Moroccan Cohort Research Articles

Real world results of locally advanced and metastatic lung cancer patients treated with platinum doublet chemotherapy in first line: Moroccan cohort

BackgroundDoublet platin-chemotherapy was the old standard treatment for different histology types of advanced and metastatic lung cancer (LC) and is still an option for patients who are not eligible for immune checkpoint inhibitors. However, in low- and middle-income countries, chemotherapy, either in monotherapy or in combination with platinum, is still the only accessible option in public institutions. The efficacy of different platin-based chemotherapy in patients with LC who are treatment-naïve is unknown. MethodsIn this retrospective study, we selected patients with advanced and metastatic (IIIB-IVB) non-squamous non-small cell LC (NSCLC), squamous NSCLC, and lung neuroendocrine tumours (small cell LC (SCLC), large cell neuroendocrine, and atypical carcinoid) aged beyond 18 years who received first-line chemotherapy (docetaxel, gemcitabine, etoposide, paclitaxel, pemetrexed, and vinorelbine) combined with platinum between January 1, 2013, and December 31, 2022. Within the population with non-squamous NSCLC, squamous NSCLC, and neuroendocrine tumours, progression-free survival (PFS) and overall survival (OS) were the primary assessed endpoints. Hematologic safety was the secondary endpoint. ResultsOverall, 611 patients were included. In the group of patients with non-squamous NSCLC (n = 390), there was no statistical difference between subgroups of patients who received first-line platin-chemotherapy. The median PFS was 182 (95 % confidence interval [CI], 167–208) days (hazard ratio for progression: NR [Not Reached]; p = 0.37), and the median OS was 446 (95 % CI, 405–559) days (hazard ratio for death: 1.31; 95 % CI, 0.94 - 1.82; p = 0.1). In the group of patients with squamous NSCLC (n = 149), we note the absence of statistical significance between subgroups of patients who received platin-based chemotherapy. The median PFS was 195 (95 % CI, 142–238; hazard ratio for progression: 1.21, 95 % CI, 0.29–5.02; p = 0.27), while the median OS was 428 (95 % CI, 324–940) days (hazard ratio for death: 1.76; 95 % CI, 0.93 to 3.3; p = 0.32). The absence of significance has been noticed in the neuroendocrine subgroup of patients who received first etoposide-platinum, vinorelbine-platinum, or paclitaxel-platinum (n = 72). The median PFS was 216 (95 % CI, 193–277) days; hazard ratio for progression: 1.74, 95 % CI, 0.41–7.27; p = 0.69, while the median OS was 273 (95 % CI, 241–459) days (hazard ratio for death: 2.95; 95 % CI, 0.4–21.7; p = 0.51). Grade 3–4 neutropenia grade was the predominant adverse event associated with chemotherapy in almost 11 % of patients. ConclusionMoving forward, treatment strategies must be refined for patients, with an emphasis on increasing the number of patients who can benefit from emergent approaches in order to guarantee a wider, deeper, and longer-lasting outcome.

Is the gemcitabin cisplatin doublet the optimal induction chemotherapy for non-Asian patients with NPC? Insights from a northeastern Moroccan cohort.

e18057 Background: According to the latest guidelines for NPC, induction chemotherapy followed by concomitant chemoradiation therapy (CCRT) is recommended as the preferred standard of care for patients with locally advanced nasopharyngeal carcinoma (stage III-Iva). However, the optimal regimen for induction chemotherapy (IC) in patients with locally advanced NPC remains uncertain. Methods: We conducted a retrospective study between January 2016 and October 2022 at the "CHU Hassan II" Oncology Hospital in Fes, Morocco, to compare the efficacy and tolerability of two platinum-based induction therapy regimens: cisplatin gemcitabine (GC) and cisplatin doxorubicin (DP), in the treatment of newly diagnosed locally advanced NPC. The main objectives of this study were to compare the efficacy including objective response rates (ORR), PFS ,OS and safety. Results: After eligibility assessment, we included 105 cases (62 patients in the DP group and 43 in the GC group), including 65 men and 40 women, with a mean age of 49.5 years (range = 19-79years) and a Karnofsky score ranging from 87% to 100%. 34% of patients were diagnosed at stage IVA. In the DP group, 3% of patients (2 out of 62) achieved a complete response CR, 60% achieved a partial response PR,25% remained stable SD and 19% experienced progression. In the GC group, 2% of patients (1 out of 43) achieved a CR, 39.5% achieved a PR, 39.5% remained stable, and 19% experienced progression. A statistically significant difference in PR was observed between the two groups (p = 0.028) ,and the difference in terms of progression is approaching the limit of significance (p=0,06) after a median follow-up of 27 months (5,3 -82). The 2-year progression-free survival (PFS) was 70% in the DP group compared to 80% in the GC group; the 2-year overall survival (OS) was 75% in the DP group and 90% in the GC group. No significant survival difference was observed between the two groups Patients in the DP group exhibited less grade 3-4 thrombocytopenia but more grade 3-4 leukopenia and neutropenia compared to the GC group. Conclusions: In patients with locally advanced nasopharyngeal carcinoma, GC-based induction chemotherapy demonstrated superior ORR over the DP regimen with acceptable toxicities. Further studies are needed to validate these results.

High expression of BTN3A1 is associated with clinical and immunological characteristics and predicts a poor prognosis in advanced human gliomas.

Gliomas represent the most prevalent and aggressive tumors within the central nervous system. Despite the current standard treatments, the median survival time for glioblastoma patients remains dismal, hovering around 14 months. While attempts have been made to inhibit the PD-1/PD-L1 and CTLA-4/CD80-CD86 axes through immunotherapy, the outcomes have yet to demonstrate significant efficacy. The immune checkpoint Butyrophilin 3A1 (BTN3A1) can either be involved in advantageous or detrimental function depending on the cancer type. In our study, we utilized a Moroccan cohort to delve into the role of BTN3A1 in gliomas. A transcriptomic analysis was conducted on 34 patients, which was then corroborated through a protein analysis in 27 patients and validated using the TCGA database (n = 667). Our results revealed an elevated expression of BTN3A1 in glioblastoma (grade 4), as evidenced in both the TCGA database and our cohort of Moroccan glioma patients. Within the TCGA cohort, BTN3A1 expression was notably higher in patients with wild-type IDH. We observed a positive correlation between BTN3A1 expression and immune infiltration of B cells, CD8+ T cells, naive CD4+ T cells, and M2 macrophages. Patients exhibiting increased BTN3A1 expression also presented elevated levels of TGF-β, IL-10, and TIM-3 compared to those with reduced BTN3A1 expression. Notably, patients with high BTN3A1 expression were associated with a poorer prognosis than their counterparts with lower expression. Our findings suggest that BTN3A1 might promote the establishment of an immunosuppressive microenvironment. Consequently, targeting BTN3A1 could offer novel therapeutic avenues for the management of advanced gliomas.

Clinical features of Wilson disease in Moroccan cohort

Clinical features of Wilson disease in Moroccan cohort

Epidemiological profile of type 2 diabetic patients followed at a secondary care referral center: Data from a Moroccan cohort study

BackgroundType 2 diabetes is a major public health problem responsible for several macro and microvascular complications, including diabetic nephropathy. The main objective of this study was to describe the epidemiological profile of type 2 diabetic patients at admission to a reference center for chronic diseases and to explore associated factors with a glomerular filtration rate decline (GFR). MethodsThis retrospective cohort study aims to examine the epidemiological characteristics of patients with type 2 diabetes who had at least one consultation between November 2005 and December 2020. ResultsThe study included 19,953 patients, of whom 67.8 % were women, with an average age of 58.2 ± 12.2 years. The majority (64.7 %) had a diabetes duration of less than 5 years. On admission, 37.6 % of patients had high blood pressure, 41.8 % were overweight, while 31.5 % were obese. Nearly 9 % of patients had at least one complication on admission: 2.6 % had heart disease, 2 % had nephropathy, 1.8 % had retinopathy, 0.7 % had neuropathy and 0.5 % had a diabetic foot. The study found that 76.8 % of patients had poorly controlled diabetes, and 30.1 % had a GFR 〈 60 ml/min/1.73 m². Women, patients over 65 years, those with a diabetes duration 〉 30 months, hypertensive patients, those with at least one complication on admission, patients with overweight or obesity, and those with positive albuminuria had significantly lower GFR (p < 0.001). ConclusionOur study showed that most patients were initially diagnosed with Type 2 diabetes in primary healthcare and had a very high risk of complications. Primary care health centers may not have sufficient human and material resources to effectively screen for and monitor these complications. Therefore, it is crucial to strengthen secondary care referral centers to ensure comprehensive and optimal management of diabetes patients, including diabetic control and early detection and management of its complications.

Idiopathic intracranial hypertension in a Moroccan cohort

Idiopathic intracranial hypertension in a Moroccan cohort

Evolution of COVID-19 According to Vaccination Status in a Moroccan Cohort

Introduction: Since the development of vaccines against the new emerging virus SARSCoV-2, which causes the coronavirus disease 2019 (COVID-19), several fundamental questions remain regarding the efficacy of these vaccines and their impact on the disease, its occurrence and its clinical course. In this sense, the study of the efficiency of the proposed vaccines has become an obligation in order to determine their true influence on COVID-19 in real clinical situation. Materials and Methods: This is a retrospective and prospective cohort study with descriptive and analytical cross-sectional aims conducted in the Avicenna hospital in Marrakech over a period of 50 days, between December 20, 2021 and February 10, 2022, among patients diagnosed as positive for SARS-CoV-2 infection confirmed by RT-PCR. Data collection was performed retrospectively and prospectively on medical records and by telephone calls of the patients diagnosed positive using a pre-established operating form. Results: 512 patients were included during the study period. The average age of the patients was 41 years with a slight male predominance (sex ratio M/F=1.37). 24.4% of our patients had at least one associated comorbidity, with diabetes and hypertension the most frequent comorbidities with a percentage of 15.2% and 9.8% respectively. - 75.8% of the patients included in our study were fully vaccinated against COVID-19, while 24.2% were partially or not vaccinated. The evolution was marked by the occurrence of severe COVID-19 in 3.9% of the cases combined, out of only 1.8% of the fully vaccinated cases developed a severe form compared to 10.5% of the partially or non-vaccinated patients. The analytical study of our results showed that vaccination status and clinical progression had a statistically significant relationship and that complete vaccination was a protective factor against the occurrence of severe COVID-19 disease, although the overall efficacy of complete vaccination against these ........

Classification of common variable immunodeficiency through immunological and clinical phenotyping in Moroccan patients.

Objective: Common variable immunodeficiency (CVID) is a complex inborn error of humoral immunity with complications of both infectious and non-infectious origins. Classifications of CVID patients provide a clearer understanding of the pathogenesis, prediction, and management of non-infectious complications. This study aims to classify Moroccan CVID patients based on the European classification (EUROclass). Materials and Methods: We recruited 20 CVID patients meeting standard diagnostic criteria (5-6). After collecting clinical and demographic data, we used flow cytometry to analyze B-cell subsets and group patients and assess the relation of each group with clinical manifestations. Results: 90% of the patients in our cohort study had a history of respiratory infections. The noninfectious manifestations included splenomegaly, autoimmunity, lymphadenopathy, and granulomatous diseases diagnosed in 50%, 45%, 40%, and 25% of patients, respectively. We observed significant co-occurrence of splenomegaly with autoimmunity and granulomatous diseases to a lesser extent. Patients had a significant reduction in total, switched memory, marginal zone-like, plasma blasts, and a substantial increase in the percentage of activated B cells, suggesting a defect in the late phases of B-cell differentiation. This condition was linked with an increased occurrence of splenomegaly and granulomatous affections. Besides, patients also had an expansion of CD21low B-cells, which was strongly associated with splenomegaly. Conclusion: The classification of the first Moroccan cohort of CVID patients showed agreement with previous results. It suggests the possibility of adopting this approach on a global scale for better diagnosis and follow-up of CVID patients.

Epidemiology and prognostic factors of 114 patients with mycosis fungoides in a Moroccan cohort: a 29-year review.

Limited data regarding survival of Moroccan patients with mycosis fungoides (MF). To evaluate the clinical profile and long-term outcomes of these patients. A retrospective review of 114 MF cases diagnosed from 1993 to 2022 who were followed up for more than 6months of diagnosis was performed. Of 114 patients, 71.9% were male and the median age at diagnosis was 56years. Approximately 64 and 36% of the patients had an early stage and advanced stage, respectively. Median follow-up duration was 56months, and median duration of symptoms before diagnosis was 31months. Various subtypes were observed, including mycosis fungoides folliculotropic (12.3%), poikilodermatous (11.4%), and palmaris et plantaris MF (5.3%). The 10-year overall survival was 89% in early-stage patients and 48.8% in advanced-stage patients. Complete response to treatment occurred in 45.6%, stable disease in 16.7% and disease progression in 7.9% of patients. Older age of > 60years, higher T-stage (T3/T4) and advanced-stage MF were statistically significant in predicting poorer outcomes in MF. Despite delay in diagnosis, most cases of MF in Morocco were diagnosed in early stages. We observed a high proportion of classic MF and favorable prognosis.

49P First report on pan-immune-inflammation value as a new prognostic factor in ovarian cancer: A biomarker analysis of OVANORDEST-1 study

Inflammation is a hallmark of cancer. In our recent Umbrella systematic review of systematic reviews, we demonstrated that inflammatory biomarkers based on peripheral blood count impact both progression-free survival and overall survival (OS) in ovarian cancer. Pan-Immune-Inflammation Value (PIIV) is a new prognostic factor that was studied in breast cancer and other malignancies, but never in ovarian cancer. In this study, we provide the first results of the prognostic value of PIIV in a Moroccan cohort of ovarian cancer patients based on a biomarker-analysis of OVANORDEST-1 study. An exploratory biomarker set from our OVANORDEST-1 database was included in the final analysis with OS as a primary endpoint. PIIV was calculated as previously described: (neutrophil count × platelet count × monocyte count)/lymphocyte count. Receiver operating characteristic (ROC) was used to evaluate the optimal cut-off of PIIV. Cox proportional hazard model was used for multivariable analysis and Kaplan-Meier method to estimate OS. A total number of 158 patients treated for epithelial ovarian cancer with a median age of 55 years were included in the survival analysis. A ROC-based cut off of 991.7 of PIIV was used for patients’ stratification. Survival analysis using Log rank test showed a significant association of PIIV with OS (p<0.0001). Women with high PIIV had the worst outcomes as compared to those with low PIIV (median OS: 16 months versus 35.4 months, respectively). On Cox proportional hazard model, PIIV was an independent predictor of OS (HR=2.38, CI:1.47-3.85; p<0.0001). High PIIV is associated with an increased risk of death in women with epithelial ovarian cancer. A validation set of this study is ongoing and a prospective enrollment to develop a nomogram based on PIIV is being planned.

Biological parameters and the histological response in rectal cancer treated by neoadjuvant chemoradiotherapy: A Moroccan Cohort

Biological parameters and the histological response in rectal cancer treated by neoadjuvant chemoradiotherapy: A Moroccan Cohort

Male breast cancer: A North African Center for cancer treatment’s experience, and systematic review of literature

Background: Male breast cancer is a rare disease that accounts for less than 1% of all male cancers and 1% of all incident breast cancers. Materials and methods: We conducted a descriptive, observational, retrospective study of 92 cases of male breast cancer treated at our center between 2000 and 2020. Data were collected on the basis of a standardized data sheet after literature analysis. Objectives: Our research focused on the clinicopathological features, treatments, and prognostic factors in a Moroccan cohort of 92 men with breast cancer, and compared these results with those found in the literature. Interventions: The data collection lasted for 3 months, from January 2021 to March 2021. For patients treated before 2014, we had to retrieve their paper files from the archives of our center to collect the necessary information. We were able to select more recent files using the ENOVA file computerization system. To find the files of interest, we selected the breast as the main organ, then limited ourselves to the files of male patients, and finally, we limited the period of file research from January 2014 to January 2020. Results: Epidemiological data: The median age was 71.3 years, and the primary reason for initial consultation was periareolar nodule self-examination. Patients consulted 12.1 months after the first clinical signs. Infiltrating ductal carcinoma (88.3%) was the most common histological type of carcinoma. The most common immunohistochemical profile (55.5%) was Luminal B. Treatment: The treatment plan included radical mastectomy with axillary lymph node dissection, followed by adjuvant radiotherapy with or without adjuvant chemotherapy. Tamoxifen has been suggested to be effective for all patients with hormone receptors. Follow-up: The evolution was marked by complete remission (62%), local relapse (7%), progressive disease (7%), metastatic relapse (14%), and death (10%) over a median followup period of 42 months (8-156 months). Conclusion: Although breast cancer in men is very similar to breast cancer in women, it has distinct characteristics. Future prospective studies on a global scale are required to improve the management and prognosis of such patients.

Prevalence, characteristics and risk factors in a Moroccan cohort of Long-Covid-19.

IntroductionCovid-19 can involve persistence of nonspecific symptoms and sequelae that last weeks to months after initial recovery, but the definition of this situation is lacking. Thus, the aim of our study is to estimate the prevalence, symptoms, and signs extending beyond the acute phase of Covid-19 compared to the general population not infected with the virus and to assess the factors influencing the occurrence of these symptoms in developing countries like Morocco.Patients and methodsThis study recruited 118 healthcare workers who endured the Covid-19 infection and 118 matched controls that had never experienced it. We have defined Long-Covid-19 according to guidance for NICE, and we used a survey made of direct questions and short answers sent to the recruiters via mail to evaluate the demographic parameters, severity and duration of the Covid-19 symptoms, vaccination against SARS CoV-2, and pulmonary involvement, and a series of general symptoms were looked for.FindingsOur study found that the prevalence of Long-Covid-19 was 47.4%. Compared to the general population, the symptoms with statistical significative results were predominated by asthenia, myalgia, and brain fog. The severity of the pulmonary involvement on chest CT scan was the only risk factor to their occurrence, whereas no effect of the vaccination anti-SARS-CoV-2 was found.ConclusionComparing to the literature, this study showed that nearly half of the patients who have been infected with SARS-CoV-2 will experience a variety of symptoms after the acute phase of this infection, and that it would be a real burden even in the youngest. We also found that vaccination against SARS-Cov-2 has no impact on this prevalence, which is to the best of our knowledge has never been previously studied.

Cytometric analysis and clinical features in a Moroccan cohort with severe combined immunodeficiency.

Severe combined immunodeficiency (SCID) is a form of primary immunodeficiency disease (PID). It is characterized by a serious abnormality of the cellular and sometimes humoral system due to a deficiency in development of T cells, B cells and/or NK cells. The early diagnosis of SCID improves the prognosis. Typically, the initial consideration of SCID is made based on low lymphocyte counts. Notwithstanding, the heterogeneity of lymphocyte count presentation makes the diagnosis of SCID a significant challenge. The objective of this cross-sectional retrospective study was to analyze the lymphocyte subpopulation counts along with clinical manifestations within a Moroccan cohort diagnosed as SCID compared to children diagnosed with non-PID diseases. Thirty-five SCID confirmed patients were selected in the period between 2008 and 2018 and compared with non-PID patients. Results of peripheral blood T, B, and NK lymphocyte subpopulation counts were measured by flow cytometry for each SCID subtype. As expected, T cell count was less than 300 cells/μL in most patients with SCID (85.5%). Unexpectedly, significantly higher T cell counts were detected in some patients with a confirmed clinical diagnosis and family history of SCID. 5.7% of our SCID Moroccan cohort had T cell numbers in the range between 300 and 500 cells/μL. 8.7% of our SCID Moroccan cohort had T cell numbers higher than 500 cells/μL. Of the SCID subtypes, the proportion of SCID with B cell deficiencies was highly represented in our cohort. 71.4% of Moroccan SCID patients (25 out of 35 patients) were of T-B-subtype. Furthermore, 40% of the patients (14 out of 35 patients) had a T-B-NK+ profile and 31.4% had a T-B-NK- profile (11 out of 35 patients). The most common clinical manifestations observed in our SCID cohort were pneumonia, failure to thrive, candidiasis, diarrhea, bronchitis and urinary tract infections. Our results not only highlight the relatively frequent presence of atypical SCID in the Moroccan population with unexpectedly high T cell numbers, but also describes the incidence pattern of common SCID subtypes in Morocco. Physicians in Morocco may find this local region-specific difference in SCID important for making improved early diagnosis of this disease.

Human cytomegalovirus and isocitrate dehydrogenase status in glioma: association and prognosis value in Moroccan population.

Human cytomegalovirus (HCMV) and isocitrate dehydrogenase (IDH) have been separately associated to gliomas. IDH is a molecular marker considered in the histo-molecular classification of gliomas as well as in their management and prognosis. However, even if oncomodulatory properties were attributed to HCMV, its association to gliomas remains a controversy. Most of the studies that investigated this association used the histological classification of gliomas; nevertheless, in 2016, the World Health Organization recommended the introduction of molecular characteristics to refine this classification. The aims of this study were to determine the prevalence of HCMV in glioma patients, the association between HCMV and IDH with gliomas and subsequently their associations with survival of patients in a Moroccan cohort. A series of 102 gliomas and 32 controls were analyzed by nested PCR (nPCR) to determine the HCMV status. PCR and sequencing were used to determine the IDH subtypes in tumors samples. IDH mutation and HCMV status were correlated to the characteristics of the tumors using SPSS, whereas the survival curves were obtained by the Kaplan-Meier method and the log rank test. HCMV shows significant association with gliomas with a detection rate of 30.4% and no case in the control group. The IDH mutation was identified in 40.9-50% of grade II-III gliomas and in 10.9% of grade IV gliomas. A significant association was obtained between survival in patients with glioblastomas and IDH/HCMV status. Glioblastoma patients with HCMV+ and IDHwt had a poor prognostic. HCMV was detected exclusively in tumor cases and was significantly associated with poor prognosis in patients with gliomas and particularly with glioblastomas. The worst overall survival was significantly seen in patients with gliomas HCMV+/IDHwt. So, it will be of interest to consider HCMV and IDH status in gliomas management strategies.

P.R138Q and p.R229Q Screening In NPHS2 Gene in a Moroccan Cohort with Steroid Resistant Nephrotic Syndrome

Mutations in the NPHS2 gene encoding podocin are implicated in an autosomal-recessive form of nonsyndromic steroid-resistant nephrotic syndrome in both pediatric and adult patients. The p.R138Q (c.413G&gt;A) mutation in exon 3 was the most prevalent mutation in European series. The p.R229Q (c.686G&gt;A) variant in exon 5 is the first human variant discovered with a mutation-dependent pathogenicity. We aimed in this study to screen for the p.R138Q mutation and the p.R138Q variant in a Moroccan cohort with Steroid Resistant Nephrotic Syndrome.

The immune checkpoint VISTA exhibits high expression levels in human gliomas and associates with a poor prognosis

In human gliomas, anti-tumor T cell responses are inhibited through induction of local and systemic immunosuppression. Immune checkpoint blockade is proving to be a success in several types of cancers. However, many studies reported that the treatment of glioblastoma patients with anti-CTLA-4 or anti-PD-1 has no survival benefit compared to standard chemotherapy. This study aimed to investigate the expression and role of VISTA, a newly described immune checkpoint regulator, in human gliomas. mRNA expression was assessed in a total of 87 samples from glioma patients. 57 glioma tissues were taken at different grades. 20 peripheral blood mononuclear cells (PBMC) samples were taken before surgery and ten after surgery, all from the same set of patients. As for the control, ten specimens of PBMC were taken from healthy donors. Protein expression using immunohistochemistry was performed for 30 patients. The Cancer Genome Atlas (TCGA) data set, was also used to investigate VISTA expression through analysis of RNA-seq data of 667 glioma patients. In the Moroccan cohort, VISTA gene expression was significantly upregulated in glioma tissues related to PBMC of healthy donors. This high expression was specific to patient tissues since VISTA expression in PBMC was low when assessed either before or after surgery. Besides, VISTA exhibited higher expression levels in grade III/IV relative to grade I/II glioma patients. Interestingly, VISTA correlated positively with PD-1 expression. PD-1 also showed elevated expressions in higher glioma grades. The TCGA cohort corroborated these observations. Indeed, VISTA was also found to be strongly expressed in high grades. It was positively correlated with other critical immune checkpoints. Finally, increased VISTA transcript levels were associated with weak overall survival of glioma patients. Our study highlighted a correlation between high levels of VISTA expression and poor prognosis in glioma patients. VISTA might be involved in glioma progression and could be considered as a possible new therapeutic target, especially in advanced gliomas.

Neuropsychiatric profile of idiopathic Parkinson's disease and quality of life correlations in a Moroccan cohort in an academic hospital

Little is known about the neuropsychiatric dimension of Parkinson's disease in Moroccan patients. The aim of this work is to investigate the neuropsychiatric profile of Parkinson's disease and the impact of symptoms on quality of life in a Moroccan cohort in an academic hospital.

Cardiogenic Shock in the Setting of Acute Coronary Syndrome: Predictive Factors and Outcomes in a Moroccan population

Introduction: Cardiogenic shock (CS) is a life-threatening complication in patients with acute coronary syndrome (ACS), and its development can be unpredictable. The aim of this study was to find independent predictive factors of CS in a Moroccan cohort of ACS patients. Methods: This was a retrospective, comparative, and analytical monocentric study, including 319 ACS patients admitted between January 2018 to April 2021 in MVMIH’s cardiology center. Patients who presented with CS on admission were excluded from the study. This population was divided into two groups: the « shock » group patients eventually developed in-hospital CS and the « no shock » group which did not, and we compared overall patient characteristics and outcomes. Results: 319 ACS patients were included, among them 21 (6,6%) developed CS. Overall, the strongest predictive factors included the presence of acute heart failure on admission (OR = 14,83; 95% CI = 5,45 – 40,32; p &lt; 0,001), GRACE score ≥ 140 (OR = 9,03; 95% CI = 3,20 – 25,46; p &lt; 0,001), left ventricular ejection fraction &lt; 50% (OR = 8,94; 95% CI = 3,08 – 19,53; p &lt; 0,001), eccentric left ventricular hypertrophy (OR = 9,78; 95% CI = 2,61 – 36,70; p &lt; 0,001), and right ventricular dysfunction (OR = 12,25; 95% CI = 2,55 – 58,93; p = 0,002). Complications were more prevalent in the « shock » group with a higher mortality rate of 57,1%. Conclusion: CS in the setting of ACS is correlated with poorer prognosis and higher late mortality, justifying adequate and early diagnosis and management in high-risk patients.

Molecular diagnosis of dystrophinopathies in Morocco and report of six novel mutations

Dystrophinopathies are the most common genetic neuromuscular disorders during childhood, with an X-linked recessive inheritance pattern. Because of clinical and genetic heterogeneity of dystrophinopathies, genetic testing of dystrophin gene at Xp21.2 is constantly evolving. Multiplex Polymerase Chain Reaction (MPCR) is used in the first line to detect common exon deletions of dystrophin gene (accounting for 65% of mutations), followed by the Multiplex Ligation-dependent Probe Amplification (MLPA) technique to reveal deletions of exons outside the usual hotspot and duplications in male and female carriers. (MLPA adds another 10–15% positive cases to MPCR). Recently, Next Generation Sequencing allows to screen for rare large and point mutations.We report here, molecular analysis results of dystrophin gene during 27 years in a large Moroccan cohort of 356 patients, using the multiplex polymerase chain reaction (MPCR) to screen for hot-spot exon deletions. First applications of whole dystrophin gene sequencing in our lab lead to the identification of six novel mutations.