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Objectives This study aimed to estimate prehospital delay and to identify the factors associated with the late arrival of patients with ischemic stroke at the Souss Massa Regional Hospital Center in Morocco. Patients and methods An observational, prospective, cross-sectional study was conducted from March 2019 to September 2019 in the Souss Massa regional hospital center, which is a public hospital structure. A questionnaire was administered to patients with ischemic stroke and to bystanders (family or others), while clinical and paraclinical data were collected from medical records. Univariate and multivariate logistic regression analyses were used to identify the factors associated with delayed arrival at emergency department. Results A total of 197 patients and 197 bystanders who fulfilled the criteria for the study were included. The median time from symptom onset to hospital arrival was 6 hours (IQR, 4–16). Multiple regression analysis showed that illiteracy (OR 38.58; CI95%: 3.40–437.27), waiting for symptoms to disappear (patient behavior) (OR 11.24; CI95%: 1.57–80.45), deciding to go directly to the hospital (patient behavior) (OR 0.07; CI95%: 0.01–0.57), bystander's knowledge that stroke is a disease requiring urgent care within a limited therapeutic window (OR 0.005; CI95%: 0.00–0.36), and direct admission without reference (OR 0.005; CI95%: 0.00–0.07), were independently associated with late arrival (> 4.5 hours) of patients with acute ischemic stroke. In addition, illiteracy (OR 24.62; CI95%: 4.37–138.69), vertigo and disturbance of balance or coordination (OR 0.14; CI95%: 0.03–0.73), the relative's knowledge that stroke is a disease requiring urgent care and within a limited therapeutic window (OR 0.03; CI95%: 0.00–0.22), calling for an ambulance (relative's behavior) (OR 0.16; CI95%: 0.03–0.80), distance between 50 and 100 km (OR 10.16; CI95%: 1.16–89.33), and direct admission without reference (OR 0.03; CI95%: 0.00–0.14), were independently associated with late arrival (> 6 hours) of patients with acute ischemic stroke. Conclusion Patient behavior, bystander knowledge and direct admission to the competent hospital for stroke care are modifiable factors potentially useful for reducing onset-to-door time, and thereby increasing the implementation rates of acute stroke therapies.

Background: Weight load is a cosmopolitan health problem. In Morocco, women are the most affected by the phenomenon since obesity has risen from 26.8% to 29.0%. Objective: To determine the prevalence of weight load and associated factors among female students in higher education. Methods: Data were collected by a questionnaire. Anthropometric measurements were made using a scale and a wall-mount- ed scale. Data were analysed by the statistical software SPSS version 13.0. Quantitative variables were described in mean ± standard deviation. Factors associated with obesity were determined by binary logistic regression. Results: About two-thirds of the students had a normal weight, 21% were overweight and 3% were obese. In addition, 58% of students were physically inactive and 77% ate cake and fast food. In addition, 63% of students were dissatisfied with their weight. A significant relationship is found between level of primary education, type of establishment, cake and fast food consumption and weight load. Conclusion: The results revealed that 24% of participants were weight load and had behavioral risk factors such as a sed- entary lifestyle and an unbalanced diet, which requires the promotion of a healthy lifestyle among these students as well as psychological support for those dissatisfied with their body image. Keywords: Weight load; obesity; overweight; perception; female students; higher education; Morocco.

Background Moroccan incidence of cancer is increasing with the lengthening of life expectancy. Data regarding elderly Moroccan cancer patients are lacking. In the context of our project aiming to develop an adapted version of the Comprehensive Geriatric Assessment CGA to the Moroccan population, we launched the first Moroccan multicenter transverse study to explore the characteristics of elderly Moroccan cancer patients. Methods The study was conducted in nine Moroccan medical oncology departments. Patients were enrolled over 4 months. Inclusion criteria were patients aged 65 years or over with verified solid cancer. The questionnaire included four sections: socio-demographic and economic data, clinical data, vulnerability and EORTC-QLQ C30. We explored the entire included population. Then, we compared the results according to age (65–70 years old and ≥ 71 years old) and sex. We also explored the correlation between G8 scores and the ability to practice religion as an indicator of fitness level. Results In total, 164 patients were enrolled. The mean age was 73.18 ± 6.01 years. The majority of patients were married, lived with their children and received their financial income from them. Fifteen percent of families asked to hide the diagnosis from the patient. Breast (23%), colorectal (15.9%) and lung (14%) cancers were the most frequent, and 83.5% had an abnormal G8. The majority of the patients were independent for basic daily activities. Female patients had poorer social and economic conditions. Abnormal G8 was correlated with religious practice and quality of life scores. Conclusion This is the first multicenter prospective study designed to collect data on the lifestyle and clinical profiles of elderly Moroccan cancer patients as an Arab and Muslim population. Our study shows that it is a well-cared-for population with strong social ties. However, there is deep economic vulnerability, especially among women, requiring urgent care. Religious practice is an important daily activity for our elderly patients and should be included in the Moroccan CGA.

Aim: The objective of this study was to analyse the effect of the introduction in 2010 of the pneumococcal conjugate vaccine (PCV) on the reduction in mortality from respiratory causes in children under 5 years in Morocco. Methods: Child mortality rates from respiratory cause were analysed using an interrupted time series analysis. Mortality rates from congenital and chromosomal causes were also analysed for comparative purposes. Results: In the post-vaccination period, child mortality rates from respiratory causes decreased by 28% (Mortality rate ratio (MRR) = 0.72, 95% CI: 0.58–0.83) and by 30% in children under 1 year (MRR = 0.70, 95% CI: 0.50–0.98). In children aged between 1 and 5 years, the decrease in the child mortality rate was not statistically significant (MRR = 0.99, 95% CI: 0.91–1.08). Mortality rates from congenital and chromosomal causes in the post-vaccination period were stable in children under 5 years (MRR = 1.19, 95% CI: 0.97–1.48), in children under 1 year (MRR = 1.15, 95% CI: 0.94–1.40) and in children aged between 1 and 5 years (MRR = 1.19, 95% CI: 0.97–1.48). Conclusion: The decrease in child mortality from respiratory causes in the post-vaccination period provides strong evidence of the effectiveness of PCV. Keywords: Child mortality, Pneumococcal conjugate vaccine, Interrupted time series analysis, Morocco

BACKGROUND: Colorectal Cancer (CRC) is a major health problem around the globe. In Morocco, the disease ranks third after breast and lung cancers. This study is the first in Morocco to investigate epidemiological, clinical and therapeutic features while exhaustively describing toxic side-effects to chemotherapy of CRC and studying the 3-years survivorship.METHODS: This is a descriptive and analytical retrospective study of about 290 patients with CRC enrolled during the period of January-December 2013. Statistical analysis was performed to correlate clinicopathological data with chemotherapy toxicity and survivorship in patients, by Chi2 test. Overall Survival (OS) rate has been calculated by the Kaplan-Meier method and compared using Log-rank test.RESULTS: Fifty-five percent had a tumor localized in rectum, and 42,8% in colon. Mean age of these patients at diagnosis was 56,16 ±14,6. incidence rate of adverse events (grade I to IV) was 85,6%. Diarrhea was the predominant toxicity (4.6%) occurring at a high grade (grade III-IV). The 3-years OS rate of patients with CRC was 71%. OS decreased by age, and patients with age subgroup between 40 to 59 years had a better OS than the other age subgroups (60 to 79 years and >80 years) with a p-value of 0.0001. Occurence of toxicity (all grades and types) was linked to a higher survival rates compared to the group who had no toxicity noticed (p-value of 0.001).CONCLUSION: Our study shows that patients who had a polychemotherapy had a better OS than those who had monotherapy (p-value of 0.002).

Introduction:in otolaryngologic surgery, ankle is frequently used for monitoring anesthesia in place of brachial when the patient doesn´t need invasive arterial cannulation. If there is a clinically useful and Predictable link between the two readings in hemodynamic normal patient, this difference during otolaryngologic surgery, was not evaluated. We aimed to investigate the reliability and the acceptability of non invasive blood pressure measurements at the ankle compared to those obtained concurrently at the arm during otolaryngologic surgery. Methods:eighty ASA grade I and II patients who had to be operated under general anesthesia were taken as subjects for our study. Blood pressures were measured simultaneously in the 2 limbs before induction and then every 10 minutes until the end of the surgical procedure. Readings were initiated concurrently. Statistical analysis was performed with PASW Statistics 13. Results:there were 41 males (51.2 %) and 39 females (48.8 %). Bland-Altman analysis of mean difference between the ankle and arm (95 % limits of agreement) was -11.47 (- 23.77 to 0.82)mmHg for systolic blood pressure (SBP), -7.89 (-19.16 to 3.36)mmHg for diastolic blood pressure (DBP) and - 9.09 (18.19 to 0.00)mmHg for mean arterial pressure (MAP). Non-parametric analysis showed that 67.5 % of SBP, 46.2 % of DBP and 56.2 % of MAP measurements differed by > 10mmHg. Conclusion:ankle BP cannot be used routinely in otolaryngological surgery. Although, the ankle can be used as an alternative where the arm cannot be used taking into account a difference.

Congenital malformations are one of the leading causes of neonates and infants’ mortality and morbidity. The frequency of these congenital malformations varies in different populations. The objective of this study was to find out the prevalence and pattern of congenital malformations in a tertiary teaching hospital in Rabat, Morocco. This four-year retrospective descriptive study was conducted from January 2011 to December 2014. All newborns with congenital malformations diagnosed at birth were included. Mothers and newborn characteristics were analyzed using SPSS 13.0. A total of 706 newborns were noted to have congenital malformation. The prevalence rate was 1.02%. The mean maternal age was 28.8±7.2 years. The mean maternal body mass index was 28.1±6.9 kg/m2. 13.3% of the mothers had a history of abortion. The nervous system was the most affected system (19.4%) followed by the musculoskeletal system (14.2%), the chromosomal abnormalities (12.3%) and the genito-urinary system (10.8%). Males newborns (57.9%) had more congenital malformations than females (40.5%). The rates for live-births, fetal asphyxia and stillbirths were 75.2%, 7.2% and 17.3%, respectively. This retrospective study provides recent and detailed data about congenital malformations in a Moroccan region. The result from this study will contribute to the knowledge of congenital malformations in this particular area and hence the supportive preventive policy.

Background: Stroke is increasingly becoming a major cause of disability and mortality. However, it can be prevented by raising awareness about risk factors and early health care management of patients. Objective: The aim of this study is to assess the level of knowledge on stroke, its risk factors, and warning signs in the population attending urban primary health care centers in the city of Agadir, Morocco. Methods: This is a multicentric cross-sectional study with a descriptive and analytical purpose. The study was conducted at five urban primary health care centers in Agadir in centralwest Morocco. All persons over the age of 18 years who consulted the health centers and who agreed to fill in the questionnaire were recruited, except for the foreign population and health workers. An interview questionnaire was used to assess the level of knowledge on stroke. Findings: A total of 469 participants were involved in the study. The median knowledge score was 8 (Interquartile range 4–13). High blood pressure (55.7%), depression and stress (48.8%) were the most well-known risk factors. Sudden weakness of the face, arms or legs (37.3%) was the main warning sign cited by the participants. Multivariate analysis revealed that illiteracy (OR 1.92; CI95%: 1.08–3.44) primary education (OR 3.43; CI95%: 1.63–7.21), rural residential (OR 1.67; CI95%: 1.07–2.59), no history of stroke among respondents (OR 16.41; CI95%: 4.37–61.59) and no history of stroke among relatives, acquaintances, or neighbors (OR 4.42; CI95%: 2.81–6.96), were independently associated with a lower level of knowledge of stroke (Table 4). Conclusions: The low level of knowledge on stroke among this Moroccan population indicates the importance of implementing stroke education initiatives in the community. More specifically, proximity education and awareness programs ought to be considered to anchor lifestyle preventive behaviors along with appropriate and urgent actions regarding the warning signs of stroke.

Resume Le kyste hydatique cardiaque est une pathologie parasitaire rare. L’objectif de cette etude etait d’evaluer les resultats de la chirurgie de cette pathologie et de decrire ses caracteristiques cliniques et paracliniques a partir de notre experience. Methodes Entre 1984 et 2014, 12 hommes et 5 femmes porteurs de kyste hydatique cardiaque, d’un âge moyen de 25 ± 13 ans ont ete operes dans notre unite. Tous les patients se plaignaient de dyspnee et 12 (71 %) presentaient des douleurs thoraciques atypiques. Le diagnostic, rendu possible grâce l’examen histologique des pieces operatoires, a ete fortement suspecte a partir des donnees de l’echocardiographie et du scanner thoracique. Le traitement du kyste faisait appel a l’aspiration du liquide associe a une kystectomie (69 %) ou a une perikystectomie (31 %). La cavite residuelle a ete laissee ouverte (37,5 %) ou traitee par capitonnage soigneux (62,5 %). Resultats Cinq localisations ont ete retrouvees, qui sont par ordre de frequence decroissant : le ventricule gauche, le septum inter-ventriculaire, le ventricule droit, l’oreillette gauche et l’artere pulmonaire. La mortalite hospitaliere a ete de 11,8 % (n = 2). La morbidite a ete marquee essentiellement par des troubles de la conduction (n = 2) et par un hematome de la cavite residuelle (n = 3). Apres un suivi moyen de 40,5 ± 19,4 mois, aucun cas de recidive n’a ete rapporte. Conclusion Le kyste hydatique cardiaque est une pathologie potentiellement grave dont le traitement est essentiellement chirurgical. La kystectomie et la perikystectomie demeurent les deux techniques chirurgicales capables d’offrir des chances de guerison avec une morbi-mortalite acceptable.

BACKGROUND Growing evidence suggests that hypovitaminosis D contributes to the pathogenesis of multiple sclerosis (MS). OBJECTIVE This study aimed to evaluate whether vitamin D levels are associated with having MS and some of its characteristics in the Moroccan population. METHODS Using liquid chromatography-tandem mass spectrometry, the 25(OH)D3 metabolite was measured to quantify vitamin D serum levels (DSLs) in 113 patients with MS and 146 healthy controls matched for gender and age. DSLs were then compared between patients and controls, with correlations sought between DSLs and gender, age at onset, disease duration, MS type, degree of disability (EDSS score) and disease severity (MSSS) in patients. RESULTS Hypovitaminosis D (DSL

Background. The LRRK2 G2019S mutation is the most common genetic determinant of Parkinson’s disease (PD) identified to date. This mutation, reported in both familial and sporadic PD, occurs at elevated frequencies in Maghreb population. In the present study, we examined the prevalence of the G2019S mutation in the Moroccan population and we compared the motor and nonmotor phenotype of G2019S carriers to patients with idiopathic Parkinson’s disease. Methods. 100 PD patients were assessed for motor and nonmotor symptoms, current medication, and motor complication including motor fluctuations and dyskinesia. The LRRK2 G2019S mutation was investigated by direct sequencing in patients and ethnically matched controls, all of Moroccan origin. Results. Among the 100 PD Moroccan patients, 41 (41%) were carriers of the G2019S mutation. The mutation frequency was higher among probands with autosomal dominant inheritance (76%) than among sporadic ones (28%). Interestingly, G2019S mutation was also found in 5% of control individuals. Clinically, patients carrying the G2019S mutation have more dystonia (OR = 4.6, p = 0.042) and more sleep disorders (OR = 2.4, p = 0.045) than noncarriers. Conclusions. The LRRK2 G2019S prevalence in Morocco is the highest in the world reported to date. Some clinical features in G2019S carriers such as dystonia and sleep disturbances are worth noting.

BackgroundThe aim of this systematic review is to determine the epidemiological and etiological profiles, the influential factors of the prehospital delay, thrombolysis management, the acute and 3-month mortality rate and the genetic aspect of ischemic stroke in Morocco.MethodsThe present work is a systematic review that was conducted according to the recommendations of the “Preferred reporting items for systematic reviews and meta-analysis”. We used Pubmed, Sciencedirect, Scopus, Clinicalkey, and Google scholar databases for the raking of the gray literature during the time frame 2009 and 2018. The protocol of the review was registered in the PROSPERO register (CRD42018115206).These studies were analyzed based on: Age, sex ratio, risk factors, etiological profile according to Trial of ORG classification 10,172 in Acute Stroke Treatment, prehospital delay average and its influential factors, thrombolyzed patients’ proportion, acute and 3-month mortality and the genetic factors of ischemic stroke in Morocco.ResultsTwenty-nine (n = 29) studies were selected. The average age ranged from 49 ± 15.2 to 67.3 ± 9.9 years old. Moreover, we reported male predominance within all ages in 13 studies. High blood pressure, diabetes, smoking and heart disease were the four identified main risk factors by the prementioned studies. Atherosclerosis and cardioembolic were the main described etiologies of cerebral ischemia, and the average prehospital time ranged from 26 to 61.9 h. The proportion of thrombolysed patients ranged from 1.8% to 2.9%, the mortality rate varied in the acute phase from 3 to 13%, and the 3-month mortality ranged from 4.3 to 32.5%. It is also important to highlight that most of these studies, which were conducted in hospital environment, have a reduced sample size and no confidence interval.ConclusionsIschemic stroke is affecting more likely the young population with male predominance. Moreover, the long prehospital delay and the low proportion of thrombolysed patients are alarming. This indicates the need to investigate in depth the key factors influencing the access to care for Moroccan patients in order to improve the management of this neurologic deficit in Morocco.

Acute lower respiratory infection is a major cause of death in children aged5 years in Morocco. The 13-valent pneumococcal conjugate vaccine (PCV) was introduced to the Moroccan National Immunization Programme in 2010.To investigate the trend in the incidence of acute lower respiratory infection in children aged5 years during 2005-2014 in Morocco.Data on acute lower respiratory infection in children aged5 years were obtained from the data published annually by the Moroccan Ministry of Health. We used joinpoint regression analysis to estimate the trend in incidence of acute lower respiratory infection during the study period.The incidence of acute lower respiratory infection increased significantly between 2005 and 2011: by 3.08% annually in children aged5 years and by 3.24% annually in children aged 1 to5 years. However, the incidence was stable after 2011 as the observed trends were not significant, although the incidence decreased from 2011 to 2014 by 4.26% annually in children aged5 years, by 3.57% annually in children aged 1 to5 years and by 5.14% annually in urban areas.Our results suggest a probable influence of the PCV on the trend in incidence of acute lower respiratory infection in Morocco.تطور عدوى الجهاز التنفسي السفلي الحادة في الأطفال الذين تقل أعمارهم عن 5 سنوات في المغرب في الفترة بين عامي 2005 و2014.ندى بناني مخيتا، رشيد رزين، مجدولين أوبتل، عبد الإله المرنيسي، ليلى لحلوح، عماد شرقاوي، عزيزة لغفوري، مصطفى مرابط، رضوان أبو كال.تُعتبر عدوى الجهاز التنفسي السفلي الحادة أحد الأسباب الرئيسية للوفاة في الأطفال الذين تقل أعمارهم عن 5 سنوات في المغرب. وأُدخل اللقاح المتقارن المضاد للمكونات الرئوية المكون من 13 عنصراً في البرنامج الوطني للتحصين في المغرب في عام 2010.هدفت هذه الدراسة إلى تحري الاتجاه السائد في معدل الإصابة بعدوى الجهاز التنفسي السفلي الحادة في الأطفال الذين تقل أعمارهم عن 5 سنوات في الفترة 2005-2014 في المغرب.تم الحصول على بيانات عن الإصابة بعدوى الجهاز التنفسي السفلي الحادة في الأطفال الذين تقل أعمارهم عن 5 سنوات من البيانات التي تُنشرها سنوياً وزارة الصحة المغربية. وقد استخدمنا تحليل انحدار النقط لتقدير الاتجاه السائد في معدل الإصابة بعدوى الجهاز التنفسي السفلي الحادة خلال فترة الدراسة.ارتفع معدل الإصابة بعدوى الجهاز التنفسي السفلي الحادة ارتفاعاً كبيراً في الفترة بين عامي 2005 و2011: بنسبة 3.08٪ سنوياً في الأطفال الذين تقل أعمارهم عن 5 سنوات، وبنسبة 3.24٪ سنوياً في الأطفال الذين تتراوح أعمارهم بين سنة إلى أقل من 5 سنوات. وعلى الرغم من ذلك، كان معدل الإصابة ثابتاً بعد عام 2011 ، إذ أن الاتجاهات الملحوظة لم تكن ذات أهمية، على الرغم من زيادة معدلات الإصابة من عام 2011 إلى عام 2014 بنسبة 4.26٪ سنوياً في الأطفال الذين تقل أعمارهم عن 5 سنوات، وبنسبة 3.75 ٪ سنوياً في الأطفال الذين تتراوح أعمارهم بين سنة إلى أقل من 5 سنوات، وبنسبة 5.14٪ سنوياً في المناطق الحضرية.تُشير نتائجنا إلى تأثير محتمل للقاح المتقارن المضاد للمكونات الرئوية على اتجاه معدل الإصابة بعدوى الجهاز التنفسي السفلي الحادة في المغرب.Mesure de l’évolution de l’infection aiguë respiratoire basse chez l’enfant de moins de cinq ans au Maroc de 2005 à 2014.L'infection aiguë respiratoire basse constitue une cause majeure de décès chez les enfants de moins cinq ans au Maroc. Le vaccin antipneumococcique conjugué 13-valent (VPC 13) a été introduit dans le cadre du Programme de vaccination national du Maroc en 2010.Mesurer l'évolution de l'incidence de l'infection aiguë respiratoire basse chez les enfants de moins de cinq ans durant la période comprise entre 2005 et 2014 au Maroc.Des données sur l'infection aiguë respiratoire basse chez les enfants de moins de cinq ans ont été obtenues à partir des données publiées chaque année par le ministère de la Santé marocain. Nous avons recouru à l'analyse de régression joinpoint pour estimer la tendance de l'incidence de ce type d'infections pendant la période de l'étude.L'incidence de l'infection aiguë respiratoire basse a augmenté de manière significative entre 2005 et 2011 de 3,08 % par an chez les enfants de moins de cinq ans et de 3,24 % par an chez les enfants dont l'âge était compris entre un et moins de cinq ans. Cependant, l'incidence était stable après 2011, les tendances observées n'étant pas significatives, bien que l'incidence ait diminué de 4,26 % par an entre 2011 et 2014 chez les enfants de moins de cinq ans, de 3,57 % par an chez les enfants dont l'âge était compris entre un et moins de cinq ans et de 5,14 % par an dans les zones urbaines.Nos résultats suggèrent une influence probable du VPC 13 sur l'évolution de l'incidence de l'infection aiguë respiratoire basse au Maroc.

Despite the use of antiviral prophylaxis, the active cytomegalovirus (CMV) replication is still occurred in the seropositive kidney recipients. The aim of this study was to assess the incidence of CMV reactivation and potential risk factors associated with CMV disease. Data of sixty kidney transplant recipients who had received CMV prophylaxis were obtained between 2013 and 2017. Quantitative nucleic acid amplification testing for CMV viraemia was assessed using Abbott RealTime Polymerase Chain Reaction (PCR). Among the seropositive recipients, cumulative incidence for reactivation was 63%. In patients with quantitative viraemia, the time of active replication was significantly lower compared to those with detectable viraemia (141.5 ± 96.9 vs 294.1 ± 112.6 days, P < 0.001). During prophylactic treatment, 46.7% of patients with quantifiable viraemia had experienced active replication and none among patients with detectable viraemia (P= 0.017). Importantly, symptomatic reactivation was significantly observed in the younger patients with higher peak viraemia compared to those with symptoms free (28.8 ± 5.12 vs. 38.1 ± 12.34 years, P= 0.007) and 3.8 ± 1.59 vs. 2.4 ± 0. 79 log10IU/ml, P = 0.003, respectively). Furthermore, the median duration of viraemia (21.2, vs. 13.4 days, P= 0.028) and period of CMV therapy (24.3 vs 12.3 days, P P = 0.028) and acute rejection (50 % vs 0%, P = 0.003) were significantly more frequent in symptomatic reactivation group. In addition, peak viral load was a potential risk factor for development of symptomatic reactivation with odds ratio 3.39, 95%CI=1.21-9.53, P = 0.02). In conclusion, CMV reactivation remains serious problem for seropositive recipients who were expected to be on antiviral prophylaxis. Patients with high level of viraemia may be at an increased risk of progression to CMV disease and adverse outcomes.

Background: Pandemic confinement of COVID-19 may influence dietary behaviors and physical activity, and increases the risk of stress, especially among adolescents. This increases the subsequent risk of degenerative diseases such as obesity, diabetes, cardiovascular disease, etc., which can lead to a higher risk of death. This study aims to evaluate the effect of confinement on the weight load, physical activity and dietary behavior of higher education students during the period of confinement. Methods: Data was collected by an anonymous online questionnaire with 406 students. Physical activity was evaluated with the International Physical Activity Questionnaire. A reference score of the National Nutrition and Health Program (PNNS-GS) was used to determine the dietary habits. Stress appreciation was assessed by using a psychological instrument known as the “Perceived Stress Scale” provided by Mind Garden. Results: More than a quarter of the students were overweight or obese. During the confinement of COVID-19, most of the students suffered from nutritional disorders, only one-third were moderately physically active, and the majority of students were at risk of stress. Multivariate analysis showed that the concept of threat of Stress increases the risk of weight gain at a risk level of 2.4 [95% CI 1.09–5.43], low physical activity increases the risk level to 1.9 [95% CI 1.18–3.04]. However, a balanced diet is protective against the occurrence of weight gain (ORa = 0.30, [95% CI 0.15–0.61]). Conclusion: The study showed that confinement appeared to contribute to weight gain and those students were more sedentary than active with unhealthy eating behaviors. Understanding these behaviors during COVID-19 confinement will help public health authorities implement future policies on recommendations when new pandemics arrive and confinement policies are implemented.

External apical root resorption (EARR) is one of the major problems associated with orthodontic treatment. Such lesions represent an iatrogenic risk that must be detected as early as possible, with regular radiological follow-up and appropriate therapeutic precautions. The causes and mechanisms leading to susceptibility to root resorption following the application of an orthodontic force are often not clear and are generally said to be of multifactorial origin. The aim of this clinical study was to analyze the factors linked to the occurrence of moderate to severe resorption (MSR) of upper incisors during orthodontic treatment in a group of Moroccan patients treated in the Dento-Facial Orthopedic Department of the Dental Consultation and Treatment Center (Centre de consultation et de traitements dentaires [CCTD]) in Rabat.A total of 82 patients (28% males, 72% females) aged between 12 and 27, with various malocclusions, who had been treated with fixed appliances for at least 1 year and for whom panoramic X-rays at the start, during and at the end of treatment were available, were selected randomly. The reduction in maxillary incisor root length was evaluated using resorption scores. The factors studied in relation to the risk of occurrence of MSR were: age, sex, treatment duration, extraction or non-extraction, type of malocclusion (Class I arch-length discrepancy, Class II, Class III), the vertical diagnosis (normal, supraocclusion, open bite), presence of dysfunction, impacted canines and root morphology. Statistical analysis was performed using SPSS software, version 18.0. Statistical tests used were: Kaplan-Meier analysis and the univariate and multivariate Cox models for the study of factors associated with MSR. The threshold of significance adopted was 0.05.The factors that were significantly associated with the occurrence of MSR at the level of the upper incisors were: tooth type, with a greater risk for the lateral incisor (HR=3.2 95% CI [2.3-4.5] P0.001), treatments with extraction (HR=1.64 95% CI [1.16-2.33] P0.05), the presence of supraocclusion (HR=2.17 95% CI [1.33-3.53] P0.05) or open bite (HR=3.12 95% CI [1.66-5.86] P0.001) and root malformation (HR=1.5 95% CI [1.09-2.07] P0.05). Age, sex, type of malocclusion, dysfunction and impaction of canines were not associated at a statistically significant level with the risk of occurrence of MSR of the upper incisors.EARR is difficult to avoid; the orthodontist's role remains crucial in identifying risk factors so as to adopt a treatment strategy taking these factors into account. In our population, the risk of MSR in the upper incisors appeared to increase in treatments with extraction, situations of supraocclusion or open bite, and in the presence of root abnormalities. Finally, clinical recommendations for the prevention of the occurrence of MSR of the maxillary incisors are proposed, taking into account all the risk factors identified.

Introduction: Triple-negative breast cancer (TNBC) is a group of breast carcinoma characterized by the lack of expression of estrogen and progesterone hormone receptors (ER, PgR) and HER2. This form is also characterized by its aggressiveness, a low survival rate, and the absence of targeted therapies. This study was planned to evaluate the clinical features, treatment, and prognosis characteristics of TNBC in a population of Moroccan patients. Methods: In this retrospective study, a total of 905 patients diagnosed with breast cancer at the National Institute of Oncology in Rabat, Morocco, have been included. Based on molecular subtype, patients were divided into 2 categories: TNBC and non-TNBC patients. Data were recorded from patients’ medical files and analyzed using SPSS 13.0 software (IBM). Results: Overall, 17% of the patients had TNBC. At diagnosis, the median age of TNBC cases was 47 years, with extreme ages of 40 and 55 years. The median follow-up time was 30 months (10-53 months) and the 3-year survival rate was 76%. No significant difference was observed among the patients in terms of age at diagnosis, age at menarche, age at the time of first birth, nulliparity, oral contraception, and family history of breast cancer. Menopausal status and the number of pregnancy were significantly higher in the non-TNBC group. The percentage of grade 3 (G3) tumors was higher in the TNBC group ( P Conclusions: This retrospective study was very informative and showed that women with TNBC had a less favorable prognosis than non-TNBC cases. Clinical data demonstrated that risk factors including age, premenopausal status, parity, hormonal contraceptive use, advanced disease, and a high histologic grade were independently associated with TNBC. However, large tumors and high Scarff-Bloom and Richardson grade prevail in TNBC cases with a higher incidence of lymph node metastases.

Background About 95% of patients with tuberculosis (TB) and 70% of patients with diabetes mellitus (DM) live in low and middle-income countries. As a result, DM and TB are increasingly occurring together. The risk of tuberculosis is two to five times greater in patients with diabetes.The purpose of this study is to analyze the characteristics of pulmonary tuberculosis in patients with diabetes and to evaluate the impact of tuberculosis on diabetes control.Patients and Methods This is a retrospective study of 80 patients with confirmed pulmonary tuberculosis, comparing 30 patients with diabetes with 50 without diabetes.Results Diabetes was more frequent in older patients with tuberculosis and in male patients. 63,3% had type 2 diabetes. Tuberculosis symptoms did not differ between the two groups. Involvement of basal segments of the lower lobes and cavitation occurred more frequently in patients with diabetes, but this difference was not significant. The time for conversion to negative of sputum culture was longer in control patients (44,1 ± 20,2 days) than in case (36 ± 18.3) (p = 0.08).Conclusion Tuberculosis is frequently associated with diabetes mainly in low-income countries. The problem with this association could be accentuated in the future.

Introduction: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is known as a therapy of choice of advanced Parkinson's disease. The present study aimed to assess the beneficial and side effects of STN DBS in Moroccan Parkinsonian patients. Material and Methods: Thirty five patients underwent bilateral STN DBS from 2008 to 2016 in the Rabat University Hospital. Patients were assessed preoperatively and followed up for 6 to 12 months using the Unified Parkinson's Disease Rating Scale in four conditions (stimulation OFF and ON and medication OFF and ON), the levodopa-equivalent daily dose (LEDD), dyskinesia and fluctuation scores and PDQ39 scale for quality of life (QOL). Postoperative side effects were also recorded. Results: The mean age at disease onset was 42.31 ± 7.29 years [28-58] and the mean age at surgery was 54.66 ± 8.51 years [34-70]. The median disease duration was 11.95 ± 4.28 years [5-22]. Sixty-three percentage of patients were male. 11.4% of patients were tremor dominant while 45.71 showed akinetic-rigid form and 42.90 were classified as mixed phenotype. The LEDD before surgery was 1200 mg/day [800-1500]. All patients had motor fluctuations whereas non-motor fluctuations were present in 61.80% of cases. STN DBS decreased the LEDD by 51.72%, as the mean LEDD post-surgery was 450 [188-800]. The UPDRS-III was improved by 52.27%, dyskinesia score by 66.70% and motor fluctuations by 50%, whereas QOL improved by 27.12%. Post-operative side effects were hypophonia (2 cases), infection (3 cases), and pneumocephalus (2 cases). Conclusion: Our results showed that STN DBS is an effective treatment in Moroccan Parkinsonian patients leading to a major improvement of the most disabling symptoms (dyskinesia, motor fluctuation) and a better QOL.

Background 5% of multiple sclerosis have their onset in childhood. Objectives We aim to show the clinical features and follow-up of Moroccan pediatric MS patients. Methods 25 pediatric MS records were analyzed between 2005 and 2013 at the Neurology B department of Rabat Ibn sina University Hospital and Medical School Group of Neurogenetic Disorder of Rabat Mohammed V University Souissi. Results The median duration of follow up was 4 years [1.56]. The median age at disease onset was 14 years. Clinical symptoms were described. At the last evaluation, the median EDSS score was 3.0 [0–7.5]. The median time between disease onset and diagnosis was 2 years [1–9] and the median time from MS onset to second neurological episode was 1 year [0.9–3] with an average of 2 relapses in the first 2 years. The median time to reach EDSS 3.0 was 4.5 years [2–17] and the median time to go from EDSS 3.0 to 6.0 was 4 years [2.5–6]. The majority of cases at the last follow-up were; relapsing–remitting (17 patients: 68%), although 8 patients (32%) developed secondary progressive MS after median disease duration of 5 years [4–19]. None of the patients had a primary progressive MS. Conclusion Time EDSS 3.0 and to secondary progression was shorter in our cohort than previously reported in other series.

Background The impact of dialysis on patient quality of life has been recognized as an important outcome measure. The Dialysis Outcomes and Practice Patterns Study compared quality of life in 4 continents [1] , but very scarce information is available about dialysis patients' quality of life in Africa. The objective of this study was to translate the Kidney Disease Quality of Life–Short Form (KDQOL-SF) into Moroccan and measure its psychometric properties. Methods The questionnaire was first translated into Moroccan by 2 independent translators, and then 2 backward translations into English were performed after pretesting in 10 dialysis patients. The final questionnaire was then administered to 80 dialysis patients. Reliability was estimated by internal consistency and test–retest reliability. Validity was assessed using known group comparisons and correlations between overall health rating and scales scores. Results Some activities were substituted since they were not common in Morocco. All subscales had a Cronbach α above the recommended value except for 3 scales. All of the items showed good test–retest reliability. Correlation of items within subscales was higher than that of items outside subscales in 87% of cases. Regarding construct validity, all KDQOL-SF scales had significant correlation with overall health rating except for sexual function and dialysis staff encouragement. Furthermore, the questionnaire could be used to discriminate between subgroups of the patients. Conclusions The psychometric properties of the KDQOL-SF resulting from this first-time administration of the instrument support the validity and reliability of the KDQOL-SF as a measure of quality of life of patients having hemodialysis in Morocco.

In Morocco, breast cancer is the most prevalent cancer in women and a major public health problem. Several Moroccan studies have focused on studying this disease, but more are needed, especially at the genetic and molecular levels. It is therefore interesting to establish the genetic and molecular profile of Moroccan patients with breast cancer. In this paper, we will highlight some pertinent hypotheses that may enhance breast cancer care in Moroccan patients. This review will give a precise description of breast cancer in Morocco and propose some new markers for detection and prediction of breast cancer prognosis.

Objectives. To evaluate the impact of the body mass index (BMI) before pregnancy and the weight gain during pregnancy, on the occurrence of maternal and neonatal morbidity in the Moroccan population, as well as to analyze the quality of the weight gain depending on the BMI.Methods. A study was carried out over a period of one year from October 1, 2010 to October 1, 2011, using data collected from a descriptive-transversal study. We recruited nondiabetic women without several HTAs, delivering singletons from 37 completed weeks up to 42 weeks gestation.Results. Total of 1408 were analyzed. The risks of moderate hypertension, macrosomia, dystocia, and resort to cesarean section were higher among overweight or obese women, as well as among women whose weight gain was >16 kg. The differences were significant Conclusion. This study demonstrates that overweight women before pregnancy and weight gain during pregnancy are associated with higher risks of maternal and neonatal complications. These data provide ideas on prevention opportunities.

INTRODUCTION: le cancer du sein represente un probleme de sante publique au Maroc. L’objectif de ce travail etait d’estimer le taux de survie au cancer du sein chez les patientes habitant la ville de Rabat. METHODES: etude pronostique realisee chez les patientes diagnostiquees pour cancer du sein de 2005 a 2008, habitant la ville de Rabat et enregistrees au registre des cancers de Rabat. La date d’inclusion dans l’etude correspondait a la date de confirmation histologique du cancer. L’estimation de la survie a ete realisee par la methode de Kaplan Meier, et la comparaison entre les differentes classes d’une variable a ete realisee par le test de log rank. L’etude des facteurs associes a la survie a ete effectuee par le modele de Cox. RESULTATS: durant la periode d’etude 628 cas de cancer du sein ont ete collectes. Le pourcentage de deces etait de 19,9%. La survie globale a un an etait de 97,1%, elle etait de 89,2% a 3 ans et de 80,6 % a 5 ans. En analyse multivariee la survie au cancer du sein etait statistiquement moins bonne chez les patientes âgees de plus de 70 ans (p

BACKGROUND:Breast cancer in young women is quite uncommon and shows more aggressive characteristics with major disparities between worldwide populations. Prognosis and outcome of breast cancer in young patients are widely studied, but still no consensus is available. METHODS:We retrospectively included 716 cases of breast cancer women diagnosed in 2009 at the National Institute of Oncology of Rabat. Patients were divided into two groups according to their age: women aged ≤40 years (Group 1) and women aged >40 years (Group 2). Data were recorded from patients' medical files and analyzed using SPSS 13.0 software (IBM). RESULTS:Young patients represent 24.9% of all patients with breast cancer. The comparison between the two groups displayed significant differences regarding nulliparity (p = 0.001) and progesterone receptor negativity (p = 0.01). Moreover, more progression (Metastases/Relapse) was registered in young women as compared to older women with breast cancer (p = 0.03). The estimated median follow-up period was 31 months. The 5-years Event-Free Survival (EFS) of patients with local disease was 64.6% in young women and 71.5% in older women with breast cancer (p = 0.04). Multivariate analysis in young women showed that nulliparity (HR: 7.2; 95%CI: 1.16-44.54; p = 0.03), T3 tumors (HR: 17.39; 95%CI: 1.74-173.34; p = 0.01) and negative PgR status (HR: 19.85; 95%CI: 1.07-366.54; p = 0.04) can be considered as risk factors for poorer event free survival while hormone therapy was associated with better EFS (HR: 0.11; 95%CI: 0.00-0.75; p = 0.03). In Group 2, multivariate analysis showed that patients with inflammatory breast cancer, N+ status, absence of radiotherapy, absence of chemotherapy, and absence of hormone therapy are at increased risk of recurrence. CONCLUSIONS:In Morocco, breast cancer is more frequent in young women as compared to western countries. Breast cancer in young women is more aggressive and is diagnosed late, leading to an intensive treatment. Moreover, the main factors associated with breast cancer development in young women would be hormonal and reproductive status. Analysis of other genetic biomarkers is needed to explain the high prevalence of breast cancer in young women to improve breast cancer management in Morocco.

Le ballon de contre pulsion intra-aortique (BCPIA) est frequemment utilise en chirurgie cardiaque, comme moyen d'assistance circulatoire en cas de bas debit cardiaque. Il est d'interet clinique de determiner les facteurs pronostiques chez les patients porteurs d'un BCPIA en chirurgie cardiaque, et qui restent un sujet rarement elucide dans la litterature. L'objectif de notre travail est de determiner les facteurs predictifs de morbimortalite chez les patients sous ballon de contre pulsion intraortique en perioperatoire d'une chirurgie cardiaque. Il s'agit d'une etude retrospective portant sur l'ensemble des patients operes en chirurgie cardiaque sous circulation extracorporelle, et ayant beneficies de la mise en place d'un ballon de contre pulsion intra-aortique en perioperatoire, au service de chirurgie cardiovasculaire de l'Hopital Militaire Mohamed V de Rabat, entre le mois de janvier 2005 et le mois d'aout 20014. Soixante dix patients ont ete inclus dans notre etude. En analyse univariee l'âge, la dyspnee de stade III et IV, l'insuffisance cardiaque, la presence d'un infarctus du myocarde, d'une coronaropathie mono et bitronculaire, les anomalies du doppler de trons supra-aortique et du membre inferieur, le caractere urgent de la chirurgie, la duree de la circulation extracorporelle, l'instabilite hemodynamique postoperatoire, le saignement et l'insuffisance renale postoperatoire etaient statistiquement associes a une mortalite postoperatoire elevee. La dyskinesie preoperatoire et la sortie de circulation extracorporelle sous drogues etaient associees a une morbidite globale elevee. En analyse multi variee, seule l'âge, constituait un facteur de risque independant de mortalite dans notre serie avec un Odds Ratio (OR): 1,89 ; un Intervalle de Confiance (IC) 95% de (1,52-4,97) et un p =0,045. Au terme de notre etude, le taux de mortalite etait de 48,57% et de morbidite globale etait de 87,1%. Il nous parait donc necessaire pour diminuer l'incidence de cette morbimortalite dans notre population, d'agir sur les facteurs que nous jugeons modifiables tels l'amelioration de la fonction cardiaque preoperatoire, l'optimisation de la fonction renale, la reduction de la duree de CEC et le controle du saignement. Key words : Ballon de contre-pulsion intra-aortique, chirurgie cardiaque, mortalite, morbidite

Introduction The Luminex® technology has become an integral component of clinical decision-making and diagnosis of transplanted organ rejection. Despite the superior sensibility of this technology, it is not completely problem free. We have observed in these bead-based assays that sera of some patients give a high negative control bead (NC) value which makes assessing HLA antibodies difficult. Treatment of sera by the Adsorb Out™ reagent may reduce the high background. In this study, we want to evaluate the effect of the Adsorb Out™ on the NC's MFI value by comparing treated and untreated patients' sera. Methods HLA antibody screening was performed on 3011 sera. These sera came from patients awaiting and undergoing renal transplant from different Moroccan hospitals. The sera were analyzed using the standard protocol for Luminex® antibody screening. Sera with high NC's value has been pre-incubated by the Adsorb Out™, and analyzed on Luminex®. Results 3% of studied samples have high NC's value. The Adsorb Out™ decreases the NC's value and brings it back to a normal range in 62.2% treated sera. It has no effect in 12.3%. The Adsorb Out™ effect depends only of NC's value, independently to age, storage date, sex and immunization. Conclusion The Adsorb Out™ reagent has an important effect in decreasing NC value of sera. However, it has no effect in some patient's sera. In these cases we could try another treatment, as EDTA, DTT. The non-specific binding may be caused by multiple patient-specific factors, it would be important to search correlation between them and NC's values.

Background Motivations for cessation of smoking should be studied to determine which factors have an impact. Educational messages can then be developed to help smokers become more successful in adopting healthy behavior. The objective of our work was to determine the factors influencing the quality of motivation for smoking cessation among patients attending a lung disease clinic. Methods Between March and June 2008, patients attending the outpatient clinical of the Moulay Youssef Hospital Department of Pneumology in Rabat were studied. Data on the smoking status and motivation to stop smoking (Richmond's test) were collected using a standardized questionnaire. A logistic regression model was developed to analyze the quality of their motivation to quit smoking. Results The median age for smoking the first cigarette was low ( Conclusion Our investigation provides evidence in favor of searching for different factors which might affect motivation to stop smoking among patients seeking care in a lung disease clinic. Lung specialists, who manage the large majority of these patients should be particularly active in this area.

Introduction : Le maintien de la stabilite hemodynamique est un objectif primordial de l'anesthesie pour craniotomie. Peu d'etudes ont prouve l'efficacite de l'infiltration du scalp par un anesthesique local pour le maintien de la stabilite hemodynamique apres l'incision. L'objectif de notre travail est d'evaluer l'influence de l'infiltration de la ligne d'incision du scalp par la lidocaine a 0,5% adrenalinee sur les parametres hemodynamiques apres incision pour craniotomie supratentorielle. Methodes : Etude prospective en double aveugle realisee au bloc operatoire de l'hopital des specialites de Rabat sur une periode d'une annee incluant 80 malades programmes pour craniotomie supratentorielle. Les malades etaient randomises par tirage au sort en 2 groupes: Le groupe 1 etait infiltre par 40 ml du serum sale adrenaline (1/200 000) et le groupe 2 etait infiltre par 40 ml de la lidocaine 0,5% adrenalinee (1/200 000). Le critere de jugement principal etait la pression arterielle moyenne (PAM) apres l'incision. L'etude statistique a fait appel aux tests t de student et l'U- mann-whitney. Une valeur de p

Background Cancer of uterine cervix is the second most common cause of cancer related deaths among women. The aim of this study is to report the experience of Military Hospital Mohamed V in the management of cervical cancer and their results. Methods All cervical cancer managed at the radiotherapy department of Military Hospital Mohamed V between January 2005 and February 2010, were included for investigation of their demographic, histological, therapeutic and follow-up characteristics. Of the 162 cases managed, 151 (93.2 %) cases were treated in our department. Results In our study the median age was 51.5 years (33–82). The median duration of symptoms before diagnosis was four [3, 7] months. The major presenting complaints were abnormal vaginal bleeding (89.8 %). Squamous cell carcinoma cervix was seen in 86.2 % (n = 137), adenocarcinoma in 11.3 % (n = 18) and adenosquamous carcinoma in 2.4 % (n = 4). One hundred seventeen (84.8 %) cases were seen at late stage. An abdominal and pelvic computed tomography (CT) scan was performed in 34.6 % (n = 56) of cases, magnetic resonance imaging (MRI) in 62.9 % (n = 102). The pelvic lymph nodes were achieved in 16.6 % of cases. Over half of patients 58.3 % (n = 88) were treated with a combination of external beam radiation therapy (EBRT) and a concurrent cisplatin based chemotherapy (40 mg /m2 weekly). With a mean of 51.6 months (2 to 109), we recorded 19 (12.6 %) pelvic relapse and 15 (9.9 %) metastases. The median time to onset was 19.4 months (2–84 months). The local control rate was 63.6 % (n = 96) and 21 (13.9 %) patients were lost to follow-up. The overall survival (OS) at 3 years and 5 years was respectively 78.3 % and 73.6 % and the relapse-free survival (RFS) was respectively 80 % and 77.2 %. Conclusion Most of cervical cancer patients in Morocco are seen at late stage necessitating referral for radiotherapy, chemotherapy or palliative care. This may reflect lack of cervical screening in order to early detect and treat pre-malignant disease stage.

Background The T1D is a multifactorial disease; with a strong genetic control. The human leukocyte antigen (HLA) system plays a crucial role in the autoimmune process leading to childhood diabetes. About 440,000 of the childhood population of the world (1.8 billion children under 14 years of age), have type 1 diabetes, and each year an additional 70,000 develop this disorder. The objective of this study was to investigate the distribution of HLA class II in Moroccan families of diabetic children to identify susceptibility alleles of the Moroccan population. Subjects and methods We included in this study, Moroccan families who have at least one child with T1D. The age of onset of diabetes was less than 15 years. HLA class II (DRB1* and DQB1*) was carried out by molecular biology techniques (PCR-SSP and PCR-SSO). The FBAT test (family-based association test) was used to highlight the association between T1D and the HLA-DRB1* and -DQB1* polymorphism. Results The association of HLA class II (DRB1*, DQB1*) in type 1 diabetes was analyzed in fifty-one Moroccan families, including 90 diabetics. The results revealed that the most susceptible haplotypes are the DRB1*03:01–DQB1*02:01, DRB1*04:05–DQB1*03:02 (Z = 3.674, P = 0.000239; Z = 2.828, P = 0.004678, respectively). And the most protective haplotype is the DRB1*15–DQB1*06. Conclusion This is the first family-based association study searching for an association between HLA class II and T1D in a Moroccan population. Despite the different ethnic groups forming Morocco, Moroccan diabetics share the most susceptible and protective HLA haplotypes with other Caucasians populations, specifically the European and Mediterranean populations.

Background ischemic cardiomyopathy is a common and severe complication of type 2 diabetes. The aim of our work is to study the epidemiological profile of ischemic cardiomyopathy in diabetic patients. Patients and methods we conducted a prospective observational study collated in the department of cardiology of Mohammed V Military Hospital of Rabat, between January 2008 and April 2012 concerning 111 patients admitted for ischemic cardiomyopathy, 61 of whome were diabetic. Results The mean age was higher in diabetic patients with a statistically significant difference between the two groups. A male predominance was noted in both groups without significant difference. The main cardiovascular risk factor was hypertension (70%) in diabetic patients (p=0.005) and smoking (66%) in non-diabetic patients (p = 0.821). The main symptom was dyspnea in diabetics (66.3%) and chest pain in non-diabetics (68%). Signs found on electrocardiogram were: repolarization disorders (58% non-diabetics vs 55% diabetics), Q waves (56% non-diabetics vs 51% diabetics) and left bundle branch block (34% diabetics vs 26% non-diabetics). The mean left ventricular ejection fraction was estimated at 28,92% in diabetic patients and at 27,38% in non-diabetic patients. Coronary angiography has objectified a multi-vessel disease in 68.8% of diabetic patients and 56% of non-diabetic patients. In addition to optimal medical treatment, transluminal coronary angioplasty was performed in 31.1% of diabetic patients vs. 26% of non-diabetic patients and bypass surgery was performed in 24.5% of diabetics vs. 22% of non-diabetics. The intra-hospital evolution was marked by 8 deaths in diabetic patients and 2 deaths in non-diabetic patients. Conclusion Type 2 diabetes has an effect on morbidity and mortality in ischemic cardiomyopathy, that emphasize the importance of controlling all known risk factors in patients with type 2 diabetes and detecting earlier this disease.

INTRODUCTION: Le but de ce travail était d'étudier la mortalité et les facteurs pronostiques de la Coagulopathie Traumatique (CoT) aigue précoce. METHODES: Il s'agissait d'une étude prospective sur 21 mois, incluant tous les traumatisés crâniens graves 16 ans. Les données clinico-démographiques biologiques et radiologiques ont été collectées à l'admission. La CoT a été définie par une thrombopénie 120 000 /mm3 et/ou un Taux de Prothrombine (TP) 70 % et/ou un International Normalized Ratio (INR) 1,3 et/ou un Temps de Céphaline Activé (TCA) 40 sec. RESULTATS: Nous avons colligé 69 patients ayant une CoT avec une médiane d'âge à 29 avec un intervalle interquartile à (23-41), et une prédominance masculine dans 87% des cas (60 patients). L'ISS médian à 56 avec un intervalle interquartile à (42-75). La mortalité était de 52,2 % des cas (36 patients) suite à une souffrance cérébrale dans 74,3 % des cas (26 patients). La durée médiane de séjour de 10 jours avec un intervalle interquartile à (5-19). Les facteurs associés à la mortalité en analyse univariée étaient : le passager de véhicule, le délai de prise en charge, l'hématome sous dural aigu, l'AAIS tête et l'ISS à l'admission; alors qu'en analyse multivariée c'étaient le délai de prise en charge (OR: 1,01; IC à 95%: 1,001-1,02) et l'ISS à l'admission (OR: 1,1; IC à 95%: 1,04-1,15) sont des facteurs pronostiques indépendants. CONCLUSION: L'amélioration du pronostic de ces patients repose essentiellement sur un développement de la médecine pré-hospitalière.

Background Endovascular coiling is one of the main procedures for treatment of cerebral aneurysms. Radiologists are usually faced with two situations: the ruptured aneurysms and unruptured aneurysms. They have to inform patients about the potential costs of care especially in patients who do not have insurance health plan. Is there a difference in the overall cost of care and in cost of pharmaceutical products for patients in the two situations? Methods Eighty-six patients who had 1 aneurysm were admitted in hospital between January 2010 and October 2014 and were included in this study. The overall cost was assessed by using the micro-costing technique. All data on principal parameters were taken from the hospital information system. A Mann-Whitney analysis was used to define the difference between the two groups of patients. Statistical analyses were performed using SPSS V.13.0. Results Eighteen patients have had an unruptured aneurysm and 68 have had a ruptured aneurysm. The results are summarized in the Table 1 . Conclusion The cost of pharmaceutical products is higher among patients with unruptured aneurysms; this is probably due to the size of the aneurysm and his neck, which are greater than in patients with a ruptured aneurysm. However, the overall length of stay is longer in patients who had a ruptured aneurysm. This high cost offsets the high cost of pharmaceutical products observed in the first group. That is why the overall cost does not differ between the two situations. These results should be considered by physicians when they inform their patients about their aneurysms care cost.

Background Biological glues are indicated in surgery to improve haemostasis when conventional techniques such as compression, sutures or electrocoagulation are insufficient. Indications for biological glues are reducing bleeding occurring after surgery, including particular contexts. Purpose Through this work, we evaluated the impact of using biological glue in surgical procedures for cyanotic congenital heart diseases on the cost of pharmaceuticals, postoperative intensive care, volume of postoperative bleeding and number of bags of blood and blood derivatives transfused. Material and methods A study of patient records who underwent surgery to treat a cyanotic congenital heart disease (tetralogy of Fallot, pulmonary atresia, transposition of the great arteries) was made between 2010 and 2014. All patients in whom the surgeon used biological glue were followed since the introduction of the glue to the hospital in 2012. Other patient records were randomly selected; they represent those treated by surgery for their cyanotic congenital heart diseases before the introduction of the biological glue to the hospital. A Mann-Whitney analysis was used to define differences between the two groups of patients. Statistical analysis was performed using SPSS V.13.0. Results 60 patient records were collected; the surgeon has used biological glue in 28 patients after the introduction of this product to the hospital. Conclusion Bleeding is an important factor for morbidity and mortality in surgical procedures. Bleeding can have serious consequences for patients at a young age, especially for cyanotic congenital heart diseases. The contribution of biological glue is already confirmed in intraoperative haemostasis. However, our results show that in our studied series, the use of the biological glue did not reduce the postoperative bleeding volume, did not reduce hospital stay in the ICU and did not reduce the number of bags of blood and blood derivatives transfused. These results should be confronted by other results from other series. References and/or Acknowledgements Cardiac surgery team. No conflict of interest.

Objective To report the characteristics of the most frequent tremors in a population of Moroccan patients. Background Tremor is the most common movement disorder. It implies a wide variety of disorders with Parkinson's disease and essential tremor being the most frequent. Methods A retrospective study of 148 patients with tremor referred to our movement disorders outpatient clinic was performed. Clinical features and treatment regimens were analyzed. Patients with parkinsonian tremor were excluded. Results We included 62 patients with non-parkinsonian tremor. The etiologies were as follows: essential tremor (54.8%), dystonic tremor (19.4%), tremor associated with dystonia (14.5%), enhanced physiological tremor (3.2%), cerebellar tremor (3.2%), psychogenic tremor (3.2%) and Holmes’ tremor (1.6%). The characteristics of essential tremor patients were analyzed. Female patients accounted for 67.6% of patients. Mean age at the onset of tremor was 52.2 ± 16.4 years. Family history of tremor was reported in 17.6% of cases. Tremor affected the arms (94.1%), head (52.9%), voice (35.3%) and legs (8.8%). Tremor was bilateral in 87.5% but was asymmetrical in 50% of patients. Patients had postural tremor (76.5%), kinetic tremor (79.4%) and rest tremor (associated in 11.8%). Treatment relied on propranolol (88.3%), primidone (14.7%), gabapentin (14.7%), clonazepam (14.7%), alprazolam (11.8%), topiramate (5.9%) and, in one patient, radiosurgery. Conclusions Essential tremor was the predominant diagnosis, confirming its high prevalence. There was a predominance of female patients and a peak of age at onset in the fifth and sixth decades. Asymmetry of the disease was noted in half of patients.

Background The aims of this study were to determine the hospital-acquired infections (HAI) prevalence in all institutions of Rabat University Medical Center, to ascertain risk factors, to describe the pathogens associated with HAI and their susceptibility profile to antibiotics. Materials and methods Point-prevalence survey in January 2010 concerning all patients who had been in the hospital for at least 48 hours. At bedside, 27 investigators filled a standardized questionnaire from medical records, temperature charts, radiographs, laboratory reports and by consultation with the ward’s collaborating health professionals. Risk factors were determined using logistic regression. Results 1195 patients involved, occupancy rate was 51%. The prevalence of HAI was 10.3%. Intensive care units were the most affected wards (34.5%). Urinary tract infection was the most common infected site (35%). Microbiological documentation was available in 61% of HAI. Staphylococcus was the organism most commonly isolated (18.7%) and was methicillin-resistant in 50% of cases. In multivariate analysis, risk factors associated with HAI were advanced age, longer length of hospital stay, presence of comorbidity, invasive devices and use of antibiotic use. Conclusion HAI prevalence was high in this study. Future prevention program should focus on patients with longer length of stay, invasive devices, and overprescribing antibiotics.

Introduction Multiple system atrophy (MSA) is a sporadic and rapidly progressive neurodegenerative disorder of poor prognosis, characterised clinically by any combination of parkinsonian, autonomic, cerebellar, or pyramidal signs. We report our experience in movement disorders consultation concerning the clinical presentation and the course of MSA in Moroccan patients. Methods A retrospective review of the medical records of 17 patients with diagnosis of MSA seen in our outpatient clinic from January 2007 to December 2010. Results In our 17 patients, 76.5% were men and the mean age of onset was 52 ± 9 years. MSA-P was the major clinical phenotype (82.4%). Eleven patients (64.7%) were classified as having probable MSA and six patients (35.3%) as possible MSA. Dysautonomic features were detected in all patients; urinary symptoms were found in 76.5% of cases and orthostatic hypotension in 64.7%. Treatment regimen included l -Dopa with a mean daily dose of 621.4 ± 346.8 mg/day and symptomatic treatment of dysautonomia. The mean duration of disease evolution was of 4.7 ± 1.9 years. Discussion Our results show a male predominance and an early age of disease onset. MSA-P was the predominant subtype. Our results are similar to the European MSA series. Conclusion Multicentre studies are needed to better characterise MSA in Morocco given the rarity of this disease.

Background Breast cancer is uncommon in young women and induces more aggressive biologic characteristics. Survival in young women has been widely studied in developed countries. Less favorable prognosis and low survival were found. In Morocco, this study is the first investigation of clinical features, treatment and prognosis associated with breast cancer in young women. Findings Four hundred and nine women aged 35 years or less were included in this study. All these women were diagnosed as having breast cancer at the National Institute of Oncology in Rabat, Morocco between 2003 and 2007. The relation between clinical and therapeutic characteristics and event-free survival (EFS) and overall survival (OS) were assessed by Cox regression analysis. The median age of the patients was 32 years. Fifty three patients (13%) have metastatic disease at diagnosis and 356 patients (87%) had localised disease. In 57.9% of the cases, the estrogen receptors status was positive. The median follow-up was 32.2 months. After 3 years the survival rate was 80.6%. In the case of localised disease, OS and EFS at 3 years were 83.2% and 62.5%, respectively. OS and EFS at 3 years was higher in patients with stage I than patients with stage II and stage III (p = 0.001). Positive estrogen receptors was significantly associated to OS and EFS at 3 years compared to negative estrogen receptors (p = 0.001). Adjuvant chemotherapy, adjuvant radiotherapy and adjuvant hormone therapy were associated with net benefit in OS and EFS at 3 years. Cox regression analysis showed that negative ER was significantly associated with poorer OS (HR = 2.42, 95% CI = 1.25 - 4.66, p < 0.009) and poorer EFS (HR = 1.73, 95%CI = 1.05 - 2.86, p = 0.03). Stage III disease were associated to poorer EFS (HR = 5.35, 95%CI = 1.60 -17.84, p = 0.006). Conclusions In Morocco, young women with breast cancer had less favorable prognosis. Multivariate analysis showed that negative hormone receptor status was associated with lower EFS and OS. Clinical trials should be launched to improve the survival of these young women with breast cancer.

This study aimed to assess students’ perceptions of their educational environment in the Faculty of Medicine and Pharmacy of Rabat, Morocco, using the Dundee Ready Educational Environment Measure (DREEM). A cross-sectional survey was conducted in the Faculty of Medicine and Pharmacy of Rabat, Morocco, in which medical students’ perceptions of their educational environment were assessed using the DREEM criteria during the 2013-2014 academic years. The DREEM inventory encompasses 50 items divided into five subdomains: perceptions of learning, perceptions of teaching, academic self-perceptions, perceptions of atmosphere, and social self-perceptions. The DREEM has a maximum score of 200, which would correspond to a perfect educational environment. The mean scores (±standard deviation) of students’ responses were compared according to their year of study and gender. The responses of 189 postgraduate medical students were included. The mean total DREEM score was 90.8 (45.4%). The mean total scores for five subdomains were 21.2/48 (44.2%), 21.8/44 (49.6%), 13.1/32 (40.9%), 19.0/48 (39.6%), and 15.6/28 (55.7%) respectively. Female students reported higher perceptions of teaching scores than males (P=0.002), and students in their fifth year of study reported significantly higher social self-perceptions scores than those in their fourth year (P=0.03). In this study of the oldest faculty of medicine in Morocco, students perceived the educational environment as having many problems.

Objective To characterize clinical aspects of Idiopathic Parkinson’s disease from a movement disorders consultation in University Hospital of Rabat. Methods Retrospective review of medical records of 117 patients with diagnosis of Idiopathic Parkinson’s disease seen in our outpatient clinic from 2006 to 2011. Results Mean age was 64 ± 10 years with predominance of men (61.5%). Mean age at disease onset was 57 ± 11 years. Early onset Parkinson’s Disease was recorded in 12.8%. The median duration of disease was 5 years. Initial symptom appeared on the right side in 56.5%. Tremor presentation was the most frequent (40.2%). Symptom severity was mild to moderate in 80% of cases (UPDRS 600 mg are identified as risk factors for motor fluctuations whereas duration of Levodopa treatment is a risk factor of dyskinesias. Conclusion Our patients are younger compared to most series with high prevalence of early onset forms. In the majority of cases, Levodopa was introduced within the first year following onset which expose patients to dyskinesias early in the course of the disease.

7069 Background: In recent years, a rapid increase in lung cancer mortality has been observed among women. The aim of this study was to describe the epidemiological profiling and to analysis the su...

Introduction The mouse mammary tumor virus (MMTV) like sequences have been reported to be present in some human breast cancers, but their association with breast cancer development is still controversial. Methods In this retrospective study, we investigated the status of MMTV-like in 42 tumor biopsies and 18 paired normal tissues from Moroccan patients with breast cancer. MMTV-like env sequences were identified by PCR and confirmed by direct DNA sequencing. Results Specific MMTV-like env sequences were found in 24 (57.14%) cases of breast carcinomas, and 6 (33.3%) cases of matched normal breast tissues. Comparison to sociologic and clinicopathological parameters showed no significant association between the presence of MMTV-like sequences and age, menopausal status, histological subtype, histological grade, tumor size and the expression of hormone receptors (estrogen ER and/or progesterone PgR) and Her 2. However, a significant correlation was found between MMTV-like presence and parity (p = 0.024). Conclusions This present study confirms the presence of MMTV-like env sequences in breast cancer in Moroccan women, prompting further evaluation, on large sampling, to elucidate the probable causal roles of MMTV-like in breast cancer development.