Evaluation et analyse de l’insomnie en hémodialyse chronique

L'insomnie est aussi fréquente chez les hémodialysés chroniques qu'elle est négligée par le personnel  soignant, davantage attelé à gérer les complications qui accompagnent l'insuffisance rénale chronique terminale et la dialyse chronique. Notre travail a eu pour but de déterminer la prévalence de l'insomnie et les facteurs qui lui sont associés, afin de pouvoir, dans un temps futur, lui dédier une stratégie de prise en charge adaptée. Il s'agit d'une étude transversale incluant 93  hémodialysés chroniques, dont nous avons étudié les données sociodémographiques, biologique, dialytiques ; nous avons également collecté les caractéristiques de l'insomnie, et enfin mis en exergue les facteurs associés à sa survenue. L'insomnie a été définie par un score total supérieur ou égal à 15 au questionnaire de l'I.S.I (Insomnia Severity Index). Ainsi, la prévalence de l'insomnie est de 67,7% (n=63); l'âge moyen est de 55,6±12,7 (22-82) ans, le sexe ratio de 24  Hommes/39 Femmes, la durée moyenne en hémodialyse de 94,6 ± 58,2 (6-252) mois. 45 des patients insomniaques sont dialysés deux fois par semaine. Cette insomnie concernait le début de la nuit dans 52,3% des cas, le milieu de la nuit dans 55,5% des cas, et le petit matin dans 19,04% des cas. Les troubles associés à cette insomnie ont été: la somnolence diurne dans 79,3% des cas (n=50), le syndrome de la jambe sans repos dans 17,4% des cas (n=11), et les cauchemars dans 30,1% des cas (n=19). Une prise régulière d'hypnogènes a été notée chez 20 patients (31,7%). En analyse univariée, les facteurs associés à la survenue de l'insomnie sont l'âge avancé des patients, le sexe féminin, l'ancienneté en hémodialyse, la fréquence de deux séances de dialyse par semaine, le taux d'urée en prédialyse, le score de Charlson, la présence d'une douleur chronique (depuis plus de trois mois), la dépression et enfin l'hypertension artérielle. En analyse  multivariée, on retient l'âge avancé des patients, le sexe féminin, l'ancienneté en dialyse et la fréquence de deux séances de dialyse par semaine. En conclusion, les  troubles du sommeil et en particulier l'insomnie chez les hémodialysés chroniques sont fréquents et multifactoriels. Une attention particulière doit leur être   accordée, incluant une collaboration régulière et étroite entre néphrologues et psychologues, psychiatres et spécialistes du sommeil.Key words: Insomnie, hémodialyse chronique, âge, ancienneté de dialyse, fréquence de dialyse, comorbidités, dépressio

Stratégie de prise en charge de l’hypertension artérielle en hémodialyse chronique: un modèle appliqué d’éducation thérapeutique des patients (ETP)

Même après l'entrée en dialyse, la prévalence de l'hypertension artérielle (HTA) reste élevée. Elle est  souvent greffée d'une forte morbi-mortalité, et altère la qualité de vie des patients hémodialysés  chroniques. La « méthode du poids sec (PS) », établie par Scribner, présente un intérêt indéniable dans la gestion de l’HTA chez le patient hémodialysé. Le but de notre travail était de déterminer la prévalence et les facteurs de risque (FDR) de l'HTA chez nos hémodialysés  chroniques et d'en tenter une réduction en nous basant sur une stratégie d’éducation thérapeutique basée sur les recommandations de Scribner.  Nous avons mené une étude prospective interventionnelle en trois mois et en trois phases, auprès des 93 hémodialysés chroniques de l'Hôpital Al Farabi d'Oujda. En phase 1, nous avons déterminé la prévalence de l'HTA par la surveillance horaire de la tension artérielle (TA) durant la séance de dialyse pendant deux semaines, soit sur un total de 442 séances. Les patients ont également mesuré leur pression artérielle (PA) hors-centre de façon biquotidienne les jours de non-dialyse, soit un total de 1720 mesures  hors-centre. L'HTA a été définie par une Pression Artérielle Systolique (PAS) supérieure ou égale à  140mmHg et/ou une Pression Artérielle Diastolique (PAD) supérieure ou égale à 90mmHg sur au moins 2 mesures. En phase 2, les patients hypertendus ont bénéficié d’une prise en charge basée sur les   recommandations de Scribner et une éducation thérapeutique (ETP). En phase 3, nous évalué les  retombées de notre prise en charge. Une HTA a été notée sur 231  séances chez 57 patients, soit une prévalence de 61,3%. La PAS moyenne était de 172,75±17,69 (145-220) mmHg. Les FDR retenus sont: l'âge, la PPID  importante, le non respect des règles hygiéno-diététiques (RHD) et le rythme de 2 séances de dialyse/semaine. Au départ, 13 patients (22,8%) étaient dialysés trois fois par semaine; nous avons doublé ce taux. Nous avons également réduit le PS chez 48 patients, à raison de ½Kg tous les 15 jours. Les résultats en phase 3 montrent que 8 patients sont passés dans le groupe des patients «normotendus », la prévalence de l’HTA passant ainsi à 52,7% .Dans le nouveau groupe «HTA+» (n=49), la PAS  moyenne est passée à 166,12±17,05 (140-200) mmHg. La PPID a baissé de 0,98±0,425 (0,35-2,1) Kgs chez 46 patients. La prévalence de l’HTA dans notre population rejoint les données de la littérature, mais en appliquant les principes de l’ETP à la prise en charge de celle-ci, nous avons pu en baisser la  prévalence. Ainsi, La « méthode du PS » peut permettre de corriger l’HTA en HD, mais ce succès ne doit se concevoir sans un effort pédagogique soutenu de la part de l’ensemble de l’équipe soignante, d’où l’intérêt de planifier une ETPKey words: Hypertension artérielle, éducation thérapeutique des patients, poids sec, prise de poids  interdialytique, rythme de dialyse, régime hyposodé, règles hygiéno-diététique, modèle constructiviste, pédagogie allostérique

Flexible insulin therapy improves metabolic control and decreases the risk of hypoglycemia in type 1 diabetic patients

Introduction: flexible insulin therapy (FIT) is considered as a crucial turning point in the management of type 1 diabetes. The purpose of this study was to evaluate the impact of this optimum therapeutic approach on improving metabolic control and decreasing hypoglycemic events in patients with type 1 diabetes. Methods: thirty-seven type 1 diabetic patients were included in a five days training programme of FIT. They had an HbA1c between 7.5 and 10%. Those patients were enrolled in a flexible insulin program and we evaluate clinical and metabolic parameters (glycated haemoglobin (HbA1c), hypoglycemic events, body mass index (BMI) and the rate of blood glucose measurements) before the course of FIT and 3, 6 and 9 months after the course. Results: over a 9 months period of the study, the frequency of mild hypoglycemia decreased from 11.7 to 1.7 episodes/3 months (p = 0.005). The baseline HbA1c value improved by 1% at 3 months with an increase of 0.2% at 6 months, which remained unchanged at 9 months (p = <0.0001). Patients who were poorly controlled (HbA1c ≥ 8%) improved their baseline HbA1c value from 9.2% to 8.0% (p = <0.0001). Conclusion: the present study confirms that a structured training programme for FIT improves glycemic control and decreases hypoglycemic events in patients with type 1 diabetes and it can be adopted in countries with weak or intermediate income (e.g. Morocco), which allows those patients to take advantages of this therapeutic approach

A psychological insight of Moroccan adults’ immunisation behaviour towards emergency vaccines

Background: The psychology of vaccination behaviour explains how thoughts and feelings influence people’s willingness to receive vaccines. Understanding vaccination behaviour is crucial to successfully managing vaccination campaigns. Aim: Investigating factors associated with immunisation stress among students at Mohammed First University. Setting: This study was conducted on students at Mohammed First University institutions. Methods: This study is a descriptive and analytical cross-sectional study. It was conducted on 305 students at Mohammed First University institutions using a 90-item questionnaire. Results: Three hundred and five participants have been included in this survey. Overall, 65.5% of the students in our sample had a positive perception towards COVID-19 vaccines. Nevertheless, 34.5% had a negative opinion regarding immunisation. According to the analysis of perceived stress scale, 40% (n = 122) of students expressed moderate to high stress regarding vaccination. Students with a negative perception of vaccine showed a higher level of stress than those with a positive one. Stressed students tended to be older than others, coming from other institutions, other than the medical faculty, and were renting alone. Vaccine accessibility was the less significant reason associated with stress regarding vaccination. Moreover, participants with high levels of confidence in social media, exhibited higher stress. Nevertheless, those who believed in scientific journals were significantly less stressed. Conclusion: These results reflect a positive perception and acceptance of vaccines, with a considerable level of stress regarding vaccination. Contribution: This study suggests emphasising the mental health of Moroccan young adults, to better sensitise and inform them about immunisation

Abrupt introduction of distance learning during the covid-19 pandemic: what psychological impact on teachers?

Background: As soon as the COVID-19 pandemic appeared, the Moroccan education ministry decided to adopt distance learning (DL). Our target was to study the psychological impact of DL on Moroccan teachers during the pandemic. Method: This cross-sectional study used an online questionnaire based on the Hospital Anxiety and Depression Scale. Results: Among 148 responses,64.9% were women, and the average age was 41.1±11.5 years. 79.1% participated in DL, 58.8% were required to acquire DL tools and 71.6% had never received DL training. Between the start and the end of confinement, we noticed a decrease in the motivation of teachers.36.2% had definite depressive symptomatology and 41.3% had certain anxiety symptomatology with a significant predominance in women. The frequencies of depression and anxiety were higher in those who had participated in DL, but the association was not significant. Depression was significantly frequent among teachers who were obliged to acquire tools to practice DL p=0.02, those who had never received training DL p=0.046, and those who were not satisfied with the situation p=0.03. Conclusion: We didn’t find a direct association between DL and anxiety and depression, which the small sample size may explain, but we did find an association with the variables related to DL

Suicidal ideations, plans and attempts in primary care: cross-sectional study of consultants at primary health care system in Morocco

Introduction: the aim of the study is to estimate the prevalence of suicidal ideation among Moroccan consultants in primary health care system. Methods: we conducted a cross sectional survey in three health care centers in two cities of Morocco to estimate the prevalence of suicidal ideation, plan and suicide attempts among 396 consultants in the primary health care system, using the Mini International neuropsychiatric interview. Patients were 18 years and older, without known psychiatric or chronic somatic disease. Statistical analysis was performed by the SPSS 13.0 software. Results: the prevalence of suicidal ideation was 5.3%, and 2.7% of the patients planned their suicide and 1.2% tried to commit suicide. The multivariate analysis did not demonstrate significant association. Conclusion: suicidal ideation, plan and suicide attempts are prevalent in primary health care patients, but they are still under diagnosed. An adequate training of physicians and the establishment of education programs is essential to reduce the rate of suicide.The Pan African Medical Journal 2016;2

Exploring Geographic Variability in Cancer Prevalence in Eastern Morocco: A Retrospective Study over Eight Years.

BackgroundMalignant diseases have been believed to be more common in some areas of Eastern Morocco, but until now, cancer patterns have not been reported for this region. In this paper we present for the first time the cancer prevalence analysis in Eastern Morocco.MethodsCross-sectional study carried out among all patients diagnosed and/or treated with cancer at the Hassan II Regional Oncology Center (ROC) since it was established in October 2005 until December 2012. The ROC is the only hospital specialized in cancer care in Eastern Morocco.ResultsA total of 8,508 cases of cancer were registered among residents in Eastern Morocco, with a female to male ratio of 2.1. The mean age at diagnosis was 53.9 ± 15.2 years (median age = 53 years). Thus, unlike in Western countries, cancer in Eastern Morocco afflicts younger population. The areas of Eastern Morocco did not differ significantly by mean age at diagnosis (p = 0.061). However, these regions differed significantly by sex ratio (p ConclusionsFor the first time, our study presents the pattern and distribution of diagnosed cancers in Eastern Morocco. Our study illustrates substantial differences in cancer patterns between areas of Eastern Morocco. These findings are important for cancer control and highlight the need to develop program aiming at controlling and preventing the spread of major cancer sites in Eastern Morocco, particularly in areas with increased cancer prevalence rates

Correction: Exploring Geographic Variability in Cancer Prevalence in Eastern Morocco: a Retrospective Study over Eight Years.

[This corrects the article DOI: 10.1371/journal.pone.0151987.]

Predictive factors of histological response after preoperative concomitant radiochemotherapy in middle and low rectal cancer

Objective: The aim of our study was to identify potential predictive factors beyond pathologic response after neoadjuvant radiochemotherapy. Patients and Methods: Between January 2009 and December 2014, 40 patients with rectal carcinoma were included in the study. The treatment consisted of radiation ranging between 39 and 50.4 Gy associated with a concomitant chemotherapy with capecitabine. The correlation between histological response (complete response and downstaging) and potential predictive factors was investigated. Results: Complete response was 15% (06 patients), tumor regression of 32.5% (13 patients), and the absence of tumor response of 52.5% (21 patients). In univariate analysis, the circumferential extension of the tumor was significantly associated with tumor downstaging (p = 0.007) and complete tumor response (p = 0.001). However, the delay between the RCT and the surgery was a significant predictor for downstaging (p = 0.02). Conclusion: the parietal circumferential extension was a potential predictor of pathologic complete response (pCR) and downstaging after neoadjuvant chemoradiation. The time between the radiochemotherapy and the surgery was a significant predictor for downstaging. Delaying surgery beyond 8 weeks seems to result in the highest probability of pCR. Keywords: Rectal cancer, adenocarcinoma, neoadjuvant radiochemotherapy, histologic response, predictive factor