The Safety and Effectiveness of Bevacizumab in Metastatic Colorectal Cancer With Unresectable Metastases: A Real-Life Study From the South of Morocco.

Background Colorectal cancer constitutes a significant public health challenge, despite remarkable strides made in the last two decades, particularly in the medical management of metastatic stages. Notable progress has been achieved through targeted therapies such as anti-epidermal growth factor receptors or anti-angiogenic antibodies, as well as advancements in surgical approaches for hepatic metastases. This study seeks to assess the efficacy and safety of bevacizumab plus chemotherapy in individuals with metastatic colorectal cancer. Methodology This is an observational, cross-sectional, retrospective study of all patients who were followed up for metastatic colorectal cancer with unresectable metastases and were treated with bevacizumab in combination with standard chemotherapy from January 2010 until December 2019 in the medical oncology department of the Centre Hospitalier Universitaire (CHU) Souss-Massa of Agadir. Results Of the total 162 cases, 117 (72%) had metastatic disease, and 45 (28%) progressed to metastatic disease after initial treatment. The median age of the patients was 55 years (range = 23-79 years) with a sex ratio of 1.1 (M/F). The tumor was located in the left colon in 135 (83.3%) patients. The results represented adenocarcinoma in 137 (84.6) cases and mucinous subtype in 23 (14.19) cases. The three most common sites of metastasis were the liver (99, 61.1), peritoneum (67, 41.3), and lung (33, 20.3). In the first line, all patients received bi-chemotherapy plus bevacizumab, i.e., fluorouracil, oxaliplatin, and leucovorin in 34 (20.9%) patients; capecitabine plus oxaliplatin in 88 (54.3%) patients; leucovorin, fluorouracil, and irinotecan in 17 (10.4%) patients; and capecitabine plus irinotecan in 23 (14.1%) patients. Response after first-line treatment was progression in 74 (45.7) cases, stability in 42 (25.9) cases, partial response in 35 (21.6) cases, and complete response in 11 (6.8) cases. Nine (6%) patients were able to benefit from surgical resection of metastatic lesions. Overall, 77 (47%) patients received second-line chemotherapy, i.e., 5-FU with irinotecan in 40 (51.8%) cases or with oxaliplatin in 30 (38.8%) cases. Two patients developed undesirable side effects under bevacizumab (hypertension). The median progression-free survival and median overall survival of the study cohort were 9 months and 14 months, respectively. Nevertheless, patients who underwent primary tumor resection (p = 0.048), those with right­sided tumors (p = 0.022), those who received a higher number of treatment cycles (p = 0.020), and those who received maintenance treatment (p = 0.001) had a longer median overall survival. Conclusions Chemotherapy combination with bevacizumab is considered as the cornerstone of metastatic colorectal cancer treatment in our region. With the new healthcare and social security systems, easier access to expensive treatments and molecular pathology tests is currently available. It is important to highlight that real-world data can offer valuable insights into the daily clinical practice of medical oncology.

Smoking in chronic hemodialysis patients: prevalence and cardiovascular morbidity / Tabagisme chez les patients hémodialysés chroniques : prévalence et morbidité cardiovasculaire

Introduction: Smoking is common in chronic hemodialysis patients who are characterized by a high cardiovascular risk. Patients & methods: This is a multicenter cross-sectional study over a period of 4 months, from July 2021 to October 2021, in the Agadir province. Results: Among the 245 patients interviewed, 9,4% were current smokers and 16,7% were former smokers. Compared to non-smoking patients, former and current smokers were predominantly male, had more comorbidities, higher diastolic blood pressure, higher mean ultrafiltration rate and more antihypertensive treatments. In multivariate analysis, active smoking was significantly associated with the presence of cardiovascular disease. Conclusion: Smoking is an important and modifiable cardiovascular risk factor in chronic hemodialysis patients.

Introduction: Le tabagisme est fréquent chez les patients hémodialysés chroniques qui sont caractérisés par un risque cardiovasculaire élevé. L'objectif de notre étude était de déterminer la prévalence du tabagisme et le risque cardiovasculaire associé chez les patients hémodialysés chroniques. Patients et méthodes: Il s'agit d'une étude transversale multicentrique sur une période de 4 mois, de juillet à octobre 2021, dans la province d'Agadir. Résultats: Parmi les 245 patients interrogés, 9,4 % étaient des tabagiques actuels et 16,7 % étaient des anciens tabagiques. En comparaison aux patients non tabagiques, les fumeurs anciens et actuels avaient plus de comorbidités, une pression artérielle diastolique plus élevée, une ultrafiltration moyenne plus importante et un plus grand nombre de traitements antihypertenseurs. En analyse multivariée, le tabagisme actif était significativement associé à la présence d'une maladie cardiovasculaire. Conclusion: Le tabagisme représente un facteur de risque cardiovasculaire important et modifiable chez les patients hémodialysés chroniques.

Factors associated with psychological burden of breast cancer in women in Morocco: cross­sectional study.

BACKGROUND: Depression and anxiety are among the psychological diagnoses impacting individuals diagnosed with breast cancer. This study aims to estimate the prevalence, as well as the predictors, of anxiety and depression in women with breast cancer. MATERIALS AND METHODS: This was a cross-sectional, multi-center study conducted over an eight-month period among women with breast cancer in oncology centers in southern Morocco. Anxiety and depression were assessed using the validated Moroccan dialectal version of the Hospital Anxiety and Depression Scale (HADs). To identify the predictors of anxiety and depression in the study population. Multiple linear regression analyses were performed, including variables for which univariate analyses were significant with a p < 0.05 value. Statistical analyses were performed using Jamovi software version 2.2.3. RESULTS: A total of 230 participant responses were collected. The prevalence of anxiety and depression was 77.4% and 62.6%, respectively. Multiple linear regression analysis revealed the following factors increased anxiety: being younger than 50 years old, not having studied beyond elementary school, having children aged between 10 and 18 and having TNM stage III and IV. The following factors decreased anxiety in patients with breast cancer: good physical functioning (Karnofsky score), satisfaction with social support and financial support. Regarding depression, the following factors decreased depression: good physical functioning (Karnofsky score), a minimum of 2.5 h per week of physical activity, active occupational status, satisfaction with social support and financial support. In contrast, the recurrence of breast cancer was an associated factor with increased depression. CONCLUSION: The prevalence of anxiety and depression in women with breast cancer is very high in our context. Therefore, routine screening tests for depression and anxiety as well as psychosocial management care are necessary for patients with breast cancer in Morocco.

The Prevalence and Contributing Factors of Burnout Among Anesthesiologists and Intensive Care Unit Staff in Morocco: A Cross-Sectional Analysis.

Introduction Burnout is a common issue in the medical field, particularly in specialties like anaesthesiology and intensive care. It carries significant personal and professional consequences for healthcare providers and can impact the relationship between caregivers and patients. Despite its seriousness, there's been limited research on its causes in North Africa. In this study, our aim was straightforward: we wanted to find out how prevalent burnout is among Moroccan healthcare workers in anaesthesiology and intensive care and identify the main factors contributing to it. Methods To achieve this, we conducted a comprehensive multicenter cross-sectional study that included hospitals from different regions of Morocco. We focused on anesthesiologists and nurse anesthetists currently practicing in these settings. We measured burnout using the French version of the Maslach Burnout Inventory. Results We distributed 500 questionnaires and received and analyzed 396 of them, accounting for an 84% response rate. The results were striking: 48% of participants experienced high emotional exhaustion, 43.2% had a significant level of depersonalization, and 21% exhibited a low sense of personal accomplishment. When we looked at various factors, such as age, income, on-call duties, years of experience, and work location, our analysis showed statistically significant differences in all three dimensions of burnout. In our more complex multivariate analysis, we found that the risk factors for all three dimensions of burnout were practicing for 5 to 15 years and participating in on-call rotations. Surprisingly, practicing for over 25 years seemed to be a protective factor against all dimensions of burnout. Conclusion Our study clearly indicates that burnout is a shared issue among healthcare professionals in anaesthesiology and intensive care units in Morocco. Importantly, we've pinpointed specific risk factors that should be the foundation for a national strategy to prevent burnout in these critical healthcare sectors.

Awareness, Knowledge and Attitude Regarding Cervical Cancer among Women Living with HIV in the Souss-Massa Region, Southern Morocco: A Cross-Sectional Study.

BACKGROUND: Human immunodeficiency virus- positive women have an increased risk of precancerous lesions and invasive cervical cancer. This study aims to identify the level of awareness/knowledge and attitudes toward cervical cancer among women living with Human immunodeficiency virus in the region of Souss-Massa in southern Morocco.  Methods: This is a multicenter cross-sectional study conducted in the Souss-Massa region (southern Morocco) among women attending Human immunodeficiency virus treatment and care centers between March 2022 and September 2022. A questionnaire was used for data collection. The Chi-square test and logistic regression were deployed to identify factors associated with cervical cancer awareness among the target population. RESULTS: A total of 494 respondents to the questionnaire, 440 (89.1%) are aware of cervical cancer. Nevertheless, 405 (82.0%) and 369 (74.7%) were unaware of cervical cancer risk factors and symptoms, respectively. Only 125 (25.3%) knew the exact frequency of cervical cancer screening among Human immunodeficiency virus positive women, whereas 221 (44.7%) had ever been tested for cervical cancer. Factors associated with women's awareness of cervical cancer are as follows:  level of education (adjusted Odds Ratio = 3.78 with 95% CI, 1.23-11.65), time since diagnosis of Human immunodeficiency virus (adjusted Odds Ratio = 4.31 with 95% CI, 1.12- 16.52), knowledge of women with cervical cancer (adjusted Odds Ratio = 6.30 with 95% CI, 1.87-21.18) and heard the pap- smear/visual inspection with acetic acid (adjusted Odds Ratio = 4.92 with 95% CI, 2.35-10.33). CONCLUSION: The general knowledge of seropositive women regarding cervical cancer remains very low, which justifies the integration of cervical cancer prevention services with Human immunodeficiency virus care, and pinpoints the crucial role of patient education.

Prevalence, motivation, and associated factors of medicinal herbs consumption in pregnant women from Eastern Mediterranean Regional Office: a systematic review.

CONTEXT: Worldwide access to medication remains a major public health problem that forces pregnant women to self-medicate with several sources, such as medicinal plants. This alternative medicine is increasing in many low- and high-income countries for several reasons. OBJECTIVE: This a systematic literature review on the prevalence of herbal use during pregnancy from the World Health Organization (WHO) Eastern Mediterranean Regional Office. METHODS: Cross-sectional studies were searched from January 2011 to June 2021 on PubMed, Scopus, and Web of Science. We used the Rayyan website to identify the relevant studies by screening the abstracts and titles. These were followed by reading the full texts to identify the final studies to be included. The data were extracted, and the quality of the studies was assessed using the quality appraisal tool. RESULTS: Of the 33 studies included in this review, 19 were conducted in Iran, 5 in Saudi Arabia, 4 in Palestine, 2 in Egypt, and 1 each in Oman, Iraq, and Jordan; the prevalence of herbal medicine use among pregnant women varied from 19.2% to 90.2%. Several plants were mentioned for pain management during the pregnancy period. The findings suggest family and friends are major motivating sources for the use of herbal medicine. CONCLUSIONS: The wide variety of herbal products used in this study reflects the traditions and geographic diversity of the region. Despite the importance of literature-based data about the use of herbal medicine, it is necessary to obtain knowledge, attitude, and motivation for herbal consumption among pregnant women.

Teleconsultation use and satisfaction among cancerologists during the COVID-19 pandemic in Morocco.

Introduction: health care benefits have undergone major changes during the COVID-19 pandemic. This has led to an explosive growth in teleconsultation services mainly for cancer patients. The purpose of this study was to assess the perception and experience of Moroccan oncologists with the use of teleconsultation during the COVID-19 pandemic. Methods: a 17-question anonymous cross-sectional survey was conducted on Google forms and emailed to all Moroccan oncologists. Statistical analysis was performed using the statistical software Jamovi (version 2.2). Results: out of a total of 500 oncologists who received the questionnaire, 126 responded, with a response rate of 25%. During the pandemic, only 59.5% of oncologists used teleconsultation, with no significant differences among the three groups (radiation oncologists, medical oncologists and cancer surgeons (p=0.294)). Most participants were satisfied with being able to explain medical diagnosis, provide assessment results, and provide treatment recommendations during teleconsultation. Finally, 47.2% of participants were willing to continue conducting teleconsultations after the COVID-19 pandemic, with no significant differences among the three groups. Conclusion: oncology physicians were satisfied with their experiences with teleconsultation and agreed that it is likely to be part of their long-term practice. Future studies are needed to assess patient satisfaction with teleconsultation and to improve patient care through this virtual technology.

Religiosity, stress, and depressive symptoms among nursing and medical students during the middle stage of the COVID-19 pandemic: A cross-sectional study in Morocco.

Background: Recent studies on nursing and medical students showed a higher prevalence of depression and stress than the general population. Religiosity and spirituality are common in Muslim countries and are usually used as a means of coping strategy for psychological and mental disorders. Objective: Our objective was to evaluate the association between religious actions, depressive symptoms, and stress among students of nursing education lasting 3 years and students from the first 3 years of medical education lasting 7 years. The study was conducted at Ibn Zohr University of Agadir, Morocco. Method: A sample of different stages of nursing and medical students was recruited. Religiosity was assessed by Muslim Belief into Action (M.BIAC) scale. The depressive symptoms and stress were, respectively, assessed by the Beck Depression Inventory (BDI-II) and Perceived Stress Scale (PSS). Results: Four hundred and thirteen students participated in this study. Our results showed a high prevalence of depressive symptoms (62.2%) and stress (66.8%). The depression scores were higher in the following subsample categories: students in the first 2 years of studies, female medical students, and nursing students with significant differences. The recorded religiosity was greater among students without depression compared to students with depression (p < 0.001). In the multivariate regression, the BIAC score demonstrated religiosity as neither a risk factor nor a protective factor of depression. Conclusion: Religiosity constitutes a protective factor of depression and stress among nursing and medical students. This should improve the student's ability to cope with stressful situations during their training. Prospective studies are needed to further investigate this association and how religiosity improves mental health. This would contribute to improved academic performance and wellbeing among medical and nursing students.

Moroccans' Views on Resuscitation According to Presumed Degree of Disability: A Cross-Sectional Study.

INTRODUCTION: According to the World Health Organization (WHO), disability is a public health problem that can be difficult to manage medically and financially. Disability can either be innate or develop after resuscitation. Therefore, the decision regarding whether to resuscitate a patient or not raises certain ethical questions, especially in the context of a Muslim country such as Morocco. AIM: The main aim of this study is to survey the public's opinions regarding their willingness to be resuscitated or have their relatives be resuscitated based on their foreseeable degree of disability. METHODS: This cross-sectional study was conducted over a 10-month period and employed a self-administered questionnaire. The participants included were all adult (i.e., over 18 years of age) Moroccan nationals, and they were selected regardless of their religious identity. Moreover, the modified Rankin Scale (mRS) was used to measure the participants' foreseeable degree of handicap. The participants were divided into two groups: healthcare workers and non-healthcare workers. RESULTS: In total, 1083 questionnaires were retained. The average age of the participants was 30 (± 8) years, with the male-to-female sex ratio being 0.78. Moreover, 39.6% of the participants were healthcare workers. It was found that compared to the non healthcare workers, the healthcare professionals were more willing to be resuscitated themselves and have resuscitation performed on their relatives, but only when the degree of foreseeable disability was estimated to be absent or insignificant, whereas they were less willing to be resuscitated and have resuscitation performed on their relatives when the degree of foreseeable disability was estimated to be mild or higher. CONCLUSION: In conclusion, there should be a pre-established procedure, along with a legislative and multidisciplinary framework, within the hospital structures in order to help in the decision-making process regarding whether to resuscitate a patient or not.

Self-medication practice among pregnant and postpartum women attending the regional hospital center of Souss Massa, Morocco: a cross-sectional study.

Background: Self-medication among pregnant women represents a serious risk to the mother's and child's health. It is a global concern that requires careful attention from professionals in healthcare. In Morocco, there is a lack of available data on self-medication and predicting variables among pregnant and postpartum women. The purpose of this study was to determine the incidence of self-medication and the factors that contributed to it among pregnant and postpartum women in the Sous Massa Regional Hospital. Methods: A cross-sectional study was conducted using a pretested questionnaire among 420 pregnant and postpartum women who were attending the regional hospital center of the Sous Massa region from April to December 2022. Statistical analysis was performed using Jamovi Software. The logistic regression analysis was used to determine the significance of the association between the outcome and independent variables. Results: The research enrolled 420 pregnant and postpartum women. During the current pregnancy, 24.8% of the women used self-medication. The leading common causes/symptoms that necessitate self-medication among pregnant and postpartum women were Anemia (84.8%), epigastralgia (16.8%), vomiting, pyrosis (15.2%), and urinary and vaginal infections The therapeutic families concerned with self-medication practice were Analgesics (41.4%), Antacids (20.3%), antimicrobials (13.5%), and Vitamin supplements (9%). According to the findings, the most frequent sources of information were pharmacists (45.6%), followed by physicians (44.3%). The primary reasons given by respondents for self-medication were the need for rapid release (51.7%), previous treatments with the same drugs (31.7%), and 20% reported difficulty of access to healthcare professionals. Out of 95.9% of the participants reported that they knew the dangers of self-medication and 96% of them were informed and received information about the dangers and contraindications of self-medication during pregnancy. This was significantly statistically associated with self-medication respectively with p-value = 0.031 and p-value = 0.005. Conclusion: The findings of the present study provide an initial awareness of the state of self-medication among pregnant and postpartum women attending the regional hospital centers. It is recommended that healthcare professionals increase their interventions to improve the consciousness of pregnant women; this might require implementing suitable strategies to regulate the commercialization, delivery, and use of conventional medications.

[Assessing psychological, anxiety, depression and stress levels of Senegalese general population during COVID-19 pandemic]. / Les niveaux d'impact psychologique, d'anxiété, de dépression et de stress de la population générale du Sénégal pendant la pandémie de COVID-19.

OBJECTIVES: - Assessing of Impact of Event, depression, anxiety and stress levels in the Senegalese general population during the COVID19 pandemic and identifying associated factors. METHODS: - Socio-demographic data, psychological impact of the pandemic, and mental health status of participants were collected using an online questionnaire administered to the general population of Senegal between April 1st and April 30th 2021. Psychological impact and mental health status were assessed, respectively, by the Impact of Event Scale-Revised (IES-R) and the Depression, Anxiety, and Stress Scale 21 (DASS21). The data were analyzed by Jamovi software, version 1.6.23. Logistic regression in univariate and multivariate analyses were used to determine statistically significant associations with a significance level of p<0.05. RESULTS: - We enrolled 447 respondents with 19% reporting a moderate to severe psychological impact of the outbreak. Respectively 13.4%, 5.1% and 15.2% had moderate to extremely severe symptoms of depression, anxiety and stress. Statistically significant associations with higher odds of severe levels of psychological impact of the event, depression, anxiety, and stress were represented by five characteristics: Living in Dakar, no formal education, a personal medical chronic disease, a close family member with a chronic medical disease and poor to very poor self-reported health status. CONCLUSION: - This study determined the prevalence of post-traumatic stress disorder, depression, anxiety, and stress in the Senegalese general population during the COVID19 pandemic. Our study assessed the prevalence of post-traumatic stress disorder, depression, anxiety, and stress in the general population of Senegal during the COVID pandemic19. It confirms that the pandemic has truly an impact on the mental health of the Senegalese population. This impact is strongly influenced by geographic area and level of education.

Cervical cancer in Morocco: A systematic review.

BACKGROUND: This systematic review aims to determine the epidemiological profile, etiology and risk factors, prevention, diagnosis, treatment, cost-effectiveness, survival, and quality of life related to cervical cancer in Morocco. METHODS: This study was conducted according to the recommendations of the "preferred reporting items for systematic reviews and meta-analysis." The PubMed, ScienceDirect, Springer, Web of Science data bases were used, as was Google Scholar for the grey literature. The review protocol was registered in the PROSPERO register (CRD42021235241). RESULTS: Fifty studies were selected. The mean age was 49.31 ±6.3 years. HPV infection prevalence ranged from 13.30% to 76%, with a peak in HIV-positive women. Acceptability of the HPV vaccine was higher among parents (35% and 82%) than among adolescents (16.9% to 46.6%). Knowledge of the vaccine and its price are two key factors related to vaccine acceptability among parents. This systematic review highlights that the fact that few eligible women (not more than 11%) were participating in the cervical cancer screening program. Moroccan women's level of knowledge and awareness regarding cervical cancer screening was low, negatively impacting their use of such screening tools, as illustrated by the high percentage (mean 76.32% ± 17.21) of women who had never been screened for cervical cancer. Treatment was the most significant component of the global care budget (95.87%), with an annual cost of $13,027,609. Five-year overall survival ranged from 41.3% to 73.6%, with higher survival rates for patients diagnosed at an earlier stage (77.3-85% for stage I). Lastly, low quality of life was observed in women with tumors at an advanced stage who had received brachytherapy and lacked social support. CONCLUSIONS: Subjects that require further investigation include Moroccan women's knowledge, attitudes, and awareness, especially among those at high risk of developing cervical cancer, and its impact on their quality of life and survival.

The impact of COVID-19 on the quality of life of southern Moroccan doctors : A gender-based approach.

OBJECTIVES: After the World Health Organisation (WHO) declared COVID-19 a global pandemic, various countries took preventive health measures to limit the spread of the coronavirus. The quality of life (QOL) of many populations was affected by lockdown and social distancing. The pandemic increased healthcare professionals' workload and decreased doctors' QOL. Our study aimed to evaluate the QOL of doctors in southern provinces of Morocco during the COVID-19 pandemic. In addition, the study compared QOL of the two genders at that time. METHODS: This was a cross-sectional and descriptive study. The sample included 257 doctors practicing in the southern provinces of Morocco. To assess QOL, we used the online self-administered WHOQOL-BREF questionnaire, which evaluates QOL in four domains: physical, mental, social and environmental. The cut-off between good and poor QOL was 60. RESULTS: All doctors showed poor QOL in all domains. The mean scores and standard deviations for the physical, mental, social, and environmental domains were 57.88 ± 17.12, 57.09 ± 20.13, 55.57 ± 23.66 and 47.99 ± 17.34, respectively. Comparing the two genders, males had a higher QOL than females with a statistically significant difference (p-value ≤ 0.05) in all domains. Both men and women had poor QOL in the environmental domain (less than 60). Doctors who worked directly in the COVID-19 circuit had poorer QOL in all domains. Even with scores lower than 60, males working in COVID-19 circuit had better QOL compared to females, except in the social domain. CONCLUSION: Southern Moroccan doctors' QOL was reduced in all domains. All doctors working in COVID-19 circuit had poor QOL, and women's scores were even lower than those of men.

University students' perceptions and factors contributing to obesity and overweigh in Southern of Morocco.

BACKGROUND: Weight load is a cosmopolitan health problem. In Morocco, women are the most affected by the phenomenon since obesity has risen from 26.8% to 29.0%. OBJECTIVE: To determine the prevalence of weight load and associated factors among female students in higher education. METHODS: Data were collected by a questionnaire. Anthropometric measurements were made using a scale and a wall-mounted scale. Data were analysed by the statistical software SPSS version 13.0. Quantitative variables were described in mean ± standard deviation. Factors associated with obesity were determined by binary logistic regression. RESULTS: About two-thirds of the students had a normal weight, 21% were overweight and 3% were obese. In addition, 58% of students were physically inactive and 77% ate cake and fast food. In addition, 63% of students were dissatisfied with their weight. A significant relationship is found between level of primary education, type of establishment, cake and fast food consumption and weight load. CONCLUSION: The results revealed that 24% of participants were weight load and had behavioral risk factors such as a sedentary lifestyle and an unbalanced diet, which requires the promotion of a healthy lifestyle among these students as well as psychological support for those dissatisfied with their body image.

Evolution of acute lower respiratory infection in children aged < 5 years in Morocco from 2005 to 2014.

BACKGROUND: Acute lower respiratory infection is a major cause of death in children aged < 5 years in Morocco. The 13-valent pneumococcal conjugate vaccine (PCV) was introduced to the Moroccan National Immunization Programme in 2010. AIMS: To investigate the trend in the incidence of acute lower respiratory infection in children aged < 5 years during 2005-2014 in Morocco. METHODS: Data on acute lower respiratory infection in children aged < 5 years were obtained from the data published annually by the Moroccan Ministry of Health. We used joinpoint regression analysis to estimate the trend in incidence of acute lower respiratory infection during the study period. RESULTS: The incidence of acute lower respiratory infection increased significantly between 2005 and 2011: by 3.08% annually in children aged < 5 years and by 3.24% annually in children aged 1 to < 5 years. However, the incidence was stable after 2011 as the observed trends were not significant, although the incidence decreased from 2011 to 2014 by 4.26% annually in children aged < 5 years, by 3.57% annually in children aged 1 to < 5 years and by 5.14% annually in urban areas. CONCLUSIONS: Our results suggest a probable influence of the PCV on the trend in incidence of acute lower respiratory infection in Morocco.

Association of Prostate Cancer with Nuts, Seeds, Alcohol and Processed Meats: A Worldwide Population-Based Study.

There are conflicting data with regards to the link between diet and the prostate cancer. The purpose of this study was to assess the association of dietary factors with incidence, prevalence and mortality rates of prostate cancer worldwide. We conducted an ecological study including 170 countries, whose data on incidence, prevalence and mortality rates of prostate cancer, dietary factors, and potentially confounding factors were available and collected in May 2020. Univariable and multivariable linear regression analyses were used. Consumption of nuts and seeds was inversely associated with incidence, prevalence and mortality rates of prostate cancer (ß -0.7, P < 0.001; ß -2.1, P < 0.001; ß -0.1, P = 0.02; respectively). Intake of alcohol was associated with increased incidence, prevalence and mortality rates of prostate cancer (ß 1.8, P < 0.001; ß 4.5, P < 0.001; ß 0.4, P < 0.001; respectively). Consumption of processed meats was also associated with increased incidence and prevalence rates of prostate cancer (ß 0.6, P = 0.003; ß 2.8, P = 0.001; respectively). These data suggest that consumption of nuts and seeds have a protective effect against prostate carcinogenesis, progression, and metastasis, while alcohol and processed meat increase these risks.