Abstract:

Cholelithiasis presents in approximately 20 % of the total population, ranging between 10% and 30 %. It presents one of the most common causes for non malignant surgical treatment. The cornerstone therapy is laparoscopic cholecystectomy, urgent of elective. Laparoscopic cholecystectomy is nowadays the gold standard surgical treatment method, however bile duct injury occurred to as high as 0.4-3% of all laparoscopic cholecystectomies. The percentage has decreased significantly to 0.26-0.7% because of increased surgical experience and advances in laparoscopic imaging the past decade which have brought to light new achievements and new methods for better intraoperative visualization such as HD and 3D imaging system. However, bile duct injury remains a significant issue and indocyanine green fluorescence imaging, mainly cholangiography but also angiography, can further enhance the safety of laparoscopic cholecystectomy as it allows the earlier recognition of the cystic and common bile duct, even in several times before dissecting the Callot triangle. Fluorescence cholangiography could be an ideal method in order to improve bile tree anatomy identification and enhance prevention of iatrogenic injuries during laparoscopic cholecystectomies and also it could be helpful in young surgeons training because it provides enhanced intraoperative safety, but however this method does not replace CVS. Finally, our ongoing current study results comparing intravenous to direct administration of ICG in the gallbladder will be presented.

Abstract

Drug addiction remains a chronic global crisis, affecting an estimated 3–4% of Canadians, and effective public health policy is critical to addressing this issue. A narrative review of national surveys, public health reports, and peer-reviewed literature evaluated both individual and community-level interventions. At the individual level, rehabilitation and counseling are widely used but face high dropout rates exceeding 50%, with most patients requiring multiple attempts, while medication-assisted therapy (MAT) with methadone, buprenorphine, or naltrexone reduces mortality by up to 59% yet remains underutilized, reaching only 22% of eligible patients in 2021. Integrated treatment programs show better outcomes than abstinence-only models, though relapse rates remain 40–50%. At the community level, harm reduction has proven highly effective: Canada’s distribution of over 590,000 naloxone kits by 2019 prevented thousands of overdoses, and supervised consumption sites (SCS) reversed nearly 29,000 overdoses in British Columbia between 2017 and 2024, with Toronto reporting a 67% drop in neighborhood deaths and Saskatchewan a 28% decline in drug-toxicity deaths. Portugal’s decriminalization model further highlights the impact of progressive policy, reducing drug-related deaths by 75% over two decades. However, controversies persist, as prohibitionist policies have consistently failed, debates continue between abstinence and harm reduction advocates, and community resistance to SCS remains strong due to stigma, despite evidence showing no increase in crime; moreover, policy shifts, such as Oregon’s repeal of decriminalization in 2024, reflect ongoing challenges. Overall, evidence strongly supports integrated strategies that combine individual MAT and social support with community harm reduction and policy reform, though consistent implementation remains difficult.

Abstract

Quality end-of-life care (EOLC) in intensive care units often remains suboptimal despite its importance. A recent integrative review examined barriers perceived by critical care nurses in delivering EOLC, drawing on 11 studies published between 2010 and 2023. Thematic analysis revealed four key challenges: communication issues, such as difficulties in nurse–family interactions, frequent update requests, misunderstandings about prognosis, and family conflicts; organizational barriers, including inadequate institutional policies, unclear protocols, ICU design limitations, staffing shortages, and environmental noise; training gaps, with many nurses lacking specialized education to address complex symptoms, cultural needs, and ethical dilemmas; and emotional distress, as nurses reported sadness, burnout, and moral strain compounded by limited managerial support. Collectively, these factors hinder compassionate and effective EOLC delivery. The review underscores the need for targeted interventions—such as enhanced EOLC education, stronger support systems, and revised ICU policies—to improve the quality of end-of-life experiences for both patients and families in critical care settings.

Abstract

The LRRK2 gene, particularly its G2019S variant, has emerged as one of the most frequently reported genetic mutations associated with Parkinson’s disease (PD) across diverse populations. Global epidemiological data underscore the pronounced ethnic variability in its prevalence: approximately 13% among Ashkenazi Jews, up to 30% in Arab-Berber cohorts, and variable rates among Spanish populations, ranging from 6.1% to 41% in sporadic PD cases. In contrast, LRRK2 mutations are infrequent in Asian populations, reflecting distinct genetic backgrounds and founder effects. The G2019S variant has also been observed in 5.6% of North American families with familial PD, 6.6% in autosomal dominant cases from Southern Europe and Latin America, and 1.7% of British patients with sporadic PD. In the Moroccan context, the relevance of screening for the G2019S mutation lies in its potential utility as a predictive and diagnostic biomarker. Carriers of this mutation often present with a clinically milder form of PD, marked by slower disease progression and relatively preserved cognitive function. This genotype-phenotype correlation can facilitate more accurate patient stratification and personalized therapeutic strategies. The present study aims to estimate the prevalence of the G2019S mutation among Moroccan PD patients and to situate these findings within broader regional and international epidemiological trends. Conducted at the University Hospital Center (CHU) of Fès, the research involved 78 patients followed by the Neurology Department, all of whom met established clinical criteria for idiopathic PD. Molecular analysis was performed through PCR and bidirectional sequencing to detect the G2019S substitution in exon 41 of the LRRK2 gene. This investigation not only contributes to clarifying the genetic landscape of PD in Morocco but also underscores the importance of integrating molecular diagnostics into clinical neurology. Such efforts support the development of region-specific databases and foster precision medicine approaches tailored to North African populations.