Carbon footprint of a hemodialysis unit in Morocco.

Climate changes have a major influence on the overall health of the population. They are directly linked to the emissions of the greenhouse gases (GHG). The extent of GHG emission in relation to hemodialysis has been measured by several studies all over the world. Up to this date, no similar study has been conducted in Morocco. Therefore, the objective of our study is to conduct a review of the GHG emissions and to evaluate its specificities in order to establish a targeted action plan to reduce the ecological impact of hemodialysis in Morocco. To do this, we sought the help of a certified audit firm. Carbon Footprint tool (L'outil Bilan Carbon), established in Morocco in collaboration with Mohammed VI Foundation for the Protection of the Environment, was used to analyze the results collected for the year 2019. Our unit (conventional hemodialysis 3 × 4 hours, 424 m2 , 24 generators, 80 patients, and 29 nursing staff) generates 408.98 tonnes of CO2 equivalent per year (t CO2-eq per year) or 5.11 TeqCO2 per patient per year. The largest contributors to GHG emissions are electrical energy consumption (28%), equipment purchase and services (27%), and staff and patients travel (22%). The use of renewable energy for the operation of hemodialysis centers can be a realistic solution to reduce the ecological impact of this type of healthcare in Morocco.

An unorthodox pathophysiology of severe cases of COVID-19 the weak heme hypothesis.

Important amount of severe cases is the main concern in COVID-19 pandemic. It could be the running cause of the burn out of the health system in many countries. The aim of this paper is to suggest a pathophysiologic hypothesis to explain the main characteristics of severe cases of COVID-19 and its underlying conditions. In fact, the clinical and biological picture of severe cases of COVID-19 can easily be explained by free heme toxicity exceeding the endogenous antioxidant systems. Severe cases of COVID-19 are comparable to acute porphyria. On the other hand, the geographical distribution of severe cases of COVID-19 is directly associated to how fresh or polluted the air is. Finally, the relatively low rate of severe cases of COVID-19 could be explained by the presence of an unstable hemoglobin variant highly sensitive to the intrinsic conditions resulting from the acute pneumonia secondary to SARS-CoV2 infection. The combination of air pollution and free heme toxicity, resulting from the interaction between an unstable hemoglobin variant and SARS-CoV2 infection, seems to be the best scheme to explain clinical and biological manifestations in severe COVID-19. The arguments to support this hypothesis are detailed. We also propose some strategies to verify the concordance of our hypothesis with the reality and the implications it could have, if verified, either for scientists and decision makers.

Autodialysis in Morocco: how much longer can we wait?

INTRODUCTION: Autodialysis is the dialysis performed by the patient himself at a local center instead of a hemodialysis center. In Morocco, the practice of hemodialysis dates back to 1970; however, an autodialysis center does not yet exist. The objective was to assess the potential medical fitness and adherence of the patients to an autodialysis program. METHODS: Descriptive and analytical multicenter study conducted in March 2015 involving patients from of eight hemodialysis centers in Casablanca (Morocco). The study was conducted in two steps: 1) a transversal assessment of the medical potential to achieve autodialysis that included 556 patients; 2) a survey of the autodialysis membership that included 383 out of 556 patients who were deemed eligible for autodialysis. RESULTS: The average age was 54.63 ± 15.16 years; the average of hemodialysis duration was 85.9 ± 78.1 months. Diabetic nephropathy (22.7%) was the predominant cause of kidney disease. The assessment of medical potential to achieve autodialysis highlighted that almost all of the patients were in good condition (93%), independent (81%), and those without major comorbidities were less than 76 years old. Regarding the potential patients' adherence to autodialysis, among the 383 patients previously deemed suited for autodialysis, 293 (76.5%) responded favorably to the proposal of self-dialysis. CONCLUSION: The practice of hemodialysis should be implemented in a short time in Morocco because our patients' profile is perfectly suitable to this therapeutic method especially when they are young, in good general condition, autonomous, without major comorbidities, and willing to learn.