Economic burden of chronic obstructive pulmonary disease in Morocco: a cost of illness study.

Chronic obstructive pulmonary disease (COPD) carries an important economic burden worldwide. However, the cost of this disease in Morocco is not well explored. This study aimed to estimate the economic cost associated with COPD in Morocco and identify its determinants. A cost of illness, prevalence-based study using a bottom-up approach method, including COPD patients, was carried out in 2021-2022. The cost was estimated from a societal perspective, and the time horizon was 1 year. Data collection was performed using a questionnaire including socio-demographic, clinical data, and utilization of health care resources in 2019: hospitalization, medical tests, medications, and medical visits. Direct health cost (DHC) was estimated by multiplying the use of health services by the official prices (unit costs) published by the National Agency for Health Insurance. The indirect cost (IC) represented by labor productivity losses was calculated using the human capital method. Costs were compared according to different socio-demographic and clinical factors. We included 159 patients; 82.4% were men, 80.4% were current or former smokers, and 78.7% were categorized as "high-risk" groups (grades C-D). The DHC was estimated at $1816.6 per patient per year. Pharmaceutical and hospitalization costs represented the highest part of the total DHC (42.5% and 22.1%, respectively). The IC was estimated at $709.5±1081.3 per patient per year. DHC increased with increasing disease severity and with the number of severe exacerbations (p<0.001). Current and former smokers were more costly to the healthcare system than nonsmokers (p=0.029). IC also increased with the number of severe exacerbations (p=0.003). In this study, we showed that COPD in Morocco generates important costs for the health system, mainly related to smoking and the severity of the disease. It is therefore important to strengthen tobacco control measures in our country.

Simple techniques for a complex problem: Sampling malaria vectors in Africa.

Disease surveillance, including entomological surveillance, serves as the basis for all vector control program activities. How to do this in the most ecologically sensible way, so that the most suitable, naturalistic method, of control for that population can be identified, should be a priority. Here we describe a set of techniques, whose only energy requirement is a torch (flashlight), that can be used to collect both endo and exophagic and endo and exophilic malaria vectors. The data obtained over a number of years from an individual sentinel house in a village in Mozambique and from a village in Cambodia using these kinds of collection techniques, is presented.

Model-based exploration of the impact of glucose metabolism on the estrous cycle dynamics in dairy cows.

BACKGROUND: Nutrition plays a crucial role in regulating reproductive hormones and follicular development in cattle. This is visible particularly during the time of negative energy balance at the onset of milk production after calving. Here, elongated periods of anovulation have been observed, resulting from alterations in luteinizing hormone concentrations, likely caused by lower glucose and insulin concentrations in the blood. The mechanisms that result in a reduced fertility are not completely understood, although a close relationship to the glucose-insulin metabolism is widely supported. RESULTS: Following this idea, we developed a mathematical model of the hormonal network combining reproductive hormones and hormones that are coupled to the glucose compartments within the body of the cow. The model is built on ordinary differential equations and relies on previously introduced models on the bovine estrous cycle and the glucose-insulin dynamics. Necessary modifications and coupling mechanisms are thoroughly discussed. Depending on the composition and the amount of feed, in particular the glucose content in the dry matter, the model quantifies reproductive hormones and follicular development over time. Simulation results for different nutritional regimes in lactating and non-lactating dairy cows are examined and compared with experimental studies. The simulations describe realistically the effects of nutritional glucose supply on the ovulatory cycle of dairy cattle. CONCLUSIONS: The mathematical model enables the user to explore the relationship between nutrition and reproduction by running simulations and performing parameter studies. Regarding its applicability, this work is an early attempt towards developing in silico feeding strategies and may eventually help to refine and reduce animal experiments. REVIEWERS: This article was reviewed by John McNamara and Tin Pang (nominated by Martin Lercher).

Biogeochemistry of natural ponds in agricultural landscape: Lessons learned from modeling a kettle hole in Northeast Germany.

Kettle holes, small shallow ponds of glacial origin, represent hotspots for biodiversity and biogeochemical cycling. They abound in the young moraine landscape of Northeast Germany, potentially modulating element fluxes in a region where intensive agriculture prevails. The Rittgarten kettle hole, with semi-permanent hydroperiod and a surrounding reed belt, can be considered as a representative case study for such systems. Aiming to provide insights into the biogeochemical processes driving nutrient and primary producer dynamics in the Rittgarten kettle hole, we developed a mechanistic model that simulates the carbon, nitrogen, phosphorus and oxygen, phytoplankton, and free-floating macrophyte biomass dynamics. After model calibration and sensitivity analysis, our modeling exercise quantified the simulated nutrient fluxes associated with all the major biogeochemical processes considered by the model. Seasonality of nutrient concentrations, magnitude of primary productivity rates, and biogeochemical process characterization in the pond were reasonably reproduced by the model from July 2013 to July 2014. Our results suggest that the establishment of a phytoplankton community well-adapted to low light availability, together with the differential use of N and P from free-floating macrophytes and phytoplankton can explain their coexistence in kettle holes. Sediment nutrient release along with decomposition of decaying submerged macrophyte are essential drivers of internal nutrient cycling in kettle holes. Our results also suggest that the Rittgarten kettle hole act as a net source of CO2 to the atmosphere on an annual scale, which offers a testable hypothesis for kettle holes with structural and functional similarities. We conclude by discussing the need to shed light on the effects of water level fluctuations on nutrient dynamics and biological succession patterns, as well as the relative importance of external sources and internal nutrient recycling mechanisms.

Grading of follicular lymphoma using flow cytometry.

BACKGROUND: The treatment and prognosis of follicular lymphoma (FL) is dependant on the grade of the disease. In the World Health Organization classification of lymphoma, grading of FL into low grade (1 and 2) and high grade (3) is recommended. Grading of FL is possible in excision biopsy; histological grading is subjective and inconsistent. Grading is extremely difficult in needle core biopsies and fine needle aspirates. We attempted to grade FL using flow cytometry (FCM) and CD19/ forward scatter. MATERIALS AND METHODS: Cases of FL seen in our institution and submitted for FCM were evaluated for the percentage of cells detected beyond the 500-channel mark (on a 1024 scale) on a CD19/forward scatter dot plot. We hypothesized that these cells most likely represent centroblasts and their percentage would reflect the grade of the disease. Histological grading of the lymphoma on the open biopsies constituted the reference for FL grade. RESULTS: Thirty-six cases of FL, including 22 males and 14 females, ranging in age from 19 to 92 years (median, 42 years), were studied. There were 17 cases of low grade (grade 1; n=10 and grade 2; n=7) and 19 cases of high grade (grade 3) FL. The percentage of cells identified beyond the 500-channel mark on CD19/forward scatter dot plot ranged from 0.12% to 12.55% (median, 4.9%) in low grade (grade 1 and 2) whereas the percentage of those cells in high grade FL ranged from 6.22% to 51.95% (median, 21%; P=0.00001). CONCLUSION: Our findings suggest that using a CD19/forward scatter dot plot can help identify centroblasts in FL making grading possible on FCM, especially in small biopsies and fine needle aspirates.

Radiographic assessment of post-retained crowns in an adult Jordanian population.

AIM: The objective of this study was to radiographically assess and compare the quality of post-retained crowns fabricated at the Dental Health Centre of the Jordan University of Science & Technology (JUST). METHODS AND MATERIALS: Study data were collected in 2002 from existing dental records for all patients receiving treatment with post-retained crowns between October, 1997 and June, 1999. The posts were assessed radiographically to evaluate various aspects of the quality of post-retained crowns. All 129 posts were fabricated in the dental school. RESULTS: The most-frequently restored teeth were the maxillary incisors (38.8%). Sixty-two percent of the posts were tapered, while 38% were parallel-sided. The mean length of the posts was 0.95 mm (SD 0.41) with a range between 0.22-2.85 mm. Caries was diagnosed radiographically in 10.8% of cases with lesions located on root surfaces in 64.3% of them, while 35.7% of lesions were within the root canal. Three posts (2.3%) were deviated from the line of the root canal in the mesio-distal plane. No evidence of root filling was found in 2.3% of the cases. In the remainder of teeth 15.5% had gutta percha extended to the radiographic apex of the tooth, while 59.7% fell 0.5-1 mm short of the radiographic apex. Gutta-percha was extruded beyond the apex in 22.5% of the teeth. Space between the end of the post and the root filling was found in 22.2%. The percentage of canals with apparently completely healthy periapical tissue was 51.2%. In the rest of the cases 34.8% had areas of radiolucency at or near the root apices and 14% demonstrated widening of the periodontal space around the root apex. Root resection had been completed in 2.3% cases. Signs of external resorption were apparent in one case (0.78%). CONCLUSION: The standards of the treatment of the endodontically treated teeth made at the dental hospital were satisfactory but could be improved by a controlled academic supervisory environment and a strict scientific approach to fixed prosthodontics within the dental school.

Morphologic, immunphenotypic and clinical discriminators between T-cell/histiocyte-rich large B-cell lymphoma and lymphocyte-predominant Hodgkin lymphoma.

BACKGROUND: Features of T-cell/histiocyte rich large B-cell lymphoma (THRLBCL) overlap with those of lymphocyte predominant Hodgkin lymphoma (LPHL). The two lymphomas may represent a spectrum of the same disease, and differentiation between the two can sometimes be difficult. We looked at histomorphologic, immunophenotypic and clinical information that may help differentiate the two entities. METHODS: Cases of THRLBCL and LPHL were blindly reviewed and studied for histological pattern (nodular vs. diffuse), nuclear features and pattern of expression of CD20, CD30, CD57, epithelial membrane antigen (EMA) and Epstein-Barr virus (EBV). A score encompassing diffuse histology, high nuclear grade, CD20 single-cell pattern, CD30+, CD57-, EMA-, and EBV+ was estimated for the diagnosis of TCHRLBCL. RESULTS: There were 58 cases, including 30 cases of TCHRLBL and 28 cases of LPHL. The median age was 36 years for TCHRLBCL and 21 years for LPHL (P = 0.0001). Three types of nuclei were identified (lymphocytic/histocytic, Reed-Sternberg and centroblast-like). The latter two high-grade nuclei were suggestive of TCHRLBCL. TCHRLBCL and LPHL, respectively, showed diffuse histology, 90% vs. 4% (P = 0.001), single CD20+ cells, 93% vs. 3.5% (P = 0.00004), CD30+ cells, 30% vs. 0% (P = 0.01), CD57+ cells, 41% vs. 93% (P = 0.008), EMA+ cells, 27% vs. 60% (P = 0.113), EBV+ cells, 24% vs. 0% (P = 0.117), high nuclear grade, 70% vs. 0% (P = 0.001), total score 2-7 (mean 4.68) vs. 0-2 (mean 0.72) (P = 0.001), high stage, 86% vs. 7% (P = 0.0001). CONCLUSION: Our findings indicate that a combination of multiple parameters can help differentiate between the two diseases. Two cases originally diagnosed as LPHL were re-assigned the diagnosis of THRLBCL.