Ischemic stroke in Morocco: Prehospital delay and associated factors.

OBJECTIVES: This study aimed to estimate prehospital delay and to identify the factors associated with the late arrival of patients with ischemic stroke at the Souss Massa Regional Hospital Center in Morocco. PATIENTS AND METHODS: An observational, prospective, cross-sectional study was conducted from March 2019 to September 2019 in the Souss Massa regional hospital center, which is a public hospital structure. A questionnaire was administered to patients with ischemic stroke and to bystanders (family or others), while clinical and paraclinical data were collected from medical records. Univariate and multivariate logistic regression analyses were used to identify the factors associated with delayed arrival at emergency department. RESULTS: A total of 197 patients and 197 bystanders who fulfilled the criteria for the study were included. The median time from symptom onset to hospital arrival was 6hours (IQR, 4-16). Multiple regression analysis showed that illiteracy (OR 38.58; CI95%: 3.40-437.27), waiting for symptoms to disappear (patient behavior) (OR 11.24; CI95%: 1.57-80.45), deciding to go directly to the hospital (patient behavior) (OR 0.07; CI95%: 0.01-0.57), bystander's knowledge that stroke is a disease requiring urgent care within a limited therapeutic window (OR 0.005; CI95%: 0.00-0.36), and direct admission without reference (OR 0.005; CI95%: 0.00-0.07), were independently associated with late arrival (>4.5hours) of patients with acute ischemic stroke. In addition, illiteracy (OR 24.62; CI95%: 4.37-138.69), vertigo and disturbance of balance or coordination (OR 0.14; CI95%: 0.03-0.73), the relative's knowledge that stroke is a disease requiring urgent care and within a limited therapeutic window (OR 0.03; CI95%: 0.00-0.22), calling for an ambulance (relative's behavior) (OR 0.16; CI95%: 0.03-0.80), distance between 50 and 100km (OR 10.16; CI95%: 1.16-89.33), and direct admission without reference (OR 0.03; CI95%: 0.00-0.14), were independently associated with late arrival (>6hours) of patients with acute ischemic stroke. CONCLUSION: Patient behavior, bystander knowledge and direct admission to the competent hospital for stroke care are modifiable factors potentially useful for reducing onset-to-door time, and thereby increasing the implementation rates of acute stroke therapies.

Association of vitamin D status with multiple sclerosis in a case-control study from Morocco.

BACKGROUND: Growing evidence suggests that hypovitaminosis D contributes to the pathogenesis of multiple sclerosis (MS). OBJECTIVE: This study aimed to evaluate whether vitamin D levels are associated with having MS and some of its characteristics in the Moroccan population. METHODS: Using liquid chromatography-tandem mass spectrometry, the 25(OH)D3 metabolite was measured to quantify vitamin D serum levels (DSLs) in 113 patients with MS and 146 healthy controls matched for gender and age. DSLs were then compared between patients and controls, with correlations sought between DSLs and gender, age at onset, disease duration, MS type, degree of disability (EDSS score) and disease severity (MSSS) in patients. RESULTS: Hypovitaminosis D (DSL<30ng/mL) was observed in 97.3% of MS patients and in 98.6% of controls. Although the mean DSL was slightly lower in patients (11.69±6.97ng/mL) than in controls (12.98±6.58ng/mL), there was no significant association between DSL and MS status (P=0.131). Similarly, among patients, no apparent association was found between DSL and MS type (P=0.214), EDSS score (P=0.076) or MSSS (P=0.772). CONCLUSION: Our study suggests that DSL is not associated with having MS nor with MS type, degree of disability or disease severity in the Moroccan population. On the other hand, DSL was lower in women and decreased with age.

[Economic impact of centralization of chemotherapy preparation: Experience of the National institute of oncology of Rabat]. / Impact économique de la centralisation de la préparation de la chimiothérapie : expérience de l'Institut national d'oncologie de Rabat.

INTRODUCTION: Centralized preparation of anticancer drugs meets quality and safety objectives. Its economic interest has been the subject of several studies, with very heterogeneous methodological approaches. OBJECTIVE: This study evaluates the economic impact of the centralization of the preparation of chemotherapy in the national institute of oncology of Rabat, the referral institute in the management of cancer in Morocco. MATERIALS AND METHODS: The analysis included 3000 preparations. It compared the costs of anticancer drugs in a centralized unit at theoretical costs in the healthcare units, modelled according to two approaches. RESULT: With a conservative approach, the impact of centralization was estimated at 80%. The centralized system made it possible to materialize 80% of the potential gain. The remaining 20% is considered a loss. It was very much related to the preparation of the expensive molecules (90%). CONCLUSION: Centralization thus allows a better distribution of roles within the hospital and provides a source of self-financing for quality improvement.

[Cardiac hydatid cyst about 17 operated cases]. / Les kystes hydatiques cardiaques à propos de 17 cas opérés.

Cardiac hydatid cyst is a rare parasitic disease. The purpose of this study was to describe the clinical, pathological features and the outcome of the surgical treatment of cardiac hydatid disease in our unit over a twenty-year period. METHODS: Between May 1994 and May 2014, seventeen cases of cardiac hydatid cysts were operated at our unit. Overall, twelve patients were male (mean age 25±13years). All patients were complaining of dyspnea and 71% presented with chest pain. The diagnosis, based on histological examination, was suspected on echocardiography and computed tomography of chest. RESULTS: Our study revealed five possible locations, which were in decreasing order of frequency: left ventricle, interventricular septum, right ventricle, left atrium and pulmonary artery. The surgical procedure was a controlled puncture and aspiration of the cyst content, with cystectomy (69%), or pericystectomy (31%). The resulting cavity left open in 6 cases (37.5%) or carefully closed in 10 (62.5%). Hospital mortality was 11.8% (n=2). Morbidity was marked by conduction abnormalities (n=2), bleeding and hematoma of the residual cavity that required surgical treatment (n=3). Eleven patients were followed with a mean period of 40.5±19.4 months. At follow-up, neither late deaths nor recurrence have occurred. CONCLUSION: Cardiac hydatid cyst is a serious disease whose treatment is surgical. Cystectomy and pericystectomy remain the two surgical techniques able to offer good chance of cure with acceptable morbidity and mortality.

Family-based association study of HLA class II with type 1 diabetes in Moroccans.

BACKGROUND: The T1D is a multifactorial disease; with a strong genetic control. The human leukocyte antigen (HLA) system plays a crucial role in the autoimmune process leading to childhood diabetes. About 440,000 of the childhood population of the world (1.8 billion children under 14 years of age), have type 1 diabetes, and each year an additional 70,000 develop this disorder. The objective of this study was to investigate the distribution of HLA class II in Moroccan families of diabetic children to identify susceptibility alleles of the Moroccan population. SUBJECTS AND METHODS: We included in this study, Moroccan families who have at least one child with T1D. The age of onset of diabetes was less than 15 years. HLA class II (DRB1* and DQB1*) was carried out by molecular biology techniques (PCR-SSP and PCR-SSO). The FBAT test (family-based association test) was used to highlight the association between T1D and the HLA-DRB1* and -DQB1* polymorphism. RESULTS: The association of HLA class II (DRB1*, DQB1*) in type 1 diabetes was analyzed in fifty-one Moroccan families, including 90 diabetics. The results revealed that the most susceptible haplotypes are the DRB1*03:01-DQB1*02:01, DRB1*04:05-DQB1*03:02 (Z=3.674, P=0.000239; Z=2.828, P=0.004678, respectively). And the most protective haplotype is the DRB1*15-DQB1*06. CONCLUSION: This is the first family-based association study searching for an association between HLA class II and T1D in a Moroccan population. Despite the different ethnic groups forming Morocco, Moroccan diabetics share the most susceptible and protective HLA haplotypes with other Caucasians populations, specifically the European and Mediterranean populations.

Translation, cultural adaptation and validation of the kidney disease quality of life-short form 1.3 in an African country.

BACKGROUND: The impact of dialysis on patient quality of life has been recognized as an important outcome measure. The Dialysis Outcomes and Practice Patterns Study compared quality of life in 4 continents [1], but very scarce information is available about dialysis patients' quality of life in Africa. The objective of this study was to translate the Kidney Disease Quality of Life-Short Form (KDQOL-SF) into Moroccan and measure its psychometric properties. METHODS: The questionnaire was first translated into Moroccan by 2 independent translators, and then 2 backward translations into English were performed after pretesting in 10 dialysis patients. The final questionnaire was then administered to 80 dialysis patients. Reliability was estimated by internal consistency and test-retest reliability. Validity was assessed using known group comparisons and correlations between overall health rating and scales scores. RESULTS: Some activities were substituted since they were not common in Morocco. All subscales had a Cronbach α above the recommended value except for 3 scales. All of the items showed good test-retest reliability. Correlation of items within subscales was higher than that of items outside subscales in 87% of cases. Regarding construct validity, all KDQOL-SF scales had significant correlation with overall health rating except for sexual function and dialysis staff encouragement. Furthermore, the questionnaire could be used to discriminate between subgroups of the patients. CONCLUSIONS: The psychometric properties of the KDQOL-SF resulting from this first-time administration of the instrument support the validity and reliability of the KDQOL-SF as a measure of quality of life of patients having hemodialysis in Morocco.

A clinical study of non-parkinsonian tremor in Moroccan patients.

OBJECTIVE: To report the characteristics of the most frequent tremors in a population of Moroccan patients. BACKGROUND: Tremor is the most common movement disorder. It implies a wide variety of disorders with Parkinson's disease and essential tremor being the most frequent. METHODS: A retrospective study of 148 patients with tremor referred to our movement disorders outpatient clinic was performed. Clinical features and treatment regimens were analyzed. Patients with parkinsonian tremor were excluded. RESULTS: We included 62 patients with non-parkinsonian tremor. The etiologies were as follows: essential tremor (54.8%), dystonic tremor (19.4%), tremor associated with dystonia (14.5%), enhanced physiological tremor (3.2%), cerebellar tremor (3.2%), psychogenic tremor (3.2%) and Holmes' tremor (1.6%). The characteristics of essential tremor patients were analyzed. Female patients accounted for 67.6% of patients. Mean age at the onset of tremor was 52.2 ± 16.4 years. Family history of tremor was reported in 17.6% of cases. Tremor affected the arms (94.1%), head (52.9%), voice (35.3%) and legs (8.8%). Tremor was bilateral in 87.5% but was asymmetrical in 50% of patients. Patients had postural tremor (76.5%), kinetic tremor (79.4%) and rest tremor (associated in 11.8%). Treatment relied on propranolol (88.3%), primidone (14.7%), gabapentin (14.7%), clonazepam (14.7%), alprazolam (11.8%), topiramate (5.9%) and, in one patient, radiosurgery. CONCLUSIONS: Essential tremor was the predominant diagnosis, confirming its high prevalence. There was a predominance of female patients and a peak of age at onset in the fifth and sixth decades. Asymmetry of the disease was noted in half of patients.

Clinical prognostic factors in locally advanced nasopharyngeal carcinoma in Moroccan population.

BACKGROUND: Nasopharyngeal carcinoma is a distinct cancer of head and neck by its pathology, etiology, epidemiology and clinical behavior. Morocco is considered an endemic region with intermediate incidence. The aim of our report is to underline some clinical determinants of survival in locally advanced disease. PATIENTS AND METHODS: We conducted a retrospective study from January 2003 to December 2005. All patients with undifferentiated nasopharyngeal carcinoma treated in the National Institute of Oncology of Rabat, Morocco were recorded. Classified stage II to IVB disease according to TNM classification adopted by the AJCC (American Joint Committee of Cancer) 6th edition. RESULTS: The study included 339 patients, 122 women and 217 men (sex-ratio: 1.7). Mean age was 43 years old (range: 6-91years). Median duration to diagnosis was 6 months (range: 1-72) presenting symptoms at diagnosis were predominantly cervical lymph node in 79%. Forty- two patients have T1 tumors, 159 = T2 tumors, 64 = T3 tumors and 69 = T4 tumors. Sixty-five patients do not have lymph-node involvement, 49 have N1, 128 have N2 and 95 have N3. Three patients were at stage IIA, 57 patients were at stage IIB, 40 patients were at stage III, and 57 patients were at stage IVA and the remaining 96 patients were at stage IVB. Eighty-seven percent of patients underwent sequential chemoradiation and 17% underwent concurrent chemo-radiation (CTR). Response to induction chemotherapy was assessed in 235 patients. There were 31 patients with complete response and 59 patients have partial response. Complete response to radiotherapy was reached in 235 patients. Mean overall survival (OS) was 66.2%. Gender was a prognostic factor of OS (p=0.045) and DFS favoring women. Age wasn't a prognostic factors determining the outcome with no difference between patients aged more than 40 years old and patients younger. Tumor size was not a determinant of survival with a non-significant p in OS and DFS (0.27 and 0.46 respectively) but T4 stage patients appear to have a worse prognosis. Lymph node involvement was significantly determining the outcome either in OS and DFS (p=0.001 and 0.009 respectively). TNM stage was also a significant prognostic factor in OS but not in DFS favoring those with early stage (p= 0, 004 and p= 0, 13 respectively). The treatment strategy was not a significant prognostic factor with no difference between patients who underwent sequential or concurrent chemoradiation (OS p= 0, 48 and DFS p= 0, 9). In multivariate analysis, lymph-node involvement is the most significant factor. CONCLUSION: Our findings were mostly concordant with the literature data in endemic areas for TNM staging; however we are limited by the bias of retrospective studies. Prospective studies would be more accurate to define those prognostic factors in our population. KEYWORDS: UCNT, prognostic factors, endemic areas, lymph node involvement.

Profile of multiple system atrophy in Moroccan patients attending a movement disorders outpatient clinic in Rabat university hospital.

INTRODUCTION: Multiple system atrophy (MSA) is a sporadic and rapidly progressive neurodegenerative disorder of poor prognosis, characterised clinically by any combination of parkinsonian, autonomic, cerebellar, or pyramidal signs. We report our experience in movement disorders consultation concerning the clinical presentation and the course of MSA in Moroccan patients. METHODS: A retrospective review of the medical records of 17 patients with diagnosis of MSA seen in our outpatient clinic from January 2007 to December 2010. RESULTS: In our 17 patients, 76.5% were men and the mean age of onset was 52±9 years. MSA-P was the major clinical phenotype (82.4%). Eleven patients (64.7%) were classified as having probable MSA and six patients (35.3%) as possible MSA. Dysautonomic features were detected in all patients; urinary symptoms were found in 76.5% of cases and orthostatic hypotension in 64.7%. Treatment regimen included l-Dopa with a mean daily dose of 621.4±346.8mg/day and symptomatic treatment of dysautonomia. The mean duration of disease evolution was of 4.7±1.9 years. DISCUSSION: Our results show a male predominance and an early age of disease onset. MSA-P was the predominant subtype. Our results are similar to the European MSA series. CONCLUSION: Multicentre studies are needed to better characterise MSA in Morocco given the rarity of this disease.

[Factors predictive of good motivation to quit smoking among Moroccan smokers attending a lung disease outpatient clinic in 2008]. / Les facteurs prédictifs de la bonne motivation de cesser de fumer chez les fumeurs marocains consultant pour une symptomatologie pulmonaire en 2008.

BACKGROUND: Motivations for cessation of smoking should be studied to determine which factors have an impact. Educational messages can then be developed to help smokers become more successful in adopting healthy behavior. The objective of our work was to determine the factors influencing the quality of motivation for smoking cessation among patients attending a lung disease clinic. METHODS: Between March and June 2008, patients attending the outpatient clinical of the Moulay Youssef Hospital Department of Pneumology in Rabat were studied. Data on the smoking status and motivation to stop smoking (Richmond's test) were collected using a standardized questionnaire. A logistic regression model was developed to analyze the quality of their motivation to quit smoking. RESULTS: The median age for smoking the first cigarette was low (<20 years); pharmacological dependence on nicotine was low (Fagerström score<8 in 71.8%). More than a third of patients (36.6%) had already intended to cease smoking. According to the Richmond test, only 46.0% were well motivated (score>or=8). At multivariate analysis, factors predictive of a good motivation to quit smoking were a previous attempt to stop smoking (OR=5.4 [2.5-11.7]), severe disease (OR=3.7 [1.6-8.2]). Beginning the tobacco addiction before the age of 18 years was predictive of poor motivation (OR=2.7 [1.4-5.3]). CONCLUSION: Our investigation provides evidence in favor of searching for different factors which might affect motivation to stop smoking among patients seeking care in a lung disease clinic. Lung specialists, who manage the large majority of these patients should be particularly active in this area.