Azeddine Ibrahimi

Breast cancer in Morocco: a literature review.

In Morocco, breast cancer is the most prevalent cancer in women and a major public health problem. Several Moroccan studies have focused on studying this disease, but more are needed, especially at the genetic and molecular levels. It is therefore interesting to establish the genetic and molecular profile of Moroccan patients with breast cancer. In this paper, we will highlight some pertinent hypotheses that may enhance breast cancer care in Moroccan patients. This review will give a precise description of breast cancer in Morocco and propose some new markers for detection and prediction of breast cancer prognosis.

Acinetobacter infections prevalence and frequency of the antibiotics resistance: comparative study of intensive care units versus other hospital units

Introduction This study aims to determine the Acinetobacter sp clinical isolates frequency and its antibiotic susceptibility pattern by comparing results obtained from the Intensive Care Units (ICUs) to that of other units at the Mohammed V Military Teaching Hospital in Rabat. Methods This is a retrospective study over a 2-years period where we collected all clinical isolates of Acinetobacter sp obtained from samples for infection diagnosis performed on hospitalized patients between 2012 to 2014. Results During the study period, 441 clinical and non-repetitive isolates of Acinetobacter sp were collected representing 6.94% of all bacterial clinical isolates (n = 6352) and 9.6% of Gram negative rods (n = 4569). More than a half of the isolates were from the ICUs and were obtained from 293 infected patients of which 65, 2% (191 cases) were males (sex ratio = 1.9) and the median age was 56 years (interquartile range: 42-68 years). Acinetobacter clinical isolates were obtained from respiratory samples (44.67%) followed by blood cultures (14.51%). The resistance to ciprofloxacin, ceftazidime, piperacillin / tazobactam, imipenem, amikacin, tobramycin, netilmicin, rifampicin and colistin was respectively 87%, 86%, 79%, 76%; 52%, 43%, 33% 32% and 1.7%. The difference in resistance between the ICUs and the other units was statistically significant (p <0.05) except for colistin, tetracycline and rifampicin. Conclusion This paper shows that solving the problem of prevalence and high rate of multidrug resistant Acinetobacter infection which represents a therapeutic impasse, requires the control of the hospital environment and optimizing hands hygiene and antibiotics use in the hospital.

Relationship Between Vitamin D Deficiency and Chronic Low Back Pain in Postmenopausal Women

OBJECTIVE To examine whether vitamin D deficiency is a determinant risk factor of chronic low back pain (LBP) in Moroccan postmenopausal women. METHODS A biochemical assay of serum calcium, phosphate, 25(OH)D, and parathormone (PTH) was performed for 105 patients complaining from a chronic LBP with no obvious causes and compared to those of 45 healthy patients. All participants were postmenopausal. Patients were matched with controls for age and body mass index (BMI). Vitamin D deficiency was defined as a circulating level of 25(OH)D below 20 ng/ml. RESULTS Vitamin D deficiency was significantly more common in patients suffering from chronic LBP than in controls (79 % vs 61.4 %; P= 0.02). Falls antecedent was also associated with chronic LBP (37.1 % in patients vs 20.5% in controls; P< 0.01). There was no significant association between chronic LBP and age, BMI, smoking status, nor with number of pregnancies. In multiple logistic regression, after adjusting for potential confounders factors potentially influencing chronic LBP (age, BMI, smoking status, number of pregnancies), the main determinants of chronic LBP were vitamin D deficiency [OR 2.5 (95% IC, 1.1-5.8; P = 0.04)] and falls antecedent [OR 3 (95% IC, 1.2-7.2; P = 0.01)]. CONCLUSION Our study shows a significant association between vitamin D deficiency and chronic LBP in Moroccan postmenopausal women. Further studies are clearly warranted to determine the effectiveness and the mechanism(s) of this links between vitamin D deficiency and chronic LBP.

Three-dimensional Structure Prediction of the Human LMTK3 Catalytic Domain in DYG-in Conformation

Lemur Tyrosine Kinase 3 (LMTK3) plays a key role in the regulation of α Estrogen Receptor (ERα) activity. It has been defined as an essential actor involved in the endocrine resistance process in breast cancer patients accelerating the dispersion and invasion of tumor cells which are the first steps of the metastatic process. In the absence of a crystallized structure of LMTK3 and in order to study its inhibition, we generated its tridimensional structure. We constructed the LMTK3 kinase in its active state (DYG-in) using the homology modeling approach. The evaluation of the generated model by several tools indicated the reliability of the predicted 3D structure and the good quality of the stereochemical characteristics model were confirmed by the PROCHECK tool. In conclusion, the docking approach used to study LMTK3-ATP interaction allows us to determine key residues of the ATP binding site that may be useful in the design of potential competitive ATP inhibitors of human LMTK3.

Multiple sclerosis: Clinical characteristics and disability progression in Moroccan children

BACKGROUND 5% of multiple sclerosis have their onset in childhood. OBJECTIVES We aim to show the clinical features and follow-up of Moroccan pediatric MS patients. METHODS 25 pediatric MS records were analyzed between 2005 and 2013 at the Neurology B department of Rabat Ibn sina University Hospital and Medical School Group of Neurogenetic Disorder of Rabat Mohammed V University Souissi. RESULTS The median duration of follow up was 4 years [1.56]. The median age at disease onset was 14 years. Clinical symptoms were described. At the last evaluation, the median EDSS score was 3.0 [0-7.5]. The median time between disease onset and diagnosis was 2 years [1-9] and the median time from MS onset to second neurological episode was 1 year [0.9-3] with an average of 2 relapses in the first 2 years. The median time to reach EDSS 3.0 was 4.5 years [2-17] and the median time to go from EDSS 3.0 to 6.0 was 4 years [2.5-6]. The majority of cases at the last follow-up were; relapsing-remitting (17 patients: 68%), although 8 patients (32%) developed secondary progressive MS after median disease duration of 5 years [4-19]. None of the patients had a primary progressive MS. CONCLUSION Time EDSS 3.0 and to secondary progression was shorter in our cohort than previously reported in other series.

Stroke and syphilis: A retrospective study of 53 patients

OBJECTIVE The aim of this study was to describe the clinical, biological and radiological characteristics of patients with syphilitic vasculitis, and to assess the outcome after treatment. METHODOLOGY A retrospective review was carried out based on the records of patients with ischemic stroke, and reactive CSF TPHA and VDRL results. None of these patients showed symptoms of any other diseases or had received high doses of penicillin. RESULTS A total of 53 patients with stroke met the diagnostic criteria for syphilitic arteritis. Their average age was 41±12 years. Nine patients had a history of genital ulcer (17%), and the median duration of illness after presenting a chancre was 8 [range: 1-14] years. A prodromal syndrome was seen in 27 patients (50.9%) and included changes in mental status in 14 patients (26.4%), seizures in 10 cases (18.9%), headache in eight (15.1%) and memory loss in seven (13.2%). Neurological events included focal motor deficits in 29 cases (54.7%), ataxia in 11 (20.8%) and movement disorders in 15 (28.3%). HIV serology was performed in 31 patients and proved negative in every case. Disease evolution was generally favorable: 12 patients (22.6%) were autonomous at the time of hospital discharge; 29 (54.7%) had partially recovered; and only seven (13.2%) still had signs of severe sequelae. CONCLUSION A diagnosis of syphilitic stroke should be suspected in young patients as a manifestation of syphilis, and tests for neurosyphilis should be routine in neurology departments to make a prompt diagnosis, thereby preventing psychological sequelae.

Intensive care unit-acquired Acinetobacter baumannii infections in a Moroccan teaching hospital: epidemiology, risk factors and outcome

Introduction The objective of this study was to examine the epidemiology, risk factors and outcome associated with Acinetobacter baumannii infections in the intensive care units (ICUs) in a Moroccan teaching hospital. Methods This is a matched case-control study conducted as a joint collaboration between the clinical Bacteriology department and the two ICUs of Mohammed V Military Teaching Hospital from January 2015 to July 2016. Results Among 964 patients hospitalized in the ICUs, 81 (8.4%) developed A. baumannii infections. Multivariate logistic regression analysis identified the following independent risk factors for ICU-acquired A. baumannii infections: ICU stay ≥14 days (odds ratio (OR)=6.4), prior use of central venous catheters (OR=18), prior use of mechanical ventilation (OR=9.5), duration of invasive procedures ≥7 days (OR=7.8), previous exposure to imipenem (OR=9.1), previous exposure to amikacin (OR=5.2), previous exposure to antibiotic polytherapy (OR=11.8) and previous exposure to corticotherapy (OR=5). On the other hand, the admission for post-operative care was identified as a protective factor. The crude mortality in patients with A. baumannii infection was 74.1%. Multivariate analysis showed that septic shock (OR=19.2) and older age (≥65 years) (OR=4.9) were significantly associated to mortality risk in patients with A. baumannii infection. Conclusion Our results show that shortening the ICU stay, rational use of medical devices and optimizing antimicrobial therapy could reduce the incidence of these infections. Elderly patients and those with septic shock have a poor prognosis. These findings highlight the need for focusing on the high-risk patients to prevent these infections and improve clinical outcome.