Association between chronic airflow obstruction and socio-economic position in Morocco: BOLD results.

BACKGROUND: Chronic obstructive lung disease (COPD) is the third most common cause of death in the world. Factors other than smoking, such as socio-economic status, could be involved in the development of COPD.OBJECTIVE: To investigate the association between chronic airflow obstruction and socio-economic status in Morocco.DESIGN: Questionnaires were administered and spirometry tests performed as part of the BOLD (Burden of Obstructive Lung Disease) Study carried out in Fez, Morocco. Socio-economic status was evaluated using a wealth score (0-10) based on household assets. The ratio of forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) was used to measure airflow obstruction.RESULTS: A total of 760 subjects were included in the analysis. The mean age was 55.3 years (standard deviation [SD] 10.2); the average wealth score was 7.54 (SD 1.63). After controlling for other factors and potential confounders, FEV1/FVC increased by 0.4% (95%CI 0.01-0.78; P < 0.04) per unit increase in wealth score. Ageing, tobacco smoking, underweight, history of tuberculosis and asthma were also independently associated with a higher risk of airflow obstruction.CONCLUSION: Our findings suggest that airflow obstruction is associated with poverty in Morocco. Further investigations are needed to better understand the mechanisms of this association.

Evaluation and management of thromboprophylaxis in Moroccan hospitals at national level: the Avail-MoNa study.

Venous thromboembolism (VTE) is a common clinical problem that is associated with substantial morbidity and mortality. The aim of this study was to describe the clinical practices in VTE prophylaxis in university and peripheral hospitals in Morocco. This is a national, cross-sectional, multicenter, observational study assessing the management of the VTE risk in selected Moroccan hospitals (four university and three peripheral). The thromboembolic risk of the selected patients was assessed according to the American College of Chest Physicians (ACCP) guidelines (2008). We hypothesized that interventions for VTE guideline implementation in those hospitals may improve prophylaxis use for hospitalized patients. A total of 1318 patients were analyzed: 467 (35.5%) medical and 851 (64.5%) surgical. The mean age of patients was 52.6 ± 16.5 years, and 52.7% were female. A total of 51.1% patients were considered to be at risk of VTE according to ACCP guidelines and were eligible for thromboprophylaxis (TP). Medical patients were more likely to present risk factors than surgical patients (53.6 vs. 50.7%, respectively). TP was prescribed for 53.1% of these patients, 57.4% in at-risk surgical patients and 50.3% in at-risk medical patients. TP was also prescribed for 42.9% of non-at-risk patients. The concordance between the recommended and the prescribed prophylaxis was poor for the total population (kappa = 0.110). TP did not improve sufficiently in our hospitals, even after implementation of the guidelines. New strategies are required to appropriately address TP in hospitalized patients.

Evolution of quality of life in patients with breast cancer during the first year of follow-up in Morocco.

BACKGROUND: Quality of life has an important place in the future of patients with breast cancer. The objective of this study is to assess the evolution of the patient's quality of life with breast cancer in Morocco after a year of follow-up. METHODS: This study involved the patients with breast cancer with all types of treatment as determined by their physicians. Patient's quality of life was assessed with the Moroccan Arabic version of QLQ- EORTC QLQ C30 and EORTC-BR23 questionnaires. Data were analyzed using SPSS Version 20 software. RESULTS: Regarding EOTRC questionnaires QLQ C-30, there was a significant improvement in global health status and all scales of the functional dimension except the social functional where there was a trend towards improvement and the financial impact of the disease where the situation has deteriorated. Quality of life was improved for most symptom-sized scales dimension of EORTC QLQ- C30 with the exception of diarrhea where it was observed degradation. Most of the EORTC QLQ-scales BR23 questionnaires showed a favorable trend in the quality of life except those of sexual functioning, sexual enjoyment, hair loss and the side effects of systemic therapy. CONCLUSION: The quality of life of the patient is significantly improved after 1 year of follow up. Quality of life instruments can be useful in the early identification of patients whose score low on functional scales and symptoms.

Psychoactive substances use and associated factors among middle and high school students in the North Center of Morocco: a cross-sectional questionnaire survey.

BACKGROUND: Data on psychoactive substance (PAS) consumption among adolescents in the North Center of Morocco are not at all available. Therefore, the current study aimed at investigating the prevalence and the determinants of psychoactive substances use among middle and high school students in this region. METHODS: A cross-sectional study was conducted from April 2012 to November 2013 in public middle and high schools in the North Central Region of Morocco. An anonymous self-administered questionnaire was used to assess psychoactive substances use among a representative sample of school students from the 7th to the 12th grade, aged 11-23 years, selected by stratified cluster random sampling. Factors associated with psychoactive substance use were identified using multivariate stepwise logistic regression analyses. RESULTS: A total of 3020 school students completed the questionnaires, 53.0 % of which were males. The overall lifetime smoking prevalence was 16.1 %. The lifetime, annual and past month rates of any psychoactive substance use among the study subjects were 9.3, 7.5, and 6.3 % respectively. Cannabis recorded the highest lifetime prevalence of 8.1 %, followed by alcohol 4.3 %, inhalants 1.7 %, psychotropic substances without medical prescription 1.0, cocaine 0.7, heroine 0.3, and amphetamine with only 0.2 %. Psychoactive substance use was associated with males more than females. The risk factors identified by multivariate stepwise logistic regression analyses were being male, studying in secondary school level, smoking tobacco, living with a family member who uses tobacco, and feeling insecure within the family. CONCLUSIONS: The prevalence among all school students reported by the current study was comparable to the national prevalence. Efforts to initiate psychoactive substance prevention programs among school students should be made by designing such programs based on the significant factors associated with psychoactive substance use identified in this study.

Estimating attributable fraction of lung cancer linked to smoking in Morocco.

The objective of this research was to estimate the attributable fraction (AF) of lung cancer linked to smoking in Morocco. The estimation was based on the SAMMEC (Adult Smoking-Attributable Mortality, Morbidity and Economic Costs) method based on the Levin formula to calculate AF linked to tobacco. Data about frequencies, association measures and relative risks were taken from available sources. The AF of lung cancer linked to smoking was about 87%, and around 3049 cases of this cancer in men could be avoided if tobacco use could be prevented. About a 10% reduction in smoking prevalence would result in a reduction of 346 lung cancer cases. Our study provides additional important elements for further advocacy to policy-makers to implement a tobacco control strategy based on a prevention policy in line with the epidemiological situation which could avoid a huge burden on the country.

[Descriptive study of traffic injuries in the health district of Diema]. / Accidents de la circulation routiere dans le district sanitaire de Diema.

BACKGROUND: Road traffic accidents are major causes of mortality and morbidity. Therefore, we proposed to do a descriptive study of these accidents in the Diéma Referral Health Center during our study period. MATERIAL AND METHODS: This is a descriptive cross-sectional study, which took place in the health district of Diema (Kayes region) from February to July, 2010. It concerned patients victim of road traffic accidents and admitted to the Diema referral health center. Patient information was collected from medical records using a customized questionnaire. Data analysis was done using the SPSS 12.0 software. Quantitative variables were expressed as mean and standard deviation and categorical variables by proportions. RESULTS: A total of 143 patients were admitted. The prevalence of accidents was 8.66%. The mean age of patients was 31.5 ± 12.2 years. The male sex was the most affected 72%. Automobiles were most involved 67.1%. The frequency of these accidents was higher in March at 30.1%. The injuries were the most common lesions with 86.1% of cases and the head was the most affected with 48.3%. Half of these accidents occurred between 8 o'clock and 12 o'clock. We observed 4.9% of deaths. CONCLUSION: Traffic accidents remain true public health problems today because of the serious consequences they generate. To reduce this problem, it is necessary to have well adapted roads and ensure a rigorous application of the rules of the road.

INTRODUCTION: Les accidents de la circulation routière constituent des causes importantes de mortalité et de morbidité. De ce fait, nous nous sommes proposé de faire une étude descriptive de ces accidents au Centre de santé de référence de Diéma durant notre période d'étude. MATÉRIELS ET MÉTHODES: Il s'agit d'une étude transversale descriptive qui s'est déroulée dans le district sanitaire de Diéma (région de Kayes) durant la période de Février à Juillet 2010. Elle a concerné les patients victimes d'accidents de la circulation routière et reçus au centre de santé de référence de Diéma. Les informations sur les patients ont été recueillies à partir des dossiers médicaux à l'aide d'un questionnaire établi à cet effet. L'analyse des données essentiellement descriptive a été faite à l'aide du logiciel SPSS version 12.0. Les variables quantitatives ont été exprimées par la moyenne et l'écart type et les variables qualitatives par les proportions. RÉSULTATS: Au total, 143 patients ont été enregistrés. La prévalence des accidents était de 8,66%. L'âge moyen des patients était de 31,5 ± 12,2 ans. Le sexe masculin a été le plus atteint 72%. Les automobiles seules ont été les plus en cause 67,13% .La fréquence de ces accidents était plus élevée au mois de Mars avec 30,1% .Les blessures ont été les lésions les plus retrouvées avec 86,12% et la tête a été la plus touchée avec 48,32% .La moitié de ces accidents s'est produite entre 8heures et 12 heures .On a observé 4,9% de décès. CONCLUSION: Les accidents de la circulation demeurent de véritables problèmes de santé publique de nos jours du fait des graves conséquences qu'ils engendrent. Pour diminuer ce fléau, il est donc nécessaire d'avoir des routes bien adaptées et veiller à une application rigoureuse du code de la route.

Prevalence of chronic obstructive pulmonary disease in Fez, Morocco: results from the BOLD study.

OBJECTIVE: To present population-estimated prevalence of spirometrically confirmed chronic obstructive pulmonary disease (COPD) in adults (age ⩾40 years), living in the city of Fez, Morocco. DESIGN: Following the Burden of Lung Disease (BOLD) methodology, population-based sampling plans were used for the recruitment of eligible adults. The study collected questionnaire data on respiratory symptoms, medical history, health status, exposure to risk factors for COPD and quality of life. Post-bronchodilator spirometry was performed and COPD and its stages were defined according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. RESULTS: Among 768 individuals with valid data and acceptable quality post-bronchodilator spirometry results, the overall prevalence of stage 1 or higher COPD was 12.6%. The prevalence of GOLD stage 2 or higher COPD was 7.9%. The population-estimated prevalence of lower limit of normal (LLN) modified stage 1 or higher COPD was 8% among non-smokers, and it increased with number of pack-years (17.8% for >20 pack-years vs. 3.8% for <10 pack-years). The prevalence of physician-diagnosed COPD was 3.2%; this was associated with an increase in smoking pack-years. CONCLUSION: These results emphasise the urgent need to take necessary measures to reduce the prevalence of tobacco smoking.

Translation and validation of EORTC QLQ-H&N 35 into Moroccan Arabic for ENT head and neck cancer patients in Morocco.

Disease-specific quality of life (QOL) measures have enhanced the capacity of outcome measures to evaluate subtle changes and differences between groups. As many of the QOL measures have been developed in English, they require translation to ensure their usefulness in a multi-cultural and/or international society. Published guidelines provide formal methods to achieve cross-culturally comparable versions of a QOL tool. The aim of this study was to adapt the head and neck specific module of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-H&N 35 questionnaire) into Moroccan Arabic and to determine its psychometric properties. After translation, back translation and pretesting of the pre-final version, the translated version was submitted to a committee of professionals composed by otolaryngologists and epidemiologists. The psychometric properties were tested in patients with ENT cancer. Internal consistency was tested using Cronbach's alpha and the test-retest reliability using interclass correlation coefficients. Construct validity was assessed by examining item convergent and divergent validity. It was also tested using Spearman's correlation between QLQ-H&N 35 scales and EQ-5D. The study was conducted in 120 patients. The Moroccan version was internally reliable, Cronbach's α ranged from 0.71 for "trouble with social contact" to 0.94 for "senses impairment", indicating good internal consistency. Test-retest reliability was assessed using the intra-class correlation coefficient, which ranged from 0.64 for "speech trouble" to 0.89 for "physical activities". The instrument demonstrated a good construct and concomitant validity. We have developed a semantically equivalent translation with cultural adaptation of EORTC QLQ-H&N 35 questionnaire. The assessment of its measurement properties showed that it is quite reliable and a valid measure of the effect of cancer on the quality of life in Moroccan patients.

Using surveillance data to understand cancer trends: an overview in Morocco.

BACKGROUND: The aim was to use the existing surveillance data sources of cancer in Morocco that could be used to better describe cancer mortality and incidence trends in Morocco. METHODS: National incidence data were derived from population-based cancer registries. Mortality data were collected from the international GLOBOCAN database. RESULTS: An overview of the main results was presented. In general, the most commonly diagnosed cancers in men are lung and prostates whereas in women, breast and cervical cancers are the pre-dominant cancers. Fifty nine percent and of breast and 65.7 % of cervical cancers in women are diagnosed at stages II and III. Cancer remains the second highest cause of mortality in Morocco. CONCLUSION: The data provides a description of the cancer incidence and trends in the Moroccan population. The Moroccan national cancer program should aim for more coherent, consistent and comparable incidence data between different cancer registries in the country, and develop uniform datasets with respect to quality.

INTRODUCTION: L'objectif était d'utiliser les sources de données existantes de surveillance du cancer qui pourraient être utiles pour décrire les tendances d'incidence et de mortalité du cancer au Maroc. MÉTHODES: Les données de morbidité et mortalité nationales et internationales disponibles ont été explorées. Les registres populationnels de cancer couvrent les données d'incidence régionale. Les données de mortalité sont disponibles par les données internationales de Globocan. RÉSULTATS: Un aperçu des principaux résultats a été présenté. Globalement, les cancers les plus fréquents sont le poumon et la prostate chez les hommes; le sein et le col utérin chez les femmes; ces deux cancers représentant 56,3 % de cancers féminins. Les cancers de sein et du col sont diagnostiqués dans 59 % et 65,7 % aux stades II et III. Le cancer est la deuxième cause de mortalité au Maroc. CONCLUSION: Les données fournissent une description de l'incidence des cancers et leurs tendances dans la population marocaine. Le programme national du cancer marocaine devrait viser pour les données d'incidence cohérents et comparables entre les différents registres du cancer dans le pays, et de développer des ensembles de données uniformes par rapport à la qualité.

Suicidal behaviors among Moroccan school students: prevalence and association with socio-demographic characteristics and psychoactive substances use: a cross-sectional study.

BACKGROUND: Suicidal behavior is a major cause of injury and death worldwide, especially among adolescents and young adults. Few studies have tackled this issue in the Arab world. The present study investigated the prevalence and the risk factors of suicidal behaviors among Moroccan school students. METHODS: From April 2012 to November 2013, a cross-sectional study was conducted in the North-Centre region of Morocco among students in public secondary schools selected using stratified cluster random sampling. The data were collected via anonymous self-administered questionnaires. The Mini International Neuropsychiatric Interview was used in its Moroccan Colloquial Arabic version to assess suicidality according to the DSM-IV criteria. RESULTS: A total of 3020 students (53 % boys) aged 11-23 years (average age = 16 ± 2.1 years) were included in the study. The prevalence of suicide ideation, suicide planning and suicide attempts during the last month were 15.7, 6.3, and 6.5 % respectively. Univariate analyses demonstrated that suicidal behaviors followed different epidemiological patterns. According to the multivariate analyses, the risk factors for all suicidal behaviors among Moroccan school students were the female gender, middle school level, urban locations, low family income, parents' divorce, tobacco consumption and psychoactive substances (alcohol and cannabis) use. CONCLUSIONS: The intervention of preventive programs has become an emergency to overcome the issue of suicidality in Morocco. Further researches on adolescents' suicidal behaviors are suggested to update temporal data and assess the effectiveness of potential interventions.

Acceptability of the human papilloma virus vaccine among Moroccan parents: a population-based crosssectional study.

Data about the public's awareness and acceptability of the human papilloma virus (HPV) vaccine are lacking in the Eastern Mediterranean Region. This study aimed to explore parental acceptability of HPV vaccination for their daughters in Morocco. A cross-sectional survey was carried out among mothers and fathers of girls aged 12-15 years at 12 middle schools from 6 regions of Morocco. Despite weak knowledge of genital warts and HPV infection, acceptability of the HPV vaccine was 76.8% (95% CI: 73.3-79.9%) among mothers and 68.9% (95% CI: 65.2-72.5%) among fathers. Only 8.8% of mothers and 7.0% of fathers were against administration of the HPV vaccine to their daughters. Predictors of parents' acceptance of the HPV vaccine were living in precarious housing/slums and low household income (for mothers) and living in urban areas (for fathers). These results will be useful for preparing the introduction of the HPV vaccine in health ministry programmes.

Frequency, types and determinants of degenerative complications of type 2 diabetes in Morocco: "EpiDiaM" cohort inclusion data.

Degenerative complications as a result of diabetes impose a heavy disease burden and increase mortality. This study presents epidemiological and clinical profiles of diabetic patients in the EpiDiaM cohort study, which include 1196 diabetic cases recruited from the basic health care network in the city of Fez. The mean age of the participants was 57.5 (SD 10.4) years with 47.1% aged between 50 and 60 years. The majority (77.7%) were women. The mean duration of diabetes was 8 (SD 6.6) years. Hypertension was found in 49.3% of the cohort, 77.9% were overweight or obese and 63.8% had one or more complications. Among those with complications, retinopathy was the most common (69.4%), followed by heart conditions (50.8%), neuropathy (45.6%) and renal disease (4.8 %). The high prevalence of complications emphasizes the need to address the avoidable risk factors and prevent complications.

Screening for childhood lead poisoning in the industrial region of Fez, Morocco.

The study objectives were to estimate lead poisoning prevalence among children living next to an industrial area, to compare it to that in a control population, and to establish clinical and biological follow-up of the poisoned children. This is a descriptive cross-sectional study including 150 children (exposed and unexposed) performed between January 2012 and April 2013. It was meant to determine blood lead levels (BLLs) in children considered to be an exposed population (EP N 90), living in the industrial area Ain Nokb Fez compared with BLLs of children of other areas belonging to the same city supposed to be unexposed [UP (N = 60)]. A sociodemographic questionnaire was obtained, and a blood lead analysis was performed. Clinical and biological follow-up has been performed of poisoned children. The sample consisted of 90 EP children with an average age of 6.82 ± 3.32 years and male-to-female sex ratio (SR) of 1.5 and 60 UP children with an average age of 6.45 ± 3.29 years and an SR of 1.2. Among the 150 children recruited, the average of BLLs was 58.21 ± 36 µg/L (18-202.3 µg/L). The average of BLLs in EP children (71 ± 40 µg/L) was statistically greater (p < 0.0001) than that registered in UP children (38 ± 13 µg/L). All poisoned children belonged to the EP group at a prevalence of 21.1 %. The clinical and biological examinations of poisoned children showed a few perturbations such as anemia, hypocalcaemia, and deficiencies in magnesium and iron. No renal disease or objective neurological disorders were observed. In the follow-up of the children with BLL ≥100 µg/L (19 cases). BLL monitoring showed a significant decrease in average of blood concentration ranging from 136.75 ± 32.59 to 104.58 ± 32.73 µg/L (p < 0.0001) and in lead poisoning prevalence (p < 0.001), which decreased to 7.8 % from 21.1. Our study showed a high prevalence of lead poisoning (21.1 %) in EP children. The relocation of the industrial site associated with corrective and preventive measures has contributed to a decrease of exposure and lead poisoning prevalence in the aforementioned population.

[Assessment of the methodological quality of theses submitted to the Faculty of Medicine Fez]. / Évaluation de la qualité méthodologique des thèses soutenues à la Faculté de Médecine de Fès.

A thesis in medicine is a scientific work which allows a medical student to acquire a Doctor of Medicine degree. It is therefore recommended that theses presented by students fulfill essential methodological criteria in order to obtain scientifically credible results and recommendations. The aim of this study was to assess the methodology of thesis presented to the Faculty of Medicine in Fez in 2008. We developed an evaluation table containing questions on the different sections of the IMRAD structure on which these theses were based and we estimated the proportion of theses that conformed to each criterion. There were 160 theses on various specialties presented in 2008. The majority of the theses (79.3%) were case series. Research questions were clearly expressed in 62.0% but the primary objectives were pertinent in only 52.0%. Our study shows that there were important deficiencies in the methodological rigor of the theses and very little representation of the theses in publications.

Dyspnea: a strong independent factor for long-term mortality in the elderly.

OBJECTIVE: To determine the association between dyspnea at entry into the PAQUID cohort and 13-year mortality, taking into consideration BMI and other mortality-related factors. DESIGN: Longitudinal study. SETTING: In Dordogne and Gironde, South Western France. SUBJECTS: A total of 3646 French community dwellers aged 65 years old and over from the PAQUID study were included. MAIN OUTCOME MEASURES: dyspnea measured on 5-grades scale, mortality measured over 13 years of follow-up. Adjustment variables: age, gender, BMI (kg/m²), antecedent of ischemic heart disease, antecedent of stroke, hypertension, smoking history and diabetes. RESULTS: The study sample included 3646 subjects out of whom 54.11% died at 13 years of follow-up, 57.3% of participants were women and mean age was 75.3 (SD 6.8) years. Univariate analysis showed that dyspnea was associated with 13-year mortality. Death occurred in 45.6% of non-dyspneic subjects , 51.8% in those with level 1 of dyspnea, 65.6% in level 2 and 80.6% in level 3 and 4 (P<10⁻4). The median survival was at 13.26 (SD 0.20) years for level-0 of dyspnea, 12.33 (SD 0.31) years for level-1 of dyspnea, 9.28 (SD 0.44) years for level-2 and 6.43 (SD 0.45) years for level-3 and 4 (P=10⁻³). In the multivariate analysis, the risk of mortality for level1 compared to level-0 was HR=1.13 (CI95%=[1.01-1.26]); this risk increases to HR=1.42 (CI95%=[1.25-1.63]) for level-2 and to HR=1.90 (CI95%=[1.61-2.25]) for level-3 and 4. CONCLUSION: These findings suggest that the relationship between long-term mortality and dyspnea is strong, consistent and independent of other covariates in the elderly.

[Epidemiological and pathological features of cancer in Fez Boulemane region, Morocco]. / Aspects épidémiologiques et anatomopathologiques des cancers dans la région de Fès-Boulemane (Maroc).

In Fez-Boulemane, Morocco, there is no cancer registry so there is a lack of information about the incidence and characteristics of cancer in the region. In this retrospective study we examined the epidemiological and pathological features of 5532 cases of cancer collected from the Department of Pathology in Hassan II University Hospital of Fes from 2004 to 2010. The mean age of the patients was 53.5 years and 52% were male. Digestive cancers and skin cancers were the most common. Digestive cancers were predominantly colorectal and stomach. Cancers of the urinary bladder and colorectal cancers were the leading cancers in men accounting respectively for 9% and 8% of all male cancers. In women, cancers of the breast (62%) and uterine cervix (22.6%) predominated. As a first step in cancer control in our area, establishment of a regional cancer registry is recommended.

Factors associated with treatment default by tuberculosis patients in Fez, Morocco.

Interruption in tuberculosis (TB) treatment still remains the most important challenge for control of the disease. This study aimed to identify the determinants of TB treatment default in Fez, Morocco. A 1:2 pair-matched case-control study was carried out in the TB control units in Fez. Cases were defaulters to TB treatment and were matched by age and sex to non-defaulters (controls). Of the 320 patients (108 defaulters, 212 controls), 80.6% were male. The main reason for defaulting reported by patients was the sensation of being cured. Predictive factors for treatment default in the multivariate conditional logistic regression analysis, were: relapsed case (adjusted OR = 4.49; 95% Cl: 1.87-10.8), current smoking (aOR= 2.10; 95% Cl: 1.07-4.14), alcohol use (aOR = 2.92; 95% Cl: 1.04-8.19), being more than 30 minutes away from the health centre (aOR = 3.34; 95% Cl: 1.06-10.5) and perception of having received insufficient explanation about the disease (aOR = 2.87; 95% CI: 1.53-5.36). The rate of defaulting in Fez can be lowered through targeted and realistic measures.

Prognostic factors of Atractylis gummifera L. poisoning, Morocco.

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

[Prolonged corticosteroid-therapy and anxiety-depressive disorders, longitudinal study over 12 months]. / Corticothérapie prolongée et troubles anxieux et dépressifs. Étude longitudinale sur 12 mois.

UNLABELLED: To date, there is little data in the literature describing the anxiety and depressive disorders iatrogenic to corticosteroids. These disorders are common, underestimated, with potentially serious consequences that may jeopardize the patient's prognosis; their management is not consensual. OBJECTIVES: The objective of our work is to determine the prevalence of anxiety and depressive disorders induced by corticosteroids, assessing their accountability to the corticosteroids and studying their risk factors. METHODS: We conducted a prospective longitudinal study over 12months evaluating the prevalence of anxiety and depressive disorders in patients followed for chronic skin diseases treated with prolonged corticosteroid-therapy. Our patients were assessed using standardized instruments: the Mini International Neuropsychiatric Interview (MINI), the Hamilton Anxiety Scale (HAS) and the Beck Depression Inventory (BDI). RESULTS: Of 54 patients included, our study showed a high prevalence of anxiety and depressive disorders estimated at 27%. These disorders were divided into depressive disorder in 16% of cases, and anxiety disorder in 11% of cases. The early onset of these disorders was found during the first weeks of treatment. According to the Beck Depression Inventory (BDI), depression was moderate in 67% of cases; severe with suicide attempts in 22% of cases, and mild in 11% of cases. According to the Hamilton Anxiety Scale (HAS), anxiety was mild in 33% of cases and moderate in 67% of cases. The disorders observed were mainly distributed into: 33% deep pemphigus, 27% lupus, 13% bullous pemphigoid and 13% dermatomyositis. In this study the statistically significant risk factors are dose of corticosteroids and personal psychiatric history of the patient; in addition, there is a high prevalence of disorders in patients whose age exceeds 40 years, female gender, and patients treated for deep pemphigus. The evolution after pharmacological treatment and supportive psychotherapy was favorable in most patients. CONCLUSION: The psychiatric examination prior to prescription of long-term corticosteroid-therapy use should be standard practice to identify patients at risk, discuss the treatment modalities, and provide comprehensive care.

[Introduction of pharmacovigilance in a new university hospital in Morocco: how and why]. / L'instauration de la pharmacovigilance dans un nouveau centre hospitalier universitaire au Maroc: comment et pourquoi?

In an effort to improve patient safety, Hassan II hospital in Fez introduced a pharmacovigilance system for notification of adverse drug reactions as a priority objective. The implementation of pharmacovigilance activities actually began in June 2007 but it was in 2009 after the inauguration of the new complex that the system became properly operational. This report outlines the activities carried out to develop and implement this system, including informing and training the health professionals, and the results obtained after its introduction. From 2007 to 2009, fewer than 100 cases of adverse drug reactions were reported. Up to June 2011, however, 520 reports of adverse drug reactions were recorded. The classes of drugs most implicated in adverse events were: cancer drugs (26%), anti-inflammatory drugs and antibiotics (each 15%), analgesics (12%), iodinated contrast agents (6%), and anticoagulants and corticosteroids (5%). The main adverse events were dermatological and 27% of reports came from the internal medicine department, followed by hepatogastroenterology (25%). Of the 520 cases reported, 46% were severe.