Think Forward.

GERIATRIE : COMMENT PRÉVENIR LES ESCARRES CHEZ LES PERSONNES ÂGÉES ? 4072

Dr Moussayer khadija, 2 y.
- Science - Society - Health -
3.5 min read.
DES ESCARRES MAL SOIGNEES PEUVENT PRECIPITER LA PERSONNE ÂGEE DANS LA DEPRESSION ET MÊME LA MORT L’escarre est une plaie ouverte, qui se forme à l’endroit où la chair est prise en étau entre l’os et le support (matelas, fauteuil) pendant plusieurs heures chez une personne obligée de garder le lit ou ayant perdue son autonomie. Sa fréquence n’est pas toujours bien appréciée mais on peut estimer néanmoins qu’au moins une personne âgée sur deux en sera touchée plus ou moins gravement. Outre les souffrances physiques, elle est en effet dévalorisante. Elle provoque souvent la survenue ou l’accentuation d’un phénomène dépressif. QU'EST CE EXACTEMENT QU'UNE ESCARRE Quand une personne alitée repose plusieurs heures sur les mêmes points d’appui, la chair est alors compressée à ces endroits, freinant ainsi la bonne circulation du sang et l’oxygénation du sang. Une fois en état d’hypoxie (terme médical pour désigner un manque d’apport en oxygène au niveau des tissus de l’organisme), les tissus vont se dégrader très vite. Le passage du stade d’érythème (rougeur cutanée) à celui d’ulcère (plaie ouverte) peut prendre seulement quelques heures. Selon la classification la plus utilisée, le processus se décline en plusieurs phases de développement : - stade 0, rougeur apparaissant mais disparaissant quand on appuie dessus ; - stade 1, rougeur ne blanchissant pas sous la pression du doigt ; - stade 2, désépidermisation : arrachement cutané touchant l’épiderme et éventuellement le derme, dont une variante au niveau du pied est la phlyctène (ou ampoule) hémorragique ou séreuse, selon qu’elle contient ou non du sang ; - stade 3, nécrose : plaie profonde avec plaque de nécrose recouvrant en général des tissus sous-jacents dévitalisés ; - stade 4, ulcère : plaie ouverte profonde, résultant le plus souvent d’une escarre de stade 3 après élimination des tissus nécrotiques ; les muscles sont touchés, au point que l’on peut voir tendons et articulations à nu. Une autre classification utilisée repose sur une cartographie des couleurs et un raisonnement en termes de pourcentage des couleurs QUELS ENDROIT DU CORPS DOIVENT ÊTRE SURVEILLES ? 40 % des escarres siègent au sacrum (le sacrum, au bas du dos, est formé de la soudure des 5 vertèbres sacrées) et 40% aux talons. Les autres localisations les plus fréquentes sont les ischions (l’ischion est l‘ un des trois os qui sont soudés chez l’adulte pour former le bassin : il supporte le poids du corps en position assise) et le trochanter (les protubérances de la partie supérieure du fémur) ainsi que, par ailleurs, l’occiput en pédiatrie. Pour le malade en fauteuil, roulant ou non, on surveillera : la nuque, les omoplates, les fesses et les talons. Pour le malade couché sur le côté, on surveillera : les trochanters, la face interne des genoux et les faces internes/externes des pieds. Pour le malade sur le dos, on surveillera : l’occiput, la nuque, les omoplates, les coudes, les crêtes iliaques, le sacrum, les fesses, la face interne des genoux et les talons. QUELS SONT LES FACTEURS DE RISQUES ? Ils sont multiples. Quelqu’un qui ne gère pas bien son capital santé, ne se nourrit pas et/ou ne s’hydrate pas correctement présente plus de risque. L’escarre guette également, tout particulièrement les sujets atteints : - de troubles de la conscience et de neuropathie ; - d’artérite, de problèmes vasculaires, d’hypertension ou d’insuffisance cardiaque ; - des conséquences physiques de maladies auto-immunes (polyarthrite rhumatoïde, lupus, scléroses en plaques…) - d’anémie et, de façon générale, de tout problème nécessitant une hospitalisation. QUELS GESTES PRÉVENTIFS ? - Observation régulière de l’état cutané à chaque changement de position et lors des soins d’hygiène. Une rougeur qui subsiste à la pression d’une palpation doit immédiatement alerter. - Corps étrangers : les sondes urinaires ou les lunettes à oxygène sont à surveiller car sources d’escarres. - Nutrition : l’entourage (famille, personnel soignant) doit surveiller l’appétit de la personne âgée, une perte de poids rapide favorisant en effet l’escarre. Au besoin, il faut enrichir ses plats et veiller à ce qu’il reçoive, notamment, une ration protéinique identique à une personne plus jeune et active car la personne âgée synthétise moins bien les protéines et va avoir besoin d’en consommer plus en cas d’escarre. Il faut également veiller à une bonne hydratation, variée si possible (eau, tisanes, jus de fruits…). La capacité à se nourrir correctement est centrale dans le processus de cicatrisation. - Sensibilité : la sensibilité cutanée de la personne est diminuée si on s’aperçoit qu’elle ne change pas de position spontanément en l’espace d’une demi-heure. Il faut alors planifier des changements de position environ toutes les 2 heures pour solliciter d’autres points d’appui. - Hygiène : Il est important de maintenir la personne au sec en évitant les risques de macération QUELS SONT LES PREMIERS SOINS ? – Nettoyage de la plaie et de son pourtour : employer l’eau et le savon ou du sérum physiologique. L’intérêt des antiseptiques ou des antibiotiques n’est pas démontré en l’absence d’infection. La plaie ne doit pas être asséchée mais, après les soins, on peut tamponner légèrement avec une serviette douce. – Traitement de l’escarre constituée : La détersion est nécessaire sur les plaies nécrotiques et/ou fibrineuses, soit mécaniquement soit à l’aide de pansements. Les matières mortes et le sang issu des capillaires sanguins endommagés produisent en effet une masse au fond de la plaie. Cette masse, souvent dure et sèche, s’oppose au processus de reconstruction cellulaire et donc à la cicatrisation. La colonisation bactérienne est, par ailleurs, constante dans les plaies chroniques : différente de l’infection, elle est utile à la cicatrisation et doit être simplement contrôlée par un nettoyage et une détersion soigneuses des tissus morts. QUELS SONT LES GESTES A PROSCRIRE – Pas d’utilisation de produits agressifs (éosine, alcool, antiseptique), de glace sur la plaie, de chaleur (sèche-cheveux par exemple) pour sécher la plaie. Ces gestes détruisent la flore cutanée alors qu’elle est une barrière aux infections. – Pas d’utilisation d’huile essentielle. – Pas de massage des rougeurs – Pas de gestes brusques pour lever le malade ou lui tirer les draps, sous peine de provoquer des coupures de la peau. Dr MOUSSAYER KHADIJA Spécialiste en Gériatrie EN SAVOIR PLUS 1/Liens utiles : - Société Française et Francophone des Plaies et Cicatrisations, rubrique Escarres http://www.sffpc.org/index.php?pg=connaiss&rubrique=escarre - Conférence de consensus publiée par la Haute Autorité de Santé http://www.has-sante.fr/portail/jcms/c_271996/prevention-et-traitement-des-escarres-de-ladulte-et-du-sujet-age - Claire Dubois, Prévenir et soigner les escarres : nouvelles recommandations, 2013 http://www.actusoins.com/13601/prevenir-et-soigner-les-escarres-nouvelles-recommandations.html
Dr Moussayer khadija Dr Moussayer khadija

Dr Moussayer khadija

Dr MOUSSAYER KHADIJA الدكتورة خديجة موسيار Spécialiste en médecine interne et en Gériatrie en libéral à Casablanca. Présidente de l’Alliance Maladies Rares Maroc (AMRM) et de l’association marocaine des maladies auto-immunes et systémiques (AMMAIS), Vice-présidente du Groupe de l’Auto-Immunité Marocain (GEAIM)


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Will AI coding replace me as a Software Engineer in Germany? 167

Fares Aouani, 8 h.
- Technology -
1.7 min read.
Will AI coding replace me as a Software Engineer in Germany? Today, my coworker showed me a Golf-Assistant app his friend built using claude code. It is fully functional, includes GPS tracking and a payment system, and it took him a couple of weekends to finish. It would take a Senior Software Engineer a couple of months to finish this, not using AI. Then he said "one day, we won't need us anymore" Will this really be the case though? Most companies use openai and anthropic as their LLM providers, and seeing the goofy mistake of anthropic not hiding sourcemap files while releasing a new version doesn't help with trust. For german companies, this is a gigantic no. Here someone has to be responsible. Someone has to pay the price in case of a problem, and the price is often high and heavy. Take H&M Hennes & Mauritz Online Shop as an example: managers illegally collected data on the private lives of their employees, this resulted in a 35.3 Million Euro fine, or Vodafone being fined a total of 45 Million Euros for two major breaches: 1-failing to oversee third party sales agencies, leading to fraud and 2- fro security flaw in their MeinVodafone Portal which allowed unauthorized access to customer eSim Profile. And these are man made errors ! What about potential AI-made errors? Most companies use chatgpt or claude as their LLM provider. So what if the AI Model made an error? Who would be responsible in the eyes of the law? Certainly not OpenAI or Anthropic Would the company itself be responsible for not having a good enough prompt to cover every single area of mistake the AI could make? What would be the extent of such a mistake? Would the company haft for not having another AI to double check what the initial AI did? If so, this would have to be an agentic system that react intelligently. How would such an agentic system look like and how much would it cost? And if the system becomes that big, how would you have it certified? tested? Could it scale easily? Does that have limits? In order for companies (still talking about Germany) to replace us with AI and 1- be completely covered in the eyes of the law and 2- follow the german standard of quality, this would roughly mean that: 1- The life cycle of the Data is 100% trackable and securely managed 2- AI doesn't make a single fatal mistake 3- There is a clear process that companies can follow to build a By-AI-Managed company and scale it afterwards 4- All of the previous questions (and many many more) are not only answered, but have specific and very detailed law texts. How long would this last? For a law to be passed nowadays it must go through a process that takes in average 1 to 2 years. Furtheremore, discussing before even proposing ONE new law text takes at least a couple of months. So would AI replace me as a software engineer in Germany? Curious to hear about how it is in your country?
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Morocco and the Trust Economy: The Invisible Capital of Development... 740

Aziz Daouda, 3 d.
- Politics - Society - Business -
2.9 min read.
In the economic history of nations, some assets are visible, such as natural resources, geographical position, infrastructure, or market size. Others, however, are invisible but often decisive. Among them, trust holds a central place and constitutes the true cement of sustainable economies. An economy can survive with few natural resources, but it cannot prosper sustainably without trust. Morocco today has many assets: remarkable political stability, a strategic position, world-class infrastructure, and active economic diplomacy. Yet, the decisive step in development now consists of building a true trust economy, capable of sustainably reassuring citizens, entrepreneurs, and investors. This is not a slogan. Trust is an institutional and cultural architecture that is built over time. It is the primary capital of a modern economy and a determining factor. It reduces transaction costs, encourages investment, facilitates innovation, and stimulates individual initiative. When an entrepreneur knows that the rules of the game are stable, that contracts will be respected, and that justice is swift and independent, he invests more easily. When a citizen trusts the tax administration and institutions, he more willingly accepts taxes and participates in the formal economy. Conversely, a lack of trust generates precautionary behaviors: capital flight, informality, low long-term investment. The economy then becomes cautious, fragmented, and inefficient. For Morocco, the central question is therefore not only to attract investments, but to create an environment where trust becomes a collective reflex. It would be unfair not to recognize the considerable progress made over the past decades. The foundations are solid. The country has massively invested in infrastructure: Tanger Med is today one of the world's most important logistics hubs. Nador and Dakhla are coming soon. Industrial zones have enabled the emergence of high-performing sectors, in the automotive industry with Renault Group and Stellantis, and in aeronautics with Boeing, Airbus, and Safran. The country's ambition in energy transition is exemplary. This shows that it is capable of carrying out structuring projects and offering a stable macroeconomic environment. However, the next step in development requires a qualitative leap: moving from an opportunity economy to a trust economy with a determining role for the rule of law. Trust first rests on the solidity of institutions. For investors as for entrepreneurs, the predictability of rules is a decisive element. Laws must be stable, readable, and applied equally, with three particularly crucial dimensions: **The independence and efficiency of justice** A swift, accessible, and credible justice system is the keystone of any trust economy. Commercial disputes must be resolved within reasonable timeframes. Judicial decisions must be enforced without ambiguity. Legal security is often the primary factor of attractiveness. **Fiscal stability** Investors do not necessarily expect very low tax rates; they primarily seek stability and readability. Predictable taxation allows companies to plan investments over the long term. Morocco has already undertaken several major tax reforms, but the challenge now is to go further and consolidate a clear and durable fiscal pact. **The fight against rents and privileges** Trust disappears when the rules of the game seem unequal. A dynamic economy relies on fair competition and equal opportunities. Transparency in public markets, competition regulation, and limiting rent situations are essential levers. A trust economy is also an economy of freedom, capable of unleashing entrepreneurial energy. The freedom to enterprise, innovate, and experiment is one of the fundamental engines of growth. Morocco has a talented youth, competent engineers, and an influential diaspora. However, several obstacles remain: administrative complexity, access to financing for SMEs, slowness of certain procedures. The challenge is to create an environment where individual initiative becomes the norm rather than the exception. Moroccan startups in fintech, artificial intelligence, or agricultural technologies already demonstrate the country's potential. With a more fluid ecosystem, they could become tomorrow's economic champions. In a world marked by geopolitical uncertainty and economic recompositions, trust also becomes a comparative advantage. If Morocco manages to position itself as a country where rules are stable, justice reliable, and administration predictable, it could become one of the main investment platforms between Europe and Africa. This ambition aligns with the Kingdom's African strategies and its growing international openness. Trust could thus become Morocco's true economic hallmark. Several strategic orientations deserve to be prioritized: - Accelerate the modernization of the judicial system, particularly in handling commercial disputes and enforcing judicial decisions. - Radically simplify administrative procedures for businesses through complete digitalization of public services. - Establish multi-year fiscal stability to enhance visibility. - Promote transparency and fair competition in all economic sectors. - Strengthen training and valorization of human capital, particularly in technological and scientific fields. - Develop a culture of trust between the State, businesses, and citizens. This dimension is often overlooked, yet it constitutes the invisible foundation of development. Morocco finds itself today at a pivotal moment in its economic history. The infrastructure is in place, strategic ambitions are affirmed, and the international environment offers new opportunities. The next step therefore consists of building a sustainable trust ecosystem. If Morocco succeeds in this gamble, and it must, it could not only accelerate its development but also become one of the most credible and attractive economies in the emerging world. In the 21st-century global economy, trust is undoubtedly the rarest and most powerful capital.

Football: When Passion Kills the Game in Impunity and Tolerance.. 1441

Aziz Daouda, 6 d.
- Society - Sports -
2.7 min read.
Football (Soccer for Americans) is first and foremost a matter of emotions. By its very essence, it is an open-air theater where human passions play out in their rawest, most primal form. It generates joy, anger, pride, humiliation, and a sense of belonging. From the stands of Camp Nou to those of the Diego Armando Maradona Stadium, through the fervor of the Mohamed V sport Complex in Casablanca, the vibrant enclosures of Stade Léopold Sédar Senghor in Dakar, or even the Parc des Princes in Paris, the Vélodrome In Marseille, and the Bernabeu In Madrid, football transcends the mere framework of the game to become a total social phenomenon. But this emotional intensity, which makes football's beauty, also constitutes its danger. For without rigorous regulation, it quickly tips into excess, then into violence. Today, it must be acknowledged that the rules exist, but they are too often circumvented, stripped of their substance, or applied with disconcerting leniency. On the pitches as in the stands, excesses are multiplying: insults toward referees, provocations between players, systematic challenges, physical violence, projectile throwing, pitch invasions, xenophobic remarks, racist offenses. What was once the exception is tending to become a tolerated norm. Astonishingly, we are starting to get used to it. Recent examples are telling. In Spain, in stadiums renowned for their football culture, racist chants continue to be belted out without shame, targeting players like Vinícius Júnior. Most recently, it was the Muslim community that was insulted. And yet, Spain's current football prodigy is Muslim. An overheated crowd that has doubtless forgotten it wasn't so long ago that it was Muslim itself. Among those chanting these remarks, and without a doubt, some still carry the genes of that recent past... In Dakar, just a few days ago, clashes escalated, turning a sports celebration into a scene of chaos. In Italy, incidents involving supporters who invaded the pitch, during a friendly match, no less, endangered players and officials, recalling the dark hours of European hooliganism in the 1980s. These episodes are not isolated; they reflect a worrying normalization of violence in and around stadiums. Even at the highest level of African football, behavioral excesses are becoming problematic. The 2025 Africa Cup of Nations final left a bitter taste. What should have been a moment of celebration for continental football was marred by behaviors contrary to sporting ethics. Pressures on refereeing, excessive challenges, and game interruptions have become commonplace. When a coach manipulates a match's rhythm to influence a refereeing decision, it is no longer strategy but a challenge to the very foundations of the sport. Despite international outrage, the sanctions imposed on teams, clubs, or players involved remain often symbolic, insufficient to eradicate these behaviors. A very surprising phenomenon: rarely have clubs or federations clearly distanced themselves from such crowds. They accommodate them, and when they condemn them, it is half-heartedly, in a muffled, timid tone with no effect. The problem is twofold. On one hand, disciplinary regulations exist but lack firmness. On the other, their application suffers from a lack of consistency and political courage. Bodies like FIFA, continental confederations, and national federations hesitate to impose truly dissuasive sanctions such as point deductions, prolonged closed-door matches, competition exclusions, or even administrative relegations. Yet without fear of sanction, the rule loses all effectiveness. It suffices to compare with other sports to measure the gap. In rugby, for example, respect for the referee is a cardinal value. The slightest challenge is immediately sanctioned. In athletics, a false start leads to immediate disqualification, no discussion. Football, meanwhile, still tolerates too many behaviors that should be unacceptable. This permissiveness has a cost. It undermines football's image, discourages some families from attending stadiums, and endangers the safety of the game's actors. More gravely, it paves the way for future tragedies. History has already taught us, through catastrophes like the Heysel Stadium disaster, that violence in stadiums can have tragic consequences. It is therefore urgent to react. Regulating football does not mean killing its soul, but rather preserving it. It is not about extinguishing passions, but channeling them. This requires strong measures, exemplary sanctions against offending clubs and players, accountability for national federations, increased use of technology to identify troublemakers, and above all, a clear political will from national and international governing bodies. Football cannot continue to be this "market of emotion" left to its own devices. For by tolerating the intolerable, it risks losing what makes its greatness and its ability to unite rather than divide. If FIFA does not decide to act firmly, the danger is real: that of seeing football sink into a spiral where violence triumphs over the game, and where, one day, tragedies exceed the mere framework of sport. The long-awaited decision of the Court of Arbitration for Sport (CAS) in the 2025 AFCON final case should confirm rigor and integrity in the application of rules, at least at this level, thereby strengthening the credibility of the pan-African competition and football in general.

April 2026 or the Certain Confirmation of the Moroccan Victory... 1622

Aziz Daouda, 7 d.
- World Politics - History -
3 min read.
We are entering a decisive month of April. The international dynamic is shifting even further in Morocco's favor on the Sahara issue. April once again promises to be a pivotal moment in the international handling of the Moroccan Sahara question. This structuring diplomatic ritual corresponds to the presentation of the annual report by the UN Secretary-General's Personal Envoy to the Security Council. But this year, the context is profoundly different. The lines have shifted, balances have been redrawn, and a new dynamic is taking hold, clearly favorable to Morocco, a logical follow-up to the adoption of Resolution 2797, with strong structuring potential. The adoption of this resolution marks an essential milestone. It goes beyond simply renewing the existing framework. It consolidates a political direction initiated over several years, by enshrining the preeminence of a realistic, pragmatic, and sustainable political solution, centered exclusively on the Moroccan autonomy initiative. This resolution fits into a strategic continuity that progressively marginalizes unrealistic options, those that long relied on outdated or inapplicable references in the current geopolitical context. It also increases pressure on the parties to engage in a credible political process under the exclusive auspices of the United Nations, but in reality under strong American pressure. The United States has directly engaged in favor of the Kingdom, with the return of roundtables in Madrid and then Washington as key pivots. These meetings have confirmed a diplomatic reality that is now hard to contest. The format of the gatherings, including Morocco, Mauritania, the Polisario Front, and Algeria despite itself, is the only relevant framework for progress. It implicitly enshrines Algeria's central role, long eager to present itself as a mere observer. Its active participation, even forced, places it at the heart of the dispute, profoundly altering the reading of the conflict and redistributing political responsibilities. Madrid and Washington are not insignificant venues. They reflect the growing involvement of Western powers in seeking a resolution, with increasing convergence around the Moroccan proposal. One of the expected developments this month concerns the future of MINURSO. The time has come to redefine the mission. From its inception, it has never fulfilled the role for which it was established. A major evolution is likely emerging in support of implementing autonomy in the southern provinces within the framework of the Kingdom's sovereignty. Long confined to monitoring the ceasefire, the mission will see its name change and its mandate evolve to adapt to on-the-ground realities and the demands of a renewed political process. Such a change would be highly significant. It would mark the end of UN inertia and reflect the international community's will to move from managing the status quo to an active and definitive resolution logic. Much to the dismay of those who, for 50 years, have done everything to perpetuate the conflict through their proxy; the latter is increasingly suffering from the shifting landscape. Washington has toughened its tone and put the Polisario in its sights. Algeria is evidently feeling the effects. The introduction in the US Congress of a proposal to designate the Polisario as a terrorist organization represents a potentially major turning point. If successful, such a designation would have considerable political, financial, and diplomatic consequences. It would further isolate the movement, weaken its supporters, and reshape the balance of power. Above all, it would reinforce the security reading of the dossier, in a Sahel-Saharan context marked by rising transnational threats. This adds to a Security Council increasingly aligned with the Moroccan position. The Council's current composition clearly leans in favor of Moroccan positions. Several influential members explicitly or implicitly support the autonomy initiative, seen as the most serious and credible basis for settlement. This shift is no accident. It results from active, coherent, and consistent Moroccan diplomacy, which has successfully embedded the Sahara issue within logics of regional stability, counter-terrorism, and economic development. Algeria, for its part, faces its contradictions. In this context, the Algerian regime appears increasingly beleaguered. Its positioning, long structured around ideological rhetoric and systematic opposition to Morocco, now seems out of step with international system evolutions. Algiers' relative diplomatic isolation, including in its Sahelian environment, contrasts with its regional ambitions. Internally, economic and social challenges exacerbate tensions in a country with considerable resources but unevenly distributed benefits. Algerian populations suffer from much injustice and lack the essentials. The Sahara issue, instrumentalized for decades as a lever for foreign policy and internal cohesion, thus reveals the limits of a politically exhausted model. The trend thus confirms a historic turning point depriving the Algerian regime of its artificial political rent. All elements converge toward one conclusion: April 2026 could mark a decisive step in the evolution of the Moroccan Sahara dossier. Without prejudging an immediate outcome, current dynamics are progressively narrowing the space for blocking positions. More than ever, resolving this conflict seems to hinge on recognizing geopolitical realities and adhering to a pragmatic political solution. In this perspective, Morocco appears in a position of strength, bolstered by growing legitimacy and increasingly assertive international support. The question remains whether other actors, particularly Algeria, will adapt to this new reality or choose to oppose it at the risk of greater isolation in a world where balances of power evolve rapidly. There will undoubtedly be a before and after April 2026, and above all, the consolidation of a Moroccan position oriented toward further development of the southern provinces. The Security Council's output is awaited in this direction.