Early and Late Patient Outcomes in Urgent-Start Peritoneal Dialysis: A Prospective Study of Unplanned Initiation of Chronic Dialysis.

BACKGROUND: Peritoneal dialysis (PD) has become a well-established complementary alternative to hemodialysis (HD) as the first-line renal replacement modality. Unlike the temporary catheter for hemodialysis that can be used immediately after implementation, the PD catheter usage period remains controversial. The aim of this study was to compare the short- and long-term outcomes in patients under peritoneal dialysis according to the delay of starting the dialysis after catheter placement. METHODS: This observational prospective study was conducted over an eight-year and four-month period (from April 2014 to August 2021), including all patients treated with peritoneal dialysis for 18 months (from April 2014 to October 2015). The patients were divided into two groups according to whether the catheter was used during the first 15 days (PD-E) or 15 days after (PD-L) catheter placement. The primary outcomes were early complications (mechanical and infectious) within 90 days. Secondary outcomes included technique survival. RESULTS: Among the 36 patients included in the study, 14 started PD early (38.8%), while 22 started it 15 days after catheter placement (61.2%). The mean age between the two groups was not significantly different (41 ± 17 years vs 35 ± 16 years, p: not significant). There were no significant differences in the Charlson comorbidity index or the degree of autonomy. The incidence of infections was not significantly different between the two groups (13.6% in PD-L vs 21.4% in PD-E, p: not significant). The total number of mechanical complications was not significantly higher in the PD-E group compared to the PD-L group (42.8% vs 27.3%, respectively, p: not significant). Kaplan-Meier estimates of technique survival were comparable between the groups (log Rank: 1.908, p: 0.67). CONCLUSIONS: Our study showed no increase in the risk of complications associated with early use of the PD catheter and no difference in technique survival. PD can be used as first-line renal replacement therapy in the unplanned initiation of chronic dialysis.

Examining the Determinants of COVID-19 Severity: A Cohort Study in Morocco of 915 Patients.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) is unpredictable and it varies from mild to severe and critical forms that are associated with a higher mortality rate. Risk factors associated with severe forms of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been investigated worldwide. We aimed to evaluate the clinical course of severe COVID-19 patients and to compare them with the non-severe patients concerning clinical and epidemiological characteristics, biological parameters and outcomes and thus, highlight the factors associated with severe forms of COVID-19 in our country. METHODS: This is a single-center, ambidirectional cohort study, conducted in Tangier's COVID-19 care premises. We included diagnosed COVID-19 patients between August 2020 and October 2021. Sampling was performed through stratification according to clinical forms. All patients were followed-up throughout disease evolution, until remission for mild to moderate forms and 30 days after discharge for hospitalized patient's group (severe to critical forms). Data were collected using the WHO International Severe Acute Respiratory and Emerging Infection (ISARIC) case report form (CRF) and extracted from medical records alongside with interviews with patients and their relatives. RESULTS: Among 915 included COVID-19 patients in Tangier, the non-severe group comprised 344 (37.6%) patients and the severe group comprised 571 (62.4%) patients. Some 514 were males (56.2%) and 401 were females (43.8%) and the mean age was 56.01 years (±16.76). The mean delay from onset of symptoms to diagnosis was 6.65 days ±4.68 in the severe group and 5.4 days ±4.57 in the non-severe group (p<0.001). Among the severe patient's group, 230 (40.3%) patients were admitted to the resuscitation unit, 258 (45.2%) patients were deceased during hospitalization, 313 (54.8%) were discharged alive, and 16 deaths occurred after discharge. Demographic, clinical, and biological characteristics showed significant differences between non-severe group and severe group. Multivariable logistic regression analysis showed increased odds of severity with male gender (adjusted odds ratio, aOR=2.91, p<0.003), age over 65 years old (aOR=2.68, p<0.001), diabetes (aOR=2.18, p<0.03), elevated D-dimers (>1 mg/mL) (aOR=6.09, p<0.001), superinfection (aOR=3.78, p<0.001), and baseline lymphopenia < 1000c/mm3 (aOR=8.66, p<0.001). CONCLUSION: The high-risk factors for developing severe COVID-19 are age > 65 years, male gender, diabetes, elevated D-dimers, baseline lymphopenia, and superinfection. To predict severe and fatal COVID-19, factors identified may be used in the development of prediction tools for COVID-19 prognosis and risk stratification. Recalling the importance of considering at-risk populations, the management of epidemics must be planned in conjunction with the specificity of each community. Findings from our study may serve for health economic analyses and research in order to assist public health decisions in the future and should be integrated into health emergency preparedness and response strategies ensuring a resilient health system.

Predictive Factors of Death and the Clinical Profile of Hospitalized Covid-19 Patients in Morocco: A One-Year Mixed Cohort Study.

Background Since the onset of the Covid-19 pandemic, several studies have been conducted around the world in an attempt to understand this heterogeneous and unpredictable disease and to prevent related death. It was therefore necessary to study the associated risk factors of Covid-19-related mortality. Objectives The aim of this study was to describe the clinical profile and to identify the factors associated with mortality of patients with Covid-19 in Morocco. Methods We performed a mixed cohort study (retrospective and prospective) of 615 in-patients with Covid-19 disease, enrolled between August 2020 and October 2021. We followed the cohort throughout the hospitalization until discharge and 30 days thereafter. Results The median age was 64 years old; 62.1% of the patients were male. The mean time from symptom onset to hospitalization was 8.5 days (±4.67), and 68.1% of patients had comorbidities. On admission, the most common symptoms were dyspnea (82.2%), cough (80.3%), and fever (76.8%). The main follow-up complication was secondary infection (56.9%). Based on univariate analysis, male gender (p<0.008 and brut relative risk {bRR}=1.57), advanced age (p<0.001), lung involvement (p<0.001), lymphopenia (p<0.001 and bRR=2.32), D-dimers of >500 µg/l (p<0.007 and bRR=2.47), C-reactive protein (CRP) of >130 mg/l (p<0.001 and bRR=2.45), elevated creatinine (p<0.013 and bRR=1.61), lactate dehydrogenase (LDH) of >500 U/l (p<0.001 and bRR=7.16), receiving corticosteroids (p<0.001 and bRR=5.08), invasive ventilation (p<0.001 and bRR=30.10), the stay in the resuscitation unit (p<0.001 and bRR=13.37), and acute respiratory distress syndrome (ARDS) (p<0.001 and bRR=10.98) were associated with a higher risk of death. In the opposite, receiving azithromycin and hydroxychloroquine (p<0.001 and bRR=0.28) and pre-admission anticoagulants (p<0.005 and bRR=0.46) was associated with a lower risk of mortality. Multivariate regression analysis showed that age of >60 years (p<0.001 and adjusted odds ratio {aOR}=4.90), the use of invasive ventilation (p<0.001 and aOR=9.60), the stay in the resuscitation unit (p<0.001 and aOR=5.09), and acute respiratory distress syndrome (p<0.001 and aOR=6.49) were independent predictors of Covid-19 mortality. Conclusion In this cohort study focusing on Covid-19 in-patient's mortality, we found that age of >60 years, the use of invasive ventilation, the stay in the resuscitation unit, and acute respiratory distress syndrome were independent predictors of Covid-19 mortality. The results of this study can be used to improve knowledge for better clinical management of Covid-19 in-patients.

[Evaluation of the practice of prescribing oral chemotherapy type "Capecitabine" by medical oncologist: A first study from Morocco]. / Évaluation de la pratique de prescription d'une chimiothérapie orale type « capécitabine ¼. Résultats de la première enquête auprès des oncologues médicaux marocains.

INTRODUCTION: Oral anticancer therapy is becoming increasingly developed; their prescription has become a common practice in oncology. However, there is a variability and diversity in prescription practice. Its magnitude has been very little studied in scientific literature. To our knowledge, this is the first study in Morocco and North Africa to evaluate the practice of prescribing oral chemotherapy. METHODS: The authors conducted a national exhaustive cross-sectional survey, to evaluate the practice of the oral chemotherapy "Capecitabine" type prescription by Moroccan oncologists and to identify strategies to promote an adherence to oral anti-neoplasic therapy. RESULTS: Ninety-one medical oncologists answered out of 118, from public oncology centres (29.7%), Hospital University (58.2%), and private sector (12.1%). Thirty-four of the oncologists replied by email, 33 through phone conversation and 24 by filling paper questionnaires. In total, 32% of the cases were handwritten prescriptions, and 51.6% electronically generated. Forty-six percent of medical oncologists dedicated more time to the oral chemotherapy type Capecitabine prescription versus its intravenous equivalent 5FU. However, 33% medical oncologists take less time to this prescription, and 20.9% of them take the same time. Adherence to oral chemotherapy was evaluated by simply questioning of patients in most of the cases (94%) and 4% of medical oncologist declared that they did not evaluate this adherence. In total, 87.9% of Moroccan medical oncologists revealed that they have not received any specific training in the therapeutic education of the patient with oral anti-cancer treatment. CONCLUSION: In Morocco, there is a great variability in prescription and follow-up practice for patients receiving oral chemotherapy. There is a lack of a national standardization with regards to the procedures of prescribing and monitoring patients to ensure the quality and safety of the oral chemotherapy prescription.

Risk factors and early renal effects of environmental exposure to the trace elements in Moroccan adolescents.

BACKGROUND: In Morocco, the use of leaded-gasoline is still common even after its ban in 2011, and other sources of contamination by traces elements are not regulated. We aimed to assess blood and urinary cadmium, blood lead, and total blood mercury levels in Moroccan adolescents and to identify determinants and early renal effects of exposure. METHODS: The study included 149 school adolescents (12 to 18 years), from urban, industrial, and rural areas in Fez city (north of Morocco). Risk factors were investigated by interviews and questionnaires. Internal doses and early renal effects were evaluated by analyzing blood and urinary samples. RESULTS: The mean of blood lead levels (BLLs) in all adolescents was 47.81µg/l with no difference between boys and girls. Adolescents from the urban area had the highest BLLs mean. The means of blood cadmium levels (BCLs) and urinary cadmium levels (UCLs) were 0.29µg/l and 0.45µg/l respectively, with no differences between living areas or according to sex. The total blood mercury levels (BMLs) mean was 0.52 µg/l. BMLs mean was higher in the industrial area and among boys. This can be associated to the frequency of fish intake, the use of dental amalgams fillings, and the consumption of chewing gum. Rates of early renal effects markers were low, not correlated to the metals, and may indicate that renal effects of this environmental exposure could be limited. CONCLUSIONS: There is an urgent need for the limitation of trace elements' sources, particularly the strict application of the laws concerning leaded-petrol prohibition.

Skin Reactions to Personal Protective Equipment among First-Line COVID-19 Healthcare Workers: A Survey in Northern Morocco.

OBJECTIVES: Health care workers (HCWs) adopted several protective measures, including hand hygiene and wearing personal protective equipment (PPE) during the COVID-19 outbreak. However, the frequent use of these preventive measures can lead to skin reactions. Our study aimed to determine the frequency of these reactions in Northern Morocco. In addition, we also looked at the risk factors and the consequences of these injuries on work efficiency and performance. MATERIALS AND METHODS: An anonymous online survey was used to collect data, which was sent to 500 health workers in the study region. Descriptive and inferential statistics were used to analyze the data on IBM SPSS software. RESULTS: In total, 273/500 responded to the questionnaire (55%). For the participants' profession, 41% were doctors, 32% were nursing staff, and 26% held other jobs. The general prevalence rate of adverse reactions for all health workers was (80%), including skin problems: after wearing goggles (58%), after wearing surgical masks and respirators (57%), after handwashing and wearing gloves (45%), after wearing a face shield (23%), and after wearing protective clothing (11%). Bleach immersion was highly significantly associated with hand reaction (OR: 2.9, 95% CI: 1.77-4.90; P < 0.001). Moreover, we found a statistically significant association between hand cream use more than twice daily and fewer reactions (OR: 1.9, 95% CI: 0.98-3.77; P = 0.038). The skin reactions related to goggles use were also significantly associated with use duration (OR: 1.7, 95% CI: 0.988-3.12; P = 0.05). Similarly, wearing masks and N95 respirators and their related adverse reactions were significantly associated with use duration (OR: 0.5, 95% CI: 0.20-0.7; P = 0.02). In addition, adverse reactions of regular use of protective clothing were related to the frequency of its use per shift (OR: 3.5, 95% CI: 1.47-8.54; P = 0.05). CONCLUSIONS: Our survey-based study showed that the prevalence of these skin reactions in our context should not be neglected. The length of daily wearing time and the frequency of PPE uses were the most implicated factors. More attention must be paid to these reactions for better care of HCWs during these critical times.

Mental Health Problems Experienced by Patients with Rheumatic Diseases During COVID-19 Pandemic.

BACKGROUND: Patients with rheumatic diseases are more likely to suffer from anxiety, depression and insomnia. Yet, little is known about mental health status during COVID-19 pandemic. OBJECTIVE: This study aims to measure the prevalence of mental health disorders among patients with rheumatic diseases in the era of COVID-19 pandemic and to determine potential risk factors for major symptoms of depression, anxiety, and insomnia in participants. METHODS: Participants with rheumatic diseases were asked to complete a questionnaire using a telephonic interview. Sociodemographic and rheumatic disease characteristics were recorded. Mental health status was assessed by the patient health questionnaire-9 (PHQ-9), generalized anxiety disorder (GAD)-7, and insomnia severity index (ISI) questionnaires to detect depression, anxiety and insomnia symptoms, respectively. RESULTS: We included 307 patients in the survey. Rheumatoid arthritis was the most frequent diagnosis (55%). Of all participants, 7.5% had known depression and 5.5% known anxiety. Mental health disorders were insomnia (34.9%), anxiety (33.2%), and depression (24.4%). Major symptoms of insomnia, anxiety, and depression were noted in respectively, 19.9%, 12.4%, and 7.8% of participants. Risk factors for major insomnia were male gender (OR= 4.36, 95% CI 2.06 to 9.25; p<0.0001), low socioeconomic status (OR= 2.64, 95% CI 1.44 - 4.83; p<0.002) and having rheumatoid arthritis (OR= 2.00, 95% CI 1.04 to 3.84; p<0.036). Major anxiety was associated with low monthly income (OR=1.79, 95% CI 1.07 to 3.01; p<0.026), and higher Numerical Rating Scale (NRS) of pain (OR=1.795, 95% CI 1.074 to 2.994 ; p<0.026). Major depression was associated with the worsening of rheumatic disease (OR=1.86, 95% CI 1.06 to 3.26; p<0.03). CONCLUSION: A high frequency of undiagnosed depression, anxiety and insomnia symptoms was found in rheumatic patients. Rheumatologists should be aware of these comorbidities, especially in the era of COVID-19 pandemic.

Patients with Rheumatic Diseases Overlooked during COVID-19 Pandemic: How are They Doing and Behaving?

BACKGROUND: People with rheumatic disease may be at higher risk for more severe course with COVID- 19, and the adverse effects of drugs used to treat rheumatic diseases is a major concern. OBJECTIVE: We conducted this survey to learn about the real impact of COVID-19 pandemic on patients with rheumatic diseases. METHODS: Participants were asked to complete a questionnaire using a telephonic interview conducted by two rheumatologists. Rheumatic disease characteristics, knowledge and attitude toward COVID-19, and impacts of pandemic on rheumatology care and patient's compliance were assessed. RESULTS: We included 307 patients in the survey, and rheumatoid arthris was the main rheumatic disease. Patients had mostly moderate level of knowledge about COVID-19, and patients with higher level of education were more likely to have better knowledge. Participants respected mainly recommended preventive measures. The pandemic and sanitary containment impacted strongly the rheumatology care. Over quarter of patients noted worsening of their rheumatic disease, two-thirds reported postponed or canceled medical apointments and more than three quarters postponed their laboratory tests. Patients with higher disease activity were more likely to have lack of follow-up. Medication change was noted in more than third of cases. It was mostly stopped, and DMARDs were mainly affected. Patients living in rural areas and who had canceled, or postponed their appointments were more likely to change their treatment. CONCLUSION: Our data are useful to better manage rheumatic patients. Physicians are encouraged to renew contact with their patients to insure medication compliance.

Death in Children After Atractylis gummifera L. Poisoning in Morocco-Report of Three Cases and Review of Literature.

BACKGROUND: Atractylis gummifera L. is a poisonous thistle plant that grows in the Mediterranean regions especially in northern Africa like Morocco and southern Europe. It has been used frequently to treat some diseases in traditional medicine, and its ingestion is a common cause of fatal poisoning. Here, we report 3 death cases in children after accidental ingestion of the Atractylis gummifer L. CASES REPORTS: We report 3 cases of death in children after accidental ingestion of the poisonous plant Atractylis gummifer L. The poisoned children were admitted to hospital in deteriorated general state with clinical symptoms, such as nausea, vomiting, epigastric, and abdominal pain, diarrhea, followed by coma. However, they died a few hours later. The postmortem investigations were performed, and the diagnosis of Atractylis gummifer L. poisoning was confirmed by toxicological examination (chromatography), the latter showed the presence of atractyloside (potassium atractylate), a toxic compound of the plant Atractylis gummifera L.Atractylis gummifer L. poisoning was discussed with review through the literature. CONCLUSIONS: Through the presented cases, we show that Atractylis gummifera L. poisoning remains a health problem that involves children in Morocco, where the plant grows spontaneously. Thus, teaching children to recognize dangerous plants will be helpful to prevent accidental ingestion.

Knowledge, attitudes, and practice of organ donation in Morocco: A cross-sectional survey.

In any health system, public awareness of organ donation fundamentally affects the organ transplantation programs. The aim of this study was to evaluate the knowledge and perception of the people in Morocco toward organ donation as well as to identify the reasons and determinants for refusal of organ donation. This opinion survey included a representative sample of 2000 participants in Morocco, and data related to sociodemographic characteristics, knowledge and self-opinion about organ donation, and reasons behind refusal were collected. Statistical analysis showed that 55.2% of the participants were women, the median age was 21 years, and 60.8% of included participants had secondary education. Almost two-thirds of surveyed participants (62.3%) showed a low to mid-level of knowledge about organ donation and transplantation in Morocco. About half of the interviewed participants (48.8%) refused to donate their organs. Concern about risk of medical error and the belief in trafficking of procured organs were the main reasons for refusal, seen in 66% and 62% of the interviewees, respectively. Univariate and multivariate logistic regression models showed that the older, the less educated and the less informed a person is, the less he accepted organ donation. Therefore, promotion of organ donation in Morocco should involve a regular information and awareness among the general population.

Efficacy of Argane Oil on Metabolic Syndrome in a Moroccan Knee Osteoarthritis Population.

Five medical conditions which characterize metabolic syndrome are abdominal obesity, elevated blood pressure, elevated fasting plasma glucose, high serum triglycerides, and low highdensity lipoproteins cholesterol. When a patient has any three of the five above conditions, he is known to have metabolic syndrome, and these conditions represent a key element in cardiovascular diseases. On the other hand, knee osteoarthritis is a degenerative disease which was shown to be affected by some of the parameters of metabolic syndrome. Edible Argane oil is used in Moroccan folk medicine against several health conditions, such as knee osteoarthritis, though, evidence-based medical data about the above health benefit from Argane oil treatment are lacking. In the present clinical controlled study, we have found that consumption of Argane oil by 38 patients who have knee osteoarthritis and metabolic syndrome can improve several of their metabolic syndrome parameters and decrease their blood lipid atherogenic ratios. The present clinical study, to the best of our knowledge, is the first one to show that Argane oil consumption could be a therapeutic preventive tool against key cardiovascular risk factors of metabolic syndrome in knee osteoarthritis patients.

Cost-effectiveness of diagnostic-therapeutic strategies for paediatric visceral leishmaniasis in Morocco.

INTRODUCTION: Visceral leishmaniasis (VL) is a neglected parasitic disease with a high fatality rate if left untreated. Endemic in Morocco, as well as in other countries in the Mediterranean basin, VL mainly affects children living in rural areas. In Morocco, the direct observation of Leishmania parasites in bone marrow (BM) aspirates is used to diagnose VL and meglumine antimoniate (SB) is the first line of treatment. Less invasive, more efficacious and safer alternatives exist. In this study we estimate the cost-effectiveness of alternative diagnostic-therapeutic algorithms for paediatric VL in Morocco. METHODS: A decision tree was used to estimate the cost-effectiveness of using BM or rapid diagnostic tests (RDTs) as diagnostic tools and/or SB or two liposomal amphotericin B (L-AmB) regimens: 6-day and 2-day courses to treat VL. Incremental cost-effectiveness ratios, expressed as cost per death averted, were estimated by comparing costs and effectiveness of the alternative algorithms. A threshold analysis evaluated at which price L-AmB became cost-effective compared with current practices. RESULTS: Implementing RDT and/or L-AmB treatments would be cost-effective in Morocco according to the WHO thresholds. Introducing the 6-day course L-AmB, current second-line treatment, would be highly cost-effective if L-AmB price was below US$100/phial. The 2-day L-AmB treatment, current standard treatment of paediatric VL in France, is highly cost-effective, with L-AmB at its market price (US$165/phial). CONCLUSIONS: The results of this study should encourage the implementation of RDT and/or short-course L-AmB treatments for paediatric VL management in Morocco and other North African countries.

Knowledge, Attitudes, and Preventive Practice Towards Breast Cancer among General Practitioner Health Professionals in Morocco

Background: Breast cancer is the most common cancer of women in Morocco and its diagnosis is usually made at advanced stages. The aim of this study was to describe the knowledge, practices and attitudes of general practitioners regarding early detection of breast cancer. Methods: A cross-sectional study was carried out during July 2011 on a sample of 140 general practitioners employed in basic health care facilities. Results: The majority (85.7%) of general practitioners were aware of the existence of a ministerial circular which aimed to generalize breast cancer screening. Systematic practice of clinical breast examination was reported by 18.0% of doctors for every woman between 45 and 70 years and a systematic breast self-examination check-up was reported by 59.4% of physicians. Mammography was requested by 54.1% of physicians in the presence of risk factors. Females and physicians practicing in urban areas were less likely to have a knowledge, attitudes and practices score higher than 8 as compared to male physicians and those practicing in rural areas. Discussion and conclusion: Our study showed that the knowledge, attitudes and practices of general practitioners regarding the early detection of breast cancer program were not satisfactory; hence the urgent need for improved implementation of the program in the affected regions.

Pediatric psoriasis: Should we be concerned with comorbidity? Cross-sectional study.

BACKGROUND: Similarly to psoriasis in adults, recent research has linked psoriasis to several comorbidities in children. The aim of this study was therefore to describe comorbidities associated with pediatric psoriasis, to investigate their relationship with psoriasis characteristics and severity, and to perform a review of the literature. METHODS: A cross-sectional study was performed on a sample of Moroccan children with psoriasis, in 2014-2016. RESULTS: A total of 64 pediatric psoriasis patients had metabolic comorbidities in association with psoriasis; 20 children had non-metabolic comorbidities; and 76 children had no comorbidity. The metabolic comorbidities were as follows: abdominal obesity, 40% (n = 64); overweight, 12.5% (n = 20); metabolic syndrome, 3.7% (n = 6); and dyslipidemia, 3.1% (n = 5); the non-metabolic comorbidities were atopy, 4.3% (n = 7); epilepsy, 3.1% (n = 5); celiac disease, 1.8% (n = 3); vitiligo, 1.8% (n = 3); alopecia ariata, 0.6% (n = 1); and valvular cardiopathy, 0.6% (n = 1). No cases of diabetes mellitus, obesity, or high blood pressure were recorded. Significant factors associated with metabolic comorbidity were extended psoriasis vulgaris >10% (P = 0.01; OR, 2.19), severe psoriasis especially pustular and erythroderma (P = 0.018; OR, 2), nail involvement (P = 0.016; OR, 1.5), face involvement (P = 0.01; OR, 1,59), resistance to topical treatment (P = 0.003; OR, 2.5) and alteration of quality of life (P = 0.02; OR, 1,7). There was no significant risk factor associated with non-metabolic comorbidity. CONCLUSIONS: Given the frequent association of pediatric psoriasis with many disorders, these comorbidities should be investigated and identified so that they can be taken into account in the management of psoriasis in order to avoid treatment failure. Regular follow up should be carried out in patients at risk of metabolic comorbidity.

Health risk behaviours amongst school adolescents: protocol for a mixed methods study.

BACKGROUND: Determining risky behaviours of adolescents provides valuable information for designing appropriate intervention programmes for advancing adolescent's health. However, these behaviours are not fully addressed by researchers in a comprehensive approach. We report the protocol of a mixed methods study designed to investigate the health risk behaviours of Moroccan adolescents with the goal of identifying suitable strategies to address their health concerns. METHODS: We used a sequential two-phase explanatory mixed method study design. The approach begins with the collection of quantitative data, followed by the collection of qualitative data to explain and enrich the quantitative findings. In the first phase, the global school-based student health survey (GSHS) was administered to 800 students who were between 14 and 19 years of age. The second phase engaged adolescents, parents and teachers in focus groups and assessed education documents to explore the level of coverage of health education in the programme learnt in the middle school. To obtain opinions about strategies to reduce Moroccan adolescents' health risk behaviours, a nominal group technique will be used. DISCUSSION: The findings of this mixed methods sequential explanatory study provide insights into the risk behaviours that need to be considered if intervention programmes and preventive strategies are to be designed to promote adolescent's health in the Moroccan school.

[Renal needle biopsy in the Department of Nephrology in Fès: indications and results in 522 cases]. / Ponction biopsies rénales dans le Service de Néphrologie de Fès: indications et résultats: à propos de 522 cas.

The contribution of renal needle biopsy (RNB) to make a diagnosis, a treatment selection and a prognostic evaluation of nephropathies is significant. No Moroccan study has evaluated the practice and the contribution of RNB. Our aim was to study RNB indications, to determine the frequency of kidney diseases identified by RNB in our region and make a comparison between clinical and biological data and histological diagnosis. This is a retrospective study conducted between January 2009 and December 2012. We included all patients in the Department of Nephrology, CHU Hassan II, Fez, who underwent biopsy of native kidneys. 522 RNB were performed. We excluded 8 biopsies due to lack of informations and 514 were retained. The average age of the patients at the time of RNB was 39±17 years (3-82 years). Sex ratio was 0.9. Nephrotic syndrome was the most common clinical diagnosis to all ages (58.2%). Glomerular nephropathies represent 94,2% of diagnosed renal diseases, their distribution varies according to patients' age. RNB confirmed the first clinically suspected diagnosis in 40.65% of cases, whereas it revealed an unexpected diagnosis in 22.5% of them. Syndromic diagnosis can orient the clinician toward the most probable kidney disease and guide any emergency treatment while awaiting RNB results. But it can never replace RNB which remains the gold standard.

Mortality Attributable to Second Hand Smoking in Morocco: 2012 Results of a National Prevalence Based Study.

PURPOSE: To estimate the number of deaths attributable to second hand smoking (SHS) in Morocco in 2012. MATERIALS AND METHODS: prevalence based study focusing on mortality from ischaemic heart disease (IHD) and lung cancer among non-smokers aged 35 and over. Prevalence of SHS among never smokers was gathered from a national cross sectional survey on tobacco and population attributable risk (PAR) was calculated by applying PARs to mortality. The analyses were stratified by sex, age and area of exposure. RESULTS: Rates for exposure to SHS among men aged 35-64 years ranged from 20.0% at home to 57.4% at work. Among non-smoking Moroccans aged 35 and over, 233 (IC: 147 - 246) deaths were attributable to exposure to SHS; 156 (IC: 100 - 221) in women and 77 (IC: 44 -125) in men. A total of 173 (122 - 222) deaths were estimated to have been caused by exposure only at home, 34 (9 - 76) by exposure only at the work place and 26 (15 - 58) by exposure both at home and work places. Exposure to SHS could be responsible for 182 (128 - 237) deaths from IHD and 51 (19 - 109) from lung cancer. CONCLUSIONS: These data confirm that SHS needs urgent attention in Morocco.

Cost of Pediatric Visceral Leishmaniasis Care in Morocco.

BACKGROUND: Visceral leishmaniasis (VL) is a neglected parasitic disease that is fatal if left untreated. VL is endemic in Morocco and other countries in North Africa were it mainly affects children from rural areas. In Morocco, the direct observation of Leishmania parasites in bone marrow aspirates and serological tests are used to diagnose VL. Glucantime is the first line of treatment. The objective of this study was to report the costs associated to standard clinical management of pediatric VL from the provider perspective in Morocco. As a secondary objective we described the current clinical practices and the epidemiological characteristics of pediatric VL patients. METHODS: From March to June 2014 we conducted a survey in eight hospitals treating pediatric VL patients in Morocco. A pro-forma was used to collect demographic, clinical and management data from medical records. We specifically collected data on VL diagnosis and treatment. We also estimated the days of hospitalization and the time to start VL treatment. Costs were estimated by multiplying the use of resources in terms of number of days in hospital, tests performed and drugs provided by the official prices. For patients receiving part of their treatment at Primary Health Centers (PHC) we estimated the cost of administering the Glucantime as outpatient. We calculated the median cost per VL patient. We also estimated the cost of managing a VL case when different treatment strategies were applied: inpatient and outpatient. RESULTS: We obtained data from 127 VL patients. The median total cost per pediatric VL case in Morocco is 520 US$. The cost in hospitals applying an outpatient strategy is significantly lower (307 US$) than hospitals keeping the patients for the whole treatment (636 US$). However the outpatient strategy is not yet recommended as VL treatment for children in the Moroccan guidelines. VL diagnosis and treatment regimens should be standardized following the current guidelines in Morocco.

Metabolic syndrome in Moroccan patients with psoriasis.

BACKGROUND: Several recent reports have shown a significant association between psoriasis and metabolic syndrome (MBS). OBJECTIVE: The goal of this study was to investigate the prevalence of MBS and, in particular, the main factors that determine this syndrome in Moroccan patients with psoriasis. METHODS: A case-control study has included 150 patients with psoriasis and 300 controls matched for age and sex, the MBS was defined according to the International Diabetes Foundation, and the severity of psoriasis was assessed by body surface area. RESULTS: Mild psoriasis was seen in 10.7%, 40.3% had moderate psoriasis, and 49% had severe psoriasis. MBS was higher in cases than in controls with statistical differences (44.7 vs. 2.7%, odds ratio [OR]: 26 CI: [12.4-54.3]; P = 0.000). Abdominal obesity and dyslipidemia were the only metabolic factors significantly related to psoriasis whereas diabetes, hypertension, smoking, alcohol consumption, and cardiovascular diseases were not significant. MBS increases with age in our patients with psoriasis, whereas there was no relationship between MBS and gender. Hypertension (P = 0.007), diabetes (P = 0.003), and increased level of triglycerides (P = 0.05) and high-density lipoprotein cholesterol (P = 0.003) were associated with the severity of psoriasis. CONCLUSION: Metabolic syndrome is an important comorbidity in patients with psoriasis, and vigilance and enhanced screening may be important in this population, especially patients with severe disease.

Breast Cancer Screening in Morocco: Performance Indicators During Two Years of an Organized Programme.

BACKGROUND: Breast cancer is commonly diagnosed at late stages in countries with limited resources. In Morocco, breast cancer is ranked the first female cancer (36.1%) and screening methods could reduce the proportion presenting with a late diagnosis. Morocco is currently adopting a breast cancer screening program based on clinical examination at primary health facilities, diagnosis at secondary level and treatment at tertiary level. So far, there is no systematic information on the performance of the screening program for breast cancer in Morocco. The aim of this study was to analyze early performance indicators. MATERIALS AND METHODS: A retrospective evaluative study conducted in Temara city. The target population was the entire female population aged between 45-70 years. The study was based on process and performance indicators collected at the individual level from the various health structures in Tamara between 2009 and 2011. RESULTS: A total of 2,350 women participated in the screening program; the participation rate was 35.7%. Of these, 76.8% (1,806) were married and 5.2% (106) of this group had a family history of breast cancer. Of the women who attended screening, 9.3% (190) were found to have an abnormal physical examination findings. A total of 260 (12.7%) were referred for a specialist consultation. The positive predictive value of clinical breast examination versus mammography was 23.0%. Forty four (35.5%) of the lesions found on the mammograms were classified as BI-RADs 3; 4 or 5 category. Cancer was found in 4 (1.95%) of the total number of screened women and benign cases represented 0.58%. CONCLUSIONS: These first results of the programme are very encouraging, but there is a need to closely monitor performance and to improve programme procedures with the aim of increasing both the participation rate and the proportion of women eligible to attend screening.