Evaluation of the cost of cervical cancer at the National Institute of Oncology, Rabat

Introduction: The Cervical Cancer (CC) is one of the heavy and costly diseases for the population and the health system. We want to know through this study, the first in Morocco, the annual cost of the treatment of this disease at the National Institute of Oncology (NIO) in Rabat, we also want to explore the possibility of flat-rate management of this disease in order to standardize medical practices and improve reimbursement by health insurance funds. Methods: 550 patients were treated for their cervical cancer in the Rabat's NIO. Data of all of medical and surgical services offered to patients were collected from the NIO registry. The cost of care was assessed using the method of micro-costing. We will focus to the total direct cost of all the services lavished to patients in NIO. Results: The global cost was about US$1,429,673 with an average estimated at US$ 2,599 ± US$ 839. Radiotherapy accounts for 55% of total costs, followed by brachytherapy (27%) and surgery (7%). This three services plus chemotherapy influence the overall cost of care (p <0.001). Other services (radiology, laboratory tests and consultations) represent only 10%. The overall cost is influenced by the stage of the disease, this cost decreased significantly evolving in the stage of CC (p <0.001). Conclusion: The standardization of medical practices is essential to the equity and efficiency in access to care. The flat-rate or lump sum by stage of disease is possible and interesting for standardizing medical practices and improving the services of the health insurance plan.Pan African Medical Journal 2016; 2

Endovascular treatment of acute aortic isthmian ruptures: case study

Traumatic rupture of the aortic isthmus is a rare lesion occurring in patients subjected to violent deceleration. Because of the forces involved, it is frequently associated with concomitant life-threatening injuries. The endovascular intervention has been described to be a feasible and efficient technique which may be proposed as a therapeutic option for patients with multiple traumas instead of delayed classical surgical repair after stabilization. We report the case of an adult who has had an accident with a traumatic rupture of the aortic isthmus associated with other lesions, our patient received endovascular treatment. The aortic prosthesis was imported from France and the surgery was done 3 days after the patient's admission. This procedure was performed for the first time in Morocco in our hospital with a multidisciplinary team. The prosthesis was implemented successfully and the result was very satisfactory on the heart level.Keywords: Endovascular treatment, aortic isthmian ruptures, endovascular prosthesi

RAPID IMPLEMENTATION OF REAL-TIME REVERSE-TRANSCRIPTION POLYMERASE CHAIN REACTION (REAL-TIME RT-PCR) ASSAY FOR THE DETECTION OF SARS-COV-2 IN A MOROCCAN HOSPITAL

Background: The main challenge faced in the African countries was to implement efficient molecular diagnostic facilities and start Covid-19 diagnosis as fast as possible to handle the rapid and unpredictable rise of cases. Materials, Methods and Results: We describe our experience in implementing a molecular biology unit at Sheikh Zaïd International University Hospital in Rabat, with a delay as short as one week, and starting real-time RT-PCR assay for the detection of SARS-Cov-2 infection, since the outbreak widened in Morocco in mid-March, 2020. Conclusion: The challenges encountered in the first period of Covid-19 pandemic are still present. This work aims to give an example of a rapid and adaptive response in order to maintain our diagnosis ability for Covid-19 and for other pathogen

Green synthesis of novel biocomposites from treated cellulosic fibers and recycled bio-plastic polylactic acid

This study investigated mechanical properties of biocomposites developed from recycled polylactic acid (PLA) from packaging industry and treated cellulosic fibers from pulp and paper solid waste. Microwave and enzymatic treatments were used for extraction and surface modification of hydrophilic cellulosic fibers. Enzymatic treatment was specifically performed for activation of hydroxyl groups and improvement of adhesion between matrix and fibers including controlling the length of cellulosic fibers with size reduction of around 50% (142 and 127 mm for primary and mixed biosolids, respectively) as compared to microwave treatment. Microwave treatment produced cellulosic fibers of 293 and 341 mm, for primary and mixed biosolids, respectively. Mechanical properties of biocomposites with 2% (w/w) of treated cellulosic fibers (Young's Modulus 887.83 MPa with tensile strain at breakpoint of 7.22%, tensile stress at yield 41.35 MPa) was enhanced in comparison to the recycled PLA (Young's Modulus 644.47 ± 30.086 MPa with tensile strain at breakpoint of 6.01 ± 0.83%, tensile stress at yield of 29.49 ± 3.64 MPa). Scanning electron microscopy revealed size reduction of cellulosic fibers. X-ray diffraction and Fourier transform infrared spectroscopy confirmed strong mechanical properties of novel biocomposites.The authors are sincerely thankful to the Natural Sciences and Engineering Research Council of Canada (Discovery Grant 355254 and NSERC CRD Grant), and CRIBIQ for financial support. We would like to thank Mr. R. Fortin and Colin Jacob Vaillancourt from Gaudreau Environment for providing rPLA samples. Likewise, the support of Ozymes Inc. is equally appreciated for valuable comments during the experimental planning from industrial perspective. Financial assistance by the ‘Fonds de recherche du Quebec- Nature et technologies (FRQNT)’ and INRS-ETE has been thankfully acknowledged by K Hegde.info:eu-repo/semantics/publishedVersio

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance.

Investment in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing in Africa over the past year has led to a major increase in the number of sequences that have been generated and used to track the pandemic on the continent, a number that now exceeds 100,000 genomes. Our results show an increase in the number of African countries that are able to sequence domestically and highlight that local sequencing enables faster turnaround times and more-regular routine surveillance. Despite limitations of low testing proportions, findings from this genomic surveillance study underscore the heterogeneous nature of the pandemic and illuminate the distinct dispersal dynamics of variants of concern-particularly Alpha, Beta, Delta, and Omicron-on the continent. Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve while the continent faces many emerging and reemerging infectious disease threats. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Enterobacteriaceae producing extended-spectrum β-lactamases (ESBLs) colonization as a risk factor for developing ESBL infections in pediatric cardiac surgery patients: “retrospective cohort study”

Abstract Background Children with cardiac defects need many hospitalizations and repetitive antibiotic therapies, with an increasing risk of colonization with multidrug-resistant bacteria (MDRB) such as extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) Post-operative infections with these bacteria in paediatric cardiac surgery are life threatening. This article aims to study the prevalence of ESBL colonization among paediatric cardiac surgery patients, and to compare occurrence of post-operative infections with and without ESBL colonization. We also aim to study the correlation between the onset of postoperative infection and other parameters such as age, length of stay and preoperative antibiotic therapy. Methods A retrospective cohort study included paediatric cardiac surgery patients in Cheikh Zaid hospital in Rabat, Morocco, between the 1st of January 2011 and 31 December 2014. A screening for ESBL colonization was requested for children who had a risk factor (previous hospitalization and/or taking antibiotics) at admission. Swabs were collected from three sites (throat, nose and anus). Two groups were compared – patients colonized and not colonized with ESBLs. Statistical analysis was performed using R software. Results ESBL colonization screening was performed in 111 patients. Positive colonization was detected in 17 cases (15%). Klebsiella pneumoniae (KP): 9 (53%) was the most frequently isolated species. Among the 17 patients, 23.5% (4/17) developed a postoperative infection due to ESBLs versus only one patient without colonization (1%). There was a statically significant difference in terms of occurrence of postoperative infection between the two groups (p = 0.001). Relative risk of developing a postoperative infection with positive colonization was 22 (95% CI, 8.37–58.5). Conclusions The analysis of colonization with multidrug-resistant bacteria and the prevention of nosocomial infections appear to be important challenges for paediatric cardiac surgery. Systematic screening of ESBL colonization for cardiac surgery could have a significant contribution, on one hand to guide prophylactic antibiotic therapy of patients, and on the other, to prevent spread of those infections

Knowledge, attitudes and practices of the liberal doctors in relation to the national convention signed in the framework of Mandatory Health Insurance in Morocco: a cross-sectional study

Introduction: under the Mandatory Health Insurance (MHI) scheme, liberal doctors signed their first national convention in the year of 2006. The delay in renewing this agreement could negatively affect the accessibility of the insured persons to medical care. The objective of this study was to explore the knowledge, attitude and practice of the liberal doctors towards their adherence to the national convention signed under MHI scheme and to propose some improvements. Methods: our study is cross-sectional based on a descriptive survey targeting the population of liberal doctors adhering to the signed convention under the MHI in Morocco. The material used was a questionnaire that was administered to doctors selected. The processing and analyzing of results were performed with SPSS 13.0. Results: the study, conducted in 2016, examines included 40 liberal doctors. 97.5% of them reported dissatisfaction with the National Reference Pricing. 60% of the them were demotivated to the application of the national convention because of the lack in educational materials. There was no significant difference in the attitudes between general practitioners and specialists, all of whom considered that remuneration was unfair under MHI (p = 0.689), they also considered that working conditions have deteriorated (p = 0.256). Conclusion: the behavior of liberal doctors towards the national convention signed within the framework of the MHI hides a general dissatisfaction whatever the place of practice. This dissatisfaction was felt by physicians regardless of their seniority or specialty. Several efforts should be made to find a compromise between doctors and the health insurance system to improve patient access to care

Assessment of non-destructive spectroscopy and chemometrics tools for the development of green analytical methods to determine the shelf-life of olive oils

The development of sustainable and environmentally friendly analytical methods for agri-food products and the modification of reference methods is an essential issue to be treated in green analytical chemistry. The potential application of non-destructive spectroscopic techniques with chemometrics tools to achieve these principles are examined in this work. In this study a new sustainable analytical approach based on the use of fluorescence spectroscopy and multivariate analysis methods of Machine-Learning(Support Vector Machine regression) and chemometrics (Partial Least Square regression) have been developed to control the quality of virgin olive oils in Morocco according to their shelf life. The spectral data of 45 samples were first analyzed by principal component analysis method (PCA), the PCA method shows an important classification of the three groups of olive oil according to their shelf life. The use of the regression methods SVM and PLS shows a high ability to predict the quality of olive oils, this ability is shown by the high value of R-square and the low value of root mean square error of calibration and crossvalidation (RMSEC, RMSECV), the validation of these models by cross-validation shows the potential of this sustainable analytical approach in the determination of the quality of virgin olive oils

Bioequivalence regulation in emerging countries: Example of Moroccan regulations on immediate release formulations and comparison with international guidelines

International audienceThe purpose of this study was to analyze Moroccan regulations on bioequivalence studies and compare them with some international guidelines. It emerged that, as most common guidelines, Moroccan regulations treated essential questions relating to the conduct of bioequivalence studies while remaining general. An effort to harmonize the Moroccan regulations as closely as possible with international guidelines such as European Medicines Agency and World Health Organization was made. The decree 2-12-198 on bioequivalence studies includes worldwide gold standards such as inclusion and exclusion criteria, study design, choice and number of subjects, conduct of the study, pharmacokinetic parameters, BE acceptance criteria, and biowaiver requirements. It specifically addresses issues such as pro-drug, metabolites, urinary samples, and endogenous substances. Specific precisions such as the case of the modified release forms, the replacement of subjects on the withdrawal, or drop-out of a volunteer are not covered by this general decree and should be part of new directives, in the future. For an emerging country, the integration of Biopharmaceutics Classification System biowaivers within the decree confirms the efforts being made by the Moroccan regulations to join the most advanced guidelines on the investigation of bioequivalence and to prepare the International Council on Harmonisation M9 adoption