A thermo-mechanically loaded rotating FGM cylindrical pressure vessels under parabolic changing properties: An analytical and numerical analysis

This study aims to develop an exact analytical solution for steady-state thermo-mechanical stress in a functionally graded (FG) thick-walled cylindrical vessel. The cylinder is subjected to combined rotational speed and internal pressures while the thermal load is with convective and radiative boundary conditions. The dimensionless governing equations and boundary conditions, represented as a quartic equation, are derived and solved using Ferrari's method. The temperature, displacement, and stress fields across the thick-walled cylindrical vessel are calculated by finding the roots of the quartic equation. In order to investigate the accuracy of the exact analytical solution, a numerical model is constructed based on a standard Galerkin discretization approach of the finite element method (FEM). The analytical solutions and the results obtained through FEM show a high level of agreement. Furthermore, the study analyzes the effects of material parameters on temperature, displacement, and stress fields. Displacement, temperature, and stress fields are presented in the form of dimensionless graphs along the radial direction. For the considered parametric studies, results revealed that parabolic grading is beneficial than conventional grading. This study reveals that for the thermal loading, the maximum temperature, displacement, and tangential stress decrease for the parabolic grading. A similar but lower value of temperature, displacement, and tangential stress is also observed in the case of thermomechanical loading. This study is expected to assist in the assessment of the reliability of load calculations and contribute to the overall durability of pressure vessels. The results obtained from this study can provide valuable insights into thermo-elasticity and the thermo-mechanical behavior of thick-walled cylindrical vessels and can aid in the design and optimization of such systems.

Adherence to the World Cancer Research Fund/American Institute for Cancer Research Recommendations and Colorectal Cancer Risk in Morocco: A Case-Control Study

Background: Currently, colorectal cancer (CRC) incidence and mortality were rising in African countries; these rates are alarming and should be considered to make prevention policies. The World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) released 8 recommendations on body fatness, physical activity and diet to prevent against cancer development. Aim: The current study was designed to evaluate the association between the WCRF/AICR recommendations and the risk of CRC in a case-control study among Moroccan adults. Methods: A case-control study was conducted in 5 Moroccan hospital centers, including 1516 cases and 1516 controls. The study was matched on sex, age (± 5 years) and center. The habitual diet was assessed with a validated food frequency questionnaire. Adherence to WCRF/AICR recommendations was evaluated through a score that incorporates 6 components (body fatness, physical activity, foods and drinks that promote weight gain, plant foods, animal foods, alcoholic drinks). Each related component recommendation was rated using a score of 2 levels: (1) when the recommendation was met; (0.5) when the recommendation was partially met; (0) when the recommendation was not met. The overall WCRF/AICR score ranged from 0 (no adherence to WCRF/AICR guidelines) to 6 (high adherence). To categorize this score, we calculated the tertile cut-offs of controls (reference population) for both sexes (men and women separately) that we applied on the whole population. Conditional logistic regression was used to calculate ORadjusted and its 95% confidence intervals adjusted for age, residence, education level, monthly income, family history of CRC, smoking status, BMI, physical activity, total energy intake, and alcohol intake unless the variable was part of recommendation under evaluation. Results: CRC risk was significantly reduced with increasing adherence to each WCRF/AICR recommendation: for body fatness (ORa = 0.47; 95% CI, 0.36-0.63), physical activity (ORa = 0.33; 95% CI, 0.24-0.45), sugary drinks (ORa = 0.58, 95% CI, 0.42-0.80), plant foods (ORa = 0.18; 95% CI, 0.12-0.29) and animal foods (ORa = 0.47; 95% CI, 0.36-0.62). Also a significant inverse association was observed for the highest category of adherence to WCRF/AICR guidelines for CRC risk (ORa = 0.29; 95% CI, 0.23-0.37) compared with the lowest category. Conclusion: The WCRF/AICR index including a combination of 6 components showed strong protective associations for CRC risk in Morocco. These results confirm the importance of promoting the WCRF guidelines among the Moroccan population to prevent CRC incidence.

Is There Any Association Between Processed Meat Consumption and Colorectal Cancer Risk in Morocco?

Background: Colorectal cancer (CRC) is the third most commonly diagnosed malignancy and the fourth leading cause of cancer-related deaths worldwide. A large body of epidemiologic research show that countries where people eat more red meat and processed meat are also countries where the risk of CRC is high. The processed meat intake was described as a convincing risk factor for CRC according to the recent report of the World Cancer Research Fund published in 2017. In Morocco the incidence of CRC is increased significantly during the last years according to the Cancer Registry of the Greater Casablanca region. In addition to the imported of modern processed meat; this country is characterized also by the presence of their traditional processed meat as: quaddid (obtained by salting and sun-drying of meat) and khlii (obtained from salted-dried meat, which is cooked and conditioned in fat). In contrast, no studies have been conducted previously to evaluate the association between processed meat and CRC risk. Aim: This study aimed to evaluate the association between processed meat intake and CRC risk in Morocco. Methods: A case-control study was conducted in 5 major public health hospitals in Morocco. Each case was matched with a control by age (±5 years), sex and center. Dietary data were collected by a validated Food Frequency Questionnaire including traditional processed meat (quaddid and khlii) and modern processed meat (delicatessen meat). Conditional logistic regression was done to predict the association between processed meat consumption and CRC risk. Results: Among 500 cases and 500 controls matched by age; sex and center, 50.9% were male and 49.1% were female. The mean age was 55.53 ± 14.53 years. Among the cases, 44.5% was diagnosed with colon cancer, and 55.5% with rectum cancer. Most participants live in the urban area; never attend school and are poor. The bivariate analysis was used to evaluate the association between processed meat intake and CRC. We found no statistical significant between the occurrence of CRC and consumption of traditional processed meat (OR = 1.04; 95% CI, 0.74-1.48; P = 0.43). While, this study found strong significant association between modern processed meat and CRC risk (OR = 9.23; 95% CI, 3.91-21.77; P = 0.00). Conclusion: This study support that high consumption of modern processed meat such delicatessen meat increased the risk of CRC. In contrast, this study did not provide evidence that traditional processed meat is related to CRC risk in Morocco. We could explain this association by the low consumption of traditional processed meat in this study sample. In addition, the increases in the urbanization could also reduce the consumption of these types of traditional processed meat. Further studies are needed to evaluate the association between meat consumption and CRC risk in the context Moroccan.

[Diabetes and erectile dysfunction in Morocco: epidemiological study among outpatients]

We studied the relationship between erectile dysfunction (ED) and diabetes among 189 men (> 40 years) attending primary health care centres in Morocco. Of the 89 diabetic men, 82% had ED while only 17% of the 100 non-diabetic men had ED. The frequency of ED among diabetic men increased with age, from 60% in those aged 40-49 years to 94.95% in those aged > or = 60 years (from 6.3% to 35.4% in men without diabetes for similar ages). ED was reported by 93.3% of diabetic men who had had diabetes for > 15 years. The frequency of ED did not differ with type of diabetes but it was significantly commoner in diabetic men with a low level of education and with hypertension.

[Prevalence of anti-HCV antibodies and seroconversion incidence in five haemodialysis units in Morocco]

Dialysis patients are among groups at risk for development of hepatitis C infection (HCV). The aim of the study was to evaluate the prevalence and the incidence of seroconversion for HCV in five haemodialysis units in Morocco. The study was conducted during the period from September 2003 to September 2004. We studied 303 patients (148 females), mean age 49+/-16 years; dialysis duration was higher than five years in 64% of the cases. The prevalence of HCV infection was evaluated by using a fourth generation enzyme immunoassays. In the seronegative patients, we performed anti-HCV tests at three and six months intervals and monthly testing of alanine aminotransferase (ALT) activity and assessment of anti-HCV tests if the ALT activity was elevated. Moreover, risk factors, such as blood transfusion, surgery and other invasive procedures were recorded. Seroprevalence of HCV was 68.3%. Among 85 patients who were tested negative for anti-HCV at the entry of the study, four (4.60%) seroconverted in six month (estimated incidence: 9.41 new cases per year). HCV seropositivity was associated with longer duration of dialysis (p=0.000), and previous blood transfusions (p=0.047). The follow-up of the ALT in the seronegative patients did not show any significant variation. In conclusion, the prevalence and incidence of HCV infection in haemodialysis units in Morocco are dramatically elevated. High incidence seropositivity suggested nosocomial transmission of HCV; the dialysis processes itself, and blood transfusions are important risk factors for HCV transmission in these patients.

An autosomal dominant major gene confers predisposition to pulmonary tuberculosis in adults

The molecular basis of genetic predisposition to pulmonary tuberculosis in adults remains largely elusive. Few candidate genes have consistently been implicated in tuberculosis susceptibility, and no conclusive linkage was found in two previous genome-wide screens. We report here a genome-wide linkage study in a total sample of 96 Moroccan multiplex families, including 227 siblings with microbiologically and radiologically proven pulmonary tuberculosis. A genome-wide scan conducted in half the sample (48 families) identified five regions providing suggestive evidence (logarithm of the odds [LOD] score >1.17; P < 0.01) for linkage. These regions were then fine-mapped in the total sample of 96 families. A single region of chromosome 8q12-q13 was significantly linked to tuberculosis (LOD score = 3.49; P = 3 × 10⁻⁵), indicating the presence of a major tuberculosis susceptibility gene. Linkage was stronger (LOD score = 3.94; P = 10⁻⁵) in the subsample of 39 families in which one parent was also affected by tuberculosis, whereas it was much lower (LOD score = 0.79) in the 57 remaining families without affected parents, supporting a dominant mode of inheritance of the major susceptibility locus. These results provide direct molecular evidence that human pulmonary tuberculosis has a strong genetic basis, and indicate that the genetic component involves at least one major locus with a dominant susceptibility allele.

[Part of Chlamydia pneumoniae in atherosclerosis and exacerbation of chronic obstructive pulmonary disease and asthma]

Chlamydia pneumoniae infection has been often associated with several chronic diseases including asthma and chronic obstructive pulmonary diseases (COPD). The spectrum of Chlamydia pneumoniae infection has been expanded to the association with coronary heart disease (CHD). In Morocco, the implication of Chlamydia pneumoniae infection in these pathologies is unknown. The aim of our study was to determine the relationship between infection with Chlamydia pneumoniae and respiratory pathology and atherosclerosis. The patients were from two departments (department of respiratory disease and of cardiology), and presented exacerbation of COPD and asthma or atherosclerosis. The mean age was 45 years a with a 1.7 sex ratio for the first population and 61 years with a 1.4 sex ratio for the second population. Serological diagnosis of Chlamydia pneumoniae infection has been determined by microimmunofluorescence (MIF). All samples were tested for anti-Chlamydia pneumoniae IgG, IgA and IgM. In the first group, we found 42 % positive for IgG, 11 % for IgA, and no case for IgM. In the second group the presence of anti-Chlamydia pneumoniae IgG was observed in 67.5 % cases, IgA in 16.5 % cases and IgM in 2 % cases, 14 % of patients had negative serology for IgA, IgG, and IgM. Our results are in accord to those reported by other studies. According to these results, it seems that a certain degree of association exists between Chlamydia pneumoniae infection and exacerbation of COPD, asthma and atherosclerosis which should be of importance on a therapeutic point of view.

Association of IL12RB1 polymorphisms with pulmonary tuberculosis in adults in Morocco

Five disease-causing genes, including the IL12RB1 gene that encodes the beta 1 chain of the receptor for interleukin (IL)-12 (IL-12R beta 1), are known to be associated with the syndrome of Mendelian susceptibility to mycobacterial diseases. Some IL-12R beta 1-deficient patients present with tuberculosis as the only clinical phenotype. A comprehensive genetic study of IL12RB1 was conducted among 101 Moroccan families, including 157 offspring (age, >15 years) who had culture-positive pulmonary tuberculosis (PTB). The promoter, exons, and flanking intron regions of IL12RB1 in 40 randomly selected patients with PTB were entirely sequenced, leading to the detection of 19 variants (including 10 novel mutations). Blood cells obtained from individuals who were homozygous for any of the 13 most common variants responded to IL-12, indicating that these polymorphisms were not loss-of-function mutations. By use of a family-based study, 2 promoter polymorphisms that were in strong linkage disequilibrium were found to be associated with PTB, especially -2C-->T (odds ratio for CT or TT vs. CC, 2.69 [95% confidence interval, 1.19-6.09]). This result suggests that IL12RB1 polymorphisms might influence the risk of development of PTB in adults.

Chronic cases of tuberculosis in Casablanca, Morocco

OBJECTIVE

To evaluate the prevalence and patterns of drug resistance of Mycobacterium tuberculosis isolates collected from patients with chronic tuberculosis in Casablanca, Morocco.

METHODS

Between February 1996 and September 2001, 122 isolates were recovered from 112 different patients. The male to female ratio was 2.4.

RESULTS

From February 1996 to May 1997, 77.5% of isolates were multidrug-resistant (MDR-TB), compared to 69.4% from February 1999 to May 2000 and 78.7% from June 2000 to September 2001. The prevalence of MDR-TB is similar from the initial to the last period of this study. Analysis of the 69 bp hypervariable region of the rpoB gene by DNA sequencing on 42 M. tuberculosis isolates (37 resistant, 5 sensitive) showed nine different types of mutations on codons rpoB 513, rpoB 516, rpoB 522, rpoB 523 and rpoB 526. A new point mutation was observed on codon rpoB 523 on one isolate. No mutation was detected on this rpoB region for four resistant isolates.

CONCLUSION

The high rate of MDR-TB illustrates a serious problem. The public health authorities have introduced a new regimen protocol consisting of 3 months of kanamycin, ofloxacin, pyrazinamide and ethionamide, followed by 18 months of ofloxacin, pyrazinamide and ethionamide (3KOZEA/18OZEA) for this category of patients, and it is hoped that the additional use of ofloxacin during the intensive phase of treatment will reduce the rate of resistance.

Variants of the human NRAMP1 gene and susceptibility to tuberculosis in Morocco

It has been well established that the host genetic background is an important modulator of tuberculosis susceptibility. The NRAMP1 (alias SLC11A1) gene has been associated with tuberculosis susceptibility in several ethnic groups. Here we studied the association and linkage of NRAMP1 with tuberculosis in 116 nuclear families, comprising 211 affected offspring, from Casablanca, Morocco. All enrolled tuberculosis cases were culture-positive. No evidence was found of linkage or association of NRAMP1 with tuberculosis. These findings suggest heterogeneity in the genetic control of tuberculosis susceptibility.

Antibody responses to recombinant Epstein-Barr virus antigens in nasopharyngeal carcinoma patients: complementary test of ZEBRA protein and early antigens p54 and p138

Serological tests based on the antibodies directed against the Epstein-Barr virus early antigen (EA) and viral capsid antigen (VCA), which have been recognized as tumor markers for nasopharyngeal carcinoma (NPC), are routinely used to help in the diagnosis of this malignancy. The detection of these antibodies reveals very low titers, found only in a small proportion of young compared with older NPC patients. This is a problem for the diagnosis of NPC, especially among Maghrebians, among whom young people are also affected, and emphasizes the necessity to search for more reliable markers. The present study reports results of immunoglobulin G (IgG) and IgA responses of NPC patients to recombinant EA antigens p54 (BMRF1) and p138 (BALF2), VCA complex antigens p18 (BFRF3) and p23 (BLRF2), and EBNA antigen p72 (BKRF1). Our results show that IgA-EA-p54 and -p138 (IgA-EA-p54+138) antibodies have a diagnostic value for detection of NPC (70%), compared with IgA-VCA-p18+23 and IgA-EBNA-p72, which have limited diagnostic value, especially in young patients. It is also noteworthy that IgA-EA-p54+138 can detect a high percentage (64%) of NPC cases negative by immunofluorescence. These results, however, clearly show that a single test cannot achieve the objective of detecting all NPC patients, and it seems advisable to combine different tests for the diagnosis of NPC. The combination of IgG-ZEBRA with IgA-EA-p54+138 improved the sensitivity of detection of NPC to 95% in the overall NPC population. The use of IgA-EA-p54+138 in combination with IgG-ZEBRA will facilitate detailed studies on the pattern of antibody response, which may result in the development of useful serological markers to guide the treatment of NPC.

Direct genotyping and nucleotide sequence analysis of VS1 and VS2 of the Omp1 gene of Chlamydia trachomatis from Moroccan trachomatous specimens

To determine the range of ocular strains of Chlamydia trachomatis circulating in southern Morocco, where trachoma is endemic, and to compare the value of the molecular methods for genotyping C. trachomatis, ocular specimens were subjected to a direct Omp1 PCR-restriction fragment length polymorphism (RFLP)-based analysis and direct sequencing. PCR-RFLP analysis shows that the Ba genotype represents the most frequent one (63%), followed by genotype A (45%), whereas no B or C genotypes were identified among the 53 out of 108 specimens that were strongly positive in the Omp1 CT1-CT5 PCR. Our results further show that the notion of interfamily and intrafamily transmission is very likely. To confirm the genotype identity of C. trachomatis as determined by PCR-RFLP, 16 selected specimens were sequenced across variable sequence 1 (VS1) and 2 (VS2). No discrepancies were found between PCR-RFLP typing and the genotype identity confirmed by nucleotide sequencing of the PCR product. Our results clearly indicate that both molecular methods of typing chlamydiae (i.e., PCR-RFLP and sequencing) are important and have specific applications for clinical epidemiological purposes. This is the case for individuals infected with more than one clonal population of C. trachomatis. The unambiguous nucleotide sequencing therefore defines an important epidemiologic descriptor for the infected patient whether the source is from a clonal population of organisms or whether it represents a more dynamic process of strain dominance or genetic change. Furthermore, Omp1 genotyping affords the necessary approach to epidemiologic investigations in areas of the world endemic for trachoma, where only one or two serovars are known to predominate.

Study of human leukocyte antigen class I phenotypes in Moroccan patients with nasopharyngeal carcinoma

Previous reports demonstrated an association between the human leukocyte antigen (HLA) and risk for nasopharyngeal carcinoma (NPC) among the Chinese in Singapore, a population with a high incidence of this malignancy. In our study, we assess the association between HLA and NPC in Morocco, a median-prevalence area for this cancer, where NPC presents the particularity of also affecting young individuals. Using the standard microlympho-cytotoxicity test, we typed a total of 154 Moroccan NPC patients and 257 unrelated healthy controls for their HLA-A and B antigens. The results of these analyses show that the frequencies of HLA-A10, HLA-B13 and HLA-B18 were found to be higher in the NPC group than in the control group, whereas HLA-A9 was associated with a decreased risk. After correction for the number of specificities tested, these differences were statistically significant only for HLA-B18 (corrected p value [pc] < 0.023, relative risk [RR] = 4.14) and HLA-A9 (pc < 0.023, RR = 0.45). The comparison of the distribution of the HLA antigens in younger and older cohorts of patients shows that the incidence of HLA-A10 and HLA- B18 was higher in the older group, whereas the frequencies of HLA-A19 and HLA-B13 were significantly higher in younger patients compared with controls. The presence of both HLA-A19 and HLA-B13 phenotypes correlated with an increased risk of developing NPC among overall patients compared with controls. According to the sex distribution, increased frequency of HLA-B18 was found in male and female NPC patients compared with controls, whereas the frequency of HLA-A10 was higher only in male NPC patients compared with controls.

Different cytokine profiles of peripheral blood mononuclear cells from patients with persistent and self-limited hepatitis C virus infection

An imbalance between T helper cell Th1 and Th2 like cytokines has been described in several chronic infectious diseases. In an attempt to characterise the mechanism responsible for viral persistence in hepatitis C virus (HCV)-related chronic infection, we analyzed Th1 cytokines (IL-2, IL-12, IFN-gamma) and Th2 cytokines (IL-4, IL-10) production by phytohemagglutinin (PHA)-stimulated peripheral blood mononuclear cells (PBMC) derived from ten patients with viremic chronic hepatitis C, five healthy HCV seropositive individuals and four HCV seronegative individuals. Cytokine production was determined by enzyme-linked immunosorbent assay (ELISA) after 72 h of stimulation. The results showed that the production of IFN-gamma by PHA-stimulated PBMC was decreased in patients with hepatitis C infection (P=0.05). IL-4 production was not detected in both patients and controls, while no difference was observed for IL-2, IL-10 and IL-12 production between patients and controls. Furthermore, IL-12 and IFN-gamma production was weaker in patients with viremic chronic hepatitis C than in subjects who were able to clear the virus (P=0.01; P=0.03, respectively). These results clearly indicate that a defect both in IL-12 and IFN-gamma production may contribute to the persistence of HCV infection.

Genetic variation among populations of the Hessian fly Mayetiola destructor (Diptera: Cecidomyiidae) in Morocco and Syria

The RAPD-PCR technique was used to study genetic variation within and among geographical populations of the Hessian fly, Mayetiola destructor (Say), from Morocco and Syria, associated with the fly's ability to overcome resistance in three wheat cultivars containing H5, H13 and H22 resistance genes. Variation was detected both for the level of susceptibility of the cultivars and RAPD profiles of M. destructor populations. By the use of RAPD-PCR, high genetic variability was detected among individuals and populations of M. destructor within and between areas separated geographically. The DNA fingerprints of populations of M. destructor were area-specific with Nei's measures of genetic distance ranging from 0.156 (between Abda and Beni Mellal, Morocco) to 1.977 (between Marchouch, Morocco and Lattakia, Syria). Cluster analysis of the genetic distances among the populations, identified the Syrian population as an outlier. A highly significant correlation (r = 0.81) observed between the genetic and geographic distances among the populations, provided genetic support for dispersal of the fly from its presumed origin in West Asia to Morocco.

A randomized study comparing two guidewire strategies for angioplasty of chronic total coronary occlusion

Chronic total coronary occlusions were more frequently crossed using the Crosswire as a primary guidewire strategy than with the conventional strategy. This strategy resulted in a lower number of guidewires being used, a trend toward shorter procedural and fluoroscopy times, and decreased use of contrast media.

Antibodies to the Epstein-Barr virus transactivator protein (ZEBRA) as a valuable biomarker in young patients with nasopharyngeal carcinoma

Epstein-Barr virus (EBV)-associated nasopharyngeal carcinoma (NPC) generally occurs in adults, especially in high-prevalence populations such as the Chinese and Eskimos. In Maghrebian populations, young patients affected with this malignancy represent 25% of the total NPC cases. In adults with NPC, relatively high titers of IgA antibodies to the EBV viral capsid antigen (VCA) and early antigen (EA) represent important markers. However, nearly 50% of young NPC patients are negative for IgA-anti-VCA and -EA or exhibit very low titers of these antibodies. We report here that 92% of sera from young NPC patients negative for IgA-EA and 89% of those negative for IgA-VCA were positive for IgG antibodies to the EBV transactivator protein (ZEBRA) at very high titers. Our results show that in young patients with NPC these antibodies represent the most reliable marker for diagnosis and prognosis, particularly when compared with conventional NPC markers, i.e., IgA-VCA (58%) and anti-EA (25%). The titers of IgG-ZEBRA antibodies increased along with lymph node involvement only in the young patient group, suggesting a prognostic value of this marker in this patient group.

Stenting of bifurcation lesions: classification, treatments, and results

Percutaneous transluminal balloon coronary angioplasty (PTCA) of coronary bifurcations is associated with a low success rate, high rate of complications, and high incidence of target vessel revascularization (TVR). The strategy of systematic coronary stenting in bifurcation lesions involving a side branch >/= 2.2 mm in diameter was prospectively evaluated in a single-center observational study during a 35-month inclusion period. All patients meeting these criteria were consecutively included. Bifurcation lesions and treatment were predefined in the study. The study included 366 patients (12.1% of PTCA) with 373 bifurcation lesions, mean age 63.7 +/- 11.6 years, 79.2% male, 46.7% with unstable angina, and 8.3% acute MI. The left anterior descending/diagonal bifurcation was involved in 55.2% of cases, circumflex/marginal 22. 2%, PDA/PLA 10.4%, left main bifurcation in 6.8%, and others 5.4%. The main branch (2.78 +/- 0.42 mm reference diameter) was stented in 96.3% of cases and the side branch (2.44 +/- 0.43 mm) in 63.2% (the two branches were stented in 59.5% of cases). Procedural success was obtained in 96.3% in both branches and 99.4% in the main branch. At1-month follow-up, The major cardiac event rate (MACE) was 4.8% (death 1.1%, emergency CABG 0.6%, Q-wave MI 0.9%, acute or subacute closure 1.4%, repeat PTCA 1.1%, and non-Q-wave MI 2.3%). At 7-month follow-up, the total MACCE rate was 21.6%, including a TVR rate of 17.2%. Analysis of the 7-month outcome according to two study periods (period I, 1 January 1996 to 31 August 1997, 182 patients; period II, 1 September 1997 to 30 June 1998, 127 patients) showed that the TVR rate decreased from 20.6% to 13.8% (P = 0.04) and the MACE rate from 29.2% to 17.1% (P < 0.01) in period I and II, respectively. This was associated by univariate analysis with an increasing use of tubular stents deployed in the main branch (94.2% vs. 59.1%, P < 0.001) and kissing balloon inflation after coronary stenting (75.4% vs. 18.1%, P < 0.001). Bifurcation lesions are frequent. Procedural success of coronary stenting is high with a low rate of in-hospital MACE. TVR rate at follow-up is relatively low. In-hospital and follow-up results are influenced not only by the learning curve but also by the use of tubular stents in the main branch and final kissing balloon inflation.

Stenting of bifurcation lesions: classification, treatments, and results

Percutaneous transluminal balloon coronary angioplasty (PTCA) of coronary bifurcations is associated with a low success rate, high rate of complications, and high incidence of target vessel revascularization (TVR). The strategy of systematic coronary stenting in bifurcation lesions involving a side branch >/= 2.2 mm in diameter was prospectively evaluated in a single-center observational study during a 35-month inclusion period. All patients meeting these criteria were consecutively included. Bifurcation lesions and treatment were predefined in the study. The study included 366 patients (12.1% of PTCA) with 373 bifurcation lesions, mean age 63.7 +/- 11.6 years, 79.2% male, 46.7% with unstable angina, and 8.3% acute MI. The left anterior descending/diagonal bifurcation was involved in 55.2% of cases, circumflex/marginal 22. 2%, PDA/PLA 10.4%, left main bifurcation in 6.8%, and others 5.4%. The main branch (2.78 +/- 0.42 mm reference diameter) was stented in 96.3% of cases and the side branch (2.44 +/- 0.43 mm) in 63.2% (the two branches were stented in 59.5% of cases). Procedural success was obtained in 96.3% in both branches and 99.4% in the main branch. At1-month follow-up, The major cardiac event rate (MACE) was 4.8% (death 1.1%, emergency CABG 0.6%, Q-wave MI 0.9%, acute or subacute closure 1.4%, repeat PTCA 1.1%, and non-Q-wave MI 2.3%). At 7-month follow-up, the total MACCE rate was 21.6%, including a TVR rate of 17.2%. Analysis of the 7-month outcome according to two study periods (period I, 1 January 1996 to 31 August 1997, 182 patients; period II, 1 September 1997 to 30 June 1998, 127 patients) showed that the TVR rate decreased from 20.6% to 13.8% (P = 0.04) and the MACE rate from 29.2% to 17.1% (P < 0.01) in period I and II, respectively. This was associated by univariate analysis with an increasing use of tubular stents deployed in the main branch (94.2% vs. 59.1%, P < 0.001) and kissing balloon inflation after coronary stenting (75.4% vs. 18.1%, P < 0.001). Bifurcation lesions are frequent. Procedural success of coronary stenting is high with a low rate of in-hospital MACE. TVR rate at follow-up is relatively low. In-hospital and follow-up results are influenced not only by the learning curve but also by the use of tubular stents in the main branch and final kissing balloon inflation.

Scorpion envenomation and serotherapy in Morocco

A clinical and biologic study was conducted in Morocco to assess the efficiency of antivenom therapy for treating victims of scorpion stings. Epidemiologic and clinical data were collected from 275 patients envenomed by Androctonus mauretanicus mauretanicus and Buthus occitanus scorpions. Patients received antivenom or other drugs. Blood samples were collected at the time of hospital admission and 1 hr and 3 hr after treatment. Serum venom levels were quantified by using an ELISA. An association was found between clinical signs of envenoming and the level of venom in serum. Patients classified as grade II (moderate envenoming) had higher serum levels of venom level than patients classified as grade I (mild envenoming). At admission to the hospital, the mean venom concentration was not significantly different between the group not treated with antivenom, the group who received 2-5 ml of antivenom, and the group who received 10 ml of antivenom. A significant decrease in serum venom levels and an improvement in the clinical conditions were observed in patients administered 10 ml of antivenom. The lower decrease in serum venom levels in patients who received 2-5 ml of antivenom was due to lower doses of antivenom. No difference in the venom concentration was observed in patients who were not treated with antivenom. The absence of administration of antivenom increased the risk of developing clinical signs at the end of the hospitalization period. However, this risk was much higher when more than 1 hr elapsed between the time of the scorpion sting and the time of hospital admission. The results demonstrate that antivenom is effective in decreasing circulating venom and morbidity. Serotherapy is more efficient when given as soon as possible after envenomation and with adequate quantities of antivenom.

[Epidemiologic and virologic study of hepatitis C virus infections in Morocco]

OBJECTIVES

We prospectively studied 783 consecutive Moroccan patients to define: 1) the prevalence of anti-hepatitis C virus (HCV) antibody (Ab), 2) the prevalence of other viral infections: HBs Ag, anti-HAV IgM, anti-HGV, HGV RNA, 3) the risk factors of spreading HCV infection, and 4) the distribution of HCV genotypes.

RESULTS

60/783 (7.7%) patients had anti-HCV Ab (48 H/12 F), 26 (3.3%) HBs Ag, and 3 (0.3%) IgM anti-HAV. Anti-HGV Ab was found in 11/60 (18.3%) anti-HCV positive patients, and 6/38 (15.8%) anti-HCV negative patients. 2/22 (9%) serum anti-HCV positive and anti-HGV negative patients were positive for HGV RNA. The 60 HCV positive patients rarely had other viral infections: 3 (5%) HBs Ag, 11 (18.3%) anti-HGV positive, 2 (9%) HGV RNA positive, and none had anti-HBc, IgM anti-HAV, or anti-HIV. HCV positive patients had more often undergone transfusion of blood products (21.7 vs 5.5%; P < 0.0001), and dental treatment (55% vs 8.3%; p < 0.0001). Patients with anti-HCV Ab frequently had hepatitis lesions on liver biopsy, i.e. chronic active hepatitis (n = 44) or cirrhosis (n = 16). HCV RNA was positive in 45/60 (75%) anti-HCV positive patients. HCV genotypes were: 1b (n = 21, 47%), 2a/2c (n = 13, 29%), 1a (n = 6, 13%), et 3 (n = 1, 2%).

CONCLUSIONS

In our Moroccan population, the prevalence of HCV was high (7.7%). Other viral infections (HBV, HAV, HGV) were rare.

[Cockayne's syndrome with unusual retinal involvement (report of one family)]

Cockayne's syndrome is a very rare autosomal recessive affection. Ocular involvement is an essential element for positive diagnosis; the retina shows a typical salt and pepper retinitis with optical atrophy. We report a family with four brothers who had Cockayne's syndrome with unusual retinal involvement. The patients' parents were first cousins. Ophthalmologic examination of the mother showed unilateral left pigmentary retinopathy localized in the peripapillary region. The father's ophthalmological examination was normal. The four brothers presented disharmonious dwarfism, cutaneous hyperpigmentation of skin areas exposed to sun with old-appearance of the skin, sensorineural deafness, kyphoscoliosis, a cerebellar syndrome and mental retardation. The ophthalmological examination showed hypermetropia in all four brothers and bilateral maculopathy with no papillary or vascular abnormalities. The electroretinogram was in favor of cone dystrophy. Computed tomography showed one case of calcifications of the basal ganglia and cerebral atrophy. The karyotypes of the four brothers and the mother were normal. We discuss the ocular symptoms and the etiopathogenesis of this syndrome.

The gene distribution in the genomes of pea, tomato and date palm

The vast majority of genes of maize, rice, barley and wheat are contained in long gene-rich regions (collectively called the 'gene space') separated by long gene-empty regions. The gene space covers a narrow, 0.8-1.6%, GC range, possibly because of the presence of abundant transposons. Here we report that the gene space is not an exclusive property of Gramineae, because it also exists in the large genome of pea (5000 Mb). Moreover, the gene space is not just dependent upon genome size, since a gene space is found in rice (415 Mb), but not in Arabidopsis (120 Mb), nor in two other plants investigated in the present work, date palm (250 Mb) and tomato (1000 Mb).

Evaluation of IS6110 as amplification target for direct tuberculosis diagnosis

We describe in the present study an evaluation of the IS6110 repetitive element in the rapid diagnosis of pulmonary and extrapulmonary tuberculosis by polymerase chain reaction (PCR). A pair of oligonucleotide primers was designed to amplify a 201-bp DNA fragment of IS6110. The amplified DNA was detected by ethidium bromide stained agarose gel electrophoresis and confirmed by Sal I digestion and Southern blot hybridization with a 32P-labeled probe. To detect the presence of amplification inhibitors, an internal control DNA that used the same primers as for the target sequence was added to each PCR reaction. PCR results were compared with the results of acid fast stained smears, cultures, and clinical data in 102 sputum and 41 extrapulmonary specimens. With the exception of four samples, M. tuberculosis was detected by PCR in all smear- and culture-positive cases and in all smear-negative, culture positive cases. Additionally, PCR was able to detect 6 cases that were smear and culture negative but clinically strongly suspected of tuberculosis. The final PCR sensitivity and specificity were 93.1% and 95.18%, respectively. One M. tuberculosis strain isolated from a sputum was found to lack IS6110. This study shows that (1) PCR diagnosis based on IS6110 reached the best sensitivity and specificity but must be considered carefully since some M. tuberculosis strains lack IS6110; and (2) PCR must be interpreted in conjunction with clinical and radiological data when it is discordant with conventional methods results.

The prevalence of sexually transmitted pathogens in patients presenting to a Casablanca STD clinic

The objective of this study conducted at the sexually transmitted diseases (STD) clinic of the Pasteur Institute of Morocco (SCPIM) is to describe clinical complaints and biological findings in patients attending this facility. Two thousand two hundred sixty-four patients had visited the STD clinic from 1992 to 1996. The main reported symptom was genital discharge for men (44.5%) and women (68.6%). Genital eruption and ulcer were more frequent in men. The principal biological result shows a seroprevalence of 0.62% for human immunodeficiency virus (HIV), 3.05% for hepatitis B virus (HBV), 51.5% for chlamydiae and 13.2% for syphilis. Factors associated with clinical findings were age and Gonococcus for men (odds ratio (OR): 1.94 and 5.96, respectively) and Trichomonas and positive TPHA for women (OR: 9.49 and 0.25, respectively). This work describes for the first time the distribution of various germs involved in sexually transmitted diseases in Moroccan population and underlines the importance of studying its sexual behavior as well as determinants of STD incidence.

Tortuous internal mammary artery angioplasty: accordion effect with limitation of flow

Mechanical straightening of a tortuous vessel during angioplasty has been well described. It can be mistaken for thrombus, dissection or spasm. This report presents a case in which straightening of vessel due to stiff guide wire results in accordion effect and flow limitation.

[Single coronary artery arising from the right coronary sinus. Report of two cases]

The authors report two cases of single coronary artery arising from the right coronary sinus. Both patients had angina with reversible myocardial ischaemia on exercise Thallium scintigraphy. Coronary angiography showed single coronary artery arising from the right coronary sinus in both cases with severe stenosis of the right coronary artery in the first and occlusion of the right coronary artery in the second patient. Both underwent surgical revascularisation with a good result. Single coronary artery is a rare congenital abnormality (approximately 0.36 per 1,000) diagnosed at autopsy until 1963, and thereafter at coronary angiography. A review of the literature shows that an equal number of single coronary arteries arise from the right as from the left coronary sinus: there does not seem to be an increased risk of complication when a branch runs between the aorta and pulmonary artery. On the other hand, single coronary arteries arising from the right coronary sinus seem to be more commonly associated with atherosclerosis than a network with two coronary arteries, but when the lesions are proximal, the risk is high. Revascularisation is indicated only when myocardial ischaemia has been documented.

Canine leishmaniasis due to Leishmania infantum MON-1 in northern Morocco

A seroprevalence study of canine leishmaniasis was carried out in five provinces in northern Morocco: Taounate, Al Hoceima, Zouagha Moulay Yacoub, Chefchaouen and Ouezzane. 55 localities have been concerned and a total of 1,013 dogs were screened, which represents almost 100% of the canine census. Of the screened dogs: 87 showed antibody titer > or = 100 when tested by IFAT (seroprevalence of 8.6%) and were distributed in 83 asymptomatics (without clinical symptoms) and four symptomatics (with one or several symptoms of leishmaniasis) with important variations according to the locality. Relative frequency of asymptomatic dogs was observed (8.2%), and the seroprevalence increased in middle altitude (500 m < altitude < 1,000 m) and high altitude (> or = 1,000 m). Parasites isolated from dogs were identified as L. infantum MON-1 by isoenzyme profile and Rsal digestion.

[Recurrent bronchogenic cyst with rupture into the pericardium. A case report]

A case of tamponnade due to intrapericardial rupture of a recurrent bronchogenic cyst, presenting as pericarditis, is described. This case is unique because it demonstrates the possibility of rupture of a bronchogenic cyst into the pericardium and by the unusual mode of presentation. It also shows that bronchogenic cysts may recur many years after incomplete ablation. Bronchogenic cysts are benign dysembrioplasic formations characterised by their respiratory epithelial lining. The usual presentation in the adult is by haemorrhage or infection, but our case shows that recurrent pericarditis without an obvious cause may be due to bronchogenic cyst, which should be systematically excluded. The diagnosis suspected after medical imaging (chest X-ray, scanner, magnetic resonance imaging) is confirmed by histology. Total surgical ablation is the treatment of choice and may be curative.

Beneficial effect on serum apo AI, apo B and Lp AI levels of Ramadan fasting

In order to investigate for the first time in Morocco the effect of fasting in Ramadan, the ninth lunar month of the muslim year, on lipoprotein metabolism, we determined the levels of serum apolipoproteins; apolipoprotein AI (apo AI), apo B, apo AIV and those of lipoprotein particles; apo AI-containing lipoprotein particles (Lp AI) and also apo AI and apo AII containing lipoprotein particles (Lp AI:AII) in a group of 32 healthy, volunteer adult males. Determination of all these parameters was carried out on each week of the month of Ramadan and the results are compared with the pre-fasting and the post-fasting values. Ramadan fasting reduces significantly serum apo B (P < 0.05), while serum apo AI is significantly increased (P < 0.05) compared with the pre-fasting period. The increase of apo AI occurred on day 29 of Ramadan by 11.8%. Serum apo AIV was unchanged during the fasting period indicating that food intake during Ramadan is not based on lipid diet. The observed diet pattern during Ramadan showed an increase of total energy intake based on carbohydrates (+1.4% of total energy), proteins (+0.4% of total energy) but not on fat (-0.7% of total energy), compared with a usual diet used in the rest of the year. The fat diet is high in monounsaturated (P < 0.05) and polyunsaturated fatty acid in contrast to saturated fatty acid which decreased (P < 0.05) during Ramadan. On the other hand, analysis of serum Lp AI and Lp AI:AII showed that the levels of Lp AI:AII were unchanged but those of Lp AI were significantly increased (P < 0.01) at the end of Ramadan. These findings show that feeding behaviour that occurs during Ramadan beneficially affects serum apolipoprotein metabolism and may contribute to prevention of cardiovascular diseases.

[PCR detection of Mycobacterium tuberculosis lacking IS 6110]

We have evaluated the frequency of M. tuberculosis strains which lack IS 6110 among 102 sputa isolated from Moroccan patients. A pair of primers was designed to amplify a 201bp DNA fragment of IS 6110. The amplified DNA was detected by ethidium bromide stained agarose gel electrophoresis and confirmed by southern blot hybridization with a 32P-labelled probe (PMTO2). To detect the presence of amplification inhibitors, an internal control DNA was added in each negative PCR result. Among 102 samples, 6 sputa were negative by PCR-IS 6110 but culture positive. The test of detection of M. tuberculosis for 2/6 sputa by PCR Amplicor amplifying 584 pb of rRNA 16s sequence was positive. RFLP analysis of these 2 strains revealed no bands hybridizing IS 6110 but PCR-Mt 308 was positive. These results confirmed that these M. tuberculosis strains are lacking IS 6110.

Fasting during Ramadan induces a marked increase in high-density lipoprotein cholesterol and decrease in low-density lipoprotein cholesterol

We demonstrated for the first time in a Moroccan population that fasting during Ramadan, the ninth lunar month of the Muslims' year, affected lipid and lipoprotein metabolism in a group of 32 healthy adult male volunteers. This investigation was conducted to study the changes in serum total cholesterol, triglycerides, cholesterol in high-density lipoprotein (HDL) and low-density lipoprotein (LDL), glucose, and body weight during Ramadan. The results showed a significant decrease (7.9%, p < 0.001) in serum total cholesterol concentration during Ramadan as compared with the prefasting period. Also, we obtained a significant decrease of serum triglyceride concentration (30%, p < 0.001) during Ramadan fasting as compared to the period before Ramadan. The reduction of both serum triglycerides and total cholesterol was maintained 1 month after Ramadan. By the end of Ramadan, serum HDL cholesterol had markedly increased (14.3%, p < 0.001) and remained elevated 1 month after Ramadan in contrast to LDL cholesterol which showed a significant decrease (11.7%, p < 0.0001) also maintained 1 month after Ramadan. Mean body weight declined by 2.6% (p < 0.01) on day 29 of Ramadan, whereas during Ramadan, the diet pattern used by our subjects showed an increase of total energy intake due to carbohydrates (+ 1.4% of total energy), proteins (+ 0.4% of total energy) but not fat (-0.7% of total energy) compared to a usual diet used throughout the rest of the year. Moreover, the fat diet is high in monounsaturated (p < 0.05) and polyunsaturated fatty acid in contrast to saturated fatty acid which significantly (p < 0.05) decreased during Ramadan. These findings suggest that feeding behavior that occurs during Ramadan beneficially affects plasma lipids and lipoproteins.

Survey of primary drug resistance of Mycobacterium tuberculosis in Casablanca, Morocco

SETTING

In 1990, a 6-month short-course regimen (2 SHRZ/4 RH) was introduced for the treatment of tuberculosis in Morocco.

OBJECTIVE

To assess the efficacy of the national tuberculosis control programme, a prospective study of primary drug resistance was conducted from April 1992 to July 1994 in Casablanca.

DESIGN

A total of 402 strains isolated from 402 patients living in Casablanca with no previous history of tuberculosis was included in the study.

RESULTS

The overall rate of primary drug resistance to at least one drug was 23.9%; it was 19.7% to streptomycin, 11.4% to isoniazid, and 8.2% to both streptomycin and isoniazid. The rates of resistance to rifampicin and ethambutol were both less than 1%. The survey was divided into two periods of 14 months each. The rates of primary drug resistance increased from 21.1% to 27.6% during these two periods (Odds Ratio [OR] 1.43; 95% Confidence Interval [CI] 0.88 to 2.32); this increase occurred only for streptomycin (15.9% to 24.7%, OR 1.73; 95% CI 1.02 to 2.93).

CONCLUSION

The rate of primary drug resistance of Mycobacterium tuberculosis in Casablanca has risen in recent years to an ominous level. Urgent measures are needed in order to interrupt this trend.