Gastric cancer and associated pathogens: is there any association in Moroccan region?

Helicobacter pylori, Epstein-Barr virus and human papillomavirus are three pathogens associated with various human cancers. This study aimed to investigate the role of these pathogens in gastric cancer in Moroccan population. For this, a retrospective study has been conducted on participants attending the gastroenterology department of Hassan II University Hospital of Fez. A total of 279 participants were enrolled. H. pylori, EBV and HPV were detected and genotyped by PCR. In results, a significant association has been established between H. pylori, EBV and gastric cancer. 93.4% and 43.3% of gastric cancer cases are related to H. pylori and EBV respectively (p≤0.01). H. pylori-EBV co-infection is responsible of 31.6% of gastric cancer cases (p<0.01). Correlation between pathogens genotypes and gastric cancer shows 54.6% of GC EBV positives are carrying the 30 bp deletion in LMP1gene, while 16% of gastric cancers cases are carrying high-risk genotypes of HPV (p=0.21). The obtained results highlight the possible role of co-infection in gastric cancer development.

Analysis of the nutritional composition and organization of school meals in the province of Kadiogo in Burkina Faso: challenges and prospects.

Background: In the face of food shortages and precariousness, school meals are an effective means of encouraging pupils to attend and stay in school, and of combating nutritional deficiencies. Unfortunately, there are bottlenecks to be identified and resolved. Objective: Analyzing the composition of meals served to school-age children in primary schools in the province of Kadiogo, while assessing the opinion of school staff on these meals (Burkina Faso). Methods: A descriptive cross-sectional survey about school meals was carried out during the period from April to May 2019 among school stakeholders in primary schools in five (05) municipalities of the province of Kadiogo. Results: Insufficient quantity and quality of rations served were recorded in primary schools. The endogenous initiative canteens represented 46.4% of the registered canteens. The promotion of Health-Hygiene-Nutrition (H-H-N) activities in schools encountered difficulties in covering the sanitary needs of school-aged children because unavailability of socio-sanitary infrastructures. School meals consisted of starchy foods and legumes in rural schools and more diversified meals consisting of fruits and vegetables as well as meat and fish in urban schools. In rural municipalities, school meals were insufficient in quantity and quality, while in the urban municipality, macronutrient intakes were in excess with micronutrient intakes largely deficient. Conclusion: Despite the shortcomings, school officials specified that school meals cover lunch rations, increase school enrolment, and improve school-aged children' learning capacity.

Study of the SARS-CoV-2 genomic data generation to evaluate the introduction of genomics in epidemiological surveillance and public health decision making.

Introduction: the limited number of equipped laboratories and the lack of expertise left Africa lagging behind in terms of contribution in genomic data generation. The COVID-19 pandemic has drawn the attention of all public health stakeholders so that it can be used as a marker of the efforts that public health systems can produced. The main purpose of the present analytical study was to evaluate the contribution of the African continent in the genomic surveillance of SARS-CoV-2. Methods: data from the two most popular genomic databases on SARS-CoV-2 (GISAID EpiCov and NCBI Virus) were extracted and analyzed. Comparisons were made using the sequencing ratio which represents the number of genomic sequence published over one thousands confirmed cases. Results: considering continental blocks, the Africa occupied the fourth place after Oceania, Europe and North America based on sequencing ratios. However, when the considered comparison parameter is the number of sequences, the African continent was the fifth contributor after Europe, North America, Asia and South America. Conclusion: the study showed that African countries have effectively integrated the genomic data generation in the public health response strategies but the effective use of these data for a perfect surveillance is not clearly established. There is a need for capacity building in genomic data analyses for a better response to public health threats in Africa.

Discontinuation of healthcare and factors associated to mortality among severe acute malnourished children under five years in healthcare and nutritional care settings.

BACKGROUND AND AIMS: Even if under-five children mortality tends to decrease considerably in developed countries, it remains a major concern in Sub-Saharan Africa. The purpose of the present study is to assess causes of healthcare discontinuation and factors associated with mortality among severe acute malnourished children under five years old in the health district of Gorom-Gorom in Burkina Faso. METHODS: A descriptive retrospective study on healthcare discontinuation and deaths of severely acute malnourished children under five years old who registered from July to December 2018, in the health district of Gorom-Gorom in Burkina Faso. RESULTS: A total of 377 records of children suffering from severe acute malnutrition were exploited. Children of age range 6-23 months were the most predominantly malnourished. Healthcare discontinuation was observed at rates around 24.4%.Deaths were recorded in 9.72% of children hospitalized in the CRNE and around 1% in children in the ambulatory care management. The severe acute malnutrition co-morbidity factors included oral candidiasis [OR = 14.8; (95%CI 1.128-194.285)], dehydration [OR = 11.46; (95%CI 1.085-121.038)] and malaria [OR = 8.32; (95%CI 1.915-36.191)]. CONCLUSION: The risk of death of severe acute malnourished children is higher when the disease is associated with complications.

Bacterial sexually transmitted infections and syndromic approach: a study conducted on women at Moroccan University Hospital.

INTRODUCTION: In Morocco, a syndromic approach has been implemented for sexually transmitted infections (STIs) management. However, those infections can be asymptomatic and the use of the syndromic approach to their management can be inappropriate and lead to dissemination of infection. Therefore, it would be important to determine the epidemiology and risk factors of bacterial STIs (Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT) and Mycoplasma genitalium (MG)) in a Moroccan population and their association with symptoms to assess the appropriacy of the use of the syndromic approach. METHODS: Cervical samples were collected from symptomatic and asymptomatic consenting women attending the University Hospital of Fez and were tested by PCR for NG, CT and MG using specific primers. We assessed the infection status and its association with different risk factors and genital STIs-related symptoms. RESULTS: Of 809 tested for CT, NG and MG, 16.6% tested positive for at least one STI. Of the 134 participants who tested positive for at least one bacterial STI, 74.2% had no genital STIs-related symptoms. Moreover, the results showed a significantly high rate of NG and MG infections in asymptomatic women. However, the determined risk factors for NG, MG and CT infections were menopause (p=0.002), oral contraception (p=0.036) and a high number of parities (p=0.048), respectively. CONCLUSIONS: This investigation shows a predominance of NG infection and a high prevalence of STIs in asymptomatic patients. These results highlight that the adopted syndromic approach will not be adapted in the management of these STIs. Thus, the implementation of a systematic diagnostic program in order to enhance their management is needed.

Prevention and treatment of COVID-19: Focus on interferons, chloroquine/hydroxychloroquine, azithromycin, and vaccine.

The ongoing pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has drawn the attention of researchers and clinicians from several disciplines and sectors who are trying to find durable solutions both at preventive and treatment levels. To date, there is no approved effective treatment or vaccine available to control the coronavirus disease-2019 (COVID-19). The preliminary in vitro studies on viral infection models showed potential antiviral activities of type I and III interferons (IFNs), chloroquine (CQ)/hydroxychloroquine (HCQ), and azithromycin (AZM); however, the clinical studies on COVID-19 patients treated with CQ/HCQ and AZM led to controversies in different regions due to their adverse side effects, as well as their combined treatment could prolong the QT interval. Interestingly, the treatment with type I IFNs showed encouraging results. Moreover, the different preliminary reports of COVID-19 candidate vaccines showcase promising results by inducing the production of a high level of neutralizing antibodies (NAbs) and specific T cell-mediated immune response in almost all participants. The present review aims to summarize and analyze the recent progress evidence concerning the use of IFNs, CQ/HCQ, and AZM for the treatment of COVID-19. The available data on immunization options to prevent the COVID-19 are also analyzed with the aim to present the promising options which could be investigated in future for sustainable control of the pandemic.

Detection of Ureaplasma Biovars and Subtyping of Ureaplasma parvum among Women Referring to a University Hospital in Morocco.

Objectives: The aim of this study was to determine the prevalence of Ureaplasma biovars and Ureaplasma parvum (U. parvum) serovars, their associated risk factors, and genital STI-related symptoms. Methods: DNA obtained from cervical samples of 1053 women attending the department of Obstetrics and Gynecology and the laboratory of pathological anatomy of Hassan II university hospital of Fez, Morocco, was used to detect Ureaplasma biovars (U. urealyticum and U. parvum) and to subtype U. parvum by polymerase chain reaction (PCR). Results: Of the 1053 women examined, 25.4% (268/1053) were Ureaplasma positives. The rates of U. urealyticum and U. parvum were 12.1% (128/1053) and 7% (74/1053), respectively, and the copresence of these biovars was noted in 6.3% (66/1053) cases. The U. parvum subtyping revealed a predominance of the serovar 3/14 (61.4%). The association of demographics variables with Ureaplasma biovars was studied and shows that the age ("<30" years) seems to be a risk factor of Ureaplasma spp. and U. urealyticum carriage (OR 1.729, 95% CI [1.113-2.687] and OR 1.848, 95% CI [1.026-3.330], respectively). There was no difference in the prevalence of Ureaplasma type regarding symptoms. However, a significant association was found between U. parvum serovar 1 and infertility (P = 0.011). Conclusion: This first study conducted in Morocco provides an idea on Ureaplasma biovars and U. parvum serovars circulating in this region, their associated risk factors, and genital STI-related symptoms. Therefore, further studies are required to clarify and confirm the pathogenic role of these Ureaplasma species.

Molecular Antimicrobial Resistance of Neisseria gonorrhoeae in a Moroccan Area.

Objectives: To identify the prevalence and the types of Neisseria gonorrhoeae (NG) resistance plasmids-mediated penicillin (PPNG) and tetracycline (TRNG), the ciprofloxacin resistance (CRNG), and related risk factors of each types of resistance. Methods: The beta-lactamase-producing plasmid types (Africa, Asia, and Toronto), tetM tetracycline resistance plasmid types (America and Dutch), and the determination of the Ser-91 mutation of GyrA were detected by specifics PCRs on 149 diagnosed NG positives samples followed by Hinf1 digestion for tetM and gyrA mutation. Results: 135 (90.1%) samples showed a profile of molecular resistance to at least one antibiotic with predominance of ciprofloxacin resistance. In fact, 36 (24.2%) and 69 (46.3%) cases harbored PPNG and TRNG, respectively, and 116 (77.9%) cases showed the mutation Ser-91 of GyrA (CRNG). From a total of 36 PPNG isolates, the Toronto, Asian, and Toronto/Asian types were detected in 13 (36.1%), 10 (27.8%), and 13 (36.1%) cases, respectively, whereas the African type was not detected. In addition, the American type of TRNG was detected in 92.8% (64/69) of cases, while the Dutch type was detected in 7.2% (5/69) of cases. The association of demographics and clinical variables with NG resistance to ciprofloxacin, penicillin, and tetracycline was studied and the risk factors have been determined. Conclusion: Resistance to penicillin, tetracycline, and ciprofloxacin among NG samples positives remained at high levels in Morocco as determined by molecular profile. So, the use of molecular tools for NG antimicrobial resistance detection can help in the management and spread limitation of this infection.

Cancer hallmarks and malignancy features: Gateway for improved targeted drug delivery.

Cancer chemotherapy is mainly based on the use of cytotoxic compounds that often affect other tissues, generating serious side effects which deteriorate the quality of life of patients. Recent advancements in targeted drug delivery systems offer opportunities to improve the efficiency of chemotherapy, by the use of smaller drug doses with reduced side effects. In the gene therapy approach, this consists in improving the transformation potential of the gene delivery system. Interestingly, these systems further provide good platforms for the delivery of hydrophobic and low-bioavailability compounds, while facilitating the penetration of the blood-brain barrier. The present report provides an overview of biologically relevant cancer hallmarks that can be exploited to design effective delivery vehicles that release cytotoxic compounds specifically in cancer tissues, in a targeted manner. The relevance of each cancer marker is presented, with particular emphasis on the generation of these hallmarks and their importance in cancer cell biology.

Awareness of cervical cancer among women attending an HIV treatment centre: a cross-sectional study from Morocco.

OBJECTIVE: To explore awareness about cervical cancer among Moroccan women attending an HIV treatment centre in Laâyoune city, Morocco. DESIGN: A cross-sectional study was conducted from April to June 2017 using a knowledge test regarding cervical cancer, its risk factors and its prevention. SETTING: HIV treatment centre at the Hospital of Moulay Hassan Ben Elmehdi in Laâyoune city, Morocco. PARTICIPANTS: One hundred and twenty-three HIV-positive women aged 19 years and older were recruited to this study. RESULTS: A total of 115 women were eligible to participate in the study. The average age was 34.9±10.2 years. Few women (20%) had heard about cervical cancer and its screening, the majority (17.4%) having received information from mass media. The vast majority (79.1%) of respondents had no knowledge of cervical cancer risk factors, and 80.8% did not know any symptoms of cervical cancer. Only 13% had undergone a Pap smear test. The main reason for not seeking Pap smear was the absence of symptoms (47%). CONCLUSION: Our study documents poor awareness of cervical cancer. Given that the HIV-positive population is at increased risk of cervical cancer, health education programmes should be promoted to increase awareness of cervical cancer as well as access and participation in cervical cancer screening.

Cervical Cancer Induction Enhancement Potential of Chlamydia Trachomatis: A Systematic Review.

Human papillomavirus (HPV) persistent infection is the necessary but not sufficient cause of cervical cancer. Other co-factors are required to induce cell transformation that will evolve to malignant cervical cancer. These co-factors include physical elements, other sexually transmitted infections, and immune response. Chlamydia trachomatis the most common bacterial sexually transmitted infection is often asymptomatic but causes various syndromes such as cervicitis, endometritis, pelvic inflammatory disease, and infertility. It is established that this bacterium is involved in cell proliferation process and inhibit apoptosis. Furthermore, C. trachomatis may induce chronic inflammation, interfere with immune response by decreasing the number of antigen presenting cells, and reduce the cell-mediated immunity allowing the persistence of HPV. However, it is unclear whether this bacterium plays a particular role in cervical cancer induction. We therefore aimed at enlightening the actual knowledge about the relationship between C. trachomatis and cervical cancer or precursor lesions through a systematic literature review. We summarized and analyzed the epidemiological data on C. trachomatis and its co-infection with HPV and their association to cervical cancer.

Distribution of Carcinogenic Human Papillomavirus Genotypes and Association to Cervical Lesions among Women in Fez (Morocco).

OBJECTIVES: To determine the distribution of cervical high-risk human papillomavirus genotypes and their association to cellular abnormalities in women from Fez and its neighborhood. METHODS: Women attending the Hassan II University Hospital for cervical pap smears were recruited after an informed consent. Interviews and two cervical samples were performed for each woman. Cervical samples were used for cytological analysis and HPV DNA detection. HPV was typed using a method based on multiplex PCR with fluorescently labeled specific primers followed by capillary electrophoresis. The study was approved by the ethics committee of the Faculty of Medicine and Pharmacy of Fez. RESULTS: The HPV prevalence in the studied population was 43.1% and the most prevalent types were HPV 53 (23 cases); HPV 16 (20 cases); HPV 35 (18 cases); HPV 51 (10 cases) and HPV 56 (7 cases). From the 619 confirmed pap smears, 20% were abnormal. The cytological abnormalities were significantly associated to HPV infection, women age, number of pregnancies and parity (p < 0.05). CONCLUSION: More attention should be given to HPV in Morocco because it represents an important public health concern. The distribution of carcinogenic HPV types in the studied population is different from the data in other regions but epidemiological studies in other Moroccan regions are required.

Human papillomavirus infection and fertility alteration: a systematic review.

BACKGROUND: HPV is the most prevalent sexually transmitted infection and its effect in cancer induction is well documented. HPV infections are mostly asymptomatic, but it is unclear whether HPV infections can result in alterations of reproductive health. OBJECTIVE: To determine the relationship between human papillomavirus infections and reproductive health in both men and women. METHODS: A systematic literature review was performed in PubMed and ScienceDirect data bases from January 1994 through August 2014. RESULTS: HPV infections are shown to be significantly associated to many adverse effects in the reproductive function. These adverse effects were reported in different levels from cells production to pregnancy and may be related to the infecting genotype. CONCLUSIONS: It appears from this study that HPV detection and genotyping could be of great value in infertility diagnosis at least in idiopathic infertility cases. Like for the risk of carcinogenesis, another classification of HPV regarding the risk of fertility alteration may be considered after deep investigations.

Oncogenic human papillomavirus genotyping by multiplex PCR and fragment analysis.

Human papillomavirus (HPV) detection and genotyping are determinant in cervical cancer prevention. They help to identify women at risk and allow the establishment of epidemiologic profiles. Many PCR-based genotyping methods have been developed. They require many steps or specialized equipment increasing the assay duration and cost. This affects their routine use, especially in developing countries. Therefore, the aim of this study was to develop a new HPV genotyping method that can be routinely used also in low incomes countries. For this purpose, fifteen high risk HPV type specific reverse primers were designed on L1 gene and fluorescently labeled. These primers were used on two multiplex PCR with one common forward primer (MY11). The lengths of products were revealed by capillary electrophoresis. This technique identifies sixteen high risk HPVs (types 16, 18, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 68, 73 and 82). It was optimized on HPV genome plasmids and evaluated on artificial and cervical samples. All the sixteen targeted genotypes were identified specifically and repeatedly in simple and multiple infections in both artificial and clinical samples. The developed technique is sensitive, specific, easy to perform and appropriate for routine laboratory use and high throughput screening programs.