Ethical issues related to the hydroxychloroquine treatment prescription for Covid-19.

The 2019-20 coronavirus pandemic (COVID-19) has led to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). To date, no drugs have demonstrated safety and efficacy in randomized controlled trials for patients with COVID-19. Although the association between Hydroxychloroquine and Azithromycin efficacy lack of solid evidence-base, several governments have adopted it for all virology confirmed Covid-19 cases even for those who are asymptomatic. In the following, we aim to discuss some of the ethical issues associated with the use of this treatment association. We mainly tried to discuss the following controversial questions: Is it ethical not to treat a patient while a treatment exists and is used for other indications than Covid-19 for which it's not proven yet? If yes, is a randomized controlled trial to prove the hydroxychloroquine for the Covid-19 treatment, necessary, in the context of covid-19 pandemic? If no, is it the government's right to decide the hydroxychloroquine treatment for all covid-19 patients? And what should be the physicians' attitudes? Finally, what are the government, physicians, and patient's rights and responsibilities? The paper conclude that, since health authorities in some countries recommended this off-label use treatment, physicians are challenged by the requirement of veracity while providing care to their patients and the implications of such a requirement; they are facing the challenge of balancing this guideline and their own conviction. Furthermore, the fundamental principles of beneficence and non-maleficence, and respect for persons should underlie any reflection process to address this dilemma. In addition, in a pandemic context, the limits between the government's, practitioner's and patient's rights and obligations are not clear which could significantly endanger the universal ethical principles in clinical practice. It could also undermine any attempt to develop serious clinical trials to prove the considered off-label drug.

La pandémie de coronavirus 2019-2020 (COVID-19) conduit au syndrome respiratoire aigu sévère coronavirus 2 (SRAS-CoV-2). À ce jour, aucun médicament n'a démontré son innocuité et son efficacité dans des essais contrôlés randomisés pour les patients atteints de COVID-19. Bien que l'association entre l'hydroxychloroquine et l'azithromycine manque de preuves solides, plusieurs gouvernements l'ont adoptée pour tous les cas de Covid-19 confirmés, même pour ceux qui sont asymptomatiques. Dans ce qui suit, nous discutons certains des problèmes éthiques associés à l'utilisation de cette association thérapeutique. Nous avons principalement essayé de discuter les questions controversées suivantes: est-il éthique de ne pas traiter un patient alors qu'un traitement existe et est utilisé pour d'autres indications que le Covid-19 pour lequel il n'est pas encore prouvé ? Si oui, un essai contrôlé randomisé pour prouver l'hydroxychloroquine pour le traitement Covid-19 est-il nécessaire dans le contexte de la pandémie Covid-19 ? Si non, le gouvernement a-t-il le droit de décider du traitement à l'hydroxychloroquine pour tous les patients de Covid-19 ? Et quelles devraient être les attitudes des médecins ? Enfin, quels sont les droits et responsabilités du gouvernement, des médecins et des patients ? Le document conclut que, puisque les autorités sanitaires de certains pays ont recommandé ce traitement hors AMM, les médecins sont confrontés aux challenges de l'exigence de véracité de l'efficacité du traitement tout en prodiguant des soins à leurs patients et aux implications d'une telle exigence ; ils sont confrontés au défi d'équilibrer ces exigence et leur propre conviction. En outre, les principes fondamentaux de bienfaisance et de non-malfaisance, et le respect des personnes devraient sous-tendre tout processus de réflexion pour résoudre ce dilemme. Enfin, dans un contexte de pandémie, les limites entre les droits et obligations du gouvernement, du praticien et du patient ne sont pas toujours claires, ce qui pourrait mettre en danger de manière significative les principes éthiques universels dans la pratique clinique. Cela pourrait également saper toute tentative de développer des essais cliniques sérieux pour prouver le médicament hors AMM considéré.

[Factors associated with intrapartum and very early neonatal mortality at the materniry of University hospital Mohamedd VI, Marrakech, Morocco. Case-control study]. / Les facteurs associés à la mortalité intrapartum et néonatale très précoce au niveau de la maternité du centre hospitalier universitaire Mohammed VI, Marrakech, Maroc. Étude cas témoin.

BACKGROUND: Per-partum stillbirth continues to represent a public health burden despite the efforts of countries around the world. Prevention of this mortality can only be effective with a better knowledge of factors that are life-threatening to the fetus or newborn. This work aims to determine associated factors with intrapartum and very early neonatal mortality. METHODS: A case-control study was carried out at the maternity of the university hospital in Marrakech, where 290 subjects were selected: 145 cases of intrapartum fetal death or a very early neonatal death, and 145 controls of surviving newborn weighing 2500g or more at birth. Data were collected from obstetric, partogram and death records for the year 2016. The factors that were compared between the two groups were factors before admission to maternity, factors related to the management during labor and to the care of newborn. RESULTS: Statistically significant associations were found between these deaths and several factors including: multiparity versus primiparity adjusted OR=2.27 [1.17-4.42], pregnant women referral from another health facility adjusted OR=2.11 [1.12-3.99], care for women during the transfer adjusted OR=0.21 [0.9-0.49] and prenatal follow-up of pregnancy adjusted OR=0.22 [0.12-0.4]. Were also associated: fetal monitoring during labor adjusted OR=0.22 [0.08-0.62], neonatal respiratory distress adjusted OR=18.48 [7.60-44.98] and Apgar score (⩽7) adjusted OR=6.05 [2.51-14.62]. CONCLUSION: Intrapartum and very early neonatal mortality is closely related to the newborn's condition at birth, fetal monitoring during labor, pregnancy monitoring, and the organization of the referral system.

Measurement of visual function among patients undergoing corneal transplantation using the VF-14 index in Morocco.

OBJECTIVE: To validate the Moroccan version of the VF-14 in candidates for keratoplasty and to assess their quality of life using this tool before and after transplantation. METHODS: This is a longitudinal prospective study that assessed 57 patients who underwent penetrating keratoplasty, recruited in the ophthalmology service in Marrakech over 5 years. The original VF-14 questionnaire was adapted into Moroccan dialect. The questionnaire was administered before and 2 years after transplantation. The VF-12 questionnaire was also used, deleting the last two items. Data analysis was performed using SPSS 16.0 software. Comparisons of VF-14 scores before and after transplantation used the Wilcoxon test for paired samples. RESULTS: In total, 57 patients participated in the study. The most frequent indication for surgery was keratoconus (44%). All patients underwent penetrating keratoplasty. Chronbach's alpha value was 0.989 for VF-14 and 0.990 for VF-12. The two scores were negatively correlated with logMAR visual acuity. The strongest correlation was found with VA in the fellow eye. The average best-corrected visual acuity of the eye scheduled for keratoplasty was 1.1±0.16 logMAR. The average of VF-14 was 53±3. After keratoplasty, the average best-corrected visual acuity of operated eye was 0.34±0.31. The average postoperative astigmatism was 3 D. After keratoplasty, an increase in VF-14 score was observed from 53.5 to 81.92 (P<0.001). In postoperative follow-up, graft rejection was noted in two patients and maculopathy in a single patient. DISCUSSION: Graft transparency, absence of complications, minimal astigmatism, and good visual acuity have long been indicators of a successful corneal transplant. However, this does not provide information on visual quality and its impact on everyday life. It is in this sense that the VF-14 was adapted into several languages, as reliable, valid and sensitive as the original Anglo-American version, to assess objectively and subjectively the quality of life of patients after keratoplasty. CONCLUSION: With advances in techniques and availability of better materials, surgical success in performing keratoplasty is increasing. At the same time, vision-related quality of life of corneal graft recipients deserves more attention from ophthalmologists.

[The local anesthesia for the prostatic biopsies echo-guided: forward-looking randomized study comparing two methods]. / L'anesthésie locale pour les biopsies prostatiques écho-guidées: étude prospective randomisée comparant deux méthodes.

INTRODUCTION: The realization of the prostatic biopsies is a painful act. The objective of our work was to compare the analgesic efficiency of the injection of the lidocaine at the level of periprostatics laterals and apical areas compared with the use of gel of lidocaine intrarectal associated with the taking of oral tramadol. PATIENTS AND METHODS: Between November 2007 and December 2009, 60 patients admitted in the service of urology of the university hospital Mohammed VI of Marrakesh for prostatic biopsies were randomized in two groups. The group 1 (30 patients) received two tablets from tramadol 50mg with 10 mL of gel of lidocaine 2% intrarectal while 30 patients of the group 2 received 10 mL from lidocaine 2% injected at the level of periprostatics laterals and apicales. The pain was estimated by a visual analog scale (AVS) at the introduction of the probe of echography (AVS 1), at the time of the biopsy (AVS 2) and 20 minutes later (AVS 3). RESULTS: There was no significant difference between both groups concerning AVS 1 means. The average score of the pain was significantly lower in the group 2 for the AVS 2 and AVS 3. CONCLUSION: The periprostatics anesthesia assured a better control of the pain at the time of the prostatic biopsy and 20 minutes later, without increase of the complications. We recommend it to decrease the pain and the discomfort related to this technique.

[Prevalence of obesity and overweight among children in primary schools in Marrakech, Morocco]. / Prévalence de l'obésité et du surpoids chez les écoliers de primaire à Marrakech, Maroc.

BACKGROUND: Childhood obesity is a phenomenon of growing concern today because of its rapid growth worldwide. The aim of our study was to estimate the prevalence of overweight and obesity among school age children in Marrakech. METHODS: We conducted a cross-sectional study of a random sample of 1418 schoolchildren aged 8-15 years in the public sector in Marrakech in May 2011. Trained physicians measured the weight and size of respondents. The body mass index (BMI) was calculated for each child. Overweight was assessed by comparing BMI with World Health Organization (WHO) and International Obesity Task Force (IOTF) references. Statistical analysis was performed using SPSS version 16.0 and using a macro of WHO Anthro for SPSS. RESULTS: The mean age was 10.8 ± 1.6 years. The sex ratio (girl/boy) was 1. The prevalence of overweight and obesity were 8 % (95 % CI [6.7, 9.6]) and 3 % (95 % CI [2.2, 4.1] based on WHO reference. This prevalence were respectively 12.2 % (95 % IC [10.5; 14.0]) and 5.4 % (95 % IC [4.3; 6.7]) using the IOTF reference. CONCLUSION: In the absence of national data, our results reflect the importance of the phenomenon in our context, hence the importance of monitoring the nutritional status on both individual and collective levels and the need to develop strategies for prevention, diagnosis and early treatment before the problem becomes more widespread.

[Weaning before the age of 6 months in Marrakech: associated factors and prevalence]. / Sevrage des nourrissons avant six mois à Marrakech: facteurs associés et prévalence.

BACKGROUND: In Morocco breastfeeding has become a declining practice. The objectives of this study were to estimate the prevalence of weaning before the age of 6 months and to identify associated factors. METHODS: A cross-sectional survey was conducted among 400 mothers of infants aged 0 to 24 months. Participants were recruited from patients attending 40 randomly selected general practices in Marrakech. A trained interviewer administered a questionnaire to collect data on breastfeeding practice and factors associated with it. Early weaning was defined as a cessation of breastfeeding before the age of 6 months and was studied in mother-child couples whose infants were aged 6 months and older. Three binary logistic regression models were used to model the probability that an infant aged 6 months or more is weaned early. RESULTS: Breastfeeding was initiated by the majority of respondents (97.5%). Early weaning was observed in 75 infants (28% of registered weaning). Factors associated with early weaning were: mother having an occupational activity (Odds Ratio [OR]=2.09; 95% confidence interval [CI]: [1.07-4.06]), caesarean delivery (OR=4.15; 95% CI: [1.74-9.88]) and the fact that the pregnancy was desired (OR=0.19; 95% CI: [0.05-0.68]). CONCLUSION: Weaning before 6 months of age is a common practice in our context. Identifying factors associated with early weaning is critical to promote breastfeeding.

Correlación entre el índice de masa corporal y circunferenciade la cintura en personas mayores de 15 años / Correlation between body mass index and waist circumference in individuals aged 15 years and over

Introducción: La detección y tratamiento precoz del sobrepeso y la obesidad son una prioridad de salud pública. El Índice de masa corporal (IMC) y la circunferencia de la cintura (CC) son los principales índices antropométricos utilizados para medir el exceso de adiposidad. Objetivo: Describir la relación existente entre la obesidad abdominal, medida mediante el IMC y la obesidad central a través de la CC. Material y métodos: Se realizó un estudio descriptivo de corte transversal desde Enero a Marzo de 2007,en 662 personas mayores de 15 años reclutadas en diez centros de salud de Marrakech. Profesionales capacitados recolectaron datos sobre edad, sexo y medidas antropométricas (peso, talla y circunferencia de la (..) (AU)

Introduction: Screening and early treatment of overweight and obesity are a public health priority. Body mass index (BMI) and waist circumference (WC)are major anthropometric indices used to measure the excess of adiposity in practice. Objective: To describe the correlations between abdominal obesity measured by BMI and central obesity as measured by WC. Methods: Descriptive cross-sectional study conducted from January to March 2007, with 662 individuals aged 15 and over recruited ten health-care centers of Marrakech. Trained professionals collected data on age and gender, and anthropometric measurements(weight, height and waist circumference). The correlations between BMI and WC were calculated for both (..) (AU)