Ponction biopsies rénales dans le Service de Néphrologie de Fès: indications et résultats: à propos de 522 cas

L'apport de la ponction biopsie rénale (PBR) dans le diagnostic, le choix thérapeutique et l'évaluation pronostique des néphropathies est considérable. Aucune étude marocaine n'a évalué la pratique et l'apport de la PBR. Notre objectif est d'étudier les indications de la PBR, déterminer la fréquence des maladies rénales identifiées par PBR dans notre région et de faire une confrontation entre les données clinico-biologiques et le diagnostic historique. Notre étude menée entre Janvier 2009 et Décembre 2012, est rétrospective. Nous avons inclus tous les patients du service de Néphrologie du CHU Hassan II de Fès ayant bénéficié d'une biopsie de reins natifs. 522 PBR ont été réalisées. Nous avons exclu 8 biopsies devant le manque de renseignements et avons donc retenu 514. L'âge moyen des patients au moment de la PBR est de 39 ±17 ans (3-82 ans). Le sex ratio est de 0,9. Le syndrome néphrotique est le diagnostic clinique le plus fréquent à tous les âges (58,2%). Les néphropathies glomérulaires représentent 94,2% des maladies rénales diagnostiquées, leur distribution varie selon l'âge des patients. La PBR a confirmé le premier diagnostic suspecté cliniquement dans 40,65 % des cas, alors qu'elle a révélé un diagnostic inattendu chez 22,5% d'entre eux. Le diagnostic syndromique permet d'orienter vers la maladie rénale la plus probable et de guider les thérapeutiques urgentes en attendant les résultats de la PBR. Mais il ne peut en aucun remplacer la PBR qui reste le gold standard.Pan African Medical Journal 2016; 2

Health risk behaviours amongst school adolescents: protocol for a mixed methods study

Abstract Background Determining risky behaviours of adolescents provides valuable information for designing appropriate intervention programmes for advancing adolescent’s health. However, these behaviours are not fully addressed by researchers in a comprehensive approach. We report the protocol of a mixed methods study designed to investigate the health risk behaviours of Moroccan adolescents with the goal of identifying suitable strategies to address their health concerns. Methods We used a sequential two-phase explanatory mixed method study design. The approach begins with the collection of quantitative data, followed by the collection of qualitative data to explain and enrich the quantitative findings. In the first phase, the global school-based student health survey (GSHS) was administered to 800 students who were between 14 and 19 years of age. The second phase engaged adolescents, parents and teachers in focus groups and assessed education documents to explore the level of coverage of health education in the programme learnt in the middle school. To obtain opinions about strategies to reduce Moroccan adolescents’ health risk behaviours, a nominal group technique will be used. Discussion The findings of this mixed methods sequential explanatory study provide insights into the risk behaviours that need to be considered if intervention programmes and preventive strategies are to be designed to promote adolescent’s health in the Moroccan school

Nutrition et fonction immunitaire

Un apport suffisant en nutriments peut avoir un effet bénéfique sur la fonction immunitaire, la modulation des affections inflammatoires et auto-immunes chroniques et la diminution de risque d'infection. Cette étude vise à mettre en relief la relation qui existe entre la nutrition et la fonction immunitaire en réalisant un inventaire des principaux nutriments ayant des effets sur les différents éléments acteurs du système immunitaire et leur association aux maladies. Pubmed et Google scholar ont été utilisés pour la recherche de la bibliographie récente en relation avec le sujet. La réponse immunitaire dépend de la présence de certains nutriments qui ont des rôles synergiques basés sur leurs modes d'actions complémentaires. Il a été établi que le système immunitaire complexe et intégré a besoin de plusieurs micronutriments spécifiques (les vitamines A, D, C, E, B6 et B12, de folate, fer, zinc, cuivre, sélénium et magnésium) et macronutriments (lipides tels que les AGPI oméga 3, AGMI), en plus des fibres alimentaires, les polyphénols et les protéines. Tous ces éléments aident à produire et maintenir une réponse immunitaire efficace tout au long de la vie. La carence en ces nutriments a été associée aux plusieurs maladies métaboliques et cardiovasculaires et plusieurs types de cancer, ainsi qu'à la mortalité toutes causes confondues.Les nutriments sont liés dans leurs fonctions pour maintenir ou améliorer la défense de l’organisme, y compris l'inhibition des médiateurs pro-inflammatoires, la promotion des fonctions anti-inflammatoires, la modulation de l'immunité à médiation cellulaire, l’altération des fonctions des cellules présentatrices d'antigènes et la communication entre les systèmes immunitaires inné et adaptatif

L’autogestion de la maladie : Cas de diabète type

Introduction : Diabetes is a chronic disease whose prevalence poses a threat to global public health due to the human and financial costs associated with it Self-management, a concept that encompasses all the activities that a diabetic must carry out to meet the requirements of maintaining and improving their health. The objective of our study is to describe the factors that influence the self-management of type 2 diabetes by patients. Methods: This was a cross-sectional study. Data collection was carried out using a questionnaire with 80 diabetic patients attended in health centres at Tetouan (Morocco). Results: Factors influencing diabetes self-managment related to patients, to healthcare provision and to the environment were identified in the population studied.  85% of patients are illiterate, 69% do not respect the diet and 59% of patients do not practice any physical activity. 46% have HbA1c greater than 8.5% and 53% developed complications. The majority of participants do not have a glucometer to control glycemia levels and 36,25% are unaware of the chronicity of the disease. The majority of study participants consider the nursing intervention to be unsatisfactory. Conclusion: The results of this study give useful elements to highlight the reality of diabetes self-management, which still remains a public health proble

Student Satisfaction with Online Learning: A Study Among Medical Students at a Medical School in Northern Morocco During the COVID‑19 Pandemic

Introduction: The COVID-19 pandemic has forced the use of e-learning. The aim of this study was to assess medical students’ experience with e-learning methods. Methods: We conducted a cross-sectional study, using a Google Forms questionnaire. Results: From a total of 303 participants, 75% of them rated the e-learning experience as good to excellent, and more than 46% considered that distance learning can be equivalent to face-to-face learning. Conclusion: The experience of e-learning should motivate and challenge us to improve our technological skills in order to adopt a modern and practical pedagogy.Introduction. La pandémie de COVID-19 a imposé l’utilisation de l’apprentissage en ligne. Le but de cette étude était d’évaluer l’expérience des étudiants en médecine vis-à-vis de la méthode d’apprentissage en ligne. Méthodes. Nous avons mené une étude transversale, en utilisant le questionnaire Google-Forms. Résultats. Sur un total de 303 participants, 75,2 % d’entre eux ont évalué l’expérience de ce type d’apprentissage comme bonne à excellente; plus de 46 % considèrent que l’apprentissage à distance peut être équivalent à l’apprentissage en face à face. Conclusion. L’expérience de l’apprentissage en ligne devrait nous motiver et nous encourager à améliorer nos compétences technologiques afin d’adopter une pédagogie moderne et pratique

Psychometric Properties of Update Arabic Version of the Trait Hope Scale and the Rosenberg Self-Esteem Scale

Hope and self-esteem are crucial components of positive psychology, and there is a lack of tools to assess these concepts in Morocco. Therefore, this study aims to provide the necessary instruments for evaluating hope and self-esteem among Moroccan college students. A total of 1150 college students (444 males, 703 females) completed an updated Arabic version of the Trait Hope Scale (THS) and the Rosenberg Self-Esteem Scale (RSES). The data underwent factorial and reliability analyses, with test-retest reliability assessed using responses from 26 students. Both the THS and RSES revealed a two-factor solution, and Multigroup Confirmatory Factor Analysis (MGCFA) demonstrated measurement invariance with respect to gender. Furthermore, the results indicated good and acceptable internal consistency (α = .85 for THS and α = .70 for RSES) and acceptable temporal stability (r = .72 for THS and r = .76 for RSES). In conclusion, the updated Arabic versions of the THS and RSES exhibited strong psychometric properties and stability. They have been established as valid and reliable tools for assessing hope and self-esteem among Moroccan college students.CC BY 4.0</p

Cost-effectiveness of diagnostic-therapeutic strategies for paediatric visceral leishmaniasis in Morocco

INTRODUCTION: Visceral leishmaniasis (VL) is a neglected parasitic disease with a high fatality rate if left untreated. Endemic in Morocco, as well as in other countries in the Mediterranean basin, VL mainly affects children living in rural areas. In Morocco, the direct observation of Leishmania parasites in bone marrow (BM) aspirates is used to diagnose VL and meglumine antimoniate (SB) is the first line of treatment. Less invasive, more efficacious and safer alternatives exist. In this study we estimate the cost-effectiveness of alternative diagnostic-therapeutic algorithms for paediatric VL in Morocco. METHODS: A decision tree was used to estimate the cost-effectiveness of using BM or rapid diagnostic tests (RDTs) as diagnostic tools and/or SB or two liposomal amphotericin B (L-AmB) regimens: 6-day and 2-day courses to treat VL. Incremental cost-effectiveness ratios, expressed as cost per death averted, were estimated by comparing costs and effectiveness of the alternative algorithms. A threshold analysis evaluated at which price L-AmB became cost-effective compared with current practices. RESULTS: Implementing RDT and/or L-AmB treatments would be cost-effective in Morocco according to the WHO thresholds. Introducing the 6-day course L-AmB, current second-line treatment, would be highly cost-effective if L-AmB price was below US$100/phial. The 2-day L-AmB treatment, current standard treatment of paediatric VL in France, is highly cost-effective, with L-AmB at its market price (US$165/phial). CONCLUSIONS: The results of this study should encourage the implementation of RDT and/or short-course L-AmB treatments for paediatric VL management in Morocco and other North African countries

Effects of fasting during Ramadan on renal function of patients with chronic kidney disease

Fasting during Ramadan is prohibited when an individual′s health is endangered. Little work has been published in this direction in patients with chronic kidney disease (CKD). We aimed to evaluate the impact of fasting during Ramadan on the renal function of patients with CKD, adjusting for the initial degree of renal impairment. We prospectively studied 60 patients with CKD (35 females; mean age 45.6 ± 15.8 years). All study patients were older than 15 years, being followed-up at the nephrology clinic for more than six months, having a stable CKD during the preceding six months and who had fasted during Ramadan the previous year. Patients who had a medical contra-indication for fasting were excluded from the study [severe or resistant arterial hypertension, insulin-requiring diabetes, acute renal failure (ARF), active renal disease, repetitive urolithiasis or terminal chronic renal failure]. Statistical analysis was performed in collaboration with the epidemiology lab at the Fez Medical School using the SPSS software version 17. Three of the study patients developed ARF in the first week and four of them at the end of the month of the study period. The risk of developing ARF was significantly higher for patients with baseline creatinine clearance of <60 mL/min/1.73 m 2 . However, the small sample size does not allow us to draw any firm conclusions on fasting during Ramadan in stable CKD patients. Studies on larger numbers of patients are recommended

Effect of the SARS-CoV-2 Vaccination on the Duration of COVID-19 Symptoms in Outpatients in Morocco

Introduction: To identify if there is an association between Severe acute respiratory syndrome-Coronavirus-2 (SARS-CoV-2) vaccination and the duration of symptoms in patients with mild-to-moderate Coronavirus disease-2019 (COVID-19). Materials and Methods: We conducted a prospective observational cohort study which included patients with mild-to-moderate COVID-19 that was confirmed via biological and/or radiological methods (reverse transcription-polymerase chain reaction, TAG-rapid, and chest computed tomography) and who were treated as outpatients from August 2021 to September 2021. The duration of symptoms was defined as the interval between the onset of symptoms and their resolution. We compared the symptom duration between unvaccinated, partially vaccinated, and fully vaccinated patients. The other variables were also adjusted. Results: We included 283 patients with positive SARS-CoV-2 test results. Among these participants, 28.6% were fully vaccinated, 25.1% were partially vaccinated, and 46.3% were unvaccinated. The median duration of symptoms was 10 days, interquartile range [(IQR) (7-13)] in vaccinated patients and 13 days [IQR (9-15)] in unvaccinated patients. After adjusting for confounding factors, a short duration of symptoms was significantly associated with age <50 years [odds ratio (OR)=0.41; 95%, confidence interval (CI) (0.22-0.76); p<0.005] and the vaccination status. Patients who received one vaccine dose had an OR of 0.48 [95% CI (0.26-0.88); p<0.019]. Patients who received both vaccine doses had an OR of 0.26 [95% CI (0.12-0.50); p<0.000]. Conclusion: There was a significant association between vaccination status against SARS-CoV-2 and short duration of symptoms in outpatients with mild-to-moderate COVID-19. This finding may have significant public health implications like admitting the effective role of vaccination in preserving individual and collective well-being. In addition, it provides insights into vaccination strategies for patient care by giving indications of how long symptoms persist, enabling more effective management of isolation and quarantine measures