Research cartography of implantable medical devices in the three Maghreb countries: A comparative study between Morocco, Algeria, and Tunisia.

BACKGROUND: Biosafety and efficacy are essential aspects in the use of implantable medical devices (IMD) in several medical and surgical disciplines. To this effect, and depending on the therapeutic indication, the diversity of IMD imposes enormous evaluation strategies from their design through to their impact on improving the patient's quality of life. OBJECTIVE: To elaborate cartography which traces back the research tracks published on IMD regarding the three Maghreb countries, namely Morocco, Algeria, and Tunisia, and this through laying emphasis on a comparative study in view of highlighting the similarities and differences between them. METHODS: First, the research work was concerned with studies on IMD published between 2013 and 2023, which met the inclusion criteria, and which used the above-mentioned keywords on the four databases Scopus, Web of Science, ScienceDirect and PubMed. Second, the results are processed for a comparative descriptive study. In second, a descriptive and inferential analysis of association and classification to establish a research map on IMD. RESULTS: Articles selected; 86 articles out of 1081 for Morocco, 70 out of 900 for Algeria and 136 out of 1303 for Tunisia. Unlike domains (P=0.014), the research methods used highlights similarities in methodological research (P>0.05) ranging from simple descriptions to meta-analyses for the medical sciences with an inequitable distribution whose high share in favor of patient-reports. CONCLUSION: The design of maps raises a diversity of fields that concern medical and engineering sciences, while medical economic studies have yet to be developed in all three countries.

The regulatory landscape of biosimilars: Algeria's efforts and progress made from 2006 to 2021.

Biologics are tremendously efficacious biological molecules that have enabled the treatment of many life-threatening diseases, which have previously been hard to treat. Biosimilars, also known as "follow-on biologics", are highly similar versions of another already approved biologic, called the Reference Product. The European Union has been a pioneer in the regulation of biosimilars. WHO guideline on evaluation of biosimilars published in 2009 was an important landmark in biosimilar regulations worldwide, and several countries have adopted its principles in the development of their own regulatory pathway for the approval of biosimilars. Most countries in the Middle East North Africa (MENA) region still lack official and scientific guidelines for biosimilar approval pathways. This article explores the regulatory situation of biosimilar registration pathways in Algeria and describes the progress made and the regulatory landscape changes for biosimilars in Algeria during the past ten years. Our findings indicate that the development of biosimilar regulation in Algeria went through three major phases between 2006 and 2021, during which there has been much progress in drafting guidance documents for biosimilars. Since 2016, Algeria has used the EMA, FDA and WHO guidelines as the basis for approval of several biosimilars and no national guidelines or regulations have been adopted to date. Additionally, there has been no regulation on substitution/interchangeability. The Algerian regulatory authority has gained considerable experience with approval and use of increasingly complex biosimilars over the past 5 years and has the potential to create its own biosimilar-specific regulatory pathway in the near future.

[Time trends and age-period-cohort effects on the incidence of the most frequent cancers in Oran, Algeria, 1999-2018]. / Tendances temporelles et effets âge-période-cohorte sur l'incidence des principales localisations cancéreuses à Oran, Algérie, 1999­2018.

BACKGROUND: Cancer is currently one of the major public health problems in Algeria. The aim of this study was to examine time trends and the effects of age, period and cohort on incidence at the major cancer locations from 1999 to 2018 in Oran, Algeria. METHODS: Data on the five most frequent primary cancer locations among patients aged 20-79 years were collected from the Oran cancer registry. Annual percentile changes in incidence rates were evaluated using the Joinpoint regression program. Age-period-cohort models were designed to examine the effects of age, period and birth cohort on cancer incidence. RESULTS: From 1999 to 2018, there were 12,278 incident cases at the five major cancer locations. Unfavorable trends in incidence were observed regarding lung and colorectal cancers in both sexes, as well as breast cancer in women. Age-period-cohort analysis showed that age, period and birth cohort yielded different effects at different cancer locations. CONCLUSION: The observed trends primarily reflect lifestyle changes in Algeria over the course of recent years.

[Quality of "crisis communication" media during the COVID-19 pandemic in the Great Maghreb countries]. / Qualité des supports de communication de crise lors de la pandémie de la COVID-19 au Grand Maghreb.

OBJECTIVE: To objectively assess the quality of "crisis communication" media, during the COVID-19 pandemic, in the three Greater Maghreb countries (Tunisia, Algeria, Morocco). METHODS: A compliance audit for press releases and epidemiological bulletins was analyzed against a quality benchmark, which had been specifically designed by the authors. This framework, made up of five dimensions and 50 items, graded (0/1), was applied by two researchers in preventive medicine. Multiplying the scores by a coefficient of two resulted in a partial score of 20 points for each dimension and a total score of 100 points for the checklist taken as a whole. The quality of the communication media was considered to be good when exceeding the thresholds of 15/20 for the different dimensions and 75/100 for the entire grid. RESULTS: A total of 141 information media were included in this audit (Tunisia: 60; Algeria: 60; Morocco: 21). The overall median quality score for these media was only 56/100 (IIQ: [46-58]), without major variability between countries. The most appreciated dimension was "maintaining the confidence of the population", with an overall median score of 14/20 (12/20 for epidemiological bulletins and 16/20 for press releases). The most poorly rated dimension was "strengthening community participation", with a median score of only 4/20 (6/20 for epidemiological bulletins and 4/20 for press releases). CONCLUSION: The quality of the Maghreb crisis communication media during COVID-19 was insufficient in most of its dimensions and items, particularly from a psychosocial standpoint. Reinforcement of the capacities of communication officers to develop information material and supports during health crises is indispensable and should be considered as an urgent matter.

[Epidemiological Evolution of Type 1 Diabetes in Children: Data from the Register of the Department of Oran, Algeria, 1973-2017]. / Évolution épidémiologique du diabète de type 1 chez l'enfant : données du registre du département d'Oran, Algérie, 1973­2017.

BACKGROUND: Diabetes in children is undergoing a profound change in terms of frequency and age at onset worldwide. Algeria is particularly impacted by the epidemic to the point of appearing in the "top 10" 2016 of countries with very high incidence of T1D. Our study was aimed to present the epidemiological evolution of T1D in children using data from the register of the department of Oran. METHODS: New cases of T1D are children under 15 years old coming from primary care units and pediatric departments. Registration was centralized at the level of the "C" pediatric unit of Oran University Hospital since 1973 with an assessment close to 100%. RESULTS: From 1973 to 2017, 2358 T1D new cases aged less than 15 years at T1D diagnosis have been registered. The average annual incidence under 15 years old for the last 5 years 2013-2017 is 31.12±3.60 cases per 100,000 and 22.62±5.18, 36.92±6.88 et 37.93±6.53 for children 0-4, 5-9 et 10-14 years old, respectively. The average annual evolution was at 12.78% in the last 25 years for the whole group and 15.03, 15.50 and 9.10% for children of 0-4, 5-9 and 10-14 years old, respectively. The estimated prevalence on December 31st 2017 was 207 per 100,000 equivalent to 1 T1D for 482 children under 15. The sex ratio for all cases is 0.94 with non-significant fluctuations. The winter/summer seasonality, significant from 1973 to 2013 in favor of winter months is no longer present starting from 2013. CONCLUSION: We confirm, in agreement with other teams, the outsized increase in the incidence of T1D and the younger age at onset in children under 15 in our country. This evolution, mainly related to environmental problems poses new difficulties to families and teams in charge of the disease.

[Comorbidity schizophrenia and diabetes mellitus in Algeria - A study of risk factors]. / Comorbidité schizophrénie et diabète de type 2 en Algérie ­ étude des facteurs de risque.

BACKGROUND: The combination of schizophrenia and diabetes mellitus presents a public health problem in the world. Several studies have been carried out for the analysis of this comorbidity, including prognostic factors. OBJECTIVE: The objective of our study is to determine the risk factors associated with the comorbidity schizophrenia and diabetes mellitus. METHODS: From a sample of 200 cases of schizophrenic patients hospitalized at the Sidi Chami psychiatric hospital of Oran in Algeria, we carried out a descriptive transversal and analytical study during the period of one year. RESULTS: Our results are consistent with those of the different studies carried out in neighboring countries. Among the risk factors recorded in our study, we mention the age of 40 and over, divorce, dyslipidemia, high blood pressure, overweight and severe and moderate obesity, the age of schizophrenia of 30 to 40 years, the first-generation neuroleptic treatment and family history related to diabetes. While the male sex, celibacy and second-generation neuroleptics were found in the study as protective factors against the onset of diabetes mellitus in schizophrenic patients. CONCLUSION: The factors associated with comorbidity schizophrenia and type 2 diabetes are manifold. These factors must be taken into account when introducing preventive behaviors that must be multidisciplinary in order to ensure better patient care.

Diversity of nodular bacteria of Scorpiurus muricatus in western Algeria and their impact on plant growth.

A total of 51 bacterial strains were isolated from root nodules of Scorpiurus muricatus sampled from 6 regions of western Algeria. Strain diversity was assessed by rep-PCR amplification fingerprinting, which grouped the isolates into 28 different clusters. Partial nucleotide sequencing of the 16S rRNA gene and BLAST analysis revealed that root nodules of S. muricatus were colonized by different species close to Rhizobium vignae, Rhizobium radiobacter, Rhizobium leguminosarum, Phyllobacterium ifriqiyense, Phyllobacterium endophyticum, Starkeya sp., and Pseudomonas sp. However, none of these strains was able to form nodules on its host plant; even nodC was present in a single strain (SMT8a). The inoculation test showed a great improvement in the growth of inoculated plants compared with noninoculated control plants. A significant amount of indole acetic acid was produced by some strains, but only 2 strains could solubilize phosphate. In this report we described for the first time the diversity of bacteria isolated from root nodules of S. muricatus growing in different regions in western Algeria and demonstrated their potential use in promoting plant growth.

[Prevalence of cardiovascular risk factors in urban and rural communities in the Wilaya of Tlemcen (Algeria): A comparative study]. / Prévalence des facteurs de risque cardiovasculaire au sein des communautés urbaine et rurale dans la Wilaya de Tlemcen (Algérie) : l'étude de deux communes.

BACKGROUND: In Algeria, few studies have been conducted to determine the prevalence of genetic and environmental risk factors of cardiovascular diseases as a function of residence. The objective of this study was therefore to determine the prevalence of cardiovascular risk factors according to sex and age in urban and rural communities in the Wilaya of Tlemcen (Algeria). MATERIAL AND METHODS: A population survey was conducted on a representative sample of 864 individuals aged 20years and over, among inhabitants in urban and rural communes in the Wilaya of Tlemcen. Each subject answered the questionnaire on cardiovascular risk factors, underwent a physical examination and had a blood sample drawn. RESULTS: The prevalence of hypercholesterolemia was 6.6%, it was found to be higher in urban areas (8.4%) than in rural areas (4.6%). The prevalence of low HDL cholesterol levels was higher in urban (28.8%) than rural (23.9%) areas. The prevalence of family history of cardiovascular disease did not differ between the two sexes and between urban (15.7%) and rural (14.0%) areas. The prevalence of hypertension was higher in urban (28.0%) than in rural (16.8%) areas, and was highest among women aged 65 years or older in urban areas (67.3%) and in rural areas (66.6%). The prevalence of diabetes was higher among women living in urban areas (21.4%) compared with rural areas (15.4%). Obesity was much more frequent among women than among men in urban areas (24.7% in women and 9.5% in men) and in rural areas (28.3% in women and 8.3% in men). The prevalence of smoking was 45.8% for men and with no significant variations between urban areas and rural areas. CONCLUSION: The prevalence of cardiovascular risk factors according to sex and age in the two communes are high in two communes in the Wilaya of Tlemcen. However, the prevalence of hypertension, hypercholesterolemia and diabetes were higher in women in urban than in rural areas. This finding focuses attention on the need for measures to reduce the prevalence of these cardiovascular risk factors in these communities. Factors such as sex age and area of residence are indicators to consider when targeting interventions.

[News of antibiotic resistance among Gram-negative bacilli in Algeria]. / Actualité de la résistance aux antibiotiques chez les bacilles à Gram négatif en Algérie.

Antibiotic resistance has become a major public health problem in Algeria. Indeed the past decade, we have seen a significant increase in resistance to antibiotics especially in Gram-negative bacilli. Resistance to ß-lactams in enterobacteria is dominated by the production of ESBL CTX-M-3 and CTX-M-15. The strains producing these enzymes are often the cause of potentially serious infections in both hospital and community settings. Identified plasmid cephalosporinases are CMY-2, CMY-12 and DHA-1. The isolation of strains of Enterobacteriaceae and Pseudomonas aeruginosa producing carbapenemases is rare in Algeria. Some Enterobacteriaceae producing OXA-48 or VIM-19 have been reported; so far, only VIM-2 has been identified in P. aeruginosa. However, the situation regarding the strains of Acinetobacter baumannii resistant to carbapenemases seems to be more disturbing. The carbapenemase OXA-23 is the most common and seems to be endemic in the north. The carbapenemase NDM-1 has also been identified. Resistance to aminoglycosides is marked by the identification armA gene associated with blaCTX-M genes in strains of Salmonella sp. Several other resistance genes have been identified sporadically in strains of Enterobacteriaceae, P. aeruginosa and A. baumannii. Resistance genes to fluoroquinolones are more recent identification in Algeria. The most common are the Qnr determinants followed by the bifunctional enzyme AAC[6']-Ib-cr. Resistance to sulfonamides and trimethoprim was also reported in Enterobacteriaceae strains in the west of the country.

[Parasitological study of 78 cases of human cystic echinococcosis collected between 2005 to 2012 in Mustapha hospital center of Algiers]. / Étude parasitologique de 78 cas d'échinococcose kystique humaine colligés entre 2005 et 2012 au CHU Mustapha d'Alger.

AIM: The aim of this work is to know the fertility rate of the metacestodes resulting from patients suffering from hydatidosis, the one of protoscoleces's viability and by comparing the results obtained with those found elsewhere. It reports, also, the epidemiological, clinical and diagnostically aspects of the studied patients. MATERIALS AND METHODS: This study has carried on 78 hydatics samples resulting from 78 patients collected between 2005 and 2012 at the laboratory of parasitology of the Mustapha hospital center of Algiers. A questionnaire on the epidemiological context (contact with an animal-host of the cycle, place of residence, presence of family cases reached of hydatidosis and knowledge on the hydatic disease) concerned 69 patients. For each sample, a direct microscopic examination is made with or without vital staining. The presence of protoscoleces made qualified the fertile cyst. Those visualized moving or resistant to eosin at 0.2% are considered viables. Indirect diagnosis is based on the techniques: passive hemagglutination, electrophoresis, Elisa IgG Echinococcus granulosus and immunoblotting IgG "Echinococcus". Molecular analysis is based on PCR and sequencing the partials fragments of two mitochondrial genes with the primers COX1 and ND1. RESULTS: The results obtained show that the surgical frequency of hydatidosis is significant at the young adult and at the child. The epidemiological context associated at the disease is the conjointly presence of a dog and herbivores. The fertility rate of human hydatid cysts is 88.4% and the ones of viability of the protoscoleces is 74.5%. In this series, the serology shows global positivity at 70%. The molecular characterization of five samples identify the species: E. granulosus ss. CONCLUSION: Finally, the viability and fertility rates found here are raised. Sometimes viables protoscoleses are found after use of scolicidal solution. In front of these results, the parasitical treatment is more than necessary in order to minimize the risk of occurred of secondary echinococcosis or the relapses postoperatives.

[Seroprevalence of toxoplasmosis in pregnant women in Annaba, Algeria]. / Séroprévalence de la toxoplasmose chez les femmes enceintes dans la wilaya d'Annaba, Algérie.

BACKGROUND: The aim of the study was to estimate the seroprevalence and risk factors of toxoplasmosis in pregnant women in the department of Annaba, Algeria. METHODS: We performed a cross-sectional study with analytical purposes. The study was collaboration between the laboratory of Parasitology-Mycology, Faculty of Medicine of Annaba and Parasite Biology Department at the Pasteur Institute of Algeria. A total of 1028 pregnant women who underwent prenatal diagnosis/visit were included over a period of 4 years from January 2006 to December 2009. Immunoglobulin G and M were assayed, using the microparticle enzyme method. The avidity test was used to determine the date of contamination according to age of pregnancy. Search for the parasite was made by inoculation of the placenta and cord blood in white mice. The study compared mother-to-child serological profiles using Western Blot (WB) IgG and IgM. Direct (not well-cooked meat) and indirect (presence of cat, gardening) indicators were recorded to search for parasite exposure. RESULTS: Seroprevalence was 47.8 % (95 % CI: 44.8 to 51.0) and the rate of active toxoplasmosis was 1.1 % (95 % CI 0.6 to 1.8). According to their immune status, this was the first serology for 41 % (CI95 %: 38.0-44.0) of women; 12 % (CI95 %: 10.5-14.6) of primiparous women had only one serology test during their entire pregnancy. Major risk factors were consumption of poorly-cooked meat and exposure to cats. CONCLUSION: Toxoplasmosis during pregnancy is a serious issue and an effective prevention program is needed.

Algerian medical teachers' research output and its determinants during the 2000-2009 decade.

BACKGROUND: Publications are the primary output of scientific research. We conducted a national study to quantify Algerian medical teachers' research output and identify its determinants during the 2000-2009 decade. METHODS: The American Medline database and the French Pascal database were used. A publication was eligible only if the lead author was an Algerian medical teacher (in medicine, pharmacy, or dentistry) working in Algeria. The same questionnaire was completed by cases (teachers who were first authors of an original article during the study period) and randomly selected controls. Logistic regression analysis was used to identify factors related to research output. RESULTS: A total of 79 original articles (42.2% of publications) were retrieved, a quarter of which were listed in Pascal alone. The publication rate was 2.6 original articles per 1000 teachers per year. The journals that published these original articles had a median impact factor of 0.83. The ability to publish an original article was 4.3 times higher if the teacher had undergone training in biostatistics and/or epidemiology (adjusted odds ratio [aOR]=4.31, 95% confidence interval [CI]: 1.79-10.38). A promotion evaluation grid that did not encourage writing (aOR=3.44, 95% CI: 1.42-8.33), a doctoral thesis, seniority, foreign collaboration, and English language proficiency were found to be associated with publication output. CONCLUSIONS: Algerian medical teachers' research output was particularly low. Replacing the current promotion grid with a grid that promotes writing, developing abilities to read and write articles and developing English language proficiency are likely to improve this situation.

Staphylococcal cassette chromosome mec characterization of methicillin-resistant Staphylococcus aureus strains isolated at the military hospital of Constantine/Algeria.

Staphylococcal cassette chromosome mec is a genetic mobile element that carries the gene mecA mediating the methicillin resistance in staphylococci. The aim of this study is to type the Staphylococcal cassette chromosome mec (SCCmec) in 64 non-redundant methicillin-resistant Staphylococcus aureus (MRSA) strains recovered at the military hospital of Constantine (Algeria) between 2005 and 2007. Methicillin resistance was detected by oxacillin and cefoxitin discs and PBP2a test, and then confirmed by mecA PCR. The SCCmec complex types were determined by real time PCR. The analysis showed that 50 isolates were hospital acquired (HA-MRSA) and 14 were community-acquired (CA-MRSA). SCCmec type IV and V (traditionally attributed to CA-MRSA) were harbored by both HA-MRSA and CA-MRSA, while SCCmec type I, II and III were not recorded. These findings motivate more investigations to be carried on HA-MRSA in our hospital and other national health care centers.

[Epidemiological profile of 290 cases of human cystic echinococcosis diagnosed in the Mustapha University Hospital (Algiers) from 2006 to 2011]. / Profil épidémiologique de 290 cas d'échinococcose kystique humaine diagnostiqués au CHU Mustapha d'Alger (2006 à 2011).

THE AIM OF THE STUDY: This study reports a series of 290 cases of hydatidosis confirmed by the surgery and/or the imagery with a positive immuno-diagnosis collected between 1st January 2006 and 31 March 2011 at parasitology-mycology laboratory of hospital university center of Mustapha of Algiers. Our aim is to specify, through the listed cases, the epidemiological aspects of this affection and compared with those obtained in two previous Algerian epidemiological investigations carried out, between 1963-1964 and 1966-1975. PATIENTS AND METHODS: It is a retrospective (2006-2008) and prospective (2008-2011) study. The parasitological diagnosis was carried out by the direct macroscopic and/or microscopic identification of the parasite and indirect diagnosis based on four techniques: passive hemagglutination, Elisa IgG "Echinococcus granulosus", Western Blot IgG "Echinococcus" and electrophoresis. RESULTS: The study shows that this affection is still prerogative of the young adult. It bring out also in this study that the child of school age (ten years), in particular the boy, pays a heavy tribute. At the child, the preferential pulmonary seat of the hydatic disease is not devoid of risk. At adult, this parasitic disease mainly affect the active woman. CONCLUSION: Generally, the epidemiological and clinical characteristics join the endemic countries data and confirmed the row of our country among them. The transmission seems as strong as in the past, in spite of a much better social educational level.

[Epidemiological and clinical features of primary open angle glaucoma in Bejaia: "The Bejaia Eye Study"]. / Aspects épidémiologiques et cliniques du glaucome primitif à angle ouvert à Bejaia : « Bejaia Eye Study ¼.

PURPOSE: To determine the prevalence of POAG and its clinical features in a population aged 40years and over in Bejaia. METHODS: This was a descriptive, cross-sectional survey for analytical purposes in a representative sample from the municipality of Bejaia. The target population consists of residents of the municipality aged 40 and over who were examined in basic health facilities in the municipality of Bejaia, from May 31, 2015 to July 12, 2016. The visual field, OCT, vertical C/D and intraocular pressure (IOP) criteria were used to define whether or not primary open angle glaucoma was present. RESULTS: A total of 1484 people (99 %) participated in the study. The mean age of the study population was 57.97±10.77years, with a median of 56years and sex ratio of 1.07. The prevalence of glaucoma in our study was 5.5 %: POAG 4.6 % (95% CI=3.5-5.7); PACG 0.3 % (95 % CI=0.1, 0.7); secondary glaucoma 0.5 % (95 % CI=0.2-0.7). The prevalence of ocular hypertension was 3.0 % (95% CI=2.2-4.0). The age-adjusted prevalence was 0.8 % between 40 and 49years of age and 6.9% between 60 and 69years of age. The mean age was 66.76±9.31years for men and 67.68±12.10years for women. The mean IOP was 17.53±5.69mm Hg. The mean pachymetry was 518.3±34.3µm in the right eye and 517.4±33.9µm in the left eye. The mean cup/disc ratio was 0.7±0.2 in both eyes. Multivariate analysis of risk factors in our study showed that age and ocular hypertension were significantly associated with the presence of POAG. DISCUSSION: The prevalence of POAG is disparate in relation to the age difference, the method of recruitment and the diagnostic criteria: in Bejaia, it is 4.6 %; in Morocco: Marrakech 2.0 %, Fez 6.4 %; in Tunisia: Bardo 2.7 %, Mahdia 2.4 %. The prevalence of POAG increases exponentially with age without significant gender difference. The inclusion of suspect cases influences the prevalence (Beaver Dam, Namil Study). We found that the prevalence of OHT in our study approximates that of the BMES, but it did not show a significant increase with age. The mean CCT in Bejaia (526.35±34.86 microns) and Fez (522.16±41.45 microns) are comparable. The mean vertical C/D ratio in Bejaia was also comparable to data in the literature. A significant difference was observed in the mean median deviation (MD) between subjects with glaucoma and normal subjects. The retinal nerve fiber layer as well as the mean ganglion cell complex thickness in glaucoma subjects was significantly thinner than in healthy subjects. CONCLUSION: The prevalence of POAG is high, similar to that of people of African descent, but at older ages and among men. The rate of glaucoma in Bejaia rises significantly with age. Glaucoma is a major ocular health problem and will become increasingly important as the population ages.

[Cancer epidemiology in Algeria, 1996-2019]. / Épidémiologie des cancers en Algérie, 1996­2019.

INTRODUCTION: Cancer is a major public health problem in Algeria. The aim of this article was to estimate trends in cancer incidence in Oran, Algeria, over the period 1996-2019. PATIENTS AND METHODS: Nine cancer sites were analyzed. Incidence data over the 1996-2019 period were collected from the Oran cancer registry. The annual percent changes in incidence rates were evaluated with Joinpoint analysis. RESULTS: Between 1996 and 2019, unfavorable trends in incidence were observed for lung and colorectal cancers in both sexes, as well as female breast cancer. In contrast, a continuous decrease in incidence rates of cervical cancer were observed. As for the prostate, no corresponding trend was emerged for this cancer. CONCLUSION: The upward trend in incidence rates for some cancers underscores the need to strengthen prevention efforts.

[Asthma control in adult Algerian patients. Comparison with other North African and Middle-East countries]. / Contrôle de l'asthme chez l'adulte en Algérie. Comparaison avec les autres pays d'Afrique du Nord et du Moyen Orient.

INTRODUCTION: Lack of recent data on asthma control in Algeria led to this study whose results were compared with those of the same study conducted in the Middle East and North Africa (MENA). METHOD: This cross-sectional epidemiological study was performed in adults who had been diagnosed with asthma for at least one year and without exacerbation within the last 4 weeks. Asthma control was assessed using the 2012 Global Initiative for Asthma (GINA) criteria and the Asthma control test (ACT) questionnaire. RESULTS: We studied 984 patients mainly managed by specialist physicians; 61% female, mean age 45 years, body mass index 27kg/m2, active smokers 2%. Medication was prescribed in 92% with 78% receiving inhaled corticosteroids alone or with add-on therapies. Good adherence was observed in 27%. Asthma control was observed in 34.6% vs. 28.6% in other countries (P < 0.001). Low level of education, absence of medical insurance, lack of physical exercise, and-long duration of the disease were significantly associated with uncontrolled asthma. CONCLUSION: Poor control of asthma is still observed in Algeria despite a high level of specialist involvement. Except for adherence, known predictive factors of poor asthma control have been observed. Quality improvement training of health care professionals and patient education are probably the main issues to be addressed.

Cystic Echinococcosis in Algeria: the Role of Cattle as Reservoirs in the Dynamics of Transmission of Echinococcus granulosus to Humans via Dogs.

In North Africa, the parasite Echinococcus granulosus is transmitted in a synanthropic cycle evolving mainly between dogs (DH) and sheep (IH), but other animals like cattle are most often found to be more infested with hydatid cysts but their potential role in human contamination via dogs is unknown. The purpose of this study is to assess the prevalence and fertility rates of hydatid cysts in ruminants (cattle and sheep) in two slaughterhouses in central and eastern Algeria. Determining the frequency and fertility of cysts in cattle will assess the degree of involvement of this species, alongside sheep, in the epidemiological cycle of E. granulosus in Algeria. In the present study, prevalence rates were estimated at 4.9% and 10% in slaughtered ruminants, all species combined at the slaughterhouses of El Harrach and Souk Ahras, respectively. The distribution of the prevalence by species indicates higher infestation rates in cattle compared to sheep: 6% vs 3.9% and 37% vs 4.7% in the slaughterhouses of El Harrach and Souk Ahras, respectively. The survey results showed relatively low cyst fertility rates in cattle compared to sheep: 13.8% vs 43.7% and 33.3% vs 71.4% in the two slaughterhouses, El Harrach and Souk Ahras, respectively. The low fertility rate of cysts in cattle can be explained by a poor adaptation of the species, E. granulosus sensu stricto, previously identified by molecular analysis in all samples of hydatid cysts collected from cattle in Algeria. In conclusion, cattle infested with E. granulosus sensu stricto, with low fertility rates, play a minor role in the epidemiology of cystic echinococcosis in Algeria. It is rather an indicator of the persistence of cystic echinococcosis infection in endemic regions.

En Afrique du Nord, le parasite Echinococcus granulosus est transmis dans un cycle synanthropique évoluant principalement entre les chiens (HD) et les moutons (HI). Mais d'autres animaux comme les bovins se révèlent le plus souvent très infestés par les kystes hydatiques : leur rôle potentiel dans la contamination humaine via des chiens est inconnu. Le but de cette étude est d'évaluer la prévalence et les taux de fertilité des kystes hydatiques chez les ruminants (bovins et ovins) dans deux abattoirs du centre et de l'est de l'Algérie. La détermination de la fréquence et de la fertilité des kystes chez les bovins permettra d'évaluer le degré d'implication de cette espèce, aux côtés des ovins, dans le cycle épidémiologique d'E. granulosus en Algérie. Dans la présente étude, les taux de prévalence ont été estimés à 4,9 et 10 % chez les ruminants abattus, toutes espèces confondues dans les abattoirs d'El Harrach et de Souk Ahras respectivement. La répartition de la prévalence par espèce indique des taux d'infestation plus élevés chez les bovins que chez les ovins : 6 vs 3,9 % et 37 vs 4,7 % dans les abattoirs d'El Harrach et de Souk Ahras respectivement. Les résultats de l'enquête ont montré des taux de fertilité des kystes relativement bas chez les bovins par rapport aux ovins : 13,8 vs 43,7 % et 33,3 vs 71,4 % dans les deux abattoirs, El Harrach et Souk Ahras respectivement. Le faible taux de fertilité des kystes chez les bovins peut s'expliquer par une mauvaise adaptation de l'espèce E. granulosus sensu stricto, précédemment identifiée par analyse moléculaire dans tous les échantillons de kystes hydatiques prélevés sur des bovins en Algérie. En conclusion, les bovins infestés par E. granulosus sensu stricto, avec des kystes à faible taux de fertilité, jouent un rôle mineur dans l'épidémiologie de l'échinococcose kystique en Algérie. Il s'agit plutôt d'un indicateur de la persistance de l'infection à échinococcose kystique dans les régions endémiques.

[The plethysmographic reference equations established for adult natives of Eastern Algeria are not applicable to natives of Northern Algeria]. / Les équations de référence pléthysmographiques établies chez les adultes natifs de l'Est Algérien sont inapplicables pour ceux natifs du Nord Algérien.

INTRODUCTION: The validity of the published plethysmographic reference equations specific to adults living in Eastern Algeria (RE-EA) in the interpretation of spirometric results in adult natives of Northern Algeria has not been assessed. AIM: To test the application of the RE-EA (Constantine, mean altitude=694m) to a population of healthy adults living in Algiers (mean altitude=153m). METHODS: The plethysmographic parameters of 453 healthy adults living in Algiers (234 women; age: 45±15 years, height: 1.66±0.10m, weight: 73±14kg) were determined and were compared with those predicted from the RE-EA. In addition, the percentages of adults with an obstructive ventilatory defect (OVD), a restrictive ventilatory defect (RVD) and/or lung hyperinflation were noted. The RE-EA are considered inapplicable to healthy adults living in Algiers if, firstly, the differences between the determined and predicted plethysmographic parameters are statistically significant and, secondly, more than 5% of healthy adults have OVD and/or RVD and/or lung hyperinflation. RESULTS: The RE-EA significantly overestimated the following parameters: FEV1 by 0.27±0.39L, MMEF by 0.52±0.75L/s, FEF25% by 0.75±0.56L/s, FEF50% by 0.85±1.02L/s, FEF75% by 0.28±1.25L/s, VC by 0.21±0.50L, TLC by 0.31±0.62L, ERV by 0.06±0.48L, IC by 0.27±0.48L, FEV1/VC by 0.03±0.05, and FEV1/FVC by 0.03±0.05. They significantly underestimated the RV/TLC by 0.01±0.05. Moreover, 14.35 %, 8.83 % and 5.74 % of healthy adults had OVD, RVD and lung hyperinflation, respectively. CONCLUSION: The RE-EA are not applicable in adult natives of Northern Algeria.

[Epidemiology of Cutaneous Leishmaniasis in Algeria through Molecular Characterization]. / Épidémiologie de la leishmaniose cutanée en Algérie à travers la caractérisation moléculaire.

Three distinct noso-epidemiological cutaneous leishmaniasis (LC) entities coexist in Algeria: the so-called sporadic form of the North (LCN), the zoonotic form (LCZ) and the chronic form (LCC). The precise identification of the parasitic species involved in each of the forms makes it possible to specify the geographical distribution of each of the forms raised, to distinguish their clinical aspects, to guide the therapeutic behaviors and to adapt the control programs. Ninety-seven (97) human strains from 97 cases of LC were subjected to molecular characterization by PCR-ITS1 followed by sequencing of this inter-gene space. Our results confirm the endemicity of the three forms. The LCN, caused by L. infantum (17 isolates/97 i.e. 17.52%) is limited to the North of the country mainly (16 isolates/17). Its geographical distribution is superimposable to that of visceral leishmaniasis with an extension more and more reported in previously unaffected areas, such as the regions of Tlemcen and Oran in the West, Setif, Annaba and Collo in the East. The LCZ, due to L. major (70 strains/97 i.e. 72.16%), remains the dominant form in the arid and semi-arid zones (47 strains/70) with a progression towards the North (20/70 strains). Indeed, long confined to the Sahara, it shows a geographical extension outside its historic homes of Biskra and Abadla. This form is progressing dangerously towards the highlands and the steppe regions of the country. The most interesting fact was the identification of L. tropica for the first time in North-Central and North-West Algeria in Algerian patients who had never left the national territory. Out of the 10 strains of L. tropica identified, 8 belonged to patients of Syrian origin and 2 to Algerian patients. L. tropica was reported for the first time in 2008 in 6 patients living in Constantine (North-East Algeria) and in 2017, still in the North-East of the country, in Annaba. The observation of L. tropica in the North and Northeast center of the country, where L. infantum and L. major coexist, suggests changes in the epidemiology of cutaneous leishmaniasis in Algeria, which highlights the interest of more investigations to better understand the transmission cycle of the different entities.

Trois entités nosoépidémiologiques distinctes de leishmaniose cutanée (LC) coexistent en Algérie : la forme dite du nord, dite sporadique (LCN), la forme zoonotique (LCZ) et la forme chronique (LCC). L'identification précise des espèces parasitaires impliquées dans chacune des formes permet de préciser la répartition géographique de chacune de ces trois formes, de distinguer leurs aspects cliniques, d'orienter les conduites thérapeutiques et d'adapter les programmes de lutte. Quatre-vingt-dix-sept souches humaines ont fait l'objet d'une caractérisation moléculaire par une PCR-ITS1, suivie d'un séquençage de cet espace intergénique. Nos résultats confirment l'endémicité des trois formes. La LCN, causée par Leishmania infantum (17 isolats/97, soit 17,52 %), est limitée au nord du pays principalement (16 isolats/17). Sa répartition géographique est stable et superposable à celle de la leishmaniose viscérale. La LCZ, due à Leishmania major (70 souches/97, soit 72,16 %), reste la forme dominante au niveau des zones arides et semi-arides (47 souches/70) avec une progression vers le nord (20 souches/70). Cette forme connaît une extension géographique en dehors de ses foyers historiques et progresse vers les Hauts Plateaux et les régions steppiques du pays. Le fait remarquable est l'identification de Leishmania tropica pour la première fois au centre nord et nord-ouest de l'Algérie, chez des patients algériens n'ayant jamais quitté le territoire national. L'observation de L. tropica au centre nord et nord-ouest du pays, où coexistent L. infantum et L. major, suggère des modifications de l'épidémiologie de la LC en Algérie, ce qui souligne l'intérêt de plus d'investigations pour mieux comprendre le cycle de transmission des différentes entités.