Estimating attributable fraction of lung cancer linked to smoking in Morocco

The objective of this research was to estimate the attributable fraction [AF] of lung cancer linked to smoking in Morocco. The estimation was based on the SAMMEC [Adult Smoking-Attributable Mortality, Morbidity and Economic Costs] method based on the Levin formula to calculate AF linked to tobacco. Data about frequencies, association measures and relative risks were taken from available sources. The AF of lung cancer linked to smoking was about 87%, and around 3049 cases of this cancer in men could be avoided if tobacco use could be prevented. About a 10% reduction in smoking prevalence would result in a reduction of 346 lung cancer cases. Our study provides additional important elements for further advocacy to policy-makers to implement a tobacco control strategy based on a prevention policy in line with the epidemiological situation which could avoid a huge burden on the country

[Frequency, types and determinants of degenerative complications of type 2 diabetes in Morocco: "EpiDiaM" cohort inclusion data]

Degenerative complications as a result of diabetes impose a heavy disease burden and increase mortality. This study presents epidemiological and clinical profiles of diabetic patients in the EpiDiaM cohort study, which include 1196 diabetic cases recruited from the basic health care network in the city of Fez. The mean age of the participants was 57.5 [SD 10.4] years with 47.1% aged between 50 and 60 years. The majority [77.7%] were women. The mean duration of diabetes was 8 [SD 6.6] years. Hypertension was found in 49.3% of the cohort, 77.9% were overweight or obese and 63.8% had one or more complications. Among those with complications, retinopathy was the most common [69.4%], followed by heart conditions [50.8%], neuropathy [45.6%] and renal disease [4.8 %]. The high prevalence of complications emphasizes the need to address the avoidable risk factors and prevent complications

Acceptability of the human papilloma virus vaccine among Moroccan parents: a population-based crosssectional study

Data about the public's awareness and acceptability of the human papilloma virus [HPV] vaccine are lacking in the Eastern Mediterranean Region. This study aimed to explore parental acceptability of HPV vaccination for their daughters in Morocco. A cross-sectional survey was carried out among mothers and fathers of girls aged 12-15 years at 12 middle schools from 6 regions of Morocco. Despite weak knowledge of genital warts and HPV infection, acceptability of the HPV vaccine was 76.8% [95% CI: 73.3-79.9%] among mothers and 68.9% [95% CI: 65.2-72.5%] among fathers. Only 8.8% of mothers and 7.0% of fathers were against administration of the HPV vaccine to their daughters. Predictors of parents' acceptance of the HPV vaccine were living in precarious housing/slums and low household income [for mothers] and living in urban areas [for fathers]. These results will be useful for preparing the introduction of the HPV vaccine in health ministry programme

[Assessment of the methodological quality of these submitted to the faculty of medicine Fez]

A thesis in medicine is a scientific work which allows a medical student to acquire a Doctor of Medicine degree. It is therefore recommended that theses presented by students fulfill essential methodological criteria in order to obtain scientifically credible results and recommendations. The aim of this study was to assess the methodology of thesis presented to the Faculty of Medicine in Fez in 2008. We developed an evaluation table containing questions on the different sections of the IMRAD structure on which these theses were based and we estimated the proportion of theses that conformed to each criterion. There were 160 theses on various specialties presented in 2008. The majority of the theses [79.3%] were case series. Research questions were clearly expressed in 62.0% but the primary objectives were pertinent in only 52.0%. Our study shows that there were important deficiencies in the methodological rigor of the theses and very little representation of the theses in publications

Epidemiological and pathological features of cancer in Fez Boulemane region, [Morocco]

In Fez-Boulemane, Morocco, there is no cancer registry so there is a lack of information about the incidence and characteristics of cancer in the region. In this retrospective study we examined the epidemiological and pathological features of 5532 cases of cancer collected from the Department of Pathology in Hassan II University Hospital of Fez from 2004 to 2010. The mean age of the patients was 53.5 years and 52% were male. Digestive cancers and skin cancers were the most common. Digestive cancers were predominantly colorectal and stomach. Cancers of the urinary bladder and colorectal cancers were the leading cancers in men accounting respectively for 9% and 8% of all male cancers. In women, cancers of the breast [62%] and uterine cervix [22.6%] predominated. As a first step in cancer control in our area, establishment of a regional cancer registry is recommended

Factors associated with treatment default by tuberculosis patients in Fez, Morocco

Interruption in tuberculosis [TB] treatment still remains the most important challenge for control of the disease. This study aimed to identify the determinants of TB treatment default in Fez, Morocco. A 1:2 pair-matched case-control study was carried out in the TB control units in Fez. Cases were defaulters to TB treatment and were matched by age and sex to non-defaulters [controls]. Of the 320 patients [108 defaulters, 212 controls], 80.6% were male. The main reason for defaulting reported by patients was the sensation of being cured. Predictive factors for treatment default in the multivariate conditional logistic regression analysis, were: relapsed case [adjusted OR = 4.49; 95% CI: 1.87-10.8], current smoking [aOR = 2.10; 95% CI: 1.07-4.14], alcohol use [aOR = 2.92; 95% CI: 1.04-8.19], being more than 30 minutes away from the health centre [aOR = 3.34; 95% CI: 1.06-10.5] and perception of having received insufficient explanation about the disease [aOR = 2.87; 95% CI: 1.53-5.36]. The rate of defaulting in Fez can be lowered through targeted and realistic measures

Prognostic factors of Atractylis gummifera L. poisoning, Morocco

In Morocco, acute Atmctylis gummifera L. poisoning represents the leading cause of death by plant poisoning especially for children. All cases received in the Moroccan poison control centre from January 1981 to December 2009 [n = 467] were included in a retrospective study of the characteristics and risk factors of A gummifera L. poisoning The most vulnerable age group was children [63,4% of cases]. Most cases were due to accidental exposure [75.5%], but some were from therapeutic use [18.1%] or attempted abortion [7.4%]. Patients presented with moderate poison seventy signs [grade 2] in 22.3% of cases or severe signs [grade 3] in 21.0%. The mortality rate was 39.2%. The majority of deaths [81.1%] occurred in children aged < 15 years following accidental exposure. Multivariate logistic regression analysis revealed that risk factors for mortality were coma [OR = 20.5]; hepatitis [OR = 52.7] and rural residence [OR - 7.26], while gastric decontamination was a protector factor [OR - 0.26]

Introduction of pharmacovigilance in a new university hospital in Morocco: how and why

In an effort to improve patient safety, Hassan II hospital in Fez introduced a pharmacovigilance system for notification of adverse drug reactions as a priority objective. The implementation of pharmacovigilance activities actually began in June 2007 but it was in 2009 after the inauguration of the new complex that the system became properly operational. This report outlines the activities carried out to develop and implement this system, including informing and training the health professionals, and the results obtained after its introduction. From 2007 to 2009, fewer than 100 cases of adverse drug reactions were reported. Up to June 2011, however, 520 reports of adverse drug reactions were recorded. The classes of drugs most implicated in adverse events were: cancer drugs [26%], anti-inflammatory drugs and antibiotics [each 15%], analgesics [12%], iodinated contrast agents [6%], and anticoagulants and corticosteroids [5%]. The main adverse events were dermatological and 27% of reports came from the internal medicine department, followed by hepatogastroenterology [25%]. Of the 520 cases reported, 46% were severe

Knowledge and attitude about antismoking legislation in Morocco according to smoking status

Despite tobacco control legislation enacted in Morocco in 1996, the Moroccan population appears to have little interest in or awareness of tobacco control measures. This household survey aimed to assess knowledge and attitudes about tobacco legislation among Moroccans, according to their smoking status. A cross-sectional study was conducted on a random sample of 9195 Moroccans. Only 33.3% knew about the antismoking legislation: 38.7% of smokers versus 323% of non-smokers. Among the 3050 people who knew about the law, 60.1% knew about the ban on smoking in public areas and 22.4% knew there was an obligatory health warning on tobacco packaging. The attitude questions showed that 27.2% agreed that the price of tobacco products should increase sharply and 45.0% that antismoking legislation should prohibit tobacco sales to children. These data demonstrate low levels of information among Moroccans concerning current tobacco control legislation

Burden of smoking in Moroccan rural areas

The aim of this study was to estimate the prevalence and characteristics of current smoking among rural Moroccans. The population study included 3438 individuals aged 15 years and above from both sexes. The crude prevalence of current smoking [currently smoked and had smoked > 100 cigarettes in lifetime] was 16.9% in the adolescent and adult rural population: 31.0% among men and 1.1% among women. The majority of smokers [74.4% of men and 68.8% of women] began smoking before age 20 years. Multiple logistic regression analysis showed that age, sex, marital status, occupation and region of residence were the strongest determinants of current smoking. These results showed a high prevalence of smoking among males in the rural population of Morocco

Prevalence of the nosocomial infection and risk factors

The prevalence of the nosocomial infection was 6, 7%, in the first study done at the University hospital center. The results were considered as underestimated. This study was done to determine the prevalence and risk factors associated with to create a new strategy against NI in this UHC. A cross sectional study was conducted. All the patients hospitalized the day of the study in this establishment were included and were examined to look for NI. The following risk factors were also looked for: the presence of a catheter, a urinary sound and surgical intervention. The statistical analysis was carried out using the software Epi info version 6. Chi-square test was used for comparing categorical data, and the Student's t-test for comparing the means. Significance was taken as P < 0.05. 276 patients were hospitalized the day of the study. Sex Ratio [Men/Women] was 0.92. The average age was 35.25 +/- 21 years with [0 - 84]. More than a third of the investigated patients [40.9%] had surgery and 36.2% of them had a vascular catheter, 13.8% had a urinary sound and 4.3% benefited from artificial ventilation. The prevalence of NI was 11.2% in all departments. 79, 3% of patients got NI on the same day of study and in the same hospitalised department The two main factors associated with the occurance of NI were surgicl operations [p = 0.04] and duration of hospitalisation [15 days or more] [p = 0, 002]. The results between the present and previous study [2004 and 2006 respectively] shows a significant increase of the NI prevalence [p = 0, 036]. The results of this study 2006 allowed estimating the NI prevalence evolution with a more relevant collection of data, consequently, a rational and adequate decision-taking

[Diabetes and erectile dysfunction in Morocco: epidemiological study among outpatients]

We studied the relationship between erectile dysfunction [ED] and diabetes among 189 men [> 40 years] attending primary health care centres in Morocco. Of the 89 diabetic men, 82% had ED while only 17% of the 100 non-diabetic men had ED. The frequency of ED among diabetic men increased with age, from 60% in those aged 40-49 years to 94.95% in those aged >/= 60 years [from 6.3% to 35.4% in men without diabetes for similar ages]. ED was reported by 93.3% of diabetic men who had had diabetes for > 15 years. The frequency of ED did not differ with type of diabetes but it was significantly commoner in diabetic men with a low level of education and with hypertension

[Prevalence and risk factors for nosocomial infections in Hassan II University Hospital, Fes, Morocco]

We determined the prevalence and risk factors for nosocomial infection at Hassan II university hospital and the causative microorganisms among 282 inpatients. The mean duration of hospitalization was 16.4 [SD = 15] days. The prevalence of nosocomial infection was 6.7%. Infections at the site of the operation were the commonest. No catheter-related infection was noted. The main organisms isolated were Escherichia coli, Klebsiella pneumoniae and Candida albicans. The occurrence of a nosocomial infection was significantly associated with surgical operation [P = 0.005], presence of urinary catheter [P = 0.002] and length of hospital stay greater than 3 weeks [P = 0.04]

[Epidemiology of animal bites related risk in Fez in Morocco]

Our strudy was carried out has for main objective to estimate the extent of the problem of the animal bites involving a potential risk of rabies in Fès city to describe the epidemiologic profile of people bitten by animals. Our study was carried out during one year period [2004] at the Municipal Office of Hygiene of Fez by using the data of a monitoring register. A descriptive statistical has been conducted. The study related to 868 bite cases. The median age of the bitten cases was 21 years; [range 1 to 90 years]. 72% were male. September was the month when the frequency of the bites was most important [n=94], the winter months seem to correspond to a period of lower risk. Most animal bites were from dogs [85.4%] and in 95% of cases the bite was single. These bites generally occured on the lower limbs [498 cases, 64%], followed by upper limbs [197 cases, 25%]. The part of the body affected differed according to victim age: 8,5% of victims under 14 years of age had been bitten on the head, compared to 2% of victims aged more than 30 years. On the other hand, 72,4% of victims aged more than 30 years had been bitten at the lower limbs, compared to 56% of victims under 14 years of age [p<0,00001]. In our series the median time between the bite and the beginning of prevention is one day. The anti-tetanus serum was received by 327 patients [37.7%] while only 93 cases [10.7%] received an antirabic serotherapy. This study allowed estimating the frequency of animal bites exposing to the risk of rabies in Fez. The results encourage us to develop and implement measurements to prevent animal bites and rabies

Clinical trial practices: methodological and ethical aspects

The objective of this article is to review the methodology of controlled clinical trial, the protocol construction stages and their various ethical aspects. Controlled clinical trial is an experiment plant in which two contemporary groups of patients are compared in a forward-looking way, the first one is treated by the reference treatment [controlled group] and the other one if treated by the new treatment [tested group]. The allocation of treatments must be unpredictable and the follow-up of the patients makes blind with regard to the received treatment. These principles constitute the methodological frame of the controlled clinical trial which can not be approached under its only methodological or statistical angle. But also through an ethical serious reflexion worldwide especially with the fast progress of biologic sciences and medical techniques. In Morocco, the rule of the medicines is governed mainly by the Ministry of Health which has to assure security and the sanitary safety of the citizens. It is responsible for all the politics of medicines in Morocco and all their aspects. The realization of the bio equivalence and bio availability trials are two criteria which are darkened from the at present current texts. The accompanying measures of the implementation of these trials for example: universal principles in person's protection, the Good Practices of Medicine's manufacture, the Good Clinical Practices, the Good Practices of Laboratory are not foreseen either by the current rule

Dyspnea: Mechanisms and assessment

This work studies the pathophysiological mechanisms of dyspnea and describes the assessement of intensity of dyspnea. The study of mechanisms of dyspnea show that dyspnea can result from a respiratory muscle dysfunction, an excessive stimulation and/or alteration of pulmonary and extrapulmonary receptors, and a direct and excessive stimulation of respiratory centres. The assessment of dyspnea can be made generally by indirect methods based on questionnaires and direct methods based on psychophysiology techniques. The understanding of pathophysiological mechanisms and the study of the assessment of dyspnea represents the key principles in strategy and effectiveness of the dyspnea treatment