 - 81] with a sex-ratio M/F of 1.05. The average of Eckardt score before dilation was 5.9 [3 - 9]. An average of 1.41 dilation sessions was performed per patient with 85.9% of the initial success rate (n = 67). Initial success without further dilation sessions was achieved in 55.1% of our patients (n = 43). A clinical recurrence requiring further dilation sessions was observed in 30.8% of the cases (n = 24). The average relapse time after first dilation success was 2.7 years, 75% occurs within the first year. Dilation failure was retained in 14 patients (17.9%) requiring surgery. Only one post-dilation perforation was noted. In multivariate analysis, only odynophagia and the number of dilatation sessions were factors of failure of the endoscopic dilation. Conclusion: Pneumatic dilation is a minimally morbid and effective procedure. Our work showed that odynophagia, and the number of dilation sessions, are two predictive factors of endoscopic treatment failure.
O professor e seu mandato de mediador, herdeiro, intérprete e crítico
Mellouki, M'hammed;Gauthier, Clermont;
Educa??o & Sociedade , 2004, DOI: 10.1590/S0101-73302004000200011
Abstract: the point of this article is to show that schools are cultural institutions, in the full sense of the term, where teachers are the most important actors. this assertion relies on three main points: a) culture does not boil down to the sum of someone's knowledge; b) teachers have the daily mandate of making sure their students receive cultural information; c) teachers are intellectuals, i.e., they convey, interpret and analyze culture.
Da abordagem por competências e do problema da medida da competência
M′hammed Mellouki,Clermont Gauthier
Eccos Revista Científica , 2007,
Abstract: Si lapproche de formation par compétences exerce un attrait de plus en plus grand en enseignement et en formation des enseignants, elle a de prime abord acquis ses lettres de noblesse dans dautres domaines avant de simposer dans le monde scolaire. Après avoir exposé sommairement quelques-uns des facteurs contextuels qui ont concouru à lintroduction de cette approche dans les politiques éducatives et les programmes scolaires, cet article tentera de passer en revue les principales définitions qui lui ont été données, de cerner la place que les auteurs lui réservent dans lenseignement supérieur et en formation à lenseignement, et de poser, enfin, lépineux problème de la mesure de la compétence.
Acute pancreatitis revealing ulcerative colitis—A case report  [PDF]
Nora Bousfiha, Iliass Iliass Charif, Mohamed el Abkari, Adil Ibrahimi, Ihsane Mellouki
Open Journal of Gastroenterology (OJGas) , 2014, DOI: 10.4236/ojgas.2014.41003
Abstract: The association of acute pancreatitis with ulcerative colitis [UC] has been described in the literature. It is usually induced by drugs, but sometimes it may be idiopathic. This association remains rare. We report the case of a patient who was treated in our department. Medical observation: Mr. KA, a 60-year-old man, was admitted in our unit for management of acute epigastric. The clinical examination at the admission was normal. After eliminating a cardiac or surgical cause, the diagnosis of acute pancreatitis was made on the basis of the presence of a serum lipase up to 5 times the normal level and pain intensity. An abdominal scanner tomography was performed for the assessment of the pancreatitis. It has shown a pancreatitis stage C associated with a thick rectosigmoidien that was discovered incidentally. Symptomatology was enriched 10 days after by the occurrence of rectal bleeding. A lower endoscopy was performed after the improvement of the pancreatitis and had shown an ulcerative colitis on pancolitis which was confirmed by biopsy. In order to search other causes of this pancreatitis, other tests were made [a biliary IRM, endoscopic ultrasonography, autoimmune tests] and the results were negative. We concluded an idiopathic pancreatitis. The ulcerative colitis was classified as moderate and the patient was put on oral corticosteroids with degression. The evolution was marked by a clinical and biological improvement of pancreatitis and colitis. Conclusion: The association of idiopathic pancreatitis with ulcerative colitis is rare. The case of our patient is the first case reported in our series with 400 cases of ulcerative colitis diagnosed in our service.
Role of laparoscopy in diagnosis of peritoneal tuberculosis (About 414 cases)  [PDF]
H. Abid, I. Charif, I. Mellouki, N. Aqodad, D. Benajah, A. Ibrahimi, M. El Abkari, M. El Yousfi
Open Journal of Gastroenterology (OJGas) , 2013, DOI: 10.4236/ojgas.2013.33033

Peritoneal tuberculosis is still common in Morocco. Its diagnosis is based on several methods. Laparoscopy with directed biopsies is still considered as the referenced method. The aim of our work is to show the place and the importance of laparoscopy in the diagnosis of peritoneal tuberculosis through the study of various endoscopic aspects. Materials and Methods: This is a retrospective descriptive study extended from January 2001 to December 2011. We collected 414 cases of isolated ascites confirmed by ultrasonography. Different parameters were analyzed: epidemiological data, indications of laparoscopy and its results and complications. Results: The average age of our patients was 38 years (range: 8 years - 90 years) with a female predominance (sex ratio F/M: 2.3). Abdominal ultrasound performed in all patients has confirmed the presence of ascites in 100% of cases. Based on clinical data (soft or tense abdomen) and ultrasound (free or partitioned ascites), we performed a standard laparoscopy in 313 cases and open laparoscopy in 101 cases. The presence of granules was noted in 318 cases (76.8%). Peritoneal tuberculosis was found in 81.5% of cases with small whitish granulations distributed homogeneously, while peritoneal carcinomatosis was confirmed in 86.8% of patients with large granules distributed inhomogeneously. The presence of adhesions was observed in 33% of cases with peritoneal tuberculosis, while it was mentioned in only 2.8 cases of carcinomatosis. Conclusion: Despite the development of imaging means, ascitic fluid culture and PCR (polymerase chain reaction), laparoscopy remains indispensable for an early diagnosis of peritoneal tuberculosis and adequate management.

Predictors of early rebleeding and mortality after acute variceal haemorrhage in patients with cirrhosis  [PDF]
Iliass Charif, Kaoutar Saada, Ihsane Mellouki, Mounia El Yousfi, Dafr Allah Benajah, Mohamed El Abkari, Adil Ibrahimi, Nourdin Aqodad
Open Journal of Gastroenterology (OJGas) , 2013, DOI: 10.4236/ojgas.2013.37056

The upper gastrointestinal bleeding from esophageal or gastric varices is the most dangerous complication of portal hypertension. The purpose of this study was to identify the predictors of early rebleeding and mortality after a bleeding episode. Patients and Methods: It was a retrospective study including 215 patients admitted in our department of hepatology and gastroenterology at the Hassan II University Hospital of Fez, from January 2001 to January 2010. Results: The mean age of our patients was 51 years. Thirty percent of patients had cirrhosis due to virus (B or C). The majority of patients (79%) had only esophageal varices. Fifty patients (23%) had a bleeding recurrence. Twenty-five patients (11.5%) died during the first ten days, of which 52% had presented rebleeding (p = 0.01). In 30% of cases, the rebleeding was secondary to a fall of pressure ulcers. Univariate analysis showed that early mortality of patients was significantly associated with advanced age (p = 0.018), low prothrombin time (PT) (p = 0.022), low serum sodium (p = 0.03), low platelet count (p = 0.05), and elevated transaminases (p = 0.02). Conclusion: The survival of cirrhotic patients after a bleeding episode was influenced by advanced age, a low rate of PT, of serum sodium, and of the platelet count, and elevated transaminases.


Viral Hepatitis B during Chronic Inflammatory Bowel Diseases at Fez University Hospital: Prevalence and Risk Factors  [PDF]
H. Abid, H. Meyiz, O. Laalaj, I. Mellouki, M. El Yousfi, N. Aqodad, D. Benajeh, A. Ibrahimi, M. El Abkari
Open Journal of Gastroenterology (OJGas) , 2018, DOI: 10.4236/ojgas.2018.81002
Abstract: Patients with chronic inflammatory bowel diseases (IBD) have long been considered at risk for viral hepatitis B. However, recent epidemiological studies have found similar prevalence, or even lower than in the general population. The objective of this work is to determine the prevalence of viral hepatitis B (HVB) during IBD, to determine the risk factors in the service of Hepato-gastroenterology of university hospital Hassan II-Fez, and of evaluate the impact on therapeutic management. PATIENTS AND METHODS: This is a retrospective study, spread over a period of 17 years and a half (January 2001-June 2017). All patients treated for IBD who are tested for Hbs Ag and anti Hbcwere included. The HVB DNA levels were tested in case of positivity of HbsAgor anti Hbc. Results: Over the study period, 755 patients were included. The average age of our patients was 35 years [14 - 87] with a sex-ratio H/F of 0.67. We had 391 cases (51.8%) of Crohn’s disease (CD) and 364 cases (48.2%) of ulcerative colitis (UC). Anti HBctest was positive in 1.98% of cases (N = 15). In these patients, HBsAg was positive in 1.19% of cases (N = 9). The prevalence of HVB was 2.55% in CD (N = 10) versus 1.37% in UC (N = 5). In our work, no history of surgery, digestive endoscopy or transfusion has been shown to be a risk factor for viral transmission. CONCLUSION: The prevalence of HVB in IBD is similar to that of the general population. The safety of blood transfusions and the improvement of asepsis probably explain these results. However, the risk of viral reactivation during HVB, sometimes fatal under immunosuppressive treatment, requires systematic screening.
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