The analysis of asthma control using Markov models: MOSAR study (Multicenter Observational Study of Asthma in Rabat-Morocco).

BACKGROUND: This study aimed to analyze the probabilities of transitioning between controlled, uncontrolled, and partially controlled states of asthma patients and investigate the influence of age, smoking, dust allergy, and obesity on these probabilities. METHODS: This study aimed to analyze the probabilities of transitioning between controlled, uncontrolled, and partially controlled states of asthma patients and investigate the influence of age, smoking, dust allergy, and obesity on these probabilities. RESULTS: Results showed that controlled patients were more likely to remain in that state, with approximately 79 out of 100 patients expected to stay in optimal control in the long term. A discrete nonhomogeneous time Markov Model with the stationarity criterion was used to examine the factors affecting patient states and transitions. Patients seen during the spring and summer seasons were more likely to move into a controlled state compared with those seen in the fall and winter seasons. Patients with dust allergies and obesity significantly impacted asthma exacerbation, with overweight patients more likely to transition into a controlled state. The study estimated the transition intensities matrix under certain conditions, assuming the regularity of patients. In the long term, the probability of an asthmatic patient being in a controlled state was approximately 0.8. CONCLUSION: This study provided insights into the probabilities and factors influencing asthma progression in Morocco. Dust allergy and obesity were identified as significant contributors to asthma exacerbation, emphasizing the need for effective management strategies.

Ochratoxin a in breast milk in Morocco: the affecting dietary habits of the lactating mothers and the degree of exposure of newborns "CONTAMILK study".

The aim of the present study is to evaluate the level of contamination of breast milk (BM) by ochratoxin A, among Moroccan lactating mothers in the city of Rabat, and to identify the associated factors of exposure, also to estimate the degree of exposure of the breastfeed infant. The analysis of ochratoxin A (OTA) was accomplished by ELISA method on 82 colostrum samples. OTA was detectable (>0.08 ng/mL) in 55% of samples with a maximum concentration of 10.04 ng/mL, and the levels exceeded 0.5 ng /mL in 50 % of the samples. In addition, several factors and dietary habits affect significantly the level of OTA in the analyzed samples of breast milk including, the consumption of industrial dairy products, the frequency of consumption of canned foods, dried fruits and legumes, also the period of breast milk collection. Besides, OTA was higher than the tolerable daily intake for 49% newborns. However, these results need to be confirmed by multicenter studies to more broadly estimate the levels of exposition of Moroccan population to OTA. Furthermore, awareness campaigns are recommended to inform the public, especially pregnant women and lactating women about appropriate preventive measures to limit exposure to this mycotoxin.

Levels of mercury in Moroccan breast milk and the affecting factors: CONTAMILK study.

This study aims to evaluate the level of mercury in the breast milk of Moroccan mothers and its association with several maternal parameters and habits, and to estimate the daily intake of the newborns. Inductively coupled plasma mass spectrometry (ICP-MS) was used to determine the concentrations of mercury in 70 colostrum samples. Indeed, a structured questionnaire was administrated during milk collection to report data concerning the maternal socioeconomic and anthropometric parameters, as well as dietary habits and smoking habits in the family, etc. The median of mercury in breast milk was 3,56 µg/L (range 1.64-124 µg/L) and exceeded normal levels of 1.7 µg/l, suggested by the World health organization in 99% of milk samples. Significant associations were found between mercury levels and the occurrence of previous miscarriages, anemia before pregnancy and vitamin & mineral supplementation during pregnancy, as well the frequency of consumption of cereals and the use of lipstick. The estimated daily intake was higher than the tolerable daily intake of the World health organization and the European food safety authority in 30% of newborns. These results need to be confirmed by multicenter studies to investigate the levels of mercury in the breast milk of the Moroccan population.

Lead concentrations in breast milk of Moroccan nursing mothers and associated factors of exposure: CONTAMILK STUDY.

The aim of CONTAMILK study was to estimate levels of contamination of breast milk (BM) of Moroccan nursing mothers by some xenobiotics including, lead (Pb), to identify associated factors of exposure and to determine the daily intake of newborns. Lead concentrations were determined in 70 samples of colostrum by ICPMS and a structured questionnaire was filled during milk collection to report participants' data. The median lead concentration was 908 µg/L (range 1.38-515,39 µg/L) and in 79 % of samples, levels were higher than the normal range reported by the World Health Organization (WHO) in BM (2-5 µg/L). Indeed, preterm delivery, frequency of use of cosmetic powders and lipsticks were significantly associated with the level of lead in BM. The estimated daily intake was greater than the tolerable daily intake (TDI) of the European food safety authority (0.5 µg/kg/day) for 39 babies and 6 babies according to the WHO (3.6 µg/kg/day).

Aflatoxin M1 prevalence in breast milk in Morocco: Associated factors and health risk assessment of newborns "CONTAMILK study".

The aim of this study was to assess the contamination of breast milk by aflatoxin M1 among nursing mothers from Rabat, Morocco, and to explore its association with several maternal parameters and dietary habits. In addition, the health risk assessment of the newborns by the estimation of the daily intake. A competitive Enzyme Linked Immunosorbent Assay method was used for the analysis of aflatoxin M1 in breast milk samples. Analytical results indicate that out of 82 total samples, 43 samples (52.4%) of milk were positive. Aflatoxin M1 levels ranged from undetectable to 13.33 ng/L, while the mean level was 5.75 ± 3.44 ng/L. Besides, several factors and foodstuffs seem to increase the level of AFM1 in breast milk. As regards the estimated daily intake of aflatoxin M1, it varies between immeasurable and a maximum of 1.16 ng/kg.bw. The degree of exposure to AFB1 and the levels of its metabolite AFM1 in breast milk were low, compared to some studies from other countries. Further investigations and periodic monitoring programs are recommended in large samples and in many cities of morocco to assess the level of exposure of the Moroccan population.

Systematic Review of the Literature of Factors Affecting the Exposure and the Levels of Lead in Human Breast Milk.

Human milk may sometimes contain chemical contaminants, which could have adverse effects on neonates or nursing infants. Lead (Pb) is of considerable interest due to its toxicity and occurrence. Furthermore, it has been suggested that human milk is a significant potential source of lead exposure to nursing infants. A systematic literature search in PubMed, Science Direct, and Google Scholar databases was performed to identify relevant studies, published in English until 2017, that investigated and explored common factors affecting the level of lead in human milk among lactating women around the world. Forty-nine papers were rated and explored the effect of one or several factors on the level of lead in human milk from 28 countries and carried out over a wide time frame from 1983 to 2017 and through Europe, Asia, America, and Africa, reviewing more than 5,000 subjects. Place of residence, maternal age, stage of lactation, smoking habits, maternal dietary intakes, and parity were the mostly assessed factors among the studies and considered as the main factors affecting Pb levels in BM. Other factors were not studied well enough and considered minor because few surveys evaluated their impacts. However, the literature findings are very controversial.

Cadmium Contamination in Breast Milk of Moroccan Lactating Women and the Associated Factors: CONTAMILK Study.

The objectives of this study were to assess levels of contamination of breast milk (BM) by cadmium (Cd) among lactating mothers from Rabat, Morocco, and to investigate its association with several maternal habits, parameters, and factors. In addition, to estimate the daily intake of the newborns. Cd concentrations were measured by inductively coupled plasma-mass spectrometry (ICP-MS) in 70 human milk samples collected between the 2nd and 5th day postpartum. Accuracy of the analysis was checked by various methods including the use of reference material. A structured questionnaire was filled during the collection of milk reporting data concerning anthropometric, sociodemographic parameters, dietary and cosmetic habits, etc. The median (range) of Cd in human milk was 0.49 µg/L (range 0.013-95.19 µg/L) respectively. In 21 (30%) of 70 samples, Cd levels were higher than the normal reported by the World Health Organization (WHO) in BM (< 1 µg/L). Indeed, several factors affect significantly Cd levels in BM of the mothers such as low maternal education level, preterm delivery, cesarean delivery, and area of residence. Also, the frequency of consumption of milk and dairy products as well dried fruits and wheat bread and the frequency of use of cosmetic powders. However, the daily intake of cadmium by the newborns was lower than tolerable daily intake of the WHO for 97% of them. Our results revealed low cadmium concentrations in human milk samples from Moroccan lactating mothers living in Rabat, also the association of some factors with the levels of contamination found in this population.

Total, organic, and inorganic mercury in human breast milk: levels and maternal factors of exposure, systematic literature review, 1976-2017.

This systematic review summarizes the finding of 58 studies from 33 countries, which assessed mercury concentrations in breast milk and the factors related to the level of contamination. We performed a literature search in Pubmed, Science Direct, and Google Scholar databases for studies published between 1976 and 2017 that are monitoring and measuring mercury in human breast milk and investigating the associated factors. Then, we extracted more information about the aim of the study, the country, samples size, time of lactation, mercury concentration, and other data. Most of the studies used mature milk or colostrum for analysis and in about 60% of them, the concentrations exceed significantly the limit set by the World Health Organization (WHO) of 1.7 µg/l; In addition, many factors and parameters were related to the level of mercury contamination in breast milk. Periodic monitoring surveys are recommended in each country to evaluate the level of mercury in milk of lactating women and to estimate the level of exposure of newborns.

Factors associated with asthma control: MOSAR study (Multicenter Observational Study of Asthma in Rabat-Morocco).

BACKGROUND: The purpose of the study is to describe the profile of patients with asthma and to identify the signifiant risks and the protective factors associated with asthma control. METHODS: A prospective epidemiological study was conducted in three hospitals of Rabat-Morocco and included 396 patients with asthma. Differences in characteristics across the levels of asthma control were compared by the one-way analysis of variance for continuous variables, and chi-square test was used for categorical variables. The risk and protective factors associated with the asthma control levels were determined by Proportional Odds Model (POM) for bivariate and multivariate ordinal logistic regression, also expressed as Odds Ratios (OR) and 95% Confidence Intervals (95% CI). RESULTS: From 7440 patients screened by 28 physicians, 396 were included in study. 53% of the particiants sufferd controlled, 18% had partly controlled and 29% had uncontrolled asthma symptoms. A multivariate ordinal logistic regression analysis showed that having respiratory infections (AOR = 5.71), suffering from concomitant diseases (AOR = 3.36) and being allergic to animals (AOR = 2.76) were positively associated with poor control of asthma. However, adherence to treatement (AOR = 0.07), possession of health insurance (AOR = 0.41) and having more than 2 children (AOR = 0.47) were associated with good asthma control. CONCLUSION: The study established a clinical-epidemiological profile of asthmatic patients in Rabat region in Morocco. By ordinal logistic regression we found that 6 factors - respiratory infections, concomitant diseases, animals allergy, adherence to treatment, health insurance and having more than two children - were associated with asthma control.

Assessment of cadmium levels in human breast milk and the affecting factors: A systematic review, 1971-2014.

BACKGROUND: This is a first systematic review summarizing 43 years of research from 36 countries for the assessment of cadmium in breast milk, a suitable matrix in human biomonitoring. OBJECTIVES: To report from the published literature the levels of cadmium in breast milk, and the affecting factors causing increase in cadmium concentrations. In addition, to gather several quantitative data that might be useful to evaluate the international degrees of maternal and infant exposure. METHODS: We reviewed the literature published between 1971 and 2014, available on Pubmed, Science Direct, and Google Scholar, reporting quantitative data about cadmium levels in human breast milk. Information about the aim of the study, name of the country, period of collection of samples, size of samples, sampling method, time of lactation, mother's age, area of residence, cadmium concentration, and other data were extracted. RESULTS: Sixty-seven studies were selected and included in this systematic review. Some concentrations greatly exceed the limit set by the World Health Organization (WHO); however, about 50% of the studies had less than 1 µg/L cadmium concentration (recommended by the WHO); as well as many factors have shown their implication in breast milk contamination. CONCLUSIONS: Breast milk is a pathway of maternal excretion of cadmium. It is also a biological indicator of the degree of environmental pollution and cadmium exposure of the lactating woman and the nourished infant. Therefore, preventive measures and continuous monitoring are necessary.

Outcome of Breast Cancer in Moroccan Young Women Correlated to Clinic-Pathological Features, Risk Factors and Treatment: A Comparative Study of 716 Cases in a Single Institution.

BACKGROUND: Breast cancer in young women is quite uncommon and shows more aggressive characteristics with major disparities between worldwide populations. Prognosis and outcome of breast cancer in young patients are widely studied, but still no consensus is available. METHODS: We retrospectively included 716 cases of breast cancer women diagnosed in 2009 at the National Institute of Oncology of Rabat. Patients were divided into two groups according to their age: women aged ≤40 years (Group 1) and women aged >40 years (Group 2). Data were recorded from patients' medical files and analyzed using SPSS 13.0 software (IBM). RESULTS: Young patients represent 24.9% of all patients with breast cancer. The comparison between the two groups displayed significant differences regarding nulliparity (p = 0.001) and progesterone receptor negativity (p = 0.01). Moreover, more progression (Metastases/Relapse) was registered in young women as compared to older women with breast cancer (p = 0.03). The estimated median follow-up period was 31 months. The 5-years Event-Free Survival (EFS) of patients with local disease was 64.6% in young women and 71.5% in older women with breast cancer (p = 0.04). Multivariate analysis in young women showed that nulliparity (HR: 7.2; 95%CI: 1.16-44.54; p = 0.03), T3 tumors (HR: 17.39; 95%CI: 1.74-173.34; p = 0.01) and negative PgR status (HR: 19.85; 95%CI: 1.07-366.54; p = 0.04) can be considered as risk factors for poorer event free survival while hormone therapy was associated with better EFS (HR: 0.11; 95%CI: 0.00-0.75; p = 0.03). In Group 2, multivariate analysis showed that patients with inflammatory breast cancer, N+ status, absence of radiotherapy, absence of chemotherapy, and absence of hormone therapy are at increased risk of recurrence. CONCLUSIONS: In Morocco, breast cancer is more frequent in young women as compared to western countries. Breast cancer in young women is more aggressive and is diagnosed late, leading to an intensive treatment. Moreover, the main factors associated with breast cancer development in young women would be hormonal and reproductive status. Analysis of other genetic biomarkers is needed to explain the high prevalence of breast cancer in young women to improve breast cancer management in Morocco.

Factors influencing anti-asthmatic generic drug consumption in Morocco: 1999-2010.

BACKGROUND: The increasing availability of generic drugs (GD) resulted in a remarkable reduction in treatment costs that allowed a better access to health care.The aim of this study is to evaluate the share of anti-asthmatic generic drugs during the period 1999-2010 in Morocco and to look at the factors influencing generic development. METHODS: In this study, we used Moroccan sales data from IMS Health (Intercontinental Marketing Services). The consumption of the drugs was expressed in DDD/1000 inhabitants/day according to the WHO ATC/DDD methodology. RESULTS: Between 1999 and 2010, anti-asthmatic consumption increased from 3.91 to 14.43 DDD/1000 inhabitants/day. The market of anti-asthmatic generic drugs progressed from 1.83 (47%) to 2.18 (23%) DDD/1000 inhabitants/day from 1999 to 2010. In 2010, inhaled glucocorticosteroids ranked first (0.83 DDD/1000 inhabitants/day), followed by inhaled short acting beta agonists (0.73 DDD/1000 inhabitants/day). The number of brands went from 27 in 1999 to 34 in 2010, with a generic share increasing from 55.55% to 70.59%. The number of anti-asthmatic pharmaceutical preparations increased from 57 to 64 during the same period, of which 31 and 42 were generic preparations. In 2010, the total cost of anti-asthmatic dugs was about 22 million euro, the generics representing 14 million euro. CONCLUSION: Despite the introduction of a compulsory insurance scheme called "AMO", that allows a refund for 69.5% of anti-asthmatic specialties marketed in Morocco, anti-asthmatic generic drug consumption remains limited. The Moroccan market is still largely dominated by the originator drugs with still valid patents.

[Generic drugs and the consumption trends of antihypertensives in Morocco]. / Les médicaments génériques et l'évolution de la consommation des antihypertenseurs au Maroc.

BACKGROUND: To evaluate the evolution of consumption of antihypertensive drugs generic among 1991-2010, to assess the impacts after the institution of Mandatory Health Insurance and the marketing of generic drugs. METHODS: We used sales data from the Moroccan subsidiary of IMS Health Intercontinental Marketing Service. RESULTS: Consumption of generic antihypertensive drugs increased from 0.08 to 10.65 DDD/1 000 inhabitants/day between 1991 and 2010. In 2010, generic of the calcium channel blockers (CCBs) represented 4.08 DDD/1 000 inhabitants/day (82.09%), followed by angiotensin converting enzyme inhibitors (ACEI) by 2.40 DDD/1 000 inhabitants/day (48.29%). The generics market of CCBs is the most dominant and represented in 2010, 79.21% in volume and 62.58% in value. CONCLUSION: In developing countries like Morocco, the generic drug is a key element for access to treatment especially for the poor population.

Trends in the use of antiasthmatic medications in Morocco (1999-2010).

BACKGROUND: Asthma is a big public health problem in Morocco. The drug therapy existing in Morocco is currently insufficient because of the low purchasing power and the low health insurance coverage available to the average citizen in Morocco. In this study we evaluated the consumption of antiasthmatics in Morocco during the period 1999-2010, the classes of used drugs and the generics' market share. METHODS: We used sales data from the Moroccan subsidiaries of the IMS Health "Intercontinental Marketing Service". The consumption volume was converted to Defined Daily Doses (DDDs). RESULTS: During 1999-2010, antiasthmatics's consumption increased from 3.91 to 14.47 DDD per 1000 inhabitants per day. In 2010, the association Beta-2-mimetic-Glucocorticosteroids were the most consumed (8.53 DDD/1000 Inhabitants/day) followed by the short-acting inhaled Beta-2-mimetic (4 DDD/1000 Inhabitants/day) and inhaled Glucocorticosteroids alone accounted for 1.13 DDD/1000 Inhabitants/day. The largest consumption share in volume was held by the short-acting inhaled Beta-2-mimetic (42%) followed by the combination Beta-2-mimetic-Glucocorticosteroids (38%). Between 1999 and 2010, the market for generic antiasthmatics increased from 1.84 to 2.18 DDD/1000 Inhabitants/day. The ratio of the monthly average cost of treatment to the minimum wage in Morocco decreased from 10.8% in 1999 to 7.11% in 2010. CONCLUSION: Antiasthmatics' consumption in Morocco has undergone significant changes between 1999 and 2010. However, the availability of these drugs expressed as the Average Monthly Expenditure/Guaranteed Minimum Wage ratio improved. Despite this, the use of antiasmathics in Morocco remains low.