The prevalence of headache in the adult population of Morocco: a cross-sectional population-based study.

BACKGROUND: The series of population-based studies conducted by the Global Campaign against Headache has, so far, included Pakistan and Saudi Arabia from the Eastern Mediterranean Region. The Maghreb countries of North Africa, also part of this Region, are geographically apart and culturally very different from these countries. Here we report a study in Morocco. METHODS: We applied the standardised methodology of Global Campaign studies, with cluster-randomized sampling in regions of Morocco selected to be representative of its diversities. In three of these regions, in accordance with this methodology, we made unannounced visits to randomly selected households and, from each, interviewed one randomly selected adult member (aged 18-65 years) using the HARDSHIP structured questionnaire translated into Moroccan Arabic and French. In a fourth region (Fès), because permission for such sampling was not given by the administrative authority, people were randomly stopped in streets and markets and, when willing, interviewed using the same questionnaire. This was a major protocol violation. RESULTS: We included 3,474 participants, 1,074 (41.7%) from Agadir, 1,079 (41.9%) from Marrakech, 422 (16.4%) from Tétouan and 899 from Fès. In a second protocol violation, interviewers failed to record the non-participating proportion. In the main analysis, excluding Fès, observed 1-year prevalence of any headache was 80.1% among females, 68.2% among males. Observed 1-day prevalence (headache yesterday) was 17.8%. After adjustment for age and gender, migraine prevalence was 30.8% (higher among females [aOR = 1.6]) and TTH prevalence 32.1% (lower among females [aOR = 0.8]). Headache on ≥ 15 days/month (H15+) was very common (10.5%), and in more than half of cases (5.9%) associated with acute medication overuse (on ≥ 15 days/month) and accordingly diagnosed as probable medication-overuse headache (pMOH). Both pMOH (aOR = 2.6) and other H15+ (aOR = 1.9) were more common among females. In the Fès sample, adjusted prevalences were similar, numerically but not significantly higher except for other H15+. CONCLUSIONS: While the 1-year prevalence of headache among adults in Morocco is similar to that of many other countries, migraine on the evidence here is at the upper end of the global range, but not outside it. H15 + and pMOH are very prevalent, contributing to the high one-day prevalence of headache.

Evaluation of COVID-19 preventive practices among sellers in the Beni Mellal region of Morocco.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) is caused by the SARS-CoV-2 virus. It has impacted millions of individuals and caused numerous casualties. Consequently, there was a race to develop vaccines against the virus. However, there has been unequal vaccine distribution among nations, and concerns over side effects have resulted in vaccine hesitancy, reducing vaccination rates in many countries and hindering pandemic eradication. Preventive measures like well-fitted masks, frequent hand washing, alcohol-based sanitizers, and maintaining physical distance remain crucial to curb SARS-CoV-2 transmission. This study examined the adoption of these preventive measures among sellers in the Beni Mellal region of Morocco. RESULTS: We analyzed a cohort of 700 merchants, including 40.28% middle-aged males. Among them, 53% (371/700) wore masks, with 61.08% using medical masks, and 44.05% correctly positioned their masks. Additionally, 20.29% (142/700) carried disinfectants, of whom 117 used them at least once in 30 minutes. However, physical distancing was lacking in 78.29% of sellers, particularly among young and middle-aged males (18% and 31.86%, respectively). More than 80% of the vendors had frequent physical contact with others, primarily through hands. Surprisingly, only 1% (7/700) of participants combined the following preventive measures: using a disinfectant at least once, wearing a well-fitted mask, practicing physical distancing, and avoiding contact with others. Two individuals (0.29%) refrained from touching any surfaces. Money accounted for 76.57% of commonly touched surfaces; yet only 0.29% adhered to the preventive measures while handling money. Furthermore, a majority of individuals (92.14%, 645/700) were observed touching their faces at least once.

A comparative genomics approach reveals a local genetic signature of Leishmania tropica in Morocco.

In Morocco, cutaneous leishmaniasis (CL) caused by Leishmania (L.) tropica is an important health problem. Despite the high incidence of CL in the country, the genomic heterogeneity of these parasites is still incompletely understood. In this study, we sequenced the genomes of 14 Moroccan isolates of L. tropica collected from confirmed cases of CL to investigate their genomic heterogeneity. Comparative genomics analyses were conducted by applying the recently established Genome Instability Pipeline (GIP), which allowed us to conduct phylogenomic and principal components analyses (PCA), and to assess genomic variations at the levels of the karyotype, gene copy number, single nucleotide polymorphisms (SNPs) and small insertions/deletions (INDELs) variants. Read-depth analyses revealed a mostly disomic karyotype, with the exception of the stable tetrasomy of chromosome 31. In contrast, we identified important gene copy number variations across all isolates, which affect known virulence genes and thus were probably selected in the field. SNP-based cluster analysis of the 14 isolates revealed a core group of 12 strains that formed a tight cluster and shared 45.1 % (87 751) of SNPs, as well as two strains (M3015, Ltr_16) that clustered separately from each other and the core group, suggesting the circulation of genetically highly diverse strains in Morocco. Phylogenetic analysis, which compared our 14 L. tropica isolates against 40 published genomes of L. tropica from a diverse array of locations, confirmed the genetic difference of our Moroccan isolates from all other isolates examined. In conclusion, our results indicate potential regional variations in SNP profiles that may differentiate Moroccan L. tropica from other L. tropica strains circulating in endemic countries in the Middle East. Our report paves the way for future research with a larger number of strains that will allow correlation of diverse phenotypes (resistance to treatments, virulence) and origins (geography, host species, year of isolation) to defined genomic signals such as gene copy number variations or SNP profiles that may represent interesting biomarker candidates.

Seroepidemiological assessment of SARS-CoV-2 vaccine responsiveness and associated factors in the vaccinated community of the Casablanca-Settat Region, Morocco.

Assessing the prevalence of SARS-CoV-2 IgG positivity through population-based serological surveys is crucial for monitoring COVID-19 vaccination efforts. In this study, we evaluated SARS-CoV-2 IgG positivity within a provincial cohort to understand the magnitude of the humoral response against the SARS-CoV-2 vaccine and to inform evidence-based public health decisions. A community-based cross-sectional seroprevalence study was conducted, involving 10,669 participants who received various vaccines (two doses for BBIBP-CorV/Sinopharm, Covishield vaccine, and Pfizer/BioNTech, and one dose for Johnson & Johnson's Janssen COVID-19 vaccine). The study spanned 16 provinces in the Casablanca-Settat region from February to June 2022, during which comprehensive demographic and comorbidity data were collected. We screened samples for the presence of IgG antibodies using the SARS-CoV-2 IgG II Quant assay, which quantifies antibodies against the receptor-binding domain (RBD) of the spike (S) protein, measured on the Abbott Architect i2000SR. The overall crude seroprevalence was 96% (95% CI: 95.6-96.3%), and after adjustment for assay performance, it was estimated as 96.2% (95% CI: 95.7-96.6). The adjusted overall seroprevalences according to vaccine brands showed no significant difference (96% for BBIBP-CorV/Sinopharm, 97% for ChAdOx1 nCoV-19/Oxford/AstraZeneca, 98.5% for BNT162b2/Pfizer-BioNTech, and 98% for Janssen) (p = 0.099). Participants of older age, female sex, those with a history of previous COVID-19 infection, and those with certain chronic diseases were more likely to be seropositive among ChAdOx1 nCoV-19/Oxford/AstraZeneca and BBIBP-CorV/Sinopharm vaccinee groups. Median RBD antibody concentrations were 2355 AU/mL, 3714 AU/mL, 5838 AU/mL, and 2495 AU/mL, respectively, after two doses of BBIBP-CorV/Sinopharm, ChAdOx1 nCoV-19/Oxford/AstraZeneca, BNT162b2/Pfizer-BioNTech, and after one dose of Janssen (p < 0.0001). Furthermore, we observed that participants vaccinated with ChAdOx1 nCoV-19/Oxford/AstraZeneca and BBIBP-CorV/Sinopharm with comorbid chronic diseases exhibited a more pronounced response to vaccination compared to those without comorbidities. In contrast, no significant differences were observed among Pfizer-vaccinated participants (p > 0.05). In conclusion, our serosurvey findings indicate that all four investigated vaccines provide a robust humoral immune response in the majority of participants (more than 96% of participants had antibodies against SARS-CoV-2). The BNT162b2 vaccine was found to be effective in eliciting a strong humoral response compared to the other three vaccines. However, challenges still remain in examining the dynamics and durability of immunoprotection in the Moroccan context.

Histopathological and morphological characterization of Cysticercus fasciolaris isolated from domestic and wild rodents in Morocco.

Cysticercus fasciolaris is a parasitic helminth that usually infects feline and canine mammal hosts. The intermediate hosts (rodents, occasionally lagomorphs, and humans) get infected by the consumption of feed or water contaminated with eggs. Rodents are vectors of disease and reservoirs of various zoonotic parasites. The current survey was aimed at determining endoparasitic helminth infections in rodents in central Morocco. Sampled rodents after specific identification were sacrificed and examined to identify parasitic helminths following ethical guidelines. Parasites were identified using morphological characteristics. A total of 197 specimens of rodents were collected and examined in this study. Ten rodent species were identified morphologically as Rattus rattus, R. norvegicus, Apodemus sylvaticus, Mus musculus, M. spretus, Mastomys erythroleucus, Meriones shawi, M. libycus, Gerbillus campestris, and Lemniscomys barbarus. The parasitological results showed that metacestode of tapeworms was found encysted in the liver, the larval stage of Taenia taeniaeformis develops large multinodular fibrosarcomas which envelope the tapeworm cysts in the liver of the R. rattus and R. norvegicus. Based on morphological data, the metacestode was identified as C. fasciolaris in 23 (23/80) R. rattus 2 (2/8) and R. norvegicus with a prevalence of 11.7 % and 1.0 %, respectively. Rodents are major vectors of human and domestic animal diseases worldwide, and therefore, important parasitic zoonotic agents (C. fasciolaris), which are transmitted by black rats (R. rattus) and brown rats (R. norvegicus), must be considered to prevent the infectivity of humans, domestic animals, and livestock such as cattle, sheep, and rabbits.

Independent clinic-based evaluation of point-of-care testing for the screening of Chlamydia trachomatis, Neisseria gonorrhoea and Trichomonas vaginalis in women-at-risk in Australia, Guatemala, Morocco, and South Africa.

BACKGROUND: In 2018, the World Health Organization commenced a multi-country validation study of the Cepheid GeneXpert for a range of molecular-based point-of-care (POC) tests in primary care settings. One study arm focused on the evaluation of POC tests for screening 'women at risk' for chlamydia (CT), gonorrhoea (NG) and trichomonas (TV) in four countries - Australia, Guatemala, Morocco and South Africa. METHODS: Study participants completed a pre-test questionnaire which included demographics, clinical information and general questions on POC testing (POCT). Two vaginal swab samples (either self-collected or clinician collected) from each patient were tested on the GeneXpert at the POC and at a reference laboratory using quality-assured nucleic acid amplification tests (NAATs). RESULTS: One thousand three hundred and eighty-three women were enrolled: 58.6% from South Africa, 29.2% from Morocco, 6.2% from Guatemala, and 6.0% from Australia. 1296 samples for CT/NG and 1380 samples for TV were tested by the GeneXpert and the reference NAAT. The rate of unsuccessful tests on the GeneXpert was 1.9% for CT, 1.5% for NG and 0.96% for TV. The prevalence of CT, NG and TV was 31%, 13% and 23%, respectively. 1.5% of samples were positive for all three infections; 7.8% were positive for CT and NG; 2.4% were positive for NG and TV; and 7.3% were positive for CT and TV. Compared to reference NAATs, pooled estimates of sensitivity for the GeneXpert tests were 83.7% (95% confidence intervals 69.2-92.1) for CT, 90.5% (85.1-94.1) for NG and 64.7% (58.1-70.7) for TV (although estimates varied considerably between countries). Estimates for specificity were ≥96% for all three tests both within- and between-countries. Pooled positive and negative likelihood ratios were: 32.7 ([CI] 21.2-50.5) and 0.17 (0.08-0.33) for CT; 95.3 (36.9-245.7) and 0.10 (0.06-0.15) for NG; and 56.5 (31.6-101.1) and 0.35 (0.27-0.47) for TV. CONCLUSION: This multi-country evaluation is the first of its kind world-wide. Positive likelihood ratios, as well as specificity estimates, indicate the GeneXpert POC test results for CT, NG and TV were clinically acceptable for ruling in the presence of disease. However, negative likelihood ratios and variable sensitivity estimates from this study were poorer than expected for ruling out these infections, particularly for TV. TRIAL REGISTRATION: Ethics approval to conduct the ProSPeRo study was granted by the WHO Ethics Review Committee, as well as local ethics committees from all participating countries.

Uncontrolled blood pressure and its risk factors among hypertensive patients, Marrakech, Morocco.

Hypertension is a public health problem. Failure to control blood pressure figures is responsible for morbidity and premature mortality. This study aims to describe the characteristics of hypertensive patients followed at primary health care centers in Marrakech. Between May 2021 and December 2022, a cross-sectional study of 922 hypertension patients attending primary health care centers in Marrakech was done. To gather socio-demographic, behavioral, and clinical data, as well as hypertension treatment features and the care-patient-physician triad, a face-to-face questionnaire was employed. To identify risk factors associated with uncontrolled blood pressure, multivariate logistic regression was used. Uncontrolled blood pressure was found in 73.5% of people. The patients' average age was 63.4 ± 9.4 years (mean ± standard deviation), and 524 (77.3%) were women. Tobacco consumption (Adjusted Odd Ratio of 4.34; 95% CI [1.58-11.9]); lack of self-monitoring of hypertension (AOR of 1.69; 95% CI [1.14-2.52]); a family history of hypertension (AOR of 1.58; 95% CI [1.12-2.22]); overweight or obesity (AOR of 1.73; 95% CI [1.15-2.58]); and nonadherence to antihypertensive medication (AOR of 1.58; 95% CI [1.05-2.38]) were identified as risk factors for uncontrolled blood pressure. In hypertensive individuals, the percentage of uncontrolled blood pressure is considerable. It is essential to provide therapeutic education classes for hypertension patients in order to strengthen their power and autonomy in managing their hypertension.

Human activities and densities shape insecticide resistance distribution and dynamics in the virus-vector Culex pipiens mosquitoes from Morocco.

BACKGROUND: Mosquitoes of the Culex pipiens complex are widely distributed vectors for several arboviruses affecting humans. Consequently, their populations have long been controlled using insecticides, in response to which different resistance mechanisms have been selected. Moreover, their ecological preferences and broad adaptability allow C. pipiens mosquitoes to breed in highly polluted water bodies where they are exposed to many residuals from anthropogenic activities. It has been observed for several mosquito species that anthropization (in particular urbanization and agricultural lands) can lead to increased exposure to insecticides and thus to increased resistance. The main objective of the present study was to investigate whether and how urbanization and/or agricultural lands had a similar impact on C. pipiens resistance to insecticides in Morocco. METHODS: Breeding sites were sampled along several transects in four regions around major Moroccan cities, following gradients of decreasing anthropization. The imprint of anthropogenic activities was evaluated around each site as the percentage of areas classified in three categories: urban, agricultural and natural. We then assessed the frequencies of four known resistance alleles in these samples and followed their dynamics in five urban breeding sites over 4 years. RESULTS: The distribution of resistance alleles revealed a strong impact of anthropization, in both agricultural and urbanized lands, although different between resistance mutations and between Moroccan regions; we did not find any clear trend in the dynamics of these resistance alleles during the survey. CONCLUSIONS: Our study provides further evidence for the role of anthropic activities in the selection and maintenance of mutations selected for resistance to insecticides in mosquitoes. The consequences are worrying as this could decrease vector control capacities and thus result in epizootic and epidemic outbreaks. Consequently, concerted and integrated disease control strategies must be designed that include better management regarding the consequences of our activities.

First molecular evidence of potential Culicoides vectors implicated in bluetongue virus transmission in Morocco.

BACKGROUND: Bluetongue is a non-contagious viral disease that affects both domestic and wild ruminants. It is transmitted primarily by small hematophagous Diptera belonging to the genus Culicoides (Diptera: Ceratopogonidae). The current study represents the first molecular investigation into the potential role of Culicoides imicola, Culicoides paolae, Culicoides newsteadi, Culicoides spp., and Culicoides circumscriptus as bluetongue virus (BTV) vectors in Morocco. Additionally, the study aimed to evaluate the vectorial activity of midges during the survey seasons. METHODS: Parous females of these species were captured from several regions of Morocco (6 out of 12) from 2018 to 2021 using Onderstepoort Veterinary Institute (OVI) traps. A total of 2003 parous female specimens were grouped into 55 batches. The midge body of each batch was dissected into three regions (head, thorax, and abdomen), and these regions were analyzed separately using reverse transcription quantitative polymerase chain reaction (RT-qPCR). RESULTS: BTV RNA was detected in 45 out of the 55 batches tested, indicating a positivity rate of 81.8%. The RT-qPCR-positive pools of the studied Culicoides species exhibited high levels of BTV positivity in each body part (head, thorax, and abdomen), confirming the successful replication of the virus within midge bodies. The BTV circulation was substantial across all three survey seasons (spring, summer, and autumn). High infection rates, calculated using the minimum infection rate (MIR) and maximum likelihood estimation (MLE), were observed during the collection seasons, particularly in autumn and spring, and for all investigated Culicoides species, most notably for C. imicola and C. newsteadi. These increased infection rates underscore the significant risk of Culicoides transmitting the BTV in Morocco. CONCLUSIONS: The detection of BTV positivity in Culicoides spp. (lacking wing spots that allow their differentiation according to morphological identification keys) suggested that other Culicoides species are competent for BTV transmission in Morocco. The study results indicated, for the first time at the molecular level, that C. imicola and C. newsteadi are the primary potential vectors of BTV in Morocco and that C. paolae and C. circumscriptus are strongly implicated in the propagation of bluetongue at the national level.

Prevalence and Risk Factors of Chronic Obstructive Pulmonary Disease Among Users of Primary Health Care Facilities in Morocco.

Background: Chronic obstructive pulmonary disease (COPD) is a major public health problem. In Morocco, few studies have focused on COPD in primary health care facilities, whose main mission is prevention. The aim of our work is thus to assess the prevalence of COPD and to study the factors associated with this silent disease among users of health care facilities in Morocco. Methods: This is a cross-sectional observational study of participants aged 40 and over. Data were collected by questionnaire. Pulmonary function testing was conducted using a spirometer before and after administration of a bronchodilator. COPD was defined as fixed ratio of the post-bronchodilator forced expiratory volume in 1 second / forced vital capacity less than 0.7. Logistic regression models were applied to define factors associated with COPD. Results: From 550 participants aged 40 and over, we selected only 477 patients with exploitable spirometry results for inclusion in the final analysis. The mean age of participants was 54.91±11.92 years, and the female/male ratio was 1.59. The prevalence of COPD was 6.7% (95% CI; 4.6 to 9.3%), and was higher in men than in women (11.4% vs 3.8%, p=0.002). The prevalence of COPD increased significantly with age, from 3.3% in those aged 40 to 49 to 16.9% in those aged 70 and over (p=0.001). Current smokers had a higher prevalence of COPD than former and never smokers. Age, smoking, asthma diagnosis and childhood hospitalization for lung disease were risk factors associated with the development of COPD. Only 6.25% of participants identified as having COPD had previously been diagnosed with COPD. Conclusion: COPD remains largely under-diagnosed among primary care consultants in Morocco. Efforts for early detection and promotion of prevention of the main risk factors need to be intensified in order to reduce the burden of this silent pathology on a national scale.

Risk factors affecting patients survival with colorectal cancer in Morocco: survival analysis using an interpretable machine learning approach.

The aim of our study was to assess the overall survival rates for colorectal cancer at 3 years and to identify associated strong prognostic factors among patients in Morocco through an interpretable machine learning approach. This approach is based on a fully non-parametric survival random forest (RSF), incorporating variable importance and partial dependence effects. The data was povided from a retrospective study of 343 patients diagnosed and followed at Hassan II University Hospital. Covariate selection was performed using the variable importance based on permutation and partial dependence plots were displayed to explore in depth the relationship between the estimated partial effect of a given predictor and survival rates. The predictive performance was measured by two metrics, the Concordance Index (C-index) and the Brier Score (BS). Overall survival rates at 1, 2 and 3 years were, respectively, 87% (SE = 0.02; CI-95% 0.84-0.91), 77% (SE = 0.02; CI-95% 0.73-0.82) and 60% (SE = 0.03; CI-95% 0.54-0.66). In the Cox model after adjustment for all covariates, sex, tumor differentiation had no significant effect on prognosis, but rather tumor site had a significant effect. The variable importance obtained from RSF strengthens that surgery, stage, insurance, residency, and age were the most important prognostic factors. The discriminative capacity of the Cox PH and RSF was, respectively, 0.771 and 0.798 for the C-index while the accuracy of the Cox PH and RSF was, respectively, 0.257 and 0.207 for the BS. This shows that RSF had both better discriminative capacity and predictive accuracy. Our results show that patients who are older than 70, living in rural areas, without health insurance, at a distant stage and who have not had surgery constitute a subgroup of patients with poor prognosis.

Chemotherapy-related adverse effects with anthracycline and taxane-containing regimens in patients with localized Breast cancer: a descriptive study : Mohammed VI University Hospital, Medical Oncology Department, Marrakech, Morocco.

BACKGROUND: Although the side effects of chemotherapy are frequently described in research studies, there is little evidence on how common they are in everyday clinical care. This study's goal was to assess the most prevalent short-term side effects experienced by patients with localized breast cancer, undergoing chemotherapy based on anthracyclines and taxane-containing treatments, at the medical oncology department of the Mohammed VI University Hospital of Marrakech, Morocco. METHODS: This was a descriptive study. We conducted a listening session at the outpatient department of the hospital with the help of a structured questionnaire. The session engaged 122 women who had undergone cycles of chemotherapy. A chi-square test was used to compare the incidence and relative risk of short side effects with both anthracycline and taxane-containing regimens. RESULTS: The average age of participants was 49.1 years. In both regimens, the findings highlighted the frequency and relative risk of the following adverse effects: systemic symptoms (fever, asthenia and sleep disorder), gastrointestinal toxicity (Vomiting, nausea, diarrhoea, constipation, mucositis and loss of appetite), dermatological toxicity (Skin reactions on hands/feet, nail toxicity, allergies, alopecia and peripheral edema), neurological toxicity (neuropathy), arthromyalgia and ocular toxicity. CONCLUSIONS: In conclusion, it is crucial for healthcare professionals to be conscious of the significance of these adverse effects. They must also know how to manage them. Likewise, the listening approach highlights its importance in the daily follow-up and monitoring of patients.

Multiple sclerosis in Morocco: Epidemiological, clinical, and therapeutic profile.

OBJECTIVE: This study aims to describe the clinical, therapeutic, and epidemiological profiles of MS patients in Morocco. METHODS: This descriptive study involved 170 patients representing four Morocco regions. We collected the data using an electronic survey. RESULTS: The results show female dominance in patients with MS. Besides, most patients present with relapsing-remitting MS (RRMS). The main clinical symptoms reported by patients are fatigue, cognitive issues, spasticity, bowel or bladder complaints, and visual issues. Furthermore, the findings show that almost half of the patients use Interferon bêta-1a and azathioprine as disease-modifying therapies; 60.5 % use traditional and complementary medicine, of which 30.6 % use cupping, 30 % recite the Holy Quran, and 28.2 % use apitherapy. The findings show that there is a statistically significant relationship between specific MS factors such as professional activity (p = 0.0071), degree of satisfaction with treatment (p = 0.005), stress (p = 0.014), and the frequency of relapses. CONCLUSIONS: In addition to DMT, patients also use traditional and complementary medicine. There is also a relationship between some epidemiological characteristics and the frequency of relapses in patients with MS.

Entomological, parasitological and molecular investigations in a new focus of cutaneous leishmaniasis in Youssoufia region, Morocco.

BACKGROUND AND AIMS: Leishmaniasis is a neglected tropical infection caused by Leishmania parasite that affect human and animal. In Morocco, the cutaneous leishmaniasis has spread substantially to the new areas. The surveillance limited to active foci may underestimate the occurrence of cutaneous leishmaniasis (CL). This study aims to investigate the local transmission of CL in rural districts of Youssoufia province, central Morocco, as a potential focus of CL. METHODS: For this purpose, parasitological, molecular and entomological investigations were carried out in this area. Data collection concerns potential vectors and human cases. Thus, 402 patients were examined for suspected leishmaniasis lesions in three localities of the province of Youssoufia. In these same localities, 983 sand flies were collected by CDC light traps and sticky paper during one-night per month during 6 months. These sand flies were all identified morphologically using the Moroccan identification key. RESULTS: The results showed that among the 25 skin lesions detected in a population of 402 individuals, 18 were confirmed by kDNA nested PCR as CL positive patients, of which only 25% were positive by direct examination. Leishmania tropica and Leishmania major were identified as causative agents of CL in the study area. Direct parasitological examination showed a low sensitivity (27.78%), especially for L. major, although its specificity was evaluated at 100%. Regarding entomological results, both genera of the Moroccan sand fly were collected in the study area: Genus/Phlebotomus (75.28%) and Sergentomyia (24.72%). Phlebotomus (P) papatasi, the proven vector of L. major, was the most abundant species (33.98%), followed by Paralongicollum sergenti (22.58%), the confirmed vector of L. tropica; while Sergentomyia (S) minuta, P. longicuspis, S. fallax and P. kazeruni were collected with, respectively, 17.60%, 16.99%, 7.12% and 1.73%. CONCLUSION: This study constitutes the first report of CL in the study areas, as well as the coexistence of L. tropica and L. major in these rural localities. Local transmission of CL is highly probable, as indicated by the prevalence of the two proven vectors of L. major and L. tropica. To control the spread of this disease, our results suggest the use of highly sensitive molecular methods to detect CL cases in potential leishmaniasis foci, which will improve surveillance.

Knowledge, attitudes and practices towards epilepsy in morocco: A cross-sectional study.

BACKGROUND: This study aims to assess knowledge, practices and attitudes of the general Moroccan population towards epilepsy and to highlight predictive factors. METHOD: A cross-sectional study was conducted in the Casablanca-Settat Moroccan region. A questionnaire was used to collect sociodemographic data and item answers from 400 people with epilepsy (PWE) and without epilepsy caregivers on dependent variables: knowledge, attitudes, and practices towards epilepsy. Bivariate and logistic regression analyses were performed using IBM SPSS Statistics 21.0. Statistical significance was set when P value < 0.05. RESULTS: The rates of poor knowledge, practices, and attitudes toward epilepsy were 11.5 %, 41 %, and 66.6 %, respectively. In the multivariate analysis, the risk of having poor knowledge about epilepsy was favored by lack of education (ORa = 4.31;CI95%:1.83-10.13;p = 0.001) and the absence of familiarity with epilepsy (ORa = 4.05;CI95%:1.92-8.54;p < 0.001). The risk of preferring allopathic practices to treat epilepsy was associated with lack of education (ORa = 2.21;CI95%:1.01-4.82;p = 0.046), residence in a city outside Casablanca (ORa = 2.33;CI95%:1.06-5.15;p = 0.035), age over 59 years (ORa = 2.50;CI95%:1.26-4.95; p = 0.008), residence in a rural areas (ORa = 4.41;CI95%:2.61-7.47;p < 0.001) and absence of familiarity with epilepsy (ORa = 4.08;CI95%:2.33-7.15;p < 0.001). Predictors of stigma towards epilepsy were female sex (ORa = 3.05;CI95%:2.04-4.56;p < 0.001) and the tendency to abandon anti-seizure medication for allopathic alternatives (ORa = 3.98;CI95%:2.21-7.17;p < 0.001), whereas advanced age was a protective factor (ORa = 0.57;CI95%:0.36-0.89;p = 0.014[39-59 years vs 18-29 years];ORa = 0.44;CI95%:0.23-0.82;p = 0.011[>59 years vs 18-29 years]). CONCLUSIONS: The rate of poor attitudes and treatment-seeking behavior was high. This socio-cultural context certainly impacts the quality of life and care of Moroccan PWE. These results should be considered to raise awareness in the Moroccan population.

Anopheles mosquitoes in Morocco: implication for public health and underlined challenges for malaria re-establishment prevention under current and future climate conditions.

BACKGROUND: The potential reappearance and/or expansion of vector-borne diseases is one of the terrifying issues awaiting humanity in the context of climate change. The presence of competent Anopheles vectors, as well as suitable environmental circumstances, may result in the re-emergence of autochthonous Malaria, after years of absence. In Morocco, international travel and migration movements from Malaria-endemic areas have recently increased the number of imported cases, raising awareness of Malaria's possible reintroduction. Using machine learning we developed model predictions, under current and future (2050) climate, for the prospective distribution of Anopheles claviger, Anopheles labranchiae, Anopheles multicolor, and Anopheles sergentii implicated or incriminated in Malaria transmission. RESULTS: All modelled species are expected to find suitable habitats and have the potential to become established in the northern and central parts of the country, under present-day conditions. Distinct changes in the distributions of the four mosquitoes are to be expected under climate change. Even under the most optimistic scenario, all investigated species are likely to acquire new habitats that are now unsuitable, placing further populations in danger. We also observed a northward and altitudinal shift in their distribution towards higher altitudes. CONCLUSION: Climate change is expected to expand the potential range of malaria vectors in Morocco. Our maps and predictions offer a way to intelligently focus efforts on surveillance and control programmes. To reduce the threat of human infection, it is crucial for public health authorities, entomological surveillance teams, and control initiatives to collaborate and intensify their actions, continuously monitoring areas at risk. © 2023 Society of Chemical Industry.

Comparison of different Pancreatic cancer treatments: a three-year retrospective study in the oncology center of Tangier university hospital, Morocco.

BACKGROUND: Pancreatic cancer is among the most lethal malignancies, with a 5-year overall survival (OS) of less than 10% for all stages. The present study aims to evaluate the epidemiological and clinical characteristics, as well as the results of different treatments of patients diagnosed and treated between 2019 and 2021 in the Oncology Center of Tangier, University Hospital, Morocco. METHODS: To compare the evolution of the pancreatic cancer between the different chemotherapy regimens, a retrospective study was performed using data collected over a period of 3 years. For each patient, the data were described and statistically analyzed in the dedicated operating sheet. RESULTS: 55 pancreatic cancer patients were included in this study, and the median follow up was 3 months. The mean age of patients was 59.5 ± 10.3 years (extremes 34-79) and the sex ratio male/female was 0.9. Most patients were diagnosed with adenocarcinoma (92.3%), but metastatic stage was the most frequent (56.4%). The surgery was applied to 16.36% of patients. 10.9% of patients have received adjuvant chemotherapy and 76.4% received palliative chemotherapy. Chemotherapy regimens included mainly Gemcitabine and Folfirinox. The median OS was significantly longer for patients treated with Folfirinox versus Gemcitabine (6 months versus 3 months, p-value < 0.016). The median OS for patients that received Folfirinox and Gemcitabine successively (19.7 months) was significantly longer compared to patients that received a monotherapy with either Folfirinox or Gemcitabine alone (p-value < 0.016). CONCLUSION: These findings reinforce the use of advanced methods for earlier detection of pancreatic cancer and the development of effective immunotherapies or more targeted therapies.