Historical epidemiology of hepatitis C virus in select countries-volume 4.

Due to the introduction of newer, more efficacious treatment options, there is a pressing need for policy makers and public health officials to develop or adapt national hepatitis C virus (HCV) control strategies to the changing epidemiological landscape. To do so, detailed, country-specific data are needed to characterize the burden of chronic HCV infection. In this study of 17 countries, a literature review of published and unpublished data on HCV prevalence, viraemia, genotype, age and gender distribution, liver transplants and diagnosis and treatment rates was conducted, and inputs were validated by expert consensus in each country. Viraemic prevalence in this study ranged from 0.2% in Hong Kong to 2.4% in Taiwan, while the largest viraemic populations were in Nigeria (2 597 000 cases) and Taiwan (569 000 cases). Diagnosis, treatment and liver transplant rates varied widely across the countries included in this analysis, as did the availability of reliable data. Addressing data gaps will be critical for the development of future strategies to manage and minimize the disease burden of hepatitis C.

Seasonal and regional occurrence of heat-resistant spore-forming bacteria in the course of ultra-high temperature milk production in Tunisia.

Spore-forming bacteria, principally Bacillus species, are important contaminants of milk. Because of their high heat resistance, Bacillus species spores are capable of surviving the heat treatment process of milk and lead to spoilage of the final product. To determine the factors influencing the contamination of milk, spore-forming bacteria occurrence throughout the UHT milk production line during winter, spring, and summer was studied. The obtained results confirm that the total viable rate decreases rapidly throughout the production line of UHT milk showing the efficiency of thermal treatments used. However, the persistent high rate of spore-forming bacteria indicates their high heat resistance, especially in spring and summer. In addition, a significant variation of the quality of raw milk according to the location of the collecting centers was revealed. The molecular identification showed a high degree of diversity of heat-resistant Bacillus species, which are isolated from different milk samples. The distribution of Bacillus species in raw milk, stored milk, bactofuged milk, pasteurized milk, and UHT milk were 28, 10, 16, 13, and 33%, respectively. Six Bacillus spp. including Bacillus licheniformis (52.38%), Bacillus pumilus (9.52%), Bacillus sp. (4.76%), Bacillus sporothermodurans (4.76%), Terribacillus aidingensis (4.76%), and Paenibacillus sp. (4.76%) were identified in different milk samples.

[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.

[Determinants of patient and health system delays for women with breast cancer in Morocco, 2013]. / Déterminants des délais patient et système de santé des femmes atteintes d'un cancer du sein au Maroc, 2013.

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.

In vitro antimicrobial activity of Pistacia lentiscus L. edible oil and phenolic extract.

Pistacia lentiscus L. is known in some Tunisian forest area by its fixed oil used in traditional medicine as an antiseptic product. This investigation is the first to study the antimicrobial activity of P.lentiscus edible oil and its phenolic extract. Oil was extracted from fruits harvested from six provenances located in Tunisia. The antimicrobial activity was tested using disc diffusion assay and the broth dilution method. Kbouch and Sidi Zid oils were most efficient (p < 0.003) against, respectively, Staphylococcus aureus and Aspergillus niger with an inhibition zone of 9.33 mm. The phenolic extract had the largest spectrum of sensitive microorganisms. The minimum inhibitory concentration and minimum bactericidal concentration results showed that all strains were inhibited by both oil and extract.

Determinants of consultation, diagnosis and treatment delays among new smear-positive pulmonary tuberculosis patients in Morocco: a cross-sectional study.

We conducted a cross-sectional survey in 2012 in 12 selected provinces and prefectures in Morocco to determine consultation delay (patient delay), diagnosis delay and treatment delay (health system delays), and factors relating to these delays. The sample included 250 eligible and consenting newly diagnosed smearpositive pulmonary tuberculosis patients who were interviewed at the time of their registration within Diagnosis of Tuberculosis and Respiratory Diseases Reference Centers (CDTMR) or Integrated Health Centers (CSI) using a pretested and structured questionnaire. The median total delay was 46 days [inter-quartile interval (IQI) = 29-84 days]. Patient delay (median = 20; IQI = 8-47 days) was higher than health system delay (median=15; IIQ = 7-35 days). Being illiterate, thinking symptoms will disappear by themselves; having financial constraints and feeling fear of diagnosis or social isolation were associated with patient delay. Consulting first in the private sector or having 3 or more consultations before diagnosis was associated with health system delay.

Determinants of consultation, diagnosis and treatment delays among new smear-positive pulmonary tuberculosis patients in Morocco: a cross-sectional study

We conducted a cross-sectional survey in 2012 in 12 selected provinces and prefectures in Morocco to determine consultation delay [patient delay], diagnosis delay and treatment delay [health system delays], and factors relating to these delays. The sample included 250 eligible and consenting newly diagnosed smear-positive pulmonary tuberculosis patients who were interviewed at the time of their registration within Diagnosis of Tuberculosis and Respiratory Diseases Reference Centers [CDTMR] or Integrated Health Centers [CSI] using a pretested and structured questionnaire. The median total delay was 46 days [inter-quartile interval [IQI]= 29-84 days]. Patient delay [median = 20; IQI = 8-47 days] was higher than health system delay [median-15; IIQ = 7-35 days]. Being illiterate, thinking symptoms will disappear by themselves; having financial constraints and feeling fear of diagnosis or social isolation were associated with patient delay. Consulting first in the private sector or having 3 or more consultations before diagnosis was associated with health system delay

Nous avons conduit en 2012 une étude transversale dans une sélection de 12 provinces/préfectures au Maroc pour déterminer les délais de consultation [délai patient], de diagnostic et de mise sous traitement [délai système de santé]chez les nouveaux cas de tuberculose pulmonaire à microscopie positive et les facteurs en relation avec ces délais. L’échantillon comprenait 250 patients, éligibles et consentants, qui ont été interviewés lors de leur enregistrement aux Centres de Diagnostic de la Tuberculose et des Maladies Respiratoires [CDTMR] ou aux Centres de Santé Intégrés [CSI], en utilisant un questionnaire structuré et prétesté. Le délai total médian est de 46 jours [intervalle interquartile [IIQ]: 29-84 jours]. Le délai patient [médiane : 20 jours ; IIQ : 8-47] est supérieur au délai système de santé [médiane : 15 jours ; IIQ : 7-35]. Etre analphabète, croire à la disparition spontanée des symptômes, avoir des contraintes économiques ou peur du diagnostic et de l’isolement social sont associés au délai patient. Consulter en premier dans le secteur privé ou faire trois consultations au moins avant le diagnostic sont associés au délai système de santé

[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.

The combined effect of nisin, moderate heating and high hydrostatic pressure on the inactivation of Bacillus sporothermodurans spores.

AIMS: To investigate the combined effect of hydrostatic pressure (HP), moderate temperature and nisin on the inactivation of Bacillus sporothermodurans spores which are known to be contaminant of dairy products and to be extremely heat-resistant. METHODS AND RESULTS: A central composite experimental design with three factors, using response surface methodology, was used. By analysing the response surfaces and their corresponding contour plots, an interesting interaction with the three factors was observed. The inactivation observed was shown to be well fitted with values predicted by the quadratic equation, since the adjusted determination coefficient (R(adj)(2)) was 0·979. The optimum process parameters for a 5-log spores ml(-1) reduction of B. sporothermodurans spores were obtained, 472 MPa/53°C for 5 min in presence of 121 UI ml(-1) of nisin. CONCLUSION: Nisin and temperature treatments improve the effectiveness of pressure in the inactivation of highly heat-resistant spores of B. sporothermodurans. SIGNIFICANCE AND IMPACT OF THE STUDY: This study shows the potential of using high HP for a short time (5 min) in combination with moderate temperature and nisin to inactivate B. sporothermodurans spores in milk. Such treatments could be applied by the dairy industry to ensure the commercial sterility of UHT milk.

[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.

In vitro antifungal activity of the essential oil and the methanolic extract of Ruta chalepensis.

Ruta chalepensis L. (Rutaceae), is an ancient aromatic medicinal plant still used in the traditional medicine of many countries as a laxative, antiinflammatory, analgesic, antispasmodic, abortifacient, antiepileptic, emmenagogue and for dermatopathy treatment. Regarding increasing prevalence of mycotoxins and inefficiency of methods used to decrease them, it is possible to use plants metabolites to decrease mycotoxins. This study was carried out to evaluate chemical composition, antifungal and anticandidal activities of R. chalepensis extracts. The chemical composition of its essential oil was analyzed by gas chromatography coupled with mass spectrometry (GCMS). The major components of R. chalepensis essential oil were menthol (49.92%), linalool (31.1%) and 2-hexanal (5.2%). The antifungal and anticandidal effects of the essential oil and methanolic extract of R. chalepensis leaves were studied by disc diffusion assay and broth dilution method. The obtained results showed that R. chalepensis extracts had a significant fungicidal effect against Aspergillus niger, Aspergillus flavus and Candida albicans. The inhibition zones diameters and the minimum inhibitory concentration values for tested microorganisms were in the range of 11-17 mm and 3.25-6.25% (v/v), respectively. The methanolic extract showed much better antimicrobial activity than the essential oil against three tested micro-organisms

Preparedness and health risks associated with Moulay Abdellah Amghar moussem, Morocco, 2009-2010.

The objective of this study was to describe the risks and human health outcomes associated with attendance at the Moulay Abdellah Amghar moussem (a pre-planned mass gathering attracting more than 360 000 participants) for the purposes of public health prevention, planning, preparedness and response. We performed an environmental health risk assessment and retrospectively reviewed local health centre records before, during and after the event. In addition, standardized interviews with key stakeholders were performed to qualitatively evaluate local public health preparedness and response capacities. During the event, average daily health centre visits increased 5-fold. The sex ratio of health-care visits changed significantly from an average of 1.8:1 female:male visits per day to 1.2:1. The proportion of injuries varied from an average of 3.7% pre- and post-event to 14.8% (P < 0.01) during the event. A significant increase in digestive diseases was also observed during the event. Recommendations include increasing accessibility to free sanitation and hygiene facilities and improving health communications concerning hand washing and food and water safety.

Optimization of pressure-induced germination of Bacillus sporothermodurans spores in water and milk.

Bacillus sporothermodurans produces highly resistant endospores that can survive ultra-high-temperature treatment in milk. The induction of endospore germination before a heat treatment could be an efficient method to inactivate these bacteria and ensure milk sterility. In this work, the rate of spore germination of B. sporothermodurans LTIS27 was measured in distilled water after high-pressure treatments with varying pressure (50-600 MPa), treatment temperature (20-50 °C), pressure-holding time (5-30 min) and post-pressurization incubation time (30-120 min) at 37 °C or 4 °C. The results showed that pressure-induced germination was maximal (62%) after a treatment at 200 MPa and 20 °C and increased with pressure-holding time and post-pressurization incubation time. Treatment temperature had no significant effect on germination. A central composite experimental design with three factors (pressure, pressure-holding time, and post-pressurization incubation time) using response surface methodology was used to optimize the germination rate in distilled water and in skim milk. No factor interaction was observed. Germination was induced at lower pressure and was faster in milk than in distilled water, but complete germination was not reached. The optimum germination obtained with experimental data was 5.0 log cfu/mL in distilled water and 5.2 log cfu/mL in milk from 5.7 log cfu/mL of spores initially present in the suspension. This study shows the potential of using high hydrostatic pressure to induce the germination of B. sporothermodurans spores in milk before a heat treatment.

Epstein-Barr virus-associated hepatic leiomyosarcoma after renal transplantation: case report.

The incidence of neoplastic complications after solid organ transplantation is increasing tremendously probably as the consequence of long term immunosuppression. Beside usual risk factors, the oncogenic role of some viruses like Epstein-Barr virus is well established. We report a case of a primitive EBV-induced liver leiomyosarcoma after renal transplantation.

Corticomedullary mixed tumor of the adrenal gland.

A 34-year-old woman presented with weight gain, hirsutism, recent hypertension and secondary amenorrhea. Laboratory findings showed hypokalemia, elevated cortisol and androgen levels with normal urine metanephrines and normal aldosteronemia. Abdominal magnetic resonance imaging showed a right heterogeneous adrenal mass measuring 4 x 6 cm with mixed component of fat and adrenal tissue suggesting corticosurrenaloma. After right adrenalectomy, blood pressure normalized and hypokalemia resolved. In the postoperative course, the patient presented adrenal insufficiency treated with hydrocortisone hemisuccinate. Histological examination showed a single tumor mass composed of an admixed population of adrenal cortical and medullary cells. Immunohistochemical evaluation was positive for chromogranin A.

Rapid Aeromonas hydrophila identification by TaqMan PCR assay: comparison with a phenotypic method.

AIMS: Aeromonas hydrophila is recognized as a human pathogen following wound exposure or ingestion of contaminated water and food. For rapid identification of this bacterium, a TaqMan-based real-time PCR assay has been developed. METHODS AND RESULTS: Primers and probes that target specific sequences of the 16S rRNA gene and cytolytic enterotoxin gene (aerA) were combined in a duplex assay. Presence and size of PCR products were confirmed with microchannel fluidics electrophoresis analysis. After validation, using type strain CIP7614T DNA, the PCR assay was tested on 12 positive and negative controls. Twenty-one Aeromonas strains were isolated from environmental samples and were identified with biochemical tests as Aer. sobria, Aer. caviae and Aer. hydrophila. Only Aer. hydrophila strains tested positive by PCR assay. CONCLUSIONS: The PCR developed here was successfully applied for the identification of Aer. hydrophila from reference, clinical and environmental samples and showed a high discrimination between Aer. hydrophila and other Aeromonas species. SIGNIFICANCE AND IMPACT OF THE STUDY: This molecular method is convenient, rapid (2.5 h vs 24 h), specific to identify Aer. hydrophila and usable for diagnosis in medical and veterinary laboratories.

Retroperitonial liposarcoma mimicking pheochromocytoma.

The authors report the case of a 46-year-old woman who presented with a 4 month history of paroxystic and recent hypertension accompagned by headaches, tachycardia and sweating. The patient had decreased appetite with epigastric discomfort and abdominal distension. Physical examination was initially normal with mainly normal tension and no abdominal or lombar mass in palpation. While hospitalised, she developed paroxystic crisis of flush, headaches and hypertension of 190/100 mmHg. Biological findings revealed hypokaliemia and normal kaliuria on 3 day samples, with normal glycaemia and normal creatininaemia. Hormonal investigation revealed elevated metanephrines (3 mg/24 hours). Magnetic resonance imaging showed an 11 cm x 8.5 cm retroperitoneal mass with an enhanced signal in T2, a hypotrophic non-functional left kidney and no adrenal adenoma. Clinical and hormonal features suggested a diagnosis of pheochromocytoma. After preoperative medication, open excision, including left radical nephrectomy and adrenalectomy, normalized the catecholamine urinary level, resolved hypokalemia, and improved hypertension. Pathologic examination revealed a well-differentiated liposarcoma, without any pheochromocytoma component, and left adrenal hyperplasia. The tumour cells were immunonegative for chromogranin A. No metastatic lesion was identified by thoraco-abdominal computed tomography.

Assessment of disinfectants cleaning against bacterial biofilm of house hold water tanks.

UNLABELLED: The purpose of this study was to compare the efficacy, in terms of bacterial biofilm penetration and killing, of some chemical disinfectants against E. coli and P. aeruginosa. This study was undertaken to examine the efficacy of some disinfectants including sodium hypochlorite, povidine and tryad detergent against E. coli biofilms and the efficacy of sodium hypochlorite and tryad detergents against P. aeruginosa. Two species biofilm of E. coli and P. aeruginosa were grown by flowing a dilute tryptic soy broth medium over an inclined cement, polyethylene, fiberglass and galvanized steel slides, 2.25 x 2.25 cm2 for 15 days. Biofilm formation was evaluated by scanning electron microscopy (SEM) and standard plate counts procedures through selective media for both E. coli and P. aeruginosa. In addition, some disinfectants were selected through disk diffusion susceptibility test. The disinfectants which gave higher zone of inhibitions, were applied to remove of E. coli and P. aeruginosa biofilms from cement, fiberglass, polyethylene and galvanized steel slide surfaces. Results showed that all disinfectants tested gave high inhibition of biofilm adhesion to tank surfaces with some being significant. CONCLUSION: polyethylene and galvanized steel are strongly recommended as alternative drinking house holds water tanks in Saudi Arabia. The choice of disinfectants or cleaning agents along with optimum concentrations and the time of action is very important when destroying microbes. It is also important that resistance of microbes to some disinfectants and cleaning agents is take into consideration when planning the cleaning process.