Détermination des concentrations plasmatiques de l'isoniazide et la rifampicine chez les patients sous antituberculeux

Introduction : La tuberculose est un problème de santé publique dans le monde entier. Son traitement est basé sur quatre antituberculeux majeurs dont l'isoniazide et la rifampicine qui ont bouleversé le pronostic de cette maladie. L'objectif de cette étude était de montrer l'apport du suivi thérapeutique pharmacologique dans la prévention des échecs thérapeutiques en cas de sous-dosage et de toxicité en cas de surdosage.Matériels et méthodes : Il s'agit d'une étude rétrospective faite à l'Hôpital Moulay Youssef et le laboratoire de toxicologie et de pharmacologie du centre anti-poison et de pharmacovigilance du Maroc sur une période de 9 mois, et menée sur 142 patients ayant tous bénéficié d'un suivi thérapeutique pharmacologique de l'isoniazide et la rifampicine. Les dosages étaient réalisés par chromatographie liquide haute performance après extraction liquide-liquide. Résultats : Notre étude a montré qu'à dose thérapeutique, 78,2% des patients tuberculeux avaient des concentrations plasmatiques de rifampicine au-dessous de la fourchette thérapeutique et 35,4% des patients avaient des concentrations plasmatiques d'isoniazide au-dessus de la fourchette thérapeutique.Conclusion : Dans le cadre du traitement antituberculeux, le recours au suivi thérapeutique pharmacologique permet aux cliniciens

[Description of poisoning reported in Marrakech-Tensift-Al Haouz region in Morocco between 1981 and 2008]. / Description des intoxications notifiées dans la région de Marrakech-Tensift-Al Haouz au Maroc entre 1981 et 2008.

In Morocco, the Marrakech-Tensift-Al Haouz region is one of the 16 regions most affected by poisoning. The aim of this study was to determine the epidemiological profile of poisoning recorded in the study region. A retrospective study of poisoning cases, declared between 1981 and 2008 in the Morocco Poison Control and Pharmacovigilance Center, was conducted. During the study period, 8517 poisoning cases were collected. The average age of patients was 22 ± 15 years. The male/female sex ratio was 0.85. Food poisoning was the most reported in the region, with 26.6% of cases. Among the 2,779 patients for whom the outcome was known, 65 died, with lethality rate of 23.4‰. The maximum lethality rate was recorded among those poisoned by paraphenylenediamine (170.7‰).

[Peganum harmala L. poisoning and pregnancy: two cases in Morocco]. / Intoxication au Peganum harmala L. et grossesse : deux observations marocaines.

Peganum harmala L. (wild or Syrian rue) is commonly used as an emmenagogue and abortifacient in traditional medicine in the Middle East and North Africa including Morocco. The purpose of this report is to describe two cases of Peganum harmala L. poisoning in pregnant women. Both cases were treated successfully with good maternal-fetal outcome good for mother and child.

Epidemiological profile of snakebites in Morocco

The present work aims to find the epidemiological profile of snakebites in Morocco through a retrospective study of 1,423 snakebite cases that occurred between 1992 and 2007. Data were obtained from medical charts of envenomation at the Poison Control and Pharmacovigilance Center of Morocco. Results revealed that 86 percent of the snakebites had occurred in rural areas and that males were significantly more affected than females at a sex ratio of 23:20. Furthermore, 35 percent of the bites happened during the summer, with a peak of 215 cases in June (15.1 percent). We also discovered that 67.3 percent of the patients were bitten during the day. The age group that comprised the most agriculturally active persons, from 20 to 44 years old, was the most affected by snakebites (551 cases). In terms of evolution, patients who were at least 60 years of age (8.89 percent) as well as those who were less than 10 years old (7.50 percent) presented higher mortality. According to clinical severity grades, the data revealed a 70 percent predominance of grade 2 cases (430). Deaths had occurred only in patients with grades 3 and 4. Furthermore, grade 4 patients presented 100 percent mortality whereas grade 3 registered 10.7 percent. The distribution of snakebites according to administrative regions in Morocco showed a predominance of the Souss-Massa-Daraa region both in terms of frequency (32 percent) and mortality (72.1 percent). Our study clearly displayed the severity and extent of the snakebite problem in the country, thus revealing that public health authorities should give more attention to this serious situation.(AU)

Epidemiological and clinical characteristics of scorpion stings in children in Fez, Morocco

Scorpion stings are a public health problem in Morocco, especially among children, who experience the most severe cases. Epidemiological and clinical findings on scorpion stings in Fez, Morocco, were evaluated in this investigation. Of 163 cases that required medical attention, 62.6 percent were male children. The mean age of patients was 4.8 ± 3.4 years. The mean time between stings and first medical attention was 3.36 ± 2.5 hours. Almost all cases occurred in the summer (94 percent) and extremities represented the most frequent sting sites (86.5 percent). Local pain, hyperemia, scarification, vomiting, sweating, restlessness, tachycardia and tachypnea were the observed clinical symptoms. Regarding severity, 55.2 percent of patients belonged to class III, followed by class II (26.4 percent) and class I (18.4 percent). None of our patients received antivenom; however, all of them were treated symptomatically depending on clinical manifestations.(AU)

Risk factors caused by scorpion stings and envenomations in the province of Kelâa Des Sraghna (Morocco)

The present study aims to elucidate the risk factors involved in deaths caused by scorpion envenomation. A retrospective study was carried out in the province of Kelâa des Sraghna from 2003 to 2004. The hospital charts of scorpion envenomation cases treated in the Essalama Hospital in Kelâa des Sraghna were exhaustively analyzed. Our study contains 31 cases of death among 470 hospitalization cases. Most stings had occurred during the hot period peaking in July and August (54.6%). Moreover, the scorpion stings occurred at night in 60.1% of the cases, between 6:00 pm and 6:00 am. In addition, all age groups were affected by envenomation, with a higher frequency in children aged less than 15 years (68.3%). The envenomation rate (class II + class III) was 70.9%. The statistical analysis of the data shows that being less than 15 years old, having been stung during the night and belonging to class III are risk factors that aggravate vital prognosis of hospitalized patients. Furthermore, clinical severity factors, elicited by relative risk analysis, are cardiovascular, respiratory and neurological vital distresses, with relative risks of 14.84, 11.92 and 48.33, respectively. The results of our study clearly displayed the severity and extent of the scorpion envenomation problem. Thus, great attention must be paid to this region of Morocco by the national health authorities.(AU)

Scorpion sting: a public health problem in El Kelaa des Sraghna (Morocco)

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)

[Scorpion poisonous stings in the population of Khouribga (Morocco)]. / Les piqûres et les envenimations scorpioniques au niveau de la population de Khouribga (Maroc).

Poisonous stings caused by scorpion constitute a public health problem in Morocco because of their frequency severity and socio-economic consequences that they generate. The province of Khouribga surveyed for this study is situated in a zone of high incidence and high lethality caused by scorpion stings in Morocco. In order to analyze the epidemiological profile and the poisoning risk factors, we are presenting the results of a past study conducted from April to December 2001. It consisted in making an exhaustive follow up from admission to release of all patients stung by scorpion. These patients consulted a sanitary structure (dispensary health centre or hospital) in the province of Khouribga, Morocco. Within a total of 1212 cases of stings, 63% of them occurred at night (between 06 pm and 06 am) particularly during July and August. Youngsters under fifteen represented 36% of these cases. 3.4% of the people who got stung presented typical poisoning and envenomation. The delay expected from sting to transfer to a medical structure was 1.85 +/- 0.11 hours for the patients who recovered against 2.67 +/- 0.11 for those who did not recover. To be noticed as well that 1.3% of the subjects who got stung die. Variance analysis indicates that the type of sanitary structures receiving patients, admission classes, and age of patients influence significantly the recovery rate of people who are stung.

[Establishment and analysis of a log to record scorpion stings in Morocco]. / Implantation et analyse d'un registre des piqûres de scorpion au Maroc.

Within the framework of a strategy against scorpion stings, an information system was established to track the indicators of morbidity and mortality caused by scorpion stings. The study of these indicators was carried out based upon a national record of scorpion stings. During the year 2001, 15,571 cases of scorpion stings were reported, that translates into an incidence rate of 1.2%. The patients were poisoned in 11.6% of the cases. Most of the patients (79.3%) were only put under clinical surveillance and did not receive any symptomatic treatment. The death rate was 6.3% and death only occurred in children of less than 15 years old (2.1% of the cases). This study demonstrated an improvement in morbidity and mortality indicators in comparison to the data collected before this campaign, all of which verifies the positive impact of the strategy which was put into place. However, it is necessary to continue monitoring until Morocco can overcome this problem.

[National strategy in the battle against scorpion stings and envenomations. Application and evaluation]. / Stratégie nationale de lutte contre les piqûres et envenimations scorpioniques. Application et évaluation.

Scorpion stings represent the first cause of poisoning with an incidence of 30 to 50% of all declared cases in the Centre Anti Poison of Morocco (CAPM). Aware of this increasing problem, the CAPM paid special attention to this pathology. Thanks to its retrospective and prospective studies, the scorpion species mapping has been determined as well as the demographic features of stung patients, the nature and the chronology of clinical events in scorpion envenimation, and the epidemiological, clinical and therapeutical factors of severity. On this basis, the CAPM worked out a national strategy to struggle against scorpion stings whose aim was to decrease the morbidity and mortality caused by stings of scorpion as well as to rationalise economic expenses. The components of this strategy were based on the training of the medical and paramedical staff, on information, education, communication involving different sectors, on identification of needs and on follow-up and assessment. A nationwide campaign was implemented to change the population and health-care staff's behaviour regarding this pathology. Its evaluation permitted to improve the compilation of cases with census of 14104 cases, to reduce lethality rate and to rationalise expenses while banishing some medicines and avoiding useless hospitalization.