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

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

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

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Abstract: Background: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions: The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown