Rifampicin and isoniazid plasma concentrations in relation to adverse reactions in tuberculosis patients: a retrospective analysis.

OBJECTIVE: High concentrations of antituberculosis (anti-TB) drugs can be associated with many adverse drug reactions (ADRs). The objective of this study was to examine the plasma concentrations of rifampicin (RMP) and isoniazid (INH) in patients with and without ADRs. METHODS: Concentration monitoring data of patients treated with anti-TB drugs were retrospectively analyzed from 2009 to 2011. RMP and INH plasma concentrations were measured 2 and 3 h after drug administration respectively using high-performance liquid chromatography. RESULTS: A total of 54 out of 120 patients have experienced ADRs to anti-TB drugs. The median concentrations [interquartile range (IQR)] obtained in patients with and without ADRs were 6.7 mg/l (3.7-9.9) and 5.6 mg/l (2.9-8.6) (p = 0.56) for RMP and 4.3 mg/l (2.3-5.3) and 3.1 mg/l (1.7-4.8) (p = 0.04) for INH, respectively. Related median doses (IQR) were 8.7 mg/kg (8.0-10.0) and 8.6 mg/kg (6.5-9.9) (p = 0.42) for RMP and 4.8 mg/kg (4.3-5.0) and 4.0 mg/kg (2.8-5) (p < 0.01) for INH, respectively. Concentrations above the expected range in patients with and without ADRs were not reached for RMP, but were 76% and 65% for INH, respectively. Correlation between concentrations and doses has not been established for RMP or INH. In addition, high INH concentrations showed no association with sex, age, liver injury or renal or diabetes. CONCLUSIONS: High INH concentrations were common in patients with and without ADRs whereas RMP concentrations were low or within the normal range in most patients. Further studies are required to assess the association between high INH concentrations and the occurrence of ADRs.

[Fatal poisoning in Mali]. / Les intoxications mortelles au Mali.

AIMS: The aim of this study was to determine the epidemiological characteristics of the cases of fatal poisoning in Mali. METHODS: This retrospective study examined the cases of fatal poisoning recorded between 2000 and 2010 in six Health Reference centers, six regional hospitals and three university hospitals in the district of Bamako. RESULTS: During the study period, 146 cases of fatal poisoning were recorded, accounting for 4.6% of all poisoning cases during this period. The average age of patients who died was 24 ± 17.7 years with a female-male ratio of 1.05. Nearly half (43%) were younger than 20 years. The ingestion was intentional in 66.4% of cases, mainly suicide attempts (47%) and therapeutic errors (19%). The median time until arrival at hospital was 8 hours after poisoning with multiple and varied clinical signs. CONCLUSIONS: Decreasing the mortality rate from poison ingestion requires increasing public awareness about poisons and improving emergency service equipment and health personnel training.

Mapping rare erythrocyte phenotypes in morocco: a tool to overcome transfusion challenges.

The aim of this research is to search for the distribution of blood groups in all the regions of Morocco. This study, done for the first time, aimed to provide the frequency of the Rhesus system and Kell (K) in more than 55000 blood donors from nine different regions around the country. In addition, the frequency of the Cellano, Duffy, Kidd, and MNS blood antigens was searched for 500 blood donors from the Rabat's region. Frequency of blood donors with rare blood groups was characterized for the first time in the country and compared to results found from other populations.

[Predictive factors of mortality of the burnt persons: study on 221 adults hospitalized between 2004 and 2009]. / Facteurs prédictifs de mortalité des brûlés : étude sur 221 adultes hospitalisés entre 2004 et 2009.

The objective of the present study is the evaluation of the predictive factors of mortality to a troop of Moroccan grown-up serious burnt persons. Variables analyzed in the study are: the age, the sex, the localization of the burn, the degree of burn, indicates Total Body Surface Area (TBSA), indicate Unit of Standard Burn (UBS) and the indication of leases, sepsis and the medical histories (tobacco, diabetes). Factors associated significantly to a mortality raised at the burned patients were the female genital organ, the localization of the burn at the level of the head, the sepsis, one TBSA greater or equal to 20%, an UBS greater or equal to 200 and an indication of leases greater or equal to 75. Other factors such as the age, the degree of burn and the histories did not show a significant difference. An evaluation and a good knowledge of factors associated to a high risk of death allow an adequate coverage of this category of patients.

Hepatitis B in Moroccan blood donors: a decade trend of the HBsAg prevalence in a resources limited country.

OBJECTIVES: To calculate the hepatitis B surface antigen (HBsAg) reactive rate for 2011 blood donors (BD) across Morocco. In addition, to monitor the profile of donors bearing the HBsAg during 2000 and 2011, we calculated the percentage of the prevalence in both sexes, in different age groups and in first-time replacement and regular BD from the Rabat Regional Blood Transfusion Centre. BACKGROUND: Hepatitis B is a viral infection that spreads through blood and other biological fluids. The hepatitis B virus remains one of the most common serious complications of transfusion. No information exists on the real prevalence of hepatitis B in Moroccan BD. METHODS: For the 2011 national HBsAg reactive rate, the percentage was calculated based on enzyme-linked immunosorbent assay (ELISA) results of the 232 190 blood donations collected around the country. For the Rabat blood Centre, we calculated the hepatitis B sero-prevalence from donations made at the donors' suite during 2000 and 2011. RESULTS: The national prevalence of HBsAg was 1·34%. The HBsAg variations among different regions was between 0·43 and 2·86%. The Rabat donors' suite hepatitis B prevalence decreased from 2·47% in 2000 to 0·91% in 2011 (P < 0·001). In both years, family/replacement donors were found as safe as first-time BD and female donors were the safest. CONCLUSIONS: These results, presented for the first time in the country, mapped the hepatitis B distribution across Morocco in a healthy population. The findings of this study could be of great importance in setting up strategies for the recruitment of the BD and keeping blood safety at the highest level.

[Description of poisoning reported in Marrakech-Tensift-Al Haouz region in Morocco between 1981 and 2008]. / Description des intoxications notifiées dans la région de Marrakech-Tensift-Al Haouz au Maroc entre 1981 et 2008.

In Morocco, the Marrakech-Tensift-Al Haouz region is one of the 16 regions most affected by poisoning. The aim of this study was to determine the epidemiological profile of poisoning recorded in the study region. A retrospective study of poisoning cases, declared between 1981 and 2008 in the Morocco Poison Control and Pharmacovigilance Center, was conducted. During the study period, 8517 poisoning cases were collected. The average age of patients was 22 ± 15 years. The male/female sex ratio was 0.85. Food poisoning was the most reported in the region, with 26.6% of cases. Among the 2,779 patients for whom the outcome was known, 65 died, with lethality rate of 23.4‰. The maximum lethality rate was recorded among those poisoned by paraphenylenediamine (170.7‰).

Prognostic factors of Atractylis gummifera L. poisoning, Morocco.

In Morocco, acute Atractylis gummifera L. poisoning represents the leading cause of death by plant poisoning especially for children. All cases received in the Moroccan poison control centre from January 1981 to December 2009 (n = 467) were included in a retrospective study of the characteristics and risk factors of A. gummifera L. poisoning. The most vulnerable age group was children (63.4% of cases). Most cases were due to accidental exposure (75.5%), but some were from therapeutic use (18.1%) or attempted abortion (7.4%). Patients presented with moderate poison severity signs (grade 2) in 22.3% of cases or severe signs (grade 3) in 21.0%. The mortality rate was 39.2%. The majority of deaths (81.1%) occurred in children aged < 15 years following accidental exposure. Multivariate logistic regression analysis revealed that risk factors for mortality were coma (OR = 20.5); hepatitis (OR = 52.7) and rural residence (OR = 7.26), while gastric decontamination was a protector factor (OR = 0.26).

[Peganum harmala L. poisoning and pregnancy: two cases in Morocco]. / Intoxication au Peganum harmala L. et grossesse : deux observations marocaines.

Peganum harmala L. (wild or Syrian rue) is commonly used as an emmenagogue and abortifacient in traditional medicine in the Middle East and North Africa including Morocco. The purpose of this report is to describe two cases of Peganum harmala L. poisoning in pregnant women. Both cases were treated successfully with good maternal-fetal outcome good for mother and child.

Blood donation in Morocco: a 20-year retrospective study of blood collection in the Rabat blood centre.

OBJECTIVES: We trace the history of blood donors and the recruitment strategies developed between 1988 and 2008 in the regional blood transfusion centre of Rabat. Beside, we draw a distribution map of the blood donors' population in Morocco during the year 2008. BACKGROUND: Limited resource countries face considerable obstacles to ensuring a safe blood supply and safe blood transfusions. Many countries used and some of them still depend on replacement blood donors. METHODS: Data published in this article had been collected from the CRTS of Rabat archives and reports. Data from all the 16 regional blood transfusion centres were collected from the report annually presented by the different regions. RESULTS: We found that during the 20 years period studied, the number of blood units collected by Rabat recorded many fluctuations. In the mean time, many measures were taken to promote the recruitment of voluntary blood donors. The proportion of these later jumped from 16·55% in 1988 to reach almost 80% in 2008. Beside, the whole country's blood collection map for the year 2008 showed that 190 504 of whole blood units were collected. This means that there are only six donations per 1000 people. CONCLUSION: This is the first study conducted in Morocco that provided detailed information on ongoing trends in blood donor profiles. The creation and development of new mobile drive units and maintaining them over time was the key to increase the collection of blood units from voluntary, non-remunerated blood donors.

[Ophidian envenomation in the region Souss-Massa-Drâa in Morocco]. / Les envenimations ophidiennes dans la région de Souss-Massa-Drâa au Maroc.

The present study aims to determine the main characteristics of ophidian envenomation in the Souss-Massa-Drâa region in Morocco. It consisted of a descriptive retrospective analysis of all snakebite cases recorded by the Moroccan Poison Control and Pharmacovigilance Center, from 1980 to 2008. According to reported data, this region is the most affected in Morocco with 479 cases, that is 27.6% (17 cases/year). The average age of victims was 26.07 ± 18.28 years. The patients developed clinical signs (55%) dominated by disorders of the digestive system (35.5%), cardiovascular diseases (21.4%), and heart rhythm disorders (16.8%). The lethality and sequelae rates were 12% and 1.9%, respectively.

Alanine transaminase level in a healthy population in Morocco.

A little is known about the prevalence of elevated alanine transaminase in a Moroccan healthy population. Our aim was to search for the upper limit of normal alanine transaminase in the blood donors and then to apply the upper limit of normal alanine found in the population so as to assess the prevalence of subjects with abnormal transaminase level. We then, investigated for factors associated with increased level of transaminase in our population. This study was carried out on 14071 blood donors, (74.1% of men and 25.9% female) aged between 18 to 60 years, randomly chosen. Serum transaminase activity was measured using on IEMS Reader, Labsystems. Hepatitis B and C were performed by ELISA. The upper limit of normal transaminase found were 64 for men and 52 for women. Consequently, 2.08% blood donors had an abnormal level of transaminase. Follow up results revealed that drug was the first cause of elevated transaminase in our cohort followed by diet and alcohol consumption. One seroconversion for hepatitis C was identified. In conclusion, this study showed that even though there is an evident lack of efficiency in using alanine aminotransferase testing qualifying blood donors in our country, preventing viral potential transmission through transfusions was possible.

[Epidemiology of snakebites in Morocco]. / Epidémiologie des envenimations ophidiennes au Maroc.

This study was based on a retrospective descriptive analysis of all cases of snakebite recorded at the Poison Control and Pharmacovigilance Center of Morocco from 1980 to 2008. A total of 1,761 snakebites, i.e., 61 cases per year, were observed during the study period. Males accounted for 54.5% of victims (sex ratio (M/F) = 1.2) and 70% of cases occurred in rural areas. The average age of snakebite victims was 26.7 +/- 17.5 years. A seasonal snakebite peak was observed between May and August coinciding with the warmest period of the year, harvest time and snake migration. Sixty-two percent of patients presented clinical symptoms including respiratory, cardiovascular, gastrointestinal, neurological and mucocutaneous signs. The average fatality rate was 7.2% per year and the sequel rate was up to 1.04%. This study demonstrates that management of snakebite is problematic in Morocco. Morbidity was probably underestimated. Restricted access to antivenom is a major problem in rural areas where the population cannot afford the cost.

[Poisoning by Atractylis gummifera L. Morocco poison control center data]. / Intoxication par Atractylis gummifera L. Données du centre antipoison et de pharmacovigilance du Maroc.

To assess the extent and severity of poisoning by Atractylis gummifera L. in Morocco, a descriptive retrospective study was conducted on all the poisoning cases listed between 1981 and 2004 to the Morocco Poison Control Center. During this period, 240 people were hospitalized for glue thistle poisoning, 72% of which are children under 16 years. The severity of the poisoning has been affirmed by significant intrahospital lethality. Indeed, among the 182 patients for whom the outcomes were known, 98 died (54%).

Epidemiological analysis of burn patients in the military hospital, Rabat, Morocco.

A retrospective study was conducted of burn patients admitted to the military hospital in Rabat, Morocco, in the 6-yr period from 2004 to 2009. This is the first multivariate study to be performed in Morocco. The epidemiological data from the 291 patients hospitalized were collected and studied. The type of burn was indicated in 284 of the patients: 94% of the injuries were thermal burns, 4% were electrical burns, and 1.5% chemical burns. In 261 cases the exact aetiology was noted: 56% of accidents were caused by flames, 38% by hot liquids, 4% by electric current, and 2% by chemicals. The distribution of the Moroccan population is as follows: 0-4 yr, 7%; 5-l4 yr, 8%; 15-19 yr, 8%; 20-59 yr, 70%; over 60 yr, 7%. The male/female sex ratio was 1.63. The mean duration of hospitalization stay was 42 ± 62 days. The mean body surface area burned was 21 ± 18%. Total mortality was 5%; 57% of deaths were due to septic shock. Our results were similar to data from other studies in the literature, with certain characteristics in our series, especially the age bracket most affected, the body surface area burned, and the mechanisms of injury.

[Scorpion envenomation treated at Beni Mellal Provincial Hospital in Morocco]. / Les envenimations scorpioniques a l'hôpital provincial de Beni Mellal (Maroc).

The Beni Mellal province has one of the highest incidences of scorpion envenomation in Morocco. The purpose of this retrospective study was to report and analyze data recorded in scorpion envenomation victims admitted to the intensive care department of the Beni Mellal Provincial Hospital. A total of 63 patients were admitted in 2005. Most stings occurred during summer mainly in June and July. Most (60.3%) occurred at night between 6 p.m. and 6 a.m. Most patients were children younger than 16 years (mean, 10.2 +/- 12.9 years). At the time of admission, general manifestations of envenomation were present in 72.6% of patients and life-threatening symptoms were observed in 27.4%. Therapy consisted of symptomatic treatment and in-hospital mortality was 28.6%. There was not a significant difference in mortality in function of age or severity of manifestations at the time of admission.

Characterization of lactic acid bacteria isolated from the one humped camel milk produced in Morocco.

One hundred and twenty (120) strains of lactic acid bacteria (LAB) were enumerated and isolated from raw dromedary milk in Morocco using various cultured media. Strains isolated were characterized by phenotypic, physiological and biochemical properties. Results showed that high counts of LAB were found. Presumptive lactobacilli counts ranged from 2.5x10(2) to 6x10(7)cfu/ml, presumptive lactococci levels varied from 5x10(2) to 6x10(7)cfu/ml, presumptive streptococci counts varied from 4.2x10(2) to 8x10(7)cfu/ml, presumptive leuconostoc levels ranged from 5.4x10(2) to 5.4x10(7)cfu/ml. Results showed also that Lactobacillus and Lactococcus were the predominant genera with 37.5% and 25.8%, respectively. The dominated species found were Lactococcus lactis subsp. lactis (17.5%), Lactobacillus helveticus (10%), Streptococcus salivarius subsp. thermophilus (9.20%), Lactobacillus casei subsp. casei (5.80%) and Lactobacillus plantarum (5%). This is the first report on the characterization of LAB strains isolated from the one humped camel milk produced in Morocco.

Risk factors for scorpion stings in the beni mellal province of morocco

Scorpion stings comprise a serious problem throughout the globe, especially in regions where they are more frequent. In Morocco, Beni Mellal is one of the provinces most affected by this burden. This study aimed to trace the epidemiological profile of scorpion stings in Beni Mellal in order to improve patient care and prevent both morbidity and mortality. Our work is a retrospective study of scorpion stings based on medical charts of Beni Mellal. From 2002 to 2007, 8,340 cases were registered in this province with an average incidence of 1.36‰. The stings were more frequent in summer months, particularly July and August, and between 6 p.m. and 6 a.m. (59.8 percent). The average age of victims was 26.54 ± 18.42 years. Children were affected in 30.3 percent of the cases. Of all registered cases, 67.3 percent of the patients received medical aid in less than an hour after the sting. The envenomation rate (Class II and Class III) was 12.4 percent and the overall case-fatality rate was 0.42 percent with a mortality rate of 0.005‰. Statistical analysis of the various studied factors revealed a significant connection among the envenomation class, patient age and evolution.(AU)

Epidemiological profile of snakebites in Morocco

The present work aims to find the epidemiological profile of snakebites in Morocco through a retrospective study of 1,423 snakebite cases that occurred between 1992 and 2007. Data were obtained from medical charts of envenomation at the Poison Control and Pharmacovigilance Center of Morocco. Results revealed that 86 percent of the snakebites had occurred in rural areas and that males were significantly more affected than females at a sex ratio of 23:20. Furthermore, 35 percent of the bites happened during the summer, with a peak of 215 cases in June (15.1 percent). We also discovered that 67.3 percent of the patients were bitten during the day. The age group that comprised the most agriculturally active persons, from 20 to 44 years old, was the most affected by snakebites (551 cases). In terms of evolution, patients who were at least 60 years of age (8.89 percent) as well as those who were less than 10 years old (7.50 percent) presented higher mortality. According to clinical severity grades, the data revealed a 70 percent predominance of grade 2 cases (430). Deaths had occurred only in patients with grades 3 and 4. Furthermore, grade 4 patients presented 100 percent mortality whereas grade 3 registered 10.7 percent. The distribution of snakebites according to administrative regions in Morocco showed a predominance of the Souss-Massa-Daraa region both in terms of frequency (32 percent) and mortality (72.1 percent). Our study clearly displayed the severity and extent of the snakebite problem in the country, thus revealing that public health authorities should give more attention to this serious situation.(AU)

Sex, age and ABO blood groups in chemotherapy-induced oropharyngeal mucositis.

AIM: The contribution of host genetic factors in oropharyngeal mucositis is not fully understood. Therefore, we conducted this study to determine possible associations of age, sex, underlying disease, type of chemotherapy and ABO blood group antigens with the risk of chemotherapy-induced oropharyngeal mucositis. METHODS: A total of 641 patients (395 boys and 246 girls; mean age 6.82+/-4.08 years) treated by standard chemotherapy for different type of malignancies were enrolled in the study. Mucositis was scored using the WHO scale. RESULTS: Oropharyngeal mucositis was found in 65.4% of our population. Patients with hematological malignancies (RR=1.87; 95% CI 1.33-2.67; P<0.0001) and under antimetabolities drugs (RR=1.88; 95% CI 1.33-2.63; P<0.0001) were associated with increased risk of oropharyngeal mucositis. Also, patients with blood group O were at higher risk (RR=2.86; 95% CI 2.03-4.02; P<0.0001) compared to patients with blood type A (RR= 0.47; 95% CI 0.33-0.66; P<0.0001) and blood type B (RR=0.59; 95% CI 0.38-0.91; P= 0.01). No relationship was found between oropharyngeal mucositis and age or sex. CONCLUSIONS: To our knowledge this is the first report demonstrating an association between ABO blood group and oropharyngeal mucositis. Further investigations are needed for a better understanding of this relationship.