[Epidemiological profile and analysis of predictive factors of organ donation refusal in the Moroccan population]. / Profil épidémiologique et analyse des facteurs prédictifs du refus du don d'organe chez la population marocaine.

Organ donation is influenced by several factors. A better understanding of the reasons for organ donation refusal would allow an increase in the number of donors. The objective of our study is to assess the knowledge and position of the general Moroccan population considering organ donation and to determine the factors that influence their positions. In this study, socio-demographic data, knowledge and attitude towards organ donation and reasons for refusing organ donation were collected from 677 Moroccan participants. Although only 1% of participants are enrolled in the donor registry, our survey showed that 64.7% of participants are in favor of organ donation. The level of education, the socio-professional category, the marital status, the ethnic origin and the medical coverage are the socio-demographic factors most discriminating concerning the will to donate organs or not. The binary logistic regression made it possible to identify the factors that prevent organ donation, namely the problem of confidence in the health system, personal and religious reasons but also the lack of valid reasons. Thus, a better knowledge of the legislation in force and of the position of the Islamic religion as well as the establishment of training and information programs through advertising campaigns will promote organ donation. LEVEL OF EVIDENCE: 3.

[Neonatal healthcare associated-infections in the Maghreb. A systematic review and meta-analysis]. / Infections associées aux soins en néonatalogie dans la région du grand Maghreb. Revue systématique et méta-analyse.

BACKGROUND: Healthcare-associated infections are a major source of morbidity and mortality in neonatology. Our aim was to describe the epidemiology of Healthcare-associated infections in neonatology (frequency, associated factors and prognosis). METHODS: Articles were searched in the PubMed, Scopus and Web of Science databases. We included observational studies describing prevalence, incidence or mortality among new-born babies having developed infections more than 48hours after hospitalization. The pooled prevalence, incidence and mortality estimates were analysed using the random effects model. Publication bias was analysed using the funnel plot and Egger's test statistics. Data analysis was carried out using R Studio software v1.2. RESULTS: Among the initially identified 137 studies, ten articles fulfilled the inclusion criteria and were included in the metanalysis. They mainly concerned Morocco, Tunisia and Algeria. Pooled incidence was 10% (95% CI [4%-18%]) and overall mortality was 49% (95% CI [33%-66%]). Heterogeneity between studies was significantly high, with rates of 98% and 90% respectively. CONCLUSION: This review underlined a need to undertake more large-scale multicentric surveys and studies on monitoring systems and the attitudes and practices of relevant caregivers, the objective being to better understand the realities of healthcare-associated infections in Greater Maghreb neonatology units.

Magnitude of prematurity in the countries of the Great Maghreb.

BACKGROUND: Prematurity is the leading cause of death in neonates, accounting for 75% of neonatal mortality, and the second leading cause of death among children under 5 years of age. OBJECTIVE: To study the extent of prematurity in the Great Maghreb, concerning its various aspects: frequency, risk factors and complications. METHOD: We conducted a systematic review of the literature by searching for all data from the Greater Maghreb related to prematurity published between 2000 and 2018. The search strategy relied on the Medline and Google Scholar databases. Prematurity is defined as any birth occurring at a gestational age less than 37 weeks of amenorrhea. RESULTS: In the Maghreb, the prevalence of prematurity ranged from 6.7% to 15.4%. The main risk factors were infections and chronic maternal conditions, extreme maternal ages and adverse socio-economic conditions. The mortality rate among premature infants ranged from 28% to 45%. Short-term complications were dominated by respiratory and metabolic disorders and infections. CONCLUSION: In view of the serious complications and high mortality caused by prematurity, prevention strategies must be put in place. These should be based on the development of pregnancy surveillance programs, the fight against precariousness and the upgrading of neonatal care structures.

[Retrospective study of neuromeningeal cryptococcosis in patients infected with HIV in the infectious diseases unit of university hospital of Casablanca, Morocco]. / Étude rétrospective de la cryptococcose neuroméningée chez les patients infectés par le VIH dans le service des maladies infectieuses du CHU de Casablanca, Maroc.

OBJECTIVE: To report the cases of neuromeningeal cryptococcosis and to describe the clinical, paraclinical, therapeutic and outcomes of patients. PATIENTS AND METHODS: Retrospective study of 43 patients infected with HIV admitted from January first 2010 to June 30th 2015 in the infectious disease unit of UHC Ibn Rochd, for neuromeningeal cryptococcus. RESULTS: The mean frequency of neuromeningeal cryptococcosis in patients infected with HIV was 1.4%. The mean age was 39 years and a sex ratio of 1.38. The mean CD4 count was 70 cells/mm3. The diagnosis of HIV was revealed by neuromeningeal cryptococcus in 77% of cases. Fifteen days interval was reported between the first symptom and hospital admission. Headache (77%) was the most represented clinical sign. The cerebrospinal fluid analysis showed hypoglycorachy (67%), hyperproteinorachy (65%) and lymphocytosis (63%). Chinese ink direct examination for Cryptococcus neoformans in CSF was positive in 86% of cases and all cases were positive after culture on Sabouraud's medium. Patients were treated with monotherapy amphotericin B (42%) or fluconazole (28%) and bitherapy amphotéricine B/fluconazole (28%). Fatal evolution was observed in 60% of cases. CONCLUSION: Neuromeningeal cryptococcosis remains a severe opportunistic infection in HIV patients with a heavy mortality rate.

[Survey of general practioners in the management of diabetes in primary health facilities of Casablanca city, Morocco: opportunities and constraints]. / Enquête d'opinion auprès des médecins généralistes sur leur Prise en charge de diabétiques dans les structures de 1ère ligne de las ville de Casablanca (Marco): Contraintes et Opportunités.

BACKGROUND: Diabetes is a global health problem in full expansion, because of its increasing frequency, it frightening complications and the costs of its medical covering. AIM: In this study, we tried to make the current situation of the diabetes management in first-line public structures of the city of Casablanca. METHODS: The survey of transverse observation to descriptive aiming was conducted using a pre questionnaire tested and selfadministered. RESULTS: It shows that 46.7 % of the questioned general practitioner judged that the quantity and the quality of average therapeutic existing in the center were insufficient to meet the needs for their diabetic patients. The weak socio-economic statute of the patients (78.8% of the cases), the lack of personnel (76.6%), the low educational level of patients (75.2%) and the problem of access to hospital (73.3%) constituted major problems of the correct diabetic medical covering. However, the majority of the doctors (98.1%) estimated to need training on diabetes management. The most required topics requested are: The control of the insulin treatment (97%), the diabetic education (91%) and the follow-up of diabetic (89%). CONCLUSION: The training of general practitioners particularly motivated and interested in diabetes could be the solution to improve the management of diabetes especially because of the lack of specialists in our country.

[Evaluation of the care for diabetes patients by general practitioners in the province of Khourigba, Morocco]. / Evaluation de la prise en charge des diabétiques par le médecin généraliste dans la province de Khouribga (Maroc).

Diabetes is a disease of concern due to its increasing frequency and high cost of care. This cross-sectional study evaluated the types of care provided to diabetes patients in primary care for management of the condition. Between December 2010 and March 2011, 54 general practitioners (CPs) in health centres in Khouribga province were asked to complete a pretested questionnaire on their care of diabetes patients. For type 2 diabetes, 46% of the CPs would prescribe diet and lifestyle treatment alone. The practice setting influenced how treatment was managed for typel diabetes patients: 88.5% of rural doctors prescribed premixed insulin versus 58.3% of urban GPs (P = 0.02). Insulin analogues were prescribed by 20.8% of urban GPs as against 3.8% of rural GPs (P = 0.09). There are several shortcomings in the quality of care for diabetes patients. Training GPs could be a solution, especially with the lack of specialists in our country.

Evaluation of the care for diabetes patients by general practitioners in the province of Khouribga, Morocco

Diabetes is a disease of concern due to its increasing frequency and high cost of care. This cross sectional study evaluated the types of care provided to diabetes patients in primary care for management of the condition. Between December 2010 and March 2011, 54 general practitioners [GPs] in health centres in Khouribga province were asked to complete a pretested questionnaire on their care of diabetes patients. For type 2 diabetes, 46% of the GPs would prescribe diet and lifestyle treatment alone. The practice setting influenced how treatment was managed for type1 diabetes patients: 88.5% of rural doctors prescribed premixed insulin versus 58.3% of urban GPs [P = 0.02]. Insulin analogues were prescribed by 20.8% of urban GPs as against 3.8% of rural GPs [P = 0.09]. There are several shortcomings in the quality of care for diabetes patients. Training GPs could be a solution, especially with the lack of specialists in our country

[Quality of life and pemphigus]. / Qualité de vie et pemphigus.

INTRODUCTION: Pemphigus is a frequent chronic bullous dermatosis in Morocco that predominantly affects young women. It requires serious therapeutic management and often repeated hospitalizations. The purpose of this study was to assess the particular impact of pemphigus on quality of life by comparing the quality of life in patients suffering from pemphigus with that of the general population using a generic instrument of measure of health related quality of life: the SF-36, in association with a questionnaire exploring the impact of the disease on self perception, social relationship and behaviour. PARTICIPANTS AND METHODS: A French version of the SF-36 underwent 2 translations from French to Moroccan dialect, then two retrograde translations. After a pre-test, the questionnaire survey was administered by the same investigator to 30 patients who suffered from pemphigus, followed-up in the Ibn Rochd UHC in Casablanca and to 60 healthy adults. The two samples were paired according to age and sex. RESULTS: In the pemphigus group, there was a significant decrease of mean scores of all the SF-36 dimensions, except for physical pain and alteration in general status of health. The greatest alteration concerned the impact on physical and emotional status (p<0.00001) and the smallest alteration concerned the perception of general health (p=0.02). The factors influencing this impact were: profession, face involvement and extent of lesions. Other results concerning the psychosocial impact of pemphigus are presented. CONCLUSION: Our study confirmed that pemphigus is responsible for great alterations in health related quality of life. Therefore, the management of this disease must take into account its impact on various fields of life of the patients.