Measuring health-related quality of life in the population of Tetouan, Morocco, by the SF-36: normative data and the influence of gender and age.

Measuring health-related quality of life (HRQOL) is an essential complement to medical evaluation. However, few studies of this type have been conducted in Morocco. This study aims to develop normative data for the SF-36 and analyse the HRQOL according to gender and age in the population of Tetouan city, Morocco. The SF-36 was administered to a sample selected by quotas containing 385 subjects aged over 16 years living in Tetouan. Comparisons of means were done to determine the significance of differences. The study population perceived mental health to be worse than physical health. Men presented significantly higher mean scores than women for all domains of the SF-36. Perceived health, especially physical health, declines with age, and so participants over the age of 55years recorded a poor perception of their health in the majority of domains measured. The results highlight the vulnerability of the two groups: women and the elderly.

Measuring health-related quality of life in the population of Tetouan, Morocco, by the SF-36: normative data and the influence of gender and age

يعتبر قياس جودة الحياه المرتبطة بالصحة مكملا اساسيا للتقييم الطبي بيد أنه لم تجر سوى دراسات قليله من هذا النمط في المغرب وتهدف هذه الدراسه الى اعداد بيانات معياريه لاستبيان SF-36 وتحليل جودة الحياه المرتبطة بالصحة وفقا للنوع والسن لدى سكان مدينة تطوان بالمغرب فقد اعطى الـ SF- 36 لعينه اختيرت بموجب الحصص النسبيه تضم 385 شخصا تزيد اعمارهم عن 16 عاما يعيشون في تطوان واجريت مقارنات بين المتوسطات لتحديد دلاله الفروق فرأت عينه الدراسه ان الصحه النفسيه اسوأ من الصحه البدنيه وكانت متوسطات الدرجات التي منحها الرجال لكافة مجالات الـ SD-36 اعلي بكثير من تلك التي منحتها لها النساء وبما أن الاحساس بالصحه وخاصة الصحه البدنيه يتراجع مع تقدم السن فقد سجل المشاركون الذين تزيد اعمارهم على 55 عاما تصورا سيئا عن حالتهم الصحيه في معظم المجالات التي جرى قياسها فهذه النتائج تسلط الضوء على هشاشه هاتين الفئتين النساء وكبار السن

La mesure de la qualité de vie en relation avec la santé (QVRS) est un complément essentiel à l'évaluation médicale. Cependant, peu d’études en ce sens ont été réalisées au Maroc. Ce travail vise à déterminer les données normatives du questionnaire d’évaluation de la santé perçue Short Form-36 Health Survey(SF-36) et d'analyser la QVRS selon le sexe et l'âge chez la population de la ville de Tétouan au nord du Maroc. Le questionnaire SF-36 a été administré chez un échantillon choisi par quotas qui comprenait 385 sujets de plus de 16 ans vivant dans la ville de Tétouan au nord du Maroc. Les comparaisons des moyennes ont été effectuées pour déterminer la significativité des différences. La population étudiée perçoit sa santé psychique moins bien que sa santé physique. Les hommes ont obtenu des scores significativement plus élevés que les femmes pour tous lesdomaines du SF-36. La santé perçue, et en particulier physique, décline avec l’âge ; c’est ainsi que les personnes âgées de plus de 55 ans ont une mauvaise perception de la majorité des domaines mesurés. Ces résultats mettent en évidence la vulnérabilité de ces deux groupes : les femmes et les personnes âgées.

Measuring health-related quality of life (HRQOL) is an essential complement to medical evaluation. However, few studies of this type have been conducted in Morocco. This study aims to develop normative data for the SF-36 and analyse the HRQOL according to gender and age in the population of Tetouan city, Morocco.The SF-36 was administered to a sample selected by quotas containing 385 subjects aged over 16 years living in Tetouan. Comparisons of means were done to determine the significance of differences. The study population perceived mental health to be worse than physical health. Men presented significantly higher mean scores than women for all domains of the SF-36. Perceived health, especially physical health, declines with age, and so participants over the age of 55years recorded a poor perception of their health in the majority of domains measured. The results highlight the vulnerability of the two groups: women and the elderly.

[Concomitant fractures of the radius and scaphoid with an elbow dislocation]. / Fractures concomitantes du radius et du scaphoïde associées à une luxation du coude.

A variety of associated injuries of the upper limb have been described in the literature. The authors report a case of bifocal fracture of the radius and a scaphoid fracture together with elbow dislocation. In our knowledge, this association of lesions has never previously been described.

[Pigmented villonodular synovitis of the wrist invading bone. Case report]. / Synovite villonodulaire hémopigmentée du poignet envahissant l'os. A propos d'un cas.

Pigmented villonodular synovitis of the wrist is a rare and benign lesion. The bone involovement means an agressive form, but adequate treatment permit to avoid the recurrences. The authors analyse a case with good evolution after synovectomy and bone debridement, with review of literature.

[The floating forearm: elbow and perilunate dislocation]. / Avant-bras flottant: luxation périlunaire du carpe et luxation du coude.

To the five cases published in the literature concerning concomitant elbow and perilunate dislocation, the authors add a sixth case and discuss the epidemiologic, clinical and therapeutic characteristics of this complex injury.

[Stress test and aortic stenosis]. / Epreuve d'effort et rétrécissement aortique.

In patients with severe asymptomatic aortic stenosis (AS), the decision to operate is difficult. In effect, the operative mortality is not negligible (about 5% in subjects age over 75 years) while spontaneous mortality from sudden death is low (about 0.4% per year). The aim of the stress test is to detect patients who are falsely asymptomatic (due to subconscious self limitation of daily physical activity) for whom aortic valvular replacement should be proposed because of the risk of sudden death. On the other hand, if the stress test is negative (normal blood pressure elevation on effort, the absence of either any symptoms, ST segment depression of more than 2 mm, or severe ventricular rhythm disorders linked to effort), surgical intervention could (and probably should) be postponed. This article presents the studies which have allowed integration of the stress test as an aid to the decision of when to operate in patients with asymptomatic severe AS with good left ventricular function into the European and North American recommendations.

[Apolipoprotein E and angiotensin-converting enzyme gene polymorphisms as risk factors of coronary disease]. / Implication du polymorphisme génétique de l'apolipoprotéine E et de l'enzyme de converstion de l'angiotensine dans l'athérosclérose coronarienne.

The objective of this study was to test the hypothesis that apo E (RFLP, HhaI) and/or angiotensin-converting enzyme (ACE) (ins16del) are associated with higher risk for coronary heart disease. We investigated 250 patients who underwent complete cardiac examination comprising coronary angioplasty and biological analysis (CT, HDLc, LDLc, TG, apo A and apo B). Prevalence of the alleles of apo E and ACE was assessed by molecular analysis. Patients without stenosis or with non-significant stenosis (> 50% of the vascular lumen) were used as reference group (141 patients). Those presenting a significant stenosis of the coronary artery (. 50% of the vascular lumen) were considered as cases (109 patients). The relative frequency of the e 4 allele was significantly higher in cases than in reference group (p > 0.02). A strong association have been found between coronary heart disease and apo E polymorphism (2 = 8.91; p > 0.05). The presence of the e 4 allele increase the risk of atherosclerosis (RR = 2.71; IC95%: 1.25-5.90; p > 0.02) compared to e 3 allele. Also, subjects with D allele were more frequent in cases than in reference group (p > 0.001). A significant association was noted between ACE polymorphism and coronary heart disease (2 = 42.15; p > 0.001). This relationship was positive (rho de Spearman = 0.39; p > 0.01). With D/D homozygotes patients, the RR for coronary heart disease was 19.10 (p > 0.001), while The RR with I/D heterozygotes was 6.91 (p > 0.001) compared to I/I homozygotes. A significant interaction have been shown up between D/D genotype and arterial hypertension (HTA) (2 de Wald = 16.10; p > 0.001). The multivariate analysis showed that the chronic smoking, diabetes, hypoapolipoproteinemia A, interactive effects between D/D and HTA, I/D and obesity, and between D/D and hypertriglyceridemia were the major significant factors to take into consideration in our population. We also note that subjects with both D and e 4 alleles were presenting a high risk to coronary heart disease (RR = 5.93; IC95%: 2.00-17.55; p > 0.01). Thus, those two alleles (4 and D) appears to be important cardiovascular risk factors in the moroccan population.

Inhibition of caffeine metabolism by 5-methoxypsoralen in patients with psoriasis.

Eight patients with psoriasis were given 200 mg caffeine orally with or without 1.2 mg kg-1 of 5-methoxypsoralen. Blood and urine samples were collected over a 2-day period. During 5-methoxypsoralen coadministration, the apparent volume of distribution of caffeine remained unchanged, but oral clearance (CLp.o.) decreased from 9.5 +/- 3.8 (mean +/- s.d.) to 3.2 +/- 0.51 h-1 (P < 0.01). The area under the plasma concentration-time curve (AUC) increased from 24 +/- 9 to 73 +/- 29 mg 1(-1) h (P < 0.001). This decrease in CLp.o. with increased AUC was consistent with a CYP1A2-dependent inhibition of caffeine N-demethylation which was further supported by significant decreases in the (AFMU+1U+1X)/17U and (AFMU+1U+1X)/17X urinary metabolic ratios.

Stability of debrisoquine (CYP2D6) phenotype in liver transplant patients.

Liver metabolism may be modified after liver transplantation according to the phenotype of the donor and may be influenced by posttransplantation complications. The CYP2D6 phenotype was assessed in 13 patients (group I) before and after liver transplantation using debrisoquine. CYP2D6 activity was also assessed in vitro on microsomes from the liver of the recipients and the donors, using dextromethorphan. Twelve patients were extensive metabolizers both before and after transplantation. One apparently poor metabolizer was transplanted with the liver of another poor metabolizer. The intrinsic clearance of dextromethorphan (CL(int)) measured on recipient liver microsomes was significantly lower than that on donor liver microsomes (p < 0.05). In extensive metabolizers, the debrisoquine metabolic ratio was correlated with CL(int) before (r = 0.78, p < 0.05) and after (r = 0.89, p < 0.0005) transplantation. Debrisoquine phenotype was measured repeatedly in nine additional patients (group II) up to 3 years after liver transplantation. Their phenotype was stable during the follow-up observation, although the variations observed may be clinically relevant. Therefore, no change in CYP2D6 phenotype (extensive/poor metabolizer) was observed because of the liver transplantation, and the debrisoquine log metabolic ratio was largely unaffected by the liver complications observed during the posttransplantation follow-up observation.