The objective of our consensus process was to develop a unique classification of the natural history of scorpion stings and their clinical signs and symptoms. The technique used was an adapted Delphi approach completed by a nominal group meeting. Researchers included in a study received a questionnaire in which we listed all terms used in published studies to characterize clinical consequences of scorpion stings and all signs and symptoms belonging to each class. For each term, experts had to judge the relevance for classifying clinical consequences of scorpion stings and state whether they agreed with the terminology; they could also propose new terms or classes. For each sign or symptom, they had to choose in which class it belonged and also propose if any other sign or symptom should be added. Sixteen researchers participated. Consensus was reached to include four classes: local manifestations; minor systemic manifestations; major systemic manifestations; lethal envenomation. Signs and symptoms associated with each class were defined. A second Delphi round is planned to define indicators to follow the epidemiological situation within and across countries and to develop recommendations for an optimal management of scorpion envenomations. These consensus-based tools should facilitate development of international clinical studies.

Background. Aluminum phosphide poisoning has high mortality resulting from cardiac impairment and hemodynamic disorders. We report two cases of aluminum phosphide associated with reversible myocardial injury. Cases Reports. A 19-year-old woman and a 28-year-old man were admitted to hospital following ingestion of aluminum phosphide. The clinical course was characterized by the development of a shock syndrome requiring the use of vasoactive amines in the woman. However, the arterial hypotension in the man was improved by fluid filling and vasoactive drugs. The myocardial injury was objectively documented in both cases. The electrocardiogram showed ST-segment elevations and diffusely abnormal repolarization. The plasma concentrations of cardiac enzymes were elevated. In the second case, echocardiography showed similar myocardial involvement with left ventricular hypokinesis (left ventricle ejection fraction 30%). In both cases, there was progressive improvement in hemodynamic status, cardiac traces, and biochemical values. A simultaneous improvement was observed in echocardiogram of the second case (left ventricle ejection fraction increased to 50%). Conclusion. Reversible myocardial injury following aluminum phosphide poisoning has been described in few cases. We objectively documented progressive clinical and electrical improvement in two cases.

BackgroundData on psychoactive substance (PAS) consumption among adolescents in the North Center of Morocco are not at all available. Therefore, the current study aimed at investigating the prevalence and the determinants of psychoactive substances use among middle and high school students in this region.MethodsA cross-sectional study was conducted from April 2012 to November 2013 in public middle and high schools in the North Central Region of Morocco. An anonymous self-administered questionnaire was used to assess psychoactive substances use among a representative sample of school students from the 7th to the 12th grade, aged 11–23 years, selected by stratified cluster random sampling. Factors associated with psychoactive substance use were identified using multivariate stepwise logistic regression analyses.ResultsA total of 3020 school students completed the questionnaires, 53.0 % of which were males. The overall lifetime smoking prevalence was 16.1 %. The lifetime, annual and past month rates of any psychoactive substance use among the study subjects were 9.3, 7.5, and 6.3 % respectively. Cannabis recorded the highest lifetime prevalence of 8.1 %, followed by alcohol 4.3 %, inhalants 1.7 %, psychotropic substances without medical prescription 1.0, cocaine 0.7, heroine 0.3, and amphetamine with only 0.2 %. Psychoactive substance use was associated with males more than females. The risk factors identified by multivariate stepwise logistic regression analyses were being male, studying in secondary school level, smoking tobacco, living with a family member who uses tobacco, and feeling insecure within the family.ConclusionsThe prevalence among all school students reported by the current study was comparable to the national prevalence. Efforts to initiate psychoactive substance prevention programs among school students should be made by designing such programs based on the significant factors associated with psychoactive substance use identified in this study.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3143-5) contains supplementary material, which is available to authorized users.

Scorpion stings are a public health problem in Morocco, especially among children, who experience the most severe cases. Epidemiological and clinical findings on scorpion stings in Fez, Morocco, were evaluated in this investigation. Of 163 cases that required medical attention, 62.6% were male children. The mean age of patients was 4.8 ± 3.4 years. The mean time between stings and first medical attention was 3.36 ± 2.5 hours. Almost all cases occurred in the summer (94%) and extremities represented the most frequent sting sites (86.5%). Local pain, hyperemia, scarification, vomiting, sweating, restlessness, tachycardia and tachypnea were the observed clinical symptoms. Regarding severity, 55.2% of patients belonged to class III, followed by class II (26.4%) and class I (18.4%). None of our patients received antivenom; however, all of them were treated symptomatically depending on clinical manifestations.

Objective. This work aimed to survey medicinal plants used in phytotherapy in the Fez-Boulemane region, Morocco. Methods. A comprehensive ethnobotanical survey was conducted using a questionnaire to collect data from thirty herbalists on medicinal plants used for therapeutic purposes in the Fez-Boulemane region, Morocco. Results. The mean age of herbalists interviewed was 52.13 years. Forty percent of the herbalists were illiterate, and 73% referred to the experiences of their parents as knowledge of the properties and uses of medicinal plants. One hundred and eight medicinal plants belonging to 51 botanical families were recommended by herbalists in the region of Fez-Boulemane, Morocco, for treatment. According to the respondents, Lawsonia inermis L., Rosmarinus officinalis L., and Lavandula coronopifolia L. were the most used plants with the percentage of 13%, 12%, and 11%, respectively. Most plants had been involved in the treatment of digestive disorders (25%) and osteoarticular diseases (24%). Some (7.4%) of the plants mentioned in our survey were potentially toxic. Conclusion. It was learned that irrational use of toxic plants and unknown compositions of recipes are recommended to consumers. As a result, particular attention should be paid to risks related to plants used in traditional treatment without scientific validation. It is envisaged that increasing awareness, by conducting educational campaigns and transferring evidence-based scientific knowledge, on traditional treatments among the local population is expected to have beneficial impacts on health and disease management.

Acute pesticide poisoning among children is a reality in Morocco. Preventive measures may be needed.

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Paracetamol is the most widely drug involved in accidental paediatric exposures and deliberate self-poisoning cases because of its availability. N-acetyl cystein is the main treatment for this poisoning. We report a case of a 24-year-old Arab female who has deliberately ingested 100 tablets of 500 mg paracetamol each (50g). Her first examination was normal. She has received oral N-acetyl cystein (NAC) 6 hours after the ingestion. Serum paracetamol level done 18 hours post ingestion was 900 mg/l. On review the next days, she did not develop any symptoms of liver failure. However, due to the massive paracetamol ingestion associated with high serum paracetamol levels, oral NAC was continued for 3 days. The patient was discharged well on the fifth day of hospitalization. Our patient has ingested one of the highest paracetamol overdose (50g) with the highest paracetamol blood levels ever reported in medical literature. She was treated, six hours after ingestion, with oral NAC for 3 days without any side effects.