Prevalence and predictive determinants of overweight and obesity in children aged 0-24 months in Morocco: a cross-sectional study.

Background: Preventing overweight and obesity in early childhood is a priority for healthcare systems worldwide due to the harmful effects on health and economy over the medium and long term. Objective: The aim of this study is therefore the identification of the determinants predictive of overweight and obesity during the first 24 months of a child's life. Material and Methods: From May 2021 to January 2022, 1012 mother-child pairs were included in this study and were interviewed at urban and rural health centers in the Skhirat-Temara in Morocco prefecture using a questionnaire. The anthropometric measurements of the children were also taken according to World Health Organization standards. Results: The prevalence of overweight and obesity in children aged 0-24 months was 16.5%. This prevalence increased with age (12.5% for the 0-6 months group, and 15.5% and 21.5% respectively for the 7-12 months and 13-24 months groups). Cesarean delivery (aOR=1.78; 95%CI: 1.26-2.51; p=0.001), more than two living siblings in the household (aOR=1.48; 95%CI: 1.03-2.12; p=0.03), male gender (aOR=1.56; 95%CI: 1.10-2.20; p=0.01), and child age (aOR=0.94; 95%: 0.92-0.97; p <0.001) are significant predictors of overweight and obesity. Paternal smoking (aOR=2.16; 95%CI: 1.15- 4.06; p=0.01), short sleep duration (aOR=4.05; 95%CI: 1.27-12.88; p=0.01) in children aged 7-12 months, and combined breastfeeding (aOR=5.88; 95%CI: 2.07-16.72; p<0.001) during the first six months in children aged 13-24 months are also predictive determinants for this problem. Conclusion: The identification of early predictors of overweight and obesity can be used by public health decision-makers as a roadmap for action to prevent and improve health.

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 national moroccan registry of ST-elevation myocardial infarction (MR-MI).

BACKGROUND: MR-MI is the first national Moroccan ST-elevation myocardial infarction (STEMI) registry. Its objectives are to assess patient management modalities and highlight the clinical and therapeutic characteristics of this pathology in all cardiology centres on a national scale. METHODS: Adult patients presenting with STEMI within 5 days of symptoms onset were enrolled over a period of 18 weeks from April to August 2018. 57 cardiology centres distributed in 22 cities in Morocco participated in the study, including 5 university hospitals, representing 70% of Moroccan centres managing STEMI patients. A case report form was sent to the investigators in both electronic and paper forms. Sociodemographic, clinical, management, revascularization, and follow-up data were collected. RESULTS: A total of 809 patients were recruited. The population was mostly male (74.8%) with an average age of 62.6 ± 11.6 years. The most common risk factors were smoking (38.3%) arterial hypertension (30.7%), and diabetes (28%). 30% of patients were admitted within the first 6 h of symptoms onset and early revascularization was performed on 49.6%. Mortality rate was 5.2% in-hospital and 3.2% at the one-month follow-up. CONCLUSION: MR-MI is the first Moroccan STEMI registry on a national scale. Relevant management delays are much longer than other countries, and less than 50% of the patients that present on time benefit from early revascularization. Efforts remain to be done on the optimal diagnosis and treatment of STEMI.

Role of preoperative neutrophil to lymphocyte ratio in prediction of recurrence, progression, and BCG failure in non-muscle invasive bladder cancer: a retrospective study.

Introduction: neutrophil/lymphocyte ratio (NLR), as a biomarker of the systemic inflammatory response, has been studied for diverse tumors. Our study aims to determine whether the NLR can be reliably used as a tool to predict disease course in patients diagnosed with primary non-muscle invasive bladder tumors (NMIBC). Methods: a retrospective study between 2009 to 2014 was conducted on 300 patients newly diagnosed with NMIBC at our institution. The cut-off value of NLR was set at 2.5. Survival curves were compared using the log-rank test. The association between recurrence, progression, and NLR was assessed univariate, and the prognostic significance of high NLR was assessed using multivariate analysis. Results: one hundred and seventy-five patients had an NLR <2.5 and 125 patients had an NLR ≥ 2.5. The survival rate with recurrence at 5 years was higher in the group with an NLR >2.5 (p<0.001, 35 vs 18 months), similarly, the survival rate with progression at 5 years was higher in the group with an NLR > 2.5 (p=0.001, 36 vs. 27 months). The failure rate of immunotherapy using BCG was higher when the NLR was over 2.5. In a multivariate analysis, the factors associated with recurrence were NLR>2.5 (HR=2.03, 95% CI=1.32-3.11, p=0.001), pathologic stage pT1 (HR=2.42, 95% CI=1.52-3.85, p=0.001), high-grade (HR=1.76, 95% CI=1.52-3.92, p=0.01), concomitant CIS lesions (HR=2.31, 95% CI=1.36-3.92, p=0.001), presence of lymphovascular emboli (HR=5.77, 95% CI=1.77-18.78, p=0.004), and BCG immunotherapy failure (HR=5.29, 95% CI=2.88-9.70, p=0.001). With regard to progression, in a multivariate study, the significant factors were NLR>2.5(HR=2.91, 95% CI=1.17-7.23, p=0.01), BCG immunotherapy failure (HR=5.68, 95% CI=3.16-10.22, p=0.001), and the presence of lymphovascular emboli (HR=5.01, 95% CI=1.50-16.05, p=0.001). Conclusion: preoperative NLR value could predict recurrence, progression, and failure of BCG immunotherapy in NMIBC patients.

Circulating microRNA profiles in Wilms tumour (WT): A systematic review and meta-analysis of diagnostic test accuracy.

Background: Wilms tumour (WT) is caused by aberrant embryonic kidney development and associated with dysregulated expression of short, non-protein-coding RNAs termed microRNAs (miRNAs). At present, there is no reliable circulating biomarker of WT, and this remains an urgent unmet clinical need. Such biomarkers may assist diagnosis, subtyping/prognostication, and disease-monitoring. Here, we established the list of dysregulated circulating miRNAs in WT from the existing published literature. Methods: Regardless of publication date, PubMed, Scopus, Web-of-Science, and Wiley online library databases were searched for English/French studies on WT circulating miRNAs. The PRISMA-compliant search was registered in PROSPERO. The QUADAS tool measured retained article quality. The meta-analysis assessed the sensitivity and specificity of miRNAs for WT diagnosis. Results: Qualitative analysis included 280 samples (172 WT patients; 108 healthy controls) from five of 450 published articles. The study uncovered 301 dysregulated miRNAs (144 up-regulated, 143 down-regulated, 14 conflicting). The pooled sensitivity, specificity, and AUC of the 49 significantly dysregulated microRNAs from two studies was 0.67 [0.62; 0.73], 0.95 [0.92; 0.96] and 0.77 [0.73; 0.81] respectively, indicating a stronger diagnostic potential for WT. Conclusions: Circulating miRNAs show promise for WT diagnosis and prognosis. More research is needed to confirm these findings and determine associations with tumour stage/subtype. Prospero registration number: CRD42022301597.

Characteristics of Late-Onset Spondyloarthritis: Data from the Moroccan Registry of Biological Therapies in Rheumatic Diseases.

Introduction The Assessment of SpondyloArthritis International Society (ASAS) criteria for axial and peripheral spondyloarthritis (SpA) allow for the classification of patients with an age of onset of disease of less than 45 years. However, SpA can start after this age. This study aimed to assess the characteristics of late-onset SpA (SpA>45 years) in the Moroccan registry of biological therapies in rheumatic diseases (RBSMR). Methods A cross-sectional study was conducted using the baseline data of the RBSMR. The protocol for the original RBSMR study was reviewed and approved by the Ethics Committee for Biomedical Research Mohammed V University - Rabat, Faculty of Medicine and Pharmacy of Rabat (approval number for the study was 958/09/19, and the date of approval was September 11, 2019), and all patients had given their written consent. Patients who met the 2009 ASAS criteria for SpA were included. They were divided into two groups: early-onset SpA (≤ 45 years) and late-onset SpA (>45 years). Clinical, biological, radiological, and therapy data of the two groups were compared. Statistical analysis was performed using SPSS v25 software (IBM Corp. Armonk, NY). Parameters with a p-value ≤0.05 were considered significant. Results Our population consisted of 194 patients. Thirty-one patients (16%) had late-onset SpA. Comparison between patients with early-onset (≤45 years) and late-onset SpA (>45 years) revealed that late-onset SpA had a higher tender joint count (p=0.01), a higher swollen joint count (p=0.02), depression (p=0.00), fibromyalgia (p=0.001), hypercholesterolemia (p=0.01), and a lower frequency of coxitis (p=0.008). Logistic regression analysis confirmed that late-onset SpA was associated with a higher tender joint count (OR=0.93, CI 95%: 0.88-0.98), a higher swollen joint count (OR=0.92, CI 95%: 0.85-0.99), depression ( OR=0.19, CI 95%:0.04-0.38), fibromyalgia (OR=1.75, CI 95%: 1.74-17.85), and a lower frequency of coxitis ( OR=0.29, CI 95%: 0.11-0.75). Conclusion As life expectancy increases, late-onset SpA will become increasingly common. It is therefore imperative to determine its characteristics. In the RBSMR study, late-onset SpA was associated with a high number of tender and swollen joints, depression, fibromyalgia, and a lower frequency of coxitis.

Varicella-zoster virus in actively spreading segmental vitiligo skin: Pathological, immunochemical, and ultrastructural findings (a first and preliminary study).

Segmental vitiligo (SV) is a unilateral subtype of vitiligo which is clinically characterized by a cutaneous depigmentation and histologically by a melanocyte loss from the epidermis and hair follicle reservoirs. To date, its pathogenesis remains a mystery. In many cases, this skin depigmentation shares several clinical features and dysfunctions with herpes zoster (HZ). So, for the first time, we examined whether any nucleus and cell fusion associated with a positive immunolabelling of varicella-zoster virus (VZV) and VZV mature virions could be found in SV skin samples as in herpes zoster (HZ). A total of 40 SV samples were used for histological and immunochemical studies. Control samples were obtained from three HZ, and 10 generalized vitiligo lesions. For ultrastructural study, three recent SV and one HZ as controls were recruited. Here, we report that nuclear fusion in epidermal cells were statistically associated with recent SV (p < .001), whereas syncytia formation was associated with long-lasting SV (p = .001). A positive detection of VZV antigen was statistically associated in the epidermis with recent SV and in the dermis with long-lasting SV (p = .001). Finally, the discovery of mature virions in 3/3 recent SV samples provides additional arguments for our viral hypothesis.

Glioma dataset from Rabat: Clinicopathological, immunohistochemical and disease progression features of 32 Moroccan patients with diffuse Glioma.

The Moroccan Glioma Dataset contains the clinical data of 32 patients with glioma. The clinical data including demographic data (age, sex), tumor characteristics (tumor location, Glioma type, Karnofsky performance score, mitotic activity, cell density, necrosis, endotheliocapillary vascular proliferation, MRI contrast pick-up, corpus collosum infiltration and Oedema), treatment strategy (subtotal resection, gross resection, biopsy, radiotherapy, chemotherapy), expression pattern of tumor biomarkers (IDH1, HIF-1alpha, P53, Ki-67), and survival data (Kaplan-Meier curves for disease progression). The dataset can be used to relate tumor characteristics to tumor biomarkers and to predict disease progression for a better treatment management. The data were presented, analyzed, and described in the article "Immunohistochemical expression of HIF-1α, IDH1 and TP53: prognostic profile of Moroccan patients with diffuse glioma" published in Journal of Chemical Neuroanatomy [1].

Immunohistochemical expression of HIF-1α, IDH1 and TP53: Prognostic profile of Moroccan patients with diffuse glioma.

Diffuse gliomas are growing brain tumors that occur in adult life. This study was designed to determine whether the immunohistochemical analysis of IDH1, HIF-1alpha, or TP53 can provide useful biomarkers of clinical severity and progression of diffuse gliomas. Also, it is hypothesized that the expression of IDH1 mutant induces HIF-1alpha. Immunohistochemical staining for HIF-1alpha, IDH1, and TP 53 was performed in biopsy or resection (sub-total or gross-total) tissue from diffuse gliomas in a clinical series of 32 patients. Associations of the HIF-1alpha, IDH1, and TP53 with clinical characteristics were evaluated and the co-expression of two biomarkers (HIF-1alpha and IDH1) was tested. Our data revealed that each biomarker is expressed in a subset of gliomas (IDH1 was positive in 56% cases, HIF-1alpha was positive in 50% cases and TP53 was positive in 44% cases). While no associations were found between clinical characteristics and the expression of HIF-1alpha, and TP53, IDH1 expression was associated with less severe clinical presentation (Karnofsky Performance Status) and disease progression and was more often expressed in females than males. In addition, there was no clear association between IDH1 and HIF-1alpha expression (21.9% of patients co-expressed IDH1 and HIF-1alpha). The current series provides clinical and immunohistochemical findings that can be useful for the clinical management of patients with diffused gliomas.

Correlation of immunohistochemical expression of HIF-1alpha and IDH1 with clinicopathological and therapeutic data of moroccan glioblastoma and survival analysis.

INTRODUCTION: Glioblastomas are aggressive primary intracranial tumours of the central nervous system causing significant mortality and morbidity worldwide. OBJECTIVE: This study aims to evaluate the prognostic value of tissue expression by immunostaining of hypoxia-inducible factor (HIF-1α), isocitrate dehydrogenase 1 (IDH1), and tumour protein p53 in glioblastoma in Moroccan patients. The association of HIF-1α, IDH1, and p53 expression with the clinicopathological data and overall patient survival (OS) was also evaluated. MATERIALS AND METHODS: Confirmed glioblastomas were included in this study. Twenty-two tissue samples were obtained by neurosurgical intervention resulting from total resection, and subtotal resection or biopsy. Karnofsky index, histological type of tumour, and the status of IDH1, p53 protein, and HIF-1α expression by immunostaining were reported. RESULTS: The majority of the patients were males (64%) with a sex ratio of 1.75. The average age was 54 ± 13. Median follow-up was 10.10 months and median overall survival was 10 months. The expression of HIF-1α was high in 10 samples (45%) and low in 12 (55%). There was a statistically significant difference in OS of 85% at 12 months for the subgroup of patients "HIF-1α negative IDH1 positive" p = 0.038, the unadjusted analysis showed that the group "HIF-1α positive, IDH1 positive" was a poor prognostic factor, the HR was 0.08 (95% CI: 0.009-0.756, p = 0.027). CONCLUSION: Patients with negative HIF-1α expression and positive IDH1 expression have a better prognosis, suggesting that these two biomarkers may be useful in the search for new approaches for targeted therapy in glioblastoma.

The first biological choice in patients with rheumatoid arthritis: data from the Moroccan register of biotherapies.

INTRODUCTION: the aim of our study is to determine, from data of the Moroccan register of biotherapies, the factors influencing the choice of the first prescribed biological treatment. METHODS: cross-sectional multicenter study including rheumatoid arthritis patients who were initiated the first biological treatment either: Rituximab, an anti-TNF, or Tocilizumab. The determinants related to the patient and disease have been gathered. A univariate and then multivariate analysis to determine the factors associated with the choice of the first bDMARDs was realized. RESULTS: a total of 225 rheumatoid arthritis patients were included in the Moroccan registry. The mean age was 52 ± 11 years, with female predominance 88% (n = 197). The first prescribed biological treatment was Rituximab 74% (n = 166), the second one was Tocilizumab, 13.6% (n = 31) then comes the anti-TNF in 3rd position with 12.4% (n = 28). The factors associated with the choice of Rituximab as the first line bDMARDs prescribed in univariate analysis were: the insurance type, the positivity of the rheumatoid factor. In multivariate analysis, only the insurance type that remains associated with the choice of Rituximab as the first biological drugs. The Tocilizumab was associated with shorter disease duration and was more prescribed as mono-therapy compared to non Tocilizumab group. TNFi was associated with the insurance type. CONCLUSION: our study suggests that Rituximab and TNFi are associated with the type of insurance and Tocilizumab is the most prescribed biologic mono-therapy in RA patients. Further studies are needed to confirm these results.

Management of gout by Moroccan rheumatologists: a Moroccan Society for Rheumatology National Survey.

To assess the modalities and current practices in gout management reported by Moroccan rheumatologists. We performed a cross-sectional online survey using a questionnaire e-mailed to 360 rheumatologists included 30 multiple-choice questions. 105 rheumatologists responded to the survey with 29% of response rate. The number of gout patients seen per month was five (3-9); they were referred in 58.7% by a general practitioner. The clinical presentation of gout patients was dominated by gout crisis in 71%, and the association gout crisis and gouty arthropathy accounted for 19% of severe forms. 40% of rheumatologists apply the 2015ACR/EULAR classification criteria. Obesity accounted for 85.7% of the associated comorbidities. The most commonly prescribed Urate-lowering therapy (ULT) was allopurinol in 81.3% (± 12). 48% of rheumatologists reported starting allopurinol at 200 mg daily and associated it with colchicine during the first 6 months by 33.3%. The determination of uric acid levels was monitoring in 76.2% every 3 months. Administration of ULT to asymptomatic hyperuricemia was found in 69.5% when patients had renal complications, while only 14.3% recommended dietary and lifestyle measures. The median duration for therapeutic education was 15 min (10, 20). In 96.2%, the education of the patient was done orally. 93.3% of rheumatologists inform their patients on how to manage a gout attack, and 96.2% on the measures of hygiene and diet has adopted. Our survey gives an insight into the elements that should be improved in the management of gout by the Moroccan rheumatologists. It highlights the need to standardize the management of gout, hence the importance of developing Moroccan recommendations on gout.

Moroccan residents' perception of hospital learning environment measured with French version of the postgraduate hospital educational environment measure.

PURPOSE: This study aimed to assess the educational environment of resident in Morocco and to compare the residents' perception depending on their specialties. METHODS: We applied the French version of the postgraduate hospital educational environment measure (PHEEM) to measure the educational environment in 6 hospitals in Rabat from January to June 2017. Internal reliability of the questionnaire was assessed using Cronbach's alpha coefficient. Principal component analysis was conducted to assess the construct validity of the three subscales of the PHEEM questionnaire. Variance analysis (ANOVA test) was performed to compare means of PHEEM overall, subscale, and each item score among 6 specialties. RESULTS: The response of 255 resident was included. The 40 items PHEEM questionnaire showed reliability with a Cronbach's alpha of 0.91. Principal component analysis on all 40 items suggested three factors explaining 48% of the variance with better results for the teaching subscale. Moroccan resident perceived their educational environment as more positive than negative. There was a significant difference in the overall and subscales score among the 6 specialties. CONCLUSION: French version of the PHEEM score is a valid and reliable instrument in Morocco. Moroccan resident perceived their educational environment as more positive than negative but room for improvement of many challenges particularly the poor infrastructure, the suboptimal quality of supervision, and teaching and inadequate work regulation remained.

Contribution of fibrin glue in the surgery of cyanogenic and non-cyanogenic congenital cardiopathies: retrospective cohort study.

BACKGROUND: Postoperative bleeding in cardiovascular surgery is a frequent and complicated situation for the surgical team, and may also be responsible for significant hospital expenditures. Fibrin glue are indicated in surgery to improve hemostasis when conventional techniques such as compression, sutures or electrocoagulation are insufficient. Through this study, we tried to study the contribution of fibrin glue to the improvement of the clinical parameters (volume of postoperative bleeding, length of stay in intensive care, volume of blood transfusion ...) in two populations having undergone cardiac surgery, one in which we used the fibrin glue and one without fibrin glue. METHODS: This was a retrospective cohort study conducted in the cardiovascular surgery department of our Hospital in Rabat between June 2012 and June 2015. Fibrin glue (Tissucol® of BAXTER) was used in one group with an haemostatic aim. The pre and post-operative clinical data of the patients were analyzed and compared with data from patients who were operated without the use of fibrin glue because it was not yet available in the hospital. The clinical parameters were collected analyzed using the SPSS 13.0 software. RESULTS: One hundred ten patients were included in this study. The fibrin glue was used intraoperatively in 55 patients and not used in 55 patients. 43 (39.1%) had cyanogenic diseases and 67 (60.9%) had non-cyanogenic pathologies. The volume of transfused red blood cells was lower in patients in whom we used biological glue (p = 0.005), as well as the number of days spent in intensive care (p = 0.02). However, the difference was not significant between the two groups for other parameters such as bleeding volume per kg, the number of units of fresh frozen plasma and the platelet units count transfused. CONCLUSIONS: The results we found show that fibrin glue reduces the duration of hospitalization in resuscitation and reduces the number of units of transfused red blood cells to patients after surgery. However, it does not reduce significantly the total postoperative bleeding volume per weight, the number of fresh frozen plasma units or platelets units transfused. The fibrin glue could therefore be of moderate benefit in pediatric cardiac surgery.

Prevalence and management of coronary artery anomalies in tetralogy of Fallot at Cheikh Zaid Hospital's Pediatric Cardiac Surgery Department in Morocco: retrospective study.

INTRODUCTION: Tetralogy of Fallot (TOF) is one of the most common cyanogenic congenital heart defects. It represents 10% of congenital heart diseases in children. Coronary artery anomalies (CAA) have been reported in 2% to 14% of cases in patients with TOF, according to angiographic, surgical and autopsy series. Many of these anomalies are difficult to detect during surgery. The objective of this article is to study the prevalence of the coronary artery anomalies in patients with TOF as well as their surgical management in our hospital between 2007 and 2015. METHODS: A retrospective study was conducted on 90 patients with TOF aged 1 month to 10 years who were operated on in the Department of Paediatric Cardiac Surgery of Cheikh Zaid Hospital between 2007 and 2015. None of the patients had preoperative coronary angiography and all the anomalies were diagnosed during surgery. Patient clinical data were collected from patient records and from the hospital information system. The qualitative variables are expressed as mean and standard deviation and the quantitative variables are expressed as a percentage. Statistical analyses were performed using SPSS 13.0 software. RESULTS: Of the 90 patients with TOF followed in the study period, 9 (10%) patients had coronary artery anomalies. We found in 3 (33%) patients an anomalous origin of the left anterior descending coronary artery (LAD) from the right coronary artery (RCA), an anomalous origin of the RCA from the left coronary trunk (LCT) in 1 (11%) patient and a large infundibular branch blocking the pulmonary infundibulum in 5 (56%) patients. All the patients underwent a complete surgical treatment (closure of the ventricular septal defect (VSD) by patch plus stenosis resection plus infundibular enlargement by patch). Eight (89%) patients progressed well in postoperative care and 1 (11%) died immediately after surgery in intensive care. CONCLUSION: The coronary anomalies detected in patients with TOF are rare but represent a challenge for the surgical team because of the difficulty of diagnosing them pre-operatively. The management of these anomalies is mainly surgical and the technique used by our team is proved to be safe and effective.

Trend analysis of leprosy in Morocco between 2000 and 2017: Evidence on the single dose rifampicin chemoprophylaxis.

BACKGROUND: Morocco has achieved the goal of leprosy elimination as a public health problem several years ago (less than 1 case/ 10 000 habitant). The aim of this study was to analyze trends of leprosy detection during the last 17 years taking into consideration the implementation of single dose rifampicin chemoprophylaxis (SDRC) started in 2012. METHODOLOGY: Time series of leprosy cases detected at national level between 2000 and 2017. Variable collected for each year were leprosy per 100000 H, age category, gender, origin, regions, grade of disabilities and clinical forms. The detection time series was assessed by Joinpoint Regression Analysis. Annual percentage changes (APCs) were estimated to identify the years (joinpoint) when significant changes occurred in the trend. We therefore examined trends in leprosy detection according to epidemiological variables. FINDINGS: Joinpoint regression showed a reduction in the detection rate between 2000 and 2017. The APC for the period 2012-2017 (-16.83, 95% CI: -29.2 to -2.3, p <0.05) was more pronounced than that of the previous period 2000-2012 (- 4.68, 95% CI: -7.3 to -2.0, p <0.05); with a significant break in the same joinpoint year SDRC implementation. In stratified analysis, case detection decreased, but not significantly, after the joinpoint years in men, children, multi-bacillary cases, grade 0-1 disabilities, rural and urban cases and in ten regions. CONCLUSIONS: Leprosy detection was declining over years with a significant reduction by 16% per year from 2012 to 2017. SDRC may reduce leprosy detection over the years following its administration.

Does smoking increase the risk of progression of nephropathy and/or cardiovascular disease in type 2 diabetic patients with albuminuria and those without albuminuria?

UNLABELLED: Diabetic nephropathy is the primary cause of chronic kidney disease and is associated with increased cardiovascular mortality. Cigarette smoking is probably the most complex and the least understood among the risk factors for chronic kidney disease and cardiovascular disease in diabetic patients. The aim of this study was to determine the impact of smoking on progression of nephropathy and cardiovascular disease in type 2 diabetic patients with albuminuria and those without albuminuria. METHODS: This is a prospective study. The Ethics Committee of Morocco's Mohammed V University in Rabat approved the study protocol. Inclusion criteria targeted patients who were type 2 diabetics and who had nephrology follow up for at least 36 months. RESULTS: A total of 671 cases of T2D were included. Mean age of all patients was 65 ± 11 years and 12.1% were smokers. There was no statistically significant difference between T2D patients with albuminuria according to absence of presence of smoking at the time of enrollment, at 1 year and 3 years of follow-up, concerning the median albumin excretion rate (mg/day): 98 [56-281] vs. 124 [56-323] (p=0.59); 98 [56-281] vs. 124 [56-323] (p=0.15) and 98 [56-281] vs. 124 [56-323] (p=0.52) respectively. There was a statistically significant difference between T2D patients with albuminuria according to absence or presence of smoking at the time of enrollment and the end of follow-up, concerning cardiovascular events: 56 (12.3%) vs. 19 (28.4%) (p<0.001) and 66 (14.5%) vs. 19 (28.4%) (p=0.004) respectively. CONCLUSION: Smoking remains one of the most important modifiable risk factors for progression of renal and cardiovascular disease in diabetic patients, thus adding to the burden of morbimortality.

Practices and perceived barriers regarding pain management among Emergency Department physicians: a nationwide multicenter survey in Moroccan hospitals.

Aim: To describe pain management practices in Moroccan emergency departments, and to identify perceived barriers among emergency department physicians regarding pain management. Methods: Eleven Moroccan emergency departments participated in the study. A nationwide survey was administered to physicians. The questionnaire covered physicians' characteristics, practices regarding pain management, and the perceived barriers to pain control. Results: A total of 86 questionnaires were analyzed. The participants' mean age was 41±7 years and 59.3% had more than 10 years working experience in emergency departments. The majority of participants were general physicians (87.2%) with no pain education (73.3%). Pain assessment in emergency departments was carried out by 59.3% of the physicians. Simple interrogatory assessment was the main tool (88.3%) with poor use of algometric scales (11.7%). Pain assessment results were not recorded in clinical charts in 93% of cases. Pain reassessment after treatment was carried out by 23.2% of respondents. Physicians had opiophobia in 80.2% of cases. None of the Moroccan emergency departments participating in the study have a written protocol for pain management. Barriers relating to medical staff and the health care system were the most commonly encountered hindrances that preclude emergency department physicians from proper pain management. Conclusions: Despite the availability of international guidelines, pain management practices are still sub-optimal in Moroccan emergency departments.

Sequential therapy versus standard triple-drug therapy for Helicobacter pylori eradication: a prospective randomized study.

PURPOSE: Eradication rates following standard triple therapy for Helicobacter pylori infection are declining. Recent studies, conducted in a number of countries, have shown that sequential therapy for H. pylori infection yields high cure rates. AIM: To compare the efficacy and tolerability of a sequential regimen as a first-line treatment of H. pylori infection with a standard triple treatment regime in Morocco. METHODS: A total of 281 naive H. pylori-infected patients, confirmed by histological examination, were assigned randomly to one of two treatment groups: standard triple therapy [omeprazole (20 mg bid) + amoxicillin (1 g bid) + clarithromycin (500 mg bid) for 7 days] or sequential therapy [omeprazole (20 mg bid) + amoxicillin (1 g bid) for 5 days, followed by omeprazole (20 mg bid) + tinidazole (500 mg bid) + clarithromycin (500 mg bid) for an additional 5 days]. H. pylori eradication was checked 4-6 weeks after treatment initiation by using a ¹³C-urea breath test. Compliance and adverse events were assessed. RESULTS: The two groups did not differ significantly in gender, age, previous disease history, endoscopic and histological features and smoking. The intention-to-treat and per-protocol eradication rates were 65.9 and 71 % in the standard triple therapy group, and 82.8 and 89.9 % in the sequential therapy group, respectively. The eradication rate was significantly higher in the sequential therapy group than in the standard triple therapy group (p < 0.001), There was no statistically significant difference in compliance (97.5 vs. 96.3 %) and incidence of side-effects (27.5 vs. 27.9 %) between the two groups. CONCLUSIONS: Based on our results, we conclude that for eradication of H. pylori infection, the 10-day sequential therapy is more effective than the standard triple therapy and is equally tolerated. These results confirm those of other studies in other countries.