Search

Funding Acknowledgements Type of funding sources: None. Background Global Cardiovascular (CV) mortality is highly increasing, mainly in low and middle-income countries because of lifestyle change and the rise of cardiovascular risk factors. Controlling these risk factors is very important to reduce cardiovascular disease morbidity and mortality. Risk factor control is particularly important in patients with established cardiovascular disease since these patients are at very high cardiovascular risk. SURF is an international and simple clinical audit that aims to record and manage cardiovascular risk factors in patients with established coronary heart disease (CHD). The goal of this analysis is to investigate risk factor recording and management in secondary prevention of CHD in the Moroccan population, a country considered as a very high CV risk according to the European Society of Cardiology. Methods Data of Moroccan patients with documented coronary heart disease (including stable angina pectoris, acute coronary syndrome, PCI and CAGB) were collected via an online survey during routine clinic visits. Patients’ demography, risk factors, physical and laboratory measurements, and medications were recorded. Results A total of 324 patients were recruited in 3 different centers in Morocco. There was a male predominance (81.5%) and mean age was 66.5 (SD 10.6) years. Recording of risk factors was high for smoking (96.7%), physical activity (97.3%) and blood pressure (87.8%). However, for some risk factor measurements like LDL cholesterol (recording 29.9%), information was often missing. Risk factor recording in Morocco was higher than the North Africa and Eastern Mediterranean (NAEM) regional and global estimates for smoking and physical activity; similar for blood pressure; and lower for LDL levels. Considering the attainment of risk factor goals defined by clinical guidelines, 79.6% of patients never smoked or quit smoking, and 25.0% were practicing physical activity at least 30 min 3-5 times a week. Regarding risk factor measurements, 38.2% had blood pressure Conclusion The patients enrolled in our registry have multiple modifiable risk factors, with a poor control. The results underline the need for interventions to improve secondary prevention of CHD in Morocco.

Introduction Peyronie's disease is a widespread and potentially disabling condition affecting patients’ quality of life. Practitioners and researchers should explore the different approaches proposed to optimize management and tailor it to the patient. Objective To evaluate the efficacy and reproducibility of a semi-invasive protocol for Peyronie's disease made of "optimized" platelet-rich plasma (PRP) injections + penile traction + Phosphodiesterase type 5 (PDE5) inhibitors. Methods The study selected 12 patients who presented with the typical symptomatology of Peyronie's disease for less than 18 months with a curvature of less than 60° and had not received any other medical therapy. The average age was 49 years. 8 patients had a single plaque while 4 had multiple locations. The protocol consisted of 6 sessions of PRP injection, associated with a stretching of the penis and a daily intake of 5mg of Tadalafil. The parameters collected before and after the protocol were: Angulation of the penis, pain Visual Analogue Scale (VAS) on intercourse, International Index of the erectile function-5items (IIEF5), plaque size on ultrasound as well as the Peyronie Disease's Questionnaire scale (PDQ). Protocol description: - PRP injections: 6 injection sessions at one-week intervals. Each session is performed as follows: 1) Autologous collection of 10ml of blood which will be centrifuged at a force of 1500g RCF for 10min, only the supernatant plasma will be taken, avoiding the buffy coat which will only maintain an inflammatory reaction and will considerably reduce the activity of the PRP. 2) Performing a penile block with pure lidocaine 7ml on each side, avoiding peri-platelet injections which will lead to a significant decrease in platelet functionality. 3) Mechanical fragmentation of the plaques with an 18G or 25G needle depending on the sensitivity of the subject, after manual or ultrasound identification, is an essential time of the protocol conditioning the result. 4) Plasma injection around and inside fibrous plaque of the albuginea - Penile traction therapy (PTT): Throughout the protocol, the patient will stretch his penis for one hour, three times a day minimum. - Daily intake of 5mg of Tadalafil. Results The patients were well informed and followed the same protocol during the 6 weeks. The evaluation was done 3 months after the first injection: - Improvement in mean angulation: from 34° to 16°. - Significant decrease in pain during intercourse: from 57% to 22%. - Improvement of the average IIEF5 score: from 14 to 18.75 - Decrease in average plaque size: from 15mm to 6.7mm (55% reduction) - Improvement of PDQ scale in 91% of subjects. No infectious complications were noted. Only one subject reported a minimal hematoma at the injection site during a single session. Conclusions This study requires confirmation in a longer series of cases, but the preliminary results of this safe, reproducible, and very inexpensive protocol are promising and should encourage practitioners to adopt it, especially in low and middle-income countries. Disclosure No

Introduction Recent studies suggested that younger women were more likely to suffer from an ischemic stroke than men of the same age. Purpose Our aim is to confirm whether younger women in France are more exposed to ischemic strokes. Methods We compared male and female one-year hospitalization numbers for ischemic stroke in different age groups in France. We also used the French population data by sex and similar age group. Chi-square Tests of Homogeneity were used to assess statistical significance of the differences among men and women hospitalization numbers for each age group. Results Women in the age group 15–24 y-o experienced more ischemic strokes than men (151 hospitalizations for women vs 113 for men; p=0,0088). In the 25–34 y-o group, no differences were found between men and women (385 hospitalizations for men vs 370 for women; p=0,3497). In the 35–44 y-o group, women experienced less ischemic strokes than men (906 hospitalizations for women vs 1200 for men; p Conclusion Younger women (15–24 y-o) are at higher risk of ischemic strokes than men of the same age in France. As far as ischemic stroke incidence is rising among young adults in France, an urgent awareness should be raised and further studies should focus on the possible etiologies. Funding Acknowledgement Type of funding sources: None.

Funding Acknowledgements Type of funding sources: None. Introduction Cardiovascular diseases are usually known as men’s diseases, and many beliefs tend to assert that women are protected by their hormones before menopause. However, in France, women are suspected to die more than men due to acute cardiovascular disease. Purpose Our aim is to confirm this excess women mortality and to propose a new indicator in order to assess the probable delay in diagnosis and hospital care in acute cardiovascular settings among women. Methods We focused on major acute cardiovascular pathologies : Pulmonary Embolism (PE), Myocardial Infarction (MI) and Stroke. We compared males and females death numbers for these diseases. Deaths were age-standardized in order to assess mortality differences by sex. Then we suggested a new ratio which relates number of hospitalizations to number of deaths for each one of the three cardiovascular pathologies. Results Women died more than men from acute cardiovascular pathologies in France between 2000 and 2016. Stroke is the first cause of death from acute cardiovascular disease in women in 2016. Men’s Standardized Mortality Ratio (SMR) over women’s SMR was in favor of an excess man mortality when age bias is taken into account (SMR men/SMR women = 1,18 for PE, 1,25 for Stroke and 2,16 for MI). The new indicator (HD) was lower in women for Stroke and Myocardial Infarction (3,23 and 3,08 in females versus 5,05 and 4,72 in males, respectively). Conclusion Women in France die more than men from cardiovascular causes. This new indicator should contribute to a better understanding of delays in diagnoses and care in acute cardiovascular settings among women. Imperative measures should be taken in order to reverse the excess women mortality trend.

Lymphatic malformation (ML), formerly called cystic lymphangioma is a benign hamartomatous tumor of lymphatic vessels. The onset of lymphangiomas is either at birth (60% to 70%) or up to two years of age (90%) and rare in adults. These malformations can occur in any region of the body, Lymphangiomas have marked predilection for the head and neck region (50% - 70%). The most common location in the mouth is the dorsum of tongue. If the positive diagnosis is generally easy, the therapeutic management remains controversial. We report the clinical case of a 23-year-old adult patient with cystic lymphangioma on the floor of the oral cavity extending gradually to the right submandibular region. The clinically suspected tumor was thoroughly explored using tomodensitometry. The treatment consisted of complete resection by a cervicotomy with histological examination confirming the macroscopic diagnosis of cystic lymphangioma. Follow-up at 3 years showed no recurrence.

Highlights • The diagnosis of primary malignant tumors is increasingly described with the improvement of life expectancy and the advent of new technologies. • The management must be multidisciplinary and adapted to the condition of each patient. This entity affects elderly people with many comorbidities. • Treatment should be the least aggressive and start with the most aggressive tumor. • The elderly, a family history of neoplasia and smoking appear to be the factors favoring the appearance of multiple synchronous tumors. Our patient was an elderly person and a heavy smoker, Introduction The simultaneous appearance of several primary cancers is rare. Presentation We report the case of a 77-year-old man admitted to the Mohammed V military hospital in Rabat (university hospital) and presenting severe dysuria on the PSA test which was 10.83 ng / ml. The prostate MRI performed revealed a suspected lesion. He had left renal colic associated with hematuria two weeks later. A CT scan of the abdomen and pelvis performed revealed a 14 × 12 mm middle and lower calyx excretory tract tumor on the left and a 27.6 × 26.4 lower right polar kidney tumor enhanced after injection of product from contrast. The prostate biopsy confirmed an adenocarcinoma of the prostate. He first underwent a left nephroureterectomy for the tumor of the excretory tract, followed by radiotherapy combined with hormone therapy for his adenocarcinoma. It was decided to monitor the tumor of the right kidney. Discussion The literature contains only a few case reports and reviews of patients with three or more synchronous malignancies. We report the case of a man in whom three different cancers were found over a period of three months. The patient had no significant medical history, such as a family history of cancer or chemotherapy other than old age and chronic smoking. Therefore, we suggest that these factors may favor the occurrence of several synchronous primary cancers. Conclusion There is no consensus on the treatment of multiple malignant tumors. Patient care is individual, by a multidisciplinary team, accounting for the type and the stage of each tumor with a more conservative approach.

Prostate cancer (PCa) remains the second cause of cancer death in men, it is a public health problem especially in elderly patients with 35.5% cases diagnosed after 75 years...

Schwannomas of the descending loop of the hypoglossal nerve are very rare. Existing literature of the schwannoma of the descending loop of the hypoglossal nerve is limited to two previously reported case. They are slow-growing tumors that may masquerade a carotid body tumor. We herein described a rare case of schwannoma of the descending loop of the hypoglossal nerve in the s right latero-cervical region with diagnostic imaging and histopathological findings. A 37-years-old woman has had a palpable firm, mobile mass in the right latero-cervical region, of imaging, MR images showed homogeneous hypointensity on T1-weighted imaging (T1-WI), heterogeneous hyperintensity on T2-WI, and heterogeneous enhancement on contrast-enhanced T1-WI. Diagnostic imaging using computed tomography (CT) and magnetic resonance imaging (MRI) was suspected of Chemodectoma or neurogenic tumor. At operation, a 4 cm mass arising from the descending loop of the hypoglossal nerve of was resected en bloc with the loop itself; Final diagnosis was confirmed on the basis of histopathological finding and intraoperative findings. Postoperative course was uneventful and the patient is free from disease recurrence at tree-year follow-up. En bloc resection remains the real curative treatment of Schwannomas, ensuring unlimited freedom from disease, although causing functional impairment which may be significant. Nonetheless recurrence should be prevented as, besides requiring reintervention, it may harbor a malignant evolution towards sarcoma. Schwannomas of the descending loop of the hypoglossal nerve may masquerade a chemodectoma of the carotid bifurcation and can be curatively resected without any functional impairment. This case confirmed the differential diagnosis on the basis of the intraoperative finding that the tumor was continuous with the hypoglossal nerve.

In this work, binding characteristics of two hydrophilic nutraceutical models, namely epigallocatechin gallate (EGCG) and folic acid (FA), to sodium caseinate were studied by fluorimetry technique. EGCG‐loaded casein molecules were then converted to either re‐combined casein micelles (r‐CMs) or casein nanoparticles (CNPs). Binding stoichiometry of EGCG and FA was 0.81 and 1.02, respectively. As determined by DLS technique, the average particle size of r‐CMs prepared at 0.5% concentration was 66.2 nm. Thermal treatment (74°C, 20 s) had significant (p

Radio-Histological Correlations of Parotid TumorsThe salivary gland tumor pathology remains relatively rare, representing 3 to 4% of all tumors of the head and neck...

INTRODUCTION Centralized preparation of anticancer drugs meets quality and safety objectives. Its economic interest has been the subject of several studies, with very heterogeneous methodological approaches. OBJECTIVE This study evaluates the economic impact of the centralization of the preparation of chemotherapy in the national institute of oncology of Rabat, the referral institute in the management of cancer in Morocco. MATERIALS AND METHODS The analysis included 3000 preparations. It compared the costs of anticancer drugs in a centralized unit at theoretical costs in the healthcare units, modelled according to two approaches. RESULT With a conservative approach, the impact of centralization was estimated at 80%. The centralized system made it possible to materialize 80% of the potential gain. The remaining 20% is considered a loss. It was very much related to the preparation of the expensive molecules (90%). CONCLUSION Centralization thus allows a better distribution of roles within the hospital and provides a source of self-financing for quality improvement.

Pumpkin oil cake protein isolate (POCPI) was hydrolysed using two food-grade enzymes alcalase and trypsin. Alcalase-hydrolysed POCPI (POCPH1) was selected as the optimum treatment based on the DPPH radical scavenging, total antioxidative, and ferrous ion chelating activities. Amino acid composition showed a direct relationship between the antioxidative activity of POCPH1 and the amount of hydrophobic amino acids that formed 33.49% of its total amino acids. Surface hydrophobicity decreased as a result of hydrolysis and potent thermal and pH stability was observed in POCPH1 (p ˂ 0.05). In terms of molecular weight distribution, size exclusion chromatogram indicated that the majority of peptides possessed molecular weight less than 6.5 kDa. Based on the results, POCPH1 could be employed as a natural antioxidative agent with strong pH and thermal stability.

Background Chemical risk is the result of occupational exposure to a chemical agent. This exposure can induce several effects that can cause fatal intoxications. Purpose The purpose is to assess the risks related to the chemical reagents used in the control laboratory and to propose preventive measures to reduce these risks. Material and methods We used a tool named OPERA ‘First Chemical Risk Assessment Tool by Activity Analysis’. It allows to quantify the level of severity of the chemical risk and to guide its reduction. The quantification of the level of severity is established by giving the information on the label or on the material safety data sheet: the nature of the risk; the nature of the safety; the conditions of use products; and the respect of safety measures. Two scales of values have been established: the first allows the qualification of the level of severity of the risk and the second prioritises the setting up of an action. Results Our analysis is established for 85 chemical reagents in the laboratory. Twenty-four per cent of the reagents are classified as non-hazardous, such as calcium carbonate. As for the ‘dangerous’ products, the analysis showed that 37% of these reagents present a high to very high risk, such as formaldehyde, 42% have a medium risk such as nitric acid and 21% pose a low to very low risk such as acetone. Our second aim was to reduce risks, so we have proposed preventive measures such as the use of personal protective equipment (mask, gloves) and collective (hoods). The levels of risk have significantly decreased: 82% of the reagents with a very low risk and 12% have a medium risk. The products that have kept a very high severity are used rarely and in small quantities. Conclusion Our results concord with the literature. We have demonstrated that the level of severity of reagent is manageable by acting on two risk factors: the respect of the safety measure of each chemical and the exposure of the operator to the operations carried out. Reference and/or acknowledgements Abecassis P. La methode Oper@ pour l’evaluation chiffree du risque chimique. Arch Malad Profession Environ 2004;65:2–3. No conflict of interest.

Background The lack of quality control of cytotoxic preparations can reduce the security of the chemotherapy circuit. In fact, an overdose may result in serious side effects at the expense of treatment efficiency. On the other hand, a sub-dosage can compromise treatment efficiency and potential recovery, especially in children. Purpose The aim of this pilot trial is to develop and to validate an analytical method to control the concentrations of etoposide preparations in hospital. Material and methods It is a fast, simple qualitative and quantitative analysis, using UV spectroscopy. Appropriate aliquot portions of etoposide solution (20 mg/ml) were diluted in NaCl 0.9% to obtain a calibration range covering all paediatric therapeutic concentrations. Solutions were scanned in UV-visible for identification. Absorbances of solutions were measured at 283 nm and a calibration curve was constructed. For samples, we prepared 10 etoposide preparations. One mL was withdrawn from each bag and diluted with NaCl 0.9%. Absorbances of samples were measured in 283 nm and amounts of etoposide were determined by referring to the calibration curve. The validation of the method was carried out according to guideline ICH Q2. Results Etoposide was identified qualitatively by comparing absorption spectra of the samples to reference spectra. The same spectra were observed with a wavelength of maximum absorption (283 nm). For quantitative analysis, the proposed method has successfully estimated the amount of etoposide. Linear regression of absorbance gave equation y=0.0085x–0.0022 with R2=0.9992. Relative standard deviation was 0.56, indicating that the method was precise. Results also showed good accuracy. Our method is easier and more accurate than any other methods published in the literature, such as gravimetric and balance control. Conclusion This trial is the first in our hospital centre and in our country. The method was validated and the concentrations of all samples were exact, and it can be used for routine quality control analysis of etoposide. This trial allows us, in the future, to implement analytical control for all cytotoxic measured by UV-visible. Reference and/or acknowledgements Basuyau F. Comparaison de deux mesures physiques pour le controle de la dose des preparations injectables de medicaments anticancereux avant administration: application au 5-FU. J Pharma Clin 2000;19. No conflict of interest.

Background The medical prescription is the main document of communication between the doctor, the pharmacist and the patient. The careful writing of this document enables the reduction of many therapeutic errors. Purpose The purpose of this work was to evaluate the quality of the form of medical prescriptions from public hospitals and private clinics. Material and methods This was a transversal descriptive study of 210 medical orders. The quality of the form was evaluated using two parameters: the presence of the obligatory mentions and their legibility. An analysis grid with several items was used to collect the information needed to describe the form quality of the medicinal prescriptions. The pharmacist used a scale of 1 to 3 to evaluate the readability of prescriptions. Results In our study, 210 patients were included taking a total of 588 drugs. 28.57% (60) medical prescriptions came from public hospitals, while 71.42% (150) prescriptions stemmed from private clinics. For all the medical prescriptions analysed, only 21 were computerised and came from private clinics. Only one medical prescription from a public hospital was undated. All prescriptions were written with commercial drug names. In the sample studied, 15.71% (33) prescriptions had no patient identity (first and last name) and came from public hospitals. Only six medical prescriptions contained the age and weight of the patient and came from private clinics. The identity of the prescribing physician was absent in 14.2% (30) medical prescriptions and 38.57% (81) medical prescriptions did not contain a treatment period. Among the medical prescriptions reviewed, 10% (21) were deemed illegible by the pharmacist, while 40% (84) were considered difficult to read. Conclusion This study shows that prescriptions from public hospitals have serious incoherence compared to those from private clinics. This is due to the high number of patients who consult in public hospitals. This work has also demonstrated that hand-written medical orders give several non-compliance. The teaching of order-writing technique and its computerisation are required to improve the quality of medical prescribing. References and/or acknowledgements Dr Mamouni Alaoui Faical. No conflict of interest.

Background The new ICH Q3D guideline has been recently developed to define and provide a global policy for evaluating and limiting elemental impurities in drug products. Thus, a risk assessment and appropriate control of elemental impurities according to this guideline have become necessary. Purpose The purpose of this study was to explain the risk assessment approach for limiting the presence of elemental impurities in the drug substance. Material and methods According to the guideline ICH Q3D, the identification of elemental impurities of concern and their potential sources of occurrence is realised. The possible levels of elemental impurities were determined based on the published literature and provided information from suppliers. For high-risk elemental impurities, class 1 and class 2A, they we determined by the ICP-MS method. The determined level was then compared with the Permitted Daily Exposure defined in ICH Q3D. All of these assessment results were summarised into one single assessment sheet for each manufacturing step. Results The potential sources of elemental impurities have been identified and several possible sources of class 1 and 2A elemental impurities have been identified. Based on the information in the assessment sheet, an appropriate control point in the manufacturing process and control method were determined. Additionally, the information was included in the assessment sheet to show the control strategy. Conclusion The risk analysis approach provides a complete risk assessment of potential elemental impurities in the drug substance. All potential sources of elemental impurities of concern for the manufacturing process of the drug substance were mapped together with the control strategy in the proposed assessment sheet. This assessment sheet is considered to also be useful for the life-cycle management of the drug substance. References and/or acknowledgements Dr Mamouni Alaoui Faical. No conflict of interest.

Background Cross-contamination of hospital preparations is one of the most frequent problems in hospitals. It is responsible for quality defects of the drug and the consequences can be very serious. The failure mode and effects criticality analysis (FEMECA) is a simple and effective tool for minimising the high risk related to the cross-contamination of preparations. Purpose The aim is to realise a risk analysis using FEMECA, focused on the preparation process of anti-cancer drugs in a paediatric hospital and to propose corrective and preventive actions in minimising the risks. Material and methods The first step was to carry out a cause-effect diagram (Ishikawa diagram), that facilitates the identification of possible causes of cross-contamination during preparation. After that, we identified all failure modes and possible risks for each step of the preparation process and we listed each failure mode, and assigned a score for likelihood occurrence (1 to 4), severity (1 to 4) and detection (1 to 4). Finally, the risk priority number was calculated by multiplying the three scores and identifying the critical points associated with preparation. The rating of each criterion is based on predetermined rating tables. Results We classified the identified risks according to their criticality, and defined priority areas of work. Thus, the criticality values suggest focusing on five major risks in priority: contamination of the hood; contaminated materials (syringes, serum pouch); bad identification of materials; errors in the use of raw materials; and poor cleaning. Improvement measures have been defined and implemented to reduce major risks to an acceptable level, such as: training preparers in good manufacturing practices; cleaning; biodecontamination of materials before preparation; and development of a cleaning procedure. Conclusion In general, FEMECA gave satisfactory results, with no critical risk and 30% of the major risks decreased after the implementation of corrective and preventive actions. The continuous training of staff, the traceability of each stage of the process and the good organisation of the circuit makes it possible to reduce the risk of cross-contamination and to guarantee good quality preparations that can be administered safely to the patient. References and/or acknowledgements 10.1136/ejhpharm-2018-eahpconf.470 No conflict of interest.

Background Emulsions form the basis of a wide range of manufactured products in the pharmaceutical domain. They are constituted by at least two non-miscible liquids. However, instability is the major inconvenience of these galenic forms. Purpose Paraffin oil and gum arabic are used in the formulation of the oil-in-water emulsion type, which has a lot of applications in drug delivery, either as a medicament or as a vehicle. In the hospital pharmacy, the emulsion for intravenous administration, for example, must be the oil-in-water type. However, a good stability is required. The aim of the present study is the formulation of emulsion based on paraffin oil and to evaluate the influence of gum arabic content and mixing rate on the stability of emulsions. Material and methods Distilled water was used as a dispersant phase (75%) and paraffin oil as a dispersed phase (20%). Tween 80 and Span 80 served as mix surfactants (60/40). The formulation was performed according to the Lipophilic Balance-Hydrophilic (HLB) method. Gum arabic concentrations ranging from 2.5%–10% w/w were used. The stability of the emulsions was evaluated by centrifugation at 4000 rpm for 15 min. The creamer index (IC) was used for the interpretation of the results. The emulsions thus prepared are mixed at 4000, 8000 and16000 rpm for 10 min. Results The IC of emulsions ranged from 29%–30% with a HLB of 10.72. High levels of gum arabic (10, 7.5 and 5% (w/w)) increased the creaming, therefore the stability was decreased. After addition of 2.5% (w/w) of gum arabic, 1.6% creaming was observed. In 3% (w/w) gum arabic-containing emulsion, no creaming was observed. Microscopic images of emulsions mixed at 4000, 8000 and 16000 rpm, showed that emulsion prepared at 16000 rpm had homogeneously distributed individual small droplets with no sign of flocculation compared to the others. Conclusion The present experiment has shown that a concentration of 3% w/w gum arabic, and a mixing rate of 16000 rpm provided the optimum stability of oil-paraffin emulsion. Reference and/or acknowledgements Ramin L, et al. Soy protein isolate and gum arabic composite affects stability of beverage emulsion. Iran J Chem Eng 2009;6. No conflict of interest.