Blood lead, cadmium and mercury among children from urban, industrial and rural areas of Fez Boulemane Region (Morocco): Relevant factors and early renal effects

Objectives: To describe blood lead (Pb-B), cadmium (Cd-B) and mercury (Hg-B) levels in children living in urban, industrial and rural areas in Fez city (north of Morocco) and to identify the determinants and some renal effects of exposure. Material and Methods: The study was conducted from June 2007 to January 2008 in 209 school children (113 girls, 96 boys), aged 6-12 years, from urban, industrial and rural areas in Fez city. Interview and questionnaires data were obtained. Blood and urinary samples were analyzed. Results: The mean of blood lead levels (Pb-B) in our population was 55.53 μg/l (range: 7.5-231.1 μg/l). Children from the urban area had higher blood lead levels (BLLs) mean (82.36 μg/l) than children from industrial and rural areas (48.23 and 35.99 μg/l, respectively); with no significant difference between boys and girls. BLLs were associated with traffic intensity, passive smoking and infancy in the urban area. The mean of blood cadmium levels (BCLs) was 0.22 μg/l (range: 0.06-0.68 μg/l), with no difference between various areas. Rural boys had higher BCLs mean than rural girls, but no gender influence was noticed in the other areas. BCLs were associated with the number of cigarettes smoked at children's homes. The blood mercury levels (BMLs) mean was 0.49 μg/l (range: 0.01-5.31 μg/l). The BMLs mean was higher in urban and industrial areas than in the rural area with no gender-related difference. BMLs were associated with amalgam fillings and infancy in the urban area. About 8% of the children had BLLs ≥ 100 μg/l particularly in the urban area, microalbuminuria and a decrease in height were noticed in girls from the inner city of Fez and that can be related to high BLLs (89.45 μg/l). Conclusions: There is a need to control and regulate potential sources of contamination by these trace elements in children; particularly for lead

Perception de l'impact à court et à long terme d'une intervention psychocorporelle sur la santé mentale et le bien-être des étudiants en médecine : Une étude qualitative

Introduction La santé mentale des étudiants, en particulier des étudiants en médecine, est un sujet de préoccupation. Des études récentes montrent une augmentation des plaintes psychologiques chez les étudiants, en particulier les étudiants en médecine. Le niveau élevé de stress reste un problème tout au long de leurs études et jusqu'à la poursuite de leur formation médicale. Le stress constant et le nombre élevé de cas d'épuisement professionnel sont également documentés chez les médecins. L'exposition chronique au stress et ses conséquences sur les professionnels de la santé est un problème de santé publique important. Objectif du projet Étudier la perception et l'expérience des étudiants en médecine participant à une intervention Mind body utilisée pour améliorer la santé mentale et le bien-être à la Faculté de médecine du CHU de Lausanne (UNIL). Matériel et méthodes La population étudiée est composée d'étudiants ayant déjà participé à une intervention Mind Body de onze semaines, qui s'est déroulée à raison de 2 heures hebdomadaires durant le semestre de printemps 2018. Une approche d'évaluation par focus group et par entretien individuel semi-structuré a été utilisée pour explorer les expériences et les perceptions des étudiants ayant participé à l'intervention Mind Body. Hypothèse de l'étude Le groupe étudié d'étudiants participant au groupe de discussion et aux entretiens individuels semi-structurés donne un aperçu de l'expérience de l'intervention Mind Body et de ses effets perçus sur la santé mentale et le bien-être des étudiants ainsi que sur leur compassion envers eux-mêmes et les autres. Valeurs ajoutées (implications cliniques) Nous avons obtenu une perspective profonde dans les expériences et les perceptions de nos sujets d'étude subissant une intervention Mind Body, et de décrire les changements perçus en ce qui concerne le bien-être global et la santé mentale des étudiants

Atteinte cardiaque au cours de la dystrophie myotonique de Steinert: Expérience marocaine, à propos de 18 cas

La maladie de Steinert ou dystrophie myotonique de type 1 (DM1) est une maladie génétique à transmission autosomique dominante caractériséepar une myotonie et une atteinte de plusieurs organes dont le coeur. L'atteinte cardiaque est la plus grave des atteintes systémiques puisqu'elleconditionne le pronostic vital. Ce travail a pour but de déterminer les anomalies cardiaques rencontrées au cours de la DM1 et de mettre enexergue l'intérêt d'un examen cardiaque rigoureux et régulier,  indépendamment de la sévérité de l'atteinte neuromusculaire, ainsi que l'apport des examens cardiaques complémentaires et notamment l'exploration électrophysiologique. 18 patients atteints de DM1 ont  bénéficiés d'une exploration cardiaque systématique. Il s'agit de 9 hommes et de 9 femmes, d'âge moyen de 41,8 +/- 16,2 ans. 66 p.100 des patients sont symptomatiques sur le plan cardiovasculaire. Les  anomalies électrocardiographiques sont dominées par un trouble de la conduction intraventriculaire dans 16 p.100 des cas et un BAV de 1er degré dans 16 p.100 des cas. L'Holter ECG objective une hyperexcitabilité à l'étage atrial et/ou ventriculaire dans 50p.100 des cas. L'ETT est normale chez 95 p.100 des patients. L'exploration électrophysiologique, réalisée chez 4 patients symptomatiques, a objectivé un bloc tronculaire dans un cas ayant conduit à l'implantation d'un PM double chambre. Un seul patient est décédé suite à une détresse respiratoire. Enfin, on n'a pas noté de corrélation entre l'atteinte cardiaque et neuromusculaire. Une exploration cardiaque est indispensable chez tout patient atteint de DM1, en dépit de l'absence de symptômes, et un bilan annuel minimal s'impose pour guetter un éventuel trouble rythmique et/ou conductif, fatal en l'absence de traitement adéquat

Clinical and molecular findings in a Moroccan family with Jervell and Lange-Nielsen syndrome: a case report

Abstract Background Jervell and Lange-Nielsen syndrome (Online Mendelian Inheritance in Man 220400) is a rare autosomal recessive cardioauditory ion channel disorder that affects 1/200,000 to 1/1,000,000 children. It is characterized by congenital profound bilateral sensorineural hearing loss, a long QT interval, ventricular tachyarrhythmias, and episodes of torsade de pointes on an electrocardiogram. Cardiac symptoms arise mostly in early childhood and consist of syncopal episodes during periods of stress, exercise, or fright and are associated with a high risk of sudden cardiac death. Jervell and Lange-Nielsen syndrome is caused by homozygous or compound heterozygous mutations in KCNQ1 on 11p15.5 or KCNE1 on 1q22.1-q22.2. Case presentation We report the case of a 10-year-old Moroccan boy with congenital hearing loss and severely prolonged QT interval who presented with multiple episodes of syncope. His parents are first-degree cousins. We performed Sanger sequencing and identified a homozygous variant in KCNQ1 (c.1343dupC, p.Glu449Argfs*14). Conclusions The identification of the genetic substrate in this patient confirmed the clinical diagnosis of Jervell and Lange-Nielsen syndrome and allowed us to provide him with appropriate management and genetic counseling to his family. In addition, this finding contributes to our understanding of genetic disease in the Moroccan population

Effects of wheat-flour biscuits fortified with iron and EDTA, alone and in combination, on blood lead concentration, iron status, and cognition in children: a double-blind randomized controlled trial

Background: Lead is a common neurotoxicant and its absorption may be increased in iron deficiency (ID). Thus, iron fortification to prevent ID in populations is a promising lead mitigation strategy. Two common fortificants are ferrous sulfate (FeSO4) and ferric sodium EDTA (NaFeEDTA). EDTA can chelate iron and lead. Objectives: Our study objective was to determine the effects of iron and EDTA, alone and in combination, on blood lead (BPb) concentration, iron status, and cognition. Design: In this 2 × 2 factorial, double-blind placebo-controlled trial, 457 lead-exposed Moroccan children were stratified by school and grade and randomly assigned to consume biscuits (6 d/wk at school) containing 1) ∼8 mg Fe as FeSO4, 2) ∼8 mg Fe as NaFeEDTA that contained ∼41 mg EDTA, 3) ∼41 mg EDTA as sodium EDTA (Na2EDTA), or 4) placebo for 28 wk. The primary outcome was BPb concentration; secondary outcomes were iron status and cognitive outcomes from subtests of the Kaufman Assessment Battery for Children and the Hopkins Verbal Learning Test. These outcomes were measured at baseline and endpoint. All data were analyzed by intention-to-treat. Results: The adjusted geometric mean BPb concentration at baseline was 4.3 μg/dL (95% CI: 4.2, 4.3 μg/dL), and at endpoint these values were 3.3 μg/dL (95% CI: 3.1, 3.5 μg/dL) for FeSO4, 2.9 μg/dL (95% CI: 2.7, 3.0 μg/dL) for NaFeEDTA, 3.3 μg/dL (95% CI: 3.1, 3.5 μg/dL) for EDTA, and 3.7 μg/dL (95% CI: 3.5, 3.9 μg/dL) for placebo. We found an effect of iron (P = 0.009) and EDTA (P = 0.012) for reduced BPb concentrations at endpoint, but no iron × EDTA interaction. Iron fortification improved iron status, but there were no positive effects of iron or EDTA on cognitive test scores. Conclusions: Food fortification with iron and EDTA additively reduces BPb concentrations. Our findings suggest that NaFeEDTA should be the iron fortificant of choice in lead-exposed populations. This trial was registered at clinicaltrials.gov as NCT01573013.ISSN:0002-9165ISSN:1938-320

Effects of wheat-flour biscuits fortified with iron and EDTA, alone and in combination, on blood lead concentration, iron status, and cognition in children: a double-blind randomized controlled trial

Background: Lead is a common neurotoxicant and its absorption may be increased in iron deficiency (ID). Thus, iron fortification to prevent ID in populations is a promising lead mitigation strategy. Two common fortificants are ferrous sulfate (FeSO4) and ferric sodium EDTA (NaFeEDTA). EDTA can chelate iron and lead. Objectives: Our study objective was to determine the effects of iron and EDTA, alone and in combination, on blood lead (BPb) concentration, iron status, and cognition. Design: In this 2 × 2 factorial, double-blind placebo-controlled trial, 457 lead-exposed Moroccan children were stratified by school and grade and randomly assigned to consume biscuits (6 d/wk at school) containing 1) ∼8 mg Fe as FeSO4, 2) ∼8 mg Fe as NaFeEDTA that contained ∼41 mg EDTA, 3) ∼41 mg EDTA as sodium EDTA (Na2EDTA), or 4) placebo for 28 wk. The primary outcome was BPb concentration; secondary outcomes were iron status and cognitive outcomes from subtests of the Kaufman Assessment Battery for Children and the Hopkins Verbal Learning Test. These outcomes were measured at baseline and endpoint. All data were analyzed by intention-to-treat. Results: The adjusted geometric mean BPb concentration at baseline was 4.3 μg/dL (95% CI: 4.2, 4.3 μg/dL), and at endpoint these values were 3.3 μg/dL (95% CI: 3.1, 3.5 μg/dL) for FeSO4, 2.9 μg/dL (95% CI: 2.7, 3.0 μg/dL) for NaFeEDTA, 3.3 μg/dL (95% CI: 3.1, 3.5 μg/dL) for EDTA, and 3.7 μg/dL (95% CI: 3.5, 3.9 μg/dL) for placebo. We found an effect of iron (P = 0.009) and EDTA (P = 0.012) for reduced BPb concentrations at endpoint, but no iron × EDTA interaction. Iron fortification improved iron status, but there were no positive effects of iron or EDTA on cognitive test scores. Conclusions: Food fortification with iron and EDTA additively reduces BPb concentrations. Our findings suggest that NaFeEDTA should be the iron fortificant of choice in lead-exposed populations. This trial was registered at clinicaltrials.gov as NCT01573013

Effective interventions and strategies for improving Early Child Development

This article synthesises evidence about effective interventions and strategies to improve early child development, and call for it to be included in a new global strategy on women's, children's, and adolescents' health.