Risk factors leading to preterm births in Morocco: a prospective study at the maternity Souissi in Rabat

Introduction: Eminent morbidity and mortality of preterm infants is perceived, especially in developing countries. The aim of the study is to identify the main factors involved in the occurrence of premature births in Morocco. Methods: This was a descriptive and analytical study conducted at the maternity  Souissi in Rabat, from January 2011 to December 2011. The data were collected using interview with women in the postpartum, and via, the exploitation of obstetric and perinatal records. The data sheet was filled out for each newborn, including sociodemographic, obstetrical, maternal, childbirth and neonatal data, as well as, monitoring and surveillance of pregnancy. Results: A total of 1015 births were collected. 954 were full term babies and 61 were preterms. The  gestational age was between 33-34 weeks in 57.4%. Relying on Statistical analysis, many risk factors were, significantly, associated with the occurrence of prematurity, namely: low level of maternal  education (p ? 0.004), absence of pregnancy’ monitoring (p < 0.001), multiparity (p < 0.001), maternal  chronic diseases (p < 0.001), and drug taking during pregnancy (p < 0.001).Conclusion: To reduce the incidence of preterm births, reliable programs must be established, devoting all its interest, to educate the young woman in childbearing age about the appropriate ways of monitoring pregnancy, as well as, the qualitative and quantitative development of health care structures.Key words: Preterm infants, risk factors, mortalit

Aspects épidémiologiques, cliniques, cytologiques et immunophénotypiques des leucémies aiguës chez les enfants: expérience du laboratoire d’hématologie du Centre Hospitalier Universitaire IBN Sina

L’objectif de ce travail était de décrire les caractéristiques  épidémiologiques, cytologiques et immunophénotypiques des leucémies aigues (LA) chez les enfants diagnostiqués au Centre Hospitalo-universitaire (CHU) Ibn Sina et de déterminer aussi la concordance entre les résultats de la cytologie à ceux de l’immunophénotypage. Il s’agit d’une étude transversale réalisée au laboratoire d’hématologie du CHU Ibn Sina entre Juin 2012 et Mai 2014. Parmi 104 cas de LA diagnostiqués, 52% étaient des garçons avec un sex-ratio H/F= 1,32 et l’âge médian de 5,7 ans. La répartition des différents types de LA était : LA lymphoïde (LAL) (74%), LA myéloïde(LAM) (20,2%), LA biphénotypique(LAB) (65,8%). Parmi les LAL ,78% ont été classé LAL B et 22% comme LALT. Les signes cliniques étaient principalement présentés par le syndrome tumoral (73,1%),la fièvre (61%) et syndrome hémorragique (50%).Les anomalies de l’hémogrammeles plus fréquents étaient : thrombopénie (89,4%), anémie (86,5%), hyperleucocytose (79,8%).Le taux des blastes périphérique et médullaires était statistiquement élevé pour LAL que pour LAM et LAB (p<0,001). Le taux de rechute et de mortalité était respectivement de 21,2% et16, 3%.Le taux de concordance entre les résultats de la cytologie et ceux de l’immunophénotypage était de 92,7% pour LAL et de 82,6% pour LAM. Le diagnostic des LA se base toujours en premier sur la cytologie. L’immunophénotypage nous a permis de faire une meilleure distinction entre les leucémies aiguës. La prise en charge des LA pédiatriques est un problème majeur qui nécessite les centres spécialisés.Pan African Medical Journal 2016; 2

Therapeutic Characteristics, Chemotherapy-Related Toxicities and Survivorship in Colorectal Cancer Patients

BACKGROUND: Colorectal Cancer (CRC) is a major health problem around the globe. In Morocco, the disease ranks third after breast and lung cancers. This study is the first in Morocco to investigate epidemiological, clinical and therapeutic features while exhaustively describing toxic side-effects to chemotherapy of CRC and studying the 3-years survivorship.METHODS: This is a descriptive and analytical retrospective study of about 290 patients with CRC enrolled during the period of January-December 2013. Statistical analysis was performed to correlate clinicopathological data with chemotherapy toxicity and survivorship in patients, by Chi2 test. Overall Survival (OS) rate has been calculated by the Kaplan-Meier method and compared using Log-rank test.RESULTS: Fifty-five percent had a tumor localized in rectum, and 42,8% in colon. Mean age of these patients at diagnosis was 56,16 ±14,6. incidence rate of adverse events (grade I to IV) was 85,6%. Diarrhea was the predominant toxicity (4.6%) occurring at a high grade (grade III-IV). The 3-years OS rate of patients with CRC was 71%. OS decreased by age, and patients with age subgroup between 40 to 59 years had a better OS than the other age subgroups (60 to 79 years and >80 years) with a p-value of 0.0001. Occurence of toxicity (all grades and types) was linked to a higher survival rates compared to the group who had no toxicity noticed (p-value of 0.001).CONCLUSION: Our study shows that patients who had a polychemotherapy had a better OS than those who had monotherapy (p-value of 0.002).&nbsp

Faut-il continuer à infiltrer le scalp par un anesthésique local pour une craniotomie?

Introduction: Le maintien de la stabilité hémodynamique est un objectif primordial de l'anesthésie pour craniotomie. Peu d'études ont prouvé l'efficacité de l'infiltration du scalp par un anesthésique local pour le maintien de la stabilité hémodynamique après l'incision. L'objectif de notre travail est d'évaluer l'influence de l'infiltration de la ligne d'incision du scalp par la lidocaïne à 0,5% adrénalinée sur les paramètres hémodynamiques après incision pour craniotomie supratentorielle. Méthodes: Étude prospective en double aveugle réalisée au bloc opératoire de l'hôpital des spécialités de Rabat sur une période d'une année incluant 80 malades programmés pour craniotomie supratentorielle.  Les malades étaient randomisés par tirage au sort en 2 groupes: Le groupe 1 était infiltré par 40 ml du  sérum salé adrénaliné (1/200 000) et le groupe 2 était infiltré par 40 ml de la lidocaïne 0,5% adrénalinée (1/200 000). Le critère de jugement principal était la pression artérielle moyenne (PAM) après l'incision. L'étude statistique a fait appel aux tests t de student et l'U- mann-whitney. Une valeur de p <0.05 était considérée significative.Résultats: L'étude a inclus 80 patients (40 hommes et 40 femmes). L'âge moyen était 42 ,33±14,76  ans. Le poids moyen était 71,58 ±10 kg. Le 3/4 des patients était ASA 1, seulement 25% étaient ASA2. La durée moyenne de la chirurgie était de 252,06±38,62 mn. Les deux groupes étaient comparables  concernant l'âge, le sexe, le poids, la durée d'intervention, le type d'abord chirurgical, la dose totale du fentanyl reçue jusqu'a l'incision, ainsi que les paramètres hémodynamiques avant l'incision. Après l'incision la FC moyenne a augmenté dans les deux groupes: 80,53±7,72 bpm dans le groupe contrôle et 76,85±8,52 bpm dans le groupe lidocaïne. La différence d'augmentation de la FC entre les deux groupes était statistiquement significative (p=0,047). L'augmentation de la PAM était également  significativement plus élevée dans le groupe placebo (96,45± 3,53mmHg vs 94,75± 3,76mmHg)  (p=0,041). Nous n'avons pas noté de troubles de rythme ou d'hypertension artérielle par les solutions adrénalinées à 1/200000. Par contre, six cas d'hypotension artérielle ont été notés (3cas dans chaque groupe) après 2 minutes de l'infiltration et ayant répandu au remplissage par 500 ml de sérum salé 0,9 %. Conclusion: L'infiltration par la lidocaïne procure une stabilité hémodynamique (PAM et FC)  statistiquement significative. Les autres études rapportées dans la littérature et avec un échantillon  réduit ont permis de retrouver une différence significative concernant uniquement la PAM et non la  fréquence cardiaque.Key words: Scalp, infiltration, lidocaïne, anesthesie local, craniotomie

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

Congenital Malformations among Newborns in Morocco: A Retrospective Study

Congenital malformations are one of the leading causes of neonates and infants’ mortality and morbidity. The frequency of these congenital malformations varies in different populations. The objective of this study was to find out the prevalence and pattern of congenital malformations in a tertiary teaching hospital in Rabat, Morocco. This four-year retrospective descriptive study was conducted from January 2011 to December 2014. All newborns with congenital malformations diagnosed at birth were included. Mothers and newborn characteristics were analyzed using SPSS 13.0. A total of 706 newborns were noted to have congenital malformation. The prevalence rate was 1.02%. The mean maternal age was 28.8±7.2 years. The mean maternal body mass index was 28.1±6.9 kg/m2. 13.3% of the mothers had a history of abortion. The nervous system was the most affected system (19.4%) followed by the musculoskeletal system (14.2%), the chromosomal abnormalities (12.3%) and the genito-urinary system (10.8%). Males newborns (57.9%) had more congenital malformations than females (40.5%). The rates for live-births, fetal asphyxia and stillbirths were 75.2%, 7.2% and 17.3%, respectively. This retrospective study provides recent and detailed data about congenital malformations in a Moroccan region. The result from this study will contribute to the knowledge of congenital malformations in this particular area and hence the supportive preventive policy

Long term effectiveness of inactivated vaccine BBIBP-CorV (Vero Cells) against COVID-19 associated severe and critical hospitalization in Morocco

Background We provide national estimates of the real-world Vaccine effectiveness (VE) based on nationally available surveillance data. The study aimed to estimate the effectiveness of the inactivated Covid-19 vaccine BBIBP-CorV (Vero Cells) Sinopharm vaccine currently deployed in Morocco against SARS- CoV-2 severe disease/ hospitalization” within 9 months after vaccination. Methods We conducted a test-negative, case-control study among a population aged 18 years or older who were tested by rt-PCR for SARS-CoV-2 infection from February to October 2021 in Morocco. From the national laboratory COVID-19 database; we identified cases who were rt-PCR positive amongst severe and critical COVID-19 cases and controls who had a negative rt-PCR test for SARS-CoV-2. From the national vaccination register (NVR); individuals vaccinated with COVID-19 Vaccine (Vero Cell) and those unvaccinated were identified and included in the study. The linkage between databases was conducted for the study of Vaccination status based on the timing of the vaccine receipt relative to the SARS-CoV-2 rt-PCR test date. For each person, who tested positive for SARS-CoV-2, we identified a propensity score-matched control participant who was tested negative. We estimated vaccine effectiveness against SARS- CoV-2 severe disease/ hospitalization using conditional logistic regression. Results Among 12884 persons who tested positive and 12885 propensity score-matched control participants, the median age was 62 years, 47.2% of whom were female. As a function of time after vaccination of second dose vaccination, vaccine effectiveness during the first month was 88% (95% CI, 84–91), 87% (95% CI: 83–90) during the second and third month, 75% (95% CI: 67–80) during the fourth month, 61% (95% CI: 54–67) during the fifth month, and 64% (95% CI: 59–69) beyond the sixth month. VE remained high and stable during the first three months in the two-age subgroup. In the fourth month, the VE in the older population aged 60 years and above (64%) was reduced by 20 points compared to VE in the younger population (84%). Conclusion A Sinopharm vaccine is highly protective against serious SARS-CoV-2 infection under real-world conditions. Protection remained high and stable during the first three months following the second dose and decreases slightly beyond the fourth month especially beyond 60 years