M. Amine

Validity and Reliability of the Arabic Adapted Version of the DN4 Questionnaire (Douleur Neuropathique 4 Questions) for Differential Diagnosis of Pain Syndromes with a Neuropathic or Somatic Component

Background:  Verbal descriptors of pain can provide a basis for distinguishing neuropathic pain (NP) from pain of non‐neuropathic origin. Much research has been undertaken to develop screening tools for this purpose. The DN4 questionnaire (NP in four questions), is one of theses tools, which was developed and validated in French in 2005. The purpose of this work is to provide an Arabic, culturally appropriate, reliable, and valid version of the DN4 interview questionnaire for the diagnosis of NP.

Prevalence of Chronic Pain with Neuropathic Characteristics in the Moroccan General Population: A National Survey

OBJECTIVE We conducted a telephonic survey to determine the prevalence of chronic pain with neuropathic characteristics (NC) in the Moroccan general population. DESIGN We performed a large nationwide telephonic survey based upon a random sampling of households in the 16 administrative regions of Morocco to determine the prevalence of chronic pain with NC in the general population. We used a stratified sampling taking into account the number of residents in each region. A sample of households was drawn for each of the 16 regions using systematic sampling. OUTCOME MEASURES A questionnaire aimed at identifying chronic pain (defined as daily pain for at least 3 months), evaluating its intensity, duration, and body locations was used. The Moroccan validated version of DN4 questionnaire was used to identify neuropathic characteristics. RESULTS A total of 5,328 respondents participated in the survey. 21% of the respondents (1,074) (95%CI: 19,9-22,2), reported chronic daily pain for more than 3 months. The point prevalence of chronic pain with NC, was 10.6% (95% CI: 9,75-11,45). The prevalence was higher in women and individuals older than 60. Chronic pain with NC was significantly more prevalent in women, elderly, illiterate respondents, and respondents from lower social class. It was more frequently located in the lower limbs, and its intensity and duration were higher in comparison with chronic pain without neuropathic characteristics. CONCLUSION Chronic pain with neuropathic characteristics is probably more prevalent in the general population than was previously thought and is generally more severe than other chronic pain.

IgG anti-toxoplasma antibodies among asymptomatic HIV-infected patients in Marrakesh-Morocco

Detection and monitoring of anti-Toxoplasma gondii antibodies are of a great interest among human immunodeficiency virus (HIV)-infected patients, since cerebral toxoplasmosis is a life-threatening opportunistic infection within this vulnerable population. The IgG anti-T. gondii seroprevalence was assessed in 95 asymptomatic HIV-infected adults living in Marrakesh city and its surrounding areas. Our results showed a seroprevalence of 62.1%, which is high compared to most other countries. The mean of CD(4+) T-cells count of involved patients was 381.9cells/μl. Given these results, HIV-infected patients in Marrakesh region could be at high risk to develop toxoplasmosis disease, especially when CD(4+) T-cells count falls below 100cells/μl. Accordingly, there is a serious need of widening antiretroviral therapy and chemoprophylaxis against toxoplasmosis, when indicated, to ovoid toxoplasmosis reactivation among this population.

Prévalence des anticorps de l'hépatite A chez l'enfant dans la région de Marrakech

Resume Objectifs Definir la prevalence des anticorps anti-hepatite A (HAV) chez les enfants marocains, et examiner les facteurs influencant sa transmission. Methode 150 enfants âges de 6 mois a 14 ans ont ete testes. Un prelevement sanguin a ete analyse afin de mettre en evidence la presence d’lgG indiquant une infection anterieure. Un questionnaire concernant les donnees personnelles et epidemiologiques a ete egalement rempli pour chaque enfant. Resultats Parmi 150 enfants testes, 51 % avaient des anticorps anti-HA. II n’y avait pas de difference significative entre les garcons et les filles. La frequence des anticorps anti-HAV variait avec l’âge : 70,3 % au dela de 6 ans et 45,2 % avant 6 ans. Les habitants de milieu urbain presentaient une prevalence un peu superieure a ceux vivant en milieu rural. Les facteurs socio-economiques ainsi que le niveau d’education des parents avaient une influence significative sur la predominance des anticorps anti-HA. Conclusion Le pourcentage eleve d’enfants atteints par le virus de l’hepatite A fait du Maroc un pays d’endemie. L’introduction de la vaccination contre l’hepatite A parmi les vaccinations obligatoires permettrait de reduire la frequence de cette maladie.

Leishmaniose cutanée à Leishmania tropica dans la région de Marrakech (Maroc) : un foyer rebelle !

Resume Au Maroc, la leishmaniose cutanee (LC) est due a trois especes : Leishmania major , Leishmania tropica qui sont responsables de la majorite des cas de LC rencontres dans notre pays repartis de facon endemo-epidemique et Leishmania infantum , qui engendre des cas sporadiques. Nous rapportons dans ce travail les donnees de la surveillance epidemiologique de la LC a Leishmania tropica menee dans la province de Chichaoua (region de Marrakech) de 2000 a 2006. Cette surveillance montre la presence d’un foyer emergent depuis l’an 2000, devenu epidemique et localise dans la seule ville d’Imintanout. En effet, cette ville a vocation rurale a fait l’objet de la part du ministere de la Sante d’une lutte anti-leishmanienne depuis l’apparition des premiers cas de LC en 1999, mais nous notons la persistance d’une forte incidence annuelle le long de ces sept annees de lutte : 383 en 2000, 2 740 en 2001 et 1 533 en 2006. Ainsi, il est recommande de mener des enquetes sur le terrain autour de ce foyer epidemique, et de s’interesser de pres au reservoir de cette parasitose ainsi qu’aux modalites de lutte anti-leishmanienne et l’adapter au mode de vie des habitants de la region.

Prévalence du diabète de type 2 et facteurs associés au cours de la dépression

OBJECTIVES The aim of our study was to estimate the prevalence of type 2 diabetes in patients with depression and to describe its associated factors. METHODS A cross-sectional descriptive study was conducted over a period of three months (from May to August 2012) in a hospital in Tlemcen, Algeria. The sample study had included 73 consecutive depressed patients who had attended the unit for assessment, education or treatment of depression or its complications. Data collection was conducted using a questionnaire. Blood sampling was performed in all patients to measure glycemic levels. Data analysis was performed using the spss version 10 software. P-value was considered significant when ≤ 0.05. RESULTS Means age was 53 ± 15 years. Sex-ratio female/male was 1.35. The prevalence of type 2 diabetes was 69.9% with 95% CI [57.9; 79.8]. Heredity and collective lifestyle were significantly associated with diabetes (P<0.0001). We have not found an association of diabetes with the factors studied: gender, presence of remaining associated diseases, smoking, and treatment regime. CONCLUSION In the absence of national epidemiological data, the results of our study provide the frequency of type 2 diabetes during depression. This requires planning strategies for diagnosis and appropriate care for this population.

Facteurs thérapeutiques affectant la cicatrisation au cours des gangrènes du périné

Fournier gangrene is a rare and severe necrotizing fasciitis. It is burdened with high morbi-mortality, requiring early and massive medical and surgical management. Initial treatment is based on patients resuscitation associated with surgical debridement. Subsequently, the main challenge is the healing process and its possible sequelae. Several therapeutic approaches are currently available to improve and accelerate the healing process. We conducted a retrospective study of 20 cases. The median age of our patients was 56 years. The study included 16 men and 7 women. Comorbidity was present in 15 patients. Antibiotic therapy was administered in all cases, with a median duration of 15 days. All patients underwent surgery. Iterative reviews were necessary in all patients, who needed, on average, 3 dressing changes. Colostomy was performed in 6 cases. Hyperbaric oxygen therapy was performed in 4 cases. Vacuum assisted closure was performed in 1 case. Soft tissue coverage was necessary in 2 cases. The mean duration of healing was 15 days with oxygen therapy versus 24 days in the absence of this treatment. The mean duration of hospitalization was 20 days. Four patients died. Healing process without sequelae is a therapeutic challenge. Despite the addition of new therapeutic approaches, outcomes are not satisfactory. However, multidisciplinary approach associated with oxygen therapy and vacuum assisted closure might improve patients outcomes.

Psychometric Properties of a Moroccan Version of the Summary of Diabetes Self-Care Activities Measure

Background. The Summary of Diabetes Self-Care Activities (SDSCA) is a widely used self-report measure for diabetes self-management. It is an interesting tool for practice and research. Objectives. To translate and culturally adapt the SDSCA to the Moroccan context and to assess psychometric properties of the adapted version among type 2 diabetic patients. Methods. The Moroccan version was obtained following forward and backward translations. An expert panel issued a final version. The adapted version was administered to patients aged 30 years and older who have type 2 diabetes. Psychometric evaluation consisted of assessing validity through internal consistency (Cronbachs alpha, item-to-scale and interitem correlations) and exploratory factor analysis and reproducibility (test-retest reliability). Results. Seventy-five participants were included. Cronbachs alpha ranged from 0.20 (diet) to 0.99 (exercise). Moderate to good interitem and item-to-scale correlations were found. Factor analysis resulted in a Moroccan SDSCA version consisting of 8 items, organized in four subscales that explained 89.6% of the variance: diet, exercise, blood sugar testing, and foot-care. Intraclass correlations ranged from 0.27 to 0.52 for subscales. Conclusion. This study provides preliminary evidence for suitability of use of the Moroccan SDSCA among type 2 diabetic patients in order to assess diabetes self-management.

Sevrage des nourrissons avant six mois à Marrakech: facteurs associés et prévalence

BACKGROUND In Morocco breastfeeding has become a declining practice. The objectives of this study were to estimate the prevalence of weaning before the age of 6 months and to identify associated factors. METHODS A cross-sectional survey was conducted among 400 mothers of infants aged 0 to 24 months. Participants were recruited from patients attending 40 randomly selected general practices in Marrakech. A trained interviewer administered a questionnaire to collect data on breastfeeding practice and factors associated with it. Early weaning was defined as a cessation of breastfeeding before the age of 6 months and was studied in mother-child couples whose infants were aged 6 months and older. Three binary logistic regression models were used to model the probability that an infant aged 6 months or more is weaned early. RESULTS Breastfeeding was initiated by the majority of respondents (97.5%). Early weaning was observed in 75 infants (28% of registered weaning). Factors associated with early weaning were: mother having an occupational activity (Odds Ratio [OR]=2.09; 95% confidence interval [CI]: [1.07-4.06]), caesarean delivery (OR=4.15; 95% CI: [1.74-9.88]) and the fact that the pregnancy was desired (OR=0.19; 95% CI: [0.05-0.68]). CONCLUSION Weaning before 6 months of age is a common practice in our context. Identifying factors associated with early weaning is critical to promote breastfeeding.

Enquête sur la prévalence des anticorps de l’hépatite A chez l’enfant dans la région de Marrakech

Les hepatites virales type A (VHA) constituent un authentique probleme de sante au Maroc. Leur reputation de benignite tient au caractere a– ou peu symptomatique lorsqu’elles sont contractees en bas âge : neanmoins, le medecin ne doit pas perdre de vue que les formes symptomatiques peuvent se compliquer d’evolution biphasiques et/ou fulminantes, entrainant le deces si la situation est meconnue et le patient refere trop tard pour transplantation. Vu l’evolution du profi l epidemiologique de la maladie, il n’est pas certain que la vaccination des groupes les plus a risque suffi se a elle seule a prevenir la transmission du virus de l’hepatite A dans la population generale. Comme la dynamique de l’infection change dans differentes populations, il faudra faire des etudes dans notre contexte et exercer une surveillance constante en vue de recueillir des donnees pour prendre d’autres decisions [1-3]. De nombreux rapports ont ete publies dans le monde sur l’epidemiologie changeante de VHA et sur sa prevalence. La faible prevalence de VHA dans les pays occidentaux a entraine une baisse generale de l’immunite dans la population. Il y a donc lieu de se demander si une vaccination universelle contre le VHA est indiquee. Pour prendre une decision a cet egard, il faut disposer de renseignements sur le taux d’immunite dans la population [4-6]. Dans notre contexte marocain, la connaissance imparfaite de l’epidemiologie et du degre de gravite chez l’enfant laisse encore de larges incertitudes dans les indications du vaccin. Les enjeux, en particulier economiques, sont importants. Ainsi, la presente etude porte donc sur la seroprevalence du VHA dans la region de Marrakech en milieu pediatrique et sa correlation a un certain nombre de parametres d’environnement, d’habitat et d’hygiene.