Management of Chronic Kidney Disease in Morocco: A Cost-of-Illness Study.

INTRODUCTION: Chronic kidney disease (CKD) is a global public health problem. The aim of this study is to estimate the mean annual direct medical cost per patient with CKD before the start of renal replacement therapy (RRT) in Morocco. METHODS: This is a cross-sectional cost-of-illness study, using a prevalence approach among adults with CKD before RRT in a Moroccan university hospital. Information on direct medical costs was collected from the patient's report and associated costs were estimated according to national tariff/fee catalogues. We computed annual direct medical costs using society perspective. Costs were then estimated and compared according to CKD stages, health insurance categories, and monthly income. RESULTS: Eighty-eight participants were included; 63.6% of them were female, their mean age was 61.8±14.0 years, and 76.1% were in stages 4 or 5. The estimated annual direct medical cost of CKD was estimated at $ 2008.80 (95%CI 1528.28-2489.31), Hospitalization, diagnosis, and treatment represented the main expenses of the direct medical cost (32.2%, 29.7%, and 32.2%, respectively). The direct medical cost components were not significantly different between CKD stages. CONCLUSION: The cost of CKD in Morocco in its early stages is still lower than the cost of RRT, which brings to light the necessity of secondary prevention of CKD to postpone or prevent the progression to end-stage renal disease.

The Role of Nephrologists in the Management of Methanol Poisoning.

Acute methanol poisoning is a rare but serious condition that can lead to significant morbidity and mortality. Toxic metabolites produced by methanol, primarily formaldehyde, can cause high anion gap metabolic acidosis, with the severity of clinical presentation ranging from mild symptoms to multi-organ failure. Nine people died and four patients needed treatment at our university hospital following a collective intoxication caused by the consumption of homemade alcoholic beverages in the central region of Morocco. The four patients presented to the emergency department with varying clinical symptoms, such as decreased visual acuity, severe agitation, and dyspnea. The laboratory tests confirmed high anion gap metabolic acidosis and a subsequent toxicology screen revealed that they had consumed methanol-tainted alcohol. The treatment regimen involved inhibiting the formation of toxic metabolites using an antidote (ethanol or fomepizole), correcting metabolic acidosis, enhancing the elimination of toxic metabolites through prolonged hemodialysis, and administering adjunctive therapies. While two patients had favorable outcomes, the other two died from multi-organ failure. These findings highlight the importance of prompt diagnosis and treatment in cases of methanol poisoning.

A Spontaneous Bilateral Quadriceps Tendon Rupture in a Patient Undergoing Long-Term Hemodialysis.

Spontaneous quadriceps tendon rupture is very rare. Its occurrence is usually linked to an underlying disease that weakens the tendons causing them to rupture. Here, we report the case of a 44-year-old patient undergoing long-term hemodialysis who had spontaneous bilateral quadriceps tendon rupture. We present the clinical presentation and the management of this injury.

Anti-Struvite, Antimicrobial, and Anti-Inflammatory Activities of Aqueous and Ethanolic Extracts of Saussurea costus (Falc) Lipsch Asteraceae.

Saussurea costus (Falc) Lipsch is a traditional herb used to treat kidney stone problems because it contains several molecules used to treat this health problem, such as quercitrin. Infectious stones are the most painful of all urinary tract disorders, with ammonium phosphate (struvite) and carbapatite stones being the most common, caused by a bacterial infection with urease activity. These stones are treated with antibiotics, but antibiotic resistance is on the rise. The current study investigated the anti-urolithic activities of S. costus aqueous and ethanolic extracts of against struvite crystals synthesized using microscopic crystallization and turbidimetric methods, respectively. The utilized methods indicated that the ethanolic extract of this plant has a significant inhibitory effect on struvite crystallization, with a percentage inhibition of (87.45 ± 1.107) (p < 0.001) for a concentration of 1 mg mL−1 and a decrease in the number of struvite crystals, reaching values less than 100/mm3. For the number of struvite crystals inhibited by cystone, we found a value of 400/mm3 and with the aqueous extract we found 700/mm3. The antibacterial activity of the plant extracts studied was examined against several urease-producing bacteria, and this activity was evaluated by qualitative and quantitative evaluation methods; the highest minimum inhibitory concentration was seen in the ethanolic extract, with an MIC of 50 mg mL−1 for Staphylococcus aureus followed by an MIC of 200 mg mL−1 for Klebsiella pneumoniae. It showed a minimal bactericidal concentration (MBC) against S. aureus and K. pneumoniae (>50 mg mL−1 and >200 mg mL−1, respectively). Furthermore, to determine the extract's anti-inflammatory activity, in vivo anti-inflammatory activity was investigated in rats. The results show that at a dose of 400 mg kg−1, the ethanolic extract has a maximum edema inhibition of 66%.

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.

Beware of Rhabdomyolysis After a Renal Graft.

In recent years, there has been a significant advancement in the field of immunosuppressive therapy in renal transplantation. However, these treatments have side effects, including rhabdomyolysis. In this article, we report the case of a transplant patient with rhabdomyolysis secondary to tacrolimus and shed light on different aggravating factors. Treatment withdrawal, hydration, and forced diuresis are allowed in the majority of cases.

Tuberculosis in Dialysis Patients in the Central Region of Morocco: What Is the Health-Care Delay?

INTRODUCTION: Due to the predominantly cellular immunosuppression, infections are frequent in chronic dialysis patients, in particular tuberculosis (TB). The main objective of our study is to evaluate tuberculosis healthcare delay in dialysis patients and to raise the diagnostic challenge in these patients. MATERIAL AND METHODS: The study is retrospective and multicenter including tuberculosis cases of chronic dialysis patients either in hemodialysis (HD) or peritoneal dialysis (PD) in the central region of Morocco during a 10-year period between 2012 and 2021. RESULTS: We included 94 patients, five of whom were in PD, with a mean age of 50.79 ± 16.72 years, and a sex ratio of 0.67. The time between the initiation of dialysis and the onset of the clinical and biological presentation was 50.3 ± 67.12 months. The most frequent initial manifestations were an alteration of the general state (85.1%), a biological inflammatory syndrome (83%) or a prolonged fever (70.1%). Among our 94 patients, the diagnosis was confirmed with bacteriological evidence only in 18 cases (19.1%), by identification of Koch's Bacillus (BK) in 13 cases, by molecular biology test (GeneXpert; Cepheid, Inc., Sunnyvale, CA, USA) in five cases. The diagnosis of tuberculosis was presumptive in most cases (79 cases), i.e. 80.9%. Twenty-one patients underwent the interferon gamma release essay test (QuantiFERON; Qiagen, Hilden, Germany) which was positive in 14 patients. Thirty-four (36.1%) cases had a histological diagnosis. The remaining patients were offered a trial treatment. Tuberculosis localization was mostly extra-pulmonary (75.5%): lymph node (23.4%), pleural (13.8%), peritoneal (13.8%), whereas it was pulmonary in 23 cases (24.5%). Most of our patients had a clear delay in management from symptom onset to initiation of anti-TB treatment 78.9% (time >21days) vs 21.1% (time ≤21days). The median time to management delay was 46.5 interquartile range (IQR) (28.5-90), the mean delay was 78.4 ± 87.9 (6-360). All patients were treated according to the RHZE/RH protocol (R: rifampicin, H: isoniazid Z: pyrazinamide and E: ethambutol), with a duration between six and 18 months. Side effects associated with anti-tuberculosis treatment were observed in half of the patients (51.1%). The evolution was favorable with remission and improvement of the general condition in 90% of cases. Two cases of resistance were noted in our series. The overall mortality was 7.7%. CONCLUSION: We have confirmed a delay in the diagnosis and treatment of tuberculosis in chronic dialysis patients. This can be explained by the often atypical or incomplete clinical and paraclinical presentation and the extra-pulmonary localizations, making diagnosis difficult in this population whose prognosis remains poor. It is therefore necessary to establish a diagnostic approach that is adapted to the specificities of these high-risk patients within the framework of a national tuberculosis control program.

Chemical Composition and Anti-Urolithiatic Activity of Extracts from Argania spinosa (L.) Skeels Press-Cake and Acacia senegal (L.) Willd.

Ethnobotanical studies have reported the traditional medicinal uses of Acacia senegal (L.) Willd. and Argania spinosa (L.) Skeels against kidney stone formation and other chronic kidney diseases. The present work is undertaken to study the litholytic activity and the inhibiting activity of calcium oxalate crystallization by bioactive compounds identified in Argania spinosa (L.) Skeels press-cake (residue of Argan oil) and in Acacia senegal (L.) Willd. The litholytic activity was studied in vitro on cystine and uric acid stones using a porous bag and an Erlenmeyer glass. The study of the inhibiting activity of calcium oxalate crystallization, was based on temporal measurements of the optical density, registered at a 620 nm wavelength for 30 min using an ultraviolet−visible spectrophotometer. The silylation method was performed to identify phytochemicals, followed by gas chromatography coupled with mass spectrophotometry (GC/MS) analysis. The results show significant litholytic activity of Argania Spinosa press-cake hydro-ethanolic extract on uric acid and cystine stones, respectively, with dissolution rates (DR) of 86.38% and 60.42% versus 3.23% and 9.48% for the hydro-ethanolic extract of Acacia senegal exudate. Furthermore, the percentages of nucleation inhibition are 83.78% and 43.77% (p ˂ 0.05) for Argania spinosa and Acacia senegal, respectively. The results point to the detection of 17 phytochemicals in Argania spinosa press-cake extract, the majority of which are phenolic acids and have potent anti-urolithiatic action.

Chemical Composition, Antioxidant Potentials, and Calcium Oxalate Anticrystallization Activity of Polyphenol and Saponin Fractions from Argania spinosa L. Press Cake.

A wide range of biological properties and a potent therapeutic and prophylactic effect on chronic diseases are all present in Argania spinosa L. press cake. The aim of this research is to valorize the anticrystallization properties against calcium oxalate crystals of Argania spinosa L. press cake fractions and identify its bioactive components. Chemical species identification was performed using GC-MS analysis. The turbidimetric model was used to investigate crystallization inhibition in vitro. Infrared spectroscopy technique was used to characterize the synthesized crystals. Furthermore, both DPPH and FRAP methods were used to assess antioxidant activity. The results show that the fractions are equally important in crystallization inhibition percentages of calcium oxalate crystals. For saponin and polyphenol fractions, the inhibition percentages are in the orders of 83.49% and 82.83%, respectively. The results of the antioxidant activity by DPPH method show that the two fractions are equally important in the elimination of free radicals; the inhibition percentages were 77.87 ± 4.21 and 89.92 ± 1.39 for both polyphenols and saponins, respectively. FRAP method showed that the absorbance increases proportionally with concentration, and the absorbance are almost similar for both fractions and reach maximum values in the orders of 0.52 ± 0.07 and 0.42 ± 0.03, respectively, for saponins and polyphenols. These findings demonstrate that both fractions are rich in bioactive chemicals and have an anticrystallization capacity, allowing them to be employed for the curative and prophylactic effects against urolithiasis.

Prevalence and risk factors associated with chronic kidney disease in Moroccan rural communes: Fez-Meknes region.

BACKGROUND AND AIMS: Chronic kidney disease is a worldwide public health issue. It can be a serious problem, especially in developing countries including Morocco. However, few studies have explored the factors influencing chronic kidney disease in this country. Hence, using the definitions proposed by Kidney Disease Improving Global Outcomes in 2012, we have conducted this study to establish the prevalence and risk factors of chronic kidney disease particularly in rural communities in the Fez-Meknes region. METHODS: Weight, height, blood pressure, proteinuria, hematuria, plasma creatinine, estimated glomerular filtration rate (using the Modification of Diet in Renal Disease formula), and fasting glycemia were measured. Abnormal results were controlled within two weeks; estimated Glomerular filtration rate was retested at 3 months. Furthermore, to determine the factors associated with chronic kidney disease, multivariate logistic regression was used. RESULTS: A total of 431 patients participated in the study; the prevalence of confirmed proteinuria, hematuria, and reduced estimated Glomerular filtration rate was 5.3%, 1.8%, and 3%, respectively. Overall, chronic kidney disease was found to be present in 6.5% of the population. Chronic kidney disease 1 and 2 accounted for 32.1% and 21.4% of the overall chronic kidney disease population, respectively, while chronic kidney disease 3 accounted for 46.4% (3A: 38.2%; 3B: 7.14%). Chronic kidney disease 4 and 5 were not present in the total chronic kidney disease population. Chronic kidney disease was strongly linked with advanced age (OR 2.65; 95%CI: 1.05-6.65), hypertension (OR 2.41; 95%CI: 1.03-5.63), agricultural occupation (OR 1.02; 95%CI: 1.00-1.04) and contact with Agrochemicals (OR 1.40; 95%CI: 0.81-2.71). CONCLUSIONS: It is important to note that screening for kidney damage and being aware of the risks linked to it, is key for the early detection and management of chronic kidney disease; they are also crucial to provide in a database for the development of a national prevention policy.

Comparison of quality of life in end-stage renal disease patients undergoing hemodialysis and peritoneal dialysis in a Moroccan city.

PURPOSE: End-stage renal disease patients (ESRD) generally complain about a poor quality of life (QOL). The current study aims to describe and compare ESRD patients' QOL according to dialysis modalities (hemodialysis [HD] and peritoneal dialysis [PD]). METHODS: This is a cross-sectional study, conducted in dialysis facilities of a Moroccan university hospital, during October 2018. All adult ESRD patients, treated either by HD or PD for more than 3 months and agreeing to participate, were included. Medical data were collected using a questionnaire, whereas the QOL data were collected using the Kidney Disease Quality of Life Short Form (KDQOL SF v 1.3) scale previously validated in dialectal Arabic. The patients' characteristics and QOL data were compared between dialysis modalities (HD vs. PD), using a linear regression, before and after adjustment on several demographic and medical factors as well as a propensity score created to reduce the effect of confounding factors related to the choice of the treatment. RESULTS: Out of the 91 included patients (50.5% of men, median age 52.0 (IQR [36.5; 62.0]) years), 71 were on HD and 20 were on PD. The highest subscale score, for all participants, was the social support's one with a median of 83.3 (IQR [66.7; 100]), and the lowest one was the kidney disease burden with a median of 25.0 (IQR [0.00; 46.9]). The univariate analysis showed that the Physical Component Score (PCS), the cognitive function, and the dialysis staff encouragement were better in PD patients (p = 0.03, p = 0.04, and p = 0.007, respectively), while the multiple linear regression indicates that the PCS, the dialysis Staff encouragement, and the patient's satisfaction subscores decreased within patients on HD compared with those on PD (p = 0.01, p = 0.03, and p = 0.02, respectively) and that the burden of the kidney disease and the work status subscores increased within patients on HD against those on PD (p = 0.007 and p = 0.04, respectively). CONCLUSION: This study showed a significant difference between dialysis modalities in some sides of quality of life.

Is the Use of Dialysis Associated With an Increased Risk of Death in COVID-19-Related Acute Kidney Injury?

INTRODUCTION: Acute kidney injury (AKI) is frequently reported in the setting of severe acute respiratory syndrome coronavirus 2 (SARS­CoV­2) infection. The aim of our work is to evaluate the impact of acute dialysis use on mortality in patients with AKI during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: This is a retrospective study conducted in the Hassan II University Hospital of Fez, Morocco. From July 2020 to December 2021, we included all patients admitted to a COVID-19 unit with acute kidney injury defined according to Kidney Disease Improvement Global Outcomes 2012 (KDIGO 2012) criteria. Our patients were older than 18 years, and SARS-CoV-2 infection was confirmed by a positive RT-PCR test or thoracic CT scan imaging. Patients with end-stage renal disease (ESRD) and pregnant women were excluded from our study. RESULTS: The total number of patients hospitalized in the COVID-19 unit during the study period was 2560, including 206 in an intensive care setting. We included 61 patients with AKI, with an incidence in the intensive care unit (ICU) setting of 15.5%. Eighty percent of patients had respiratory distress on admission, which was the main reason for consultation. Stage 1 AKI was found in 1.6% of patients, 25.8% had stage II AKI, and 72.6% had KDIGO stage 3 AKI. The main etiology of AKI was acute tubular necrosis. Lung involvement secondary to infection was severe in 18 patients; 21 had moderate involvement. In our study, twenty-one of our patients (34.4%) were hospitalized in an ICU. Thirteen of our patients were intubated (21.1%). Twenty-one (34.4%) patients were hemodynamically unstable and were put on vasoactive drugs. Twenty-three (37.7%) of our patients received at least one session of conventional acute hemodialysis with an average duration of 2.1 hours ± 0.9 (1-3.5). The indication was overload (27%), severe metabolic acidosis (1.6%), threatening hyperkalemia (1.6%), and symptomatic hyperuremia (62%). The evolution was marked by a return to baseline renal function in two patients, partial improvement in 35 of them at discharge, and no improvement in 24 patients. We recorded a death rate of 34.4% (n=21). In a univariate analysis, we compared the demographic, clinical, paraclinical, and dialytic characteristics of the dialysis and non-dialysis groups. There was a significant difference between unstable, intubated patients and those hospitalized in the ICU in the dialysis group, with respective p-values of p=0.0001, p=0.0001, and p=0.01. We noticed there were more deaths in the dialysis group than in the non-dialysis group; this difference was statistically significant with a p-value of 0.005. In multivariate analysis, a logistic regression model was performed to test the relationship between dialysis and COVID-19 mortality while adjusting for other co-factors. The final model did not show a significant association between dialysis and mortality (p = 0.150, OR: 2.578 [0.710-9.364]). The only factor that remained independently significant was admission to the intensive care unit (p = 0.004, OR: 6.732 [1.847-24.540]). CONCLUSION: AKI is a frequently encountered complication in patients with COVID-19, especially those hospitalized in the ICU. In the context of the SARS-CoV-2 infection, the use of at least one dialysis session seems to represent an excess risk of mortality related to AKI.

Farmers' Knowledge, Attitudes, and Perceptions Regarding Carcinogenic Pesticides in Fez Meknes Region (Morocco).

Pesticides play an important role in the improvement of agricultural production, but their use may result in adverse effects on the environment, consumers, and farmers' health. As there are limited data focusing on the factors influencing safety behavior toward pesticide use in Morocco, we conducted a cross-sectional survey in 15 rural communities of Morocco's Fes Meknes region to assess the attitudes, knowledge, and practices regarding pesticide use. A structured questionnaire was completed, containing the data of the interviewed farmers, their behavior towards safety measures, the type of active ingredient used, as well as the perception of risks to their own health following exposure to pesticides by the existence of chronic, self-perceived symptoms. Non-probability (empirical) sampling with the quota method was carried out, which consists of constructing the sample. Results showed that most respondents have not been trained in the application of pesticides, with almost half of the farmers using a category of pesticides which are classified by the International Agency for Research on Cancer as probable human carcinogenic (i.e., Glyphosate, Malathion). In terms of pesticide storage, 40% of farmers said that they did not store pesticides in a separate room after purchasing or using them. The empty containers were buried or burnt by half of the responders, while the remainder were thrown at the edge of fields or in public dumps. Although the participants were aware of the negative effects on their own health and on the environment caused by the application of pesticides in use, the protection measures by individual equipment were insufficient. A canonical analysis indicates that these behaviors were influenced by the farming experience, the benefit of the agricultural council services, the follow-up of training, and the education level. These variables are important factors in explaining and understanding the dangers to both the environment and health caused by pesticides. The most recorded likely consequences of pesticide exposure were visual impairment (46%), followed by dizziness (44.3%), headache (39.4%), and excessive sweating (34.4%), and 30.2% of participants identified consequent respiratory problems. Extension services targeted at safety and protection measures should be developed and accompanied by educational programs to put farmers' perceptions into practice and encourage them to adopt healthy and environmentally friendly behaviors.

The Synergistic Effect of Three Essential Oils against Bacteria Responsible for the Development of Lithiasis Infection: An Optimization by the Mixture Design.

The present study aimed to determine the chemical composition and the synergistic effect of three plants' essential oils (EOs), Eucalyptus camaldulensis (ECEO), Mentha pulegium (MPEO), and Rosmarinus officinalis (ROEO), against three bacterial strains, Proteus mirabilis, Klebsiella pneumoniae, and Staphylococcus aureus, in order to increase the antimicrobial effectiveness by the use of a low dose of essential oils, consequently decreasing the toxicity and negative impact. For this reason, an augmented simplex-centroid mixture design was used to build polynomial models in order to highlight the synergy between the essential oils against bacterial strains. Antimicrobial effect screening was performed by the disc diffusion method and the minimal inhibitory concentrations (MIC) were also studied. The gas chromatography/mass spectrometry (GC-MS) results show the richness of these essential oils by terpenic compounds, especially 1,8-Cineole and P-Cymene for ECEO, Pulegone for MPEO, and α-Pinene and Camphene for ROEO. Moreover, a significant antibacterial effect has been demonstrated and the best values were revealed by MPEO and ECEO against P. mirabilis and K. pneumoniae, with inhibition zones (IZ) of 25 and 20 mm, respectively, and an MIC of 0.0391% (v:v) against K. pneumoniae. The optimal mixtures showed a synergistic effect of essential oils, and the lowest minimal inhibitory concentrations of the mixtures (MICm) were in the order of 29.38% of MPEO, 45.37% of ECEO, and 25.25% of ROEO against P. mirabilis and in the order of 60.61% of MPEO and 39.39% of ROEO against K. pneumoniae. These results indicate the antibacterial efficacy of the three essential oils combined and suggest their importance in the treatment of urinary tract infections caused by resistant bacterial strains.

Electrodialysis Can Lower the Environmental Impact of Hemodialysis.

The hemodialysis technique, used worldwide for patients with chronic kidney disease, is considered as a treatment with a high economic and ecological impact, especially for water consumption. Getting ultrapure water for the preparation of the dialysate to clean patient's blood from toxins leads to high volumes of salt-enriched water that directly goes to sewage. The aim of this work is to propose operating conditions for electrodialysis to allow the reuse of reverse osmosis (RO) rejects. We first performed a parametric study to evaluate the influence of different parameters, such as flow rates, initial concentration, and applied voltage on the demineralization rate (DR) and specific energy consumption (SPC) with a NaCl model solution. The optimal conditions for desalination (i.e., a potential of 12 V, and flow rate of 20 L·h-1) were then successfully applied to real samples collected from a dialysis center with total dissolved salts concentration of about 1.4 g/L (conductivity of 2.0 mS·cm-1). We demonstrated that the choice of adequate conductivity targets allowed meeting the physico-chemical requirements to obtain water re-usable for either rehabilitation swimming pool, manual or machine washing of instruments before sterilization or irrigation. Saving this water could contribute in the reduction of the environmental impact of hemodialysis.

Phytochemical screening and inhibitory activity of oxalocalcic crystallization of Arbutus unedo L. leaves.

The present study is focused on the experimental verification of the efficiency of Arbutus unedo L. leaves against the crystallization of calcium oxalate. The inhibition of crystallization has been studied in vitro with the absence and the presence of the different concentrations of the infusion and hydroalcoholic extract of the plant. This study consists of measuring, using a UV-Visible spectrophotometer, the temporal evolution of the optical density at λ = 620 nm corresponding to the crystals formation. The latter have been characterized by microscopic observation using an optical microscope, and by Fourier Transform Infrared Spectroscopy (FT-IR). The results suggest a greater effectiveness of the plant infusion with respect to the hydroalcoholic extract against crystallization or nucleation at percentages of 69.41 ± 0.24 or 19.76 ± 0.27% and at 93.92 ± 2.61 and 45.16 ± 3.06% against the aggregation, for both the infusion and the hydroalcoholic extract respectively. A. unedo leaves is a very promising and effective remedy against the crystallization of calcium oxalate and especially in the aggregation stage.

[Medical simulation in hemodialysis]. / Simulation médicale en hémodialyse.

INTRODUCTION: Simulation is an innovative educational tool based on learning experience in a secure environment without fear of repercussions especially in critical situations such as in emergencies. It offers great prospects in the development of dialysis training. METHODS: We report the results of an observational study comparing medical simulation to conventional training methods in the management of hemodialysis in emergency situations. We discuss afterwards the possibilities currently allowed by medical simulation in dialysis training. RESULTS: The training was beneficial (significant difference between initial and final level of knowledge) for all participants. There was no significant difference between the conventional approach, simulation training and the two combined tools. However, satisfaction rate was higher in simulation training. We observed a tendency to have better results in "active players" of the simulation compared to observers. CONCLUSION: We emphasize the importance of integrating medical simulation training in our dialysis training strategies as a complementary tool to classical teaching/learning methods.

[Initial presentation and course of lupus membranous glomerulonephritis]. / Forme initiale et évolution de la glomérulonéphrite extramembraneuse lupique pure.

INTRODUCTION: Lupus membranous nephropathy (MN) is associated with a substantial risk of developing end-stage renal disease and may thus be fatal. There is currently no consensus about specific immunosuppressive treatment. We describe the presentation of lupus MN and its course according to type of immunosuppressive treatment. PATIENTS AND METHODS: This retrospective study included all patients with lupus MN (only, not associated with any proliferative nephropathy) hospitalized in the nephrology unit of Ibn Sina University Hospital in Rabat from 1994 through 2005. RESULTS: MN was found in 18 patients, 16.7% of our patients with lupus. The average age at first admission of these 18 was 29+/-2.1 years (17-52), with a sex ratio of 0.12. The mean follow-up period was 54+/-31 months (3-130). The initial clinical presentation of MN was marked by the presence of proteinuria, nephrotic in 11 cases. Mean serum creatinine was 18.6+/-3.9 mg/L. Leukocyturia was noted in 12 cases (67%) and microscopic hematuria in 8 cases (44%). Extrarenal signs were cutaneous (14 cases), articular (14 cases), hematologic (8 cases), cardiac (6 cases) and neurological (4 cases). Patients were treated by corticosteroids only (group 1=7 cases) or by corticosteroids combined with cyclophosphamide in cases of renal insufficiency or neurological signs (group 2=11 cases). Complete remission occurred in 11 cases, and partial remission in the others. Four relapses were observed, including three in group 2. Mean serum creatinine blood levels were comparable in the 2 groups. Four patients died of extrarenal causes. Only one patient, in group 2, progressed to end-stage renal disease. CONCLUSION: The initial presentation of lupus MN is variable. Cyclophosphamide has favorable renal effects, but does not prevent lethal complications, especially neurological complications.

[Effects of anxiety and depression on haemodialysis adequacy]. / Troubles anxio-dépressifs et qualité de l'hémodialyse.

UNLABELLED: Depression and anxiety are the most commonly encountered psychological problems in patients with end-stage renal disease, especially those on renal replacement therapy. We sought to assess the prevalence of anxiety and depressive symptoms in patients undergoing haemodialysis treatment and to establish the relationship between these psychological problems and criteria of haemodialysis adequacy. METHODS: We implemented a transversal study on 93 adult haemodialysis patients recruited from in Ibn-Sina Haemodialysis department in Rabat in April 2003. They underwent three tests performed by a psychiatrist. The first one was the brief psychiatric rating scale (BPRS) and then Hamilton anxiety and depression rating scales. We also studied anthropometric features, comorbidity, dialysis session's characteristics, and the following haemodialysis adequacy parameters: extracellular volume, nitrogenous retention, nutritional status, phosphocalcic balance, serum potassium, acid-basic equilibrium, anaemia, and inflammatory markers. RESULTS: The mean (+/-SD) age of our population was 42+/-15.5. The sex-ratio was 1.11 (49 W/44 M). Only one patient had a history of psychological care by a psychiatrist. The prevalence of depression and anxiety among the patients surveyed was 67 and 69.3% respectively. Seven patients had a severe depression. We did not found any other psychological condition by BPRS. Depression has been shown to be associated to several haemodialysis adequacy markers like high blood pressure, interdialytic weight intake, nutritional parameters (serum albumin concentration...), and serum creatinin concentration. Depression was more frequent in women, diabetics, and patients with C hepatitis. CONCLUSION: This study will be continued by a prospective screening of patients under appropriate therapy.