The journey of cancer patients and the quest to equity: findings from Morocco.

OBJECTIVES: Rapid diagnostic and assessment pathways for cancer patients provide timely and effective care. This study took place in Morocco, where the majority of patients treated in the public sector are diagnosed at an advanced stage. The aim of this study was to determine the duration of different time intervals along the cancer patient pathway and to highlight problem areas so that strategies can be implemented to make the process more equitable and effective. STUDY DESIGN: Cross-sectional study. METHODS: Recently diagnosed cancer patients were recruited from four major oncology centres in Morocco; namely, Marrakech, Casablanca, Rabat, and Fez. A questionnaire survey was administered, including sociodemographic and medical information and questions on access to the oncology centre, beliefs, and opinions on the medical staff. The dates of symptom recognition, assessment, diagnosis referral, biopsy, and treatment initiation were collected. Different time intervals (patient, diagnosis, biopsy, and treatment) were estimated and their determinants were investigated. RESULTS: A total of 812 patients were interviewed. The majority of participants were breast cancer patients. In total, 60% of participants were at stage III-IV. The main facilitators of cancer diagnosis confirmation and treatment initiation were easy access to diagnosis and treatment facilities, financial resources, personal history of cancer, time availability, late stage at diagnosis, advanced age, and private health insurance. The patient interval (i.e., time from symptom recognition to initial healthcare assessment) had a median duration of 30 days. The biopsy and treatment intervals were within the current international recommendations (7 and 28 days, respectively). However, the diagnosis interval (52 days) was twice as long as the recommended timeframes from the UK, Australia, and the World Health Organization (<28 days). CONCLUSIONS: Interval targets should be defined to encourage health systems to be more equitable and effective and to ensure that cancer patients are treated within a defined timeframe.

COPEDOL: A two-year observational study in pretreated HIV-1-infected patients switching to a dolutegravir-based regimen.

OBJECTIVES: Dolutegravir is a second-generation integrase strand transfer inhibitor of particular interest as a rescue treatment for people living with HIV (PLWHIV) who develop resistance to multiple antiretrovirals (ART). We assessed the virological treatment response in patients switched to a dolutegravir-based regimen following failure of previous ART treatment in a real-world treatment setting. PATIENTS AND METHODS: This was a multicenter, longitudinal, observational study with retrospective patient enrolment. Patients were enrolled between February 2017 and January 2018. Patients starting dolutegravir treatment between February 2014 and September 2016 were retrospectively included. Patients were followed up for 24 months after dolutegravir initiation. During this period, treatment with dolutegravir could be discontinued at any time at the physician's discretion. Treatment failure was either defined as a viral load≥50 copies/mL at two consecutive blood samples or as clinical or biological safety issues. Overall, 459 patients were enrolled and 329 completed 24 months of treatment. The primary study outcome measures were treatment response and time to treatment response. RESULTS: 346/440 patients (78.6%) achieved a treatment response; 86 patients discontinued dolutegravir treatment (of whom 17 for failure to achieve or maintain viral suppression and 38 for tolerability issues). Acquired dolutegravir-resistance mutations were identified in five patients. CONCLUSIONS: A sustained treatment response can be obtained with a dolutegravir-based treatment regimen in PLWHIV experiencing treatment failure, even in vulnerable patients with a long history of previous ART failure, infected with multidrug-resistant HIV strains, and with multiple comorbidities.

Theoretical design of D-π-A system new dyes candidate for DSSC application.

Currently, dye-sensitized solar cells (DSSCs) are one of the energy technologies that has piqued the interest of researchers, due to their distinct characteristics such as excellent air stability, ease of synthesis and photovoltaic properties interesting. This work aims to study the optoelectronic properties and photovoltaic of six organic dyes based on phenothiazine (PTZ). The effects of bridging core modifications of recently synthesized PSB-4(R) molecule on structural, photovoltaic, electronic, and optical properties of D1-D6 are studied. Using the method Density Functional Theory (DFT) level of the B3LYP (Becke three-parameter Lee-Yang-Parr) exchange correlation functional with 6-31G (d, p) and time-dependent DFT (TD-DFT). According to the obtained results, optoelectronic properties and photovoltaic of the dyes, we can suggest that these designed molecules are better sensitizers as a candidate for the production of dye solar cells (DSSCs). This theoretical study paves the way for chemists to synthesize more efficient sensitizers for applications in dye solar cells.

Peroneal Nerve Palsy due to Bulky Osteochondroma from the Fibular Head: A Rare Case and Literature Review.

Common peroneal neuropathy is the most common compressive neuropathy in the lower extremities. The anatomical relationship of the fibular head with the peroneal nerve explains entrapment in this location. We report the case of a 14-year-old boy admitted with a left foot drop. The diagnosis was an osteochondroma of the proximal fibula compressing the common peroneal nerve. The patient underwent surgical decompression of the nerve and resection of the exostosis. Three months postoperatively, there was a complete recovery of the deficits. The association of osteochondroma and peroneal nerve palsy is rare. Early diagnosis is required in order to adjust the management and improve the results. It is worth to underscore that surgical resection is proven to be the appropriate treatment method ensuring high success rates.

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.

Intracaval Migration of Ureteral Stent.

Ureteral stents have proven to be an invaluable tool for endourologists. Morbidity is minimal, but complications do exist. Up to 3 months complications are not frequent, but longer indwelling times are associated with increasing frequency of incrustation, infections, secondary stone formation, obstruction of the stented tract and migration. We report a rare case of a 33 year old pregnant patient with migration of an ureteral endoprosthesis. The patient received a right ureteral stent at 12 weeks for acute obstructive pyelonephritis. When her urologist tried to remove the ureteral stent post delivery, the stent was not found in the bladder. Ureteroscopy was performed but no ureteral stent was found. The patient showed a moderate improvement of the pyelonephritis, but complained about insidious palpitations. A CT scan was performed and showed the presence of the ureteral stent extending from the inferior vena cava up to the right atrium. Endovascular retrieval was performed through a puncture of the common femoral vein, using a curved guide that was introduced through the vena cava into the right atrium. Under fluoroscopic control, it was twisted around the stent and pulled out. The outcome was favorable, and no other complications were noted.

Microbiological impact of treatment lagoons on the economics of water for reuse in agriculture a case study in Morocco (Settat and Soualem regions).

This study was undertaken to enumerate pathogens: fecal coliforms, Escherichia coli, fecal enterococci and Salmonella in the areas irrigated with treated wastewater. The samples were isolated from Settat (33°00'N, 7°37'W) and Soualem regions (34°26'N, 5°53'W). A total of (n= 48) raw water, (n=48) treated water, (n=71) of vegetables samples irrigated by treated water taken from Waste Water Treatment Plant Settat; A total of (n=24) raw water, (n=24) treated water, (n=97) of vegetables samples irrigated by treated water taken from Waste Water Treatment Plant Soualem. The results show the total average in the two stations of raw water 7.9, 6.1 log MPN 100 ml⁻¹ for respectively fecal coliforms and E. coli, 5.4 log CFU 100 ml⁻¹ for fecal enterococci and 5.2 log MPN L⁻¹ for Salmonella; for treated water 4.6, 3.1 log MPN 100 ml⁻¹ for respectively fecal coliforms and E.coli and 3.5 log CFU 100 ml⁻¹ for fecal enterococci. Regarding plants, four types of crops were harvested and analyzed (forage, herbs, cereals and vegetables), the germs charges were found with fecal coliforms, E.coli and fecal enterococci respectively 3.2, 2.8 and 4.1 log CFUg⁻¹. Salmonella was never detected in both treated water and crops samples.

[Macular edema revealing scleral necrosis following scleral buckling surgery]. / OEdème maculaire cystoïde révélateur d'une nécrose sclérale secondaire à une indentation sclérale.

INTRODUCTION: Macular edema is a very rare complication of scleral necrosis after scleral buckling surgery. OBSERVATION: We report the case of a 45-year-old women with an ocular history of severe myopia in both eyes and retinal detachment in the left eye. She underwent segmental scleral buckling in 2003. Two years and nine months later, the patient had acute, painless visual loss in her left eye. Funduscopic examination revealed cystoid macular edema with no intraocular inflammation. A fluorescein angiography and OCT revealing cystoid macular edema consistent with the macular edema was noted clinically. The surgical exploration revealed scleral necrosis beneath the scleral buckle. After removal of the scleral buckle, a scleral patch was performed. Several months after surgery, the vision had improved; funduscopic examination and OCT revealed no residual macular thickening. DISCUSSION: Macular edema is a rare complication of scleral necrosis following scleral buckling surgery, with only one case described in the literature. Our patient's complication occurred 2 years after surgery. The macular edema is likely the result of the scleritis. This inflammatory process can extend from the sclera and result in several ocular complications, including uveitis. Regression of macular edema occurs frequently after removal of the scleral buckle.