Economic burden of lung cancer in Morocco: A cost of illness study.

INTRODUCTION: Lung cancer is the most common cancer in men and the second most common cancer in women. It is associated with substantial economic impact in terms of direct and indirect costs. The main objective of this study is to estimate the direct medical cost of lung cancer management in Morocco MATERIALS AND METHODS: A cost-of-illness study was conducted among patients treated at the Mohammed VI Center of Cancer (Casablanca) in 2019. The costs were estimated from the societal perspective using a bottom-up approach. The materials and procedures used were identified and quantified retrospectively from the information system and files. Their monetary value was calculated according to official prices published by the national health insurance agency. The horizon time adopted was 12 months. RESULTS: The study included 271 patients, with an average age of 62.5 ± 9.5 years. Of these, 93.4 % were men and 92.1 % were former smokers. In terms of cancer staging, 68.3 % of patients were in stage IV while 28.8 % were in stage III. Adenocarcinoma was present in 43.5 % of cases. Patients underwent an average of 10.6 ± 5.1 radiological investigations, 56.1 ± 30.9 biological tests, and 24.1 ± 11.7 consultations. The average direct medical cost was 4455.3 USD (95 % CI: 4037.4-4873.2). Chemotherapy accounted for 19.9 % of the total cost, while radiological investigations and drugs accounted for 18.7 % and 17.6 %, respectively. Diagnostic tests and radiotherapy each accounted for 7.6 % of the total cost, while biological tests accounted for 7.5 % and hospitalizations accounted for 7.1 %. The cost was statistically higher in young patients (p = 0.017), in patients with adenocarcinoma (p < 0.0001), in patients with stage II tumor (< 0.00001), in patients who have undergone surgery (p = 0.002), chemotherapy (p < 0.0001), radiotherapy (p < 0.001) and in those without metastases (p < 0.0001). CONCLUSION: These results provide evidence to support the ratification of the Framework Convention on Tobacco Control and the full adherence of the Kingdom of Morocco to the MPOWER measures.

Cultural Adaptation and Validation of the Modified Checklist for Autism in Toddlers, Revised with Follow-up in Moroccan Arabic dialect.

BACKGROUND: The prevalence of autism spectrum disorder is increasing worldwide, making screening and early intervention necessary. Several screening instruments have been developed in recent years. The Modified Checklist for Autism in Toddlers Revised with Follow-up (M-CHAT-R/F) is considered to be one of the specific measures designed to identify toddlers at risk for autistic spectrum disorder. OBJECTIVE: The aim of the study was to translate and adapt the original version of M-CHAT-R/F from the English to the Moroccan Arabic language. STUDY DESIGN: Specialized translators and clinicians ensured forward and backward translation of the scale into Moroccan Arabic. Then, a two-stage screening of the M-CHAT-R/F-T was applied to a study sample comprised of 56 toddlers with autistic spectrum disorder (category I) and 96 toddlers with normal development (category II). "Kappa test", "Cronbach's alpha" test, the intra class correlation coefficient, and the area under the curve were determined. RESULT: The average score results of M-CHAT-R/F were 13.12 for category I, while it was 2.24 for category II. The Cronbach's alpha coefficient of the checklist was 0.929. The kappa values ranged from k=0.78 to k=0.97 with a confidence interval of 95% indicating good convergence. The intra-class correlation coefficient ranged from 0.97 to 0.99, which is excellent. The area under the curve in our study was 0.988, an excellent result. CONCLUSION: Efficiency of the Moroccan Arabic version of the MCHAT was demonstrated for screening in the general population.

Depression and anxiety in patients with diabetes in a Moroccan region.

AIMS: To estimate prevalence of anxiety and depression in patients with diabetes mellitus and identify their determinants. METHODS: A cross-sectional study was conducted at Hassan II University-Hospital of Fes in 2019-2020. Anxiety and depression were measured by using the Hospital Anxiety and Depression Scale (HADS). Multivariate analysis by logistic regression was used to determine factors associated with depression and anxiety, adjusting for confounding factors. All statistical analyses were conducted using EPIINFO7. RESULTS: A total of 243 diabetics were included in the study. The average age of the participants was 48.07±14.25 years, 58% were females and 72% were diagnosed with diabetes type II. The prevalence of depressive symptoms and anxiety symptoms was (18, 1%, CI95%=(13-23)) and (29.6%, CI95%=(24-35)), respectively. The prevalence of depression and anxiety was higher among women than man and increases with increasing duration of the disease. In multivariate analysis, illiterates (OR=3.19, CI95%=(1.46-6.98)), those with depression (OR=3.61, CI95%=(1.78-7.32)), and type 1 diabetics (OR=3.22, CI95%=(1.44-7.21)) are a higher risk of developing anxiety. Depression was associated with older age (OR=2, 65, CI95%=(1, 14-6, 14)), use of insulin (OR=3.77 CI95%=(1.50-9.44)) and anxiety symptoms (OR=4, 27, CI95%=(2, 05-8, 91)). CONCLUSION: High prevalence of depressive and anxiety symptoms in diabetics suggests consideration of psychological aspect in implementation of diabetes managing program.

[Impact of the SARS-CoV-2 pandemic on diabetic macular edema and prognostic factors]. / Impact de la pandémie du SARS-CoV-2 sur l'œdème maculaire diabétique et facteurs pronostiques.

PURPOSE: To assess functional and anatomical consequences of the delay in intravitreal injections for diabetic macular edema (DME) patients during the corona virus pandemic lockdown in Morocco as well as to evaluate factors associated with disease progression. PATIENTS AND METHODS: This cross-sectional study included DME patients who did not complete their scheduled intravitreal bevacizumab injections during the Lockdown period (March 20, 2020 to May 20, 2020). Data recorded included age, duration of diabetes, number of previous intravitreal injections, best-corrected visual acuity, and central macular thickness before and after the lockdown. RESULTS: One hundred and fifty four eyes of 104 patients were analyzed. 57.8% were male. The mean age was 59.4±9.04 years. The mean duration of delay of intravitreal injections was 57.3±6.7 days. The mean number of intravitreal bevacizumab injections received before the lockdown was 2.29±2.1. Worsening of visual acuity was noted in 44.8% of patients and was associated with a lower number of intravitreal injections performed prior to the lockdown (P=0.001) and with glycemic imbalance (P=0.04). An increase in central macular thickness was noted in 26.6% of patients and was associated with a lower number of intravitreal injections (P=0.038). CONCLUSION: The delay in intravitreal injections during the lockdown had negative effects on visual acuity and central macular thickness in eyes with DME. Prolonged delay in intravitreal anti-VEGF injections in diabetic patients should be avoided.

Evolution of quality of life in patients with breast cancer during the first year of follow-up in Morocco.

BACKGROUND: Quality of life has an important place in the future of patients with breast cancer. The objective of this study is to assess the evolution of the patient's quality of life with breast cancer in Morocco after a year of follow-up. METHODS: This study involved the patients with breast cancer with all types of treatment as determined by their physicians. Patient's quality of life was assessed with the Moroccan Arabic version of QLQ- EORTC QLQ C30 and EORTC-BR23 questionnaires. Data were analyzed using SPSS Version 20 software. RESULTS: Regarding EOTRC questionnaires QLQ C-30, there was a significant improvement in global health status and all scales of the functional dimension except the social functional where there was a trend towards improvement and the financial impact of the disease where the situation has deteriorated. Quality of life was improved for most symptom-sized scales dimension of EORTC QLQ- C30 with the exception of diarrhea where it was observed degradation. Most of the EORTC QLQ-scales BR23 questionnaires showed a favorable trend in the quality of life except those of sexual functioning, sexual enjoyment, hair loss and the side effects of systemic therapy. CONCLUSION: The quality of life of the patient is significantly improved after 1 year of follow up. Quality of life instruments can be useful in the early identification of patients whose score low on functional scales and symptoms.

[Place of Malaria in Febrile Illnesses Etiologies In The Community Health Center of Macina central, Mali]. / Place Du Paludisme Dans Les Etiologies Des Affections Febriles Dans Le Centre De Sante Communautaire de Macina Central, Mali.

BACKGROUND: Malaria is a major public health problem because of its morbidity and mortality. The objective is to study the place of malaria in the etiology of febrile access in Community Health Centre of Macina central. METHODS: This is a descriptive prospective study was conducted which covered a period of 12 months from 1 September 2015 to 31 August 2016 at the community health center of Macina central. It concerned all patients admitted to the community health center for febrile with an axillary temperature greater than or equal to 38° C and having agreed to participate in the study. Data collected were analyzed using epi info 7 software version 3.3.2. RESULTS: Febrile accesses represented 13.37% of all consultations during our study period. The majority of patients were men (55.0%). Malaria was the leading cause (64.2%) of febrile accesses followed by respiratory infections (16.2%). In the majority of patients, fever has not exceeded 7 days (89.9%) and the axial temperature was between 38° and 38.9° in 67.6% of cases. Children under five years were most affected by these febrile illnesses (61.3%) and of these, 37.9% had malaria. The most associated symptoms with fever were cough (58.5%), vomiting (48.7%) and headache (47.1%). Co-morbidities were found between malaria and respiratory infections (20.60%) and diarrhea (26.20%). CONCLUSION: Malaria remains a major cause of fever in our study area. However, it is necessary to follow the clinical procedure well in case of fever.

INTRODUCTION: Le paludisme est un véritable problème de santé publique tant de part sa morbidité que par sa mortalité. L'objectif est d'étudier la place du paludisme dans les étiologies des accès fébriles au centre de santé communautaire (CSCOM) de Macina central. MATÉRIEL ET MÉTHODES: Il s'agit d'une étude prospective à visée descriptive qui a été menée sur une période de 12 mois allant du 1er Septembre 2015 au 31 Aout 2016 au centre de santé communautaire de Macina central dans le district sanitaire de Macina. Elle a concerné tous les patients admis au CSCOM pour accès fébrile avec une température axillaire supérieure ou égale à 38° C et ayant accepté de participer à l'étude. Les données recueillies ont été analysées à l'aide du logiciel épi info 7 version 3.3.2. RÉSULTATS: Les accès fébriles ont représenté 13,37% de toutes les consultations durant la période d'étude. La majorité des patients étaient des hommes (55,0%). Le paludisme était la première cause (64,2%) de ces accès fébriles suivi des affections respiratoires (16,2%). La fièvre n'a pas excédée 7 jours chez 89,9% des patients et la température axiale était comprise entre 38° et 38,9° dans 67,6% des cas. Les enfants de moins de cinq ans ont été les plus touchés par ces affections fébriles (61, 3%) et parmi ceux-ci, 37,9% étaient atteints de paludisme. Les symptômes les plus associés à la fièvre ont été la toux (58,5%), les vomissements (48,7%) et les céphalées (47,1%). Des co-morbidités ont été retrouvées entre le paludisme et les infections respiratoires (20,6%) et la diarrhée (26,2%). CONCLUSION: Le paludisme demeure une importante cause de fièvre dans notre zone d'étude. Cependant, il est nécessaire de bien suivre la démarche clinique devant tout cas de fièvre.

[Syphilis: 57 observations in Fez, Morocco]. / Syphilis: 57 observations à Fès, Maroc.

A prospective study of syphilis cases over a period of 2 years (January 2008 to September 2009) was carried out in the Department of Dermatology of the Hassan II University Hospital Center in Fes, Morocco. A total of 57 cases were identified. The M/F sex ratio was 0.89. Mean patient age was 40.5 years (range, 22-80). Risk factors included unprotected sex in 96.5% of cases and multiple partners in 42.1%. Nine patients had a history of sexually transmitted infection. No patient had received blood transfusion. Clinical picture was late latent syphilis in 70.2% of cases (n = 41). Only one case was associated with human immunodeficiency virus. The mainstay treatment was intramuscular benzathine benzylpenicillin. Outcome was favorable in 48 cases.

Inequalities in smoking profiles in Morocco: the role of educational level.

BACKGROUND: Cigarette smoking is increasingly associated with lower socio-economic status, indicated by lower educational levels. This association has never been investigated in Morocco. OBJECTIVE: The MARTA survey was undertaken to assess tobacco use in the Moroccan population according to level of education and other socio-demographic characteristics. METHODS: A cross-sectional survey based on a representative sample of the Moroccan population was conducted in 2005-2006. The survey questionnaire gathered socio-demographic information, educational level and smoking status. chi(2) analyses were performed to determine whether the smoking outcome variables differed significantly between different educational levels in relation to demographic variables. Multiple logistic regression analysis was used to calculate the adjusted odds ratio for smoking status according to educational level. RESULTS: A total of 9195 subjects were included in the study; 52% were men and 17.9% illiterate. The overall prevalence of current smoking was 18.0% (95%CI 17.2-18.8): 31.5% (95%CI 30.2-32.9) in males and 3.3% (95%CI 2.8-3.8) in females. The prevalence of current smoking was inversely associated with level of education in men and increased with educational level in women. Illiterate males tended to have a higher probability of being current smokers than males with university-level education (OR 1.93, 95%CI 1.51-2.46). CONCLUSION: These results indicate a need for tobacco control to reach all sectors of society, and especially the illiterate population.

[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]

[Measuring levels of professionally-related stress in taxi drivers in Fes, Morocco]. / Mesure du stress professionnel des chauffeurs de taxi a Fès, Maroc.

Professional stress is a harmful physical and emotional reaction that can occur when tension exists between the requirements imposed on a person and the level of control that person may, or may not, have on the fulfillment of these requirements (essentially tension between what one is expected to achieve and what one can realistically achieve). At present, traffic accidents are considered to be a major social problem in Morocco. The authors aim to describe stress levels in taxi drivers and to study potential associated factors, in particular the risk of having an accident while driving. A questionnaire was administered in a cross sectional survey to a sample of 338 taxi drivers working in the city of Fes, Morocco. Stress was evaluated by using a standardized scale developed by the French National Institute of Research and Safety (INRS). It allows for the intensity of stress to be quantified according to a set of seven scores. According to the INRS scale, 46.3% of the taxi drivers could be considered as stressed. Moodiness and blood pressure problems were specifically identified as indicators of stress in this population. These results should incite interest in developing prevention measures in order to reduce or eliminate sources of stress at work in order to decrease the number of traffic accidents related to stress, and hence to improve the taxi drivers' working conditions.