[Peganum harmala L. poisoning in Morocco: about 200 cases]. / L'intoxication au Peganum harmala L. au Maroc : à propos de 200 cas.

AIM OF THE STUDY: Peganum harmala L. is commonly used in traditional medicine in Morocco for its sedative and emmenagogue properties but expose to the risk of overdose and poisoning. The aim of our study was to analyze a series of 200 cases of poisoning collected in poison control and pharmacovigilance center of Morocco in order to describe the epidemiological, clinical, therapeutic features and outcome of patients and indicate the toxicity of this plant used primarily for therapeutic purposes. METHODS: This retrospective study performed over a period of twenty four years from January 1984 to December 2008. RESULTS: The mean age of patients was 24.4±16.8 years with a female predominance (167 women against 33 men). Therapeutic circumstance was found in 32.5%, followed by suicide (28.5%) and abortion (13.5%). The symptomatology was dominated by neurological, gastrointestinal and cardiovascular signs respectively 34.4%, 31.9 % and 15.8%. The evolution has been specified in 114 cases, 7 deaths have been deplored with a fatality rate of 6.2%.

[Pesticide poisoning in Moroccan children: epidemiological and prognostic aspects (1990-2008)]. / L'intoxication par les pesticides chez l'enfant au Maroc : profil épidémiologique et aspects pronostiques (1990-2008).

OBJECTIVE: The purpose of this paper is to describe the epidemiological profile of acute pesticide poisoning in children (APP) treated by the Moroccan Poison Control Center (CAPM) and to analyze death cases in order to determine factors predictive of severity. METHOD: the study is based on a retrospective study of all cases of APP collected by the CAPM over a period of eighteen years (January 1990 to December 2008). Univariate analysis was performed to identify risk factors. RESULTS: 2,672 cases of childhood poisoning by pesticide were collected. The mean age was 5.6 ± 4.57 years. The sex ratio was 1.12. The cause of poisoning was accidental in 87.1% of cases, followed by attempted suicide (12.1%). Organophosphates were the most frequent poison (50.7%), followed by alpha-chloralose (26.5%). The case fatality rate was 3.3%. Mortality was attributed to organophosphates in 30 cases, followed by inorganic derivatives (7 cases) and carbamates (6 cases). A univariate analysis comparing survivors and groups who died showed that rural origin (p = 0.04), voluntary circumstances (p = 0.001), and the type of chemical class of pesticide (p < 0.001) significantly influence fatal poisoning. CONCLUSION: Acute pesticide poisoning among children is a reality in Morocco. Preventive measures may be needed.

A selective method for quantification of diazinon in human plasma by GC-MS.

Diazinon is a synthetic molecule known as an organophosphorus insecticide. It is used for gardens and for agriculture. This molecule represents a toxicological concern for humans. For this reason, the detection and the quantification of the diazinon in human samples are important in order to monitor an exposure and to diagnose intoxications. The aim of this work is to develop a selective method for the quantification of diazinon in human plasma by means of a gas chromatography (GC) with a mass spectroscopy (MS) detector. The method presented in this article includes a liquid-liquid extraction (LLE) using dichloromethane/propanol-2/heptane. The correlation coefficient for the calibration curve is 0.992. The limit of detection (LOD) and the limit of quantification (LOQ) are respectively 5 µg/L and 2 µg/L. The average recovery of the three different concentrations (15, 250 and 375 µg/L) varies from 22.8% to 31%. A test of stability at ambient temperature for 24 hours and at 4 °C for 48 hours was conducted. The relative error factor was found to be inferior to 15%. The results obtained show that the method developed gives satisfying validation parameters in human plasma. Therefore, the compound could be detected at very low concentration with a good linearity. This method can be used with other matrices, such as blood or urine, for a partial validation.

Medication errors: pharmacovigilance centres in detection and prevention.

1. Detecting medication errors needs collaboration between various organizations, such as patient safety institutions, pharmacovigilance centres, and poison control centres. In order to evaluate the input of pharmacovigilance centres and poison control centres in detecting and evaluating medication errors a pilot project was initiated by the World Alliance for Patient Safety in collaboration with the Uppsala Monitoring Centre; the Moroccan pharmacovigilance centre acted as project coordinator. As part of this project, a questionnaire on detecting medication errors was circulated to pharmacovigilance centres and poison control centres around the world, in order to assess their ability to detect and analyse medication errors. 2. The results showed that through their databases pharmacovigilance centres can detect, identify, analyse, and classify medication errors and carry out root cause analysis, which is an important tool in preventing medication errors. 3. The duties of pharmacovigilance centres in preventing medication errors include informing health-care professionals about the importance of reporting such errors and creating a culture of patient safety. Pharmacovigilance centres aim to prevent medication errors in collaboration with poison control centres. Such collaboration allows improved detection and improved preventive strategies. In addition, collaboration with regulatory authorities is important in finalizing decisions. 4. Collaboration between pharmacovigilance centres and poison control centres should be strengthened and bridges need to be built linking pharmacovigilance centres, poison control centres, and organizations dedicated to patient safety, in order to avoid duplication of workload.

[Therapeutic drug monitoring of three antiepileptic drugs - Back on twenty years of experience]. / Suivi thérapeutique pharmacologique de trois médicaments antiépileptiques: retour sur vingt années d'expérience.

INTRODUCTION: The therapeutic drug monitoring (TDM) of antiepileptic drugs is a tool widely used in the management of epilepsy. In Morocco, this monitoring is carried out by the Centre Anti Poison et Pharmacovigilance (CAPM) since April 1995. METHODS: This is a retrospective study spanning 20 years. It concerns the therapeutic drug monitoring of Phenobarbital (PB) of carbamazepine (CBZ) and valproic acid (VPA). RESULTS: Therapeutic drug monitoring of the 3 antiepileptic drugs represent 58.85% of all applications received by the CAPM. The dosage of PB was ranked first followed by that of CBZ and finally by the VPA. Weak demand for therapeutic drug monitoring in Morocco could be explained by the low number of neurologists in addition to social factors. With its affordable price by patients, PB is the most prescribed antiepileptic drug in our country, which explains the high demand for its dosage. As for the therapeutic drug monitoring of the antiepileptic drug, they were mainly related to age, the occurrence of adverse effects, the association antiepileptic drugs or in the case of verification of patient compliance. CONCLUSION: Efforts are required for promoting the interests of therapeutic drug monitoring of antiepileptic drug in the management of epilepsy in Morocco.

NAT2 Genotypes in Moroccan Patients with Hepatotoxicity Due to Antituberculosis Drugs.

AIM: Isoniazid (INH) is the most effective drug used as a first-line tuberculosis (TB) treatment besides rifampicin, pyrazinamide, and ethambutol. It is also the most commonly associated with hepatotoxicity. Differences of toxicity induced by INH have been attributed to genetic variability of the N-acetyltransferase 2 (NAT2) gene which encodes a drug-metabolizing enzyme. The aim of this study was to characterize the acetylation profile of patients who developed hepatotoxicity after TB treatment by genotyping NAT2 polymorphisms. PATIENTS AND METHODS: This study included 42 Moroccan patients who developed hepatotoxicity after TB treatment and 163 Moroccan controls without TB. We genotyped four selected variants of the NAT2 gene (NAT2*5, NAT2*6, NAT2*7, and NAT2*14) by Sanger sequencing for patients and real-time polymerase chain reaction for controls. RESULTS: The majority of patients had NAT2 genotypes previously described as slow acetylators including NAT2*5/*5, NAT2*5/*6, NAT2*6/*6, and NAT2*6/*14 (78%) and none were genotyped as rapid acetylators. Controls were slow, intermediate, and rapid acetylators with frequencies of 72.39%, 21.48%, and 6.13%, respectively. CONCLUSION: There were no fast acetylator genotypes found among the patients having INH-hepatotoxicity. This finding suggests that the slow acetylator phenotype may contribute to the development of TB treatment hepatotoxicity.

Pharmacovigilance of herbal medicines in Africa: Questionnaire study.

In order to describe and evaluate Herbal Medicine (HM) pharmacovigilance in African countries who are members of the WHO International Programme for Drug Monitoring a survey questionnaire was sent to the national centres and national drug regulatory agencies of these countries. Data collection was carried out from October 1st to 31st December, 2014. Among the total of 39 African countries, 34 (87.2%) answered the questionnaire and 25 (64.1%) accepted to share their data in this publication. Spontaneous adverse reaction reporting for HM is voluntary in 7 (43.7%) countries. HM pharmacovigilance programmes covered suspected adverse HM reactions in 14 (87.5%) countries; HM information in 7 (43.7%) countries; HM dependence or abuse in 6 (37.5%) countries; medication errors in 5 (31.2%) countries; falsification and adulteration in 2 (each 12.5%) countries and HM-drug interactions in 1 (6.3%) country. Groups in countries encouraged to submit herbal reports were pharmacists and physicians (both n=15); nurses (n=13); herbal therapists (n=12); patients (n=11) and local manufacturers (n=8). The number of herbal reports received by most countries was very low or even insignificant. VigiFlow is used by 10 countries. Information from pharmacovigilance activities is disseminated using many means. Only five countries have regulatory status and quality control of their HM products. The participants identified a need for HM regulation, technical and training assistance, and funding as being major challenges to HM pharmacovigilance in countries. Particular attention to the development of pharmacovigilance of HM is required in Africa.

Side effects of cade oil in Morocco: an analysis of reports in the Moroccan herbal products database from 2004 to 2012.

Cade oil is a dark, faintly aromatic oil which is distilled from the branches and wood of Juniperus oxycedrus. Although this oil is known to have toxic effects related to its content of phenols, cade oil continues to be used in folk medicine. Because of this use, a determination of the safety and possible side effects of cade oil is required. The safety of cade oil is discussed based on the experience of the Moroccan pharmacovigilance herbal products database, and supported by literature. The data on the adverse effects of cade oil suggests that it could have life-threatening effects which can occur following topical exposure, ingestion or inhalation. Phenol's adverse effects involve a wide variety of organ systems such as the gastro-intestinal system, central and peripheral nervous systems, cardiovascular, liver and biliary systems, the urinary tract, skin and appendages, respiratory system. Platelet function, bleeding and clotting, vision, metabolism, and white cell and reticuloendothelial system function are also affected.

The involvement of Pharmacovigilance Centres in medication errors detection: a questionnaire-based analysis.

OBJECTIVES: This study assesses the ability of Pharmacovigilance Centres (PVCs) to detect medication errors (ME) and to proceed to building Patient Safety (PS) via their information networks and to underline the limits for this challenge. METHODS: This was an exploratory study conducted in PVCs members of the World Health Organization International Drug Monitoring network. A questionnaire specifically designed for the needs of the study was sent to a network via a confidential email system. The questionnaire asked for information, progress and improvement made by PVCs in PS and ME. RESULTS: Among the 88 countries, 21 answered. Reporting of Adverse Drug Reactions (ADRs) by health care professionals (HCP) is mandatory for 42% of PVCs. 100% of countries receive reports from HCP, 66% from patients and 24% from PCCs. ADRs reports are received by all communications means. There is an heterogeneity between countries regarding PVCs and PS activities. Among them, 4 PVCs have the prime activity of PS organization. CONCLUSION: PVCs are able to detect and analyze ME. There is a need to coordinate efforts between countries to optimize ME detection, and its analysis. Bridges need to be built linking PVCs, PCCs and PS organizations in order to avoid duplication of workload.