The prevalence of headache in the adult population of Morocco: a cross-sectional population-based study

BACKGROUND

The series of population-based studies conducted by the Global Campaign against Headache has, so far, included Pakistan and Saudi Arabia from the Eastern Mediterranean Region. The Maghreb countries of North Africa, also part of this Region, are geographically apart and culturally very different from these countries. Here we report a study in Morocco.

METHODS

We applied the standardised methodology of Global Campaign studies, with cluster-randomized sampling in regions of Morocco selected to be representative of its diversities. In three of these regions, in accordance with this methodology, we made unannounced visits to randomly selected households and, from each, interviewed one randomly selected adult member (aged 18-65 years) using the HARDSHIP structured questionnaire translated into Moroccan Arabic and French. In a fourth region (Fès), because permission for such sampling was not given by the administrative authority, people were randomly stopped in streets and markets and, when willing, interviewed using the same questionnaire. This was a major protocol violation.

RESULTS

We included 3,474 participants, 1,074 (41.7%) from Agadir, 1,079 (41.9%) from Marrakech, 422 (16.4%) from Tétouan and 899 from Fès. In a second protocol violation, interviewers failed to record the non-participating proportion. In the main analysis, excluding Fès, observed 1-year prevalence of any headache was 80.1% among females, 68.2% among males. Observed 1-day prevalence (headache yesterday) was 17.8%. After adjustment for age and gender, migraine prevalence was 30.8% (higher among females [aOR = 1.6]) and TTH prevalence 32.1% (lower among females [aOR = 0.8]). Headache on ≥ 15 days/month (H15+) was very common (10.5%), and in more than half of cases (5.9%) associated with acute medication overuse (on ≥ 15 days/month) and accordingly diagnosed as probable medication-overuse headache (pMOH). Both pMOH (aOR = 2.6) and other H15+ (aOR = 1.9) were more common among females. In the Fès sample, adjusted prevalences were similar, numerically but not significantly higher except for other H15+.

CONCLUSIONS

While the 1-year prevalence of headache among adults in Morocco is similar to that of many other countries, migraine on the evidence here is at the upper end of the global range, but not outside it. H15 + and pMOH are very prevalent, contributing to the high one-day prevalence of headache.

Access to kidney transplantation for patients with end-stage renal failure in Maghreb countries: state of art and recommendations

We present an overview of kidney transplantation activity in the Maghreb countries, based on data from the 9th Colloque France-Maghreb (Paris, May 20 and 21, 2022). For Algeria, Morocco and Tunisia, the incidence of end stage renal failure is respectively 120, 130 and 130 per million inhabitants, its prevalence 626, 900 and 833 per million inhabitants and the part of patients with a functional graft of 10.3, 1.8 et 8.5% with an annual number of transplants of 6.5, 0.8 and 8.7 per million inhabitants. Living donor transplants account for 99% of transplants in Algeria, 93% in Morocco and 80% in Tunisia. In conclusion, access to transplantation remains low in the Maghreb countries. All the modalities (living donor with enlargement of the circle of donors, deceased donors) must be further developed. Recommendations were issued to support activity.

Regional Agriculture and Food Systems Amid the COVID-19 Pandemic: The Case of the Near East and North Africa Region

The COVID-19 pandemic affected agri-food systems worldwide. However, while the impacts differed from one country/region to another, the scholarly literature seems to focus on developed countries in the Global North. Consequently, this review scrutinizes the literature on the pandemic's impacts in the Near East and North Africa (NENA) region. A search on the Web of Science in March 2023 generated 334 documents, of which 151 were eligible for inclusion in the systematic review. According to the bibliometric analysis, the most active nations are Saudi Arabia, Egypt, Jordan, the United Arab Emirates, and Lebanon. In general, the coverage of studies is better in the Gulf region than in the less developed countries of North Africa and those suffering from wars (cf. Libya, Syria, and Yemen). Studies generally focus on crop production and the downstream food chain (cf. distribution and consumption). While the pandemic influenced every pillar of food security, this research concentrates on access and utilization. Meanwhile, the lion's share of the literature deals with the pandemic's socio-economic effects, especially those linked to food (in)security and health. The pandemic, which laid bare the agri-food system vulnerabilities, should be seized to foster the transition towards more resilient agri-food systems in the NENA region.

Introduced and extinct: neglected archival specimens shed new light on the historical biogeography of an iconic avian species in the Mediterranean

Collection specimens provide valuable and often overlooked biological material that enables addressing relevant, long-unanswered questions in conservation biology, historical biogeography, and other research fields. Here, we use preserved specimens to analyze the historical distribution of the black francolin (Francolinus francolinus, Phasianidae), a case that has recently aroused the interest of archeozoologists and evolutionary biologists. The black francolin currently ranges from the Eastern Mediterranean and the Middle East to the Indian subcontinent, but, at least since the Middle Ages, it also had a circum-Mediterranean distribution. The species could have persisted in Greece and the Maghreb until the 19th century, even though this possibility had been questioned due to the absence of museum specimens and scant literary evidence. Nevertheless, we identified four 200-year-old stuffed black francolins-presumably the only ones still existing-from these areas and sequenced their mitochondrial DNA control region. Based on the comparison with conspecifics (n = 396) spanning the entirety of the historic and current species range, we found that the new samples pertain to previously identified genetic groups from either the Near East or the Indian subcontinent. While disproving the former occurrence of an allegedly native westernmost subspecies, these results point toward the role of the Crown of Aragon in the circum-Mediterranean expansion of the black francolin, including the Maghreb and Greece. Genetic evidence hints at the long-distance transport of these birds along the Silk Road, probably to be traded in the commerce centers of the Eastern Mediterranean.

[DROSOPHILA MELANOGASTER GASTROINTESTINAL MYIASIS: ABOUT A MOROCCAN CASE REPORT]

Introduction

Myiasis is an infestation of humans or animals by larval forms of brachycetes. Commonly observed locations are otolaryngological and cutaneous. Gastrointestinal localization remains exceptional. In this work, we report the observation of a Moroccan case of gastrointestinal myiasis caused by Drosophila melanogaster. Observation. The patient was a 56-year-old man living in a rural region of northwest Morocco. He was being followed at the National Oncology Institute in Rabat for pulmonary and renal adenocarcinoma and was put on neo-adjuvant chemotherapy with concomitant radiochemotherapy. The patient presented vomiting twice containing about forty small white, circular and hairless worms measuring 4 mm in length. This sample was sent to the parasitology and mycology laboratory for identification. Microscopic study of the larvae and adult flies obtained after rearing in the laboratory of parasitology allowed the diagnosis of myiasis caused by Drosophila melanogaster.

Discussion/Conclusion

This observation is noteworthy for both its exceptional anatomical localization and the implicated parasite species.

[Hydatid cyst sampling by FTA Card method for characterizing Echinococcus granulosus sensu lato in Algeria. Preliminary results]

Introduction and objectives

Cystic echinococcosis is highly endemic in Algeria and constitutes a major socio-economic problem. Typing the species of the Echinococcus granulosus sensu lato complex circulating in cattle requires the use of a hydatid cyst sampling method adapted to difficult field conditions (high heat and humidity, long transport time). The FTA Card method currently constitutes an effective means of preserving biological samples before their molecular analysis. In the present study, the FTA Card method was used in the collection of hydatid cysts to identify the species of E. granulosus sensu lato circulating in ruminants (intermediate hosts) in eastern Algeria.

Material and methods

A PCR was carried out for 41 samples of hydatid cysts taken from six slaughterhouses in eastern Algeria, targeting the cox1 mitochondrial gene. PCR products were visualized by electrophoresis in a 1% agarose gel.

Results and conclusion

The results of the molecular analysis of all hydatid cyst samples confirmed the presence of E. granulosus sensu stricto in sheep, cattle and camels. The ubiquitous nature of the G1 genotype has been demonstrated. The use of FTA Card sampling is an efficient and simple method to obtain a biological sample in order to characterize the species of E. granulosus sensu lato in Algeria. The good preservation of the DNA in this matrix will make it easier to obtain new molecular data from difficult regions. The identification of the species of the E. granulosus sensu lato complex involved in the biological cycle is an essential prerequisite for the implementation of control measures, since different host species participate in their evolutionary cycle. The characterization of E. granulosus genotypes is essential to define an appropriate control strategy against cystic echinococcosis.

A new species of the Baetisfuscatus group (Ephemeroptera, Baetidae) from Morocco

Baetisrifensissp. nov. is the first representative of the Baetisfuscatus group to be described from the Maghreb. It was collected from streams in the Rif region of northern Morocco. All species of the B.fuscatus group are morphologically very similar, with slight differences in colour. Thus, in addition to morphological description, species delimitation based on genetic evidence was carried out. The new species was compared with other members of the B.fuscatus group from the Palaearctic region.

A new species of the genus Alainites Waltz & McCafferty, 1994 (Ephemeroptera, Baetidae) from the north of Morocco

A new species of Alainites is described from northern of Morocco Alainitesalbaisp. nov. It can be separated from the other west Palearctic species by the gill number, the spination of the distal margin of tergites, the leg setation, and the paraproct shape and spination. This species is widespread in the study area but never abundant. It prefers small to medium streams with slow flow, and does not seem to be very sensitive to pollution and water logging activities.

Analysis of Morphological Traits in Herbarium of Historical Cannabis Specimens from Maghreb: Morphological Characteristics of Landrace Kif

Background: Exploring the morphological traits of historical Cannabis populations from the Maghreb can provide invaluable information about the characteristics of the Maghreb Landrace Kif and contribute to the preservation of this vulnerable Cannabis resource. Aim: The purpose of the present study was to analyze the morphological characteristics of Cannabis specimens collected before worldwide introgressive hybridization and summarize the morphological traits of the Maghreb Landrace Kif. Discussion: Despite the limited number of specimens collected in the Maghreb, this study identified distinct types of Cannabis in the herbaria, including the Maghreb Landrace Kif, European hemp, and potentially East Asian hemp. By examining the morphological traits of kif specimens and reviewing the relevant literature, the study identifies the morphological traits that tend to characterize Maghreb Landrace Kif. Morphologically, Kif is different from drug-type Cannabis indica ("Sativa" and "Indica"). It resembles European hemp Cannabis sativa, but has female inflorescence characteristics that allow it to be distinguished from the latter, even when the growing conditions are optimal. These are the density of pistillate inflorescences (perigonal bract-to-leaf index), and the capitate stalked glandular trichomes cover density on the perigonal bracts. Conclusion: The characteristics of pistillate inflorescences identified in this study can be used to distinguish and select plants before phytochemical and genetic analysis, thus facilitating the identification of the Maghreb Landrace Kif.

Eating disorder and anxiety during Covid19 pandemic: the Maghrebian experience

The coronavirus pandemic is considered the worst-hit that the world had witnessed in the current century. The impact of the pandemic, especially during the lockdown, was not only diverse but also worldwide. The African continent, including the Maghreb, was no exception. The aim of this study was to assess the levels of anxiety and eating behaviors and their correlations in three Maghrebian countries following the official outbreak of the COVID19 pandemic. It is a cross-sectional study of 754 participants from Tunisia, Algeria and Morocco. It took place between 30 April and 2 July 2020. The survey showed that eating disorders represented 45.9% of the sample while 26.8% (202 participants) matched the anxiety criteria. Statistical significant factors for eating disorders were gender (p = 0.002; OR = 1.760), underweight (p = 0.021; OR = 0.306), anxiety (p = 0.001; OR = 0.470), bulimia (p = 0.000; OR = 0.794) and body dissatisfaction (p = 0.000; OR = 0.920). This rise goes along with other surveys in different parts of the world. These results can be explained by multiple reasons such as the 'food insecurity' mechanism, the excessive feeling of boredom and loneliness resulting from social distancing and the overwhelming overthinking about the onset of a serious economic crisis.

[Elucidating and characterizing the dynamic biological processes that account for the sustainability of Leishmania populations]

To attempt resolving this issue accurately, it was necessary to anchor our experimental approaches in the observations and pioneering work of our predecessors, notably Alphonse Laveran, Louis Parrot, Edmond and Étienne Sergent. The latter, among other things, had identified as natural hosts of leishmaniasis, rodent populations with which hematophagous telmophagous sand fly populations cohabited closely.When human populations emerged in these natural ecosystems, after the sedentarization of Homo sapiens, more or less important disturbances would have led to a transition of sand fly hematophagy, from zoophilia, to zoo-anthropophilia and anthropophilia.The creation of infrastructures that allow the breeding and integration into experimental groups of both holobiont sand flies and holobiont laboratory rodents (rats, mice, hamsters, etc.) remains crucial. With such infrastructures, it becomes possible to grasp and characterize the multilateral dynamic processes - mostly clinically silent - that account for the biogenesis of tissue and/or cellular niches protecting populations of Leishmania developmental morphotypes, including those ensuring host-to-host transmission, albeit in small numbers.

First Study on Gyrodactylus (Monogenea: Gyrodactylidae) in Morocco, with Description of a New Species from Luciobarbus pallaryi and Luciobarbus ksibi (Actinopterygii: Cyprinidae)

To date, 41 species of Gyrodactylus have been described from Africa. However, none of these have been reported in Morocco. After identifying and examining 738 cyprinid host specimens, 26 specimens belonging to Gyrodactylus were found to parasitize the gills of nine species of Luciobarbus, Carasobarbus, and Pterocapoeta. The current study provides new information about the presence of a new parasitic species in Morocco, the first to be characterized on a species level in the Maghreb region. It describes in detail 12 specimens of Gyrodactylus isolated from the gills of Luciobarbus pallaryi (Pellegrin, 1919) and Luciobarbus ksibi (Boulenger, 1905). Based on morphoanatomical observations, the characterization of the specimens collected indicates a species of Gyrodactylus that is new to science, described here as Gyrodactylus nyingiae n. sp. The new species is different from previously described gyrodactylids infecting African cyprinid hosts because it has a longer hamulus total length, a longer hamulus root, a downward projecting toe of the marginal hook, and a trapezium-shaped ventral bar membrane with a slightly striated median portion and small rounded anterolateral processes. This study increases the total number of Gyrodactylus spp. found in African cyprinids to four.

Epidemiology of equine influenza in the Maghreb area

Equine influenza (EI) is one of the most contagious respiratory infections in horses, donkeys and mules, caused by equine influenza A virus (EIV). It remains a disease with a strong economic stake for the equine industry. This review focuses on the epidemiological situation of EIV in the Maghreb area, which includes Algeria, Morocco and Tunisia. There is serological evidence for extensive circulation of EIV in the Maghreb area since the early 1970s, but reports of detailed investigation of outbreaks are scarce with no documented isolation or molecular characterization of EIV from Tunisia. Isolates of EIV were obtained from outbreaks in Algeria in 1971/1972 and 2011. Similarly, in Morocco, isolates were obtained from outbreaks in 1997 and 2004. The viruses isolated in 2004 showed evidence of 'evolutionary stasis', with haemagglutinin and non-structural protein 1 sequences most similar to those of viruses isolated decades earlier. In conclusion, effective surveillance of equids in the Maghreb region, where there is potential for virus re-emergence, should be encouraged.

[Nasal myiasis due to lucilia sp. in intubated patient: about one case in Morocco]

INTRODUCTION

Myiasis is the infestation of living bodies of animals and humans with fly larvae or maggots. These accidental or obligatory parasites grow in three stages in the host while feeding on his tissues. Myiasis in a hospital area is a rare situation when flies accidentally lay their eggs on patients, mostly in open wounds or cavities. Case presentation. We report a case of a 72-year-old patient admitted to a general surgery department for peritonitis, then to an intensive care unit (ICU) for septic shock where he was intubated. Some maggots were seen moving in his nasal cavity a few days after his admission and were sent to our laboratory for examination. The larvae were identified as the third larval stage of Lucilia sp. They were removed entirely after intense nasal washing. A checking examination of his nasal cavities revealed no evidence of further infestation. After nasal washing, no other larvae were seen but unfortunately, the patient died of septic shock a few days later.

DISCUSSION

Few cases of nasal myiasis in hospitalized patients were reported. ICU myiasis, extremely rare, is caused by the patient's inability to fend off the flies because of their conscious state, presence of blood or odors caused by infections, and the warm humid environment.

CONCLUSION

Myiasis in intensive care unit is a delicate situation that might be underreported. Preventing this infection is directly related to the control of the flies.

Characterization of the O/ME-SA/Ind-2001d foot-and-mouth disease virus epidemic recorded in the Maghreb during 2014-2015

The O/ME-SA/Ind-2001d has been the main foot-and-mouth disease virus (FMDV) lineage responsible for FMD epidemics outside the Indian subcontinent from 2013 to 2017. In 2014, outbreaks caused by this FMDV lineage were reported in Maghreb, where it was initially detected in Algeria and Tunisia and later in Morocco. This was the first incursion of an FMDV type O of exotic origin in the Maghreb region after 14 years of absence. In this study, we report analyses of both VP1 and whole-genome sequences (WGSs) generated from 22 isolates collected in Algeria and Tunisia between 2014 and 2015. All the WGSs analysed showed a minimum pairwise identity of 98.9% at the nucleotide level and 99% at the amino acid level (FMDV coding region). All Tunisian sequences shared a single putative common ancestor closely related to FMDV strains circulating in Libya during 2013. Whereas sequences from Algeria suggest the country experienced two virus introductions. The first introduction is represented by strains circulating in 2014 which are closely related to those from Tunisia, the second one, of which the origin is more uncertain, includes strains collected in Algeria in 2015 that gave origin to the 2015 outbreak reported in Morocco. Overall, our results demonstrated that a unique introduction of O/Ind-2001d FMDV occurred in Maghreb through Tunisia presumably in 2014, and from then the virus spread into Algeria and later into Morocco.

[Comparative study of patients hospitalized for SARS-CoV-2 infection in two consecutive waves in Tunisia]

Introduction

Since December 2019, a novel coronavirus (SARS-CoV-2) has triggered a global pandemic with a heavy medical and societal-economic toll. The health consequences were not similar during the successive waves that affected several countries. The aim of our study was to compare the sociodemographic, clinical and evolutionary features of COVID-19 patients hospitalized at the Military Hospital of Tunis (HMPIT) during the 2^nd and 3^rd waves that affected the country.

Patients and methods

Observational prospective study involving 1,527 COVID-19 patients hospitalized at HMPIT over 11 months, divided into two periods: from July 2020 to December 2020 called the second wave (V2) and from January 2021 to May 2021 called the third wave (V3). We compared the epidemiological data, the clinical form and the evolution of the patients for each period.

Results

The number of hospitalized patients was 636 during V2 compared to 891 during V3. Average age was 63.5 ± 15.3 years during V2 versus 65.8 ± 17.8 years during V3 (P = not significant [NS]). The percentage of young adults [18-40 years] was 6.5% during V2 compared to 6.7% during V3 (P = NS). The gender ratio (M/F) was 1.59 for V2 and 1.42 for V3 (P = NS). Comorbidities were present in 65% of V2 patients and 66.3% of V3 patients (P = NS), with hypertension being the most prevalent one in both groups (47.2% for V2 versus 44.9% for V3; P = NS), followed by overweight, dyslipidemia and diabetes (33% for V2 versus 39.3% for V3; P = 0.012). The median duration between symptoms onset and hospitalization was 7 days [5-10] during V2 versus 8.5 days during V3 [5-12] (P = 0.0004). The severe clinical form was present in 49% of patients admitted during V2 compared to 34.8% during V3 (P < 10^-3). The critical form represented 18.6% of cases during V2 against 16.8% during V3 (P = NS). The average hospital length of stay in COVID units (outside of intensive care unit) was 8.4 ± 5.4 days during V2 and 9.8 ± 5.7 days during V3. The average length of stay was significantly longer for the intensive care unit (11.3 ± 3.4 days for V2 versus 13.8 ± 3.9 days for V3; P = 0.01). The case fatality rate was 24.5% during V2 and 20.7% during V3 (P = NS). Median age of death was 70.2 years [42-88] during V2 and 70.4 years [22-96] during V3 with 2 patients less than 40 years of age (1%) for the latter period. The gender ratio (M/F) of deceased patients was 3.21 for V2 and 1.5 for V3 (P = 0.001). The case fatality rate was higher in the intensive care unit (65.4% for V2 versus 69.7% for V3; P = NS). Causes of death were dominated by ARDS (acute respiratory distress syndrome) for both periods (55.1% for V2 versus 70.8% for V3; P = 0.002), followed by septic shock (12.8% for V2 versus 10.8% for V3; P = NS) and multi-organ failure (9.6% for V2 versus 7.0% for V3; P = NS).

Conclusion

This study revealed a decrease in severe and critical clinical forms during the 3rd wave, as well as a decrease in the case fatality rate compared to the previous wave, due to improved management and vaccination. On the other hand, the percentage of ARDS was significantly higher during this wave probably related to the beginning of circulation in our country of the Delta variant causing more severe clinical cases.

[Hydatidosis of psoas muscle revealed by vascular axis compression in lower limb: About one case at the Ibn Sina University hospital, Rabat, Morocco]

INTRODUCTION

Hydatidosis is a zoonosis caused by Echinococcus granulosus. It's a real public health problem in Morocco. Muscle localization is unusual, even in endemic countries. We report a rarely described case of a hydatid cyst of the psoas muscle diagnosed in our laboratory.

CASE REPORT

The patient was a 32-year-old male, living in a rural area. He reported a contact with dogs. He was admitted in vascular surgery department for left hypochondrium pain, with heaviness of the left lower limb and appearance of varicose veins. Clinical examination has found a huge painful and hard mass of the left flank arriving to the hypogastrium with varicose veins of the left leg. An injected CT scan of the pelvic region showed a 189 x 137 mm cystic mass of the left psoas muscle reflowing left iliac vessels. This suggested hydatid cyst. No other localization was found. Hydatid serology was positive with an ELISA test and an indirect hemagglutination test. The patient underwent surgery to remove the mass. Several white vesicles of a few centimeters were found in the cyst and were sent to the parasitology laboratory. Microscopic examination has confirmed the presence of viable Echinococcus granulosus. The patient received albendazole 400 mg twice daily for only a month and was not seen for follow-up. One year after surgery, he showed the same symptoms of abdominal pain and heaviness. Recurrence of hydatid cysts in the same localization was diagnosed with ultrasound showing two hydatid cysts type 3 according to Gharbi classification.

DISCUSSION

Diagnosis of all hydatidosis localizations is based on epidemiological, clinical, and radiological data and confirmed by serology and parasitological examination of the surgical specimen. Surgery is then a diagnostic and therapeutic tool that cannot be bypassed since it allows the definitive elimination of the parasite and eviction of recurrence if it's well done. Conservative methods are related to recurrent cysts.

CONCLUSION

Muscle hydatidosis is extremely rare but should not be forgotten when radiological and epidemiological data suggest it. It's a benign infection but can be severe and deadly if not appropriately treated.

[Ocular syphilis associated to HIV: A report of 2 patients treated in Marrakech, Morocco]

Introduction

Syphilis is a sexually transmitted disease. All organs might be affected, but ocular syphilis occurs only in 0.6 percent of patients. A resurgence of syphilis cases has been observed for several years in many countries, especially in HIV-infected subjects. These patients often present with concomitant primary and secondary lesions or extensive presentations of syphilis.

Case reports

We report 2 patients with syphilitic uveitis diagnosed and treated at the department of infectious diseases at the University hospital of Marrakech. Ocular involvement was inaugural in both HIV patients. Each had a specific treatment, but none had a complete recovery of visual function; the first patient was treated by ceftriaxone and the second one was treated by penicillin.

Conclusion

Syphilis must be discussed in all patients diagnosed with uveitis or papillitis. The diagnosis should be suspected in cases of eye inflammation even in the absence of favourable clinical presentation or anamnesis. Search for HIV co-infection should be systematic. Although not evidence-based, prompt therapy may lead to functional recovery. Ceftriaxone could be a suitable alternative to penicillin in the treatment of early syphilis in HIV-infected patients. This treatment has a concomitant effectiveness even for asymptomatic forms of neurosyphilis. Ocular syphilis is a form of neurosyphilis and requires neurosyphilis therapy regardless of when it develops after primary infection.Conventional syphilis staging is of little use in understanding ocular syphilis. Co-infection between HIV and ocular syphilis is common, but does not affect response to a neurosyphilis regimen of penicillin in the short term.

[Spinal cord compression secondary to metastasis of gingival Burkitt lymphoma revealing a case of HIV infection in Morocco]

Burkitt lymphoma in HIV-infected patients is seldom seen in the oral cavity, and they are rarely reported in the literature. The clinical manifestations may suggest other tumors or gingival infections, which delays diagnosis and management. Spinal cord involvement is exceptional and only a few cases are reported. We report a case of Burkitt lymphoma in the oral cavity and spinal cord, revealing HIV infection in a 44-year-old patient, who responded well to chemotherapy and antiretroviral treatment and is on remission.

[A case of acute renal failure revealing brucellian endocarditis and neurological complications in Batna (Algeria)]

Introduction

Brucellosis is a major zoonosis affecting livestock and transmitted to humans; it is widespread worldwide with 500,000 new cases per year according to the World Health Organization. It has become rare in countries that have established an eradication policy of the disease in animals and pasteurization of milk, but remains endemo-epidemic in Algeria, where it constitutes a public health problem (incidence of 24.41 per 100,000 inhabitants in 2017). The disease is more crippling than fatal. Severe forms are exceptional, and deaths are rare, most often following endocarditis or complicated neurological damage. The biological diagnosis is made by culturing the samples (mainly blood cultures), serology or molecular biology methods. We report the case of a patient with complicated and fatal subacute multiorgan brucellosis.

Observation

A 51-year-old man is hospitalized in cardiology for endocarditis, complicated by neurovascular and skin manifestations, discovered in the stage of severe renal failure, one of the dreaded autoimmune complications of infectious endocarditis. The diagnoses were confirmed by various radiographic (echocardiography, brain computed tomography, magnetic resonance imaging) and biological examinations. The brucellian etiology was proved by bacteriological test of blood cultures (Brucella melitensis) and Wright's serodiagnosis, in the absence of the Polymerase Chain Reaction (PCR) test.

Conclusion

Brucellosis can have atypical, multiple, varied and misleading presentations, responsible for a difficult clinical diagnosis. The possibly fatal evolution of this pathology should remind practitioners to evoke it, in particular in front of a multivisceral infectious presentation, in a country where brucellosis is endemic. Clinicians must also act quickly and not hesitate to ask for at least a serological test.

[Molecular characterization of algerian strains of Blastocysts sp]

INTRODUCTION

Blastocystis sp. is a protozoan that colonizes the gastrointestinal tract of humans and many animals and is currently the most common parasite found in human stools. In some developing countries, its prevalence in study populations may exceed 50%. Morphologically, isolates of Blastocystis sp. found in different hosts are very similar. However, these same isolates show a very high genetic diversity between them and no less than 17 subtypes (or genotypes) have already been identified from molecular data. Genotyping studies have been carried out in many countries around the world and in particular in some Mediterranean countries such as France, spain, Italy, Turkey and Egypt. However, very little genotyping data is available in Algeria. To this end, we conducted the present study to identify and genotype Blastocystis in human and animal stool samples.

PATIENTS AND METHODS

One thousand eight hundred and sixty-nine (1,869) stool samples from kitchen staff as part of the periodic medical check-up, from subjects for the provision of a medical certificate required for the processing of a visa file and from patients with gastrointestinal disorders were examined. In addition to human faeces, animal samples, including 10 poultry, 2 cattle and 2 murine animals were examined. All stools were subjected to direct microscopic examination supplemented by concentration techniques and modified Ziehl Neelsen staining. Molecular characterization of 39 human and 14 animal isolates was performed by sequencing and the resulting sequences compared with those available from GenBank. Sequencing was only contributory for 30 human and 9 animal strains.

RESULTS

Of all human samples examined 284 were positive (15.19%) with a prevalence of 7.38% for Blastocystis. Of the 30 strains that were molecularly characterized, ST3 was predominant (15/30, 50%) followed by ST1 (10/30, 33.33%) and in third place ST2 (4/30, 13.33%). ST4 was identified in only one patient (1/30, 3.33%). The correlation between clinical status and the subtype of Blastocystis identified showed that the number of ST3 was high in asymptomatic subjects (11/15, 73%) compared to symptomatic subjects (4/15, 26.66%), as well as for the ST1 subtype (7/10, 70% versus 3/10, 30%). Conversely, the number of ST2 was higher in subjects with gastrointestinal disorders (3/4, 75%). In addition to human strains, we genotyped 7 avian, 2 murine and 2 bovine strains. Characterization of the avian strains revealed 5 ST6 (71.42%) and 2 ST7 (28, 57%). The murine and bovine strains are identified as ST7 and ST6 respectively.

Which plants matter? A comparison of academic and community assessments of plant value and conservation status in the Moroccan High Atlas

As interest in including local communities and their knowledge in biodiversity conservation increases, challenges to do so become clear. One of them is to harmonize local and academic assessments of conservation status. Here, we document the culturally valuable flora of two Amazigh communities in the Moroccan High Atlas Mountains and contrast local conservation observations with IUCN and other red-listing assessments. Our study reveals two levels of mismatch. Unsurprisingly, the species of interest of these two knowledge systems differ considerably. Moreover, species' availability and populations' trends of change and the conservation evaluations often diverge between local and academic assessments. Locally valuable species are rarely threatened, but a focus on locally prioritized species is essential to ensure the active participation of local communities in conservation initiatives. Given the salient role of IUCN Red Lists in guiding conservation action, a better understanding of the differences in plant value and conservation assessments between the two knowledge systems can help harmonize biodiversity conservation and community wellbeing goals.

[Cost and factors associated with the prescription of non-antiretroviral drugs among HIV-infected patients under antiretroviral therapy in a reference hospital in Morocco]

Objective

To determine the costs of non-antiretroviral drugs and to identify the factors associated with their prescription in HIV-1 patients on antiretroviral therapy in Morocco.

Methods

Retrospective study of a cohort of 264 patients living with HIV-1 who were given antiretroviral therapy in the Venerology Dermatology Department at the Mohamed V Military Training Hospital of Rabat during the period from January 1st, 2014, December 31st, 2018. The costs retained were those of the hospital pharmacy for essential drugs, otherwise they were the costs in the private pharmacies. The logistic regression model was used to analyze the factors associated with prescription.

Results

Of the 264 patients included, the male predominance was 75%. The median age of patients was 49 [41-57]. At the onset, 21.2% of patients were already in the AIDS stage. After a mean duration of 11.1 ± 6.8 months of antiretroviral therapy, 71.6% of patients received at least one prescription for a non-antiretroviral drug. Over the entire follow-up period, the mean cost per patient was 24.2 €, and the mean cost supported per patient was 22.1 €. After cotrimoxazole (30.7% of patients), the most frequently prescribed drugs were iron (29.2% of patients), antibiotics (20.8% of patients), hypolipemics (20.1% of patients) and general antimycosics (16.3% of patients). Age (RR: 1.01; 95% CI: 1.00-1.07), AIDS stage (RR: 2.15; 95% CI: 1.61-4.19), anemia (RR: 2.02; 95% CI: 2.10-5.41) and number of comorbidities (RR: 2.45; 95% CI: 2.10-5.41) were significantly associated with the prescription of non-antiretroviral drugs.

Conclusion

Our work highlights the high frequency of prescription of non-antiretroviral drugs in patients living with HIV in Morocco; especially those who are older, anemic at the onset and those who are already at the AIDS stage.

Ultrasonography of Shoulder in Rheumatoid Arthritis: A Reliability Exercise Using Consensual Definitions among Maghrebian Rheumatologists

The shoulder may be affected in a large portion of patients with rheumatoid arthritis (RA) worldwide. However, this joint does not receive the attention required during follow-up. Indeed, although numerous clinical tests for diagnosis of a painful shoulder are available, differentiating articular from peri-articular lesions may be difficult in daily practice. Fortunately, the precise diagnosis of shoulder pain in RA has benefited from a reliable imaging modality used to detect its exact origin-ultrasonography (US). This study was aimed at assessing the intra- and inter-observer reliability of ultrasonographic findings for patients with established RA with shoulder pain in a patient-based exercise as a clinical challenge among Maghrebian rheumatologist experts in US. A total of 7 operators examined 10 patients in two rounds independently and blindly of each other. Before beginning the session, all of the rheumatologists reached a consensus on sites and US settings by performing a brief exercise on a normal shoulder. Outcome Measures in Rheumatology Clinical Trials (OMERACT) definitions of US-detected pathologies were used. Each patient underwent US scanning of the painful shoulder in predefined sites based on US technical guidelines of the European Society of Musculoskeletal Radiology: long head of biceps (LHB), subscapularis recess, posterior recess and axillary recess. The presence of subdeltoid or subcoracoid bursitis or full rupture of the suprasupinatus was identified if present. Intra- and inter-observer reliability measures were calculated using the κ coefficient. Intra-observer reliability was good for gray-scale (GS) synovitis in subscapularis and posterior recesses (κ = 0.77 and 0.73, respectively). It was moderate in the presence of GS synovitis and effusion in LHB (κ =0.53 and 0.40, respectively), posterior and subscapularis recess effusion (κ = 0.56 and 0.60, respectively) and GS and power Doppler (PD) synovitis in axillary recesses (κ = 0.58 and 0.49, respectively). Inter-observer reliability was good for PD for LHB signals (κ = 0.78). It was moderate for GS for LHB synovitis (κ = 0.54). Inter-observer agreement was poor for effusion and GS synovitis for subscapularis, posterior and axillary recesses, and very poor for PD signals in these recesses. US was a reliable imaging tool for detecting tenosynovitis in the LHB. However, reliability was moderate to poor in detecting synovitis in subscapularis, posterior and axillary recesses. These findings could be optimized by standardization of sites to assess.

Biogeographic and demographic history of the Mediterranean snakes Malpolon monspessulanus and Hemorrhois hippocrepis across the Strait of Gibraltar

BACKGROUND

The contribution of North Africa to the assembly of biodiversity within the Western Palaearctic is still poorly documented. Since the Miocene, multiple biotic exchanges occurred across the Strait of Gibraltar, underlying the high biogeographic affinity between the western European and African sides of the Mediterranean basin. We investigated the biogeographic and demographic dynamics of two large Mediterranean-adapted snakes across the Strait and assess their relevance to the origin and diversity patterns of current European and North African populations.

RESULTS

We inferred phylogeographic patterns and demographic history of M. monspessulanus and H. hippocrepis, based on range-wide multilocus data, combined with fossil data and species distribution modelling, under present and past bioclimatic envelopes. For both species we identified endemic lineages in the High Atlas Mountains (Morocco) and in eastern Iberia, suggesting their persistence in Europe during the Pleistocene. One lineage is shared between North Africa and southern Iberia and likely spread from the former to the latter during the sea-level low stand of the last glacial stage. During this period M. monspessulanus shows a sudden demographic expansion, associated with increased habitat suitability in North Africa. Lower habitat suitability is predicted for both species during interglacial stages, with suitable areas restricted to coastal and mountain ranges of Iberia and Morocco. Compiled fossil data for M. monspessulanus show a continuous fossil record in Iberia at least since the Pliocene and throughout the Pleistocene.

CONCLUSIONS

The previously proposed hypothesis of Pleistocene glacial extinction of both species in Europe is not supported based on genetic data, bioclimatic envelopes models, and the available fossil record. A model of range retraction to mountain refugia during arid periods and of glacial expansion (demographic and spatial) associated to an increase of Mediterranean habitats during glacial epochs emerges as a general pattern for mesic vertebrates in North Africa. Moreover, the phylogeographic pattern of H. hippocrepis conforms to a well-established biogeographic partition between western and eastern Maghreb.

[Generalized old world leishmaniasis: first Moroccan case in an immunocompetent adult?]

BACKGROUND

Post-kala-azar dermal Leishmaniasis (PKDL) is a rare skin syndrome observed after treatment of visceral Leishmaniasis (VL) with pentavalent antimonial organic salts, never described in Morocco before. Here we report a case in an immunocompetent adult.

CASE

A 36-year-old-man from Tata in southern Morocco, with a history of visceral Leishmaniasis 2 years before and treated with meglumine antimoniate and amphotericin B with good clinical course, was hospitalized in dermatology for an erythematous papulo-nodular closet of the face. Six months ago, he presented oral mucosa involvement, then 3 months later, cutaneous lesions appeared on the face. The dermatological examination revealed a papulo-nodular erythematous closet extending to the nose and both cheeks, crusty and lupoid lesions on the forehead, around the eyes and chin, associated with an ulcerative and painless lesion on the heeL. The examination of the oral mucosa revealed an ulceration of the posterior third of the tongue and a papillomatous aspect of the soft palate. The skin biopsy and smear found some amastigote forms of Leishmania bodies. ITS1 PCR was positive (genus Leishmania). The HIV serology was negative. The diagnosis of PKDL was then evoked. The patient received intra-muscular injections of meglumine antimoniate with good progress.

CONCLUSION

To our knowledge, this is the first case of generalised leishmaniasis suggesting PKDL reported in a Moroccan immunocompetent adult.

The COVID-19 Outbreak in North Africa: A Legal Analysis

North African nations, especially Egypt, Algeria, and Morocco, have been heavily affected by COVID-19 if compared to other African countries. Governments in North Africa took proactive legal measures to manage the virus threat, safeguarding population health, but also triggering repressive and invasive mechanisms that in some cases jeopardized basic freedoms and rights. This work will analyze comparatively the anti-COVID-19 legislations, pointing out how the legislative measures mirrored the level of transition of democracy, the opacity of some regimes, exploitation of the pandemic to foster repressive control, and highlighting the weakness of new democratic institutions unprepared to balance health security and democracy.

[Contribution of Real-Time PCR in the Diagnosis of Cutaneous Leishmaniasis: Experience of the Pasteur Institute of Tunis]

The aim of this study was to assess the performance of real-time PCR (qPCR) in the diagnosis of cutaneous leishmaniasis (CL). Culture, direct microscopic examination (DE) and qPCR were performed on dermal exudate samples collected from 235 confirmed CL cases. The qPCR was found to be more sensitive than other diagnostic techniques and was able to correct the diagnosis in 49 patients (20.9%) with negative dermal smears. Median parasitic load (PL) of the 49 dermal exudates with negative DE was lower than that of positive ones in microscopy. This suggests that PL likely impact the sensitivity of microscopy. On the other hand, qPCR was performed on DNA extracts of scraped products collected from the 23 out of 49 archived negative Giemsa-stained slides and showed 11 positive. Parasitic loads in the latter smears were lower than those in corresponding exudates. The results highlight qPCR relevance for the diagnosis of CL and recommend its use directly on dermal exudates collected from CL lesions.

Health status and infectious diseases in male unaccompanied immigrant minors from Africa in Spain

INTRODUCTION

The aim was to examine the health status and infectious diseases in a cohort of unaccompanied immigrant minors (UIMs) from Africa in Spain, and to detect if there are differences according to the geographical area of origin.

METHODS

Cross-sectional study in 622 African male UIMs at the time of admission to residential care in Aragon (Spain) during 2005-2019. A physical, nutritional and laboratory examination was performed following sanitary guidelines.

RESULTS

The mean age of the African UIMs was 16.1 years (SD 1.7; range 13-17). 88.9% were from Maghreb (mean age 15.9 years; SD 1.5) and 14.1% from Western Sub-Saharan (mean age 16.8 years; SD 1). We found that the prevalence of caries, iron deficiency and dermatological problems was significantly higher (p<.05) among Maghrebian, and the prevalence of past and present hepatitis B virus (HBV) infection, intestinal parasitosis, eosinophilia (p<.00001) and latent tuberculosis (p=.0034) was significantly higher in those of Sub-Saharan origin.

CONCLUSION

The most relevant finding was the high prevalence of present HBV infection (14.8%) among Sub-Saharan adolescents. This finding highlights the importance of recommending targeted screening, preventive vaccination programs, and integration into local health care systems that allow for long-term treatment and follow-up as a way to prevent the transmission of HBV infection.

[Culicidae Larvae and Their Seasonal Dynamics in the Region of Fez-Meknes, Morocco]

Objective

As part of the prevention of vector-borne diseases in central Morocco, a study of the seasonal fluctuation of Culicidian biodiversity was conducted from November 2015 to November 2016 on four breeding sites located in the city of Fez in central Morocco (Jnan El Alami, Lgaâda dam, Awinat Elhajaj, Douwar Lhandiya Source). The study aimed to improve the knowledge of seasonal dynamics and activity period of Culicidian mosquitoes, in order to target the period of control.

Methods

Larvae were collected by dipping method at a 15-day interval at least once a month. Statistical analyses were performed using version 3.6.1 of the statistical processing software.

Results

During this study, nine species were found with high monthly and seasonal variations in numbers of each species and from site to site. Predominant species are vectors of disease: Culex pipiens, Cx. perexiguus, Cx. theileri, known vectors of West Nile virus, followed by Anopheles maculipennis s. l. and An. sergentii that are the main vectors of malaria in Morocco. Cx. pipiens and Cx. perexiguus reached the highest density in September, while Cx. theileri was found in large numbers in February and can therefore emerge in late winter and mid-spring. The lowest number of An. sergentii was collected in November, but increased in September, October and December. An. maculipennis s. l. occurred in June, with recurrences in March and July. Culiseta longiareolata was found in spring and summer and in abundance in June. However, Uranotaenia unguiculata was only present in September and October. Both An. cinereus and Cx. hortensis were present in November and February.

Conclusion

The results obtained will be an important tool for management and monitoring Culicidae proliferation and can be used to improve the efficiency of control management.

A systematic review and meta-analysis]

BACKGROUND

Healthcare-associated infections are a major source of morbidity and mortality in neonatology. Our aim was to describe the epidemiology of Healthcare-associated infections in neonatology (frequency, associated factors and prognosis).

METHODS

Articles were searched in the PubMed, Scopus and Web of Science databases. We included observational studies describing prevalence, incidence or mortality among new-born babies having developed infections more than 48hours after hospitalization. The pooled prevalence, incidence and mortality estimates were analysed using the random effects model. Publication bias was analysed using the funnel plot and Egger's test statistics. Data analysis was carried out using R Studio software v1.2.

RESULTS

Among the initially identified 137 studies, ten articles fulfilled the inclusion criteria and were included in the metanalysis. They mainly concerned Morocco, Tunisia and Algeria. Pooled incidence was 10% (95% CI [4%-18%]) and overall mortality was 49% (95% CI [33%-66%]). Heterogeneity between studies was significantly high, with rates of 98% and 90% respectively.

CONCLUSION

This review underlined a need to undertake more large-scale multicentric surveys and studies on monitoring systems and the attitudes and practices of relevant caregivers, the objective being to better understand the realities of healthcare-associated infections in Greater Maghreb neonatology units.

Transfusion safety in the Maghreb region

The Maghreb region comprises five countries: Algeria Libya, Morocco, Mauritania, and Tunisia. This is a review aiming at providing an update on the situation of transfusion in the five countries. Three countries have developed regulations covering all transfusion-related activities including policy development. All the countries are running blood safety activities using a National Blood Service as the main entity. Except for Mauritania and Lybia, all the blood safety activities are centralized and conducted regularly. The blood safety indicators are globally better compared to those of sub-Saharan Africa. Despite the efforts of the states of the Maghreb region, and the progress made in the field of transfusion in these countries, shortcomings persist and concern virtually all the key elements of a national blood supply system mainly in the quality management system.

[Inverted Takotsubo Syndrome due to Severe Scorpion Envenomation: Report of one Case]

Scorpion envenomation (SE) is common in tropical and subtropical regions. Cardio-respiratory manifestations, mainly cardiogenic shock and pulmonary oedema are the leading causes of death after scorpion envenomation. Cardiac failure can be due to massive release of catecholamines, myocardial damage induced by the venom or myocardial ischemia. Although it has been exceptionally reported, Takotsubo syndrome during SE can help to better elucidate the pathophysiology of this cardiomyopathy. We report a case of inverted Takotsubo following a SE in a 26-year-old patient admitted to the Intensive care unit department for severe scorpion envenomation. His evolution was favorable. We concluded that cardiac involvement in this case fulfills all clinical and paraclinical criteria of Takotsubo syndrome emphasizing the importance of catecholaminergic discharge during scorpion envenomation. We discuss again the management of this syndrome in this specific condition.

Water Is Needed to Exist: Habitat Preferences of Tiger Beetles (Coleoptera: Cicindelidae) in a Desert Country

Simple Summary

Many species of tiger beetles are habitat specialists, which make them useful as bioindicators of the status and changes in the quality of the environment. Their diversity and community structure in particular habitats can point to the stability of habitat. We studied six different macro and microhabitat factors that influence the habitat preferences of four Cicindelidae species occurring in different Tunisian desert areas. This is the one of only a few such studies in Africa. The results clearly show high habitat specialization of most studied taxa, as well as importance of water reservoirs in species distribution in the Sahara Desert.

Abstract

Tiger beetles are a group of predatory insects occurring mainly in diverse sandy areas, with particular species often characterised by narrow habitat preferences, which makes them both very important bioindicators for determining patterns of biodiversity and a flagship group for nature conservation. However, the precise roles of particular habitat parameters in the distribution of these beetles in desert areas are almost unknown. Habitat preferences for four tiger beetles species were analysed in Tunisia. Fifty samples from a major part of the country were collected, for which climate data, macrohabitat types. and soil parameters (soil humidity, salinity, pH, and structure) were studied. Here we show that most studied Cicindelidae were characterised by unique habitat preferences and did not co-occur with other ones, including two taxa found as habitat specialists, occurring in only one type of macrohabitat. Two other species were noted as more eurythopic and occupied 2–3 macrohabitat types, with Lophyra flexuosa as the most ubiquitous species not related to the measured parameters. The presence of a source of water (understood as a part of the habitat type, such as river banks and oases, or high soil humidity) was found as the most important factor in the distribution of the studied tiger beetle species. The present study is the first one focused on habitat preferences and habitat specialization of Cicindelidae fauna of Maghreb, and one of only a few in Africa.

Self-Imposed Exile, Marginality, and Homosexuality in the Novels of Abdellah Taïa, Rachid O., and Eyet-Chékib Djaziri

A burgeoning canon of Maghrebian writers in self-imposed exiled in France has in the last decade begun to openly broach the subject of homosexuality in Arab-Muslim communities of the Maghreb. Novels of writers like Abdellah Taïa, Rachid O. and Eyet-Chékib Djaziri reflect a fascinating trans-Mediterranean construction of homosexual identity. Drawing on Svetlana Boym's critical work, particularly her observation that nostalgia "charts an affective geography of the native land that often mirrors the melancholic landscapes" of the exiled, this paper analyzes the construction of homosexuality against the notions of exile, nostalgia, and marginality. The novels of these Maghrebian writers highlight nostalgia as both cathartic and paralyzing for "gay" migrant protagonists who find themselves trapped in the subtle seam between a cherished Maghreb that is framed as homophobic in the sexual clash of civilizations and a more liberal yet inauspicious France. The nostalgic contemplation of the constitution of a homosexual subjectivity is read as a critical performance and mainstreaming of hitherto marginalized voices that now subvert and fight back against normalizing discourses of ethnicity, sexual and gender identity as well as nationality.

Health status and infectious diseases in male unaccompanied immigrant minors from Africa in Spain

INTRODUCTION

The aim was to examine the health status and infectious diseases in a cohort of unaccompanied immigrant minors (UIMs) from Africa in Spain, and to detect if there are differences according to the geographical area of origin.

METHODS

Cross-sectional study in 622 African male UIMs at the time of admission to residential care in Aragon (Spain) during 2005-2019. A physical, nutritional and laboratory examination was performed following sanitary guidelines.

RESULTS

The mean age of the African UIMs was 16.1 years (SD 1.7; range 13-17). 88.9% were from Maghreb (mean age 15.9 years; SD 1.5) and 14.1% from Western Sub-Saharan (mean age 16.8 years; SD 1). We found that the prevalence of caries, iron deficiency and dermatological problems was significantly higher (p<.05) among Maghrebian, and the prevalence of past and present hepatitis B virus (HBV) infection, intestinal parasitosis, eosinophilia (p<.00001) and latent tuberculosis (p=.0034) was significantly higher in those of Sub-Saharan origin.

CONCLUSION

The most relevant finding was the high prevalence of present HBV infection (14.8%) among Sub-Saharan adolescents. This finding highlights the importance of recommending targeted screening, preventive vaccination programs, and integration into local health care systems that allow for long-term treatment and follow-up as a way to prevent the transmission of HBV infection.

[A Retrospective Study on Planorbarius metidjensis and Its Role as a Potential Intermediate Host in the Transmission of Schistosoma haematobium in the Souss-Massa Region (Morocco)]

A retrospective research study was carried out by our team on Planorbarius metidjensis to highlight its epidemiological role as a potential host snail of Schistosoma haematobium in the Souss-Massa region. Contrary to the habitats colonized by Bulinus truncatus, the main host snail, those of P. metidjensis are located at the altitude of above 300 m. The best results of the experimental infections with S. haematobium were obtained using juvenile planorbids of 2 to 3 mm in diameter and a dose of five miracidia per snail. No snail naturally infected with the parasite was found when dissecting 3,457 adult bulinids and 2,470 adult planorbids. Despite the location of its habitats in altitude, P. metidjensis is a potential intermediate host of S. haematobium and it is important to follow these populations, as those of B. truncatus, in the future to avoid possible reoccurrence of indigenous cases of the disease.

Model of Effective Control of Leishmaniasis in North Central Morocco and Updating the Mapping of the Circulating Species

Leishmaniasis is among the most important emerging vector-borne protozoal disease in terms of disability adjusted life year (DALY'S). The main objectives of this study are, firstly to evaluate the epidemiological situation of Cutaneous Leishmaniasis (CL) from 2000 to 2015 in Moulay Yacoub Province and Fez Prefecture and secondly to analyze the impact of several factors (geographical and socio-economic factors) on the distribution of CL in these provinces. In addition, this study aims to identify the circulating species of Leishmania in order to justify the cause of the case maintenance and to prevent possible epidemics. The spatio-temporal evolution of CL from 2000 to 2015 in the study area revealed the endemic and epidemic character of the disease with a variation in the number of cases according to provinces, and districts. The sharp decrease of cases observed in the study area could be explained by the several control measures that concern the different actors of leishmaniasis. According to the statistical study, the presence of leishmaniasis is mainly related to population movement and environmental conditions. The results of the clinical identification of cutaneous leishmaniasis in the study area showed a diversity of clinical features with the presence of symptoms miming for L. tropica or L. infantum. This result was confirmed by the molecular study PCR-ITS1-RFLP.

[Epidemiology of Cutaneous Leishmaniasis in Algeria through Molecular Characterization]

Three distinct noso-epidemiological cutaneous leishmaniasis (LC) entities coexist in Algeria: the so-called sporadic form of the North (LCN), the zoonotic form (LCZ) and the chronic form (LCC). The precise identification of the parasitic species involved in each of the forms makes it possible to specify the geographical distribution of each of the forms raised, to distinguish their clinical aspects, to guide the therapeutic behaviors and to adapt the control programs. Ninety-seven (97) human strains from 97 cases of LC were subjected to molecular characterization by PCR-ITS1 followed by sequencing of this inter-gene space. Our results confirm the endemicity of the three forms. The LCN, caused by L. infantum (17 isolates/97 i.e. 17.52%) is limited to the North of the country mainly (16 isolates/17). Its geographical distribution is superimposable to that of visceral leishmaniasis with an extension more and more reported in previously unaffected areas, such as the regions of Tlemcen and Oran in the West, Setif, Annaba and Collo in the East. The LCZ, due to L. major (70 strains/97 i.e. 72.16%), remains the dominant form in the arid and semi-arid zones (47 strains/70) with a progression towards the North (20/70 strains). Indeed, long confined to the Sahara, it shows a geographical extension outside its historic homes of Biskra and Abadla. This form is progressing dangerously towards the highlands and the steppe regions of the country. The most interesting fact was the identification of L. tropica for the first time in North-Central and North-West Algeria in Algerian patients who had never left the national territory. Out of the 10 strains of L. tropica identified, 8 belonged to patients of Syrian origin and 2 to Algerian patients. L. tropica was reported for the first time in 2008 in 6 patients living in Constantine (North-East Algeria) and in 2017, still in the North-East of the country, in Annaba. The observation of L. tropica in the North and Northeast center of the country, where L. infantum and L. major coexist, suggests changes in the epidemiology of cutaneous leishmaniasis in Algeria, which highlights the interest of more investigations to better understand the transmission cycle of the different entities.

Quantitative Inventory of Mosquito Larvae (Diptera: Culicidae) and Physicochemical Analysis of Aquatic Habitats in the Region of Fez, Morocco

Mosquitoes occupy a major health problem, as a potential vector for the transmission of many pathogens, the most important of which in Morocco are Plasmodium parasites and West Nile fever virus. Acquiring knowledge about the biotypology of these mosquitoes is an essential step in any control strategy. Thus, the objective of this study is to draw up an inventory of the culicidian fauna in the Fez region (North-central part of Morocco) and to determine the physicochemical parameters influencing the production of mosquito larvae of aquatic habitats in this area. Mosquito larvae of the extant biotopes were sampled every two months between November 2015 and December 2016, by means of the "dipping" method. The physicochemical parameters of the various larval biotopes were collected six times during the year of follow-up. Mosquito species were identified using morphological criteria. The results were analyzed using ecological indices and the generalized linear model (Poisson model) on R software. The identification of the 1,122 mosquito larvae collected from the various studied breeding areas revealed the presence of 11 species belonging to two subfamilies (Culicinae and Anophelinae) and five genera (Anopheles, Culex, Culiseta, Aedes, and Uranotaenia). Anopheles were observed in small numbers in permanent, stagnant, and shallow habitats. The larvae of An. maculipennis s. l. (major vector of malaria in Morocco) were collected. Culex larvae, especially Cx. pipiens (the main vector of WNV in Morocco), were collected in the majority of the larval habitats and on the different types of environments. Two other species of Culex, which plays a significant role in the transmission of WNV, were also collected, particularly, Cx. perexiguus and Cx. theileri. The results found, via this first study of its kind at the regional level, also made it possible to update the list of Culicidae species reported in the Fez region. Four new species have been recorded: Aedes flavescens, Uranotaenia unguiculata, Culiseta longiareolata, and Culex perexiguus. The results of this study will contribute to the provision of information for entomological surveillance and to better plan and guide vector control activities at local and national levels.

[Morphological Keys for Identification of Sandflies from Morocco (Diptera: Psychodidae: Phlebotominae)]

The Moroccan phlebotomine fauna is composed of 24 species whose morphological determination may be difficult for non-taxonomists. The identification keys, presented here, allow the identification of sandflies genera and species in Morocco and will facilitate future studies on these insects of medical importance, Leishmaniasis vectors.

Cystic Echinococcosis in Algeria: the Role of Cattle as Reservoirs in the Dynamics of Transmission of Echinococcus granulosus to Humans via Dogs

In North Africa, the parasite Echinococcus granulosus is transmitted in a synanthropic cycle evolving mainly between dogs (DH) and sheep (IH), but other animals like cattle are most often found to be more infested with hydatid cysts but their potential role in human contamination via dogs is unknown. The purpose of this study is to assess the prevalence and fertility rates of hydatid cysts in ruminants (cattle and sheep) in two slaughterhouses in central and eastern Algeria. Determining the frequency and fertility of cysts in cattle will assess the degree of involvement of this species, alongside sheep, in the epidemiological cycle of E. granulosus in Algeria. In the present study, prevalence rates were estimated at 4.9% and 10% in slaughtered ruminants, all species combined at the slaughterhouses of El Harrach and Souk Ahras, respectively. The distribution of the prevalence by species indicates higher infestation rates in cattle compared to sheep: 6% vs 3.9% and 37% vs 4.7% in the slaughterhouses of El Harrach and Souk Ahras, respectively. The survey results showed relatively low cyst fertility rates in cattle compared to sheep: 13.8% vs 43.7% and 33.3% vs 71.4% in the two slaughterhouses, El Harrach and Souk Ahras, respectively. The low fertility rate of cysts in cattle can be explained by a poor adaptation of the species, E. granulosus sensu stricto, previously identified by molecular analysis in all samples of hydatid cysts collected from cattle in Algeria. In conclusion, cattle infested with E. granulosus sensu stricto, with low fertility rates, play a minor role in the epidemiology of cystic echinococcosis in Algeria. It is rather an indicator of the persistence of cystic echinococcosis infection in endemic regions.

[Antibiotic Susceptibility of Haemophilus influenzae in Sfax: Two Years after the Introduction of the Hib Vaccination in Tunisia]

A retrospective study was conducted at the Sfax hospitals between 2013 and 2014 to study the susceptibility to antibiotics of Haemophilus influenzae after the introduction of Hib vaccination in Tunisia. Capsular typing was done by PCR. MICs for β-lactams were determined by E-test^®. The bla_TEM, bla_ROB and ftsI genes were searched using PCR. Among the 259 strains of H. influenzae isolated, 248 (95.7%) were non-invasive. Five strains were encapsulated (3 type b and 2 type c). Resistance rates were 33.4% for ampicillin, 10.4% for amoxicillin-clavulanic acid, 2.3% for cefixime, 1.1% for cefotaxime and 1.9% for fluoroquinolones. Among the strains resistant to β-lactams, 67 produced β-lactamase type TEM and 40 had a modification of PLP3. This study shows the change in the epidemiology of H. influenzae induced by vaccination with a dramatic decrease of invasive infections. Replacement with other capsular types or with non-typable strains that may be resistant to antibiotics requires continuous surveillance for H. influenzae infections.

[Updated List of Phlebotominae (Diptera: Psychodidae) from Morocco]

A list of Phlebotominae from Morocco is presented in alphabetical order. It consists of 24 species divided between two genera (Phlebotomus and Sergentomyia) and seven subgenera (Phlebotomus, Paraphlebotomus, Larroussius, Sergentomyia, Parrotomyia, Grassomyia and Sintonius). A history of the implementation of the current inventory is given by the comments on some species and subspecies quotes during the various researches carried out in Morocco.

Ethnoveterinary remedies used in the Algerian steppe: Exploring the relationship with traditional human herbal medicine

ETHNOPHARMACOLOGICAL RELEVANCE

Ethnoveterinary medicine is vastly under-documented, especially in North Africa, where livestock care is increasingly medicalised. Despite evidence of the interdependence of ethnoveterinary practices and ethnomedicine for human care, the overlap between these two systems and the possible drivers of similarity are rarely addressed in ethnopharmacological literature. Here, we present the first quantitative comparison of remedies used to treat human and animal health among a pastoral society.

AIMS

This study aims to document the plants and other materials used in ethnoveterinary medicine among nomadic herders in the Algerian steppe. We calculate the overlap with remedies used for human health and evaluate some of the possible drivers of similarities between the two interlinked medical systems.

METHODS

The field study was conducted in spring 2018 with 201 local knowledge holders in five provinces in the central part of the Algerian steppe. Forty-six camps and ten weekly animal markets were visited. After obtaining prior informed consent, data was collected through structured interviews. Anonymous sociodemographic information was collected along with veterinary use data. Plant specimens were acquired, identified and deposited in the Botanical Laboratory Herbarium of the University of Tiaret. Ethnobotanical information was structured in use reports and therapeutic applications organised into 13 simple categories. Plants used in ethnoveterinary medicine were compared to those used in human health care using a Chi square test, and ethnoveterinary use was predicted using a generalised linear model with use for human care and plant family as predictive variables. Logistic regressions were also used to test if any specific medicinal application predicts shared use in human and veterinary medicine.

RESULTS

Sixty-six plant species from 32 botanical families and ten non-vegetable remedies were documented. Plants from the Lamiaceae, Asteraceae, Fabaceae and Apiaceae families were most commonly used. The plants most often cited by interviewees are all harvested from the wild (Echinops spinosissimus Turra, Atriplex halimus L., Artemisia campestris L., Juniperus phoenicea L. and Peganum harmala L.). Leaves are the most commonly used plant part and decoction is the most common preparation method. There are important similarities between remedies used to treat humans and other animals: two thirds of the remedies used in ethnoveterinary medicine are also used in human health care, and these represent half of the human health treatments. Use for human health and plant family both predict the use of a medicinal plant in veterinary medicine, but no correlation is found regarding specific therapeutic applications.

CONCLUSIONS

Traditional veterinary knowledge is still key to sheep and goat herders in the Algerian steppe, but a knowledge transmission gap seems to exist between older and younger generations, and ethnoveterinary practices may disappear in the near future. Treatments for human and animal care overlap to a large extent, and a causal relationship possibly exists for, at least, some of them. However, overall a smaller number of remedies are used to treat animals than humans and for less therapeutic applications. This difference in the diversity of therapeutic applications and remedies should be the object of future research.

[The rites of protection of the newborn in the Maghreb]

In the Maghreb, rites of protection are performed to prevent or compensate for any threats to which newborns are exposed as a result of their birth. The passage from one world to another is therefore accompanied by rituals, real vectors of socialisation, values and knowledge. They are important therapeutic levers in the context of transcultural psychotherapy, in order to reappropriate a containing and mixed cultural sheath.

[Central Neurological Diagnosis in Patients Infected with HIV in the Infectious Diseases Unit of University Hospital of Casablanca, Morocco]

The aim of this work is to study the epidemiology of central neurological system (CNS) diagnosed in the population of people living with HIV in the department of infectious diseases in UHC Ibn Rochd of Casablanca from January 2005 to May 2015. The demographic and clinical profile along with the outcome of these patients were studied. The data were collected from Nadis software. Three hundred and eighty-seven patients were admitted for CNS diagnosis, out of 3496 people living with HIV admitted during this time period, i.e., a prevalence of 11%. The sex ratio (M/F) was 1.27. The average age was 39 years (± 7). Neurological involvement was indicative of HIV infection in 225 cases (68.8%). Neurological disorders were dominated by headache (70%), focal neurological syndrome (35%), and meningeal syndrome (30%). CNS diagnosis noted were CNS tuberculosis (37%), cerebral toxoplasmosis (30%), and cryptococcal meningitis (20%). The median CD4 T-lymphocyte was 184 cells/mm³. Infection with severe immunosuppression was progressive multifocal leucoencephalitis, cryptococcal meningitis, and primary cerebral lymphoma. Lethality was 39%. In the department of infectious diseases of the UHC, the main cause of death among HIV-infected patients is tuberculosis. Collaboration between the national tuberculosis and AIDS programs has been established to improve the detection and management of these patients.

Symptoms of Canine Leishmaniosis in Tunisian Dogs

Canine leishmaniosis (CanL) is a fatal disease caused by Leishmania infantum which is a zoonotic protozoan transmitted to humans from dogs through sandflies. In Tunisia, there is a lack of knowledge on CanL risk and protective factors that limits the possibilities to design control strategies. In this study, 269 dogs suffering from CanL that were presented by their owners to the clinic of the National School of Veterinary Medicine of Sidi Thabet (Tunisia), were examined. Male dogs were more infected than female dogs (sex-ratio = 1.53). The age distribution in dogs has a normal distribution; mostly animals less than 4 years old (48.7%) gets affected by this disease. The majority of the animals were German Shepherded (14.4%) followed by Staffordshire (12.6%) and Rottweiler (9.6%). Most of the dogs live outdoor (87%), did not receive any acaricidal treatment (88.5%) and were not dewormed (70.3%). Poor body condition (73.2%), depilation (69.1%), lymph node enlargement (67.3%) and lethargy (60.2%) were the most frequent symptoms. Further studies need to be carried out to establish the presence of a relation between the zymodems and the clinical typology of CanL. It is also important to know if these disparities were due to differences in the canine population under study, to inherent differences in susceptibility to the disease or to a genetic diversity of the parasite.

Report on Gasterophilus spp. (Diptera, Gasterophilidae) of Horses in Algeria: Prevalence, Intensity, and Monthly Variations

The composition, prevalence, and seasonal dynamic of Gasterophilus species were studied at the slaughterhouse of Constantine region (East Algeria) in 128 horses over an 18 months period. Our survey revealed that 124 (96.9%) horses were infected with a mean intensity of 161 larvae of Gasterophilus spp. Four species of Gasterophilus were identified; Gasterophilus intestinalis and G. nasalis were by far the predominant species with 95.3% and 77.3% respectively, followed by G. haemorrhoidalis (14.0%) and G. pecorum (10.1%). The age, sex, and breed of horses did not affect the distribution of the infection. Second-stage larvae (L2) of G. intestinalis were absent between April and July and present in higher numbers between December and February. In addition, third-stage larvae (L3) were few in number, mainly from September to November, a consequence of their fecal elimination and suggesting that the effective period of adult activity of G. intestinalis is autumn. Therefore, the population dynamics of G. nasalis shows that its activity is two months longer and occurs earlier than that of G. intestinalis. The incidence of G. pecorum infection was linked to the rainiest months.