Cluster analysis of dietary patterns associated with colorectal cancer derived from a Moroccan case-control study.

INTRODUCTION: Colorectal cancer (CRC) is a global public health problem. There is strong indication that nutrition could be an important component of primary prevention. Dietary patterns are a powerful technique for understanding the relationship between diet and cancer varying across populations. OBJECTIVE: We used an unsupervised machine learning approach to cluster Moroccan dietary patterns associated with CRC. METHODS: The study was conducted based on the reported nutrition of CRC matched cases and controls including 1483 pairs. Baseline dietary intake was measured using a validated food-frequency questionnaire adapted to the Moroccan context. Food items were consolidated into 30 food groups reduced on 6 dimensions by principal component analysis (PCA). RESULTS: K-means method, applied in the PCA-subspace, identified two patterns: 'prudent pattern' (moderate consumption of almost all foods with a slight increase in fruits and vegetables) and a 'dangerous pattern' (vegetable oil, cake, chocolate, cheese, red meat, sugar and butter) with small variation between components and clusters. The student test showed a significant relationship between clusters and all food consumption except poultry. The simple logistic regression test showed that people who belong to the 'dangerous pattern' have a higher risk to develop CRC with an OR 1.59, 95% CI (1.37 to 1.38). CONCLUSION: The proposed algorithm applied to the CCR Nutrition database identified two dietary profiles associated with CRC: the 'dangerous pattern' and the 'prudent pattern'. The results of this study could contribute to recommendations for CRC preventive diet in the Moroccan population.

Direct Healthcare Cost of Ischemic Stroke Management in Morocco.

BACKGROUND: Strokes are a group of heterogeneous conditions that can cause lasting brain damage, long-term disability, or even death. In Morocco, the management of this disease generates important expenses and increases the financial burden on health care. In order to rationalize the expenses and to direct the budgetary policy in healthcare, we aimed to estimate the cost of ischemic stroke (IS) management in Morocco through this study. METHODS: A cost-of-illness study was conducted between March 2018 and March 2019 at the neurology department of the Hassan II University Hospital, Fez. We included all patients who were admitted, during this period, to the department for IS. The collected data included sociodemographic information, and all details regarding the patient's medical management (diagnosis, treatment, etc.). The cost was estimated using a "bottom-up micro-costing" approach with a societal perspective. RESULTS: A total of 267 individuals were included in this study with a female predominance (56.6%); the mean age was 66.93 ± 14.83 years. The total cost of ischemic stroke management per patient per year was estimated at $3674.32 ± 1340.81, with a high share related to hospitalization at $1415.06 ± 1015.53. A statistically significant association was found between total cost and age (p=0.014), National Institutes of Health Stroke Scale (NIHSS) score (p≤0.001), and length of hospitalization (p≤0.001); however, no association was found with other factors (sex, complication, Rankin score, etc.). CONCLUSION: Ischemic strokes are relatively frequent in Morocco. Their management generates an important cost, which is influenced by several factors such as severity of the disease and the duration of hospitalization. This cost can be decreased by rationalizing the expenses and acting on various risk factors of ischemic strokes.

Anxiety and Depression in Patients With Chronic Respiratory Diseases in the Fès-Meknès Region of Morocco.

Background Chronic respiratory diseases (CRDs) are a major public health problem in Morocco. Several studies have shown that anxiety and depression are important comorbidities of CRDs and are often associated with CRDs. This study aimed to estimate the prevalence of depression and anxiety and identify their determinants in patients with CRDs. Methodology A cross-sectional study was conducted in the Pneumology Department at the Hassan II University Hospital in Fez in 2021. An anonymous questionnaire was used to collect sociodemographic, clinical, and therapeutic data. The Moroccan version of the Hospital Anxiety and Depression Scale (HADS) was used to measure depression and anxiety. A descriptive analysis was performed, followed by a bivariate analysis to investigate the association between anxiety and depression and other factors using tests appropriate to the types of variables studied. A p-value ≤0.05 was considered significant. Data entry was performed in Excel 2013 (Microsoft Corp., Redmond, WA, USA), and data analysis was done using SPSS software version 26 (IBM Corp., Armonk, NY, USA). Results The study included 209 patients, 50.7% (n = 106) of whom were female, with an average age of 57.84 ± 15.36 years. Chronic obstructive bronchopneumopathy was the most represented CRD (43.1%; n = 90), followed by asthma (32.2%; n = 67). The prevalence of depression and anxiety was 46.4% (n = 97) (95% confidence interval (CI) = 39.2-52.8) and 57.4 % (n = 120) (95% CI = 50.3-63.7), respectively. In the univariate analysis, depression was associated with the presence of dyspnea (51.3% vs. 32.7%; p = 0.018), the presence of asthenia (56.5% vs. 38.5%; p = 0.009), the use of oxygen therapy (66.7% vs. 42.7%; p = 0.015), and a higher number of hospitalizations (76.9% vs. 44.4%; p = 0.023). Moreover, 87.6% of patients with depression also had anxiety (p < 0.001). Anxiety was associated with a history of surgery (37.2% vs. 62.4%; p = 0.003) and with the presence of chronic obstructive pulmonary disease (66.7% vs. 50.4%; p = 0.019). Conclusions The results reveal the importance of screening for anxiety-depressive disorders in patients with CRDs and taking into account psychological aspects in the management of the disease to improve quality of life.

Validation of the Moroccan Arabic Version of the Pediatric International Knee Documentation Committee Score (Pedi-IKDC) Questionnaire for Children With Knee Disorders.

Background The Pedi International Knee Documentation Committee (Pedi-IKDC) is a questionnaire for the evaluation of knee function in children and adolescents with knee disorders. It has been translated and validated into many languages. The aim of this study was to translate this questionnaire into Moroccan Arabic and evaluate its psychometric properties in a pediatric population. Methods The original English version of the questionnaire was translated into Moroccan Arabic according to international guidelines. The Arabic version was administered twice to two groups: a group of children with knee disorders and a control group, and the following properties were calculated: reliability, internal consistency, and discriminant validity. The reliability was assessed using the intraclass correlation coefficient (ICC), standard error of measurement (SEM), and smallest detectable change. Internal consistency was evaluated using Cronbach's alpha. Results A total of 88 cases and 33 controls, aged between 6 and 16 years old, completed the questionnaire. The Pedi-IKDC showed adequate test-retest reliability (interclass correlation coefficient (ICC =0.89), standard error of measurement (SEM= 5.45), smallest detectable change (SDC=15.11), and appropriate internal consistency (Cronbach alpha= 0.7). The Pedi-IKDC was also able to distinguish between patients and controls (P<0.0001). Conclusion The Moroccan-Arabic version of the Pedi-IKDC showed acceptable psychometric properties and can be used in children with knee disorders.

The Impact of Systemic Lupus Erythematosus-Related Respiratory Manifestations on the Quality of Life and Psychological Health of Patients During the COVID-19 Pandemic.

Introduction Respiratory manifestations are common among patients with Systemic Lupus Erythematosus (SLE) and can present as chest pain, dyspnea, and cough and are often accompanied by fever. These symptoms can resemble those of COVID-19, which may cause increased anxiety in SLE patients. Therefore, the aim of this study is to investigate the impact of SLE-related respiratory manifestations on anxiety, depression, and quality of life among SLE patients during the COVID-19 pandemic. Patients and methods The study involved SLE patients and was conducted in the year 2020, after the start of the pandemic in Morocco, using a cross-sectional design. Anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale (HADS), while the quality of life was assessed using the Short Form-12 Health Survey (SF12). Statistical analysis was performed using R software (R Foundation, Vienna, Austria). Results A total of 102 SLE patients, with an average age of 41.6 ± 13.7 years, participated in the study, of whom 92.2% were female. Respiratory manifestations were reported by 20.6% of the patients, and there were no significant differences observed in the general characteristics of the study population between the two groups with and without SLE-related respiratory manifestations. The study found that the prevalence of anxiety and depression was significantly higher in patients with SLE-related respiratory manifestations (50% Vs. 76,2% and 50% Vs. 85,7% successively). These patients also reported significantly more impairment in their physical quality of life (31.8 ± 8.9 Vs. 38.5 ± 10.9). This was observed across three domains of the SF12 survey, including physical functioning (34.4 ± 11.4 Vs. 39.9 ± 11.7), bodily pain (26.9 ± 11.2 Vs. 36.1 ± 14.3), and general health (28.6 ± 10.7 Vs. 35.2 ± 12.3). Although the association between mental quality of life and respiratory manifestations did not reach statistical significance (33.5 ± 12.5 Vs. 39.1 ± 11.5), there was a trend toward poorer mental quality of life in patients with SLE-related respiratory manifestations. Moreover, two domains of mental quality of life were significantly more affected in these patients, namely "social functioning" (30.6 ± 11.3 Vs. 38.7 ± 12.4) and "role-emotional" (26.8 ± 11.6 Vs. 33.8 ± 10.8). Conclusion During the COVID-19 pandemic, the presence of SLE-related respiratory manifestations appeared to be associated with a more negative impact on the psychological health and quality of life of SLE patients.

The Double Burden of Obesity and Underweight in Yemeni Adults.

INTRODUCTION:  Yemen has a unique low-income population with several sociopolitical challenges and the association between weight disorders and sociodemographic and lifestyle factors is not clearly understood. AIM:  The aim of this study is to estimate the prevalence of obesity, overweight and underweight among Yemeni adults, and to identify their associated factors. METHODS: A cross-sectional study was conducted from 11 January to 25 March 2020, including 561 subjects of Yemen's adult population aged 18 and above, from four Yemeni governorates, who answered a questionnaire including demographic, socio-economic, and physical activity items after getting their signed consent. Height and weight were measured, and body mass index (BMI) was computed. The association between obesity or overweight (BMI ≥ 25.0kg/m2) or underweight (BMI < 18.5 kg/m2) and the other variables was analyzed using multinomial logistic regression. RESULTS: A total of 561 subjects aged ≥ 18 years have participated in this survey. The overall prevalence of obesity and overweight was 10.3%, 95% CI [7.7%; 12.8%] and 20.3%, 95% CI [17%; 23.5%] respectively, while the one for underweight was 21.2%, 95% CI [17.8%; 24.5%]. The risk of overweight-obesity increased with age (OR=1.02, 95% CI (1.01-1.03)), living in urban areas (OR= 1.680, 95% CI (1.105-2.552)) and average-high socioeconomic status (SES) (OR= 1.729, 95% CI (1.156-2.587)) while the risk of underweight decreased with the age (OR= 0.981, 95% CI (0.964-0.998)). CONCLUSION: These findings provide a special case of high prevalence of obesity, overweight, and underweight in Yemen. Therefore, implementing awareness and prevention programs is highly recommended there.

The Moroccan Knee Osteoarthritis Outcome Score (KOOS)-Child Scale: Translation, Cultural Adaptation, and Validation.

Objective The objective of this study was to perform a cross-cultural validation and adaptation of the Moroccan Dialectal Arabic version of the Knee Osteoarthritis Outcome Score (KOOS)-Child scale. Methodology Two groups of participants were recruited: a group of children affected by knee problems and another group serving as a control, free of any knee pathology. Participants were asked to complete the KOOS-Child scale twice with a minimum interval of 15 days. Results This study included 130 patients aged 9.82 ± 3.16 years, comprising 88 (67.7%) patients with knee problems and 42 (32.3%) controls. The baseline comparison showed no statistically significant difference between the two groups. The KOOS-Child scale was translated into Moroccan Dialectal Arabic without encountering difficulties in the translation and cross-cultural adaptation process. It proved practical, reliable, and suitable for assessing problems that children and adolescents with knee disorders may encounter. The scale exhibited good content validity and test-retest reliability. The Moroccan scale also demonstrated excellent internal consistency, except for the symptoms subscale. Confirmatory factor analysis indicated that the structure of the Moroccan version of the KOOS-Child scale was acceptable. Conclusions The Moroccan KOOS-Child scale exhibited good acceptability, reliability, discriminative capacity, and overall good internal consistency, with the exception of the symptoms subscale.

Expression of Histo-blood Group Antigens in Tumor and Adjacent Normal Breast Tissues as Prognostic Markers of Breast Carcinoma.

PURPOSE: Aberrant glycosylation of the histo-blood group antigens (including the angina bullosa haemorrhagica [ABH]) is often observed during malignant transformation in most types of carcinomas. Data concerning their ethnic distributions are diverse which explains why their biological characteristics have to be studied in different populations. Our aim was to analyze the expression of the histo-blood group (specifically the ABH) antigens in breast carcinoma. METHODS: The expression of the histo-blood group (specifically the ABH) antigens was studied in 109 patients with breast carcinoma using immunohistochemistry. Statistical analysis was performed using χ2 and Fisher analyses. RESULTS: The loss of expression of histo-blood group (ABH) antigens in breast carcinoma was observed in 81.13% of patients with blood group O, 37.93% with blood group A, and 96.30% with blood group B. One key finding of this study was that the loss of expression of the ABH antigen was also observed in normal tissues adjacent to the tumor. The loss of expression was associated with higher tumor grade (p < 0.05). Expression of H antigen was observed in 50% of cases with loss of expression of B antigen and was associated with human epidermal growth factor receptor 2 (HER2) overexpression (p < 0.05). The loss of H antigen in patients with blood group O was associated with estrogen receptor expression (p < 0.001). Incompatible A antigen in tumor was expressed in 20.75% of patients with blood group O. CONCLUSION: Loss of the ABH antigens correlated with the Scarff-Bloom-Richardson histologic grading. H antigen was associated with HER2 overexpression in breast cancer. However, further studies are needed to determine the role of incompatible A antigen in mammary carcinogenesis.

Cross-cultural adaptation and validation of the Moroccan version of the incontinence quality of life questionnaire (I-QoL) in urinary incontinence patients.

OBJECTIVE: Because of the importance and prevalence of incontinence in women, there is growing interest in the development and use of well-designed quality of life questionnaires. The objective of this study is to adapt and validate, the I-QoL, a quality of life questionnaire, in Moroccan dialect, and to assess its psychometric properties in people suffering from urinary incontinence STUDY DESIGN: One hundred patients (77 % female) with a symptom of urinary incontinence participated in the study and filled out the Moroccan version of the questionnaire. The reliability and validity of the questionnaire were assessed by Cronbach's alpha coefficient (α), the intraclass correlation coefficient (ICC), and confirmatory factor analysis. RESULTS: The results showed that the Moroccan version of the I-QOL has very good psychometric properties. The overall I-QoL summary score and subscales showed high internal consistency (alpha ranging from 0.94 to 0.99). Inter-rater reliability was substantial for the three subscales and the total score. The ICC, assessing reproducibility at two weeks, ranged from 0.89 to 0.99, demonstrating the stability of the scores. The I-QOL was able to discriminate between different levels of self- perceived severity. Significant differences in I-QOL scores (p<0.001) were observed when comparing I-QOL scores by the number of incontinence-related medical visits made by patients during the past year. CONCLUSION: The Moroccan version of the I-QOL is a valid and reliable tool to determine the influence of urinary incontinence on health-related quality of life in Moroccan persons.