RESUMEN
Fallout radionuclides, such as 137Cs, have been recognized as a valuable means for studying soil erosion processes. In this study, the 137Cs technique was used to assess soil erosion magnitude and to investigate the effectiveness of terrace cultivations in the High Atlas of Morocco, particularly, the Ourika watershed. 137Cs depth distribution profiles were established along slope gradients associated with land use considering cereal crop, arboriculture and native forests. Along the slope gradient, depth distribution profiles highlight dissimilarities reflecting differences in land use, topographic roughness, soil particle distribution and stoniness. 137Cs inventory decreases exponentially with depth and its penetration increases along the slope. It becomes higher at the bottom of the slope, with penetration reaching 30â¯cm. 137Cs mass activity and inventory significantly decrease in cultivated terraces, compared to native forest. Although the pattern of 137Cs gain/loss varied according to topography, soil properties and vegetation cover, showing eroding and aggrading profiles, most samples had 137Cs values lower than the reference value, suggesting net-loss of soil as a consequence of erosion processes. The net erosion rates were estimated about 8.5 and 6.0â¯tâ¯ha-1 yr-1 in cereal crop and arboriculture agrosystems, respectively, whereas in the forest, the net erosion rate was lower at about 4.2â¯tâ¯ha-1 yr-1. Soil loss on agricultural terraces is not significantly above tolerable erosion rates for Morocco (<7â¯tâ¯ha-1 yr-1), particularly for arboriculture terraces. A strong correlation was observed between 137Cs and both soil organic carbon and slope gradient, in uncultivated area, whereas, there was no correlation for cultivated terraces. Terraced arboriculture systems should be encouraged for better soil preservation against water erosion in the Ourika watershed.
Asunto(s)
Radioisótopos de Cesio/análisis , Fenómenos Geológicos , Monitoreo de Radiación , Contaminantes Radiactivos del Suelo/análisis , Suelo/química , Agricultura , MarruecosRESUMEN
BACKGROUND: In Morocco, breast cancer is the first most common cancer in women. It is diagnosed in most cases at an advanced stage. Delay in diagnosis and access to treatment for breast cancer increases morbidity and mortality. The objective of this study was to determine the consultation delay (patient delay), diagnosis delay and access to treatment delay (health system delays) of women with breast cancer admitted at the National Institute of Oncology in Rabat. Factors associated with these delays were analyzed. METHODS: We conducted a cross-sectional study from December 2012 to May 2013 at the National Institute of Oncology in Rabat. Two hundred eligible and consenting women were interviewed using a structured and pre-tested questionnaire. Stages I and II were identified as "early stages" and III and IV as "advanced stages". RESULTS: In our population, 54% were diagnosed at an early stage of breast cancer and 46% at an advanced stage. The median total delay was 120 days (interquartile interval [IIQ]=81-202 days). The patient delay (median=65 days, IIQ=31-121) was longer than the health system delay (median=50 days, IIQ=29-77). High risk for a long total delay (more than 4 months) was observed for women who were aged over 65 years (OR=1.30, 95% CI 1.10-4.20), illiterate (OR=4.50, 95% CI 2.10-6.20), rural residents (OR=3.40, 95% CI 1.23-8.13), in a lower socioeconomic category (OR=4.75, 95% CI 1.45-15.60), without knowledge about breast self-examination (OR=5.67, 95% CI 2.65-12.15) and seen more than 2 times before diagnosis (OR=7.70, 95% CI 2.88-20.50). A long total delay increased the risk of being diagnosed at an advanced stage (OR=5.62, 95% CI 3.03-10.45). CONCLUSION: Efforts should be directed to providing good information to the population at risk, better access to screening and continuing medical training to enable diagnosis and early treatment.
Asunto(s)
Neoplasias de la Mama/diagnóstico , Diagnóstico Tardío , Aceptación de la Atención de Salud , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Persona de Mediana Edad , Marruecos , Encuestas y Cuestionarios , Factores de TiempoRESUMEN
The study objectives were to estimate lead poisoning prevalence among children living next to an industrial area, to compare it to that in a control population, and to establish clinical and biological follow-up of the poisoned children. This is a descriptive cross-sectional study including 150 children (exposed and unexposed) performed between January 2012 and April 2013. It was meant to determine blood lead levels (BLLs) in children considered to be an exposed population (EP N 90), living in the industrial area Ain Nokb Fez compared with BLLs of children of other areas belonging to the same city supposed to be unexposed [UP (N = 60)]. A sociodemographic questionnaire was obtained, and a blood lead analysis was performed. Clinical and biological follow-up has been performed of poisoned children. The sample consisted of 90 EP children with an average age of 6.82 ± 3.32 years and male-to-female sex ratio (SR) of 1.5 and 60 UP children with an average age of 6.45 ± 3.29 years and an SR of 1.2. Among the 150 children recruited, the average of BLLs was 58.21 ± 36 µg/L (18-202.3 µg/L). The average of BLLs in EP children (71 ± 40 µg/L) was statistically greater (p < 0.0001) than that registered in UP children (38 ± 13 µg/L). All poisoned children belonged to the EP group at a prevalence of 21.1 %. The clinical and biological examinations of poisoned children showed a few perturbations such as anemia, hypocalcaemia, and deficiencies in magnesium and iron. No renal disease or objective neurological disorders were observed. In the follow-up of the children with BLL ≥100 µg/L (19 cases). BLL monitoring showed a significant decrease in average of blood concentration ranging from 136.75 ± 32.59 to 104.58 ± 32.73 µg/L (p < 0.0001) and in lead poisoning prevalence (p < 0.001), which decreased to 7.8 % from 21.1. Our study showed a high prevalence of lead poisoning (21.1 %) in EP children. The relocation of the industrial site associated with corrective and preventive measures has contributed to a decrease of exposure and lead poisoning prevalence in the aforementioned population.
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Exposición a Riesgos Ambientales/estadística & datos numéricos , Contaminantes Ambientales/sangre , Intoxicación por Plomo/diagnóstico , Plomo/sangre , Niño , Preescolar , Estudios Transversales , Exposición a Riesgos Ambientales/análisis , Femenino , Humanos , Industrias , Intoxicación por Plomo/sangre , Intoxicación por Plomo/epidemiología , Masculino , Marruecos/epidemiología , PrevalenciaRESUMEN
For several decades, Morocco is confronted to medico-social problem of scorpion stings and envenomations. In 2009, epidemiological data established by the Poison Control Center recorded 29,816 stung patients, with an incidence of 1.1 and a fatality rate of 0.18%. The neurotoxins from scorpion venom are potent activators of the autonomic nervous system resulting a physiopathological disorder of vital systems. The most serious clinical manifestations are neurotoxic effects, pulmonary edema and cardiovascular distress. This present work reports the cases of three children (4 years and 6 months, 8 months and 15 days, 4 years), hospitalized in intensive care for an envenomation by Androctonus mauritanicus (the most fatal scorpion specie). The children presented cardiac dysfunction where pulmonary edema and state of shock were complications resultants. Two cases survived after supportive and symptomatic treatment based on dobutamine as primordial treatment in cardiovascular and pulmonary correction and other drugs. The third case died. The objective of this work was to detect the limit of the effectiveness of symptomatic treatment during a severe scorpion envenomation.
Asunto(s)
Enfermedades Cardiovasculares/inducido químicamente , Edema Pulmonar/fisiopatología , Picaduras de Escorpión/fisiopatología , Venenos de Escorpión/envenenamiento , Escorpiones , Choque/fisiopatología , Animales , Enfermedades Cardiovasculares/complicaciones , Enfermedades Cardiovasculares/tratamiento farmacológico , Enfermedades Cardiovasculares/fisiopatología , Preescolar , Dobutamina/uso terapéutico , Resultado Fatal , Humanos , Lactante , Marruecos , Edema Pulmonar/tratamiento farmacológico , Edema Pulmonar/etiología , Choque/etiologíaRESUMEN
In Morocco, acute Atractylis 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 severity 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).
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Atractylis/envenenamiento , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Humanos , Lactante , Modelos Logísticos , Masculino , Persona de Mediana Edad , Marruecos/epidemiología , Intoxicación por Plantas/mortalidad , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Adulto JovenRESUMEN
Iron deficiency anemia as a hematologic complication of the antithyroid medication (ATS) that has not been already described in the literature. We report on two exceptional cases: the first case concerns a 24 years old man admitted for an anemic syndrome. He was treated with carbimazole for Graves' disease. The blood count showed a non-regenerative microcytic anemia. Serum ferritin was severely decreased. The etiologic searching for bleeding, hemolysis, malabsorption or iron deficiency was negative. Treatment with iron salts was introduced without any real improvement. Given this situation, and given the negativity of the etiologic investigations, the decision to stop carbimazole was taken. Since that, the clinical and biological evolutions have been favorable. The second observation is much more original and concerns a 35 years old woman. The clinical, laboratory, etiological and treatment data are similar to those of the first observation. The evolution after withdrawal of carbimazole was favorable. The originality of this observation is that a reintroduction test of carbimazole was performed and allowed to reproduce the same haematological effects. These findings led us to hold the diagnosis of anaemia due to carbimazole. In this occasion, and in the light of the data in the literature, we underline the exceptional character of these two cases and we raise the possibility of an etiopathogenic link between administration of ATS and the occurrence of anaemia by iron deficiency.
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Anemia Ferropénica/inducido químicamente , Antitiroideos/efectos adversos , Carbimazol/efectos adversos , Adulto , Antitiroideos/uso terapéutico , Análisis Químico de la Sangre , Carbimazol/uso terapéutico , Femenino , Ferritinas/sangre , Enfermedad de Graves/complicaciones , Enfermedad de Graves/tratamiento farmacológico , Humanos , Compuestos de Hierro/uso terapéutico , Masculino , Adulto JovenRESUMEN
INTRODUCTION: The cardiac involvement in hypereosinophilia remains a major cause of morbidity and mortality. Recent advances have identified new molecular mechanisms responsible for the expansion of the eosinophilic lineage, allowing a better classification of the different forms of Hypereosinophilic syndrome (HES) and especially targeted therapy. Since the discovery of the involvement of deregulated tyrosine kinases in the pathophysiology of these diseases, and particularly the identification of the fusion gene FIP1L1-PDGFRA, new molecules inhibiting specifically this signaling pathway (imatinib) were individualized, leading to dramatic therapeutic benefits in proliferative forms of HES considered before that of very poor prognosis. CASE REPORT: We report here the dramatic effectiveness of imatinib used as second line therapy for dilated cardiomyopathy revealing a hypereosinophilic syndrome in a patient in whom the search for FIP1-L1-PDGFRA fusion gene was negative. CONCLUSION: If hypereosinophilia has varied clinical and morphological outcome, its clinical consequences, particularly on heart function, are sometimes dreadful, and are not correlated either with blood eosinophil levels or with a specific etiology. We report here a case of HES lacking the FIP1-L1-PDGFRA fusion gene showing that despite the absence of this molecular defect, imatinib mesylate may have therapeutic interest in those cases of HES resistant to first line therapies.
Asunto(s)
Síndrome Hipereosinofílico/tratamiento farmacológico , Síndrome Hipereosinofílico/genética , Proteínas de Fusión Oncogénica/genética , Piperazinas/uso terapéutico , Inhibidores de Proteasas/uso terapéutico , Pirimidinas/uso terapéutico , Receptor alfa de Factor de Crecimiento Derivado de Plaquetas/genética , Factores de Escisión y Poliadenilación de ARNm/genética , Adulto , Asma/complicaciones , Benzamidas , Electrocardiografía , Eosinófilos/fisiología , Femenino , Humanos , Síndrome Hipereosinofílico/fisiopatología , Hipertensión/fisiopatología , Hipertensión Pulmonar/complicaciones , Mesilato de Imatinib , Recuento de LeucocitosRESUMEN
INTRODUCTION: Autoimmune hemolytic anemia with cold autoantibodies or cold agglutinin disease is a rare chronic disorder in which no treatment has, until now, evidence of its effectiveness. CLINICAL CASE: We report a patient who successfully responded to rituximab for a cold agglutinin disease refractory to conventional therapy with very good tolerance and a complete remission. CONCLUSION: There are only few observations that have been reported in the literature regarding the efficacity of rituximab in the treatment of cold agglutinin disease. This promising therapy could, in the future, constitute a real alternative.
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Anemia Hemolítica Autoinmune/tratamiento farmacológico , Anticuerpos Monoclonales de Origen Murino/uso terapéutico , Antineoplásicos/uso terapéutico , Resistencia a Medicamentos , Humanos , Masculino , Persona de Mediana Edad , RituximabRESUMEN
INTRODUCTION: The liver and central nervous system are the usual targets of Wilson's disease, an inherited disorder of copper metabolism. Severe hemolytic anemia is an unusual complication of Wilson's disease. EXEGESIS: We report a case of Wilson's disease revealed by acute intravascular repeating hemolytic anemia associated with liver failure. The initially negative etiologic investigation was directed by occurred of liver failure. The genetic study allowed to discover an other similar case. The evolution was favourable under treatment with zinc sulfate and penicillamine. DISCUSSION: Diagnosis of Wilson's disease must be considered in case of acute hemolytic anemia associated with liver failure in young adults.
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Anemia Hemolítica/etiología , Degeneración Hepatolenticular/diagnóstico , Enfermedad Aguda , Arritmias Cardíacas/etiología , Quelantes/uso terapéutico , Terapia por Quelación , Niño , Consanguinidad , Cobre , Disnea/etiología , Femenino , Degeneración Hepatolenticular/complicaciones , Degeneración Hepatolenticular/tratamiento farmacológico , Degeneración Hepatolenticular/genética , Humanos , Ictericia Obstructiva/etiología , Fallo Hepático/etiología , Masculino , Penicilamina/uso terapéutico , Recurrencia , Adulto Joven , Sulfato de Zinc/uso terapéuticoAsunto(s)
Enfermedades Intestinales/microbiología , Intestino Delgado/patología , Infecciones por Yersinia pseudotuberculosis/diagnóstico , Antibacterianos/uso terapéutico , Ciprofloxacina/administración & dosificación , Femenino , Gangrena , Humanos , Enfermedades Intestinales/patología , Enfermedades Intestinales/terapia , Intestino Delgado/microbiología , Intestino Delgado/cirugía , Persona de Mediana Edad , Infecciones por Yersinia pseudotuberculosis/tratamiento farmacológico , Infecciones por Yersinia pseudotuberculosis/cirugíaRESUMEN
Scorpion stings are the first cause of poisoning, and represent between 30 and 50% of all cases reported to the Moroccan Poison Control Centre. Concerned by the size of the problem, we have paid special attention to this pathology. Through retrospective and prospective studies, it has been possible to determine the nature and the chronology of clinical stages, as well as the epidemiological, clinical and therapeutic factors of gravity. On this basis, we worked out a new management to provide support for patients. This management will standardize support provided at the national level, and will reduce the number of lethal case and rationalize spending by reviewing medication, transfer of patients and hospital care. This standardization is an essential component of the national strategy against scorpion poisoning. Other components include training of medical staff, awareness campaigns, and information systems to monitor lethal cases. A survey over five years shows a reduction in the number of lethal cases and rationalization of costs. Medical care provided rests upon the distinction between patients stung by scorpions and patients actually poisoned. The first category of patients will be monitored up to four hours after the scorpion sting, while poisoned patients will be transferred to an intensive care unit.
Asunto(s)
Picaduras de Escorpión/diagnóstico , Picaduras de Escorpión/terapia , Animales , Árboles de Decisión , Humanos , Marruecos , Escorpiones , Índice de Severidad de la EnfermedadRESUMEN
The present study aimed at verifying the impact of a Moroccan strategy against scorpion stings and specifically at identifying the epidemiological features of patients envenomed or just stung by scorpions. It included 11,907 patients from El Kelaa des Sraghna Province, Morocco, who were evaluated over five years (2001-2005). Most stings occurred during the hot period and mainly at night. The average incidence was 3.2 per 1,000 inhabitants; patients <15 years accounted for 34 percent, and the envenomation rate was 12 percent. Average lethality rate was 0.7 percent. Our work evaluated the efficacy of the adopted strategy based on indicators of follow-up, morbidity and lethality due to scorpion sting and envenomation.(AU)
Asunto(s)
Salud Pública , Picaduras de Escorpión , Indicadores y Reactivos , EscorpionesRESUMEN
CONTEXT AND OBJECTIVES: Pulmonary hypertension (PHT) represents one of the severest complications and is life-threatening for patients suffering from systemic sclerosis (SSc). In France, the modalities for screening and treating PHT related to SSc are not well codified and no consensus has been reached. We conducted a survey among physicians inscribed on the list of the French Research Group on Sclerosis (GRFS - Groupe de Recherche Francais sur la Sclerodermie) to gather information on the status of the management of PHT related to SSc. METHODS: In 2002, we sent a questionnaire to 160 physicians, members of the GRFS, to assess the epidemiology and clinical profile of SSc patients as well as the modalities of screening and management of PHT in these patients. RESULTS: Eighty-eight physicians in 71 centres replied to the questionnaire. Each centre followed-up a mean of 33 SSc patients, with a global distribution of 53% limited and 47% diffused SSc. These physicians saw a mean of 5 new cases of SSc per year. The patients had been referred by town practitioners (53%) or from the hospital (47%). The mean number of SSc patients with PHT was of 5.1 per physician (1.5 new SSc + PHT patients per year). Almost all the centres (65/67) who replied systematically screened for PHT in SSc patients using Doppler echocardiography a mean of every 1.3 years. For the management of the patients exhibiting PHT, the majority (41/63) of centres collaborated with a specialized unit. Around one third of the centres treated these patients with calcium channel inhibitors (82%) and/or prostacyclin (90%). All the patients were followed-up by Doppler echocardiography. The majority of the physicians (72%) were interested in a research protocol on the subject and each could have included 4 patients, i.e., a total of 160. CONCLUSION: Pulmonary hypertension, a severe complication of SSc is screened for by the physicians of the GRFS using echocardiography with a frequency similar to Who guidelines (1.3 versus once/year).
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Hipertensión Pulmonar/diagnóstico , Hipertensión Pulmonar/etiología , Tamizaje Masivo/normas , Pautas de la Práctica en Medicina/estadística & datos numéricos , Esclerodermia Sistémica/complicaciones , Diagnóstico Diferencial , Ecocardiografía Doppler , Francia , Encuestas de Atención de la Salud , Humanos , IncidenciaRESUMEN
PURPOSE: Mooren's ulcer (MU) is a chronic peripheral corneal ulceration featuring conjunctival immunoglobulin deposits. It is considered as the result of a limbic immune process with hyperactivation of T and B lymphocytes. The etiology remains unknown. The response to topical steroid therapy and surgical procedures usually poor and the visual outcome can be devastating. METHODS: Clinical follow-up of 3 patients who had rebel MU to conventional therapy, and were treated with 1g monthly intravenous cyclophosphamide. RESULTS: First patient was a 24-years-old man who had MU in his left eye. The response to surgical procedure and intravenous steroid treatment was poor and corneal perforation occurred. The affected cornea healed after 9 months of Cy treatment. The second patient was a 50-years-old man who had MU in his left eye, which did not improved with lamellar keratoplasty and topical steroid therapy. Corneal healing was obtained after 20 months of Cy treatment. The third patient was a 70-years-old man who presented with a furrowed MU in his right eye which healed with conjunctival resection and 4 months of Cy perfusion. No adverse effects of Cy was noted as opposed to Cy given orally. CONCLUSION: We report the effectiveness of 1g monthly intravenous cyclophosphamide (Cy) treatment in rebel MU. We suggest that immunosuppressive therapy using IV monthly Cy may be proposed in severe rebel MU.