Analysis of the drug formulary and the purchasing process at a Moroccan university medical center.

AIM: To give an overview of the pharmaceutical policy in the largest medical center in Morocco, a developing country in socio-economic transition. METHODS: This is an analytical descriptive study of the drug formulary and the purchasing process carried out at the Ibn Sina University Medical Center. RESULTS: Our formulary included 830 drugs belonging to 14 classes according to the Anatomical, Therapeutic and Chemical (ATC) Classification System. There was a respective predominance of class N (21.8%), class B (13.5%), and class J (12.6%). Injectable route was dominant (46%). Drugs had a significant actual benefit in 70% (according to the French Data), reimbursable in 42.8%, essential in 29.2% according to World Health Organization (WHO) list, and in 36.9% according to the Moroccan list. The calls for tenders included 542 drugs representing 65% of the formulary, and the attribution rate was 71%. The main reason for non-attribution was the lack of offers. Generics accounted for 45% by volume and 26.5% by value. CONCLUSION: With this first study, we were able to identify key indicators on drugs used in the largest medical center in Morocco. The current challenge is to introduce pharmacoeconomics in decision making concerning the updates of the drug formulary.

[Cardiovascular risk factors in Algeria. Analysis of the subgroup from the "Africa/Middle East Cardiovascular Epidemiological" Study]. / Facteurs de risque cardio-vasculaires en Algérie. Une analyse du sous-groupe de l'étude « Africa/Middle East Cardiovascular Epidemiological ¼.

OBJECTIVES: This cross-sectional epidemiological study aimed at determining the prevalence of cardiovascular risk factors (CVRF; including obesity, dyslipidaemia, hypertension, diabetes and smoking), among patients from the Algerian sub-population of the "Africa/Middle East Cardiovascular Epidemiological" study attending general practitioners at primary healthcare facilities, and stratified according to their environment (rural/urban), sex and age. PATIENTS AND METHODS: The study sites, located in 10 wilayas (administrative regions), were situated in urban and rural areas (rural populations defined as living at least 50km away from urban centres, or lacking access to suburban transport). RESULTS: Four hundred and ten subjects (262 female, 148 male) were enrolled; 287 subjects were from an urban environment and 123 from a rural environment. Mean age was 50.4 years. Ninety one point eight percent of patients had ≥1 CVRF; 48.2% had ≥3 CVRF. Prevalence for the different CVRF was: 61.7% for dyslipidaemia; 39.5% for hypertension; 25.0% for diabetes; 10.0% for smoking, 70.0% for abdominal obesity and 32.0% for a body mass index ≥30kg/m2. CONCLUSION: The high prevalence of all CVRF observed in the Algeria sub-group, especially among the rural population, should encourage us to develop a carefully planned strategy for primary prevention, opportunistic screening and early management, in both urban and rural settings, and with particular attention to young adults. These actions should involve all state bodies and those active in civil society, in order to guarantee full achievement of set goals. The ACE trial is registered under NCT01243138.

Trends in antihypertensives use among Moroccan patients.

PURPOSE: In this study, we analyzed the consumption trends of antihypertensives in Morocco during the 1991-2010 period and the impacts after the institution of Mandatory Health Insurance and the marketing of generic drugs. METHODS: We used sales data from the Moroccan subsidiary of IMS Health "Intercontinental Marketing Service". The consumption volumes were converted into defined daily doses (DDDs). RESULTS: Between 1991 and 2010, outpatient consumption of antihypertensives went from 4.37 to 23.14 DDD/1000 inhabitants/day, a 5.30-fold increase. In 2010, calcium channel blockers (CCBs) and angiotensin converting enzyme inhibitors (ACEI) were the most consumed (4.97 DDD/1000 inhabitants/day) for each one, followed by diuretics (4.20 DDD/1000 inhabitants/day). The most consumed products were amlodipine (4.27 DDD/1000 inhabitants/day) followed by ramipril (3.18 DDD/1000 inhabitants /day) and indapamide (1.72 DDD/1000inhabitants/day). Between 1991 and 2010, the consumption of generic antihypertensives went from 2% to 46%. CONCLUSION: Antihypertensive consumption increased between 1991 and 2010. However, despite the increase of generic drugs consumption, the levels of antihypertensive consumption remain lower than the needs of hypertensive patients.

Detection and molecular identification of human adenoviruses and enteroviruses in wastewater from Morocco.

AIMS: Reclaimed wastewater is a considerable water resource in Morocco. Its agricultural reuse requires an assessment of viral contamination. The aim of this study was to detect both infectious and noninfectious human adenoviruses (HAdV) and enteroviruses (EV) in raw wastewater and treat effluent from wastewater treatment plants (WWTPs) and domestic sewage in Morocco. METHODS AND RESULTS: A total of 22 samples were analysed. A polyethylene glycol (PEG) precipitation method was used, followed by integrated cell culture-PCR (ICC-PCR) using two cell lines: human rhabdomyosarcoma tumour tissue and laryngeal carcinoma cells (RD and Hep2 cells). Furthermore, viral genome amplification was confirmed by sequencing. HAdV were detected in 10 (45·5%) of the 22 samples involving two species: HAdV-B and HAdV-D. EV was detected in 5 (23%) samples belonging to Coxsackievirus B5 and poliovirus vaccine strain (Sabin 2). CONCLUSIONS: Human adenoviruses and EV were detected in the analysed samples from two WWTPs and HAdV in domestic sewage. SIGNIFICANCE AND IMPACT OF THE STUDY: This work is the first study in Morocco using cell culture, PCR and sequencing of enteric viruses from wastewater. The presence of infectious HAdV and EV in treated effluent emphasizes the need of wastewater treatment surveillance.

[Hepatitis B prevalence and risk factors in Morocco]. / Prévalence de l'infection par le virus de l'hépatite B et l'évaluation des facteurs de risque au Maroc.

AIM: The aim of this study was to determine the prevalence of hepatitis B and the risk factors in Morocco. STUDY DESIGN: A total number of 16,634 individuals were screened for HBsAg using the Murex HBsAg Version 3 assay and were interviewed using a structured standard questionnaire to collect information about risk factor. RESULTS: Two hundred seventy-six subjects were positive for HBsAg, the prevalence of HBV infection was 1.66%. Using a structured standard questionnaire we reported that sexual behaviours (43.84%) are among the main risk factors for HBV transmission. CONCLUSION: This study indicates that the prevalence of HBsAg in Morocco is currently estimated at 1.66% in the active population. The risk factors for HBV infection identified here indicate that prevention is the most cost-effective method for successfully controlling HBV infection, so vaccination remains the best way to control this infection and its related complications.

Bartonella clarridgeiae, B. henselae and Rickettsia felis in fleas from Morocco.

A total of 554 fleas were collected in the Moroccan Casablanca and Tiznit regions from domesticated animals and ruminants between August 2007 and October 2008 and were tested for the presence of Rickettsia spp. and Bartonella spp. using molecular methods. For the first time in Morocco, we found Rickettsia felis, the agent of flea-borne spotted fever in Ctenocephalides felis; B. henselae, an agent of cat scratch disease; and Bartonella clarridgeiae, a cat pathogen and potentially a human pathogen.

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.

Detection of Shiga toxin-producing Escherichia coli in meat marketed in Casablanca (Morocco).

The contamination of meat and meat products with Shiga toxin-producing O157:H7 and non-O157 Escherichia coli (STEC), obtained from markets in Casablanca, Morocco, was investigated. A total of 460 meat and meat products were sampled between March 2004 and July 2006 analysed and 176 strains of E. coli were isolated from these samples. The presence of the stx1, stx2, eae and ehxA genes, recognized as major virulence factors of STEC, was tested in E. coli isolates by polymerase chain reaction (PCR). STEC was detected in 4 (0.9%) samples. The result of serotyping by molecular method showed that two of these STEC isolates corresponded to the serotype O157:H7. The others Shiga toxin-producing E. coli non-O157 corresponded to O6:H21 and O76:H19. The presence of O157:H7 and non-O157 STEC in meat and meat products marketed in Casablanca, Morocco, emphasizes the importance of implementing the Hazard Analysis and Critical Control Point (HACCP) system, as well as the need for implementing, evaluating, and validating antimicrobial interventions to reduce the presence of potential pathogenic microorganisms.

Afriflu--international conference on influenza disease burden in Africa, 1-2 June 2010, Marrakech, Morocco.

The burden of influenza disease is to a large extent unknown for the African continent. Moreover, the interaction of influenza with common infectious diseases in Africa remains poorly described. Solid scientific evidence on the influenza disease burden in Africa is critical for the development of effective influenza vaccine policies. On 1st and 2nd June 2010 in Marrakech, Morocco, over eighty surveillance and influenza experts from 22 African countries as well as Europe and America met at the 'Afriflu' conference to discuss influenza challenges and solutions for the continent. During the meeting, participants exchanged their experiences and discussed a wide variety of topics related to influenza in Africa, including diagnosis, surveillance, epidemiology, and interventions. The meeting concluded with a pledge to improve influenza knowledge and awareness in Africa, with an emphasis on accurate determination of disease burden to help orient public health policies.

Molecular typing of Escherichia coli strains isolated from food in Casablanca (Morocco).

Serotyping of O- and H- antigens is regarded as the gold standard in classification of E. coli for taxonomic and epidemiological purposes similar to the Kaufmann-White scheme for Salmonella enterica. Molecular methods to replace or to support the serotyping were recently applied. Using the molecular polymorphism of the somatic (O- antigen) gene rfb cluster and flagella (H- antigen) gene fliC, 74 E. coli strains carrying the virulent genes isolated from food were characterised by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The results showed that 49 (66%) of the isolates revealed a reproducible and clear cut classification, with a very good correlation to the collection of reference strains, were found.

Rapid detection of Listeria monocytogenes in food by polymerase chain reaction.

The standard conventional methods for the detection of Listeria monocytogenes in foods require high time 7 to 10 days to give ready results. To dissolve this problem we have evaluate a short method using Polymerase Chain Reaction (PCR) to analyze food samples. In parallel with this study, a comparison was made between PCR amplification from templates directly prepared from food and the official standard ISO procedure 11290-1. In this study we have used a Half Frazer broth as an enrichment medium; there were positive results of PCR detection of L. monocytogenes in different food sample analyzed (milk, cheese and meat) with approximately 1.5 10(1) Colony Forming Units /25 g in less than 36 h. This PCR procedure has proved to be rapid and sensitive method suitable for the routine analysis; firstly, because this assay required just a short pre-enrichment step before PCR. Secondly, this procedure is very simple and time-saving; it could take less than one working day to obtain results if initial microbiological load was very important.

Fighting rabies in Africa: the Africa Rabies Expert Bureau (AfroREB).

Rabies experts from 14 francophone African countries met in Grand Bassam (Côte d'Ivoire), 10-13 March 2008. They presented the situation in their respective countries, acknowledging the lack of rabies awareness among the population, health care workers and health authorities. They recognized that infrastructure for the management of rabies exposure is scarce, modern vaccines are in limited quantity and immunoglobulins are lacking in most of their countries. They defined as a priority the need to have reliable figures on the disease burden, which is necessary for informed decision making and priority setting, and for applying for aid in controlling the disease. This meeting sealed the establishment of the Africa Rabies Expert Bureau (AfroREB).

Intraspecific variability and pharmacokinetic characteristics of Androctonus mauretanicus mauretanicus scorpion venom.

We evaluated the degree of venom toxicity and protein content of several specimens of Androctonus mauretanicus mauretanicus. The quantity of protein of individual venom obtained after manual extraction from 31 different scorpions varied from a minimum of 0.15 mg to a maximum of 1.53 mg. We determined the venom toxicity, in mice, by estimating the number of LD(50)s of 20 scorpions chosen randomly among the 31 scorpions. It ranged from less than 40 LD(50)s to a maximum of 272 LD(50)s. The correlation between protein content and venom lethality is not systematic. We also determined the pharmacokinetics of the venom and its specific anti-venom in rabbits to compare their distribution and elimination properties. After a subcutaneous injection, high concentrations of venom were measured by ELISA in the vascular space rapidly after the injection (T(max) = 0.5 h). The terminal half-life was 2.8 h, close the one determined after intravenous injection (t(1/2beta) = 3.2 h). The total volume of distribution (Vd(ss) or Vd(beta)) was between 317 and 380 ml/kg. The total body clearance was 82 ml/kg/h. For scorpion anti-venom, the terminal half-life, after intravenous injection, was 20.25 h; the volume of distribution was 83 ml/kg and the total body clearance was 3 ml/kg/h. After intramuscular administration, T(max) was reached at 36 h. The results show that venom lethality varies from specimen to specimen and that pharmacokinetic parameters of venom and anti-venom are totally different. This must be taken under consideration in anti-venom production (anti-venom titre) as well as in therapeutic protocols (dose, injection route) to improve serotherapy.

[Synthesis and pharmacological study of three 1-alkyl-3-(ethoxycarbonylmethylene)-2-oxo quinoxalines]. / Synthèse et étude pharmacologique de trois dérivés alkylés de la 3-(éthoxycarbonylméthylène)- 2-oxo quinoxaline.

The acute toxicity study and the psychotropic activity of three alkylated derivatives of 3-(ethoxycarbonylmethylene) -2-oxo quinoxaline did not demonstrate any toxicity of these products at therapeutic dosages. In the animal, these compounds have sedative, myorelaxant and anxiolytic properities.

Experimental toxicity of Peganum harmala seeds.

Peganum harmala is plant known since the first century A.D. and still, currently used for therapeutic purposes. Harmaline, the active principle of the plant seeds, and its derivatives, cause visual troubles, loss of coordination, agitation and delirium, and, at high doses, it can produce paralysis. The present study was initiated to evaluate the use and manipulation of therapeutic doses of aqueous extract of P. harmala. Wistar rats were orally dosed acutely and the LD(50) obtained was 2.70+/-0.05g/kg. In chronic studies aqueous extract of P. harmala administered orally for six times a week at doses of 1, 1.35 and 2g/kg during 3 month period increased transaminases. Changes in glucose and creatinine were not significant. No significant gross changes were found at necropsy. Histologic study showed liver degeneration and spongiform changes in the central nervous system (CNS) in rats treated with 2g/kg dose but not at the therapeutic dose of 1g/kg.

Acute and chronic toxicity of Nigella sativa fixed oil.

We investigated the toxicity of the fixed oil of Nigella sativa L seeds in mice and rats through determination of LD50 values and examination of possible biochemical, hematological and histopathological changes. The acute toxicity of Nigella sativa fixed oil was investigated in mice. LD50 values, obtained by single doses, orally and intraperitoneally administered in mice, were 28.8 ml/kg body wt. p.o. [26.2-31.6] and 2.06 ml/kg body wt. i.p. [1.86-2.26], respectively. Chronic toxicity was studied in rats treated daily with an oral dose of 2 ml/kg body wt. for 12 weeks. Changes in key hepatic enzymes levels, including aspartate-aminotransferase, alanine-aminotranferase, and gamma-glutamyltransferase and histopathological modifications (heart, liver, kidneys and pancreas) were not observed in rats treated with Nigella sativa after 12 weeks of treatment. The serum cholesterol, triglyceride and glucose levels and the count of leukocytes and platelets decreased significantly, compared to control values, while hematocrit and hemoglobin levels increased significantly. A slowing of body weight gain was also observed in Nigella sativa treated rats, as compared to control animals. The low toxicity of Nigella sativa fixed oil, evidenced by high LD50 values, key hepatic enzyme stability and organ integrity, suggests a wide margin of safety for therapeutic doses of Nigella sativa fixed oil, but the changes in hemoglobin metabolism and the fall in leukocyte and platelet count must be taken into consideration.