La Peste Noire : une pandémie qui a métamorphosé le monde

La peste noire du XIVe siècle (1348-1353), responsable de la mort de la moitié de la population en Europe et dans les pays musulmans, constitue un événement exceptionnel dans l’histoire de l’humanité. Par les pertes démographiques qu’elle a occasionnées et les perturbations économiques qu’elle a provoquées, elle a bouleversé le cours de l’histoire pour plusieurs siècles. En ces temps de pandémie mondiale, il serait instructif de se remémorer le moment crucial de la peste noire, afin de scruter les horizons des changements que ne manquera pas de provoquer la pandémie du Covid- 19

Imagerie de la maladie de Creutzfeldt Jacob sporadique

Les encéphalopathies spongiformes subaiguës transmissibles (ESST) sont des maladies infectieuses, neurodégénératives et génétiques. Elles sont caractérisées par la présence d’une substance protéique : le prion. L’imagerie par résonance magnétique (IRM) encéphalique peut actuellement contribuer au diagnostic des ESST. Nous rapportons le cas d’une patiente de 70 ans qui présenta en Juin 2004 un syndrome démentiel avec myoclonies, d’aggravation rapide et d’évolution fatale. L’électroencéphalogramme (EEG) objectivait une activité de fond ralentie et symétrique sans activité périodique. L’IRM encéphalique montrait des hypersignaux au niveau des noyaux gris centraux surtout du striatum mais aussi au niveau cortical. L’étude du Liquide céphalorachidien (LCR), trouvait une cytochimie normale avec présence de la protéine 14-3-3. Les sérologies syphilitiques étaient négatives, la sérologie de l’hépatite C positive et le bilan thyroïdien normal. Le diagnostic de maladie de Creutzfeldt Jacob sporadique probable a été retenu. Une preuve anatomopathologique est le seul moyen d’obtenir un diagnostic certain dans les ESST, l’apport de l’imagerie et surtout les nouvelles techniques d’IRM peuvent être d’une aide précieuse dans le diagnostic des maladies à prion. Dans les formes sporadiques, l’IRM peut mettre en évidence des hypersignaux des NGC visibles sur les séquences T2, Flair ou de diffusion, ce qui peut être un argument pour le diagnostic de MCJ sporadique chez un patient présentant une démence d’évolution rapide

Clinical and genetic data of Huntington disease in Moroccan patients

Background: Huntington's disease (HD) occurs worldwide with prevalence varying from 0.1 to 10 /100,000 depending of the ethnic origin. Since no data is available in the Maghreb population, the aim of this study is to describe clinical and genetic characteristics of Huntington patients of Moroccan origin.Methods: Clinical and genetics data of 21 consecutive patients recruited from 2009 to 2014 from the outpatient clinic of six medical centers were analyzed. Statistical analysis was performed using descriptive statistics.Results: Twenty one patients from 17 families were diagnosed positive for the IT15 gene CAG expansion. Clinical symptoms were predominantly motor (19/21). Twelve patients had psychiatric and behavioral disorders, and 11 patients had cognitive disorders essentially of memory impairment. Analysis of genetic results showed that 5 patients had reduced penetrant (RP) alleles and 16 had fully penetrant (FP) alleles. The mean CAG repeat length in patients with RP alleles was 38.4 ± 0.54, and 45.37 ± 8.30 in FP alleles. The age of onset and the size of the CAG repeat length showed significant inverse correlation (p <0.001, r = -0.754).Conclusion: Clinical and genetic data of Moroccan patients are similar to those of Caucasian populations previously reported in the literature.Keywords: Huntington disease/diagnosis, Huntington disease/epidemiology, Huntington disease/genetics, Trinucleotide repeat expansio

Clinical and genetic data of Huntington disease in Moroccan patients

Background: Huntington's disease (HD) occurs worldwide with prevalence varying from 0.1 to 10 /100,000 depending of the ethnic origin. Since no data is available in the Maghreb population, the aim of this study is to describe clinical and genetic characteristics of Huntington patients of Moroccan origin. Methods: Clinical and genetics data of 21 consecutive patients recruited from 2009 to 2014 from the outpatient clinic of six medical centers were analyzed. Statistical analysis was performed using descriptive statistics. Results: Twenty one patients from 17 families were diagnosed positive for the IT15 gene CAG expansion. Clinical symptoms were predominantly motor (19/21). Twelve patients had psychiatric and behavioral disorders, and 11 patients had cognitive disorders essentially of memory impairment. Analysis of genetic results showed that 5 patients had reduced penetrant (RP) alleles and 16 had fully penetrant (FP) alleles. The mean CAG repeat length in patients with RP alleles was 38.4 \ub1 0.54, and 45.37 \ub1 8.30 in FP alleles. The age of onset and the size of the CAG repeat length showed significant inverse correlation (p <0.001, r = -0.754). Conclusion: Clinical and genetic data of Moroccan patients are similar to those of Caucasian populations previously reported in the literature

Deep Brain Stimulation in Moroccan Patients With Parkinson's Disease: The Experience of Neurology Department of Rabat

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

Neurolinguistic and acoustic study of logopenic Primary Progressive Aphasia in Arabic

The primary progressive aphasia (PPA) or Mesulam syndrome is an isolated and progressive deterioration of language, usually due to progressive focal atrophy of the left peri sylvian regions. Given that very little data on PPA is available in non-Western languages in the literature, we describe the first case of logopenic PPA in Arabic. Neuropsychological, neuroimaging and linguistic protocol have been administered to the patient. The Neurolinguistic assessment was carried out with the Moroccan version of the Montreal-Toulouse linguistic exploration protocol, the apraxia of speech protocol, the Moroccan version of MLSE (Mini-Linguistic Status Examination); some subtests of the BDAE (Boston Diagnostic Aphasia Examination) while the computerized acoustic analysis was performed with Vocalab4 ™. The acoustic analysis showed mainly instability in pitch and amplitude. However articulatory disruptions are very mild in our case. There is a parallelism between spoken language which is marked by phonological paraphasias with a „pseudostuttering „and written language disorder which displays a phonological alexia, a severe acalculia and an agraphia. Our pa tient presents L-PPA subtype 1 on the logopenic spectrum. These results are consistent with the neuropsychological hypothesis of a dysfunction in phonological buffer reflecting the features of logopenic PPA. Furthermore, our case displayed atypical neurolinguistic patterns in comparison with other cases described in the European languages due to the Arabic specific linguistic structure

Socioeconomic status and stroke prevalence in Morocco: results from the Rabat-Casablanca study.

BACKGROUND: Stroke is a growing public health concern in low- and middle- income countries. Improved knowledge about the association between socioeconomic status and stroke in these countries would enable the development of effective stroke prevention and management strategies. This study presents the association between socioeconomic status and the prevalence of stroke in Morocco, a lower middle-income country. METHODS: Data on the prevalence of stroke and stroke-related risk factors were collected during a large population-based survey. The diagnosis of stroke in surviving patients was confirmed by neurologists while health, demographic, and socioeconomic characteristics of households were collected using structured questionnaires. We used Multiple Correspondence Analysis to develop a wealth index based on characteristics of the household dwelling as well as ownership of selected assets. We used logistic regressions controlling for multiple variables to assess the statistical association between socioeconomic status and stroke. FINDINGS: Our results showed a significant association between household socioeconomic status and the prevalence of stroke. This relationship was non-linear, with individuals from both the poorest (mainly rural) and richest (mainly urban) households having a lower prevalence of stroke as compared to individuals with medium wealth level. The latter belonged mainly to urban households with a lower socioeconomic status. When taking into account the urban population only, we observed that a third of poorest households experienced a significantly higher prevalence of stroke compared to the richest third (OR = 2.06; CI 95%: 1.09; 3.89). CONCLUSION: We conclude that individuals from the most deprived urban households bear a higher risk of stroke than the rest of the population in Morocco. This result can be explained to a certain extent by the higher presence of behavioral risk factors in this specific category of the population, which leads in turn to metabolic and physiological risk factors of stroke, such as obesity, diabetes, and hypertension

Lifestyle differences among socioeconomic groups in urban and rural areas (mean comparison test).

<p>Notes:</p>a<p>t-test for comparing means between tertile 1 and tertile 3.</p>b<p>Number of years of schooling successfully completed.</p>c<p>Number of consultations over the last 12 months, obtained by interview. All types of providers were considered including medical and paramedical staff, and traditional healers (herbalist or fkih).</p>d<p>Frequency of consumption obtained by interview. Figures range from 1 (every day) to 5 (never). The higher the value, the lower the frequency of consumption.</p

Lifestyle differences among socioeconomic groups in urban and rural areas (test of proportions).

<p>Notes:</p>a<p>χ² test for comparing proportions between tertile 1 and tertile 3.</p>b<p>smoker status obtained by interview.</p>c<p>practice of a sport status obtained by interview, type and frequency of sport activity were not recorded.</p

Association of SES and history of stroke in study population aged over 15yrs (N = 44,742), wealth index introduced in tertiles (Model 2).

<p>Notes: *** significant at 1%; ** significant at 5%; * significant at 10%.</p><p>Coeff.: Coefficient; OR: Odds Ratio; CI: Confidence interval.</p>a<p>Odds ratios adjusted for wealth index, age, gender, history of hypertension, diabetes, heart disease, neuropsychiatric disorders, rheumatism and other chronic diseases (prior to stroke).</p>b<p>P-value provided for Hosmer-Lemeshow test.</p