La problématique du coût des nouvelles thérapeutiques en oncologie: qu’en-est-il du Maroc?

Le cancer est un problème majeur de santé public en Afrique. Les progrès réalisé dans le traitement des cancers ces dix dernières années est indéniable. L'émergence des thérapies ciblés en oncologie a permit de modifier l'histoire naturelle de certains cancers réputés de mauvais pronostic. En dépit de leurs efficacité, ces thérapeutiques pose un problème majeur de coût qui les rend inaccessible à la majorité des patients dans les pays en voie développement. Au Maroc, le cancer est reconnu comme a une affection de longue durée et les patients bénéficient de ce fait d'une couverture médicale totale. L'implication de la société civile a permis aussi d'améliorer la prise en charge ainsi qu'un accès plus élargi aux médicaments innovants pour les patients les plus démunis.Pan African Medical Journal 2016; 2

Métastase vésicale d’un adénocarcinome gastrique en bague à chaton

Bien que le cancer primitif de la vessie représente le deuxième cancer urologique après le cancer de la  prostate, les métastases vésicales sont rares et le primitif gastrique reste exceptionnel. On rapporte le cas d’un patient âgé de 46 ans, avec des épigatsralgies chroniques, qui présentait une hématurie totale avec des signes irritatifs urinaires. La cystoscopie a montré une vessie inflammatoire sans lésion tumorale décelable. La biopsie vésicale avec une étude anatomopathologique a été en faveur d’un adénocarcinome peu différencié à cellules indépendantes. Le scanner thoraco-abdomino-pelvien a montré un épaississement vésical et gastrique. La fibroscopie oeso-gastroduodénale a montré une tumeur bourgeonnante ulcérée fundique qui a été biopsiée. L’étude anatomo-pathologique a montré un adénocarcinome gastrique à cellules indépendantes mucipares. Le patient a eu 6 cures de chimiothérapie palliative de première ligne type EOX à base  d’Epirubicine, Oxaliplatine, et Capécitabine, avec une légère régression tumorale puis une chimiothérapie de maintenance à base de Capécitabine.Key words: Métastase vésicale, adénocarcinome gastrique, cellules en bague à chato

Synthesis of lipophilic tyrosyl esters derivatives and assessment of their antimicrobial and antileishmania activities

<p>Abstract</p> <p>Background</p> <p>Preparation of tyrosyl lipophilic derivatives was carried out as a response to the food, cosmetic and pharmaceutical industries' increasing demand for new lipophilic antioxidants.</p> <p>Results</p> <p>A large series of tyrosyl esters (<b>TyC₂</b>to <b>TyC_18:1</b>) with increasing lipophilicity was synthesized in a good yield using lipase from <it>Candida antarctica </it>(Novozyme 435). Spectroscopic analyses of purified esters showed that the tyrosol was esterified on the primary hydroxyl group. Synthetized compounds were evaluated for either their antimicrobial activity, by both diffusion well and minimal inhibition concentration (MIC) methods, or their antileishmanial activity against <it>Leishmania major </it>and <it>Leishmania infantum </it>parasite species.</p> <p>Among all the tested compounds, our results showed that only <b>TyC₈</b>, <b>TyC₁₀</b>and <b>TyC₁₂</b>exhibited antibacterial and antileishmanial activities. When MIC and IC₅₀values were plotted against the acyl chain length of each tyrosyl derivative, <b>TyC₁₀</b>showed a parabolic shape with a minimum value. This nonlinear dependency with the increase of the chain length indicates that biological activities are probably associated to the surfactant effectiveness of lipophilic derivatives.</p> <p>Conclusion</p> <p>These results open up potential applications to use medium tyrosyl derivatives surfactants, antioxidants, antimicrobial and antileishmanial compounds in cosmetic, food and pharmaceutical industries.</p

Using GPS Tracking Collars and Sensors to Monitor the Grazing Activity of Browsing Goats in Forest Rangeland

peer reviewedThe recent advancements in sensor technologies to monitor and record behavioral activities of livestock provide an accurate scope to extend the database and understand the animal behavior under actual grazing conditions. The aim of this work was to determine the seasonal variation in grazing activities of goats using the Global Positioning System (GPS) and leg sensor technologies. The study was conducted in the Southern Mediterranean forest pasture of Northern Morocco. Eight dairy alpine goats have been fitted with GPS tracking collars and tri-axial accelerometers over a 3-day period of each grazing season (spring, summer, and fall). Most of the behavioral activity of goats was dedicated to grazing (36 to 59%), followed by resting (22 to 30%) and walking without grazing (10 to 24%). During summer and fall, goats traveled longer distances compared to the spring. The combination of the two studied sensors provided useful data information to understand the behavioral activity of goat grazing in forest pasture

SPATIAL DISTRIBUTION OF ATMOSPHERIC POLLUTION IN DUHOK URBAN AREA BY USING GIS TOOLS

Air pollution is becoming a serious challenge in thickly populated areas in the world. The air pollution in Kurdistan region is clearly noticed, especially in areas where pollution sources and human population are concentrated. Urbanization and economic growth are proceeding at a rapid pace, accompanied by increasing emissions of a mixture of greenhouse gases especially from transporting sector, that positively contribute to accelerate climate change around the globe, and also have impacts on public health and vegetation. In order to decrease the effects that caused by atmospheric pollution, suitable monitoring systems are urgently needed that can rapidly and reliably detect and quantify polluting sources and concentration for monitoring by local authorities in order to restrain more damage of the current pollution levels. In this study, GIS with portable gas detector (K-60 IV) KELISAIKE safety equipment, China, have been used to assess the status of NOx, VOCs and noise pollution at 54 randomly selected urban locations of Duhok city. The measurements were taken during the week and weekend days started from 9 am until 4 pm. The results showed that there is a variation in the values of the three variables NOx, VOCs and noise, where the highest values recorded during working days in the locations distributed along the highway and the city center with heavy traffic load and dense human population in comparison to lowest values obtained during weekend days in locations distributed outskirt of the city with lower population and traffic loads. Therefore, likely such connections exist between the urban traffic density and  low air pollution quality within urban locations around Duhok city

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10&nbsp;years; 78.2% included were male with a median age of 37&nbsp;years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely