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International audience; Dry eye disease (DED) is a common eye condition worldwide and a primary reason for visits to the ophthalmologist. DED diagnosis is performed through a combination of tests, some of which are unfortunately invasive, nonreproducible and lack accuracy. The following review describes methods that diagnose and measure the extent of eye dryness, enabling clinicians to quantify its severity. Our aim with this paper is to review classical methods as well as those that incorporate automation. For only four ways of quantifying DED, we take a deeper look into what main elements can benefit from automation and the different ways studies have incorporated it. Like numerous medical fields, Artificial Intelligence (AI) appears to be the path towards quality DED diagnosis. This review categorises diagnostic methods into the following: classical, semi-automated and promising AI-based automated methods.

Points essentiels Les hepatopathies auto-immunes (HTAI) representees par l’hepatite auto-immune (HAI), la cirrhose biliaire primitive (CBP), la cholangite sclerosante primitive (CSP) et la cholangite auto-immune (CAI), sont malgre leur relative rarete des entites cliniques imposantes en pratique clinique. Plusieurs mecanismes sont impliques dans l’initiation de l’atteinte auto-immune et inflammatoire du foie dont la predisposition genetique, le mimetisme moleculaire et/ou les anomalies des lymphocytes T-regulateurs. Leur mode d’expression clinique est tres polymorphe, allant de la decouverte fortuite a l’insuffisance hepatique aigue grave. Le diagnostic des HTAI repose sur la presence d’une hypergammaglobulinemie, d’une cytolyse, d’une cholestase, d’auto-anticorps caracteristiques d’HAI (anti-F actine, anti-LKM1, anti-LC1, ANA) ou de CBP (anti-M2, anti-Sp100, anti-Gp210), et de lesions histologiques inflammatoires et necrotiques. L’apport des anticorps anti-F actine, anti-LKM1, anti-LC1 est determinant d’autant plus qu’ils permettent de distinguer lʼHAI de type 1 et celle de type 2. Les Ac anti-SLA/LP, plutot associes a une hepatite plus severe sont particulierement utiles pour le diagnostic des HAI seronegatives pour les auto-Ac courants. Grâce a la valeur diagnostique quasi-certaine des Ac anti-M2, anti-Sp100, et anti-gp210, le diagnostic de la CBP est plus facilement abordable que celui de la CSP et de la CAI. Orientee par les donnees cliniques, la demarche du diagnostic immunologique des HTAI tire profit des differentes techniques specialisees de laboratoire incluant l’immunofluorescence, l’immunodot ou blot, et l’Elisa, sous condition d’une etroite collaboration clinico-biologique.

In this chapter, a case study using a specific wearable Multi-Channel EMG device will be considered. In particular, eight EMG channels will be used through Myo Armband system. The purpose is to deploy a verification biometric system using EMG signals corresponding to hand gestures. More specifically, the idea behind this concept is the capacity to generate a digital signature for each specific hand gesture.

Human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis Cvirus (HCV) are major public health concerns. We aimed to determine the prevalence of HBV and HCV infections among HIV-infected patients, and to identify the main circulating hepatitis strains in Morocco. The study was carried out in 503 HIV-infected patients. Our survey indicated that the prevalence of HIV/hepatitis co-infection was 10.6%; 5.2% of patients were HBV surface antigen positive, and 5.4% of patients were anti-HCV positive. Among the HBV surface antigen-positive group, HBV DNA sequencing identified exclusively genotype D (D1: 26.7%; D7: 73.3%) in accordance with what is found in the general population. In contrast, sequencing of HCV isolates produced an unusual subtype distribution with a decreasing order of prevalence: 1a, 3a (both 23.5%), 1b, 4a (both 17.6%), 1c (11.8%) and 6h (6%).

Autoimmune hepatopathies (AIHT) including autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC) and autoimmune cholangitis (AIC), represent an impressive entities in clinical practice. Their pathogenesis is not perfectly elucidated. Several factors are involved in the initiation of hepatic autoimmune and inflammatory phenomena such as genetic predisposition, molecular mimicry and/or abnormalities of T-regulatory lymphocytes. AIHT have a wide spectrum of presentation, ranging from asymptomatic forms to severe acute liver failure. The diagnosis of AIHT is based on the presence of hyperglobulinemia, cytolysis, cholestasis, typical even specific circulating auto-antibodies, distinctive of AIH or PBC, and histological abnormalities as well as necrosis and inflammation. Anti-F actin, anti-LKM1, anti-LC1 antibodies permit to distinguish between AIH type 1 and AIH type 2. Anti-SLA/LP antibodies are rather associated to more severe hepatitis, and particularly useful for the diagnosis of seronegative AIH for other the antibodies. Due to the relevant diagnostic value of anti-M2, anti-Sp100, and anti-gp210 antibodies, the diagnosis of PBC is more affordable than that of PSC and AIC. Based on clinical data, the immunological diagnosis of AIHT takes advantage of the various specialized laboratory techniques including immunofluorescence, immunodot or blot, and the Elisa systems, provided of a closer collaboration between the biologist and the physician.

The implication of hemochromatosis (HFE) gene mutations in chronic viral hepatitis remains controversial. The aim of the present study was to measure the frequencies of the common HFE gene mutations in Moroccan subjects with chronic viral hepatitis B and C and to assess their influence on the progression of liver disease. H63D and C282Y mutations were screened by the polymerase chain reaction followed by restriction fragment length polymorphism analysis in 170 chronic hepatitis B patients, 168 chronic hepatitis C patients, and 200 healthy controls. A very small proportion of patients infected with hepatitis B virus (HBV) or hepatitis C virus (HCV; 1.8% and none, respectively) were heterozygous for the C282Y mutation, that is, rates not statistically different from those observed in healthy control (2%, P > 0.05). Similarly, the frequency of the H63D allele was not significantly different between HBV (13.8%) or HCV (14.3%) patients and controls (13.5%, P > 0.05). Multivariate analysis showed that carriers of the H63D mutation infected with HBV are at higher risk to progress towards an advanced liver disease when compared with patients infected with HBV with wild-type (OR = 2.45, 95% CI = 1.07–5.58). In contrast, no association between HFE mutated HCV-infected patients and an increased risk of disease progression was found (OR = 1.24, 95% CI = 0.61–2.50, P = 0.547). In conclusion, in Morocco the frequency of the HFE C282Y allele is very low and H63D mutation carriage occurs in almost 14% of the patients, a rate similar in chronic hepatitis patients and healthy controls. In the case of chronic hepatitis B, the carriage of the H63D variant represents a risk factor of evolution towards a more active disease. J. Med. Virol. 83:2096–2102, 2011. © 2011 Wiley Periodicals, Inc.

The aim of the present study was to identify basic amino acid in the core region in subtype 1b-infected, treatment-naive patients from Morocco and to search for their eventual association with liver cancer. The survey included 151 patients (86 patients with chronic hepatitis and 65 patients with hepatocellular carcinoma, HCC). We performed direct sequencing, and compared the data obtained with the consensus sequence of core protein. Several recurrent amino acid substitutions were observed. The Arg70 was changed for a Gln in 22 of 112 patients (19.6%) and Leu91 was changed to Met in 23 of 112 patients (20.5%). Besides, the threonine at position 75 (Thr75) was mutated for alanine or serine in 43 (38.4%) and 40 (35.7%) of the patients, respectively. Overall, there was no significant difference between patients with chronic hepatitis and those with HCC regarding amino acids substitution number (24% vs. 33%, respectively, P = 0.457). Our study provides the first inventory of predominant amino acid substitutions in the HCV core region genotype 1b. The impact of single or combined mutations on the resistance to treatment or on disease progression is still unknown and deserves more attention in the future.

Background: Genetic variation in the IL28B gene has been strongly associated with treatment outcomes, spontaneous clearance and progression of the hepatitis C virus infection (HCV). The aim of the present study was to investigate the role of polymorphisms at this locus with progression and outcome of HCV infection in a Moroccan population.Methods: We analyzed a cohort of 438 individuals among them 232 patients with persistent HCV infection, of whom 115 patients had mild chronic hepatitis and 117 had advanced liver disease (cirrhosis and hepatocellular carcinoma), 68 individuals who had naturally cleared HCV and 138 healthy subjects. The IL28B SNPs rs12979860 and rs8099917 were genotyped using a TaqMan 5' allelic discrimination assay.Results: The protective rs12979860-C and rs8099917-T alleles were more common in subjects with spontaneous clearance (77.9% vs 55.2%; p = 0.00001 and 95.6% vs 83.2%; p = 0.0025, respectively). Individuals with clearance were 4.69 (95% CI, 1.99-11.07) times more likely to have the C/C genotype for rs12979860 polymorphism (p = 0.0017) and 3.55 (95% CI, 0.19-66.89) times more likely to have the T/T genotype at rs8099917. Patients with advanced liver disease carried the rs12979860-T/T genotype more frequently than patients with mild chronic hepatitis C (OR = 1.89; 95% CI, 0.99-3.61; p = 0.0532) and this risk was even more pronounced when we compared them with healthy controls (OR = 4.27; 95% CI, 2.08-8.76; p = 0.0005). The rs8099917-G allele was also associated with advanced liver disease (OR = 2.34; 95% CI, 1.40-3.93; p = 0.0100).Conclusions: In the Moroccan population, polymorphisms near the IL28B gene play a role both in spontaneous clearance and progression of HCV infection.

International audience; Hepatitis C virus (HCV) isolates circulating in Morocco are poorly documented. To determine the subgenotype distribution of HCV in chronically infected patients, serum samples from 185 anti-HCV-positive patients were analyzed. Determination of the HCV genotype and subtype was performed by sequencing the 5'UTR, NS5B and core regions. According to the NS5B phylogeny, the HCV strains primarily belonged to subtypes 1b (75.2%), 2i (19.1%) and 2k (2.8%). Using a Bayesian approach, the mean date of appearance of the most recent common ancestor was estimated to be 1910 for HCV-1b and 1854 for HCV-2i. Although it is currently the most frequent genotype in Morocco and the dominant form in hepatocellular carcinoma, it thus appears that HCV-1b was introduced into the population subsequently to HCV-2i.

International audience; OBJECTIVES: The aim of this study was to determine the prevalence of Hepatitis B Virus (HBV) genotypes, subgenotypes, HBV surface antigen (HBsAg) subtypes and naturally occurring mutations in Major Hydrophilic region (MHR) of HBsAg among Moroccan patients with chronic HBV infection. METHODS: The study included 200 patients chronically infected with HBV. The HBV genotypes, subgenotypes, HBsAg subtypes and MHR variants were determined by direct sequencing of the HBV surface (S) gene and phylogenetic analysis. RESULTS: The S gene was successfully amplified in 134 patients. The mean age was 40.6 ± 12.2 years. Genotype D was predominant (90%, 120/134) and genotype A was less frequent (10%, 14/134). Genotype D strains belonged to subgenotypes D7 (70.8%, 85/120), D1 (25.8%, 31/120) and D2 (0.9%, 1/120). Three strains (2.5%) could not be classified in any subgenotype of genotype D. All genotype A strains belonged to subgenotype A2. HBsAg subtypes found were ayw2 (82.1%, 110/134), adw2 (10.4%, 14/134), ayw3 (3%, 4/134) and ayw4 (3%, 4/134). The global prevalence of MHR variants was 15% (20/134) with substitution P120T/S the most frequent (3.7%, 5/134). The occurrence of MHR variants was significantly associated with advancing age (>40 years) (p = 0.003) and independent of sex, HBeAg status, viral load, genotype, subgenotype and HBsAg subtype. CONCLUSIONS: This study provides the first description of predominance of HBV subgenotype D7/subtype ayw2 among Moroccan HBV chronic carriers. It also showed a significant prevalence of naturally occurring MHR variants in Morocco.

The implication of haemochromatosis (HFE) gene mutations in chronic viral hepatitis remains controversial. The aim of the present study was to assess the frequencies of the common haemochromatosis gene mutations in Moroccan subjects with chronic viral hepatitis B and C. H63D and C282Y mutations were screened by using polymerase chain reaction followed by restriction fragment length polymorphism analysis in 170 chronic hepatitis B patients, 168 chronic hepatitis C patients and 200 healthy controls. The distribution of allele frequency was then compared between different groups of patients. No subject homozygous for the C282Y mutation was found while 1.76% and 0% were heterozygous for this mutation in HBV and HCV patients, that is, rates not statistically different from those observed in healthy control (2%, 0.129

Hepatitis C virus (HCV) evolution is a highly dynamic process. There is little information about molecular epidemiology of HCV isolates in Morocco, an area known for an intermediate prevalence of HCV infection. The primary aim of this study was to determine the subgenotype distribution of HCV strains in patients with chronic HCV infection in Morocco and an eventual association between HCV subgenotypes and liver cancer. The secondary aim was to estimate the prevalence of amino acid substitutions in the HCV core region in treatment-naive patients from Morocco and an eventual association between amino acid substitutions and liver cancer. Serum samples from a total of 185 anti-HCV positive patients were included in this study (81 males and 104 females). The identification of HCV genotype and subtype was respectively performed by sequencing of the 5’UTR and core regions and phylogenetic analysis of the NS5B region. HCV demographic history was inferred using a Bayesian Monte Carlo Markov chain analysis. Of the 174 patients with detectable viremia, the core and the NS5B regions were amplified in 152 (87.4%) and 141 (81.0%) patients respectively. Phylogenetic analysis based on NS5B region revealed that most HCV strains were classified into subtypes 1b (75.2%) followed by subtypes 2i (19.1%), 2k (2.8%). Subtypes 2a, 1a, and 4a were found in a single patient. HCV subtype 1b had an even higher prevalence in liver cancer cases (84.4% vs 67.5% in chronic hepatitis, P= 0.031). Using a Bayesian approach, the mean date of appearance of the most recent common ancestor was estimated to be 1910 for HCV-1b and 1854 for HCV-2i. Based on core region, mutations at R70Q or L91M were detected in more than one fourth of patients infected with HCV 1b.