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Background Infective endocarditis (IE) is a severe disease requiring microbial identification to successfully adapt its treatment. Currently, identification of its etiological microorganism remains unresolved in 5.2% of cases. We aimed to improve IE diagnosis using an ultra-sensitive molecular technique on cardiac samples in microbiologically nondocumented (culture and conventional polymerase chain reaction [PCR]) IE (NDIE) cases. Methods Cardiac samples explanted in a tertiary hospital in Lyon, France, from patients with definite IE over a 5-year period were retrospectively analyzed. NDIE was defined as Duke definite-IE associated with negative explorations including cardiac samples culture, bacterial amplification, and serologies. Ultrasensitive molecular diagnosis was achieved using the Universal Microbe Detection kit (Molzym®). Fungal identification was confirmed using 26S-rDNA and internal transcribed spacer amplifications. Fungal infection was confirmed using Grocott-Gromori staining, auto-immunohistochemistry on cardiac samples, and mannan serologies. Results Among 88 included patients, microbial DNA was detected in all 16 NDIE cases. Bacterial taxa typical of IE etiologies were detected in 13/16 cases and Malassezia restricta in the 3 other cases. In these 3 cases, histological examination confirmed the presence of fungi pathognomonic of Malassezia that reacted with patient sera in an auto-immunohistochemistry assay and cross-reacted with Candida albicans in an indirect immunofluorescent assay. Conclusions M. restricta appears to be an underestimated causative agent of NDIE. Importantly, serological cross-reaction of M. restricta with C. albicans may lead to its misdiagnosis. This is of major concern since M. restricta is intrinsically resistant to echinocandins; the reference treatment for Candida-fungal IE.

Since the 1950s, the Kingdom of Morocco has been and remains one of the pioneers in the fight against trachoma, a disease that has completely disappeared in the majority of its national territory, but some endemic pockets have persisted and pose a health risk, particularly for children and women. Morocco finds itself today, thanks to years of joint efforts, at the forefront of the world stage of the fight against trachoma. The country has demonstrated through its experience the effectiveness and relevance of the "SAFE" strategy - an extensive programme designed to tackle trachoma and its complications. The strategy is complex in its implementation and requires the synergy of a set of actors dedicated to specific activities, whether medico-surgical management activities aimed at setting up a physical project for local development, or information and awareness-raising activities. The key to the long-term success of eliminating blinding trachoma was not only to link distribution of drugs to the entire project area for several years to reduce substantially the reservoir of human- to-human transmission, but also to ensure permanence. In addition, services that provide quality palpebral surgery and especially repeat treatment campaigns with antibiotics, as well as health education campaigns and the promotion of personal and collective hygiene have generated sustainable changes in the living environment of receiving populations.القضاء على التراكوما في المغرب: استعراض تاريخي.جواد حمو، مجدولين أوبطيل، رشيد رزين، أمينة برحو، محمد بلمكي.منذ خمسينات القرن الماضي، واصلت المملكة المغربية دورها كرائدة لجهود مكافحة التراكوما، وهو المرض الذي اختفى كلية من معظم ترابها الوطني، غير أن بعض الجيوب المستوطنة بالمرض ما زالت موجودة وتمثل خطراً صحياً، لا سيما بالنسبة للنساء والأطفال.ويتبوأ المغرب اليوم، بفضل سنوات من الجهود المشتركة، مكان الصدارة على ساحة الجهود العالمية المبذولة للقضاء على التراكوما. وأوضح البلد من خلال ما يمتلكه من خبرة فعالية استراتيجية جراحة الأهداب والمضادات الحيوية ونظافة الوجه وتحسين البيئة ومدى ملاءمتها - وهي عبارة عن برنامج ممتد صُمِّم للتصدي للتراكوما ومضاعفاتها. وتتسم الاستراتيجية بالتعقيد في تنفيذها وتتطلب تحقيق تآزر بين مجموعة من الجهات الفاعلة المُكرّسة لأنشطة محددة، سواء كانت أنشطة تدبير علاجي طبي وجراحي تهدف إلى إنشاء مشروع فعلي للتنمية المحلية، أو أنشطة إعلامية ومُذكية للوعي.ولم يكن السر وراء النجاح الممتد لجهود القضاء على التراكوما المسببة للعمى متمثلاً وحسب في ربط توزيع الأدوية بكامل منطقة المشروع للحد بصورة جوهرية من مستودع انتقال العدوى بين البشر، بل وتمثل أيضا في العمل على ضمان استدامة المشروع. وعلاوة على ذلك، فقد أدت الخدمات التي تُقدَّم من خلالها جراحة أهداب جيدة، وتكرِّر حملات العلاج بالمضادات الحيوية على وجه خاص، إلى جانب حملات التثقيف الصحي وتعزيز النظافة الشخصية والجماعية، إلى إحداث تغييرات مستدامة في البيئة المعيشية للفئات السكانية المتلقية لتلك الخدمات.Élimination du trachome au Maroc : une revue historique.Depuis les années 1950, le Royaume du Maroc est l’un des pionniers de la lutte contre le trachome. Cette maladie a complètement disparu de la majeure partie de son territoire national, mais elle demeurait endémique dans certaines poches, représentant un risque pour la santé, en particulier pour les enfants et les femmes.Aujourd’hui, grâce à des années d’efforts conjoints, le Maroc se trouve à l’avant-scène de la lutte mondiale contre le trachome. À travers son expérience, le pays a démontré l’efficacité et la pertinence de la stratégie « CHANCE », programme à grande échelle conçu pour s’attaquer au trachome et à ses complications. La mise en oeuvre de cette stratégie est complexe. Elle nécessite la participation conjointe d’un ensemble d’acteurs se consacrant à des activités spécifiques, qu’il s’agisse d’activités de prise en charge médico-chirurgicale visant à mettre en place un projet physique de développement local ou d’activités d’information et de sensibilisation.Pour réussir à éliminer durablement le trachome cécitant, la solution a consisté non seulement à étendre la distribution de médicaments à toute la zone du projet pendant plusieurs années afin de réduire considérablement le réservoir de transmission interhumaine, mais également à assurer la permanence de cette distribution. De plus, les services qui assurent une chirurgie palpébrale de qualité et surtout des campagnes régulières de traitement par antibiotiques, ainsi que des campagnes d’éducation sanitaire et la promotion de l’hygiène personnelle et collective, ont généré des changements durables dans l’environnement de vie des populations qui en bénéficient.

Background Brown tumors (BTs) represent the typical nonmalignant lesions of hyperparathyroidism. Mandibles, ribs, and large bones are the most usual localization of BT. The diagnosis of these tumors requires biological and radiologic assessments. Their treatment is essentially based on parathyroidectomy. Case Description The present case report describes a patient with primary hyperparathyroidism who developed a cervical BT revealed by slow spinal compression. Conclusions The brown tumor, when localized at the level of the spine, can be life-threatening and must be managed as soon as possible.

Macroscopic hematuria is the most common telltale clinical sign for muscle-infiltrating or non-muscle bladder tumors. Lower urinary tract disorders, pelvic pain or signs related to upper urinary tract obstruction may be associated. In our case, the reason for consultation is sciatica, progressing to functional impairment of the lower right limb without any urological sign.

MiR-10b, miR-335, and miR-21 are classes of microRNAs (miRNAs) that are overexpressed in breast cancer. Thus, in our study we aimed to test the hypothesis that miRNAs may have direct interactions with proteins and the possibility to inhibit/activate the functional site of proteins and enzymes. For this purpose, we choose three miRNAs involved in breast cancer to study interactions between some proteins and genes, including BRCA1 and PTEN, by processing the docking and matching tools using the Hex8 and HADDOCK server. Mathematically, the hidden Markov models were created by using MATLAB script according to the algorithm in order to study and validate the interactions and bonds between proteins and miRNAs. The main results demonstrate the ability of miR-10b, miR-335, and miR-21 to create direct interactions with 3D protein structures. Furthermore, these results may lead to another pathway of research, i.e. the direct interaction between proteins and their sub-units, to highlight the data obtained previously and demonstrate that proteins may directly interact with ncRNA instead of mRNA. Moreover, our study suggests developing research on different pathways of association proteins-miRNAs as a part of epigenetic extra-nuclear regulation. Taken together, our study provides the first evidence of direct interactions between miRNAs and proteins.

The sheer growth of information and communication technologies (ICT) has reshaped teaching and learning practices tremendously in the learning environments all over the globe. Research reveals that teachers are the key agents in the integration of ICT in particular in language teaching and learning. However, some of the many factors, this ICT integration are associated with teachers’ personal characteristics such as gender. Therefore, the current study investigates the Moroccan male and female teachers’ level of ICT integration in teaching English as a foreign language (EFL) in the public secondary school EFL classrooms. This study aims to explore whether gender influences the way EFL teachers’ ICT use in the classroom. It is a survey which adopts a mixed-method approach of investigation, and two instruments are used to collect data: a questionnaire and a semi-structured interview. Eighty full-time teachers (45 male and 35 female teachers) belonging to different public secondary schools in the area of Agadir Idaoutanane and Inzegane Ait-Meloul participated in the study by answering a questionnaire, and eight teachers out of this sample (4 male and 4 female teachers) are interviewed. The results of data analysis reveal that although female teachers employed ICT in their teaching less than their male counterparts, there is no significant difference in using ICT in language teaching between the two groups. A number of propositions are presented as to how to incorporate ICT in language learning in the Moroccan secondary schools EFL contexts.

Reading acquisition disorders constitute the main problem in children's learning. in Morocco, epidemiological data are very rare. Research, mainly in the English language, concerns either the sociological or the cognitive field. Few studies, among them not one in Arabic, have explored the link relating to social and cognitive factors. The purpose of our work is to study and analyze the cognitive and social variables related to different reading skills among Moroccan pupils in primary and secondary public schools. From a sample of 754 learners (388 boys and 366 girls) ranging in age from 9 to 15 years with an average of 11.59 years, the diagnostic tests identified 145 students with deficient skills "Bad readers (BR)," 128 suspected of being in difficulty classified as « intermediate level (IL) » and a group of 481 children as good readers ( GR). Statistical analyses have shown that the first two groups (BR and IL) represent 24% in the favoured areas compared to 43% in the disadvantaged. The analysis of scores and the nature of the errors made on various reading tests show that 41 students, or 5.43% of our sample, present a dyslexia profile. 13 (1.72%) of whom have very severe difficulties. The phonological aptitudes (Rapid automatized naming, phonological short-time memory and especially phonological awareness) mainly reflect the level of reading. These phonological abilities are highly influenced by early attendance of preschool and by the degree of exposure to written language at home. These data, which are unique in Morocco, are consistent to that of the published subject literature. They make it possible to plan preventive actions by generalizing pre-school teaching, particularly in precarious environments. These actions should be based on playful exercises aimed at improving phonological abilities at an early age, while exploiting the brain sensitivity to reading at that age. Phonological awareness and rapid naming are the most implicated factors in the disparity of reading skills. These abilities are highly influenced by the integration of preschool at a very early age and by the degree of exposure to written language activities. Therefore, there is a need to plan preventive actions, based on playful exercises, aiming to improve phonological skills from the pre-school period

Ziziphus lotus (Nbeg) is very common in Morocco where it occupies various ecosystems and presents different interests; however it remains devalued and knows recent deterioration due to the human pressure through clearing, wood collection, irrational cuts’ exploitation and overgrazing. This study aims to prepare activated carbon from the cores of this interesting biomaterial, for the first time to the best of our knowledge, according to a manufacturing process based on its chemical and thermal activation. The cores of Ziziphus lotus (Nbeg) were chemically activated by sulfuric acid (H2SO4, 98%) for 24h with a mass contribution (1:1), and then carbonized at a temperature of 500 °C for 2 hours. The obtained activated carbon was characterized by scanning electron microscopy, X-ray diffraction, Fourier transform infrared spectroscopy and specific surface measurement. These characterization results showed an important porosity and a surface structure having acid groups and carboxylic functions. The adsorption of methylene blue (MB) was evaluated, by Langmuir and Freundlich models examination, in order to explain the adsorption efficiency in a systematic and scientific way. Also pseudo-first order and pseudo-second order kinetic models were used to identify the possible mechanisms of this adsorption process. The results showed that the MB adsorption process on activated carbon follows the Langmuir model and that the adsorption kinetic is best represented by kinetics data of the pseudo-second order model. Therefore, Z. lotus can be used as a low-cost available material to prepare a high quality activated carbon having a promising potential in the wastewater treatment.

Contains fulltext : 245450.pdf (Publisher’s version ) (Open Access)

Trachoma is a blinding disease caused by repeated conjunctival infection with different Chlamydia trachomatis (Ct) genovars. Ct B genovars have been associated with more severe trachoma symptoms. Here, we investigated associations between Ct genovars and bacterial loads in ocular samples from two distinct geographical locations in Africa, which are currently unclear. We tested ocular swabs from 77 Moroccan children (28 with trachomatous inflammation-follicular (TF) and 49 healthy controls), and 96 Sudanese children (54 with TF and 42 healthy controls) with a Ct-specific real-time polymerase chain reaction (PCR) assay. To estimate bacterial loads, Ct-positive samples were further processed by multiplex real-time qPCR to amplify the chromosomal outer membrane complex B and plasmid open reading frame 2 of Ct. Genotyping was performed by PCR-based amplification of the outer membrane protein A gene (~1120 base pairs) of Ct and Sanger sequencing. Ct-positivities among the Moroccan and Sudanese patient groups were 60·7% and 31·5%, respectively. Significantly more Sudanese patients than Moroccan patients were genovar A-positive. In contrast, B genovars were significantly more prevalent in Moroccan patients than in Sudanese patients. Significantly higher Ct loads were found in samples positive for B genovars (598596) than A genovar (51005). Geographical differences contributed to the distributions of different ocular Ct genovars. B genovars may induce a higher bacterial load than A genovars in trachoma patients. Our findings emphasize the importance of conducting broader studies to elucidate if the noted difference in multiplication abilities are genovar and/or endemicity level dependent., Author summary We investigated the association between different Ct genovars, the approximate load of infection, and the distribution of Chlamydia genovars by comparing samples from one trachoma-endemic area (i.e., the city of El-Gadaref in Al Qadarif, Sudan) and one previously endemic area (i.e., the Zagora Province in Morocco), currently considered as non-endemic. This study is the first to reveal a significant difference between the genome copy numbers of Ct genovar A and B/Ba in children with TF. Evidence that Ct is still circulating in rural foci of countries like Morocco that are no longer considered endemic implies that the continuation of the trachoma surveillance must be warranted in future to avoid further spreading of Ct. The clinical significance of different infectious loads in the development of sequelae has to be determined as well as whether these differences are genovar specific or related to the given endemicity level.

Among the strategies to encourage pregnant women to be vaccinated against pertussis in the postpartum period, that of giving them a prescription has been evaluated only sparsely.To measure the effect of giving women who are not immunized against pertussis a prescription for the vaccine at discharge from the maternity unit.Single-center before-and-after study (2011: before; 2015: after). All women received both oral and written information about vaccination against pertussis. During the after period, they were also specifically asked their immunization status during pregnancy. Those currently unimmunized received a written prescription for it at discharge.Among the women unimmunized at delivery, the percentage who were vaccinated postpartum climbed from 17 to 42% between 2011 and 2015 (p0.001), while the percentage of their unimmunized partners who were vaccinated remained stable (27 and 29%, p = 0.74). During this time, the percentage of women immunized against pertussis at the beginning of pregnancy rose from 32 to 52% (p0.001). Finally, the percentage of all women protected against this disease postpartum climbed from 44 to 72% between these two periods (p0.001).In the postpartum period, giving a prescription for pertussis vaccine to women unimmunized is accompanied by a significant elevation in their vaccination rate. Nevertheless, this rate remains low and better strategies have to be implemented.

Hydatidosis is a rare parasitic disease that is endemic in many countries of the Mediterranean basin. Among unusual localizations, renal involvement is rarer (2–3% of visceral forms) than splenic and soft tissue localizations but more frequent than cardiac, bony or cerebral localizations.

The biometric domain is very important for multinational corporations and economic companies all over the field of research and innovation and the protection of personal confidential information. Thus, governments invest millions of dollars in the protection and the identification of citizens’ personal data and use different types of biometric data modalities (iris, fingerprints, faces, etc.) for the recognition of the individual. The iris modality requires special and adequate treatment so that the biometric recognition system can recognize the person and this by going through several stages: image acquisition, segmentation, normalization, feature extraction and finally matching. The segmentation is a delicate step for the iris localization. The process detects the iris by two concentric circles, the first circle for the pupil region and the second circle for the iris region. The two most widely used methods in the literature are the John Daugman method (Intergro-Differential Operator) [7] and the Hough Transform circular [8]. The method of John Daugman detects the iris region and the pupil as well as the arches of the upper and lower eyelids. The Hough circular transform makes it possible to obtain the coordinates of the radius, the center of the pupil and the iris. The main objective is to obtain the essential information, which is the size of the pupil radius and the iris radius. And that makes it possible to crop the radius rl of the pupil and the radius r2 of the iris to have a good segmentation. Experiments were made on the following iris data: Casia-iris-interval v4 [21], Ubiris vl [23], MMU 1, MMU 2 [22] and the SDULMA-HCM iris database [24].

Environmental factors such as pesticides are considered key determinants of brain damage and brain dysfunction. In the present work, we investigated the effect of an organophosphate pesticide, i.e., malathion, administrated peri- and postnatally on the antioxidant system as well as on acetylcholine esterase (AChE) activity in the brains of mice pups during the three postnatal weeks. Furthermore, we analyzed the behavior of the offspring just after weaning to assess the eventual effect of the pesticide on anxiety traits and social interaction. Concerning the biochemical biomarkers, the continuous treatment with malathion given either at a low dose of 5 mg/kg or at a medium one, 15 mg/kg, causes alterations in the activities of catalase, superoxide dismutase, glutathione S-transferase, and glutathione peroxidase, accompanied by high level of peroxidation of membrane lipids, indicating a disturbance in intracellular redox homeostasis with subsequent increased intracellular oxidative stress. The effect was more pronounced when the high dose was applied. This was also demonstrated for the activity of AChE, downregulated at all postnatal ages investigated (5, 15, and 21), whereas the low dose (5 mg/kg) did not alter this enzymatic activity which is in line with the absence of locomotor activity alteration as assessed by open field (OF). With regard to this last test, results obtained show also that the treated offspring mice develop an anxiogenic state as evidenced by open field as well as an impairment of social interaction. Altogether, these results provide an accurate characterization of the association between neurobehavioral outcomes and brain alterations following malathion administrated in gestational and lactational periods, even given at low dose, classified as safe, and indicate clearly that the developing brain is sensitively vulnerable to this organophosphate pesticide.

Resume Introduction La prise en charge des valvulopathies mitrales pendant la grossesse continue a poser un defi au medecin. Objectif Le but de cette etude etait d’evaluer les consequences du retrecissement mitral sur la mere et le fœtus. Materiel et methodes Quatre-vingt-trois patientes atteintes d’un retrecissement mitral (RM) ont ete suivies de maniere prospective de 2009 a 2012 et evaluees par le stade de la NYHA, l’ECG et l’echocardiographie durant la grossesse et apres la delivrance. Resultats Les patientes avaient une forte incidence de complications, l’aggravation du stade de la NYHA a ete observee (44,57 %, p = 0,0001), l’insuffisance cardiaque congestive a ete retrouvee (27,71 %, p = 0,0001), l’hospitalisation (33,73 %, p = 0,0001), le recours au traitement medical specifique (53,75 %, p = 0,009), les troubles du rythme (16 %, p Conclusion Le RM serre constitue un groupe a haut risque de complications, un suivi rigoureux doit etre exerce pendant la grossesse avec une surveillance du fœtus, la correction de valvulopathie doit etre effectuee avant la conception.

The interplay between experiences during critical developmental periods and later adult life is crucial in shaping individual variability in stress coping strategies. Exposure to stressful events in early life has strongly programs an individual's phenotype and adaptive capabilities. Until now, studies on programming and reversal strategies in early life stress animal models have been essentially limited to males. By using the perinatal stress (PRS) rat model (a model more sensitive to aging changes) in middle-aged females, we investigated the behavioral and endocrine responses following exposure in later life to an unpredictable chronic mild stress (uCMS) condition for six weeks. PRS by itself accelerated the ageing-related-disruption in the estrous cycle and led to reductions in the levels of estradiol. It also reduced motivational and risk-taking behavior in later life, with PRS females being characterized by a reduction in self-grooming in the splash test, in the exploration of the light compartment in the light/dark box test and in the time spent eating a palatable food in the novelty-induced suppression feeding test. PRS females showed impaired regulation of plasma glucose and insulin levels following a glucose challenge, with a hyperglycemic phenotype, and disrupted feedback of the HPA axis after acute stress with respect to controls. Remarkably, all PRS-induced alterations were modified by exposure to the uCMS procedure, thus resulting in a disease-dependent intervention; controls were not affected by uCMS, except for a slight and transient reduction in body weight, while PRS females displayed a reduced body weight gain for the entire duration of the uCMS procedure. Interestingly, the effects of uCMS on PRS females were still observed up to two months after its termination and the females displayed heightened rhythms of locomotor activity and enhanced sensitivity to reward with respect to controls exposed to uCMS. Our findings indicate that many parameters of the PRS female adult phenotype are shaped by both early and later life experiences in a non-additive way. As a consequence, early stressed individuals may be programmed with a more dynamic phenotype than non-stressed individuals.

The purpose of this study was to assess and analyze the radiation doses during head pediatric CT from different CT units within six Tunisian hospitals representing different geographic regions in order to optimize the dose given and minimize the radiology risk to this category of patients and towards the derivation of national diagnostic reference levels. Patient data and exposure parameters were collected for four age groups (

This report aimed to provide an overview of the epidemiological situation of COVID-19 in Morocco and to review the actions carried out as part of the national response to this pandemic. The methodology adopted was based on literature review, interviews with officials and actors in the field, and remote discussion workshops with a multidisciplinary and multisectoral working group. Morocco took advantage of the capacities already strengthened within the framework of the application of the provisions of the International Health Regulations (IHR) of 2005. A SWOT analysis made it possible to note that an unprecedented political commitment enabled all the necessary means to face the pandemic and carry out all the response activities, including a campaign of relentless communication. Nevertheless, and despite the efforts made, the shortage of human resources, especially those qualified in intensive care and resuscitation, has been the main drawback to be addressed. The main lesson learned is a need to further strengthen national capacities to prepare for and respond to possible public health emergencies and to embark on a process overhaul of the health system, including research into innovative tools to ensure the continuity of the various disease prevention and control activities. In addition, response to a health crisis is not only the responsibility of the health sector but also intersectoral collaboration is needed to guarantee an optimal coordinated fight. Community-oriented approaches in public health have to be strengthened through more participation and involvement of nongovernmental organizations (NGOs) and civil society in operational and strategic planning.

International audience; Type-5 metabotropic glutamate receptors (mGlu5) have been implicated in the mechanism of resilience to stress. They form part of the postsynaptic density (PSD), a thickening of the glutamatergic synapse that acts as a multimodal hub for multiple cellular signaling. Perinatal stress in rats triggers alterations that make adult offspring less resilient to stress. In the present study, we examined the expression of gene encoding the mGlu5 (Grm5), as well as those encoding the short and long isoforms of Homer proteins in different brain regions of the offspring of dams exposed to repeated episodes of restraint stress during pregnancy (“perinatally stressed” or PRS offspring). To this end, we investigated unconditioned behavioral response using the light/dark box test, as well as the expression of PSD genes (Homer1a, Homer1b, and Grm5), in the medial prefrontal cortex, cortex, caudate-putamen, amygdala, and dorsal hippocampus. PRS rats spent significantly less time in the light area than the control group. In the amygdala, Homer1a mRNA levels were significantly increased in PRS rats, whereas Homer1b and Grm5 mRNA levels were reduced. In contrast, the transcript encoding for Homer1a was significantly reduced in the medial prefrontal cortex, caudate-putamen, and dorsal hippocampus of PRS rats. We also evaluated the relative ratio between Homer1a and Homer1b/Grm5 expression, finding a significant shift toward the expression of Homer1a in the amygdala and toward Homer1b/Grm5 in the other brain regions. These topographic patterns of Homer1a, Homer1b, and mGlu5 gene expression were significantly correlated with risk-taking behavior measured in the light/dark box test. Remarkably, in the amygdala and in other brain regions, Homer1b and Grm5 expression showed positive correlation with time spent in the light box, whereas Homer1a in the amygdala showed a negative correlation with risk-taking behavior, in contrast with all other brain regions analyzed, wherein these correlations were positive. These results suggest that perinatal stress programs the developmental expression of PSD molecules involved in mGlu5 signaling in discrete brain regions, with a predominant role for the amygdala.

International audience

Introduction - Les cardiopathies valvulaires demeurent fréquentes malgré l’améliorationdes conditions sanitaires qui ont permis la réduction de l’incidence du rhumatismearticulaire aigu (RAA). Les indications chirurgicales et interventionnellesse sont élargies et nous opérons aujourd’hui à des stades précoces voire asymptomatiques.Une réintervention chirurgicale valvulaire est nécessaire dans environ15% des cas au cours de l’évolution d’une valvulopathie opérée. L’objectif de notreétude est de déterminer la fréquence des réinterventions valvulaires et d’identifierles principales indications de ces réinterventions.Méthodes - Il s’agit d’une étude rétrospective descriptive, portant sur 45 patients,admis au service de cardiologie du Centre Hospitalo-Universitaire (CHU) d’Oran, dejanvier 2011 à juillet 2013, et présentant une valvulopathie déjà opérée nécessitantune autre réintervention chirurgicale valvulaire.Résultats - La moyenne d’âge est de 41 ans, 73% des patients sont des femmes et27% des hommes (Sex ratio de 0,37). La plupart de nos patients sont symptomatiques(dyspnée stade II de la NYHA). Les réinterventions intéressent la valve mitraledans 69% des cas, la valve aortique dans 37% des cas et la valve tricuspide dans35%. Nous avons constaté l’importance des insuffisances aortiques et tricuspidesnégligées lors de la première intervention (31% et 62% respectivement). Le délaimoyen entre les deux interventions, tout type confondu, est de 21 ans.Conclusion - Les réinterventions cardiaques peuvent survenir au cours de l’évolutiond’une valvulopathie. Une bonne évaluation cardiaque initiale des valvulopathieslors d’une chirurgie portant sur la valve mitrale ou aortique est indispensablepour pallier au problème d’une réintervention pour des valvulopathies négligées.

Background Rheumatoid arthritis (RA) is a known cause of cardiovascular disease (CVD). Several studies suggest that serum uric acid (SUA) is significantly associated with CVD in RA. However, the association between SUA and inflammation remains controversial. Objectives The aim of the present study is to determine the prevalence of hyperuricemia in RA patients, to assess its association with inflammation and to evaluate whether disease modifying anti rheumatic drugs (DMARDs) have a hypouricemiant effect. Methods We have conducted a cross-sectional study over four months in our department of rheumatology. A total of 204 RA patients receiving DMARDs in their treatment were enrolled. All patients fulfilled the RA ACR-EULAR criteria. SUA and inflammatory markers were studied. Hyperuricemia was defined as SUA>70mg/L for males and >60mg/L for females. Data analysis was carried out using the SPSS 20 Software. Univariate and multivariate regressions were performed to identify the impact of hyperuricemia in RA patients. Results The mean age was 51.76±12.84 and the mean age at RA diagnosis was 42.5 ± 15.23. Fourteen patients (6.9%) had hyperuricemia and the average rate of SUA was 41.99 ± 11.85 mg/L. All patients were taking Methotrexate, 34% received also Sulfasalazine, 6.4% Hydroxychloroquine and 77% steroids. Males and post-menopausal women had significantly higher SAU levels (p Conclusion The prevalence of hyperuricemia is low in our RA patients and similarly gout remains infrequent. However, RA patients must be screened for hyperuricemia. There is growing evidence that higher doses of steroids can cause hyperuricemia. Practitioners should be aware that these patients are at risk of having high SUA levels as well as more traditional cardiovascular risk factors. Thus, appropriate preventive interventions in these patients should be introduced. References [1] J.-Y. Choe, S.-K. Kim. Association between serum uric acid and inflammation in rheumatoid arthritis: Perspective on lowering serum uric acid of leflunomide. Clin Chim Acta. 2015Jan1;438:29-34. [2] Kuo D, et al. Hyperuricemia and incident cardiovascular disease and noncardiac vascular events in patients with rheumatoid arthritis. International Journal of Rheumatology, 2014 Aug 17;523897-7. [3] Zaragoza-Garcia O, et al. Hypertriglyceridemic waist is associated with hyperuricemia and metabolic syndrome in rheumatoid arthritis patients. Diabetes Metab Syndr. 2019 Jan - Feb;13(1):722-729. Disclosure of Interests None declared

In mouse embryo gastrulation, epiblast cells delaminate at the primitive streak to form mesoderm and definitive endoderm, through an epithelial-mesenchymal transition. Mosaic expression of a membrane reporter in nascent mesoderm enabled recording cell shape and trajectory through live imaging. Upon leaving the streak, cells changed shape and extended protrusions of distinct size and abundance depending on the neighboring germ layer, as well as the region of the embryo. Embryonic trajectories were meandrous but directional, while extra-embryonic mesoderm cells showed little net displacement. Embryonic and extra-embryonic mesoderm transcriptomes highlighted distinct guidance, cytoskeleton, adhesion, and extracellular matrix signatures. Specifically, intermediate filaments were highly expressed in extra-embryonic mesoderm, while live imaging for F-actin showed abundance of actin filaments in embryonic mesoderm only. Accordingly, Rhoa or Rac1 conditional deletion in mesoderm inhibited embryonic, but not extra-embryonic mesoderm migration. Overall, this indicates separate cytoskeleton regulation coordinating the morphology and migration of mesoderm subpopulations., eLife digest As an embryo develops, its cells divide and specialize to form different tissues and organs. Early in development the cells arrange into so-called germ layers, which each produce particular types of tissue. One of these layers, called the mesoderm, develops into the muscles, bones and circulatory system of the embryo. It also contributes to the support structures that feed and protect the embryo, such as the placenta, umbilical cord and yolk sac. If these ‘extra-embryonic’ structures do not develop correctly, the embryo may not grow properly. Much of what we know about how the cells of the mesoderm move around to form different tissues comes from studies of species that lay eggs; for example, chicks, frogs and fish. The initial steps of embryo development in these animals are similar to how mammals develop, but bigger differences emerge as the extra-embryonic tissues start to form. Recent methodological advances are now making it possible to dynamically study this later stage of development in live mouse embryos. Saykali et al. studied mouse embryos whose mesoderm cells contained a ‘reporter’ that allowed them to be identified when viewed using a microscopy technique known as two-photon live imaging. This approach allows cells to be tracked as they move through living tissue. Saykali et al. found that the mesoderm cells change shape depending on which region of the embryo they are in, and on which germ layer they are next to. The cells that become extra-embryonic are larger and longer, and develop small protrusions. Instead of moving directly to their destinations, they tend to zigzag. Further experiments revealed that embryonic and extra-embryonic mesoderm cells produce different amounts of several proteins, including the distinct types of filaments that act as the cell’s internal skeleton. Mesoderm cells that are destined to become extra-embryonic depend less on signaling proteins called Rho GTPases to move around. Knowing how mesoderm cells form extra-embryonic structures will help researchers to understand how problems with these structures can affect how embryos grow. The techniques used by Saykali et al. will also help to design new ways to cultivate mesoderm cells in the laboratory for future experiments. These could, for example, investigate whether human mesoderm cells develop in the same way as mice mesoderm cells.

Introduction Silent myocardial ischemia (SMI) is an important cause of morbidity and mortality. Its screening is of a capital importance for its management. Objective The objective of our study was to determine the prevalence of SMI in diabetic patients with high cardiovascular risk as well as the predictive factors. Method We recruited 216 diabetic patients with high cardiovascular risk defined according to the recommendations of ALFEDIAM/SFC 2004, in whom we searched for a SMI type 1, using an exercise electrocardiogram. The study was performed in Sidi Bel Abbes cardiology university hospital service. Results The mean age of the population was 59.47 ± 8.25 years and the sex ratio of 1.48. The prevalence of SMI in both genders was 17.6% without significant difference. Criteria for a highly positive SMI was found in 34.2% of them with a higher frequency in men (P Conclusion Highly positive SMI was more common for men. Some predictive markers of the disease were determined, including left ventricular hypertrophy, carotid stenosis, a clinical history of peptic ulcer and an increase in serum creatinine.

extracorporeal shock wave (ESLW) is a common and relatively safe procedure, with a high success rate and low side effects. its complications are limited to the kidneys and always disappear spontaneously. Acute pain is the only manifestation of kidney hematoma and should be explored. Conservative treatment is generally the treatment of choice. We reported the case of a 60-year-old man who underwent extracorporeal lithotripsy, 4 h after the procedure, he was presented to the emergency with severe abdominal pain, and a CT scan showed a hematoma of the left kidney. Conservative treatment was performed, and the patient was discharged at home in 48h.

Background:Rheumatoid arthritis (RA) is a progressive autoimmune disorder of joints that is associated with high health care costs, yet guidance is lacking on how early to initiate biologic disease-modifying antirheumatic drugs (DMARDs). Few studies have examined the factors associated with the transition from non biologic DMARDs to biologic DMARDs in RA patients.Objectives:to examine the association of patient’s comorbidities with initiation of biologic DMARDs (disease-modifying antirheumatic drugs) in rheumatoid arthritis (RA).Methods:cross-sectional study was designed on a cohort of RA patients. Sociodemographic, clinical data and comorbidities were collected. Logistic regression analysis was used to explore the impact of comorbidities on the initiation of bDMARD. The statistical analysis was done by SPSS. 20, p Results:among the 257 patients, 90.5% were females. Their mean age was 54.66 ± 11.9 years. The most frequent comorbidities in our population were: high blood pressure (22.5%), diabetes (16.6%), history of heart disease (5.1%), history of neoplasia (2.4%) and nephropathies (2%). RA patients with comorbidities were more likely to initiate bDMARD: high blood pressure (p = 0.003 OR=2.36, 95% CI: 1.332- 4.181), history of heart disease (p = 0.036 OR=3.01, 95% IC: 1.073-8.468) and history of neoplasia (p = 0.026 OR= 5.07, 95% CI: 1.219- 21.110). In multiple regression models, high blood pressure was associated to the initiation of biologic agents (p= 0.026, OR= 2.07, 95% CI: 1.090-3.932).Conclusion:the probability of initiating therapy with biologic agents in patients with RA is affected by different co-morbidities in our context specifically hypertension.References:[1]Machado-Alba JE, et al. Time to and factors associated with initiation of biological therapy in patients with rheumatoid arthritis in Colombia. Rev Colomb Reumatol. 2018[2]Priyanka Gaitonde et al. Factors associated with use of disease modifying agents for rheumatoid arthritis in the National Hospital and Ambulatory Medical Care Survey. Seminars in Arthritis and Rheumatism. 2017Disclosure of Interests:None declared

Epithelial Ovarian cancer (EOC) although rare is the most lethal gynecological cancer in women worldwide. Despite its high prevalence few studies have been performed to evaluate the prevalence and determinants of HPV infection worldwide. The aim of the present study was to investigate the presence of HPV-DNA in Moroccan patients with EOC using PCR among women in Casablanca, and to examine the prevalence of some HPV genotypes in Moroccan population. We performed a study of HPV detection on Fresh biopsies of 70 epithelial ovarian cancer patients. PCR was realized using the MY09/11 and GP5+/6+ primers. Genotyping of HPV was performed by PCR typespecific for HPV 6, 11, 16, 18, 31, and 33.Data was statistically analyzed using SPSS software. Hence, the mean age was 48.9 years (range,21-76 years). Serous adeno carcinoma (75.71%) and stage III of the disease represent the majority of cases. eight patients were HPV positive (11.42%).Results of HPV genotyping revealed predominance of two genotypes: HPV 16 (87.5%) and HPV 31(12.5).No co-infection identified. Approximately 75% of positive cases had a serous cystadeno carcinoma and more than 62,5% had FIGO advanced stage (III or IV).Our study showed that high-risk HPV infection could play a major role among patients with EOC in Morocco.

Contamination with mercury is a real health issue for humans with physiological consequences. The main objective of the present study was to assess the neurotoxicological effect of inorganic mercury: HgCl2. For this, adult mice were exposed prenatally, postnatally, and during the adult period to a low level of the metal, and their behavior and antioxidant status were analyzed. First, we showed that mercury concentrations in brain tissue of treated animals showed significant bioaccumulation, which resulted in behavioral deficits in adult mice. Thus, the treated mice developed an anxiogenic state, as evidenced by open field and elevated plus maze tests. This anxiety-like behavior was accompanied by a decrease in social behavior. Furthermore, an impairment of memory in these treated mice was detected in the object recognition and Y-maze tests. The enzymatic activity of the antioxidant system was assessed in eight brain structures, including the cerebral cortex, olfactory bulb, hippocampus, hypothalamus, mesencephalon, pons, cerebellum, and medulla oblongata. The results show that chronic exposure to HgCl2 caused alterations in the activity of catalase, thioredoxin reductase, glutathione peroxidase, superoxide dismutase, and glutathione S-transferase, accompanied by peroxidation of membrane lipids, indicating a disturbance in intracellular redox homeostasis with subsequent increased intracellular oxidative stress. These changes in oxidative stress were concomitant with a redistribution of essential heavy metals, i.e., iron, copper, zinc, and magnesium, in the brain as a possible response to homeostatic dysfunction following chronic exposure. The alterations observed in overall oxidative stress could constitute the basis of the anxiety-like state and the neurocognitive disorders observed.

BackgroundTrichiasis is present when one or more eyelashes touches the eye. Uncorrected, it can cause blindness. Accurate estimates of numbers affected, and their geographical distribution, help guide resource allocation.MethodsWe obtained district-level trichiasis prevalence estimates for 44 endemic and previously-endemic countries. We used (1) the most recent data for a district, if more than one estimate was available; (2) age- and sex-standardized corrections of historic estimates, where raw data were available; (3) historic estimates adjusted using a mean adjustment factor for districts where raw data were unavailable; and (4) expert assessment of available data for districts for which no prevalence estimates were available.FindingsInternally age- and sex-standardized data represented 1,355 districts and contributed 662 thousand cases (95% confidence interval [CI] 324 thousand-1.1 million) to the global total. age- and sex-standardized district-level prevalence estimates differed from raw estimates by a mean factor of 0.45 (range 0.03-2.28). Previously non-standardized estimates for 398 districts, adjusted by ×0.45, contributed a further 411 thousand cases (95% CI 283-557 thousand). Eight countries retained previous estimates, contributing 848 thousand cases (95% CI 225 thousand-1.7 million). New expert assessments in 14 countries contributed 862 thousand cases (95% CI 228 thousand-1.7 million). The global trichiasis burden in 2016 was 2.8 million cases (95% CI 1.1-5.2 million).InterpretationThe 2016 estimate is lower than previous estimates, probably due to more and better data; scale-up of trichiasis management services; and reductions in incidence due to lower active trachoma prevalence.Author SummaryAs an individual with trichiasis blinks, the eyelashes abrade the cornea, which can lead to corneal opacity and blindness. Through high quality surgery, which involves correcting the position of the in-turned eyelid, it is possible to reduce the number of people with trichiasis. An accurate estimate of the number of persons with trichiasis and their geographical distribution are needed in order to effectively align resources for surgery and other necessary services. We obtained district-level trichiasis prevalence estimates for 44 endemic and previously-endemic countries. We used the most recently available data and expert assessments to estimate the global burden of trichiasis. We estimated that in 2016 the global burden was 2.8 million cases (95% CI 1.1-5.2 million).The 2016 estimate is lower than previous estimates, probably due to more and better data; scale-up of trichiasis management services; and reductions in incidence due to lower active trachoma prevalence.

S 47445 is a positive modulator of glutamate AMPA-type receptors, possessing neurotrophic and enhancing synaptic plasticity effects as well as pro-cognitive and anti-stress properties. Here, the drug was assessed in the perinatal stress (PRS) rat model, known to have a high predictive validity with monoaminergic antidepressants. The effects of a chronic treatment (i.p.) with S 47445 were investigated on risk-taking, motivational and cognitive behavior. S 47445 (1 and 10 mg/kg) increased the exploration of the elevated-plus maze and light/dark box as well as the time spent grooming in the splash test, and improved social memory in PRS rats. Also, the effects of S 47445 were examined on the synaptic neurotransmission. The reduced depolarization-evoked glutamate release induced by PRS was corrected with S 47445 (10 mg/kg). Remarkably, the reduction in glutamate release induced by PRS and corrected by S 47445 chronic treatment was correlated with all the behavioral changes. S 47445 at 10 mg/kg also normalized the lower levels of synaptic vesicle-associated proteins in ventral hippocampus in PRS rats. Finally, S 47445 reversed the decrease of mGlu5 receptors, GR and OXTR induced by PRS. Collectively, in an animal model of stress-related disorders, S 47445 corrected the imbalance between excitatory and inhibitory neurotransmission by regulating glutamate-evoked release that is predictive of PRS behavioral alterations, and also normalized the reduction of trafficking of synaptic vesicles induced by PRS. These results support the interest of glutamatergic-based therapeutic strategies to alleviate stress-related disorders.

Exposure of the mother to adverse events during pregnancy is known to induce pathological programming of the HPA axis in the progeny, thereby increasing the vulnerability to neurobehavioral disorders. Maternal care plays a crucial role in the programming of the offspring, and oxytocin plays a key role in mother/pup interaction. Therefore, we investigated whether positive modulation of maternal behavior by activation of the oxytocinergic system could reverse the long-term alterations induced by perinatal stress (PRS; gestational restraint stress 3 times/day during the last ten days of gestation) on HPA axis activity, risk-taking behavior in the elevated-plus maze, hippocampal mGlu5 receptor and gene expression in Sprague-Dawley rats. Stressed and control unstressed dams were treated during the first postpartum week with an oxytocin receptor agonist, carbetocin (1 mg/kg, i.p.). Remarkably, reduction of maternal behavior was predictive of behavioral disturbances in PRS rats as well as of the impairment of the oxytocin and its receptor gene expression. Postpartum carbetocin corrected the reduction of maternal behavior induced by gestational stress as well as the impaired oxytocinergic system in the PRS progeny, which was associated with reduced risk-taking behavior. Moreover, postpartum carbetocin had an anti-stress effect on HPA axis activity in the adult PRS progeny and increased hippocampal mGlu5 receptor expression in aging. In conclusion, the activation of the oxytocinergic system in the early life plays a protective role against the programming effect by adverse experiences and could be considered as a novel and powerful potential therapeutic target for stress-related disorders. 66